Phimosis is an ancient attendant on our inheritance of the prepuce, we being, in fact, born with it; this is the rule. There are, however, exceptions to this rule, which, singularly enough, are found to be hereditary. The writer has met with a number of such instances, and they have always been found to have been family traits. Within the past year, after attending a confinement, his attention was called to the child by the nurse, who thought that the child was deformed; the nurse, singularly enough, never having seen a natural-looking glans penis in all her life, was astonished at the size and appearance of the member. On examination, the organ showed a complete absence of prepuce. On inquiry, the father and another son, born more than twenty years previously,—this comprising every male member of the family,—were found to have been thus born, with the glans fully exposed. The family is now residing in San Diego, and is naturally one of more than superior physical health and intelligence. I saw another family similarly affected in the north of France, and of individual cases, without knowing the history of the rest of the family, I have seen a large number. As the prepuce can be observed in every stage of disappearance among mixed races, it would seem that in time it would disappear altogether. Its effectual absence in so many cases evidently belongs to some evolutionary process, and shows beyond question that nature does not insist on its presence either as a necessity or as an ornament.
The word or term “phimosis” is derived from two Greek roots, signifying “string” and “to tighten,” or “to tie with a string.” Galen, from its signification, accepted the word, and from him it has been transmitted through the different epochs of medicine down to our own times. In virtue of its etymological significance, it was formerly applied to any stenosis or closure of duct or aperture, but at present the term is used simply to denote that constriction that affects the prepuce, and which prevents the glans from being passed through the preputial orifice. Phimosis is said to be congenital or natural and acquired. The first of these is the common lot of all, as a rule, and with some it remains so throughout life. As babyhood advances in boyhood and boyhood into youth, the prepuce gradually becomes lax and distensible, and in proportion to the existence of these conditions it also loses in its length. Where, however, the distal end persists in its constricted condition it is drawn forward as the penis increases in bulk.
In many cases its tightness prevents the escape of the sebaceous matter that collects in the sulcus back of the corona, and the resulting irritation on the surface of the glans and the inner mucous fold of the prepuce ends in an inflammatory thickening of the latter, its inner surface becoming thick, undilatable, hard, and unyielding, all the natural elasticity that should be present having departed, with more or less inflammatory thickening and adhesions between the two layers of skin that form the prepuce. In this unyielding tube the glans is imprisoned and compressed, often suffering the tortures that the “maiden” of the dungeons of the Inquisition inflicted on the unhappy heretics. It becomes elongated, cyanosed, and hyperæsthetic; the meatus of the urethra is congested and hypertrophied, the corona is undeveloped and often absent, the glans having, on the whole, the long-nosed, conical appearance of the head of a field-mouse. There are hardly five per cent. of the uncircumcised but who suffer in some degree from this constricting result of the prepuce, to a greater or less extent.
On the other hand, the unconstricted glans penis assumes the shape and appearance that is seen in the circumcised. The head is shorter, the face flat and abrupt, and the meatus, instead of being at the end of a conical point, is situated on the smooth, rounded front of the glans, and does not differ in color from the covering of the glans itself. From the superior commissure of the meatus to the sulcus in the rear of the corona its topographical outline may be said to describe two opposite segments of a circle, as seen in the cuts representing the glans in its natural shape. The corona is prominent and well developed.
The opponents of circumcision base much of their opposition to the fact that circumcision interferes with the natural condition of the parts. The question may well be asked, which of these two shaped glans is the natural product as nature intended it should be? It is a well-known fact that the most forlorn and mouse-headed, long-nosed glans penis will, within a week or two after its liberation from its fetters of preputial bands, assume its true shape. We may naturally inquire if nature made the glans of a certain shape, which seems to be the proper shape for copulative purposes, only to have the condition most effectually abolished by a constricting, unnatural band? How much the shape of this glans, from meatus to corona, may have to do with retaining the urethra to a healthy and normal calibre and condition has not been inquired into, but, as far as the writer has observed, a normal glans seems to have less abnormalities of the urethra, and in treating such cases he has always found that when the urethra of one of these normal-glans subjects was affected it was far easier to manage; on the other hand, secondary and even a tertiary recurrence to an operation is often the fate of a long, narrow, conical-pointed penis.
Phimosis is known to have been a cause of male impotence by its direct interference with the outward flow of the seminal fluid; but, although we have cases where impregnation has taken place by the aid of a warm spoon and a warm syringe, as in the case related in a former chapter, it must be admitted that the corona is not without some functional office in the act of procreation. Its shape indicates a valve action like that of the valve in a syringe-piston, and if we examine the two extremes of these conditions of glans—one devoid of corona, as many are, and the other with the corona in its most pronounced form, when in a state of erection—the difference, either in the appearance of the two organs or in the different philosophical action and results that must necessarily follow the use of these two differently shaped glans, will at once be apparent. Unfortunately—or, as many may consider it, most fortunate—the female organs are not always so shaped as to be in themselves wholly favorable to impregnation. The wearing of corsets, the habitual constipation of females, the relaxed and unnatural condition of the uterine ligaments and vagina in civilized women, all favor uterine displacement, with any or all forms of uterine ailments. To this we may add the effect of repeated miscarriages, application of astringent washes, irregular menstruation, etc., all of which conditions often result in an elongation of the neck, constriction of the cervical canal, with the external os placed on the depended point of the sharply pointed cervix, which is liable to point in any direction. Just imagine one of these conditioned females and one of the mouse-headed, corona-deficient, long-pointed glans males in the act of copulation! The conical penis finds its way in the reflected fold of the vagina, while the point of the uterus may be two or three inches in some other direction, making impregnation wholly impossible; besides, in the normal-shaped penis, the corona acting as a valve, behind which the circular muscular fibres of the vagina close themselves, tends to retain the seminal fluid in front, while the very shape of the organ assists in straightening out the vaginal canal and to bring the uterus in proper position. In the long, thin, narrow and pointed glans, devoid of corona, there is no mechanical means to retain the seminal discharge. Some years ago some one introduced the idea of postural copulation, to be tried in cases of sterility, and it has been found that impregnation would take place in some cases where it had formerly appeared impossible, this position having the effect of righting malpositions during the act, which were the cause of the sterility; but it stands to reason that, where the shape of the organ is such that it further favors malpositions, as well as where it offers no obstacle to the vagina immediately expressing or dropping out all the seminal fluid, impregnation is more difficult, and that, where the uterine deformity is coincident with this condition of penis to assist, it becomes well nigh impossible. Foderè mentions a penis about the size of a porcupine-quill on an adult male, and Hammond mentions one of the size of a lead-pencil in diameter and two inches in length. From total absence of the penis, either through disease or accident, to the diminutive organs mentioned by Foderè and Hammond, and on up to the full-sized and normal-shaped organ, we have every degree of sizes and shapes, and with these go every conceivable degree of ability or faculty for impregnation.
Aside from the foregoing considerations, there are others equally important. Although Greece was involved for years in war and ancient Troy was destroyed and all its inhabitants slaughtered because of the seduction of one woman; and Semiramis, through her beauty, got all her successive husbands in chancery; and poor, susceptible Samson, from firing Philistine vineyards and killing lions bare-handed, and the Philistines by the thousands with the jaw-bone of an ass, was reduced through Delilah to bitter repentance and turning Philistine mill-stones; and we know that the familiar infatuation of Antony for Cleopatra ruined Antony; and we are familiar with the well-known maxim of the French police-minister, that to catch a criminal it was but necessary to first locate the woman and the man would soon be found,—society has determined to ignore the influence of the animal passions as factors in our every-day life, or factors in the estrangements, coldness, and the bickerings that end in divorces. Not to shock the reader with detailed accounts as to what an important factor the shape of the penis may be in the domestic economy, I will refer the reader to Brantome’s works.
Although the councils of the older church were not above giving these conditions their calm and deliberate consideration, which resulted in the foundation of the present physical considerations in relation to divorce laws, such studies or considerations are at present only touched upon gingerly and with apologies for doing so, as if the “study of man” was of any less importance to-day from what it was in the days of Moses, the elder church, or when Pope formulated his oft-quoted but little-followed maxim, that “the proper study of mankind is man.” The present miscalled “delicacy of sentiment” is about as misplaced a condition of disastrous and misleading morality as was the out-of-place and untimely bravery of poor old Braddock when refusing Washington’s advice at the Monongahela. The success and beauty of the Mosaic law is its squarely facing the conditions of actual life, and its absence from nonsense or nauseating sentimentality. Were our present churches to observe more of this plain talk, for which the good old Anglo-Saxon is as fully expressive and convincing as the old Hebrew, and deal less in rhetorical flourishes and figurative mean-nothings to tickle the ears of our modern Pharisees, mankind as well as womankind would be infinitely so much the better off, mentally, morally, and physically, and there would be less of the conflict between science and religion. Luther’s dream of restoring religion to its primitive purity has come to but as poor realization at the hands of his so-called followers, which leads one to think that if the martyrs of the Reformation could come back and see the fruits of their martyrdom—suffered that pure religion might live—they would conclude that, for all the resulting good accomplished, they might as well have kept a whole skin and a whole set of bones.
In cases of pronounced phimosis the aperture in the prepuce may not be in a line with the meatus, and the resulting discharge of urine or the ejaculations of seminal fluid may from this cause be unable to find an egress. The fluid escaping from the urethra will, in case the opening is at the side or upper part of the prepuce, cause it to balloon out until a sufficient quantity is thrown out so as to distend, the opening as well as the prepuce, before it can find its way out; in such cases impotency is liable to be as complete as in those cases of stricture wherein the seminal fluid is forced backward into the bladder. Having given this general view of the effects of phimosis as it may affect man in the shape of his organ, which may have a serious result in his domestic relations or in becoming a father, we will proceed to the consideration of diseases and conditions that phimosis encourages and to which it renders man more liable. In the consideration of these cases it must not be forgotten that the sexual relations are much more to man or woman than is generally acknowledged. The days for the establishment of the Utopian republic of Plato are not yet with us. That Platonic love does exist is true, as it has in the past and will in the future. Scipio, refusing to accept the beautiful betrothed bride of an enemy as a present, or Joseph leaving his coat-tail in the hands of the amorous bride of the eunuch Potiphar, with the suicide of Lucretia, in the past, are events which virtue and modern continence probably duplicate every day; but these are exceptions to the rule. Physicians daily see evidences of the most devoted Platonic affection in either sex, but they also see enough of the opposite side of the question to convince them that in the majority of cases the sexual relations are the bond of union, as well as the mainspring of love. As observed by Montesquieu, the bride of a first-class Turkish eunuch has but a sorry time, and a woman of the same calibre of mind as that possessed by the ordinary Circassian or Armenian bride cannot be in a much happier condition with a husband partly eunuchised by a constricted prepuce.