Chapter VII: Summary

I. Circumcision as a sacrificial rite has been practised by very numerous races of diverse origin, and dates from an extremely remote antiquity; probably from the Stone Age, as suggested by the internal evidence of Biblical records.

II. This fact, together with that of its application by many tribes to the persons of female children, deprives the religious ceremony of any title to the hygienic character and purpose, which have been frequently attributed to it.

III. The surgical operation of circumcision, especially where infants are concerned, has therefore to be discussed solely on its own merits, wholly apart from any theory of Divine intentions, based upon theological considerations. It appears to be erroneous _in principle_.

IV. It consists in a _mutilation_; in the removal of a perfectly normal structure, with which, for patent physiological reasons, every male child is endowed by nature. The morality of such a practice, without grave necessity, is open to question.

V. Unless as the result of subsequent disease, no deformity, and indeed no actual abnormality, exist as factors productive of the condition designated 'Congenital Phimosis.' Almost every male child suffers at birth from some degree of the same phenomenon--the imperfect separation of two muco-cutaneous surfaces, developed in contiguity.[27]

VI. Symptoms ascribed to a 'contracted prepuce' are due to natural growth of the glans penis, when this physiological separation is very incomplete, and when, therefore, a rigid constricting envelope prevents development. _No true contraction_ exists, except as the result of superadded inflammation; and is rarely of much importance, unless an element of contagion has been introduced.

VII. The rational treatment of congenital phimosis primarily consists in the efficient execution of the process originally intended by nature, but imperfectly carried out. And, secondarily, in precautions to ensure the permanently free mobility of the prepuce upon the glans penis.

VIII. Such complete separation of the two contiguous layers of membrane may almost invariably be effected by very simple means; and, with some slight attention to after-treatment, will permanently secure all that is desired, without risk and without even transient disability.

IX. The treatment of congenital phimosis by dilatation is the common-sense remedy for this condition. It has been carried out by many practitioners with different instruments and variations of detail; and all who have thus attempted it with ordinary care (including the present writer) seem eminently satisfied with the results.[28]

X. When diseased processes co-exist with congenital phimosis, the case must necessarily be treated on its own merits. Simple dilatation, even if practicable, is not always sufficient, but should be combined with incisions of as limited a nature as possible. Mr. Furneaux Jordan's operation is then useful.

XI. In the event of disease, the operation of circumcision is not devoid of risk, and should be reserved as far as possible for extreme cases, in which removal of the whole prepuce is obviously a matter of necessity.[29]

XII. In healthy children the operation seems to be rarely fatal in this country. Many cases of death directly traceable to circumcision have, however, been reported on the Continent.

XIII. The immediate effects of circumcision, especially when performed on young infants, involve considerable and protracted suffering.

XIV. The most conspicuous _remote_ result is that of an extremely contracted _meatus urinarius_, as the consequence of subsequent inflammatory processes, due to the exposure and continual friction of the unprotected glans.

XV. The compulsory enforcement of local cleanliness procured by circumcision seems hardly a sufficient argument for the general adoption of the practice by peoples not utterly indifferent to all laws of hygiene; and has little weight even in individual cases.

XVI. The superior chastity and purity of mind and body supposed to be procured for its recipients by ritual circumcision, lie open to very considerable question, in the face of abundant well-known facts.

XVII. The advantage of circumcision in obviating future venereal contagion is restricted by its principal advocate to one form (albeit the most important) of such disease. Even in this limited field the facts adduced appear open to dispute, and greatly to need confirmation by independent observers.

XVIII. In the hands of careless or inexperienced operators the surgical operation of circumcision has been followed by the most disastrous permanent consequences.

XIX. In face of the facts here set forth, it is NOT advisable to apply the operation of circumcision, as a remedy for congenital phimosis, to Christian infants; much less to extend this, as a routine custom, to the whole male population.

FOOTNOTES:

[27] The word 'adhesion' in the previous pages is employed solely as a term of convenience, to denote this imperfect separation, and does not imply any analogy to inflammatory processes.

[28] The writer first drew attention to the advantages of this method of treatment in the _British Medical Journal_, Nov. 15, 1874. Having instituted a tolerably extensive search through the medical literature of the preceding three or four decades, he is unable to find any account of a case in which the procedure failed to effect a permanent cure, unless there had existed previous disease.

[29] A fatal case, after circumcision for gonorrhoeal inflammation, in a youth of 17, is reported in the _Lancet_, Feb. 25, 1882. Death took place on the eighth day apparently from septicæmic pneumonia.

_BIBLIOGRAPHY._

PUBLISHED WORKS.

I.--MEDICAL.

Erichsen's _Surgery_, Ninth Edition; Holmes's _System of Surgery_, Third Edition; Maunder's _Operative Surgery_; Joseph Bell's _Manual of Surgical Operations_; Jacobson's _Operations of Surgery_; Reginald Harrison's _Diseases of Urinary Organs_, Third Edition; Keyes's _Diseases of Urinary Organs_; Keating's _Cyclopædia of the Diseases of Children_; Ashby and Wright's _Diseases of Children_; Jaffé's _Die rituelle Circumcision im Lichte der antiseptischen Chirurgie_; Asher's _The Jewish Rite of Circumcision_; Wunderbar's _Biblisch-Talmudische Medicin_; Gideon Bircher's _Die Beschneidung der Israeliten_; Dr. Hayes Agnew's _Principles of Surgery_; Sayre's _Orthopædic Surgery_; Hilton's _Rest and Pain_; _International Encyclopædia of Surgery_, 1886; _Guy's Hospital Reports_; _American Journal of Syphilis and Dermatology_, October 1872; Walsham's _Theory and Practice of Surgery_, &c. &c.

II.--HISTORICAL AND MISCELLANEOUS.

_The Testaments, Old and New_; _The Talmud_; _Maimonides on Circumcision_; Tylor's _Primitive Culture_; Moncure Conway's _Demonology and Devil Lore_; Keil's _Biblical Archæology_; Smith's _Dictionary of the Bible_; Calmet, _Dictionary of the Bible_, _Encyclopædia Americana_, _Encyclopædia Britannica_; Howard, _Royal Encyclopædia_; _Penny Cyclopædia_; _Chambers's Encyclopædia_; _Encyclopædia Metropolitana_; Winer's _Realwörth_; Brewster, _Edinburgh Encyclopædia_; _English Cyclopædia_; Wilkes's _Encyclopædia Londinensis_; _Globe Encyclopædia_, &c.

PERIODICALS.

_The Lancet_, _British Medical Journal_, _Medical Times and Gazette_, _Medical Record_, _Dublin Journal_, _Boston Medical and Surgical Journal_, _Chicago Medical Standard_, _Gazette des Hôpitaux_, _Allgemeine Wiener Med. Zeitung_, _Wiener Med. Presse_, &c.

BY THE SAME AUTHOR.

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