2 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Legal reforms needed to protect boys from assault</h3> A shameful incident in Bundaberg, Queensland, in 2002 highlights the need for better protection of boys against unwanted interference with their genitals. In this case a Moslem father forced circumcision on his two sons, aged five and nine, against their own wishes, against the wishes of their mother, and in breach of a specific order by the Family Court. The father was separated from his former partner (an Australian woman of indigenous origin), who had sole custody of the boys, but who allowed them to visit him on the understanding that the man's sister would ensure that they were not harmed. He took advantage of this generosity during one stay to race the boys off to a doctor and have their foreskins amputated. Although the case was investigated by the Queensland Police child abuse unit, which sought to prosecute the man for assault, the case was dismissed in the Bundaberg magistrate's court on legal technicalities. The case shows up the shameful state of medical ethics in Queensland. How was it possible to find a doctor to perform this unnecessary and harmful surgery on two normal boys merely because an adult preferred them to be like him? And not an adult with any legal rights over the boys: had the surgeon done his homework, he would have discovered that the father did not have custody of he boys, and that the Family Court had specifically ordered that they were not to be circumcised. That it was possible is partly a tribute to the destructive influence of circumcision advocates like Professor Brian Morris at Sydney University and the maverick Queensland GP Dr Terry Russell. They are forever popping up in the media to urge parents to have their sons circumcised. Russell's own medical practice consists almost entirely of severing the foreskins from baby boys by means of the plastibell device. No medical organization in the world recommends circumcision, and in Australia both the Australian College of Paediatrics and the Australian Medical Association have issued strong statements against the practice How effective is Queensland and Australia law in protecting the bodily integrity of children? In several European countries, including Sweden and Norway, the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. A simple rule like that in Australia that could have prevented this tragedy. The case also shows up the sexist and discriminatory double standard by which female circumcision is condemned with horror as female genital mutilation while male circumcision is tolerated as a trivial or even beneficial adjustment. Yet Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation. If these boys had been girls there would be universal outrage and demands for education programs and legal reform to prevent such cases in the future. Why the sexist double standard? Do boys not have the same right to a complete set of genitals as girls? The father's right to practise his religion and culture does not extend to the right to inflict injury or disfiguring bodily alterations on other people, especially if they are defenceless children. In this special report we print a number of items relating to this tragic and disturbing case. Because new charges may still be laid against the man, it is not possible to reveal his name or that of his ex-partner and the boys. <h3> <a id="media" name="media"></a>Report in News-Mail, Bundaberg, Friday 9 August 2002</h3> Dad escapes charges By Tanya Moore A MAN who had his two young sons circumcised without their mother's permission had charges of grievous bodily harm against him dismissed yesterday. The Bundaberg father, who cannot be identified for legal reasons, had his case dismissed when the prosecution revealed they were not ready to proceed. Bundaberg Magistrates Court was told the man had taken the boys to a Bundaberg hospital while their mother was on holidays to have the operation performed on the six- and nine-year-old boys. Defence barrister Tim Ryan said the doctor had no problems with the "routine operation" because both the boys and the father had given their consent. The court was told the father was "sincere in his religious beliefs" that the boys should be circumcised. But the court was also told the mother, who is separated from the man, disagreed with the procedure and had been involved in a Family Law Court matter, which was the centre of the prosecution's case. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution was unable to go ahead without the certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But Mr Ryan said the request was "simply outrageous" given the case had been set down for a hearing since May and the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, on which charges could still be laid. <h3>Report in News-Mail, Bundaberg, Saturday 10 August 2002</h3> Cutting anger By Tanya Moore DOUBLE standards allowed two boys to be circumcised without their mother's permission, an outraged Australian health group said yesterday. Circumcision Information Australia spokesman Shane Peterson said the case in which a six- and nine-year-old boy were circumcised by their Bundaberg father, despite their mother's opposition, was "a tragedy". "In European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys", Mr Peterson said. "This rule should be implemented in Australia to prevent such tragedies." Mr Peterson said the case illustrated a double standard whereby female circumcision was condemned as mutilation while male circumcision was viewed as trivial or even a beneficial adjustment. He said the case also highlighted the lack of implementation of the UN Convention on the Rights of the Child by Australian law. The mother of the boys is also angry at what she sees as a double standard on circumcision. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged," said the woman, who cannot be identified for legal reasons. "Because it is my two sons who have been harmed, few people seem to care." She said her estranged husband had performed the operation during an access visit to the children last year. Grievous bodily harm and unlawful wounding charges were laid against the boys' father, but these were dropped on Thursday when the prosecution revealed they were not ready to proceed with their case. Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still pursue the case, on which charges could still be laid. <h3>Article in Sunday Mail (Brisbane), Sunday 11 August 2002</h3> Mother's fury as boys circumcised by Elissa Lawrence A MOTHER has spoken of her anguish at discovering her two young sons were circumcised without her knowledge. The woman, 27, who cannot be identified, said she was devastated to learn her former partner and father of her sons had arranged for the boys, then aged nine and five, to be circumcised at a Bundaberg hospital last October for religious reasons. The man appeared in Bundaberg Magistrates Court on Thursday facing charges of grievous bodily harm (for the circumcision). The court was told the Muslim man had taken his sons to hospital to have the operations performed while their mother was on holidays and was "sincere in his religious beliefs" that they should be circumcised. The court was also told the mother objected to the procedure and was involved in a Family Law Court matter central to the prosecution's case. But the charges were dropped when the prosecution revealed missing Family Law Court paperwork meant it was not ready to proceed with the case. An adjournment request was denied, forcing the police prosecutor to offer no evidence against the man. Outside court, arresting officer Detective Senior Constable Peter Cormack from the Gold Coast child abuse investigation unit said police would pursue the case and that charges could still be laid. The boys' mother, who now lives on the Gold Coast, said in a statement she believed her sons had been assaulted. "My sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs", she said. "If I had been in this situation with two daughters who were circumcised ... the Australian public would be outraged. Being of indigenous Australian descent, I understand the importance of freedom of personal beliefs in a multicultural society." Circumcision Information Australia spokesman Shane Peterson said circumcision was a form of mutilation. "For a long time Australia has had a double standard on male and female circumcision", he said. "Female circumcision is illegal yet male circumcision continues to be unregulated. It's morally wrong. An adult is surgically inflicting their religious, cosmetic or sexual preferences on a child. Surgery of any kind is one of the most invasive and high-risk forms of medical intervention possible, and it should always be the last resort. In European countries, the permission of both parents is necessary before a doctor can legally perform a circumcision on boys." <h2> <a id="release" name="release"></a>Media release by Circumcision Information Australia</h2> <h3>Dropping of charges on father who forced circumcision on sons shows double standard on genital mutilation</h3> A committal hearing for charges of grievous bodily harm and unlawful wounding was scheduled in Bundaberg yesterday against a father who forced his two sons to undergo circumcision during an access visit to his family home last year. The father, of Muslim faith, arranged for his sons aged 5 and 9 to be circumcised for non-medical reasons. This was against the expressed wishes of their mother. "Being of indigenous Australian descent I understand the importance of freedom of personal beliefs in a multicultural society", she said. "I believe my sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs; I am devastated that the father has stolen that opportunity away from my boys." The charges were dropped yesterday as documents from 1998 needed as evidence for the case could not be located. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution could not proceed without certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But defence barrister Tim Ryan said the request was "simply outrageous" given the case had been scheduled for a hearing since May and claimed the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const. Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, and charges could still be laid. By arranging circumcision of the boys, the father was in breach of orders by the Family Court, Brisbane. After a long documented history of physical abuse by the father to the mother, the Family Court ruled that the boys would reside with their mother, and she would have the day to day care and control of their welfare and development. Despite the Court's rulings and the issue of protection orders, on a number of occasions the father threatened to abduct the children, force them to undergo circumcision, and accompany him to Turkey. The father tried to fulfil the first part of his threats by applying to the family court for the boys to be circumcised. The mother of the boys said that the man had a history of substance abuse and psychiatric illness, and that the Family Court "justly dismissed his application for my boys to be forcibly circumcised." The mother feared for her family's safety and moved from Bundaberg to an anonymous address in the Gold Coast to escape the father's continued threats and harassment. For her boys' well-being, she preferred that they have no contact with their father. "I only allowed my boys to stay with their father during the recent access visit as his sister agreed she would be responsible for their care and well-being", she said. It seems the mother's trust was misplaced, as the boys' aunt did not prevent the circumcision that went ahead. The mother believes this was due to the family's Muslim faith. "The father always used his Muslim religion as an excuse for his violence", she said. "He treated us as though we were less than human; he saw us as objects or property for him to do with as he pleased. And now he has assaulted and mutilated my two boys in the worst possible way, by cutting off part of their sexual organs and depriving them of future sexual pleasure". The boys are reluctant to speak of their experience, but have expressed that their father misled them to believe they were going to the doctor for an examination. They are very upset that part of their bodies was removed and do not want any contact with their father. Despite the obvious trauma and breach of court orders, the father's barrister argued that the circumcision should be treated as a moral rather than a criminal issue. This has outraged the mother, who is adamant that her sons have been assaulted. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged. Because it is my two sons who have been harmed, few people seem to care". A spokesman for Circumcision Information Australia, Mr Shane Peterson, said that the case highlighted the lack of implementation of the United Nations Convention on the Rights of the Child by Australian law. "In several European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. This rule should be implemented in Australia to prevent such tragedies." Mr Peterson also said that the case illustrated the double standard by which female circumcision is condemned as mutilation, yet male circumcision is viewed as a trivial or even beneficial adjustment. "Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation." <h3>Further comments on multiculturalism</h3> Stricter rules governing consent for non-therapeutic circumcision could have prevented this sad and all too common occurrence. A high proportion of marriages in Australia are between men and women of different ethnic/cultural backgrounds, and the children of such unions cannot be said to belong strictly to one or the other group; this is all the more true in the many cases where marriages end in separation while the children are still young. Children in such situations will eventually decide which (if any) of the parental cultures they wish to identify with, or whether they wish to choose a cultural identity of their own, and we recognize their right to make a free choice. In a multicultural society, freedom of religion means that each individual must have the freedom to adopt his or her own religion and not have it imposed on them. In order to ensure that this right is real, their bodies should be protected from tell-tale and irreversible alterations. Although these children may choose to identify with the culture of one or other of their parents, they are not only members of that culture; they are also Australian citizens who are entitled to the protection of Australian law and custom. Individual determination has a physical as well as a mental dimension. Multiculturalism was intended as a policy to make people from non-English speaking backgrounds feel more at home in Australia; it was never meant as a carte blanche for the retention of customs that Australian society finds abhorrent. In the <a href="http://www.cirp.org/library/legal/Re_J/">United Kingdom</a> and <a href="http://www.circumstitions.com/Sweden.html">Sweden</a> the judicial systems have intervened in instances where Moslem fathers have sought or arranged for the circumcision of boys without maternal consent. In two cases the fathers were convicted, and in one of these cases the father was gaoled for three months. The practitioner who performed the circumcision was also charged with an offence, though acquitted, by the National Board of Health and Welfare. The United Nations Convention on the Rights of the Child and other international treaties which protect the physical and moral integrity of individuals are available at <a href="http://www.arclaw.org/">http://www.arclaw.org</a> <h2> <a id="rej" name="rej"></a>Important British case upholds child's right to physical integrity</h2> <h3>In re J (1999) confirms that child's physical integrity is more important than desires of parent</h3> J was a five-year old boy living in England, born of a mixed marriage. J's father is a Turkish Moslem, his mother is British. The father wanted him brought up as a Moslem and circumcised. The mother did not, and she took the father to court to prevent that from happening. In a landmark decision she won on both issues. Here are some significant quotes from the judgement of Wall J, delivered in England on 6 May 1999. What the judge said Where there was disagreement between those who had parental responsibility for the child, including a local authority exercising parental responsibility under a care order, circumcision was not to be carried out without the leave of the court. The question of the father taking J to Turkey on holiday is, however, linked with the question of his circumcision. If I decide that J should not be circumcised, the question arises as to whether or not the father's family and/or a Turkish court would accept that decision and feel themselves bound by it. The father assured me in evidence that he would respect the English court's decision, however much he might disagree with it, and would not seek to have J circumcised in Turkey. The father also recognised that if J returned from Turkey circumcised that would constitute a clear contempt of the English court. It is, therefore, clear to me that in Islamic law, J is to be regarded as a Muslim. According to Dr Hinchcliffe, circumcision is not mentioned in the text of the Koran, but in the Sunna (the practice of the Prophet Mohammed), which is the second recognised source of law, it is strongly recommended, and sayings from the Prophet himself are cited in support of the practice. J is plainly not in a position to give an informed consent to his circumcision. There is also ... a body of medical opinion which regards both male and female circumcision as invasive procedures involving unnecessary mutilation of the genitals, and which calls for male circumcision to be criminalised, except in the rare cases where it is medically called for. A case can be made for describing ritual male circumcision without any medical need for it as an assault on the bodily integrity of the child; indeed, that is the case which is made in much of the medical literature to which I was referred. If J were to be circumcised this could be carried out as a day case. J would be likely to be unconscious for about 20 to 30 minutes. It would be a painful procedure. The medical benefits arising from circumcision (apart from the three conditions identified by Dr S for which surgery is indicated) are highly contentious. There is a powerful body of medical opinion which puts strongly in issue any suggestion that male circumcision prevents or reduces the risk of urinary tract infection, penile cancer, or sexually transmitted disease. Equally contentious is the suggestion that it reduces the incidence of cervical cancer in women. There is evidence that tissue loss during circumcision removes or destroys the function of tissue which plays an important part in the overall sensory mechanism of the penis, and that there is a consequential loss of sexual sensory pleasure during sexual intercourse. Dr S's view, as a paediatrician, was that circumcision should only be carried out if medically indicated. I should add, in parenthesis, that amongst the documents shown to me was material from an organisation called Norm UK, the aims of which are to provide education about (1) the need to avoid circumcision and (inter alia) (2) about foreskin restoration. Within this material was an article on foreskin restoration which indicates that it is possible, although restoration cannot give back the erotogenic nerves amputated at circumcision. Equally, there was nothing in the medical evidence I read and heard which indicated that J could not be circumcised as an adult. The father simply could not understand the objections to circumcision. It was a means of demonstrating and reinforcing J's relationship with him: they had to be the same. The procedure for a child of J's age carries small but identifiable physical and psychological risks. It is an invasive procedure, which therefore carries with it risks shared by all surgical interventions: pain, bleeding, infection, surgical mishap and complications of anaesthesia. The father did not accept the risks, either physical or psychological, outlined in the medical evidence by Dr S; and I have to say that, despite his obvious sincerity, there was an element of exaggeration in the father's account of his own circumcision (no doubt as a result of the passage of time), and in my judgment he minimises its painful aspects and underestimates the likely effect of the procedure on J. In my judgment, the strained relationship between the parents, and the fact that as a circumcised child J would be unlike most of his peers, increases the risk that J will suffer adverse psychological effects from being circumcised. The disadvantages are that despite the father's passionate defence of the procedure, J may be traumatised by it. Thus, contrary to the father's perception, circumcision may in fact weaken rather than strengthen his relationship with J. Circumcision carries with it the small but definite risks of both physical and psychological harm to which I have referred. Furthermore J, as a circumcised child, would undoubtedly be different from the majority of his peer group. The consequential possibility that he may be picked on or teased by his peers cannot be excluded as a risk. I think that, because of his strong feelings and the passage of time, the father minimises the pain and discomfort likely to be suffered by J if the operation is performed. Circumcision is an effectively irreversible surgical intervention which has no medical basis in J's case. It is likely to be painful and carries with it small but definable physical and psychological risks. Under art 9 [of the Human Rights Act 1999], the father says that his right to manifest his religion in practice includes the right to arrange for the circumcision of his son in accordance with the tenets of his religion. That seems to me plainly correct. It follows that any limitations on that freedom imposed by a court must be (1) as are prescribed by law; and (2) as are necessary in a democratic society for the protection of the rights and freedoms of others - in this case, the rights and freedoms of both the mother and J himself. … I therefore see nothing inconsistent with the proper operation of arts 8 and 9 of the Convention in a decision of the court which, on the particular facts of this case and in the exercise of a judicial discretion, refuses to make a specific issue order permitting J's circumcision, alternatively prohibits the father from causing J to be circumcised. … Equally, given the balance which the court has to strike between the competing rights of the mother, the father, and the child, it does not seem to me that an order prohibiting circumcision in the circumstances of this case could properly be described as discriminatory under art 14. In my judgment, the argument put forward by the Official Solicitor on this point is sound. Circumcision is an irrevocable step in a child's life. Changes of surname, which require applications to the court in cases of disagreement are reversible: circumcision is not. In my judgment, therefore, where there is a dispute between parents or other persons having parental responsibility for a child over the child's circumcision, that dispute should be referred to the court. For all these reasons, there will be no order on the father's application for J to be brought up as a Muslim and there will be a prohibited steps order preventing the father from arranging or permitting J to be circumcised without the leave of the High Court. I propose to invite counsel to agree the precise terms of the order. Order accordingly. Leave to appeal granted. Re J (child's religious upbringing and circumcision) FAMILY DIVISION, Judge WALL J. 2, 3, 4 MARCH, 6 MAY 1999 Justice Wall's decision was confirmed on appeal. <a href="http://www.cirp.org/library/legal/Re_J/">The full text of the judgement</a> <h2> <a id="muslim" name="muslim"></a>The truth about Muslim circumcision practices</h2> Although the father in the Bundaberg case, and his barrister, tried to excuse his actions by reference to the Moslem religion, Islam does not impose an obligation on parents to circumcise their children. Furthermore, its recommendations about circumcision apply to women as much as men. The Koran, the Moslem bible, makes no mention of circumcision at all, but the prophet Mohammed is reported to have stated that "Circumcision is a sunnah for the men and a makrumah for the women". (Note the reference to men and women: nothing about boys and girls.) The term sunnah means customary or traditional; the term makrumah means meritorious. The most you could conclude is that circumcision was customary for men and meritorious for women, and thus desirable for both but obligatory for neither. In these respects Islam is quite different from Judaism, which requires the head of the household not only to circumcise his baby sons at eight days, but also his male servants and employees, which makes no mention of women in this context, and in which the rule of circumcision is stated prominently in the first book of the Jewish bible. Mohammed further laid down five rules for Moslem men: shaving the pubic hair; circumcision; trimming the moustache; plucking the hairs from the armpits; and clipping the nails. These constitute the fitrah, or laws of personal deportment, to which a pious man in pursuit of perfection must conform. According to Sami Aldeeb, "They are not compulsory, but simply advisable". The vital point about this list is that circumcision is a recommendation for adult men, perhaps no more important than trimming their moustache or shaving their pubic hair. It is thus less obligatory than the rule of prayer five times a day, the pilgrimage to Mecca, fasting at Ramadan or abstention from alcohol and pork. There is certainly nothing in the fitrah which requires a father to circumcise his children. Before assuring the Bundaberg magistrate's court that the man in this case was "sincere in his religious beliefs", his barrister should have established that he scrupulously observed all these requirements, not just the observance that his sons, rather than he himself, had to pay for. There is no unanimity among Islamic theologians as to whether Mohammed himself was circumcised and how it happened. Some say that he was born without a foreskin, others that he was circumcised by an angel or his grandfather. It is thus obvious that, whatever traditions may have evolved in particular cultures over the centuries, Islam does not require parents to have their boys and girls circumcised; and that parents who do have them circumcised cannot appeal to rules of their religion as a justification for this assault. Some Moslems even question whether circumcision itself is necessary and suggest it was merely a custom taken over unthinkingly from desert Arabs when Islam arose in the seventh century. The Egyptian Dr Nawal El-Saadawi writes: "If religion comes from God, how can it order man to cut off an organ created by Him as long as that organ is not diseased or deformed? God doe not create the organs of the body haphazardly without a plan. It is not possible that He should have created the clitoris in woman's body only in order that it be cut off at an early stage in life." As a woman and a victim of circumcision herself, she was referring to the female genitals, but the point is equally applicable to the male foreskin - the part of the penis removed by circumcision. References Sami A. Aldeeb Abu-Sahlieh, <a href="http://www.nocirc.org/symposia/fourth/aldeeb.html">Jehovah, his cousin Allah and sexual mutilations</a>, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy, New York, Plenum Press, 1997 Dr Sami Aldeeb, <a href="http://www.cirp.org/library/cultural/aldeeb1/">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Medicine and Law, Vol 13, No 7-8, 1994, pp. 575-622 Also available at <a href="http://www.quran.org/CIRCUMCISION.HTM">http://www.quran.org/circumcision.htm</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://go.to/samipage">Dr Aldeeb's home page</a> Sami A. Aldeeb Abu-Sahlieh, Male and female circumcision among Jews, Christians and Muslims: Religious, medical, social and legal debate, Warren PA, Shangri-La Publications (Marco Polo Monographs, No. 5), 2001 <h3>The marsh Arabs: Report by an English traveller</h3> When he was travelling through the marshy region of the lower Euphrates River in the 1930s (present-day Iraq), the British traveller Wilfred Thesiger encountered many Arab people who did not practice circumcision, and others who did and suffered nasty injuries and infections as a result of the operation. His report makes a mockery of the ill-informed statement by the Australian College of Pediatrics (1996) that circumcision "probably originated as a hygiene measure in communities living in hot and dry environments". On the contrary: cutting flesh in primitive conditions was about the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and permanent disability or death, as Thesiger found. Thesiger writes: Circumcision, although nowhere mentioned in the Koran, is generally regarded as obligatory for Moslems following the example of the prophet Mohammed himself, who was circumcised in accordance with Arab custom. No uncircumcised person may lawfully make the pilgrimage to Mecca. Among the tribes in southern Iraq … the operation was often deferred until manhood … and was seldom performed before puberty. It was done by specialists who travelled round from village to village in the summer. Their traditional fee was a cock [!], but more often they charged five shillings. The examples of their work which I saw were terrifying. They used a dirty razor, a piece of string and no antiseptics. Having finished, they sprinkled the wound with a special powder, made from the dried foreskins of their previous victims, and then bound it up with a tight rag. People living under these conditions acquire a remarkable resistance to infection, but they could not resist this, and boys sometimes took two months to recover, suffering great pain in the meanwhile. One young man came to me for treatment ten days after his circumcision, and although I am fairly inured to unpleasant sights and smells, the stench made me retch. His entire penis, his scrotum and the inside of his thighs were a suppurating mess from which the skin was sloughing away, the pus trickling down his legs. I cured him eventually with antibiotics. In spite of the social stigma of being uncircumcised, some boys not unnaturally refused. In other cases the fathers would not allow their sons to be operated on because there was no one else to look after the buffaloes. A few maintained that they had been circumcised by an angel at birth, a superstition that is also current in Egypt. Later I visited villages … where I heard that hardly anyone was circumcised. Wilfred Thesiger, The marsh Arabs, London 1964, pp. 101-2 <h3>Further information on Islamic circumcision</h3> <a href="https://www.circinfo.org/sattouf.html">Riad Sattouf's account of his circumcision as 8-year old in Syria</a> Dr Sami Aldeeb, <a href="http://www.quran.org/CIRCUMCISION.HTM">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Also available at <a href="http://www.cirp.org/library/cultural/aldeeb1/">http://www.cirp.org/library/cultural/aldeeb1/</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://www.quran.org/khatne.htm">A site maintained by Moslems who oppose circumcision</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Abduction and forced circumcision of Queensland boys darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Dr Morris descants on the evils of preputial adhesions</h3> About eighty per cent of all Aryan American women have adhesions which bind together the glans of the clitoris and its prepuce, in part or wholly, and which cause little or much disturbance. The condition very evidently represents a degenerative process that goes with higher civilization. It dates back to the embryonic life of the individual, and consists anatomically in a failure of the genital eminence to develop its epithelial surfaces perfectly enough for complete cleavage between the opposed surfaces of the prepuce and the glans of the clitoris. ... Preputial adhesions in women are similar in character to those which occur less frequently in men, and the resulting disturbances are alike in both sexes, but greater in degree in women because of the more impressionable nervous system of the gentler sex. <div>* * * * * * *</div> Baker Brown was very near the subject of clitoris adhesions when he published his work On the curability of various forms of insanity, epilepsy, catalepsy and hysteria, but his method consisted, not in separation of adhesions, but in bodily removal of the offending clitoris; and he found so many cures resulting from the treatment that he was led astray, as many pioneers are, and amputated the clitoris so often that he was expelled from the London Obstetrical Society in 1867. If he had observed the role that clitoris adhesions play, he would not have fallen into disrepute, because his work, where useless, would certainly have been harmless. It is strange that the subject has been overlooked by so many sharp-eyed gynecologists; but the clitoris is small, and they were after larger game. I doubt if there is a man in this audience who knows if there is a large hole in his left-hand trouser pocket. ... [A review of the literature shows that little has been written on this subject.] Dr Merrill Ricketts, in his noteworthy paper on Circumcision, says, referring to preputial adhesions: "Hystero-epilepsy is a result found in boys and girls alike. No girl or boy should be allowed to become one month old without a thorough examination of the genitals having been made. In many of these cases in girls, or even in women, adhesions, growths, or malformations are the source of the irritation, and should receive immediate and radical attention." Dr N.C. Jones, of Brooklyn, in one of his osteotomy reports, states incidentally that all the patients with bow-legs and knock-knees had preputial adhesions â€“ a coincidence in sings of degeneration probably, and not a relation of cause and effect. Remondino, in his History of Circumcision, says: "The idea of masturbation or of irritation of the genitals ending in reflex neurosis is always, as a rule, associated with the male, and that it has not been associated with the female has deprived her of the same benefit that the prosecution of the study in this regard has been to the male sex." Dr M.F. Price, in a paper read before the American Medical Association in 1874, incidentally refers to the case of a young girl, illy developed [sic], who had neither walked nor talked, and who, on examination by Dr L.A. Sayre, was found to have preputial adhesions with retained secretion. This, Dr Sayre thought, accounted for the child's condition. The above quotations and references are all that I could find upon the subject through the aid of the two great bibliographies, and yet there are thousands upon thousands of women in this country who are suffering from reflex neuroses that are directly and solely dependent upon preputial adhesions. It has now been determined that many of the schoolboys who are known to be bright and yet who cannot study have errors of refraction or heterophoria, and that they are repulsed by print without knowing why. The boy who finally becomes the expert baseball-pitcher might become an Alexander von Humboldt if his eyes were only properly cared for. As a parallel we can now learn that the girl who becomes irritable, disagreeable and hysterical may become charming, interesting and possessed of all feminine graces when her prepuce is forcibly peeled away from the glans of the clitoris, and we have made a distinct step forward in civilization when this fact is generally appreciated by the profession. The importance of preputial adhesions in the female will be doubted by some observers and overestimated by others, just as is the case with heterophoria; but those of us who try to take an intermediate position will know that while some patients are strong enough to withstand one or both of these conditions for a lifetime, there are countless numbers who sink beneath the load that seats itself so insidiously that the patient herself does not realize what she is carrying until neurasthenia untunes her resisting power. <div>* * * * * * *</div> <h4>Summary</h4> 1. The prepuce and the glans clitoridis are bound together by adhesions, partly or completely, in about eighty per cent of all Aryan American women. 2. Preputial adhesions are rare among Negresses, and seem to occur in only a few of the individuals possessing a large admixture of white blood. 3. Highly developed domesticated animals do not present examples of the degeneration, so far as the author's observation has gone. 4. When preputial adhesions are extensive, the glans clitoridis and the imprisoned mucous glands remain undeveloped, but they may develop later when the physician has separated adhesions. 5. The failure of the embryonic genital eminence to properly develop the prepuce and the glans clitoridis for perfect cleavage undoubtedly means that nature is trying to abolish the clitoris as civilization advances. 6. The degenerative process represented by preputial adhesions is characteristic of the civilized type of homo sapiens, in which we find decaying teeth, early falling hair, and imperfect mammae and eye muscles. 7. Preputial adhesions which involve small portions of the glans clitoridis are of interest simply as anatomical curiosities. 8. Preputial adhesions involving a large part or the whole of the glans clitoridis may cause profound disturbance, and they are among the most pronounced of the peripheral irritators. They cause desire for masturbation which leads to neurasthenia, and they are responsible for grave reflex neuroses. 9. Preputial adhesions for a very common factor in invalidism in young women. 10. The clitoris is a little electric button which, pressed by adhesions, rings up the whole nervous system. <h4>Discussion</h4> Dr A.H. Corder A few years ago Dr Sayre advanced view similar to those Dr Morris has propounded, and reported a number of cases, but his experience was confined principally to boys with adherent and inflamed foreskins. He specified early the class of cases in which benefit from circumcision could be expected, and surgeons who select their cases according to Dr Sayre's views are not often disappointed in the results following operative procedures. That a constant state of genital excitement produced by any cause in the male or female may produce structural changes in the [spinal] cord and other remote organs is, in my mind, a settled fact. We all know that a stone in the bladder can produce pain in the glans penis; also that an irritation applied to the periphery may and often is manifested in remote organs â€“ a prolonged reflex irritation will produce structural changes in the organs involved; especially is this true of the genito-urinary organs. I have in more than once instance relieved reflex nervous symptoms and thwarted permanent injury to remote organs by an early circumcision. I see no reason why the same truths should not be applied to the female sexual organs. Dr Morris (closing the discussion) For the sake of brevity I presented this subject in abstract, but my paper when examined in full in the Transactions will answer all the points brought out in the discussion. ... I think Baker Brown was almost on the right track. If he had separated adhesions instead of amputating the clitoris he would not have been expelled from the London Obstetrical Society. He found such profound relief resulting from removing the clitoris that he tried to cure all kinds of reflex neuroses by doing it. Robert T. Morris MD, "Is evolution trying to do away with the clitoris?", Transactions of the American Association of Obstetricians and Gynecologists, Vol. 5, 1892, pp. 288-302 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Abolishing the clitoris (1892) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4><img alt="" height="289" src="https://assets.nationbuilder.com/darboninstitute/pages/437/attachments/original/1751335183/Robert_Darby_aged_5.jpg?1751335183" style="display: block; margin-left: auto; margin-right: auto;" width="212"/></h4> Robert Darby, aged five, about to set off on the long journey that would demonstrate the truth of Ecclesiastes 1.18: "For in much wisdom is much grief; and he that increaseth knowledge increaseth sorrow." With feminine intuition, his sister looks doubtful. <h1>Robert Darby BA, B Litt, PhD</h1> I am an independent historian and freelance writer with degrees from La Trobe University (BA 1975), the Australian National University (B Litt 1985) and the University of New South Wales (PhD 1989). I live in Canberra, Australia, and do most of my research at the National Library and the Australian National University - where I was a Visiting Fellow in the School of Social Sciences in 2004. I am also a frequent visitor to the wonderful History of Medicine Library maintained by the Royal Australasian College of Physicians in Sydney. I first became interested in male circumcision in the late 1990s as part of a wider interest in the history of male sexuality, and of the various ways in which it has been viewed and managed by different societies. I began to study circumcision because it seemed a useful guide to how a society perceived and valued masculinity and how it judged or categorised sexual behaviour; it provided a particularly sharp focus on the point where culture and biology, society and nature, steel and flesh, came together so fatefully. As I read more deeply into the literature on this topic I quickly realised that there was a serious imbalance in sex and gender studies - all too often seen as the history of women, and all too often focused on the mind rather than the body. I have thus been particularly concerned to redress what I saw as the imbalance in sex and gender studies - too often seen as the history of women - by bringing men into the picture; and to correct the tendency in studies of masculinity to concentrate on the mind and downplay the importance of the body. Many studies of masculinity, and even of the penis - particularly those written by Americans - seemed completely unaware of the fact that most penises all over the world and throughout history have included the foreskin with which it came into the world. Ignoring the fact that the biologically - and on a world scale, numerically - normal penis was not circumcised seemed a dangerous example of cultural blindness that ought to be countered. It soon became apparent from my study of circumcision in Britain that many of the early beneficiaries/victims of the operation were not happy with the result; I therefore wanted to tell something of their story and to arouse some sympathy for the indignities and cruelties inflicted on men and boys in the name of controlling disease and curbing sexual desire, especially in the nineteenth century, when masturbation was seen as such a crime that forcible surgery seemed an acceptable response. The historical literature on the masturbation scare offered plenty of information, often written in a tone of justified indignation, about surgery on women, such as clitoridectomy; but such texts were usually silent about the fact that similar surgery on men's genitals had been introduced first and was always far more common. When I began my research I was of course aware that routine male circumcision was still common in the USA, and that Australia had a past history of the practice, but I thought that it was pretty much a thing of the past. Since Australian paediatric bodies had been discouraging the procedure since the early 1970s, and I had observed that the boys of all my same-age relations and friends were growing up (very happily) with normal and unaltered penises, I assumed that the fad was dead as a doornail. Nobody with any medical knowledge or scientific understanding would ever try to revive the old Victorian stories about the "health benefits" of pre-emptive amputation - or so I thought. Imagine my astonishment when I found that a few vocal evangelists from the fringes of the medical world were trying to do just this, and, what was more, that they were getting a lot of coverage in the popular media. It seems that whenever a new and incurable disease involving the genitals appears, some people always jump to the conclusion that the solution is to cut part of them off. The reason for this is to be found in the fact circumcision emerged as a valid medical treatment at a time when the causes of most diseases were poorly understood, children were not regarded as having any independent human rights, no meaningful standards of medical evidence had been established, and medical ethics were rudimentary or non-existent. History is thus needed to explain the persistence of the practice into an age which should know better. Although this site does not intend to take issue with contemporary claims for the "advantages of circumcision", I hope that the historical perspective it provides will encourage people to take a sceptical view of reports that it should be enforced on children as a preventive of AIDS, cervical cancer, urinary tract infections etc, and show them to be not so far removed from nineteenth century assertions that circumcision should be enforced to prevent or cure masturbation, syphilis, epilepsy, bed-wetting, hip-joint disease, hernia, pimples and other disorders too numerous to mention. And also to wonder whether it was ethically acceptable to inflict such a mutilation on helpless children even if such therapeutic claims were true. <h2>My publications</h2> "A source of serious mischief: The demonisation of the foreskin and the rise of preventive circumcision in Australia", in George Denniston, Frederick Hodges and Marilyn Milos (eds) Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem, London and New York, Kluwer Academic Publishers and Plenum Press, 2001. <a href="https://www.darboninstitute.org/a_source_of_mischief_part_1" rel="noopener" target="_blank">Full text available on this site</a> "Been there, done that: Thoughts on the proposition that yet more circumcision can save the world from AIDS", Australian Quarterly, Vol. 74. No. 5, Sept-Oct 2002 "<a href="http://www.mja.com.au/public/issues/178_04_170203/contents_170203.html">Medical history and medical practice: Persistent myths about the foreskin</a>", Medical Journal of Australia, Vol. 178, 17 February 2003 "<a href="http://www.mja.com.au/public/issues/178_11_020603/contents_020603.html">Treating phimosis</a>", Medical Journal of Australia, Vol. 178, 2 June 2003 "Circumcision as a preventive of masturbation: A review of the historiography", Journal of Social History, Vol. 36, Spring 2003. "An oblique and slovenly initiation': The circumcision episode in Tristram Shandy", Eighteenth Century Life, Vol. 27, Spring 2003. "Where doctors differ: The debate on circumcision as a preventive of syphilis, 1855-1914", Social History of Medicine, Vol. 16, Spring 2003 "Captivity and captivation: Gullivers in Brobdingnag", Eighteenth Century Life, Vol. 27, Fall 2003. <a href="https://www.darboninstitute.org/christian_attitudes_to_circumcision" rel="noopener" target="_blank">Full text available on this site</a>. "A post-modernist theory of wanking", review article of Thomas Laqueur, Solitary sex: A cultural history of masturbation, in Journal of Social History, Vol. 38, September 2004. "William Acton's antipodean disciples: A colonial perspective on his theories of male sexual (dys)function", Journal of the History of Sexuality, Vol 13, April 2004 "Male circumcision and risk of HIV-1 infection", The Lancet, Vol. 363, June 12, 2004, p. 1997 "Pathologising male sexuality: Lallemand, spermatorrhoea and the rise of circumcision", Journal of the History of Medicine and Allied Sciences, Vol. 60, July 2005, pp. 283-319 "The sorcerer's apprentice: Why can't we stop circumcising boys", Contexts magazine (USA), Vol. 4, No. 2, Spring 2005. <a href="https://www.darboninstitute.org/the_sorcerer_s_apprentice_2005" rel="noopener" target="_blank">Expanded version available on this site</a>. "The riddle of the sands: Circumcision, history and myth", New Zealand Medical Journal, Vol. 118, 15 July 2005 Abstract Although many nineteenth century misconceptions about the foreskin have been dispelled since Douglas Gairdner showed that infantile phimosis was not a congenital defect, other old ideas have proved more persistent. Among the most ubiquitous are the proposition that ritual or religious circumcision arose as a hygiene or sanitary measure; and the related idea that allied troops serving in the Middle East during the Second World War were subject to such severe epidemics of balanitis that mass circumcision was necessary. Both these claims are medical urban myths which should be firmly laid to rest. <h3>New book</h3> A surgical temptation: The demonization of the foreskin and the rise of circumcision in Britain (Chicago and London: <a href="https://press.uchicago.edu/ucp/books/book/chicago/S/bo3534612.html" rel="noopener" target="_blank">University of Chicago Press</a>, 2005) What the critics say: "an extremely worthwhile topic that adds considerably to our knowledge of sexual attitudes and medical practices". -- Dr Lesley Hall, Wellcome Library for the History and Understanding of Medicine "exceptional detail and sound judgment. ... A very interesting study." -- Professor Peter Stearns, George Mason University. "Left to its own devices, the male foreskin goes on its merry way, but Victorian England would have none of that. The uncircumcised penis was blamed for the "moral and physical decay of syphilis and masturbation", while doctors characterised the emission of sperm as "a life-threatening illness that demanded drastic treatment if there was to be any hope of a cure". Medical historian Robert Darby, a visiting fellow at ANU, brilliantly records the rise of circumcision as "a miracle working cure-all for many ills", including hysteria." -- Tony Maniaty, Weekend Australian, 10 September 2005, p. R14 "... this book should be required reading for American physicians in particular, especially those who continue to perform an operation seldom practiced in the rest of the world and who might not know why it was originally begun." -- <a href="http://jama.ama-assn.org/cgi/content/extract/294/21/2771">Journal of the American Medical Association</a>, 7 December 2005 "Surgical temptation: A chance to cut is a chance to cure?", American Sexuality Magazine, November 2005 <h3>Review articles</h3> "AIDS and society in Tanzania", review article of Philip Setel, A plague of paradoxes: AIDS, culture and demography in northern Tanzania, in Archives of Sexual Behaviour, December 2005. <a href="https://www.darboninstitute.org/aids_and_society_in_tanzania_2000s" rel="noopener" target="_blank">Full text available on this site</a><a href="https://www.historyofcircumcision.com/templates/pages/aids_and_society_in_tanzania.html">.</a> "Fortifying medical ethics with human rights and conscience", Review of Thomas Alured Faunce, Pilgrims in Medicine: An Allegory of Medical Humanities, Foundational Virtues, Ethical Principles, Law and Human Rights in Medical Personal and Professional Development. Leiden: Martinus Nijhoff, 2005. H-Net Reviews, June 2006 In his stress on the importance of incorporating "international human rights" into medical ethics, Faunce takes the familiar list of grounds on which people should not be subject to unequal treatment (sex, race, color, religion, disability, perhaps age and sexual preference) very seriously, but these are social rights, exercised as members of a community, not rights relating to a person as a biological or corporeal entity. Does or should the body itself have rights? The constant emphasis on the right to autonomy and physical integrity suggests that it does, but the book does not delve deeply enough into the problem of possible collisions among the various rights. Faunce is aware that the right to physical integrity may conflict with other principles (such as the right of parents to follow practices authorized by their culture or religion), but the awareness is expressed in disappointingly partial (not to say discriminatory) terms. There are several references to female genital mutilation as a harmful cultural practice, and thus one that ethical doctors should not perform, but what about boys? Do they not also have rights to physical integrity and to construct their personal life narrative that might protect them from genital mutilation? Or which might at least discourage doctors from performing such procedures? The author's apparent blind spot here is surprising given the flood of literature on the question of "routine" (that is, medically unnecessary) circumcision of minors over the past decade, and all the more remarkable considering that he cites one of the texts that contains a seminal essay on this very issue--Margaret Somerville's "Altering Baby Boys' Bodies: The Ethics of Infant Male Circumcision," in her collection The Ethical Canary (2003) It is all very well to appeal to the authority of international instruments requiring observation of named rights, the promotion of non-discriminatory policies in medical care and the supply of health services, but what does a doctor do when confronted by Somali or Sudanese parents who bring their little girl and boy along, and request that their genitals be altered in accordance with the traditions of their original home culture? Or Australian or American parents wanting their baby boy done because they had seen a newspaper article or TV program in which it was suggested that, if he was not circumcised, he would be sure to get phimosis and urinary tract infections as an infant, STDs and probably AIDS as an adult, and (in the unlikely event that he lived that long) would die an agonizing death from cancer of the penis in middle age? (The medical excuses for circumcision of minors make many of the cultural reasons seem rational by comparison.) <a href="http://www.h-net.msu.edu/reviews/showrev.cgi?path=19181153409834">Full text available at H-Net Reviews</a> "American Psycho: Another Surgical Temptation", Review of Andrew Scull. Madhouse: A Tragic Tale of Megalomania and Modern Medicine. New Haven: Yale University Press, 2005. xiii + 360 pp. Illustrations, notes, bibliography, index. $30.00 (cloth), ISBN 978-0-300-10729-6. H-Net Reviews, July 2006 In a long and distinguished career, few historians of medicine have done more to expose the fads and fallacies ruling the treatment of mental disorder than Andrew Scull, especially when they have involved therapies, such as confinement or surgery, that we would now regard as barbaric. Like a medieval priest or tribal sorcerer casting out demons, an astounding number of modern physicians, all boasting of their scientific credentials, seem to have worked on the assumption that the human body is its own worst enemy, and thus to have concluded that the road to health lay through the extraction or amputation of whatever body part could be held responsible for the dysfunction. In Madhouse, Scull excels with a detailed account of the appalling career of Dr. Henry Cotton, superintendent of the Trenton, New Jersey hospital for the insane from 1907 until his death in 1933. The story is, as he comments, a Gothic nightmare in which masked and white-gowned jailers drag terrified and often screaming patients from their cells to a well-appointed operating theater where various bits of their anatomy are surgically removed. The only features which distinguish Trenton from a torture chamber or a horror movie, such as Flesh for Frankenstein (1973), is that it all really happened, anaesthetics were usually administered, and the operations were performed solely for the benefit of the patients. And if these procedures were carried out with a benevolent and therapeutic intent, there was as little need for informed consent as there could be reason to regard the result as mutilation. Not that there was much evidence of benefit. Walking the wards of Trenton in 1928, a newly appointed Swiss staff member "felt sad, seeing hundreds of people without teeth.... While in hospital they suffer from indigestion ... not being able to masticate their food. At home, recovered, these poor people have the same troubles, not being in a position to choose food which they would be able to eat without teeth. In addition, they are ashamed of being without teeth, since in their communities it is known to be a token of a previous sojourn at the State Hospital. They abstain from mixing with other people, refuse to go out and look for a job.... Thus, many of those recovered develop a reactive depression" (p. 255). To describe how this tragic situation came about, and explain why all attempts to curb Cotton's exuberance failed, are the twin objectives of Scull's study. An impressive feat of archival research stretching over two decades, including interviews with surviving players in the drama, Madhouse is at once a gripping narrative, a muckraking expose of medical fraud and professional vanity, and a sobering cautionary tale for our own times. <a href="http://www.h-net.org/reviews/showrev.cgi?path=136101159738062">Full text at H-Net Reviews</a> Male and female circumcision compared: "A Rose by any other Name: Rethinking the Similarities and Differences between Male and Female Genital Cutting" (with J. Steven Svoboda) Medical Anthropology Quarterly, Vol. 21, September 2007, pp. 301-323. ABSTRACT This paper offers a critical examination of the tendency to segregate discussion of surgical alterations to the male and female genitals into separate compartments - the first known as circumcision, the second as genital mutilation. It is argued that this fundamental problem of definition underlies the considerable controversy surrounding these procedures when carried out on minors, and that it hinders objective discussion of the alleged benefits, harms and risks. The variable effects of male and female genital surgeries are explored, and a scale of damage for male circumcision to complement the World Health OrganizationÂ´s categorisation of female genital mutilation is proposed. The origins of the double standard identified are placed in historical perspective, and a brief conclusion makes a plea for greater gender neutrality in the approach to this contentious issue. <a href="http://ucpressjournals.com/journal.asp?j=maq">MAQ Homepage</a> | <a href="https://assets.nationbuilder.com/darboninstitute/pages/437/attachments/original/1751335850/rd-rose07.pdf?1751335850">Download PDF here</a> <h3>New book</h3> Round the Red Lamp and Other Medical Writings by Arthur Conan Doyle <a href="http://www.valancourtbooks.com/">Valancourt Books</a>, 2007 When Round the Red Lamp appeared in 1895, reviewers were appalled. Expecting tales in the style of Conan Doyle's popular Sherlock Holmes stories, readers were shocked to find instead harrowing medical stories involving childbirth, venereal disease and botched amputations. Before he became famous as a prolific writer, Arthur Conan Doyle (1859-1930) had trained as a medical doctor, practised as a GP in Portsmouth, tried his luck as an eye specialist in London and written a number of non-fiction articles and other contributions on medical subjects. For this edition, Robert Darby has collected not only the original stories compiled for Round the Red Lamp and three other stories with a medical theme, but also the full range of Conan Doyle's medical non-fiction. As he argues in a comprehensive introduction, these writings provide a rare glimpse into the world of a provincial GP at the moment when old style medicine was dying and the modern medical profession was emerging. The stories are further illuminated by detailed explanatory notes and references. <h3>More on Isaac Baker Brown and Victorian genital surgeries:</h3> "The benefits of psychological surgery: John Scoffern's satire on Isaac Baker Brown", Medical History, Vol. 51, October 2007 <h3>Two papers in new book on male and female genital cutting</h3> "A rose by any other name: Symmetry and asymmetry in male and female genital cutting" (with J. Steven Svoboda) ABSTRACT The human body, and the genitals specifically, are characterized by bilateral symmetry; both male and female sets develop from the same embryonic tissue, and the male genitals are anatomically homologous with the female: glans penis, foreskin, scrotum and testicles correspond to clitoris, clitoral hood, labia and ovaries. This biological symmetry is not, however, reflected in Western cultural discourses on the genitals, which tend to be extremely asymmetrical, regarding and evaluating the male genitals (and especially the part of the penis known as the foreskin) very differently from the female genitals. The asymmetry is most strikingly expressed in the contrasting discourses on surgical alterations to these organs that have evolved since the mid-nineteenth century. In this article we make a critical examination of the tendency to segregate discussion of such genital modifications into separate compartmentsâ€”the first known as male circumcision, the second as female genital mutilation. It is argued that this fundamental problem of definition underlies the considerable controversy surrounding these procedures, especially when carried out on minors, and that it hinders objective discussion of the alleged benefits, harms, and risks. The variable effects of male genital cutting (MGC) and female genital cutting (FGC) are explored, and a scale of damage for MGC to complement the World Health Organization's categorization of FGC is proposed. The origins of the double standard identified are placed in historical perspective, and there is a discussion of the respective roles of science and culture in promoting or discouraging these practices. We conclude by urging greater gender neutrality in the approach to this contentious issue. "Objections of a sentimental character: The subjective dimension of foreskin loss" (with Lawrence Cox) ABSTRACT Proponents of routine circumcision of male minors tend to downplay or ignore the adverse effects of circumcision on male sexual experience and to assert that only an insignificant minority of circumcised men are unhappy about their condition. We present evidence dating back to the nineteenth century that significant numbers of men have been sufficiently concerned to complain, and we particularly consider three attitude surveys carried out in Britain, the United States and Australia in the 1990s. We argue for the relevance of ethical, biological and subjective factors in decision-making about routine circumcision of minors, and conclude with a discussion of the implications of these considerations for medical policy. both published in Chantal Zabus (ed.), Fearful Symmetries: Essays and Testimonies around Excision and Circumcision (Amsterdam and New York: Rodopi, 2009) </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource About Robert Darby darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Hands Off My Foreskin! Dr. Martin Winckler on the Care of Baby Boys</h2> by Martin Winckler, M.D. © 2013 <a href="http://droitaucorps.blogspot.fr/2012/06/decalottage-chez-lenfant-conseils-aux.html" rel="noopener" target="_blank">Lire en Français ici</a>. Translated to English by Nicolas Maubert and Danelle Frisbie for DrMomma.org with Dr Winckler’s blessing. Dr. Martin Winckler is a general practitioner and author in France. Read more from him at his website, <a href="http://martinwinckler.com/">MartinWinckler.com.</a> Reposted at Circinfo.org by permission of <a href="http://www.drmomma.org/2013/02/hands-off-my-foreskin-dr-martin.html">Peaceful Parenting</a> (DrMomma.org), to which we extend our thanks. Many young mothers today are very worried because their mother, or their mother-in-law, or their doctor, told them they must “clean” the glans (head) of the penis of their baby boy, and that to do so, you must retract (i.e. roll back) the foreskin like a turtleneck. In reality, however, this should not be done. The practice of retraction only causes problems and has no benefits. What follows is an article interview printed in the L’Arbre à bébé Association's November 2005 issue. For this interview I answered some questions on the delicate topic of proper penile care and retraction that I am now sharing here with you. Question One: What is your position regarding foreskin retraction, as a physician and as a parent? Do you retract your own patients? Do you retract your own sons for 'cleaning?' Answer I have never retracted the foreskin of a boy. Not any one of my patients, nor any of my five sons. (I believe if I asked them what they think of foreskin retraction they would look at me like something was wrong with me to have such strange ideas!) Very early in my career, in the early 1980s, while reading the work of pediatrician Aldo Naouri, I had the notion that the practice of retraction was not only unnecessary, but aggressive for everyone -- starting with those most concerned (the boys), but also for their parents. The act itself is aggressive because once you touch a little boy’s penis, an erection is induced. Not all mothers [or fathers] are going to be comfortable with this, and we understand why. Boys will often smile or laugh that it tickles and very quickly we find that parents prefer to leave that area alone to care for itself. Question Two: What do you think of the arguments commonly used by proponents of retraction (that retraction will prevent adhesions, phimosis)? Answer Phimosis is the condition in which the orifice of the foreskin is too tight to allow the glans to leave when the boy is erect. So it can not interfere with boys until the age at which they are likely to have intercourse. However, most studies that have been done on the subject show that any amount of retraction, 'just a little' or a lot, has no medical function, neither for hygienic purposes, nor to prevent phimosis, which is an uncommon condition to begin with. It used to be said that retraction was necessary to fight against adhesions and to 'clean up' anything under the prepuce. However, preputial secretions are as normal as vulvar secretions in the little girls. There is nothing wrong with them whatsoever. Never have we suggested that we 'clean' the vulva of our daughters with a cotton swab, yet I have seen mothers try to pass a cotton swab under the foreskin of their son because a doctor told them to do so! Quite simply, the foreskin is self-cleaning. The orifice of the foreskin is tight at birth on purpose to prevent dirt (bacteria, viruses, etc.) from creeping into it. Retraction (a dilating force) is then entirely unnatural. And it hurts! Retraction causes tears and can cause paraphimosis (having the foreskin stuck in a retracted position behind a swollen glans) which itself is an emergency. This induced paraphimosis is actually much more common than true phimosis. A common scenario: A mom wanted to retract a boy (usually in the bath). The manipulation resulted in a retraction after erection. Suddenly, the foreskin 'turtlenecks' (squeezes) the glans, which then swells and turns purple. The child yells. And in a warm bath, it gets worse. [Vasocongestion takes place, leading to more blood flow, a throbbing erection, and tighter constriction.] In short, parents call the doctor and then one of two things happen. Either the doctor panics and sends the child and his parents to the emergency room, or the doctor understands what has just happened solves it very simply: <ol> <li>Do not pull the foreskin forward after retraction and paraphimosis (it does not work).</li> <li>You must first empty the warm water bath. Then pour somewhat cooler water (but not iced/cold water) on the penis. The cooler water deflates the penile engorgement.</li> <li>Then gently squeeze the swollen glans (head) of the penis. As the penis deflates, the foreskin will start to roll back down over the glans by itself.</li> </ol> I saw dozens of situations like this one early in my career. It was always among boys whose mothers had a slight obsession of making sure their son was “clean”, or among those whose parents had conscientiously felt pressure to retract following the advice of a relative or highly invasive physician. So much so that their little boy was retracted three times each week - so often that these little boys begin to develop anxiety when their mothers approached them to change or “clean” them. The more mothers touched their boys’ penises in this fashion, the more young children became angry, the more it hurt, the more retraction became torment, until they developed paraphimosis. And then parents call for help. In short, it is a vicious cycle. Very quickly I started to pass along the message to young parents that they should not even touch the foreskin. Leave it alone. And with this advice, over the years, I began to see less and less paraphimosis among my patients. There were now more and more happy little boys who tugged on their own foreskin, laughing, without anxiety. And I saw more and more mothers delighted with the fact that they did not have to handle their son’s penis - in fact, they did not have to do anything for its care. I have not had any little boys need surgery on their penis during my career as a general practitioner, and I saw very few boys ever in need of surgery during medical school, because in my district, no doctor was a fan of retraction. Question Three: At what age should I be worried and consider surgery for a boy whose foreskin does not retract? Answer It’s simple: you should never worry because there is no reason to worry. Foreskin retraction is a cultural practice [in a few nations], and does not take place at all in other countries. Still, there are no more cases of phimosis or “problems” among those nations where foreskin retraction is unheard of. Retraction by someone other than a boy himself serves no purpose at any age. And yet, all parents of little boys can testify that fiddling and tugging on the foreskin are commonplace practices among infants and toddlers (up to eight to ten years old). This self-exploration causes no problems. Quite simply, the foreskin is not meant to be retracted by anyone other than the owner himself - it serves as a sheath to the glans in this way, a protector from outside invasion. As a child grows, the foreskin lengthens and softens over time. With puberty and masturbation, the foreskin opens on its own. It stretches along the penis little by little, allowing for erections to take place without cause for concern. By the time the hormones of puberty are in full swing, the vast majority of boys have already retracted their own foreskin and eased the preputial orifice open. Even if their prepuce was tightly closed in childhood, they do not have phimosis, and this is evident as young adults. So small is this concern that these boys do not even know the word 'phimosis!' In rare cases when there is a real issue, it is at puberty that this is discovered, not before. If a 'problem' arises before puberty, it is likely paraphimosis, because a boy is being retracted - see above. Throughout my career as a general practitioner [~30 years in 2013] I have only had to circumcise one single man, aged 22 years, who had developed untreatable phimosis that was the result of brutal retraction as an infant and child that left tight foreskin scarring on his penis. This started to bother him at puberty - not before. And, in fact, it was the way he was treated as a baby and child that caused the inflammation that resulted in his phimosis - not the other way around. He had to be circumcised as a result of improper care by those who did not know any better. When we repeatedly tear the foreskin at an age of development, it does lead to scarring, and this in turn tightens the foreskin over time, causing the problems we then blame on foreskin (rather than improper care). Question Four: What is your advice to a mother who does not know what a pediatrician will do to her baby during a check-up? What should she do if a physician suggests that she retract? How should she handle guilt-trips pushing improper care? Answer Retraction is a problem that exists merely because it is a matter of culture-based opinion and not a factual issue of prevention or health. Again, there is no evidence that retraction has even the slightest benefit, but its disadvantages are medically obvious. Doctors do not exist to dictate their personal opinions onto parents, and there should be no guilting of mothers who consciously decide they will not "mess with" the penises of their sons. In fact, I find these mothers to be the ones who are the most mentally stable and emotionally healthy. Would a mother okay the circumcision of her son just to please a physician who tells her it is "cleaner"? Of course not. The same goes for retraction. If a doctor talks about such things, tell him that you will leave your child to figure things out for himself, and if a problem arises down the road, you will deal with it at that point. Above all, do not let a physician who is suggesting retraction use your child for their demonstration. Just as there is zero justification in performing vaginal exams on infant and young girls, so also is there never justification to retract and examine the inside of a baby boy's or child's penis when there is nothing wrong. Doing so is not alright for girls, and it is not alright for boys. The only time a physician should be handling your child's genitals (gently!) is if the penis or vulva in question has a visible abnormality that requires examination. If this is not the case, then hands off! Source: Hands Off My Foreskin! Dr. Martin Winckler on the Care of Baby Boys by Martin Winckler, M.D. © 2013 <a href="http://www.drmomma.org/2013/02/hands-off-my-foreskin-dr-martin.html" rel="noopener" target="_blank">Originally posted at Peaceful Parenting, with comments from readers</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Advice on foreskin care from French doctor darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> A Plague of Paradoxes: AIDS, Culture and Demography in Northern Tanzania. By Philip W. Setel. Chicago and London: Chicago University Press, 1999, 308 pp Reviewed by Robert Darby [1] Archives of Sexual Behavior, Vol. 34, No. 6, December 2005, pp. 707â€“714 Introduction How a disease afflicting thousands of homosexual men and intravenous drug users in developed nations became an epidemic affecting millions of heterosexual men and women in Africa is one of the great puzzles of epidemiology. In hindsight it will probably eclipse the centuries-long debate over whether syphilis and gonorrhoea were different diseases or phases of the same one. It may well be seen to have elicited many of the same explanatory efforts, moral judgements and therapeutic or preventive responses as the syphilis epidemic of the eighteenth and nineteenth centuries; then, as with AIDS today, many schools of thought contended, some stressing behavioural, some socio-economic, some micro-biological, some moral and some anatomical factors. [2] Philip Setel's aim in this richly textured and illuminating study is to historicise the impact of AIDS in a region of Tanzania â€“ to move away from a narrow focus on virus particles, receptor cells and body parts, and to consider the broad social and human environment which has enabled the disease to exercise the effects it has. He thus seeks to explain both why its spread has been so fast and so terrible and to illustrate the ways in which it has been perceived and experienced by Tanzanian men and women. While not denying the centrality of sexuality in the process, Setel insists that it is mediated by its social context: "AIDS in Kilimanjaro has been an outgrowth of culture, history, demography and political economy. ... It has been a disorder of social reproduction that emerged through the intersection of HIV with people engaged in a conscious struggle with forces both impinging on and internal to their cultural worlds. Sexuality ... has been framed as an outcome of socio-cultural change in productive and reproductive regimes." (p. 236) The region studied is occupied by the Chagga people, living in the north of Tanzania, on the slopes of Mt Kilimanjaro, near the border with Kenya. The main town in the area is Moshi. Among the paradoxes which give the book its title, Setel notes that contemporary sexual ideologies (lamenting the immorality or bad character of modern youth) have been based on nostalgia for a vanishing demographic system. He emphasises that "traditional" Chagga culture was not static, but constantly evolving under internal and external influences, such as other ethnic groups, Arab slave traders, and of course European colonialism. The latter brought new diseases, but also new economic opportunities, such as coffee, cultivation of which transformed the vegetable plots traditionally farmed by Chagga families. Rapid population growth led to massive emigration from the region after World War II, especially of young single men, who naturally sought sexual contacts wherever they went, but who were not able to marry until they had accumulated the resources needed to buy a wife (the bridewealth). [3] From its earliest appearance, HIV was associated with mobile men, especially itinerant businessmen (often just petty traders), whose proliferation in the 1980s was itself a sign of structural changes in the world economy, Tanzania's failed development strategies and shrinking economic options in other areas. The disease spread fast. In 1992 Kilimanjaro was listed as the seventh most severely affected region, with 134.2 cases per 100,000; in 1994 the fifth; and in 1997 the third. In 1991 over 70 per cent of self-identified prostitutes tested sero-positive. Setel points out that these figures are not confirmed by the lower level of sero-prevalence measured among blood donors, suggesting either that AIDS detection in the region is more thorough than elsewhere in Tanzania, or (more probably) that many infected people are returning home to die. A welcome focus of the book is its stress on women's experience. Setel points out that the high level of HIV infection among women is an effect of both their economic and social subordination as much as of their sexuality. He particularly mentions female poverty and economic insecurity, leading many into various forms of prostitution; their dislocation from cultural institutions which could protect them from unwanted advances from husbands or former lovers; and their general lack of rights and subordination to male power. As in Victorian England, the double standard on sexuality morality is strongly in evidence: one man made no apology for his own fondness for screwing around, yet criticised the looseness of contemporary youth and insisted that any future wife be a virgin. It is this moral environment, far more than their expense, which explains the low level of condom use in the region. Even though many women knew about them and wanted their protection, as respectful wives they could not make the suggestion to their husband; yet men did not want to put them on because they were uncomfortable and reduced sensation. On top of that, the local Christian churches preached against their use, and other opponents spread the rumour that they had actually been impregnated with HIV. Not that condoms alone are the answer: as Brooke Schoepf has argued, "Failure to recognise the economic causes of prostitution, to address the structural causes of under-development, poverty and joblessness, builds resentment ... and resistance to advice such as the need for condoms" (quoted, p. 237). The lesson is that any program to combat AIDS in Tanzania must also aim to raise the social status and economic security of women. "African sexuality"? Setel is critical of accounts which identify "African sexuality" as the main culprit in the spread of HIV, agreeing with Schoepf that it is not sexuality per se which is the problem, but "situations of risk produced by intersections of biology, political economy and culture". He points out that there is no such thing as "African sexuality" and that such explanations can easily stereotype Africans as being unusually randy and promiscuous, as well as more generously endowed â€“ a trope with a long history in envious European discourse. Yet his own study does bring out very clearly that traditional, no less than modern, Tanzanian culture was marked by a high level of sexual activity (promiscuity by any other name), involving sexual liaisons soon after puberty, multiple partners at any one time, various forms of polygyny and polyandry and more casual relationships in adulthood, a strong preference for vaginal intercourse over other (safer) forms of enjoyment, and a high valuation placed on fertility. A successful man wanted to advertise the fact by having as many children by as many women (both wives and "girlfriends") as possible, and that meant a lot of unprotected fucking. A carpenter in Moshi regretted that the saddest effect of AIDS had been to lessen the amount of fun people could have: "AIDS has ruined their way of life. The greatest achievement here is sex. Our way of life has been very seriously affected. Even with one girl there is not much fun. You need to have several to have a good time. ... Life has become very miserable". (p. 179) It hardly needs pointing out, as all studies of HIV have shown, that frequent unprotected sex with multiple partners is the most important risk factor for infection. As Setel himself writes, "where there has been historically low condom use, poor treatment of STDs, and a general preference for penetrative vaginal sex ... multipartner sexuality among some can be statistically related to increased risk of being infected with HIV." (p. 201) Circumcision not a significant factor There is no comfort here for the small band of researchers from circumcising cultures who are seeking to prove that the male foreskin is the decisive factor in the high incidence of AIDS in the Third World, supposedly because it is uniquely vulnerable to penetration by the virus. Given the pre-existing ubiquity of both male and female circumcision in Africa, it seems an eccentric argument, and it is a sign of the cultural bias of such researchers that they make no attempt to suggest that, or to test whether, female circumcision might be the key factor â€“ that the labia or clitoral hood might as treacherous a pair of Trojan horses as the prepuce. [4] It is certainly not an issue in Kilimanjaro, where both boys and girls are circumcised as part of a complex sequence of initiation rites at puberty. His foreskin gone, the former boy is visibly different and now both subject to adult responsibilities and entitled to adult privileges, such as the right to seek sexual opportunities and economic advancement in the village. Initiation for girls used to involve excision of both the labia minora and the clitoris, but now appears to involve only the latter: whatever the details, the adjustment likewise marks their transition from girl to woman, with attendant rights and responsibilities. There is no suggestion in this book that circumcision or lack of it could have anything to do with the prevalence of HIV among males, though one man interviewed asserted that the discontinuation of female circumcision was a factor in rising rates of both immorality and HIV infection: "This is all because Chagga culture has been polluted and mixed with European ways. ... In the past there was initiation and puberty training. Men learned their age sets and women were circumcised. ... The youth of today are tied up in the profligacy of the disco, bearing children out of marriage, and so on". (pp. 59-60) It is the sort of conservative lament for lost virtue common to all societies in the throes of change. A Plague of Paradoxes demonstrates the value of an anthropological approach to the question which is generating more literature each year than anybody could read in a lifetime: how to explain, and thus contain, the high incidence of HIV infection in Africa, so much worse than anywhere else. Several types of theory have been proposed, variously emphasising genetic susceptibility, patterns of sexual behaviour, iatrogenic misadventure (non-sterile medical procedures), failure to institute effective programs or to do so in time, and even anatomical variables, such as male and, to a lesser extent, female circumcision. Setel's argument is that any mono-causal account is missing the point, and that explanations (and thus effective control strategies) are to be sought in the peculiar combination of social, demographic, economic, cultural and behavioural evolution in each African region. Such an approach requires a lot more than just the counting of foreskin-free penises or herpes lesions which has become fashionable in some medical circles. He shows clearly, and often in moving detail, how demographic patterns, social change, economic need, cultural understandings, sexual behaviour and medical responses created an environment in which HIV was sure to thrive. Tanzanian sexual practices (frequent unprotected intercourse with multiple partners) would have been enough on its own to ensure the spread of the virus (as it was among homosexual communities in the USA), but it is these broader factors, coupled with the tardy response to the problem by medical authorities [5] and limited resources, as a consequence of poverty, when they did, which explains why the epidemic has had such a devastating impact on the lives of African people. References and notes 1. Visiting Fellow, School of Social Sciences, Australian National University, Canberra, ACT 0200, Australia 2. Peter Baldwin, Contagion and the State in Europe, Cambridge University Press, 1999, ch. 5; Robert Darby, "Where doctors differ: The debate on circumcision as a protection against syphilis, 1855-1914", Social History of Medicine, Vol. 16, 2003, pp. 57-78 3. A remarkably similar situation in Victorian England was blamed for the proliferation of prostitution and consequent high level of syphilis and other venereal diseases. 4. It is only a few doctors from Moslem countries practising female circumcision and some conservative Africans who assert that failure to be circumcised makes women more vulnerable to infection and that the operation is therefore a valuable prophylactic. While western researchers on this issue have generally seen female circumcision as a means of spreading AIDS, they have, rather inconsistently, seen male circumcision as a means of stopping it. 5. The first HIV cases were noticed in 1984, the first death in Moshi was in 1986, but it was not until "the early 1990s" that meaningful preventive programs were in place. Such a delay gave the virus an enormous head start in which to establish itself throughout the population. This situation contrasts with countries such as Australia and Britain, where the response was rapid, moralism was avoided, and effective education programs stressing safe sex were developed with the full involvement of, and thus acceptance by, the at-risk communities. That such an approach is working in Africa is suggested by David Moore and Robert Hogg, <a href="http://www.cirp.org/library/disease/HIV/moore1/" rel="noopener" target="_blank">"Trends in antenatal human immunodeficiency virus prevalence in western Kenya and eastern Uganda: Evidence of differences in health policies?"</a>, International Journal of Epidemiology, Vol. 33, 2004, pp. 1-7 <h3>Update 2006: Toronto AIDS conference refuses to embrace circumcision as miracle prophylactic</h3> While the huge AIDS conference in Toronto in August 2006 produced the familiar calls, from the usual suspects, for mass male circumcision as the great surgical hope against HIV in underdeveloped countries, the conference as a whole remained sceptical of this approach and did not endorse Mr Gates' stress on this strategy. Although his keynote speech and a few papers advocating circumcision received disproportionate publicity, most of the conference focused on the need for education, encouragement of safe sex, the development of topical applications and the empowerment of women. This was the most valuable suggestion in Mr Gates' presentation, since it is the subordinate position of women in many traditional cultures which prevents them from refusing sexual advances, or insisting on condoms or safe sex when they consent. There were even papers on the irrelevance of circumcision and the importance of condoms, regretting the fashionable stress on the former and the incomprehensible neglect of the latter. They pointed out that it was irrational to promote a risky and harmful surgical operation such as circumcision, offering at most a 60 per cent reduction in risk, clinically shown to be effective over only 20 months, in the much-hyped study by Bertran Auvert, the extravagant claims of which have been criticised by <a href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078" rel="noopener" target="_blank">Michel Garenne</a> at the Pasteur Institute. Consistent condom use provided 90 per cent protection over a person's lifetime. <a href="http://www.circumstitions.com/HIV-SA.html" rel="noopener" target="_blank">A thoughtful critique of Auvert</a> <a href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078" rel="noopener" target="_blank">Michel Garenne paper</a> <a href="http://www.circinfo.org/news.html" rel="noopener" target="_blank">Condoms the best defence</a> <a href="http://www.populationaction.org/resources/publications/condomscount/data.htm" rel="noopener" target="_blank">Further information on condom use in underdeveloped countries</a> <h3>Circumcision not so protective after all</h3> Male Circumcision May Not Protect Against HIV Infection: Paper by Dr Vinod Mishra, Presented at AIDS 2006 By Danny Kucharsky TORONTO, CANADA -- August 17, 2006 -- HIV prevalence is not necessarily lower in populations that have higher male circumcision rates, according to findings from a study of African countries presented here at the 16th International AIDS Conference (AIDS 2006). The study, which examined the association between male circumcision and HIV infection in 8 Sub-Saharan African countries, contradicts the findings of previous research and the opinion of several prominent personalities active in the fight against AIDS, such as former US President Bill Clinton. While several studies have indicated that male circumcision has a protective effect against sexually transmitted infections (STI), including HIV infection, the evidence is inconclusive, said investigator Dr. Vinod Mishra, director of research, <a href="http://www.orcmacro.com/whatsnew.aspx" rel="noopener" target="_blank">ORC Macro, Calverton, Maryland</a>. "We're just questioning that push," he said of the optimism displayed by Clinton and others. The study used demographic findings from recent demographic and health surveys in Burkina Faso, Cameroon, Ghana, Kenya, Lesotho and Malawi, and AIDS indicator surveys from Tanzania and Uganda. The surveys were conducted from 2003 to 2005 and sample sizes ranged from 3,300 men in Lesotho to 10,000 men in Uganda. In survey fieldwork in each country, men aged 15 to 59 gave blood for anonymous HIV testing. Information on circumcision status and on STI/STI symptoms was based on men's responses to questions in survey interviews. Prevalence of male circumcision ranged from a high of 96% in Ghana to a low of 21% in Malawi. Among the other countries, circumcision rates were 84% in Kenya, 89% in Burkina Faso and 25% in Uganda. HIV prevalence was markedly lower among circumcised than uncircumcised men only in Kenya (11.5% among uncircumcised men vs. 3.1% among circumcised men). A small protective effect of male circumcision was also seen in Burkina Faso (2.9% vs. 1.7%, respectively) and Uganda (5.5% vs. 3.7%). In the other countries, there was either no difference in HIV rates between circumcised and uncircumcised men or circumcised men were more likely to be HIV-positive than uncircumcised men. For example, in Lesotho, HIV was seen in 23.4% of circumcised men compared to 15.4% of uncircumcised men. "If anything, the correlation [between circumcision and HIV infection] goes the other way," in most of the countries studied, Dr. Mishra said during his presentation on August 15th. When adjusted for sociodemographic and behavioral factors, a small protective effect was observed in 6 of the 8 countries, but it was not statistically significant in any country, Dr. Mishra said. In Kenya, and to a lesser extent, in Ghana, Malawi, Tanzania and Uganda, circumcised men were less likely than uncircumcised men to report having had an STI or STI symptoms in the 12-month period prior to the survey (2.1% vs. 5.4%, respectively). The relationship was reversed in Cameroon (8.0% vs. 2.5%) and Lesotho (12.1% vs. 7.5%). With other factors controlled, male circumcision had some protective effect in 5 of the 8 countries, but the effect was statistically significant only in Tanzania. In addition, "circumcised men tend to have more lifetime sex partners, so there's some [high-risk] behaviors that go with circumcision status," he said. A study limitation is that it was based on self-reported information on circumcision status and STI/STI symptoms. It also lacks data on age at circumcision and degree of circumcision, which might influence susceptibility to HIV infection. However, Dr. Mishra said the study is consistent with other research that has failed to find a protective effect of male circumcision on HIV and STIs. Dr Vinod Mishra, "Is Male Circumcision Protective of HIV Infection?" (Conference abstract TUPE04010 <a href="http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571CD005207D9" rel="noopener" target="_blank">http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571CD005207D9</a> <a href="http://www.orcmacro.com/whatsnew.aspx" rel="noopener" target="_blank">http://www.orcmacro.com/whatsnew.aspx</a> <h3>Wot, no condoms</h3> Condoms Still Out in the Cold at Toronto AIDS Conference: Emerging Prevention Technologies Take Centre Stage, Proven Condom Given Short Shrift 16 August 2006 TORONTO, Canada â€” "Prevention" and "new technologies" are the buzzwords at the XVI International AIDS Conference in Toronto, but UNFPA, the United Nations Population Fund, is calling attention to the fact that millions of people still lack access to the most basic and available preventive method of allâ€”the male and female condom. The Conference, which has attracted 25,000 scientists, activists and policymakers from all over the world, marks the first time the international community has seized upon prevention as the most cost-effective and sustainable response to the global pandemic. Keynote speakers former United States President William Clinton and Microsoft co-founder Bill Gates both emphasized the need for female-controlled methods, such as microbicides to halt the virus's spreadâ€”particularly among young women and girls who now make up the fastest growing proportion of the newly infected. The potential of vaccines and male circumcision to slow transmission rates have also grabbed the lion's share of attention. Steve Kraus, Chief of the HIV Branch of UNFPA, asserts that, while discussions around new prevention technologies represent an important step in the evolution of the global HIV response, all of them are still years away from becoming widely available. "People are getting infected now," he says. "While we applaud discussion and research into new technologies, we are still not using what we have available today. The condom already exists and it hasn't been delivered. It works and represents the best tool we have in the fight against HIV/AIDS," says Dr. Kraus. Today, an estimated 8 to 10 billion condoms are being used in low-and middle-income countries. This represents only half of the total need. In sub-Saharan Africa, where HIV prevalence is highest, African males have access to only 10 condoms on averageâ€”per year. While female condom distribution is increasing, the total market share remains woefully lowâ€”at only 0.3 per centâ€”despite rising demand in high-prevalence settings such as Zimbabwe and Malawi. To meet increased demand, UNAIDS estimates, resources will have to double from about $320 million a year today to between $500 million and $630 million by 2015. SOURCE: <a href="http://www.unfpa.org/news/news.cfm?ID=842" rel="noopener" target="_blank">http://www.unfpa.org/news/news.cfm?ID=842</a> UNFPA, the <a href="http://www.unfpa.org/" rel="noopener" target="_blank">United Nations Population Fund</a>, is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. Contact information: Patricia Leidl Toronto Cell Phone: +1 917-535-9508 Email: leidl (AT) unfpa.org Abubakar Dungus New York Tel. +1 (212) 297-5031 Email: dungus (AT) unfpa.org </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource AIDS and society in Tanzania (2000s) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Circumcision no barrier to HIV infection</h3> Whatever the US media may claim, there are increasing reports that AIDS is making rapid headway in the Middle East â€“ that is, among Moslem populations where most of the males are circumcised. A recent report by Nicholas Eberstadt and Laura M. Kelly in the US journal Foreign Policy suggests that denial of the problem, failure to take action, repressive attitudes to sexuality and lack of attention to counselling in safe sex practices are more important factors in the spread of the disease than normal (or even abnormal) human anatomy. <h4>THE MUSLIM FACE OF AIDS</h4> On a cold December evening in the southern Iranian city of Kerman, the stars blazed overhead as a father took his son's life. Enraged, and with an axe in hand, the head of a prominent Iranian family chopped his child to pieces for bringing shame upon his relatives. The son's crime? Contracting HIV, the virus that causes AIDS. In a country where, in some parts, nearly 60 percent of HIVâ€“positive citizens take their own lives within the first year of their diagnosis, the 23-year-old son faced little chance of acceptance, even from his family. That tragic story is just one of the many being told as the deadly contagion unfolds across the massive Islamic expanse, from Morocco to the Philippines. In the years immediately ahead, the AIDS pandemic will exact a grim toll on a number of vulnerable populations with volatile polities â€“ places unlikely to cope with the significant social stresses and economic burdens that AIDS can cause. Officially, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates the total HIV population of North Africa, the Middle East, and predominantly Muslim Asia at nearly 1 million people today. At the end of 2003, UNAIDS estimated that up to 420,000 people in Mali, 180,000 in Indonesia, 150,000 in Pakistan, and 61,000 in Iran had HIV/AIDS. Those numbers, however, are severely understated. UNAIDS figures depend upon surveillance data; thus a lack of information can be taken as a lack of infection. UNAIDS data on the number of people living with HIV/AIDS are completely missing for Afghanistan, Turkey, and Somalia, all countries with large at-risk populations. Moreover, UNAIDS' HIV estimates are determined by conferring with local governments, and politicians who do not wish to allocate domestic resources to HIV/AIDS programs (or to deter foreign investors) can downplay its reach or simply refuse to admit its presence. Although the prevalence rates of Muslim infections may seem small when compared with the tragedy that is unfolding in southern Africa, they stand in sharp contrast to official estimates that suggest no disease at all. An instructive tale for the Muslim world lies in the differing responses to HIV/AIDS in Thailand and South Africa. In the early 1990s, both countries had an official national prevalence of between 2 and 3 percent. Thailand embarked on an aggressive antiâ€“HIV campaign that reached all sectors of society. AIDS education programs were delivered in schools as well as in brothels, and senior political leaders delivered AIDS-prevention messages as a part of almost every public address. As a result of this campaign, HIV rates remained low throughout the 1990s. By comparison, South Africa did little to halt the spread of HIV until the dawn of this millennium and now has the nightmarish task of controlling a disease that already infects nearly a quarter of its adult population. The Muslim world now must decide if it will replicate Thailand's relative success, or follow South Africa's deadly path. <h4>It Couldn't Happen Here</h4> The first cases of HIV in the region were officially recorded in Bahrain, Qatar, Iran, and several other Muslim states in the midâ€“1980s. Despite identifying the disease early on, many countries still have not launched treatment or public health education programs to prevent its further spread. One major reason for this lack of action has been assumptions that premarital sex, adultery, prostitution, homosexuality, and intravenous drug use do not occur in the Muslim world, or happen so infrequently that the risk of the disease gaining a foothold in these countries is low. In 1995, for example, Indonesia's Council of Ulemas urged that condoms only be sold to married couples with prescriptions from general practitioners. It was felt that strong religious convictions would prevent people from having extramarital sex. Members of the international public health community, for their part, have not only seemed to accept the presumptions behind those arguments but on occasion have also espoused them. As recently as February, an official in Pakistan's National AIDS Control Programme asserted that HIV prevalence was lower in Pakistan than in other countries thanks largely to "better social and Islamic values." Islamic culture and Muslim beliefs, unfortunately, are not sufficient to inoculate populations against the spread of HIV. The trajectory of the virus in predominantly Muslim regions of the sub-Sahara proves this point. In Nigeria, 6 to 10 percent of adults are infected, and between 10 to 18 percent of adults in Ethiopia are HIV-positive. Both are countries in which fully half of the people practice some form of Islam. Although the HIV epidemic in Muslim Africa should have sounded a wake-up call to other Islamic communities, few Islamic authorities north of the Sahara seem to have heard the alarm. For all the diversity within the more than 1 billion-strong Muslim world â€“ from Albania and Turkey in Europe, across Northern Africa and through the Persian Gulf, and to Malaysia and Indonesia in South Asia â€“ a couple of common features have kept its efforts to combat the disease frozen in time. One is that there is no prescribed separation of faith and state in many Islamic countries today: The Koran is consulted not only as a religious text but also as a source of law, a guide to statecraft, and an arbiter of social behavior. Although such reliance on the Koran may help leaders envision an ideal human society (one with low rates of drug abuse, prostitution, and other types of crime), it also often keeps them from providing civic assistance to counter real social problems. Another common factor that contributes to a slow response to HIV/AIDS is the relative absence of firmly rooted or functional democratic systems in many Muslim countries. Citizens of these countries simply do not expect their governments to provide social services to mitigate the impact of HIV/AIDS. Taken together, these two tendencies â€“ political primacy of the Koran and weak or absent democracy â€“ have cost Muslim leaders valuable time in the fight against the epidemic. <h4>Tackling the Taboo</h4> Although many Muslim leaders have done little to control HIV/AIDS other than deport the foreigners that they blame for the disease, a handful of leaders have acknowledged their epidemics and are working diligently to find ways to control infections. One of the Muslim governments that does seem to be responding to its gathering HIV problem is, surprisingly, "axis of evil" member Iran. Although the social stigma associated with the disease remains quite severe â€“ until 2001, workers could be fired from their jobs for being HIV-positive, and throughout 2002, doctors and hospitals could refuse to treat AIDS patients â€“ recent government actions paint a more promising picture. Iran's President Mohammad Khatami and his administration have been very forthcoming about the extent of the epidemic and the urgent need to control the further spread of the disease. HIV education is now offered as a standard part of the health curriculum in many Iranian public schools, and lectures about how to prevent the disease are also given to couples who apply for marriage licenses. Perhaps surprising, given the Iranian regime's strict conservative reputation, needle-exchange programs also have been offered in high drug-use areas of Tehran, and syringes are now sold over the counter in many pharmacies. Hopefully, the incoming administration will continue HIV education and prevention efforts. Yet, spread of the disease among prostitutes and their clients remains a challenge for Iran. Officials are not even sure how many commercial sex workers there are, and estimates range from 30,000 to more than 300,000. Creating social welfare programs and communicating alternative, safer behaviors for poor or troubled women and girls could reduce the number of prostitutes and levels of transmission in this difficult-to-reach group, thus preventing the further spread into the general population. Another Muslim society has seen considerable progress in HIV education and prevention efforts within gay and bisexual networks and commercial sex circles. In Bangladesh, recent surveys have found that knowledge of HIV and its transmission is low among both male and female sex workers, and efforts to increase condom use are under way around the country. Since 1997, the Bandhu Social Welfare Society has provided safer-sex promotion activities for more than 76,000 homosexual and bisexual men. Some officials hope to expand this successful non-governmental organization from six cities where anti-HIV and anti-STD education and prevention are offered to a national program. The Bangladeshis have also successfully experimented with awareness programs in the social and religious center of each community: the mosque. Because imams play an important role in shaping values, training them to educate people to the dangers of HIV seems natural. With assistance from the Islamic Foundation, the Islamic Medical Mission, and the United Nations Development Programme, thousands of religious leaders â€“ including some women â€“ are now trained to deliver anti-HIV and anti-STD educational and prevention messages. Unfortunately, the efforts of Iran and Bangladesh far outpace those of other Muslim countries. Little or no surveillance data are available on the disease in many countries with significant higher-risk populations of intravenous drug users â€“ Afghanistan and Iraq among them. Saudi Arabia and other states in the Persian Gulf have only recently begun to admit that they have a small but persistent domestic locus of infection after decades of blaming foreigners for the disease. <h4>Guarding the Faithful</h4> A look at the latest UNAIDS update for Muslim nation statistics is telling for its lack of information: a handful of cases here, empty columns there. But all these blank pages cannot mask the toll AIDS is taking, and will take, on the Muslim world. If Muslim societies are to respond effectively to their own stillâ€“gathering domestic HIV epidemics, they must begin mounting aggressive HIV/AIDS surveillance programs. To control the epidemic, sweeping legislative and social changes are also required. Following the example of Iran, conservative and fundamentalist regimes must harness their religious piety to deal with this urgent social need. In addition to teaching safer behaviors to higherâ€“risk groups, social messages can be crafted to teach people that they can still be good Muslims and care for those infected with this disease. Counsellors for an Egyptian hotline encourage callers to accept acquaintances and family members with AIDS by reminding them of the relationships they shared before the diagnosis. By stressing similarities between the infected and the nonâ€“infected, the counsellors encourage greater social acceptance of the disease. In the Muslim world, as everywhere else, battling HIV/AIDS is in part a women's issue. Islamic women must refuse to be infected and die in silence. They must embrace the fight against this disease at all levels of society. Married women must talk to their husbands who work as remittance laborers overseas and urge them to avoid extramarital sexual contact (or use condoms if they do stray). HIV/AIDS education and control efforts could also become part of each citizen's zakat, or charity giving. In nations that use taxes as part of their zakat, some portion of the contributions could establish AIDS awareness and treatment programs. Helping Muslim societies confront their own HIV/AIDS problem might actually become an avenue of positive engagement for the United States â€“ in regions where America could stand to improve its image. Domestic or international, anti-AIDS action for the Muslim world must be planned and implemented soon. Unchecked, HIV/AIDS will continue to spread through Muslim countries â€“ destroying families and deepening poverty â€“ until it has ruined the very fabric of these societies. Muslim countries must acknowledge that contemporary societal ills are serious domestic issues, but also that modern public health and scientific measures can help them conquer this disease. And those of us in the West must respect the fundamental fact that socially conservative societies will adapt to some issues but will not necessarily buy what we mean by "modernity" wholesale. Islamic countries are at a crossroads. They can choose to act slowly and mount only superficial education and prevention programs. Or they can choose to confront this killer virus that threatens their community of believers. After a shaky start, the formidable powers of national religious leaders can be harnessed to educate people to protect themselves. Most important, these countries have to reach out to their most vulnerable â€“ to the people who are most at risk â€“ to stop the continued spread of the disease. If they don't, AIDS will exact an even greater toll among the faithful. Nicholas Eberstadt is the Henry Wendt Scholar in Political Economy at the American Enterprise Institute. Laura M. Kelley is the principal author of the U.S. National Intelligence Council's 2002 study, The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China. <a href="http://www.frontpagemag.com/Articles/ReadArticle.asp?ID=18641">The Muslim Face of AIDS</a> By Nicholas Eberstadt and Laura M. Kelley Foreign Policy, July 7, 2005 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource AIDS now a threat in Middle East (2005) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>AAP waves white flag as Vikings storm fortress circumcision</h1> The case for circumcision has been dealt a final, fatal blow. Danish research showing that the vast majority of normal (uncircumcised) boys never experience any “foreskin problems”, and that only a tiny minority of boys with a problem require circumcision to fix it, has forced the American Academy of Pediatrics to admit that the case for routine (prophylactic) circumcision is empty and bankrupt. The key facts from the paper by Ida Sneppen and Jorgen Thorup, are as follows: <ul> <li>5% of boys (aged 0-18) experienced a foreskin-related problem (mainly phimosis, BXO and frenulum breve).</li> <li>1.7% of boys required surgery to correct the problem.</li> <li>0.4% of boys required circumcision to correct the problem.</li> </ul> <h2>95 per cent of uncircumcised boys will never experience a foreskin problem</h2> What this really means is that: <ul> <li>95% of boys will never experience a foreskin problem.</li> <li>More than 98% of boys will not need foreskin-related surgery (mainly because most foreskin problems, especially phimosis, can be addressed by non-surgical means, such as topical medication).</li> <li>Only a tiny minority of boys (less than half a per cent) will need to be circumcised because their particular foreskin problems are not amenable, or did not respond, to medical treatment.</li> </ul> The paper also noted that meatal stenosis (narrowing of the urethral opening) is 3 times more common in circumcised boys. This website <a href="https://www.circinfo.org/news_2012.html#au93" rel="noopener" target="_blank">pointed out</a> some years ago that 93% of Aussie boys would never experience a foreskin problem, and thus that routine circumcision makes no medical sense at all. This latest, comprehensive Danish study confirms this assessment, and further shows that only a small minority of the unlucky few who do experience problems will require surgery. The case for precautionary circumcision in advance is now well and truly dead and buried. Source: Ida Sneppen and Jorgen Thorup, <a href="http://pediatrics.aappublications.org/content/early/2016/04/04/peds.2015-4340" rel="noopener" target="_blank">Foreskin morbidity in uncircumcised males</a>, Pediatrics 137 (5), May 2016. Advance access 6 April 2016 <h3>Waving the white flag:</h3> <h2>Astonishing admissions from American Academy of Pediatrics</h2> In response to this devastating avalanche of scientific evidence, the AAP has more or less conceded that its 2012 circumcision policy was not really concerned with the medical case for circumcision at all, but with cultural and religious issues. In an editorial accompanying the Sneppen/Thorup paper, Andrew Freedman, a member of the circumcision policy taskforce, makes the following amazing admissions: <ul> <li>Circumcision is basically and usually a religious or cultural preference on the part of the parents, not a medical decision.</li> <li>Parents and medical advisers use medical evidence selectively to bolster their prior ideological positions on circumcision.</li> <li>We did not recommend circumcision.</li> <li>Circumcision is not necessary for optimum health.</li> <li>Underlying aim of 2012 circumcision policy was to counter proposals to prohibit non-therapeutic circumcision of minors.</li> <li>“Given the role of the phallus in our culture”, it is legitimate to consider non-medical factors in the circumcision decision.</li> <li>Not all penises have to look the same.</li> <li>The risk/benefit equation we devised (“benefits outweigh risks”) is applicable and relevant only to those who have non-medical (cultural, religious, social) reasons for circumcision.</li> </ul> Source: Andrew Freedman, <a href="http://pediatrics.aappublications.org/content/early/2016/04/04/peds.2016-0594" rel="noopener" target="_blank">The circumcision debate: Beyond benefits and risks</a>. Pediatrics 137 (5), May 2016. Advance access 6 April 2016. The obvious questions arising from Dr Freedman's admissions are: 1. If circumcision is not a medical procedure, is not recommended and is not necessary for health, and if it is primarily a religious, cultural or social ritual, how can the AAP justify its recommendation that it is legitimate for health insurance providers to fund it? 2. Given the above, plus the acknowledged non-medical significance of the penis in our culture, how can the AAP justify its assumption that it is the parents, rather than the owner of the penis, who are the appropriate parties to make the circumcision decision? We must point out that it was Freedman who, when the <a href="https://www.circinfo.org/United_States_circumcision_policy.html" rel="noopener" target="_blank">AAP policy was under attack</a> back in 2012, notoriously stated that he did not circumcise his own boys for medical reasons, but because he felt the weight of centuries of ancestors breathing down his neck. It is evidence of his continuing commitment to circumcision as a cultural/religious rite that he makes no mention of bioethical or human rights issues, such as the <a href="https://www.academia.edu/17264543/" rel="noopener" target="_blank">child’s right to an open future</a>; nor does he acknowledge that the AAP’s risk/benefit calculation <a href="https://www.academia.edu/12035421/" rel="noopener" target="_blank">has been criticised</a> as empirically false, conceptually misconceived and inadequate to the complexity of the “circumcision decision”. Despite the title of his editorial, Freedman has not gone far enough beyond “benefits and risks”. The key point is that those who have sought to advocate or defend circumcision (whether for cultural or medical reasons) on the basis that the AAP had guaranteed the soundness of the health case in its favour now find that the cheque has bounced. The fact is that the AAP bank account is empty. The last remaining bastion of respectable circumcision advocacy has been the American Academy of Pediatrics; now that their fortress has been stormed by a devastating Viking raid, the case for circumcision is well and truly on its last legs. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource American Academy of Pediatrics: admits 2012 circumcision policy dictated by cultural and political concerns darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>US Doctor: No need to circumcise most boys</h3> The following article by Dr Roxanne Allegretti was published in the Freelance Star, Fredericksburg, Virginia, USA, in November last year. It shows that even in the USA, where circumcision of baby boys is still common, doctors are very critical of the custom and recommend that boys be left as nature made them. <h4>American doctor says routine circumcision of baby boys is wrong</h4> FOR THOSE OF YOU who read my last column and the letters to the editor that followed, you already know that my comments about anti-circumcision demonstrators at the recent American Academy of Pediatrics meeting in Washington D.C. were not well received. My column was about SIDS prevention, but I slipped in a little joke about the demonstrators being mostly "graying hippies" and having bumper stickers like, "Not Circumcised? You Lucky Stiff!" While I was trying to be funny, and make light of the controversy at our conference, I apparently offended people all over the U.S.A. and Canada. And all this for a column that wasn't even about circumcision. Obviously, people feel very strongly about this issue. The funny thing is, I agree with the demonstrators. I don't think circumcision should be routinely performed on newborns. I don't do circumcisions. I was trained to, and had to do them while still in the Navy. But in our area, unlike where I trained in California, Ob/Gyn doctors perform most circumcisions. Even if they didn't, I still would not perform them. Like the demonstrators, I believe that removing a healthy body part for cosmetic reasons is not appropriate. Well, let me rephrase that, because I have no problem at all with liposuction in a consenting adult. But in most cases of neonatal circumcision, we're talking about a helpless newborn losing a very sensitive part of the body for no good medical reason. Certainly there are religious reasons for some families -- more on that later. In the U.S.A., most people who choose to circumcise their newborns do because they think that that the penis looks "normal" that way and so that it will be cleaner. Neither of these reasons is valid. Isn't the "normal" penis the one that God created? Whatever happened to, "If it ain't broke, don't fix it?" In fact, 80 percent to 85 percent of the world's male population is not circumcised. So that is more "normal." I hear fathers say they worry that if their son does not have it done, he'll wonder why he doesn't look like his dad. Well, that is just as easy to explain as questions like, "Dad, why do you have hair there and I don't?" Or, "Dad, why do you have blue eyes and I have brown eyes?" Hygiene is also a non-issue for most people. There are rare cases, like soldiers out in the field for days and days without bathing, in which the uncircumcised penis is more prone to infection. [Ed: Unlikely â€“ <a href="http://www.historyofcircumcision.net/templates/pages/the_riddle_of_the_sands.html" rel="noopener" target="_blank">see The Sand Myth</a>.] But in most cases, boys who are "uncut" learn to care for their penises just like they learn to brush and floss their teeth, and it's no big deal. Let me mention that there are religious reasons for circumcision in the Jewish and Islamic faiths. I consider that to be very different than the routine circumcision done just because everybody else is doing it. In the Old Testament, circumcision is described as a symbolic act by which a Jewish male enters into a covenant with God. This is a long-standing tradition, and the bris ceremony is very important in the Jewish faith. However, I have learned that the practice is beginning to be questioned by many Jews (See <a href="http://www.jewishcircumcision.org/" rel="noopener" target="_blank">Jewish Circumcision Resource Centre</a>). It is unclear why Christians in Britain and the USA took up the practice, or why it occurs more in the U.S.A. than any other country in the world. There are Christian organizations such as <a href="http://www.catholicsagainstcircumcision.org/" rel="noopener" target="_blank">Catholics Against Circumcision</a> which state that the New Testament has passages that recommend against the practice. Several resources I read mentioned that the practice became more widespread in the late nineteenth century in the U.S.A., and was touted as a way to cure masturbation (which was thought at the time to cause insanity, blindness and all sorts of horrible things). The circumcised penis is certainly less sensitive, due to the loss of a ring of tissue near the tip of the foreskin, which is the most sensitive part of the penis. But, I'm not really seeing that this was a cure Anyway, routine circumcision goes on in many areas, despite the fact that the American Academy of Pediatrics, American Academy of Family Practitioners, and the American Medical Association have all published statements that do not support routine neonatal circumcision. These are echoed by medical organizations all over the world, including the Australian Association of Paediatric Surgeons, which put it like this: "We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise." As the American Academy of Pediatrics notes in its position statement, there are potential medical benefits, but they are minimal and do not outweigh the risks. (<a href="http://www.cirp.org/library/statements/" rel="noopener" target="_blank">You can read the statement online</a>.) There are definitely fewer urinary tract infections in male infants under 1 year of age who are circumcised. However, fewer than 1 percent of uncircumcised baby boys get UTIs, so the increased risk is still pretty minimal. The same goes for the increased risk of penile cancer in uncircumcised men. There is a slightly increased risk, but this cancer is quite rare. [Ed: The risk is increased <a href="http://www.cirp.org/library/disease/cancer/" rel="noopener" target="_blank">only if hygiene is badly negected and phimosis is present</a>.] Potential <a href="http://www.cirp.org/library/complications/" rel="noopener" target="_blank">complications of circumcision</a> are more likely and include bleeding, poor cosmetic results, adhesions (I see a lot of those), scarring of the urethral opening, infection, and very rarely, penile amputation or death. Then there is another issue I never thought about until I started researching this article. In the U.S.A., 1.2 million circumcisions are performed each year, yet this is considered a medically unnecessary procedure. The cost adds up to somewhere between $150 million to $270 million per year. Just think of how that money could be better spent! In Virginia, Medicaid still pays for circumcisions. If that money was saved, it could pay for many of the infant's immunizations, for example. Several states, including California, Arizona, Florida, Washington and Oregon, already have disallowed <a href="http://www.icgi.org/" rel="noopener" target="_blank">Medicaid coverage of circumcision</a>. Having to pay $100 upfront to be circumcised was certainly a big deterrent at my last practice in California. In California, circumcision is in the minority -- approximately 33 percent of newborns are having it done. In Virginia, it is still more widespread than that, but seems to be decreasing in popularity. (Exact numbers are difficult to come by, but I think we are in the range of 75 percent). It seems like I end almost every column this way: Be informed. Know the risks and benefits before you decide. If you choose to have the surgery performed on your newborn, be sure that analgesia is used. Lidocaine injected into the base of the penis is very helpful in reducing pain during the procedure. Also, giving the baby sugar on a pacifier decreases their pain response. Hard to believe, but even a few years ago it was routine practice not to use any analgesia or anesthesia for newborns being circumcised. Now, it's considered the standard of care. [Ed: It is difficult to avoid the pain, since it is not safe to give babies effective anaesthetics. Pain control is far easier in adults, as they can be given general anaesthetics and effective painkillers after the surgery. <a href="http://www.cirp.org/library/pain/" rel="noopener" target="_blank">Further information here.</a>] If you choose not to circumcise your son, you don't need to do anything special to care for the penis -- just normal bathing. Do not try to retract the foreskin! This should not be done until years later, and will happen naturally with time. For more information on care of the intact penis, see <a href="http://www.nocirc.org/" rel="noopener" target="_blank">Nocirc USA</a> <a href="http://www.cirp.org/pages/parents/" rel="noopener" target="_blank">Circumcision Information and Resource Pages</a> <a href="http://www.doctorsopposingcircumcision.org/" rel="noopener" target="_blank">Doctors Opposing Circumcision</a> Dr Roxanne Allegretti welcomes reader comments and questions. Write to her at Free Lance Star 616 Amelia St Fredericksburg, Virginia, 22401 USA email: <a class="__cf_email__" data-cfemail="3b555e4c48495454567b5d495e5e575a55585e484f5a4915585456" href="/cdn-cgi/l/email-protection">[email protected]</a>. <a href="http://fredericksburg.com/News/FLS/2005/112005/11132005/143815" rel="noopener" target="_blank">Free Lance Star</a> Fredericksburg, Virginia, USA 13 November 2005 <h2>Other American doctors agree with Dr Allegretti</h2> The following rather forthright letter was sent by Dr Chris Fletcher, a doctor in Santa Fe, New Mexico, to parents who sent him the following inquiry: Dr. Fletcher, My wife Lycia is the daughter of Tom and Julie ..., who are friends of yours, I believe. They mentioned that you are a strong opponent of circumcision. We have a baby boy due at the end of March and are debating that very issue. If you have a minute or two, would you mind giving us your arguments? Thanks very much in advance. Regards, Eric ... Portland, OR <h4>Dr Fletcher replied:</h4> The issues regarding circumcision are both quite simple (just leave it alone) and very complex (why do American parents persist in "needing it", since it is basically a rare or unknown procedure most other places in the world). I would be happy, in order to save your son's natural or God-given genitals from a mutilator and real/potentially nasty side-effects, to spend a lot of time discussing this. In fact, when I got Tom and Julie's Xmas card mentioning that Lycia was pregnant and expecting in March (and a boy at that) I actually wondered whether circumcision would be an issue, and whether someone might contact me. Washington and Oregon states wisely restricted Medicaid monies, along with many other Western states (and a total of 16 at present), for unnecessary procedures, including newborn male genital mutilation (circumcision), so the kids from poorer families actually now get a better deal than the ones with private insurance! First, pick up the latest issue (September-October) of <a href="http://www.mothering.com/" rel="noopener" target="_blank">Mothering Magazine</a> -- two good articles, one by a mother of an intact 3 year old boy who very simply and persuasively argues the case against it, and the other, an article on legal issues which is partly an interview conducted by a reporter with me as the reportee. I am attaching a paper which I presented at Oxford several years ago exploring the issues of what American doctors actually tell their patients, charge, do for their own sons, believe, etc. That paper makes up part of the above article in Mothering. Then I would go to the best all-inclusive website (<a href="http://www.cirp.org/" rel="noopener" target="_blank">CIRP.org</a>) which has everything you would ever need to really understand the issues, the cons and whatever pros people have dreamed up, and which has won many important national and international awards for websites. After that, if you have any lingering issues or doubts, call me or email me again. Believe me, it is only a prowess and money issue for doctors. Only child molesters, perverts, or really uneducated physicians would in any way argue that it is a good thing. Still the two most common arguments are the 1950s one -- "Isn't it cleaner doctor?" -- what we call the cleaner wiener argument. And "I want my son to look like me". Both are really stupid and simplistic when you think about it: how can a cut/wounded/mutilated tissue be cleaner than the one all baby boys are born with, especially when you put the bleeding and now smaller penis stump in a diaper (full of clean things like urine and stool). What if your son has different eye color or looks like his mother or has dark hair instead of blond, etc... ? Do you remove eyes and put different colored ones in? Do fathers and their sons ever actually stand side by side (when they are old enough to speak and think rationally!), and compare their penises? Mine never did -- not my father, not my brothers, not my friends in the locker rooms, and not my own sons. (I ran track and was a swimming champion, so I have been around a lot of naked guys.) When I moved from Massachusetts in 1981, I was fully prepared, as trained, to continue mutilating little baby boys, but I was given articles at my clinic in Santa Fe which immediately made me seriously question what I was doing. Giving up a procedure which I thought I had learned as part of my fine training was an ego issue; the money was not, since I had never been paid for doing circs as a resident. Circumcision is not simply a little snip, but a major and brutal surgery on the most sensitive part of a male's anatomy, with lifetime consequences for all cut boys. Erectile dysfunction, increased infections in boys, such as multi-antibiotic resistant staphylococcus aureus (MRSA), lack of sensitivity, etc. <a href="http://www.cirp.org/library/general/laumann/" rel="noopener" target="_blank">The Lauman lifestyle study </a> (University of Chicago) mentioned in the first Mothering article was fascinating since it showed that circumcised men were more likely than uncircumcised (entire) men to need anal and oral sex, girlie magazines, X-rated movies, prostitutes, sex toys, masturbation, and were more likely to get syphilis and chlamydia, all simply the end results of seeking out avenues for stimulation because of the decreased functionality from lacking a foreskin and from the scarring caused by the mutilation itself. I prescribe many times more Viagra, Cialis, etc. for circumcised guys than normal men. Circumcision prevents no disease, and does not improve anyone, except perhaps certain Hasidic Jews (<a href="http://www.slate.com/id/2125225/" rel="noopener" target="_blank">see today's New York Times</a>) who mistakenly believe that God commanded them (and no other Jews, of course) to perform a certain weird type of circumcision in which the boy's penis needs to be sucked clean of blood by the circumciser. Several babies have recently died from herpes communicated by this unhygienic practice. In the 19th century this practice was banned in New York and many other places because of transmission of syphilis, tuberculosis and other diseases. Anyway, my two sons were left intact, and are quite pleased that they were not cut. The older one (Lycia remembers Christopher) is now 23, and when he was a college student won an international essay contest questioning the ethics of circumcision. The younger one, Benjamin, now in college, surprisingly, wrote a similarly powerful paper on it in prep school. So I have attached my paper and two graphs which are part of it, a listing of the crazy justifications for circumcision given in the US over the last century, and the legal definition of surgery. I suppose you are not in the medical field, so for someone like me to load you up with this might seem weird. I know I felt that way when my assumptions and lack of knowledge were first challenged. Now it seems so normal not to cut, and so perverted and wrong medically, ethically, and legally to allow circumcision, and so right and honest to help parents make the correct and caring decision for their son. Hello to Lycia ... Christopher Fletcher MD </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource American doctors today (2000s) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Midwives, Greens, media columnists, mothers ...</h3> <h2>More voices call for boys to be protected from circumcision</h2> In May 2010 the American Academy of Pediatrics astonished the world by announcing a policy on female circumcision that accepted the right of parents to impose mild forms of genital cutting on girls, such as a “ritual nick” to the clitoris. The suggestion was dropped after massive protests, and reminders that even this would be illegal under United States law. But the first groups to raise objections were the American and British anti-circumcision organisations (<a href="http://www.nocirc.org/">Nocirc</a>, <a href="http://www.arclaw.org/">Attorneys for the Rights of the Child</a>, <a href="http://www.intactamerica.org/">Intact America</a>, <a href="http://www.norm-uk.org/">Norm-UK</a>, etc). These bodies are critical of any genital mutilation of children, both male and female, but are generally regarded as being more concerned with male circumcision. It was only after they had taken the lead that the mainstream organisations concerned specifically with female genital mutilation (FGM) and the obstetrical colleges spoke up. The unfolding of the affair can be followed at <a href="http://www.circumstitions.com/">Circumstitions</a> and <a href="http://www.arclaw.org/letters/AAP051010.php">Attorneys for the Rights of the Child</a>. The policy has since been dumped, but its principal advocate, Dena Davis, a professor of law at Cleveland State University, argues that it is very difficult to maintain a blanket ban on all forms of FGM when the law in nearly all countries is completely silent on circumcision of boys - a far more damaging surgical intervention than a nick - and the practice remains common. As reported by <a href="http://www.economist.com/node/16329452">the Economist</a>, Ms Davis argues that “in America at least, it is not acceptable to criminalise all female genital cutting (FGC) while adopting a relaxed stance to the male sort. She suspects that by allowing male circumcision while forbidding even a symbolic cut on girls, Western countries show respect for only those religious and cultural practices with which they are already comfortable.” <h3>Professor Davis and the question of equal protection</h3> That may be so, but if Professor Davis is so concerned with gender equity and the rights of children, why did she not begin to even up the scales by reducing the risk to boys, by (for example) advocating a “ritual nick” on their penis in place of radical amputation of the foreskin? Giving boys a fraction of the protection already given to girls would do much more for both children’s rights and gender equity than reducing the protection given to girls. The fault here may well not lie with Davis, however, but with other, less ethically-minded, members of the AAP’s Bioethics Sub-Committee. In previous publications Davis has shown herself quite sensitive to the sufferings of circumcised boys and has warned that the American policy of a blanket ban on all forms of female genital cutting and open slather on all forms of circumcision (male genital cutting) contravenes at least two clauses of the United States Constitution: the First Amendment, which prohibits Congress from making laws to establish a religion or to prevent the free exercise of religion; and the Fourteenth Amendment, which gives all American citizens equal protection under the law. The former is invoked by Jewish citizens as a guarantee of their right to circumcise boys, but why should it not also be invoked by African or Muslim parents whose religion prescribes circumcision of girls? The right to equal protection has been deployed to ensure that women share the rights and protections enjoyed by men, but it also implies that men should share the rights and protections enjoyed by women. Heard in Seattle maternity hospital Obstetrician to Pregnant Woman: "If it's a boy, do you want him circumcised?" Pregnant Woman: "Yes, and also if it's a girl." Female circumcision will never stop as long as male circumcision is going on. How do you expect to convince an African father to leave his daughter uncircumcised as long as you let him do it to his son? Sami Aldeeb, <a href="http://www.fgmnetwork.org/authors/samialdeeb/index.html">To mutilate in the name of Jehovah or Allah</a> Davis also points out, in words echoed in the AAP’s 2010 FGC policy, that US laws on FGC prohibit “procedures significantly less substantial than newborn male circumcision”, including the ritual nick or scratch that doctors in Seattle proposed as a substitute for the full circumcision demanded by Somali parents. If the American public regard even a scratch on the vulva as unacceptably harmful, they must logically regard radical amputation of the entire foreskin (a substantial part of the juvenile penis) as far more harmful. Davis is perfectly aware and highly critical of these inconsistencies, and agrees with Doriane Coleman, author of a detailed study of the “Seattle Compromise”, that the proposed symbolic scratch was far less injurious that the average male circumcision: <blockquote> If we compare the Seattle proposal to the unregulated practice of berit milah (ritual Jewish circumcision of newborn males), it appears that the latter involves more skin removed, with less likelihood of adequate pain control and no systematic reporting system for complications. The Seattle proposal was [as Coleman comments] ‘less injurious to the health, welfare and safety of girls than male circumcision is to the health, welfare and safety of boys’. The primary difference between the operation proposed in Seattle … and the one performed daily on newborn males in America is that the first is associated with ‘bizarre’ practices brought to America by strange people practising strange customs, while the other is a Western practice with which we are familiar. </blockquote> Davis not only defends the ritual scratch as a reasonable compromise between the demands of the parents and the rights of the children to “an open future”, but also makes proposals to give boys some protection against routine circumcision, including greater regulation by the state, centralised collection of data on outcomes (including “complications”) and certification of ritual practitioners. These timid suggestions hardly go far enough, and the very first rule that a genuine bioethicist would like to see is that medical personnel be prohibited from asking new mothers if they would like their perfect baby boy circumcised: the practice is too like touting for business, and gives the impression that the circumcision decision is no more significant than deciding whether you want chips or salad with your steak. Still, in the American context the suggestions are a start, and undermine the claim of some critics that Davis has no interest in the welfare and happiness of boys. In accordance with her own philosophical principles, they too possess a “right to an open future”, which must include the right to decide whether or not to have a foreskin. <h3>References</h3> Dena Davis, Genital alteration of female minors, in David Benatar (ed), Cutting to the Core: Exploring the Ethics of Contested Surgeries (New York: Rowman and Littlefield, 2006) ----, Male and female genital mutilation: A collision course with the law?, Health Matrix: Journal of Law and Medicine, Vol. 11, 2001 ----, Genetic Dilemas: Reproductive Technology, Parental Choices and Children’s Futures (London: Routledge, 2001) Doriane Coleman, The Seattle compromise: Multicultural sensitivity and Americanization, Duke Law Journal, Vol. 47 (4), 1998, 717-783 <h3>AAP admits that male circumcision is harmful</h3> The most bizarre aspect of the affair were the efforts of the American Academy of Pediatrics to justify their attempted change in policy by pointing out that the "ritual nick" to which there was nearly universal objection was far less damaging than the average male circumcision, of which there was widespread acceptance. In its aborted FGM policy it stated "The ritual nick suggested by some pediatricians is ... much less extensive than routine newborn male genital cutting" (<a href="http://pediatrics.aappublications.org/cgi/reprint/peds.2010-0187v1">AAP FGC Policy</a>, April 26, 2010); yet when it was forced to abandon the policy it stated: "This minimal pinprick is forbidden under federal law and the AAP does not recommend it to its members" (<a href="http://www.aap.org/advocacy/releases/fgc-may27-2010.htm">Retraction of AAP FGC Policy</a>, May 27, 2010). How then can the AAP condone its members performing "routine [non-therapeutic] newborn male genital cutting"? Ironically, the publicity generated by the affair has led to the raising of the very question that the circumcision diehards within the AAP wished to keep suppressed: if girls have total protection, why don't boys have any? The most positive effect of the affair has been to provoke a variety of new voices to speak up for gender equity and to argue that boys should also be given at least some protection against genital mutilation. In recent weeks British midwives, Australian Greens, a British columnist and an American mother have all argued that boys are entitled to protection from circumcision, just as much as girls from FGM. See also the <a href="http://org2.democracyinaction.org/o/5922/p/salsa/web/common/public/content?content_item_KEY=2741">Open Letter published by Intact America in the Washington Pos</a>t, criticising the American Academy of Pediatrics for its double standards and sexism when dealing so inconsistently with male and female genital cutting. <h3>Analysis finds AAP motivated by non-medical considerations and political pressure</h3> Robert Van Howe. The American Academy of Pediatrics and Female Genital Cutting: When National Organizations are Guided by Personal Agendas. <a href="https://www.ethicsandmedicine.com/2011/09/ethics-medicine-volume-273-fall-2011/" rel="noopener" target="_blank">Ethics and Medicine, Vol. 27 (3), Fall 2011</a>. ABSTRACT The Committee on Bioethics of the American Academy of Pediatrics released a policy on female circumcision on April 26, 2010 proclaiming that some forms of genital cutting in minor females were permissible, particularly nicking the clitoris. The policy was quickly met with opposition and “retired” by the Academy on May 27, 2010. This paper explores the changes in policy from the Academy’s 1998 position and the possible implications of the changes. It is argued that these changes were driven by the personal agendas of members of the Committee and of the author of the policy. The short-lived policy failed to recognize the basic human right to bodily integrity that applies to all humans, including infants and children, placing the Academy outside the mainstream of how ethicists currently view the rights of children. <h2>Midwives condemn male genital mutilation</h2> Female genital mutilation is a frequently discussed topic by midwives and policy-makers alike, but British midwife Ann Higson highlights the often-ignored subject of enforced circumcision of male children. For some time now the issue of female genital mutilation (FGM) or female circumcision has been a hot topic of conversation within midwifery circles. It is an unnecessary abuse inflicted onto children in order to control their sexuality and promote chastity. FGM is illegal in the UK. Male genital mutilation (MGM) or male circumcision has been largely ignored. It is an unnecessary abuse inflicted onto children in order that they may conform to religious or cultural beliefs. MGM is legal in the UK. The Universal Declaration of Human Rights states that every man, woman and child should have equal rights without discrimination (United Nations, 1948). These rights should have meaning within our everyday lives and aim to protect all people from injustice. FGM is considered a violation of human rights by the World Health Organization (WHO, 2001). Their only concern regarding MGM is that local communities should make it freely available for neonates and children as research has shown that in countries where AIDS is rife, it can reduce transmission by up to 60% (Auvert, 2005). Tobian et al (2009) found a significant reduction of human papillomavirus (HPV) in their circumcised group. HPV transmission during sexual intercourse can cause cervical cancer (Muñoz et al, 2003). These are impressive results and they will certainly give credence and support to parents who wish their children to be circumcised. However, children are not sexually active until they become aware of their sexuality. Delaying male circumcision until the child can make an informed choice would reduce violations of his human rights. The British Medical Association (BMA, 2006) sit on the fence with this issue and can only recommend that MGM be carried out by a competent person and that consent is gained by both parents. They believe that it is up to society to put restraints on parental choices. However, they do conclude that parents do not have the right to demand that medical professionals carry out unnecessary surgical procedures on their children. According to Glass (1999), Jewish law requires that male neonates undergo circumcision on the eighth day following their birth. This is generally carried out without any form of analgesia, although one Jewish mother told me that her son would be given a ‘taste of wine’ before the ceremony. The Koran does not require MGM, though it is generally accepted that Islamic males should be circumcised. This is seen as a rite of passage into the Islamic faith and is usually carried out before puberty (Adamec, 2007). Analgesia is used with children, but not neonates. FGM is seen by the Islamic faith in general as a ‘barbarous cultural practice that pre-dates Islam’ (Maqsood, 2008). It has now been accepted that neonates are capable of feeling pain (Anand et al, 1987). Performing MGM on a neonate without analgesia can therefore be assumed to be a painful experience (Wellington and Rieder, 1993). Research has also shown that circumcised males show a higher behavioural pain score several months after MGM while undergoing vaccinations (Taddio et al, 1995). This suggests that male neonates are not only suffering physically but psychologically from this early painful stimuli. Morbidity rates are estimated to range from 0.1% to 35%, according to the American Academy of Family Physicians (AAFP) (2007). The most common complications are infection, haemorrhage and failure to remove enough foreskin (Kaplan, 1983). Rare complications include: <ul> <li>Necrotising fascitis – inflammation due to bacterial infection</li> <li>Meatitis – inflammation of the urethral opening</li> <li>Meatal stenosis – abnormal narrowing of the urethral opening</li> <li>Urethral fistula – abnormal opening within the penile tissue</li> <li>Penile necrosis – death of some or all of the cells of the penis</li> <li>Penile amputation – surgical removal of all or part of the penis (AAFP), 2007).</li> </ul> The mortality risk of MGM is 1:500,000 (AAFP, 2007). Some countries have passed laws to stop non-medical individuals from performing MGM on infants, and in Australia, a few states have stopped the practice of non-therapeutic male circumcision in public hospitals. Put together, these two sanctions would both be needed to protect neonates within the UK. Unless the act of performing MGM becomes a child abuse issue in the UK and therefore illegal, male children will continue to be denied their human rights. It seems unfair that girls are protected against FGM by law, while boys are left to suffer. Perhaps using the word ‘mutilation’ to describe female circumcision helped society to recognise the harm done to young girls by this practice? By penning the term ‘male genital mutilation’, a similar response could be hoped for, in order to find a solution to what is at present a very sensitive issue. <h3>References</h3> American Academy of Family Physicians. (2007) Circumcision: position paper on neonatal circumcision. See: www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html (accessed 16 April 2010). Adamec CW. (2007) Islam: A historical companion. Tempus Publishing: Gloucestershire. Anand KJS, et al. (1987) Pain and its effects in the human neonate and fetus. New England Journal of Medicine 317(21): 1321-9. Auvert B, et al. (2005) RCT of male circumcision for reduction of HIV infection risk. PloS Medicine 2(11): 1112-22. British Medical Association. (2006) <a href="http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp">The law and ethics of male circumcision: guidance for doctors</a>. Glass JM. (1999) Religious circumcision: a Jewish view. BJU International 83(1): 17-21. Kaplan GW. (1983) Complications of circumcision. Urol Clin North Am 10: 543-9. Maqsood RW. (2008) Need to know? Islam. Harper Collins: London. Muñoz N, et al. (2003) Epidemiologic classification of human papillomavirus types associated with cervical cancer. New England Journal of Medicine 348: 518-27. Taddio A, et al. (1995) Effect of neonatal circumcision on pain responses during vaccination in boys. The Lancet 345(8945): 291-2. Tobian A, et al. (2009) Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. New England Journal of Medicine 360(13): 1298-309. United Nations. (1948) The universal declaration of human rights. See: www.un.org/en/documents/udhr (accessed 16 April 2010). Wellington N, Rieder MJ. (1993) Attitudes and practices regarding analgesia for newborn circumcision. Pediatrics 92(4): 541-3. WHO. (2001) FGM: integrating the prevention and the management of the health complications into the curricula of nursing and midwifery. WHO: Geneva. <a href="http://www.rcm.org.uk/midwives/features/whos-looking-after-the-boys/" rel="noopener" target="_blank">Midwives Magazine</a> (UK), June/July 2010 <h2>Australian Greens defend the rights of the child</h2> Circumcision and the rights of children by Laura Ealing On May 28, it was reported that the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was considering allowing a certain form of female circumcision, involving “ritual nicks”. RANZCOG later said it was a misrepresentation, and that “anyone suspected of performing such genital mutilation should be reported to authorities”, the Sydney Morning Herald said the same day. But if we reject all forms of female circumcision, why is it that male circumcision remains so acceptable? Circumcision of girls often entails absolutely brutal practices, such as the total removal of the labia and the clitoris, particularly in Northern Africa — although many countries are trying to stop it. It often takes place without any anaesthetic and with non-sterilised instruments. It is not uncommon for girls to die due to infection, but for those who do survive, a lifetime of pain and suffering awaits them, as well as a loss of sexual sensitivity. Such mutilation has rightly been decried as a terrible practice. Clearly these practices also entail a greater level of violence than male circumcision does. But at the other end of the extreme, female circumcision may involve nothing more than a superficial “nick”; this could be viewed as being less significant than the total removal of the foreskin in males. According to RANZCOG president, Dr Ted Weaver, “Child protection legislation is about stopping [such ‘nicking’] happening ... all of the states have legislated in this way so it is illegal in Australia”, the SMH said . Tasmanian Commissioner for Children Paul Mason, has questioned whether it is actually legal — let alone ethical — to conduct male circumcision, a non-therapeutic procedure. In every other circumstance, Mason says, it is legally considered assault to perform a non-therapeutic surgery without consent. According to him, it should be banned, along with female circumcision and gender assignment operations on intersex infants, until the person in question is old enough to make an informed decision about their body. Supporters of circumcision focus on hygiene and health concerns for uncircumcised boys. There is also credible evidence suggesting circumcision reduces the likelihood of transmitting diseases such as HIV/AIDS. We shouldn’t ignore this. But in Australia, should we be focusing our energies on getting boys circumcised, or just making sure that they use condoms? Condoms are ultimately substantially more reliable than the absence of a foreskin in preventing the spread of STDs. Moreover, if the medical evidence is so solid, then why is it against hospital policy to perform non-therapeutic male circumcision in public hospitals in Tasmania, New South Wales, Victoria, South Australia and Western Australia? Most leading medical associations across the world and in Australia agree that there is not enough medical evidence to support routine circumcision. Indeed, many studies suggest that, like most parts of the body, the foreskin may serve a purpose. Though disputed, studies have shown that the foreskin appears to be highly innervated and enhances sexual pleasure. Perhaps reflecting a growing awareness of these factors, male circumcision is decreasing in Australia. In the 1970s, close to 90% of baby boys were circumcised. Today, it is just 12%. Despite this, the federal government continues to pay a medical benefit for the procedure! Taxpayers are paying parents money so that they can have their infant boys’ foreskins chopped off. Historically, male circumcision has been a spiritual or religious ritual. Any moves to ban it would probably be interpreted as restricting religious freedom. But in a secular society we must base laws on a consistent set of values. We must consider the rights of children above the rights of parents to their religious expression. When it would be illegal to carry out any other non-therapeutic, invasive and irreversible surgery on a child, we need to ask ourselves why male circumcision has fallen through the gaps. This is not a value judgement about circumcision, or making all circumcisions per se illegal. This is about protecting children’s rights and giving them a choice in a matter that fundamentally affects their body. The Tasmanian Law Reform Institute discussion paper on the law and ethics of non-therapeutic circumcision <a href="http://www.law.utas.edu.au/reform/">is available here</a>. <a href="https://www.greenleft.org.au/node/44360" rel="noopener" target="_blank">Green Left</a>, Sunday 6 June 2010 <h2>British columnist calls for boys to be protected from circumcision</h2> It’s time to protect boys as well as girls from the barbaric practice of circumcision by Christina Odone Let the squeamish look away now: this blog post is about male and female circumcision, a subject that’s raising controversy again. Why is female circumcision abhorrent but male circumcision kosher? I blame our cultural hypocrisy. The practice of female genital mutilation is widely embraced by African and Middle Eastern tribes (Muslim, Christian, animist alike) while male circumcision is a Judeao-Christian tradition widely practised in the Middle East but also in America. We associate the former with deepest darkest Africa, tribal violence and misogyny; while the latter speaks to us of Abrahamic and Puritan traditions and elderly men with flowing white beards, all of which we are much more comfortable with. The World Health Organisation warns that three million girls are at risk each year of some kind of female genital cutting. In certain African countries (Somalia and Egypt) over 95 per cent of women have undergone some kind of circumcision. “Some kind” covers incisions ranging from a superficial cut of the clitoral prepuce, done under medical supervision, to the deep cut to the clitoris that a village woman will perform with a piece of broken glass. Defenders of the practice claim it is religious in nature – though you will have noticed that no Christian cleric in Europe has ever called for this barbarity. Critics counter that female circumcision is a patriarchal means of controlling women’s sexuality, as the operation is supposed to curb female sexual appetite and pleasure. Their claim is undermined by the lucrative industry that has sprung up in Beverly Hills (and elsewhere): Western women are going in for labioplasty, the de-hooding of the clitoris to lengthen and increase sexual pleasure. Male circumcision affects about 750 million males, according to the WHO. As in female circumcision, the range of procedures ranges from the surgeon’s careful incision to the village imam or rabbi operating on the child without anaesthetic. Our forefathers cut the foreskin invoking religious reasons; but theirs too was a puritanical obsession: they believed it would stop masturbation, curb sexual pleasure, and reduce appetite. They were right, up to a point: the circumcised penis is less sensitive than the uncircumcised one, as an article in the BMJ recently revealed. Defenders of THIS practice claim it stems the spread of HIV and some sexually transmitted diseases – though sexual relationships are many years down the line for those infants being ritually (literally) abused. Children of both sexes should be spared these barbaric practices. But while preventing female circumcision is a global political campaign, embraced by feminists of all faiths and none, no one seriously addresses the issue of male circumcision. Dena Davis, the legal consultant for the American Academy of Paediatrics, criticises this policy as nonsense. It reflects, as she told The Economist this week, cultural prejudice rather than medical knowledge. It would seem that although we cannot understand cutting a little girl, we can watch someone cutting an infant boy’s foreskin, and feel we are not leaving our comfort zone. <a href="http://blogs.telegraph.co.uk/news/cristinaodone/100043247/its-time-to-protect-boys-as-well-as-girls-from-the-barbaric-practice-of-circumcision/" rel="noopener" target="_blank">Daily Telegraph</a> (UK), 12 June 2010 <h3>There have been numerous comments on the article, including this one:</h3> This female vs male circumcision argument is tiresome. The fact that some forms of female circumcision are worse than male circumcision is not an argument for the procedure. Cutting of a person’s entire leg is worse than cutting off their pinky toe but that doesn’t make cutting off a pink toe right. Cutting off a toe and a leg without consent are both equally a violation of a person’s human rights. This is the point. They are both wrong. Female and male circumcision both violate the child’s human rights. The WHO says about FGM “It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.” Does anyone here think that boys and girls should have different rights? Does male circumcision not carry the risk of complications and death? Even when performed in the west by competent doctors? It should also be noted that a huge reason why people have this misconception of FGM=bad and male circumcision=good is because they are looking at a surgery performed in the west vs a surgery performed in sub-Saharan Africa. A quick Google search shows two articles just published this week about the “horrors” of male circumcision as well. “Seven youths have died of botched circumcision in the past nine days, said departmental spokesperson Sizwe Kupelo. The health department was “extremely concerned” about the deaths and the high number of casualties involved, with 24 initiates in hospital, some of them since March. Last year alone, 91 initiates died and hundreds were hospitalised in the province.” Another article: “Another youth has died at a circumcision school in Mthatha, bringing to nine the number of initiation-related deaths in the past ten days, the Eastern Cape health department said. “It is a traumatic experience to see a young boy losing his genitals in one day. Our nurses are finding it hard to deal with,” said spokesman Sizwe Kupelo. The latest death was on Monday.” Another article that came out this week says: “Three Transkei boys have been admitted to Mthatha’s Nelson Mandela Academic Hospital with gangrenous penises following illegal circumcisions, says the Eastern Cape health department. Kupelo said it had emerged that a 14-year-old arrested last week for performing illegal circumcisions on his age-mates, was responsible for previous botched operations that had already resulted in nine penis amputations.” Hmm. Nine deaths in 10 days. Countless gangreen penises that have had to be amputated. Last summer alone over 90 boys died in under two months from being circumcised. When conditions are similar, so are the outcomes. Take a step back and try to picture for a moment that western countries had never started routinely circumcising infant boys. Now try to think what our reaction would be hearing these kinds of stories. We would be JUST as opposed to this being done to males as females. Do you think men with amputated penises have an easy time having sex or urinating or reproducing? Comparing the “horrors” of female circumcision in Africa to male circumcision in sterile hospitals by surgeons is like comparing the risks of brain surgery here to a brain surgery performed in a hut. Both are wrong, both can have horrific life ending complications, and both should be illegal to perform on infants. For further details of circumcision death and injury in South Africa, see the <a href="https://www.circinfo.org/africa.html">Africa page of this site</a> and <a href="http://www.circumstitions.com/">Circumstitions.com</a> <h2>An American mother decides not to circumcise</h2> Everything about this pregnancy was different. My previous two pregnancies happened soon after we began “trying,” with two years between, as planned. This one happened soon after we began discussing preventing more pregnancies, six years after my second child was born. Despite it being my third, this was my smallest pregnancy - most people didn’t even realize I was pregnant until my third trimester. My two previous births were induced at a convenient mid-day time and lasted about 10 hours, with me succumbing to an epidural in both cases. This time I went into labor naturally, ignorantly waiting until 3 a.m. to leave for the hospital. Since it seemed too late to call friends, we took the kids with us. I howled intermittently as my husband sped down Duke Street, the minivan hopping with each well-known dip in the road. In between contractions, I alternated between yelling at him to slow down and pleading with him to get there in time for an epidural before this thing happened. At 3:36 a.m., I leapt out of the car and ran into the hospital. I quickly pushed my bag through the scanner, buckling under another contraction while I asked the security guard if there was an anesthesiologist in the house. A woman arrived with a wheelchair, but I refused to sit down, begging her ineffectively to show me to the delivery room ASAP. We had to check-in first, during which I tried, in the diminishing spaces between contractions, to impart the desperate need for speed. Given my obvious distress, I couldn’t understand why everyone was smiling, until I got to the delivery room, where - within minutes - my water broke and my doctor informed that the baby was crowning. Aligned with the romantic notions of nearly every mom, I had wanted a natural, drugless birth with my first child; but now I knew better, and I WANTED AN EPIDURAL! This sentiment only brought more smiles from the doctor and nurses. When they absolutely refused to let me give birth standing up (and to give me an epidural), I finally lay down and immediately gave birth at 4:01. “I guess we ought to buy some diapers now,” my husband said as we looked at the beautiful, bruised face of our newborn son. The next day, our doctor asked if we wanted our son circumcised. We took for granted that our first son would be circumcised like nearly every other American, consenting to the procedure before really thinking about it. This time we had talked about it but still hadn’t decided, though we leaned toward circumcision, if for no other reason than our two sons would look the same “down there.” Fortunately, our doctor called us on this “easy way out” and engaged us in the lengthy and informed discussion we needed. The earliest circumcision record dates to about 2200 BC in Egypt, where it was a spiritual right of passage. It was later adopted by nearby Semitic peoples (including Jews and Muslims). According to Genesis, God commanded Abraham to circumcise himself and his household as a covenant. The Greco-Roman courts considered circumcision evidence of Judaism, prompting many Jews to hide their circumcisions and even undergo surgeries to restore the appearance of being uncircumcised. In the 1st century Jewish circumcision was thought to benefit health, cleanliness, and fertility, while reducing pleasure. It was recommended the procedure be performed as early as possible, as it was unlikely to be done by someone’s free will. During the Renaissance, non-Jewish Europeans did not practice male circumcision, and the Catholic Church ordered against it. Although other European countries considered arguments for circumcision unfounded, by the early 1900s English-speaking countries performed the procedure primarily for medical reasons, specifically cleanliness (Encyclopedia Britannica). Regarding religious reasons, the encyclopedia points the reader to “Mutilation” and “Deformation.” Indeed, most developed countries abhor the practice of ‘female circumcision’ (also originating in Ancient Egypt, though now performed mostly in Asia and Africa), primarily due to the lack of patient consent. Currently the major medical societies in the United States, Britain, Canada, Australia and New Zealand do not recommend routine non-therapeutic infant circumcision. Nonetheless, physicians in nearly half of neonatal circumcisions (2006, American Medical Association) “did not discuss the potential medical risks and benefits of elective circumcision prior to delivery. … Deferral of discussion until after birth, [and] the fact that many parents’ decisions about circumcision are preconceived, contribute to the high rate of elective circumcision.” In a 1987 study, most American parents chose circumcision due to “concerns about the attitudes of peers and their sons’ self concept,” rather than medical reasons. Our doctor informed that circumcision had no proven medical benefits, except perhaps for a slightly lower HIV risk in third-world countries with high HIV incidence. Furthermore, an uncircumcised boy was no more difficult to clean, if simply cleaned in the same manner as a circumcised boy. It should come as no surprise that we chose not to circumcise our second son, or that we chose without question to circumcise our first, for that matter. We feel fortunate to have made a conscientious decision this time, and glad for the objective doctor-patient discussion regarding circumcision that our society has apparently finally begun. <a href="http://www.thedurhamnews.com/2010/06/16/202336/the-2nd-time-around.html" rel="noopener" target="_blank">Melissa Rooney, The 2nd time around</a>, The Durham News (North Carolina, USA), 16 June 2010 <h3>See also:</h3> <a href="http://www.restoringtally.com/blog/2010/03/fathers-talk-his-son-about-infant-circumcision" rel="noopener" target="_blank">A circumcised father explains circumcision to his uncircumcised 10-year old son</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource American female circumcision boo-boo ignites calls for equal treatment darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>The case of Boldt v. Boldt</h3> A long-running legal saga in the United States was finally resolved in late 2009, when courts in the state of Oregon ruled that a parent could not compel a child over which he had custody to get circumcised against the boy’s will. The case is of considerable interest in its potential to limit the power of parents to impose circumcision and similar physical alterations on children and in its implicit recognition that children have their own rights – to physical integrity and freedom of conscience and religion – independently of their parents’ belief. <h2>Background: A messy custody case</h2> The Boldt case was a custody battle, and like all custody battles, it was a complex story, but the basic facts are that the Boldts were adherents of the Russian Orthodox Church and had one child, Mikhail James, whom the mother called Misha and the father Jimmy. After a bitter divorce, custody of the boy was eventually given to the father. Some time after this the father decided to convert to Judaism and tried to take Misha (then aged 9) with him, a transition that necessarily entailed arranging for him to be circumcised. The boy’s mother obtained a temporary court injunction prohibiting the circumcision, and filed an application for custody. The father testified that Misha himself wished to convert and undergo the operation, but that even if he did not his wishes were irrelevant because the custodial parent had complete authority to make what he called “medical decisions” for a child. The mother testified that Misha did not want to be circumcised and was afraid to contradict his father. After a lengthy series of hearings and appeals, by which time the boy was 12, the Oregon Supreme Court decided that “although circumcision is an invasive medical procedure that results in permanent alteration of a body part and has attendant medical risks, the decision to have a male child circumcised for medical or religious reasons is one that is commonly and historically made by parents,” and it concluded that the custodial parent’s rights in this respect were not fettered by the views of the non-custodial parent. But because this was a custody, rather than a right to circumcise, case, the court ruled that forcing the boy to get circumcised would damage his relationship with his father, and sent the case back to the trial court to determine the boy’s own views. When Misha, by now aged 14, finally got the opportunity to express his own opinion (at a hearing in judges’ chambers in April 2009) he made it clear that he did not wish to convert to Judaism, and he most definitely did not want to get circumcised or to remain with his father. Accordingly, the court issued an order that he was not to be circumcised and returned him temporarily to his father while child custody officials worked out the details of how to return him to his mother. <h2>Involvement of Doctors Opposing Circumcision</h2> Although the original trial court ruled that a decision to circumcise was a legitimate power of the custodial parent and refused to hold a hearing on the matter, it issued a stay pending the outcome of an appeal by the mother. The Court of Appeal agreed with the trial court and refused to order a hearing, at which point the mother appealed to the Oregon Supreme Court and requested the American human rights group, Doctors Opposing Circumcision, to intervene in the case as amicus curiae (friend of the court – a role performed by those with no personal interest or standing in a case, but who can assist the court through its expertise in the technical questions raised). DOC filed two briefs in the case, one in support of the petition for review, and then, following the Oregon Supreme Court grant of certiorari (the right to appeal), a second brief on the merits. Parental and child rights were considered under the constitutions of Oregon, Washington (the child’s state of residence), the United States, and even a Supreme Court of Canada decision on parental duties under the Canadian Charter of Rights and Freedoms. DOC’s briefs were limited to arguments against circumcision on medical, legal, and human rights grounds, and did not take a position on the issue of custody. These were matched by three influential American Jewish organisations that submitted their own amicus curiae briefs in support of the father’s claim of an unfettered right to circumcise his son. At no point in their submission did they show the slightest sympathy for the plight of the child or show any interest in his preferences in the matter. They and the father claimed an absolute right to circumcise the boy under the “Free Exercise” clause of the First Amendment to the United States Constitution, which bars Congress from establishing any religion or prohibiting the free exercise thereof. Although the Oregon Supreme Court, in obiter dicta (a passing observation, not related to the legal issues that decided the case), paid deference to a custodial parent’s right to make a decision about circumcision, it remanded the case back to the trial court with an order that it should determine the view of the child. The child was then twelve years of age. <h2>Court recognises that child’s preferences must be considered</h2> The father then petitioned the United States Supreme Court for certiorari (right to appeal), which was denied, and the case returned to the Circuit Court of Jackson County, Oregon, where a hearing was held on 22 April 2009, before Judge Lisa Greif. At that time, Misha, now 14 years of age, testified in her chambers, on the record, that he did NOT want to be circumcised, he did NOT want to convert to Judaism, was afraid of his father and wanted to live with his mother. The court then issued an oral order from the bench that the child NOT be circumcised. The court then followed that with a written order on 2 June 2009, in which the court found that a substantial change of circumstances had occurred and ordered an investigation by an independent child custody evaluator for a future evidentiary hearing. In the meantime, the boy remains in the custody of his father, but under protective orders against circumcision. <h2>Significance of the Boldt case</h2> Despite the Oregon Supreme Court’s remark about the decision to circumcise a child being “commonly and historically made by parents”, the case remained a custody battle throughout, and no determination was ever made as to whether parents did in fact have the right to make such a decision, and if so with what qualifications. Since the question does not seem be as settled in law as the court’s confident words suggest, the observation may be regarded as no more than an obiter dictum. In a similar case, a divorced mother having custody of a nine-year-old son remarried, this time to a Jewish man, and sought to have the boy circumcised at the behest of her new husband. The father objected, and when the matter came to court the judge dismissed the mother’s claim of medical necessity and ordered that the boy be protected from circumcision until his 18th birthday, at which point he would be free to make his own decision. (Schmidt vs. Niznick, Cook County Illinois, 00D18272, cited in Doctors’ Opposing Circumcision, Amicus Curiae Brief on Boldt, 26) In denying that the non-custodial parent had no prerogatives with respect to medical decisions about a child, the Oregon Supreme Court certainly did not mean that the child had no say in the matter; indeed, in directing that the trial court discover Misha’s own views it implied quite the contrary. The significance of the case is in establishing a precedent that a parent’s authority to circumcise a child is not unlimited and may not even exist. Although the court took account of the boy’s age (twelve), recognising that it might be difficult to get a boy of that age to lie down submissively in a doctor’s surgery, it is hard to see why the principle of physical integrity would not apply to a child of any age. There is no obvious reasons why a child has the right to physical integrity at 12, but not at 8 years, 4 years, 6 months or 2 weeks. By the age of 12 Misha certainly knew that he wanted to keep his foreskin and was confident enough to make his views heard, and (this being the case) we may reasonably infer that if an infant or young child too young to be capable of expressing an opinion on the matter were able to do so, he would say NO, or at least ask that the operation be delayed until he was old enough to inform himself as to the pros, cons and harms of circumcision and make his own decision. A <a href="https://www.circinfo.org/news.html#chong">recent study in the USA</a> found that even if circumcision were proved to be effective insignificantly lowering the risk of HIV infection, only 0.7 per cent of adult men would be willing to get themselves circumcised. The clear implication is that if an infant or child were asked if he wanted to get circumcised, and he was capable of giving a rational answer, the answer would be “No way.” This alone is a sufficient reason why circumcision should not be imposed on minors. <h2>Age not the issue:</h2> <h3>All humans have autonomy and the right to physical integrity</h3> Some commentators on the Boldt case have suggested that while a 12 or 14-year old might be mature and competent enough to reject circumcision, younger boys and especially babies must just accept whatever their parents think best for them. This position makes no sense at all, for reasons set out clearly in the Canada Medical Association Journal a long time ago: The performance of unnecessary surgery on minors who have no say in the matter does not sit well with many people who consider circumcision a denial of basic human rights specifically an infant’s right to the respect and autonomy fundamental to Canadian law. … Removal of a normally function healthy body part without medical indication has also been viewed as a violation of the Hippocratic oath, falling under the United Nations’ definition of genital mutilation. As such, circumcision is seen as being against the Universal Declaration of Human Rights and the UN Convention on the Rights of the Child. … In BC [British Columbia], the Infants Act stipulates that a child should be accorded the same protection under law as adults: if an adult male cannot be forced to undergo circumcision in adulthood, it follows that he shouldn’t be forced to have it in infancy simply because he is too small to resist. (Eleanor LeBourdais, Circumcision No Longer a “Routine” Surgical Procedure, 152 CANADIAN MED. ASS’N. J. 1873-4 (1995) The fundamental problem with the idea that circumcision of an adult requires informed consent but circumcision of a minor can be accomplished at the wish of a parent is that childhood is a temporary condition but circumcision a permanent one. A person soon ceases to be a child, but no matter how old he gets he will not get back what has been taken away; as an adult the person has the same mark or absence that his parents were entitled to effect by the mere fact of his being a minor. There is thus no significant difference between forcible circumcision of an adult (which is illegal) and circumcision of a minor, since the result in adulthood, when the parts affected are most needed, is the same in each case. To make an adult’s right to physical integrity meaningful it must be respected in infancy and childhood, implying that irreversible bodily alterations should not be performed. By defining respect for autonomy as “requiring that persons with the mental capacity to make certain medical decisions have these decisions respected”, the parental authority school drastically reduces the scope of autonomy and effectively denies it to children and incompetent adults. This is a radical departure from accepted principles of bioethics [1] and a succession of legal judgements in the USA, Britain and Australia [2] that restrict the power of adults to make medical decisions on behalf of incompetent family members. Lack of mental capacity, neither in infancy nor in adulthood, does not negate a person’s right to physical integrity; if parents are determined to violate this right, the state is entitled to intervene in defence of those who lack the capacity to defend their own interests. <h2>Parental authority and the child’s right to an open future</h2> The following principles would also appear to have been endorsed by the outcome of this case. (1) Parental rights are an extension of, and derivative from, parental responsibilities to the child. Parental rights exist as against outsiders or strangers to the family; they are not rights of the parent against or over the child, who is held in trust during his minority. Behind every assertion of a parental ‘right’ must be a discernible concern for the independent co-relative rights and well-being of the child as a separate person and individual in his own right. (2) The child has an independent right to his own religious beliefs or non-beliefs. These rights are stated clearly in the foundation documents of the modern human rights framework: The Universal Declaration of Human Rights; the International Covenant on Civil and Political Rights; and the Convention on the Rights of the Child. These treaties give all people the right to freedom of religion and conscience and to physical integrity, irrespective of age or gender. To mark a child permanently and physically as a member of any religion deprives him of his own right to religious freedom and personal choice. To take an unfamiliar example, many Shiite Muslims believe they have the right to slit their children’s foreheads each year on the festival of Ashura, commemorating the death, by beheading, of their sainted Imam Hussein. [3] Even if performed by a doctor under sterile conditions, it is hard to believe that Western law or custom would accept this practice as an appropriate exercise of the religious freedom of the parent. (3) In his paper “The Children We Abandon: Religious Exemption to Child Welfare and Education Laws as Denials of Equal Protection to Children,” [4] James Dwyer has argued that far too often Anglophone law has abridged the child’s more fundamental rights to health and even life itself, to accommodate mere beliefs, even whims, of the parent. It is to be hoped that the Boldt case marks the beginning of a more child-centred tradition. (4) As argued by the late legal philosopher Joel Feinberg, children have a “right to an open future”, that is, one in which all options for the future development of the child as an adult-to-be are protected and retained. [5] This applies not only to affection, food, shelter, and education, but also to freedom from irrevocable parental choices of which circumcision is a permanent, palpable and entirely unnecessary example. For these reasons and many others, we should make sure that we maintain a sharp focus on the rights of the child as an independent entity distinct from his parents, one whom they hold in trust and cannot treat as property, and who is entitled to human rights of his own, of which the right to a set of intact genitals is surely one of the most fundamental. <h3>Documents relating to the case available here</h3> <a href="http://www.doctorsopposingcircumcision.org/pdf/2007-04BoldtReview.pdf">Doctors Opposing Circumcision, Brief of amicus curiae in support of the petition for review</a> (PDF, 184 kb) <a href="http://www.doctorsopposingcircumcision.org/pdf/2007-07BoldtMerits.pdf">Doctors Opposing Circumcision, Brief on the merits of amicus curiae</a> (PDF, 102 kb) <a href="http://www.doctorsopposingcircumcision.org/info/appeal.html" rel="noopener" target="_blank">Summary of early phases of case at DOC website</a> <a href="https://www.circinfo.org/DOC_Boldt_case.html">Letter from Doctors Opposing Circumcision to Journal of Clinical Ethics</a> <h2>References</h2> 1. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (Oxford University Press, 1977) As set out in this basic text, the fundamental principles of bioethics are: Beneficence — Does the proposed procedure provide a net therapeutic benefit to the patient, considering the risk, pain, and loss of normal function? Non-maleficence — Does the procedure avoid permanently diminishing the patient in any way that could be avoided? Proportionality — Will the final result provide a significant net benefit to the patient in proportion to the risk undertaken and the losses sustained? Justice — Will the patient be treated as fairly as we would all wish to be treated? Autonomy — Lacking life-threatening urgency, will the procedure honor the patient’s right to his or her own likely choice? Could it wait for the patient’s assent? Medically unnecessary circumcision of male minors violates every one of these principles. 2. J.S. Svoboda et al, <a href="http://www.cirp.org/library/legal/conundrum/">Informed consent for neonatal circumcision</a>, esp. 80-81, 87, 89-90; Gregory Boyle et al, <a href="http://www.cirp.org/library/legal/boyle1/">Circumcision of Healthy Boys: Criminal Assault?</a>, 7 J Law Med 301 (2000); Frank Bates, <a href="http://www.cirp.org/library/legal/bates1/">Males, Medical Mutilation and the Law: Some recent Developments</a>, 9 J Law Med 68 (2001) 3. The theory is that young men slash only their own foreheads, but there are plenty of pictures available on the web that show adults doing it to young children: see “Ashura observed with blood streams to mark Karbala tragedy” at <a href="http://www.jafariyanews.com/2k5_news/feb/20ashur.htm">Jafariya News</a> and <a href="http://atlasshrugs2000.typepad.com/atlas_shrugs/2009/01/islam-celebrate.html">Atlas Shrugs</a>. 4. James Dwyer, The Children we Abandon: Religious Exemptions to Child Welfare and Education Laws as Denials of Equal Protection to Children of Religious Objectors, 74 N.C.L. Rev. 1321 5. Joel Feinberg, The Child’s Right to an Open Future, in Freedom and Fulfilment: Philosophical Essays (Princeton University Press, 1992). See also Dena Davis, Genetic Dilemmas: Reproductive Technology, Parental Choices and Children’s Futures (London and New York: Routledge, 2001), and idem, Genetic Dilemmas and the Child's Right to an Open Future, 28 Rutgers Law Journal 549 (1997) </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource American legal precedent confirms child’s right to reject circumcision darby