The foregoing method, to be used in these cases, has proved very serviceable in my hands, and it is here given that it may assist others; as there is no need of waiting for granulations or of allowing the patient to undergo so much misery, which, besides the local injury, cannot help but affect the general health very injuriously. The penis can stand any amount of forcing backward; it stands this in cancer or hypertrophy of the prepuce, or in the inflammatory thickenings that precede gangrene of the prepuce, in any extended degree; becoming, for the time being, more or less atrophied. As has been shown by Lisfranc, the penis can be made nearly to disappear into the pubes; so that we are not as helpless in these cases as our text-books would have us believe.

In infants, and in young children below the age of ten or twelve, the Jewish operation, as modified and done in accordance with the dictates of modern surgery, will be found the most expedient. By this method we avoid the need of any anaesthetic agents, which are more or less dangerous with children, as well as the need of sutures, which are painful of adjustment and very annoying to remove in those little fellows who dread new harm; there is also much less risk of haemmorrhages, as the frenal artery is not wounded. In children of a year or over, a very good result will be found often to follow Cloquet's operation, care being taken to carry the slitting well back, as well as care in taking it on one side of the frenum, so as to avoid any wound of that artery, the subsequent dressing being a small Maltese-cross bandage, pierced so as to admit the glans to pass through; the prepuce is retracted and the tails folded over each other and held there by a small strip of rubber adhesive plaster; a little vaselin prevents the soiling by urine underneath. This last operation is short and very easy, is not painful, nor does it require much manipulation; it is only one quick cut on the grooved director and it is over; by the retraction of the prepuce, the longitudinal cut becomes a transverse one, making the prepuce wider and shorter at once; the glans soon develops and remains uncovered. As there is a very small wound to heal over, the repair is very prompt.

In adults with a very narrow, thin, not overlong prepuce, a very good result often follows a combination of the dorsal slit with the inferior slit alongside of the frenum of Cloquet. The narrower and tighter the prepuce, the better the result, as the cuts are at once converted from longitudinal into transverse wounds, and the organ at once assumes the shape and condition of a circumcised organ, without having suffered any loss of substance; three stitches or sutures in each cut (silver or catgut) adjust the cut edges; a small roller of lint and adhesive plaster, placed so as to shoulder up against the corona, completes the dressing. Where this operation is practicable, by the thinness and narrowness of the prepuce, it has many advantages. I have repeatedly performed it on lawyers, book-keepers, clerks, and even laboring men, who have gone from the office to the courts, counting-rooms, or stores without the least resulting inconvenience or loss of time. In laborers it is better to perform the operation on a Saturday evening, which gives them a rest of thirty-six hours before going to their labor again. The operation is comparatively painless and almost bloodless, as there need not be more than half a teaspoonful of blood lost during the operation; there is no danger of any subsequent haemorrhage, and, with proper precautions against the occurrence of erections, from seventy-two to ninety-six hours is sufficient for a complete union; the sutures are then removed and a simple lint and adhesive-plaster dressing worn for a few days more. In many, no more dressings are required. In many cases, with a properly adjusted dressing, that comes forward underneath so as to include the frenum, the simple dorsal slit is sufficient; but if any of the prepuce depasses the dressing underneath, it will puff and become oedematous and require frequent puncturing. To avoid it, it is better to make the Cloquet slit at once. This operation is of no value, and perfectly impracticable in a thick, pendulous prepuce. Absorption will often remove considerable preputial tissue, but where there is too much its very bulk interferes with its removal by any natural means.

Dilatation is recommended by a number of surgeons, but, I must admit, in my hands it has always proved a failure; it may be, that if the subsequent history of the cases reported as so operated upon had been carefully traced, the reports would not have been so good. Nelaton, whose dilating instrument is generally recommended, seems, himself, to prefer some of the circumcising methods, as in the volume on "Diseases of the Genito-Urinary Organs," in his "Surgery," being the sixth volume of the revised edition of 1884, by Despres, Gillettte, and Horteloup, the subject of dilatation is dismissed in two short lines. St. Germain, of Paris, uses, as has been before observed, a two-bladed forceps, used after the manner of Nelaton, and reports good results. Dr. J. Lewis Smith agrees in his statements with Dr. St. Germain. Dr. Holgate, of New York, reports a like experience. In my own practice the prepuce has often been made temporarily lax and retractable, but with the usual results of the return of the contraction, with a possible thickening of the inner fold, as a result of the interference; so that only in case of any immediate demand, where the tight prepuce is producing irritation, either through pressure or adhesions, or retained sebaceous matter, do I ever resort to dilatation; always, however, even then, not as a final operation, but merely as preparatory procedure toward a future operation of a more efficient order.

In cases of timid adults, who refuse all kinds of operative interference, good results may be obtained by the use of a mild lead-wash or cold tea-baths and the introduction of flat layers of dry lint interposed between the prepuce and the glans; this has a very good effect in keeping the parts apart and dry, and may in time produce a certain amount of dilatation; but even when this is done, unless it will render the foreskin sufficiently loose to allow of its being kept finally back of the corona, it is, after all, but a temporary makeshift. The corona should be exposed and kept clear of the preputial covering; anything short of this will not give all the good results to be desired. I have more than once performed a secondary operation on Jews, who had been imperfectly circumcised by not having the prepuce removed sufficiently, and in whom the subsequent contraction of the preputial orifice had re-covered part of the glans, and only lately visited a four-year-old boy, circumcised when eight days old, in whom the prepuce covered half of the glans, the corona acting as a tractive point from which the penile integument was being drawn forward. In this case the simple pierced-lint Maltese cross was used, with an adhesive band to hold the tails down behind and around the penis just back of the corona.

These means, although not circumcision either in a surgical or in the Hebraic religious sense, are, nevertheless, sufficient in a medical sense for all desired purposes; provided, however, that there is no resulting constriction, or a mild condition of paraphimosis, back of the corona, and that the whole of the glans is sufficiently uncovered, and that no abnormal dog-ears are left to garnish each side of the penis like an Elizabethan frill or collar; although Agnew holds that, in slitting, the practice adopted by many of rounding off the corners is mostly superfluous, as nature will do so itself in time.

The ordinary way of performing the operation by modern surgeons is by what is known as the Bumstead circumcision. It was not an invention of Bumstead, but was adopted by him in preference to all others. The requisites are a sharp-pointed bistoury, blunt-pointed scissors, and a pair of Henry's phimosis forceps, with fine needles and fine oculists' suture silk. The penis is allowed to hang naturally and the position of the corona glandis marked on the outer skin with a pen and ink, which is to serve as a guide for the incision. The prepuce is now drawn forward until this line is brought in front of the glans and grasped between the blades of the forceps. The prepuce is now transfixed, and, with a downward cut, that portion is severed; the knife's edge is now turned upward and the excision finished. The forceps are now removed and the integument allowed to retract; with the scissors the inner mucous fold is now split along the dorsum and trimmed off so as to leave about half an inch in front of the corona. The parts are then brought together with the continuous suture and dressed according to the fancy of the surgeon. Care must be taken not to bruise the parts with the forceps, as, in such cases, sloughing of the sutured edges will be the result instead of union. I have seen this accident happen more than once, in one case being followed by a penitis that seriously complicated matters.

It has been my practice to use fine silver-wire and catgut sutures in all operations on the prepuce; they excite less suppuration as well as less irritation. In case of need, the silver can be left in longer, and they are much easier of removal than the silk; besides, they have the advantage of not cutting. In the after-treatment the same general plan can be followed as with any amputated stump, except that it must not be forgotten that at the end of this organ dwells what has been termed the sixth sense, and that heat and moisture are very apt to awaken the dormant energies of the organ, even after it has undergone cruel mutilation, and even has suffered considerable loss of blood; for that reason it is best always to avoid wet or sloppy dressing, or too much ointment, as they are more apt to cause erection than to do any good. Besides, I find water does here, as elsewhere, interfere with the deposited plastic matter, properly organizing into cicatricial tissue; so that I prefer a snug, dry dressing, which is left on for four or five days without being interfered with, and light covering, plain diet, quiet, with fifteen grains each of bromide of sodium and chloral hydrate at bed-time to insure rest and freedom from annoying erections. Where the organ is large in its flaccid state, it is better to support it on a small oakum-stuffed pillow, made for the purpose, than to let it hang downward. Should the stitches give way and the skin tend to retract, the plan proposed on a previous page can be followed to advantage. In urinating, care must be taken not to soil the dressings; some patients are very careless about this if not warned. The penis should hang nearly perpendicular while in the act, and all dribbling should have ceased and the meatus and underneath be mopped dry with some soft cotton before raising the organ; nothing so irritates the parts, retards union, or is more offensive than a urine-saturated dressing.

Dr. Hue, of Rouen, uses an elastic ligature, which he introduces into the dorsal aspect of the prepuce by means of a curved needle. This he ties in front, and in three or four days it cuts its way through. Although Hue reports a large number so operated upon, the tediousness of the procedure and the swelling and oedema, as well as the active pain that must necessarily accompany the operation, will hardly recommend the ligature in preference to the incision by the knife.

Dr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has operated on over eleven hundred circumcisions, besides the cases of phimosis occurring in his general practice. His opinion of the procedure of M. de Saint-Germain by dilatation is not favorable. He has employed it in a number of cases of phimosis, at the time unfit for a more radical operation. He has, however, observed that cicatricial thickenings and recontractions are very apt to occur, and, as to the septic accidents mentioned in connection with circumcision, he has noted that they are as liable to occur in hands that are as careless and slovenly with what they do with their dilating forceps as they are with what they do with their bistouries. Dr. Bernheim prefers the circumcision forceps of Ricord, as modified by M. Mathieu. This instrument he prefers by reason of its gentler pressure, which, at the same time, is all-sufficient to properly fix the prepuce. In applying the forceps, he includes as little as possible of the lower part, keeping away as much as possible from the frenic artery. The dorsum of the inner fold he cuts with the scissors. In children under two years of age, he simply turns this back over the free edge of the integument; in children over two years of age, he uses serres-fines. In children, he uses a piece of lint dressing steeped in a watery solution of boracic acid; in adults, he uses iodoform-gauze dressings. He finds cases unite in from three to ten days. Dr. Bernheim warns us against using antiseptics on infants or young children, in connection with the after-dressing of circumcision. Neither phenic acid, corrosive sublimate, nor iodoform are well borne by these young subjects, and he has seen serious results follow upon as light an application as a 1/100 solution of phenic acid. In a number of cases he reports operating with the galvano-cautery of Chardin, instead of the knife. These operations were bloodless, and cicatrization was as rapid as when the knife was used. He has in several cases operated by the dorsal incision, owing to disease of the prepuce not allowing any other operation.

In France, the Bumstead operation is known under the title of Ricord's procedure. Lisfranc, Malapert, M. Coster, and Vidal all have operations which are not as useful as Ricord's, and have not, therefore, come into general use. M. Sedillot condemns the dorsal incision as leaving two unsightly-looking flaps. The reverse, or inferior incision of M. Jules Cloquet is likewise not in favor with either Malgaigne or Ricord. This inferior incision or section, alongside of the frenum was first advised by Celsus. M. Cullerier contented himself with slitting the inner preputial fold, longitudinally, from its junction with the skin backward to the corona. M. Chauvin, by the aid of a complicated instrument with barbed points, drew out the mucous fold as far as possible before excising.

There is something unaccountable in the difference in results that various operations give in the hands of different surgeons. It must be that all methods are correct with properly-chosen cases and when properly performed, as well as properly looked after subsequently to the operation. It must not be expected, however, that, in operations where the kindly assistance of nature is a thing contemplated in absorbing superfluous tissue, the case will at once give satisfaction to all. These cases must have the required time before judgment can be passed upon the merits of the operation, just as required time in cases of dilatation or in the method of M. Cullerier will often demonstrate that the benefits are but transient, and that often even cases that have been so operated upon will require a complete circumcision, a la Ricord or a la Bumstead, owing to the resulting thickening induration and overconstriction, when, if left alone, the dorsal slitting or the inferior incision of Cloquet would have previously given satisfactory results.

The final cosmetic results in the combined Cloquet and dorsal-slit operation, for instance, depend on, first, properly choosing the case. One on whom the operation is unadaptable it is useless to attempt it on, as a future circumcision or tedious and annoying re-operation of trimming would be required. The next care is to properly cut through all constricting bands, which, like fine, tough strings, will be found to encircle the penis. These must be carefully clipped with a fine pair of strabismus scissors, as these bands do not give way, either then or afterward, of their own accord, but form the nucleus for stronger constricting bands for the future. Then you must be sure to cut far enough back, either above or below, until you have reached where you obtain the normal and largest calibre of circumference of the penis. The adaptation of the edges of the parts and the proper application of a smooth, equal pressure, by means of the lint strap, is of the next importance; and then comes the strapping of the whole surface for about an inch and a half back of the corona, which should and must include all the tissues of the preputial part of the frenum. A neglect or careless performance of any of the details, or the carelessness of the patient in not keeping the dressing clean, necessitating its change before the fourth day, all tend not only to interrupt the union, but to mar the future cosmetic results as well. It may be asked why all this care and trouble, and not circumcise at once? As already observed, this operation admits of the patient following his business; whereas circumcision, on the male, will assuredly lay him up for four or five days, and perhaps ten days,—something that many, be they rich or poor, cannot afford, and will not submit to.

The cosmetic condition of the penis as a copulating organ is a thing of some importance, and this should not be overlooked; for, although the particular dimension, shape, or peculiarity of the penile end never figures prominently in the complaints of women who apply for divorce,—the charges being everything else under the sun,—it can safely be assumed that this organ and its condition is the original, silent and unseen, as well as unconscious power behind the throne that is at the bottom of the whole business in more than one case. Like the fable of the poor lamb that the wolf wished to devour: the real reason of his wishing to kill him was that he might eat him, the pretext set forth by the wolf that the lamb had encroached on his pasture, muddied his brook, or kept him awake by his bleating having been disproven by the lamb. Besides, it is well not to leave any distinctive or distinguishing mark, like an individual baronial crest, on the head of the organ.

To return, however, to the operative procedures, we find that Dr. Vanier finds that the operation of Cloquet by incision alongside of the frenum has the advantage of not leaving any deformity—contrary to the opinion of Ricord and Malgaigne. He, in fact, holds this procedure in such high esteem that he considers that Cloquet deserves great credit for reviving this old Celsian operation. H. H. Smith, in his "Operative Surgery," coincides with Vanier in his favorable opinion of this method, as he there says: "Frequent opportunities of testing the advantages of the plan of Cloquet having satisfied me of its value, I do not hesitate to recommend it as that best adapted to the adult, because it fully exposes the glans and leaves little or no lateral deformity, as is frequently the case with the dorsal incision,"—an opinion that I can fully agree with, from the results of the same operation in my hands, although I have used the method even on infants. Vanier does not approve of the dorsal incision unless it is made V-shaped, as it otherwise leaves the unsightly lateral flaps, but thinks well of the modification of Cloquet's practiced by M. Vidal de Cassis, which is performed in the following manner: The patient stands before the operator, who remains sitting; the operator seizes the prepuce on its dorsum and draws it toward him; he then introduces a narrow, sharp-pointed bistoury, with its point armed with a small waxen bullet, down alongside of the frenum until he reaches the pouched extremity of the preputial cavity at this point; the point of the bistoury is now made to transfix the waxen bullet and out through the skin, which from this point is divided from behind forward. Vanier very sensibly suggests that the operation that is effectual, and which can be accomplished in the least number of movements or temps, as being the least likely to cause extensive pain and agony, should be the one preferred, and that the aim of the surgeon should be to simplify the operation by reducing the number of necessary movements. For this reason, where an excision of considerable amount of tissue is required by the nature of the case, he prefers another operation, performed by Lallemand,—that of making a dorsal transfixion and cutting off the two lateral flaps, which can all be done in three movements.

It makes but little difference as to which operation is performed on the adult, but that the subsequent dressing will exercise a good or evil influence, and greatly assist not only in the present comfort or discomfort of the patient, but in the ultimate result as well. Bearing these points in view, Charles A. Ballance, of St. Thomas's Hospital, has adopted the following procedure:—

"When the patient is etherized, the outline of the posterior border of the glans is marked on the skin with an aniline pencil. The skin of the prepuce is slit and removed up to the aniline line. The mucous membrane is next cut away, leaving only a free edge of about one-eighth of an inch in width. Any bleeding which occurs should be entirely arrested, and asepsis must be insured by frequent sponging with carbolic or sublimate solution. Numerous coarse-hair stitches are then inserted, so as to bring accurately together the fresh-cut edges of the skin and mucous membrane, and subsequently, after a further sponging and drying, a piece of gauze two layers of thickness, and wide enough to reach from the root of the penis nearly to the meatus, is wrapped loosely around the penis and secured by several applications of the collodion-brush. The setting of the collodion is hastened by the use of a fan, so that the air is kept in motion, and the patient should not be allowed to recover from the anaesthetic until the dressing is quite firm and hard. This dressing forms a carapace for the penis, protecting it from the bedclothes and effectually preventing the annoying and distressing erections. Mr. Ballance reports excellent results from this dressing." (Braithwaite's Retrospect, July, 1888.)

In applying the above dressing, the shrinking incident to the drying of the collodion must not be overlooked, and the gauze layers must be loosely applied, as they would otherwise become too tight. The dressing is a very ingenious and serviceable one.

Mr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical Society, reported a new method of dressing after circumcision. "It consisted in first closely suturing the skin and mucous membrane by numerous catgut sutures, then painting the surface with Friar's balsam and covering it over with two or three layers of cotton wadding, on which the balsam is poured. The glans penis was left sufficiently free to allow of water passing. The band or ring of dressing should be at least one inch broad. The dressing was not suitable for young infants who were frequently wetting. In the case of older children, they might be allowed to go about on the second or third day, when the dressing would be quite dry, and would not be required to be changed or renewed." (Braithwaite's Retrospect, January, 1888.)

Any constricting or immovable and inelastic dressing is subject to the same objections as plaster-of-Paris dressings in thigh-fractures,—that of being dangerous and not expedient, unless the patient is constantly under your eye.

Dr. Neil Macleod, in the Edinburgh Medical Journal for March, 1883, advises a procedure that has always looked favorably to me, and which I once put in practice through the means of the ordinary ptosis fenestrated forceps, in place of the ordinary circumcision forceps, the sutures being introduced through the fenestra and the prepuce cut off on the outer side of the forceps, the thickness of the steel arm on the outer side of the fenestra allowing of the properly-sized border for the hold of the sutures. Dr. Macleod places his sutures all in position before making any incisions,—a procedure which will be found to save the patient considerable pain; as with many the seizing and holding of the edges of the skin and mucous membrane and the forcible pressure exerted by the fingers or forceps while the needle is being forced through is the most painful part of the operation. In doing this, care must be taken to allow sufficient length to each thread to make two sutures, as well as care must be taken to properly pull out the thread in the centre between the four folds of tissue and to cut it equidistant, after the ablation of the prepuce, a blunt hook being used to fish up the threads from the preputial opening.

Erichsen favors the Jewish operation in young children, as being the easiest and safest of performance. Slitting, or the inferior or superior incision, he thought, left too much of the prepuce, which, wherever there is a tendency to phimosis, should be entirely removed, "with a view of preserving the health and cleanliness of the parts in after life." In the phimosis that is acquired by old men, he found dilatation with a two-bladed instrument to be sufficient, provided the indurated circle was made to yield. For the circumcision of adults he has invented an adjustable shield, something like the Jewish spatula, with which he protects the glans.

Gross (the elder) used both slitting on the dorsum and circumcision. He found neither objection nor deformity in the flaps left by the dorsal incision, as they were only temporary; in some cases, he simply followed the practice of Cullerier, of making multiple slits in the constricting and inelastic mucous membrane.

Agnew believes in circumcision in the treatment of reflex troubles. He relates a case, in the second volume of his "Surgery," of eczema extending over the abdomen, of over a year's standing, cured in a child by circumcision; he operates by incision on the dorsum, in which he leaves nature to make away with the flaps, or he circumcises by the Bumstead method.

Van Buren and Keyes recommend both the incision on the dorsum and the operation of Ricord; where the mucous membrane alone is tight and constricted, they follow Cullerier's method of either single or multiple incisions of the inner coat. They lay great stress on the necessity of keeping the patient quietly in bed to insure rapid and complete union.

My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a number of cases, the operation being perfectly painless, the little patients submitting to it and feeling no more pain than if it were having its toe-nails trimmed, the local anaesthesia being produced by the hypodermatic injection of cocaine. This procedure is now used to a considerable extent throughout the country, and it is a far safer and more comfortable performance than either etherizing or chloroforming, as the sudden and spasmodic filling of the lungs of young children—who will resist and hold their breath for a long time, then suddenly inhale—with anaesthetic vapor is almost unavoidable, having in two instances nearly lost two children from such an accident.

Dr. G. W. Overall, in a late Medical Record, which is quoted in the Journal of the American Medical Association of February 21, 1891, gives the description of a very good and painless method of producing this local anaesthesia; for it need hardly be said that with a nervous, irritable child the introduction of the hypodermatic needle is as formidable an operation as either slitting or the Jewish operation. Dr. Overall is in the habit of holding a solution within the preputial cavity and then to introduce the needle in the mucous fold, having previously applied a light rubber band back of the corona, on the outer integument, so as to act like a tourniquet and limit the action of the anaesthetic effect to the prepuce. By this procedure he avoids all pain and the operation can be performed while the child is even amusing itself, care being taken that it does not see it. Sutures that require removal should not be used, according to the Doctor, and the operation thereby becomes a perfectly painless and unalarming performance to the patient in all its details.



NOTES TO TEXT.

[1] "Letters of Certain Jews to Monsieur Voltaire, Containing an Apology for their own People." Pages 451-476. Translated by Dr. Lefann. Philadelphia, 1848.

[2] "Circoncision chez les Egyptiens." Brochure by F. Chabas. Paris, 1861.

[3] "Atlantis." By Ignatius Donnelly. Page 472.

[4] Ibid., page 115.

[5] Ibid., page 234.

[6] Ibid., page 178.

[7] "Circumcision." A. B. Arnold. New York Med. Record, Feb. 13, 1886.

[8] "Atlantis," page 178.

[9] This word is, in the Mandan, Maho-peneta; in the Welsh, Mawr-penaethir. "Atlantis," page 115.

[10] "Cyclopedia of Biblical, Theological, and Ecclesiastical Literature," vol. viii, page 58. Article, Phallus.

[11] "Origine, Signification et Histoire, de la Castration, de l'eunuchism, et la circoncision." Par. F. Bergmann. Published in the "Archivio per le Traditione Populaire," 1883.

[12] "Dictionaire des Sciences Medicales." Par une Societe de medecins et de Chirurgiens. Paris, 1826, 60-volume edition.

[13] Dr. Delange mentions a peculiar social habit or custom among a tribe of Arabians that in a sociological sense is worth mentioning. He observes that for these dances females are preferred, but owing to the peculiar habit about to be related it is impossible to have any of the village women in Algeria assist at this part of the festivities; hence the men have to do the dancing. It appears that the females of one tribe—this being the tribe of Ouleds-Nails, who live on the southern borders of Algiers—are in the habit, when young, of emigrating to the oases of the Sahara, which are occupied by the French and traveling Arabs, where they give themselves up to a life of prostitution. After having exercised this life for some years they return to the tribe with a dowry in money, besides an ample supply of clothes and jewelry,—the result of their economy,—which enables them to contract favorable marriages. This practice is so common in this one particular tribe, and so much have they monopolized the profession of courtesan, that the name of the tribe of Ouleds-Nails is in Arabia synonymous with that of courtesan. These young women dance every evening in the Arab cafes, and are at times employed to do the dancing at Arab feasts. For this reason no self-respecting Arab woman ever allows herself to dance in public, or why the practice of both sexes dancing together is not practiced in Algerian villages, as a man would thereby consider himself disgraced.—Dr. Delange, in Receuil de Memoires de Medecine de Chirurgie et de Pharmacie Militaire, No. 105, August, 1868.

[14] "Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis primarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione, AEgrotorum Visitatione," etc. Oxonii, 1690.

[15] Michel Le Feber. "Le Theatre de la Turquie." Paris, 1681.

[16] "La Circoncision, Sa Signification Social et Religieuse." Par M. Paul Lafargue, in the Bulletins de la Societe d'Anthropologie de Paris. Tome x, 3d fascicule, Juin a Octobre, 1887.

[17] "Circumcision." By A. B. Arnold. New York Med. Record, Feb. 13, 1886.

[18] Bancroft's "Native Races," vol. ii, page 278.

[19] "Recherches Philosophiques sur les Americains, ou Memoires Interessants pour servir a l'Histoire de l'Espece Humaine." Par M. de P. Edition par Dom Pernety. Tome ii. Article, Circoncision, Berlin, 1774.

[20] "The Family, a Historical and Social Study." By Charles Franklin Thwing. Boston, 1887.

[21] The "Recherches Philosophiques sur les Americains" and Virey, in the 24th volume of the "Dictionaire des Sciences Medicales," are very full on this subject, and for fuller information the reader is referred to those works.

[22] "Cause Morale de la Circoncision des Israelites, Institution Preventive de l'Onanisme des Enfants." Par le Docteur Vanier, du Havre. Paris, 1847.

[23] "Annual Report of the Bureau of Ethnology." By J. W. Powell. Washington, 1881, 1882.

[24] "Among Cannibals, or Four Years' Travels in Australia." By Carl Lumholtz. Page 46. Charles Scribner & Son, 1889.

[25] These interesting historical facts in relation to the holy prepuce were published in the Journal l'Excommunier in January of 1870, when the writer was in France. They were contributed by A. S. Morin, of Miron, a learned historiographer and antiquary. Europe has not recovered from its love of the supernatural that it had so strongly in the middle ages. The blood of St. Gennaro still liquefies once a year, and many churches still claim to possess the identical winding sheet that served our Lord prior to his resurrection, as well as more than one church has the holy cloth that St. Veronica used on the way to Calvary, which has an impression of the face of the Saviour.

[26] This church has a remarkable history connected with its foundation. The tradition relates that in the dark ages some sacrilegious soldier had robbed a church in the neighborhood of its holy vessels of gold and silver. In the vessel in the Tabernacle there happened to be a consecrated wafer. The soldier journeyed on to Turin to dispose of his plunder, when, on arriving at the spot on which the church now stands, the wafer is said to have ascended miraculously to some distance above the soldier's head, while at the same time the mule he rode, being imbued with more religious piety than his master, reverently knelt down on his front legs. The holy wafer was now encircled by a halo of shining light; this, with the kneeling donkey and the soldier raining blows on the pious animal, while he himself was unconscious of the presence of the host above him, attracted the attention of the populace, who apprehended the soldier, on whom the stolen vessels were found. The bishop in his pontificial robes, in solemn procession, received the consecrated wafer, which promptly descended into pious hands. The donkey was adopted by the bishop and the soldier was promptly hanged, in accordance with the general treatment of thieves in those days. The writer has more than once seen a flagstone inclosed within a railing that occupies the central spot of the floor or pavement of the church, it being the identical spot on which the donkey knelt.

[27] Rush's "Medical Inquiries," vol. i, page 217.

[28] Fothergill. "Gout in its Protean Aspects," page 158.

[29] "Philosophy of Magic," from the French of Eusebe Salverte, vol. ii, page 143.

[30] "Dictionaire des Sciences Medicales." Cullerier. Article, Phimosis. Vol. xli.

[31] Bergmann has gone into this subject at length, and the writer has drawn freely from his brochure on "Castration and Eunuchism," reprinted from the "Archivio per le Traditione Populaire" of 1883.

[32] "The Hermit." By the Rev. Charles Kingsley. See Introduction.

[33] "Dictionaire des Sciences Medicales," vol. liv, page 570.

[34] Ibid., page 567.

[35] Ibid., page 570.

[36] "Cyclopedia of Biblical, Theological, and Ecclesiastical Literature," vol. iii, page 351.

[37] Smollett gives a good account of the Carthagena expedition in his "Roderick Random," and for a good satisfactory detail of the blundering Walcheren expedition the reader is referred to Harriet Martineau's "History of England," vol. i, pages 269, 272, 273, and 354.

[38] Schoopanism, or paederastia, is at times practiced by the Omahas, and the man or boy who suffers as the passive agent is called min-quga, or hermaphrodite.—"Third Annual Report of the Bureau of Ethnology." By J. W. Powell. Washington, 1881, 1882.

[39] When the missionaries first arrived in this region they found men dressed as women and performing women's duties who were kept for unnatural purposes. From their youth up they were treated, instructed, and used as females, and were even frequently publicly married to the chiefs or great men.—Bancroft's works, vol. i, "Native Races," page 415.

[40] "Recherches Philosophiques sur les Americains," tome ii.

[41] "The History of the Hebrew Commonwealth." From the German of John Jahn, D.D. Page 25. Oxford, 1840.

[42] "L'Hermaphrodite devant le Code Civil." Par le Docteur Charles Debierre. Bailliere et Fils. Paris, 1886.

[43] "Recherches Philosophiques sur les Americains," tome ii, page 78.

[44] "L'Hermaphrodite devant le Code Civil." Debierre.

[45] Occidental Medical Times, Sacramento, Cal., October, 1890, page 543.

[46] "Dictionaire des Sciences Medicales," vol. xxxi., page 41.

[47] British and Foreign Medico-Chirurgical Review, vol. xviii, 1856.

[48] "L'Hermaphrodite devant le Code Civil." Debierre.

[49] Sir Thomas Brown's works, vol. ii, "Religio Medici."

[50] "The Bible and other Ancient Literature in the Nineteenth Century." L. T. Townsend, D.D. Chautauqua press, 1889. See pages 32-45.

[51] "The Religions of the Ancient World." George Rawlinson, M.A. Alden edition of 1885. Page 174.

[52] "The Intellectual Development of Europe." John W. Draper. Vol. ii, page 113.

[53] Ibid. vol. ii, page 122.

[54] In "Clarke's Commentary," vol. i, page 113, the reason of choosing the eighth day is given. Circumcision was not only a covenant, but an offering to God; and all born, whether human or animal, were considered unclean previous to the eighth day. Neither calf, lamb, or kid was offered to God until it was eight days old.—Lev., xxii, 27.

[55] A father circumcised his children and the master his slaves. In case of neglect the operation was performed by the magistrate. If its neglect was unknown to the magistrate, then it became the duty of the Hebrew, upon arriving of age, to either do it himself or have it done.—"Clarke's Commentary," vol. i, page 113.

[56] Bishop Newton points out the remarkable analogy that marks the Hebrew race as descendants of Isaac and the Arab race as the descendants of Ishmael, from whom sprung the Saracenic people. These are the only two races that have gone on in their purity from their beginning. They intermarry only among themselves and have, alike, the same customs and habits as their fathers. The sculptured faces of the Hebrew on the Babylonian monuments are the same faces that are met in the synagogues of Paris or New York. So with the descendants of Ishmael, in whom there flows partly the blood of the dominant element of ancient Egypt; neither custom, habit, nor physiognomy have changed. In these two races, as observed by Bishop Newton, we have an ocular demonstration of the Divine origin of our faith, if verification of Scripture history is any criterion.—"Clarke's Commentary," vol. i, page 111; also, Hosmer's "Story of the Jews," page 5.

[57] "Cause Morale de la Circoncision." Vanier, du Havre. Pages 40-45.

[58] "De la Circoncision." Par le Dr. S. Bernheim. Page 7. Paris, 1889.

[59] "Cyclopedia of Biblical, Theological, and Ecclesiastical Literature," vol. ii, page 350.

[60] Among the Semitic race, however, it seems possible to bring forward better evidence than this of an early Stone Age. If we follow one way of translating we find, in two passages of the Old Testament, an account of the use of sharp stones or stone knives for circumcision,—Exodus, iv, 25: "And Zipporah took a stone"; and Joshua, v, 2: "At that time Jehovah said to Joshua, Make thee knives of stone." ... The Septuagint altogether favors the opinion that the knives in question were of stone, by reading, in the first place, a stone or pebble, and, in the second, stone knives of sharp-cut stone. These are mentioned again in the remarkable passage which follows the account of the death and burial of Joshua (Joshua, xxiv, 29, 30),—"And it came to pass, after these things, that Joshua, the son of Nun, the servant of Jehovah, died, being a hundred and ten years old, and they buried him in the border of his inheritance in Timnath Serah, which is in Mount Ephraim, on the north side of the hill of Gaash." Here follows, in the LXX, a passage not in the Hebrew text, which has come down to us: "And there they laid with him in the tomb, wherein they buried him there, the stone knives wherewith he circumcised the children of Israel at the Gilgals, when he led them out of Egypt, as the Lord commanded. And they are there unto this day." The rabbinical law, in connection with this subject, reads as follows: "We may circumcise with anything, even with a flint, with crystal (glass), or with anything that cuts, except with the sharp edge of a reed, because enchanters made use of that, or it may bring on a disease; and it is a precept of the wise men to circumcise with iron, whether in the form of a knife or scissors, but it is customary to use a knife." This mention of the objectionable nature of the reed as a circumcising medium is attributed to the danger that may arise from splinters. The Fiji Islanders use both a rattan knife and a sharp splinter of bamboo in performing circumcision and in cutting the umbilical cord at child-birth. Herodotus mentions the use of stone knives by the Egyptian embalmers. Stone knives were supposed to produce less inflammation than those of bronze or iron, and it was for this reason that the Cybelian priests operated upon themselves with a sherd of Samian ware (Samia testa), as thus avoiding danger. There seems, on the whole, to be a fair case for believing that among the Israelites, as in Arabia, Ethiopia, and Egypt, a ceremonial use of stone instruments long survived the general adoption of metal, and that such observances are to be interpreted as relics of an earlier Stone Age.—"Researches into the Early History of Mankind." By Edward B. Tylor. Pages 217-220. London, 1870.

[61] The cannibals of Australia do not eat white people, as the flesh of these produces a nausea, which the flesh of the vegetable-fed blacks does not do. The rice-fed Chinese are considered a treat, and these are slaughtered in great number, ten Chinamen having been served up at one dinner.—"Among Cannibals." By Carl Lumholtz. Page 273.

[62] "Cause Moral de la Circoncision." Par le Dr. Vanier. Page 266.

[63] Ibid., page 288.

[64] Cincinnati Clinic, vol. ii, page 165.

[65] "The Story of the Jews." Hosmer. Page 263.

[66] "Traite d'Hygiene, publique et privee." Michel Levy. 2d. edition, vol. ii, page 754.

[67] Ibid.

[68] "Diseases of Modern Life." B. W. Richardson. Page 19.

[69] "Longevity and other Biostatic Peculiarities of the Jewish Race." By John Stockton Hough, M.D. New York Med. Record, 1873.

[70] "Vital Statistics of the Jews." By Dr. John S. Billings. North American Review, No. 1, vol. 152, page 70, January, 1891.

[71] "On Regimen and Longevity." By John Bell, M.D. Page 13.

[72] British and Foreign Medico-Chirurgical Review, vol. xliii, page 539.

[73] Ibid., vol. xlii, page 17.

[74] In "Influence of the Trades on Health," Thakrah mentions the peculiar exemption enjoyed in this regard by the butcher class. He quotes Tweedie in saying that he never saw a butcher admitted to the fever hospital.

[75] Lancereaux. "Distribution de la Phthisie Pulmonaire."

[76] Ashhurst. "Int. Enc. Surgery."

[77] Horner. "Naval Practice."

[78] Cincinnati Lancet and Observer., vol. xvi, 1873.

[79] It may well be a question of some interest whether the atrophy of the testicle in the aged may not at times be partly due to the compression exercised by the prepuce on the glans through reflex action, and whether at times the virility that is departing cannot be restored by circumcision in such cases. I have seen such results, being guided to the idea by the Biblical relation in the case of Abraham.

[80] This patient subsequently died of a uraemic complication following on an attack of fever. The man was in his prime, and had been of most exemplary habits. The fever that he had was, I had every reason to believe, directly due to the results of imperfect blood depuration incident on the irritability of his kidneys, which, retroactively, again allowed the uraemic condition to assume that dangerous degree that suddenly and very unexpectedly to his friends and family ushered the patient into eternity. This man had only been merely inconvenienced by his prepuce up to the time that it caused his death. It is interesting to observe what little trifles bring about the end of some men. The unlucky habit of putting the royal countenance on paper brought Louis XVI to a sudden halt at Varennes, and his head to the scaffold. The lucky meeting of the aides of Bonaparte and Desaix between Novi and Marengo gave to France its empire and to Europe the enlightenment that was diffused by that event. If such trifles affect individuals and nations, we must not be astonished that the little useless prepuce should be endowed with the mischief-working power of the historical old cow and kerosene lamp that reduced Chicago to ashes.

[81] In the London Lancet for 1885 there is a very interesting communication at page 46 on this subject. There is no doubt but that the prepuce offers the best skin-grafting material.

[82] In the seventeenth volume (third series) of "Guy's Hospital Reports" there is a most interesting report at page 243 of a case of skin-grafting that was performed by Thomas Bryant. The case was an extensive ulcer resulting from an injury. Bryant took some skin-grafts from the man's arm and some from a colored man in an adjoining bed. The account gives the daily report as taken from the note-book of Mr. Clarke, and is accompanied by a colored plate to illustrate the subject; the proliferation of the black skin is astonishing. In closing the report Mr. Clarke says: "But in the figures depicted the amount of increase in the black patches will be well seen. In ten weeks the four or five pieces of black skin, which together were not larger than a grain of barley, had grown twentyfold, and in an another month the black patch was more than one inch long by half an inch broad, the black centres of cutification having clearly grown very rapidly by the proliferation of their own black cells."

[83] American Journal Med. Sciences, vol. lx.

[84] "Circumcision." By Dr. A. B. Arnold, of Baltimore.

[85] "De la Circoncision." By Dr. S. Bernheim. Paris.

[86] The reader is referred to a very interesting paper detailing conditions of adhesions in the American Journal Med. Sciences for July, 1872. It is taken from the Hungarian of M. Bokai.

[87] New York Med. Journal, vol. xxvi.

[88] American Journal Med. Sciences, vol. lx.

[89] Dr. Vanier describes this operation of Celsus mentioned by Vidal in his work on "Circumcision," at page 294, which consisted in making, by a circular incision immediately back of the glans, like in a circular amputation, a complete detachment of the integument from back of the corona. The penis was then made to retreat into the sheath thus made and a short catheter introduced into the urethra, to the end of which the free end of the new preputial fold was made fast, a piece of oiled lint being interposed between the raw inner surface and the glans. Another operation consisted in forcibly drawing the integument forward and in making a number of transverse incisions in the integument so as to assist its extensibility. By these means it was drawn sufficiently forward so as to fasten it to a canula or catheter made fast in the urethra. But it can well be imagined that a person must possess the most exalted idea of the physiological needs of a prepuce and feel the most sensitive need of such an appendage to submit to the first of these operations, although it is more than probable that many Jews submitted to the operation in the days of Celsus to avoid being exiled or plundered of all their possessions. The resulting prepuce could not have been a much more unsightly appendage than that which ornaments the overburdened virile organ of many Christians, and there is no doubt but that in many cases they passed muster.

[90] "Circumcision." Dr. A. B. Arnold.

[91] Ashhurst. "Int. Enc. Surgery," vol. vi.

[92] "Pertes Seminales."

[93] "Circoncision." Dr. Vanier, du Havre.

[94] "Dictionaire des Sciences Medicales."

[95] Erichsen's "Surgery," page 1144. Edition of 1869.

[96] Medical News of Philadelphia, page 115. Vol. for 1860.

[97] "Pertes Seminales." In the fourth American edition of the English translation of McDougall of Lallemand we find that he fully appreciated the dangers that lurk in a prepuce. At page 216 he says: "Such is the condition which the parts present in cases of recent balanitis, and these are the inflammations and ulcerations that cause more or less extensive adhesions of the prepuce to the glans. Such adhesions are generally cellular, but sometimes fibrous or even cartilaginous, according to the severity and frequent repetition of the inflammation. Various degrees of induration also results according to the intensity, the duration, and the frequency of the phlogosis. Thus, I have often found a mucous membrane hardened, thickened, and covered with numerous papillae, sometimes fibrous or cartilaginous, with three times its natural thickness. I have also met with cases in which the prepuce has become cancerous. I have operated in several cases of cancer of the penis, too, which certainly arose from no other cause. The patients were generally peasants between fifty and sixty years of age, who had never known other than their own wives, but who had frequently suffered from balanitis attended by abundant discharge, swelling of the prepuce, and excoriation of its opening, which was so contracted as to prevent the passage of the glans. I have seen one case, also, in which balanitis, irritated by a forced march and the abuse of alcoholic stimulants, passed into gangrene, by which the greater part of the glans was destroyed. Such have been the accidents which I have observed on those whose prepuce was too narrow to permit the glans being uncovered; accidents which I can only attribute to the long retention of the sebaceous matter in a kind of cul-de-sac, into which a certain quantity of urine passes every time the patient makes water."

[98] Claparede. "La Circoncision."

[99] Baron Boyer. "Traite des Maladies Chirurgicales," vol. x, page 370.

[100] I have practiced considerably among the Jewish people, but I have never seen their elderly men suffer with prostatic troubles like our own people who are uncircumcised. From having observed the tendency to prostatic complications in young people with troublesome prepuces, and that the great number of the elderly people who are affected with prostatic disease or enlargement are the unlucky possessors of long or large prepuces, I have arrived at the conclusion that the prepuce can be entered as a factor in the etiology of enlarged prostate.

[101] I have now under my care a poor consumptive who has all the appearance of having always been as virtuous as Joseph, but who, unlike Joseph, has from infancy had as a constant companion a long, miserable, smegmanous, and annoying prepuce. The young man has an oedema which first affected his feet, but one day, owing to the irritation of a slight balanitis, the prepuce swelled at once; it proceeded through the penis integument to the scrotum; the penis itself retracted, leaving the integument and scrotum to assume a translucent, puffy, cork-screw appearance and attitude; from its labyrinthic passage the urine slowly dribbles during urination in a scalding stream. In addition to the physical sufferings, he is tormented by the knowledge that his friends attribute all his disease and troubles—since the occurence of the penile oedema—to the fact that his earlier manhood must have been indiscreet, as well as sinful. The laity cannot connect any penile, scrotal, or testicular disease with anything except venereal disease; and if the physician attempts to explain matters, they simply look upon it as the good-natured and well-intentioned efforts of the doctor to deceive them and to cover up the shortcomings of some frail mortal. Many a poor fellow has to leave this world under a cloud of mistrust and a bad odor of past deviltry to which he is not entitled, and suffer all this in addition to all his physical ills, owing to his having been ornamented through life with an annoying prepuce,—the luckless heritage of having been born a Christian. Columbus in chains moralizing on the ingratitude of this world is nothing to the poor invalid with a swollen prepuce, innocently acquired, silently "cussing" the ignorance of his relatives and friends.

[102] This patient, on convalescing, suffered considerable from the action of numerous small carbuncles, resulting from the toxaemic condition induced by the partial suppression of urine that he at times suffered from, and, when nearly well, brought on a serious relapse by the mail-bag appendage at the penis working up the organ into a state of erection. While so situated he had intercourse, and from 99 deg. his temperature immediately rose to 1041/2 deg., where it remained for several days, lengthening out his illness by several weeks, into a long-protracted convalescence. The man is not yet circumcised, and, from the knowledge that I have of his tendency to uraemia, I feel that, although in his prime, a fever or an accident may take him off at any moment.

[103] In looking over the literature of reflex neuroses and more direct injurious results, I find that George Macilwain, in a work on "Surgical Observations on the More Important Diseases of the Mucous Canals of the Body," published in London in 1830, calls special attention to the case of a man aged thirty-eight, admitted to the Finsbury Dispensary, and who was in the care of Mr. Hancock. The patient was suffering from excruciating pain in different joints, the pain being so great that he was confined to his bed and unable to stand on his feet. He was unable to rest at nights, and neither rheumatic nor any other apparently suitable treatment was of any service. Rigors were soon added to his other troubles, and during their continuance the pain in his joints was greatly aggravated. He was referred to Mr. Macilwain for treatment, who promptly relieved him by the removal of a urethral stricture, which had quietly been the cause of all the disturbance. It is particularly interesting that even at that early day the reflex neuroses and complications that may arise from the irritability of the genito-urinary organs were so well understood. How well Dr. Macilwain appreciated the nicety of these relations can be seen from his remarks in connection with the above case, in which he says: "It may be observed that the severity of the symptoms is not always commensurate either with the duration of the disease or the degree of stricture, and that, although the progressive development of them varies considerably in rapidity, in different individuals, it is, nevertheless, in the latter stages, always more rapid." Macilwain also graphically describes the insidious approach of these genito-urinary troubles. In speaking of stricture he says: "Although minute inquiry generally informs us that the stricture has been of some standing, and in some instances has existed for years, yet it may happen that it is only a few months or a year since the patient's attention has been directed to the disease. This is very intelligible; for, in conformity with what we observe in other parts of the body, the bladder has a power of accommodating itself to a change of circumstances. Its strength, for a long time, may increase so correctly in proportion to the increase of the obstacle which opposes the ejection of its contents that a very considerable period elapses before the difficulty in making water becomes cognizable to the patient, or it occasions an annoyance so trifling as scarcely to excite his attention. This increase of strength in the bladder frequently renders the formation of stricture so insidious that the urethra at the affected part is very narrow before the individual is aware of the existence of any contraction whatever; the bladder, however, at length becomes unable to empty itself, and the abdominal muscles and diaphragm powerfully act as coadjutors, so that each effort to make water is accompanied by a straining which is very distressing, and the complete evacuation of the bladder is often not accomplished even by these combined forces. The straining which accompanies stricture, and which seems necessary to evacuate the bladder, although it be occasionally exceedingly annoying to the patient at the time, is more important with reference to the results which are its consequence. I am firmly of opinion that there are a great number of patients laboring under hernia which has been produced by no other cause. I must confess that I had seen a great number of instances of stricture in ruptured patients before I drew any inference from the observation of their co-existence." The foregoing observations of Macilwain, made in 1830, are here reproduced for their clearness of expression and explanation, as well as to show what injuries can be produced on the young child afflicted with phimosis. We are, as surgeons, familiar with the anatomical and pathological changes there are undergone by the bladder and its lining membrane, as well as in the ureters and kidneys, in many cases of stricture, as well as of the great amount of prostatic irritability and enlargement that is due to the same cause. How similarly these results can be and are actually produced by phimosis is undeniably expressed by the post-mortem appearances in the poor infant described by Golding Bird to the London Medical Society, and mentioned in the London Lancet of May 16, 1846. The bladder and ureter were like those of a man who had long suffered from stricture. From the remarks of Dr. J. Lewis Smith, that phimosis may be productive of inguinal hernia and prolapsus of the rectum, and the observations of Edmund Owens and Arthur Kemp, both high authorities on children's diseases, being both connected with children's hospitals, as well as the remarks of Mr. Bryant in his "Surgical Diseases of Children," who all concur in looking upon phimosis as a great factor in hernia, Bryant having observed thirty-one in fifty consecutive cases of phimosis, we are certainly warranted in assuming that phimosis is not only a mere local timely inconvenience that will disappear with the approach of puberty, but a condition which, in the more easily affected organism of the child,—lacking, as it does, that resistance that comes with our prime,—is productive of serious harm; as even the first few years of life, even a few months of infant life, with a phimosis, are sufficient to so change the structures of parts that the poor child will grow into a man with an impaired kidney or sacculated ureter. The strain required to induce a prolapsus of the bowel or a rupture into the inguinal canal is exerted as much on the bladder, ureter, and kidney as on the other localities. Physicians who have taken the pains to observe must have noticed, more than once, how the child afflicted with a phimosis has not only at times to wait for the stream of urine to appear, there seemingly being some obstruction to its starting, but how often such a case is afflicted with a stammering, halting urination. A child thus started out into life, with a defective kidney or kidneys, is sadly handicapped in his usefulness, comfort, or in properly competing in the race of life. No parent would for a moment think of starting his son in life by giving him a business that is heavily mortgaged at the start, but many a parent unconsciously launches the unsuspecting child into a life of such ill health—resulting from a simple narrow prepuce—beside which a heavy mortgage or a heavy yearly tribute would be but a mere trifle. I have seen such men, who in after life, broken-down and perfectly physical wrecks, would gladly have given all their wealth and been willing to have some genii set them down in the middle of the Sahara, shirtless and pennyless, provided they had their health. To say nothing of the trifling loss of the prepuce, these parties would gladly have had a foot or a leg go with the prepuce if necessary, and have their health.

[104] I have often performed dilatation where, for some reason, either the timidity of the parents or the health of the child seemed to contraindicate any more radical procedure. It is customary to advise mothers or the nurses to retract the skin daily, but even after a good dilatation I have found as sudden a recontraction, and even in the majority of cases, where daily drawing back the skin might have been practicable, the cries and struggles of the child are a positive prohibition to these instructions being carried out; it is not once in ten times that it can be carried out. I have seen two very annoying cases of paraphimosis resulting from this procedure, the struggles of the child having prevented the return of the prepuce to its proper place, and the violent crying and sobbing of the child having assisted to congest the organ.

[105] It may well be a question, considering the well-established fact that nervous injuries and affections are easily transmissible and become hereditary, how much feeble-mindedness is due to an heredity originally induced in either parent through reflex neuroses from the genital organs. The Jews have a very small percentage of feeble-minded; it is true that they have not any inebriates to assist in their manufacture, but still the absence of these well-pronounced cases of reflex neuroses among the race must be largely ascribed to their practice of circumcision, as that operation cures the gentiles so afflicted.

[106] I have seen precisely similar conditions resulting from a sphincterismus being relieved by anal dilatation. I had one such case who had fallen into the hands of a quack, who made him believe that he was being affected with incipient softening of the brain; systematic dilatation or a rupture of the sphincter a la Van Buren is the appropriate remedy.

[107] In the first volume of the "American and English Encyclopedia of Law" there is an interesting account of a young child (who had been bound out by the parish officials) who murdered his little bed-fellow and, on trial and conviction, was sentenced to be hanged, but who was reprieved by royal favor on account of his tender years, the sentence being changed to imprisonment for life. The little fellow was only eight years of age. On the trial the boy said he was driven to commit the crime because the other child soiled the bed. The two children being both paupers, it may well be imagined that their bedding was none of the cleanest at the best, or that their bed-room had the best of ventilation. As at the time the murder was committed English paupers were not treated in the most humane manner, it is not surprising that a nervous, sensitive child would, under such a combination of circumstances, be converted into an insane murderer.

[108] The study of prematurely acquired impotence in the male is a most interesting one. I have frequently seen it result from the presence of anal or rectal irritation, from haemorrhoids. I have seen cases who could not have erections, and in whom all sexual desire was extinct at a very early age, who have informed me that, although unable to have sexual intercourse because of the total absence of sexual desire, the flaccidity of the organ, and the want of sound physiological organic functional activity to suggest the thought, they had, nevertheless, frequently been the victims of nocturnal emissions before the total extinction of the function. As a rule, much of this premature impotence—induced by either irritation of the genital organs or rectal or anal troubles—runs its unfortunate possessor through such a course of physical incidents as described by Hammond, as the wild Indians of the Southwest induce in the mujerado. At first the sound organ responds in a natural manner to any stimulus that may affect it, but soon a local satyriacal condition is set up, which, running a more or less rapid period of intense activity, soon leaves its victim completely, permanently, and hopelessly impotent, even as much so as if eunuchized in the most approved manner. Hammond's description of the manner in which these unfortunates are manufactured is an interesting addition to the facts contained in the natural history of man, and is as follows: "A mujerado is an essential person in the saturnalia, or orgies, in which these Indians, like the ancient Greeks, Egyptians, and other nations, indulge. He is the chief passive agent in the pederastic ceremonies which form so important a part in the performances. These take place in the spring of every year, and are conducted with the utmost secrecy, as regards the non-Indian part of the population. For the making of a mujerado one of the most virile men is selected, and the act of masturbation is performed upon him many times every day; at the same time he is made to ride almost continuously on horseback. The genital organs are thus brought, at first, into a state of extreme erethism, so that the motion of the horse is sufficient to produce a discharge of seminal fluid, while at the same time the pressure of the body on the animal's back—for the riding is done without a saddle—interferes with their proper nutrition. It eventually happens that, though an orgasm may be caused, emissions can no longer be effected, even upon the most intense degree of excitation. Finally, the accomplishment of an orgasm becomes impossible; in the meantime the penis and testicles begin to shrink, and in time reach their lowest plane of degradation. But the most decided changes are at the same time going on, little by little, in the instincts and proclivities of the subject. He loses his taste for those sports and occupations in which he formerly indulged, his courage disappears, and he becomes timid to such an extent that, if he is a man occupying a prominent place in the council of the pueblo, he is at once relieved of all power and responsibility, and his influence is at an end. If he is married his wife and children pass from under his control,—whether, however, through his wish or theirs, or by the orders of the council, I could not ascertain. They certainly become no more to him than other women and children of the pueblo." Hammond examined one of these men, who had, as he himself informed him, formerly possessed a large penis and testicles "grande como huevos,"—as large as eggs. The penis was in its flaccid state and about an inch and a half in length, with the glans about the size of a thimble, which it very much resembled in shape. The glandular structure of the testicles had disappeared; they were atrophied, little besides connective tissue remaining. He examined another mujerado in the pueblo of Acoma, who had been so made when at about the age of twenty-six. The penis was not more than an inch in length and about the diameter of the little finger, and of the testicles there was apparently nothing left but a little connective tissue. Both of these men had high-pitched voices. The last one examined was then thirty-six years of age. (Hammond: "Male Impotence.") The foregoing detailed description shows an extreme degree of results produced by an equally extreme degree of intense and persistent irritation applied to the genital organs, purposely employed to obtain certain results. In the cases cited the irritation or excitation is directly applied, but it is safe to assume that reflex irritability from the anus or rectum, or from that of a stricture or of a prepuce, will in some cases produce a certain degree of excitation in the testicles that may result in their functional or organic derangement, in a degree proportionate to that of the amount of excitation from which they have suffered. That the testicles are very apt to suffer from the existence of a stricture is a well-known fact. I have myself worried over a case of stricture, in whom the attempted passage of a filiform bougie was always immediately followed by a severe attack of epididymitis, and who had always been afflicted with a tenderness and a tendency to inflammation of the testes. I have also noticed a much greater tendency to orchitis in the wearer of an irritating prepuce than where it was absent; so that the presence of a satyriacal tendency, no matter in what proportion of a degree it may be present, can safely be assumed to result in a corresponding degree of apathy, due to an actual physical degeneration of the parts. That these conditions, when present in any degree of permanency or persistence, will in the end induce early impotence, I have no reason to doubt. In this regard we must not overlook the fact that persons with phimosis, stricture, or other genital irritants and impediments, are more liable to be afflicted with haemorrhoids, prolapsus ani, or other anal and rectal irritation, which retroactively assist in bringing about the condition under question. How much this may have to do with certain prolific peculiarities among the Jews may well be questioned; it is a well-known fact that in London the Jewish excess of male births has been as high as eighteen per cent., while among the Christian or Gentile population it is only six and one-half per cent.,—a somewhat analogous condition of proportion being also observable in the United States. Here, it is accounted for, in a measure, by Dr. Billings, in the following words: "This comparatively large proportion of males among the Jews is probably due to the fact that the death-rate of their infants is less for males, as compared with females, than it is among the average population." Children gotten during the prime of life of the parents are naturally more virile and have better stamina than those gotten before full maturity is reached. If the father is on the verge of impotency just about the time he is expected to beget his best offspring, that offspring cannot be expected to present an extra amount of vitality, virility, or physical stamina; hence, the prepuce can be brought in as directly tending—in no matter how small the degree it may be, but nevertheless a factor—to the physical degeneracy of the race, as well as it demonstrates the existence of some law for the production of the sexes which we do not as yet fully comprehend. Aside from the above considerations, there are those of the actual bar to the increase of population which the prepuce induces, either by primarily being the cause of impotence or by direct interference, as already mentioned, and the impotence that naturally results from the causes set forth in this note. The results of a prepuce are certainly such as must act like a moist, warm, and oily poultice to the irritability induced in the most confirmed Malthusian when contemplating the—to him—rapid and unwarranted increase of population.



WORKS AND AUTHORITIES QUOTED.

These pour le doctorat en Medecine, par J. B. B. Edmond Nogues, sur la Anatomie, Physiologie, et Pathologie du Prepuce. Paris, 1850.

These a la faculte de Medecine de Strasbourg. Par J. B. A. Chauvin. Consideration sur le Phimosis et Operation de la Circoncision par un procede nouveau. Strasbourg, 1851.

De la Circoncision chez les Egyptiens. F. Chabas. Paris, 1861.

Cause Morale de la Circoncision des Israelites. Vanier, du Havre. Paris, 1847.

La Circoncision, son importance dans la Famille et dans l'Etat. Par le Docteur Claparede. Paris, 1861.

Dissertation sur la Circoncision, sons les rapports religieux, hygieniques, et Pathologiques. Par le Docteur Moyse Cahen. Paris, 1816.

Origine, Signification, et Histoire, de la Castration, de l'Eunuchisme, et de la Circoncision. Par le Docteur F. Bergmann de Strasbourg. Archivio per le Tradizioni Populari, vol. ii.

Darstellung der Biblichen Krankheiten. Von Dr. J. P. Trusen. Posen, 1843.

Archives Israelites de France, No. 9, 4em annee, Septembre, 1843.

Bulletins de la Societe d'Anthropologie de Paris. Tome x (serie iii), 3d fascicule, Juin a Octobre, 1887.

Recueil de Memoires de Medecine, de Chirurgie, et de Pharmacie Militaires. Tome xxi (serie iii), No. 105, August, 1868.

Traite d'Hygiene, publique et privee. Michel Levy. 2d ed. Paris, 1850.

Neuroses des Organes Genito-Urinaires de l'homme. Ultzmann. Paris, 1883.

L'Hermaphrodisme, sa Nature, son Origine, ses Consequences Sociales. Par le Docteur Charles Debierre. Paris, 1886.

L'Onanisme. Tissot. Lausanne, 1787.

Traite de la nymphomanie. Dr. Bienville. Amsterdam, 1784.

La Folie Erotique. Par Prof. B. Balt. Paris, 1888.

Des Pertes Seminales Involontaires. Lallemand. Paris, 1836.

Spermatorrhoea. Lallemand and Wilson. Philadelphia, 1861.

The Philosophical Dictionary. Voltaire. London, 1765.

Oeuvres Completes, avec notes, etc. Montesquieu. Paris, 1838.

Dictionaire d'Hygiene, publique et de salubrite. Tardieu. Paris, 1862.

Guide du Posthetomiste. Par le Docteur L. Terquem. Paris.

La Circoncision et ses suites. Par A.S. Morin. Ext. du Journal l'Excommunie, January, 1870.

La Circoncision. Par le Docteur S. Bernheim.

Circumcision. By Dr. A. B. Arnold, of Baltimore. Reprint from the New York Medical Journal of February 13, 1886.

Among the Cannibals. By Carl Lumholtz. New York, 1889.

Recueil de Questions proposes par une Societe de savants voyageant an Arabie, Michealis. Amsterdam, 1774.

Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis primarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione, AEgrotorum Visitatione, etc. Oxonii, 1690.

Le Theatre de la Turquie. Michel Le Feber. Paris, 1681.

Recherches Philosophiques sur les Americains, ou Memoires Interessants pour servir a l'Histoire de l'Espece Humaine. Par M. de P. Augumentee par Dom Pernety. Berlin, 1774. (Also the first edition of the same work printed at Cleves in 1772.)

History of the Hebrews' Second Commonwealth. Wise. Cincinnati, 1880.

History of the Hebrew Commonwealth. Jahn. Oxford, 1840.

Jews' Letters to Voltaire. Philadelphia, 1848.

The Jewish Nation. Revised by Kidder. New York, 1850.

The Jews Under Roman Rule. By W. D. Morrison. New York, 1890.

The Story of the Jews. By James K. Hosmer. New York, 1887.

The History of the Jews. By the Rev. H. H. Milman. New York, 1843.

Early Oriental History. By John Eadie, D.D., LL.D. London, 1852.

The Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York, 1889.

Legends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New York, 1884.

The Religions of the Ancient World. By George Rawlinson, M.A. New York, 1885.

The Hermits. By the Rev. Charles Kingsley. New York, 1885.

Letters on Demonology and Witchcraft. Letters addressed to J. G. Lockhart, Esq., by Sir Walter Scott. London, 1831.

The Philosophy of Magic, Prodigies, and Apparent Miracles. From the French of Eusebe Salvert. New York, 1855.

Atlantis, the Antediluvian World. Donnelly. New York, 1882.

Sir Thomas Browne's Works. London, 1852.

Physical Education, or the Health Laws of Nature. By Felix Oswald, M.D. New York, 1882.

The Family: an Historical and Social Study. By Thwing. Boston, 1887.

The Intellectual Development of Europe. By John W. Draper, M.D. New York, 1876.

History of European Morals. By W. E. H. Lecky, M.A. New York, 1884.

Longevity and other Biostatic Peculiarities of the Jewish Race. By John Stockton Hough. Reprinted from New York Medical Record, 1873.

Vital Statistics of the Jews. By Dr. John S. Billings, in North American Review for January, 1891.

On Regimen and Longevity. By John Bell, M.D. New York, 1842.

Diseases of Modern Life. By B. W. Richardson, M.D. New York, 1876.

Cyclopedia of Biblical, Theological, and Ecclesiastical Literature. By McClintock and Strong. New York, 1886.

Early History of Mankind. Tylor. London, 1870.

Dictionaire des Sciences Medicales. 60-vol. edition. Paris, 1816.

British and Foreign Medico-Chirurgical Review, vols. for 1846, 1854, 1856, 1858, 1863, 1868, and 1869. London.

Braithwaite's Retrospect of Medicine and Surgery.

The Chinese. By John Francis Davis, Esq., F.R.S. London, 1851.

Massachusetts State Board of Health Report for 1873.

On Diseases of Children. Stewart. New York, 1844.

Diseases of Children. West. Philadelphia.

Lectures on Diseases of Children. Henoch. New York, 1882.

Women's and Children's Diseases. Dillnberger. Philadelphia, 1871.

Male Impotence. Hammond. New York, 1883.

Genito-Urinary Diseases. Otis. New York, 1883.

Urinary and Renal Diseases. Roberts. Philadelphia, 1885.

Urinary and Renal Disorders. Beale.

Renal and Urinary Organs. Black. Philadelphia, 1872.

Gout in its Protean Aspects. Fothergill. Detroit, 1883.

Venereal Diseases. Bumstead and Taylor. Philadelphia, 1883.

Traite sur les Maladies des Organes Genito-Urinaires. Civiale. Paris, 1850.

Pathologic Chirurgicale, tome vi. Nelaton. Paris, 1884.

Pathologie Externe, tome v. Vidal (de Cassis). Paris, 1846.

Guy's Hospital Reports, 3d series, vol. xvii. London, 1872.

Transactions of the Ninth International Medical Congress, vol iii. Washington, 1887.

American Journal of Obstetrics for January, 1882.

On the Reproductive Organs. Acton. Philadelphia, 1883.

Operative Surgery. Smith. Philadelphia, 1852.

Operative Surgery. Stephen Smith. Philadelphia, 1887.

System of Surgery. Gross. Philadelphia, 1859.

Principles and Practice of Surgery. Agnew. Philadelphia, 1881.

International Encyclopedia of Surgery. Ashhurst. Philadelphia, 1886.

Science and Art of Surgery. Erichsen. Philadelphia, 1869.

Diseases of the Kidneys. Ralfe. Philadelphia, 1885.

The Clinic. Cincinnati, 1872.

American Journal of the Medical Sciences for July, 1872; also vol. lx.

New York Medical Journal, vols. xvi, xix, xxvi.

Occidental Medical Times. Sacramento, October, 1890.

London Lancet, 1875.

Distribution Geographique de la Phthisie Pulmonaire. Lancereaux. Paris, 1877.

Annual Report of the Bureau of Ethnology. J. W. Powell. Washington, 1884.

Western Journal of Medicine and Surgery. Louisville, 1846.

Native Races of the Pacific Coast. Bancroft. San Francisco, 1875.

Encyclopedia Britannica, 9th edition.

Classical Dictionary. Lempriere. New York, 1847.

Commentary on the Bible. Clark.

Satellite for February, 1889, and January, 1891. Philadelphia.

Pedigree of Diseases. Hutchinson.

Medical Inquiries. Rush. Philadelphia.

Half-Yearly Abstract of the Medical Sciences, vols. xii and lx, Philadelphia.

Cincinnati Lancet and Observer, vol. xvi.

Statistics and Climate of Consumption. Millard.

Traite des Maladies Chirurgicales, vol. x. Baron Boyer. Paris, 1825.

Dictionary of Medicine. Quain. New York, 1884.



INDEX

Abolishment of circumcision by Christians, 18; by the Romans, 66 of eunuchism in Italy, 91, 96

Abraham, 32

Absence of penis, 13 of testicles, 105

Abyssinians, carry off the male members of slain enemies, 30; circumcised bishop among the, 64

Acosta, Rev. Father, on Mexican circumcision, 47

Adams, Dr. C. Powell, of Hastings, Minn., 198

After-treatment of circumcised Hebrews, 158

Agnew, D. Hayes, on penile cancer, 230; on eczema as a reflex neurosis from phimosis, 320

Albutt, T. Clifford, on primary cause of disease, 13

American circumcision, 47; infibulation and muzzling, 48

Amputation of penis, 230, 233, 247

Androgynes, 118

Augleria, Pierre d', on American circumcision, 47

Apis, the white bull, sacred to the Egyptians, 29

Apollo Belvidere, as evidence of exactness of ancient sculpture, 62

Apure Indians and their circumcision, 48

Arabian circumcision, 38; prostitutes, 323

Arias Montan, on Mexico, 46

Arnold, Dr. A. B., of Baltimore, 25, 219, 220, 223

Asthma as a reflex neurosis from genital irritation, 291

Australian circumcision, 44; operation on the urethra, 56

Author's modification of circumcision, 307

Aztec circumcision, 46

Ballance, C. W., dressing after circumcision, 317

Bamboo stick worn in vagina as a chastity protector, 52

Baptismal ceremonies of Omaha Indians, 56

Barbarous Arabian marriage custom, 54 mutilations of Guamo and Othomaco Indians, 48

Bas-relief representing Egyptian emasculation, 31

Bassouto circumcision, 42

Battos circumcision, 45

Baumgartner's devout and chaste dervish, 49

Beale, Sir Lionel, on blood changes, 296

Bell, Dr. John, on Jewish hygiene, 181 Dr. J. Royes, 191, 223, 229, 239

Bells, jingling of, under the skirts, denotive of Judean virginity, 52

Belt of brass mail to insure female chastity, 51

Berbers, mutilations of their prisoners, 30

Bergmann, of Strasburg, 20, 27

Bergson, Dr., 160

Bernbeim, Dr., on freedom of Jews from syphilis, 195; on preputial statistics, 220; on circumcisial operation, 312

Bernoulli, Prof., of Bale, 168

"Beth Yosef" of Joseph Karo, 153

Biblical vouching for homoeopathy, 113

Billings, Dr. John S., U. S. Army, on Jewish vital statistics, 174; on cancer amongst Jews, 230

Bird, Dr. Golding, on phimosis, 257

Bishop of Abyssinia accused of heresy on account of circumcision, 64

Blood of prepuce sprinkled on bride's veil, 55; sprinkled on ears of corn, 56 changes as starting-points of disease, 293, 298

Bobovii, Alberti, on Mohammedan circumcision, 39

Bogera, or African circumcision, 44

Bokai, on preputial statistics, 220

Bornean circumcision, 45

Bowditch, Henry I., on Jewish vital statistics, 176

Boyer, Baron, on cancer of the penis, 232; on gangrene of the penis, 237

Brett, Dr. F. H., case of hypertrophy of prepuce, 251

Bryant, Thomas, on skin-grafting, 328

Bumstead, on circumcision, 310

Burial of Algerine prepuces in the sands of the deserts, 39

Cahen, Dr., on diminished sensibility of glans after circumcision, 224

Calculus, liability of the Chinese to preputial, 248; Dr. J. G. Kerr, on preputial, 248; C. H. Martin, of Mobile, on climatic influence on, 248; Prof. Enoch, of Berlin, on preputial and vesical calculi, 249; Claparede's case, 249; composition of preputial, 249; Civiale's case, 249; induced by phimosis, 287

Canary Islands, remains of an antediluvian world, 25

Cancer of the penis, 232; views of Jonathan Hutchinson as to its origin, 226; pre-cancerous stage of, 226; views of Lallemand, 228, 329; statistics of, 231; Cullerier on, 231; fifty cases reported by Dr. Zielewicz, 233; early mention of, 234; views of Prof. John C. Warren, 235; views of Walshe, 235

Canon of St. John Lateran and his profane doubts, 74

Carter, Dr. Wm., on toxic urines, 298

Casalis, M., on Bassouto circumcision, 42

Cases of spontaneous circumcision, 58

Castration, etymology of the term, 80; as a self-sacrifice to deities, 89

Celsus, on Roman infibulation, 50; on operations on the prepuce, 302, 313, 328; originator of Cloquet's operation, 313

Chabas, M., description of Egyptian bas-relief, 23

Charlemagne endows an abbey with a holy prepuce, 72

Charles V sacks Rome, and robbery of the holy prepuce, 73

Chastity among Egyptian dervishes, 49; belt of brass mail of the Ethiopians, 51; plug of bamboo of Soudan, 51; rings to insure chastity in the male mentioned by Nelaton, 54; enforced among the Hindoo bonzes by infibulation, 54; among the Cybelian priesthood, 89; Greek monks, ideas of, 89; comparative, among the different religious creeds of Prussia, 195

Chinese, peculiar liability of, to calculous disease, 248; considered a delicate diet by Australian cannibals, 327

Chippeway Indians and circumcision, 23

Chivalry of the male Hottentot, 60

Christian abolishment of circumcision, 18; circumcision in Abyssinia, 63

Circumcised phallus as a religious and civic symbol, 35; races peculiarly exempt from syphilis, 192

Circumcising knife (see Knife).

Circumcision, abolished by Christians, 18; among Chippeway Indians, 23; among the Atlanteans of Plato, 23; among the Phoenicians, 34; among the Egyptians, 34; Arabian, 35, 54; during the reign of Psammetich, 34; civil and religious symbol of ancient Egypt, 35; Aztec, 46; among the Mijes, 46; Mexican, 46; Totonac, 46; among the Orinoco Indians, 47 the climatic limits of, as a general rite, 47; in the Island of Cosumel, 47; in Yucatan, 47; in old Florida, 47; Apure Indians, 48; among the Amazons, 56; accidental case of, mentioned by Cullerier, 57; spontaneous, 58; abolished by the Romans, 66; destroying marks of, 68; of Abraham, 143; Hebraic, 143; not practiced in the wilderness, 143; physical conditions that exempt Jewish children from, 144, 145; description of Hebraic, by Montaigne, 146; as a cure for epilepsy, 261; as a preventive of hernia or rupture, 263; as a preventive to prolapsus of the bowel, 263; as a preventive of idiocy, 266; as a cure for dyspepsia, 270, 271

Civiale, on moral effects of penis amputation, 247; case of phimosis and preputial calculi, 249

Claparede, on evils resulting from the prepuce, 229; on preputial calculi, 249

Clarke, Sir Andrew, on renal inadequacy, 300

Clavigero, on Mexican circumcision, 46

Climatic limits of circumcision, 65

Cloquet operation, 306, 316

Colchis, colony of, 33

Constantine punished circumcisers with death, 66

Constipation as a divine attribute, 288; as a result of phimosis and its results, 292

Consumption, relation of, to Jewish race, 178, 179

Controversy about the holy prepuce, 73

Convent of St. Corneille and the holy knife, 78

Convulsions induced by phimosis, 260, 261

Cullerier, accidental circumcision, 57; on penile cancer, 231

Cybelian priesthood and castration, 89

Dakotas, the white bull sacred among the, 26

David and the Philistine prepuces, 31

Debreyne, trappist, monk, and physician, 224

Delange, on Arabian circumcision, 37

Delpech, on female circumcision, 36

Demarquay, on penile gangrene, 236

Dervishes, holy and chaste, 49

Difference between Turkish and Buddhist heaven, 116

Dilatation of prepuce, 308, 312, 332

Donnelly, Hon. Ignatius, on Atlantean circumcision, 23

Dressing in cases of retraction of penile skin, 304; C. W. Ballance's, after circumcision, 317; A. G. Miller's, 318

Du Bisson, on Soudanese harems, 52

Dyspepsia induced by preputial irritation, 270, 271

Ebers, Dr., on Karnac bas-relief, 23

Eczema induced by phimosis, 320

Effect of the holy prepuce on the hands of a lady, 74

Effects of age on the prepuce, 285

Egypt, uncircumcised persons not allowed to study in ancient, 34

Egyptians emasculated their prisoners, 30

Emasculation, its early practices and evolutions, 29; of Uranos, 83

Emperor Adrian forbids circumcision, 66

Endurance and fortitude of Arabs, 55

Enforced continence and its effects on the penis, 61

Ennery, M., Grand Rabbi of Paris, 158

Enoch, Prof., of Berlin, on preputial calculi, 249; on results of phimosis, 266; on enuresis, 277

Enuresis, 275

Epilepsy, induced by the prepuce, 258, 261, 301

Epstein, Dr., of Cincinnati, 156

Erichsen, Prof., on cancer of the penis, 228

Ethics at the battle of Fontenoy, 76

Ethiopian infibulation of infant females, 51

Eunuchism, beneficial to guardians of public funds, 84; as excluding from the priesthood, 90; in Italy, 91; in China, 91, 93; in India, 92; in the Soudan, 99; and music, 94; as a punishment, 97; mortality attending its manufacture, 91, 92, 93, 99, 100, 107; does not prevent copulation at all times, 92, 100, 101, 102, 103; manner of procedure among the Pagan priesthood, 106; prices of eunuchs, 99; numbers annually made, 91, 98; fecundating eunuch of Mecca, 100; Velutti, the opera-singer, 102; eunuchs as possessors of harems, 90; eunuch warriors and statesmen, 90

Evidence of circumcision on Egyptian monuments, 23

Extraordinary results of phimosis, 282

Female circumcisers in Arabia, 36

Females subject to preputial reflex neuroses, 267, 268

Flaccourt, M. Martin, account of the Madecasses, 54

Fothergill and the unlicensed practitioner on renal pathology, 77

French war-office records, on Jewish vital statistics, 175

Frenum, statistics relating to abnormalities of, 221

Frerichs' ammoniaemia, 300

Fresnel, M., on marriage circumcision, 54

Full-moon rites among the Bassouto maidens, 44

Galen, on the flaccid virile member, 60, 61

Gangrene of the penis, 236

Golden padlocks worn on prepuce for five years, 54

Greek and Roman statuary and the penis, 60

Greek monks' object in infibulations, 54; extreme ideas of chastity, 89

Gregg, Dr. Robert J., operative procedure, 320

Griffith, Dr. J. D., cases of reflex irritation, 261

Gross, Prof. S. D., on penile cancer, 230; operations, 320

Grotius and the origin of the Peruvians, 46

Guimara, the, 153

Guinzburg, Dr., on Jewish vital statistics, 176

Gumilla and his South American voyages, 47

Haemostatic powders, 160

Hare, Prof. Hobart A., on circumcision, 301

Haskins, Dr. A., on Jewish vital statistics, 176

Heaven, Turkish, 115; Buddhist, 116

Hebraic idea of parental origin of constitution of the child, 144

Hebrew Consistory of Paris, 157

Hebrew words in Central American languages, 24

Hebrews, attempts to efface signs of circumcision, 69; secretly circumcise their dead, 68; Hebrew vital statistics, 169 to 179; as proverbial good livers, 171; escape epidemics, 173; peculiarly free from syphilitic taint, 191; their circumcision suitable to young children, 306

Heliogabalus, Emperor, was circumcised, 66

Henry III of France as a Moslem godfather, 64

Henry V of England and the holy prepuce, 71

Heraclius, Emperor, persecuted the Jews, 67

Hermaphrodites, earliest mention of, 117; pederasty causes belief in their existence, 118, 119, 120; Debierre on, 123; notable cases of, 124, 125, 127, 128

Hernia induced by phimosis, 263

Herodotus, his views adopted by Voltaire, 22; visits Egypt, 34

Herrera, on Mexican circumcision, 47

Hey, Dr. William, on preputial cancer, 227

Hindoo devotee wears a six-inch ring in prepuce, 54

Hitouch, 156

Holgate, Dr., of New York, on preputial adhesions, 220; on preputial dilatation, 308

Holy circumcision, 70, 78 prepuces, 70, 72 vinegar and its miraculous effects, 79

Homer, Surgeon U. S. Navy, on the worship of Venus Porclna, 193

Horrible marriage performance, 54

Hottentot restriction on making twins, 60

Hough, Dr., on Jewish longevity, 173

Humphry, Geo. Murray, on "Old Age," 14

Hutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, 226; on urethral child, 300

Hypospadias, as a heredity, 129; artificially made, 56; formerly led to belief in hermaphrodism, 129; fecundation in, 129; difficulty in determining sex owing to, 131

Idiocy induced by phimosis and preputial adhesions, 265, 269

Impious wretch steals the holy prepuce, 74

Impotence, holy vinegar and shrinal observances in, 71 to 81

Indians and circumcision, 46 to 48

Induration of prepuce, 250

Inflbulation practices, 48 to 52

Isis inaugurates Osirian rites, 29

Isserth, Rabbi Israel, 153

Jansen, Surgeon of the Belgian Armies, on frenum deformities, 221

Jews' letters to Voltaire, 22; Jews (see Hebrews).

Judaism unfavorable to religious insanity, 166

Justinia, Emperor, persecuted the Jews, 67

Karo, Joseph, and the "Beth Yosef," 153

Kemp, Dr. Arthur, on phimosis as a cause of hernia, 264

Kerr, Dr. J. G., on Chinese preputial calculi, 248

Keyes, Dr. E. L., on composition of preputial calculi, 249, 264

King David, the first homoeopathic patient, 113; secures two hundred Philistine prepuces, 31

Knife, circumcising, used in ancient Egyptian rite, 23; of shell used by Tonga Islanders, 45; of stone used by Australians, 45; of the holy circumcision, 78; made of rattan among the Fiji Islanders, 327

Lafargue, on Australian circumcision, 44

Lallemand, on masturbation, 223; on tendency to preputial cancer, 228, 329; on circumcision, 317

Las Casas, on Aztec circumcision, 46

Leech, Dr. T. F., on preputial irritation, 260

Letenneur, Prof., on the knife of the holy circumcision, 78

Life-insurance and the circumcised, 290

Lisfrane, rules for operations on the penis, 232; on recession of the body of the penis, 306

Livingstone, on Bassouto circumcision, 44

Longevity of Hebrews, 162, 169, 179

Lonyer-Villermay, M., on female circumcision, 36

Louis XVI as a candidate for the rite, 201

Love, Dr. I. N, on the Mosaic law, 262

Lumholtz, on Australian hypospadias, 56

Macilwain, on reflex neuroses, 330

Magruder, Dr. G. L., on reflex irritation, 261

Maids as heat radiators, 114

Maimonides, Jewish rabbi and physician, 32, 144, 153

Malay circumcision, 45

Malgaigne, operative views, 313, 316

Mapato, or mystery hut, 42

Marriage preceded by circumcision, 54

Martius and Spix, on circumcision on the Amazon, 56

Mastin, Dr. C. H., on calculous disease, 248

Masturbation, 224

Maury, Dr. Frank, on preputial statistics, 219

McLeod, Dr. Neil, circumcision operation, 318

McMahon, Dr. W. R., on reflex epilepsy, 261

Mendelssohn, Rabbi Moses, 164, 168

Mexican circumcision, 46

Mezizah, or act of suction, 150

Milah, 156

Miracles performed by the holy prepuce, 70 to 74

Mishna, the, 153

Mohammed, 65

Mohel, 157, 158

Moses, Dr., of New York, preputial statistics, 220

Moses circumcises his son, 150

Mott, Jr., Dr. A. R., cases of reflex irritation, 258

Music, first schools of, 94

Music at Algerine circumcision, 39; at Mohammedan, in Asia, 39; at Turkish feast, 41

Nelaton, case of infibulation, 54; on penile cancer, 231; on penile hypertrophy, 252

Nelson, Lord, disregard for red tape, 77

New Caledonian circumcision, 45

Newton, Sir Isaac, and the storm-predicting cow, 77

Nicaraguan baptism of blood, 56

Oath of mohel, 158

Oath, Egyptian manner of making oath, 35

Obod, Battle of, 36

Operations on the prepuce, 302; Cloquet's, 306; Bumstead's, 310; Hue's, 312; Bernheim's, Sedillat's, 313; Chauvin's, 313; Cullerier's, 313; Vanier's, 316; Vidal de Cassis', 316; Lallemand's, 317; A. G. Miller's, Neil McLeod's, 318; Erichsen's, 319; Gross's, 320; Van Buren and Keyes', 320; D. Hayes Agnew's, 320; Overall's procedure, 321

Origin of phallic worship, 29 of human slavery, 29

Orinoco, circumcision on the, 47

Orloth, penis or prepuce? 31

Osiris vanquished by Typhon, 28

Othomacos Indians and their bloody rite, 48

Owen, Dr. Edmund, on phimosis, 263

Packard, Dr., on preputial statistics, 219

Papal indulgences to worshipers of holy prepuce, 72

Paralysis induced by phimosis, 259

Penis, absence of, 132; diminutive specimens, 213; amputation of, 230, 233, 234, 247; cancer of, 232; gangrene of, 236; hypertrophy of, 248, 251, 252

Periah, 156

Persecutions on account of circumcision, 66

Phoenician origin of circumcision, 22

Phimosed penis on ancient statues, 60

Phimosis, 218, 221; as a cause of hernia, 263

Physicians as practical Christians, 141

Pooley, Prof. J. H., case of preputial irritation, 260

Pope, Rabbi Rav, and the Guimara, 153

Portuguese sailors as Mohammedan proselytes, 40

Potentia generandi, 103 coeundi, 104

Prepuce, infibulated, 54; swallowed by mother, 54; fired off in gun, 54; holy, 71; useful for skin grafts, 207; absence of, 209; influence on man at different ages, 225; induration of, 250; warts of, 250; reflex neuroses from, 256

Preputial miracles, 72; statistics, 219; adhesions, 219, 220; calculi, 248

Price, Dr. M. F., on reflex neuroses, 265; on female preputial irritation, 267, 268

Primitive phallic rites, 28 homoeopaths, 113

Procedure in retraction of skin of penis after circumcision, 304

Proselytes, Mohammedan, how circumcised, 40, 41

Public women between decks in U. S. Navy, 193

Puzey, Dr., of Liverpool, on preputial skin grafts, 207

Pythagoras 32; visits Egypt, 34

Ralfe, on causes of interstitial nephritis, 300

Rameses II, circumcision of his sons, 23

Ranney, Prof. A. L., on enuresis, 282

Reconstruction of a prepuce, 68, 69, 328

Rectum, prolapsus of, induced by phimosis, 263

Reflex neuroses from preputial irritation, 254, 330, 331

Regulations of French Hebrew consistories of 1854, 157

Religion, its connection to insanity, 166

Resectricis nympharum, profession of, 36

Restriction on impregnation, 57; on twins, 60

Retraction of skin of penis after circumcision, 303

Richardson, Dr. B. W., on relation of race to disease, 169, 170, 171, 177

Ricord's definition of the prepuce, 206; operations on the prepuce, 313

Roman infibulation, 58

Royal decree of 1845 in France, 157

Roux, on cancer of the prepuce, 227

Rush, Benjamin, and the cancer quack, 77

Saint-Germain, Dr., on preputial abnormalities, 264

Saint Foutin and his shrine, 78

Saint Guerluchon at Bourg-Dieu, 79

Saint Guignole and the miraculous phallus, 80

Saint Coulombs and the miraculous prepuce, 70

Saturnus the first eunuchiser, 83

Sayer, Prof. Lewis A., contributions to medical science, 255

Scythians carry off heads of the slain, 30

Self-circumcision, attempt at, 203

Semiramis first employs eunuchs, 85

Severus Sulpicius, on effects of climate, 50

Sham battles at circumcision feasts, 37, 41, 42, 44

She-circumcisers, 36

Shrine for the recovery of impotent males, 79

Smith, Dr. J. Lewis, on preputial irritation, 263

Solomon, Dr., of Brunswick, on suction, 158

Soudanese chastity protector, 52

Sphincterismus due to phimosis, 292

Spiked chastity belt in Naples museum, 52

Stallard, Dr., on Jewish vital statistics, 173

Sterility cured at sacred shrines, 71 to 81

Stricture of urethra and phimosis, 289, 290

Styptics used by mohels, 158, 159

Syphilis, statistics relating to, 187 to 199

Syphilis and scrofula, 190

Taylor, Dr. C. F., on masturbation, 269

Totonac circumcision, 46

Tonga Islanders' rite, 45

Toxaemia, resulting from phimosis, 293; of von Jaksch, 294

Tube, penis carried in, 56

Tunca Indian circumcision, 56

Turkish circumcision, 39 to 41

Tylor, on the Stone Age and circumcision, 336

Van Buren and Keyes, on circumcision, 320

Vanier du Havre, Dr., 54, 224; on operations, 316

Venus, birth of, 84

Vidal de Cassis, on preputial operations, 316

Virey, account of Hindoo bonze, 54

Virgins' chain of bells in ancient Judea, 52

Vital statistics of Jews, 169 to 179

Voltaire, on origins of circumcision, 22

Von Jaksch's definition of Toxaemia, 294

Wadd, Dr., on preputial cancer, 227; on hypertrophy of penis, 252

Walshe, on preputial cancer, 235

Warren, on preputial cancer, 235

Warts of penis and prepuce, 250

Waterman, Dr., on Jewish vital statistics, 177

Wax images of penis deposited on shrines, 79

Welsh words in Mandan language, 24

Wet dressing objectionable after circumcision, 304, 311