Part 1

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THE

BARBARITY OF CIRCUMCISION

AS A REMEDY FOR

_CONGENITAL ABNORMALITY_

BY HERBERT SNOW, M.D. LOND. &c.

SURGEON TO THE CANCER HOSPITAL

LONDON

J. & A. CHURCHILL

11 NEW BURLINGTON STREET

1890

PREFATORY NOTE

To state that the object of this little work is to 'put down Circumcision' under the circumstances indicated, would, besides savouring of unpardonable arrogance, irresistibly suggest analogy to the example of a too famous alderman, who was determined to 'put down Suicide.'

If, however, the facts and arguments therein set forth contribute in some small measure towards the abolition of an antiquated practice involving the infliction of very considerable suffering upon helpless infants; and sanctioned, on extremely questionable grounds, by men of eminent authority; the following pages will not have been written in vain.

More evil is wrought by want of thought, Than comes from want of heart.

GLOUCESTER PLACE, PORTMAN SQUARE: _October 1890_.

THE BARBARITY OF CIRCUMCISION AS A REMEDY FOR CONGENITAL ABNORMALITY.

I

CIRCUMCISION AS A RELIGIOUS RITE.

The earliest historical or quasi-historical notice of circumcision is to be found in Genesis xvii.; where Jahve enjoins upon Abraham the personal performance of this mutilation, as a sign of the covenant henceforward to subsist between them. Abraham, his son Ishmael, and all his male slaves forthwith underwent the prescribed operation; which thence-forward remained obligatory upon their posterity, though not without transient periods of desuetude. It was suffered to lapse during the passage of the Israelites through the wilderness, and was subsequently revived by Joshua (v. 5); again in the reign of Antiochus Epiphanes, when some of the Jews seem to have submitted to a plastic operation in order to obliterate its effects.[1]

The compulsory performance of circumcision was re-enacted for the last time by Mattathias, in the age of the Maccabees; and the law to this effect has remained in force until the present day.[2]

The terms in which the Deity addresses his commands to Abraham presuppose an already existing familiarity with the ritual ceremony on the part of the latter. Accordingly we find that it previously prevailed among the Colchians, Æthiopians, and ancient Egyptians of both the Upper and Lower Provinces (Gardner Wilkinson). Among the latter it appears to have become restricted, by the dawn of the historical period, to the priestly caste, and to those who desired initiation into the sacred mysteries. In the temple of Chunsu at Karnak is a delineation of the rite as performed on two young children, probably sons of Rameses II., the founder of the building. It was apparently connected with the worship of Ra, the Sun God; and a seeming allusion to it in this connection is to be found in chapter xvii. of the 'Book of the Dead.' Notices of circumcision also appear in ancient Phoenician mythology.

There can be no question of its very great antiquity, or of its wide prevalence among ancient nations. Traditional descent from a primæval Stone Age is betrayed by casual notices in Holy Writ. Thus, in Exodus iv. 25, a sharp stone is the instrument of mutilation; and in Joshua v. 2, the marginal rendering is 'knives of flints.'[3]

The Hivites, the Canaanites (Phoenician), and many if not most of the nations with whom the Israelites were brought into contact after settlement in the Promised Land, appear to have practised circumcision at some period in their history. In the Old Testament we accordingly find the designation of 'the uncircumcised' specially reserved for the Philistines, and applied to these as a term of opprobrium.

The list of peoples by whom the circumcision of males has been, or is still, an established custom is sufficiently long. Among such races at the present day, 'an almost unbroken line may be traced from China to the Cape of Good Hope,' and unless perhaps in Europe (where comparatively slight traces of aboriginal manners and customs survive), we find the ceremony characteristic not only of savage tribes, but of nations ranking fairly high in the scale of civilisation; for instance, the Mexicans, and the ancient Aztec races of Central America. The Teanas and Manaos on the Amazon; the Salivos, Guamos, Otamocos, on the Orinoco; the negroes of the Congo, with many other tribes on both the west and east coasts of Africa, notably the Kaffirs, Bechuanas, and Hottentots; the Abyssinians (Christian), Nubians and modern Egyptians; the natives of Madagascar; most of the Australian aborigines; the Papuans, New Caledonians, inhabitants of the New Hebrides, of Java, of the Philippines, and of Fiji, are only a few that may be indicated. An approximation to the rite in the form of a slitting up of the prepuce was noticed among the Friendly Islanders by Captain Cook. Although not enjoined in the Koran, it is a universal practice among the Mohammedans, as a tradition from the ante-Mohammedan period.

A cognate operation upon _females_ obtains among the modern Egyptians, the Nubians, the Abyssinians, as well as in many other parts of Africa among the negro races; also among the Malays on the shores of the Persian Gulf (Carsten Niebuhr), and on the banks of the Orinoco. As an ancient custom in Arabia and Egypt, it is noticed by Strabo.

Local variations of detail are found; as in the case of the Friendly Islanders just cited; and of the Madagascarians, who cut the flesh at three several times; the excised prepuce being eventually _swallowed_ by some relative or other.

The date at which circumcision is performed varies considerably. Among the Jews, the eighth day is, of course, the selected period; probably from consideration for the sacred number seven, for the seven days of uncleanness prescribed for the parturient mother (Lev. xii. 2), and for an idea that with the second cycle of seven days the infant then properly commenced its earthly life. Among the Arabs, it is deferred till the thirteenth year; the age at which their reputed ancestor, Ishmael, was submitted to it. And every race seems to have selected for itself what was considered the most suitable time. The Turks, for example, have chosen the seventh or eighth year; the Persians circumcise boys at thirteen, girls, between the ninth and the fifteenth year; and so on.

It is thus evident, not only that the rite is extremely ancient, but that it is impossible to refer the practice of circumcision to any single source; or to doubt that it originally arose among many widely-sundered peoples, as the result of a certain stage in man's mental evolution. The once widely-spread custom of the COUVADE, and other strange aboriginal practices, afford an illustrative analogy.[4]

Herodotus seems to have been the author, or at least the introducer, of the cleanliness theory; according to which the ceremony was invented from motives of hygiene. Philo Judæus ascribes the custom to four causes: 1. Cleanliness; 2. The avoidance of carbuncle (Qu. cancer?); 3. The symbolisation of purity of heart; 4. The attainment of numerous offspring.

Of these, it need hardly be said that the last has no foundation in fact; and the two preceding require no remark. The idea, however, that circumcision was initiated for purposes of cleanliness has lasted to the present day, and still appears to have considerable currency. Whatever may have been the social condition of the ancient Egyptians and Arabians, on behalf of both which races, as having been the source whence Abraham derived his evident familiarity with the custom, plausible pretensions have been put forth; it is simply preposterous to imagine for a moment that the numerous savage tribes (witness the Hottentots and the Australian aborigines) who practise it, could ever have been actuated by any such considerations. Its world-wide diffusion, again, totally forbids the supposition, either of its introduction into these tribes by contact with other nations more highly civilised; or of its adoption, by the former, while in a higher stage of sociology, from which they have subsequently become degraded. And this explanation is put finally out of court by the phenomenon of an analogous rite applied in sufficiently numerous quarters to the persons of females. In order, therefore, plausibly to account for the general prevalence of this strange mutilation, we are compelled to look elsewhere; and an examination of the religious ideas which are known to actuate primitive man, will afford a clue.

Copious illustrations of the working of such ideas among peoples emerging from barbarism can be traced in almost every page of the earlier books of our Old Testament; and, even in classical mythology, although overlaid by the later developments of a high civilisation, their influence is still not entirely effaced. The principle of substitution was familiar to all the nations of antiquity, to the Israelites not the least. Witness the universal resort to sacrifices, the theory of which is well indicated by that of Isaac in Genesis xxii. Further illustrative examples are afforded by the law of the scapegoat, in Leviticus xvi.; by the offering of children to Molech (Lev. xx. 2); and by the legend of Jephthah's daughter (Judg. xi.). With this, various ceremonies, involving either mutilation or the shedding of blood, were in vogue--for example, the priests of Baal (1 Kings xviii. 28); even cutting off the hair seems to have been in the nature of a representative sacrifice.[5]

Hence many German authorities cited in Keil's _Biblical Archæology_ (vol. i. p. 415) consider circumcision as a relic of ancient sacrifice: the consecration of a part of the body for the whole. The different grades in the process of humanisation may be assumed to have been successively attained as follows. In the earliest periods, human sacrifice was probably universal; in the Bible, we have the episode of Jephthah's daughter, above referred to; and in the narrative of Abraham's purpose to offer Isaac there is not the slightest indication of surprise on the part of the patriarch when he received Jahve's commands; whence may be argued evident acquaintance with such deeds. Besides which, we hear of human sacrifice among the tribes contiguous to the Israelites, until a much later date. Even the Greeks and Romans occasionally resorted to this during the historical period; in the Homeric age, it appears to have been a not infrequent practice.

As, however, men progressed in culture and in humanity, such barbarity became impossible. Instead of putting their firstborn children (often by cruel methods, as in the sacrifices to Molech) to death, they propitiated the deity by an offer of the most precious member. Indeed, in the Genesis account of Abraham's circumcision, Mr. Moncure Conway considers (_Demonology and Devil Lore_, ii. 83) that the legend, subsequently obscured by later traditions, originally points to the performance of a much more severe operation. And when still more advanced, even this became impossible; the excision of a very small portion of the organ, not of indispensable necessity to the fulfilment of its functions, being substituted. After many generations had then passed over, the custom had become so firmly implanted in the mind and habits of the people, that its eradication was rendered a matter of extreme difficulty; even by new religious dispensations and more elevated modes of thought. Hence we find the rite among the Israelites made an exception to the fierce denunciation of mutilations in general, uttered by Jahve or by his messengers; and hence also, we see it (though not prescribed in the Koran) an ordinary modern custom throughout the whole of Islam, as well as among the Christian Abyssinians.

The practice of self-emasculation in honour of a divinity was a common feature in the worship of Chronos, of Cybele, and doubtless of many other among the earlier recipients of religious adoration; it is referred to (and not in terms of reprobation) at Matthew xix. 12. It has descended to modern times--witness the fanatical sects in Russia; and even persons of high intellectual calibre (as, for instance, Origen) have submitted to it. What men regarded as honourable and meritorious in themselves, they would be not unlikely to impose also on their children. The existence of such ascetic practices among partially civilised nations must not be lost sight of in the present connection; as helping us to comprehend the mental religious attitude of primæval man.

There can be little question that here we find our correct explanation of the origin and wide prevalence of circumcision. We are, however, no longer permitted to regard this as a hygienic custom, but simply and solely as a relic of barbarism; dating from an immemorial antiquity, long anterior to the first historical records, and when man was little, if at all, removed from savagery. The venerable age of the prescriptive rite, as well as the various social and religious phases through which the peoples adopting it have since successively passed, have effectually spiritualised it and have shed around it a certain halo of sentimentalism; but should not be suffered to obscure the only rational conception of its primary significance.

The sacrificial character of the act among the Israelites was indicated by a former custom of placing a pot of dust in the room where the ceremony was to take place; that, as we read in the third chapter of Genesis, being the allotted food of the serpent. The practice seems to have continued down to a recent period, but now to have fallen into disuse.

We thus clearly see that, beside being the sign of the covenant with the tribal deity, there was also involved the idea of a propitiatory sacrifice to the awful evil demons. The most clear instance of circumcision as an act intended to conciliate an offended divinity, or malignant spirit, appears in the strange story of Zipporah at Exodus iv. 24; where the vicarious nature of the rite is also plainly set forth. There is no apparent reason for identifying the Lord ('Adonai'); who sought to slay Moses, with Jahve; from whom Moses had just parted upon excellent terms. And there can be little doubt that Samael, to whom the scapegoat was subsequently offered (Lev. xvi. 20), or some similar dread power of darkness, is here meant.[6]

If the writer is not greatly in error, an impression prevails in some quarters that _Moses_ either instituted anew or effectually perpetuated the rite of circumcision among the Israelites; as a useful measure of sanitation. However deservedly high the reputation of the great Hebrew lawgiver as a sanitarian, he does not seem entitled to credit in this connection; and alludes but casually to the ceremony, as to an already well-established custom, among certain directions for the treatment of the parturient woman at Leviticus xxii. 3. There is plainly no question of hygiene here involved. Dr. Asher (_The Jewish Rite of Circumcision_) considers that CHASTITY was the main purpose aimed at in the Divine injunction to Abraham; but, for reasons subsequently adduced, such a theory will be seen to have no foundation in fact.[7]

As the present is not an antiquarian treatise, only a very cursory historic or ethnic account of ritual circumcision is here inserted; many other curious and interesting particulars may be found in the authorities cited at the end of this volume, as well as in the copious German literature on the same subject. All that has been attempted in the preceding pages is to exhibit the custom in its original character; and (in so far as the pretensions advanced upon its behalf as a surgical procedure are concerned), divested of the traditional sanctity which is possibly largely answerable for some of the views promulgated by medical authors; whereby the general habit and practice of the medical profession become also of necessity deeply tinged.[8]

FOOTNOTES:

[1] An account of the operation (seemingly then not infrequently resorted to) performed at a much later date for the above purpose, is to be found in _Celsus_, lib. vii. cap. xxv.

[2] According to Keating's _Cyclopædia of the Diseases of Children_, 1890, vol. iii., some of the rabbins now omit it; "in the teeth of a strong and growing popular prejudice." I am informed, however, by the Rev. S. Singer, to whom I am greatly indebted for a courteous reply to inquiry on the subject, that these congregations would not be regarded as orthodox; and that the innovation is unknown in the Old World.

[3] In the _Lancet_ of April 20, 1889, is figured a curious circumcising Instrument used by the Malays, who perform the rite upon boys at the age of eight years; and also upon females, about 1/8th inch being nipped off the extremity of the clitoris. In the ceremony performed on female children, variations exist; other tribes remove the nymphæ.

[4] _La Couvade_ was the designation of the unwritten law, according to which, directly an infant was brought into the world, the husband retired to bed and was sedulously nursed for a certain prescribed period; the mother, on the other hand, getting up and attending to the affairs of the household. Tylor speaks of it as "this once world-wide custom" (_Primitive Culture_, i. 76).

[5] Examples of the substitution principle among various _modern_ races are to be found in Tylor's _Primitive Culture_, vol. ii. p. 36 _et seq._

[6] The imposition of circumcision by the Jews upon vanquished enemies, as the Idumeans and Itureans (Josephus, _Antiq._ B. 13) sounds the like note; there could hardly be any question of proselytism. At an earlier date these people would have been ruthlessly massacred _en masse_, like the Amalekites (1 Sam. xv. 8); slaughtered in great part, like the Moabites (2 Sam. viii.); or sacrificed, like Agag (1 Sam. xv. 3), to the deity of the conquerors.

[7] According to the same writer, it is absolutely impossible to say, in any given case among the Mohammedans, whether circumcision has been performed or not; for, as the muco-cutaneous membrane has not been divided, 'the soft elastic skin of the penis easily comes forward and re-covers the glans.' He states that the performance of that particular portion of the ceremony which consists in tearing and removing the membrane in question, completely distinguishes the Jews from all the other nations of the world who practise the operation as a religious rite.

[8] Two cases of interest in this connection may be here noticed. Dr. Levy, a Jew dentist of Stettin, states (_Medical Record_, May 3, 1890) that, like his father before him, he was born without a foreskin; further, that his four brothers, who died in childhood, were similarly circumstanced.

The late Dr. Asher (_op. cit._), who must be considered a high authority in such a matter (so far at least as concerns his co-religionists), says: 'No part of the human body is subject to so many varieties and irregularities as the penis and foreskin.' He believes total absence of the prepuce to be extremely rare, and doubts whether such a phenomenon has ever occurred; but seems to regard a partial deficiency as nothing unusual. He states that in most, if not all, instances of supposed congenital absence of this structure, a small portion of the skin will be found prolonged to the glans across the intervening fossa; which morsel, however small, must be excised by the Mohel, with the usual formalities. A note informs us that, according to Jewish tradition, the following personages never had foreskins: Adam, Seth, Noah, Shem, Melchizedek, Jacob, Joseph, Job, Moses, Balaam, Samuel, David, Jeremiah, Zerubbabel.

The second case bears upon the very heterodox theory of maternal impressions, and is reported in the same periodical, of dates Nov. 3, 1888, and March 23, 1889. It is that of a child born accurately circumcised, seven months and twenty days after the like operation on his elder brother (presumably in presence of the mother, although this is not stated). The local appearances in the two children are affirmed by Dr. Harvey, of Illinois, to have been exactly alike; 'the congenital case even showing the marks of the sutures.'

Both of the above cases, together with Dr. Asher's experiences, may be respectfully commended to the notice of Professor Weismann.

II

NATURE OF CONGENITAL PHIMOSIS--PHYSIOLOGICAL IMPORTANCE OF THE PREPUCE.

The word 'phimosis' ([Greek: phimoô], I bind) signifies that condition of the penis in which the prepuce cannot be retracted beyond the _corona glandis_; and which may be either congenital or factitious.

The latter is a pathological phenomenon, the product of injury or of disease. To apply the term 'abnormal' to the former is, however, hardly permissible, except when the difficulties in retraction are permanent and extreme; when they cannot be overcome by judicious perseverance, and by careful manipulation in the early weeks of infant life. A certain amount of adhesion between the two contiguous surfaces of mucous membrane is almost constantly present at birth, as a continuation of the normal intra-uterine agglutination (Keating's _Cyclopædia of the Diseases of Children_, 1890, vol. iii.; article by Dr. De Forest Willard).

The radical defect in congenital phimosis is thus the adhesion or imperfect separation of two muco-cutaneous surfaces, normally developed in close contact. As a rule, these are so slightly connected that a very slight degree of force is sufficient to part them; but in a considerable minority of instances the defect eventually becomes permanent; with the natural growth of the organ more difficulty is experienced in procuring retraction; and various disagreeable, or even dangerous, symptoms are prone then to make their appearance.

The complaint, however, is simply one of degree. If the adhesions at the margin of the urethral meatus are so tight that they fail to be quickly separated by the stream of urine directed against them--the force of which necessarily varies in different infants--considerable impediment to micturition results; and, perhaps usefully, serves to direct early attention to the state of the parts. In rare cases, no opening at all into the urethra has been discoverable; and complete retention has necessarily ensued. Very often, however, nothing of this sort happens for several weeks, months, or even years; and the existence, or rather persistence, of the disability may not be noticed at all until adolescence of adult life. The majority of instances lie between these extremes; not seldom unpleasant symptoms begin to be observed when the boy is a few months old; but there is a wide range of variation.

The penile and preputial layers of mucous or quasi-mucous membrane being firmly adherent, and growth of the glans penis proceeding apace, certain consequences necessarily follow.

The prepuce being (in extreme cases) tightly fixed to the margins of the urethral orifice, the _meatus urinarius_ still retains the same calibre as when birth took place, and becomes far too small for the needs of the rapidly growing child. A difficulty in effectually voiding the bladder is experienced, and may eventually result in complete retention. The little patient tugs at the seat of unpleasant sensation; and this elongates the folds of skin at the extremity of the penis, normally somewhat redundant, and extremely distensile. The muscular force of the bladder being spent upon overcoming the obstruction at the narrow meatus, the urine trickles out feebly, and 'balloons' in the soft pouches beyond, which continuously retain a few drops. Hence great local irritation and excoriation.