8 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>If cereal won't cool the libido, try surgery</h3> <h4>1. Circumcision</h4> The fold of integument called the prepuce, which has been previously described, has upon its inner surface a large number of glands which produce a peculiar secretion. [1] Under certain circumstances, and from inattention to personal cleanliness, this secretion may accumulate, and then often becomes the cause of irritation and serious disease. To prevent such disorders, and to insure cleanliness, the Jewish law required the removal of the prepuce, which constituted the rite of circumcision. The same practice is followed by several modern nations dwelling in tropical climates; and it can scarcely be doubted that it is a very salutary one, and has contributed very materially to the maintenance of that proverbial national health for which the Jews are celebrated. Eminent physicians have expressed the opinion that the practice would be a salutary one for all men. It is doubtful, however, whether as much harm as good does not result from circumcision, since it has been shown by extensive observation among the Jews that very great contraction of the meatus, or external orifice of the urethra, is exceedingly common among them, being undoubtedly the result of the prolonged irritation and subsequent cicatricial contraction resulting from circumcision in infancy. [2] The maintenance of scrupulous personal cleanliness, by daily cleansing, is an imperative duty. In some countries females are also circumcised by removal of the nymphae [i.e. the labia]. The object is the same as that of circumcision in the male. The same evils result from inattention to personal cleanliness, and the same measure of prevention, daily cleansing, is necessitated by a similar secretion. Local cleanliness is neglected by both sexes. Daily washing should begin with infancy, and continue through life, and will prevent much disease. Plain facts for young and old, pp. 106-7 <h4>2. Masturbation</h4> In younger children, with whom moral considerations will have no particular weight, other devices may be used. Bandaging the parts has been practised with success. Tying the hands is also successful in some cases; but this will not always succeed, for they will often contrive to continue the habit in other ways, as by working the limbs, or lying upon the abdomen. Covering the organs with a cage has been practised with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should 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, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. ... [Infibulation] Through the courtesy of Dr Archibald, Superintendent of the Iowa Asylum for Feeble-Minded Children, we have become acquainted with a method of treatment of this disorder which is applicable in refractory cases, and we have employed it with entire satisfaction. It consists in the application of one or more silver sutures in such a away as to prevent erection. The prepuce, or foreskin, is drawn forward over the glans, and the needle to which the wire is attached is passed through from one side to the other. After drawing the wire through, the ends are twisted together, and cut off close. It is now impossible for an erection to occur, and the slight irritation thus produced acts as a most powerful means of overcoming the disposition to resort to the practice. [2] [Treatment of females] In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will power has become so weakened that the patient is unable to exercise entire self-control. The worst cases among young women are those in which the disease has advanced so far that erotic thoughts are attended by the same voluptuous sensations which accompany the practice. The author has met many cases of this sort in young women, who acknowledged that the sexual orgasm was thus produced, often several times daily. The application of carbolic acid in the manner described is also useful in these cases in allaying the abnormal excitement, which is a frequent provocation of the practice of this form of mental masturbation. Plain facts, pp. 294-6 J.H. Kellogg, Plain facts for young and old: Embracing the natural history of hygiene and organic life, 2nd edition, Burlington (Iowa), 1888, facsimile reprint (New York: Arno, 1974) <h4>NOTES</h4> 1. This is an instance of the myth of Tyson's glands, and a distortion of even that, since Edward Tyson claimed to have discovered the glands of the rim, or corona, of the glans, not on the foreskin at all. As Arthur Keith found in 1904, there are no glands on or under the foreskin or on any part of the penis normally covered by the foreskin; and if there are no glands, there cannot be any secretions. What Tyson called glands have since been identified as "pearly papules", a common and perfectly harmless anatomical variant. See Arthur Keith and Arthur Shillitoe, "The preputial or odoriferous glands of man", Lancet, 16 January 1904, pp. 146-8; and Arthur Hyman et al, "Tyson's 'Glands': Ectopic sebaceous glands and papillomatosis penis", Archives of Dermatology, Vol. 99, January 1969, pp. 31-6; and the letter from P.-H. Nexmand in Vol. 100, August 1969, p. 260, pointing out that the papules are harmless and should not be confused with genital warts. <a href="http://www.historyofcircumcision.net/templates/pages/for_and_against_circumcision_1935.html">See also my notes to the 1935 circumcision controversy in Britain.</a> None of these facts, known since 1904, has prevented ignorant enthusiasts for genital surgeries from claiming that the mere existence of these glands proved the necessity for circumcision. For a summary of the long career of the myth, <a href="http://www.cirp.org/library/anatomy/cold-taylor/" rel="noopener" target="_blank">see Cold and Taylor, The prepuce</a> 2. It is interesting to note that, although Kellogg acknowledges that circumcision probably did as much harm as good, the evils of masturbation were judged so great that it was always justified as a treatment in these cases. 3. It is not at all clear that infibulation was commonly employed in either Britain or the USA, and it was probably rare outside mental hospitals and other institutions. Its great champion in Britain was Dr D. Yellowlees, medical superintendent at the Glasgow Royal Asylum, who published two articles on the virtues of his treatment: "Masturbation", Journal of Mental Science, Vol. XXII, 1876, pp. 336-7; and "Masturbation", in A dictionary of psychological medicine, ed. D. Hack Tuke (London: Churchill, 1892), pp. 784-6 </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 Dr Kellogg's prescription (1888) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4>The temptations of surgery</h4> In 1895 the Medical Record (not a crank publication, but an authoritative and mainstream journal) published an article by Dr Edgar Spratling, who explained why circumcision was the most effective tactic against the "octopus grasp" of masturbation. In the process he revealed how much surgeons like him enjoyed performing the operation. Note his remark (in paragraph 4) that the objective of most anti-masturbation devices was to immobilise the foreskin, revealing the assumption of the times that masturbation was essentially the manipulation and sliding of the foreskin. He had a far more effective and irreversible means of stopping that. <h3>Masturbation in the adult</h3> Masturbation being in itself a habit fraught with dangers to its devotee just in proportion as the nervous stamina of the individual is lacking, one would naturally think with horror of its octopus-like grasp within the walls of every institution intended for the care and treatment of those unable mentally or morally to stand on an equality with his free fellow-man. And well may those in whose care the insane are placed regard it as the arch enemy, for hand in hand with its boon companion, sodomy, it stalks through every ward, entangling its victims more hopelessly with each passing night. In women the road to cure is an endless and monotonous journey, for nothing short of ovariotomy will be found to deserve even the term palliative; clitoridectomy, anatomically and physiologically, could be but a failure, blistering only cruelty. Among men the case is not so hopeless, for there anatomy is partly in the operator's favour. Of the treatments we might speak of blistering the glans penis, but only to condemn it as an uncalled-for cruelty; the possible beneficial effect is so transient, while the untoward effect is so lasting upon the patient mentally in the way of a feeling of resentment, that it is doubtful if one could ever justify such a proceeding. The various kinds of apparatus that are intended to prevent the mobility of the foreskin are one and all to be let alone as unsatisfactory and unsuccessful, if not actually mischievous, by concentrating the patient's attention to that locality. Preventing the opportunity for the practice is simply out of the question. Castration is not to be considered for many and very obvious reasons. Complete section of the dorsal nerves of the penis (as I have previously advocated) is a rational proceeding, but rather too radical for constant routine practice. The cases require the greatest care in the selection for this operation, and even then with all due care one will generally have to encounter the most strenuous objections and later the bitterest reproach and condemnation from the patients and from their relatives â€“ though the object sought may have been obtained. In all cases, 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, granting as it does immunity from after-reproach. Those cases in which the glans presents a moist, semi-oily appearance, with papillae strikingly developed about the corona, 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. The whole operation, when the scissors and continuous suture are used, takes only four to six minutes â€“ and time is a great consideration, especially in the case of the insane, even though local anaesthetics may be used. To obtain the best results one must cut away enough skin and mucous membrane to rather put it on the 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 to readily resume his practice, not begrudging the time and extra energy required to produce the orgasm. It is true, however, that the longer it takes to have an orgasm, the less frequently it will be attempted, consequently the greater the benefit gained. Tubes, rings, clamps and directors, devised as aids in circumcision, are worse than useless on account of the time involved in their manipulation, and also because they necessitate the use of a knife instead of scissors, thus inducing more haemorrhage, and most likely necessitating interrupted sutures instead of the continuous. We may not be sure that we have done away with the possibility of masturbation, but we may feel confident that we have limited it to within the danger lines, which is the primary object sought, as we are from the outset striving for the hygienic, not the moral, benefit â€“ the latter is usually too far from our reach to even consider. The younger the patient operated on the more pronounced the benefit, though occasionally we find patients who were circumcised before puberty that require resection of the skin, as it has grown loose and pliant after that epoch. Mental depression following circumcision is practically unknown, and the only patients in whom there is any but the most pronounced physical gain are those above fifty years old. And we might note, too, that after that age masturbation seems to have very little influence on the health, the patient seemingly having passed the period at which the drain can do much harm. Many of the boys and younger men begin to show marked gain in weight and even in mental activity within ten days after the operation. generally the patients do not object to the operation when its nature and object are fully explained to them; indeed, some of the most intelligent insist on its being done, acknowledging their inability to free themselves from their habit voluntarily. Edgar J. Spratling, "Masturbation in the adult", Medical Record, Vol. 48, 28 September 1895, p. 442-3 <h3>A century of circumcision to control masturbation in infants, children and adults</h3> <h4>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 benefits of circumcision.</h4> M.J. Moses, "The value of circumcision as a hygienic and therapeutic measure", New York Medical Journal 14, October 1871, 368-74 Discusses prevention of masturbation as the first of several reasons for circumcision: "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." Edgar Spratling, "Masturbation in the adult", Medical Record 48, 28 September 1895, 442-3 Prevention of masturbation a sufficient reason for circumcision: "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." M. Clifford, Circumcision: Its Advantages and How to Perform it (London: Churchill, 1893), 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 Ernest G. Mark, "Circumcision", American Practitioner and News 31, 1901, 231 Lessened tendency to masturbation: "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 Prevention of masturbation the principal reason for circumcision: "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 Prevention of masturbation was the fourth of seven reasons Wolbarst gave as to why circumcision was a medico-moral imperative for the twentieth century: "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 Prevention of masturbation a sufficient reason for circumcision: "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!" Alan F. Guttmacher, "Should the baby be circumcised?", Parents Magazine 16, September 1941, 26, 76-78 Prevention of masturbation was the second of five reasons Guttmacher gave as to why the baby should be circumcised: "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 ... " "Excessive attention"??! -- how very Victorian! Campbell's Urology, 1970 "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." 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 Only in America! </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 Treating masturbation (1895) 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"> As these two articles from 1898 show, there was not much difference between the Orificial History Society and more orthodox medicine when it came to the dangers of preputual irritation and the benefits of an early circumcision. <h3>Far-reaching benefits of circumcision</h3> The operation of circumcision is so far-reaching in its beneficial results that performance of this operation cannot be confined to any one class of specialists, but is the common property of all, including even the general practitioner, as all can agree on one point at least â€“ that is, that removal of the prepuce is followed by a cleanlier and more aseptic condition of the glans penis. But the class who are most greatly interested in this surgical procedure are the genito-urinary surgeon and neurologist, either of whom may be frequently called upon to perform circumcision as a remedy for a venereal trouble or some obscure nervous affection. I have performed the operation of circumcision many times; but the youngest child which I have ever operated on was one forty-five hours of age. The mother of the child noticed that it was very fretful, and feared that spasms might supervene. I was called in, and both mother and father told me that they had sought diligently to find an orifice to the foreskin, but their efforts had been made in vain. I then began the search myself; but neither with the aid of my eyes or probe could I find any preputial orifice. I told the parents there was but one thing to do, and that was to circumcise the child, which I did, cutting off the foreskin when the child was but forty-five hours of age. After cutting off the foreskin and splitting up its mucous membrane on the dorsum as far as the corona glandis, I proceeded to strip the mucous membrane from the surface of the glans, which I found to be a very difficult thing to accomplish, as the adhesions had become so firm that it seemed to have become almost a portion of the glans itself, and was stripped off from it with a great deal of difficulty. Some hours after the operation (which was about six o'clock in he evening) a few drops of water passed from the orifice of the urethra, and by morning the infant began to urinate and, according to the mother's statement, must have passed a quart of water, which seems almost incredible, and probably only appeared to be that much; but the quantity must have been something enormous for the mother to have thought that such a large amount had been passed. The wound healed nicely in about the usual length of time, and the child is now well. This case is extremely interesting, for although one frequently meets with cases of nearly complete occlusion of the orifice of the prepuce, yet the occurrence of complete obstruction is rare; and I do not recollect, in looking over the literature on the subject of preputial troubles (to which I have given considerable attention), to have found any cases reported of this character. In the foregoing case there was a positive necessity for the operation; but before dwelling upon the subject in the treatment of certain neurological and genito-urinary affections, why not look at the matter in a broader light, and see if it be not a direct prophylactic procedure in the limitation of diseases of the genito-urinary and nervous systems. First of all, one of the objects most desired in other portions of the body are obtained in this region by the removal of the skin which covers the head of the penis, namely, cleanliness; which is reason enough of itself why the operation should be made general. [Various references to cleanliness, Jonathan Hutchinson's figures on syphilis, the dangers of phimosis and preputial adhesions etc] A western physician reports a case of asthma in an adult cured by circumcision â€“ but space will not permit the insertion of the many interesting cases which I might glean from the literature on the subject. Phimosis may simulate [sic: stimulate?] stone in the bladder. The cutting off of the foreskin is probably of benefit in all cases of neurasthenia, whether associated with phimosis or not. It is not surprising that phimosis may be the cause in many instances of epilepsy and some other nervous disorders, when we take into consideration the nervous distribution of the glans penis, Pacinian nerve endings being found there; and according to a well known writer, the nerve distribution to the head of the penis is not excelled in richness by any portion of the economy, even including the organs of sense. [1] This being the case, would it be any wonder that irritation produced by hardened smegma should cause, by its reflex, a convulsion of an epileptoid nature, or any other manifestations of a reflex kind. Nocturnal enuresis (or wetting the bed) may be of this character, as it seems to have been relieved by circumcision. After examining into the operation of circumcision thoroughly, as we have done, one is surprised to find that there are some opponents to the performance of it. One says that the foreskin by its friction over the sensitive corona during coition enhances the ejaculatory act. In reply would say [sic], is not the friction from the folds of the vaginal walls more to be desired? About the only objection that have been urged against cutting off the foreskin are that it leaves the sensitive head of the penis constantly exposed to friction against the clothing and other rough articles; and another objection is made that this exposure to friction decreases to a certain extent the sensibility of this very sensitive head. It does come into contact with the clothing after circumcision has been performed, but after some time the mucous membrane of the glans penis becomes toughened and thicker, and so far as the decrease in sensibility is concerned, it is an advantage, as the act of coitus is prolonged. [2] The glands of Tyson dry up, [3] so that the head of the penis of a circumcised individual remains dry and clean. Should the sensibility of the glans be too greatly reduced (some time after the operation by exposure) to suit its possessor, its sensibility may be increased considerably by wearing a condom well smeared with Vaseline over the head of the penis for a few days. [A lengthy description of his surgical technique follows.] Alex L. Hodgon MD, "A case of threatened convulsions with complete congenital occlusion of the orifice of the prepuce â€“ Followed by a few remarks on phimosis and circumcision, American Journal of Dermatology and Genito-Urinary Diseases, Vol. 2, October 1898, pp. 122-27 <h4>NOTES</h4> 1. The author was Georg Ludwig Kobelt, who had written in Die Mannlichen and Weiblichen Wollusts-Organe des Menschen und verschiedene Saugetiere (The male and female organs of sexual arousal in man and some other mammals), first published in 1844: "The glans penis is the principal point of reunion of the sensitive nerves of the virile organ, no other part which it regulates can be compared with it in this respect. In respect of richness in nerves, the glans penis yields to no other part, not even the organ of sense." Hodgon is more likely remembering the passage as quoted by William Acton, in The functions and disorders of the reproductive organs in childhood, youth, adult age and advanced life, (3rd edition [London 1862], Philadelphia: Lindsay and Blakiston, 1865), p. 153, n.1 2. As late as 1967 another American urologist fell into the same bizarre contradiction â€“ simultaneously arguing that circumcision made no difference to penile sensation, yet also that the diminished sensitivity was a good thing, since it delayed the orgasm, thus enhancing marital happiness. See the contribution of Ira M. Fielding MD, instructor in urology at Albert Einstein College of Medicine, New York, to the symposium, "Should circumcision be done routinely?", Medical Aspects of Human Sexuality, December 1967, p. 33 3. This is another instance of the myth of Tyson's glands, though Dr Hogdon can be excused, writing as he was before their existence had been disproved. <h3>Further benefits of circumcision</h3> According to Dr Bergman, "He needed the rightful punishment of cutting pains after his illicit pleasures." It is as interesting from a surgical standpoint, as it is gratifying from a humane point of view, to note the rapid changes made possible by the orificial method of handling our cases. The stimulating effect of the treatment makes the whole sympathetic nerve reverberate under its force, reaching the finest little twigs of this nervous tree, and institutes changes in the nutrition that cause the pathological conditions to yield gradually before the onslaught of healthy blood and tissue. Thus rejuvenating the entire system, it opens up a new chapter of life, new hopes are held out, and the sufferer is able to begin anew. In children, I believe, we will notice the most rapid recoveries, no doubt due to the circumstances that the vital forces of a growing system are more numerous or employed more actively than in one where are engaged forces to maintain life only, and consequently such a system is more readily impressed than one at later periods of life. Circumcision has an extraordinarily wide range of action, not as a surgical procedure to remove objectionable local conditions only, but employed as a curative means in diseases of the sympathetic nerve, in which there is to the common physician apparently no connection between the lesion and the male organ. But the orificial surgeon has learned to recognise these cases, and is able to effect a cure where ordinary medication has been tried and found a failure. In the few cases here submitted orificial treatment wrought a speedy cure, after internal medicines had failed to produce any impression for the better. <h4>Cases</h4> Case 1. â€“ Baby Andrew H., aet. 10 months, had for some time suffered from difficult urination. He was irritable and fretful to the highest degree, and was continually disturbed in his sleep. Before micturition the parts would swell up, assume a bluish colour, and with great straining and pain a small stream of urine would be expelled. I prescribed for the boy, but with very little relief, and as the condition of the boy was growing worse, I concluded to circumcise him. The prepuce was found adherent to the glans and abnormally contracted, leaving only the smallest opening for the urine. The rectal sphincter was also too tight. In a few days the boy recovered from the effects of the operation, and was well after that. The dysuria disappeared entirely, and the boy, improved in every respect, is at present at 4 years or age perfectly well and hearty. Case 2. â€“ Baby Russell R., aet. 18 months, had been treated or convulsions during dentition, but without any improvement. When he was brought to me the seizures were of such a serious nature that fear had been expressed by his former physician that the boy might not live through another attack. Although the irritation from the teeth had a great deal to do with these attacks, it was clear to me that they had a deeper source. On examination of the boy I fond this, so common condition, viz.: elongated, tight prepuce; inflamed, narrow meatus. I advised circumcision, which was immediately performed. The adherent foreskin had to be peeled off the glans, and several hard lumps of smegma were removed. The continuous catgut stitch was used to unite the mucous membrane with the skin. The little patent made a rapid recovery; the convulsions ceased at once; the boy grew and thrived and was in fact entirely changed. He became sweet and happy, his parents joy and pleasure from having been a constant care and worry. Case 3. â€“ Ernest G., 8 years old, was brought to my office by his mother, who told me the boy had always been sickly, never well. He had had all the children's diseases; would take cold with every change of he weather; would never eat much at mealtimes, but always between; could not sleep well, perhaps because he was so disturbed by his bladder in the night, and had been for nearly three years deaf in his right ear. The boy certainly looked very sickly and puny. he had taken "barrels of medicines", until his stomach had revolted, and had now come to try the new school. I suspected orificial irritation, and after having examined the boy and informed Mrs G. of a few facts, I recommended an operation, to which she consented. I found about the same condition as in the previous case and an extremely flabby and "tired" sphincter. I am pleased to report that the treatment did wonders for this boy. His appetite became more natural; the functions of the bladder normal; his hearing was restored, and during the first three months following he operation he gained nearly six pounds in weight. The principal accessories I used were baryta jod 3x for the general condition, and fer. phos. 6x for his ear. Case 4 â€“ Clarence B., aet. 16 years, had been under my care for several months for various complaints, and with varied success. He was undersized in stature, and so dull mentally that he forgot half the time to take his medicines, and could give such a poor account of himself that I made only slow progress with him. I was about to give up he case when his older married sister told me, one day, that she had wrung out of the boy a confession that he was addicted to the secret vice practised among boys. This information, of course, changed my medication, but though the boy, as I had reason to believe, stopped this injurious practice, his actual recovery did not take place until I had performed an orificial operation, consisting of circumcision and removal of pockets and papillae. It may have been that this patient could have been cured without this treatment, but I hardly believe so, for he arose from his sickbed clean. He needed the rightful punishment of cutting pains after his illicit pleasures, and realising his error he turned into another path and became rapidly restored to full vitality of body and soul. His eye grew bright, his brow clear, his gait became elastic, and he grew more in height in the following one year than he had in the previous three. His intellect widened, as his memory returned, and he last reports from school showed that he had acquitted himself as a good scholar. N. Bergman, "Report of a few cases of circumcision", Journal of Orificial Surgery, Vol. 7, December 1898, pp. 249-51 </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 Miracle cures (1898) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4>The irritable prepuce and its cure</h4> J.H Beaty MD explains how nervous and other diseases in boys â€“ anything from epilepsy and asthma to nose-picking and masturbation â€“ are often caused by an over-sensitive or irritable foreskin, and can thus be alleviated by detaching the foreskin from the glans, and permanently cured by circumcision. <h3>Some common peripheral irritations in boys</h3> In preparing this paper on this, so vital a subject, I have done very little theorizing, but beg to present reports and comments on a few representative cases. Case 1: Boy aged six years. Fell into an epileptiform fit. No history of any trouble and no other apparent cause than preputial irritation. Examination showed prepuce long and contracted with orifice hardly large enough to admit a small probe. Under chloroform operated and found adhesions over whole glans and much smegma lodged behind corona. Made full circumcision and broke up all adhesions. Result: no more fits after a year. Case 2: Shows at what an early age a child with local irritation may acquire the habit of masturbation. Boy aged six. Had been detected by his kindergarten teacher acting strangely. After some suspicious movements a strange look would come over his face, after which he would become limp, pale and languid for some time. A close watch was kept, and it was found that he was not only himself masturbating, but had taught his four-year-old brother the art; and these strange looks and actions were evidently connected with a distinct sexual orgasm. Examination showed prepuce normal in length but adherent over the whole top of the glans. To combine mental with physical reformation, these adhesions were broken without an anaesthetic (a very painful procedure both to the patient and everyone else within a block); for a while he was better, but after some weeks was detected in his old habit, and it was found that the prepuce was again adherent. Again the work was done, eliciting loud assurances that he would be good, and as far as I was ever able to learn he kept his promise. Case 3: Boy, aged three and one-half years, was noticed to pick the nose and show other so called "worm symptoms", also was noticed to stagger and fall often and preferred to play sitting or lying down. Found prepuce redundant, contracted and adherent. Circumcised and broke adhesions. Result, complete cure of all the unpleasant symptoms. Case 4: Boy aged two and one-half years. Flabby, ill-nourished, peevish and sickly. Found usual contracted and adherent prepuce, also inguinal hernia. Applied truss but found it hard to retain the hernia, and got no improvement in general health, although I prescribed carefully. Attended to the lesions of the penis, and improvement began almost immediately, and now after a year and a half the child is strong and well, the hernia seldom comes down, and we hope to be able to lay aside the truss in the course of time. Case 5: Boy, aged twelve, has suffered from asthma for several years and is getting worse. Prescribed carefully for a month with no improvement. He was taken to an allopath, who prescribed with the same result. Upon a more thorough examination, no trouble was found anywhere, except a very slight adhesion of the prepuce not more than a quarter of an inch wide. Without any expectation of a good result I broke this adhesion and advised a change of climate, but to the surprise of us all improvement was immediate and rapid, and although no more medicine was given, the boy is now, after six months, perfectly well. Case 6: Is a strange case of over-development of the sexual organs. Boy, aged eight years, rather small for his age, poorly nourished and very nervous. Two years before I saw him he had been victimized by a neighbour girl slightly older than himself, and undoubtedly had been made acquainted with sensations far in advance of his years, but I could get no evidence of masturbation, even after having him closely watched for several months. At the time of examination the penis was very irritable, erecting at the slightest touch and presenting every appearance of a fully developed organ in the state of very strong erection and large enough for an average boy of fourteen years. Under chloroform the organ relaxed and showed the prepuce to be quite redundant. I circumcised, slitting the foreskin well back to make it loose, and cut the frenum. The result was marked and immediate, the peculiar nervous wiggle left him at once, and the boy has since gained rapidly in general nutrition, and is growing rapidly. [Discussion] I find in my case-books a number of cases of enuresis [i.e. bed-wetting] cured by relieving preputial irritation, and can say that I never yet have seen a boy who suffered from this most troublesome symptom who had not some local irritation, and so far I have cured every case. Another malformation and source of irritation usually overlooked is the short frenum. I find this a very common accompaniment, if not a cause, of involuntary emissions, and I have found as a result of cutting the frenum in six cases of this trouble that cure has followed in three cases, one has not reported and two are improved. [Operative methods] In my methods of operating I have no set rule, but try to give each case just what it requires. A normal prepuce should cover about half the glans, and I will not quarrel with one that covers the whole glans, if there are no signs of irritation. When I circumcise I try to leave just about enough to cover half the glans when the organ is relaxed. I have never employed the high operation, and have heard some complaints from patients who have undergone this style of operation, who suffer from the lack of protection to the sensitive corona. Whatever method is followed, the patient must be instructed as to future care and cleanliness. In operating I use none of the many instruments specially designed for the purpose, having found them a bother and a hindrance to a perfect result. The tissue should be cut slantwise, parallel with the corona, and not stubbed off at right angles to the axis of the organ, as I have too often seen it done. The skin and mucous membrane should be trimmed so as to fit perfectly before the sutures are placed, and if difficulty is found in making the opening loose enough, the dorsal slit should be employed and corners trimmed off symmetrically. I do not consider the work complete if the frenum is left too short. It should be of sufficient length to allow the prepuce to be fully retracted without bending the glans under. If found too short, a slight snip with the scissors will be all that is needed. These cases should be watched by the physician till healing is complete and all adhesions permanently destroyed. [Conclusion] I will not tax your patience with more cases nor details, thinking I have said enough to convince you that there is something in the subject â€“ something that we as conscientious physicians cannot overlook, as it greatly influences not only the physical, but the moral development of those little ones who are placed in our charge. I hope that more interest may be aroused in this important subject, with the result that much unnecessary suffering may be prevented, and that our pauper and criminal classes, victims largely as they are of the results of sexual perversion and moral instability from physical causes, may be materially diminished as generations pass by, and I am confident that much may be done right along this line to hasten the millennium. J.H. Beaty, "Some peripheral irritations common in young boys", Journal of Orificial Surgery, Vol. 7, July 1898, p. 33-6 <h4>NOTE</h4> Although Beaty was associated with the extremist and often loopy Orificial Surgery Society, there is little difference between his understanding of phimosis and that of American physicians half a century later, nor between their methods of dealing with it. (See Alan Guttmacher, "Should the baby be circumcised", 1941). Of equal interest is the mildness of Beatty's operative technique, seeking to remove only a small portion of the foreskin and leaving enough to keep the glans half-covered. This is a far cry from the official "high and tight" style subsequently promoted by the US medical profession, in which the general aim was to remove as much tissue as humanly (some might say inhumanely) possible. </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 Preputial irritation (1898) 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"> by Hugh O'Donnell, April 2001 America began the 20th century as the land of promise: Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me. and ended it as an economic powerhouse, creating unimaginable wealth for a few and sybaritic affluence for a great many. It was a century of extraordinary progress for America and the world, driven by astonishing American scientific and technological achievements, including the harnessing of the power of the atom, and sending Earthlings to the Moon. For all that, America's greatest achievement in the 20th century -- the one that benefited mankind the most -- was to defeat an ideology that threatened to engulf and enslave the world. Despite these great achievements, America's record was imperfect. Nor should one seek perfection; perfection is akin to sterility. However, that does not preclude striving to eradicate the most egregious of blemishes. And one of the most egregious blemishes on America's record in the 20th century was its embrace and integration into its culture of the practice of male genital mutilation; moreover, the most meaningless and useless and indefensible form of that practice. Male genital mutilation has been practised by many unrelated cultures over many thousands of years, so it was by no means a novel idea for America to adopt it. However, it was certainly an incongruous development. America was clearly the world's leader in science in the 20th century. Mutilation of the genitals, male or female, is always rooted in superstitious beliefs. Superstition is the antithesis of science. America's embrace of circumcision represents a triumph for superstition over science. America cherishes the rights of individual citizens perhaps more than any other nation on Earth. Removing any part of a newborn's body (or the body of a child of any age) without compelling medical justification is a clear and gross breach of that individual's rights. It is extraordinary that America, while bearing the torch of freedom for the world, while ensuring the survival of human rights in the world, should turn a blind eye to this crime. During 20th century, more than 120 million foreskins were severed from American penises, more than in any other country in the world. At the height of the circumcision frenzy, a foreskin was being sundered, and a penis crippled, every 17 seconds. Whatever other name one might give the 20th century in respect of America, the appellation "The Circumcision Century" is particularly fitting. Although male circumcision was not made compulsory by law, parents who wanted their sons to grow up complete were browbeaten until they relented and gave their sons up for mutilation, and doctors hunted down and amputated surviving foreskins with demonic determination. The history of newborn circumcision in America is quite well documented; while the equally unsavoury history of later circumcision has received much less attention. One the eve of Genital Integrity Awareness Week 2001, it is appropriate to reflect on the experience of the century recently ended and to look at what the new century might bring. On the ABC's Good Morning America program on March 12, 2001, Charles Gibson remarked, "It may be surprising to learn that 60% of men in America have been circumcised!" It is difficult to interpret this remark. On the surface, it appears to mean that it may be surprising to learn that such a high percentage of men have been circumcised because, had Gibson intended to convey that the figure was surprisingly low, it is likely that he would have inserted the word "only". However, since "almost everyone" knows that "almost everyone" (and certainly every "real" American male) gets circumcised routinely, it is likely that the reaction of many viewers was, "What!!!??? You mean to say that 40% of men in America have NOT been circumcised??!!" Where Gibson obtained his figure from is unknown, but it is more than likely that he simply confused the newborn circumcision rate with the completely different statistic of what percentage of living males have been circumcised. And the two figures /are/ completely different; for example, the newborn circumcision rate in Australia is about 10%, but close to 50% of all living males in Australia have been circumcised. The question as to what percentage of living males in the US have been circumcised is an interesting one which is answered in the analysis below, using data in Wallerstein's book, Circumcision: An American Health Fallacy (New York 1981). The data are included in the Appendix to this essay. Wallerstein himself states that, "If anything, [the data] errs on the side of caution, using lower percentages." Indeed it is much easier to make a case that the newborn circumcision rates presented by Wallerstein underestimate the true rates than that they overestimate them. With that in mind, the results below may also be underestimates. Table 1: Intact and Circumcised Male Populations of the USA by Year, 1900 to 2000 <div align="right"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="53"> </td> <td colspan="3" width="185"> Male population (millions) </td> <td width="79"> </td> <td colspan="4" width="321"> For 5 year period Commencing with Year </td> </tr> <tr> <td width="53"> Year </td> <td width="53"> Intact </td> <td width="79"> Circumcised </td> <td width="53"> Total </td> <td width="79"> Circumcised (%) </td> <td width="64"> Male Births (millions) </td> <td width="83"> Newborn Circumcision rate (%) </td> <td width="87"> Newborn Circumcisions(millions) </td> <td width="87"> Non-newborn Circumcisions millions) </td> </tr> <tr> <td width="53"> 1900 </td> <td width="53"> 30 </td> <td width="79"> 7 </td> <td width="53"> 37 </td> <td width="79"> 18 </td> <td width="64"> 5.1 </td> <td width="83"> 30 </td> <td width="87"> 1.5 </td> <td width="87"> 0.3 </td> </tr> <tr> <td width="53"> 1905 </td> <td width="53"> 33 </td> <td width="79"> 8 </td> <td width="53"> 41 </td> <td width="79"> 20 </td> <td width="64"> 5.6 </td> <td width="83"> 35 </td> <td width="87"> 2.0 </td> <td width="87"> 0.3 </td> </tr> <tr> <td width="53"> 1910 </td> <td width="53"> 35 </td> <td width="79"> 10 </td> <td width="53"> 45 </td> <td width="79"> 22 </td> <td width="64"> 6.6 </td> <td width="83"> 42 </td> <td width="87"> 2.8 </td> <td width="87"> 0.4 </td> </tr> <tr> <td width="53"> 1915 </td> <td width="53"> 37 </td> <td width="79"> 12 </td> <td width="53"> 49 </td> <td width="79"> 25 </td> <td width="64"> 7.0 </td> <td width="83"> 50 </td> <td width="87"> 3.5 </td> <td width="87"> 0.4 </td> </tr> <tr> <td width="53"> 1920 </td> <td width="53"> 37 </td> <td width="79"> 15 </td> <td width="53"> 52 </td> <td width="79"> 29 </td> <td width="64"> 8.0 </td> <td width="83"> 52 </td> <td width="87"> 4.2 </td> <td width="87"> 0.4 </td> </tr> <tr> <td width="53"> 1925 </td> <td width="53"> 38 </td> <td width="79"> 19 </td> <td width="53"> 56 </td> <td width="79"> 33 </td> <td width="64"> 6.2 </td> <td width="83"> 55 </td> <td width="87"> 3.4 </td> <td width="87"> 0.5 </td> </tr> <tr> <td width="53"> 1930 </td> <td width="53"> 38 </td> <td width="79"> 21 </td> <td width="53"> 60 </td> <td width="79"> 36 </td> <td width="64"> 6.3 </td> <td width="83"> 58 </td> <td width="87"> 3.7 </td> <td width="87"> 0.5 </td> </tr> <tr> <td width="53"> 1935 </td> <td width="53"> 38 </td> <td width="79"> 24 </td> <td width="53"> 62 </td> <td width="79"> 39 </td> <td width="64"> 6.5 </td> <td width="83"> 60 </td> <td width="87"> 3.9 </td> <td width="87"> 0.5 </td> </tr> <tr> <td width="53"> 1940 </td> <td width="53"> 37 </td> <td width="79"> 27 </td> <td width="53"> 64 </td> <td width="79"> 42 </td> <td width="64"> 7.5 </td> <td width="83"> 65 </td> <td width="87"> 4.9 </td> <td width="87"> 0.5 </td> </tr> <tr> <td width="53"> 1945 </td> <td width="53"> 37 </td> <td width="79"> 31 </td> <td width="53"> 68 </td> <td width="79"> 46 </td> <td width="64"> 8.7 </td> <td width="83"> 70 </td> <td width="87"> 6.1 </td> <td width="87"> 0.5 </td> </tr> <tr> <td width="53"> 1950 </td> <td width="53"> 37 </td> <td width="79"> 37 </td> <td width="53"> 74 </td> <td width="79"> 50 </td> <td width="64"> 9.9 </td> <td width="83"> 72 </td> <td width="87"> 7.1 </td> <td width="87"> 0.6 </td> </tr> <tr> <td width="53"> 1955 </td> <td width="53"> 38 </td> <td width="79"> 43 </td> <td width="53"> 81 </td> <td width="79"> 53 </td> <td width="64"> 11.1 </td> <td width="83"> 75 </td> <td width="87"> 8.3 </td> <td width="87"> 0.6 </td> </tr> <tr> <td width="53"> 1960 </td> <td width="53"> 38 </td> <td width="79"> 50 </td> <td width="53"> 88 </td> <td width="79"> 57 </td> <td width="64"> 10.7 </td> <td width="83"> 78 </td> <td width="87"> 8.4 </td> <td width="87"> 0.6 </td> </tr> <tr> <td width="53"> 1965 </td> <td width="53"> 38 </td> <td width="79"> 57 </td> <td width="53"> 95 </td> <td width="79"> 60 </td> <td width="64"> 9.3 </td> <td width="83"> 80 </td> <td width="87"> 7.4 </td> <td width="87"> 0.6 </td> </tr> <tr> <td width="53"> 1970 </td> <td width="53"> 37 </td> <td width="79"> 63 </td> <td width="53"> 100 </td> <td width="79"> 63 </td> <td width="64"> 8.7 </td> <td width="83"> 82 </td> <td width="87"> 7.1 </td> <td width="87"> 0.6 </td> </tr> <tr> <td width="53"> 1975 </td> <td width="53"> 37 </td> <td width="79"> 68 </td> <td width="53"> 105 </td> <td width="79"> 65 </td> <td width="64"> 8.5 </td> <td width="83"> 85 </td> <td width="87"> 7.2 </td> <td width="87"> 0.6 </td> </tr> <tr> <td width="53"> 1980 </td> <td width="53"> 36 </td> <td width="79"> 74 </td> <td width="53"> 111 </td> <td width="79"> 67 </td> <td width="64"> 9.8 </td> <td width="83"> 80 </td> <td width="87"> 7.8 </td> <td width="87"> 0.7 </td> </tr> <tr> <td width="53"> 1985 </td> <td width="53"> 36 </td> <td width="79"> 80 </td> <td width="53"> 116 </td> <td width="79"> 69 </td> <td width="64"> 9.9 </td> <td width="83"> 74 </td> <td width="87"> 7.3 </td> <td width="87"> 0.8 </td> </tr> <tr> <td width="53"> 1990 </td> <td width="53"> 36 </td> <td width="79"> 85 </td> <td width="53"> 122 </td> <td width="79"> 70 </td> <td width="64"> 10.4 </td> <td width="83"> 68 </td> <td width="87"> 7.1 </td> <td width="87"> 1.0 </td> </tr> <tr> <td width="53"> 1995 </td> <td width="53"> 38 </td> <td width="79"> 90 </td> <td width="53"> 128 </td> <td width="79"> 70 </td> <td width="64"> 10.0 </td> <td width="83"> 63 </td> <td width="87"> 6.3 </td> <td width="87"> 1.1 </td> </tr> <tr> <td width="53"> 2000 </td> <td width="53"> 39 </td> <td width="79"> 94 </td> <td width="53"> 133 </td> <td width="79"> 70 </td> <td width="64"> </td> <td width="83"> </td> <td width="87"> </td> <td width="87"> </td> </tr> <tr> <td width="53"> </td> <td width="53"> </td> <td width="79"> </td> <td width="53"> </td> <td width="79"> Totals </td> <td width="64"> 165.8 </td> <td width="83"> 66 </td> <td width="87"> 110.0 </td> <td width="87"> 11.4 </td> </tr> </tbody> </table> </div> Sources: Population data: U.S. Bureau of the Census; Circumcision data: Wallerstein <h3>Notes</h3> 1. 70% of the current male population of the US have been circumcised. 2. 110 of the 166 million males (66%) born during the century underwent circumcision in the newborn period. 3. The annual number of circumcisions was highest between 1955 and 1965. During that decade, 1.8 million males were circumcised every year -- almost 5,000 every day. 4. Between 1915 and 1995 the intact male population remained in a very narrow band between 36 and 38 million, while the circumcised male population soared from 12 million to 90 million. 5. A male born during the century who remained intact in the newborn period had on average about a one in five chance of being circumcised after the newborn period, or a four in five probability of dying intact. That probability fell steadily during the course of the century so that, if the current post-newborn circumcision rate remains constant in the future, a male born at the end of the century who escaped circumcision in the newborn period nevertheless has less than a two in three chance of dying intact. 6. The model used to produce these figures takes into account non-newborn circumcision rates, the rate of immigration and the circumcision status of immigrants, and the circumcision status of deaths and emigrants, all important factors in arriving at the percentage of living males who have been circumcised. Table 2: Number and Percentage of Living Males in USA in 2000 who have been Circumcised, by Age and Place of Birth <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="45"> </td> <td colspan="5" width="234"> Native Born </td> <td colspan="5" width="231"> Foreign Born </td> <td colspan="3" width="151"> Total </td> </tr> <tr> <td width="45"> Age </td> <td width="57"> Pop (x1,000) </td> <td width="42"> NC (%) </td> <td width="42"> LC (%) </td> <td width="42"> Circ'd (%) </td> <td width="53"> Circ'd (x1,000) </td> <td width="53"> Pop (x1,000) </td> <td width="42"> AC (%) </td> <td width="42"> PC (%) </td> <td width="42"> Circ'd (%) </td> <td width="53"> Circ'd (x1,000) </td> <td width="57"> Pop (x1,000) </td> <td width="53"> Circ'd (x1,000) </td> <td width="42"> Circ'd (%) </td> </tr> <tr> <td width="45"> 0- 4 </td> <td width="57"> 9,600 </td> <td width="42"> 63 </td> <td width="42"> 1 </td> <td width="42"> 64 </td> <td width="53"> 6,100 </td> <td width="53"> 82 </td> <td width="42"> 5 </td> <td width="42"> 1 </td> <td width="42"> 6 </td> <td width="53"> 5 </td> <td width="57"> 9,683 </td> <td width="53"> 6,105 </td> <td width="42"> 63 </td> </tr> <tr> <td width="45"> 5- 9 </td> <td width="57"> 9,975 </td> <td width="42"> 68 </td> <td width="42"> 1 </td> <td width="42"> 69 </td> <td width="53"> 6,915 </td> <td width="53"> 233 </td> <td width="42"> 15 </td> <td width="42"> 2 </td> <td width="42"> 17 </td> <td width="53"> 39 </td> <td width="57"> 10,208 </td> <td width="53"> 6,954 </td> <td width="42"> 68 </td> </tr> <tr> <td width="45"> 10-14 </td> <td width="57"> 9,548 </td> <td width="42"> 74 </td> <td width="42"> 2 </td> <td width="42"> 76 </td> <td width="53"> 7,225 </td> <td width="53"> 464 </td> <td width="42"> 25 </td> <td width="42"> 3 </td> <td width="42"> 28 </td> <td width="53"> 128 </td> <td width="57"> 10,012 </td> <td width="53"> 7,354 </td> <td width="42"> 73 </td> </tr> <tr> <td width="45"> 15-19 </td> <td width="57"> 9,395 </td> <td width="42"> 80 </td> <td width="42"> 2 </td> <td width="42"> 82 </td> <td width="53"> 7,674 </td> <td width="53"> 756 </td> <td width="42"> 25 </td> <td width="42"> 4 </td> <td width="42"> 29 </td> <td width="53"> 216 </td> <td width="57"> 10,151 </td> <td width="53"> 7,890 </td> <td width="42"> 78 </td> </tr> <tr> <td width="45"> 20-24 </td> <td width="57"> 8,176 </td> <td width="42"> 85 </td> <td width="42"> 2 </td> <td width="42"> 87 </td> <td width="53"> 7,073 </td> <td width="53"> 1007 </td> <td width="42"> 20 </td> <td width="42"> 5 </td> <td width="42"> 25 </td> <td width="53"> 249 </td> <td width="57"> 9,183 </td> <td width="53"> 7,322 </td> <td width="42"> 80 </td> </tr> <tr> <td width="45"> 25-29 </td> <td width="57"> 7,881 </td> <td width="42"> 82 </td> <td width="42"> 2 </td> <td width="42"> 84 </td> <td width="53"> 6,625 </td> <td width="53"> 1174 </td> <td width="42"> 15 </td> <td width="42"> 6 </td> <td width="42"> 21 </td> <td width="53"> 246 </td> <td width="57"> 9,055 </td> <td width="53"> 6,871 </td> <td width="42"> 76 </td> </tr> <tr> <td width="45"> 30-34 </td> <td width="57"> 8,316 </td> <td width="42"> 80 </td> <td width="42"> 3 </td> <td width="42"> 83 </td> <td width="53"> 6,865 </td> <td width="53"> 1455 </td> <td width="42"> 15 </td> <td width="42"> 7 </td> <td width="42"> 22 </td> <td width="53"> 317 </td> <td width="57"> 9,771 </td> <td width="53"> 7,181 </td> <td width="42"> 73 </td> </tr> <tr> <td width="45"> 35-39 </td> <td width="57"> 9,676 </td> <td width="42"> 78 </td> <td width="42"> 3 </td> <td width="42"> 81 </td> <td width="53"> 7,844 </td> <td width="53"> 1539 </td> <td width="42"> 15 </td> <td width="42"> 8 </td> <td width="42"> 23 </td> <td width="53"> 347 </td> <td width="57"> 11,216 </td> <td width="53"> 8,191 </td> <td width="42"> 73 </td> </tr> <tr> <td width="45"> 40-44 </td> <td width="57"> 9,677 </td> <td width="42"> 75 </td> <td width="42"> 4 </td> <td width="42"> 79 </td> <td width="53"> 7,624 </td> <td width="53"> 1362 </td> <td width="42"> 15 </td> <td width="42"> 8 </td> <td width="42"> 23 </td> <td width="53"> 316 </td> <td width="57"> 11,039 </td> <td width="53"> 7,940 </td> <td width="42"> 72 </td> </tr> <tr> <td width="45"> 45-49 </td> <td width="57"> 8,405 </td> <td width="42"> 72 </td> <td width="42"> 5 </td> <td width="42"> 77 </td> <td width="53"> 6,433 </td> <td width="53"> 1096 </td> <td width="42"> 15 </td> <td width="42"> 9 </td> <td width="42"> 24 </td> <td width="53"> 262 </td> <td width="57"> 9,501 </td> <td width="53"> 6,695 </td> <td width="42"> 70 </td> </tr> <tr> <td width="45"> 50-54 </td> <td width="57"> 7,129 </td> <td width="42"> 70 </td> <td width="42"> 5 </td> <td width="42"> 75 </td> <td width="53"> 5,360 </td> <td width="53"> 869 </td> <td width="42"> 15 </td> <td width="42"> 9 </td> <td width="42"> 24 </td> <td width="53"> 213 </td> <td width="57"> 7,998 </td> <td width="53"> 5,572 </td> <td width="42"> 70 </td> </tr> <tr> <td width="45"> 55-59 </td> <td width="57"> 5,537 </td> <td width="42"> 65 </td> <td width="42"> 6 </td> <td width="42"> 71 </td> <td width="53"> 3,953 </td> <td width="53"> 646 </td> <td width="42"> 15 </td> <td width="42"> 10 </td> <td width="42"> 25 </td> <td width="53"> 162 </td> <td width="57"> 6,183 </td> <td width="53"> 4,115 </td> <td width="42"> 67 </td> </tr> <tr> <td width="45"> 60-64 </td> <td width="57"> 4,443 </td> <td width="42"> 60 </td> <td width="42"> 8 </td> <td width="42"> 68 </td> <td width="53"> 3,007 </td> <td width="53"> 525 </td> <td width="42"> 15 </td> <td width="42"> 11 </td> <td width="42"> 26 </td> <td width="53"> 134 </td> <td width="57"> 4,968 </td> <td width="53"> 3,141 </td> <td width="42"> 63 </td> </tr> <tr> <td width="45"> 65-69 </td> <td width="57"> 3,926 </td> <td width="42"> 58 </td> <td width="42"> 8 </td> <td width="42"> 66 </td> <td width="53"> 2,608 </td> <td width="53"> 410 </td> <td width="42"> 15 </td> <td width="42"> 11 </td> <td width="42"> 26 </td> <td width="53"> 107 </td> <td width="57"> 4,337 </td> <td width="53"> 2,715 </td> <td width="42"> 63 </td> </tr> <tr> <td width="45"> 70-74 </td> <td width="57"> 3,543 </td> <td width="42"> 55 </td> <td width="42"> 9 </td> <td width="42"> 64 </td> <td width="53"> 2,282 </td> <td width="53"> 318 </td> <td width="42"> 15 </td> <td width="42"> 12 </td> <td width="42"> 27 </td> <td width="53"> 85 </td> <td width="57"> 3,862 </td> <td width="53"> 2,367 </td> <td width="42"> 61 </td> </tr> <tr> <td width="45"> 80-84 </td> <td width="57"> 1,680 </td> <td width="42"> 50 </td> <td width="42"> 11 </td> <td width="42"> 61 </td> <td width="53"> 1,029 </td> <td width="53"> 134 </td> <td width="42"> 15 </td> <td width="42"> 13 </td> <td width="42"> 28 </td> <td width="53"> 37 </td> <td width="57"> 1,814 </td> <td width="53"> 1,066 </td> <td width="42"> 59 </td> </tr> <tr> <td width="45"> 85-89 </td> <td width="57"> 759 </td> <td width="42"> 42 </td> <td width="42"> 13 </td> <td width="42"> 55 </td> <td width="53"> 421 </td> <td width="53"> 88 </td> <td width="42"> 15 </td> <td width="42"> 13 </td> <td width="42"> 28 </td> <td width="53"> 25 </td> <td width="57"> 847 </td> <td width="53"> 445 </td> <td width="42"> 53 </td> </tr> <tr> <td width="45"> 90-94 </td> <td width="57"> 264 </td> <td width="42"> 35 </td> <td width="42"> 15 </td> <td width="42"> 50 </td> <td width="53"> 133 </td> <td width="53"> 43 </td> <td width="42"> 15 </td> <td width="42"> 14 </td> <td width="42"> 29 </td> <td width="53"> 12 </td> <td width="57"> 307 </td> <td width="53"> 146 </td> <td width="42"> 47 </td> </tr> <tr> <td width="45"> 95-99 </td> <td width="57"> 61 </td> <td width="42"> 30 </td> <td width="42"> 17 </td> <td width="42"> 47 </td> <td width="53"> 29 </td> <td width="53"> 15 </td> <td width="42"> 15 </td> <td width="42"> 14 </td> <td width="42"> 29 </td> <td width="53"> 4 </td> <td width="57"> 76 </td> <td width="53"> 33 </td> <td width="42"> 44 </td> </tr> <tr> <td width="45"> 100+ </td> <td width="57"> 8 </td> <td width="42"> 25 </td> <td width="42"> 19 </td> <td width="42"> 44 </td> <td width="53"> 3 </td> <td width="53"> 3 </td> <td width="42"> 15 </td> <td width="42"> 14 </td> <td width="42"> 29 </td> <td width="53"> 1 </td> <td width="57"> 11 </td> <td width="53"> 4 </td> <td width="42"> 40 </td> </tr> <tr> <td width="45"> </td> <td width="57"> 120,802 </td> <td width="42"> 72 </td> <td width="42"> 4 </td> <td width="42"> 75 </td> <td width="53"> 90,955 </td> <td width="53"> 12,473 </td> <td width="42"> 16 </td> <td width="42"> 8 </td> <td width="42"> 24 </td> <td width="53"> 2,968 </td> <td width="57"> 133,279 </td> <td width="53"> 93,923 </td> <td width="42"> 70 </td> </tr> </tbody> </table> Sources: Population data: U.S. Bureau of the Census; Circumcision data: Wallerstein <h3>Notes</h3> NC = Circumcised in the newborn period (neonatal circumcision) LC = Circumcised after the newborn period (later circumcision) AC = Circumcised prior to arrival in the USA PC = Circumcised after arrival in the USA 1. Table 2 also shows that 70% of the current male population of the US have been circumcised. 2. The figure for every age group below the age of 90 is over 50%. Only the (very small and rapidly diminishing number of) males born before 1910 have a better than even chance of having retained their foreskins. 3. 87% of all 20-24yo males born in US have been circumcised. From the differences in circumcision rates by race, one can infer that over 90% of all 20-24yo white males born in US have been circumcised. Table 3: Changes in Male Population by Circumcision Status between 1900 and 2000 <div align="center"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="204"> (Figures in millions) </td> <td width="136"> Intact </td> <td width="136"> Circumcised </td> <td width="136"> Total </td> </tr> <tr> <td width="204"> Population in 1900 </td> <td width="136"> 30 </td> <td width="136"> 7 </td> <td width="136"> 37 </td> </tr> <tr> <td width="204"> Births </td> <td width="136"> 56 </td> <td width="136"> 110 (a) </td> <td width="136"> 166 </td> </tr> <tr> <td width="204"> Immigrants </td> <td width="136"> 20 </td> <td width="136"> 5 (b) </td> <td width="136"> 25 </td> </tr> <tr> <td width="204"> Deaths and Emigrants </td> <td width="136"> -56 </td> <td width="136"> -39 </td> <td width="136"> -95 </td> </tr> <tr> <td width="204"> â€” of population in 1900 </td> <td width="136"> -30 </td> <td width="136"> -7 </td> <td width="136"> -37 </td> </tr> <tr> <td width="204"> â€” of births and immigrants </td> <td width="136"> -26 </td> <td width="136"> -32 </td> <td width="136"> -58 </td> </tr> <tr> <td width="204"> Switch in Status </td> <td width="136"> -11 </td> <td width="136"> 11 (c) </td> <td width="136"> </td> </tr> <tr> <td width="204"> Population in 2000 </td> <td width="136"> 39 </td> <td width="136"> 94 </td> <td width="136"> 133 </td> </tr> </tbody> </table> </div> <h3>Notes</h3> (a) Newborn circumcisions (b) Immigrants who arrived already having been circumcised (c) Non-newborn circumcisions Table 1 showed that the percentage of the male population which has been circumcised has stabilised at 70%. The factors which affect the figure, namely the newborn circumcision rate, the non-newborn circumcision rate, the percentage of immigrant arrivals who have been circumcised, and the percentage of deaths and emigrants who have been circumcised are in balance. This is further illustrated by Table 4. Table 4: Estimated Changes in Male Population by Circumcision Status between 2000 and 2001 <div align="center"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="170"> (Figures in thousands) </td> <td width="106"> Intact </td> <td width="113"> Circumcised </td> <td width="106"> Total </td> <td width="113"> Circumcised (%) </td> </tr> <tr> <td width="170"> Population in 2000 </td> <td width="106"> 39,356 </td> <td width="113"> 93,293 </td> <td width="106"> 133,279 </td> <td width="113"> 70.47 </td> </tr> <tr> <td width="170"> Births </td> <td width="106"> 778 </td> <td width="113"> 1,168 </td> <td width="106"> 1,946 </td> <td width="113"> </td> </tr> <tr> <td width="170"> Immigrants </td> <td width="106"> 300 </td> <td width="113"> 100 </td> <td width="106"> 400 </td> <td width="113"> </td> </tr> <tr> <td width="170"> Deaths and Emigrants </td> <td width="106"> -537 </td> <td width="113"> -742 </td> <td width="106"> -1,279 </td> <td width="113"> </td> </tr> <tr> <td width="170"> Switch in Status </td> <td width="106"> -236 </td> <td width="113"> 236 </td> <td width="106"> </td> <td width="113"> </td> </tr> <tr> <td width="170"> Population in 2001 </td> <td width="106"> 39,661 </td> <td width="113"> 94,685 </td> <td width="106"> 134,346 </td> <td width="113"> 70.48 </td> </tr> </tbody> </table> </div> <h3>Notes</h3> 1. Although the newborn circumcision rate has fallen, this has not resulted so far in a fallen in the percentage of living males who have been circumcised. Indeed, that percentage is at an all time high. 2. The percentage of living males who have been circumcised is a very sticky figure. Even if the newborn circumcision rate were to fall dramatically, it would take many decades for the generations of largely circumcised males to be flushed from the statistics. If the 20th century was ugly, the 21st century will be uglier still unless Americans wake to the harm they are doing to their kind. If the population of the US grows in line with projections by the US Census Bureau, and current rates of newborn and non-newborn circumcision do not change, there will be 166 million newborn circumcisions and 40 million non-newborn circumcisions in the US in the 21st century. It is less upsetting to focus on a brighter scenario; a scenario in which the efforts of those campaigning to bring an end to the stupid, barbaric custom bear fruit. In this highly optimistic scenario, the newborn circumcision rate begins immediately to fall to a similar level as pertains in almost all the free and prosperous countries in the world, reaching that level within a relatively short time span, while the non-newborn rate falls at the same speed, in tandem with the newborn rate. Table 5: Projected Newborn Circumcision Rate and Percentage of Living Males in the USA who have been circumcised, 2000 to 2050 <div align="center"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="181"> Year </td> <td width="181"> Newborn Circumcision Rate (%) </td> <td width="181"> Living Males who have been Circumcised (%) </td> </tr> <tr> <td width="181"> 2000 </td> <td width="181"> 60 </td> <td width="181"> 70 </td> </tr> <tr> <td width="181"> 2005 </td> <td width="181"> 50 </td> <td width="181"> 70 </td> </tr> <tr> <td width="181"> 2010 </td> <td width="181"> 42 </td> <td width="181"> 69 </td> </tr> <tr> <td width="181"> 2015 </td> <td width="181"> 35 </td> <td width="181"> 67 </td> </tr> <tr> <td width="181"> 2020 </td> <td width="181"> 29 </td> <td width="181"> 65 </td> </tr> <tr> <td width="181"> 2025 </td> <td width="181"> 24 </td> <td width="181"> 62 </td> </tr> <tr> <td width="181"> 2030 </td> <td width="181"> 20 </td> <td width="181"> 59 </td> </tr> <tr> <td width="181"> 2035 </td> <td width="181"> 17 </td> <td width="181"> 55 </td> </tr> <tr> <td width="181"> 2040 </td> <td width="181"> 14 </td> <td width="181"> 52 </td> </tr> <tr> <td width="181"> 2045 </td> <td width="181"> 12 </td> <td width="181"> 48 </td> </tr> <tr> <td width="181"> 2050 </td> <td width="181"> 10 </td> <td width="181"> 44 </td> </tr> </tbody> </table> </div> <h4>Assumptions:</h4> (1) US Census Bureau projections of population change (2) Newborn circumcision rate declines exponentially from 60% to 10% between 2000 and 2050 (3) Non-newborn circumcision rate declines exponentially from 6 per 1,000 per annum to 1 per 1,000 per annum between 2000 and 2050 <h3>Notes</h3> 1. Table 5 shows how slowly the percentage of living males who have been circumcised will decline, even as the newborn circumcision rate plummets. It is really only from 2020 -- when the baby boomers start to get flushed out of the statistics -- that the rate begins to decline significantly. While, in this scenario, the ewborn circumcision rate falls to 50% by 2005 and continues to decline rapidly, it takes until 2043 for the percentage of living males who have been circumcised to fall to 50%. 2. The absolute number of circumcised living males reaches a high water mark of 100,000,000 in 2011 and remains at that level (rounded to the nearest million) until 2025 inclusive. In the same way that all the factors combined to keep the intact population more or less constant during the 20th century, they now all combine to keep the circumcised population constant (while the intact population increases). Table 6: Projected Changes in U.S. Male Population by Circumcision Status between 2000 and 2050 <div align="center"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="204"> (Figures in millions) </td> <td width="136"> Intact </td> <td width="136"> Circumcised </td> <td width="136"> Total </td> </tr> <tr> <td width="204"> Population in 2000 </td> <td width="136"> 39 </td> <td width="136"> 94 </td> <td width="136"> 133 </td> </tr> <tr> <td width="204"> Births </td> <td width="136"> 83 </td> <td width="136"> 30 </td> <td width="136"> 113 </td> </tr> <tr> <td width="204"> Immigrants </td> <td width="136"> 18 </td> <td width="136"> 6 </td> <td width="136"> 24 </td> </tr> <tr> <td width="204"> Deaths and Emigrants </td> <td width="136"> -23 </td> <td width="136"> -54 </td> <td width="136"> -77 </td> </tr> <tr> <td width="204"> Switch in Status </td> <td width="136"> -8 </td> <td width="136"> 8 </td> <td width="136"> </td> </tr> <tr> <td width="204"> Population in 2050 </td> <td width="136"> 109 </td> <td width="136"> 84 </td> <td width="136"> 193 </td> </tr> </tbody> </table> </div> To some intactivists, the realisation of such numbers would be a dream come true, despite the figures showing 30 million newborn circumcisions and 8 million non-newborn circumcisions; whereas, to other intactivists, such high numbers would still be anathema. Good. They will continue to fight for the rights of all to a complete body. It should be noted, however, that in this scenario compared with the status quo, 46 million males would have been spared the loss of their foreskins by 2050, and 143 million by 2100. Appendix: Wallerstein's data The analysis in this essay is based on data presented by Wallerstein in Appendix B of his book and elsewhere in his book. Table B-2: Estimated Male Circumcision Rates in the United States <div align="center"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="453"> Year </td> <td width="474"> Frequency (%) </td> </tr> <tr> <td width="453"> 1870 </td> <td width="474"> 5% </td> </tr> <tr> <td width="453"> 1880 </td> <td width="474"> 10% </td> </tr> <tr> <td width="453"> 1890 </td> <td width="474"> 15% </td> </tr> <tr> <td width="453"> 1900 </td> <td width="474"> 25% </td> </tr> <tr> <td width="453"> 1910 </td> <td width="474"> 35% </td> </tr> <tr> <td width="453"> 1920 </td> <td width="474"> 50% </td> </tr> <tr> <td width="453"> 1930 </td> <td width="474"> 55% </td> </tr> <tr> <td width="453"> 1940 </td> <td width="474"> 60% </td> </tr> <tr> <td width="453"> 1950 </td> <td width="474"> 70% </td> </tr> <tr> <td width="453"> 1960 </td> <td width="474"> 75% </td> </tr> <tr> <td width="453"> 1970 </td> <td width="474"> 80% </td> </tr> <tr> <td width="453"> 1979 </td> <td width="474"> 85% </td> </tr> </tbody> </table> </div> Source: Wallerstein, p. 217. Wallerstein states that, "If anything, [the data] errs on the side of caution, using lower percentages." (p. 216). Wallerstein appears to transfer the figures directly into another table in note 10 of his notes to Chapter 13, viz: Table B-3: Estimated Pool of Uncircumcised Males in the United States <div align="center"> <table border="1" cellpadding="1" cellspacing="0" width="100%"> <tbody> <tr> <td width="113"> Age </td> <td width="121"> Male Population </td> <td width="121"> Estimated % Circumcised </td> <td width="136"> Estimated %Uncircumcised </td> <td width="136"> Approximate Number Uncircumcised </td> </tr> <tr> <td width="113"> Under 5 </td> <td width="121"> 8,119,000 </td> <td width="121"> 85% </td> <td width="136"> 15% </td> <td width="136"> 1,218,000 </td> </tr> <tr> <td width="113"> 5-13 </td> <td width="121"> 17,056,000 </td> <td width="121"> 80% </td> <td width="136"> 20% </td> <td width="136"> 3,411,000 </td> </tr> <tr> <td width="113"> 14-17 </td> <td width="121"> 8,626,000 </td> <td width="121"> 75% </td> <td width="136"> 25% </td> <td width="136"> 2,150,000 </td> </tr> <tr> <td width="113"> 18-21 </td> <td width="121"> 8,191,000 </td> <td width="121"> 70% </td> <td width="136"> 30% </td> <td width="136"> 2,450,000 </td> </tr> <tr> <td width="113"> 22-24 </td> <td width="121"> 5,474,000 </td> <td width="121"> 70% </td> <td width="136"> 30% </td> <td width="136"> 1,830,000 </td> </tr> <tr> <td width="113"> 25-34 </td> <td width="121"> 15,026,000 </td> <td width="121"> 60% </td> <td width="136"> 40% </td> <td width="136"> 6,090,000 </td> </tr> <tr> <td width="113"> 34-44 </td> <td width="121"> 11,088,000 </td> <td width="121"> 55% </td> <td width="136"> 45% </td> <td width="136"> 5,000,000 </td> </tr> <tr> <td width="113"> 45-54 </td> <td width="121"> 11,484,000 </td> <td width="121"> 55% </td> <td width="136"> 45% </td> <td width="136"> 5,150,000 </td> </tr> <tr> <td width="113"> 55-64 </td> <td width="121"> 9,345,000 </td> <td width="121"> 50% </td> <td width="136"> 50% </td> <td width="136"> 4,650,000 </td> </tr> <tr> <td width="113"> 65 and over </td> <td width="121"> 9,172,000 </td> <td width="121"> 35% </td> <td width="136"> 65% </td> <td width="136"> 5,950,000 </td> </tr> <tr> <td width="113"> Total </td> <td width="121"> </td> <td width="121"> </td> <td width="136"> </td> <td width="136"> 37,899,000 </td> </tr> </tbody> </table> </div> Wallerstein, p. 244. Wallerstein neglects to state a year for this calculation, even though that is quite fundamental. One must assume that the figure is as at the time of writing, i.e., circa 1979. Apart from the fact that the figures in the "Estimated % Circumcised" column required some adjustment while being transferred from Table B-2, Wallerstein makes much more serious errors by ignoring the significant effects of non-newborn circumcision and immigration. While the figure he arrives at is very close to the figures in Table 1 (37 million in 1975, 36 million in 1980), that is mere chance. It just so happens that immigration (of mostly intact males) more or less cancels out non-newborn circumcision. Actually, Wallerstein appears to misunderstand the prevalence of non-newborn circumcision. On p 128 he asks "If an American infant is not circumcised at birth, what are the risks that the surgery will be required later?" After calculating that the annual rate is less than 3 per 1,000, he proceeds to answer his own question thus: "Whether the true figure is 2, 3, or even 6 per 1,000 men, it is obvious that only a tiny fraction of potential patients undergo circumcision after infancy; more than 99% do not." This is simply untrue. In so saying, Wallerstein appears to make the same error that is commonly made with regard to the probability of getting penile cancer. The annual rate of penile cancer in the US is about 1 in 100,000. Some people mistakenly take this to mean that only one male in 100,000 will get penile cancer in his entire life. This is far from the case. The annual risk is cumulative, so that over a lifetime the probability is about 70 in 100,000 or 1 in 1400. If it were true that penile cancer is extremely rare in males who have been circumcised then, taking into account the percentage of males aged over 60 in the US (when penile cancer strikes), the probability that an intact male in the US will get penile cancer might be as high as 1 in 600. Returning to the risk of circumcision after infancy, one can make a rough approximation of the lifetime probability by simply multiplying the annual rate, say 3 per 1000, by life expectancy. Hence: 3 / 1000 * 70 = 0.21, or 21% Table 1 provides confirmation. Over the course of the 20th century the population at risk of post-infant circumcision averaged about 36.6 million. There were 11.4 million post-infant circumcisions. If male life expectancy were 100 years, one could calculate the probability of post-infant circumcision simply by dividing the number of circumcisions by the number exposed to risk. However, since male life expectancy over the period was closer to 70 years, one must multiply by 70/100. Hence: 11.4 / 36.6 * 70 / 100 = 0.22, or 22% The annual current rate is 6 per 1,000. That may sound like a low figure but the truth is: if you are lucky enough to still have your foreskin, you better keep it under lock and key because the forces of darkness are out to take it away from you. </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 A century of circumcision in the USA (1900s) 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>Critics of the harmless little operation</h3> The rapid spread of circumcision in the United States from the 1930s onwards did not go unchallenged. As early as 1941, the year of Guttmacher's recommendation that the baby should be circumcised so as to promote hygiene and deter masturbation, the physician and surgeon Miles Atkinson attacked the growing trend. He particularly criticized surgeons for making the operation fashionable, and parents for giving no thought to the matter but accepting it all too readily as a "custom, an unthinking habit". Atkinson singled out the widespread misunderstanding of normal penile development as offering the main justification for early circumcision â€“ the idea (promoted by Morris Fishbein and others) that circumcision was necessary, in the interests of cleanliness, if the foreskin could not be retracted "quickly and easily" a few days after birth. He pointed out, in words that are still not properly understood by many American medical personnel, that a non-retractable foreskin in infancy and childhood was perfectly normal and proper: <div>Sub-preputial ablutions are of no great importance in infancy, the necessity arises only as the child gets older. By that time, however, the normal processes of maturation will, in the great majority of cases, have converted what was a phimosis in babyhood into a normally retractile prepuce. It would seem to be the course of wisdom to await the workings of Nature, rather than presume that they will not occur. ... The only phimosis in an infant which absolutely demands treatment is that which is so extreme that it interferes with urination. Such cases are not common. All others can be left alone in the expectation of normal maturation. We do not advocate the destruction of nailbeds on the fingers of all male infants lest dirt collect beneath the nails. Rather, we teach children the principles of cleanliness .... Yet the removal of nails would be just as logical as circumcision when the latter operation is performed on the usual excuse.</div> Atkinson concluded that "the weight of factual evidence is strongly against circumcision. ... Aesthetically it is undoubtedly bad â€“ at best a mutilation, at worst a tragedy". [1] <h4>In the name of humanity</h4> Atkinson was followed by the humanist Joseph Lewis, who roundly attacked circumcision as a barbaric blood ritual which should have no place in a modern and civilized society which respected the humanity and rights of individuals. Reflecting the fact the circumcision advocates had still not conquered the whole of the medical terrain, he was able to cite letters and published comments from numerous physicians criticising the practice, including one from Julius Weingart of the Iowa Lutheran Hospital, who wrote: <div>Circumcision as a routine procedure is to be condemned. There are no general grounds, exclusive of ritualistic ones, to justify it. Unless indicted by definite surgical considerations, it becomes mere mutilation, as senseless as it is unworthy of a humane profession.</div> With chapters on the anthropology of circumcision as a blood rite, the medicalisation of the operation in the late nineteenth century, the justifications offered (prevention of venereal disease and cancer), the dangers and harms arising from the operation, including the risk of psychological damage, and the "Anatomy, mechanism and function of the prepuce", Lewis had prepared the most comprehensive critique of the case for circumcision to be published before Edward Wallertsein's celebrated expose in 1980. It is still worth reading, if only to show how little the debate on the "pros and cons" of circumcision has changed over the past half century. [2] <h4>The rape of the phallus</h4> Further murmurs of dissent emerged in the 1960s, including W.K.C. Morgan's well known polemics, <a href="http://www.cirp.org/library/general/morgan/" rel="noopener" target="_blank">The rape of the phallus</a>, and <a href="http://www.cirp.org/library/general/morgan2/" rel="noopener" target="_blank">Penile plunder</a>, [3] and a more detailed critique by John M. Foley, The practice of circumcision: A revaluation. He was spurred into action by a letter from a Baltimore physician, published in the Medical Tribune on 20 July 1964, demanding the compulsory circumcision of all men seeking to get married; and, not content with that, federal legislation requiring the circumcision of every male infant within eight days of birth. Foley wondered why such legislation should be necessary, given that over 90 per cent of boys born in American hospitals were already routinely circumcised, and suggested that the proposal had much to do with the desire to avoid legal liability for injury, and with even darker psychological impulses: <div>One answer, of course, is that if circumcision were made compulsory, the circumciser would be protected whenever he happens to cripple or kill the little boy he operates on â€“ a "complication" that is not so very uncommon. Another answer must be sought in the darker regions of the human mind, because circumcision is nothing but wanton and unnecessary mutilation. The annual 2 million assembly-line circumcisions in this country are a monument to the gullibility and stupidity of the American public.</div> Foley covered the usual arguments offered in favour of routine circumcision, found them all pathetically inadequate, and then devoted the bulk of his critique to the origins of circumcision as a blood sacrifice and the psychological needs which seemed to drive the circumcision advocates. [4] A shorter version of his essay was published <a href="http://www.cirp.org/news/1966.07_Foley/" rel="noopener" target="_blank">in the magazine Fact</a>. Several influential articles appeared in 1970, including Noel Preston's reconsideration of neonatal circumcision, which elicited an approving letter from C.J. Falliers, a European immigrant to the USA who was appalled at what he found being done to baby boys in maternity hospitals. Preston observed that "routine neonatal circumcision had been advocated as a means of preventing genitourinary diseases and genital cancers", but pointed out that <div>the procedure has been found to have been of questionable benefit and to be associated with both immediate and delayed risks and complications. These in turn may produce undesirable psychological, sexual, and medico-legal difficulties. Circumcision is considered with respect to carcinoma of the cervix, penis, and prostate; there is little evidence that circumcision of the newborn affords protection against subsequent development of these cancers in individuals who practice good personal hygiene.</div> He concluded that "routine circumcision of the newborn is an unnecessary procedure. It provides questionable benefits and is associated with a small but definite incidence of complications and hazards. These risks are preventable if the operation is not performed unless truly medically indicated. Circumcision of the newborn is a procedure that should no longer be considered routine." [5] If Preston had stuck to the straight and narrow calculus of claimed benefit vs. risk of "complications" (that is, damage beyond what was intended), Falliers brought up the inherent value of the body part removed by the operation. Since the foreskin played a significant role in male sexual responsiveness, its destruction must also be factored into the cost-benefit equation. [6] Another significant intervention was Sylvia Topp's article in the Village Voice (16 June 1975), "The argument over circumcision: The case against". Written by a New York journalist who had declined to allow her own baby to be circumcised and who then decided to look into the whole question, the article is of particular interest for what it reveals about the state of contemporary knowledge as to genital structure and function, and its insights into why circumcision still happened. While the obstetricians said they only did it because they thought the mothers wanted it done, the mothers said they only had it done because the obstetricians suggested it. The fact that each party sought to blame the other suggests that neither thought it a very good idea. <h4>Doubts emerge in the establishment</h4> And at last the medical establishment began to take some notice. For all the effect they had on the incidence of circumcision, which kept climbing throughout the 1950s and 60s, the protests of Atkinson, Lewis et al might have been put in a bottle and thrown out to sea. But after Capt. Preston's measured dissent, the American Academy of Pediatrics, Committee on Fetus and Newborn, cautiously inserted the following sentence in the 5th edition of its Standards and Recommendation for Hospital Care of Newborn Infants: <div>There are no valid medical indications for circumcision in the neonatal period.</div> It did not say that circumcision should not be performed, or that the foreskin had value, or that infants had rights, or that circumcision was harmful or might be a breach of medical ethics, but it was a start, and it marked the beginning of the end for routine circumcision, however slow that end has been in arriving. <a href="http://www.cirp.org/library/statements/aap" rel="noopener" target="_blank">Statements from the American Academy of Pediatrics</a> After a few years the doubts entertained by the AAP spread to the body responsible for performing most circumcision operations, the obstetricians and gynecologists. In an equally cautious paper, one of their number concluded that although "the existing literature [unbelievably vast though it be] is inadequate to evaluate appropriately routine circumcision of the newborn infant", the practice "appears to lack sufficient justification". Until the benefits "can be proved worth the risk and cost, medical resources probably should be allocated to measures of demonstrated value". A notable feature of Grimes' paper was his identification of the anomalous position of the operation, which stoutly resisted classification as a category of modern medicine. Grimes commented that it lay "outside the province of modern surgery" and "frequently features illogical bases for patient selection, neglect of the requirement to obtain informed consent, an inappropriate operator, needlessly radical technique, disregard for pain, dubious objectives, and unknown cost-effectiveness." Preventive circumcision did not fall within any recognised objective or definition of surgery: <div>Physicians' reasons for advocating routine circumcision include cleanliness; prevention of balanoposthitis, future phimosis, or cancer (in men and women); failure of the foreskin to retract; and custom. Welch has classified surgery as follows: repair of wounds, extirpation of diseased organs or tissue, reconstructive surgery, and physiologic surgery (e.g. sympathectomy*). Predictably routine newborn circumcision eludes classification. Contemporary surgery has yet to embrace the philosophy of purely prophylactic surgery. If, however, the scope of surgery broadens to encompass preventive operations, the prepuce of the neonate will likely rank low on a list of bodily parts requiring ablation. [7]</div> * Sympathectomy: "the surgical interruption of part of the sympathetic nervous system, cutting off sympathetic impulses to a part, organ or region". The sympathetic nervous system regulates the involuntary functions of the body, such as dilation of the pupils, stimulation of sweat, dilation or constriction of arteries. (Oxford Companion to Medicine, Vol. II, p. 1368.) Obviously, you would never interfere with such a system except in grave emergencies or where an intractable problem had defied other methods of treatment. <h4>Wallerstein's American health fallacy</h4> The major event of 1980 was the release of Edward Wallerstein's painstaking study, Circumcision: An American health fallacy, published by the international science publishers, Springer. Wallerstein did not really do anything different from the earlier efforts of Lewis, Foley and Preston, but he did it in a lot more detail, and with both a far greater depth of research and a far wider range of reference, embracing cultural and ethical considerations as much as narrowly medical ones. He also reviewed the case of female circumcision and clitoridectomy, finding them not so different from what was done to boys. The result was a formidable and, as it proved, unanswerable case against circumcision: there has been no successful attempt to refute the arguments and data presented in his study, though circumcision advocates have done their best to ignore it, or belittle the author as medically unqualified. (Why should he need a licence which permitted him to perform circumcisions in order to produce a critique of the practice? Wallerstein's independence from the sort of indoctrination experienced by those who had attended American medical schools was a decisive factor in his ability to see that the Emperor had no clothes.) At nearly 300 densely references pages, Circumcision: An American health fallacy is too long and detailed to summarise, but worth quoting is the opening of his final chapter, "An appeal to reason" which identifies the strange progress of the operation from social rite to a medical procedure and back again: <div>Circumcision is a unique phenomenon. It origins in antiquity are obscure, its original objectives unknown ... yet this operation, the first ritual surgery devised by humans, is still in use. ... But circumcision is more than merely ritual surgery. As a therapeutic measure, to correct a true defect, it is accepted worldwide. In the USA, circumcision is allegedly employed therapeutically â€“ to correct a pseudo-defect. A third aspect, prophylaxis, has taken on even greater significance in the United States, where many more operations are performed for prophylactic reasons than for religious or therapeutic ones. Thus the American practice is trifaceted: a religious rite, a therapeutic measure, and a prophylactic operation. No other surgical procedure can make such a claim. ... A century ago, ignorant of disease etiology, physicians introduced male circumcision to cure every disease imaginable. Despite later knowledge that most diseases did not have the remotest connection with this surgery, the practice was continued with ever-increasing frequency. Now, when all claims for ills supposedly prevented by circumcision, have been shown to be illusory, the surgery still continues unabated. The prophylaxis theories are myths; they are no longer acceptable hypotheses. In fact, the entire concept of "health" circumcision in the United States is beyond the bounds of medicine. Dr Lendon Smith claimed that: "Circumcision now seems to be a national cultural trait".* This "national cultural trait" endows circumcision with mystical prophylactic powers, and an entire health philosophy has been accreted around it. [8]</div> And indeed, an entire "health" industry. * Lendon Smith, The Children's Doctor (Englewood Cliffs, Prentice Hall, 1969), p. 195 <h4>The trickle grows to a flood</h4> Since 1980 the trickle of dissent from circumcision has grown to a torrent, with books and journal articles appearing regularly, and organizations dedicated to curbing, discouraging or even banning the operations springing up all over the place. To list all of these would be a monumental job, and <a href="http://www.cirp.org/library/general/" rel="noopener" target="_blank">further articles are available here</a>, but particular mention should be made of the following: Paul Fleiss, "<a href="http://www.foreskin.org/fleiss.htm" rel="noopener" target="_blank">Where is my foreskin? The case against circumcision</a>", Mothering: The Magazine of Natural Family Living, Winter 1997, pp. 36-45 Joseph Zoske, "<a href="http://www.noharmm.org/zoske.htm" rel="noopener" target="_blank">Male Circumcision: a gender perspective</a>", Journal of Men's Studies, Vol. 6, Winter 1998, pp. 189-208 Paul Fleiss and Frederick Hodges, What your doctor may not tell you about circumcision: Untold facts about America's most widely performed â€“ and most unnecessary â€“ surgery (New York: Time Warner Books, 2002) <a href="http://www.twbookmark.com/books/70/0446678805/index.html" rel="noopener" target="_blank">For details and to purchase a copy</a> Leonard Glick, Marked in your flesh: Circumcision from ancient Judea to modern America (New York: Oxford University Press, 2005) This remarkable study is a scholarly yet readable account of how a ritual practised by a small society of semi-nomadic herders in the distant past became the bodily signature of the world's most modern and technologically advanced superpower. An anthropologist by training, and himself Jewish, Professor Glick disentangles the strange process by which the ancient Hebrew rite of circumcision lost its religious significance while taking on the medical arguments advanced by Victorian doctors. His argument is that, these days, most American Jews circumcise primarily because they are Americans, not because they are Jewish, but conversely, that since the time of the First World War, Jewish physicians have been disproportionately prominent and vocal among American circumcision advocates. <h4>Further sources of information</h4> The following collections of conference papers also contain a wealth of material, often fully referenced: Denniston, George C., and Marilyn Milos (eds), Sexual mutilations: A human tragedy (New York and London: Plenum Press, 1997) Denniston, George C., Frederick Hodges and Marilyn Milos (eds), Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem (London and New York: Kluwer Academic and Plenum Press, 1999) Denniston, George C., Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (London and New York: Kluwer Academic/Plenum Publishers, 2001) Denniston, George C., Frederick Hodges and Marilyn Milos (eds), Flesh and blood: Perspectives on the problem of circumcision in contemporary society (London and New York: Kluwer Academic and Plenum Press, 2004) Available in many libraries, <a href="http://www.nocirc.org/" rel="noopener" target="_blank">and also from Nocirc</a>. <a href="http://www.circinfo.org/links.html" rel="noopener" target="_blank">Links to organisations and websites concerned with circumcision</a> <h3>References</h3> 1. Miles Atkinson, Behind the mask of medicine (New York: Scribners, 1941), pp. 177-83 2. Joseph Lewis, In the name of humanity (New York: Eugenics Publishing Co, 1949) 3. Journal of the American Medical Association, Vol. 193, 19 July 1965, pp. 123-4; Medical Journal of Australia, 27 May 1967, pp. 1102-3 4. John M. Foley MD, The practice of circumcision: A revaluation (New York: Materia Medica, 1966); "The unkindest cut of all", Fact Magazine, Vol. 3, July-Aug. 1966, pp. 2-9 5. E. Noel Preston, <a href="http://www.cirp.org/library/general/preston/" rel="noopener" target="_blank">Whither the foreskin: A reconsideration of neonatal circumcision</a>, JAMA, Vol. 213, 14 September 1970, pp. 1853-8 6. C.J. Falliers, <a href="http://www.cirp.org/library/general/falliers1/" rel="noopener" target="_blank">Circumcision</a>, JAMA, Vol. 214, 21 December 1970, p. 2194 7. David A. Grimes, <a href="http://www.cirp.org/library/general/grimes" rel="noopener" target="_blank">Routine circumcision of the newborn infant: A reappraisal</a>, American Journal of Obstetrics and Gynecology, Vol. 130, 15 January 1978, pp. 125-9 8. Edward Wallerstein, Circumcision: An American health fallacy (New York: Springer 1980), pp. 191-2 </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 Sceptics and dissenters 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"> Plus ca change ... American medical journals seem to have been as hospitable to verbose pro-circumcision tirades in 1902 as they have become since the 1990s. Here the prominent anti-foreskin activist, Peter Charles Remondino, attacks the enemies of circumcision as prejudiced, backward and unscientific. <h3>Circumcision and its opponents</h3> The preventive practice of medicine mentioned so very long ago by Xenophon as being something of the greatest importance, will only become a recognized necessity and practice when mankind, however seemingly enlightened or civilized, will cease to look upon diseases and their cure from the narrow and benighted point of view of the Congo Negro, and when the race will emancipate itself from that degree of irrationality that, figuratively speaking, permits men to swallow a camel without winking, whilst they go through fearful contortions of strainings when attempting to swallow a gnat. This rather uncomfortable and pessimistic view of persistent human irrationality in this particular line of our sociologic existence was forcibly impressed upon me by the perusal of an article in one of our medical journals which professed to see no benefit whatever in circumcision â€“ neither from an hygienic, preventive, pathologic or humanitarian pint of view â€“ whilst attending the deathbed of a middle aged man who, had he been fortunate enough either to have been born a Jew or a Turk, or to have fallen into the hands of an energetic and persistent advocate of circumcision when a child, would not only have been spared some long eight months of atrocious suffering, but would then in all probability have lived to a very comfortable age. <h4>[Details to make your flesh crawl]</h4> The patient was, at the time of the appearance of his misfortune, a compactly built man of some 49 years of age, robust and of an active disposition. His compact and muscular as well as active physique was what might have been looked for in a well-trained and athletic Roman legionary in the days of Rome's glory. He was possessed of more than usual intelligence, was quick witted, and was otherwise in a state of prime health, far above that of the average man at his age. Possessed of a good appetite, and of as good digestion as assimilation, he was of an optimistic and cheerful frame of mind, carrying his two score and ten years as if not more than thirty; with elastic step, strong physique in perfect physiologic action, this man entered and went through an agonizing existence of eight months duration, through the occurrence of preputial and penile cancer, ending in death, and all because he had not been circumcised, or, as has been said, had missed being born a Jew, a Turk or a Mohammedan. As an intelligent but irascible Scotch gentleman who had been raised in strict Scottish Presbyterian lines in his native land, and who had been brought up on oatmeal gruel, the scriptures and in a wholesome fear of the Lord, once expressed himself to me, after having been circumcised and convinced that much of his neurasthenia and resulting ill-health were all reflex conditions due to a tight prepuce: <div>I have been brought up and educated to look upon Saint Paul, the founder of Christianity, with awe and admiration, but, by God, Sir, if I had Saint Paul here now, Sir, I would shoot him, yes, Sir, I would shoot him. He had no biblical warrant nor no business to summarily abolish circumcision as he did. Our Lord was circumcised, so were the twelve apostles, even to that rascally Judas, and we should have all been circumcised instead of being baptized. I see that very plainly now. Saint Paul was more of an evangelist and not as scientific a man as Moses, and I may be wrong in wanting to shoot him. He probably did not know the harm he was entailing on gentile humanity by abolishing circumcision. Still, when I think of the agonies I have been made to suffer through his carelessness, I feel he ought to be shot, sir.</div> Saint Paul undoubtedly did humanity, especially Christian humanity, great wrong in every way when he failed to retain circumcision as a religious rite. <div> "Spilsbury et al [ 1 ] cite <a href="http://www.historyofcircumcision.net./templates/pages/sceptics_and_dissenters.html" rel="noopener" target="_blank">Wallerstein</a>, an anti-circumcision propagandist, failing to point out that many Victorian ideas favouring circumcision have since been confirmed (penile cancer, balanoposthitis, syphilis, etc.)." -- Brian Morris and Stefan Bailis, letter, ANZ Journal of Surgery, Vol. 74, 2004, p. 387 </div> I may say without any exaggeration that I have circumcised thousands, and that I have been consulted over more cases of unfavourable results from circumcision and complications arising in the course of the after-treatment than generally falls to the lot of the ordinary physician. I have seen both physical and mental suffering resulting from marplot operators and as a result of ignorance and inexperience as to the conduct of the dressings, but all of the resulting suffering due to properly and improperly performed operations, or to a too meddlesome idea of after-treatment and to very improper dressings, that I have so far witnessed as attending or following circumcision, could they all be rolled into one spasm of physical pain or concentrated into one pang of mental anguish, they could not be compared to the pain, anguish, and sufferings of body and mind of the uncircumcised victim of that preputial or penile cancer that slowly eats its way up from the affected prepuce or glans into the inguinal glands and thence into the abdominal walls and cavity. <h4>[Uses must be found for new medical technology]</h4> With the advantages offered by the employment of local anaesthesia and aseptic dressings, the patient, whether infant, adolescent or adult, need no longer suffer pain during the operation, nor run the seemingly needless risks that at times beset general anaesthesia. With modern methods and means of dressing the operative wound, the patient, if an adult, need no longer remain from his usual vocation, and if a child is no longer subject to the annoyances, dreads and torturing pains caused by the removal of hardened and adherent dressings, nor the interference to the healing by first intention by the repeated bathings that were formerly employed and very necessary to remove the soiled and agglutinated dressings. The stitch suppurative process and the painful ordeal of removing the sutures have been done away with by the discarding of the old silk suture material, a procedure that was wont to alarm and worry the little fellows into spasms. In place of the suppuration and infection-inducing silk, we now employ the absorbable chromacised catgut, which lasts sufficiently long for required purposes, causes no harm, and then disappears. In aristol we have an aseptic, adhesive and protective dry dressing that for young children is unequalled. The wound heals as kindly and thoroughly under aristol as it would under a dressing of asepticised collodion, with none of the drawbacks of the latter. <h4>[Circumcision is vaccination]</h4> Under these circumstances, which minimises the annoyances, pains and time of healing to the plane of an ordinary vaccination, I cannot well see why the operation of circumcision should be classed barbarous any more than vaccination. No intelligent parent who has seen the easily procurable statistics concerning the ratio in smallpox cases of unvaccinated to the vaccinated, the latter forming but the small average of less than 6 per cent of those attacked by smallpox, would permit his children to go unvaccinated. Smallpox, however, is a disease that falls under public care, and these statistical figures are easily and properly obtainable and classified, while cases of cancer, of hernia, and of the thousand and one complications that originate in the uncircumcised, are in private practice, and it is only by long and general experience that one can form even an approximate idea of the risks run by the latter class of cases; but from these an observer can easily conclude that, while the unvaccinated are only exposed to one danger, that the uncircumcised are exposed to many more, while the sufferings undergone by the uncircumcised when attacked by the maladies their condition invite, are altogether in greater excess and out of proportion to those suffered by those who have at some time in their lives undergone the operation of circumcision. <h4>[More or less, sooner or later]</h4> The history of the case of penile cancer mentioned above is not an uncommon occurrence for those who are the unfortunate possessors of an annoying prepuce. This organ or its tissues often become irritated, or rather the seat of an irritation on its mucous coat, followed with more or less inflammatory infiltration and thickening of the whole preputial tissues to an extent that it interferes with its retraction. Bathings, soothing lotions and rest generally cause this to subside, when some mild applications and lint, or some dry gauze interposed between the opposing mucous surfaces soon restore the parts to their usual state of health. At times, however, something which in these cases is liable to occur sooner or later, an unusually severe or persistent attack, and a more than usual thickening and induration of the affected tissues, causes the prepuce to press upon the glans with more than its former or usual degrees of constriction, and we have, as a result, more or less necrosis of tissue and a more or less resulting extensive suppurative and reinfecting inflammation. The sufferer often neglects to apply to a physician, considering the affair the customary trivial attack that will pass away in a day or two; but the recovery is now unaccountably postponed from day to day, and when at last he begins to think of consulting a physician, the latter finds that the prepuce has undergone some pathologic changes, and that a regular circumcision is for the time being out of the question. He slits up the hardened, thickened and lardaceous prepuce on its dorsum to liberate the compressed glans, which is then often found ulcerated and suppurating on its surfaces, and then trims off the remaining dog-ears which stand up erect on either side of the cut and whose edges refuse to hold sutures; and after a longer or shorter period of unsatisfactory local treatment the patient recovers with possibly a normal glans, and just possibly with one more or less disfigured as if it had gone through the pitting process of smallpox, and possibly with some segment of the corona permanently missing as a result of extensive suppurative destruction. ... [There follows a lengthy and increasingly lurid account of the progress of one case of penile cancer that Remondino claims to have observed.] Considering the many reflex disorders that do arise from the presence or existence of the prepuce, and the great diversity and far-reaching consequences of these disturbances, I cannot well see how one can rationally cry down circumcision as not being a most useful and salutary preventive measure. Hydrocele, hernia, hip joint disease, epilepsy, asthma, disturbances of speech or of sight, and a whole category of diseases can often be trace to their origins in some preputial irritation or cause. Some of these cases are most peculiar as well as instructive. <h4>[Circumcision prevents or cures blindness]</h4> Some years ago I was called to see a young man who was said to be going blind. I had known him for several years and could hardly account for such a calamity overtaking him. On examination I could perceive no change in the eyes, and, as he expressed it, he felt no pain, only that his sight had gradually dimmed and failed until now he could hardly distinguish light from darkness. Satisfied after a careful examination that there existed no organic defect in the eyes, and after eliminating all other possible causes, determined to examine the prepuce, as I had seen a number of cases of eye trouble resulting from preputial irritability. When asked to expose the parts the patient remarked that he knew what I referred to, but that as he had been circumcised, that the prepuce could not be looked to as the cause of his calamity. <div> "The Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today." -- Brian Morris, In favour of circumcision (Sydney: NSW University Press, 1999), p. 57 </div> Thinking perhaps that there might accidentally be some cicatricial constriction or malformation resulting from the operation that might cause the difficulty, I nevertheless insisted on examining the parts, especially as I had exhausted every other possible source of origin or cause for the eye trouble. Very reluctantly the young man disrobed, and to my surprise drew forth what looked like a yellow doll done up in thin and shiny garments. It was his circumcised organ done up in a wrapper of oiled silk with a tight rubber band about the fossa back of the corona to hold it in place. Without any hesitation I pronounced the constriction from the rubber band to be the cause of his eye trouble, and removing the oiled silk ulster and the rubber band, the patient regained his full scope of vision within the next hour. Upon being questioned as to the cause of his wearing that yellow jacket like a Chinese mandarin of high degree, he informed me that after his circumcision, some years previously, he had always carried the dÃ©colletÃ© member in a bag or sheath made of muslin, being under the impression that it needed protection. About one week previous to my being called, a friend had advised his wearing the yellow oil silk shirt with a rubber band to hold it in place. The band was smaller in diameter and stronger in texture than was actually necessary, and although he had noticed the constriction as being a little painful, and he now recalled that his eye difficulties had appeared soon after donning the yellow jacket, he had failed to make any connection between the unusual constriction and the failing sight. In a lad of twelve who came under my care for blurred vision, whose inability to read was supposed by his parents to be due to the presence of worms, as worms had previously caused other reflex difficulties, was found upon examination, and as proved by the results of the operation undertaken for his relief, to owe his eye difficulty to a tight prepuce and to the existence of some preputial adhesion. <h4>[Hip and bone diseases]</h4> With the effectual removal of the prepuce we certainly remove all possibilities for the occurrence of any cancerous disease having for its seat the preputial tissues or, for its cause, its irritating or constricting presence. Its removal will also do away with the possibility of being affected with one of those excruciatingly painful attacks of sciatica, which at times will lay up its victims for weeks or eventually cripple him with what Mauriac terms neuralgic herpes of the genito-urinary organs, who described these forms of sciatica as originating in an inflammatory vesicular eruption that is usually located on the inner lining or mucous coat of the prepuce, the nervous peripherae of this membrane giving rise through their irritation to this and to many other troubles that come from the same cause. Wherever any of these herpetic derangements of the preputial mucous membrane are met with as the easily excited results of heedless indiscretion either at the shrine of Venus or Bacchus, or a too indiscriminate indulgence in highly seasoned viands, we may feel assured of having in such cases an easy culture field for the occurrence of cancer whenever age and other favouring conditions meet in combination. Such a person will court safety by the constant practice of the virtues of continence, sobriety and studied abstemiousness. To make this doubly sure, however, I should advise him, especially if possessing what the late lamented Prof. S.D. Gross was wont to term a redundancy of preputial tissue, to follow the example of Timothy, the friend and companion of St Paul, and go and have himself circumcised, and thusly avoid the prospect of a painful and a questionable or disreputable death after a most uncomfortable malady, as the laity most always attach some venereal cause as the factor in such a death. <div>"If I were a top,* and I didn't like to use condoms, I would consider getting circumcised. If that person is not going to use a condom, maybe we'd all be better off if that person was circumcised." -- Daniel Halperin, <a href="http://www.circumcisioninfo.com/bay_area1.htm" rel="noopener" target="_blank">quoted in Bay Area Reporter</a>, San Francisco, 24 November, 1999 * That is, a gay male taking the active or insertive role in anal intercourse. Does Mr Halperin imply that he is not a top, that he does use condoms and that he is not circumcised?</div> It is these cases, combining herpetic attacks with nervous or neuralgic disorders, that form much of the groundwork or foundation for those annoying cases of coxalgia [pain in hip joint] that insidiously creep on, undermining the health and ending in crippling deformities after a protracted spell of femoral or of acetabular arthritis [in hip socket], with the resulting destructive process of osseous absorption and necrosis, the course of the initial points of the disorder being in every way analogous to those in which we observe the occurrence of simple sciatica originating in preputial herpes. It is very evident that if there is any virtue in the practice of preventive medicine that our duty here is to circumcise, and to do this promptly. While late operations and times and most unexpectedly give astonishingly happy results, we must not overlook the fact that we cannot logically look for results from preventive methods when conditions have progressed and passed to points where only other and curative methods are applicable. We should here be guided by the rule adopted and taught by Jonathan Hutchinson, that the most proper and considerate time to operate upon a cancer is in its pre-cancerous stages, and we should treat all easily irritated prepuces in the light of pre-cancerous or pre-coxalgic conditions. [ 2 ] Opponents of circumcision, when claiming that the operation has no well-defined hygienic or preventive benefits, seem to me to be arbitrarily ignoring many well known and established propositions in medicine and surgery. To argue thus in the face of the teachings of <a href="http://www.historyofcircumcision.net/templates/pages/dr_sayres_cure_fore_paralysis.html" rel="noopener" target="_blank">Lewis A. Sayre</a>, <a href="http://www.historyofcircumcision.net./templates/pages/the_crotchets_of_sir_jonathan_hutchinson.html" rel="noopener" target="_blank">Jonathan Hutchinson</a> and many other careful, accurate and conscientious observers, and in the face of daily occurring evidences where a timely performed circumcision relives many cases so effectually and so promptly as to leave no reasonable cause for believing but that the offending and removed prepuce was the exciting and maintaining cause of the disturbance, seems to me but additional cause for believing that those who so argue must deliberately shut their eyes as to all evidence, as well as to reason, are more intent on nourishing their prejudices than in exercising their reasoning faculties in an Aristotelian sense. <h4>[Circumcision cures cripples]</h4> I was once called to give an opinion over a case of femoral necrosis with suppuration following coxalgia in a young boy. The child, when beginning to favour the affected leg, had fallen into the hands of what might purely be termed a sample of the quintessence of the ignorant and irregular order of female practitioners with which the country abounds, a class of women who could not intelligently run a poultry yard, but who find in church associations and in the protected shades of medical sectarianism and faddism and social ignorance of medicine sample support and fields for the exercise of their peculiar order or want of talents [SIC]. It is needless to say that the serious gravity of the case here went unrecognised, and that the poor lad went from bad to worse. <h4>[Attack on women doctors]</h4> In time the lad fell under the notice of one of those curb-stone and street corner patient-recruiting doctors who, calling on the father of the child, so impressed him with the profundity and the superiority of his own knowledge over that possessed by the mentally irresponsible specimen of the irregular but solemn-visaged female practitioner, that he managed to assume charge of the case. He had charge of the case for several months when I was called in for an opinion. He had burrowed about the sinuses and necrosed tissues in a most indefinite and unsurgical manner at various times during the course of his attendance, to no good or to no ends, and at the time of my visit, at which he was present, seemed to have no clearly defined ideas as to what he intended to do or should do. On looking over the child, what was my surprise to find a long, tight and adherent prepuce, which in all probability was the original incentive of the whole disease processes which had eventually crippled the child and reduced it to a pitiable plight. Now, this disciple of Paracelsus Bombastus, or curb-stone and church lobby handshaking proclivities, was by no means an opponent of circumcision, only he was naturally and passively ignorant and unreceptive, and had never studied or understood the subject of coxalgia in all of its bearings and, in reality, was no more or only a little better fitted to assume charge of the case than was the solemn and owlishly wise-looking irregular female from whom he had so ingeniously swiped it. As observed, the failure to recognise the probable cause in this case was, in the hands of either of these two practitioners, pure ignorance, naturally leading to what, in better informed hands, would be criminal carelessness and inattention, but in many like cases men of small calibered minds are apt to be too easily influenced by the oft-repeated denials made by the opponents of circumcision as a general practice, that cancer, hypertrophies, excrescences, sciatica, coxalgia, reflex diseases and other derangements that at times accompany the existence of a prepuce, are either the direct or reflex outcome of the possible result of natural evolutionary growing out of the irritating presence of a prepuce. Under such misguidance they neglect to recognize the true state of affairs or to perform the operation early enough to act preventively; and at times when they do perform it later on, and at a time when the derangement for whose relief it is intended has become a settled disease, the operation is followed by no appreciable result, it only confirms them in the righteousness or correctness of their views and practice, that the prepuce was not an inciting cause, and that circumcision has no preventive value. Many of these reflex disturbances remain for a longer or shorter period easily removed, mere functional derangements, before becoming the actual seated disease which they or a time simply simulate; and the period when the actual change takes place from a simulated to a settled disease is as indefinite as the point or period when a benign wart or tumour reaches the precancerous stage, and from this swiftly passes into the cancerous. I have at times operated upon cases where great reflex disturbances had long existed, and where the operation was performed with no hope of their relief, but simply because the local preputial conditions demanded interference, when to my surprise the reflex difficulty has gradually disappeared. <h4>[Another miracle cure]</h4> Some 25 years ago, whilst in charge of a country hospital, I circumcised an inmate, a man of thirty, who was a cripple, seemingly, as the history told me, from the results of a coxalgia when a child. The right leg was neuralgic and apparently shortened, and drawn up in the peculiarly flexed and fixed position characteristic of such cases. It had been so for many years, was gradually going for the worse, and the helpless cripple had drifted into hospital. It was not, however, for the relief of this that he applied to me, but for the relief of a bladder affection which necessitated an examination. I found a long, tight, pin-holed, pendulous prepuce which he had never, even as a child, been able to retract. After questioning the man as to his previous physical history I gave it as my opinion that the crippled leg was the direct outcome of the preputial condition. I advised circumcision to relieve the bladder irritability and to make a urethral stricture more accessible for treatment, when, to my surprise, after the operation the neuralgic pain subsided and the deformity of over 25 years standing gradually lessened. Massage and passive motions were then instituted, and he recovered the almost perfect use of his leg, left the hospital and went to work. In this case some unseen and unusual constitutional resistance worked to prevent irreparable injury through the occurrence of arthritic inflammation. The least accident or taint of scrofula would here undoubtedly have turned the tables against him. Possibly the degree and nature of the persistent reflex muscular contraction were insufficient to induce serious injury to the head of the femur, but in any case the history of this case teaches us the benefits that may at times be derived from circumcision in the most seemingly hopeless cases. As observed, the results were here most unexpected, and I should be hardly be sanguine enough to see them repeated; but still, what has occurred in one case may in another, and the smallness of the percentages of these happy results should not prevent us from extending the benefits to others affected in analogous manner. Figure 2 represents a case of preputial hypertrophy somewhat similar to that of the celebrated case recorded many years ago in Paris by M. Nelaton. ... The photograph [of a freakish case of gross elephantiasis of the penis] speaks for itself as to the nature and degree of the deformity. The observed enlargement was wholly preputial in its origin and subsequent growth, and never involved the penile organ, and the operation taken for its relief was perfectly successful. To say that circumcision would not have prevented the occurrence of this condition is not a tenable proposition. It is equally certain that the hypertrophy might have entailed more serious concurrent affections than the single one operated on. Had the man been circumcised when a child, all this annoyance and risk would have been averted. <h4>[Anti-circumcision activists]</h4> The opponents of circumcision are by no means all blindly dogmatic and unreasonable in their opposition. Many only class such operations as unnecessary when performed on seemingly perfectly normal subjects. The danger from the opposition resides in those narrow, inelastic and unbending understandings who have made of uncircumcision such a creed, that they have so steeled themselves against its performance, that they will not and cannot under any circumstances ever see or realize the necessity of its performance. Like the Negro preacher and exhorter of "the sun do move" celebrity, they undertake to stick to what to them has become a religious tenet, a scriptural text or truism, no matter what may happen. Not alone are they an injury to themselves and others in their restricted conceptions of medicine and lines of practice, but carrying their prejudiced disbelief in other channels of our science, they at least reach that point where disease and medicine appear to them as purely empirical and unretroactive conditions, and only responsive to the most empirical penny-in-the-slot methods of practice. <div> "The RACP's statement on routine male circumcision is not evidence based and should be retracted". -- Brian Morris, Daniel Halperin, Stefan Bailis et al, "RACP's policy statement on infant male circumcision is ill-conceived", ANZ Journal of Public Health, Vol 30, January 2006, p. 16 </div> [Compared with the Remondinian outpourings of Prof. Morris and Co, the <a href="http://www.racp.edu.au/hpu/paed/circumcision/summary.htm" rel="noopener" target="_blank">RACP's policy statement (2002-4)</a> is a model of balance, and an obvious compromise between the pro-circumcision hawks, on one hand, and the advocates of genital integrity and a person's right to make his own health decisions on the other.] In many respects the opponents of circumcision as a general practice may be likened to the anti-vaccinationists, who magnify the risks and dangers as well as the accidental evil results of vaccination, while they attempt to minimize its immunities and advantages. History and experience do not side with either of these opponents, and it is only by adopting the most one-sided views that one can in the least arrive at anything like a comprehension of their views, or how these are reached by them. SOURCE: P.C. Remondino, "Circumcision and its opponents", American Journal of Dermatology and Genito-Urinary Diseases, Vol. 6, March 1902, pp. 65-73 <h3>References</h3> 1. Spilsbury K, Semmens JB, Wisniewski ZS, Holman C D'A J. <a href="http://www.cirp.org/library/procedure/spilsbury1/" rel="noopener" target="_blank">Routine circumcision practice in Western Australia 1981â€“1999.</a> ANZ J. Surg. 2003; 73 : 610â€“14. 2. Jonathan Hutchinson, "The pre-cancerous stage of cancer and the importance of early operations", British Medical Journal, 7 January 1882, pp. 5-6 </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 Dr Remondino blasts anti-circumcision activists (1902) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4>A new device for "bloodless" circumcision</h4> In 1910 the Journal of the American Medical Association published an article by S.L. Kistler MD, of Los Angeles, on the need for circumcision in both males and females, along with a vigorous advocacy his own patent "bloodless" method. Like Hiram Yellen and Aaron Goldstein 25 years later, he had invented a special clamp for the purpose. <h3>Rapid bloodless circumcision of male and female</h3> Circumcision, one of our most common minor operations, is bunglingly done in many instances, notwithstanding its simplicity. This operation, though an old one, is still interesting, and means have long been sought whereby it could be more easily and quickly performed and be attended with less hemorrhage, and consequently meet with less objection on the part of parent and patient. Many a surgeon has lost his best clients, and likewise many a good prospect has gone glimmering because of the unfortunate outcome of this little operation. The necessity for circumcision is abundantly evidenced, and although it may be needless to state any reasons for doing this operation, nevertheless I will mention a few: 1. Reduced tendency to convulsions in infancy arising from irritable nervous system. 2. Habit of masturbation not so likely to be formed. 3. Lessened irritability of child or adult. 4. Amorosity reduced. 5. A hygienic condition promoted. 6. Venereal diseases not so readily contracted, and consequently: 7. Fewer pelvic diseases in women. 8. For impotency in old men, as has been advocated. The ease with which this operation can be done by the use of the instrument here described is so marked that a person could circumcise himself, provided he did not become faint-hearted. Only one-quarter of [the] time required for other methods is needed. The operation is practically bloodless, as all ligatures are uniformly placed and tied before the clamp is removed. The illustration shows clamp on and ligatures inserted (A); then the removal of the foreskin (B), and next the removal of the upper section of the blades (C), and two ligatures pulled up, one of which has been cut and is ready to be tied (D). The instrument has twelve slots or ports, instead of fourteen as shown in the illustration. Method of procedure 1. Use local or general anaesthetic as deemed best. 2. Adjust clamps. 3. Insert sutures. 4. Excise foreskin with scissors or blade. 5. Remove upper section of each blade be releasing at distal extremity and lifting off. 6. Insert ligature in anterior portion of foreskin in addition to those already inserted, if desired; also insert one posteriorly. 7. Pull each suture up singly, cut loop in centre, tie each side as indicated, and having tied all the ligatures, remove clamp and apply dressing. If deemed expedient, spear the mucous membrane and draw out as desired before applying the clamp. If the foreskin adheres to the glans, split on dorsal aspect to corona, break down adhesions, apply clamp and operate one side at a time, and, having loops to pull, only skin and mucosa to unite, you can operate very rapidly. A young child may not always require stitches; however, I think it best to insert several, but each operator will use his own judgement in the matter. A better result will be obtained when the mucous membrane is cut long and the skin comparatively short, as is the case when this instrument is employed. There is practically no blood, no anxiety, no misgivings as to results, and the work is done quickly and easily. Frequently, too much mucous membrane is removed and too little skin. Leave more mucous membrane and less skin, and then an ideal result will be obtained. Many females need circumcision, and the operation is more easily performed than in the male. The clamp is applied singly to such elongated or hypertrophied parts as it is desired to remove, ligatures inserted, part excised, upper part of blades removed, ligatures tied without necessity of pulling up loops etc, clamp removed and dressing applied. I have never tried this instrument for protruding pile tumours (of considerable length), but it occurs to me that a beautiful operation could be performed by its use, for the reason that the double ligatures could be inserted through the vein posterior to the sacculated portion, and then the set of ligatures used for the vein could be withdrawn from the skin; thus the veins could be tied separately and the skin then closed with the other set of ligatures loosely tied, which would incidentally hold the vein in close contact with the skin. Other phimosis clamps have been devised, such as those of Tortat, Levis and Skillern, but the advantages of my clamp and its distinctive feature is the notched, removable portion of the blades. This feature gives a smooth surface along which to remove the redundant tissue, leaving just the margin required to hold the stitches securely. The removal of these portions of the blades leaves the sutures free for rapid tying while the remainder of the clamp is in place. S.L. Kistler, "Rapid bloodless circumcision of male and female, and its technic", Journal of the American Medical Association, Vol. 54, 28 May 1910, p. 1782-3 <h4>NOTE</h4> It is not clear just what Kistler meant by circumcision as applied to females, though the proposition that they too would derive vast health benefits from the operation was common in the USA until the 1950s. Kistler's reference to "elongated or hypertrophied parts" suggests that any parts of the clitoral hood, labia or clitoris itself which seemed longer than he considered decent or proper were fair game. </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 Rapid circumcision of male and female (1910) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4>Production line efficiency reaches the penis</h4> In 1935 Hiram S. Yellen (an obstetrician and gynecologist) and Aaron Goldstein (an inventor) collaborated in the invention of a new circumcision instrument which they called the Gomco clamp. Goldstein produced and marketed the device through his private company â€“ the Goldstein Manufacturing Company (Gomco) â€“ and patented it in 1940. They used the friendly pages of American medical journals to urge the necessity for early circumcision, and to promote their product as the best and most efficient means of performing it. It was a very successful example of medical entrepreneurship! On this page are collected a number of documents relating to the history of the Gomco clamp. <h3> <a name="yel"></a>Bloodless circumcision of the newborn</h3> Circumcision is one of the oldest operations recorded in the history of medicine, and while the method of procedure has kept pace with medical progress in general, there has always been the possibility of a haemorrhage with each case. Medical literature records many fatal haemorrhages and many infections as a result of circumcision of the newborn, and it is known that 2 per cent of all skin cancers are penis cancers. With this in mind we set about to develop a safe and simple apparatus for the performance of this operation, with the result that we now have a clamp which not only eliminates the possibility of haemorrhage, but also restricts the minimum chance of infection without the use of sutures. About a year ago Aaron Goldstein of this city [New York] developed a clamp which we have used in many cases. This efficient instrument is small, compact, light as strength will permit, and can be operated without an assistant. The technic is quite simple, and the time required is less than that by any other method. With the use of this clamp we never employ sutures, no bleeding is encountered, and it leaves a clean-cut incision which heals perfectly in 36 hours with practically no chance of infection because the mucous membrane and skin are securely clamped together. Fig. 3 is the clamp itself, and Fig. 1 and 2 are diagrams showing the procedure. The following instruments and material are all that is really required: the clamp, 2 small haemostats, a probe with a flattened end, a scissor with one blunt blade, an abscess knife or sharp pointed scalpel (No. 12 Bard-Parker blade is ideal), sterile Vaseline, and Vaseline gauze. Method After properly cleansing the penis (E) and pubis, the dorsal aspect of the prepuce (A) is put on a stretch by grasping it on either side of the median line with a pair of haemostats. A flat probe, anointed with Vaseline, is then inserted between the prepuce and the glans to separate adherent mucous membrane. The prepuce is then gently drawn backward, exposing the entire glans penis. This is again cleaned. In case where the prepuce is drawn tightly over the glans, a partial dorsal slit will facilitate applying the cone of draw stud over the glans [?? sic]. (Note: If too long a slit is made, the cone has a tendency to slip of the glans. The slit should, therefore, be made only sufficiently long to enable the cone to be easily applied.) After anointing the inside of the cone (B) , it is placed over the glans, allowing enough of the mucous membrane to fit below the cone so that too much is not removed. The prepuce is then pulled through and above the bevel hole in the platform (F), and clamped in place. In this way the prepuce is crushed against the cone, causing haemostasis. We allow this pressure to remain five minutes, and in older children slightly longer. The excess of the prepuce is then cut with a sharp knife without any danger of cutting the glans, which is always protected by the cone portion of the instrument, leaving a very fine one-thirty-second of an inch ribbon-like membrane formed between the new union of the skin and mucous membrane. The pressure is then released. The circumcision is completed and the penis covered with Vaseline gauze. No anaesthesia is used. On children older than twelve months, we find it advisable to insert a few sutures. At this date we have performed more than 500 circumcisions on the newborn and as yet have not encountered any infection or haemorrhage. Hiram S. Yellen, "Bloodless circumcision of the newborn", American Journal of Obstetrics and Gynecology, Vol. 30, 1935, p. 146-7 <h4> <a name="com"></a>Commentary: The T-model penis</h4> The Gomco clamp was heavily advertised in the Journal of the American Medical Association in 1935 and at its annual meeting in 1936. It soon proved very popular with American physicians, and established itself as the most commonly used method for early circumcision. Although Yellen had warned that the device should be used cautiously so that "not too much" of the prepuce was amputated, the design of the device allowed any quantity of tissue to be trapped and excised, depending on how far the penile skin was stretched between the ring and the cone. The temptation was always to pull more rather than less. The outcome was that the American method of circumcision became increasingly severe, leading to the "high and tight" look in which about 50 per cent of the surface tissue of the penis is cut off, and the remaining skin is stretched thin, like the membrane of a drum. The instrument remains in frequent use today. <h4> <a name="jul"></a>Julian Wan's tribute</h4> Yellen and Goldstein's work was the subject of an enthusiastic, not to say rhapsodic, eulogy by Julian Wan, published in the journal Urology in 2002. Wan praises the Gomco clamp for its "longevity and functional elegance", and as "a model of excellence in design and innovation". He notes that the device can exert from "800 to 20,000 pounds of hemostatic force against the prepuce", thus crushing it so effectively that stitches are rarely necessary. Wan also explains why Yellen was so keen to develop a new and simple circumcision method. Although American physicians had been demanding universal male circumcision since around 1910, they met strong resistance because all the available methods were clumsy, difficult and bloody, and often had unfortunate outcomes, such as dangerous bleeding, infection and death. By the mid-1930s the high level of injury and death had produced such disenchantment among British doctors that many were calling for the operation to be entirely abandoned; while in the USA Dr Winfield Scott Hugh recommended that it be treated as a major operation to be performed under local or general anaesthetic, and that every point of bleeding should be meticulously sutured. It is easy to see that if circumcision was classified as such serious surgery it would remain only a minority practice and could never become as widespread as its advocates desired. It could certainly not be regarded as a simple, "routine" procedure performed at or soon after birth by obstetricians; it would rather be a serious operation reserved to surgeons, and correspondingly more expensive and less popular. Like Kistler's clamp, Yellen and Goldstein's device was intended to reduce objections to circumcision and to promote its performance throughout the nation. Its purpose was to silence the critics and ensure that Yellen's professional fraction (the ob-gyns) got the job. In retrospect we can see (though Wan did not) that the whole affair was about business success and professional turf, and had very little to do with children's health. The T-model penis Wan reports that Goldstein was inspired by watching a mechanic at work with a tyre lever on a Ford motor car. In a broader perspective, his invention may be seen as part of the drive for speed and efficiency so characteristic of American industry in the 1920s, and the application of Fordist production line techniques to surgery. Circumcised penises would henceforth roll out of the hospitals with the same speed and efficiency as Henry Ford's cars poured out of his factories, all as standardised and uniform as the T-model itself. Wan's article is well worth studying, both for its historical information and the insights it affords into the standards of medical ethics current among American urologists. A pdf copy may be <a href="http://www.historyofcircumcision.net/images/stories/resources/wan-gomco.pdf" rel="noopener" target="_blank">downloaded here</a>. (PDF 157KB) <a href="http://www.adobe.com/products/acrobat/readstep2.html" rel="noopener" target="_blank"><img alt="Image" border="0" height="31" src="http://www.historyofcircumcision.net/images/stories/resources/get_adobe_reader.gif" title="Image" width="88"/></a> <h4> <a name="war"></a>Warning from FDA</h4> Contrary to Yellen's claims and Wan's breezy affirmations, however, the Gomco clamp has not been free from complications, and the literature offers many cases where its use has led to bleeding, infection, and amputation of the glans or entire penis. The following warning was issued by the Center for Devices and Radiological Health of the US Food and Drug Administration on 29 August 2000. They had received no fewer than 105 reports of injuries between July 1996 and January 2000 alone, including laceration, hemorrhage, penile amputation, and urethral damage. Center for Devices and Radiological Health Food and Drug Administration 29 August 2000 Dear Colleague This letter is to alert you to the potential for injury from two commonly used circumcision clamps, the Gomco/gomco-type and Mogen/mogen-type clamps. Both are widely used during circumcision to remove the foreskin while protecting the glans penis. Although research suggests that circumcision is generally a safe procedure, we are concerned that some serious device-related complications have occurred. We received 105 reports of injuries involving circumcision clamps between July 1996 and January 2000 [1]. These have included laceration, hemorrhage, penile amputation, and urethral damage. We are providing recommendations below that can help avoid these complications. Nature of the Problem Gomco and Gomco-type Clamps The use of Gomco and gomco-type clamps that have been reassembled by users with parts from different manufacturers, or that have bent parts or mismatched components, has led to clamps breaking, slipping, falling off during use, tearing penile tissue or failing to make a tight seal. Please note that although Gomco and gomco-type clamps may appear to have interchangeable parts, these parts may not always be safely interchanged because they may vary slightly in dimensions. Mogen and Mogen-type Clamps The use of Mogen and mogen-type clamps that have jaw gap dimensions greater than those in the manufacturer's specifications, or use of clamps inappropriately sized for patients, has led to patient injuries. In such cases, the clamp may allow too much tissue to be drawn through the opening of the device, thus facilitating the removal of an excessive amount of foreskin and in some cases, a portion of the glans penis. Recommendations General Before performing a circumcision procedure, examine the clamp to determine that all parts are available, undamaged, and within the manufacturer's specification. Gomco and Gomco-type clamps If you cannot be certain that a clamp component is part of the original clamp or if the clamp has stripped threads, a warped or bent base plate, a bent arm, twisted forks, or a scored or nicked bell, either contact the device manufacturer to obtain replacement parts [2] or discard the clamp. When requesting a replacement part, obtain the assurance of the manufacturer or supplier that the part ordered is compatible with the other components of your device. Do not substitute parts from different clamp manufacturers. Make sure that you reassemble a clamp from only its own parts. Do not mix up parts from different clamps, even from the same manufacturer, unless the manufacturer has assured you that the parts are interchangeable. If you choose to mark clamp parts to assure that you correctly reassemble them, ask the manufacturer about the best way to do this, because some marking methods may weaken the device or compromise your ability to sterilize it. Mogen and Mogen-type clamps Ensure that the clamp being used is appropriate for the patient size. Some manufacturers have two sizes of clamps, one for adults and the other for infants. Periodically measure the gap between the device's clamping jaws to ensure that it is within the manufacturer's specification. [3] Using a device with an inappropriate jaw gap could allow the tip of the penis to be drawn through the clamp with the foreskin and inadvertently severed or injured. Reporting Adverse Events to FDA The Safe Medical Devices Act of 1990 (SMDA) requires hospitals and other user facilities to report deaths and serious injuries associated with the use of medical devices. This means that if the use of a Gomco/gomco-type clamp or a Mogen/mogen-type clamp result in a death or serious injury, you must report that event. We request that you follow the procedures established by your facility for such mandatory reporting. If a circumcision clamp malfunctions, you can report this directly to the manufacturer. Alternatively, you can report directly to MedWatch, the FDA's voluntary reporting program. You may submit reports to MedWatch four ways: online to https://www.accessdata.fda.gov/scripts/medwatch/ by telephone at 1-800-FDA-1088; by FAX at 1-800-FDA-0178, or by mail to MedWatch, Food and Drug Administration, HF-2, 5600 Fishers Lane, Rockville, MD 20857. Getting More information If you have questions regarding this letter, please contact Sherry Purvis-Wynn, Office of Surveillance and Biometrics (HFZ-510), 1350 Piccard Drive, Rockville, Maryland, 20850, by fax at 301-594-2968, or by e-mail at <a class="__cf_email__" data-cfemail="85f5ede4ebebc5e6e1f7edabe3e1e4abe2eaf3" href="/cdn-cgi/l/email-protection">[email protected]</a>. Additionally, a voice mail message may be left at 301-594-0650, and your call will be returned as soon as possible. All of the FDA medical device postmarket safety notifications can be found on the World Wide Web at http://www.fda.gov/cdrh/safety.html. Postmarket safety notifications can also be obtained through e-mail on the day they are released by subscribing to our list server. To subscribe, send a message to <a class="__cf_email__" data-cfemail="a3c5c7c2cfcad0d7d0e3c2d1c0cbcac68dc5c7c28dc4ccd5" href="/cdn-cgi/l/email-protection">[email protected]</a>. In the body of the text, type "subscribe dev-alert". Sincerely yours, David W. Feigal, Jr, MD, MPH Director Center for Devices and Radiological Health Food and Drug Administration [29 August 2000] References and Additional Information 1. FDA MedWatch Reports, July 1992 through January 2000. 2. IPM Procedure: Circumcision Clamps, Health Devices 2000 January; 29(1):22-3. 3. Hazard: Routine inspection needed for scissors-type circumcision clamps, Health Devices 1999 Mar; 28(3):115-6. 4. Hazard: Incompatibility of different brands of Gomco-Type circumcision clamps. Health Devices 1997 Feb; 26(2):76-7. 5. Hazard: Amputations with use of adult-size scissors-type circumcision clamps on infants. Health Devices 1995 Jul; 4(7):286-7. 6. Hazard: Damaged Allied Healthcare Products Gomco circumcision clamp. Health Devices 1993 Mar; 22(3):154-5. <a href="http://www.fda.gov/cdrh/safety/circumcision.html" rel="noopener" target="_blank">http://www.fda.gov/cdrh/safety/circumcision.html</a> <h4> <a name="cor"></a>Correspondence between John Dalton and Julian Wan</h4> This report was the subject of some correspondence between John Dalton, of Norm-UK, and Dr Wan, who confessed that while he was aware of "the various types of problems with both the Mogen and the GOMCO clamps", he was not aware of the FDA's warning. Dalton's question -- Original Message -- From: John D Dalton [mailto:<a class="__cf_email__" data-cfemail="0862676066266c69647c676648606d7a6c7f616b6326666d7c" href="/cdn-cgi/l/email-protection">[email protected]</a>] Sent: Saturday, May 18, 2002 16:18 To: Wan, Julian Subject: Re: reprint Thank you. I have now seen your article. As a matter of interest, were you aware that the FDA had issued a warning in respect of the Gomco clamp: http://www.fda.gov/cdrh/safety/circumcision.html This one states "... we are concerned that some serious device-related complications have occurred. We received 105 reports of injuries involving circumcision clamps between July 1996 and January 2000 <http://www.fda.gov/cdrh/safety/#1>. These have included laceration, hemorrhage, penile amputation, and urethral damage." In message <77267925C48ED311AA2E0008C7916AA60DAED8A8 @kalmb01.kaleidahealth.org>, Wan, Julian <<a class="__cf_email__" data-cfemail="f5bfa2949bb5be9499909c9194bd909499819ddbba8792" href="/cdn-cgi/l/email-protection">[email protected]</a>> writes >Dear Mr. Dalton: > >Thank you for your letter concerning the GOMCO reprint. I haven't gotten >them yet - there is a delay of some sort with the publisher - once they are >in, I'll mail you a copy; there just may be a small lag. > >Sincerely, > >Julian Wan, MD Dr Wan's reply to the question of whether he was aware of the FDA warning. -- Original message -- Subject: reprin' To: 'John D Dalton' <<a class="__cf_email__" data-cfemail="c6aca9aea8e8a2a7aab2a9a886aea3b4a2b1afa5ade8a8a3b2" href="/cdn-cgi/l/email-protection">[email protected]</a>> From: "Wan, Julian" <<a class="__cf_email__" data-cfemail="e6acb18788a6ad878a838f8287ae83878a928ec8a99481" href="/cdn-cgi/l/email-protection">[email protected]</a>> Date: Sun, 19 May 2002 14:54:28 -0400 Message-ID: <77267925C48ED311AA2E0008C7916AA60DAED8BF @kalmb01.kaleidahealth.org> Dear Mr. Dalton, Thank you very much for the note. I was aware of the various types of problems with both the Mogen and the GOMCO clamps, but not of this particular alert. The Mogen and similar style clamps run the risk of a cross clamping injury and a blind cutting injury and have been reported in several articles in the urological literature. The GOMCO style clamps require good maintenance of the parts â€“ damage due to wear particularly at the critical force bearing areas can be a problem â€“ the older models were brass coated wit chrome, and could be deformed. The newer models are stainless steel and so are a bit more robust, but can develop sharp edges or burrs. Circumcision instrument trays are often created with different size clamps, and sometimes inexperienced personnel can mix up the components â€“ a mismatched bell and plate can lead to distortion of the clamping force and problems. I suspect the critical common theme in these injuries is the experience of the surgeon. The inexperienced and occasional circumciser is most likely to have problems. Sincerely, Julian Wan, MD It seems strange that if Dr Wan was aware of "the various types of problems with both the Mogen and the GOMCO clamps", and that the older models were prone to warping, he did not refer to these problems in his article. <h4> <a name="gom"></a>Gomco-like device banned</h4> A "Gomco-like" device made in Pakistan and sold to the USA was actually recalled by the distributor in February 2000. PRODUCT Chrome plated brass circumcision clamps, gomco like, made in Pakistan, individually packaged clamps in boxes labeled only with the catalog number, description, size and quantity. Recall #Z-402/404-0. CODE All units of the following clamps Catalog #83928, 1.1 cm, Extra Small Catalog #83929, 1.3 cm, Newborn Catalog #83930, 1.6 cm, Child. MANUFACTURER Gogi Enterprises, Sialkot, Punjab, Pakistan. RECALLED BY Medco Instruments, Inc., Crestwood, Illinois, by fax on February 16, 2000. http://www.fda.gov/bbs/topics/ENFORCE/ENF00632.html <h4> <a name="one"></a>One operator's confession</h4> Just how tricky the Gomco clamp can be, and how gruesome, is revealed in this astonishing testimony given by Dr Sunita Kantak in the course of a civil action for damages arising from a circumcision she performed in North Dakota, USA. Dr Kantak had circumcised a newborn boy using the Gomco method. Although she had obtained the mother's consent, the parents were horrified when they saw the result - an ugly and disfigured penis marked by a wound that required a long period to heal. They then sued the doctor and the hospital on the ground that they had not been warned that there was any risk of disfigurement, stating that they would never have agreed to the operation had they been given full information about the process and the possible result. In her testimony, Dr Kantak makes the extraordinary admission that in order to fasten the foreskin to the cone (here referred to as the bell) of the Gomco device, she pierced the baby's foreskin with several safety pins. She also states that she left the clamp on the crushed foreskin for seven minutes to ensure that there would be minimal bleeding when she used a scalpel to sever the foreskin and then removed the clamp. The relevant section of her testimony is reproduced here. She is replying to questions from Zenas Baer, attorney for the plaintiffs. 22 Q. Now, Dr. Kantak, on page 22 I asked 23 you at Interrogatory Number 90 of Exhibit 16 24 what the circumcision tray consisted of, and you 25 describe it as including straight mosquito 1 forceps? 2 A. Yeah. 3 Q. And then a straight Kellie forcep. 4 What is a Kellie forcep? 5 A. Kellie forcep is for to clean the 6 area for the -- to use the sterile, you know, 7 the Betadine that we clean the area before doing 8 the circumcision. 9 Q. Okay. Is there one mosquito forcep, 10 or two? 11 A. I think there are three, three. 12 Q. Okay. Three. Maybe I can just 13 refer you to the next page. I think that has a 14 more detailed description of what it contains. 15 What are safety pins used for? 16 A. The safety pins are used just to 17 hold the bell. Some people use it, some people 18 don't. 19 Q. Hold the what? 20 A. To hold the bell. 21 Q. The Gomco? 22 A. The Gomco bell. 23 Q. Hold it? 24 A. To hold it so it becomes easy to put 25 it without much manipulation. 1 Q. Where do you put the safety pins? 2 A. Just on the tip where the -- you 3 hold the bell. 4 Q. Do the safety pins puncture the 5 foreskin that you're going to remove? 6 A. Yeah. 7 Q. So you actually pull up -- or you 8 position the bell, and then you take safety pins 9 and push them through the foreskin you're going 10 to remove, and then attach or secure the safety 11 pin so that the bell stays in place? 12 A. No. Because you have to put the 13 hole -- the -- the instruments of the Gomco 14 apparatus, otherwise people use the -- what is 15 that called? I don't know what that's called. 16 They use some other things to pull it out from 17 the hole where the bell goes, so if you hold the 18 bell, the safety pins, it just becomes -- you 19 don't manipulate much and you get less bleeding, 20 is my experience. 21 Q. But the safety pins do puncture the 22 foreskin? 23 A. Yeah. 24 Q. And what is the med cup used for? 25 What is that? 1 A. To prep balls, they have some cotton 2 balls there and the nurse puts the Betadine and 3 then you clean the area before you do the 4 surgery so that there is no infection risk. It 5 reduces the infection risk. 6 Q. Okay. And the scalpel, is that used 7 to cut the foreskin once you have -- 8 A. That's right. 9 Q. -- detached it and clamped it? 10 A. Yeah. 11 Q. And obtained hemostasis? 12 A. Yes. 13 Q. How can you tell when hemostasis has 14 been achieved? 15 A. Usually the bleeding time is seven 16 to nine minutes, so that's why I just go for 17 seven minutes. That's my preference to wait. Cass District Court, State of North Dakota, USA, Court File CV-99-03761, deposition taken on 6 September 2000, by Carolyn's Reporting Service; transcript p. 148-51. <h4> <a name="gom2"></a>Gomco clamp as an S&M toy</h4> The big advantage of the Gomco device for Yellen and his ob-gyns is that it helped to make circumcision a routine operation which could be performed by any GP, medical student, intern or obstetrician; it was no longer the preserve of specialist surgeons or those who knew something about male anatomy. This gain in efficiency and simplicity came at a heavy price that was paid by the one party to the transaction who could do nothing but scream: the baby boy. There can be little doubt that the new method was the most painful yet devised, requiring first the agonising process of tearing the foreskin from the infant glans, then crushing the foreskin, then cutting it off, then putting in stitches if necessary, and all performed without anaesthetic. Although the procedure is described as "quick", it often takes 20 minutes or longer. It is doubtful whether any of the thumbscrews found in the dungeons of the Inquisition, and used to torture heretics in the Middle Ages, could have produced so much agony for so little effort on the part of the operator. (Indeed, <a href="http://www.torahview.com/bris/html/gentler.html" rel="noopener" target="_blank">Jewish doctors have plausibly asserted</a> that the Gomco clamp is far more painful than both traditional Jewish circumcision methods and many other instruments, such as the Mogen clamp.) It is thus hardly surprising that the Gomco clamp has become a prop and sex toy in the sexual dungeons and play rooms of those who specialise in the more extreme reaches of S&M, and particularly for those who get a sexual kick out of genital surgery and mutilations. Examples can be found all over the Internet: Chase Union, a supplier of S&M gear, sells not only Gomco clamps, but castration equipment. <a href="http://www.chaseunion.com/">http://www.chaseunion.com/ </a> A circumcision fetish site (pornography masquerading as medical advice and cultural studies) has pages in praise of the Gomco. <a href="http://www.circlist.com/instrstechs/instrumentset.html" rel="noopener" target="_blank">http://www.circlist.com/instrstechs/instrumentset.html</a> These fetishistic aspects are made very clear in this page of images and "hot" stories involving voluntary or forced circumcision: (Warning: sexually explicit) <a href="http://www.icon.co.za/~hugot/circum/circum.htm" rel="noopener" target="_blank">http://www.icon.co.za/~hugot/circum/circum.htm</a> And there are several internet communities devoted to the thrill of circumcision and the various instruments used in its performance, including one specifically in praise of the Gomco. <a href="https://groups.msn.com/CIRCUMCISEDGUYS" rel="noopener" target="_blank">http://groups.msn.com/CIRCUMCISEDGUYS</a> <a href="http://groups.yahoo.com/group/Gomco_circumcision_adult" rel="noopener" target="_blank">http://groups.yahoo.com/group/Gomco_circumcision_adult</a> <h4> <a name="fur"></a>Further information</h4> Any web search will bring up thousands of pages on the subject. More sober information may be obtained from <a href="http://www.cirp.org/library/procedure/" rel="noopener" target="_blank">http://www.cirp.org/library/procedure/</a> <a href="http://www.circumstitions.com/Glossary2.html" rel="noopener" target="_blank">http://www.circumstitions.com/Glossary2.html</a> <a href="http://www.noharmm.org/instruments.htm" rel="noopener" target="_blank">http://www.noharmm.org/instruments.htm</a> The perspective of the American medical establishment, as it was in 1998, may be viewed here. <a href="http://www.aafp.org/afp/980915ap/peleg.html" rel="noopener" target="_blank">http://www.aafp.org/afp/980915ap/peleg.html</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource The Gomco clamp (1935) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4>Circumcise that baby!</h4> The following article by Alan F. Guttmacher MD, associate professor of obstetrics at Johns Hopkins University, was published in the popular Parents Magazine in September 1941. This article was one of the first on the "advantages of circumcision" to appear in a mass-circulation magazine, and it represents a new phase in the medical campaign to enforce circumcision of infants throughout American society. It was very influential. As you might expect, the article is a grotesque mix of woeful stupidity and wilful mendacity. Readers will particularly note Guttmacher's fake even-handedness, his nonchalant attitude to the pain of the operation ("Naturally he wails ..."), his abysmal ignorance of male genital anatomy and his quaint Victorian obsession with the perils of masturbation and the need for scrubbing. You might regard him as the missing link between William Acton and such modern luminaries as Edgar Schoen and Australia's Brian Morris. <h3>Should the baby be circumcised?</h3> Should my baby be circumcised? Many a new mother asks her doctor this. At the same time a procession of thoughts march across her mind which lead to other questions she would like to ask her physician. What is the history of the operation? What are its advantages and disadvantages? What is the risk, if any? At what age is it best performed? How is it done? Who should do it, and what aftercare does it require? The first question, the history of the operation, is the most difficult to answer. The origin of circumcision is quite obscure, largely because its early performance antedated the dawn of recorded history. Circumcision is probably the second oldest operation in surgery; the most ancient is the cutting of the umbilical cord which joins the baby to the afterbirth. There are two main theories relating to the origin of circumcision. Some believe that circumcision first developed in one spot on the globe and ten migrated from one people to another. Many of them probably abandoned it after a trial. The adherents of the theory of multiple origins feel that it sprang up quite independently in Asia, Africa, Australia and the Americas and at very different periods in world history. Be this as it may, the operation is still performed by widely scattered primitive peoples in all these continents today. The age varies greatly from people to people, or even from tribe to tribe. No matter at what age it is done, the age is specific and unchangeable for each group, and the operation is accompanied by an elaborate ceremony. 200,000,000 people still practise circumcision as part of religious dogma or tribal law. [1] [Necessity for circumcision] Present-day hygiene requires that the prepuce, the hoodlike fold of skin which covers the end of the penis (glans) be drawn back daily and the uncovered glans thoroughly washed. Trouble occurs if this is neglected, for the secretion from the multiple glands lining the inside of the hood becomes caked, and within a few days the material may set up an inflammation. Such inflammation may lead to the growth of slender, strandlike bands of tissue between the inside of the prepuce and the glans, gluing the two together, thus forming an adherent foreskin. [2] The second source of difficulty may arise when a child is born with too small an opening at the end of the foreskin, so that attempts to draw it back are unsatisfactory. When the ringlike aperture is not large enough it either prevents the retraction of the foreskin completely (phimosis), or if it is retracted, the ring of foreskin may encircle the glans so tightly that it cannot be drawn down again (paraphimosis) into its normal position. The constriction causes pain. Adherent prepuce or phimosis frequently causes difficulty in urination, and may cause sufficient pain to lead to impotence, as in the case of the hapless Louis XV, whose seven years of sterile marriage were cured by circumcision. [3] In the light of these facts let us consider the advisability and inadvisability of circumcision. All physicians are agreed that something must be done for the newborn infant who has so small an opening in the prepuce that the glans cannot be readily exposed. The baby must either be circumcised or attempts made to enlarge the tight ring by stretching its edges in all directions with a small, scissors-like, dull-bladed clamp. The doctor does this by introducing the point of the clamp within the ring of the prepuce and gently opening the handles. This may be tried daily for several days, and if at the end of this time the opening is not sufficiently enlarged so that the foreskin retracts with ease, circumcision is necessary. [For and against] Now what about the infant whose foreskin goes back normally? Some physicians recommend routine circumcision, while others advise it only for a tight, unstretchable foreskin. What are the arguments for and against circumcision in these optional cases. Those in favour of routine circumcision claim that: 1. It makes care of the infant's genitals easier for the mother. 2. It 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. 3. Venereal disease is less easily contracted by the circumcised male, and prophylaxis against it [is] more efficient. 4. Cancer of the penis, which to be sure is extremely rare, is even less frequent in the circumcised. 5. A tight foreskin occasionally becomes tighter as the child grows older and may necessitate circumcision in adulthood. At this time the operation is very painful and requires several days or convalescence. Those who oppose routine circumcision claim that: 1. An unnecessary operation is never justified, because no surgical procedure is without risk. 2. A circumcised boy may feel self-conscious when unclothed in the presence of boys who are uncircumcised. 3. Circumcision causes some blunting of male sexual sensitivity because in the circumcised the skin of the glans becomes thicker. However, this supposed disadvantage is often listed as an advantage. [Discussion] In the United States most doctors support the affirmative side of the circumcision debate, and in urban hospitals well over 75 per cent of all newborn males are routinely circumcised, although it may be necessary in only ten to fifteen per cent of the cases. Some doctors make a practice of routine circumcision unless specific objection is raised by the parents, while others first consult the parents in order to discover their wishes. When the obstetrician performs the operation he ordinarily adds 10 to 15 per cent to his bill, although some include it in their original fee. A surgeon usually charges 25 to 50 dollars. The risk of circumcision in the infant male is very small. In a safe hospital in the hands of a competent obstetrician, genito-urinary specialist or surgeon it is almost negligible. I have never known a child to die as the result of a medical circumcision in any of the several hospitals with which I am connected. [<a href="http://www.cirp.org/library/death/">But deaths do occur, even today</a>.] The dangers following circumcision are infection and excessive bleeding. To prevent the latter complication some physicians study the blood on the day of the circumcision, especially its clotting ability. When deficient, it can be normalised in most cases by simply giving the child two thousand units (15 drops) of vitamin K by mouth. Infection is guarded against by performing the operation in an operating room, with scrupulous surgical technique. [Jewish practice] According to Jewish law, of which ritualistic circumcision is a part, it should be done on the eighth day of life. This particular day was probably selected after centuries of experimentation through trial and error. No doubt the Jews found, as we have, that when circumcision was done earlier the child had a greater tendency to haemorrhage. According to Dr Quick of Marquette University, the answer to this riddle is now known. He claims that a full-term child is born with a relatively high prothrombin level of [sic] its blood. Prothrombin is a substance which plays a significant role in the clotting of blood, and its quantity in the body is directly affected by the newly discovered chemical, vitamin K. Dr Quick states that the prothrombin level drops rapidly after birth and does not start to rise until the child is several days old, not reaching satisfactory levels again until about the seventh day. This, he believes, is the reason that a circumcision done before the eighth day, unless within the first several hours after birth, is more likely to bleed excessively than a circumcision done the eighth day or later. [4] Usually when the child weights six pounds or more, and is strong and well, the operation is done between the eighth and tenth days; but if the child is puny or weak the operation is deferred until later. In the last few years some brave spirits have been circumcising the child as soon as it is born, taking advantage of the temporary high prothrombin level. I have seen several of these cases, and they seem to do just as well as children circumcised at the later time. [Operative techniques] Several different operative techniques may be employed in doing circumcisions. A common one is modelled after the method of the Jewish ritualistic circumcision. The elastic foreskin is stretched forward beyond the glans and a clamp applied across it, just in front of the glans. A knife cut is made just behind the clamp and in front of the glans. When the severed skin retracts through its own elasticity it is sufficiently shortened so that its forward edge is now even with the base of the glans. A few key stitches are used to control bleeding, and a dressing applied. If the stitches are catgut they dissolve and drop out in a few days of their own accord. If silk stitches are used, they must be removed 48 hours after the operation. The second type of operation is termed the dorsal slit. In this, a slit is made in the foreskin with a scissors, the incision being carried back until it is flush with the base of the glans. Then a circular cut is made with the scissors, amputating a strip of foreskin. The wound is stitched and dressed. A third and increasingly popular method is the use of the clamp, a gadget which squeezes a circular groove in the foreskin at the proper distance from the end. It squeezes the skin so hard that after being severed with a knife along this compressed tract there is virtually no bleeding, and no stitches have to be used. [5] Any one of these three methods in the hands of a surgically trained operator produces excellent results. [No anaesthetic] No anaesthetic is used for an infant circumcision. The baby is merely given a piece of gauze to suck which has been dipped in plain water, sugar water, or sugar water plus whiskey. Naturally he wails during the more painful stages, but as soon as the operation is over all appears forgotten and forgiven in slumber. The amount of tissue removed is very little. It is simply a circular band of skin, five-eighths to three-quarters of an inch wide which weighs less than a quarter of an ounce. The wound heals quickly and requires little or no aftercare. The site of the incision is usually encircled with a small vaselined bandage, and then a small, sterile gauze sponge is wrapped around the end of the penis. The sponge is changed whenever the infant is rediapered, but the Vaseline bandage is allowed to remain in place for 48 hours, when it is removed. If the wound is well healed, nothing more need be done; but if some raw areas remain these are usually touched up by a nurse or doctor with a mild antiseptic. The infant is usually given only an oil bath until both the cord stump and circumcision are healed. One nice thing about circumcision is that when it is done it is finished. The foreskin never grows back. Alan F. Guttmacher, "Should the baby be circumcised?", Parents Magazine, Vol. 16 (September 1941), p. 26, 76-8 <h4>NOTES</h4> The first question that strikes a reader today is why an obstetrician should be pontificating on male anatomy and physiology, subjects about which Guttmacher demonstrably knows very little. But it is a strange fact that it was the obstetricians and gynecologists who were the major force in promoting routine male circumcision in the USA from the 1930s onwards. Even more influential than Guttmacher was the article by Miller and Snyder, "Immediate circumcision of the newborn male", published in the American Journal of Obstetrics and Gynecology in 1953. They seem to have regarded circumcision as the final phase of the birth process, and to have assumed that it was part of their job to tidy up boys' penises in much the same way as they tied the umbilical cord. Symptomatic of their focus on women are the reasons Guttmacher gives in favour of circumcision; the first two have no connection with the health of the boy at all, but are entirely to do with the supposed convenience of the mother. 1. It is quite untrue that circumcision was practised in Asia before the arrival of the Moslems or in pre-Columbian America at any period. The only regions where it is known to have occurred in prehistoric times are parts of Africa, the Middle East and north-central Australia. A few Pacific peoples practised other (and milder) forms of penile mutilation, and it is possible that these were transformed into full circumcision under the influence of either Islam or nineteenth century Western medicine; <a href="http://www.circumstitions.com/Pacific.html">Fiji and Samoa</a> may be an example of the latter, while the horrible <a href="http://www.circumstitions.com/Philippines.html">customs now prevalent in the Philippines</a> may show the influence of both. 2. This is the myth of congenital phimosis, one of the great leaps backward in Anglophone anatomy. The infant penis is nearly always adherent and non-retractable, which is just how nature intends it to be. The claim that many boys were born with foreskin openings so small as to make urination impossible is another myth; there are no such cases known. The debate over "dilatation vs circumcision" goes back to the Orificial Surgery Society in the 1890s, as the contribution by Dr Beatty shows. <a href="http://www.cirp.org/library/treatment/phimosis/">More up-to date information on phimosis available here</a>. Guttmacher cannot be blamed for repeating the medical wisdom of his period, but there is evidence that he had some acquaintance with medical history and should have known better, or at least to have wondered why "phimosis" in infants and boys had never been a problem until the 19th century. Some years after this article Guttmacher was the joint editor (with Owsei Temkin) of the most famous midwifery manual of the late ancient world, that by the Greek physician Soranus, and one which remained in use for hundreds of years. In this he might have read that medical authorities of that period considered a short or inadequate foreskin to be a defect requiring correction. The passage reads: If the infant is male and it looks as though it has no foreskin, she [the nurse of midwife] should gently draw the tip of the foreskin forward or even hold it together with a strand of wool to fasten it. For if gradually stretched and continuously drawn forward it easily stretches and assumes its normal length, covers the glans and becomes accustomed to keep the natural good shape. Soranus's Gynecology, trans. and ed. Owsei Temkin and Alan F. Guttmacher (Johns Hopkins University Press, 1956), p. 107 Soranus advice is consistent with the view of Greek and Roman physicians that a short or inadequate foreskin (one which did not provide ample coverage of the glans) was a physiological defect known as lipodermos. Their concern was to offer advice on how short foreskins could be lengthened. None of them said a word about irritation, inflammation, secretions or any of the other perverse obsessions which agitated Victorian medicos. For further details, see <a href="http://www.cirp.org/library/history/hodges1/" rel="noopener" target="_blank">Frederick Hodges, Phimosis in antiquity</a>. 3. The claim about Louis XV is nonsense. His only problem was a frenulum breve, corrected without circumcision. (See G. Androutsos, "Le phimosis de Louis XVI (1754-1793) aurait-il ete a l'origine de ses difficultes sexuelles et de sa fecundite retardee?" Progres Urologique, Vol. 12 (1), 2002) 4. Although the ancient Hebrews were heavily into blood (as in animal sacrifices etc), it is highly unlikely that they knew anything about its clotting properties in infants. Circumcision on the eighth day had a strictly ritual significance, connected with the seven days the Lord had taken to create and people the earth, and the time needed for the mother to purge the impurity induced by childbirth. The mother could be cleansed of her own polluted blood only by the shedding of purifying blood from her son's penis. (For details see Laurence Hoffman, Covenant of blood: Circumcision and gender in rabbinic Judaism, Chicago University Press, 1996) 5. This is the notorious Gomco clamp, invented by Hiram S. Yellen and Aaron Goldstein in 1935, and promoted by (you guessed it), the American Journal of Obstetrics and Gynecology. It was certainly never bloodless, nor free from "complications", but it marked the arrival of the "high and tight" American style of circumcision, in which every last shred of tissue was excised, leaving the remaining skin of the penis "tight as a drum". Americans have become very attached to this flayed look; there are even fetishistic internet communities which celebrate it as a mark of manliness. </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 Should he be circumcised? (1941) darby