Chapter 18

THE PREPUCE, SYPHILIS, AND PHTHISIS.

It is not alone the tight-constricted, glans-deforming, onanism-producing, cancer-generating prepuce that is the particular variety of prepuce that is at the bottom of the ills and ailments, local or constitutional, that may affect man through its presence. The loose, pendulous prepuce, or even the prepuce in the evolutionary stage of disappearance, that only loosely covers one-half of the glans, is as dangerous as his long and constricted counterpart. If we look over the world's history, since in the latter years of the fifteenth century syphilis came down like a plague, walking with democratic tread through all walks and stations in life, laying out alike royalty or the vagrant, the curled-haired and slashed-doubleted knight, or the tonsured monk, we must conclude that syphilis has caused more families to become extinct than any ordinary plague, black death, or cholera epidemic. Without wishing to enter into a history of syphilis, it is not outside of the province of this book to allude to its frequency and spread.

Syphilis is not restricted to classes by any means; it is not those of the lower class alone who are its victims. Dr. Fr. J. Behrend, in his work, "Die Prostitution in Berlin," observes that abolition of the brothels in that city in 1845, '46, '47 and '48, trebled the number of cases of syphilis treated at the Der Charité; in the year 1848 the cases of syphilis treated at that hospital numbered over 1800. It was also remarked during this period of legally-enforced virtue, that, as inconsistently as it might appear, the disease invaded the best of families. From Dr. Neumann, in his brochure entitled "Die Berliner Syphilisfrage," published in 1852, we learn that, in the Trades and Mechanics' Benevolent Union of Berlin, in 1849, 13.51 per cent. of the sick were so from syphilis.

In the thirteenth volume of the _British and Foreign Medico-Chirurgical Review_, we find, in a review of the control of prostitution, an estimate in regard to the syphilization of a nation. The estimates are made on the most conservative figures, as, in the desire of the reviewer not to overestimate, he starts by figuring out the actual number of prostitutes in England, Wales, and Scotland to be only 50,000, when they were estimated, by those who had carefully studied the subject, as being more than double that number; the conservative estimate is, however, suitable for our purpose; so that we cannot be accused of overestimating the results. The portion of the review to which we wish to call attention is as follows:--

"Though the result of the evidence contained in the first report of the commissioners on the constabulary force of England and Wales was that at that time about 2 per cent. of the prostitutes of London were suffering under some form of venereal disease, yet we will descend even lower, and presume that of one hundred healthy prostitutes, taken promiscuously from England and Scotland, if each submits to one indiscriminate sexual act in twenty-four hours, not more than one would become infected with syphilis, an estimate which is without doubt far too low; yet, if admitted to be correct, the necessary consequence will be, _that of the fifty thousand prostitutes five hundred are diseased within the aforesaid twenty-four hours_.

"If we next admit that a fifth of these five hundred diseased women are admitted to hospital on the day on which the disease appears, it follows _that there are every day on the streets four hundred diseased women_. Let it be supposed that the power of these four hundred to infect be limited to twelve days, and that of every six persons who, at the rate of one each night, have connection with these women, five become infected, it will follow _that there will be four thousand men infected every night, and consequently one million four hundred and sixty thousand in the year_. Further, as there are every night four hundred women diseased by these men, one hundred and eighty-two thousand five hundred _public prostitutes will be syphilized during the year; hence, one million six hundred and fifty-two thousand five hundred cases of syphilis in both sexes occur every twelve months_.

"If, then, the entire population had intercourse with prostitutes in an equal ratio, _the gross population of Great Britain, of all ages and sexes, would, during eighteen years, have been affected with primary syphilis_. Be it remembered, we do not assert that more than a million and a half of _persons_ are attacked every year, but that that number of _cases_ occurs annually in England, Wales, and Scotland, though the same individual may be attacked more than once. Although it is evident that all the estimates used for these calculations are (we know no other word that expresses it) ridiculously low, yet we find that more than a million and a half of cases of syphilis occur every year,--an amount which is probably not half the actual number. How enormous, then, must be the number of children born with secondary disease! How immense the mortality among them! How vast an amount of public and private money expended on the cure of this disease!"

The same reviewer (P. S. Holland), in another article on the "Control of Prostitution," observes that among the British troops syphilis is one of the most frequent of diseases, about one hundred and eighty cases occurring annually among every one thousand soldiers.

The effect of syphilis in depopulating the islands of the Pacific has been pointed out in a former chapter; the nature and origin of the disease that takes them off is unmistakable. Scrofula and rapid phthisis are taking off the inhabitants at a rate that, in those islands most affected, the native population will soon become extinct. According to Lancereaux, in the Marquesas group the women do not live beyond the age of thirty to thirty-five years, three or four months being the duration of the disease. Ellis, in his "Polynesian Researches," published in 1836, remarks that at that date the disease, as above described, had but recently appeared. In the nineteenth volume of the "Archives de Médecine Navale," Rey mentions that at the Easter Island pulmonary phthisis is the dominant affection with the adults, and that scrofula is very prevalent with the children.[75]

The effect of syphilization in inducing a scrofulous taint and the appearance of a rapidly-marching consumption among savage races has been well observed among the Indians in the southwestern parts of the United States, where the appearance of these fatal diseases can easily be traced to that as a cause. There is something peculiar about the Anglo-Saxon race that is fatal to the Indian; wherever they come in contact, the savage race begins physically and morally to crumble; the habits of the Anglo-Saxon in the matter of intemperance and his lust soon end the poor Indian; while, on the other hand, the Latin races mix with them without any physical detriment to the Indian. In what was formerly the Northwest Territory the French and Indian intermarried, and syphilis did not begin to tell on the Indian until the Americans settled the country. From these observations it is very evident that in the Polynesian Archipelago syphilis must have been the precursor of the phthisis and scrofula, as we know it to have been that which induced those diseases among the Indians of the Mississippi or Missouri Valleys, or of the Colorado and Mojave Deserts, or in the mountains and valleys of Arizona.

On the other hand, circumcised races, whose women have not carried a syphilitic taint into the race, are as a class free from any syphilitic taint. Neither their teeth, physiognomy, skin, nor general condition denote any syphilitic inheritance. This is true of the Jewish descendants of Abraham, who have more strictly adhered to the non-intercourse or marriage with other races, and whose women have abstained from vice; the Arabian descendants of Ishmael have, in a great measure, also retained their marked family individuality, except it be a few tribes, who, by contact with the soldiery of European nations, have had their women corrupted and syphilis introduced into the tribe through this channel.

Richardson, in his "Preventive Medicine," observing on the effects of syphilis in inducing deterioration of the organs of circulation and their degenerative changes, says that, in his opinion, syphilis is the progenitor of various diseases, and that those who give this opinion the greatest range are, unfortunately, nearest the truth. The breathing organs, he remarks, are distinctly susceptible to injury from this hereditary cause.

In 1854, at the Metropolitan Free Hospital, situated in the Jews' quarter in London, Hutchinson observed that the proportion of Jews to Christians among the out-patients was as one to three; at the same time the proportion of cases of syphilis in the former to the latter was one to fifteen. Now, this result was not due to any extra morality on the part of the Jews, as fully one-half of the gonorrhoea cases occurred among those of that faith. J. Royes Bell also observes the less syphilization among circumcised races.[76]

The absence of the prepuce and the non-absorbing character of the skin of the glans penis, made so by constant exposure, with the necessary and unavoidably less tendency that these conditions give to favor syphilitic inoculation, are not evidently without their resulting good effects. Now and then syphilitic primary sores are found on the glans, or even in the urethra or on the outside skin of the penis, or outer parts of the prepuce; but the majority are, as a rule, situated either back of the corona or on the reflected inner fold of the prepuce immediately adjoining the corona, or they may be in the loose folds in the neighborhood of the frenum, the retention of the virus seemingly being assisted by the topographical condition and relation of the parts, and its absorption facilitated by the thinness of the mucous membrane, as well as by the active circulation and moisture and heat of the parts. It must be evident that but for these favoring conditions the inoculation or infection would and could not be either as sure or as frequent. Any protecting mechanical aid that interferes with these favoring conditions grants an immunity to the individual, even when he is freely exposed; this protection has often been obtained by applying to the glans and penis a substantial coat of some tenacious oil like castor-oil, which was afterward gently washed off, first in a shower of tepid water and afterward in a tepid bath of warm water and borax.

Horner, formerly of the navy, in his interesting little work on "Naval Practice,"[77] relates that it was customary, in the older navy of the United States, to allow public women to come on board at some of the ports and to go down to the men between decks, the Department of the Navy being probably actuated by the same humane principle that used to induce some of the West Indian cannibals to lend their wives to their prisoners of war who were intended, in the shape of roast or _fricandeau_, to grace the festive board, as it was deemed inhuman by these philanthropists to deprive a man of his necessary sexual intercourse, even if they were soon to roast him and pick his bones. They may, however, have been selfish in the matter, as by some authorities it is represented that this was done to improve the flavor of the prisoner, who was said to offer a more savory dish through this considerate treatment, the strong flavor that the semen gives to flesh being well eradicated by free fornication. Whether it was through these motives of humanitarianism, or the feeling that an American tar was the equal of the British tar, whose praises and equality Sir Joseph Porter, K.C.B., writes a song about in "Pinafore," who had as much right to contract a left-handed marriage as any Prince of Wales or any other prince or crowned head of Europe, the women were, nevertheless, allowed to go down between decks in preference to giving the men indiscriminate liberty on shore, the government further providing for their welfare by causing the assistant surgeon to examine the women at the gangway or hatchway, to see that they were not diseased. Horner relates the ludicrous appearance presented by a near-sighted assistant at one of the hatchways while making this professional examination, surrounded by the sailors and marines, who were greatly-interested spectators. Had the government provided a pot of castor-oil wherein the tar could dip his penile organ, as bridge piles are dipped into a creasoting mixture, these humiliations to our professional brother could have been avoided.

In the conclusion to be reached, circumcision is not put forward as the only exempting element or preventive measure that deserves all the credit for the immunity that the Jews enjoy from syphilis, or to the absence of hereditary diseases that are secondary or due to the presence of that disease in the parents, as considerable credit is to be given to the well-known chastity of their females. This chastity is, in a great measure, due to the inseparable conditions of their religion,--moral and social fabrics which are welded into one. Their charity assumes the most practical form, so that it is not possible for one of their females to have to resort to a life of prostitution to save herself or her children from starvation, as, unfortunately, is too often the case in Christian communities, where religion is put on and off with Sunday clothes. The temperance and sobriety, as well as the economy and industry of the father, are not without a good moral as well as a hereditary effect on the daughters, who are neither rendered brutal nor demoralized through the example and instigation of drunken fathers. They have, therefore, a better average homelife, to which they cling and which protects them. The aid and benevolent associations of the Jews are among the most efficacious of charitable institutions, and no class gives more freely or generously for this purpose. The Home for Aged Hebrews in New York is an example of the character with which they dispense charity. We need not, therefore, be surprised to find, in statistics of illegitimacy by religious denominations taken in Prussia, that the Jewish women are three times as chaste as the Catholics and more than four times as chaste as the Evangelists.[78] The Jew has, therefore, two avenues of infection from syphilis cut off,--the lesser liability due to his circumcision and the chastity of the women.

Richardson mentions the immunity of the Jewish race from tubercular disease, and notices the well-known relation existing between a syphilitic taint and a phthisical tendency. The comparative statistics offered by the Mohammedans, Jews, and Christians in regard to deaths from consumption have already been mentioned in a former chapter, they being as four Christians to one Jew, while the Mohammedan, from his greater abstemiousness and temperance to assist him, shows a still lower percentage than the Jew. There can be but little doubt that to this particular and well-marked less syphilization the Hebrew race owes much of its exemption from many other diseases and its greater resistance to ordinary ailments and epidemic diseases.

The relative less frequency of syphilis among all circumcised people is noticed by Dr. Bernheim, in his brochure "De la Circoncision," he being the surgeon of the Israelitish Consistory of Paris. His utterances on this subject are worthy of attention, he having not only paid particular attention to this, but having had unusual opportunities for the basis of his opinions. Dr. Bernheim looks upon coition as a frequent source of tubercular infection, and the sensitive and absorbing covering of the uncircumcised glans as a ready medium of transmission of the virus from one system to the other. He calls attention to the frequent granular condition of the uterine os, in confirmed cases of tuberculosis, as something that is too much overlooked. This view of the case, from Dr. Bernheim's stand-point, is worthy of greater consideration than it has generally received at the hands of the profession.

The great number of examples that have recently come to light in connection with the direct inoculability of tubercular consumption, both in the later works on phthisis and in the medical press, are not without interest or without a lesson. The case recorded within the past year of a healthy chambermaid, who was immediately inoculated with tubercular matter with rapidly-following constitutional effects through a scratch on the hand, received from the sharp edge of a broken china cuspidor that a consumptive was using, is one of these cases that are to the point; so it is evident that the uncircumcised need not always wait for the degeneration of syphilis into syphilitic phthisis or syphilitic scrofula to become a consumptive, but it is within the greatest range of possibility and probability that he may become at once a consumptive through an excoriation or abrasion received during coition with a tubercular woman. So many tubercular prostitutes ply their trade, or, to be more definite, so many prostitutes become tubercular, and in its different stages follow their occupation as the only means of keeping out of the poor-house, that man runs as much if not more risk, in consorting with the class, of contracting tuberculosis than that of contracting syphilis.

There is something about syphilis that is not generally noticed; we are all well acquainted with the dire results that usually follow syphilitic infection, its course through every stage of suffering and misery, its transmission and effects in tubercular meningitis or in syphilitic affections of the mesentery through heredity in children, and of the many horrible cases of destruction of tissue, in skin, mucous membrane, cartilage, or bone, with their attending mutilations and disfigurations; but there is no record of the great number of cases, and very few physicians of any extended practice but who can recall some such cases, where, after undoubted syphilitic infection, with the usual course of primary sores and secondary eruption, the patient has suddenly blossomed out into a state of robust health that his system was an entire stranger to before the infection. The writer has, in the course of a long practice, seen a number of such results follow both the infection attended with a miliary eruption and that followed by the large small-pox-appearing eruption, both kinds being preceded by the primary sore; and these results have been observed in cases of both what are called the soft and multiple and the hard or Hunterial initial sore. Some of these cases rapidly gained in flesh, with an evident increase in the redness of their blood, increasing in vigor and strength with a very perceptibly less tendency to attacks from accidental or previously subject-to diseases.

The same result has been observed to follow an attack of small-pox with some individuals, and the writer well remembers a similar result following a very extraordinary event. The subject was a man well known among his old comrades of the First Minnesota Infantry as "Duke," and to many of the older practitioners of Wabashaw County, of that State, as "Old Duke." In early life he was sickly and weakly, never having fully recovered from a malarial fever contracted in the Mexican war. Coming to Minnesota, he adopted the life of a raftsman, with all the irregularities that accompanied such a life. On one occasion, after a protracted spree, feeling the need of stimulation and not having the wherewith to procure it, he secured a jar in which a snake and several other reptiles were preserved in spirits, and drank the fluid contents. He was, some days afterward, taken violently ill with a high fever and racking pains, ending in an eruption of boils that covered him from head to foot; he made a slow and tedious recovery; but when recovered he seemed to have become imbued with a constitution resembling _lignum-vitæ_, for a more stubborn-twisted constitution never existed than that of "Old Duke." The power of resistance that this man developed was something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and the St. Paul physicians who were connected with the regiment well remember, though, wiry, precise, and soldierly "Duke," who, even in the old Army of the Potomac, immersed up to his ears like the rest of the army in the mud and dirt of the encampment of Falmouth, above Fredericksburg, came out on general inspection as prim as if he had just stepped out of a bandbox, for which he received a medal for soldierly conduct and bearing.

These apparent digressions are not made either to be tedious or to weary the reader, nor without an object. They are made to show that, whereas syphilis is looked upon as such a deadly disease, and it may be said to be the sole cause of fear to the assiduous worshiper at the shrine of Venus Porcina, there is another still more fatal danger awaiting him, ambushed in the folds of the vaginal mucous membrane, or coming along silently out of the cervical canal,--like the legions of Cyrus stealing along the dry bed of the Euphrates into ancient Babylon, to fall unawares on the feasting Nebuchadnezzar on that fatal night. So, in like manner, the virus of tuberculosis, either extruding from a granular os or from its neighborhood, gradually moves down on the unsuspecting, uncircumcised, and easily inoculable-surfaced glans penis, to infect the system with a tubercular poison that has no such exceptions as those above noted, as at times are the followers of syphilis. It is not alone the individual himself that may be the sufferer from this poison, but his progeny for several generations may have to suffer for the infection thus received, just as much as they would were that infection to have been syphilitic. As before remarked, this has heretofore not sufficiently occupied the consideration of the profession, and, as it cannot certainly be denied that such a source of tubercular infection is both possible and probable, the subject is entitled to more serious and deliberate consideration than that which has heretofore been paid to it.

Tuberculosis certainly has these two channels of entrance: either through direct infection or through an evolutionary process resulting from syphilis. The appearance and vital statistics offered by the French War Office in regard to the Algierine provinces, the report of the United States Census, the opinion of Dr. Billings deduced from the census reports, the opinions of Hutchinson, Richardson, Bernheim, and many other observers, as well as the personal but unrecorded observations of many practitioners, all tend to bear testimony to the remarkable difference that exists between circumcised and uncircumcised races in regard to the ravages of consumption. Is circumcision a factor in this difference, or is it not? If it is, then circumcision should receive more attention than it has; if it is not, then we should not be idle in hunting up the cause of difference, for an ounce of prevention is certainly worth in this regard a whole pound of Koch's lymph as a curative agent.