History of circumcision from the earliest times to the present

by P. C. Remondino

“A. L., aged two, admitted November 28, 1877. Quite well nourished, but pale. Complete retention of urine for two days; slight redness and marked œdema of penis, scrotum, and perineum. The foreskin cannot be retracted, on account of phimosis. Abdomen distended, hard, and sensitive, the dilated bladder extending a few fingers’ breadth above the symphysis. In order to introduce the catheter, it was first necessary to operate upon the phimosis, during which a calculus, which completely occluded the meatus, was removed. The catheter, when introduced into the bladder, removed a quantity of cloudy urine. The œdema, rapidly disappeared under applications of lead-wash, but on November 29th vomiting and diarrhœa occurred during the night, with rapid collapse; December 1st, death. Autopsy: In the bladder, a sulphur-yellow stone, as large as a hen’s egg, completely filling the organ; similar calculi, from the size of a pea to that of a bean, in the pelvis of the left kidney; right kidney normal.”

In the above case, the œdema of the penis, scrotum, and perineum was as much a result of the distension of the bladder by the retained urine interfering with the return circulation from the œdematous parts as the different appearances of diseased conditions were a result of the primary phimosis; yet this case, if seen during its early infancy, when probably the contraction of the preputial orifice was as yet not so well marked, would have been pronounced one in which it would be needless and barbarous to perform circumcision upon. We would most assuredly have to wander aimlessly and unprofitably in the region of speculation to build up the etiology of the above-related case and reach the culmination there found, unless we accept the one that it was all, from first to last, the result of the phimosis.

Jonah, pitched overboard at sea to appease the tempest and swallowed by the whale, became convinced finally that he had better return to Nineveh to preach reform; while Pharaoh would not let the children of Israel depart even after Moses had so frightened him—as it is related in the rabbinical traditions compiled by the Rev. T. Baring-Gould, M.A.—that the royal bowels were completely relaxed at the sight of the snakes turned loose about the royal throne,—a circumstance which nearly lost him his claim to divinity, which was based on the fact that his bowels moved only once a week, as in this case they not only moved out of time and in the most unkingly manner, so that the noble king hid underneath the throne, but before even Pharaoh could disengage himself from the royal robes, which event could hardly have raised him in the estimation of the gentlemen eunuchs of the bed-chamber. Those who unwound the mummy of Pharaoh tell us that he had the appearance of a self-willed, despotic, but intelligent, old gentleman; but the above rabbinical relation, from Baring-Gould’s “Legends of the Patriarchs and Prophets,” seems to have had no convincing effect on Pharaoh; so we must not be surprised if even a case like the one from Henoch’s clinic would, with many, carry no conviction.

In the second volume of Otis on “Genito-Urinary Diseases,” of the Birmingham edition, at page 380, there is an interesting account of a physician who, in youth, was troubled with an annoying prepuce, which, from frequent attacks of balanitis, had finally become more or less adherent to the glans penis; up to the age of nineteen he had been unable to completely uncover the glans. By six months of hard and persistent labor he had finally broken up these adhesions. At the age of twenty-two he married, and he then ruptured the frenum, which bled profusely and left him sore for some days. Then for twenty-seven years he had no further trouble, but at the end of that time he began to experience what he believed were attacks of dumb ague, and the scrotum began to swell and felt sore on firm pressure. Heavy, aching pains then followed. This condition of things lasted for over five years, varied by the appearance of carbuncles on the nose and elsewhere, to relieve the monotony of the thing. From this time on, abscesses began to form in the scrotum and into the integument of the penis, burrowing forward into the prepuce, which was much swollen and painful. A gangrenous opening effected itself in the dorsal surface, which relieved him somewhat. The patient was finally examined by Dr. Otis, who found a badly strictured urethra, the strictures beginning at the meatus, and at intervals extended down as far as two and three-fourths inches. The case had no venereal history, the patient never having had any disease or anything of the kind. The strictures were plainly the result of the balano-posthitic attacks as much as they were the cause of the degeneration of the mucous membrane in the lower urethra, that allowed of the infiltration of urine into the tissues, which caused all the systemic disturbances, abscesses, misery, and agony of the patient, depriving him of comfort, sleep, or ability for labor, and which sent him here and there in search of health and relief.

It would seem really as if a prepuce was a dangerous appendage at any time, and life-insurance companies should class the wearer of a prepuce under the head of hazardous risks, for a circumcised laborer in a powder-mill or a circumcised brakeman or locomotive engineer runs actually less risk than an uncircumcised tailor or watchmaker. They recognize the danger that lurks in a stricture, but what a prepuce can and does do, they entirely ignore. I have not had any opportunities for comparison, but it would be interesting to know, from the statistics of some of these companies, how much more the Hebrew is, as a premium-payer, of value to the company than his uncircumcised brother. Were they to offer some inducement, in the shape of lower rates, to the circumcised, as they should do, they would not only benefit the companies by insuring a longer number of years, on which the insured would pay premiums, but they would be instrumental in decreasing the death-rate and extending longevity.

I have seen so many cases of stricture whose origin could be traced to balanitis that it can almost with confidence be assumed that, wherever there is a long prepuce with a red and inflamed meatus in a child, that unfortunate child will be a victim of fossal strictures when arrived to manhood, and that, moreover, he will be a surer victim to the reflex neuroses which so often accompany strictures, and which have been so ably described by Otis, than the victim of uncomplicated strictures acquired in the worship of Venus. There is no end to the misery that these poor fellows have to suffer, besides the habitual hypochondriacal condition into which the accompanying physical depression, throws them; it unfits them for business, any undertaking, or even for social enjoyment or entertainment; they keep themselves and their families in continued hot water. These subjects are, also, more prone to gouty and rheumatic affections, asthma, and other neuroses.

Among the many cases of nervous disorders simulating other diseases that I have seen relieved were two Jewish lads with an imperfection of the meatus. They were two brothers, and from the history of the cases, and that given me by the mother of the lads in regard to the father, the malformation must have been hereditary and congenital. It consisted of a partial occlusion of the meatus by a false membrane, which divided the meatus in two, horizontally, but which was closed at the posterior end of the lower passage, which readily admitted a probe from the front as far as the occlusion, about a third of an inch to the rear. The restoration, or rather the making the anterior urethra and meatus to their normal condition, relieved both boys of asthma, under which they had labored for years.

The many cases simulating the general disturbances that accompany many kidney disorders, that are simply the result, in their primary causes, of preputial irritation and the disturbances to the kidney function due to the same cause, have long induced me to look upon the prepuce as a great and avoidable factor to some of the many forms of kidney diseases, prostatic enlargements, vesical diseases, and many other diseases of the urinary organs, which we know full well can result from strictures, as the latter need not always act in a purely mechanical mode to do its full extent of mischief.

One result of these preputial irritations not generally or particularly mentioned in any of our text-books—a condition far-reaching as regards its own results, and more annoying and serious than it appears at first sight—usually begins with a reflex irritability of the anal sphincter muscle, or a rectal irritation of the same order, which in time produces such organic change that an hypertrophied and irritable, indurated, unyielding muscle is the result. Agnew, of Philadelphia, describes the condition, but does not mention this frequent cause under the name of sphincterismus; once this is established, the train of resulting pathological or diseased conditions that may follow are without end.[108] This is no fancy sketch, nor will the student of the pedigree and origin of diseases feel that the case is exaggerated or imaginative. These are some of those cases that are always ailing, never well and really never sick, but who are, nevertheless, gradually breaking down and finally die of what is termed “a complication of diseases,” before living out half their term of life.

How this happens is simple enough—the straining required to produce an evacuation is out of all proportion with the character of the discharge; such patients often complain of being constipated when the evacuations are semi-fluid; this straining is followed by a dilatation and consequent loss of power of the rectum, which becomes pouched and its mucous membrane thickened; the whole intestinal tract sympathizes and digestion is interfered with, and the forcible expulsive efforts affect all the abdominal and thoracic organs in a more or less degree, laying the foundation for serious organic diseases. Now, this condition, which may be said to be no more than one of obstinate constipation, is a far more reaching condition and a far more injurious state than can be imagined at a first glance. Constipation is not, as a rule, always accompanied by the indigestion, either stomachic or intestinal, that goes with this condition; the contents of the intestines in simple constipation may simply lack fluidity without undergoing putrefactive fermentation, but in this condition the undigested and retained intestinal contents do undergo that change, resulting in the generation of material whose re-absorption produces a toxic condition of the blood, from whence begins a series of serious organic changes in the blood, and from this in the organs.