CHAPTER XIX.
Is the Prepuce a Natural Physiological Appendage?
By many surgeons the idea of circumcision, unless connected with an immediate demand for interference,—such as a phimosis unmanageable by any other means, an induced phimosis from gonorrhœa or other irritation, syphilis in its initiatory sore, cancer or some such cause,—is looked upon as an unwarrantable operation, a procedure not only barbarous, painful, and dangerous, but one that directly interferes with the intentions of nature. The prepuce is by many looked upon as a physiological necessity to health and the enjoyment of life, which, if removed, is liable to induce masturbation, excessive venereal desire, and a train of other evils. The question then resolves itself, What is the real physiological status of this appendage, if it has any, and, if it is a physiological appendage, when does it merge into a pathological appendage? As by some it is held that the prepuce enjoys the same right to live and exist as the nose, ear, or a limb, which are only subject to amputation in case of a serious disease, they should be reminded that they are not taking into consideration that the nose and ear are calculated to warn us of danger, and that our legs are very useful; as even the great orator Demosthenes, by the timely and rapid use of his legs, was enabled to escape from a battle, where his oratory was of no avail against the illiterate javelins of the unscholarly Macedonians. If the prepuce only was endowed with an olfactory sense,—as, for instance, if a nervous filament from the first pair of nerves had been sent down alongside of the pneumogastric and then, by following the track of the mammary and epigastric arteries, had at last reached the prepuce, where the olfactory sense could have been turned on at will, like an incandescent lamp,—it might have been a very useful organ, as in that sense it could have scented danger from afar, if not from near, and enabled man to avoid any of the many dangers into which he unconsciously drops. But, seeing that the prepuce, to say nothing of being neither nose, eye, nor ear to warn one away from danger, or a leg to run away on after once in it, having not even the precautionary sensitiveness of a cat’s moustachios, it cannot, in any way that we can see, be compared to any other useful part of the body.
All attempts to find reasons for its existence that are of real benefit to man have so far proved unsatisfactory, and, unlike the reasons for its removal, are, as a rule, founded on speculation. To further reason out the why and wherefore of its existence or of its summary surgical execution, we must consider its shifting positions as to the effects it produces, as well as to its conditions at different ages, sitting on its case like an impartial jury in the case of some unconvicted but diabolically-inclined criminal.
As before remarked, we are, as a rule, born with this appendage, just as much as we are with the appendix vermiformis, which rises up, like Banquo’s ghost, whenever we eat tomatoes or any small-seeded fruit. This prepuce is then long, and the penis is found at the end of an undilatable canal, which is formed by the constricted prepuce; at this early stage of our existence it is often additionally bound down to the glans by a greater or less number of adhesions. We are then in what many term a state of physiological phimosis, that being a perfectly natural condition, and one consistent with health; at least, we imagine it is normal.
Phimosis in childhood is generally considered a physiological state, only to be taken as a pathological condition under certain circumstances. Preputial adhesions may, according to many observers, also be classed as physiological at an early period of life, as it is by them considered as congenital, and common enough to warrant its being classed as normal. As to the first, or phimosis, it undoubtedly is a physiological condition during infancy; but why, we do not know; and it is also a fact that from birth to puberty it remains so in fully over one-half of the cases. Out of 98 children, from one week to sixteen years of age, examined by Dr. Packard, the prepuce was entirely unretractable in 54, partly so in 3, and wholly so in 36; while in 1 it only half-covered the glans and in 4 the glans was wholly uncovered, 1 of these 4 being an infant only five weeks old.
Dr. Packard also gives the result of 172 examinations by himself, of from twelve to seventy-three years of age, and 106 examinations by Dr. Maury, a total of 278, in whom 100 had a long prepuce, 97 a partly-covered glans, and 81 (of whom 2 had been circumcised) in whom the glans was exposed.[83] As to adhesions, there is an unaccountable diversity of opinion as to their constancy as a natural condition, being frequent enough to class them as physiological occurrences. Dr. A. B. Arnold, of Baltimore, states that his experience in reference to preputial adhesions leads him to conclude that the frequency of its occurrence has been much overstated. In the number of children that he has circumcised, which exceeds 1000, he has met with it in less than four per cent. of the cases. He also mentions that in the adult the adhesions show greater firmness.[84]
On the other hand, Dr. Bernheim, of the Paris Israelitish Consistory, observes that, of over 3000 newborn whom he has examined, with but few exceptions he found the presence of preputial adhesions. He remarks, however, that in the majority these are detached or broken by the first attempt at erection.[85]
Bokai, out of 100 children, found 8 who were over seven years of age, who were perfectly free; while of the remaining 92 under that age 6 more showed no adhesions and 86 had various degrees of adhesions.[86]
Dr. Holgate, of the out-door department of Bellevue, considered that all phimosic cases have adhesions; while Dr. Moses, of New York, out of some fifty circumcisions performed at the eighth day, found only adhesions three times.[87]