History of circumcision from the earliest times to the present

by P. C. Remondino

To the practical physician these changes are evident and their cause just as plain, and it is just here where the laity lack the proper education, and where they should understand that the intelligent physician generalizes the disease and only individualizes the patient; and it is this ignorance on the part of the laity that gives to empiricism and quackery that advantage over them, as they look upon all disease as a distinct individual ailment, that should have an equally distinct and individual therapeutic agent to cope singly with. The laity know very little of these things, and in their happy ignorance care still less for the finer definitions of or of the clinical importance of toxæmia, or the processes of abnormal conditions that lead up to such a state, or the results that may follow when that condition is once reached. To them, dyspepsia is an indigestion ascribable to the stomach, and a sick-headache is ascribed to something wrong about the stomach or liver.

The laity have never been called upon to answer the questioning of the late Prof. Robley Dunglison: “What do you mean, sir, by biliousness? Do you mean, sir, that the liver does not secrete or manufacture a sufficiency of bile, or not enough? Do you mean that the bile-material is left in the blood, or too much poured in? Do you mean that there is an excess in the alimentary canal, and a deficiency elsewhere? Please, sir, explain what you really mean by the term ‘bilious!’” The Professor had a way about him that at least made one stop and seriously inquire, before adopting any random notion in regard to medicine. It is to be regretted that, in the humdrum tread-mill work of many physicians, they even have to drop into the commonplace way of treating dyspepsias and such ailments without any further inquiry. A farmer knows better than to drive a dishing wheel, or with merely having a nail clinched in the loose shoe of a valuable horse; but he is fully satisfied to do so in a metaphorical sense, as regards his own constitution, and the mere hint from his physician that he had better lay up for repairs, or that there is something wrong about him that will require investigation, and that there is an ulterior cause to his feeling tired, headachy, or dyspeptic, or an allusion that there is something systemic, as a cause, to his momentary attacks of disordered vision or amaurosis, will generally make him look on the doctor with mistrust.

The merchant, banker, and mechanic are not up to Professor von Jaksch’s ideas of toxæmia,—that toxæmia may be exogenous or endogenous, or that the latter is further subdivided into three more varieties,—and, what is worse, he cares still less. The above three classes of humanity, when sick, simply would want to know if Professor von Jaksch was good on dyspepsia, the measles, or typhoid fever. They care very little that he divides endogenous or auto-toxæmia into that produced by the normal products of tissue-interchange, abnormally retained in the body, giving rise to uræmia, toxæmia from acute intestinal obstruction, etc., the above being the first division. The second depends on the outcome of pathological processes, which change the normal course of assimilation of food and tissue-interchange; so that, instead of non-toxic, toxic matter is formed. The second group he names noso-toxicoses, which he subdivides into two principal divisions:—

(a) The carbohydrates, fats, or albuminous matter, which may be decomposed abnormally and give rise to toxic products, e.g., diabetic intoxication, coma carcinomatosum.

(b) A contagium vivum enters the body through the skin, or the respiratory or digestive tract, and develops toxic agents in the tissues on which it feeds, as in infectious diseases.

In the third group the toxic substance results from pathological non-toxic products, which again produce a toxic agent, only under certain conditions. This group he calls auto-toxicoses, and includes in it poisonous substances, resulting from decomposition of the urine in the bladder, under certain pathological conditions, and giving rise to the condition called ammoniæmia. (Medical News of January 7, 1891; from Wiener klinische Wochenschrift of December 25, 1890.)

As observed above, unfortunately the patients know nothing, nor can they be made to understand these conditions, that are only reached through labyrinthic pathological processes, and, what is still worse, this way of looking at disease is incompatible with the idea of specific-disease treatment, which to them looks more practicable and quick, and which is also more to their liking. They cannot see any sense in such reasoning, which to them is something eminently impracticable; neither can they see a reasonable being in the doctor who practices on such, as they call them, theories.

The practical physician, however, sees in Professor von Jaksch’s summary the turning-point of many a poor fellow’s career,—from one of comparative health into one of organic disintegration, decay, and dissolution,—all the required processes starting visibly from the very smallest of beginnings; any obstruction in the urinary tract or intestinal canal being sufficient to start any of the conditions which end in toxæmia; and, from a careful observation running over several years, I do not think that I am assuming too much in saying that a balanitis is often the tiny match that lights the train that later explodes in an apoplectic attack or sudden heart-failure due to toxæmia; the organic and vascular systems being gradually undermined until, unannounced and unawares, the ground gives way and the final catastrophe occurs,—unfortunately, an occurrence or ending looked upon as unavoidable by the friends of the victim. They cannot see any danger; the idea that diseases have the road paved, not only for an easy entrance but an easy conquest, by the action of these toxic agents on the tissues, is something that they cannot grasp. These blood changes or blood conditions are things too intricate, and the physician who understands them is, to them, a visionary and unpractical man. These conditions are, however, neither new nor unknown, and there is really no excuse for the ignorance exhibited in these matters by the general public, as it is through the blood that this mischief takes place. They can reason in their impotent way, that they should drench themselves with “blood tonics” and all manner of nauseous compounds to “purify” their blood, but the simple, scientific truth is something beyond their understanding, as well as something that they steel themselves against.

Sir Lionel Beale, in observing the immense importance he attaches to blood composition and blood change in diseases of various organs, truly remarks that “blood change is the starting-point, and may be looked upon as the cause, of what follows,” the other factor being the “‘tendency’ or inherent weakness or developmental defect of the organ which is the subject of attack;” to which he adds that he feels convinced that, if only the blood could be kept right, thousands of serious cases of illness would not occur; while the persistence of a healthy state of the blood is the explanation of the fact that many get through a long life without a single attack of illness, although they may have several weak organs; and that an altered state of the blood, a departure from the normal physiological condition, often explains the first step in many forms of acute or chronic disease. Sir Lionel has been a pioneer in the field of thought that looks for the cause of the disease, which, however remote it may be, should not be overlooked as a really primary affection. His extensive labor in the microscopic field has fully convinced him that many of the pathological changes in the different organs are due to what might be called some intercellular substance that is deposited from the blood. (Beale: “Urinary and Renal Disorders.”)

Toxic elements in the blood affect the kidneys in a greater or less degree, and there produce changes at first unnoticed,—at least, as long as the kidney can perform its function,—but the day arrives when, as described by Fothergill, blood depuration is imperfect, and we get many diseases which are distinctly uræmic in character, and ending in any of the so-called kidney diseases, Bright’s disease being one of the most common. As observed by Fothergill, however, the kidney is not the starting-point, the new departure only taking place when the structural change on the kidney has reached that point that it is no longer equal to its function—the “renal inadequacy” of Sir Andrew Clarke. (J. Milner Fothergill, in the Satellite, February, 1889.)