History of circumcision from the earliest times to the present

by P. C. Remondino

These observations are, however, in perfect accord. If we connect the statement of Dr. Arnold, in regard to the increasing character of the firmness in the adhesions of the adult, with the statement of Dr. Bernheim, that the first erection is often sufficient to break up the existing adhesions in the infant, we must conclude that they are nothing more at first than a slight agglutination, which the slight manipulation required to properly locate the position of the glans, and to space out the prepuce preparatory to the operation of circumcision, must, in the majority of cases, be sufficient to liberate the prepuce from the glans; this is evident also from the statement of Dr. Moses, who only found six per cent. of the cases operated upon by him as being so affected.

The writer has been present at a large number of Hebrew circumcisions performed on the eighth day, and from that up to the sixth month (as in many communities they wait until a number of children are collected, so to speak, before sending for the mohel, who may reside at quite a distance), and in all of those witnessed he has never seen any complications from adhesions; but cases of adhesion have been often encountered from the second to the eighth year, and it has always been the case, as a rule, that the older the child the greater the firmness of the adhesion. In these cases the practice generally advised of using a probe is not practicable, as the person is more apt to wound the sound prepuce than to tear the adhesions; the practice most effectual is to hold the glans firmly but gently with the thumb and forefinger of the right hand, and then to draw the prepuce as firmly back with its fold held in the forefinger and thumb of the other. It is a more expeditious mode, and the least painful; by this method extensive adhesions can readily be broken up; vaselin and a piece of fine lint should then be interposed for a couple of days to prevent a re-adherence.

Another co-existing condition with phimosis, very often found, is a shortening of the frenum. Dr. Jansen, out of 3700 soldiers of the Belgian army, found 12.3 per cent. with this pathological condition and 2.5 per cent. with a narrow prepuce.[88]

Take the three conditions above enumerated,—phimosis, preputial adhesions, and short frenum,—all are but a departure from a normal, in a greater or less degree; and whether the resulting discomfort consists in mere mechanical impediment to urination, erection, or as a factor in nocturnal enuresis, dysuria, impotence, either through reflex action or interference with emission, malposition of the urethral orifice during copulation owing to any of these conditions, or in any of the nervous derangements that may accompany this condition, or in the more serious results, ending in positive deformity of body or limb, or in the warping of moral sentiments, or, even further, in inducing insanity, it cannot well be seen how the conditions that will certainly produce these results, in a more or less degree, can ever, in any logical sense, be considered a physiological condition.

There are certain conditions to life, up to the time of birth, which, unless they then cease at once to exist, immediately become from a physiological into very serious pathological conditions. These are well understood, and have their reasons for existing during our pre-natal existence; but the prepuce has no known function during uterine life or subsequently; and there being no valid reason for its existence, there are certainly no logical grounds for its being considered a physiological condition, especially when the serious results attending the most accentuated form of the above three conditions are considered, and as its necessity, in cases of its entire absence, has not yet been demonstrated.

It can well be said that about two-thirds of mankind are affected in a greater or less degree with these pathological conditions, causing them more or less annoyance. Of these, a certain percentage suffer a life of continued misery, as a direct or indirect result of these conditions.

As to the actual necessity of a prepuce existing, or as to what annoyances or diseases persons are subjected to who are born without it, there is a most singular and expressive silence in medical literature. It stands to reason that, if it is a necessity, some one person should have found it out long ago, and there should then be some evidence to present in relation thereto. There are cases reported in some of the older surgeries wherein an attempt has been made, in the absence of a prepuce, to restore or manufacture one by means of a plastic operation. Vidal describes such an operation,[89] but there is no reason given as to why the operation was undertaken; there is no record of any diseased condition which it was intended either to cure or to alleviate; so that we are left to infer that the person simply submitted to the operation from purely cosmetic reasons. The Hebrews of Palestine, after the Roman conquest, or those in Italy or Spain, attempted a like operation, but not from any reason of lessened health or to restore any lacking physiological action, their aim having simply been to hide their identity, for the purpose of escaping persecutions, exactions, or annoyances, either from their rulers or their fellow-citizens.

Dr. A. B. Arnold, in a paper on circumcision, read before the Academy of Medicine of Baltimore, argues that it is not difficult to divine the purposes of the prepuce, holding that it is necessary to protect the tactile sensibility of the glans, due to the presence of the Pacinian bodies which Schweigger Seidel discovered in the nerves, and that a better provision than the anatomy of the prepuce cannot be conceived for shielding the very vascular and sensitive structure of the glans from external sources of irritation and friction, that might rouse the sensibility of this organ, which, on physiological grounds, may cause early masturbation; further arguing that, the corona being undoubtedly the most excitable part of the glans, its denudation by circumcision leaves it more apt to be affected by chance titillations.[90] In this latter view of the case the preponderance of views is, however, in the opposite direction. J. Royes Bell states that, owing to the induration of the glans through the means of circumcision, masturbation and syphilis are less rife amongst the circumcised than amongst the uncircumcised.[91] M. Lallemand, whose experience in the treatment of seminal emissions is of the greatest value, looked upon circumcision as one of the means of curing those diseases, looking on the diminished irritability of the glans resulting from the operation as the curative element.[92] Dr. Cahen, in a “Dissertation sur la Circoncision,” in 1816, before the Faculty of Medicine of Paris, called the attention to the diminished sensibility of the glans induced by circumcision. Dr. Vanier, of Havre, looks upon the prepuce as the most frequent cause of onanism. “If the prepuce is lax, its mobility produces an irritation to the highly irritable and sensitive nervous system of the child by the titillation in its movements on the glans; if too tight and constricted, then it compresses the glans, and by its irritation it leads the child to seize the organ.”[93] So that in either case he looks upon the prepuce, through the sensitiveness it retains and induces in the glans, as the principle cause of masturbation. M. Debreyne, the Trappist monk and physician of La Trappe, who has paid considerable attention to medicine as applied to morality, practically makes the same observations. In children who have not yet the suggestions of sexual desire imparted by the presence of the spermatic fluid, the presence of the prepuce seems to anticipate those promptings. Circumcised boys may, in individual cases, either through precept or example, physical or mental imperfection, be found to practice onanism, but in general the practice can be asserted as being very rare among the children of circumcised races, showing the less irritability of the organs in the class; neither in infancy are they as liable to priapism during sleep as those that are uncircumcised.

Dr. Bernheim says that “the prepuce may be said in general to be an appendage to man, if not positively harmful in some cases, at least useless, requiring constant care, the neglect of which is liable to entail disease and suffering; the irritation it produces through the sebaceous secretion is a frequent cause of masturbation which nothing short of circumcision will remedy.”

Through middle life, unless the prepuce be the subject of some vicious conformation, little inconvenience may result from its presence, except it be from the dangers to infections already pointed out during this period of life; an ordinarily movable and retractable prepuce will not acquire the condition of phimosis, unless it be through disease or accident; but with our entrance into old age, or after having passed our vigorous prime, the torment of the days of our infancy and childhood come to harass us again. Persons given to corpulency, with a long prepuce, are apt to become affected with phimosis in their latter years, as such persons are more subject to loss of their sexual vigor and power of erection than lean and spare people; in these, the gradual diminution of the size of the erectile tissues of the organ and its retraction allows of the reconstriction of the preputial opening, which, in the end, will not allow the prepuce to be drawn back over the gland. These conditions are followed by the irritating affections incident to phimosis of our earlier life, with the modification that age has induced in making us subject to more serious and fatal ailments, both locally and generally.