7 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>What has been the traditional Christian attitude to circumcision?</h3> The readiness with which those eager to fight disease are willing to sacrifice part of the penis is partly an effect of the popular idea that the foreskin is of no importance to any bodily function and thus that its destruction is not really any sacrifice at all. (<a href="http://www.historyofcircumcision.net/quotes.html">For two millennia of contrary evidence, click here</a>. ) This in turn is connected with assertions that the western world has not valued the foreskin and that Christianity has traditionally endorsed or at least had a neutral attitude to circumcision. Although they appear regularly in medical journals and popular articles on circumcision, these claims are false. Until the arrival of Islam in the eighth century, the only Mediterranean, European and Asian societies to practise circumcision were the Jews and the Arabs. The Greeks and the Romans admired the normal male body, and abhorred circumcision so strongly that they made several attempts to ban it. (1) Although Christianity began as a Jewish sect, it soon outgrew its parent, and in the process abandoned and then grew steadily more hostile to the rite. St Paul determined that circumcision was not necessary for converts, and the Church Fathers declared that Christ's sacrifice had removed the need for further shedding of blood; baptism had replaced cutting as the appropriate initiation for members of the church. (2) There was a good deal of controversy at first, St Ambrose observing in the fourth century that "many persons are disturbed over the question ... why circumcision should have been made an obligation under the ruling of the Old Testament, and set aside as useless by the teaching of the New Testament", (3) but by that time the church had passed a law which stated that "Roman citizens who suffer that they themselves or their slaves be circumcised ... are exiled perpetually to an island and their property confiscated; the doctors suffer capital punishment". (4) Thomas Aquinas formally restated the Christian ban on circumcision in the Summa, but the peak of the Catholic Church's opposition was probably reached in the Bull of Union with the Copts (1442) which prohibited circumcision outright and declared that it "cannot possibly be observed without loss of eternal salvation". (5) Even a humanist such as Erasmus, neither a bigot nor an anti-Semite, placed circumcision among the Jewish customs on which "we cry shame". (6) To most Englishmen, circumcision was a threat from which they had been saved by the defeat of Islamic armies. For Edward Gibbon, the prospect that "the Koran would now be taught in the schools of Oxford, and her pulpits might demonstrate to a circumcised people the sanctity and truth of the revelation of Mahomet" was the greatest of the "calamities" from which Charlemagne delivered Europe. (7) In the seventeenth century some servants of the East India Company deserted to the Mughals in the hope of a better career path, and in 1649 a company official sadly reported the defection of one Josiah Blackwell, who "most wickedly and desperately renounced his Christian faith and professed himself a Moor, was immediately circumcised, and is irrecoverably lost". (8) Forced conversions were more common than voluntary, however â€“ the fate of several hundred British soldiers captured after the Battle of Pollilur in 1780, who were circumcised and enslaved by Tipu Sultan of Mysore. One ensign recorded his shame in bitter yet revealing terms: "I lost with the foreskin of my yard all those benefits of a Christian and Englishman which were and ever shall be my greatest glory". (9) The teenage James Bristow and his mates were so distressed at what had been done to them that they caught and circumcised dogs, knowing that this would incense their captors because Moslems regard dogs as unclean. The action brought further punishment, but Bristow felt it justified because "compelling us to undergo an abhorred operation [was] so base and barbarous an act of aggression, that it was impossible to reflect on it with temper". (10) As a Christian country, England had no history of circumcision before the late nineteenth century, but there were strong "Judaizing" tendencies in Puritanism, as fundamentalist radicals turned to the Old Testament in their quest to purge Christianity of its popish accretions. Some of these went so far as to adopt Jewish customs such as Sabbath and dietary observance, and a few even tried to circumcise boys â€“ for which offence a certain Anne Curtyn was gaoled in 1649. (11) These impulses were revived in a number of utopian/millenarian sects which flourished during the turbulence of the Industrial Revolution, including the puritanical followers of John Wroe (1782-1863), one of whose disciples was prosecuted for manslaughter in 1824, after a boy he had circumcised in Bedford died from the wound. (12) Despite these examples of enthusiasm, the overwhelming English attitude was horror, and in Tristram Shandy Lawrence Sterne used a threat of circumcision to titillate his readers' sense of dread, and to emphasise the failings of Shandy senior as a father. (13) In his critique of artificial efforts to improve upon nature, John Bulwer followed the lead of Renaissance anatomists such as da Carpi and Falloppio in condemning circumcision as unnatural and emphasising the role of the foreskin in normal sexual functioning: That part which hangeth over the end of the foreskin, is moved up and down in coition, that in this attrition it might gather more heat, and increase the pleasure of the other sexe; a contentation of which they [the circumcised] are defrauded by this injurious invention. For, the shortnesse of the prepuce is reckoned among the organical defects of the yard, ... yet circumcision detracts somewhat from the delight of women, by lessening their titillation. (14) In her popular midwifery manual Jane Sharp wrote that a few people believed that the "Venerious action" might be performed better without the foreskin, but pointed out that circumcision had been forbidden by St Paul and hoped that no man will be so void of reason and Religion, as to be Circumcised to make trial which of these two opinions is the best; but the world was never without some mad men, who will do anything to be singular: were the foreskin any hindrance to procreation or pleasure, nature had never made it, who made all things for these very ends and purposes. (15) When, in the 1870s, Richard Burton remarked that Christendom "practically holds circumcision in horror", (16) the observation was ceasing to be true, but it was certainly the case before Victorian doctors sought to reconfigure the phallus. How odd that some well-meaning medical researchers today should still be treading in their footsteps. <h3>Further information</h3> CIRP, <a href="http://www.cirp.org/library/cultural/" rel="noopener" target="_blank">Documents on cultural and religious circumcision</a> <a href="http://www.catholicsagainstcircumcision.org/" rel="noopener" target="_blank">Catholics Against Circumcision </a> <h3>Circumcision and the Bible</h3> <a href="http://www.norm-uk.org/circumcision_christian.html" rel="noopener" target="_blank">http://www.norm-uk.org/circumcision_christian.html</a> <h3>References</h3> 1. Hodges, FM. <a href="http://www.cirp.org/library/history/hodges2/" rel="noopener" target="_blank">The ideal prepuce in Ancient Greece and Rome: Male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration and the Kinodesme</a>. Bull Hist Med 2001;75; 375-405 2. Aldeeb Abu-Sahlieh, SA. Male and female circumcision among Jews, Christians and Muslims: Religious, medical, social and legal debate, Warren PA: Shangri-La Publications, 2001 3. St Ambrose, Letters, ed. Mary Beyenka. Washington: Catholic University of America, 1954. (Fathers of the Church, Vol. 26), 90 4. Fleiss P. What your doctor may not tell you about circumcision. New York: Warner Books, 2002, 98 5. Proceedings of the Council of Florence, 1438-1445, New Advent Encyclopaedia, seen at <a href="http://www.ewtn.com/library/councils/Florence.htm" rel="noopener" target="_blank">http://www.ewtn.com/library/councils/Florence.htm</a> 6. Steinberg L. The sexuality of Christ in Renaissance art and in later oblivion, 2nd edition, Chicago: Chicago University Press, 1996, 54 7. Decline and fall of the Roman Empire, chapter 52 8. Dalrymple W. White Mughals: Love and betrayal in eighteenth century India. London: Harper Collins, 2002, 24 9. Colley L. Captives, New York: Pantheon, 2002, 288 10. Lawrence AW (ed.). Captives of Tipu: Survivors' narratives. London: Jonathan Cape, 1929, 35 11. Shapiro J. Shakespeare and the Jews. New York: Columbia University Press, 1996, 25 12. Harrison JFC. The second coming: Popular millenarianism 1780-1850. New Brunswick: Rutgers University Press, 1979, 141-54; Mason M. The making of Victorian sexual attitudes. Oxford: Oxford University Press, 1994, 136-7 13. Darby R. "An oblique and slovenly initiation": The circumcision episode in Tristram Shandy. Eighteenth Century Life 2003;27: 72-84 14. Bulwer, J. Anthropometamorphosis, man transform'd, or the artificial changeling. London: printed for J. Hardesty, 1650, 213-14 15. Sharp J. The midwives book: Or the whole art of midwifery discovered, London 1671, Facsimile reprint, New York: Garland, 1985, 31-2 16. Burton R. Love, war and fancy: The customs and manners of the East from writings on the Arabian Nights, ed. Kenneth Walker, London: William Kimber, 1964, 106 17. Miller G. Circumcision: Cultural-legal analysis. Virginia Journal of Social Policy and the Law 2002;9: 497-585 <h2>Captivity and Captivation: Gullivers in Brobdingnag</h2> Review essay by by Robert Darby Books discussed in this essay Linda Colley. Captives: Britain, Empire and the World, 1600-1850 (London, Jonathan Cape, 2002). Pp. xvii, 438. $27.50. ISBN 0375421521 Daniel Vitkus, ed. Piracy, Slavery and Redemption: Barbary Captivity Narratives from Early Modern England, Introduction by Nabil Matar (New York, Columbia Univ., 2001). Pp xvi, 376. $22.50 paper. ISBN 0231119054 William Dalrymple. White Mughals: Love and Betrayal in Eighteenth-Century India (London, Harper Collins, 2002). Pp xliii, 580. $34.95. ISBN 0670031844 Arthur Conan Doyle. The Tragedy of the Korosko [1898] (London, Hesperus, 2003). Pp x, 121. $12 paper. ISBN 18439039 "You cannot condemn the ways of Europe for not being those of Tahiti, nor our ways for not being those of Europe. You need a more dependable scale of judgment than that. And what shall it be? Do you know a better one than general welfare and individual utility?" -- Denis Diderot, Supplement to Bougainville's Voyage <h4>Introduction</h4> During the seventeenth century and much of the eighteenth three great Islamic empires, each more powerful and far wealthier than any European state, held sway over a vast territory in Asia, the Middle East, North Africa, and parts of south-eastern Europe. The Ottomans controlled the eastern and southern shores of the Mediterranean, the Safavids ruled Persia and parts of what is now Afghanistan, and the Mughals struggled to hold India against recalcitrant Hindu kingdoms and rival Moslem sultanates in the south. In North Africa the regencies of Tripoli, Tunis, and Algiers were formally subject to but increasingly autonomous from the Sublime Porte, while the powerful Sultan of Morocco, controlling the vital Straits of Gibraltar, was fiercely independent and pursued his own course. An important part of the economy of these four regimes derived from plunder of European shipping in the Mediterranean and the Atlantic, and the regimes maintained large corsair fleets for this purpose. Successive Islamic dynasties had been the dominant Middle Eastern power for a thousand years; and although the seventeenth century marked the height of Ottoman expansion and the eighteenth century the beginning of the end, it was not apparent to contemporaries that they were in terminal decline or that defeat outside the walls of Vienna in 1683 or acceptance of the Treaty of Carlowitz in 1699 â€“ which recognized the loss of European territory and acknowledged other powers as equal states â€“ were anything more than temporary setbacks. In the early stages of the Enlightenment radical thinkers such as Spinoza cited the might of Islam and the extent of its dominions as evidence that universal Christianity might not be the world's divinely appointed destiny, and as late as the 1750s Voltaire commented that nothing very positive had emerged from years of constant warfare with the crescent: "The Christian powers have lost a great deal to the Turks within these five centuries [i.e. since the Crusades], and have scarcely gained anything from each other." [1] The seventeenth and eighteenth centuries witnessed a slow shift in the balance of power between East and West, the decline of all the Islamic empires, and the rise of Britain as the world's pre-eminent power â€“ eclipsing the former maritime empires of Spain, Portugal, and Holland, and limiting France to a peripheral role. Between the Ottoman defeat at Vienna and the 1840s, when its decline was so apparent that the Czar could dub it "the sick man of Europe," the stand-off between the European and Moslem worlds was not unlike the Cold War between the West and the Soviet bloc from the late 1940s to the 1980s. The major powers avoided direct conflict, but there was continual confrontation and skirmishing at the periphery, where the great tectonic plates rubbed together; and for two hundred years the major earthquake zones were southern Russia, North Africa, and India. As in the Cold War, defection and imprisonment were prominent features of the interaction between the two systems. The vivid parable with which Linda Colley chooses to illustrate the themes of her absorbing study is not an obvious story of conquest and domination like Robinson Crusoe, but Swift's jaundiced satire Gulliver's Travels, in which the hero is captured, bound and exhibited by tiny Lilliputians, enslaved by gigantic Brobdingnagians, and finally won over by the equine Houyhnhnms, whose natures seem so much more noble than his own that he yearns to become one of them and ends up rejecting his own society. In different ways and to differing degrees one or other of these experiences were those of Colley's captives, Daniel Vitkus' escapees, and William Dalrymple's officers and gentlemen. They languished in prison, toiled for Moslem masters, converted in the hope of improving their lot, escaped to tell the tale of how they remained steadfast to their native country and its faith, deserted to the American Indians to avoid the floggings and brutality of the British army, or fell in love with dusky Mughal beauties and found themselves pawns in a marital intrigue orchestrated by the surprisingly canny women of the zenana. <h4>The Barbary Corsairs</h4> From the late sixteenth century to the early nineteenth, state-sponsored privateers from North African ports preyed on European shipping and even raided coastal villages in England and Ireland, from which they captured men, women, and children for sale in slave markets. Over the centuries tens of thousands of seamen, traders, travelers, and miscellaneous others were sold into slavery, many spending years in captivity before managing to raise a ransom or, less frequently, escape. Some escapees wrote narratives of their ordeals. Many, such as the seven meticulously edited and annotated by Daniel Vitkus, are extraordinary records of cultural interaction, human adaptability, and sheer endurance. Placed in context by Nabil Matar's deeply-researched introduction, the narratives range in style from short summaries telling us about the writer's religious faith and gratitude for deliverance to lengthy and informative accounts of the manners and customs of the Moors â€“ for example, the remarkable memoir by Joseph Pitts, who was probably the first westerner to visit the shrines of Mecca and Medina, and certainly the first known to have survived to tell the tale. Only fifteen when captured at sea in 1678, Pitts spent fifteen years in captivity under a succession of masters, some brutal and some kind, converted to Islam under duress from one of the former sort, was freed from slavery by one of the latter, and eventually managed to escape while on a trip to Smyrna. Even then his misfortunes were not at an end: after a year's struggle getting back to England, he was immediately kidnapped by a press gang for service in the Royal Navy and saved from another stretch of captivity only by the intervention of a local gentleman. Britons might have sung they never would be slaves, but various forms of forced labor remained common in Europe and America until well into the nineteenth century: assignment of convicts in Australia, black slavery in the USA, serfdom in Russia, and impressed service in the British Navy could all be compared with slavery in North Africa â€“not necessarily to the advantage of the West. The galleys of Spain, France, Venice, and Genoa were also manned by slaves. The common British expression "Turning Turk" signified a crossing-over rather like defection to Moscow during the Cold War. Many did so under pressure; but others chose to convert to Islam and work for the Moors out of choice because it improved their lot in life: conditions for the average laborer in war-torn Europe for much of the period were so grim that many chose to remain with their captors because they offered better chances of prosperity and happiness. A surprisingly large number of the privateers who seized European human and material cargo were captained by renegade Christians who found service with the crescent more rewarding than that with the cross. Matar writes that there were as many as 25,000 captives in Morocco around 1700 and suggests that most lived in relatively comfortable conditions and produced a cosmopolitan mingling of cultures showing greater tolerance for religious diversity than in most European centres, and certainly far more relaxed than in places where the Inquisition was still rooting out heresy. Such a benign picture may be a trifle overdrawn, since Christians and Jews, even if not slaves, were second-class citizens in Moslem countries, with restricted civil rights and only limited tolerance. Joseph Pitts commented that Algerian masters rarely forced slaves to convert because it would reduce the likelihood of ransom, but also that turning Turk did not necessarily mean release from bondage, or even better treatment as a slave. The North African states had a heavy demand for skilled labour, particularly gunners, seamen, carpenters, bricklayers, and other builders. To ascertain why they preferred to obtain them by capturing foreigners instead of training locals and why slavery and plunder were such vital parts of the economy is beyond the scope of these studies; but those questions are relevant to the scenario of western advance and Islamic decline. Colley suggests that the demand for foreign workers was generated largely by depopulation arising from repeated epidemics of plague that reduced the population of Algiers from 100,000 in the early seventeenth century to only 40,000 by 1800. This is a dramatic decline, particularly at a time when the populations of most European countries were growing rapidly; but such a desperate collapse might need the operation of other factors, such as economic stagnation, failures in the education system, and chronic political instability. It is interesting to compare the recognizably similar but more complex picture today, when vast numbers of unskilled workers from countries such as Turkey and Algeria are employed in low-level jobs in France and Germany, while such oil rich states as Saudi Arabia fly in expensive westerners to manage oil-extraction and medical care. Perhaps the enslavement of captives was an expedient in the days before immigration and the guest worker. <h4>Forced circumcision</h4> A major sub-theme in the encounters recorded in these texts is the embarrassing fact of male circumcision. Islam was (and remains) the world's largest circumcising culture, while Christianity had demarcated itself from its Judaic parent by decisively rejecting the rite and declaring its belief in the resurrection of the body with all the bits complete and unabridged. Meetings between two such opposed attitudes were sure to provoke sparks, and one of the deepest fears of Christians taken captive by Barbary pirates was that they would be circumcised as part of a forced conversion. Matar remarks that there were cases of forced conversion involving circumcision and that contemporary observers referred to the practice in general terms, but he provides no evidence from eyewitness accounts. Joseph Pitts agreed to convert after repeated beatings, but he does not reveal whether he was subsequently circumcised. He gives the impression that all that needed to be done when converting under compulsion was to make a declaration of faith and that it was only those who went over voluntarily who were required to take part in elaborate initiation ceremonies; but it is possible that the proceedings were so terrible and humiliating for him that he could not bear to refer to them. Vitkus, on the other hand, suggests elsewhere that the fear of circumcision was the result of exaggerated representations in plays and other popular literature, and that "for those who became Muslims in order to join the Barbary pirates, conversion was probably a mere formality," involving little or no obligation of religious practice. Stories of forced circumcision were "a scare tactic designed to discourage potential converts", not an accurate description of what really happened: "Because Christians ... did not practise circumcision ... this feature of Islamic custom was viewed with horror as an atavistic ritual performed by barbarians." [2] In Mughal India, however, a significant number of the thousands of British soldiers taken prisoner after the Battle of Pollilur in 1780 were later forcibly circumcised by Haidar Ali or his son and successor Tipu Sultan; and an unknown number agreed to convert to Islam in the hope of bettering the conditions of their servitude. One horrified officer wrote in his makeshift diary that they were "terribly alarmed this morning for ... [their] foreskin," while another recorded his feelings of shame in bitter terms: "I lost with the foreskin of my yard all those benefits of a Christian and an Englishman which were and ever shall be my greatest glory." Colley makes a rare lapse of cultural empathy in describing this admission as "at once comic, tortured and eloquent," being apparently unaware of the horror with which Europeans regarded circumcision; one cannot imagine her showing such cool detachment were she commenting on the reaction of a victim of clitoridectomy. Elsewhere, however, Colley does appreciate the significance of such a demonstration of raw power by the Sultan, referring to the operation as a "violation", a "mutilation" and "affront to British masculinity." The teenage James Bristow and his mates were so distressed at what had been done to them that they caught dogs and bandicoots and circumcised them, knowing that this would incense their captors because Moslems regard dogs as unclean. The action brought further punishment, but Bristow felt it was justified because "compelling us to undergo an abhorred operation [was] so base and barbarous an act of aggression, that it was impossible to reflect on it with temper." [3] Colley rightly notes that Islam does not mandate circumcision as a requirement of faith and suggests that Tipu probably intended the operation partly as a sign of his absolute control over the bodies of his prisoners and partly as "a mark of new ownership" and "an indelible symbol of these men's incorporation into the Mysore state." Both Colley and Vitkus refer to Freud's absurd claim that people less sophisticated than he confused circumcision with castration; but their own evidence establishes that there was no such confusion in the minds of captives in North Africa or India. In his discussion of eunuchs in Egypt, Joseph Pitts shows that he was perfectly clear on the difference between the two procedures; and it is evident that the Mysore prisoners also knew exactly what circumcision entailed, and that this knowledge explains both why the prospect appalled them yet also why some were willing to submit to it as the price of securing better treatment. Before most of them were executed as British forces advanced to capture Seringapatam in 1799, some four hundred Britons were still working for Tipu as soldiers in slave battalions, weavers of uniforms, or laborers in the royal mint or on roads and fortifications. <h4>Significance of captives</h4> In the sci-fi adventure Planet of the Apes the extra-terrestrials are persuaded that their human prisoners must be rational beings only when they catch a small animal in their enclosure and keep it in a cage, for only a rational being would keep other animals in captivity. But if caging other animals is a sign of rationality, perhaps it is a characteristic of humanity to lock up and observe members of one's own species: homo sapiens is the only species known to take its own kind captive; and if Linda Colley is to be believed, this tendency is a major but neglected factor in world history, having an impact far beyond the walls of any prison. In her stimulating and beautifully written study, Colley re-examines the experience of the British Empire from the perspective of the soldiers and minor officials who did the spadework overseas, great numbers of whom were captured by powerful and often cruel enemies in three significant theatres of cultural interaction â€“ the Mediterranean and North Africa, North America, and India â€“ with a concluding excursion into Afghanistan. Throughout the book she scrutinizes received readings and questions many myths, both imperial and anti-imperial. Far from having been acquired "in a fit of absence of mind," as Sir John Seeley famously ventured at the height of Victorian self-confidence, the Empire and its future was the topic of constant and often anxious debate, with fears of over-stretch, doubts about the future, and nervous memories of the corruption of Rome and the fall of Ninevah and Tyre. The core of truth in Seeley's remark is that the British probably did not set out deliberately to acquire a territorial empire; it was the unintended (though in hindsight inevitable) consequence of rivalry with other European powers for trade and trading posts. Colley emphasizes the military limitations of such a small country, the weakness of its armed forces (especially the army) compared with those of its European rivals, and its limited resources compared with those of many of the regimes in the new territories it sought to influence and then govern. She shows convincingly that the British preference for a policy of divide and rule and of relying on the local populations for military and civil tasks was dictated by sheer necessity: the Empire was acquired and managed on a shoestring budget and with a skeleton staff. The red line, she writes in an arresting image, was often anorexic, and in many places held together by teenage boys who today would be still at school or riding skateboards. <h4>Orientalism</h4> Post-colonialist accounts are also dissected with polite but telling intelligence. Colley acknowledges the seductiveness of the orientalist case, particularly Edward Said's eloquent argument that Europeans have stereotyped Arab and Islamic societies as mysterious, superstitious, backward, feminine, and stagnant, but counters with the observation that European attitudes were quite diverse and changed over time. The principal arena for the Christian encounter with Islam was the Mediterranean, where (until the 1760s) it was strong and Britain weak. The Ottomans had powerful navies and held strategic positions; Britain could not prevent its subjects from being captured and sold into slavery, and did not have the strength to rescue them. Morocco's standing army was many times the size of Britain's. In order to protect its vital bases at Gibraltar and Minorca, her majesty's government paid protection money to the rulers of Algiers and Morocco, and it relied on North Africa to supply food to its garrisons. Thus we see the surprising picture of English slaves in Algiers or Tangier visiting the English consul in those places to try to arrange a ransom and occasionally (though this was dangerous for all concerned) an escape. In the seventeenth and eighteenth centuries it was Europeans who were more likely to be feminised, violated, and penetrated, especially by Moslem captors who sold them into slavery, subjected some of them to circumcision, and occasionally forced them to play the passive role in sexual intercourse. No doubt the Christian picture of the sodomitical Turk was part of a demonizing caricature; but the fondness of Middle Eastern and North African men for white youths, especially if blond, is attested to this day by many a satisfied European and American sex-tourist. [4] As Joseph Pitts noted in the eighteenth century: "men, women and children would flock to see me, and I was much admired for having flaxen hair and being of a ruddy complexion. I heard one of them say, 'Behold! What a pretty maid it is'." It is hard to believe that he did not receive sexual attentions, though he does not mention any in his reticent narrative. Perhaps the most significant long-term contrast between the Christian and Moslem worlds, the importance of which has recently been stressed by several western scholars anxious to make sense of the resurgence of Islamic fundamentalism [5], is that while the West showed a lot of interest in the East, the latter did not reciprocate, or not to the same degree. Where Europeans from the seventeenth century onwards displayed a lively curiosity about Islamic history and culture, established chairs of Arabic studies, travelled East and wrote detailed accounts of what they found, the Ottomans were relatively contemptuous of and indifferent to the infidel world and did not admit that there was much they could learn from it. Joseph Pitts recorded that the pious Algerians he encountered were "ignorant of astronomy and hold it to be a great piece of arrogance and profaneness for any to dive into these things which belong to that science. And they moreover say that no man in the world knows when the new moon is, but God alone knows. And they say that none but Christians will inquire into such hidden and abstruse matters." It is probable that had Pitts been traveling in Europe and meeting pious Christians they would have made much the same sort of comment, and it is possible that he was pandering to a perception of what his English audience wished to hear about Islamic benightedness. In former times Arabic mathematicians and astronomers had been far in advance of their European counterparts, and their sea captains must have known enough about celestial navigation to steer their ships. (Or was the loss of such knowledge a reason why North African rulers sought European sailors?) Islam posed as thorny a dilemma for Western progressives and radicals in the eighteenth century as it does today. Some, stressing its secular strength and the power of its clerics, denounced it as a variety of theological despotism even worse than that found in backward parts of Europe. Others, stressing its spiritual side, admired it as a purified and simple faith, free from idolatry, superstition and priests, more akin to Deism than an organized religion. [6] Today progressive thinkers are similarly divided between those with sympathy for Islamic regimes and movements as the only forces that seem capable of resisting the advance of US-dominated global capitalism, and those who see such forces as both immediately oppressive and threatening a tyranny as bad as Stalin's communism or the nightmare world imagined in Margaret Atwood's Orwellian dystopia, The Handmaid's Tale. <h4>The ambiguities of "otherness"</h4> In her own discussion of such issues, Colley points out that, for the protestant English, the chief "other" was not Islam but Catholicism. The early captivity narratives collected by Vitkus describe far worse cruelty and oppression at the hands of Spanish or Genoese captors, who reportedly tortured Protestant refugees in the hope of forcing them to embrace the true faith, than from Moslem owners in North Africa, who were more interested in getting steady work or a fat ransom out of them. John Locke, in his Letter Concerning Toleration (1685, published 1689) advocated toleration for Jews and Moslems, but probably not for Catholics and certainly not for atheists. [7] The English contempt for poverty, despotism, superstition, and backwardness, so characteristic of eighteenth-century consciousness of nationhood, applied far more often to Catholic Europe, especially Britain's great rivals, France and Spain, than to the Islamic world. For their part, by the 1750s prominent Catholic intellectuals were concerned that Deists and spiriti forti (freethinkers) were greater threats to Christianity than Islam and Judaism combined [7A] â€“ and they were of course right. Belittling Moslem societies was by no means a universal tendency, and there are many examples of a counter trend to hold up the Ottoman or Persian empires as models of enlightenment and good government that Europeans would do well to emulate. Familiar examples include Montesquieu's Persian Letters, Voltaire's Zadig, and Mozart's Abduction from the Seraglio, in which the Pasha turns out to be an exemplar of humanity and justice. Perhaps such comparisons reflect both ignorance of real conditions and the perception, by the late eighteenth century, that the Ottomans were no longer dangerous, or perhaps the tendency for the dissidents of one country to appeal to the example of any enemy of their own rulers when arguing the need for reform; but it would seem that the orientalist caricature of the Islamic world did not emerge until the second half of the nineteenth century, more likely as a reflection of European domination than as a cause of or justification for it. Orientalism began as a genuine curiosity about the cultures and societies of the East and out of the impulse to know more about them â€“ exemplified by scholarly figures such as Sir William Jones, who learned Indian languages and founded the Asiatick Society of Bengal in 1784. The absence of a correspondingly vigorous "Occidentalism" on the part of eastern intellectuals has much to do with the later characterization of oriental societies as incurious and backward-looking, rather like Europe itself in the Dark Ages. It was the more popular works of lower or middlebrow culture that tended to embody the orientalist typecasting in its full colors â€“ the novels of H. Rider Haggard or G. A. Henty, the ambiguous examples of Kipling, or Arthur Conan Doyle's oddly topical story, The Tragedy of the Korosko (1898), recently republished by a small English press. This is a most hackneyed and predictable adventure tale about a party of tourists on a Nile steamer who are kidnapped by "Dervishes" (the Islamic extremists of the 1890s). The villains first intend to hold them for ransom, but this plan is frustrated by transport difficulties in the desert. They then threaten to shoot their captives, but they delay their doom by professing an interest in conversion, which the Mufti traveling with the band is eager to accommodate. The Europeans are soon rescued by a British military detachment in an episode that highlights how far the writing of thrillers has improved in the past hundred years. The most interesting passages of the book, and the only reason to read it (apart from some witty character sketches), are the exchanges concerning international politics between the retired English colonel and "a good natured but argumentative Frenchman" who held the most decided views about the deep machinations of British diplomacy and the illegality of Britain's position in Egypt. French subtlety over the dialectics of imperial reach and military intervention does not seem to have declined over the past century. There is also a remarkably relevant discussion between the colonel and an American about the white man's burden and whether the United States would indeed step in, as the colonel thought it should, to play the civilizing, modernizing, and order-keeping role, normally played by Britain, in regions then beyond the lion's reach. <h4>American War of Independence</h4> Crossing to another hemisphere, Colley's discussion of captivity in North America covers not only the narratives of settlers abducted by Indians, but the experience of all those who fought in the many conflicts among French, Spanish, British, and colonists about who would rule the territories that eventually became the United States and Canada; and Colley adds new dimensions to our understanding of the American War of Independence, particularly the significance of prisoners in the propaganda aspect of that struggle. In the early stages of colonization Indian defeats were related to divisions among the tribes, which allowed British and French forces to ally with one or other against their rivals in a complex play of shifting partnerships that was not possible in the Mediterranean but was pretty much replicated in India. At the same time, the demands of European commitments meant that Britain did not permanently station a large body of troops in America until after the Seven Years War, and they were not intended to assist the settlers in subduing Indians so much as to contain frontier conflict and keep settlers and Indians apart. Lack of funds stymied the plan to send a force of 10,000, and by the 1770s there were only some 4,500 troops to cover the entire vast expanse from Florida to Canada. The British were not racially exclusivist, and their policy of protecting Indian lands in the west annoyed the colonists: as a consequence, in the War of Independence, more support for Britain came from Indians, Negroes, and other racial minorities than from British Americans. Colley has a brilliant and fascinating discussion of the ambiguities of identity in this conflict and the importance of captives in the war of words, particularly the American endeavor to portray the British as cruel and, therefore, foreign â€“ that is, like savage Indians. The war resulted in the taking of thousands of captives by both sides and the birth of the idea that a nation's decency was to be measured by how it treated them. In their propaganda the rebels emphasized British cruelty to prisoners, thus casting doubt upon Britain's credibility among the enlightened circles of Europe and enhancing the justice of the patriot cause. Although rebel treatment of British prisoners was much the same, the British did not want to talk about the suffering of their own POWs because it was humiliating for the imperial mother to admit that so many of her children had been taken. The outcome of these manoeuvres was that, in the West, kind treatment of captives came to be one of the most important criteria by which to judge a nation's fairness in waging a war and, thereby, its civilized status in general. Subsequently, the alarm bells would ring every time a new and non-subscribing military culture was encountered, such as the Japanese in the Second World War, who reacted to European surrenders in much the same way as the Indians had: as a disgraceful abrogation of manliness that deserved punishment. To an Australian, such tales of captivity and escape have a particularly strong resonance. Modern Australia began, in Robert Hughes' provocative expression, as a Gulag for Britain after the loss of its American colonies [8], and the remote and inhospitable land was a prison for convicts and gaolers alike for many years. Rivaling the myth of Australia's noble defeat at Gallipoli, Australia's predominant wartime memories are the stories of captivity (occasionally including escape) from the Pacific War, particularly the ordeal of POWs on the Thailand-Burma railway and as slave laborers for the Japanese in other parts of east Asia. Confirming Colley's insight that the Seven Years War consolidated treatment of prisoners as the western benchmark for assessing how civilized a nation is, Australian attitudes to the Japanese were soured for two generations by the conviction that they had treated the POWs with brutal inhumanity. <h4>Fractured Islam in India</h4> The Christian-Moslem encounter was never a confrontation of pure essences. Even in the Mediterranean, Christians were divided by national and sectarian allegiances and fought as much among themselves as against the Turk; for many Christians, the main enemy could be Catholic, Protestant, atheist, or sceptic. In India these polymorphous and fracturing tendencies were magnified many times over. A traditional polytheism, later codified as Hinduism, held its own locally against Moslem monotheism; but Islam itself was riven by the great Sunni-Shi'ite division, and the Sunni Mughals had no empathy with the Shi'ite heretics to the south. In the eyes of strict Persian purists, Islam as practiced at Hyderabad or Mysore was heavily contaminated by Hindu superstition. One emigre recorded his disgust at the Hindus' blatant joy in sex and at people who removed neither their pubic hair nor the foreskins of their boys, and he was shocked that children of mixed marriages were left to choose their own religion as they matured. From the west came Portuguese and French Catholics and, later, English Protestants, followed in the eighteenth century by British who were scarcely Christian at all, but sceptical adherents of Enlightenment Deism. They held that human nature was pretty much the same everywhere and were open to other cultures, the worth of which they judged pragmatically on the basis of their contribution to individual happiness and social well-being, rather in the utilitarian manner implied by the words of the wise Tahitian in Diderot's Supplement to Bougainville's Voyage (quoted in the epigraph). They disapproved of religious fanaticism and would have agreed with the sort of detachment shown by Edward Gibbon in his celebrated characterization of religious life under the Roman Empire: "The various modes of worship which prevailed in the Roman world were all considered by the people as equally true; by the philosopher as equally false; and by the magistrate as equally useful. And thus toleration produced not only mutual indulgence, but even religious concord." [9] <h4>Europeans in India</h4> Such diversity was pretty close to the situation the early European arrivals encountered in India. They were not conquerors or missionaries, but traders who wanted to make money through exchanges profitable to both parties. The missionaries came later, intent on restoring purity of faith and demarcating believer from non-believer: Jesuit priests intended to keep the Portuguese in line; and British parsons disapproved mightily of the lax, idolatrous, and sometimes polygamous habits of so many East India Company employees. Writing back from Portuguese Goa in 1560, one Jesuit official stated that "the Inquisition is more necessary in these parts than anywhere else, since all the Christians here live together with the Muslims, the Jews and the Hindus, and this causes laxness of conscience. ... Only with the curb of the Inquisition will they lead a good life." In similar vein, an English missionary denounced the "brahminised British" of the 1780s-1820s in his indignant tract, The Government Connection with Idolatry in India (1851): "The chief officers of the Government [sic] belonged to a peculiar class. ... [They] were on the whole an irreligious body of men; who approved of Hinduism much more than Christianity, and favoured the Koran more than the Bible. Some hated Missions from their dread of sedition; and others because their hearts 'seduced by fair idolatresses, had fallen for idols foul'." Among other lessons, the research in Colley's Captives and in William Dalrymple's enthralling saga, White Mughals (from which these revealing quotations are taken), confirms the validity of Jane Jacobs' suggestion that warrior or administrative cultures are characterized by values such as exertion of power, deception, revenge, and respect for hierarchy, tradition, and discipline; while commercial cultures nurture qualities like honesty, voluntary agreements, collaboration with strangers, dissent, respect for contracts, openness to novelty, and rejection of force. [10] Much of British-Indian history from the mid-eighteenth to the mid-nineteenth century might be interpreted as the sad process by which the former syndrome conquered the latter. <h4>Anti-racism of the Enlightenment</h4> Under the influence of the universalist ideals of the Enlightenment â€“ and before the rise of territorial imperialism, evangelical Christianity, and racism in the mid-nineteenth century â€“ there was a blending of cultures in India: British officials of the East India Company adopted local customs, dress, food, and lifestyle and formed sexual liaisons (both solemnized and otherwise) with local women (and sometimes surreptitiously, as Ronald Hyam reminds us, with local men and boys). [11] Many of these were captivated rather than captured by their hosts, like Gulliver by the Houyhnhnms, and "went native" to varying degrees. Before company policy put a stop to the trend, British India was on the road to becoming a Creole society. Some of these went back to England as the atmosphere chilled and made a living by preparing curries for other returned India hands who were homesick for their adopted native land and found England itself a place of exile. India offered two main religious choices for those willing to drift away from Christian certainties. William Gardner married a Moslem princess, and his son a grand daughter of the Emperor Aurungzeb; and although it eventually inherited the Gardner barony, the family elected to remain in the East. Major General Charles Stuart, a somewhat mysterious Irishman who arrived in the 1780s while still a teenager, turned to polytheism, published several defences of Hindu customs and culture and became known as "Hindoo Stuart." He built a temple at Saugor and when he visited Europe took statues of his favourite Hindu gods with him. Other prominent figures who similarly went native were Sir David Ochterlonie, the British resident at Delhi, and General William Palmer, envoy to the Hindu Marathas, who was eventually removed by the Governor-General, Richard Wellesley, for excessive sympathy with the Indians. Another product of this hybrid milieu was James Brooke, born in 1803 to an old EIC family in Bengal. Rejecting EIC employment himself, he pressed further east and became the founder of another cross-cultural political entity, the white rajahs of Sarawak. [12] Many of these characters practiced polygamy, and some accumulated quite large harems in the true style of a local grandee. One EIC employee was believed to have no fewer than sixteen concubines; when asked what he did with them all, he replied: "Oh, I just give them a little rice and let them run around". So much for the mystique of the seraglio. As this easy-going mood gave way to the conservative reaction against the French Revolution, the imposition of puritan views on sex, an evangelical style of Christianity, and an ethnocentric view of British superiority, so British policy in India underwent a decisive transformation. From operating as a commercial enterprise with only a limited and incidental interest in the acquisition of territory, the EIC became a major political force with a large army at its command (staffed mostly by native Indians, as Colley stresses), and determined to rule as well as trade. David Ochterlonie registered the changing mood around 1800, not using a term like racism, but regretting the sudden appearance of "ill nature" and "illiberal prejudices" among senior British officials. As Governor-General, Wellesley was committed to eliminating the presence of the French, whom he suspected of radical, republican, and Jacobin sympathies; what sealed Tipu's fate was not his treatment of British captives, but his alliance with revolutionary France, Britain's major antagonist after 1790, and especially following Napoleon's conquest of Egypt in 1798, from where an invasion to liberate India was feared. <h4>James Kirkpatrick, white Mughal</h4> Caught up in and exemplifying this momentous transformation, with its implications for every aspect of British-Indian life, from strategic policy to dinner parties, were James Achilles Kirkpatrick, EIC envoy to the Nizam of Hyderabad from 1798 to 1805, and his secret bride Khair un-Nissa, youngest daughter of an important aristocratic family connected with the court. British concern at the possibility that Kirkpatrick had "turned Turk" (he had reportedly embraced Islam in order to marry Khair in accordance with Moslem forms) was heightened by alarm at the large number of Tipu's captives who had gone over to his side. Whose interests would Kirkpatrick serve? William Dalrymple's engrossing account of Kirkpatrick's life offers many pleasures, including the genealogical complexity of the Wars of the Roses, the dynastic intrigues of Salman Rushdie's Shame, and two star-crossed lovers torn apart by mistrust between their respective societies and more particularly, by the angry, jealous, and exclusivist males of Khair's family and the EIC executive. A moving personal story is firmly situated within the context of the grand commercial and increasingly territorial aspirations of the EIC, encompassing a panorama of princes, begums, zenanas, female power, money, riches beyond belief, colorful ceremonies, landscapes, cities, gardens, architecture, portraits, affection, fraternal rivalries and jealousy, as well as love, birth, death â€“ and even taxes. It is a story as teeming with detail as the streets of India itself. The scholarship is impressive throughout, and the author has made use of materials in Indian languages not often consulted by Western scholars; he has also translated local and contemporary accounts that offer crucial details or telling insights, has used hitherto unexamined letters from women, and speculated intelligently in places where the evidence peters out. As an aesthetic bonus the book is beautifully illustrated and is written in a style accessible to the general reader. One of the most interesting themes to emerge from the narrative is the remarkable initiative of yet another class of captives, this time native ones â€“ the women of Baqar Ali Khan's zenana. The eagerness and skill with which Khair un-Nissa's mother and grandmother plotted to defeat the schemes of the family males and link up with the rising British power show a high degree of dissatisfaction with Persian/Islamic patriarchy and a shrewd awareness that better hopes for prosperity and greater freedom lay with the newcomers. At a broader level it indicates both the rigidity and flexibility of Mughal culture and the greater adaptability of the British before the Enlightenment idea of a universal human nature was replaced by the racist categories characteristic of the imperial high noon. The religious scepticism of the period encouraged people like Kirkpatrick to regard Islam as no more false than Christianity; to marry Khair he would probably have embraced any religion at all, even Catholicism. For her part, Khair always stressed that she had fallen in love with the handsome officer from the moment she glimpsed him from behind the curtain, but the marriage offered significant material advantages as well â€“ rescue from the unattractive cousin her grandfather wanted her to marry, avoidance of a bossy mother-in-law, the security of monogamy, greater opportunities for her children, and an escape from purdah. Although Kirkpatrick built her a pavilion in the garden of the magnificent official residence he erected in Hyderabad, there is no question that she was free to go where she pleased: indeed, after his death she travelled and took a lover in a manner sharply at variance with the customs of her people. In the context of captivity and escape narratives, Khair might be seen as engineering her escape from the prison of Islamic patriarchy, her very own Entfuhrung aus dem Serail. The sad melodrama of James Kirkpatrick and Khair un-Nissa strikingly illustrates Richard Dawkins' argument that the human body is like a vehicle by which DNA achieves its desire to travel and mingle. [13] We are all mongrels, both genetically and culturally, and the more we mix our genes and memes (Dawkins' word for transmissible cultural constructs) and in the process modify our phenotype and social practices, the healthier and more interesting we become. Against this inexorable process stand the identity commissars, with their obsession with various forms of purity, whether racial, religious, cultural, social, or familial: the Jesuits of the Inquisition who condemned (and terrorized) the Portuguese traders at Goa, the British evangelicals who deplored the adoption of Indian dress and customs, the official who demolished the pavilion Kirkpatrick built for Khair because it smacked of "native immorality," the Islamic clerics who urged the faithful to avoid contact with the infidel, and the jealous males of Khair's family who wailed that their honor had been besmirched and their religion insulted and who seized her property and warned that she would be killed if she returned home. Khair's mother cursed religious distinctions and prayed that people could be free to follow the inclination of their hearts; as she explained to Dr. Kennedy, who had been sent to investigate rumors of the affair: "I wish he [Kirkpatrick] had her in the same manner as he might have had her before the Distinctions introduced by Moosa [Moses], Issa [Jesus] and Mahomed were known in the world." In recognizing that such ideological distinctions had little to do with the health and happiness of flesh-and-blood beings, this closeted eighteenth-century Mughal woman was far ahead of her time. <h3>Notes</h3> 1. "Essay on the Manners and Spirit of Nations", 1754, in Isaac Kramnick, ed., The Portable Enlightenment Reader (New York: Penguin, 1995), p. 370. 2. Daniel Vitkus, ed., Three Turk Plays from Early Modern England (New York: Columbia University Press, 1999), p. 5. 3. "The Narrative of James Bristow, Private in the Bengal Artillery", in A. W. Lawrence, ed., Captives of Tipu: Survivors Narratives (London: Cape, 1929), p. 35. 4. For a calm survey of the issue, see Rudi C. Bleys, The Geography of Perversion: Male-to-male Sexual Behaviour and the Ethnographic Imagination, 1750-1918 (London: Cassell, 1996). 5. Such as Bernard Lewis, What Went Wrong? Western Impact and Middle Eastern Response (New York: Oxford University Press, 2002). 6. Jonathan Israel, Radical Enlightenment: Philosophy and the Making of Modernity, 1650-1750 (Oxford University Press, 2001), pp. 702-03. 7. "A Letter Concerning Toleration," in David Wootton, ed., John Locke: Political Writings (London: Penguin, 1993), pp. 390-436, esp. pp. 426, 431. 7a. Israel, p. 681 8. The Fatal Shore: A History of the Transportation of Convicts to Australia, 1787-1868 (London: Harper Collins, 1987). 9. The Decline and Fall of the Roman Empire, Chap. 2., p. 165. 10. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics (London: Hodder and Stoughton, 1993), pp. 23-24. Jacobs identifies two sets of values, which she calls the "guardian syndrome" and the "commercial syndrome." 11. Empire and Sexuality: The British Experience (Manchester University Press, 1990), pp. 126-33. 12. J.H. Walker, Power and Prowess: The Origins of Brooke Kingship in Sarawak (Sydney: Allen & Unwin in association with the University of Hawaii Press, 2002), esp. p. 30. 13. The Selfish Gene (Oxford University Press, 1976). SOURCE: Robert Darby, "Captivity and Captivation: Gullivers in Brobdingnag", Eighteenth Century Life, Vol. 27, Fall 2003 </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 Christian attitudes to circumcision 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>Russian immigrant to the United States bitterly regrets decision to get circumcised</h3> The following letter was sent to the History of Circumcision site by a Russian immigrant to the United States who agreed to get circumcised when he was in his mid-20s. As he reports in telling detail, it was the biggest mistake of his life. I’m a 24-year-old man, originally from the former Soviet Union (Ukraine), where circumcision was not practiced (and was discouraged for that matter). When I was a toddler, I had a severe case of phimosis. My mother asked Soviet surgeons to remove my foreskin to cure the condition, but they refused, insisting on topical treatments. Eventually, treatments helped. And so the foreskin stayed. At the age of seven, I attended one of the first Jewish schools in Ukraine. My mother would get visits from Rabbis insisting that I undergo the surgery and offering a myriad of reasons why: health, spirituality, heritage, everyone in the almighty United States of America does it, etc. My mom did not want to aimlessly hurt me and the foreskin survived again. We emigrated to the USA and I came to New York City at the age of 11 and went to a Jewish school again, but being raised in an academic family, I gave little heed to religious dogma and never practiced or cared about religion or anything unscientific. High School ended and I went to college. It was a technical school where social life was limp, but I still manage to date some cute girls and sex was amazing. To summarize, a good orgasm was “AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!” Continuous, prolonged scream, followed by an “all body” sensation that tickled and sent “waves” all over me, leaving me “high” for a while afterward. For a similar orgasmic account, see this testimony at notjustskin.org. [NB: while the notjustskin.org URL still functions this is not the same website anymore] College passed, and a few traumatic events happened in my family (funeral). I missed an entrance examination deadline and had to wait a year to reapply. That left me with a lot of free time. I live in an Orthodox Jewish neighborhood, and one day I randomly decided to attend morning synagogue services (out of boredom, I guess). One thing led to another and before I knew it, I was suddenly going about wearing a head-covering, keeping Sabbath and all other laws. I met a nice, charismatic Rabbi who befriended me and I became a frequent family guest at his house for Sabbath and holidays. I also went to Israel and read a bunch of literature aimed at reconciling religion and science, which appealed to me. I fell in love and dated a Jewish girl from a similar background and after she broke up with me, I experienced such intense anguish and grief that in my depressed mind began attributing it to guilt, sin, Divine retribution and a bunch of similar reasons that my pain-stricken brain went through. [1] As a result, I started getting curious about the most fundamental ritual in Judaism -- circumcision. The Rabbis explained it to be the most fundamental and sacred commandment that shows that one has a covenant with G-d. In my foolishness, I had shared with my Rabbi that I was uncut and the brainwashing had begun. His point was that despite being such mark of the covenant, circumcision puts a “stamp” on “that which can take control over us.” In other words, it’s a symbolic “lock” that we put our animalistic desires unto and learn to channel them in a directed way (only in marriage). Judaism as a whole is aimed at making a “soldier” out of a person, and many people would agree that strict discipline in life often leads to more pleasure than chaotic life of disorderly regime. I’m not mocking that explanation because Judaism is indeed concerned with sexual pleasure, and the Rabbis have many books written on how husband and wife ought to bring each other to ecstasy. Judaism also has marital purity laws where the husband and wife separate for about a week and a half during menstrual cycle. The point is that couples live as friends for some time and the break allows them to renew sexual hunger for each other and decrease desensitization. Furthermore, a lot of emphasis is placed (written since ancient literature) on making sure a woman has an orgasm (talk about modern society finding out what a clitoris is not so long ago). “Look at an average religious woman,“ my Rabbi would say. “Does anyone look dissatisfied? Does anyone need to find tips in Cosmopolitan about 39 orgasmic tricks? They are more satisfied than secular people who get desensitized with everything, especially through porn.” All of these contemplations appealed to me in terms of living according to religion. While researchers have a disagreement as to whether it’s true, indeed I have personally noticed that modern secular world seems to make so much emphasis on sex and exposure that people could get desensitized easily. Speaking from experience, porn would often desensitize me to real women to the point of having serious quarrels with ex-girlfriends. (For an interesting book discouraging pornography, see I Love Female Orgasm, By Dorian Solot and Marshall Miller). I looked at many anti-circumcision websites, but most of them pointed to no more than “decreased sensitivity.” That definition seemed ambiguous and suggested that it related to sensitivity experienced while thrusting. Who cares, I thought. Condoms diminish sensitivity, but the orgasm is what counts! I spoke to some Russian buddies at a local synagogue who got circumcised as adults, and they favored that explanation. “Yes sensitivity decreases but it won’t hurt either you or her,“ said one. “Idiot, you last longer. What are you waiting for? Go do it!” I also understood that the sliding function would be gone. In a chat with a law school roommate, he once asked me, “Have you heard about this new lube? It lets you bang her in the breasts for a while, and it won’t hurt one bit!” “Oh yeah? I don’t need to use lube and have never even understood why it’s selling, aside from using it on girls to help with vaginal lubrication,” I replied. I also told him that I had never fully understood a famous American expression “Get your dick wet”, as natural men have normally moist organs all the time. However, that must not have stuck in my head enough. My roommate (who is not religious) replied, “Well dude, but circ is something millions of Americans do. Does anyone seem unhappy?” Why I never capitalized on the point that it’s only because they don’t know the difference, I don’t know. Another factor that got me off-track were these two pro-circ websites: www.circumcisioninfo.com and www.circlist.com. These sites have many alleged reports from men who claim to have experienced an increase in sexual pleasure following circumcision. There are many more anti-circ sites out there with negative reports, but in the mind of a confused, semi-brainwashed person, they did enough to turn the tide to the dark side. Such contemplations finally moved me to do the unreasonable and remove my foreskin. I remember worrying too much about pain, but that was needless. An experienced Jewish surgeon (called mohel) performed everything painlessly, and the wounds healed fast. A big feast was thrown in my honor, and I have become a “hero” in the community; in fact, I’m still proclaimed as such every time someone from my community gets a chance to introduce me to another person, especially a famous Rabbi. Yet, no praise in the world can cure the scar of losing that which I’ve dreamed about since Bar Mitzvah: Powerful Orgasm. To cut my long story short (no pun intended), orgasm decreased tremendously. The continuous “AHHHHHHHHHHHHHHH!” described above turned into “ah ah ah” at most. Masturbation (which I’m not a fan of for personal/desensitization reasons, but I realize many people like it) lost pleasure altogether. Barely a sound comes out. Ejaculatory force decreased, with the loss of the previously powerful, propelling Orgasm, and indeed the penis is dry and uncomfortable. It’s been a year now, and I can’t wear boxers because it hurts when my uncovered head rubs against clothing. I bought the Manhood protection device, and it does help somewhat. I realize that soon my head will lose all sensation and it won’t hurt anymore, but that’s not consoling one little bit. My grandfather once told me a story about how they used to train them to ride horses without a saddle before World War 2, which hurt a lot and after a while, a layer grew on buttocks that made such riding painless. That’s what eventually happens to cut penises. Everyone always made an argument to me that it doesn’t matter much for women, and they’re (thankfully) not dissatisfied. But as beautiful and wonderful it is that some women like uncut men and experience great pleasure regardless, no one thinks enough about whether the man is satisfied. Even in (American) porn, a woman is the sexual moaning creature that gets “out of this world” multiple orgasms, while a man is someone who just needs to “get off”, release, and go home. That may be so, and the foreskin alone doesn’t get a man to have multiple orgasms; but as far as INTENSITY is concerned, I used to scream and get such a reaction that made my girlfriends (none of whom had ever experienced a natural man) wonder whether “I’m OK”, and “how did I get to have such a powerful reactions that made me keep on moaning with closed eyes after ejaculating”? My only solace now is that had never experienced unprotected sex before and hopefully, at least that new experience would compensate for the loss, though I’m expecting it to be worse than natural sex with a condom as far as orgasm is concerned. Also, it would always keep me wondering what it would feel like to have had natural unprotected sex, as I had always dreamed. Ironically, all the best research came to me when it was too late, such as this short documentary video by Ari Libsker and the history of circumcision website. [NB: the history of circumcision website referenced was one of Robert Darby's websites, the content of which is now accessible in this archive] If you’re an adult considering circumcision, THINK AGAIN! As the Russian saying goes, “You’ll be biting your elbows,” meaning you’ll be making an irreversible mistake that you could regret for the rest of your life. Please contact me if you have any questions: <a class="__cf_email__" data-cfemail="4605333207350722332a3206212b272f2a6825292b" href="/cdn-cgi/l/email-protection">[email protected]</a> Note: I never grew up as one of those popular teenage boys who are successful with girls and used to get overly emotionally attached to whatever relationship I would acquire -- thousands of “socially inept” men (inspired by some best-selling motivational authors like Neil Strauss ) have formed a vast online “seduction” community where men share tips/strategies on how to become natural at attracting ladies - e.g. www.fastseduction.com. It would have paid better to spend the time and effort improving my “game” rather than falling into religion. </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 Circumcised as adult: One man's account 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"> Circumcision is not appropriate for 21st Century Aussie boys. A definitive article in Australia’s leading child health journal confirms the judgement of Australian paediatricians since 1971 that boys should not be routinely circumcised as a health precaution. In a rebuff to the <a href="https://www.darboninstitute.org/child_health_experts_ridicule_american_circumcision_policy_statement" rel="noopener" target="_blank">American Academy of Pediatrics</a> (and by extension the <a href="https://www.darboninstitute.org/centers_for_disease_control_and_male_circumcision_americans_out_of_touch_and_living_in_the_past" rel="noopener" target="_blank">Centers for Disease Control</a>, which repeats its errors) the article endorses the conclusion of the circumcision policy statement issued by the Royal Australasian College of Physicians in 2010, namely, that there is no medical warrant for routine circumcision in the Australian and New Zealand context. The paper, by leading Australian child health authorities, runs through the reasons traditionally cited for non-therapeutic circumcision of infants and finds none of them convincing or sufficient. They particularly reject the common argument that circumcision should be performed in order to reduce the risk of HIV infection. Although there is evidence that circumcision can reduce the risk of disease transmission during unprotected intercourse with an infected female partner, all of it comes from studies of adult circumcision in under-developed African countries with both very high HIV prevalence and social and epidemiological conditions quite different from those in Australia. As the authors point out “Although most of the research on circumcision have sound scientific basis, its findings are usually only applicable to the specific socio-cultural context in which the study was conducted”, and they warn that too many authors “tend to prematurely extrapolate the data in an attempt to set national and international standards.” (Brian Morris: are you listening?) The authors also raise important questions of bioethics and human rights, pointing out that while adult males can give autonomous consent to circumcision for any reason, “it is difficult to argue the same ethical principles for infants.” While parents have “legal rights to consent for a medical procedure if it is in the child’s best interest,” it is difficult to justify circumcision “as being in the best interest of the infant when most uncircumcised Australian adult males themselves … are reluctant to undergo adult circumcision?” In other words, circumcision fails the imputed judgement test and violates the child’s right to a open future. The upshot is that paediatricians should seek to discourage parents from having their boys circumcised, as was the case back in the 1980s. Very few boys are circumcised these days, and the incidence is declining, meaning that the old, silly argument about “looking like his father” is no longer relevant. Quite the contrary: “as fewer children are being circumcised, parents’ priorities might have changed from making the boy to look like his father to allowing the boy to look more like the other uncircumcised boys at school.” The authors conclude that “although there is a benefit of circumcision in those with urogenital tract anomalies, in a healthy newborn, the disease in the foreskin is non-existent.” Taking into account the lack of significant medical benefits, risk of complications, the harms of foreskin loss, and the financial cost, routine circumcision in Australia “cannot be justified. From medical point of view, the ‘price’ is still too high.” Source: Angelika F. Na, Sharman P.T. Tanny and John M. Hutson. <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12825/full" rel="noopener" target="_blank">Circumcision: Is it worth it for 21st-century Australian boys?</a> Journal of Paediatrics and Child Health. Advance access, 12 February 2015. </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 Circumcision “not worth it” for Aussie 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"> <h2>Circumcision always painful for babies</h2> Circumcision is “one of the most painful procedures a baby can undergo”, and no fully effective anaesthetic method has yet been devised. This is the disturbing conclusion of a paper in the Italian Journal of Pediatrics, which examines the various circumcision and anaesthetic techniques in use and finds none of them satisfactory. The authors note that although “relief of human suffering is one of the most important goals for health care providers”, there have been only half-hearted efforts to eliminate the pain of circumcision, partly because the operation originated as a cultural ritual in which endurance of intense pain was part of the rationale. “Unfortunately, even during clinical trials, babies still undergo circumcision without analgesia, and the continuous production of studies for a better analgesia is the sign that a gold standard has not yet been found”, they write. The authors found that the Mogen clamp was less painful than both the Gomco clamp and the Plastibell, though seem to be unaware that the Mogen caused such a high incidence of additional injuries that a series of lawsuits drove the company out of business. It is increasingly common these days for boys to be given a local anaesthetic with a needle, but if the evidence of <a href="https://www.youtube.com/watch?v=VRPv4ryPiTU" rel="noopener" target="_blank">many Youtube videos</a> is to be believed, the needle is itself extremely painful and often causes bleeding. EMLA cream, much vaunted by Australian circumcision salesmen, is neither effective nor recommended for use on young babies. As the authors of the present study conclude, “more research is required to find a better analgesic approach, in order to make circumcision a totally painless procedure without stress or discomfort. Present methods do not yet guarantee a total analgesia during this procedure.” Source: Bellieni CV et al. <a href="http://www.ijponline.net/content/39/1/38" rel="noopener" target="_blank">Analgesia for infants’ circumcision</a>. Italian Journal of Pediatrics 2013 39:38. </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 Circumcision always painful for babies 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>Despite what the circumcision promoters claim, prevention of masturbation was a principal reason for the introduction of male circumcision in Victorian Britain and America. Circumcision of male infants and boys cannot be understood except in relation to the 19th century anti-masturbation crusade.</h3> In 1895 a leading American medical journal published an article by a prominent MD who asserted that in all cases of masturbation: circumcision is undoubtedly the physician’s closest friend and ally, offering as it does a certain means of alleviation and pronounced benefit …. Those cases in which the glans presents a moist, semi-oily appearance … long thickened foreskin, pliant and giving, large and often tortuous dorsal veins, go to make up a picture that is exceedingly tempting to the surgeon’s scissors. … To obtain the best results one must cut away enough skin and mucous membrane to rather put it on a stretch when erections come later. There must be no play in the skin after the wound has thoroughly healed, but it must fit tightly over the penis, for should there be any play the patient will be found readily to resume his practice, not begrudging the time and extra energy needed to produce the orgasm. It is true, however, that the longer it takes to have an orgasm, the less frequently it will be attempted, and consequently the greater the benefit gained.” Edgar Spratling, “Masturbation in the adult”, Medical Record 48, 28 September 1895, 442-3 The importance of articles such as this one by Dr Spratling – one of hundreds along these lines – is that they demonstrate beyond reasonable doubt that prevention of juvenile sexual activity (masturbation and other forms of pleasurable touching and manipulation) was a primary reason for the introduction of circumcision in the second half of the nineteenth century and one of the main advantages that doctors cited when selling the surgery to parents. They also show just how avidly surgeons such as this one relished the thought of taking a pair of scissors to other men’s penises; all that luxuriant overhang was just begging to be trimmed into insignificance. Despite the overwhelming evidence – hundreds of articles in medical journals and baby and child care manuals from the 1860s until the 1930s – prominent figures in today’s pro-circumcision lobby refused to accept the truth and insist that the claim is a mere invention or falsehood of the so-called anti-circumcision movement. Typical of their approach is (1) to cite the one or two articles or textbooks that appear to agree with their position and ignore the dozens that do not; and (2) to gloss over the careful distinctions made by genuine scholars. They also claim that modern studies of sexual behaviour (such a surveys by <a href="http://www.cirp.org/library/general/richters1/">Richters et al in Australia</a> and <a href="http://www.cirp.org/library/general/laumann/">Laumann in the United States</a>) do not find much difference in the incidence of masturbation between cut and uncut adults. Both of these responses are unscholarly, irresponsible and evasive of the three crucial issues. <h2>Circumcision and masturbation: The real issues</h2> Frequency: The real issue is not whether sexually mature circumcised men masturbate less than uncut men, but whether cut men have to work harder and get less pleasure from masturbation than uncut men. This was the finding of <a href="http://www.cirp.org/library/sex_function/kim2006/">Kim and Pang’s study of Korean men</a>, and it is also a common statement in <a href="https://www.circinfo.org/account.html">personal testimony</a>. Children: For the Victorians, the issue was not whether circumcised men masturbated less than men with foreskins, but whether circumcision could reduce the incidence of masturbation among infants, children and adolescents (when it was regarded as particularly dangerous, since they were supposed to need all their energy for growth). Adult men were presumed to be satisfied by their wives, mistresses and prostitutes. Fact or belief? In relation to the Victorians, the issue is not whether circumcision actually did reduce the incidence of masturbation among children and adolescents, but whether doctors believed that it did, and whether they acted on that belief. On these points the evidence is overwhelming that the majority of the medical profession up until the 1930s did believe that circumcision reduced the frequency of masturbation in childhood and that they did act upon it by advocating and performing widespread circumcision. They did not carry out any quantitative surveys (<a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=38&Itemid=51">Jonathan Hutchinson</a> explained that the subject was too distasteful), but there is any amount of comment from clinical observation in British and US medical journals from the 1860s until the 1940s, all assuming that masturbation was a bad thing and that circumcision could help to limit it. These questions are discussed in great detail and with massive reference to contemporary sources in the only scholarly studies of the history of circumcision, published by leading university presses after a rigorous process of peer review: <ul> <li>Robert Darby, A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (Chicago University Press, 2005)</li> <li>Leonard Glick, Marked in your Flesh: Circumcision from Ancient Judea to Modern America (Oxford University Press, 2005).</li> </ul> Both scholars establish beyond any shadow of doubt that discouragement of masturbation among children and adolescents was one of the three prime motivations for circumcision from the 1860s until the 1910s (the other two being protection against syphilis and prevention of “congenital phimosis”), and a significant motivation until the 1930s (and in the case of the USA, until the 1950s). Professor Brian Morris is fond of referring to the “avalanche of evidence” as to the health benefits of circumcision; in the nineteenth century and up to the 1930s much of that avalanche was made up of claims for the effectiveness of circumcision against the scourge of masturbation. The studies by Richters and Laumann are not relevant to this question because they deal with the behaviour of adults and cover only the frequency of masturbation. They ignore the far more important question question of whether uncut men get more pleasure from the activity: libido (driven by testosterone) and psychology can explain the frequency of sexual activity such masturbation, but more frequent masturbation does not mean that the activity is more pleasurable or rewarding, merely that the person is feeling horny. As to methodology, both studies rely on self-reporting (in Richters case, from telephone interviews), meaning that this evidence is of the sort that circumcision promoters such as Brian Morris contemptuously dismiss as “anecdotal” (equals unreliable) if it runs against them. If they are willing to accept the validity of these figures arising from anecdotal evidence, they should also be willing to accept the personal testimony of men who say that circumcision has reduced the pleasure they get from masturbation and other forms of sex. Neither Richters nor Laumann gives the circumcision lobby much joy on their central contention, however, that uncircumcised men are far more liable to STDs; on the contrary, Richters found little difference in the incidence of both STDs and HIV-AIDS between cut and uncut men, <a href="https://www.circinfo.org/newsindepth.html#nsu">and in a later study</a> actually found that circumcised men were more vulnerable to some STIs. Laumann actually found STDs more common among the circumcised. The fact that circumcision as a remedy for masturbation was not mentioned in absolutely every medical text from the period proves nothing. Nobody has suggested that the contention was universal, merely that is was very common and very much part of the mainstream. The fact that some medical texts of the period did not discuss circumcision must be set against the fact that dozens of others – in fact, the majority – made much of it. This is what is known as weighing all the evidence: something that circumcision enthusiasts seem notoriously unable to do. <h3>Circumcision as pornography</h3> Among the texts the circumcision lobby cite as a reliable survey of circumcision practice that rejects the circumcision-to control-masturbation connection is a book published in the 1930s, Felix Bryk’s Circumcision in Man and Woman. This is certainly not a “major” text, if “major” is intended to mean intellectually respectable. Bryk was merely an amateur anthropologist, and the book was published by the American Ethnological Press, a far from respectable publisher, belonging to that class of publishers that liked to dress up soft core pornography as ethnological research so as to get it past the censor. The book is as much fantasy as research, but even Bryk (whatever his own opinion) quotes sources that do claim that a major motivation for circumcision was to reduce sexual pleasure. (See quotation from Nuri Bey Risa on <a href="https://www.circinfo.org/quote.html">the Quotes page</a>.) Another of Bryk’s efforts along these lines was Voodoo-Eros: Ethnological Studies in the Sex Life of the African Aborigines, published by the United Book Guild in an edition “limited to 500 copies sold only by subscription to physicians and adult students of sexology and anthropology”. Highbrow pornography, in other words. Bryk’s book on circumcision is actually less reliable than the notorious History of Circumcision (1891) by <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=62&Itemid=48">Peter Charles Remondino</a>, a fully qualified physician and a somewhat more serious researcher than Bryk. Professor Morris and friends fail to mention this book because Remondino was both an equally fanatical crusader for universal circumcision and a firm believer that one of the most important reasons for circumcision was that it would reduce the incidence of masturbation. He was sure that the prepuce was the most frequent cause of onanism and quoted the opinion of Dr Bernheim, surgeon to the Jewish community in Paris, that the irritation “it produces through the sebaceous secretion is a frequent cause of masturbation which nothing short of circumcision will remedy” (p. 225). The origins of ritual circumcision lay in the desire of ancient Judaic lawgivers first to discourage the idolatrous debaucheries practised among their free-spirited neighbours in the Middle East, and masturbation specifically; and secondly to encourage procreation. Referring to the story of the circumcision of Abraham and the impregnation of Sarah, he writes: “Here we have suggestions of a preventive to onanism, and a cure to male impotence when due to preputial interference” (p. 201). For that very reason, Remondino was convinced that universal male circumcision was a bio-medical imperative for the twentieth century. A stormy blast against "<a href="http://www.historyofcircumcision.net/index.php?option=content&task=view&id=75">the opponents of circumcision</a>" from Dr Remondino in 1902 shows that anti-foreskin activists were just as dogmatic and intolerant of criticism then as their counterparts today. Turning to the sources that the circumcision lobby always ignores, the most important are: <ul> <li>Robert Darby, A Surgical Temptation, especially chapter 9, but including many other references to the circumcision-masturbation nexus throughout</li> <li>Leonard Glick, Marked in Your Flesh, chapter 6</li> <li>David Gollaher, Circumcision: A History of the World's Most Controversial Surgery (NY: Basic Books 2000).</li> <li>Robert Darby, “The masturbation taboo and the rise of routine circumcision”, Journal of Social History, Vol. 36, Spring 2003.</li> </ul> This is a peer reviewed article on precisely this subject in a leading social history journal, and (as well as citing numerous contemporary authorities, such as William Acton, G. Frank Lydston, Charles Beard, Abraham Wolbarst etc) it cites numerous other scholarly articles that have found a strong link between the rise of circ and the desire to control masturbation and other expressions of sexuality, especially in children. <ul> <li>Frederick Hodges, The anti-masturbation crusade in antebellum American medicine, Journal of Sexual Medicine, Vol. 2, 2005, 722-31</li> </ul> <h2>Circumcision to control masturbation in infants, children and adults</h2> <h3>An avalanche of evidence in favour of circumcision</h3> Here is a random selection of quotes from the 1870s to the 1970s, showing that for over a century the medical profession cited discouragement of masturbation as one of the major reasons for circumcision. Athol Johnson, "An injurious habit occasionally met with in infancy and early childhood", Lancet, 7 April 1860, 345 In such cases [i.e. masturbation] we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice being continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate. In the female, Dr Gros has advocated, in like manner, complete or partial extirpation of the clitoris; this, however, would seldom seem to be necessary, except, perhaps, in those cases where furious masturbation is associated with congenital malformation of the organ. ... [Such measure] are most likely to be called for in boys, for in female children, with the exception of the congenital cases I have alluded to, the practice seems to be more easily checked by surveillance than it is in males. Medical Times and Gazette (London), 1867 (1), 19 January, p. 79 A Jewish surgeon informs us that the practice in question [masturbation] is virtually unknown in Jewish schools. It is well known that the removal of the foreskin diminishes the temptation and the facility. The skin of the glans becomes harder and less sensitive. The learned Dr Copland and many other writers express regret that circumcision was ever discontinued. … we have known masturbation effected habitually by a sickly child of three; but … eczema and ascarides were the exciting causes. Nevertheless, the removal of the prepuce effected a complete cure. M.J. Moses, “The value of circumcision as a hygienic and therapeutic measure”, New York Medical Journal 14, October 1871, 368-74 From time immemorial medical men have been consulted by parents and desired to prescribe for children whose haggard faces and extreme nervous irritability have caused them alarm and anxiety. The practised eye of the surgeon sees beyond the veil which shadows the case and recognizes the ravages which solitary vice is making upon the nervous system of the little sufferer. Examination of the case most frequently reveals a long, contracted and irritated prepuce, the presence of which accounts for the initial cause of the trouble. … I refer to masturbation as one of the effects of a long prepuce; not that this vice is entirely absent in those who have undergone circumcision, though I never saw an instance in a Jewish child of very tender years, except as the result of association with children whose covered glans have naturally impelled them to the habit. Letter from a Jewish surgeon, Lancet, 12 December 1874, p. 856 That the deprivation of the prepuce induces premature sexual excitement and onanism is quite opposed to experience and fact. On the contrary, the removal of the prepuce reduces in an extraordinary degree the sensitiveness of the glans penis; and, apart from biblical reasons, which have necessarily no place in your journal, I believe that the intention of the rite was to enhance and advance as far as possible the chastity of the race by blunting mechanically the sensibility of the organ of sexual appetite. The surgeon was responding to a notice in the previous issue of the Lancet about a pamphlet against circumcision by a Jewish physician in Vienna, Dr Levit. Dr J.M. McGee, "Genital irritation as a cause of nervous disorders", Mississippi Valley Medical Monthly, 1882, quoted in David Gollaher, Circumcision: A history of the world's most controversial surgery, p. 85. Whether it [circumcision] be curative or not it is conservative, and removes one source of irritation from an exquisitely sensitive organ. I would favour circumcision, however, independent of existing disease, as a sanitary precaution. … (2) It is acknowledged to be useful as a preventive of masturbation. … (5) It probably promotes continence by diminishing the pruriency of the sexual appetite. Dr McGee also claimed that circumcision alleviated the symptoms of tubercular meningitis and was a complete cure for brass poisoning. Alexander Davidson, “Genital irritation in boys”, The Practitioner, Vol. XLII, 1889, 350-56 [In uncircumcised boys] the mucous membrane and glands [sic: read glans] are unnaturally excited, while secretions increase and are pent up by adhesions. Thus the irritation is not only maintained, but intensified. The boy is in a condition of frequent irritation, and seeks to relieve it by purely physical means … He rubs himself, but quickly discovers that tugging on the prepuce is much more effectual. Continued pulling elongates it, its orifice contracts … till finally in severe cases … the prepuce balloons out during micturation, straining weakens the abdominal walls, and hernia may result. … But the fact I am anxious to emphasise is that continued irritation of the genitals induces a habit of manipulation which may persist long after the irritation ceases, and which if retained till puberty leads to the practice of masturbation in its most odious sense Case I. Aged seven years. Been ailing for a year, and under medical treatment. Previously active, intelligent and healthy. Now he is apathetic and unable to stand or walk; “plays with himself”, and suffers from nocturnal enuresis. Prepuce long, orifice contracted, with inflamed edges, and very excitable. Circumcised. Nocturnal enuresis at once ceased; in a few days he tried to walk, and within a month walked a mile without support. Former intelligence had then returned. Case II. Aged three years. Double hernia; cannot stand or walk; always “in doctor’s hands”. “Plays with himself”. Circumcised. In a week or two he began to “walk on the grip”, and withina month could walk alone. Case IV. Aged five years, Paraphimosis with superficial sphacelation. Has often been flogged for “bad habits”. Circumcised. Parents believe that he has ceased to manipulate, and his health has greatly improved. … But it may be asked, “What is to be said of the origin of masturbation during adolescence?” This is not nearly so common as is supposed, and in the great majority of cases is due to the contamination of early manipulators. … As with infant and child, the same means of relief are sought, but the results are the more serious, because now we have to contend with a developing sexual instinct. Here again it would seem that if remove purely physical causes we might reasonably hope to greatly diminish the practice, and the only method which seems to me safe and unobjectionable, simple and complete, is circumcision. Jonathan Hutchinson, "A plea for circumcison", Archives of Surgery, Vol. II, 1890, p. 15; reprinted in British Medical Journal, 27 September 1890, p. 769 It is surely not needful to seek any recondite motive for the origin of the practice of circumcision. No one who has seen the superior cleanliness of a Hebrew penis can have avoided a very strong impression in favour of removal of the foreskin. It constitutes a harbour for filth, and is a constant source of irritation. It conduces to masturbation, and adds to the difficulties of sexual continence. P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (Philadelphia and London: F.A. Davis, 1891), p. 224 Dr Vanier … looks upon the prepuce as the most frequent cause of onanism. “If the prepuce is lax, its mobility produces an irritation to the highly irritable and sensitive nervous system of the child by the titillation in its movements on the glans; if too tight … it compresses the glans and by its irritation it leads the child to seize the organ”. So that in either case he look upon the prepuce, through the sensitiveness it retains and induces in the glans, as the principal cause of masturbation. … In children who have not yet the suggestions of sexual desire imparted by the presence of the spermatic fluid, the presence of the prepuce seems to anticipate those promptings. Circumcised boys may … either through precept or example, physical or mental imperfection, be found to practice onanism, but in general the practice can be asserted as being very rare among the children of circumcised races, showing the less irritability of the organs in the class; neither in infancy are they as liable to priapism during sleep as those that are uncircumcised. Jefferson C. Crossland MD, "The hygiene of circumcision", New York Medical Journal, Vol. 53, 1891, pp. 484-5 In consequence of circumcision the epithelial covering of the glans becomes dry, hard, less liable to excoriation and inflammation, and less pervious to venereal viruses. The sensibility of the glans is diminished, but not sufficiently to interfere with the copulative function or to constitute an objection. … It is well authenticated that the foreskin … is a fruitful cause of the habit of masturbation in children. M. Clifford, Circumcision: Its Advantages and How to Perform it (London: Churchill, 1893), pp. 6-8 “The glans penis is very vascular, and is well supplied with nerves … and the slightest irritation is sufficient to cause a great deal of discomfort. It is not uncommon to see a child dragging at the foreskin as a consequence. As age advances the habit of masturbation is very frequently to be attributed to it. But after circumcision the glans penis is always dry …. It loses much of its acute sensitiveness, and all unnatural irritation being guarded against, the mind is not directed towards the sexual organs, and a decided check is put to one of the vices only too commonly practised in early manhood. … The cleanliness and chastity which circumcision undoubtedly promotes is probably the reason why the operation has been performed for so many centuries, and may also account for its acquiring a religious significance.” Compare Brian Morris: “The concept … that circumcision was used in this era to prevent masturbation is in fact a falsehood that has been promoted by anti-circumcision groups. The real reason was that it prevented smegma, itching and so on, and thus stopped males scratching their genitalia. The fact that such excessive attention to a penis to relieve the irritation might have led to arousal and thus masturbation was purely coincidental. The Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today.” Brian Morris, In Favour of Circumcision (Sydney: UNSW Press, 1999), 57 Edgar Spratling, “Masturbation in the adult”, Medical Record 48, 28 September 1895, 442-3 In all cases [of masturbation], taken as they come, circumcision is undoubtedly the physician’s closest friend and ally, offering as it does a certain means of alleviation and pronounced benefit …. Those cases in which the glans presents a moist, semi-oily appearance … long thickened foreskin, pliant and giving, large and often tortuous dorsal veins, go to make up a picture that is exceedingly tempting to the surgeon’s scissors. … To obtain the best results one must cut away enough skin and mucous membrane to rather put it on a stretch when erections come later. There must be no play in the skin after the wound has thoroughly healed, but it must fit tightly over the penis, for should there be any play the patient will be found readily to resume his practice, not begrudging the time and extra energy needed to produce the orgasm. It is true, however, that the longer it takes to have an orgasm, the less frequently it will be attempted, and consequently the greater the benefit gained. Jonathan Hutchinson, "The advantages of circumcision", Medical Review, Vol. 3, 1900, p. 641-2 It is an open question whether the removal of the prepuce tends appreciably to increase the power of sexual control. Its influence, so far as it has any, must be in that direction. The only function which the prepuce can be supposed to have is that of maintaining the penis in a condition susceptible of more acute sensation than would otherwise exist. It may be supposed to increase the pleasure of the act and the impulse to it. These are advantages, however, which in the present state of society can well be spared, and if in their loss some degree of increased sexual control should result, one should be thankful. Ernest G. Mark, “Circumcision”, American Practitioner and News 31, 1901, 231 Another advantage of circumcision … is the lessened liability to masturbation. A long foreskin is irritating per se, as it necessitates more manipulation of the parts in bathing. … This leads the child to handle the parts, and as a rule, pleasurable sensations are elicited from the extremely sensitive mucous membrane, with resultant manipulation and masturbation. The exposure of the glans penis following circumcision ... lessens the sensitiveness of the organ. G. Frank Lydstone, Sex Hygiene for the Male (Chicago 1912), 158-9 Circumcision is a most commendable practice. … Circumcision promotes cleanliness, prevents disease, and by reducing over-sensitiveness of the parts tends to relieve sexual irritability, thus correcting any tendency which may exist to improper manipulations of the genital organs and the consequent acquirement of evil sexual habits, such as masturbation. Abraham Wolbarst, “Universal circumcision as a sanitary measure”, Journal of the American Medical Association 62, 10 January 1914, 92-97 It is a well known fact that the foreskin is a frequent factor in the causation of masturbation, not alone in children but in adults as well. This has been amply proved by the fact that circumcision has become recognised as a most effective remedy in these cases. N.B. Morris and Co still cite Wolbarst as an authority for the contention that the foreskin should always be removed as a precaution against penile cancer. William J. Robinson MD, “Circumcision and masturbation”, Medical World 33, October 1915, 390 There are a hundred arguments in favour of circumcision, but to speak of them all in detail would require a book or at least a good-sized essay. At this time I wish to touch merely upon one point, the relation of the prepuce to masturbation. I am convinced that the prepuce is one of the great factors in causing masturbation in boys, and many cases of masturbation cannot be treated successfully until the prepuce is removed. Here is the dilemma we are in: If we do not teach the growing boy to pull the prepuce back and cleanse the glans there is danger of smegma collecting and of adhesions and ulcerations forming, which in their turn will cause irritation likely to lead to masturbation. If we do teach the boy to pull the prepuce back and cleanse his glans, that handling alone is sufficient gradually and almost without the boy’s knowledge to initiate him in to the habit of masturbation. While masturbation is not the terrible calamity that it was once thought to be, and while we recognize the fact now that most children recover from it without permanent effects, still we want to avoid everything possible that may be a factor in the cause of masturbation, and the prepuce unquestionably being such a factor, it should come off. Therefore, once more, off with the prepuce! Nuri Bey Risa, “Studien uber die rituale Beschneidung im osmanische Reiche”, Sammlung klinischer Vortrage, No. 438, Leipzig, 1906, quoted in Felix Bryk, Circumcision in man and woman: Its history, psychology and ethnology, New York, Ethnological Press, 1934, 102-3 The irritation which is caused by the inflammation of the distal part of the [uncut] penis leads to erection and release through ejaculation, to enuresis, to onanism and pederasty with their psycho-pathological reactions, and finally to moral crimes. A wise Moslem writer says: “It is exactly these fundamental effects and their influence upon men that the Moslem lawgivers take into consideration in establishing the strict performance of circumcision.” [A pious Moslem told him:] “The reduction of sexual pleasure is just what circumcision aims at. Too great sexual excitement puts man on an equal plane with the lower animals, impels him to wicked moral aberrations and tragic crime. On the other hand, the complete abolition of sexual feelings would make men non-organic beings. We men enjoy coitus just enough.” R.W. Cockshutt, “Circumcision”, British Medical Journal, 1935 (2), 1935, 764 I suggest that all male children should be circumcised. This is “against nature”, but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in mind it does not seem apt to argue that “God knows best how to make little boys”. Alan F. Guttmacher, “Should the baby be circumcised?”, Parents Magazine 16, September 1941, 26, 76-78 “It [circumcision] does not necessitate handling of the penis by the infant’s mother, or the child himself in later years, and therefore does not focus the male’s attention on his own genitals. Masturbation is considered less likely.” Compare Brian Morris: “The fact that such excessive attention to a penis to relieve the irritation might have led to arousal … ” M.F. Campbell, “The male genital tract and the female urethra”, in M.F. Campbell and J.H. Harrison (eds), Urology, 3rd edn (Philadelphia: W.B. Saunders, 1970), Vol. 2, 1836 “Parents readily recognise the importance of local cleanliness and genital hygiene in their children and are usually ready to adopt measures to adopt measures which may avert masturbation. Circumcision is usually advised on these grounds.” <a href="https://www.circinfo.org/quote.html">See also Quotes on foreskin and sexual function on this site</a> <h2>Circumcision and prevention of AIDS</h2> It is likely that the persistence of the masturbation taboo in the United States is a factor in the obstinate survival of routine (preventive) circumcision of newborn boys there. At a time when every variety of sexual expression is discussed on television and most may be viewed on DVD, the topic of masturbation still arouses nervous titters, if not choleric outrage. As recently as 1994 President Clinton dismissed his Surgeon General, Jocelyn Elders, for stating at a United Nations conference on AIDS that masturbation was “a part of human sexuality and … something that perhaps should be taught” (Lancet, Vol. 344, 24 Dec. 1994, p. 1714). Like the bishops of southern Africa, who believe it is more sinful to wear a condom than to infect another person with a fatal and incurable disease, Clinton and the bible-bashing Republicans he was trying to appease seem to think that the only acceptable form of safe sex is continence. The Lancet, Britain’s oldest medical journal, condemned Clinton’s action and praised Elders for speaking the truth, but it acknowledged that the medical profession was itself to blame for its own mighty contribution to the phobia about masturbation, originally whipped up by purity campaigners in the eighteenth century, which raged like an epidemic during the nineteenth and early twentieth centuries, and which is evidently far from extinct even today. This is unfortunate because, as the Lancet acknowledged, masturbation is safe sex. In a moral environment that encourages promiscuity and an ever-younger onset of sexual activity with others, any policies or practices that discourage safe sex activity must be regarded as increasing the risk of STDs and AIDS. It follows that if circumcision reduces the pleasure and incidence of masturbation, it increases the incidence of penetrative sex, and thus the likelihood of disease transmission. The Victorians looked upon masturbation as the “solitary vice”, but it is a simple truth that all sexual activity, either alone or with others, involves manual fondling and manipulation; masturbation and penetrative sex are not a dichotomy, but phases of a continuum. By radically simplifying the penis, circumcision greatly reduces its versatility and the range of fun and games to be had with it, thus steering men away from fondling and other forms of safe sex and towards penetrative and other forms of potentially unsafe sex. Circumcised men complain that wearing a condom reduces sensitivity to the point where they can’t feel a thing, and in Africa there are <a href="http://www.circumstitions.com/news/news35.html#unsafe">increasing reports</a> that victims of the American-funded World Health Organisation circumcision programs drop condom use the moment their wound heals. The facts is that the uncircumcised penis offers vastly more scope for safe sex than the simplified and stripped-down variety, however “armour plated” it may have become as a result of the surgery. The fact that the USA has both the highest incidence of neonatal circumcision in the developed world (apart from Israel) and one of the highest incidences of HIV-AIDS infection does not suggest that circumcision is a particularly effective AIDS prevention strategy. Maybe they need to fondle more and cut less. </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 Circumcision and "moral hygiene" 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>Robert Van Howe dissects Gerald Weiss</h3> This is pediatrician Robert Van Howe's reply to G.N. Weiss's bizarre outburst, "Prophylactic neonatal surgery and infectious diseases", Pediatric Infectious Diseases Journal, Vol. 16, 1997, pp. 727-34 Circumcision and infectious diseases revisited Robert S. Van Howe MD (Department of Pediatrics, Marshfield Clinic-Lakeland Center, Minocqua, WI.) Accepted for publication Oct. 24, 1997. Address for reprints: Robert S. Van Howe, M.D., Marshfield Clinic-Lakeland Center, 9601 Townline Road, P.O. Box 1390, Minocqua, WI 54548. Fax 715-358-1156 Pediatric Infectious Diseases Journal, Vol. 17, January 1998, pp. 1-6 The recently published Opinion and Analysis piece by Gerald Weiss [1] invites rebuttal. On the basis of his previous publications, Weiss is unabashedly pro-circumcision. [2-4] He has made unsubstantiated claims in the past and as recently as 1994 still believed that neonates do not feel pain. [2, 5] Although Dr. Weiss is entitled to his viewpoint, the editorial structure of well-respected and mainstream medical journals such as The Pediatric Infectious Disease Journal should permit factual refutation of what I believe are the many erroneous statements and assumptions in Weiss's article. <h4>Hyperbole</h4> The opening paragraph by Weiss, pointing out the prevalence and mortality of infectious diseases, has very little to do with infectious diseases involving the penis. He tries to create an urgency to intervene where no intervention is needed. To make this argument cogent, he would need to demonstrate that the penis is a common focus of serious infection and disease. He never does. While "half the people on this globe live in fear of plagues," only a small percentage of males ever have penile-associated infections. Weiss describes the preputial cavity as a "cesspool," demonstrating his ignorance of this cavity. The wetness found in this space is made up of prostatic, seminal vesicular and urethral secretions. The prostatic and seminal vesicular secretions are rich in lytic material, which have an immunoprotective function. [6] Weiss mentions Tyson's glands, which we today know do not exist, [7-11] and propagates the notion that a male with a foreskin must clean his preputial cavity at least three times daily or have odoriferous consequences. [4] Actually the penis with a foreskin can be self-cleaning with micturition, because sterile urine flushes out the preputial cavity before the urine is eliminated. [8] Weiss repeatedly refers to "the foreskin allowing for a pooled pocket of infected water to harbor" various pathogens. There is no research to support such a claim. The normal newborn phallus is equipped with a prepuce that contains smooth muscle arranged in a whorled pattern near the tip that acts as a muscular one-way valve, which allows urine out, but does not allow contaminants in. [12, 13] This pattern of smooth muscle fibers gives the distal infant prepuce its typical puckered appearance. Attempts to retract the prepuce prematurely violate the integrity of this natural valve and allow the influx of bacteria. While Weiss et al. [14] failed to find Langerhans cells in the mucosa of the newborn prepuce, these immunoprotective cells are present in older males. [15] Because boys are born with the preputial mucosa and the penile glans mucosa fused and because the uterus is a sterile environment, immunoprotection is initially not an issue at this location. <h4>The role of the prepuce in infectious diseases</h4> Although Weiss is correct in pointing out the role of human papillomavirus (HPV) as an etiologic factor in the development of genital cancers, he fails to point out that circumcised males are significantly more likely to have genital warts [16, 17] or that the foreskin is not a factor in other clinical HPV-associated lesions. [18] Citing a 1947 paper as evidence that horse smegma was carcinogenic in mice, he ignores the studies that attempted to replicate this result and failed, [19-21] or that horse smegma differs significantly from human smegma. [22] Intuitively it does not make sense that a natural body secretion produced in normal amounts would be carcinogenic. The rate of collected smegma in the preputial cavity is low, given that only 6% of men with preputial stenosis have collected smegma. [23] If smegma were carcinogenic, one would expect men circumcised later in life to have lower rates of penile cancer than those never circumcised, but several studies have demonstrated the opposite. [24-26] Although several studies have suggested a role of "phimosis" in the development of penile cancer, [24, 26-28] until a clear definition of phimosis emerges it is difficult to interpret this finding. Eighty percent of patients circumcised for phimosis have normal histology. [29-34] It is difficult to hypothesize how the removal of histologically normal tissue can lead to later malignancy. The remainder have balanitis xerotica obliterans, the cancer potential of which is unclear. [30, 35] Of the etiologic factors for penile cancer, smoking [26-28] and HPV infection [26, 27] emerge as the greatest risk factors, not the prepuce. Perhaps the most egregious and potentially damaging statement made by Weiss is, "No patient circumcised at birth in the United States has been reported to have developed carcinoma of the penis." There have been at least 39 such cases reported in the medical literature and untold cases that have gone unreported. [26, 36-50] Weiss listed a study with 22 such cases as one of his references, [26] demonstrating his unfamiliarity with the materials cited. The author provides a laundry list of infections and problems prevented by neonatal circumcision without providing any supporting evidence. The entire premise of the article rests on the notion that neonatal circumcision has a prophylactic benefit in preventing infectious diseases. A careful review of the medical literature demonstrates that it does not. Although some studies have found that circumcision lowers the incidence of urinary tract infections, significant factors such as rooming-in, [51] breast-feeding, [52-54] parental education and social status, hygienic practices, [55-58] race, [59-61] urine collection method [62] and diagnostic criteria [63] have never been controlled for. Any one of these factors could explain the less than 1% difference in urinary tract infections between boys with and without a prepuce seen in these studies. More importantly the incidence of asymptomatic bacteriuria is between 0.7% (95% confidence interval, 0.2 to 1.64%) [64] and 2.0%.65 This rate of "background noise," which is nearly identical with the urinary tract infection rate in non-circumcised boys, makes assessment of the significance of these findings difficult. Hoberman and Wald [63] found that in the absence of pyuria, a positive urine culture most likely represents incidental bacteriuria. Nearly one-half of the infants diagnosed with urinary tract infection in past studies did not have pyuria, [66-68] implying that all of these studies are either invalid or require reanalysis. There is strong evidence in four studies from Israel that neonatal circumcision increases the incidence of urinary tract infection. [69-72] A prospective study of 603 non-circumcised Japanese boys failed to find any urinary tract infections where 6 to 24 would have been expected. [73] Based on this, it is unclear whether the foreskin has a prophylactic effect on urinary tract infection. Although it has been speculated that circumcised males are less likely to develop sexually transmitted diseases, five studies in the past 5 years have found circumcised males to have an overall greater incidence of sexually transmitted diseases. [16, 74-77] Likewise previous studies have found no difference in the rates of penile infection or inflammation between males with and without foreskins, [78-79] but comparison of data from prospective studies [73, 80] strongly suggests that young circumcised males are more likely to develop balanitis. This has also been demonstrated in adults. [81] Finally the data regarding HIV infection have been inconsistent, but large random cross-sectional studies, which have the least degree of bias, have found that circumcised men are more likely to develop or transmit HIV infection. [77, 82-85] <h4>Surgical prophylaxis</h4> The lamentations of Weiss over Americans' reluctance to circumcise are misplaced. The current rate of neonatal circumcision continues to be more than 90% in the midwest. [80, 86] Weiss blames the separation of church and state for the lack of acceptance of "medical" circumcision in the United States. This does not explain why in Europe, where state religions are the norm, circumcision rates approach zero, with no measurable difference in penile problems. He bemoans our inability to embrace the surgical prophylaxis concept but fails to note that no one is willing to initiate surgical prophylaxis unless there is a compelling risk or medical factor. Indeed the only exception to this is the American fixation with altering male genitalia. [87] Recently the value of prophylactic oophorectomy and mastectomy in women with genetic mutations of BRCA1 and BRCA2 was evaluated. Although removal of the breasts and ovaries at 30 years of age in women without increased risk would increase life expectancy by an average of 8 months, the authors concluded that "Prophylactic surgery is obviously unreasonable for these women." Removing healthy tissue in women at increased risk is considered a "highly personal decision" made only after clear discussion of the effects of prophylactic surgery on medical outcomes takes place. [88] When the cost utility of neonatal circumcision is calculated, it has an overall negative effect on health [89] or little effect at all. [90] All analyses published have found neonatal circumcision to be cost-ineffective. [90-92] Strabo, the 1st century B.C. Greek geographer, documented that Jews circumcised girls as well as boys. [93] If the Egyptians were right about the males, they might also be right about the females. Because females have a greater incidence of fungal infections, urinary tract infections, genital cancers and smegma production, they are more likely to benefit from prophylactic surgical alteration of their genitalia than are males. If Weiss is truly interested in expanding the surgical prophylactic paradigm, a number of other possibilities exist. All breast tissue can be excised from males at birth. More men die of breast cancer than penile cancer [94] and breast tissue has no useful purpose in males. The left testis can be removed at birth, cutting the incidence of testicular cancer and testicular torsion by more than half. Toenails can be unsightly and can ingrow and become infected, so they too should be dispensed with. All of these would decrease disease risk without altering function: which is Weiss's stated goal. To paraphrase Weiss's hero, John Arderne, "What's holding us back? This will help people!" <h4>Revising history to support a modern agenda</h4> Most of Weiss's paper is taken up with a justification that the ancients instituted circumcision for its health benefits. There is no direct evidence that this occurred. To make his case Weiss cites a number of speculative pieces written around the turn of the century. During that era the medical profession was promoting circumcision as a preventive and treatment for masturbation, which was thought to be the source of a long list of maladies. [95] To convert circumcision from a religious blood ritual to a medical practice, many physicians were compelled to speculate that circumcision had a medical intent since its inception. When one looks at the primary sources, there is no evidence that it does. Although both the Old and New Testaments make numerous references to circumcision, none relates to health. In keeping with this Rabbi Moses Maimonides (1135-1204), the famous physician and philosopher, does not mention any medical purpose to circumcision, although he was 800 years closer to the source than any 20th century speculators. The only benefit Maimonides could find for circumcision was that it weakened the penis and made men more temperate sexually. He stated that the non-circumcised penis was so sexually superior that if a Jewish woman had intercourse with a non-circumcised man, she would not separate from him. [96] By contrast American women have little chance of having intercourse with a complete penis. Relying on ancient scholars such as Philo of Alexandria (1st century A.D.) [97] and Herodotus (ca. 484 to 425 B.C.) [98] is ill-advised because their writing represent opinions and impressions from an era that predates the development of the scientific method. Wallerstein points out four elements of circumcision that suggest that it was never thought of as a medical procedure. (1) If a child dies before it is 8 days old, the corpse must be circumcised before it can be interred in a Jewish cemetery. The ritual takes place at the cemetery, just prior to burial. (2) If a child is born without a foreskin or if no blood is shed during circumcision (both exceedingly rare occurrences), a drop of blood must be drawn from the glans as a symbolic circumcision. (This is known in Hebrew as hatafath dam berith.) The nicking of the glans may be done "with a knife, a needle or even the sharpened fingernails." (3) Such a symbolic circumcision is also performed when a convert to Judaism has been previously circumcised. Reform rabbis have tried to abolish this practice. (4) Up to a century or two ago, the linen cloth used in circumcision, presumably stained with blood, was retained and exhibited at the boy's Bar Mitzvah and wedding as proof of his circumcision. [99] Although Jews have been reassured and comforted by attempts to attribute health benefits to the rite, it is purely a religious exercise. The Jewish practice influenced non-Jewish acceptance of circumcision, which reinforced the Jewish ritual. [99] Erich Isaac stated, "Its presumed medical and physiological advantages are said to be at best unproven and at worst illusory." [100] The section on schistosomiasis is irrelevant and unfounded. The author admits that there have been no studies linking the foreskin to schistosomiasis. Weiss makes the assumption that circumcision was a health measure before it was transformed into a religious blood ritual. To make this statement convincing, he needs to demonstrate that the ancient Egyptians had the wherewithal to notice the small differences in health between men with and without foreskins that we have not been able to document consistently in the modern era. If it was a health measure, why is there no documentation of it as such? Why should we consider circumcision "surgical prophylaxis" in the ancient setting when no one at the time thought of it as such? Making the leap from the Egyptian Code of Cleanliness to ascribing a medical significance to a blood ritual is unfounded historically and scientifically. Weiss's reasoning then takes a circular turn. After assuming that the Egyptians instituted circumcision as a medical intervention, he uses this "fact" to prove that circumcision had medical origins. There are several historical facts inconsistent with Weiss's interpretation that he fails to address. It is not clear from the Bible whether Moses was circumcised. Some have speculated that the reason Zipporah circumcised their son was that Moses was not circumcised and like most genitally intact males did not want his son circumcised. [101-103] If Moses had been circumcised on the eighth day, he would have been killed by the Egyptians instead of being allowed to be raised in the palace. Speculating that Abraham had preputial problems that affected his ability to procreate is inconsistent with his siring Ishmael. The ritual cutting as begun by Abraham was markedly different from what is performed today. Originally the operation consisted of cutting off only the very tip of the prepuce. This fact seriously undermines Weiss's speculation about decreasing the amount of mucosa through which schistosomes could pass. This practice persisted until the Hellenistic period (ca. 300 B.C. to 1 A.D.), which may explain why David, as depicted by Michelangelo, has most of his foreskin. To fit in with the Greeks, Jews obliterated the evidence of their circumcision by blistering the tip of what remained of their foreskin to enlarge it. This practice became so popular that the rabbinate altered the surgery to make it impossible for a circumcised male to appear non-circumcised. Thereafter the entire foreskin was to be ablated, and the inner lining and frenulum excised by the mohel's fingernail, specially sharpened for this purpose. The next change, Metzitzah, occurred during the Talmudic period (ca. 500 to 625 A.D.) and consisted of moistening the lips with wine and taking the bleeding penis into the mouth and sucking the blood. [104] If circumcision was seen as a health measure, why were these unsanitary elements added? If Weiss wishes to be taken seriously, he needs to address these issues and attempt to refute them. <h4>Relying on the standard circumcision myths</h4> Weiss would like to blame operator inexperience for the horrific complications of neonatal circumcision. Although many have expressed this opinion, [105] it has never been proved. To the contrary a retrospective study found no difference in complication rates seen among physicians of differing experience levels. [106] "Speed is essential in eliminating pain," is also espoused by Weiss. Nothing eliminates the pain of neonatal circumcision. [107] A poster presentation has suggested that crying is decreased when the Mogen clamp is used, [108] but the adhesions still must be broken, and postoperative pain has yet to be addressed adequately. Weiss, citing a number of opinion pieces, states that later circumcision has increased mortality and morbidity than neonatal circumcision. This is not true. Reported retrospective complication rates include 2.0%, [105] 3.1% [109] and 6.4%. [106] The only prospective study documented hemorrhage after 9.9% of neonatal circumcisions. [110] These rates are higher than those documented in retrospective studies of circumcisions performed later in life (1.7%). [111, 112] <h4>Where are the primary references?</h4> An examination of the references used by Weiss is revealing. Of the 91 references cited 27 were pro-circumcision opinion pieces, 17 were textbooks(mostly outdated) and 12 were secondary articles. The 5 World Wide Web sites Weiss refers to cannot be considered serious resources. The majority of the citations are more than 10 years old. More than one-third are from before 1980. Instead of citing ancient sources, turn-of-the-century opinion pieces are used. The standard for review articles is to avoid citing opinion pieces, review articles or textbooks. Readers should expect review articles to be written by knowledgeable individuals who have taken the time to research primary sources of information. <h4>Conclusion</h4> Weiss is correct. Schistosomiasis, HPV and HIV do have something in common: none has been clearly shown to be reduced by circumcision. A careful examination of the medical literature would have revealed his faulty premise. He never establishes the premise that circumcision is effective or that any of the ancient authorities considered circumcision to be medical. He fails to acknowledge or address dissenting information. His arguments are disjointed, illogical and difficult to follow. For these reasons it is very difficult to take his call for neonatal prophylactic surgery seriously. <h3>References</h3> 1. Weiss GN. Prophylactic neonatal surgery and infectious diseases. Pediatr Infect Dis J 1997;16:727-34. 2. Weiss GN, Weiss EB. A perspective on controversies over neonatal circumcision. Clin Pediatr (Phila) 1994;33:726-30. 3. Weiss GN. Neonatal circumcision. South Med J 1985;78:1198-200. 4. Weiss GN. Neonatal circumcision is necessary. Fort Collins, CO: Personal brochure, 1985. 5. Weiss GN. Local anesthesia for neonatal circumcision. JAMA 1988;260:637-8. 6. Prakash S, Rao R, Venkatesan K, Ramakrishnan S. <a href="http://www.cirp.org/library/anatomy/prakash/" rel="noopener" target="_blank">Subpreputial wetness: it nature</a>. Ann Natl Acad Med Sci (India) 1982;18:109-12. 7. Hyman AB, Brownstein MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969;99:31-7. 8. Lakshmanan S, Prakash S. <a href="http://www.cirp.org/library/anatomy/lakshmanan/" rel="noopener" target="_blank">Human prepuce: some aspects of structure and function</a>. Indian J Surg 1980;42:134-7. 9. Parkash S, Jeyakumar S, Subramanyan S, Choudhuri S. <a href="http://www.cirp.org/library/anatomy/parkash/" rel="noopener" target="_blank">Human subpreputial collection: its nature and formation</a>. J Urol 1973;110:211-2. 10. Keith A, Shilltoe A. The prepucial or odoriferous glands of man. Lancet 1904;1:146-8. 11. de Sousa OM. Sur la presence de glandes sebacÃ©es au niveau de gland chez l'homme. C R Soc Biol 1931;108:894-7. 12. Barreto J, Caballero C, Cubilla A. Penis. In: Sternberg SS, ed. Histology for pathologists. New York: Raven Press, 1992:721-30. 13. Woolsey G. Applied surgical anatomy. New York: Lea Brothers, 1902:405-7. 14. Weiss GN, Westbrook KC, Sanders M. The distribution and density of Langerhans cells in the human prepuce: site of a diminished immune response? Isr J Med Sci 1993;29:42-3. 15. Van Howe RS. An objective assessment of neonatal circumcision. Presented at American Academy of Pediatrics Task Force on Circumcision, Rosemont, IL, June 8, 1997. 16. Cook LS. Koutsky LA. Holmes KK. <a href="http://www.cirp.org/library/disease/STD/cook2/" rel="noopener" target="_blank">Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic</a>. Genitourin Med 1993;69:262-4. 17. Cook LS, Koutsky LA, Holmes KK. <a href="http://www.cirp.org/library/disease/STD/cook1/" rel="noopener" target="_blank">Circumcision and sexually transmitted diseases</a>. Am J Public Health 1994;84:197-201. 18. Aynaud O, Ionesco M, Barrasso R. Penile intraepithelial neoplasia: specific clinical features correlate with histologic and virologic findings. Cancer 1994;74:1762-7. 19. Fishman M, Shear MJ, Friedman HF, Stewart H. Studies in carcinogenesis. XVII. Local effect of repeated application of 3,4-benzpyrene and of human smegma to the vagina and cervix of mice. J Natl Cancer Inst 1942;2:361-7. 20. Heins HC, Dennis EJ, Pratt-Thomas HR. The possible role of smegma in carcinoma of the cervix. Am J Obstet Gynecol 1958;76:726-35. 21. Reddy DG, Baruah IKSM. Carcinogenic action of human smegma. Arch Pathol 1963;75:414-20. 22. O'Neill HJ, Gershbein LL. Lipids of human and equine smegma. Oncology 1976;33:161-6. 23. Parkash S. Phimosis and its plastic correction. J Indian Med Assoc 1972;58:389-90. 24. Brinton LA, Li JY, Rong SD, et al. Risk factors for penile cancer: results from a case-control study in China. Int J Cancer 1991;47:504-9. 25. Windahl R, Hellsten S. Laser treatment of localized squamous cell carcinoma of the penis. J Urol 1995;154:1020-3. 26. Maden C, Sherman KJ, Beckmann AM, et al. <a href="http://www.cirp.org/library/disease/cancer/maden/" rel="noopener" target="_blank">History of circumcision, medical conditions, and sexual activity and risk of penile cancer</a>. J Natl Cancer Inst 1993;85:19-24. 27. Harish K, Ravi R. <a href="http://www.cirp.org/library/disease/cancer/harish/" rel="noopener" target="_blank">The role of tobacco in penile carcinoma</a>. Br J Urol 1995;75:375-7. 28. Hellberg D, Valentin J, Eklund T, Nilsson S. <a href="http://www.cirp.org/library/disease/cancer/hellberg1/" rel="noopener" target="_blank">Penile cancer: is there an epidemiological role for smoking and sexual behavior?</a> Br Med J 1987;295:1306-8. 29. Clemmensen OJ, Krogh J, Petri M. The histologic spectrum of prepuces from patients with phimosis. Am J Dermatopathol 1988;10:104-8. 30. Meuli M, Briner J, Hanimann B, Sacher P. <a href="http://www.cirp.org/library/treatment/phimosis/meuli/" rel="noopener" target="_blank">Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year follow-up after complete circumcision</a>. J Urol 1994;152:987-9. 31. Kristiansen VB, Sorensen C, Kryger AI, Nielsen JB, Mejdahl S. Genital lichen sclerosus et atrophicus hos drenge. Ugeskr Laeger 1989;151:1111. 32. Bale PM, Lochhead A, Martin HC, Gollow I. <a href="http://www.cirp.org/library/treatment/BXO/bale1/" rel="noopener" target="_blank">Balanitis xerotica obliterans in children</a>. Pediatr Pathol 1987;7:617-27. 33. Flentje D, Benz G, Daum R. Lichen sclerosus et atrophicus als Ursache der erworbenen Phimose: Zirkumzision als Praventivmassnahme gegen das Peniskarzinom? Z Kinderchir 1987;42:308-11. 34. Chalmers RJ, Burton PA, Bennett RF, Goring CC, Smith PJ. Lichen sclerosus et atrophicus: a common and distinctive cause of phimosis in boys. Arch Dermatol 1984;120:1025-7. 35. Campus GV, Ena P, Scuderi N. Surgical treatment of balanitis xerotica obliterans. Plast Reconstr Surg 1984;73:652-7. 36. Dean AL. Epithelioma of the penis in a Jew who was circumcised in early infancy. Trans Am Assoc Genito-Urin Surg 1936;29:493-9. 37. Reitman, PH. An unusual case of penile carcinoma. J Urol 1953;69:547-9. 38. Marshall VF. Typical carcinoma of the penis in a male circumcised in infancy. Cancer 1953;6:1044-5. 39. Paquin AJ, Pearce JM. Carcinoma of the penis in a man circumcised in infancy. J Urol 1955;74:626-7. 40. Ledlie RCB, Smithers DW. Carcinoma of the penis in a man circumcised in infancy. J Urol 1956;76:756-7. 41. Amelar RD. Carcinoma of the penis due to trauma occurring in a male patient circumcised at birth. J Urol 1956;75:728-9. 42. Kaufman JJ, Sternberg TH. Carcinoma of the penis in a circumcised man. J Urol 1963;90:449-50. 43. Melmed EP, Pyne JR. Carcinoma of the penis in a Jew circumcised in infancy. Br J Surg 1967;54:729-31. 44. Rogus BJ. Squamous cell carcinoma in a young circumcised man. J Urol 1987;138:861-2. 45. Boczko S, Freed S. <a href="http://www.cirp.org/library/disease/cancer/boczko/" rel="noopener" target="_blank">Penile carcinoma in circumcised males.</a> NY State J Med 1979;79:1903-4. 46. Loughlin KR. Psoriasis: association with 2 rare cutaneous urologic malignancies. J Urol 1997;157:622-3. 47. Girgis AS, Bergman H, Rowenthal H, Solomon L. Unusual penile malignancies in circumcised Jewish men. J Urol 1973;110:696-702. 48. Leiter E, Lefkovits AM. Circumcision and penile cancer. NY State J Med 1975;75:1520-2. 49. Malek RS, Goellner JR, Smith TF, Espy MJ, Cupp MR. Human papillomavirus infection and intraepithelial, in situ, and invasive carcinoma of penis. Urology 1993;42:159-70. 50. Cold CJ, Storms MR, Van Howe RS. <a href="http://www.cirp.org/library/disease/cancer/vanhowe/" rel="noopener" target="_blank">Carcinoma in situ of the penis in a 76 year old circumcised man</a>. J Fam Pract 1997;44:407-10. 51. Winberg J, Bollgren I, Gothefors L, Herthelius M, Tullus K. <a href="http://www.cirp.org/library/disease/UTI/winberg-bollgren/" rel="noopener" target="_blank">The prepuce: a mistake of nature?</a> Lancet 1989;1:598-9. 52. Pisacane A, Graziano L, Zona G. <a href="http://www.cirp.org/library/disease/UTI/pisacane/" rel="noopener" target="_blank">Breastfeeding and urinary tract infection</a>. Lancet 1990;336:50. 53. Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G. <a href="http://www.cirp.org/library/disease/UTI/pisacane1992/" rel="noopener" target="_blank">Breast-feeding and urinary tract infection</a>. J Pediatr 1992;120:87-9. 54. Coppa GV, Gabrielli O, Giorgi P, et al. <a href="http://www.cirp.org/library/disease/UTI/coppa/" rel="noopener" target="_blank">Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells</a>. Lancet 1990;335:569-71. 55. Malleson P. Prepuce care. Pediatrics 1986;77:265. 56. Harkavy KL. The circumcision debate. Pediatrics 1987;79:649-50. 57. Watson SJ. <a href="http://www.cirp.org/library/hygiene/watson1/" rel="noopener" target="_blank">Care of the uncircumcised penis</a>. Pediatrics 1987;80:765. 58. Cunningham N. Circumcision and urinary tract infections. Pediatrics 1986;77:267-9. 59. Herzog LW. Urinary tract infections and circumcision. a case-control study. Am J Dis Child 1989;143:348-50. 60. Skoog SJ, Belman AB. Primary vesicoureteral reflux in the black child. Pediatrics 1991;87:538-43. 61. Askari A, Belman AB. Vesicoureteral reflux in black girls. J Urol 1982;127:747-8. 62. Schlager TA, Hendley JO, Dudley SM, Hayden GF, Lohr JA. Explanation for false-positive urine cultures obtained by bag technique. Arch Pediatr Adolesc Med 1995;149:170-3. 63. Hoberman A, Wald ER. Urinary tract infections in young febrile children. Pediatr Infect Dis J 1997;16:11-17. 64. Edelmann CM, Ogwo JE, Fine BP, Martinez AB. The prevalence of bacteriuria in full-term and premature newborn infants. J Pediatr 1973;82:125-32. 65. Saez Llorens X, Umana MA, Odio CM, Lohr JA. Bacterial contamination rates for non-clean-catch and clean-catch midstream urine collections in uncircumcised boys. J Pediatr 1989;114:93-5. 66. Crain EF, Gershel JC. Urinary tract infections in febrile infants younger than 8 weeks of age. Pediatrics 1990;86:363-7. 67. Krober MS, Bass JW, Powell JM, Smith FR, Seto DS. Bacterial and viral pathogens causing fever in infants less than 3 months old. Am J Dis Child 1985;139:889-92. 68. Bonadio WA. Urine culturing technique in febrile infants. Pediatr Emerg Care 1987;3:75-8. 69. Amir J, Varsano I, Mimouni M. Circumcision and urinary tract infection in infants. Am J Dis Child 1986;140:1092. 70. Amir J, Alpert G, Reisner SH, Nitzan M. Fever in the first year of life. Isr J Med Sci 1984;20:447-8. 71. Goldman M, Barr J, Bistritzer T, Aladjem M. <a href="http://www.cirp.org/library/disease/UTI/goldman/" rel="noopener" target="_blank">Urinary tract infection following ritual Jewish circumcision</a>. Isr J Med Sci 1996;32:1098-102. 72. Cohen HA, Drucker MM, Vainer S, et al. <a href="http://www.cirp.org/library/disease/UTI/cohen/" rel="noopener" target="_blank">Postcircumcision urinary tract infection</a>. Clin Pediatr (Phila) 1992;31:322-4. 73. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. <a href="http://www.cirp.org/library/normal/kayaba/" rel="noopener" target="_blank">Analysis of shape and retractability of the prepuce in 603 Japanese boys</a>. J Urol 1996;156:1813-5. 74. Seed J, Allen S, Mertens T, et al. Male circumcision, sexually transmitted disease, and risk of HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1995;8:83-90. 75. Donovan B, Bassett I, Bodsworth NJ. <a href="http://www.cirp.org/library/disease/STD/donovan1/" rel="noopener" target="_blank">Male circumcision and common sexually transmissible diseases in a developed nation setting</a>. Genitourin Med 1994;70:317-20. 76. Laumann EO, Masi CM, Zuckerman EW. <a href="http://www.cirp.org/library/general/laumann/" rel="noopener" target="_blank">Circumcision in the United States: prevalence, prophylactic effects, and sexual practice</a>. JAMA 1997;277:1052-7. 77. Urassa M, Todd J, Boerma JT, Hayes R, Isingo R. Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS 1997;11:73-9. 78. Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child 1986;140:254-6. 79. Fergusson DM, Lawton JM, Shannon FT. <a href="http://www.cirp.org/library/complications/fergusson" rel="noopener" target="_blank">Neonatal circumcision and penile problems: an 8-year longitudinal study</a>. Pediatrics 1988;81:537-41. 80. Van Howe RS. <a href="http://www.cirp.org/library/complications/vanhowe/" rel="noopener" target="_blank">Variability in penile appearance and penile findings: a prospective study</a>. Br J Urol 1997;80:776-82. 81. Birley HDL, Walker MM, Luzzi GA, et al. <a href="http://www.cirp.org/library/disease/balanitis/birley/" rel="noopener" target="_blank">Clinical features and management of recurrent balanitis: association with atopy and genital washing</a>. Genitourin Med 1993;69:400-3. 82. Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9:927-34. 83. Barongo LR, Borgdorff MW, Mosha FF, et al. <a href="http://www.cirp.org/library/disease/HIV/barongo/" rel="noopener" target="_blank">The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania</a>. AIDS 1992;6:1521-8. 84. Van de Perre P, Carael M, NzVanaramba D, Zissis G, Kayihigi J, Butzler JP. <a href="http://www.cirp.org/library/disease/HIV/carael/" rel="noopener" target="_blank">Risk factors for HIV seropositivity in selected urban-based Rwandese adults</a>. AIDS 1987;1:207-11. 85. Chao A, Bulterys M, Musanganire F, et al. Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda: National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol 1994;23:371-80. 86. Mansfield CJ, Hueston WJ, Rudy M. <a href="http://www.cirp.org/library/procedure/mansfield/" rel="noopener" target="_blank">Neonatal circumcision: associated factors and length of hospital stay</a>. J Fam Pract 1995;41:370-6. 87. Van Howe RS, Cold CJ. Sex reassignment at birth: long-term review and clinical implications. Arch Pediatr Adolesc Med 1997;151:1062. 88. Schrag D, Kuntz KM, Garber JE, Weeks JC. Decision analysis: effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRAC2 mutations. N Engl J Med 1997;336:1464-71. 89. Ganiats TG, Humphrey JB, Taras HL, Kaplan RM. <a href="http://www.cirp.org/library/procedure/ganiats/" rel="noopener" target="_blank">Routine neonatal circumcision: a cost-utility analysis</a>. Med Dis Making 1991;11:282-93. 90. Lawler FH, Bisonni RS, Holtgrave DR. <a href="http://www.cirp.org/library/procedure/lawler/" rel="noopener" target="_blank">Circumcision: a decision analysis of its medical value</a>. Fam Med 1991;23:587-93. 91. Cadman D, Gafni A, McNamee J. <a href="http://www.cirp.org/library/procedure/cadman/" rel="noopener" target="_blank">Newborn circumcision: an economic perspective</a>. Can Med Assoc J 1984;131:1353-5. 92. Chessare JB. <a href="http://www.cirp.org/library/disease/UTI/chessare/" rel="noopener" target="_blank">Circumcision: is the risk of urinary tract infection really the pivotal issue?</a> Clin Pediatr (Phila) 1992;31:100-4. 93. Strabo. Geography. 17.2.5. In: The geography of Strabo. vol. 8. Jones L, trans. Cambridge, MA: Harvard University Press, 1982:152-3. 94. Wingo PA, Tong T, Bolden S. Cancer statistics 1995. CA Cancer J Clin 1995;45:8-30. 95. Hodges F. A short history of the institutionalization of involuntary sexual mutilations in the United States. In: Denniston GC, Milos MF, eds. Sexual mutilations: a human tragedy. New York: Plenum, 1997:17-40. 96. Moses Maimonides (1135-1204). <a href="http://www.cirp.org/library/cultural/maimonides/" rel="noopener" target="_blank">The guide for the perplexed</a>. New York: Dover Publications, 1956:378. 97. Philo. <a href="http://www.historyofcircumcision.net/quotes.html" rel="noopener" target="_blank">The special laws. 1.1.1-4</a>. In: Philo VII. Colson FH, trans. Cambridge, MA: Harvard University Press, 1984:101-3. 98. Herodotus. History 2.37. in: Herodotus I. Books I-II. Godley AD, trans. Cambridge, MA: Harvard University Press, 1920:319. 99. Wallerstein E. <a href="http://www.cirp.org/library/general/wallerstein/" rel="noopener" target="_blank">Circumcision: an American health fallacy</a>. New York: Springer, 1980. 100. Isaac E. The enigma of circumcision. Commentary 1967;43:51. 101. Brown MS, Brown CA. Circumcision decision: prominence of social concerns. Pediatrics 1987;80:215-9. 102. Bean GO, Egelhoff C. Neonatal circumcision: when is the decision made? J Fam Pract 1984;18:883-7. 103. Stein MT, Marx M, Taggart SL, Bass RA. Routine neonatal circumcision: the gap between contemporary policy and practice. J Fam Pract 1982;15:47-53. 104. Weiss C. A worldwide survey of the current practice of milah (ritual circumcision). Jewish Soc Stud 1962;1:30-47. 105. Gee WF, Ansell JS. Neonatal circumcision: a ten-year over-view: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976;58:824-7. 106. Moreno CA, Realini JP. Infant circumcision in an outpatient setting. Tex Med 1989;85:37-40. 107. Cold CJ, Van Howe RS, Storms MR. Anesthesia for neonatal circumcision. J Am Board Fam Pract 1997;10:310-1. 108. DeSilva H. Pediatric academic societies, cited in Childs ND. Physician's choice of clamp may cause more pain. Pediatr News 1997;31(8):40. 109. O'Brien TR, Calle EE, Poole WK. Incidence of neonatal circumcision in Atlanta, 1985-1986. South Med J 1995;88:411-5. 110. Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn: breast feeding as a necessary factor in the pathogenesis. Am J Dis Child 1967;113:524-33. 111. Walfisch S, Ben-Zion YZ, Gurman G. [Circumcision of new immigrants.] Harefuah 1994;126:119-21, 176. 112. Wiswell TE, Tencer HL, Welch CA, Chamberlain JL. Circumcision in children beyond the neonatal period. Pediatrics 1993;92:791-3. </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 Circumcision and infectious diseases revisted 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"> This leaflet is published by Circumcision Information Australia to complement the policy statement on circumcision issued by the Royal Australasian College of Physicians and to assist Australian and New Zealand parents care for their baby boys. <h2>1. RACP policy on circumcision</h2> The media are full of confusing information about the benefits, harms and risks of circumcision. After a thorough examination of the evidence, Australian and New Zealand doctors have concluded that there is no medical justification for circumcising normal male infants and boys in Australia and New Zealand. The circumcision policy statement issued by the Royal Australasian College of Physicians (RACP) in October 2010 states: “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.” This means that Australian and New Zealand doctors do not recommend circumcision of normal infants and boys unless there is a definite medical indication or need. The genitals of healthy babies do not need surgical modification or correction. The RACP does not recommend that boys be circumcised as a precaution against the risk of future problems or diseases to which they may be exposed later in life. Circumcision may be justified when there is a diagnosed disease or other problem that needs to be fixed, and it has not been resolved by non-surgical means after reasonable efforts. In these instances, medical treatment (with antibiotics or other medication) should always be tried first; surgery should be the last resort. <h2>2. Circumcision in Australia and New Zealand</h2> In Australia and New Zealand today circumcision of baby boys is rare, and the uncut penis is the normal thing among young people. But because both countries have a past history of widespread circumcision and many adult men are circumcised, parents are often anxious abut the subject. They may have heard stories from relatives that the uncircumcised penis is prone to problems or difficult to look after, or they may have been alarmed by media reports about epidemics in underdeveloped countries where circumcision is being deployed as a preventive health measure. There is no reason for these anxieties: the uncircumcised penis is very easy to look after, and health precautions that may be needed in underdeveloped countries are not relevant here. Although most parents will not circumcise their boys, some parents prefer to have their boys circumcised for social reasons, usually because they belong to particular ethnic/religious groups in which circumcision is a traditional practice. This guide aims to assist the majority of parents who will not have their boys circumcised, and also the minority of parents who choose circumcision for cultural/religious reasons. <h2>3. The normal (uncircumcised) boy</h2> <h3>(a) The penis</h3> The penis is covered by a double fold of sensitive, and in adults mobile, tissue, known as the foreskin or prepuce. The foreskin is an integral and functional part of the genitals of all humans, male and female (in whom it is also known as the clitoral hood). It has several known functions, including the protection of the head (glans) of the penis in infancy, accommodation of erections and the facilitation of sexual activity in adulthood. In baby boys the foreskin makes up a large proportion of the covering of the penis and usually ends in a tapering spout. Foreskin length is variable, but it is nearly always fused to the head of the penis (glans) in much the same way as the fingernail is connected to the nail-bed. As the boy grows, the two surfaces gradually separate and the foreskin is able to move freely back and forth over the glans. Like all organic processes, this can take time, and it is perfectly normal for a boy’s foreskin not to become retractable until puberty. The foreskin should never be forced back over the glans. Premature or forcible retraction is very painful for the boy, and may result in serious injury to the penis, including scarring that can permanently fuse the foreskin to the glans, narrow the foreskin opening (phimosis) or lead to paraphimosis (explained below). The first person to pull a boy’s foreskin back should nearly always be the boy himself. <h3>(b) Care of the penis</h3> Rule 1: Leave it alone! The infant penis requires no special care. For cleanliness, just wash the outside of your boy's penis with warm water and mild (baby) soap when you bathe him, or wipe it gently with a soft damp cloth or tissue. Do not make any attempt to clean inside his foreskin, and never try to pull it back. Soaps can irritate the sensitive skin at the tip and the inside of the foreskin: you should avoid getting soap on these sensitive areas, just as you prevent soap from getting in a baby’s eyes. Some boys produce a whitish, creamy material that builds up beneath the foreskin opening. This material, known as infant smegma, consists of skin cells shed by the inner foreskin and glans. Some parents become alarmed when they see smegma because they think it is pus and assume there is an infection that requires treatment. In fact, smegma is perfectly harmless and will work its way out of the foreskin opening, where it can be wiped away with a soft cloth or tissue. When a boy is old enough to wash himself, he can rinse his own penis when he takes a bath or shower. Most boys learn how to pull their own foreskins back, but some may need to be shown how to do it. If, on the other hand, his foreskin is not yet retractable, he may need to be warned against forcing it. <h3>(c) Phimosis</h3> Phimosis derives from the ancient Greek word for muzzled, and refers to a condition in which the foreskin cannot be retracted (pulled back) to expose the glans. Nearly all babies and young boys have a foreskin that will not retract, and this is perfectly normal. There is no definite age at which the foreskin is meant to become retractable. Most boys will be able to retract their foreskins by age 8, but it is a highly variable process, and quite a few wait until puberty, and some take even longer. Young boys naturally tug at their foreskin and play with their penis, and this helps the foreskin to separate from the glans and become mobile at the individual’s own pace. No matter how long the process of foreskin separation takes, there is no need for any concern or anxiety unless the boy is experiencing pain or discomfort. Too many boys are needlessly circumcised between the ages of 3 and 7 because of a mistaken diagnosis of phimosis. In most cases they would have been perfectly all right if they had been left alone and allowed to develop naturally. If a boy is experiencing regular pain or discomfort from a tight or short foreskin (for example, when he does a wee or gets an erection), or if his urine stream is very feeble, medical advice should be sought. In such cases the preferred treatment is application of steroid ointment (usually betamethasone valerate) as prescribed by a paediatrician or other medical specialist. Severe phimosis that does not respond to topical medication may require surgery. Apart from circumcision, there are several surgical operations that may resolve the problem without loss of tissue. <h3>(d) Harm of premature retraction</h3> The most common cause of penis problems in infancy are attempts to stretch, dilate or forcibly retract the foreskin before it is ready. This is likely to cause tears in the foreskin tissue that may lead to infection; adhesion of the foreskin to the glans; and induced phimosis, when scar tissue resulting from tears and abrasion causes the tissue at the opening of the foreskin to harden and shrink. The most certain way to avoid foreskin problems in infancy and childhood is to leave the foreskin alone. <h3>(e) Minor problems</h3> Like all body parts, the foreskin is liable to a variety of minor problems, most of which resolve themselves without the need for any treatment. None of these problems require circumcision. Red or inflamed tip This can have many causes, including exposure to soiled nappies, soap, chlorinated water, antibiotics, or concentrated urine resulting from not drinking sufficient fluids. It rarely indicates an infection. The treatment depends on isolating the cause, but measures such as rinsing or soaking without soap, letting him lie or run around naked, tossing a handful of salt into his bath or ensuring that he drinks more water may assist and will do no harm. In most cases the problem will resolve spontaneously, but if it does not you should seek medical advice. Lumps under the foreskin These are caused by an accumulation of smegma and will disappear spontaneously or be extruded through the foreskin opening, at which point the material can be wiped away. As mentioned above, smegma is quite harmless, and its presence indicates that normal separation of foreskin and glans is taking place. Spraying Quite a few boys go through a phase when their urine tends to spray out when they urinate. In most cases it does not last long and resolves itself, but some boys take delight in their capacity to spray a great distance and sometimes engage in contests with their mates. If the spraying persists or if it is accompanied by urinary accidents or abdominal pain, it may indicate a bladder or urinary tract problem, and expert medical advice should be sought. Ballooning Some boys find that their foreskin balloons out when they urinate. This is another passing phase that will resolve itself as the foreskin opening widens. Since the ballooning tends to stretch the foreskin, it helps to achieve separation and retractability. As with spraying, some (mainly older) boys amuse themselves by deliberately holding their foreskins shut so as to force their urine stream to reach further. As with spraying contests, such typically boyish behaviour comes under the general heading of good manners and discipline; it is not a medical issue. Paraphimosis This is a potentially serious condition in which the foreskin has been pulled back behind the glans, becomes trapped there and cannot be brought forward to cover it again. In most cases the problem can be resolved by gently compressing the glans by squeezing it and allowing the foreskin to fall forward, but in rare cases (where the condition has persisted long enough for the foreskin to become so swollen that it threatens to strangle the penis), urgent medical attention is needed. In the meantime ice may help. Paraphimosis in infants and young boys is often caused by forcible premature retraction of the foreskin, and can easily be prevented by observing the golden rule of foreskin care: leave it alone! Occasionally it is caused by the boy himself, such as when retracts his foreskin while his penis is flaccid, but then gets an erection and finds he can’t return it to the normal position. In these cases it is usually only a matter of waiting for the erection to subside. Again, ice may hasten the process. Zipper injury If the foreskin gets caught in a zipper it is very painful and the boy may be screaming. Urgent medical attention must be sought, but in the meantime application of topical anaesthetic cream or spray will dull the pain. It may also be possible to free the foreskin by cutting the zipper at the base and carefully separating the teeth. The vital thing is not to tug at the foreskin, as this will only increase the pain and enlarge the injury. Ways to minimise the risk are not to give boys trousers with zippers until they are old enough to dress themselves; always ensure that he wears underpants; and take care when dressing him. Circumcised boys can also get their penis caught in a zipper, and in these cases the same general rules should be followed. <h3>(e) Conditions where circumcision may be indicated as a therapeutic treatment</h3> There are several conditions which may require circumcision, but only after non-surgical treatments of the problem have been given a fair trial, and after expert medical advice. The conditions are Balanitis xerotica obliterans (BXO) BXO or lichen sclerosis is recognizable by a whitish ring of hardened and often cracked tissue, with redness around it, that develops at the tip of the foreskin. As this condition progresses, the ring constricts the foreskin opening and prevents retraction. The origins of the condition are obscure, and it is quite uncommon – rarely seen before the age of 5 years, and affecting no more than about 1 per cent of boys by age 15. Presence of the condition must be confirmed by specialist advice. Conservative treatment, usually with steroid ointment or injections, should be attempted before surgery is considered. Minor surgery such as preputioplasty, which makes a small incision in the foreskin without loss of tissue, may be tried before circumcision is decided on. Severe recurrent attacks of balanoposthitis (infections of glans and foreskin) Balanoposthitis (from the Greek, balanos, meaning acorn, and posthe, foreskin) refers to inflammations of both the glans and foreskin. The condition may also feature dramatic swelling and reddening of the penis and foreskin, along with discharge, bleeding from the foreskin, difficulty urinating, and occasionally inability to urinate. The problem is quite rare, affecting no more than 4 per cent of boys between 2 and 5 years. The origins of the problem are unclear, but may be the result of infection or allergy. Although balanoposthitis may be recurrent, the episodes tend to become less frequent as the boy gets older, and usually disappear naturally. Diagnosis requires specialist advice, and initial treatment should consist of bathing, topical or oral antibiotics, and steroids. Where these fail and the episodes continue to be both frequent and severe, circumcision may be considered. Recurrent urinary tract infections (UTIs) Most urinary tract infections clear up after treatment with oral antibiotics, but circumcision should be considered in the case of recurrent UTIs, with feverish symptoms, that have not responded to antibiotics, and where the urinary tract is abnormal. Again, specialist diagnosis and advice are required. The most effective preventive of UTIs is breast milk. Severe traumatic injuries Circumcision may also be necessary in the case of severe traumatic injuries, as well as gangrene, frostbite and cancer, where the tissue cannot be salvaged. Such cases are very rare. NOTE: The decision to circumcise should not be taken lightly: the operation makes a permanent physical alteration to the body, and cannot be reversed. Since not all general practitioners are fully up to date with modern treatment options, specialist advice should always be sought in these cases, before such surgery is decided on. <h2>4. The circumcised boy</h2> Like all surgery, circumcision involves the cutting of tissue, nerves and blood vessels; and like all surgery it cannot be done without the risk of pain and complications, the most common of which are bleeding, scarring and various infections. Where anaesthetics are employed there may also be an adverse reaction to the anaesthetic used, and also to pain control drugs given after the operation. The severity of the risks and the requirements for after-care differ according to the age at which the circumcision is performed. <h3>(a) Risks of circumcision</h3> At birth, a baby’s foreskin and glans are usually fused to each other, in much the same way as the eyelids of a newborn kitten are sealed. Before circumcision can be performed, the foreskin must be forcibly separated from the glans, usually with a metal probe. The entire glans of the baby’s penis and the site of the incision then become raw wounds, liable to infection and bleeding, and extremely painful to touch. The open wound may also form an adhesion to the circumcision scar on the shaft of the penis. You should watch your baby very carefully for the first few days following circumcision to make sure that the wounds are healing. Immediate complications The following immediate complications of circumcision are most dangerous in the neonatal period (first month) and early infancy, but they are possible at any age. Bleeding Babies contain very little blood, and cannot afford to lose much. If the boy’s penis continues or starts to bleed following circumcision, you should seek urgent medical attention. Do not administer aspirin as pain relief in this situation, as this interferes with blood-clotting. Boys have died following circumcision because the nappies in which they were dressed absorbed the blood from the wound and parents did not notice they were bleeding until it was too late. Infection Infections can be communicated by the instruments used in the procedure, or from subsequent exposure of the raw surfaces to bacteria from medical personnel, dressings, nappies or the parents’ clothes or hands. Increasing redness, inflammation, swelling, oozing, or fever are all signs of infection. Infections spread rapidly in newborns, and serious diseases, such as meningitis, can quickly lead to death. If you see any sign of infection, medical attention must be sought immediately. Retention of urine Circumcision sometimes leads to blocking of the urethra (urine passage). If your baby goes longer than eight hours without doing a wee after being circumcised, the doctor should be notified immediately. Urethral fistula If your baby’s urinary opening (meatus) is not at the tip of his glans, or if urine comes out of any other opening in his penis, the doctor should be notified immediately. Dislodged Plastibell circumcision device If your baby has been circumcised with the Plastibell device, the plastic ring with a string tied around its rim on your baby’s penis should drop off within five to eight days. If it does not drop off within this period, or if it slips down from his glans and onto the shaft of his penis, or if you notice any swelling, the doctor should be notified immediately. Complications from anaesthetics The penile dorsal nerve block anaesthetic requires injections at the base of the penis. Needles puncturing tissue in this area are likely to cause bruising and may damage the dorsal nerve. Accidental puncture of the dorsal artery or vein can lead to internal bleeding and gangrene. If your baby has extensive bruising or swelling around the injection sites, the doctor should be notified. Topical anesthetics such as EMLA cream are not fully effective against circumcision pain, and carry the risk of depleting the baby’s blood oxygen. Such creams are not approved for use on babies under one month. If your baby turns bluish or grayish after the application of such creams, or if he becomes lethargic, medical attention must be sought urgently. Pain Whether or not an anaesthetic is used, your baby is likely to be in pain following the procedure. Some doctors prescribe post-operative pain medication, but it is not always effective and is never 100 per cent effective. You can comfort your baby by holding him, nursing him frequently, sleeping with him, and being especially careful when changing his nappy. Older babies and children can safely be given pain relief, such as paracetamol or codeine, but be cautious about giving aspirin if there is any sign of bleeding. Behavioural changes Feeding Some babies feed readily soon after they are circumcised, but many do not. Circumcision often interferes with breastfeeding, and there is no known method of re-establishing contact except by persistence. Sleep patterns Many parents worry because their baby sleeps an unusually long time after being circumcised. The procedure is a stressful and exhausting experience for a baby, and sleep will help him to recover. <h3>(b) Caring for the circumcision wound</h3> Dressing changes If your baby was circumcised with a Plastibell device, the plastic ring should be in place with no dressing on his penis. If your baby was circumcised with other devices, such as a Gomco or other forms of clamp, his penis may be bandaged with a gauze dressing to prevent the wound on his remaining foreskin and the open wound on his glans from sticking to each other or to a nappy. Some doctors recommend gently replacing this dressing when it is soiled; others recommend removing it after an hour or two. Some doctors recommend application of Vaseline to the wound with every nappy change for three weeks following the surgery so as to prevent the wound from sticking to the nappy. The yellowish crust on your baby’s glans forms part of the healing process and will fall off as the glans heals. Bathing Following circumcision the penis will be extremely sensitive to pain and care must be taken not to allow any abrasive materials to touch it. After he has done a poo, the circumcision area should be gently rinsed with warm running water. It is best to wait until the wound has healed (seven to ten days) before touching it or using a wash cloth or “baby-wipes.” Preventing adhesions Adhesions and skin bridges may form when the raw surfaces of the glans and remaining penile skin fuse together as they heal. This can be prevented by pulling the penile shaft skin behind the line of the incision gently away from the glans once a day and applying petroleum jelly for the first three weeks. Gentle retraction should be done regularly until your baby is a year old to ensure that the deeper layers of the wound heal without fusing to adjacent tissue. <h3>(c) Later complications</h3> Meatitis In the absence of the foreskin, the urinary opening (meatus) may become inflamed and ulcerated. As ulcers heal, scar tissue forms, constricts the meatus and causes a condition known as meatal stenosis. Meatal stenosis Constriction of the meatus impedes and sometimes blocks the flow of urine. Urine retained in the bladder may allow the growth of bacteria, which can lead to infections. If you notice anything irregular about your baby’s urine flow, the doctor should be notified. Surgery may then be required to enlarge the urinary opening. Preputial stenosis As it heals, the circumcision scar sometimes forms as a tight, constricted, inelastic ring, trapping the glans behind it. This condition may require corrective surgery. Buried penis Following circumcision, the penis may become entrapped by scar tissue and retract into the pubic fat. This condition may correct itself naturally but sometimes requires surgery. Boys whose buried penis is noticed before circumcision should not be circumcised. Excessive skin removal A common complication of circumcision is excessive removal of tissue, but it rarely becomes apparent until the penis reaches its full adult size at puberty. One important function of the foreskin is to provide the slack skin necessary to accommodate the enlargement of the adult penis when erect, meaning that a tight circumcision will make erections painful, and that a very severe operation may inhibit them. Both foreskin length and penis size vary immensely from one male to another, but before puberty it is impossible to know either of these details. There is not much that can be done in cases where there has been excessive skin removal, but a boy may be able to achieve some relief by utilising the stretching techniques developed for foreskin restoration. Scarring The size, colour and shape of circumcision scars vary from male to male, and some are more noticeable than others. Many circumcised males feel self-conscious about the scar on their penis, and some scars may be painful. Desensitization The foreskin is erogenous tissue – now understood to be the most sensitive part of the penis – and its loss tends to desensitizes the penis and affect sexual function. Circumcision also causes the surface of the glans to dry out, thicken, and become dull instead of glossy, and lighter in colour. Resentment and anger Increasing numbers of men are angry and resentful at having been circumcised in infancy or childhood without their agreement, and in some individuals the resentment leads to serious psychological and behavioural problems, and even suicide in rare cases. Parents should bear this risk in mind when considering whether to have their child circumcised. Circumcision Information Australia www.circinfo.org February 2011 <h2>References</h2> <a href="http://www.racp.edu.au/page/policy-and-advocacy/paediatrics-and-child-health" rel="noopener" target="_blank">Full RACP policy statement on circumcision</a> <a href="http://baps.org.uk/page14/page14.html" rel="noopener" target="_blank">British Association of Paediatric Urologists, Management of Foreskin Conditions</a> <a href="http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp" rel="noopener" target="_blank">British Medical Association, The Law and Ethics of Male Circumcision</a> American Academy of Pediatrics, <a href="http://www.cirp.org/library/normal/aap/">Care of the Uncircumcised Penis: Guidelines for Parents</a> Simpson ET, Barraclough P. <a href="http://www.cirp.org/library/hygiene/simpson1/">The management of the paediatric foreskin</a>. Aust Fam Physician 1998;27(5):381-3 Thomas B. McGregor, John G. Pike, Michael P. Leonard. <a href="https://www.circinfo.org/Treatment_of_phimosis.html">Pathologic and physiologic phimosis: Approach to the phimotic foreskin</a>. Canadian Family Physician 2007(March);53:445-448 Dewan PA. <a href="http://www.mja.com.au/public/issues/178_04_170203/dew10610_fm.html">Treating phimosis</a>. Med J Aust 2003 178 (4): 148-150 Camille CJ, Kuo RL, Wiener JS. <a href="http://www.cirp.org/library/hygiene/camille1/">Caring for the uncircumcised penis: What parents (and you) need to know</a>. Contemp Pediatr 2002;11:61 </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 Circumcision and penis care: guide for parents 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>Was sand really such a menace to the foreskin? Did lack of circumcision really cripple armies?</h3> The Summer 2007 edition of The Skeptic magazine (Australia) included an article by Brian Morris on the medical benefits of routine circumcision. In the course of this rather aggressive excursus he defended old claims that the origins of ritual circumcision among certain ancient Middle Eastern tribes lay in health problems caused by the accumulation of sand and dust under the foreskin. Attacking an earlier article by David Vernon, he writes: “In attempting to ridicule the notion that circumcision arose in the Middle East to solve problems caused by ‘sand and dust’, Vernon cites an article by Robert Darby, an anti-circ activist. Darby’s claims stemming from ‘medical records’ ‘he analyzed’ are false. Infections, initiated by the aggravation of dirt and sand, are not uncommon under desert conditions, and have even crippled whole armies of uncircumcised soldiers. It is difficult to achieve sanitation during prolonged battle. To contradict Darby, and thus Vernon, a US Army report by General Patton stated that in World War II 150,000 soldiers were hospitalised for foreskin problems due to inadequate hygiene. (28) To quote: “Time and money could have been saved had prophylactic circumcision been performed before the men were shipped overseas” and “Because keeping the foreskin clean was very difficult in the field, many soldiers with only a minimal tendency toward phimosis were likely to develop balanoposthitis”. (28) The story was similar in Iraq during ‘Desert Storm’ in the early 1990s. (29,30) In the Vietnam War men requested circumcision to avoid “jungle rot”. [1] It might seem rather late in the day to offer a response, but since Professor Morris makes an ad hominem attack on me and suggests that my scholarship is spurious, I hope that I may be permitted a reply in which I shall show that his own respect for evidence is not all that it should be. Describing me as “an anti-circ activist” is an ad hominem device to suggest that because I am sceptical of the value and ethics of routine circumcision anything I say on the subject must be rubbish. I have indeed published extensively on circumcision issues, [2] but if that makes me an anti-circumcision activist, Morris can only be described as an anti-foreskin activist whose views demand to be treated with equal skepticism. [3] Referring to my article as cited by Vernon, he places “medical records” and “he analyzed” in inverted commas, insinuating that the records are somehow unreliable and that my analysis is faulty or even dishonest, leading to his triumphant conclusion that my refutation of this claim must be false. Morris does not identify the article, however, which was a peer-reviewed paper published in the New Zealand Medical Journal [4] – precisely an instance of those “good research studies published in reputable international journals” that Morris says Vernon should have cited. My paper relied on scholarly anthropological sources to show that ritual circumcision arose for cultural/religious, not health reasons; and on the medical volumes of the official histories of Australia and New Zealand in the Second World War to prove that balanitis caused by sand under the foreskin was not a problem in the North African campaign, and that, contrary to the “sand myth”, there were no mass circumcision drives to cure it. Does Professor Morris suggest that the authors of the official histories, in which none of the words “balanitis,” “circumcision,” or “foreskin” make a single appearance, were “anti-circ activists” or (horror of horrors) actually uncircumcised men themselves? But what of Professor Morris’s own scholarly standards? Attempting to refute my argument he cites “a US Army report by General Patton”, and lists a series of pages that are supposed to back up his claim. But when you actually check those pages you find that they have nothing to do with sand under the foreskin and fail to provide any support for the argument that Morris wishes to make. For a start he gets the details of the book wrong. It is not a “report by General Patton”, but a multi-author volume in the official history of U.S. medical services in World War 2, edited by John F. Patton MD. [5] Secondly, there are only two occurrences of the word sand in the entire volume (pages 221 and 447), neither of which has anything to do with foreskins or circumcision. The volume scarcely deals with the Middle Eastern or North African (desert) combat theatres, but mostly with the South-East Asian and Pacific theatres, characterized by dense jungles and wet, humid conditions that posed many intractable health problems, affecting many parts of the body, not just the penis. But in those conditions sand and dust were not an issue. There is not the slightest support for his hyperbolic claim that “Infections, initiated by the aggravation of dirt and sand, are not uncommon under desert conditions, and have even crippled whole armies of uncircumcised soldiers.” As for the pages nominated by Morris, let us see what they actually say: Chapter 4, Venereal Disease (John F. Patton) On page 52, in the section on chancroid, Patton notes that “any penile lesion in the presence of a redundant prepuce may present a problem and also invites secondary infection. Phimosis was a common complication of chancroid, and dorsal slits were often necessary, followed by circumcision after the local infection subsided.” He adds that “Higher headquarters sometimes questioned the number of circumcisions performed in the theater,” but insists that “all were performed from medical necessity, and none were done electively.” In other words, Patton was a fervent believer in circumcision and operated whether the soldiers liked it or not. In those days, in the absence of appropriate antibiotics, circumcision might well have been the only possible response to infections of this type. On page 64 Patton simply notes that in the Mediterranean theatre of Operations circumcision was a common treatment for venereal disease and associated phimosis and inflammation (balanitis). Chapter 6: Infections and Related Conditions (Charles Montgomery Stewart) On page 100 under the heading “Balanoposthitis” (inflammation of glans and foreskin) Stewart notes that lack of cleanliness can lead to irritation, ulcers, and infections. “Treatment requires prompt, regular, strict personal cleanliness and local hygiene. Irrigations of the preputial sac are necessary if the foreskin cannot be retracted. Early inflammation promptly treated subsides rapidly.” He goes on to suggest that in order “to prevent recurrence, circumcision should be mandatory when the local infection and inflammation have cleared”, but does not report that this was actually done. On page 102, under the heading “Balanitis: Preventive Measures”, Montgomery notes that “During the years 1942-1945, inclusive, 22,709 patients were admitted to Army hospitals for balanitis”. Although this was remarkably small proportion of the 13 million men enlisted in the U.S. army during World War 2, he went on to recommend routine circumcision as a prophylactic measure – though it is not clear whether he meant army personnel only, or the entire population. On page 105, Montgomery discusses phimosis (“a congenital or acquired narrowing of the opening of the prepuce”) and notes that “Eventually, the treatment is circumcision,” but warns that “Circumcision in the adult is not the benign procedure it appears to be. These patients are incapacitated from returning to full duty for a minimum of 10 days postoperatively.” He then gives instructions on circumcision technique, warning that “extreme care must be exercised to avoid removal of too much skin. Carelessness may result in partial denudation of the penile shaft. Sufficient preputial skin edge must be left to cover the sensitive papillae of the corona.” In other words, for all his belief in circumcision, Montgomery recognised that because excision of the foreskin could damage the penis you must not remove too much tissue. On page 106 Montgomery notes that during the entire war 110,562 men were admitted to army hospitals for paraphimosis and phimosis and repeats his view that these figures are “so startling” that they “would justify routine prophylactic circumcision.” On page 120 Montgomery discusses venereal warts, discusses topical treatment and notes that “circumcision may be necessary to obtain a permanent cure.” On page 145-6 he continues his discussion of genital warts, and maintains his rage against the foreskin: “Armed forces urological historians should be impressed with the fact that the redundant prepuce again can be pronounced guilty as a consistent contributor to the etiology and high incidence of this disease. Hospital admissions for paraphimosis, phimosis, balanitis, and condyloma acuminatum during the 1942-1945 period totaled 146,793. Had these patients be circumcised before induction, this total would be probably have been close to zero.” As I point out in the discussion below, he provides no evidence that uncircumcised men were significantly more subject to these conditions. His last comment is the fallacy of prediction in hindsight. In Chapter 8, “Genitourinary Neoplasms” (cancer), under the heading “Neoplastic Diseases of the Penis”, Vincent Vermooten notes (page 183): “Carcinomas are so rare in this age group that they call for no comment.” This is also where Morris gets one of his money quotes: “Because keeping the foreskin clean was very difficult in the field [South-East Asia], many soldiers with only a minimal tendency toward phimosis were likely to develop balanoposthitis, and in the presence of venereal warts, inflammation would almost certainly develop,” but the author added that “the use of estrogenic hormone in plastic operations on the penis aided in the prompt recovery of these patients.” Chapter 18, “Reflections” by Ormond S. Culp and John F. Patton, is where Morris finds his other money quote: “During 1942-1945 almost 150,000 soldiers were hospitalized for medical reasons with phimosis, paraphimosis, and/or balanitis; they were unable to maintain adequate local hygiene under combat conditions. The man-hours lost as a result of circumcisions and adjuvant therapy were costly to the war effort and exasperated the commanding officers. Time and money would have been saved had prophylactic circumcision been performed before the men were shipped overseas.” Comment and analysis It is obvious that the pages cited by Morris, although they contain many hostile references to the foreskin, have no bearing on the origins of circumcision in the Middle East, nor to balanitis or other inflammations among Australian or New Zealand soldiers in North Africa. There is no mention of sand at all. Most of the data comes from South-East Asia, where humidity and jungle parasites certainly were major problems; but if they were problems that especially afflicted the foreskins of the U.S. troops, one wonders how the Japanese coped, not to mention the Thais, Vietnamese and Melanesians, none of whom have ever practised circumcision. How significant are the statistics? A total of 13,104,355 men served in the U.S. military in World War 2. If we assume that half were uncircumcised, the number who experienced problems is small: 22,709 cases of balanitis would affect 0.35% and the number needed to treat would be 288.5. If all the venereal warts were in uncircumcised men (13,522 cases) then only 0.21% would get infected, and the number needed to treat would be 484.6. Phimosis and paraphimosis hospitalizations (110,562) account for only 1.69%, with a number needed to treat of 59.3. In the broad scheme of things, these numbers are trivial, and on a cost/benefit calculation alone would certainly not justify general routine circumcision in advance. [6] It is significant that the volume discussed here was published in 1987, and written by American medical doctors who had clearly been acculturated into America’s post-war love affair with circumcision. There is no detailed study of the history of circumcision in the United States, but several studies have suggested that the practice was already popular in the 1930s, became even more deeply embedded in the 1950s-60s, and that the influence of the U.S. Military was a significant factor in this development. [7] The passages quoted above are riddled with speculative assertions about what would or would not have happened if the men experiencing penis problems had been circumcised in advance. But since there are no comparative figures on the incidence of warts, balanitis or venereal infections in circumcised as compared with uncircumcised men, how can we be sure that the latter were disproportionately affected? The British army surgeon Sir Daniel Whiddon asserted that in the Middle East campaigns it was the circumcised men who were more affected by venereal disease: “The shaky science of the arguments in favour of wholesale infant circumcision is often supported by the statement, itself unsupported by any by any scientific evidence, that the circumcised are less liable to disease, particularly that they are less likely to get venereal disease and cancer. The first statement is untrue. You were long enough in the Middle East to know that our circumcised allies were the most enthusiastic supporters of the VD departments.” [8] Of course you cannot experience phimosis if you lack a foreskin with which to experience it, but then, without testicles or a prostate you won’t be at risk of testicular or prostate cancer. The definitions of phimosis given in these passages are very loose, and seem to based on the outdated Edwardian idea that a non-retractile foreskin was in itself pathological, rather than on the scientific understanding that developed in the wake of Douglas Gairdner’s research. [9] As soon as penicillin became available, most venereal diseases were routed away from urology; in those primitive days doctors circumcised for many conditions that would now be treated topically with antibiotics or other medications. The medical history volumes of the Australian official history do not mention problems caused by “lack of circumcision” in the jungles of New Guinea, and if more recent evidence is sought, there is significantly no mention of foreskin problems or circumcision in relation to control of venereal disease, balanitis or any other health issue in Ian Howie-Willis’s biography of Major-General Sir Samuel Burston, the officer in charge of Australian army medical services throughout the Pacific campaign. [10] In response to an inquiry from me, Dr Willis replied: “If circumcision had been practised as widely as your ‘urban myth’ would have it, I’d also expect that it would have been the subject of one of the many ‘technical bulletins’ issued to Medical Corps staff by the successive Directors General of Medical Services. I’ve seen most of these bulletins but certainly didn’t see one dealing with circumcision either in the context of VD or balanitis. Similarly, this is a topic which is never mentioned in any of Burston’s official or personal correspondence, which I’ve read thoroughly. … The reason that circumcision doesn’t appear in my book is that I never encountered its occurrence during my research.” (Email, 1 August 2012) Among the Australian military, it would seem that the foreskin was not seen as some sort of rogue organ and circumcision not hailed as the solution. Accordingly, one suspects that the problems identified so readily by American medical personnel had more to do with their pre-existing animus against the foreskin than with an objective appraisal of the issues. What so many of the comments (Montgomery’s especially) embody is the post-war consensus that baby boys should be circumcised as a matter of course. Worth noting is the admission that military headquarters questioned the need for so many circumcisions, suggesting that the field medical corps had a basic anti-foreskin attitude, and operated whenever there was the slightest excuse. So much for Morris’s use of Dr (not General) Patton. His other references are equally dodgy. The claim about Desert Storm relies on unsourced allegations by Edgar Schoen, an even more vigorous anti-foreskin activist than Morris himself, [11] and on the very article by Gardiner that I refute in my paper in the NZ Medical Journal. Morris is rightly critical of anecdotal evidence, but one of Gardiner’s key pieces of evidence for the “sand problem” was his claim that “a German surgeon” had told him that German Africa Corps troops had “suffered in the same way”, and had similarly been circumcised. But as I remark in my paper, the proposition that a German under the rule of Nazism would have submitted to an operation that could have identified him as a Jew, or that anybody in authority would have recommended such a course, is implausible. To make sure, Mr Hugh Young questioned Manfred Rommel, son of the German commander, who replied: “I have never heard that soldiers in the Africa Corps were circumcised. The veterans I could contact have not either.” Morris’s final claim, that “in the Vietnam War men requested circumcision to avoid ‘jungle rot,’” is backed up by no reference at all; but I am willing to concede that in humid, jungle conditions fungal and related conditions would have been a much greater problem than in the dry heat of the desert – tinea and worse between the toes and under the arms, for example. But we do not hear of doctors recommending amputation of the toes as a cure, or prophylactic digitectomy as prophylaxis. In short, for all Professor Morris’s huffing and puffing, there remains no evidence that ritual circumcision in the Middle East arose from hygienic/medical considerations, nor that troops engaged in the North African campaigns suffered epidemics of balanitis and other inflammations caused by sand and dust under their foreskin. As I concluded in my paper, such assertions are medical urban myths. NOTES and REFERENCES 1. Brian Morris, Circumcision facts trump anti-circ fiction. Australian Skeptic 27 (4) Summer 2007, 57. 2. Most recently, The child’s right to an open future: Is the principle applicable to non-therapeutic circumcision?<a href="http://jme.bmj.com/content/39/7.toc"> Journal of Medical Ethics 39</a> (July 2013). 3. Professor Basil Donovan has described him as “a man on a mission to rid the world of the male foreskin”: review of Morris, In Favour of Circumcision, in Venereology 12, 1999, 68-9. <a href="http://www.historyofcircumcision.net/index.php?option=content&task=view&id=64">Text available at History of Circumcision</a> 4. Robert Darby, <a href="http://journal.nzma.org.nz/journal/118-1218/1564/">The riddle of the sands: Circumcision, history and myth</a>. New Zealand Medical Journal 118, 15 July 2005. 5. The correct citation is Medical Department, United States Army. Surgery in World War II. UROLOGY. Edited by John F. Patton MD. (Washington: Office of the Surgeon General and Center of Military History, United States Army, 1987) Online at: http://babel.hathitrust.org/cgi/pt?id=mdp.39015026943020 6. Figures calculated by Dr Robert Van Howe, Department of Pediatrics, Central Michigan University. 7. Edward Wallerstein. Circumcision: An American Health Fallacy. New York: Springer, 1980; Frederick Hodges. “A short history of the institutionalization of involuntary sexual mutilation in the United States”, in George C. Denniston and Marilyn Milos (eds), Sexual Mutilations: A Human Tragedy, New York: Plenum Press, 1997; Robert Darby. <a href="https://www.amazon.com/dp/B00AXPRD1Q">The Sorcerer’s Apprentice: Why Can’t the United States Stop Circumcising Boys?</a> e-book, Amazon, 2013. 8. Whiddon D. <a href="http://www.cirp.org/library/general/widdicombe/">The Widdicombe file</a>. Lancet 1953;ii (15 Aug):337-8. 9. Gairdner D. The fate of the foreskin: A study of circumcision. Br Med J 1949;2:1433-7. For a listing of recent studies <a href="http://www.cirp.org/library/treatment/phimosis/">see collection at CIRP</a>. 10. Ian Howie-Willis. A Medical Emergency: Major-General ‘Ginger’ Burston and the Army Medical Service in World War II. Newport, NSW: Big Sky Publishing, 2012. 11. And one whose own use of evidence sometimes has its shortcomings: see Robert Darby and John Cozijn, <a href="http://sgo.sagepub.com/content/3/4/2158244013508960.full">The British Royal Family’s Circumcision Tradition: Genesis and Evolution of a Contemporary Legend</a>. Sage Open, 16 October 2013. <a href="http://www.circumstitions.com/sand.html">See also "He might have to fight in the desert"</a> at Circumstitions. NOTE: This reply was submitted to The Skeptic magazine, but was refused publication. </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 Circumcision and sand revisited: a skeptical reply to Brian Morris 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>German court rules non-therapeutic circumcision of boys unlawful</h2> Hot on the heels of a resolution of the Finnish Greens that non-therapeutic circumcision of children should be prohibited, a district court in Cologne, Germany, has ruled that non-therapeutic circumcision of children, even when performed for religious reasons at the request of a boy’s parents, is unlawful, and that those responsible are guilty of inflicting bodily harm. The case arose from a 4-year old boy circumcised by an Islamic doctor who later suffered severe bleeding requiring emergency medical care. The case has far-reaching implications for the future of medically unnecessary circumcision of minors and the human rights of children. The following article is translated from the German newspaper, Financial Times. German court: Religiously motivated circumcision is unlawful A judgment of the District Court of Cologne [refers to] a widespread medical intervention carried out for religious reasons. According to this judgement, (non-therapeutic) circumcision of boys will in future be regarded as personal injury. Those who circumcise boys for religious reasons make themselves liable to prosecution for assault causing bodily injury. This is the decision of the Cologne regional court, in a landmark ruling that has come to the attention of the Financial Times Germany. In its judgment, the Court made it clear that neither the rights of the parents nor the freedom of religion guaranteed in the basic law can justify this intervention. Thus, for the first time a German court places circumcision as a religious custom under the threat of penalty. Each year, several thousand boys in their first years of life are circumcised in Germany at the request of the parents. In the United States, even the majority of all boys are circumcised largely independently of religion directly after birth. Massive resistance to this practice has now developed. Worldwide around a quarter of all men are circumcised. For decades doctors in Germany operated in a legal grey area when they circumcised boys for purely religious reasons, without medical necessity. Up till now, however, they could rely on the claim that they did not know that religiously-motivated circumcision was unlawful. Even if a court accepted that there had been personal injury, the doctor would be acquitted because of legal technicalities. The Cologne decision has now eliminated this possibility. Holm Putzke from the University of Passau said “The decision is extremely important especially for doctors because they have legal certainty now for the first time.” The legal expert has called for an explicit prohibition of non-therapeutic circumcision for years. “In the past courts – like politicians – have been afraid to act out of fear of being accused of anti-semitism and hostility to religion”, said Putzke. “This decision could influence not only future case law, but lead to a change of consciousness and greater respect for the fundamental rights of children.” Muslim and Jewish organizations have so far rejected suggestions that circumcision of children is unlawful. They regard a ban as “serious interference with the right to the free exercise of religion”. They did not respond immediately to requests for comment on the Cologne court’s decision, but wanted time to consider the judgment. The judgment is likely to provoke discussions. For years struggle politicians and welfare associations have struggled to improve the integration of the Muslim population. In 2006 Wolfgang Schäuble, as Minister for the Interior, convened an Islamic Conference on his own initiative. The former German President Christian Wulff said: “Islam belongs to Germany.” His successor Joachim Gauck also commented: “Muslims who live here are part of Germany." Some Muslims are now likely to regard the Cologne decision as a step backwards. Experts assume that more cases like this will come before the courts. Eventually the question could be settled by specific regulations governing religiously motivated circumcision issued by the Federal Constitutional Court. In the Cologne case, a Muslim physician circumcised a four-year old boy at the request of the parents. Two days later he suffered severe haemorrhage, and the mother brought the boy in for emergency medical care. The public prosecutor’s office was informed of this and pressed charges against the circumciser. After the medical legal tribunal ruled the procedure to be legal the prosecutor lodged an appeal. As a result of this, the Court assessed the circumcision as “serious and irreversible impairment of physical integrity”. Source: Matthias Ruch, <a href="http://www.ftd.de/politik/deutschland/%3Akoerperverletzung-gericht-stellt-religioese-beschneidung-unter-strafe/70054618.html">Court: religious circumcision is punishable</a>, Financial Times (Germany), 25 June 2012 <h3>Circumcision of boys “an assault”: Melbourne Age</h3> The following report of the decision was published in the Melbourne Age. A GERMAN court has ruled that circumcising young boys represents grievous bodily harm, a decision that could have significant repercussions for religious groups. The president of the Central Council of Jews in Germany condemned the decision by the regional court in Cologne as '”an unprecedented and dramatic intrusion on the self-determination of religious communities” and called on the German parliament to pass legislation protecting circumcision as a religious practice. The case centred on a four-year-old boy whose Muslim parents had him circumcised by a doctor, which led to medical complications. Advertisement: Story continues below. The doctor was charged with grievous bodily harm but acquitted by a lower court, which judged he had acted within the law as the parents had given their consent. On appeal, the regional court also acquitted the doctor, but for different reasons. It upheld the original charge of grievous bodily harm, but ruled that the doctor was innocent as there was too much confusion on the legal situation. Although Muslims and Jews circumcise infant boys as a religious practice and many other people do so for health reasons, the court found that the child's “fundamental right to bodily integrity” was more important than the parents’ rights. “The body of the child is irreparably and permanently changed by a circumcision,” it said. ''This change contravenes the interests of the child to decide later on his religious beliefs.” According to the court, the religious freedom “would not be unduly impaired”, because the child could later decide whether to have the circumcision. Germany has no law against male circumcision, as there is against female genital cutting. Experts said the decision would not be enforceable in other jurisdictions. But the legal uncertainty and threat of prosecution could lead doctors to decline to perform the procedure. Holm Putzke, a criminal law expert at the University of Passau, said the ruling was not binding for other courts, but could send a welcome signal. “After the knee-jerk outrage has faded away, hopefully a discussion will begin about how much religiously motivated violence against children a society is ready to tolerate,” he told the German news agency DPA. Source: <a href="http://www.theage.com.au/world/circumcision-on-boys-assault-court-rules-20120627-212rw.html">Circumcision on boys assault, court rules</a>, The Age (Melbourne) 28 June 2012 <h3>Court ruling on circumcision is final: German legal expert</h3> The following analysis of the Cologne court ruling by the German legal expert <a href="http://www.holmputzke.de/">Dr Holm Putzke</a>, professor of law at <a href="http://www.jura.uni-passau.de/">University of Passau</a>, was published as an interview in German Turkish News, 26 June 2012. An edited English translation follows Opinion: Doctors should refuse to perform religious circumcision The District Court of Cologne has recently ruled that the circumcision of boys, even for religious reasons, shall henceforth be considered a crime. ... Criminal law professor Dr. Holm Putzke of the University of Passau evaluates the judgment in an interview for the German Turkish News. For him, the ruling is an appeal to parents to deliberate whether such interventions are really necessary. German Turkish News: How do you interpret the ruling of the Cologne Court? Is this a landmark decision? Holm Putzke: Although the Cologne District Court generally follows prevailing opinion in the legal and medical literature, this ruling does represent an important turning point. For the first time, a court has declared – no ifs and/or buts about it – that medically unnecessary circumcision on non-consenting boys is illegal, and in fact is punishable by law. Prior to this decision, the legal situation was unclear for lack of a clear judicial decision. ... German Turkish News: Could you say it's a specific feature of Western democratic societies that the legal right to physical integrity is trumps the right to religious freedom? Holm Putzke: There’s no blanket answer to that. Protecting religious freedom is important and necessary, just as it’s essential to protect the physical safety of persons, especially children. It would be a queer understanding of religious freedom if religions were simply allowed to physically injure people in the name of their faith and thereby circumvent the prevailing statutory laws of German society. ... German Turkish News: What does this ruling now mean for doctors? Should doctors basically refuse to perform circumcisions for religious reasons? Holm Putzke: Two Munich doctors, Maximilian Stehr and HansGeorg Dietz, collaborated with me on an article in 2008 that was published in the German Medical Journal regarding the criminalization of religious circumcisions on boys. Since then, more and more doctors have refused to participate in medically unnecessary circumcisions of non-consenting boys. This is primarily because the surgery carries risks, and confers absolutely no health benefits in childhood. After the Cologne ruling, doctors can now be threatened with criminal prosecution, and without going into too much detail, the inherent illegality – of the act of circumcising boys who don’t need it – will likely impact doctors’ liability insurance. If doctors are presented with a request to perform a religiously-motivated circumcision, they would do well to advise the parents of the legal situation in this country, as well as the risks of surgery itself, and refuse to perform the surgery. At the same time, doctors should clearly point out that circumcision should be postponed until the individual in question can decide about the procedure himself. German Turkish News: What message does this ruling send to the religious communities? Holm Putzke: The message is: Think about, really reflect, whether it is really necessary to put a small, often utterly frightened boy through surgery that has no medical necessity and that carries risks, or whether you can hold off on this or opt for some other ritual that symbolically fulfils the religious intent. ... German Turkish News: Do you expect there to be an appeal? Holm Putzke: This was already an appellate decision. Since the state bar apparently has decided not to consider any further appeals, the judgment is final. There is no way to challenge this ruling. This message is especially true for individuals or organizations that might viscerally attack this decision just to declare their outrage and disgust. German Turkish News: Do you expect more lawsuits because of similar incidents? Holm Putzke: I won't hazard an answer. Conceivably a storm of indignation from religious groups might initially discourage other prosecutors from bringing such cases. But in the long run the solid arguments will prevail. And those arguments pretty clearly now say that children should not have their genitals forcibly violated. Rather, they can make a decision at an appropriate age about whether they want it or not. Prof. Dr. Holm Putzke, LL.M. teaches Criminal Law at the University of Passau. Since the 2008 publication of his essay "The Criminal Relevance of Circumcision of Boys," he has made many other contributions to the subject and has participated in the public debate on the criminalization of circumcision of minors that is not medically indicated. Source: <a href="http://www.deutsch-tuerkische-nachrichten.de/2012/06/455709/nach-urteil-%E2%80%9Eaerzte-sollten-religioese-beschneidung-ablehnen%E2%80%9C/">DeutschTurkischeNachrichten, 26 June 2012</a> <h3>Implications of German circumcision decision for Britain (and Australia?)</h3> Dr John Warren’s letter to The Times Doctors throughout Europe, where there is no tradition of infant male circumcision in medical practice, have been faced in recent years by an increasing demand for this service, due to the immigration of families from other parts of the world where male circumcision has been a cultural norm. There is confusion over how to respond to this demand, both among the medical and also the legal professions. The ruling in Germany, reported in The Times on 28 June, illustrates this problem. In this case a state court ruled that circumcision on non-medical grounds of a child amounted to grievous bodily harm. In The Netherlands, the Royal Dutch Medical Association has issued a report stating that non-therapeutic circumcision of underage boys amounts to a violation of a child’s physical integrity, and so contravenes Article 8 of the European Convention of Human Rights and Article 11 of the Dutch constitution. In Norway, the Centre Party has proposed an outright ban on non-therapeutic male circumcision of under-age boys, provoking a heated debate. Here in the UK , there has so far been little debate, despite the fact that large numbers of boys are being circumcised for non-therapeutic reasons, some within the NHS, some in private clinics, and some by non-medically qualified operators. It is impossible to determine accurately how many. However, the medical literature shows a complication rate of anywhere between 2 and 20%. These do not include late problems discovered by adult men who were circumcised as infants, and our records at NORM-UK include many examples of both physical and psychological problems that appear to result from this operation. Earlier this month (June) the Westminster coroner gave a verdict of accidental death in the case of a one month old baby boy who died of haemorrhage from his wound two days after circumcision. The General Medical Council does not have a position on the issue of non-therapeutic male circumcision of children. It states: We do not have general authority to determine public policy on issues that arise within medical practice – these are matters for society as a whole to determine, through the parliamentary process. There are four principles of medical ethics: autonomy, beneficence, non-maleficence and justice. Clearly a child’s autonomy is breached by a non-therapeutic procedure permanently altering his anatomy. Regarding beneficence, no medical organisation in the world recommends routine infant circumcision for health reasons. Non-maleficence refers to not doing harm; the possibility of complications mentioned above shows that there is considerable potential for harm from this procedure. Justice asks the question ‘is it fair?’ Would you do the same to a girl? Would you do the same to an adult male without his consent, that is tie him down and forcibly remove his foreskin, possibly without anaesthesia? In my view the UK needs a debate involving doctors, lawyers, ethicists, politicians, representatives of religions and the wider public on the subject of non-therapeutic circumcision of underage boys. And the General Medical Council should consider coming off the fence and consider carefully whether its lack of position on this topic is consistent with its role: to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. Dr John Warren Chairman NORM-UK This letter was sent to The Times (London), but not published. <h3>Professor Holm Putzke’s interview with Bavarian Radio</h3> “Protection from violence is more important than religious rites” Because of an article four years ago, he finds himself now seriously threatened: Professor Holm Putzke of the University of Passau speaks out against the circumcision of boys. The recent judgment of the District Court in Cologne rests on his findings. “It’s really a question of postponing a religious act,” he explains in an interview with Bavarian Radio. BR.de: How do you view the judgment of the District Court in Cologne? Holm Putzke: The judgment of the District Court in Cologne is correct. The court came to its conclusion, after an intensive analysis of the jurisprudential debate, that religious freedom ends where physical safety of children is irreparably impacted, in this case due to unnecessary and risky surgical procedures. It should be self-evident that we simply don't allow this in a society that emphasizes the protection of children from forceful or violent acts. The verdict The District Court in Cologne determined that the circumcision of a minor boy for religious reasons in June 2012 was an injury. The judges argued that religious circumcision is a permanent and irreversible intrusion on the child. Jewish and Muslim groups criticized the decision as impermissible encroachment on the freedom of religion. BR.de: What significance does it have? Holm Putzke: It’s a brave decision, because the wave of indignation was predictable and the climate of discussion almost always suffers when it comes to any criticism of religion. Despite the this ruling being non-binding on other courts or prosecutors, the ruling could send a signal and - more importantly - finally lead to a long-overdue public discussion. BR.de: Isn’t this a very western, and therefore one-sided, view of things? Holm Putzke: It's not actually a one-sided view of things, because the court doesn’t simply make an assertion. Rather, it reaches a judgment after a careful weighing of the constitutionally protected rights to self-determination and bodily integrity against the parents’ right to free exercise of religion. You also can't really say this is a “typically western” view, since in other parts of the world enlightened people are thinking the same way. BR.de: What does the ruling now mean for doctors? Should they decline to do circumcisions for religious reasons? Holm Putzke: The risk of doctors being held criminally liable in case of complications, or losing their insurance coverage, is now elevated. However, as a doctor I wouldn't simply decline to do these circumcisions because they’re religiously-motivated, but rather because performing medically unnecessary surgery on children who can not defend themselves is ethically incompatible with the medical profession. BR.de: What message do the court judgment and your legal commentaries send to the religious communities? Holm Putzke: The point of my early 2008 article, dealing with legal culpability in the religious circumcision of boys, was not to criminalize doctors and parents, or really even religious groups. Rather, I was hoping that a broad public debate might get underway about how much religiously motivated violence against children is tolerable. Neither the judgment nor the overall viewpoint it favors prevents anyone from exercising their religion. It’s not about discrimination against religious groups or the total prevention of religious practice; it's really just about postponing a religious act. BR.de: Is this whole thing a typical German debate? How do you think this topic will be handled in Europe and globally? Holm Putzke: In other countries, especially in the United States, there has been a strong movement for decades that criticizes medically unnecessary circumcision on non-consenting children as unethical. Even Israel has seen intense debate over whether religious circumcision of children is ethically justifiable. I have received numerous letters from Israel, where parents have told me that despite their ongoing religious affiliation to Judaism they've abstained from infant circumcision, and prefer to wait until their child is able to make his own independent decision about it. So it seems that if it’s supposed to always be the case, as the Central Council of Jews here in Germany claims, that infant religious circumcision remains essential and indisputable in Judaism... then they're really only telling half the story. BR.de: There’s a good chance you’re going to be reviled and threatened over this ruling. How do you plan to handle it? [Threats to Professor Putzke have included drowning and forcible circumcision.] Holm Putzke: It would be naive to think that my critiques, and the skeptical views of what is by now the majority in the medical and law professions, will only be discussed in a rational, calm and composed manner. Any criticism of religion has always triggered emotional reactions. Insults and threats don’t bother me really, if for no other reason than some people are simply hiding behind them when they can't express their displeasure any differently. Good arguments, however, are much more likely to impress me. Source: <a href="http://www.br.de/themen/aktuell/inhalt/interview-beschneidung-putzke100.html">Bayrische Rundfunk, 29 June 2012</a> <h3>Information on Professor Putzke</h3> <a href="http://www.holmputzke.de/" rel="noopener" target="_blank">Homepage</a> Publications Zirkumzision bei nicht einwilligungsfähigen Jungen: strafrechtliche Konsequenzen auch bei religiöser Begründung; in: Deutsches Ärzteblatt 2008, A 1778–1780 (gemeinsam mit Maximilian Stehr und Hans-Georg Dietz) <a href="http://www.aerzteblatt.de/archiv/61273">Full text here (in German)</a> Strafbarkeit der Zirkumzision von Jungen. Medizinrechtliche Aspekte eines umstrittenen ärztlichen Eingriffs (Liability to penalty for circumcision in boys. Medico-legal aspects of a controversial medical intervention); in: Monatsschrift Kinderheilkunde 8/2008, S. 783–788 (gemeinsam mit Maximilian Stehr und Hans-Georg Dietz) <a href="http://www.holmputzke.de/images/stories/pdf2008_mschr_kinderheilkunde_zirkumzision.pdf">Full text (PDF) here (in German)</a> ABSTRACT in ENGLISH Often (pediatric) surgeons or (pediatric) urologists have to face the request for circumcision of a minor male by persons having the care and custody in absence of a medical indication. This review points out the imperative of refraining from such a procedure to avoid being a possible addressee of a claim according to civil law or even being accused in a lawsuit later. The attending physician who performs the circumcision without medical indication on a minor male, incurs a penalty according to § 223 para. 1 German Criminal Code, even though the person having the custody of the child signed the informed consent to that procedure. Lacking the cognizance of disposition about the legally protected interest of the child (physical inviolability), the consent is namely not effective. In this article not only the german current legal status is demonstrated, but arguments for the legitimacy of a male circumcision (treatment of phimosis, prevention of different diseases, religious aspects) are discussed. <h3>“Physical integrity is of the highest value”:</h3> <h2> <a id="maxim" name="maxim"></a>Circumcision requires consent of the individual</h2> The following interview with Munich paediatric surgeon Maximilian Stehr appeared in Deutsche Welle, 17 July 2012 Children have to be old enough to give their consent to a religious circumcision, says leading pediatrician Maximilian Stehr. But the law does not need to be changed. Maximilian Stehr is a pediatric surgeon at the University Hospital in Munich and chair of the working group on pediatric urology at the Germany Association for Pediatric Surgery. DW: What has been the effect as far as pediatricians are concerned of the ruling by the court in Cologne regarding the religious circumcision of boys who are not yet able to give informed consent? Maximilian Stehr: To start with, one should note that this ruling has not changed the law, it has merely interpreted existing law and applied it. There has of course been an effect on colleagues working in the field of pediatric surgery and urology in that the ruling has led to a public discussion, and, should similar charges be brought against a doctor in future, it will not be possible to argue [as in this case] that the doctor could not be expected to know that his actions were illegal. I know of many doctors who are currently not carrying out any circumcisions of boys who are not able to give informed consent. What is your advice to doctors who ask whether they should carry out this operation? I've always given the same advice, even before this ruling. I've always held the view that this medical intervention cannot be regarded as conforming to current law or current medical ethics. And so I continue to advise doctors not to carry out this operation; instead, if religiously-motivated circumcision is to be carried out, it should only be carried out at an age when the child or the young person is able to permit it himself or at least consent to it. Would you see the issue of the inability of the child to give its consent as a bigger issue than that of the child's physical integrity? I don't think you can separate the two. Physical integrity is certainly the highest value. That goes without question. There are certainly medical conditions and situations in which people want to decide for themselves that they would like to change something about their body. That is standard procedure in cosmetic surgery - it's the same in pediatric surgery, for example, when we correct protruding ears. For that, the child has to be able to judge for itself the seriousness of the operation, as well as its risks and side-effects, and that is only possible when the child is 14 or 16 years old. How far is this an issue of medical ethics? Medical ethics is very closely related to the Hippocratic Oath. All our actions as doctors must work towards healing and towards the benefit of the patient to the best of our knowledge and conscience. A further principle is never to cause any harm. Both these principles are imperiled when one carries out the circumcision of a boy who is unable to give consent. That means it's an unnecessary operation? It is an unnecessary operation. All the benefits which are said to come from circumcision, some of which are certainly valid - for example, concerning sexual infections or penile cancer or the development of tumors - are all reasons which argue for circumcision as a possible preventative measure - but not at this age. The German government wants to find a speedy solution to the problem, and it has hinted that it plans to introduce a law which will continue to permit religious circumcision. Would you consider that any solution must include restrictions as to age? I don't see any reason to pass a new law - one just has to apply existing law and existing medical ethics. There's no need for anything else. Then you come to the situation we have at the moment, that, if one wants to carry out such an operation which has no medical justification, it requires the consent of the patient. I would find extremely dangerous if there were to be a special law to permit such an operation to be carried out on, for example, Jewish children. That would go entirely against the principle of equal treatment. One could then certainly argue that this in itself would be discrimination. Currently, though, it's the case that the parents can decide, since they have legal custody. The legal custody of the parents only allows decisions which are clearly for the benefit of the child. That's why I consider this medical intervention to be illegal. It can only be dealt with if the religious communities can agree that the operation can be delayed until the child is old enough to decide for itself or to give its consent. There has to be a compromise, but I don't see any compromise possible which involves special laws for specific religious communities or other groups. That would go against the principle of equal treatment and would backfire in the end. Source: <a href="http://www.dw.de/dw/article/0,,16101556,00.html">Wait until later, say paediatricians</a>, by Dagmar Breitenbach and Joanna Impey, Deutsche Welle, 17 July 2012 <h3>Further discussion of Cologne court circumcision judgement</h3> Brian Earp, <a href="http://blog.practicalethics.ox.ac.uk/2012/06/religion-is-no-excuse-for-mutilating-your-babys-penis/">Religion is no excuse for mutilating your baby’s penis</a>, Practical Ethics Blog, 28 June 2012 Andrew Sullivan, <a href="http://andrewsullivan.thedailybeast.com/2012/06/germany-bans-circumcision.html">Cologne decision a victory for religious freedom</a>, Daily Beast, 27 June 2012 Kerre Woodham, <a href="http://www.nzherald.co.nz/opinion/news/article.cfm?c_id=466&objectid=10816649">Spare the children</a>, New Zealand Herald, 1 July 2012 <a href="http://intactnews.org/" rel="noopener" target="_blank">Humanistic Judaism increasingly critical of child circumcision</a>, IntactNews, 30 June 2012 Jewish Journalist Larry Derfner, <a href="http://972mag.com/stand-up-for-your-son-say-no-to-ritual-circumcision/49669">Stand up for your son: Say ‘no’ to ritual circumcision</a>, 972Mag, 29 June 2012 Robert Darby, <a href="http://www.onlineopinion.com.au/view.asp?article=13841">Non-therapeutic circumcision of minors: A legal and ethical minefield</a>, On-Line Opinion, 9 July 2012 <a href="http://www.openforum.com.au/content/should-circumcision-be-illegal" rel="noopener" target="_blank">Open slather, illegal or regulated: The new debate on male circumcision</a>, Open Forum, 16 July 2012 Dr Maximilian Stehr, <a href="http://www.spiegel.de/international/germany/commentary-circumcision-without-medical-justification-is-wrong-a-846395.html">Circumcision without medical necessity is wrong</a>, Spiegel International, 26 July 2012 <a href="http://www.circumstitions.com/news/news47.html#germany-illegal25" rel="noopener" target="_blank">Turkish-German politician supports circumcision restriction</a> (“Boys should decide at age 14”), TagesZeitung magazine, Berlin, 26 July 2012 Kenneth Houston, <a href="http://www.irishtimes.com/newspaper/opinion/2012/0731/1224321157056.html">Male genital mutilation a gross breach of baby's bodily integrit</a>y, Irish Times, 31 July 2012. <a href="http://ethxblog.blogspot.co.nz/2012/07/against-male-cicumcision-for-religious.html" rel="noopener" target="_blank">Against male circumcision on religious or cultural grounds</a>, Udo Schuklenk's Ethx Blog, 31 July 2012 Anthony Levin, <a href="http://www.thepunch.com.au/articles/we-must-bring-religion-in-on-the-push-to-ban-circumcision/?from=scroller&pos=3&referrer=article&link=text">We must bring religion in on the push to ban circumcision</a>, The Punch, 8 August 2012 <a href="http://pro-kinderrechte.de/faq-english/" rel="noopener" target="_blank">Pro-Kinderrechte - In favour of the rights of children</a> (in German; FAQ in English) Toby Lichtig, <a href="http://newhumanist.org.uk/2856/circumcision-time-to-cut-it-out">Circumcision: Time to cut it out?</a> New Humanist, Sept/Oct 2012 Brian D. Earp and Robert Darby, <a href="http://theconversation.edu.au/tradition-vs-individual-rights-the-current-debate-on-circumcision-10199">Tradition vs individual rights: The current debate on circumcision</a>, The Conversation, 2 November 2012 The Cologne decision has generated immense debate, especially in Europe, and new developments and commentary appear too fast to record. To keep up to date, check out the news pages of <a href="http://www.circumstitions.com/">Circumstitions.com</a> and <a href="http://circumstitionsnews.blogspot.co.nz/">Circumcision News Blogspot</a> <h2>German circumcision law shows political opportunism, not ethical principle</h2> In the wake of the Cologne court’s decision that non-therapeutic circumcision of minors constituted bodily harm and a violation of the child’s physical integrity and religious freedom and was thus unlawful, the German parliament passed a law clarifying the legality of circumcision. In an article published in the international journal Bioethics, Diana Aurenque and Urban Wiesing argue that the law was a response to political lobbying and ignored accepted principles of human rights and bioethics. Assessing the balance of benefits and harms from circumcision, the authors conclude that circumcision provides no benefits to the child as a child, but only risks and harms. ABSTRACT: The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the ‘child as a child’ and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany’s unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues – as in the case of religious circumcision. Diana Aurenque and Urban Wiesing, German law on circumcision and its debate: How an ethical And legal issue turned political. <a href="http://onlinelibrary.wiley.com/doi/10.1111/bioe.12077/abstract">Bioethics, early view, 23 December 2013</a>. See also the <a href="https://www.circinfo.org/Journal_of_medical_ethics_July13.html">article by Reinhard Merkel and Holm Putzke</a> in the July 2013 edition of the Journal of Medical Ethics. <h2>Finland: Parents’ power vs rights of the child</h2> Meanwhile in Finland there is a growing gulf between legal regulators, who want to tolerate minority cultural practices, and doctors and bioethical experts who consider circumcision of boys to be genital mutilation, no different in ethical and moral terms from female genital mutilation. Recently the Finland Greens passed a resolution that all non-therapeutic circumcision of minors should be stopped. The following commentary is from a Helsinki newspaper. The issue of circumcisions performed on boys for religious and cultural reasons has reached a stage in Finland in which it is difficult to find a solution that is acceptable to all. The Green League voted in favour of a resolution at its party congress a week ago that such procedures should be phased out in Finland either through advice or, if necessary, through legislation. Finns Party MP Vesa-Matti Sarakkala submitted a legislative initiative in Parliament calling for an outright ban on circumcisions. Earlier in the spring the issue was also taken up by Minister of Justice Anna-Maja Henriksson (Swed. People’s Party). In her view, the procedures should be permitted, but legislation, or at least guidelines from the ministerial level are needed on who may perform the circumcisions and under what circumstances. There are problems involved in both permitting and prohibiting the operations, but there are also problems involved in the Finnish status quo, which has no specific legislation to back it up. It is estimated that hundreds of non-medical circumcisions are performed on boys each year, but the circumstances under which they might be permitted, and when they would be classified as criminal assault are unclear. A basic guideline has been the decision handed down by the Supreme Court in 2008, in which the religiously motivated circumcision performed on a Muslim boy was not considered a crime, as it was performed in a medically sound manner. The decision has been interpreted in such a way that non-medical circumcisions have been seen as permissible as long as they are performed by a doctor. However, last year Helsinki District Court took a tougher line. The court ruled, among other things, that the person undergoing the procedure should understand what is happening. This means that circumcision of small children would not be allowed. The court based its decision on the <a href="http://conventions.coe.int/Treaty/en/Treaties/html/164.htm">Convention on Human Rights and Biomedicine</a> of the Council of Europe, which was adopted by Finland only after the Supreme Court’s decision. The case is still in the Court of Appeals, and it is too early to say if the Supreme Court will rule on it someday. As long as no legislation is passed, or case law established, cases will end up in court. The situation causes uncertainty among parents who do not know if they could face charges. If the surgeries are banned, there is a danger that they will be performed abroad, or that quacks might be enlisted for the purpose, and that if complications occur, the parents might be afraid to take their children in for treatment. In addition, both the Jewish and Muslim communities oppose any ban. However, if the procedures are permitted, Finland will be giving its approval to medically unnecessary surgery that interferes with the integrity of the body. The Finnish Medical Association takes the stand that child circumcisions are in conflict with medical ethics. The Ministry of Social Affairs and Health favours a compromise. It does not take a stand in either direction on the issue of legislation, but it is preparing a set of guidelines for health care professionals. Ministry official Marie Kolimaa is not disclosing the content or schedule of the guidelines. “There are many things that remain open”, she says. This is certainly easy to believe. A number of thorny questions need to be considered: <ul> <li>Should public health care be used for the performance of a religious ritual?</li> <li>What if all doctors refuse on ethical grounds?</li> <li>If the procedures are consigned to the private sector, is it still possible to get a public subsidy?</li> </ul> There is also the question of basic principles, which the Greens also referred to. Should Finland seek to act in such a way that non-medical circumcisions of boys would become less common, or be eliminated completely? If so, what would be the means to that end? Source: Irina Vähäsarja, <a href="http://www.hs.fi/english/article/NEWS+ANALYSIS+Finland+lacks+policy+on+religiously-mandated+male+circumcision/1329104229469">Finland lacks policy on religiously-mandated male circumcision</a>, Helsingin Sanomat International edition, 28 May 2012 <h2>Comment by CIA: Circumcision the only issue that unites Jews and Muslims</h2> Defence of their right to commit an act of violence against their children seems to be the only issue that distracts Jewish and Muslim adults from their need to commit violence against each other. Yet there is a major difference between Jewish and Muslim circumcision practices: for a devout Jewish parent who follows all the rules laid down in the Torah, there is a passage in Genesis that appears to require them to circumcise their male children on the eighth day (and also their servants and employees, though this is not insisted upon these days). Circumcision is (or should be) performed by a Mohel as a religious ceremony, analogous to baptism, with a service, liturgy, ritual and celebration following a set pattern. There are no such requirements in the Muslim scriptures: the Koran makes no mention of circumcision, and the only words from the prophet Mohammed recorded on the subject state that is desirable or meritorious for both men and women as a sign of piety and commitment to the faith. Unlike in Judaism, there is no liturgy or religious ceremony associated with the operation, which (these days) is normally carried out by a doctor in a sterile clinical setting, and no ritual elements at all. In other words, there is no obligation placed on parents to circumcise their children; circumcision is merely an act of faith that a devout Muslim might be expected to elect for himself. It follows that there is no valid reason why children of Muslim parents should not be protected from circumcision until they are old enough to decide the matter for themselves. Those who talk about the right to religious freedom forget that the treaties and declarations that guarantee such freedom extend it to everybody, irrespective of age: children have their own entitlement to religious freedom. As to the question of assault, there can be little doubt that forcible circumcision of an adult would be a criminal assault occasioning actual bodily harm; if that is the case, at what age does the same action become a legal and acceptable practice? Would it be legal to forcibly circumcise a 15-year old boy? What about a 10-year old? A 5-year old? From a logical point of view, if to circumcise an adult without his informed consent is a criminal assault, it must be equally wrong to perform the same action on a minor. To argue otherwise would be to imply that while it is wrong to commit sexual assault or rape on an adult, it would be perfectly OK to rape a child. Society has decided the contrary: that assaults on defenceless children are far more wicked than the same assaults on adults. Why should cutting of a boy’s genitals be regarded any differently? The words of Holm Putzke, a criminal law expert at the University of Passau, get to the heart of the matter: “After the knee-jerk outrage has faded away, hopefully a discussion will begin about how much religiously motivated violence against children a society is ready to tolerate.” <a href="https://www.circinfo.org/ethics.html" rel="noopener" target="_blank">Further information on the ethics page</a> <h2> <a id="bma" name="bma"></a>Doctors urge British Medical Association to stop non-therapeutic circumcision of boys</h2> The British Medical Association will be urged to debate the banning of Unnecessary Male Circumcision at its annual meeting next week after a baby bled to death in Queens Park, London. The tragic case of 28 day old Angelo Ofori-Mintah is the latest in string of deaths and injuries that have prompted some doctors to call for laws that protect girls from unnecessary genital cutting to be extended to protect boys. The <a href="http://www.circumstitions.com/news/news46.html#london-death">news of Angelo’s death</a> came in the same week that The British Association for Community Child Health reported in it’s quarterly newsletter that a baby boy’s skull was fractured during a ritual circumcision performed on a kitchen table in Bristol. Now Dr Antony Lempert GP, Director of the <a href="http://www.secularmedicalforum.org.uk/?page_id=27">Secular Medical Forum</a>, will be calling on the BMA to debate the banning of non-therapeutic circumcision in the UK at the start of its annual meeting. Other cases that have helped push the issue up the agenda include the case of a Salford midwife who will be tried for manslaughter later this year after a boy she circumcised bled to death, and a report in The Journal of Public Health that found that nearly 1 in 2 Muslim boys circumcised in an Islamic school in Oxford ended up with medical complications. There is currently a growing demand across Northern Europe to outlaw medically unnecessary circumcision of boys, with the junior party in <a href="http://www.circumstitions.com/news/news45.html#norway-ban">Norway’s coalition government</a> calling for a ban earlier this month, and medical associations in<a href="http://www.circumstitions.com/news/news45.html#finland-nolaw2"> Finland</a>, Sweden and The Netherlands also opposing the practice. Britain’s leading anti-circumcision charity, <a href="http://www.norm-uk.org/">NORM UK</a>, is heading for Rotterdam next week for an international conference on the Doctor and the Foreskin (subtitled Circumcision: Forbid, deter or encourage?) The <a href="http://endmalecircumcision.blogspot.com.au/">Campaign to End Unnecessary Male Circumcision</a> estimates that more than half a million boys living in the UK will be subjected to medically unnecessary circumcision before their 16th birthday. And the anti-circumcision movement is growing in the UK with campaigners from the group <a href="http://www.mendocomplain.com/">Men Do Complain</a> planning to protest outside the British Medical Association’s Annual Representatives Meeting in Bournemouth next week. The campaign founder, Richard Duncker, says they will be protesting because “cutting the genitals of healthy boys who cannot consent is profoundly unethical”. Another group, Genital Autonomy, is planning a mini-conference in at Keele University in July to bring together leading experts and practitioners to debate “How Can We Prevent unnecessary Male Circumcision”. Source: <a href="http://www.healthmatters.org.uk/?p=1324">Medics urged to ban circumcision as baby boy bleeds to death</a>, Health Matters (UK), June 2012 </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 Circumcision and the law: News from Australia and around the world 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>A timeline of the foreskin and circumcision</h2> <table border="1" cellpadding="8" cellspacing="4" style="border-style: solid; width: 100%; border-color: #000000; background-color: #ffffff;" width="100%"> <tbody> <tr> <td width="22%">Year</td> <td width="78%">Event</td> </tr> <tr> <td width="22%">300 million BCE</td> <td width="78%">Reptiles evolve internal fertilization, using a retractable penis.</td> </tr> <tr> <td width="22%">100 million BCE</td> <td width="78%">A proto-mammalian species evolves the foreskin, which becomes a genital feature in most mammals.</td> </tr> <tr> <td width="22%">5 million BCE</td> <td width="78%">Australopithecus (hominid ape): penis has foreskin</td> </tr> <tr> <td width="22%">400,000 BCE</td> <td width="78%">Homo sapiens: complete with foreskin</td> </tr> <tr> <td width="22%">130,000 BCE</td> <td width="78%">Modern humans: complete with foreskin</td> </tr> <tr> <td width="22%">10,000 (?) BCE</td> <td width="78%">Aboriginal tribes in central and desert regions of Australia introduce circumcision of boys as puberty rite</td> </tr> <tr> <td width="22%">6000 (?) BCE</td> <td width="78%">Circumcision (male and female) practised as puberty rite by tribes in north-eastern African and Arabian peninsula</td> </tr> <tr> <td width="22%">3100 BCE</td> <td width="78%">Egypt invaded from the south, perhaps by African tribes bringing circumcision with them.</td> </tr> <tr> <td width="22%">2300 BCE</td> <td width="78%">Egyptian bas-relief which may show some form of genital mutilation being performed. The relief is eroded and hard to interpret. More commonly seen as modern reconstruction. One interpretation is that it just shows the pubic hair being shaved. Contrary to some reports, no circumcised mummies have been found, but some statues show what may be a superincision (cutting a slit in the upper side of the foreskin, or dorsal slit).</td> </tr> <tr> <td width="22%">600 BCE</td> <td width="78%">First five books of Hebrew Bible (Torah) compiled, including Genesis with its reference to Yaweh's command to Abraham to circumcise himself, his sons and his slaves and servants. Circumcision enforced by priests among Jewish people as sign of the Covenant.</td> </tr> <tr> <td width="22%">450 BCE</td> <td width="78%">Greek historians note prevalence of circumcision and other penile mutilations among the Arabs and other Middle Eastern tribes. Herodotus (485-420 BCE) observes and deplores circumcision among the Colchians, Ethiopians, Phoenicians, Syrians, and Macrones, as well as the Egyptian priestly caste. He criticises the fanatical ritual cleanliness of the Egyptian priests: "They [even] practice circumcision for the sake of cleanliness, considering it better to be clean than handsome" - a perverse sacrifice in Greek eyes. (The context is things Egyptians do that are the reverse of what other, more sensible, people do.) He reports that the salutary influence of Greek culture led the Phoenicians to abandon circumcision. (See <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/history/hodges2/">Frederick Hodges, "The ideal prepuce"</a>, including excellent illustrations from Greek art and sculpture).</td> </tr> <tr> <td width="22%">170 BCE</td> <td width="78%">The Seleucid king Antiochus IV Epiphanes (175-165 BCE) consolidates Alexander's empire, and attempts to impose Greek civilization, including a ban on ritual circumcision. Some Jews seek foreskin restoration.</td> </tr> <tr> <td width="22%">ANNO DOMINI or Christian Era</td> <td width="78%">Jesus born and circumcised in accordance with Jewish practice.</td> </tr> <tr> <td width="22%">43</td> <td width="78%">St Paul convinces a meeting in Jerusalem that <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Xy.html">circumcision is not required</a> for Christian converts.</td> </tr> <tr> <td width="22%">45</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/quote.html">Philo</a> (c.15 BCE to c.50 CE), a Jewish philosopher in Alexandria, defends circumcision on the ground that it is a valuable curb on sexual indulgence: "The legislators thought good to dock the organ which ministers to such intercourse, thus making circumcision the symbol of excision of excessive and superfluous pleasure." </td> </tr> <tr> <td width="22%">132</td> <td width="78%">Roman Emperor Hadrian (98-138 CE) extends a previous ban, by Emperors Domitian (81-96) and Nerva (96-98), on the castration of citizens or slaves throughout the Roman Empire, to include circumcision.</td> </tr> <tr> <td width="22%">140</td> <td width="78%"> Mishnah (commentary on Torah) first written down. Gives details of Periah, or radical circumcision, involving tearing back the foreskin and ripping it from the glans, (not just cutting off the tip, as done previously.) Thought to be instituted then to prevent Jews who did not like being circumcised from stretching the remnants of their foreskin so as to cover up the glans and thus being able to pass as uncircumcised and take part in Greek athletic contests and other Graeco-Roman social life. Emperor Antoninus Pius lifts the legal prohibition on circumcision, but only for Jews, not their slaves, servants or other non-Jews (as prescribed by Genesis and Jewish law).</td> </tr> <tr> <td width="22%">170</td> <td width="78%">Galen (131-201) describes methods of foreskin restoration.</td> </tr> <tr> <td width="22%">320</td> <td width="78%">Emperor Constantine renews the ban on Jews circumcising non-Jews (such as their slaves, as was their practice).</td> </tr> <tr> <td width="22%">533</td> <td width="78%">The Digest of Justinian restates the ban of Constantine.</td> </tr> <tr> <td width="22%">550</td> <td width="78%">Christian church begins celebrating 1 January as the Feast of the Circumcision (of Christ).</td> </tr> <tr> <td width="22%">570</td> <td width="78%">Mohammed born "already circumcised" supposedly giving rise to the rule of circumcision among Moslems, the largest group of circumcised men in the world today. <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/ethics.html" rel="noopener" target="_blank">Further information</a>.</td> </tr> <tr> <td width="22%">7th-11th century</td> <td width="78%">Islamic armies overrun much of Middle East, central Asia, northern Africa and Spain. Indigenous cultures swamped and rule of circumcision enforced on local populations by Moslem conquerors. Some Christians excused because they are "people of the Book". Islam eventually reaches India, Malayan peninsular and Indonesian archipelago, bringing circumcision in its wake.</td> </tr> <tr> <td width="22%">12th century</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/quote.html">Moses ben Maimon</a> (Maimonides, 1135-1204), Jewish physician, writes Guide for the perplexed, in which he explains that circumcision was test of faith, the main purpose of which was injure the penis and discourage sexual indulgence.</td> </tr> <tr> <td width="22%">1350</td> <td width="78%">Polynesian voyagers reach Aotearoa (New Zealand) and abandon supercision. Maoris never practise circumcision or any other form of genital mutilation and regard foreskin as sacred.</td> </tr> <tr> <td width="22%">15th century</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/quote.html">Jacopo Berengario da Carpi</a> (1460-1530), Italian anatomist, identifies the most sensitive part of the penis as the foreskin.</td> </tr> <tr> <td width="22%">16th century</td> <td width="78%">Gabriele Falloppio (1523-62) describes function of the foreskin to provide lubrication and increase pleasure during sex.</td> </tr> <tr> <td width="22%">17th century</td> <td width="78%">William Harvey (1578-1657), the discoverer of the circulation of the blood, states that circumcised men have less pleasure in sex. Giovanni Sinibaldi identifies the clitoris as the functional equivalent of the foreskin and as each the main source of sexual pleasure for women and men respectively.</td> </tr> <tr> <td width="22%">1650s</td> <td width="78%">During English revolution some extreme Puritan sects turn back to Old Testament and decide that Christians are subject to Law of the Covenant. One woman is gaoled for circumcising little boys in obedience to this belief.</td> </tr> <tr> <td width="22%">1685</td> <td width="78%"> Aristotle's Master-piece, a popular sex manual throughout the eighteenth century, states that the main source of male sexual pleasure arises from the friction of the foreskin moving back and forth over the glans.</td> </tr> <tr> <td width="22%">1716</td> <td width="78%">Publication of Onania, or the heinous sin of self-pollution, and all its frightful consequences in both sexes in London, giving rise to the irrational phobia about masturbation which persisted throughout the eighteenth and nineteenth centuries, and which still survives among members of the US Congress. For the next 250 years doctors insist it is a scientifically proven medical fact that masturbation is physically and mentally harmful and must be stopped at any cost.</td> </tr> <tr> <td width="22%">1740s</td> <td width="78%">Improvements in surgical technique allow amputation of diseased tissue from the penis in advanced cases of syphilis. Because syphilitic sores were often found on the foreskin, some physicians got the idea that circumcised men might be less vulnerable to infection.</td> </tr> <tr> <td width="22%">1758</td> <td width="78%">Publication of Onanism, or a treatise on the disorders produced by masturbation, by Swiss physician Simon-Andre Tissot, further spreading the theory of masturbatory disease throughout Europe.</td> </tr> <tr> <td width="22%">1786</td> <td width="78%">English surgeon John Hunter observes that the foreskin was necessary to provide the slack skin to accommodate the penis in its erect and enlarged state.</td> </tr> <tr> <td width="22%">1830s (France)</td> <td width="78%">French physician Claude-Francois Lallemand introduces circumcision as treatment for masturbation in boys and "spermatorrhoea" (involuntary loss of semen) in men. Suggests widespread circumcision of young boys as preventive of masturbation. Ideas not taken up in Europe, but catch on in Britain and USA.</td> </tr> <tr> <td width="22%">1840s (Britain)</td> <td width="78%">English physicians invent the idea that a tight and non-retractable foreskin in male babies is a congenital abnormality which ought to be corrected by surgery.</td> </tr> <tr> <td width="22%">1850s</td> <td width="78%">James Copland, in Dictionary of practical medicine, popularises the idea of circumcision as a means of discouraging masturbation among boys.</td> </tr> <tr> <td width="22%">1855</td> <td width="78%">Jonathan Hutchinson, English physician, writes influential article, based on observations of a few Jewish and non-Jewish VD cases, that circumcised men are less likely to contract syphilis. Urges widespread circumcision in infancy. ("On the influence of circumcision in preventing syphilis", Medical Times and Gazette, NS Vol. II, 1 December 1855, pp. 542-3)</td> </tr> <tr> <td width="22%">late 1850s</td> <td width="78%">Clitoridectomy introduced as a treatment for hysteria, epilepsy, masturbation and other nervous diseases in women. On the relevance of this to male circumcision, see <a href="https://web.archive.org/web/20210724205733/http://cirp.org/library/history/moscucci/">research by Ornella Moscucci</a> </td> </tr> <tr> <td width="22%">1860</td> <td width="78%">Athol Johnson practises and urges circumcision to cure masturbation in boys. ("On an injurious habit occasionally met with in infancy and early childhood", Lancet, 7 April 1860, pp. 344-5)</td> </tr> <tr> <td width="22%">1860s</td> <td width="78%">Circumcision as means of curing or preventing masturbation in boys becomes widespread medical dogma in Britain. For the next 100 years (and in the USA 150 years) doctors insist it is a scientifically proven medical fact that the foreskin is harmful to the physical and moral health males and must be surgically removed before they even become conscious that it was ever there.</td> </tr> <tr> <td width="22%">1865</td> <td width="78%">William Acton, in the many editions of Functions and disorders of the reproductive organs, condemns foreskin as "source of serious mischief" because of its sensitivity and responsiveness to touch. Rejects emerging medical dogma that glans of penis is most sensitive part. Considers foreskin necessary to sexual performance in old age. Condemns masturbation and treats spermatorrhoea by cauterising urethra with silver nitrate.</td> </tr> <tr> <td width="22%">1867</td> <td width="78%">British medical profession rejects and effectively bans clitoridectomy because it is an irreversible mutilation and often performed without informed consent.</td> </tr> <tr> <td width="22%">1870 (USA)</td> <td width="78%">In the USA Lewis A. Sayre applies theories of Lallemand and announces that circumcision cures "paralysis" (polio), epilepsy and masturbation, setting off the medical craze for "therapeutic" circumcision. Calls for universal circumcision of male infants.</td> </tr> <tr> <td width="22%">1870s (Australia)</td> <td width="78%">George Beaney, Melbourne doctor, popularises the theories of Acton on the harmfulness of masturbation and urges curative and preventive circumcision.</td> </tr> <tr> <td width="22%">1874 (Austria)</td> <td width="78%">Eugen Levit, a Jewish doctor in Vienna, publishes pamphlet urging Jews to abolish circumcision and replace it with non-injurious rite.</td> </tr> <tr> <td width="22%">1877 (USA)</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Kellogg.html">John Harvey Kellogg MD</a> (1852-1943) publishes the first edition of Plain facts for old and young, in which he promotes circumcision as a cure for masturbation. He writes that the operation was to be performed "without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment."</td> </tr> <tr> <td width="22%">1882</td> <td width="78%">Norman H. Chapman, Professor of Nervous and Mental Disease at the University of Kansas City, writes: "It is always good surgery to correct this deformity [a long and contracted foreskin] ... as a precautionary measure, even though no symptoms have as yet presented themselves", thus ushering in routine or "preventive" circumcision. (Medical News (Philadelphia) Vol. 41, p. 317)</td> </tr> <tr> <td width="22%">1885</td> <td width="78%">Dr Samuel Newman of New York advocates the circumcision of newborn boys. One of the advantages he claimed was that it could be done without anaesthetic, and he borrowed the idea of strapping the baby to a board from the Indians. This became the modern circumstraint, still used in many hospitals to immobilise the baby while the doctor cuts off part of his penis.</td> </tr> <tr> <td width="22%">late 1880s</td> <td width="78%">The newly formed American Academy of Pediatrics supports Lewis Sayre's call for routine neonatal circumcision. Determined to lower the nation's infant mortality rate by reducing often-lethal diarrhoea, the AAP argues that the foreskin irritates the penis, which irritates the nervous system, which hampers digestion, which causes diarrhoea. Simultaneously, the AAP also condemns <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Nursing.html">breast milk</a>, claiming it is a leading cause of infant diarrhoea. This is the nineteenth century version of the urinary tract infection scare (UTI), the only surviving justification for infant circumcision.</td> </tr> <tr> <td width="22%">1890 (Britain)</td> <td width="78%">Herbert Snow, a London doctor, publishes The barbarity of circumcision, in which he deplores the rapid spread of the practice. Jonathan Hutchinson publishes article "Circumcision as a preventive of masturbation", in which he regrets that public opinion would not allow the introduction of castration as well in severe cases.</td> </tr> <tr> <td width="22%">1893</td> <td width="78%">Publication of P.C Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance. Dr Remondino was one of the most ardent crusaders for universal infant circumcision before Terry Russell and Brian Morris, and just as scientific. His lengthy book on the subject, stressing moral as well as physical reasons, was a diatribe against the foreskin as a "moral outlaw", as well as a pathogenic feature of the male body which nature ought to have abolished. He claimed that the foreskin caused and circumcision could cure just about everything from syphilis and tuberculosis to night terrors and bed wetting.</td> </tr> <tr> <td width="22%">1900 (Britain)</td> <td width="78%">Jonathan Hutchinson delivers widely reported lecture in which he urges universal male circumcision as a preventive of syphilis. ("The advantages of circumcision", Medical Review, Vol. 3, p. 641) E. Harding Freeland publishes article in which he claimed that universal male circumcision would reduce the incidence of syphilis by 49 per cent. (Lancet, 29 December, pp. 1869-71)</td> </tr> <tr> <td width="22%">1900 (Australia)</td> <td width="78%">Richard Arthur, purity campaigner and later Minister for Health in New South Wales, urges parents to adopt circumcision as cure for and preventive of masturbation in boys. Australian newborn circumcision rate estimated at 25 per cent.</td> </tr> <tr> <td width="22%">1901 (Australia)</td> <td width="78%">H.G.H . Naylor publishes "A plea for early circumcision" in Australasian Medical Gazette </td> </tr> <tr> <td width="22%">1903 (Australia)</td> <td width="78%">Popular medical writer Philip Muskett urges circumcision in his widely read Illustrated Australian Medical Guide </td> </tr> <tr> <td width="22%">1914 (USA)</td> <td width="78%">Abraham Wolbarst, Jewish doctor in New York, urges universal male circumcision as a preventive of syphilis, cancer and masturbation. (Journal of the American Medical Association, Vol. 62, 1914, pp. 92-7)</td> </tr> <tr> <td width="22%">1916 (Australia)</td> <td width="78%">Conference organised by Workers Educational Association of New South Wales recommends circumcision as preventive of syphilis and masturbation.</td> </tr> <tr> <td width="22%">1920s-50s</td> <td width="78%">Most Australian baby and child care guides recommend routine circumcision. Some suggest circumcision of girls in cases of persistent masturbation, though this is rarely done. <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Circ.html">Photos of procedures</a>.</td> </tr> <tr> <td width="22%">1920</td> <td width="78%">Australian routine circumcision rate reaches 50 per cent</td> </tr> <tr> <td width="22%">1928 (USA)</td> <td width="78%">In the USA Dr Thomas Bolling Gay recommends routine infant circumcision to prevent phimosis and hence masturbation. (Journal of the American Medical Association, 21 July 1928)</td> </tr> <tr> <td width="22%">1932</td> <td width="78%">Abraham Wolbarst claims that smegma causes and circumcision prevents cancer of the penis.</td> </tr> <tr> <td width="22%">1934</td> <td width="78%">Hiram S. ("Inch") Yellen, MD (1894-1969) and Aaron A. Goldstein (1899-1945) invent the <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Glossary2.html#gomco">Gomco clamp</a>,a particularly cruel device for separating boys from their foreskins.</td> </tr> <tr> <td width="22%">1935</td> <td width="78%">Dr R.W. Cockshutt states that all boys should be circumcised as an incentive to chastity. (British Medical Journal, 1935 (2), p. 764)</td> </tr> <tr> <td width="22%">1941</td> <td width="78%">Alan Guttmacher writes (approvingly) that some US doctors circumcise routinely without even consulting parents, and that 75 per cent of boys born in urban hospitals are circumcised. ("Should the baby be circumcised?", Parents Magazine, Vol. 16, pp. 26, 76-8)</td> </tr> <tr> <td width="22%">1942</td> <td width="78%">Battle of Guadalcanal. Mass circumcision of US soldiers in the Pacific in response to "an outbreak of phimosis and paraphimosis"! Military circumcisers Eugene A. Hand and Abraham Ravich promote circumcision to the masses through medical and popular journals after the war.</td> </tr> <tr> <td width="22%">1942</td> <td width="78%">Battle of El Alamein: allied offensive begins in Egypt. Some British, Australian and New Zealand soldiers are forcibly circumcised concurrently with widespread skin infections, giving rise to "<a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/sand.html" rel="noopener" target="_blank">sand under the foreskin</a>" myth. Italian and German soldiers (all uncut) mysteriously unaffected by this problem.</td> </tr> <tr> <td width="22%">1946-7</td> <td width="78%">British National Health Service set up, putting hospital doctors on salary and paying family doctors a flat rate per patient on their books. Circumcision not included in schedule of free procedures. Incidence of circumcision in Britain falls from about 35 per cent to less than 10 per cent.</td> </tr> <tr> <td width="22%">1949</td> <td width="78%">Joseph Lewis publishes In the name of humanity, an eloquent condemnation of infant circumcision on rational and humanitarian grounds. You may be able to get a second hand copy from <a href="https://web.archive.org/web/20210724205733/http://www.abebooks.com/">abebooks</a>.</td> </tr> <tr> <td width="22%">1949</td> <td width="78%">Douglas Gairdner publishes article "The fate of the foreskin", finally correcting the medical profession's misunderstanding of infantile phimosis and showing that a phimotic condition is normal and healthy in infants and boys. (British Medical Journal, 24 December 1949, pp. 1433-7). <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/general/gairdner/">Full text here</a>.</td> </tr> <tr> <td width="22%">1950</td> <td width="78%">US troops land in South Korea. Under subsequent US occupation and influence, <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Korea.html">South Korea</a> adopts universal boyhood circumcision.</td> </tr> <tr> <td width="22%">1955 (Australia)</td> <td width="78%">Australian routine circumcision rate peaks at 90 per cent.</td> </tr> <tr> <td width="22%">1962</td> <td width="78%">National Women's Hospital opens in Auckland, <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/NZ.html">New Zealand</a>, as a publicly-funded, foreskin-friendly zone. This leads to a dramatic fall in the rate of circumcision in NZ.</td> </tr> <tr> <td width="22%">1965</td> <td width="78%">W.K.C. Morgan publishes "The rape of the phallus", the first criticism of circumcision's murky psychology to appear in a US medical journal. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/general/morgan/">Full text here</a>.</td> </tr> <tr> <td width="22%">1965 (Australia)</td> <td width="78%">Australian circumcision rate declines to 70 per cent. Total number of circumcised males reaches all-time peak of 60 per cent; proportion falls from now on.</td> </tr> <tr> <td width="22%">1966 (USA)</td> <td width="78%">Excessively severe circumcision (involving amputation of entire penis) of "John Thiessen" (Bruce, now David, Reimer) in Winnipeg leading to sex-reassignment surgery and failed attempt to bring him up as a girl.</td> </tr> <tr> <td width="22%">1970</td> <td width="78%">In the USA Van Lewis and his brother Ben carry four signs saying "Infant Circumcision is a Sex Crime. Abolish it." "Sex Criminals for Hire? Inquire Within" "Abolish Infant Circumcision", "Men's Liberation" and "QUIT" outside the Tallahassee Memorial Hospital, Tallahassee, Florida, and are arrested. They are charged with disturbing the peace and spend the day in gaol. Van Lewis was not intimidated and continues to fight for genital integrity: <a href="https://web.archive.org/web/20210724205733/http://stopinfantcircumcision.org/" rel="noopener" target="_blank">further details here</a>.</td> </tr> <tr> <td width="22%">1971</td> <td width="78%">American Academy of Pediatrics finds "no valid medical indications for routine infant circumcision."</td> </tr> <tr> <td width="22%">1971 (April)</td> <td width="78%">The Australian Pediatric Association recommends that "newborn male infants should not, as a routine, be circumcised". (Medical Journal of Australia, 22 May 1971, p. 1148)</td> </tr> <tr> <td width="22%">1975</td> <td width="78%">Australian circumcision rate declines to 50 per cent. Canadian Pediatric Society issues policy on circumcision and calls it an "obsolete" and "mutilitive" operation which should not be routinely performed. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/statements/cps1975/" rel="noopener" target="_blank">Full text here</a>.</td> </tr> <tr> <td width="22%">1983</td> <td width="78%">Australian College of Paediatrics issues <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/doctors.html">statement on circumcision</a> which states: "1. The ACP should continue to discourage the practice of circumcision in the newborn male infant."</td> </tr> <tr> <td width="22%">1985 (Australia)</td> <td width="78%">Commonwealth Minister for Health (Neal Blewett) announces that Medicare will no longer pay for medically unnecessary circumcisions from taxpayers' healthcare funds. Decision reversed after intervention by Prime Minister Hawke, bowing to pressure from Jewish and Moslem religious leaders.</td> </tr> <tr> <td width="22%">1985 (USA)</td> <td width="78%">In the USA nurse Marilyn Milos is fired for advising parents against circumcision and founds NOCIRC (the National Organisation of Circumcision Information Resource Centers).</td> </tr> <tr> <td width="22%">Late 1980s</td> <td width="78%">Demands from circumcision advocates for mass circumcision as a means of controlling AIDS. At this time USA has highest proportion of circumcised men and highest incidence of AIDS cases in developed world. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/disease/HIV/">Further information</a>.</td> </tr> <tr> <td width="22%">1988</td> <td width="78%">California Medical Association declares circumcision "an effective public health measure" on a voice vote, at the instigation of long-time militant circumcision advocate, Aaron Fink.</td> </tr> <tr> <td width="22%">1989</td> <td width="78%">Canadian Paediatric Society <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/statements/cps1975/" rel="noopener" target="_blank">reaffirms its stand</a> against routine circumcision.</td> </tr> <tr> <td width="22%">1989 (World)</td> <td width="78%">United Nations adopts Convention on the Rights of the Child. Section 14 guarantees children their own freedom of belief and religion, and Section 24.3 requires signatories to "take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children", meaning circumcision among other cruel or harmful customs. Ratified by Australia, December 1990.</td> </tr> <tr> <td width="22%">1989</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.nocirc.org/symposia/index.html">First International Symposium on Circumcision</a>, at Anaheim, California adopts a <a href="https://web.archive.org/web/20210724205733/http://www.nocirc.org/declare.html">declaration of bodily integrity</a>.</td> </tr> <tr> <td width="22%">1989</td> <td width="78%">American Academy of Pediatrics proposal that its 1971 position against routine circumcision be re-examined is widely misreported as a reversal of its position.</td> </tr> <tr> <td width="22%">1990 (Australia)</td> <td width="78%">Australian circumcision rate declines to 20 per cent</td> </tr> <tr> <td width="22%">1991</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.nocirc.org/symposia/second/index.html">Second International Symposium</a> on Circumcision, San Francisco, California. John Taylor describes the ridged band of the foreskin.</td> </tr> <tr> <td width="22%">1992 (Australia)</td> <td width="78%">In the case of "Marion", an intellectually handicapped girl whom her guardian wished to sterilise, the High Court held that where a significant medical intervention was not needed for the immediate health of a minor, the permission of the Family Court was required.</td> </tr> <tr> <td width="22%">1992</td> <td width="78%">More than 20 nurses at St Vincent Hospital, Santa Fe, New Mexico, refuse to assist with circumcisions.</td> </tr> <tr> <td width="22%">1993</td> <td width="78%">Claim that uncircumcised men had significantly higher rate of cancer of the penis exposed as a myth, yet again.</td> </tr> <tr> <td width="22%">1993 (Australia)</td> <td width="78%">Queensland Law Reform Commission suggests that circumcision of minors without consent is probably unlawful under the Queensland criminal code.</td> </tr> <tr> <td width="22%">1993</td> <td width="78%">Important paper by Williams and Kapila on risks and complications of circumcision published in British Journal of Surgery. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/complications/williams-kapila/">Full text here</a>. Photos of typical but not so aesthetically pleasing circumcision outcomes are <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Botched1.html">available here</a>.</td> </tr> <tr> <td width="22%">1994</td> <td width="78%">David Gollaher publishes landmark article on history of medically rationalised circumcision in Journal of Social History. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/history/gollaher/">Full text here</a>.</td> </tr> <tr> <td width="22%">1995</td> <td width="78%">Two of the nurses of St Vincent (see 1992), Mary Conant and Betty Katz Sperlich, found Nurses for the Rights of the Child.</td> </tr> <tr> <td width="22%">1996 (USA)</td> <td width="78%">Female circumcision (female genital mutilation, or FGM) banned by US federal government</td> </tr> <tr> <td width="22%">1996 (Britain)</td> <td width="78%">R. Taylor's paper on the prepuce as specialised mucosa of the penis published in the British Journal of Urology. It describes the uniquely dense innervation of the ridged bands of the foreskin. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/anatomy/taylor/">Full text here</a>.</td> </tr> <tr> <td width="22%">1996 (Canada)</td> <td width="78%">Canadian Paediatric Society, Foetus and Newborn Committee, issues new policy on circumcision in which it states that "circumcision of newborns should not be routinely performed." <a href="https://web.archive.org/web/20210724205733/http://www.cps.ca/english/statements/FN/fn96-01.htm" rel="noopener" target="_blank">Full text of policy here</a>.</td> </tr> <tr> <td width="22%">1996 (Australia)</td> <td width="78%">The Australasian Association of Paediatric Surgeons states that it "does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce". Australian College of Paediatrics waters down statement against circumcision in response to AIDS scare and religious pressure.</td> </tr> <tr> <td width="22%">1996</td> <td width="78%">Fourth International Symposium on Sexual Mutilations, Lausanne, Switzerland, adopts the <a href="https://web.archive.org/web/20210724205733/http://www.nocirc.org/symposia/fourth/prescott.html">Ashley Montagu declaration</a> and submits it to the World Court.</td> </tr> <tr> <td width="22%">1997</td> <td width="78%">Paper by A. Taddio on circumcision pain shows that pain of circumcision heightens fear and pain of subsequent vaccination and other procedures. <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Pain.html">Further information on pain</a>.</td> </tr> <tr> <td width="22%">1997</td> <td width="78%">Paper by Edward O. Laumann et al on circumcision, sexual practice and STDs shows circumcision does not prevent STDs, and that higher STD rate correlates with more varied (stimulation-hungry?) sexual practices. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/general/laumann/">Full text here</a>.</td> </tr> <tr> <td width="22%">1997</td> <td width="78%">Paper by J. Lander et al proves the pain of circumcision to be excruciating. Circumcision without anaesthetic was discontinued in the study for ethical reasons. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/pain/lander/">Full text here</a>.</td> </tr> <tr> <td width="22%">1997</td> <td width="78%"> Rolling Stone blows the whistle on Dr John Money's attempt at surgical sex reassignment in the "John/Joan/John" case.</td> </tr> <tr> <td width="22%">1997 (Egypt)</td> <td width="78%">Egyptian High Court overturns a government attempt to ban female circumcision. The Islamic cleric who led traditional opposition to the ban not only thanked God for preserving a religious custom and requirement handed down by mothers and grandmothers for fourteen centuries, but stated that the operation protected the nation from AIDS by reducing promiscuity. (Los Angeles Times, 25 June)</td> </tr> <tr> <td width="22%">1998 (USA)</td> <td width="78%">Highly publicised death of baby Dustin Evans Jnr in Cleveland, Ohio, under anaesthetic during attempt to repair damage arising from circumcision complications. Doctors were at pains to distance his death from his circumcision.</td> </tr> <tr> <td width="22%">1998</td> <td width="78%">Study of UTIs by To et al shows that it would take 195 circumcisions to prevent one UTI. You can <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/References.html#To">see a graphic illustration</a> of this figure.</td> </tr> <tr> <td width="22%">1999</td> <td width="78%">In a standard textbook, leading paediatrician refers to circumcision as a mutilation: "it is fundamentally illogical that mutilating someone might be beneficial." (N.R.C. Roberton, "Care of the normal term newborn baby", in Janet M. Rennie, N.R.C. Roberton (eds) Textbook of neonatology (3rd edn, Edinburgh 1999), pp. 378-379.</td> </tr> <tr> <td width="22%">1999 (USA)</td> <td width="78%">The American Academy of Pediatrics issues <a href="https://web.archive.org/web/20210724205733/http://www.aap.org/policy/re9850.html">new policy</a> on routine male circumcision which states that the potential medical benefits of circumcision do not warrant performing it routinely, but that paediatricians may perform it at the parents' behest for "cultural, religious, and ethnic" reasons, but that analgesia is essential. You can compare that policy with their <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/AAP.html">policy on female genital mutilation</a>.</td> </tr> <tr> <td width="22%">1999</td> <td width="78%">Medina General Hospital, Ohio, settles with parents who had sued for $10,000,000. Their son had the tip of his penis amputated during a "routine" circumcision.</td> </tr> <tr> <td width="22%">1999 (Britain)</td> <td width="78%">An English judge rules that a Muslim father may not have his son circumcised contrary to the mother's wishes, even though they had originally agreed to raise the child as Muslim. The ruling is upheld in the Court of Appeal, which stated: "a newborn child does not share the conceptions of the parents" and "it [is] not in the best interests of the child to be circumcised, with its risk of pain and psychological damage which the boy would find hard to understand." Further information. <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/ethics.html">Further information</a>.</td> </tr> <tr> <td width="22%">1999</td> <td width="78%">The Lancet publishes editorial by Halperin and Bailey calling for mass circumcision in Africa to prevent spread of HIV-AIDS. Media in USA interpret this as a call for mass circumcision everywhere. Halperin tells the Bay Area Reporter in San Francisco: "If I were a top [insertive partner in anal sex], and didn't like to use condoms, I would consider getting circumcised" - contradicting his own advice in the editorial, leaving the false impression that circumcision conferred immunity against infection, and seeming ignorant that most American males are already circumcised. AIDS continues to spread in Africa even though more than half the adult male population there is also already foreskin-free.</td> </tr> <tr> <td width="22%">1999 (Australia)</td> <td width="78%">In Perth, WA, Shane Peterson sues the doctor who circumcised him as an infant for disability, pain and suffering arising from the operation. In an out of court settlement the physician admitted liability and agreed to a payment of $A360,000. <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/account.html" rel="noopener" target="_blank">Further details</a> </td> </tr> <tr> <td width="22%">2000</td> <td width="78%">Australian circumcision rate stabilises at 12 per cent nationally - but higher in New South Wales and much higher in Queensland. Total number of circumcised males falls to 48 per cent.</td> </tr> <tr> <td width="22%">2000</td> <td width="78%">Article by G. Boyle, J.S. Svoboda and C. Price, "Circumcision of healthy boys: Criminal assault?" published. <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/legal/boyle1/">Full text here</a>.</td> </tr> <tr> <td width="22%">2000</td> <td width="78%">Parents of Jacob Sweet, brain damaged after infection arising from circumcision in Anchorage, Alaska, settle <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Law.html#Sweet">medical malpractice suit</a> against doctors after 13 years.</td> </tr> <tr> <td width="22%">2000</td> <td width="78%">The American Medical Association issues a <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/AMA.html">policy statement</a> on circumcision, calling it "non-therapeutic" and recommending anaesthesia, but still endorsing the 1999 statement of the American Academy of Pediatrics. <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/AAP-ana.html">Further discussion</a>.</td> </tr> <tr> <td width="22%">2000</td> <td width="78%">Publication of The ethical canary by Margaret Somerville, including a chapter disputing the ethics of circumcising male babies. <a href="https://web.archive.org/web/20210724205733/http://www.intact.ca/canary.htm" rel="noopener" target="_blank">Full text here</a>.</td> </tr> <tr> <td width="22%">2000 (Australia)</td> <td width="78%">Sixth International Symposium on Genital Integrity in Sydney, Australia. Ken McGrath (from NZ) first describes the <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Glossary.html#delta">frenular delta</a>.</td> </tr> <tr> <td width="22%">2000 (USA)</td> <td width="78%">William Stowell, aged 18, feeling pissed off, injured and ashamed of being cut, sues the doctor who circumcised him and the hospital where it was done. <a href="https://web.archive.org/web/20210724205733/http://www.arclaw.org/">Further information</a>.</td> </tr> <tr> <td width="22%">2001 (Canada)</td> <td width="78%">Ontario Human Rights Commission reviews its policy on male circumcision, recognises the reality of harm, and moves its position closer to its policy on female genital mutilation.</td> </tr> <tr> <td width="22%">2001</td> <td width="78%">The Association for Genital Integrity in Toronto applies for public funding under the government's Court Challenges Program to file a court challenge to extend the Canadian Charter to include males in protection against genital mutilation. Application is refused. <a href="https://web.archive.org/web/20210724205733/http://www.courtchallenge.com/">Further information</a>.</td> </tr> <tr> <td width="22%">2001 (USA)</td> <td width="78%">Marilyn Milos wins Nurseweek award for patient advocacy. Nocirc issues <a href="https://web.archive.org/web/20210724205733/http://www.nocirc.org/statements/hiv_statement2001.html">statement on Circumcision and AIDS</a>.</td> </tr> <tr> <td width="22%">2001</td> <td width="78%">Important article by K. Bonner argues that circumcision is not a "natural condom". <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/library/disease/HIV/bonner1/">Full text here</a>.</td> </tr> <tr> <td width="22%">2001 (Sweden)</td> <td width="78%"> <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Sweden.html">Sweden</a> passes a law setting rules for infant male circumcision, including mandatory use of anaesthetic. Jewish and Moslem organisations protest and threaten to take Swedish Government to the European Court of Human Rights.</td> </tr> <tr> <td width="22%">2001 (Africa)</td> <td width="78%">Approximately 100 southern African boys reported to have died as a result of tribal circumcision. <a href="https://web.archive.org/web/20210724205733/http://www.circumstitions.com/Complic.html">Further information</a>. You can <a href="https://web.archive.org/web/20210724205733/http://www.cirp.org/search.html">search for news articles</a> here.</td> </tr> <tr> <td width="22%">2001</td> <td width="78%">Medicaid North Carolina ends public funding of routine circumcision.</td> </tr> <tr> <td width="22%">2002 (April)</td> <td width="78%">Revival of old claim that male foreskin increases risk of cervical cancer in women makes headlines round the world. One of the researchers demands universal male circumcision. The shonky statistical manipulations and ethical bankruptcy of the researchers pass unnoticed by the media. <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/cervical.html">Further information</a>.</td> </tr> <tr> <td width="22%">2002 (July)</td> <td width="78%">At Barcelona conference, World Health Organisation rejects circumcision as element of strategy in control of AIDS in Africa. Endorses continued reliance on proven methods of control, including sex education, promotion of human rights and gender quality, and provision of condoms. (See Stover J, Walker N, Garnet GP, et al, "Can we reverse the HIV/AIDS pandemic with an expanded response?" Lancet Vol. 360, 2002, pp. 73-77.)</td> </tr> <tr> <td width="22%">2002 (USA)</td> <td width="78%">Medicaid Arizona stops public funding of routine circumcision.</td> </tr> <tr> <td width="22%">2002</td> <td width="78%">Medicaid Missouri stops public funding of routine circumcision.</td> </tr> <tr> <td width="22%">2002 (September)</td> <td width="78%">Royal Australasian College of Physicians issues new statement on circumcision which states that there is "no medical indication for routine male circumcision" and "no evidence of benefit outweighing harm for circumcision as a routine procedure". The full statement is <a href="https://web.archive.org/web/20210724205733/http://www.racp.edu.au/hpu/paed/circumcision/index.htm" rel="noopener" target="_blank">available on the RACP website</a>. Further information available from <a href="https://web.archive.org/web/20210724205733/http://www.circinfo.org/doctors.html" rel="noopener" target="_blank">Circumcision Information Australia. </a> </td> </tr> <tr> <td width="22%"> 2002 (Denmark) </td> <td width="78%"> Articles in Danish magazine Politiken compare male circumcision to female genital mutilation and call for a ban on circumcision of boys. They should have the same protection from unnecessary genital alterations as girls. <a href="https://web.archive.org/web/20210724205733/http://www.courtchallenge.com/news/politik1.html" rel="noopener" target="_blank">Article by Uffe Hastrup, 20 November 2002</a> <a href="https://web.archive.org/web/20210724205733/http://www.courtchallenge.com/news/politik2.html" rel="noopener" target="_blank">Article by Lau Sander Esbensen</a> </td> </tr> <tr> <td width="22%"> 2002 (December) </td> <td width="78%">Chairman of Danish Council of Medical Ethics calls for ban on circumcision of boys before the age of consent; he states that "no adult is entitled to carry out irreversible surgery on a child, unless it is for health reasons"; and that "prior to eighteen years of age, Danish children have a right to be protected from ritual interventions which can cause pain or permanent damage". <a href="https://web.archive.org/web/20210724205733/http://www.courtchallenge.com/news/dagmed1.html" rel="noopener" target="_blank">Full text of article translated here.</a> </td> </tr> <tr> <td> 2003 (February)</td> <td>Medical Journal of Australia publishes three important articles showing that too many circumcisions are being performed in Australia and that the foreskin plays an important role in sexual function. <a href="https://web.archive.org/web/20210724205733/http://www.mja.com.au/public/issues/178_04_170203/contents_170203.html" rel="noopener" target="_blank">Full text of the articles</a> </td> </tr> </tbody> </table> </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 Circumcision chronology darby