1 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"> <h1>Where is the voice of the man the child will become?</h1> <h2>Defending the child's right to an open future</h2> Letter from Doctors Opposing Circumcision on case of Boldt v. Boldt In the Fall 2009 issue of the Journal of Clinical Ethics, the authors of papers from a panel discussion at the 2008 Annual Meeting of the American Society for Bioethics and the Humanities reported on a common quandary in clinical ethics, made more challenging by the age of the child-patient. This was the case of “Misha” (Jimmy) Boldt, an Oregon child who faced, for five years, uninvited conversion, including circumcision, occasioned by a religious epiphany his custodial father claimed to have undergone. Each of the authors on the panel had a different perspective: Dena S. Davis, JD, PhD, [1] was the originator and moderator of the panel Janet L. Dolgin, PhD, JD, commented on the legal/sociological aspects; [2] Douglas S. Diekema, MD, MPH, commented on the medical/clinical aspects; [3] and Noam Zohar, PhD, commented on the religious/philosophical issues. [4] Our international physicians’ organization, Doctors Opposing Circumcision (D.O.C.), filed two amicus curiae (friend of the court) briefs in the case, [5] and attended a hearing on 22 April 2009 during which the child, by then 14, testified under oath and on the record in an Oregon court that he did not wish to convert to Judaism (his father’s newly adopted religion), he did not wish to be circumcised, and he did not wish to live with his father any longer. [6] The child’s testimony showed courage and took a risk that he would be ignored, as children too often are. Because it would have been far easier for Misha to accede to his custodial father’s wishes than to defy him in public, perhaps it can be assumed his testimony was truthful. Indeed, the child returned home with his father that day. In September 2009, facing a custody hearing he was likely to lose, the father voluntarily agreed to give up physical custody of Misha to his mother, with court approval. The child’s proposed circumcision, at one point only hours away, remains judicially prohibited. None of the amicus groups that supported the father’s legal position all the way to the U.S. Supreme Court — and back to Oregon — appeared at the hearing on 22 April 2009 to hear the child’s actual “voice” (nor did they express any written sympathy for the plight of the child throughout the proceedings). [7] Our international physicians’ group was pleased to read that Diekema and Zohar stated that the child’s preference must be sought. [8] In this instance that would have been problematic, because there was no way to determine whether the father, who had full custody of the boy for many years, had not systematically steeped the child in his own beliefs. This is a common and challenging scenario in pediatric bioethics. There was, our physicians’ group believed, another voice that needed to be heard — that of the man Misha would soon become. Thus we were stung by the suggestion of Dolgin in ICE that we had ignored the voice of Misha, [9] and so did him a disservice for our own ideological reasons. We did urge the court to protect the child from an irrevocable decision he might later regret — but only if Misha supported his father reflexively. In that sense Dolgin was half correct — and only in the short-term It is overly simplistic to frame this ethical puzzle as fully solvable by merely listening attentively to the voice of the child. Our entire rationale in this case was not only to defend, cautiously, the voice of the child — which might potentially have been manipulated by adults — but also to give a voice to the man this boy is soon to become. That voice, or any voice from within the child, was entirely missing until the end of the five-year litigation. But it may be found throughout our two voluminous briefs on Misha’s behalf. [10] In all, four attorneys eventually contributed more than $80,000 in pro bono legal time to hear the voice of Misha, the future man, and, by inference, others in his situation. Contributions poured in from a half-dozen countries. Even so, ultimately Misha did the heavy lifting, finding within himself the beginnings of his forthright adult voice. We live the bulk of our lives — 60 or so years — intellectually independent from our birth families, even if we are emotionally tied to them, as autonomous individuals with the right to determine our own beliefs and the responsibility to extend the same freedom to our children. The late philosopher Joel Feinberg said that children are entitled to an “open future,” one whose options are not foreclosed by whimsical (or even pious, heartfelt) decisions of their parents, and who ought to be protected from decisions of their own that they may come to regret. [11] The cosmetic surgery or tattoo that a discontented young adolescent might crave, as Diekema warns, comes to mind. [12] Misha/Jimmy Boldt now has an open future; he can schedule his own circumcision at age 18 for religious reasons — or for no reason at all. He can study to become an observant Jew if he wishes, which would be much more credible for being his personal choice. Following the path of millions of secular Jews worldwide, he could also become an agnostic or an atheist, or anything in between. Indeed, we have no way of knowing what personal beliefs a child will develop. We would argue further that parents have no right to force a child to adopt their beliefs merely to reaffirm their own choices. Beyond issues of belief, do we, as parents, acquire a derivative right to mark our child’s body with an indelible symbol of our own belief? For example, in some quarters of fundamentalist Shiite belief, parents slash their child’s forehead three times during Ashura, so that blood flows down the child’s face to memorialize the death of the martyred saint Imam Hussein, beheaded by Sunnis in the year 780. The child is said to be protected from pain or harm by his or her faith. The ritual is repeated each year, even with toddlers. [13] Should Shiite parents be credited with honest piety and their toddlers with independent belief? Or should we attempt to forbid this practice (in North America, anyway), as it presents risks to children whose beliefs cannot yet be determined and whose scars, physical and psychological, may be permanent? One reason this particular religious practice may seem repellent is that, like female genital cutting, it is unfamiliar. Richard Dawkins, DPhil, Oxford University, has suggested that raising a child in a specific religion, to the exclusion of exposure to other beliefs including skepticism, constitutes child abuse.” [14] Perhaps that is too drastic, but it is a provocative thought in a world that includes too many young suicide bombers. Thus there is a lesson in Misha’s case to guide pediatric care-providers: the voice of the child, as Diekema touches upon but does not elaborate, may be the product of many sources: whims of the child, whims of the family, remnant memes of culture the child has been taught to parrot. Thus care-providers will do well to ignore the clamor and remain focused on what is best for the child qua future adult, preserving, when possible, all of the child’s options to be exercised, autonomously, later. That logically eliminates all occasions in which the child’s options are foreclosed, without therapeutic justification, for reasons the child-now-an-adult may regret. In the medical setting, that means avoiding procedures that humor the family at the expense of the child, who is the only patient and an adult-in-process, whom we are charged to protect. Examples include therapeutically premature, cosmetic “normalization” surgeries like otoplasty or blepharoloplasty (changing an Asian double eyelid), or precipitous gender assignment of the intersexed, when these could wait for the adult child’s expressed preference. Respect for a child’s right to an open future fully obviates the merely cultural, non-therapeutic, surgical modification of minors, including cosmetic labioplasty (alas, on the rise), [15] cosmetic piercing or reduction of the labia or foreskin, tattooing, scarification, circumcision of either gender, and the like. All reduce a child’s options and brand the child as the possession of the parents, with no regard to his or her autonomy as a future adult. Without proven therapeutic justification and pressing necessity, none enhance the child or credit his or her right to an open future or the right to choices — including physical appearance and sexual functioning — of his or her own. Finally, we were disturbed and dismayed by a footnote in Dolgin’s article that could be seen to suggest that the president of Doctors Opposing Circumcision, George C. Denniston, MD, may be anti-Semitic, which is entirely unfounded. [16] In closing, children who are welcomed, gently, into their birth communities have been given the gift of Joel Feinberg’s “open future.” They may embrace their community or they may eventually drift away; there is no way to tell, in advance, what they will choose. But, importantly, their options are left open, and none of their body parts will have been surgically modified or removed — without their consent — prior to the moment when we will be able to hear the voices of the adults they will become. John V. Geisheker, JD, LLM Executive Director, General Counsel Doctors Opposing Circumcision 2040 Westlake Avenue North, Suite 420 Seattle, Washington 98109 <h3>References</h3> 1. D.S. Davis, “Boldt v. Boldt,” The journal of Clinical Ethics 20, no. 3 (Fall 2009): 241-3. 2. J.L. Dolgin, “Where Is the Child? Circumcision and Custody in Boldt v. Boldt,” The Journal of Clinical Ethics 20, no. 3 (Fall 2009): 244-50. 3. D.S. Diekema, “Boldt v. Boldt: A Pediatric Ethics Perspective,” The Journal of Clinical Ethics 20, no. 3 (Fall 2009): 251-7. 4. N. Zohar, “Circumcision, Conversion, and Deciding for a Minor: Some Jewish Perspectives,” The Journal of Clinical Ethics 20, no. 3 (Fall 2009): 258-61. 5. “Boldt v. Boldt: Brief of Amicus Curiae, Doctors Opposing Circumcision, in Support of the Petition for Review,” http://www.doctorsopposingcircumcision.org/ pdf/2007-04BoldtReview.pdf, p. 3, accessed 13 November 2009, and as a record of the State of Oregon Court system; “Brief on the Merits of Amicus Curiae, Doctors Opposing Circumcision,” http://www.doctorsopposingcircumcision. org/pdf/2007-04BoldtReview.pdf, p. 2, accessed 13 November 2009, also as a record of the State of Oregon Court system. 6. In the Circuit Court of the State of Oregon, County of Jackson, In the matter of the marriage of James H. Boldt and Lia Boldt, Case 98-2318-D3(8), Judge’s Order signed June 2, 2009, filed and received June 3, 2009. 7. Through their lawyers, the American Jewish Congress, the American Jewish Committee, the Anti-Defamation League, and the Union of Orthodox Jewish Congregations of America. 8. Zohar writes, “Since the validity of the conversion will depend on the eventual assent of the young man, it seems nothing much would be lost by waiting with the ritual until he reaches the age of competence, at which point he shall be able to decide for himself, both with regard to the circumcision and to the conversion as a whole.” Zohar, see note 4 above, p. 261. 9. Dolgin writes, “The assumptions behind that convergence of opinion reflect a model of childhood … on which the parents and the amici curiae all relied — a model here referred to as “traditional” … between the traditional model of childhood and the individualist model, society and the law have etched a third model of childhood. Referred to here as the “transforming” model of childhood, it bears incidents of each of the other two models and differs from both. This model recognizes the autonomy and individuality of some children, in some settings, to some degree, and it defines some children, in other settings, as dependent and unequal.” Dolgin, see note 2 above, p. 247. 10. At no time did any staff member of Doctors Op¬posed to Circumcision, legal or medical, have even the slightest contact with the mother or the child, lest we be accused in open court of influencing the child’s “voice” ourselves, risking our neutral amicus status. We urged the Oregon Supreme Court to bifurcate and analyze separately the issues of custody and the claimed legality of the impending circumcision, whether unwanted or not (issues the court eventually commingled, unfortunately). At no time did we take any position with respect to which parent might be the better custodian for the child. See: “Boldt v. Boldt: Brief of Amicus Curiae,” note 5 above. 11. J. Feinberg, “The Child’s Right to an Open Future,” in Whose Child? Children’s Rights, Parental Authority, and State Power, ed. W. Aiken and H. LaFollette (Totawa, N.J.: Littlefield, Adams, 1980); also in Freedom and Fulfilment: Philosophical Essays (Princeton University Press, 1992), 12. Diekema, see note 3 above, p. 255. 13. Some recent photos of toddlers commemorating Ashura are posted at http://atlasshrugs2000. typepad.com/ atlas_shrugs/2009/01/islam-celebrate.html, accessed 13 November 2009. 14. R. Dawkins, “Childhood, Abuse, and the Escape from Religion,” in The God Delusion (New York: Houghton Mifflin, 2006), 309 et seq. 15. See, for instance Liao LM, Michala L, Creighton SM, Labial surgery for well women: A review of the literature, British Journal of Gynecology 117 (1) January 2010, 20-25: “Medically non-essential surgery to the labia minora is being promoted as an effective treatment for women's complaints, but no data on clinical effectiveness exist”. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/19906048, accessed 13 November 2009. 16. Dolgin, see note 2 above, note 41, p. 249 Journal of Clinical Ethics (New York), 21 (1), Spring 2010, 86-88 </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 Boldt case: Letter to Journal of Clinical Ethics darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Where is the voice of the man the child will become?</h1> <h2>Defending the child's right to an open future</h2> Letter from Doctors Opposing Circumcision on case of Boldt v. Boldt In the Fall 2009 issue of the Journal of Clinical Ethics, the authors of papers from a panel discussion at the 2008 Annual Meeting of the American Society for Bioethics and the Humanities reported on a common quandary in clinical ethics, made more challenging by the age of the child-patient. This was the case of “Misha” (Jimmy) Boldt, an Oregon child who faced, for five years, uninvited conversion, including circumcision, occasioned by a religious epiphany his custodial father claimed to have undergone. Each of the authors on the panel had a different perspective: Dena S. Davis, JD, PhD, [1] was the originator and moderator of the panel Janet L. Dolgin, PhD, JD, commented on the legal/sociological aspects; [2] Douglas S. Diekema, MD, MPH, commented on the medical/clinical aspects; [3] and Noam Zohar, PhD, commented on the religious/philosophical issues. [4] Our international physicians’ organization, Doctors Opposing Circumcision (D.O.C.), filed two amicus curiae (friend of the court) briefs in the case, [5] and attended a hearing on 22 April 2009 during which the child, by then 14, testified under oath and on the record in an Oregon court that he did not wish to convert to Judaism (his father’s newly adopted religion), he did not wish to be circumcised, and he did not wish to live with his father any longer. [6] The child’s testimony showed courage and took a risk that he would be ignored, as children too often are. Because it would have been far easier for Misha to accede to his custodial father’s wishes than to defy him in public, perhaps it can be assumed his testimony was truthful. Indeed, the child returned home with his father that day. In September 2009, facing a custody hearing he was likely to lose, the father voluntarily agreed to give up physical custody of Misha to his mother, with court approval. The child’s proposed circumcision, at one point only hours away, remains judicially prohibited. None of the amicus groups that supported the father’s legal position all the way to the U.S. Supreme Court — and back to Oregon — appeared at the hearing on 22 April 2009 to hear the child’s actual “voice” (nor did they express any written sympathy for the plight of the child throughout the proceedings). [7] Our international physicians’ group was pleased to read that Diekema and Zohar stated that the child’s preference must be sought. [8] In this instance that would have been problematic, because there was no way to determine whether the father, who had full custody of the boy for many years, had not systematically steeped the child in his own beliefs. This is a common and challenging scenario in pediatric bioethics. There was, our physicians’ group believed, another voice that needed to be heard — that of the man Misha would soon become. Thus we were stung by the suggestion of Dolgin in ICE that we had ignored the voice of Misha, [9] and so did him a disservice for our own ideological reasons. We did urge the court to protect the child from an irrevocable decision he might later regret — but only if Misha supported his father reflexively. In that sense Dolgin was half correct — and only in the short-term It is overly simplistic to frame this ethical puzzle as fully solvable by merely listening attentively to the voice of the child. Our entire rationale in this case was not only to defend, cautiously, the voice of the child — which might potentially have been manipulated by adults — but also to give a voice to the man this boy is soon to become. That voice, or any voice from within the child, was entirely missing until the end of the five-year litigation. But it may be found throughout our two voluminous briefs on Misha’s behalf. [10] In all, four attorneys eventually contributed more than $80,000 in pro bono legal time to hear the voice of Misha, the future man, and, by inference, others in his situation. Contributions poured in from a half-dozen countries. Even so, ultimately Misha did the heavy lifting, finding within himself the beginnings of his forthright adult voice. We live the bulk of our lives — 60 or so years — intellectually independent from our birth families, even if we are emotionally tied to them, as autonomous individuals with the right to determine our own beliefs and the responsibility to extend the same freedom to our children. The late philosopher Joel Feinberg said that children are entitled to an “open future,” one whose options are not foreclosed by whimsical (or even pious, heartfelt) decisions of their parents, and who ought to be protected from decisions of their own that they may come to regret. [11] The cosmetic surgery or tattoo that a discontented young adolescent might crave, as Diekema warns, comes to mind. [12] Misha/Jimmy Boldt now has an open future; he can schedule his own circumcision at age 18 for religious reasons — or for no reason at all. He can study to become an observant Jew if he wishes, which would be much more credible for being his personal choice. Following the path of millions of secular Jews worldwide, he could also become an agnostic or an atheist, or anything in between. Indeed, we have no way of knowing what personal beliefs a child will develop. We would argue further that parents have no right to force a child to adopt their beliefs merely to reaffirm their own choices. Beyond issues of belief, do we, as parents, acquire a derivative right to mark our child’s body with an indelible symbol of our own belief? For example, in some quarters of fundamentalist Shiite belief, parents slash their child’s forehead three times during Ashura, so that blood flows down the child’s face to memorialize the death of the martyred saint Imam Hussein, beheaded by Sunnis in the year 780. The child is said to be protected from pain or harm by his or her faith. The ritual is repeated each year, even with toddlers. [13] Should Shiite parents be credited with honest piety and their toddlers with independent belief? Or should we attempt to forbid this practice (in North America, anyway), as it presents risks to children whose beliefs cannot yet be determined and whose scars, physical and psychological, may be permanent? One reason this particular religious practice may seem repellent is that, like female genital cutting, it is unfamiliar. Richard Dawkins, DPhil, Oxford University, has suggested that raising a child in a specific religion, to the exclusion of exposure to other beliefs including skepticism, constitutes child abuse.” [14] Perhaps that is too drastic, but it is a provocative thought in a world that includes too many young suicide bombers. Thus there is a lesson in Misha’s case to guide pediatric care-providers: the voice of the child, as Diekema touches upon but does not elaborate, may be the product of many sources: whims of the child, whims of the family, remnant memes of culture the child has been taught to parrot. Thus care-providers will do well to ignore the clamor and remain focused on what is best for the child qua future adult, preserving, when possible, all of the child’s options to be exercised, autonomously, later. That logically eliminates all occasions in which the child’s options are foreclosed, without therapeutic justification, for reasons the child-now-an-adult may regret. In the medical setting, that means avoiding procedures that humor the family at the expense of the child, who is the only patient and an adult-in-process, whom we are charged to protect. Examples include therapeutically premature, cosmetic “normalization” surgeries like otoplasty or blepharoloplasty (changing an Asian double eyelid), or precipitous gender assignment of the intersexed, when these could wait for the adult child’s expressed preference. Respect for a child’s right to an open future fully obviates the merely cultural, non-therapeutic, surgical modification of minors, including cosmetic labioplasty (alas, on the rise), [15] cosmetic piercing or reduction of the labia or foreskin, tattooing, scarification, circumcision of either gender, and the like. All reduce a child’s options and brand the child as the possession of the parents, with no regard to his or her autonomy as a future adult. Without proven therapeutic justification and pressing necessity, none enhance the child or credit his or her right to an open future or the right to choices — including physical appearance and sexual functioning — of his or her own. Finally, we were disturbed and dismayed by a footnote in Dolgin’s article that could be seen to suggest that the president of Doctors Opposing Circumcision, George C. Denniston, MD, may be anti-Semitic, which is entirely unfounded. [16] In closing, children who are welcomed, gently, into their birth communities have been given the gift of Joel Feinberg’s “open future.” They may embrace their community or they may eventually drift away; there is no way to tell, in advance, what they will choose. But, importantly, their options are left open, and none of their body parts will have been surgically modified or removed — without their consent — prior to the moment when we will be able to hear the voices of the adults they will become. John V. Geisheker, JD, LLM Executive Director, General Counsel Doctors Opposing Circumcision 2040 Westlake Avenue North, Suite 420 Seattle, Washington 98109 <h3>References</h3> 1. D.S. Davis, “Boldt v. Boldt,” The journal of Clinical Ethics 20, no. 3 (Fall 2009): 241-3. 2. J.L. Dolgin, “Where Is the Child? Circumcision and Custody in Boldt v. Boldt,” The Journal of Clinical Ethics 20, no. 3 (Fall 2009): 244-50. 3. D.S. Diekema, “Boldt v. Boldt: A Pediatric Ethics Perspective,” The Journal of Clinical Ethics 20, no. 3 (Fall 2009): 251-7. 4. N. Zohar, “Circumcision, Conversion, and Deciding for a Minor: Some Jewish Perspectives,” The Journal of Clinical Ethics 20, no. 3 (Fall 2009): 258-61. 5. “Boldt v. Boldt: Brief of Amicus Curiae, Doctors Opposing Circumcision, in Support of the Petition for Review,” http://www.doctorsopposingcircumcision.org/ pdf/2007-04BoldtReview.pdf, p. 3, accessed 13 November 2009, and as a record of the State of Oregon Court system; “Brief on the Merits of Amicus Curiae, Doctors Opposing Circumcision,” http://www.doctorsopposingcircumcision. org/pdf/2007-04BoldtReview.pdf, p. 2, accessed 13 November 2009, also as a record of the State of Oregon Court system. 6. In the Circuit Court of the State of Oregon, County of Jackson, In the matter of the marriage of James H. Boldt and Lia Boldt, Case 98-2318-D3(8), Judge’s Order signed June 2, 2009, filed and received June 3, 2009. 7. Through their lawyers, the American Jewish Congress, the American Jewish Committee, the Anti-Defamation League, and the Union of Orthodox Jewish Congregations of America. 8. Zohar writes, “Since the validity of the conversion will depend on the eventual assent of the young man, it seems nothing much would be lost by waiting with the ritual until he reaches the age of competence, at which point he shall be able to decide for himself, both with regard to the circumcision and to the conversion as a whole.” Zohar, see note 4 above, p. 261. 9. Dolgin writes, “The assumptions behind that convergence of opinion reflect a model of childhood … on which the parents and the amici curiae all relied — a model here referred to as “traditional” … between the traditional model of childhood and the individualist model, society and the law have etched a third model of childhood. Referred to here as the “transforming” model of childhood, it bears incidents of each of the other two models and differs from both. This model recognizes the autonomy and individuality of some children, in some settings, to some degree, and it defines some children, in other settings, as dependent and unequal.” Dolgin, see note 2 above, p. 247. 10. At no time did any staff member of Doctors Op¬posed to Circumcision, legal or medical, have even the slightest contact with the mother or the child, lest we be accused in open court of influencing the child’s “voice” ourselves, risking our neutral amicus status. We urged the Oregon Supreme Court to bifurcate and analyze separately the issues of custody and the claimed legality of the impending circumcision, whether unwanted or not (issues the court eventually commingled, unfortunately). At no time did we take any position with respect to which parent might be the better custodian for the child. See: “Boldt v. Boldt: Brief of Amicus Curiae,” note 5 above. 11. J. Feinberg, “The Child’s Right to an Open Future,” in Whose Child? Children’s Rights, Parental Authority, and State Power, ed. W. Aiken and H. LaFollette (Totawa, N.J.: Littlefield, Adams, 1980); also in Freedom and Fulfilment: Philosophical Essays (Princeton University Press, 1992), 12. Diekema, see note 3 above, p. 255. 13. Some recent photos of toddlers commemorating Ashura are posted at http://atlasshrugs2000. typepad.com/ atlas_shrugs/2009/01/islam-celebrate.html, accessed 13 November 2009. 14. R. Dawkins, “Childhood, Abuse, and the Escape from Religion,” in The God Delusion (New York: Houghton Mifflin, 2006), 309 et seq. 15. See, for instance Liao LM, Michala L, Creighton SM, Labial surgery for well women: A review of the literature, British Journal of Gynecology 117 (1) January 2010, 20-25: “Medically non-essential surgery to the labia minora is being promoted as an effective treatment for women's complaints, but no data on clinical effectiveness exist”. Abstract at http://www.ncbi.nlm.nih.gov/pubmed/19906048, accessed 13 November 2009. 16. Dolgin, see note 2 above, note 41, p. 249 Journal of Clinical Ethics (New York), 21 (1), Spring 2010, 86-88 </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 Boldt case: Letter to Journal of Clinical Ethics 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"> The following article was published in the Village Voice in June 1975. Sub-headings have been added for ease of reading. <h3>The argument over circumcision: The case against</h3> <h4>by Sylvia Topp</h4> Circumcision is the only preventive operation left in <div> American medicine; the automatic removal of tonsils, appendix and adenoids went out of style years ago. </div> If you're the parents of a boy, chances are you had him circumcised â€“ over 80 per cent of American parents do. And chances are you had him circumcised without giving it a second thought. But is there any other part of your child's body you would automatically let a doctor remove? And without an anaesthetic? I decided not to circumcise my son when he was born four years ago, and since then I have wondered why parents are so docile in accepting such a bizarre operation. It amazes me that they think nothing of letting their child experience, as one of his first sensations in life, what must be the horrible pain and traumatic shock of being held down and having apiece of his penis cut off. And they don't even ask why. In preparation for this article I read all the current journal literature on circumcision. I interviewed by telephone, at random, 10 per cent of Manhattan's obstetricians; I questioned many recent mothers of boys; and I talked to every man I could find who had either not been circumcised at all or had been circumcised later than infancy. <h4>The blame game</h4> What shocked me most was that over half Manhattan's obstetricians consider circumcision unnecessary. Yet they continue to circumcise over 90 per cent of the boys they deliver because they believe it's useless to try to convince the parents not to. In fact, most of them don't even try. Yet two-thirds of the mothers I interviewed said they would not have had their sons circumcised if their doctor had advised against it, and the others were not sure. <h4>Origins of circumcision</h4> The theories of the origin of circumcision are numerous and confusing. The practice is firmly based in history, which is one of the reasons no questions are asked. A practical theory is that the original people practising circumcision lived in arid conditions where the operation had appeal as a prophylactic measure against balanitis (inflammation of the head of the penis), since sand might collect under the foreskin and be hard to get out, given the scarcity of water (<a href="http://www.cirp.org/library/general/leitch1/" rel="noopener" target="_blank">Leitch 1970</a>). Some think circumcision stems from the primitive custom of carrying off parts of the body â€“ the Indians took skulls, others took genitals â€“ of a defeated enemy as a trophy or testimony of manly prowess in battle. It may also have roots in the ritual castration practised in ancient matriarchal religions, but since castration inherently (and sharply) limits the perpetuation and growth of a people, a token mutilation, such as circumcision, was found far more practical (Bolande 1969). Freud also viewed circumcision as a symbol of castration, but as an act perpetrated by the father out of fear and jealousy of the son. Others claim that circumcision represents a subconscious wish on the part of the male to become female. In some societies circumcision is performed to reduce what is considered excess sexual energy, thus having a civilizing effect; in others it proves an adolescent's ability to endure pain and thereby be accepted as an adult (<a href="http://www.cirp.org/library/general/morgan/" rel="noopener" target="_blank">Morgan 1965</a>). Circumcision is practised by only one sixth of the world's population â€“ throughout the near east and parts of Africa, among the Moslems of India and south-east Asia, by the Australian Aboriginals and some Polynesians, and by some Indians of north and south America (<a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">Gairdner 1949</a>). <h4>Circumcision in the United States</h4> The American practice was taken from the Jews, who began arriving here in large numbers from eastern Europe at the end of the nineteenth century. Christians had not practised circumcision since the teachings of St Paul actually dissuaded them from it. And it wasn't until the twentieth century that doctors started developing theories that circumcision was medically beneficial. Although it caught on to some extent in England, Australia and Canada, the United States was the only western country where circumcision became really popular. It never became the prevailing custom in any European country but England. Its popularity has been decreasing in England, Australia and Canada for some years now, and I hope that America will soon join that trend. Although the <a href="http://www.cirp.org/library/statements/aap/" rel="noopener" target="_blank">American Academy of Pediatrics</a> issued a statement of policy in October 1972 which began: "Neonatal circumcision should not be considered a routine procedure", there has been little noticeable change in the circumcision policy in this country so far. <h4>Functions of the foreskin</h4> Because hardly anyone in this country has ever seen a foreskin, it might be well to describe its function. The foreskin protects the head of the penis, or glans, keeping it moist and sensitive at all times. It is drawn back during an erection or sexual intercourse (and for cleaning purposes), so the otherwise unexposed glans, which is provided with special sensory receptors for appreciating pleasurable sensations, is stimulated only during these times. During intercourse the foreskin is pushed back and forth, at times forming a wide ring at the base of the penis â€“ a sort of natural French tickler. When the foreskin has been removed, the head of the penis is constantly stimulated and loses much of its sensitivity; it dries out, and the skin becomes tough by necessity because it is constantly rubbing against clothing. Since, according to most people I asked, an uncircumcised penis affords more pleasure for both parties during sex, perhaps circumcision is part of a Puritan conspiracy to make sex ess enjoyable. Or, because the moistness of the uncircumcised penis acts as a natural lubricant during intercourse, perhaps circumcision is simply a vast Vaseline conspiracy! In a young child the foreskin protects he head of the penis from irritation by the ammonia in urine. Sometimes this irritation results in a meatal ulcer, a condition found only in circumcised boys. In addition, Ritter's disease (a staphylococcal skin infection) and meatal stenosis (a narrowing and obstruction of the opening of the urethra at the head of the penis) also occur only in the circumcised. <h4>Arguments for circumcision</h4> But what are the arguments most commonly advanced for circumcision? The diseases associated with an uncircumcised penis are phimosis, cancer of the cervix, and cancer foreskin the penis. But many doctors now think that these fears are based on false premises. Phimosis Phimosis, the inability to retract the foreskin, was found to be normal in infants; in four out of five six-month-old males, half of the one-year-olds and 10 per cent of the three-year-olds, the foreskin is still attached to the head of the penis (<a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">Gairdner 1949</a>). At the age of four or five, separation can be completed, if necessary by gently manipulation or with a probe. Cervical cancer Cancer of the cervix was thought to be caused by an uncircumcised penis, since Jewish women rarely got the disease and nearly all Jewish men are circumcised. Many doctors have discredited this theory, however, In Germany, Scandinavia, Switzerland and Japan, where circumcision is the exception, the incidence of cervical cancer is the same or less than in the United States, where circumcision is the rule. A study in India showed that although Muslim women, whose men are usually circumcised in youth, did get less cancer of the cervix than the Hindus, the Parsee women and the Indian Christian women, who attach great importance to cleanliness, got even less cancer of the cervix than the Moslems, and their men are never circumcised (Khanolkar 1950). In England a study showed no difference in the circumcision status of the husbands of 54 cervical cancer patients and 54 controls (<a href="http://www.cirp.org/library/disease/cancer/aitken-swan1/" rel="noopener" target="_blank">Aitken-Swan and Baird 1965</a>), and an American study had similar results (Terris et al 1973). An investigation in Kenya revealed no significant differences in the number of cases of cervical cancer in women of tribes whose men were or were not circumcised (<a href="http://www.cirp.org/library/general/preston/" rel="noopener" target="_blank">Preston 1970</a>). In Ethiopia the incidence of cancer of the cervix is higher than or comparable to that of Europe and the United states, even though 90 per cent of Ethiopian males are ritually circumcised (<a href="http://www.cirp.org/library/general/leitch1/" rel="noopener" target="_blank">Leitch 1970</a>). Other variables, besides the absence of circumcision, have been associated with a high risk of developing cervical cancer. These include low socio-economic status, early marriage, multiple marriages, extramarital relations, coitus at an early age, frequent coitus, non-use of contraceptives, syphilis and multiparity [i.e. having many children] (<a href="http://www.cirp.org/library/general/preston/" rel="noopener" target="_blank">Preston 1970</a>). The assumption is that smegma, present under the foreskin, is cancer-producing. However, this disease was unaffected by the use of a condom, which should protect the women from smegma (<a href="http://www.cirp.org/library/general/leitch1/" rel="noopener" target="_blank">Leitch 1970</a>). At any rate, having a circumcised husband is no insurance against cervical cancer, since even virgins get it, as do women who only have sexual relations with circumcised men. Also, Jewish women are more susceptible mow than they were at the beginning of the century, a difficult fact to explain (Wynder et al 1954). Cancer of the penis Cancer of the penis, a rare condition, is the only serious disease related to lack of circumcision. Only seven cases of penile cancer have been reported in western countries in men circumcised in infancy (<a href="http://www.cirp.org/library/general/leitch1/" rel="noopener" target="_blank">Leitch 1970</a>). However, the Zulus have a high rate, even though they practise routine circumcision (Klauber 1973). [NOTE: In South Africa it is the <a href="http://www.historyofcircumcision.net./templates/pages/ritual_circumcision_in_south_africa.html" rel="noopener" target="_blank">Xhosa who practise circumcision</a>, traditionally on boys in their late teens, not the Zulus.] Again, attempts have been made to implicate smegma, an obvious approach, since it is secreted under the foreskin, and thus only by uncircumcised men. However, these researchers have always reported negative results (Weiss 1964; Heins et al 1958; Fishman 1942). It is seldom mentioned than women also have foreskins and smegma-producing glands, and face a more difficult problem keeping the clitoral region free from smegma (if indeed any women considers she is dong this at all), since the clitoris is such a small organ compared to the penis of the male. Yet, cancer of the clitoris is extremely rare. More likely other factors are more important in causing penile cancer: a noon-retractable foreskin, which is the case in over half the males having cancer of the penis (Hanash et al 1970); a congenitally tight or long redundant foreskin (<a href="http://www.cirp.org/library/general/leitch1/" rel="noopener" target="_blank">Leitch 1970</a>; Lenowitz and Graham 1946; Dean 1935; Wolbarst 1932); poor hygiene, promiscuity, lack of prophylaxis, and failure to obtain treatment for minor inflammatory penile lesions (Schrek and Lenowitz 1947). It would seem that if a man can retract his foreskin and does keep it clean, the risk of cancer is virtually removed (Jolly 1964; <a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">Gairdner 1949</a>). In Scandinavia and Puerto Rico, where very few men are circumcised, the incidence of cancer of the penis is very low. Cancer of the penis can be treated if a doctor is seen right away. Most severe cases are not seen by any doctor until the disease is so far developed that it is too late to do anything. <h4>Preventive surgery an old fashioned fad</h4> Circumcision is the only preventive operation left in American medicine; the automatic removal of tonsils, appendix and adenoids went out of style years ago â€“ though more lives could be saved by routine appendectomy (advocated by nobody) than by routine circumcision. Also, bilateral simple mastectomy (removal of the breasts) in young girls would prevent far more breast cancer in later years than the penile cancer prevented by circumcision. "If a surgeon should perform one circumcision every 10 minutes, eight hours a day, five days a week, he would seem to be able to prevent one penile cancer by working steadily for between six and 29 years. Since a significant number of penile cancers are curable, still more time and labour might be required to prevent a fatality from this disease" (Marshall 1954). How many smokers pay any attention to the warnings about lung cancer? Most of them believe that the pleasure they get outweighs the higher risk of lung cancer â€“ a cancer far more deadly and non-treatable than cancer of the penis. Infection of the foreskin is another problem supposedly associated with non-circumcision. These infections are usually not serious, however, and not one of the uncircumcised men I interviewed mentioned any such problem. "Hygiene" is the most bizarre reason given for circumcision. What other part of your body would you consent to have surgically removed so that you would not have to wash it? Would you have all your fingernails and toenails pulled out so that dirt could not collect under them? Would you have your ear or your nose cut off so that you would not have to clan inside them? Surely the penis is an equally important part of the body, yet parents permit part of it to be cut off so that their sons will not have so much trouble cleaning it! <h4>Risks and complications</h4> The circumcision operation itself can result in infection and other complications; some complication occurred in 55 per cent of the babies in one study (<a href="http://www.cirp.org/library/procedure/patel/" rel="noopener" target="_blank">Patel 1966</a>). The infections following circumcision are usually mild, but thy can result in serious and sometimes fatal conditions, such as diphtheric infection of the wound, staphylococcal bronchopneumonia, staphylococcal septiceaemia resulting in osteomyelitis of the femur, tetanus, tuberculosis or urethritis (Byars and Trier 1958), and necrosis of the penis (Gallagher 1972). Other complications of circumcision arise from mistakes made by the doctor. They an result in deformity or dysfunction of the penis itself, and often require surgical repair. These include accidental amputation, cautery burns, bivalving of the glans, urethral fistula, concealed penis and erysipeloid infections (Burger 1974). Circumcision is often performed by inexperienced physicians or interns. One doctor says that on his daily hospital rounds in New York he frequently finds babies with ugly granulating wounds and others requiring surgical treatment to stop the bleeding. Many of these results are (more or less) remedied by the hospital staff without ever bringing them to the attention of the babies' parents. And then the pain and trauma of the operation should not be ignored. Although parents want to believe that the child will feel no pain, many doctors who have done circumcision operations vehemently deny this myth. It is normal for a boy to have an erection following the circumcision, which can separate the wound (Gottlieb). So on top of everything else, his first erection would be a painful one â€“ more trauma. Beside this, the head of the penis is at first so sensitive that it may bleed from rubbing on the diaper. <h4>Care of the uncircumcised penis</h4> An uncircumcised child must be properly cared for. First, it's not necessary (in fact, it's dangerous), to pull back the foreskin of a baby, no matter what your doctor tells you. The child does not need to be cleaned under the foreskin at this age. If his urine is coming out in a stream and not under pressure, then he is normal. If you forcibly retract the foreskin of a baby you can cause the head of the penis to be strangulated, a condition called paraphimosis, since the hole at that time is only large enough to allow urine to come through. It may be impossible to return the foreskin to its natural position, and the baby will have to be rushed to hospital for an operation. You can also tear the tissue that joins the foreskin to the head of the penis. When this tear heals the condition is called acquired phimosis: the foreskin and penis join together in scar tissue, making the foreskin non-retractable. After the age of four or five the area under the foreskin may be washed whenever the child bathes. No more attention has to be paid to cleaning this area than to cleaning other parts of the body. If someone suggested that you have your daughter circumcised, a custom practised fairly extensively throughout the world, with some medical backing even here, you would not say, "OK, why not?", but rather, "Why?" and expect a pretty good answer before you went ahead. Your son should be given as much consideration. The onus is on those who believe in circumcision to prove their case to you. Source: Sylvia Topp, "The argument over circumcision: The case against", Village Voice (New York), 16 June 1975, pp. 8-9 <h3>NOTE</h3> This article is interesting as one of the first protests against circumcision to appear in the popular press by a non-professional â€“ a New York journalist and mother who had been shocked at the idea of mutilating her child and who decided to look into the matter. The article is very much a product of its time, demonstrating how deeply decades of misinformation about the structure of the genitals and the causes of disease had seeped into popular understanding; even while rejecting the myth that circumcision was beneficial, the author accepted other myths â€“ that the origins of ritual circumcision lay in hygienic concerns (<a href="http://www.historyofcircumcision.net/templates/pages/the_riddle_of_the_sands.html" rel="noopener" target="_blank">the sand myth</a>), that the glans of the penis was particularly rich in pleasure sensing nerves, that the function of the foreskin was to preserve this sensitivity, that the foreskin had to be retractable by the time the boy was four or five, that sub-preputial moisture ("smegma") possibly was in some way harmful. (The reference to using a probe to separate foreskin from glans in a five-year-old boy is particularly unfortunate.) Today we would stress the ethical and human rights aspects of the problem â€“ the child's right to a whole body and to make his own decisions about his health, and the inherent value of the foreskin itself â€“ as paramount; yet Topp makes no more mention of these issues than the various medicos she diligently cites. Although the article cannot be taken as a reliable source of information about circumcision or advice on the care of the penis today, it is of great historical interest for three main reasons. First, it shows the poor state of 1970s medical knowledge about both the structure and function of the penis and the origins of diseases such as genital cancers (now known to be caused by a virus), and the extent to which doctors were still in the grip of Victorian myths. Second, it marks the point where the debate over the validity of routine circumcision moves out of the pages of the medical journals and into the popular media, no longer the exclusive preserve of the medically sanctified, but the property of an increasingly informed and critical public. Third, it indicates just how far, and in what ways, the debate over circumcision has advanced in the past quarter century; if there has been disappointingly little progress on the "pros and cons" side (enthusiasts still harp on about such hoary myths as cancer, venereal disease, phimosis) at least there is increasing awareness of the ethical issues and a willingness in major journals (such as the <a href="http://jme.bmjjournals.com/cgi/content/full/31/8/463">Journal of Medical Ethics</a>) to challenge the practice. </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 New York mother questions the doctors (1975) 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>Medical science in the service of Victorian morals</h4> The following article was originally given as a paper to the Fourth International Symposium on Sexual Mutilations, held at Lausanne, Switzerland, in August 1996. Although it may seem rather dated today, it blazed the research trail for others, and remains a milestone in the excavation of the true history of medically rationalised circumcision. It is a remarkable pioneering effort to uncover the truth by going back and reading the almost incredible things that doctors did not so long ago, and about which they reported, often with grisly detail, in their own professional journals. The thoroughness of the bibliography alone makes this paper one that no student of the history of circumcision can afford to ignore. <h2>A short history of enforced circumcision in the United States</h2> For the past 130 years the American medical industry has been involved in the business of removing part or all of the external sexual organs of male and female children. While the origins of sexual mutilations among prehistoric and primitive peoples is a matter for theory and speculation, the origin and spread of sexual mutilation in American medical practice can be precisely documented. Seen in the proper context of the entire scope of western history, the modern American enigma of institutionalized sexual mutilation is an historic aberration of profound significance and degree, one that could never have been predicted, and one that perhaps could not have been avoided. <h3>1. Modernization</h3> The introduction and spread of institutionalized secular sexual mutilation was a response to the tremendous social and cultural anxieties engendered by the effects of the rapid modernization and industrialization of the early decades of the nineteenth century. As the traditional rural-agrarian economy was transformed into an urbanized capitalist economy, parallel changes occurred in social structure, governmental and non-governmental institutions, demographics and technology. One significant result of these changes was the ascendancy of the middle class to positions of economic and political power. The emergent middle class was now in a position to reinterpret social mores and redefine the individual for all of society. As an outgrowth of the middle class, the medical establishment reflected and validated these social changes and offered treatment for the anxieties they inevitably produced, thereby laying the foundations of the modern therapeutic state â€“ defined by Thomas Szasz as the political order in which social controls are legitimized by the ideology of health [1]. For instance, in traditional agrarian society adulthood was considered to begin at puberty. Industrialized, middle class society extended the boundaries of childhood by ore than a decade so that middle class males could receive the specialized professional and academic training required by a modern industrialized society. The formidable anxieties engendered by this transformation found expression in an intensified focus on childhood sexuality. In conformity with middle class social mores, physicians theorized that childhood should be a period of complete asexuality and, consequently, that children should be kept ignorant of sexual and reproductive information until their delayed marriage. The functional significance of this change was that young people, who in previous generations had been expected to marry and commence sexual activity in early adolescence, were now required to restrain themselves from sexual activity and remain continent until they were in their twenties. Young people who were unable to suppress their sexual drives were subjected not only to social censure, but to medical interventions as well. <h3>2. Supporting medical theories</h3> <h4>2.1 Degenerative theory of disease and the notion of reflex neurosis</h4> For reasons unrelated to the rise of the American middle class, two French physicians in the 1820s, Xavier Bichat (1771-1802) [2] and Francois Broussais (1771-1838) [3], developed a new model of disease â€“ the theory degenerative disease. This model postulated that the human body was allotted a finite amount of vital energy which could either be conserved through correct living or permanently lost through wrong living. Energy depletion led to degeneration, which in turn led to the production of disease. Middle class American physicians readily adopted this theory, but they expanded it to imply that manifestations of sexuality necessarily represented life-threatening losses of vital energy. Non-procreative use of the sexual organs, even within marriage, was viewed as dangerous. The result was the formulation of the Reflex Neurosis Theory of Disease, which postulated that the sexual organs and the erotic sensations they produced were the cause of all human disease. To validate this theory, American physicians redefined normal human sexual behaviour, reproductive anatomy and sexual function in terms of pathology. Pathologization of sexual behaviour The pathologisation of normal sexual behaviour resulted in the masturbation hysteria. The term masturbation was frequently used in a generalised way to describe any sexual activity outside the context of heterosexual marital coitus for the purpose of procreation, but in practice a diagnosis of masturbation generally followed the discovery of a child's either having sexually stimulated him/herself or having engaged in sexual activity with another person. Physicians relied on spurious logic to support the pathologisation of sexual behaviour. Clinical interviews with patients suffering from what would today be ascribed to the effects of malnutrition, overwork, venereal disease, bacterial or viral infections, mental disorders, and tobacco or alcohol poisoning invariably revealed a past history of masturbatory activity. On this basis it was easy to conclude that masturbation had brought on these conditions. The inhabitants of the United States were at first reluctant to accept the theory that masturbation was harmful, and many resisted doctors' interference in the lives of their children; but the rising flood of articles in medical journals that allegedly proved the harm of masturbation gave physicians the power to overcome this resistance and enforce their own convictions. Pathologization of sexual anatomy In order to validate the Reflex Neurosis Theory of Disease, physicians were compelled to pathologize the three distinguishing features of the normal juvenile foreskin, namely, generous length, adherence to glans and narrowness of the preputial orifice. These perfectly natural qualities were demonized under the general diagnosis of phimosis. Physicians coined the term "congenital phimosis" to specify that the adhesion of the immature foreskin to the glans in infants was really a congenital birth defect. They adopted the term "acquired phimosis" to indicate a fictitious condition in which a previously detached foreskin became adherent as a result of masturbation. The term "hypertrophic phimosis" or "redundancy" indicated a type of phimosis whose sole symptom was a foreskin that doctors arbitrarily deemed to be "too long". Since the foreskin is the most highly innervated part of the penis, and since masturbation among normal (not circumcised) boys generally involves manually stimulating and manipulating the foreskin, and sliding the mobile sheath of the penile skin up and own the shaft (the structure of the foreskin facilitated a wide range of motion), masturbation was seen as a cause of reflex disease through the medium of the foreskin. In the absence of the germ theory of disease, American physicians who did not regard masturbation alone as the primary cause of disease, attributed bacterial, viral and fungal diseases, as well as the pathological symptoms of malnutrition, overwork etc, to phimosis. Even in the absence of a diagnosis of phimosis, the foreskin itself was indicted as a cause of disease. Phimosis in females, defined as adherence of the clitoral prepuce to the clitoris, was viewed in much the same light. Pathologization of sexual function In accordance with the Reflex Theory of Disease, erotic sensation was redefined as irritation, orgasm was redefined as convulsion and erection was redefined as priapism. Physicians argued that these manifestations of sexual function were both symptoms and cause of disease and, likewise, that stimulation of the genitals could cause problems in distant parts of the body, such as the heart, brain, back, digestive organs and eye. The pathologization of normal male sexual function soon led to the invention of spermatorrhoea. Physicians defined spermatorrhoea as a serious venereal disease whose sole symptom was the ejaculation of sperm under any condition other than marital intercourse. The release of sperm in nocturnal emissions or masturbation was now classified as a venereal disease as dangerous as any other â€“ if not more dangerous because more people suffered from it more often. Hundreds of case reports published in medical journals all over the western world proved, to the satisfaction of most physicians, that spermatorrhoea was a real and dangerous disease. French physicians such as Claude-Francois Lallemande (1790-1853) and Leopold Deslandes (1797-1852) [4] were the acknowledged world authorities n the treatment of spermatorrhoea. Their preferred treatment was to insert long steel rods, also known as bougies, up the urethra and cauterize the passage, as well as the prostate and seminal vesicle, with silver nitrate. This was supposed to slow the production and halt the loss of sperm. Lallemande also advised amputation of the foreskin in difficult cases of spermatorrhoea and in order to stop masturbation among boys. In the United States Lallemande's enthusiasm for circumcision caught the attention of Edward H. Dixon (1808-1880). In his Treatise on the Diseases of the Sexual Organs (1845) he became one of the first north American advocates of both therapeutic foreskin amputation (to correct an existing problem) and of the universal imposition of the ancient Hebrew rite of infant circumcision (as a prophylactic against possible future problems). [6] Dixon claimed that phimosis, which he defined as an elongation of the foreskin, was the primary cause of most serious diseases. At first Dixon and Lallemande were largely ignored, and for the next two decades circumcision was overlooked while other surgical treatments for masturbation, phimosis and spermatorrhoea were developed and trialled. <h4>2.2 Castration</h4> Since surgical amputation of body parts in general was considered thoroughly modern and advanced, physicians experimented with specific amputations of the sexual organs to treat masturbation. In 1842 the Boston Medical and Surgical Journal (now the New England Journal of Medicine) reported that Dr Winslow Lewis of Boston had severed and tied the left spermatic artery of a young man being treated for "excessive masturbation" [7]. In 1843 one of the first reports of castration for masturbation was published by Dr Josiah Crosby of Meredith Bridge, New Hampshire. After cathartics and emetics had failed to cure a 22-year old man, whose health had reportedly been ruined by masturbation, Crosby castrated him and pronounced him cured. [8] The American medical profession responded with interest. Two years later Dr Samuel McMinn published, in the Boston and Medical Surgical journal, a revolutionary report about an insane woman living near Tuscaloosa, who had taken a razor and amputated "the whole of her external organs of generation." McMinn arrived at the scene and fully expected the woman to die from her massive wounds, but she survived. As her wounds healed, her reason miraculously returned. Fascinated by this outcome, McMinn speculated: <div>And the results of this case may suggest a remedy. Whether it was the great loss of blood, the removal of the organs and the counter-irritation consequent that cured the patient is a question for the consideration of the profession. [9]</div> The title he gave to his report, however, betrayed his own, and presumably the journal editor's opinion as to the source of the cure. The report was dramatically entitled "Insanity cured by excision of the external organs of generation". Ten years later, in 1855, Dr William Taylor published a similar report involving a cigar-maker from Philadelphia who had gone insane and hacked off his penis and testicles with a broken bottle. [10] Although he bled profusely, his wounds healed, and his reason returned. No further proof was needed. A revolutionary new surgical approach to masturbatory insanity had been established just as the innovation of aseptic surgery was opening new vistas for surgical ambition. Orthodox American medicine now embarked upon the wholesale amputation of sexual organs as a the preferred cure for a wide range seemingly unrelated conditions. In mental hospitals inmates were castrated on a massive scale in order to stop them from masturbating and thereby restore their sanity. Right up until the beginning of the twentieth century boys caught masturbating were frequently committed to insane asylums where they could be circumcised, castrated and shackled in their cells [11, 12]. Females were subjected to "female castration", a surgery involving the removal of the ovaries, aimed at curing them of hysteria, epilepsy or nymphomania. <h4>2.3 Spermectomy, neurectomy and other treatments</h4> Various other surgeries aimed at eliminating sexual desire and thereby stopping masturbation also were developed. "Spermectomy" was invented as a less drastic alternative to castration, and consisted in the surgical removal of the spermatic ducts rather than the testicles. [13] Neurectomy had a certain vogue in the 1890s. Commonly performed on boys who had been caught masturbating, this involved the physician severing the dorsal nerves of the penis in order to destroy sensation and function completely and permanently. [14, 15] American physicians also resorted to relatively less drastic measures, such as slitting open the urethra [16}, cauterizing the prostate [17], corporal punishment [18], blistering the penis with caustics, acids or heat [19], flaying the skin of the penis with razor blades [20], sewing the penis shut with metal wire (infibulation) [21], encasing the genitals in plaster or lockable metal cages [22, 23], or fitting the penis with rings studded with sharp teeth to discourage erections [24]. In the case of females, the preferred treatment for epilepsy and masturbation was clitoridectomy. One of the first reports of therapeutic clitoridectomy was published in the San Francisco Medical Press in 1862, the abstract of which explained: <div>Dr E.S. Cooper, editor of the San Francisco Medical Press, relates two cases of removal by the scalpel of the clitoris in young girls who were inveterately addicted to the habit of masturbation, and for whom there was apparently no alternative but hopeless insanity or an early grave. The result was a perfect cure in one case, and in the other the practice was broken up, and all the mental faculties improved, except the memory, which is not restored. [24]</div> In the late 1860s the British obstetrician Isaac Baker Brown developed and promoted clitoridectomy as a cure for epilepsy and other mental problems in women. His claims of miracle cures aroused widespread interest at first, but his methods eventually alarmed professionals in the new specialty of obstetrics, and in 1867 his conduct was called into question and expelled from the Obstetrical Society. Although many continued to believe in the value of clitoridectomy, Brown's main offences were an unprofessional degree of self-promotion and failure to obtain informed consent from his patients. (He was in the habit of chloroforming any patients who came to his surgery and performing the operation on them, no matter what the problem they complained of, without telling them what he was going to do.) The British medical press was overwhelmingly in favour of banning Baker Brown, but he was vigorously defended in the United States. The editor of the influential Medical Record strongly criticised the anti-clitoridectomy crusade in England and demanded, "What now will be the chance of recovery for the poor epileptic female with a clitoris?" [26] <h3>3. Circumcision as therapy</h3> On 1 December 1855 the English surgeon Jonathan Hutchinson (1828-1913) published a paper that was to become one of the most influential texts in the history of circumcision advocacy, "On the influence of circumcision in preventing syphilis" [27]. During the 1850s London experienced a massive immigration of Jewish settlers from the ghettos of eastern Europe, attracted by the liberal and tolerant attitude prevailing in England. Hutchinson reported that at the Metropolitan Free Hospital in east London, where many of the immigrants settled, fewer Jews than Englishmen sought treatment for syphilis. Being innocent of any awareness of the principles of statistical analysis, epidemiology, the germ theory of disease or the quarantine effect of ghetto living, Hutchinson asserted that only circumcision could account for the difference in the incidence of the disease. Despite its obvious flaws, Hutchinson's paper was widely reported in foreign medical journals and continued to be cited as authoritative right up until the 1940s. In 1857 it was used as evidence at medical tribunal in Vienna, where a certain Dr Levit (under the influence of a modern western education and possibly impressed by the anti-circumcision movement in reform Judaism in Germany at that time) refused to allow his newborn son to be circumcised. The local rabbinate, under the influence of Dr Joseph Hirschfeld, held up Hutchinson's paper as proof that circumcision was not an outmoded rite, but a modern and scientifically valid means of avoiding disease. It was sufficient justification for the rabbinate to seize Levit's son and forcibly circumcise him against his father's wishes. Levit was left without legal recourse to protect his own child. [28] On the strength of Hutchinson's figures, circumcision as a prophylactic intervention now made a cautious reappearance in orthodox American medicine. At a meeting of the Boston Society for Medical Improvement on 12 August 1861, a Dr White presented a paper in which he mentioned that circumcision could prevent masturbation. [29] Seven years later Dr Charles Bliss, of Syracuse, New York, published an account of his success in curing masturbation by partial amputation of the prepuce. [30] In 1869 a learned article by the Baltimore physician A.B. Arnold described the history of circumcision in the religious context of Jews, Muslims and certain African peoples. [30] The new surgery was being legitimised by being placed in a long history, even though it was a non-western and largely Asiatic history. <h4>3.1 The American Medical Association</h4> Hailed in his lifetime as the father of orthopaedics and indeed as one of "the most distinguished benefactors whom the American medical profession has produced for the glory of medicine and the good of mankind" [32], Dr Lewis A. Sayre (1820-1900) was certainly among the most distinguished believers in the therapeutic powers of circumcision. He served as vice-president of the American Medical Association in 1870 and as president in 1880. At the annual meeting of the AMA in 1870 he delivered a remarkable paper entitled "partial paralysis from reflex irritation, caused by congenital phimosis and adherent prepuce" [33]. Supporting his claims with numerous case studies and clinical evidence, and deploying the most scientific methodologies available at that time, Sayre proved to the satisfaction of his audience that a long, adherent foreskin could not only cause paralysis in various limbs, but also hip-joint disease (probably tuberculosis of the hip-joint), hernia, bad digestion, inflammation of the bladder and clumsiness. In each case Sayre reported that amputation of the foreskin had cured the problem. For the rest of his career Sayre urged physicians always to examine a boy's prepuce in all cases of disease. Whenever phimosis, as defined by reflex theory, was found, Sayre advised immediate amputation of the foreskin. Because of his professional reputation and impeccable credentials, major American medical schools steadily incorporated Sayre's theories and therapies into their curricula. During the late 1860s and throughout the next decade epilepsy was increasingly the focus of medical interest, as indicated by the growing number of articles on the subject published in medico-scientific journals. Capitalising on the new anxiety, Sayre reported to the New York Pathological Society in 1870 that phimosis was also the cause of epilepsy [34]. A few English physicians had been experimenting with circumcision as a treatment for epilepsy since 1865 [35], but they attributed the problem to the tendency of the foreskin to encourage masturbation, and thus cited prevention of masturbation as the key to curing the condition. Sayre maintained that a long foreskin alone had the power to induce violent epileptic convulsions, and that circumcision had cured every case of epilepsy that he had encountered. As with paralysis, hundreds of case reports were published over the next 75 years, all validating Sayre's advocacy of circumcision as a cure for epilepsy. At the annual meeting of the AMA in 1875 Sayre delivered another important lecture on phimosis. Here he informed his audience that he had discovered that a long and adherent foreskin could cut off the circulation of blood to the spinal column, thereby causing lameness, curvature of the spine, paralysis of the bladder and club foot. [36] Miraculously, he reported, circumcision brought an immediate cure to all these patients, including the patient with the club foot. In the same lecture he also described several cases in which clitoridectomy brought instant relief to paralytic girls. <h4>3.2 Masturbation hysteria and circumcision</h4> Alarm amounting to hysteria about masturbation reached a climax in the last decades of the nineteenth century. From 1800 to the early 1870s there was an astounding 750 per cent increase in the number of articles in medical journals on masturbation. From the 1870s to the 1880s the number of papers on masturbation increased by 25 per cent, and from the 1880s until 1900 by a further 30 per cent. Among the more influential American physicians who noticed this obsession, and who contributed to it, were Abraham Jacobi (1830-1919) and M.J. Moses. Jacobi was the founder and first president of the American Pediatric Society, the first chairman of the Section on Diseases of Children of the AMA, and president of the New York State Medical Society, the New York Academy of Medicine and the Association of American Physicians. Both Jacobi and Moses asserted that Jewish boys were immune to masturbation because they were circumcised, and that non-Jews were especially prone to masturbation, and all the terrible diseases that resulted form it, simply because they retained their foreskin. Moses and Jacobi's studies acquired canonical authority, and their claims that the foreskin was the prime risk factor for epilepsy, paralysis, malnutrition, hysteria and other nervous diseases, were regularly cited by medical writers for the next few decades. [37] In 1871 Moses published a very influential and widely-cited article, "The value of circumcision as a hygienic and therapeutic measure", in the New York Medical Journal. In a key passage he cited his experience "as an Israelite" as giving him the authority to speak on the value of circumcision as a health, and specifically as an anti-masturbation, measure: <div>As an Israelite I desire to ventilate the subject, and as a physician have chosen the medium of a medical journal, that I may not be trammelled in my expressions ... 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. [38]</div> It is quite clear from the context that the title word "hygienic" has a different meaning from today. At that time circumcision advocates used words such as hygiene to denote moral hygiene, not personal cleanliness. Moses' paper had a big impact on American physicians, who now argued that castration should be abandoned in favour of circumcision, since circumcision cured all the same diseases, but did so without affecting the power to procreate. An article in the Medical Record in 1895 explained the power of circumcision to stop masturbation thus: <div>In all cases [of masturbation] ... circumcision is undoubtedly the physician's closest friend and ally. ... 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. [39]</div> <h4>3.3 More miracle cures</h4> The list of previously incurable diseases that orthodox physicians now claimed to be able to cure or prevent by means of circumcision continued to grow. A textbook from 1895 declared: Only within recent years, since the physiology of nervous reflexes has become better understood, has [circumcision] become a generally accepted operation with thinking surgeons. Not alone for local conditions is the operation demanded. In all cases in which male children are suffering nervous tension, confirmed derangement of the digestive organs, restlessness, irritability and other disturbances of the nervous system, even to chorea, convulsions and paralysis, or where through nerve waste the nutritive facilities of the general system are below par and structural diseases are occurring, it should be considered as among the lines of treatment. [40] Thousands of such reports and opinions were published in reputable American medical journals. In 1890 Dr William D. Gentry (1836-1922) produced a typical example, "Nervous derangements produced by sexual irregularities in boys", which detailed the frightening and varied consequences of phimosis, as well as the miracle cure offered by circumcision: <div>Whilst I was physician to the children's home at Kansas City in 1884-85, there was brought to the home from some similar institution in Chicago a child of two and half years, who was blind, deaf and dumb. It was nervous, fretful, and caused the matron a great deal of trouble. It was dwarfed and presented the peculiar general appearance which nearly every boy will present who is afflicted with sexual derangement. As soon as I saw the child the thought came into my mind that his trouble had some connection with such derangement, and on making an examination I found that he had phimosis. With the consent of the father of the boy I operated and removed the derangement. In two months the child could see and make sounds as if trying to speak. In six months he could hear, see and speak. [41]</div> Where today do we hear this gushing tone? <h4>3.4 Anti-sexual nature of circumcision</h4> The early promoters of circumcision fully acknowledged the sexual functions of the foreskin and advocated circumcision as the intentional destruction of those functions. One of many such acknowledgements was published in an issue of the Medical News in November 1900: <div>Finally, circumcision probably tends to increase the power of sexual control. The only physiological advantage which the prepuce can be supposed to confer is that of maintaining the penis in a condition susceptible of more acute sensation than would otherwise exist. It may be supposed to increase the pleasure of the act and the impulse to it. These are advantages, however, which in the present state of society can well be spared, and if in their loss some degree of increased sexual control should result, one should be thankful. [42]</div> In 1902 an editorial in the American Practitioner and News made clear the anti-sexual motivation behind the doctrine of circumcision as a hygienic measure: <div>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. It therefore lies with the physicians, the family adviser in affairs hygienic and medical, to urge its acceptance. [43]</div> <h3>4. Early twentieth century</h3> After the germ theory of disease had become widely accepted and vitamins had been identified, most bacterial diseases, such as tuberculosis, were silently removed from the list of diseases caused by phimosis. Even so, most American physicians tenaciously clung to the belief that phimosis was pathogenic and the cause of diseases, such as epilepsy, in ways not yet understood. Year by year the list of diseases blamed on phimosis continued to grow. Doctors even attributed suspicions deaths to phimosis. [44] <h4>4.1 Abraham Wolbarst and the cancer scare</h4> Abraham Wolbarst (1872-1952) was a urologist practising, among other places, at the Beth Israel Hospital and the Jewish Memorial Hospital in New York. In January 1914 he published, in the Journal of the American Medical Association, the first of series of papers indicting the foreskin as the culprit in the diseases that were to haunt the imagination of the twentieth century. Wolbarst was a prominent and influential member of both the AMA and the notorious American Society of Sanitary and Moral Prophylaxis, a reform organisation dedicated to the abolition of childhood and extra-marital sexuality. His views on sexuality were characteristically extreme. In the 1930s he argued that adult masturbators should be sterilized and forbidden to marry, and in 1914, in his influential paper, "Universal circumcision as a sanitary measure", he added his own statistics to those of Hutchinson in order to prove that circumcision conferred immunity to syphilis, and to argue that it should be made compulsory as a means of reducing the incidence of masturbation and many other problems as well. He stated that it was "generally understood that irritation derived form a tight prepuce may be followed by nervous phenomena, among these being convulsions and outbreaks resembling epilepsy. It is therefore not at all improbable that in many infants who die in convulsions, the real cause of death is a long or tight prepuce". He added that it was "the moral duty of every physician to encourage circumcision in the young" [46, 47]. In this paper it is clear that the title word "sanitary" denotes moral restraint rather than the absence of germs or dirt. It is important to note that until this time circumcision was primarily imposed as a therapy for children and adults, but not as prophylaxis for infants. As a result of Wolbarsts's ceaseless lobbying and agitation, however, the radical notion of universal, non-therapeutic, involuntary circumcision of young babies slowly gained acceptance among American physicians. (The procedure was non-therapeutic because it was performed on normal, healthy children showing no signs of deformation or disease.) Medical textbooks were rewritten to instruct obstetricians and pediatricians to examine the penis of every newborn boy to determine whether the foreskin was retractable. If not )as was usually the case), the advice was that it be removed immediately. By the mid-1930s, when most of the medical profession had converted to the theory that epilepsy was a problem of the brain, Wolbarst clung to his conviction that the most likely cause was a tight foreskin. [48]. While he never abandoned this idea, he must have sensed the need to reformulate his arguments against the foreskin in order to tailor them to appeal to the changing interests and fears of the public. In the early decades of the twentieth century the number of articles on cancer in popular magazines rose dramatically, indicating a shift in the national focus. The Readers Guide to Periodical Literature listed thirteen articles on cancer between 1900 and 1904, but by 1909 the number had doubled, and by 1928 it had increased by 569 per cent. At the peak of this surge in popular anxiety about cancer in 1932, Wolbarst published what was long regarded as the definitive paper on circumcision as the most reliable preventive of cancer of the penis. Based on his "observation" (read contention) that Jewish men never got penile cancer, Wolbarst theorised that the disease was caused by "the accumulation of pathogenic products in the preputial cavity". [49] Wolbarst offered no scientific validation in support of this notion, yet, based on this paper, the proposition that smegma was carcinogenic became widely accepted as a proven fact in the United States. <h4>4.2 Advances in understanding the anatomy and development of the foreskin</h4> In 1932 a research team at the University of Pennsylvania led by Dr H.C. Bazett published a detailed anatomical description of the innervation of the foreskin. They observed that the foreskin was richly networked with nerves and nerve endings and capable of detecting fine distinctions of touch and temperature. [50] The following year Dr Glenn A. Deibert, of the Daniel Baugh Institute of Anatomy at Jefferson Medical College, made a careful investigation of the development of the foreskin in utero and the process by which it separated from the glans after birth. [51] Deibert demonstrated that the adherence of the foreskin to the glans was neither phimosis nor a birth defect, but a normal stage of penile development. In 1935 the British anatomist Richard Hunter at Queen's University, Belfast, published a similarly detailed description of the embryological development of the foreskin. No doubt because these findings did not support the prevailing orthodoxy that the foreskin was a useless, pathological defect, all three studies were completely ignored by the medical establishment. [52] <h4>4.3 The Gomco clamp</h4> The profit margin for circumcision procedures rose with the mass manufacture and wide distribution of the now ubiquitous Gomco clamp, invented in 1934 by Aaron Goldstein and Dr Hiram S. Yellen. Gomco is an acronym for the GOldstein Manufacturing COmpany, which later changed its name to the Gomco Surgical Manufacturing Corporation of Buffalo, New York. This cruel stainless steel device is still widely used today to crush the foreskin and isolate it so that it can be excised by scalpel. The standardization of its surgical technique facilitated the rapid institutionalisation of neonatal circumcision as a routine hospital procedure and led to the acceptance of the "high and tight look" (since the clamp usually produced a maximum loss of tissue) that came to be regarded as the normal appearance of the penis. <h4>4.4 Popular perceptions</h4> The September 1941 issue of Parents Magazine included the first published article on the advisability of routine circumcision that had ever appeared in a popular magazine with such a wide readership. The author was Dr Ian F. Guttmacher, an obstetrician at Johns Hopkins University Medical School, and he fed the public with many of the same myths and scare stories that had been in circulation since the nineteenth century. Like his predecessors, he admitted that circumcision "causes blunting of male sexual sensitivity", but (like Hutchinson) argued that this was an advantage. As well as citing Wolbarst's discoveries about penile cancer, Guttmacher reiterated the Edwardian myth about the necessity for daily scrubbing of the glans. Although this had been a clichÃ© of British Empire baby care guides from the 1890s until the 1930s, in Britain it had just been exposed as a myth by Douglas Gairdner. The idea was new to American medical literature, however, and just as a better understanding of normal infant anatomy triumphed in Britain, old myths became consolidated in the United States; with all the authority conferred by his professional title and institutional connections, Guttmacher told the public: <div>Present-day hygiene require 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.</div> Thus we see the Victorian myth of acquired phimosis taking on a new lease of life in the New World of space travel. To avert this frightening scenario, Guttmacher advised parents to have their boys circumcised at birth because doing so "makes care of the infant's genitals easier for the mother", and because "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". Guttmacher succeeded in validating the perceived associations between the foreskin, difficult hygiene, inevitable masturbation, genital defects and the fear of touching the baby's penis. It also served to legitimise the increasingly common practice on the part of large urban hospitals of instituting programs of automatic circumcision of the newborn, irrespective even of parental wishes [53-55]. <h4>4.5 Abraham Ravich and the myth of cancer of the prostate</h4> Abraham Ravich was a urologist at Israel Zion Hospital, Brooklyn, from which position he became one of the most rabid crusaders for mass involuntary circumcision since Jonathan Hutchinson and Peter Charles Remondino. In 1942, expanding upon Wolbarst's theory of smegma as a carcinogen, and repeating the myth of Jewish men's immunity to such disease, he postulated a causal link between the foreskin and cancer of the prostate. He also restated the obscure theory (first suggested, without much evidence in 1926 [56]), that cervical cancer in the female was caused by smegma from the male [57]. The popular magazine Newsweek gave sympathetic coverage to Ravich's claims and quoted his demand that there be "an even more universal practice of circumcising male infants" [58]. Among the many achievements that he listed for his entry in Who's Who in America, Ravich credited himself with being the first to report on the value of neonatal circumcision as a preventive of genital cancers. [59]. <h3>5. World War II</h3> Mass recruitment and conscription during World War II put a lot of men under the power of military doctors with the authority to institute a campaign of near-routine circumcision of servicemen in all branches of the armed forces. Even at the height of the war, Navy physician Lt Marvin L. Gerber confidently stated in he pages of the United States Naval Medical Bulletin that circumcision was one of the most commonly performed surgical operations in the navy, even more common than trauma surgery [60]. Military doctors alleged that epidemics of phimosis and paraphimosis among soldiers justified the mass circumcision campaign. Men were regularly humiliated by unannounced examinations of their penises (called short arm inspections), and many who had not been circumcised were declared to be suffering from phimosis and sent off to get cut; court martials were threatened if they showed reluctance. <h4>5.1 Sexually transmitted diseases and the scapegoating of Blacks</h4> Military records reveal that Black Americans were blamed for spreading venereal disease in the military and were thus made particular targets of circumcision campaigns. Military doctors such as Eugene A. Hand (1909-c.1972), a dermatologist (VD expert) at the naval hospital, St Albans, New York, were responsible for the military's adoption of the view that Blacks were dangerous carriers of disease, and that the low rate of circumcision among them was the main reason for this. Capt Leonard Heimoff, US Army Medical Corps, declared that Negro troops were "causing 70 per cent of all new cases of venereal disease", and he organised covert military police units to monitor the sexual life of civilian Black communities. [61] Heimoff's report, like that of Hand and others, concluded that Blacks could not be taught to practise personal hygiene nor trusted to take precautions against contracting STDs â€“ presumably a euphemism for claiming that they were too stupid and/or sex crazed to use condoms. Where else today do we find this assumption guiding health policy? The war coincided with an increased national obsession with the danger of VD. From 1930 to 1940 the number of articles on VD in popular magazines increased by 192 per cent, and at an annual rate of 17 per cent from 1940 to 1947, after which interest trailed of â€“ presumably in response to the discovery of an effective cure for syphilis in the form of penicillin. At the height of this hysteria Hand delivered a paper called "Circumcision and venereal disease" at the annual meeting of the AMA in June 1947. Comparing the incidence of VD among Jews, gentiles and Blacks, and reporting that it was rare among Jewish men, Hand theorised that circumcision had a major protective effect: <div>Circumcision is not common among Negroes. ... Many Negroes are promiscuous. In Negroes there is little circumcision, little knowledge or fear of venereal disease, and promiscuity in almost a hornets nest of infection. Thus the venereal rate in Negroes has remained high. Between these two extremes there is the gentile, with a venereal disease rate higher than that of Jews, but much lower than that of Negroes. [62]</div> In the same study Hand reported that cancer of the tongue was more common among men with foreskins than among Jews. Newsweek gave generous coverage to these sensational findings, thereby fuelling the popular perception that a policy of mass circumcision was both scientifically valid and of critical importance to the future security of the nation. [63] <h4>5.2 Douglas Gairdner saves the British foreskin</h4> In December 1949 the British Medical Journal published "The fate of the foreskin", a landmark study by Cambridge pediatrician Douglas Gairdner (1910-1992). Drawing on the research of Deibert ad Hunter, and presenting his own meticulous observations on preputial development, adhesion and retractability, Gairdner debunked the phimosis myth and demonstrated that non-retractability, adhesion and length were the normal conditions of the infant foreskin, and that separation occurred gradually as the boy got older. His paper also reviewed the standard list of the benefits of circumcision (cancer, syphilis) and rejected them as spurious. Circumcision rates in Britain had been declining since the 1930s, when doctors had become concerned at the high incidence of injury and death, and Gairdner's paper gave it the death blow. [64] Under the new National Health Service established in 1948, parents who asked to have their boy circumcised were told that it was not an approved procedure and that if they wanted it they would have to pay to get it done privately. As you would expect, when a price was put on the operation most parents decided that it was not really necessary after all, and the incidence of circumcision declined rapidly. References are included in Part 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 A short history of circumcision in the United States: Part 1 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>6. Corporate institutionalisation of circumcision in the Cold War era</h3> In the United States, however, Gairdner's paper was ignored, and the old myths repackaged by doctors such as Guttmacher held sway instead. Medical textbooks became even more insistent that obstetricians should examine every newborn boy to check whether his foreskin was adherent, unretractible or too long , and to perform an immediate circumcision if such symptoms of "phimosis" were present â€“ as they nearly always were. In 1953 obstetricians Richard L. Miller and Donald C. Snyder published an influential paper in the American Journal of Obstetrics and Gynecology, calling for the immediate circumcision of all males straight after birth. Ignoring Gairdner and relying heavily on the writings of Wolbarst, they insisted that "phimosis" required immediate surgical correction, and asserted that circumcision would "reduce the incidence of onanism", heighten male libido and "increase longevity and immunity to nearly all physical and mental illness." They also stated that circumcision immediately after birth was convenient for the doctor and in the financial best interests of the hospital. Leading obstetrical textbooks were soon rewritten to include Miller and Snyder's recommendations. [65, 66] <h4>6.1 The new cancer scare</h4> During the 1950s, with syphilis under control thanks to penicillin, cancer regained its position as the most feared disease. Between 1943 and 1951 the number of articles on cancer in popular magazines increased by 182 per cent, a further 32 per cent between 1951 and 1955, and another 72 per cent from 1955 to 1957. In keeping with this renewed and increased alarm, Ravich published a new paper, "Prophylaxis of cancer of the prostate, penis and cervix by circumcision", in which he alleged that 25,000 deaths annually from cancer were really caused by the foreskin, and that between 3 and 8 million American men then living had contracted prostate cancer through the influence of their foreskin. Ravich concluded that a program of mass compulsory circumcision was necessary as an "important public health measure". [67] Ravich's theory of cervical cancer was taken up by Dr Ernest Wynder at the Manhattan Memorial Centre for Cancer and Allied Diseases, and in 1954 he published a lengthy paper that purported to show that universal neonatal circumcision of males could eliminate cervical cancer in women. [68} Again, a popular news magazine (in this case, Time) gave warm coverage to Wynder's claims, thus giving them both publicity and credibility, and encouraging public support for the burgeoning circumcision industry. [69] Meanwhile, there were also a few calls for circumcision of girls and women. During the 1950s some American physicians stepped up their efforts to popularise circumcision of adult females â€“ here meaning excision of the clitoral hood as a hygiene measure. In 1959 Dr W.G. Rathmann published an article in which he promoted the idea of female circumcision as a cure for psychosomatic illness and marital problems. He also took the opportunity to tout his newly-patented female circumcision clamp. [70] <h4>6.2 Kaiser, Gomco and Europe</h4> In the 1950s an increasing number of corporation-managed hospitals and insurance companies entered the now profitable business of routine neonatal circumcision. Private hospitals instituted policies of immediate and automatic circumcision of all male neonates, often in the delivery room. At the Kaiser Foundation Hospital in 1950, out of 889 live male births, 812 (92 per cent) were circumcised immediately after birth. [71] Likewise, many urban hospitals adopted the policy of circumcising any boys who missed out at birth when they were brought in for other common procedures, such as having their tonsils removed. In the late 1950s the American circumcision industry sought to spread the practice to Europe, with a particular focus in east and west Germany, the latter under extensive American influence as a result of the post-war occupation. Around 1957 the Gomco corporation established a distribution network in Ulm [72], and in the same year Kaiser worked with Otto Dietz, a minor official in the East Berlin secret police, to introduce circumcision in east Germany [73]. In 1959 150 babies born in a state-run clinic in Darmstadt, west Germany, were experimentally circumcised without anaesthesia a publicity stunt for the Gomco clamp [74], and in1963 Dr H. Koester arranged for the maternity clinic at the University of Giessen to adopt a policy of automatically circumcising all boys born there, again using the Gomco clamp. In 1968 a further demonstration of its speed and efficiency was arranged in east Germany [ 76]. By the early 1970s, however, the experiments had aroused the disfavour of both east and west German authorities, and the experiments came to an end. Gomco promptly turned its attention to Denmark and in 1973 arranged for 18 Danish newborns to be cut. [77]. Along with publicity photos of the clamp, the results were praised by the Danish medical press. The Danish public, however, were less impressed and strenuously resisted the idea of allowing their children's sexual organs to be surgically altered for any reason, and the campaign faded away. It is easy to see that Gomco's attempted push into Europe had nothing to do with health, but was entirely a commercial venture. <h4>6.3 Professional opposition to circumcision</h4> There was some opposition to forcible circumcision. In 1956 and 1959 Dr Richard K. Winkelmann, a fellow in dermatology at the Mayo Clinic, published two studies which documented the intense innervation of the foreskin and identified it as specific erogenous zone. [78, 79] In a period that was intensely hostile to sexual enjoyment, however, his studies were ignored. In 1954 Ravich's theory that the foreskin caused cancer of the prostate was disproved [80], and in 1962 the hypothesis that it caused cervical cancer in women was falsified [81]. In 1963 a further study invalidated Wolbarst's contention that smegma was carcinogenic. [82] In 1965 the trend towards scepticism was boosted when the Journal of the American Medical Association published Dr William Morgan's provocatively titled paper, "The rape of the phallus". In this article Morgan debunked all the then current arguments used by hospitals to justify involuntary circumcision and initiated a controversy within the American medical profession that continues to this day. [83] An even more significant article, on the nature of the juvenile foreskin, was published in 1968. The British pediatric journal, Archives of Diseases of Childhood, carried an account of the exhaustive research of the Danish pediatrician Jakob Oster, who had examined the incidence of preputial adhesions in 9,545 Danish schoolboys aged 6 to 17 years. [84] Like Gairdner, Oster's findings disproved the phimosis myth and demonstrated that adhesions between the foreskin and glans were not a birth defect, but a perfectly normal stage of penis development. He further showed that separation between glans and foreskin was a gradual biological process that often took ten years or more to complete. His research revealed that no interventions were needed in normal cases and, more importantly, that inappropriate attempts to hasten development (e.g. by tearing the foreskin from the glans) could damage both structures and actually bring about the phimosis it was supposed to fix. Oster's study significantly advanced scientific understanding of the foreskin was widely read by the British and European medical community; in the United States it was pretty much ignored. In 1970, however, the spark ignited by Morgan was fanned into flame in an article by Noel Preston, "Whither the foreskin?", in JAMA. [85] The paper debunked all the reigning circumcision myths and influenced the American Academy of Pediatrics to publish the following revolutionary statement in the fifth edition (1971) of its Standards and Recommendations for Hospital Care of Newborn Infants: "There is no valid medical indications for circumcision in the neonatal period." [86] In the late 1970s, as Americans became increasingly aware of the abuses of power rampant in the nation's social institutions, grass roots movements against the forced circumcision of American children began to emerge. In the face of ridicule and hostility from health care professionals, many American parents began to refused to allow their sons to be circumcised. At the same time, developments in medical ethics that brought the concept of informed consent into the surgical arena required doctors to explain the probable outcome of any surgery, state the known risks, offer alternative treatments for the problem and obtain written consent from the patient. Circumcision, too, now required a consent form, but since the person being operated on was not capable of giving informed consent, spokesmen for the circumcision industry claimed that parents could give consent by proxy. By presenting involuntary circumcision the parents' choice, circumcision advocates obscured the vital fact that the person who ran the risks and had to bear the lifelong consequences of the surgery was still not permitted a choice in the matter. Critics countered that doctors had no legal power to concede control of the baby's genitals to the parents because doctors had no legal power over his genitals in the first place. <h4>6.4 Backlash from the circumcision industry</h4> The high-water mark of involuntary circumcision was reached in the 1970s. With or without parental consent, hospital practice raised the incidence of neonatal circumcision to 90 per cent in the late 1970s and early 1980s. Circumcision advocates from urban areas took positions in small rural hospitals in America's heartlands and instituted new circumcision programs in regions of the country where it had not been known. At the same time, baby care guides, popular medical magazines and health texts circulated myths to the effect that a boy not circumcised in infancy would suffer terrible psychological damage if he ever saw that his father's circumcised penis differed from his own. [87-89] (Oddly enough, this had not been raised as a problem when the father was uncircumcised and the boy cut, though you would think that a person would be more upset at lacking something his father possessed than possessing something his father lacked.) Another myth that was particularly effective in exploiting middle class anxieties about conformity and social status was that an uncut boy would be made to feel weird and inferior to his circumcised classmates in school locker-rooms. [90] Accurate information on the anatomy and physiology of the foreskin was omitted from American textbooks and replaced with the pseudo-science of the circumcision lobby. [91, 92] Even anatomical representations of the penis in standard urology texts silently omitted the foreskin and showed the penis as circumcised, as though it were that way by nature [93]. The few drawings of the anatomy of the natural penis that could be found generally represented the foreskin incorrectly. The normal human penis became a strange and alien anomaly to the new generation of Americans â€“ physicians and laymen alike â€“ most of whom had never seen one. As an example of the outdated information being given to American medical students, here is a quote from the 1970 edition of Campbell's Urology, the standard urology textbook: <div>Phimotic stenosis causes extreme difficulty of urination, with straining and crying; hernia or rectal prolapse may be secondary end results. Urinary infection is a frequent complication, and is often directly predisposed to by the preputial obstruction. Malnutrition, epistaxis, convulsions, night terrors, chorea and epilepsy have all been reflexly attributed to phimosis.</div> Consistent with these Edwardian notions, it also advised circumcision as a precaution against masturbation: <div>Parents readily recognise the importance of local cleanliness and genital hygiene in their children and are usually ready to adopt measures which may avert masturbation. Circumcision is usually advised on these grounds. [94, 95]</div> The Victorian masturbation hysteria was apparently still alive and well in American medical textbooks in the scientific seventies. In October 1972 the American Academy of Pediatrics appointed a committee to discuss circumcision in order to provide guidance to health insurers who had been asking whether neonatal circumcision should be covered in their insurance policies. The outcome was never officially released, but the conclusion was unofficially presented by Dr Thomas Guthrie to an AMA conference in June 1973. He argued for even more widespread neonatal circumcision and the continuation of insurance coverage. [96] Female circumcision had not entirely disappeared from American medical practice. In 1973 Dr Leo Wollman, a gynaecological surgeon at Maimonides Hospital, Brooklyn, published an article in which he argued for female circumcision (meaning excision of the clitoral hood) as a cure for frigidity. [97] Wollman's appeal was geared to the ethos of the sexual revolution of the 1970s, when sexual pleasure was at last becoming recognised as a legitimate part of life and even the responsibility of the medical profession. Surgical modifications of the male and female genitalia, it was argued, would improve the quality of orgasm. This was the exact opposite of the message communicated a century before, when one of the chief virtues of circumcision was (correctly) held to be its effect in reducing sexual sensation. The sudden reversal of argument convinced critics that American circumcision advocates were willing to say anything in order to push circumcision onto a gullible but increasingly suspicious public. To make matters worse for the circumcision lobby, in 1975 the American Academy of Pediatrics issued a further policy on circumcision that concluded: <div>There is no absolute medical indication for routine circumcision of the newborn. ... A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk. Therefore, circumcision of the male neonate cannot be considered an essential component of adequate total health care. [98]</div> <h4>6.5 Legal action for children's rights</h4> In the 1980s men finally began to wake up to what had been done to them as infants, and several lawsuits against doctors and hospitals in California were filed, charging that hey had violated the constitutional rights of the plaintiffs by circumcising them without consent. [99, 100] The cases were filed in order to establish that parents do not have the right to consent by proxy to medically unnecessary surgery on their children, basing their claim on the 1975 AAP policy that circumcision was not medically necessary. The acknowledged lack of medical justification for circumcision put circumcisers at risk of litigation, but more importantly the constitutional challenge to the legality of subjecting children to involuntary circumcision threatened to dismantle a lucrative medical sideline â€“ which in 1986 was estimated to generate some $200 million annually. [101] If neonatal circumcision were to survive, new medical excuses would have to be found. <h4>6.6 The urinary tract infection scare</h4> In the mid-1980s the new excuse was provided by urinary tract infections (UTIs). Although nothing on this rare condition had ever appeared in a popular magazine, the medical literature reflected a surge of research interest. A search of Medline uncovered only four publications on UTIs for the period 1966 to 1974; 65 from 1975 to 1979; and 350 from 1980 to 1984. While the national incidence of UTIs had not altered from 1966 to 1989, the astounding 8,650 per cent increase increase in the number of published studies showed clearly that UTIs were the next big thing, and it was not long before the foreskin was being blamed as a risk factor. In 1982 Drs Charles Ginsburg and George McCracken published a report of a study of 100 infants with acute UTIs. Because only 3 of the 62 males were circumcised, the authors speculated that lack of circumcision might increase susceptibility, though they admitted that "perineal hygiene was inadequate in many patients". [102] In 1985, evidently intrigued by this lead, Dr Thomas Wiswell, then a neonatologist at Brooke Army Medical Centre, Texas, sought to verify it with his own studies, and soon published in Pediatrics the first of many studies promoting the theory that the foreskin increased the risk of UTIs and that circumcision was therefore a valuable prophylactic. [103] Wiswell's first review of hospital charts implied a UTI incidence of 1.4 per cent in uncircumcised boys and 0.14 per cent in circumcised boys, though he did not take into account such relevant factors as whether the babies were breast-fed (breast milk carries powerful antibodies) or the fact that many of the uncircumcised boys had been subjected to premature retraction of their foreskin, thus making it likely that the infection had been communicated by the doctor or nurse. Such questions were simply not asked. Although the difference between the two groups was very small (1.2 percentage points), it was made to appear much larger by being described as a 10 per cent increase. Circumcision enthusiasts hailed the results of Wiswell's research as a new indication for circumcision and just what they needed to defeat the emerging legal and human rights challenges. Indeed, a letter in response to Wiswell's study addressed the lawsuits directly. The author, Dr Aaron Fink (1926-1994) was a urologist in the mould of Wolbarst and Ravich and a long-time agitator for universal neonatal circumcision. He was clearly disturbed at the possibility that circumcisers might face the risk of legal action from their victims and ridiculed the idea that circumcision required the consent of the person on whom it was performed. [104] In his reply, Wiswell agreed that the medical indication he had discovered removed the need to obtain consent before operating. [105] McCracken was less convinced, however, and commented that "because the long-term outcome of UTI in uncircumcised male infants is unknown, it is inappropriate at this time to recommend circumcision as a routine medically indicated procedure." [106] Nonetheless, medical texts and popular magazines quickly incorporated UTIs into their list of why the baby should be circumcised [107-109]. Magazines such as Newsweek and US News and World Report ran feature stories on Wiswell's discoveries and hailed them as the answer to those who were trying to stop circumcision. [110, 111] Since few males ever experience a UTI the UTI myth had little power to influence fathers, but research had shown that it was the mother, more often than the father, who signed the circumcision consent form. [112-114] Among girls, however, unpleasant and painful bouts of UTI are relatively common [115, 116], and the new UTI scare proved quite effective in frightening young mothers into agreeing to the circumcision of their sons. Unlike STDs and cancer, which did not affect men until they were sexually active adults and old men, UTIs could affect infants. Wiswell's warning that the foreskin posed a serious threat to the baby's health, and even his life, in the first few weeks, and that it could increase the risk of complications such as kidney failure, meningitis and death, naturally alarmed many parents and convinced them that they had better get the baby done "just to be on the safe side". [117-118] At this point Wiswell tried to turn the legal tables by suggesting that if insurers did not cover circumcision they might be held legally liable if a baby contracted UTIs. "If ten years from now there are uncircumcised children on dialysis with kidney damage associated with UTI , insurers who would not pay for circumcision might be held liable," he wrote [119]. At the same time, oddly enough, he stated that "I tell them [parents] that I personally don't like the procedure and don't recommend it, but if they want it performed I will do it." A further effect of the UTI scare was to persuade pro-circumcision forces in the AAP to agitate for a new circumcision policy. In 1989 a new task force was established under the chairmanship of Dr Edgar Schoen (b. 1925), a pediatrician at the Kaiser Foundation Hospital, Oakland, since 1954, and a fanatical advocate of universal circumcision. (Kaiser, it will be recalled, was the commercial medical services company that tried to sell Gomco circumcision clamps to Germany and Denmark in the 1960s.) After intense debate the Task Force produced a new and highly equivocal statement that took Wiswell's UTI hypothesis into account but stopped short of recommending a return to routine circumcision: <div>Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained. [120]</div> By closing the legal loophole in the 1975 statement, the new policy protected circumcisers from legal action while avoiding any overtly unscientific or unverifiable claims. Sensitive to the awkward fact that European countries had steadfastly rejected American attempt to export circumcision, Schoen (from his office in the Kaiser Permanente Medical Centre) made another attempt to badger northern European countries into adopting programs of routine circumcision on the United States model. [121] The terse reply to his overtures, written by two of Sweden's most eminent physicians and published in a leading Swedish medical journal, invoked a number of critical issues that he had never considered: fairness, human rights and medical ethics. Pointing out that it was a violation of a person's human rights to be subjected to such a procedure without informed consent, the authors observed that it was only fair to postpone a decision on the matter until the boy was old enough to make his own decision. The authors explained that since an ethics committee on experimental animals would never accept clinical trials involving circumcision without anaesthetic on laboratory animals, Europe could hardly justify subjecting its own children to such pain and suffering. [122] <div>* * * * * * * * * * *</div> <h4>NOTE</h4> In relation to the following two sections it should be noted that this study was written in 1995-96 when the notion that the foreskin was a major risk factor for HIV-AIDS, and that circumcision was therefore an important part of any anti-HIV strategy, was no more than the speculation of cranks. At that time there was no predicting that the idea would be seized upon by the international AIDS industry, given massive funding, and presented to the world as the definitive solution to the AIDS problem in Africa, and probably in other underdeveloped regions as well. What we can observe is the consistency of the historical pattern: as soon as a new disease leaps to the forefront of public anxiety, circumcision enthusiasts suggest that the foreskin has something to do with it and yet more circumcision is the answer. In fact, the claim that mass circumcision is necessary to control AIDS is largely a re-run of the nineteenth century conviction that mass circumcision was necessary to control syphilis; in each case, an incurable disease had so terrified the public that they were ready to accept almost anything if it offered the possibility of increasing their safety without the need to change their habits. What gets forgotten is that AIDS is not a particularly contagious disease and that you have to go to some trouble to contract it; apart from blood transfusions, tattoos, surgery and intravenous drug use (where circumcision would obviously make no difference), the only way you can get AIDS is through unprotected intercourse with an infected partner. The simplest way to run no risk of HIV infection, therefore, is not to be promiscuous and to practise safe sex. This policy has successfully kept HIV infection at a low level in countries such as Australia, Germany and Britain, but western health agencies seem to have much the same attitude towards Africans as Eugene Hand exhibited towards American Blacks: because they are too stupid to use condoms and too sex crazed not to be promiscuous, the only thing that can be done is to circumcise them in the hope of slightly reducing the risk. The foreskin is targeted not because it is a particularly useful point of intervention, but because it is an easy target for surgical removal and a once-off procedure, after which the agencies can congratulate themselves that they have done all they can. It should also be remembered that there are strong cultural pressures to use the AIDS scare as the latest means of preserving circumcision as a routine procedure among the cultures that traditionally practise it. The billions poured into the World Health Organisation and UNAIDS represent a bizarre alliance between American medical research money, African tribalism and Muslim religiosity, all of which forces have an emotional commitment to finding new and "scientific" justifications for continuing their traditional practices. <div>* * * * * * * * * * *</div> <h4>6.7 The HIV scare</h4> In the early 1980s the arrival of a new and terrifying infection in the form of HIV-AIDS (as it later became known) gave the circumcision lobby a juicy new opportunity to incriminate the foreskin in the generation of disease. First to capitalise on the opportunity, as early as 1986, was the egregious Aaron Fink, who was able to persuade the New England Journal of Medicine to publish his speculation that the presence of the foreskin made men more susceptible to infection. [123] On the basis of this theory, throughout 1987 and 1988 Fink lobbied the California Medical Association to adopt a resolution endorsing routine neonatal circumcision as "an effective public health measure". His efforts were rejected by the Scientific Committee of the CMA in 1987, but in 1988 he managed to get his resolution passed on the voices at a CMA meeting. This attracted some national attention, unlike his other new reasons for circumcision â€“ group B-streptococcal disease and "sand balanitis" [124, 125] These connections were evidently too far out even for the gullible American media. Fink's theory about the foreskin and AIDS, however, was eagerly taken up by other American circumcisionists, such as Francis Plummer and Stephen Moses, who have campaigned tirelessly for new programs of neonatal circumcision as a precaution against HIV acquisition in later life. <h4>6.8 The future of involuntary circumcision</h4> Since the 1980s private hospitals have been in the business of supplying the foreskins they harvest to private biological research laboratories and pharmaceutical companies that require human tissue as raw research material, as well as manufacturers of cosmetics and artificial skin. They have also supplied foreskins to transnational corporations such as Advances Tissue Sciences (San Diego), Organogenesis and BioSurface Technology, companies that have recently emerged to reap profits from the sale of products made form harvested human tissues. [126-129] Despite the efforts of Schoen, Fink, Wiswell etc, the incidence of circumcision in the United States began to fall in the early 1980s, and the downward trend accelerated in the 1990s. The fall was not due so much to the policies of the AAP, which most doctors ignored, but to the educational efforts of popular and professional anti-circumcision groups. Official figures show that the incidence of neonatal circumcision in the western states, where such groups were most active, fell from 64 per cent in 1979 to 34 per cent in 1994. As a result of an increase in the rate in the Midwest, however, the national figures fell much less â€“ from 64 per cent to 62 per cent over the same period. In February 1996 a research team at the University of Manitoba led by Dr John Taylor published the results of the most significant investigation of the anatomy and physiology of the foreskin since Winkelmann. Their paper, "The prepuce: Specialized mucosa of the penis and its loss to circumcision", described the structural and functional components of the foreskin and established its rich innervation and vascularisation, clearly evolved to constitute an erogenous zone and to enhance erotic experience. Since circumcision had originally been instituted precisely for the purpose of destroying these very features, it is not surprising that the medical establishment was reluctant to acknowledge Taylor's work, let alone face the obvious implications. Other bodies, however, have paid attention, including the Australian College of Paediatrics and the Canadian Pediatric Society, both of which published policies on circumcision in 1996. Each recommended that circumcision of newborns be not performed, and pointed out that circumcision without informed consent was a violation of accepted principles of both medical ethics and human rights. [131, 132] Around this time, too, prominent figures from the world medical community condemned the American practice of routine circumcision of infants as both medically unnecessary and morally wrong. The consensus among critics was that irrespective of the validity of the health arguments for circumcision, the fact that it was done without consent made it an unacceptable intrusion into the personal lives of individuals and an unwarranted deprivation of their private property. [133-138] The constitutional conflict between human rights and the American medical establishment's assumption that it knows best what's good for boys may be settled in the courts. <h3>7. Conclusion</h3> The historical record makes it clear that in the late nineteenth century American physicians sought to institutionalise genital mutilation of both boys and girls as a means of eliminating childhood sexuality, and that their efforts were successful in the case of boys, unsuccessful in the case of girls. Doctors circumcised boys to denude, desensitise and disable the penis to such an extent as to make masturbation impossible, or at least not worth the effort. Clitoridectomy of girls was introduced for the same reason. While the medical establishment's use of popular fears about masturbation to justify mass circumcision has remained pretty constant since Victorian times, the subsequent supplementary excuses offered to justify circumcision follow a clearly defined pattern: whatever incurable disease happens to be the focus of national attention at any given time will be the disease that circumcision advocates will cite as a reason for circumcision. In the 1870s, when epilepsy was the disease of the moment, circumcision advocates claimed that circumcision could cure and prevent epilepsy. In the 1940s, when STDs were the focus of national health fears, they claimed that circumcision could prevent the spread of STDs. In the 1950s, when everybody was obsessed with cancer, circumcision advocates claimed that circumcision could prevent all sorts of cancers â€“ of the penis, of the tongue of the prostate and of the cervix. Since the late 1980s, when HIV-AIDS became the greatest health scare since the Black Death, circumcision advocates have predictably claimed that circumcision is the answer to AIDS control. Ironically, and despite these claims, the United States, for all that most of the men are circumcised, does not have a particularly good health record, and on most indicators is well behind places such as Japan and Scandinavia, where circumcision is practically unknown. Today the USA has both the highest percentage of sexually active, circumcised men and one of the highest rates of genital cancers and STDs in the western world. The paradox implicit in this history is that even though mass circumcision has been ineffective as a public health measure, and has done little to control either cancers or STDs, the American medical establishment has clung to its faith in circumcision and consistently sought to find new justifications for it. Their priority does not seem to have been maximising public health, but maximising their foreskin harvest. Such unscientific allegiance to an ineffective and harmful surgical procedure, when good sense would suggest the adoption of more conservative and more effective strategies, suggests that there may be a deeper, non-rational dynamic behind circumcision advocacy, and that it is not just matter of simply applying, as they so often claim, the discoveries of medical science to public health policy. [139] The history of the institutionalisation of involuntary circumcision in the United States demonstrates that American society has been willing to apply what it takes to be scientific measures at the expense of personal liberty. It is tempting to dismiss circumcision as merely a quaint example of medical quackery pursued by a handful of zealous doctors. We would do better to remember that in the name of scientific progress, millions of American citizens have been subjected to genital mutilation and deprived of an integral, functional and beautiful part of their body. In the face of increasing international criticism and constitutional challenges we must wonder how much longer the medical establishment will be able to continue to indulge in the kinds of illogical thinking and disregard for human rights that underpin their commitment to circumcision as prophylaxis and therapy. <h3>References</h3> 1. T.S. Szasz, Law, Liberty and Psychiatry, Syracuse 1989, 212 2. X. 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Ahman, Academy holds fast to position on circumcision, Pediatric News 20, 1986, 38; <a href="http://www.cirp.org/library/disease/UTI/" rel="noopener" target="_blank">more recent studies of UTIs can be found here</a>. 120. <a href="http://www.cirp.org/library/statements/" rel="noopener" target="_blank">Report of the task force on circumcision</a>, Pediatrics 84, 1989, 388 121. E.J. Schoen, Is it time for Europe to reconsider newborn circumcision?, Acta Paedatrica Scandinavica 80, 1991, 573 122. I. Bollgren and J. Winberg, <a href="http://www.cirp.org/library/disease/UTI/winberg-bollgren2/" rel="noopener" target="_blank">Reply to Schoen</a>, Acta Paedatrica Scandinavica 80, 1991, 575 123. A.J. Fink, A possible explanation for heterosexual male infection with AIDS, New England Journal of Medicine 315, 1986, 1167 124. A.J. Fink, Is hygiene enough? Circumcision as a possible strategy to prevent group B streptococcal disease, American Journal of Obstetrics and Gynecology 159, 1988, 534 125. A.J. Fink, Circumcision and sand, Journal of the Royal Society of Medicine 84, 1991, 696 126. B. Manson, Forget pork bellies, now its foreskins, San Diego Reader, 4 May 1995, 12 127. S. Brewer, New skin twin life, Longevity, September 1992, 18 128. R. Rosenberg, Companies see $1.5b market in replacement skin products, Boston Globe, 19 October 1992, 22 129. C.T. Hall, Biotech's big discovery, San Francisco Chronicle, 25 October 1996 130. J.R. Taylor et al, <a href="http://www.cirp.org/library/anatomy/taylor/" rel="noopener" target="_blank">The prepuce: Specialized mucosa of the penis and its loss to circumcision</a>, British Journal of Urology 77, 1996, 291 131. <a href="http://www.cirp.org/library/statements/acp1996/" rel="noopener" target="_blank">Position statement on routine circumcision</a>, Australian College of Paediatrics, Parkville, Vic, 1996 132. Canadian Pediatric Society, <a href="http://www.cps.ca/english/statements/FN/fn96-01.htm" rel="noopener" target="_blank">Clinical practice guidelines: Neonatal circumcision revisited</a>, Canadian Medical Association Journal 307, 1996, 769 133. J. Menage, Male genital mutilation, British Medical Journal 307, 1993, 686 134. L. Sorger, To ACOG: Stop circumcisions, ObGyn News 1 November 1994, 8 135. P.M. Fleiss, Female circumcision, New England Journal of Medicine 322, 1995, 189 136. S. Mullick, Circumcision, British Medical Journal 310, 1995, 259 137. J.P. Warren et al, <a href="http://www.cirp.org/library/general/warren1/" rel="noopener" target="_blank">Circumcision of children</a>, British Medical Journal 312, 1996, 377 138. P.M. Fleiss, More on circumcision, Clinical Pediatrics 34, 1995, 623; <a href="http://www.foreskin.org/fleiss.htm" rel="noopener" target="_blank">a more recent statement by Paul Fleiss available here</a>. 139. J. Bigelow, The Joy of Uncircumcising, Aptos 1995, 89 <h4>Source</h4> Originally published as "A short history of the institutionalization of involuntary sexual mutilation in the United States", in George C. Denniston and Marilyn Milos (eds), Sexual Mutilations: A Human Tragedy (New York: Plenum Press, 1997). The paper has been slightly edited in places for brevity and clarity. </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 short history of circumcision in the United States: Part 2 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>"A source of serious mischief": The demonisation of the foreskin and the rise of preventive circumcision in Australia</h3> To the sensitive, excitable, civilized individual, the prepuce often becomes a source of serious mischief. In the East the ... secretions between it and the glans [are] likely to cause irritation and its consequences; and this danger was perhaps the origin of circumcision -- William Acton, 1865 Diseases desperate grown, By desperate appliances are relieved -- Hamlet IV. ii. 9 <h3>Part 1. Introduction</h3> <h4> <a name="syn"></a>Synopsis</h4> Between the 1890s and the 1920s there was a minor revolution in the treatment of the male body in Australia. From being an anomaly peculiar to Jews or a mutilation practised by savages, circumcision became the mark of a clean, healthy boy and one of the stigmata of a gentleman. In this paper I trace the outlines of this transformation and show how a combination of medical advice, sexual fears (particularly fear of sexual pleasure) and social ambition led to the introduction circumcision as an all but inescapable incident in the life of the Australian boy. More specifically, I argue that this institutionalisation of male genital mutilation, eventually dignified under the euphemism "routine neonatal (or infant) circumcision", was a direct response to the nineteenth century's search for a cure for the imaginary disease of spermatorrhoea, and its phobia about masturbation specifically, and that Australia inherited the medical wisdom on these matters from Britain and the US with very little local discussion and scarcely a murmur of dissent. <h4> <a name="thebrit"></a>The British background</h4> Although the Australian experience of routine circumcision generally follows the pattern established in Britain and the United States, it has its own historical trajectory and several distinctive features. Until the twentieth century, most Australian doctors were trained in Britain, and they applied the medical wisdom they had acquired back home. The only significant differences concern chronology and incidence. Routine circumcision started a generation later than in Britain and continued long after it had been abandoned there, reflecting the growing influence of US medicine after the Second World War. The practice was also more widespread than in Britain, where it was common among the rich but relatively rare among the poor; in Australia all classes were affected equally, reflecting the greater social equality here and wider access to the latest medical advances. In the 1980s and 1990s the practice declined to a far greater extent than in the US. The essential conditions for the rise of routine circumcisionâ€”or preventive circumcision as I prefer to say, acknowledging that its purpose was to prevent a variety of supposed problems (1)â€”are thus much the same in Australia as in Britain. They can be briefly summarised in five points. 1. The taboo against masturbation began as religious prohibition, but during the nineteenth century it was medicalised as belief in God and the afterlife declined. Taking over the role of priests, doctors argued that knowledge of the harmful effects of masturbation here on earth was a more effective deterrent to immoral behaviour than fear of eternal damnation. 2. The medicalistion of the taboo led to the invention of a new and imaginary disease called spermatorrhoea. This meant any loss of semen other than in heterosexual intercourse and included wet dreams, spontaneous emissions and sexual adventures outside the marriage bed as much as masturbation. Such a scarce and precious fluid had to be hoarded, or disease, debility and death would follow. Lallemand, Acton, Courtenay, Milton and others wrote eloquently on this subject, pathologising normal male sexuality in the process. 3. The nerve force theory of disease, current until displaced by the discovery of germs in the late nineteenth century, held that diseases could be caused by imbalances in nervous force. Excessive excitement in one region could induce a drain of energy from another, thus provoking illness in the affected parts. It was really a nerve-based version of the old theory of the four humours, but it persisted in explanations of how masturbation caused harm until well into the twentieth century, and it is far from dead today. Parts of the body known to be particularly sensitive, such as the foreskin, were thus implicated in the generation of disease, and it came to be blamed for tuberculosis, rickets, convulsions, polio ("paralysis") and any other problem doctors were unable to cure. 4. The outcome of these developments was what I have called the demonisation of the foreskin. It ceased to be seen as a normal part of the body and became a pathogenic structure guilty of provoking a host of medical problemsâ€”either indirectly by encouraging masturbation, or directly by disrupting the body's nervous equilibrium by its morbid sensitivity. The most extreme version of this case was put by the fanatical Dr Remondino, but most doctors shared his general viewpoint. 5. Circumcision played a vital role in the establishment of the modern medical profession. Finding a cure for spermatorrhoea (including masturbation) was the testing ground on which regular medical practitioners sought to establish their credentials and to demarcate themselves from the quacks. William Acton, F.B. Courtenay and, in Australia, James Beaney were vehement in their denunciations of the remedies for spermatorrhoea proposed by these charlatans, but essentially it was a battle for professional turf and the right to manage all the functions of the body. Unfortunately for the regular doctors, until circumcision became an option, the treatments they could offer differed little from those of their rivals. The godfather of preventive circumcision is undoubtedly William Acton, physician to Queen Victoria and the leading authority on men's sexual health in the mid-nineteenth century. His most influential book, The functions and disorders of the reproductive organs, first published in 1857, was still being reprinted in the early 1900s; it was widely read in Australia and probably the principal source of information on male sexuality. It is surprising that David Gollaher, (2) in his otherwise informative work on the history of circumcision, does not discuss Acton's contribution, so perhaps we need to be reminded of what he wrote about the foreskin. In none of the many editions of his treatise on the male reproductive organs did Acton advocate general circumcision, but his comments on the necessity for sexlessness in children and continence in young men, coupled with his belief in the pathological irritability of the foreskin, prepared the ground. Anxious to guard against its emergence, he was concerned that a long or tight foreskin was often the cause of sexual precocity in children and recommended that boys be taught "to draw back [their] foreskin and thoroughly cleanse the glans penis every day". (3) Acton realised that this routine might lead to the very manipulations it was designed to prevent but asserted that his own experience had been to the contrary. Conceding, perhaps regretfully, that circumcision was "never likely to be introduced amongst us", (4) he was confident that his own precautionsâ€”parental watchfulness, cleanliness, fresh air and tiring exerciseâ€”should be sufficient "in most cases to remove all ill effects arising from the existence of the prepuce", but he was adamant that the foreskin itself was the root of all the problems that arose: that the prepuce in man ... is the cause of much mischief, medical men are pretty well agreed. It affords an additional surface for the excitement of the reflex action, and ... aggravates an instinct rather than supplies a want. In the unmarried, it additionally excites the sexual desires, which it is our object to repress. This was ominous enough, but Acton added an even more anxious footnote: to the sensitive, excitable, civilized individual, the prepuce often becomes a source of serious mischief. In the East, the ... secretions between it and the glans [are] likely to cause irritation and its consequences; and this danger was perhaps the origin of circumcision. That the existence of the foreskin predisposes to many forms of syphilis, no one can doubt; and ... I am fully convinced that the excessive sensibility induced by a narrow foreskin ... is often the cause of emissions, masturbation, or undue excitement of the sexual desires. (5) Already the foreskin is to blame for syphilis, masturbation, the arousal of sexual desire and the febrile excitability of modern man. Acton is obviously attracted to the idea of the preventive removal of such a malignant part of the body, and in later editions of his book, reflecting the advance of circumcision in British medical practice, he notes that some authorities had suggested "the universal performance of circumcision" as a means of guarding against childhood sexual precocity and masturbation specifically. (6) He countered that the benefits of circumcision were only speculative and continued to believe (with remarkably poor powers of prediction) that the procedure would never become general "amongst us". How wrong Acton was on this point was demonstrated by the next generation of physicians in Britain and the US, as they took up his strictures against the foreskin and developed them vigorously. (7) <h4> <a name="circ"></a>Circumcision in Australia today</h4> The decline of circumcision in Australia is easier to document than its rise. From the 1920s to the 1960s it was all but universal, Chester Eagle (born 1933) commenting on the "mostly circumcised penises" of his contemporaries at Melbourne Grammar in the late 1940s. (8) Change was signalled on 24 April 1971, when the Australian Paediatric Association (APA) resolved that "new born male infants should not, as a rule, be circumcised", (9) and the incidence of the practice declined steadily thereafter. Figures quoted by Wallerstein show a circumcision rate of 49.6 per cent in 1973-74, 48.6 per cent in 1974-75 and 43.7 per cent in 1975-76. (10) The Australian College of Paediatrics (ACP) released a stronger statement in 1983, raising human rights as well as medical issues, and this was reissued in 1991. (11) In 1996 it estimated the current rate of infant circumcision at 10 per cent. (12) One mother has told me that when her first son was born in Sydney in 1983 hospital staff asked her if she would like him circumcised; when the second was born in 1988 the possibility was not mentioned. (13) Until recently it seemed safe to say that the practice began to decline in the late 1960s and largely died out in the 1980s, except among those who do it to their children for cultural or religious (mainly Jewish or Islamic) reasons. Figures collected by NOCIRC Australia confirm this picture but reveal considerable variation from one state to another. In 1995-96 the national rate of neonatal circumcision (0â€“6 months) was 10.6 per cent, while the incidence in the states ranged from 5.4 per cent in Victoria to 17.2 per cent in Queensland, as shown in the following table: (14) <table cellpadding="1" width="437"> <tbody> <tr> <td width="212">State New South Wales Victoria Queensland Western Australia South Australia Tasmania Aust Capital Territory Northern Territory </td> <td width="209">per cent 11.8 5.4 17.2 7.2 12.3 9.3 6.2 8.7</td> </tr> </tbody> </table> In the early 1990s it looked as though such preventive (non-religious) circumcision was set to disappear, but in recent years it has made a comeback: after falling to a low of 10.4 per cent in 1996, the national rate increased to 12.1 per cent in 2000. Most of this increase occurred in Queensland (from 16.3 to 20.6 per cent) and New South Wales (from 12.3 to 14.2 per cent), outweighing declines in Victoria (from 6 to 4.9 per cent) and the Northern Territory (9.3 to 5.9 per cent). (15) The reasons for the disparities are not known, but it has been suggested that the high and rising rate in Queensland is due, at least in part, to the evangelical fervour of a prominent GP there, Dr Terry Russell, who apparently tells parents that an early circumcision is the equivalent of immunization against venereal disease, cancer of the penis and many other problems. The continuing popularity of such forcible circumcision among old guard medicos thus suggests that nineteenth century theories about the link between the foreskin and disease have lost little of their relevance. Russell writes that, if they had been circumcised, "a vast number of neonates would have been saved from UTI and its consequences of renal failure, septicaemia, meningitis, hypertension and death". Circumcision "may reduce the risk of STDs (syphilis, gonorrhoea, herpes and candida) and carcinoma of the cervix of female partners. It also prevents balanoposthitis and phimosis", not to mention such "potentially fatal conditions" as neonatal UTI, HIV/AIDS and cancer of the penis. (16) A hundred years earlier Dr Remondino had asserted: Circumcision is like a substantial and well-secured life annuity; every year of life you draw the benefit, and it has not any drawbacks .... Parents cannot make a better paying investment for their little boys, as it insures them better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor-bills, as well as increases their chances for an euthanasian death. (17) Even the British Medical Journal found such an extreme advocacy "excessive and strained". (18) Any similarities between Russell's scientific approach and late Victorian quackery are purely coincidental. <h4> <a name="theearly"></a>The early spread of circumcision</h4> Few statistical details are available for the period when the circumcision of infants and boys first became popular. Unlike the composer Percy Grainger (19) (born 1882), the writer Frank Dalby Davison (born 1893) did not leave us a nude photograph to prove he was intact, but in his last novel he clearly assumes that boys have foreskins to play with. (20) Patrick White (born 1912) was circumcised, but he was born in England to upper class parents, among whom the practice was then common. (21) The historian Russel Ward (born 1914) was "one of the very few boys in the whole World who had been circumcised", as he puts it in his autobiography, but his boyhood playmates in north Queensland were not; the extra-curricular uses they found for their foreskins would certainly have confirmed the fears of those who advocated removal on moral grounds. Significantly, his parents were respectable Methodists from "staid, puritanical South Australia" who found Queensland "uncouth and barbarous". (22) Russell Braddon (born 1921) does not reveal his own status, but he reports that in Changi prison during World War II the army doctors (mainly British) "circumcized practically every man who was not already circumcized" in the belief that the operation would improve the men's health prospects. (23) Australian doctors probably started performing circumcisions on a wide scale in the 1890s, by which time the operation was well established in Britain and the US. Herbert Moran refers to circumcision in the period 1890â€“1914 as though it was a commonplace or even routine procedure, (24) and in 1903 A.S. Joske, a surgeon in the children's department at the Alfred Hospital, Melbourne, reported that the number of children being operated on was "steadily increasing". (25) By 1906 a sceptical doctor in Brisbane referred sourly to circumcision as a "mania" of "twelfth-rate surgeons" who preached "a new gospel, the conversion of baby boys into Jews, not for their love of Judaism, but for the three or five guinea fee hanging on the operation". (26) Although Australia lagged behind the mother country it was more egalitarian; while in Britain the procedure was concentrated among middle, upper and professional classes, here "the poorer portion of our population is beginning to see the advantages of the operation". (27) There was very little discussion of the practice in the Australian medical press, and it seems likely that British-trained doctors brought it with them and that Australian-trained doctors read British and US textbooks which recommended it. In 1908 the Australasian Medical Gazette published a warm review of L. Emmett Holt's The care and feeding of children. (28) Holt was an expert on paediatric medicine in the US and a professor at the College of Physicians and Surgeons in New York. He was a zealous circumciser and recommended the practice in his influential textbook, The diseases of infancy and childhood, which became a standard work and went through eleven editions between 1897 and 1940. Where many doctors advised circumcision only when the infant foreskin could not be drawn back, Holt urged it in all cases "because of the moral effect of the operation"; the effects of neglect included "priapism, masturbation, insomnia, night terrors" and "most of the functional nervous disease of childhood". (29) Mary Truby King, author of a book on mothercraft popular in the 1930s, quoted "Professor Holt" on the nature of masturbation and continued with a sentence on the need for circumcision if the fault was found to lie with the foreskin. (30) In 1910 the same journal printed an enthusiastic review of Abraham Jacobi's textbook, Diseases of children, (31) and the author was, if possible, an even keener exponent of circumcision than Holt. Jacobi (1830â€“1919) was a founder of the American Pediatric Society, first Chairman of the Section on Diseases of Children of the American Medical Association and a leading figure in many other influential bodies. He strongly advocated the circumcision of all male infants as a means of preventing masturbation and cited his personal experience as a Jewish physician as evidence for the claim that circumcised boys did not masturbate (or not as much) and hence were not so susceptible to the many diseases which arose from the practice. (32) If this was typical of the material on which Australian doctors and medical students were being educated, it is not surprising that they came to hold such strong views in favour of circumcision. With or without debate, the practice of circumcising male babies spread rapidly. In 1916 Sir Thomas Anderson Stuart, Dean of the Faculty of Medicine at Sydney University, remarked that "more and more the operation is being performed as a simple matter of hygiene". (33) By 1921 "some medical men" were advising "the circumcision of all children as a matter of routine". (34) In 1917, in a letter to the Medical Journal of Australia, J.I. Sangster of Brighton, South Australia, observed that "nowadays it has become a surgical fashion to advocate circumcision in every male infant", but he was a critic of the trend, objecting that many of the supporting arguments were based on supposition and doubting that nature was "so often at fault as to demand universal interference". (35) One other dissenting voice joined him in the wilderness, pointing out that circumcision was originally introduced as a religious ritual in which a part of the body was sacrificed. The routine removal of a normal and healthy structure, however, was "surely the last word in absurdity" and about as sensible as removing "the labia minora or the little toe". (36) These comments attracted neither support nor condemnation. The only other reference to circumcision I have located in the Medical Journal of Australia between 1914 and 1935 is a brief report that a certain Dr C.W.B. Littlejohn demonstrated four different methods of circumcision at a meeting of the Victorian branch of the British Medical Association in 1923; (37) the report did not reveal whether the demonstration was on live subjects. The steady advance of circumcision during the 1920s may be seen in the various editions of a guide for mothers prepared by Muriel Peck. The first edition (1925) makes no mention of the procedure, but by the fourth (1929) the foreskin is seen as a problem area that needs to be washed carefully yet not interfered with; if it is tight or long, medical advice should be sought, and if circumcision is considered necessary it should be done as early as possible. (38) <a href="https://www.darboninstitute.org/a_source_of_mischief_part_2">Read Part 2</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 A source of mischief (Part 1) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>The taboo against masturbation and the malign influence of the foreskin</h3> To this period [childhood] belongs also a very important point in regard to physical educationâ€”the guarding against onanism .... one of the most certain and most terrible of those means which shorten and derange life .... I am fully convinced that the vice is exceedingly common, and highly destructive of human nature .... The grand object is to prevent onanism altogether -- Dr Christoph Hufeland, 1828 (39) ... the prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner; where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail or even in a lunatic asylum -- Dr P.C. Remondino, 1891 (40) <h3> <a name="themast"></a>The masturbation phobia</h3> As in Britain and the US, the universal phobia against masturbation was the main driving force behind the introduction of widespread circumcision in Australia at the turn of the century. David Walker has examined the fears surrounding seminal loss and their connection with conceptions of manhood and national development in three important articles (41) which are essential for understanding this topic, but there are several areas in which his studies can be amplified and modified. As Walker points out, nineteenth century medical orthodoxy held that any seminal loss weakened the system, but that masturbation was especially dangerous, partly because it was so easy to do and partly because it was indulged in mainly by the young, who needed all their energies for proper growth and development. (42) For all the fervour with which colonial medical and moral texts catalogued the evils which arose from masturbation, they largely repeated the wisdom received from Britain (and to a lesser, though increasing, extent the US); there were few original antipodean contributions to this field of medical science. In concentrating on irregular medical practitioners who offered various quack cures for seminal loss and other "private diseases, however, Walker could leave the impression that concern with masturbation was a fringe preoccupation and that mainstream doctors (those trained in medical schools and usually members of the British Medical Association) were less worried by the problem. This is misleading: the danger of masturbation was a sacred orthodoxy of the regular medical profession, and the quacks were only trying to take advantage of the fears already generated by its own advice and propaganda. Nor is it possible to draw a hard and fast line between the regular doctors and the quacks; the former exhibited plenty of evidence of ignorant faddism and eccentricity, while the latter frequently offered more humane and less damaging treatments. Ineffective they might have been, but when you are dealing with imaginary diseases it is to the advantage of the patient if the cure is not too heroic. I shall deal with each of these points in turn. It is only in recent times that masturbation has ceased to be regarded as a serious disease likely to have frightful consequences for those who indulge in it. As late as 1966 the Principal of Grimwade House, Max Haysom, told his charge of 13-year old boys at the annual sex education lecture that masturbation was wrong for three reasons: from a religious point of view, it was a sin against purity; from a social point of view it was selfish because only a man's wife had the right to the products of his penis; and from a medical point of view it would cause blindness if persisted in. The principal added ominously that there had been trouble with this sort of thing among the boarders, though he did not explain how it had been dealt withâ€”presumably not by circumcision, as in most cases that had already been seen to. (43) Even today, when every variety of sexual expression is discussed on television and most may be viewed on video, the topic of masturbationâ€”"the earliest, most intimate and perhaps the most common of all sexual behaviours, as Bennett and Rosario observeâ€”still arouses anxious titters. (44) If Haysom represented enlightened establishment opinion in the 1960s, it is apparent that the taboo against masturbation must be very deeply ingrained. Indeed, in 1860 the Australian Medical Journal reported the case of a seaman, a "finely made Irish boy, aet. 17, who actually killed himself through masturbation. He was admitted to hospital on 8 May with "slight febrile symptoms and treated for fever, but his condition steadily deteriorated and additional symptoms appeared, necessitating examination of the lower part of the body: attention being directed to the genital organs, the penis was found to be larger than natural; the glans red and inflamed, and a slight swollen condition of the prepuce. On examining his shirt the lower part was found stiffened with some albuminous fluid, much resembling that produced by the seminal vesicles. The testicles were found atrophied to about the size of a kidney bean, soft and painless to moderate pressure. On being questioned as to his habits he denied having made any improper use of himself, or being addicted to masturbation. A friend of his ... said the young man was much given to solitude and ... thought he was addicted to this bad habit when in his berth. He was again interrogated as to the escape of this albuminous fluid and admitted that some did escape after passing stool. He was warned as to consequences but persisted in denying the existence of masturbation. As soon as the possibility of masturbation arises, the boy ceases to be regarded as a patient in need of care and becomes a malefactor who must be interrogated until he confesses his crimes. On 1 June the patient was described as having "filthy habits, pretending to be unable to get up and too lazy to use the spittoon. The next day delirium was reported, and his condition worsened steadily until the 6th, when he died. A post-mortem revealed "miliary tubercles throughout both lungs, but also a contracted bladder, enlarged vas deferens and seminal vesicle, and "congestion of the spinal cord. With tell-tale signs like these the conclusion was inescapable: "a case of masturbation, producing excessive spinal irritation, debility and, indirectly, death. (45) Whatever the poor boy was suffering from, it is remarkable how quickly the doctors turned their attention to his genitals and sought the culprit in his adolescent sex drive. Most likely he was dying of tuberculosis. <h3> <a name="james"></a>James Beaney</h3> The most voluble, if not the most influential, medical writer on masturbation for the next thirty years was Dr James Beaney. He is chiefly remembered today for a scandal relating to abortion and his arguments with fellow doctors, but he deserves to be better known as the most important Australian populariser of the new medical orthodoxy on spermatorrhoea. James George Beaney (1828â€“1891) was born in Kent, took a medical degree at Edinburgh and became an army surgeon. He settled in Melbourne in 1857 and established himself as a prominent member of the medical profession there. (46) He published prolifically, but the main works in which in sought to bring the latest the understanding of sexual function and dysfunction to his colonial audience were Spermatorrhoea in its physiological, medical and legal aspects (1870) (47) and The generative system and its functions in health and disease (1872). (48) As he explained in the preface to the first of these, his books were "intended to exercise the same influence in these colonies which the works [of Lallemand, Acton and Courtenay] exercise in Europe, by spreading correct information amongst our populations (1870, p. x). In these texts, addressed to an educated public as much as to his professional colleagues, Beaney earnestly hammered Acton's main themes: masculinity was an embattled condition; spermatorrhoea was the signature disease of the day and the most deadly single threat to men's health; semen was more precious than blood; masturbation infallibly caused a raft of serious illnesses; children were a contradictory mixture of innocence and vice; treatments for spermatorrhoea could be effective; but only if victims avoided the quacks and took their problems to genuine professionals. I will consider each of these points in turn. Like Acton, Beaney saw men as beset by sexual threats: desire nagged constantly, but to yield was to risk debility, disease and ultimately madness. He sought to elucidate "the many sources of danger which threaten the integrity of their manhood (1872, p. 12) and to acquaint young men with "the dangers connected with the abuse of the sexual functions (1870, p. 45). The most serious of these was spermatorrhoea, defined as "an abnormal emission of the seminal fluid: Of all the diseases to which man is liable, there are few which induce so much ... mental anxiety as this. It embitters all the victim's social relations and subjects him to the harrowing reflection that he is the object of the taunts and jeers of those about him (1870, p. 45). Masturbation was both a specific form of spermatorrhoea and frequently also the cause. Beaney asserts that "the chief cause of this undue discharge of semen without the intention of the patient is abuse and explains that single men "ruin the nervous equilibrium of their sexual system and find themselves "at the mercy of the least excitement. Like Acton, Beaney warns that any discharge of semen is risky: even marriage, with its opportunities for legitimate intercourse, can be a trap. A married man "may so abuse the advantages which unlimited congress gives him, as also to enervate himself and subject himself to involuntary losses (1872, p. 183). Because of the importance of semen to the health of the male organism, such losses lead inevitably to illness. Beaney observes that philosophers "in all ages have held that "excessive coit. depressed the nervous system and that there was "a close connection between the brain and the seminal fluid (1872, p. 17). He considers it to be "the most important secretion of the body ... which taxes the fountain of life more than any other (1870, p. 10) and quotes Swedenborg's view that one drachm was the equivalent of an ounce of blood; "squandering such a fluid inevitably undermined "the stability of the corporeal system (1872, p. 27). It followed that masturbation must be harmful. Beaney defines "this wretched habit as "the production of emission of seminal fluid by friction and manipulation of the virile organ; or any process which produces a flow of that important secretion which is not the natural excitement of sexual intercourse with the opposite sex. Sounding more like a tub-thumping prophet than a man of science, he goes onto denounce masturbation as "one of the most pernicious habits that can possibly be indulged in, sapping ... the strength both of mind and body, reducing the most vigorous intellect to the feebleness of old age, and the most athletic frame to a condition of helplessness (1870, p. 56). In accordance with the nerve force theory of disease, he asserts that masturbation directly caused a range of disorders by disturbing the equilibrium of the nervous system: This excessive withdrawal of semen ... involves the necessity of concentrated vital energy upon the function of seminal secretion, hence, more of this valuable fluidâ€”the mainstay of the systemâ€”is drawn from the blood than the body can bear without derangement of other functions (1872, p. 182). Among the immediate consequence are a fairly contradictory bundle of symptoms, including inflammation of the urethra, irritation of the bladder, disturbed sleep, erotic dreams and nocturnal emissions, confusion of mind, vertigo, wakefulness, depression and languor (1870, pp. 61â€“3). In the long term, the practice could lead to epilepsy, phthisis (tuberculosis), insanity and impotence (1870, p. 78). On account of the "great expenditure of nervous force during unnatural excitation, masturbation was particularly implicated in the genesis of epilepsy, and Beaney found confirmation of the connection in the confession of many epileptics that they had practised that habit when young (1870, pp. 63â€“5; 1872, p. 201). Doctors thus had a duty to make every effort to minimise seminal loss, and that meant discouraging masturbation. Children should be watched closely for signs of the vice and action taken to nip it in the bud. Although he writes approvingly of circumcision as a hygienic measure, Beaney does not link it directly with the prevention of masturbation and largely repeats Acton's prescription of parental vigilance, moral exhortation, exercise and purity. He quotes the celebrated Dr Christoph Hufeland, who held that one of the "grand objects of such training was to "prevent onanism altogether, but he had little but old remedies to offer at this stage (1872, pp. 222â€“6). The most important of these was still willpower. In advocating the necessity of restraint in sexual matters, Beaney follows Acton in pathologising the normal male sexual response and exemplifies the way in which doctors were replacing priests as the watchdogs of sexual morals. He refers to men being "troubled with morbid erections and their sleep interrupted with lascivious dreams (1872, p. 233) and claims that symptoms of spermatorrhoea include "too frequent and troublesome erections at night, with erotic dreams and emissions (1872, p. 192). That many men of that period did find erections troublesome shows how effective the doctors had been in convincing the public that normal sexuality was really a disease. Beaney sounds like St Augustine, deploring his own erections as punishments sent by god to remind him of original sin, or perhaps the Council of Trent, which believed that, before the Fall, Adam's erections were voluntaryâ€”paradise indeed, for both those who wanted fewer and those who wanted more. On the issue of moral guidance, Beaney takes the Christian view that the flesh is a snare set by the devil for the ruin of the soul, but he suggests that scientific knowledge was a better basis for behaviour than theological sanction: the need for restraint was shown by the terrible consequences of indulgence. Man's mental endowment, he writes, has rendered it unnecessary to place physical barriers to the copulative function, as it gives to man a more noble means of restraint by ... the knowledge of cause and effect. The reasoning faculty is intended to teach him the consequences of acts that do violence to his physical system (1870, p. 30). Sin will undoubtedly be punished, but in this world rather than the next. Because it was impossible to establish "a code of laws to prevent sexual excess, it was "the duty of medical men to point out the ill-consequences ... and endeavour ... to modify the evil (1872, p. 32). The appeal might be to reason, but the atmosphere is that of a confessional: the relationship between a masturbator or other victim of spermatorrhoea and his doctor is much as the same as that between a sinner and his priest: It is generally difficult to obtain from the sufferer a frank confession of the cause of which he is himself the author. ... shame prevents an honest ... disclosure in many cases. The medical man ... having first gained the confidence of the patient, will generally succeed in eliciting the truth. It is always desirable that the patient should fully admit the practice ... the fact of having "made a clean breast of it gives them an access of moral courage which is very useful ... in facilitating their cure (1872, p. 187). Elsewhere he writes that doctors should "assist the feeble victims of sexual excesses by their counsel and personal influence (1870, Preface), just like a pastor with a straying sheep. Beaney is in favour of sex education, but on the assumption that it was largely a matter of teaching boys not to have sex (1870, p. 41). The sexual nature of children was another issue on which Beaney followed Acton closely. He shared the latter's opinion that "there should be perfect quiescence of the sexual function until ... maturity (1870, p. 38), but also his uneasy awareness that there usually was not. On the one hand, "as a rule the child is ... entirely free from any knowledge of the sexual functions, or indeed of the existence of any sensation of pleasure in connection with them (1872, p. 102); and yet, "I have met with hundreds of quite young children [with] ... the most complete theoretical knowledge of the character and purpose of their sexual construction. What was worse, these children have been caught "teaching others to play with their genitals (1872, p. 103). Anomalies abound: "There will ... under judicious care and education, be no tendency on the part of young children to notice sexual impressions; yet, "there are well-authenticated cases in which ... abnormal activity occurs, and the child exhibits a surprising tendency to sexual indulgence (1872, p. 5). Beaney did not expect sexual feelings to occur before puberty, yet "at a very early period of childhood some children are very prone to handle their privates, and the habit, if unchecked, becomes permanent and injurious (1872, pp. 6, 106â€“7). It almost makes one giddy to watch Beaney contradicting himself from one sentence to the next as he dodges and weaves from the empirically normal to the morally normative: ultimately it becomes apparent that the innocence of childhood is not a natural condition, but a social desideratum which must be imposed by force: That blissful period of innocence which intervenes between the birth and the advent of puberty should command the solicitude oft the parent; for it is during that interesting transition, that the foundation of lasting mischief is laid by those whose minds have already been contaminated by evil associations. The vigilance of parents and school proprietors cannot be too constantly exercised, in order that ... thoughts and impressions of a sexual nature may be prevented (1872, pp. 5â€“6). Bad practices like masturbation "must be stamped out if the children are to grow up in that virgin purity which we all expect in those of tender years (1872, p. 119). Beaney repeatedly expresses surprise at how early this vice seems to manifest itself, necessitating "the vigilance of parents to interdict any approach to the indulgence. He warns particularly against public schools, "where boys induct each other into many improper practices and adds a long quote from Acton on the problem (1870, p. 57). Although Beaney is largely recycling the new orthodoxy on spermatorrhoea advanced by Acton et al, he does make some adaptations for his Australian audience. His main point is that is that the relatively free and easy life of the Antipodes, the more relaxed social structure and the more intimate mingling of the sexes lead to increasing sexual precocity among children, thus magnifying the threat of spermatorrhoea to colonial manhood (1872, pp. 104â€“5). He fears that the "softening and purifying influence of home life is not so strong as in England and that the rough manners and lowly origin of the servant class are a constant source of dangerous knowledge and mischievous practice, and he returns repeatedly to the "evil influence of servants ... in teaching young children to handle their genitals and thus to fall into the habit of masturbation (1872, pp. 6, 114â€“23). This was a problem that also exercised Acton, but it was more severe in a new country which lacked the social checks and balances of the old. In treating cases of seminal loss and problems arising from masturbation Beaney did not rely solely on moral exhortation, but there was not much in his battery of prescriptions which distinguished him from the quacks he so routinely denounced. The most common treatments involved sitz baths, "generous diets, different kinds of alcohol and various chemical compounds, particularly potassium bromide and phosphorous (the latter believed to be an important constituent of the brain), and the application of electricity to the nervous systemâ€”"galvanism and "Faradization in Beaney's terminology, though it is not clear how the two procedures differed from each other (1872, pp. 160, 164â€“5, 202â€“5). Treatment for a man suffering from impotence induced by masturbation included sea baths, a ban on smoking, galvanism and doses of phosphoric acid, quinine, iron and strychnine (1872, p. 164â€“5). A case of epilepsy caused by masturbation was cured by a program consisting of dry sherry, phosphorous, strychnine, iron, Faradization and sleeping on a hard mattress (1872, p. 205). Unlike Acton, Beaney did not recommend cauterisation of the urethra in cases of spermatorrhoea, but his favoured treatments for prostatorrhoea (emission of prostatic fluid) tended to be more severe than those recommended for loss of semen. In addition to the nostrums above, these might include the porte-caustique, leeches, blistering of the perineum, a No. 12 galvanic sound and injections of belladonna and camphor into the urethra (1872, p. 237). If such a preposterous mixture of poisons and placebos had any curative effect it could only confirm the imaginary status of the diseases being treated. Beaney is not yet thinking of circumcision as a treatment for spermatorrhoea, but he is moving in that direction. He notes, without going into details, that "hypersensibility of the glans penis and the urethra will often be found to be at the bottom of the troubles, and he cites a case reported in the Lancet (1867) on the connection between a tight foreskin and epilepsy. This article claimed that "a variety of cerebral symptoms ... such as pain in the head, giddiness, noises in the ears, eructations etc ... may be entirely removed by circumcision, though it conceded that circumcision of several mental patients did not reduce the incidence of their epileptic fits (1872, p. 113). In accordance with the nerve force theory, Beaney is naturally alert to the phenomenon of "sympathetic irritation (1872, p. 107) and notes that a "very important cause of "morbid sensitiveness in the penis is the extreme length of the prepuce; this was not only a "source of irritation in childhood but "an embarrassment at puberty (1872, p. 109). Beaney does see the foreskin as a source of dangerous irritation and is attracted to circumcision as a remedy, but, like Acton, he is pessimistic about the chances of the procedure winning wide acceptance because of its religious connotations. He urges that the "secretions which accumulate beneath the foreskin should not be left "as a source of mischief and quotes Acton on the complicity of the foreskin in sexual precocity (1872, p. 109). He then comments that circumcision should be more widely practised and regrets that its sacred associations (Jewish and Islamic) discourage its wider adoption: It is well known that in surgery we are often obliged to do for Christian men that which is to some extent analogous to circumcision ... and the operation is sought for much more frequently than formerly on purely hygienic grounds. It is to be regretted that so valuable a preventive against many sexual disabilities should have been environed by sacerdotalism (1872, p. 111). Medical science had learned that circumcision could prevent or cure a raft of sexual problems; only irrational prejudice (or "maudlin sentiment) held up its general application. In his book on children's health (1873) Beaney does not mention circumcision (or any sexual issues) at all, but there is a passage in his Disorders of the generative system which suggests that he might have been eyeing the operation as a possible treatment for masturbation. When children are caught handling their genitals, he writes, the parent must "confront the evil in the child and take all the necessary steps, both surgical, hygienic and admonitory, to overcome the cause of the bad habit (1872, p. 113). There is no elaboration of what surgical steps he has in mind, but one wonders. <h3> <a name="themal"></a>The malign influence of the foreskin</h3> It was possibly in the next decade that doctors in Australia made the link between the "irritability of the foreskin and the aetiology of spermatorrhoea and drew the obvious conclusion that the surgical removal of the offending tissue would offer the prospect of both prevention and cure. In a paper on the need for sexual restraint published in 1884, Dr J.W. Springthorpe considered the "problem of the sexual appetite before marriage and observed that it could be dealt with in three ways: masturbation; resort to prostitutes; and restraint. He echoed Beaney in his depiction of the threat posed by seminal loss "in a young colony and the equal danger of leaving treatment of such complaints to the quacks: Upon a subject of such importance, and one too frequently neglected or relegated to the nefarious hands of quackery, it is imperative that ... physicians ... should have fairly comprehensive knowledge and definite views. And in a young colony like oursâ€”one legacy of whose fevered past has been a distinct neurotic tendency, with climatic influences that favour early bodily development, and where the newspapers, by their almost daily tales of sexual crimes, point conclusively to the existence of an extremely grave state of affairs. Self-evidently, both masturbation and resort to prostitutes were too dangerous to contemplate, leaving abstinence before marriage as the only safe way to meet the sexual appetite. By their surgical skill, doctors could assist young men (and even young women if necessary) to restrain themselves: Hence onwards until marriage the excito-motor mechanism should be the subject of investigation and regulation, so that none but the normal impressions might travel upwards to the brain. To this end it might be necessary to snip off a redundant prepuce, divide a contracted meatus, clip a short frenum ... and the same, mutatis mutandis, in the female. In the discussion which followed there was no dissent from this proposition, and a Dr McMillan affirmed that "absolute sexual continence was compatible with perfect health and opined that "the instinct of abstinence ought to be encouraged. (51) It is interesting to note Springthorpe's assertion of the medical profession's claim to investigate and regulate the normal functioning of the body. Despite Koch, Pasteur and the discovery of germs, medical opinion in these areas did not change much over the next generation: as late as 1913 the Melbourne Pediatric Society considered the case of a 13-year old boy who complained of tiredness and pain in the back of his thighs. Dr Alan Mackay suggested "the trouble was quite possibly due to masturbation in a boy of that age, and he thought the boy should be watched. He had often noted the association of nasal catarrh, dilated pupils and bad teeth with sexual aberrations. (52) With such salutary examples as these in the professional literature, who could doubt that masturbation would inevitably lead to bodily and mental weakness, insanity and death? Certainly not the authors of manuals on child rearing, who were quick to warn parents of the need to guard against the development of evil habits in their children. In Mother and child (1913) M. Danvers Power devotes the whole of a chapter called "Teaching children the natural laws of sex to this single problem. Quite little children, she or he writes, "often form the bad habit of playing ... with the sexual organ, finding that it produces a pleasant sensation. Power considered him/herself a progressive who believed in telling children the truth about sexual functions, and the truth was that bad sexual habits had terrible consequences: The children become disobedient, rebellious against authority, cross and irritable. Next, the effect upon the nervous system is very serious. The pleasant feeling which is experienced at the beginning, ends in a spasm of the nerves, which leaves the body absolutely wasted of all nerve force, drained of all nervous energy, exhausted as is the body of a person who has had a fit. And while the nerves and character are being ruined the mind is also suffering. The memory becomes dull, the child cannot grasp his lessons, and goes down to the bottom of the class. ... Where the body is not naturally strong, a general wasting may be followed by consumption, or life may be ended by some other terrible disease. ... And if continued, not only the body and character are ruined, but the mind collapses also, and madness is the result. Note the persistence of the nerve force theory of disease and how widely diffused it has become. Mothers should therefore teach their children that their sexual organs should be used only after they marry, and then only for the purpose of creating their own babies and that if they use them "before that time, or injure them by bad habits, illness and misery and probably madness will be the result. (53) Curiously enough, a Frederick Danvers Power became a leading figure in the boy scouts and prepared the first edition of the Australian Boy Scouts Handbook in 1922. You may recall the tenth lawâ€”"A scout is clean in thought, word and deedâ€”and you would be right in thinking that this meant no playing with yourself or your mates. Unclean thoughts may be in connection with the abuse of the private parts of your body. ... Thee parts have been given to you for a special purpose, and God will reward or punish you accordingly as you take care of or abuse them. They should never be handled except to clean them. (54) Both the views and the fluffy toy language are so close to those expressed in Mother and child that it is hard to believe they are not by the same person; perhaps Frederick was the husband or son of M. In warning against the dangers of self-abuse Power was following the example of Baden-Powell himself, who had included a section on continence in the appendix to Scouting for boys (1908) and a further caution in Rovering to success (1922). This included the immortal advice to "keep the organ clean and bathed in cold water every day, a suggestion which soon acquired a ribald notoriety. (55) Of undoubted progressive sympathies was the better known Marion Piddington, an exponent of sex education for the young and a supporter of both birth control and eugenics. She was no more relaxed about masturbation than Power or anybody in the medical profession: it was a harmful habit that tended "to arouse the sexual nature prematurely and could lead to interest in prostitutes, with the attendant danger of venereal disease, as well as eugenically inadvisable marriages. Piddington was definite that the habit of self-abuse should be prevented though non-specific as to the best methods; she did, however, suggest that boys should be clothed in trousers without pockets. (56) Such examples tend to confirm Neuman's conclusion that the main aims of the early sex educators were to warn children and adolescents about the impropriety of sexual exploration before marriage and to discourage autonomous activity on their part. (57) <h3> <a name="quack"></a>Quackery and orthodoxy</h3> The views of the quacks were little different from those of the mainstream medical profession, though they did tend to be cast in more lurid language. Two of Sydney's most prominent specialists in the "nervous and private diseases of males, Drs Freeman and Wallace, referred to masturbation as a "pernicious habit which caused a whole brood of diseases, a "disgusting subject, a practice alarmingly widespread among the young, and a problem which must be overcome; their own cures (not detailed in the publicity) were always efficacious in this respect. (58) Even more colourful language was employed by another practitioner, Dr W.B. Towle, who mixed moral and scientific condemnation in a manner typical of the period: The general effects of seminal weakness, nocturnal and diurnal emissions, impotence and sterility, caused by self-abuse in early life, or excessive indulgence in later years, if not relieved by appropriate and thorough treatment, are most deplorable. This malady is one of the most widespread and destructive experienced by man. Few, except physicians, have any conception of the prevalence of self-abuse, or of its disastrous effects on both mind and body. This habit, according to the experience of the most renowned medical men, degrades man, poisons the happiness of his best days and ravages society. It is certainly one of the most ruinous vices ever practised by fallen man. Its victims are found among the young of both sexes in every country .... Many who really perish from its effects are supposed to die from other causes, such as consumption, epilepsy, heart diseases, exhaustion and failure of the vital powers. It ultimately destroys the mind as well as the body. In its milder form it produces loss of memory, melancholy, depression of spirits, timidity and loss of energy. In its worst form idiocy and insanity. Many maniacs owe their loss of reason to no other cause. In the tabulated reports of every lunatic asylum are a great number of cases in which the cause of insanity is set down as "masturbation. (59) Given their generally more hellish scenarios, you might think that the quacks would be more enthusiastic about the heroic approach to male sexual problems, and masturbation specifically, than the regular doctors. In fact, the reverse is true: it was the mainstream professionals who favoured modern scientific methods of treatment, such as mechanical restraint, infibulation of the foreskin, cauterisation of the urethra and circumcision. The remedies proposed by the quacks were altogether gentler and less punitive. Freeman and Wallace did not recommend circumcision for any genital complaint and discouraged it even in cases of phimosis: "Slitting the foreskin or circumcision is frequently adopted by some surgeons, but we never resort to such measures unless ... absolutely necessary. (60) They made their own attack on quacks who offered fake cures, especially cauterising the urethra with caustic substances, a treatment recommended by Acton and widely practised by orthodox professionals. (61) Freeman and Wallace were vague about their own methods, but not Dr Towle: he specialised in electro-therapy, offering a range of electrical appliances designed to cure female complaints, liver and kidney problems, joint disease, nervous debility and impotence. The "Hercules Life Renewer could even treat self-abuse successfully, though in cases where spermatorrhoea was also present, supplementary remedies would be required. (62) There is not a word here about surgical intervention. Indeed, if published testimonials from successfully treated patients may be believed, there is evidence that some men resorted to quacks precisely to avoid the surgical remedies proposed by regular physicians. Towle quotes the example of a young man suffering from paraphimosis: A surgeon had told him he would have to undergo an operation; that the prepuce would have to be cut through. Shrinking from this prospect he decided to consult me. I administered at one some medicine, the effect of which was to relax the constricted muscles ... [and] the patient awoke to find himself quite well. He wrote saying: "I am doubly grateful to you for having not only cured me so easily, but for having saved me from having to undergo a surgical operation, which would have been very painful, and would have left its mark upon me all my days. (63) Given this sort of resistance to the operation, it is not surprising that the circumcision lobby targeted its propaganda at parents rather than the actual subjects of the procedure and that it became common only because it was done without the consent of the patient; wherever circumcision has become general it has been an operation that authority (usually parental) has inflicted on the young or otherwise powerless, rarely a procedure that competent males have elected for themselves. For all the embarrassment they caused the regulars, it is thus not so easy to draw a firm line between the quacks and the medical profession proper. The practitioner who diagnosed a case of tinnitus as stemming from masturbation and who treated it by means of electric shocks and a long course of urethral dilation with catheters was not a quack, but Dr W.F. Quaife BA, MB etc, who described his cure in the journal of the Australian branch of the British Medical Association. (64) Indeed, the campaign against quackery was part of a wider effort on the part of doctors to establish their own professional standing and assert a monopoly over the management of bodily (and some mental) functions. The mainstream doctors had been vying with the irregular practitioners since at least the 1860s, and the main issue on which the struggle was fought was their competence to provide better treatment for "nervous and private diseases. Acton had taken numerous swipes at the quacks, and another significant writer on spermatorrhoea, F.B. Courtenay, had actually put together a broadside called Revelations of quacks and quackery (1860s) in which he emerged as a crusader against the irregulars, and particularly against their claims to cure spermatorrhoeic and related diseases. In his own work on that subject he expressed the usual views on masturbation but was fairly relaxed about involuntary nocturnal emissions and critical of the cauterisation treatment advocated by Acton and others. He attacked the quacks and deplored the reluctance of the medical profession to take spermatorrhoea seriously, thus driving men into their hands. (65) As we have seen, he was one of the influential English writers whose ideas Dr Beaney had sought to popularise in Australia. Beaney's Spermatorrhoea was explicitly part of a campaign to wrest the treatment of these diseases away from the quacks and vest it with qualified doctors; as he writes in the Preface, it was "designed to lead those who are afflicted by them to abandon the pretentious quacks and turn to "legitimate and honourable practitioners like himself. (66) Like Courtenay, he is critical of his profession for its "culpable neglect of one of the most important and serious ... diseases to which mankind is subject, thereby driving "a large section of the community ... into the hands of the vilest imposters (1870, Preface). By refusing to take the disease seriously and treat it like any other medical complaint, the profession was in fact responsible for sending "thousands of wretched sufferers ... into imbecility and the madhouse and even the grave. Rejecting the prudish and old fashioned view that medical science was too delicate to be concerned with the genitals, Beaney asserts its claim to management of the whole body: "Are not the functions of the surgeon ... to embrace all the maladies to which the body is liable?, including those afflicting the genital organs (1870, p. viii). His audience here is twofold: he wants to convince the public that victims of spermatorrhoea should seek the help of professionals like him, not patronise the irregulars; but he also wants to persuade his conservative colleagues that they should accept spermatorrhoea as a real and serious disease which demanded their professional attention. Quoting from Copland's Medical dictionary and other English authorities, Beaney regrets that too few doctors took the problem seriously, thus relinquishing it to the "unqualified empiric. He is pleased to note, however, that this state of affairs is changing and that doctors are making amends for their neglect "by the ardour with which they are investigating [the problem] and the earnestness with which they endeavour to protect the public against the frauds of those quacks who have so long preyed upon them (1870, p. 48). The nub of the case was that spermatorrhoea was too grave and complex a disease to be treated by anybody except the experts: These several phases of spermatorrhoea require special treatment and suggest the folly of trusting their management to the pretentious charlatans and ignorant quacks who parade their nostrums in the daily journals. The disorder ... is too serious in its character and consequences to be carelessly dealt with. ... the question ... calls forth the highest faculties of the surgeon or physician, and taxes the powers of his art often to their limit (1870, p. 103). Yet the sad fact is that there was very little even the most conscientious physician could do about these diseases that would distinguish them sharply from the quacks they so bitterly despised. As we have seen, their treatments for various forms of spermatorrhoea consisted largely of bathing, exercise, diets and "medicines like potassium, phosphorous and strychnine; their rivals offered much the same regimen, including the application of electricity. Beaney derided them for making use of an "Electro-Galvanic Vital restorer, apparently forgetting that he himself was an exponent of galvanism and Faradization. (67) There was not much in any of this to grab the attention of the public and persuade it to abandon the irregulars; something dramatic was needed, something that only the medical profession proper could offer, some sort of magic bullet. <h3> <a name="pfor"></a>Professionalisation of medicine</h3> The years 1881â€“1914 were a crucial period in the emergence of the modern medical profession in Australia. A five-year degree had been introduced at Melbourne University in the 1860s, and Sydney followed suit in 1883; the New South Wales branch of the British Medical Association was established in 1881. The emergence of the profession was largely a process of differentiation; as Lewis and Macleod (68) have shown, doctors were struggling on two fronts: against chemists, druggists and "quacks for control over health care; and against the friendly societies over conditions of work and fees. Doctors had been trying since the 1860s to get legislation which would define and secure their position. Their efforts were opposed as an attempt to gain sectional privilege and knocked back several times, but in 1900 the NSW parliament passed the Medical Practitioners Act, which made it an offence for anybody without recognised qualifications to use a medical title and empowered the Medical Board to debar practitioners on a range of grounds. This victory recognised the new prestige of scientific medicine: "the orthodox practitioners finally won legislative endorsement because they had established a cultural authority superior to that accorded 'alternative' practitioners, (69) though it might be more precise to say that this legislative sanction created the very categories of "orthodox and "alternative: before then it had been pretty much a free-for-all. Apart from beating the quacks in the lobbying game, however, it is hard to see what medical achievements underlay the doctors' triumph, though the promise of the new germ theory of disease may have been part of it: in 1899 the Sydney Morning Herald looked forward to the conquest of cancer and even gout. (70) As the example of Herbert Moran makes clear, however, the moral and even confessional role of the doctor increased along with the growth of his scientific status, (71) and the new scientific spirit did not lead to any immediate questioning of the links which had been drawn between masturbation, immorality and disease. The case of Dr Richard Arthur (1865â€“1932) is instructive. Born in England and educated in Scotland, he settled in Sydney in 1891 and became director of a number of major city hospitals. He lived and practised in Mosman and was an independent member of the NSW state parliament for various north shore electorates from 1904 to 1932 and briefly Minister for Health in the Bavin government in 1927. (72) He inveighed against the deceitful machinations of the quacks, yet he was himself a fervent purity campaigner who wrote numerous pamphlets for the Australasian White Cross League on the necessity of youthful continence; he was a keen practitioner of hypnotism and an advocate of vegetarian diets; he warned boys against the dangers of self-abuse and advised parents to circumcise their sons as a preventive measure. It was only the last point which distinguished him from Freeman et al. Arthur agreed with the quacks that masturbation led to severe physical and mental illness: The seed is a very valuable substance, and if it is drained away continually, all the strength and vigour leave the body. The boy or man who practises this vice becomes stunted in growth and enfeebled in mind. he becomes unfit for games and athletics of any kind, and he is not able to study or devote his attention to any object. ... He may so lower his health that he falls an easy victim to that terrible malady, consumption, or he becomes subject to epileptic fits, or, worst of all, he may so injure his brain that he develops insanity in one or other of its dreadful forms. (73) He did not mention circumcision in pamphlets directed at boys, but in one addressed to adults he advised parents to watch carefully for signs of self-abuse and to consult a doctor immediately if a child displayed "any tendency to objectionable habits. In accordance with the medical wisdom of the day, he added that "this vice in the young is sometimes brought about by the existence of some local irritation ... [and] the operation of circumcision is needed. (74) Arthur was a leading light in the Australasian White Cross League, itself an affiliate of the English organisation of the same name and a direct descendant of the groups that waged the English purity campaign of the 1880s which, among other achievements, pressured parliament to raise the age of consent, restrict the circulation of pornography, ban nude bathing and criminalise homosexual activity among males. (75) In this capacity Arthur urged moral purity in the young and the strict avoidance of sexual activity before marriage. It was this obsession which led him into disagreement with the quacks, whom he criticised for scaring boys with the claim that even involuntary seminal emissions (such as wet dreams) were harmful and in need of special treatment. He reassured them that "in most cases this emission is not unnatural. It is merely a sort of overflow of the semen, and if it do not occur oftener than once in ten days or a fortnight, there need be no cause for anxiety. If, however, they are frequent or are followed by "languor and depression, the sufferer should "seek the advice of some respectable doctor, who will probably soon cure the condition. (76) Arthur's qualified and reluctant acceptance of nocturnal emissions was a consequence of his insistence on chastity; if adolescents and young men renounced masturbation and sexual intercourse, their pent-up energies would have to find release somewhere, and wet dreams were less harmful than "artificial stimulation. Arthur appears to have held a pretty low estimate of the average adolescent sex drive: to the modern mind, a teenager needing no more sex than one wet dream a fortnight would be a sorry specimen indeed. (77) In summary, then, it was not the quacks like Freeman and Towle who offered circumcision as a cure for masturbation and other male complaints. They offered the medical stock-in-trade of Dr Beaney and his colleagues from the previous generation â€”bathing regimes, proprietary medicines, electrical devices, special diets etcâ€”but were reluctant to perform surgical procedures and were losing the right to perform them. It was the university-trained and properly accredited medical practitioners who urged circumcision and other surgical interventions as effective, scientific treatments which embodied the latest advances in modern medical understanding and which they alone could provide, in opposition to and in competition with the fringe practitioners. Some patients might have resorted to quacks expressly to avoid the harsh remedies proposed by the regular physicians. In this context it is possible to see the doctor's campaign against quackery as part of a battle for professional turf, indeed, as part of the struggle to establish their own professional identity, and the circumcision cure as one of the weapons in their armoury. Quackery is a matter of perspective, and today it is the crusaders against masturbation and the advocates of circumcision who look like quacks, an impression that some of them seem only too eager to foster. Consider these examples. During a lengthy controversy on the practice in the correspondence columns of the British Medical Journal in 1935, Dr R.W. Cockshut wrote that all male children should be circumcised. This is "against nature, but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. (78) Following the decision of the Australian Paediatric Association to recommend against routine infant circumcision in 1971, a doctor in Perth, G. Hall, boasting that he had performed some 2,000 infant circumcisions with bone forceps, recorded the following objection: I am convinced that when God made his covenant with Abraham and ordered this peculiar and embarrassing mark of identification of His chosen people, he regarded it as a health law as well as a ceremonial act. I am equally convinced that that unnatural edict by the APA is Satanic in origin. The only part of the body which has ever been ordered by our Creator to be surgically removed is the male foreskin. (79) Such comments emphasise the point that the moral pressure towards circumcision has always been much stronger than any scientific demonstration of its therapeutic advantages: if it really did offer health benefits great enough to outweigh the injury, it would not be necessary to do it without the consent of the subject. <h3> <a name="thedemo"></a>The demonisation of the foreskin</h3> With the rise of the masturbation phobia came the demonisation of the foreskin. It ceased to be a normal part of the male body and came to be regarded as an inherently unhealthy structure that gave nothing but trouble. By the 1930s Moran could unthinkingly refer to (healthy) foreskins in the same breath as infected appendixes and diseased gall bladders; medically they were all in the same category. (80) Acton's views were developed further in the US by Lewis Sayre and his disciples from 1870, (81) and popularised in Australia by George Beaney. A later formulation of them was by the US physician George Beard, an edition of whose home medical guide was published in Sydney in 1884. Walker reports that the reception Beard's writings is difficult to gauge, but that James Smith, one of the most prolific men of letters in late nineteenth century Victoria, was enthusiastic about his work and drew on it for his own essays and lectures, including one on the nervous system delivered in 1881. (82) As you might expect, Beard devotes a good deal of space to "nervous diseases of modern times, including neurasthenia, seminal emissions, impotence, noises in the ear, self-abuse and "sexual exhaustion, (83) and it is in this context that he focuses on the foreskin. He notes that early masturbation is nearly always present in cases of sexual exhaustion and reports that in two thirds of nervous disease cases "there is more or less abnormal condition of the prepuce. The reason is obvious: "In a nervous person a redundant, elongated prepuce, covering the gland [sic] and pressuring upon it, acts as an irritant to the whole system, and excites any number of nervous symptoms, even to melancholia and paralysis. In such cases circumcision is needed to relieve the pressure on the glans, and such operations "have been known to radically cure cases of nervous disease. (84) These views are in accordance with the nerve force theory of disease and are no more far-fetched than what Lewis Sayre, Joseph Howe (85) and their followers had claimed, but Geo. Talbot Woolley was not afraid to go further. He was honorary surgeon at Castlemaine Hospital, Victoria, and in a paper given to the Intercolonial Medical Congress in 1889 he detailed the symptoms of tight foreskins on infants in terms that suggested he was well versed in modern medical orthodoxy. The child, he asserted, has a peevish or peaky look; the skin has a shiny, dry, cracked look about it, and there are generally some sores about the nostrils and corners of the mouth, which are quite typical and different from the common herpes .... [He] is generally ill, feverish, with bad appetite and furred tongue, and passes urine very frequently; which is sometimes thick and milky, and sometimes of a very high colour; he is generally in pain about the lower part of his abdomen, but is not able to give you any definite account of his condition. Woolley remarked that most medical men, on being told that an infant is fretful and feverish, will suggest there is something wrong with his diet, but he asserts that if you inquire more closely you will often find that the child often wets his napkin almost incessantly, that his penis is almost perpetually in a state of erection, and that ... the prepuce is so tight that it is impossible to see the lips of the meatus, which ... will be found to be in a state of congestion. The secretions generated under the foreskin accumulate and gradually this material "buries itself in the surface of the glans penis, or the under-surface of the prepuce, and sets up a definite form of constitutional disturbance. This will eventually express itself in the symptoms of a wide range of diseases, including hernia, worms, consumption of the bowels, typhoid, bloody urine, inflammation of the brain, bowels and lungs, and even paralysis of the legs. Woolley claimed that he had been able to cure all these symptoms in boys ranging in age from 20 months to eight years by the simple expedient of separating the foreskin from the glans and cleaning out the sebaceous matter. (86) What was really happening here we shall never know, but it is likely that Woolley was observing what Sayre and others had taught him to expect. (87) <a href="https://www.darboninstitute.org/a_source_of_mischief_part_3">Read Part 3</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 A source of mischief (Part 2) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>The advocates</h2> Many persons object to the direct allusion to the sexual organs of children, and urge that they should be left ... to the chapter of accidents, lest the mind of the child should be prejudiced, by directing its attention ... to what it is supposed not to recognise. This view of the case is not defensible when the advantages of interference so frequently preponderate over any imaginary evil which is advanced. The time has passed away when maudlin sentiment is to stand in the way of the appliances and teachings of medical science -- Dr George Beaney, Melbourne, 1872 In Aged Ignorance profound, Holy and cold, I clip'd the Wings Of all Sublunary Things -- Wiliam Blake, "The Gates of Paradise" <h3>Doctors</h3> Apart from the hints of Beaney and the suggestion of Springthorpe, the first explicit public advocacy of circumcision in an Australian professional journal I have located is in 1901 from H.G.H. Naylor, whose article "A plea for early circumcision" in the Australasian Medical Gazette ran the gamut of the dangers ascribed to the foreskin and the benefits arising from its removal. The "evil results of neglected foreskins" include frequent urination, loss of flesh, convulsions, phosphatic calculus, hernia, nervous exhaustion, dyspepsia, diarrhoea, prolapse of the rectum, balanitis, phimosis and masturbation; all these problems could be rapidly cured "by the simple operation of circumcision", while "disastrous results" would arise from avoiding the procedure. Naylor is apparently conversant with some of the British and US literature: he attributes the tendency to "self-abuse among young boys" to the irritation produced by secretions under the foreskin, tempting the lad to handle his penis, but he does not appear to have read (or has not been swayed by) some of the more extreme proponents of genital discipline in the US. The major advantages of circumcision are that "at the age of adolescence there is much less disposition to masturbation" and that in adult life "there is much less danger of contracting gonorrhoea and syphilis". The latter proposition goes back to Acton, and the evidence for it at this time was the belief that Jews had a lower level of venereal disease than the uncircumcised, and Naylor duly points out that very few Jews present with such complaints. (88) Not all the advocates of circumcision who followed Naylor made such extravagant claims for its therapeutic value, but nearly all followed him in listing its major benefit as the prevention (or reduction) of masturbation, and many also mentioned its value as a protection against VD. The following year A.S. Joske, having noted that more children were being brought in to the Alfred Hospital to be circumcised, emphasised the value of the operation for adults as well: it removes certain impediments to intercourse, and is a great preventative of chances of syphilis [sic: probably a printer's error for "chancres and syphilis"], of intestinal gonorrhoea, and possibly epithelioma, and under certain conditions removing the prepuce early may tend to keep boys from masturbation. (89) Joske did not specify what those conditions might have been, but one gets his drift. Similar points were made by the better-known Philip Muskett, a prolific writer on a wide range of medical, diet and lifestyle matters. He was the author of several books on child rearing and diet, none of which discusses circumcision, and of the Illustrated Australian Medical Guide, a two-volume household reference work which first appeared in 1903 and reached a second edition in 1909. This includes a very positive entry on circumcision in which Muskett adds climate to the reasons why the operation should be generally performed: "In this semi-tropical Australian climate of ours it would be infinitely better if circumcision were the rule, and not the exception". As with Naylor, the problem was that troublesome foreskin: it was liable to phimosis; it accumulated smegma, a substance which soon acquired "a very unpleasant, even markedly offensive odour"; it was likely to adhere to the glans; its opening was inclined to be too small to urinate through comfortably; it was likely to become irritated and inflamed; it could led to bed-wetting; it could provoke nervous disorders; it could constrict the proper growth of the penis; and it led to masturbationâ€”"bad habits are frequently induced by boys meddling with themselves, in consequence of the irritation produced". There was clearly only one thing to be done, and that was to follow the example of the Jewish race and "many other Eastern nations". (90) Muskett was not an extremist like some of the US doctors. His main concern seems to have been physical cleanliness, and on the surface at least he seems to have been worried only by long or tight foreskins, not foreskins per se. But as I suggest below, these formulations were not as limiting as they might seem: "cleanliness" was often as much a matter of sexual abstinence as soap and water, and in the absence of any studies of its anatomy and functions who was to judge whether a foreskin was too long or tight? (91) Muskett writes that "no male with a proper sense of cleanliness can feel that his bath has been complete, in the presence of a long or tight foreskin", (92) but it is difficult to see why a long (but retractable) one could not be scrubbed as thoroughly as its owner could withstand. If you wanted your foreskin to pass Dr Muskett's test, it had better be pretty modest. The need for self-restraint in sexual matters, the problem of the foreskin, the dangers of masturbation and the value of circumcision were brought together at a conference on the teaching of sex hygiene, organised by the Workers Educational Association of New South Wales in November 1916. The main focus of the conference was on how sex education could be used to teach children and adolescents the value of self-control in relation to sex, "preparing the minds of the young and stiffening their moral fibre against the pitfalls that await those ignorant of their physical functions". (93) Hygiene was not just a matter of physical cleanliness; as an editorial in the Australasian Medical Gazette had pointed out, it was "a matter more of moral than of intellectual consciousness" (94) and primarily a moral issue: "Just as physical dirt causes disease of the body, so moral dirt causes disease of the soul. A clean mind is as necessary for our moral welfare as a clean body is for our physical welfare", as Power put it in the Boy Scouts Handbook. (95) Above all it was a matter of sexual purity and continence: While the intensity and all-pervading influence of the sex instinct was constantly dwelt upon, almost every speaker urged the necessity and possibility of fostering self-restraint from the tenderest years. Despite the irregularities of youthful conduct, and the strength of the temptations that beset the adolescent, no speaker would abate one jot of the influence of healthy physical and moral training in its preventive action. (96) The main concern of the conference was venereal disease, the spread of which had been accelerated by the war, but masturbation came in for its own share of condemnation and tended to be seen as a precocious awakening of the sexual instinct that would lead a young man to prostitutes later on. It is of course relevant that the medical profession at this time was powerless against VD. In an age which lacked antibiotics but believed that alternative forms of sexual gratification like masturbation were both sinful and physically damaging, the only cure for venereal infections was indeed not to contract them, so it is not surprising that continence was a policy urged by both the moral and the medical establishments. The medical profession believed that it was the duty of parents to teach children "the objects of marriage and the necessity for abstaining from the gratification of sexual desires until marriage", as well as "the prolonged and serious ill-health which may result from self-abuse", but it was up to the experts to educate the public as to the dangers of VD. (97) At the WEA conference itself the importance of the issue was underlined by the presence of that veteran purity campaigner, Richard Arthur, whose paper "Teaching control of the sex instinct" rehearsed his familiar theme that there should be no sexual activity of any kind before marriage. The sociologist H. Tasman Lovell likewise spoke about "the necessity for greater self-restraint" and referred specifically to self-abuse as one of the evils that must be inhibited. (98) In this context the prophylactic value of circumcision was quickly recognised. In his paper "Sex irregularities of childhood and youth", W.A.T. Lind, a pathologist with the Victorian Lunacy Department, noted that masturbation was the chief problem and that the main cause was usually a "peripheral source such as local irritants". To deal with these, strict rules of personal hygiene should be observed, and girls should be prevented from riding bicycles. Lind commented that it was difficult to identify individuals addicted to the habit, as there was "nothing to distinguish the casual masturbator from the ordinary youth", though the former was usually unhappy, in poor health and suffered from weakness of attention. As to treatment, Lind recommended a combination of moral suasion and surgical intervention: Every youth suspected of the practice should be sent for medical inspection. He will at first stoutly deny the habit, as all masturbators are liars for the shame of the thing. Kindly advice from the physician ... that no permanent damage to his brain ... will result, provided he ceases to practice the habit, will go far to restoring the lad's confidence in himself. If there are any physical conditions present, such as an adherent foreskin, piles etc. ... they should receive surgical attention so that the reflex irritation from them may not stimulate the sexual organs. (99) Prevention of masturbation was also the prime concern of Sir Thomas Anderson Stuart, Dean of the Faculty of Medicine at Sydney University. After a brief recital of the damage resulting from the practice and the signs by which an educator could recognise a boy with bad habits, Stuart turns to the culprit: "All this inevitably brings up the question of the foreskin", and he goes on to praise the Semitic peoples for their approach to the problem: many ancient races met the same difficulty, and quite independently got over it by cutting the foreskin off in the operation of circumcision. This was made into a sacred rite ... by the Jews, Mohammedans, and many Semitic and other races. The only important Semitic peoples who did not follow the rite were the Philistines, the Babylonians and the Assyrians, and we can imagine some Jew asking, where are these people now? (100) Stuart's tone is a touch facetious, but it is clear that he admires and is urging emulation of Jewish practice; his allusion to Ninevah and Tyre (capitals of fallen empires named in Kipling's well known poem, "Recessional") would not have been lost on his wartime audience, and it is a suggestive confirmation of the link that Hyam has drawn between circumcision and imperial destiny. (101) Turning from geopolitics to personal hygiene, Stuart attributes the origin of masturbation to the secretions which accumulate under the foreskin if it "is at all longâ€”and it often is", producing irritation and leading a boy to rub the parts. Careful washing sometimes works "if this is done as a matter of habit", but if the foreskin "gives rise to persistent trouble", then "the surgeon must procure relief by the little operation of circumcision". (102) The discussion which followed this paper provides further illustration of the extent to which Jewish custom was regarded as the right model. Geo. Lewis was concerned that the boys and girls of today were "growing up without the power of self-control" and believed that "if we could get back to the law of Moses regarding the cleanliness of our bodiesâ€”circumcision, I refer toâ€”we would have a better class of men". He went on to regret that "our Christian laws" do not require "this small surgical operation [to be] performed on our boy children", even though we admit "it is clean and necessary". (103) Two features of these remarks deserve comment. First, although doctors certainly encouraged parents to treat their children like criminals when masturbation was suspected, I am not aware of anybody else in Australia who seemed to hint that circumcision should actually be required by law. Second, Lewis exemplifies the extent to which the advocacy of circumcision in Australia was part of a progressive and scientific movement, and how support for the practice was more widely diffused among the working class than in Britain. In the working man's paradise, health benefits available only to the rich at home would be the birthright of every boy and proof of his parents' aspirations to gentility. This conference was held by the Workers Educational Association, and Lewis himself was secretary of the NSW Branch of the Federated Millers' and Mill Employees' Association of Australasia. He was also a JPâ€”all round, the very model of the respectable trade union leader. The one child care expert at the conference was Zoe Benjamin, a lecturer in psychology at the Kindergarten Training College. She had read Holt (and in fact quoted from his Diseases of infancy and childhood in her paper), so she was well versed in the dangers of masturbation and not afraid to recommend heroic remedies: The practice may be corrected by mechanical and physical means, such as tying the hands, smacking, etc., up to the age of about three years, but after that age severity rarely has any effect, as it may lead to secrecy and lying, with consequent debasing of the moral fibre of the child. ... Some harmless but unpleasant medicine, occasional bathing of the parts with cold water, would help this treatment, and for the rest one must reason with the child and encourage him in every way towards self-control. If such measures are fruitless, then a slight operation in the case of both boys and girls may be the only cure. (104) Such comments certainly make one pause to reflect on how far the treatment of children has changed over the last eighty years, but also on how uneven the process has been. Nobody in the "permissive sixties" would have proposed that children should be tied up to prevent them from touching their genitals, but no voices were raised against the practice of cutting the foreskins off baby boys until the end of the decade, (105) and even then it took another fifteen years for the practice to become rare. And what does one make of Benjamin's suggestion that masturbating girls should also be the subject of an unspecified surgical attention? Although clitoridectomy had had a brief vogue in England in the 1860s the operation was quickly discredited and condemned by the Obstetrical Society, from which its leading exponent was expelled. (106) It was more popular in the US, but Benjamin's brief mention is one of the very few references to the practice I have encountered in the Australian literature. Benjamin moderated her views slightly in later years. Although she continued to regard masturbation as a bad thing which must be stopped, she sought to discourage the practice of smacking children who did it, on the ground that this only drew attention to the habit. She also referred disapprovingly to the case of a mother who had "threatened her six-year old son that if he continued to touch himself the doctor would cut off his penis". (107) Yet who can blame the mother when the doctors and child care experts had done their work so well? They had been painting fearful pictures of the dangers of self-abuse for years, and while it was only a few doctors in the US who wanted to go this far, and then only in extreme cases, the medical profession generally did urge the routine removal of a significant proportion of the infant penis with precisely this consideration in mind. <h3>Childcare advice</h3> In the wake of doctors, academics and other opinion leaders came a host of child-rearing advisers who more or less repeated their prescriptions for a popular and information-hungry audience. Kerreen Reiger has shown how, in the Edwardian period, successful child-rearing ceased to be seen as a capacity natural to women and became a skill that had to be learned; mothers increasingly sought expert advice on how to do it properly. (108) A growing number of books on baby and child care were published, and many of these advised circumcision for male babies. One of these was by Ellice Hopkins, another veteran of the English purity campaigns, (109) who was more concerned with the moral training of boys than practical advice on baby clothes. Her book The power of womanhood went through two editions in Australia and was directed even at those who could not afford an experienced nurse. Hopkins urged mothers always to be present at their sons' bath, because "often evil habits arise from imperfect washing and consequent irritation; and many a wise mother thinks it best on this account to revert to the old Jewish rite of initiation by which cleanliness was secured". (110) Writing specifically for a working class audience was Mary Gilmore, who used her regular column in The Worker (newspaper of the Australian Workers Union) to urge the provision of properly trained nurses in rural areas who knew how to handle problems common among little boys. Her language is a little coy, but her meaning is plain: mothers will ask me about things in relation to their children which, had they had trained nurse, they would have been advised to have seen to at once. One cannot be too definite here, but cases have come under my observation ... where vicious habits were developed, and neither mother nor child knew why. Many a boy owes the ruin of his life to the lack of a small surgical attention in babyhood. But it was as much a moral as a medical issue: to send the child forth "as God made him" was to let the Devil get him. (111) It would be interesting to know what Gilmore had been reading; she gives no references, but her paragraph is a telling indication of how far the case for circumcision had spread by 1908. Muskett might have been one source, as he probably was for Edith Aitken, who repeats a number of points that could have come from the Australian Medical Guide in her own treatise on child rearing, The Australian mothers' own book (1912). Circumcision, she writes, is necessary "in the case of a tight or redundant foreskin .... Mothers should not hesitate to have it performed if advised to do so by a medical man." Following Muskett (though the point had been made by dozens of authorities), Aitken observes that a tight foreskin will cause irritation that leads to masturbation and that it may inhibit urination. It may also be the cause of bed-wetting, in the case of which "an examination of the foreskin will undoubtedly reveal something abnormal, necessitating immediate circumcision". (112) In The ladies handbook of home treatment, a popular guide for mothers which went through numerous editions between 1905 and 1930, F.C. and Eulalia S. Richards also took up these themes. They urged parents to guard against masturbation, pointing that it is "practised by children of all ages and of both sexes" and warning that it was both morally wrong and physically harmful. The "excitation of the nerves" enabled the child to enjoy the sensations which should "only be experienced by the fully-developed man or woman in the married state". Masturbation also injured the mind, leading to loss of self-control, immorality and drunkenness; in boys capable of ejaculation "the immature system is weakened by the premature loss of this most highly vitalised of body fluids". (113) To control the habit the Richards enjoined parental vigilance, moral admonition and surgical intervention: Circumcision often effects a speedy cure in cases of boys addicted to self-abuse. We have no hesitation in saying that almost every boy who practises secret vice should be circumcised, as the operation usually exerts a very favourable influence on the child, apart from the good it accomplishes in correcting local defects. (114) In discussing the contribution of the foreskin to genital irritation and hence masturbation, the Richards ran up against the problem that the infamous "adherent foreskin" is "so universal in new-born male infants that it can scarcely be termed a malformation", but they did not flinch from preferring the conclusions of medical science to the evidence of nature: however natural it may be, "it is a condition which requires treatment, as secretions collect under [it] ... and cause irritation"; if the foreskin cannot be retracted and permanently separated from the glans, circumcision is necessary. (115) Even if not adherent, tight foreskins could also cause endless problems: sleeplessness, night terrors, "spasms of the bladder", retention of urine, bed-wetting, epilepsy, frequent erections and, of course, masturbation; in such cases, whether the boy is masturbating or not, "circumcision should be performed at an early date". (116) The same enthusiasm is displayed by Dr Gertrude C. Buzzard Dunlop, who told parents that "the bad habit of self-abuse (masturbation) is easily formed" and that "a tight foreskin" was often the cause. She noted that "some people believe that all baby boys should be circumcised" and agreed that the practice made it "easier for a boy to keep himself clean" and made youths less susceptible to venereal infection. So far these were medical commonplaces, but Dunlop added the novel point that treatment for VD was more difficult in the uncircumcised. She did not make clear whether all boys should be done as a matter of course, but she believed it was better to err on the side preventive caution: "If there is any doubt about the tightness of the foreskin or if the child is masturbating, have him circumcised". Dunlop also advised that the operation should be performed as early as possible: "it is less of a shock to a young baby and he is too young to interfere with his dressings". (117) <h3>Frederic Truby King and congenital phimosis</h3> Some of the tensions in the case for circumcision are apparent in the writings of Dr (later Sir) Frederic Truby King. He was possibly the doyen of the child care guidance experts in Australia and New Zealand in the 1920s and 30s, Director of Child Welfare, New Zealand, President of the Royal Society for the Health of Women and Children and widely read on both sides of the Tasmanâ€”the Dr Spock of the inter-war years, at least within the British Empire. King's international celebrity stemmed from the success of his organisation in reducing infant mortality in New Zealand. His most important book, The feeding and care of the baby, was first published in 1908, and by the 1920s it was "a virtual bible for many in infant welfare". (118) His views on masturbation and circumcision were thus assured of a wide and attentive audience. King is impeccably orthodox in regarding masturbation as a "serious vice" that should be checked as soon as possible and quotes a number of British and US sources, including Professor Holt, on the injurious consequences of the habit and the need for preventive action. He even attributes the current vogue for circumcision to the impression that it "tends to lessen the tendency to Masturbation in boys", but at this point he surprisingly diverges from the views of his colleagues. On this crucial question he is sceptical and doubts whether there are sufficient data to warrant practising it "as a mere matter of routine". In fact he goes further and ventures that there were "reasons for regarding the normal foreskin rather as a protection ... than as necessarily a source of danger", as indeed it was generally viewed. King stops short of advising that boys should not as a rule be circumcised and turns to the problem foreskin, those that are "over-long", "tight" or "adherent" and runs into the difficulty that doctors had forgotten what a normal foreskin was meant to look like or what it was meant to do. Ignorant of the physiology of the penis and trapped by Sayre et al's categories, he is led rapidly back to the camp of the circumcisers: "a tight, too long, or adherent foreskin is objectionable, as being uncleanly, a source of local irritation and an incitement to bad habits". King assures his readers that it is only these problem foreskins that need to be removed: "If the foreskin can readily be drawn back in infancy there need be no anxiety"; if it cannot, the surgeon must be summoned without delay. (119) But what looks like a large concession turns out to be a very small one. When the development and function of the foreskin were actually studied, it was found to be retractable in only 4 per cent of newborn babies and in only 20 per cent of those aged six months; separation of the foreskin from the glans was a gradual process, taking anything from six months to five years to complete. (120) King insisted that that the first duty of mothers and nurses was to try to separate the foreskin from the glans within the first month of life; we don't know how many followed this advice (probably most), but it must be recognised that they faced a dilemma: if this project was successful, it was likely to harm the tissue of both structures (bleeding, adhesions, skin bridges and other problems), often requiring removal of the damaged foreskin later; if it was unsuccessful, immediate circumcision was clearly necessary. In another text King was stricter and enjoined nurses and mothers to achieve complete separation of foreskin from glans within the first week, by which time "full uncovering of the acorn-like end of the organ should be accomplished". (121) King thus believed that circumcision would be needed only in the 5 per cent of cases where this was not possible; but given Gairdner's findings, on the basis of his own specifications the circumcision rate would have to be 96 per cent if carried out at birth, 80 per cent at six months, and so on down at higher ages as boys' bodies developed. Like many others, King was also troubled by the problem of washing the genitals. Gollaher has pointed out that in the late Victorian period cleanliness became an essential component of respectability and an important means of distinguishing nice people from "the great unwashed"; (122) similar views were expressed in Australia by Muskett. Bodily cleanliness thus assumed great importance, but the hygiene of the genitals posed a problem. Obviously they had to be kept clean, but herein lay the equally obvious danger that the manipulation involved could be found pleasurable and give rise to the usual bad habits. Contrary to Acton, King believed that instructing parents to wash their children's genitals was bad advice; it was in fact "one of the best means of teaching the child self-abuse", and the "natural parental instinct to chide or slap a child for 'fingering the privates' is sounder and more wholesome". (123) Zoe Benjamin was also aware of this dilemma. In one of her later books on child rearing she considered the various causes of masturbation and advised: "When bathing children, great care should be taken in handling and drying those parts of the body. They should be touched firmly so that no tickling sensation is set up, but not so firmly that the child is hurt". (124) A fine line to tread. It was indeed this difficulty which lay behind the common concern that servants and nurses often taught young children bad habits by careless bathing procedures or deliberate fondling of the genitals to quieten them, a common complaint going back to Beaney, Acton and beyond. As William J. Robinson had so plainly put it in 1915: The prepuce is one of the great factors in causing masturbation in boys. 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. ... Therefore, off with the prepuce! (125) The final solution to the difficulty lay in removing the root of the irritation. <h3>References</h3> <ol> <li style="font-weight: 400;">I think the term "preventive" is more accurate than the others currently in use because it captures the fact that the aim of the procedure was not only to prevent supposed medical problems, but also to discourage sexual activity itself. The term also distinguishes the medically-based circumcision introduced in the late nineteenth century from ritual or religious circumcision, which is equally routine and forcible, but not performed with the same ends in view. Ritual circumcision is essentially a tribal initiation, intended to mark the initiate as belonging to a particular religious or ethnic group; "routine neonatal circumcision" could equally describe Jewish circumcision as the medically rationalised variety, "involuntary routine circumcision" the Moslem practice and the procedures of some tribal cultures at puberty or other stages of life. "Preventive" does not quite convey the compulsory nature of the operation, but the term "forcible preventive infant (or neonatal) circumcision" is both too clumsy and too truthful to win wide acceptance.</li> <li style="font-weight: 400;">Gollaher, David L. From ritual to science: The medical transformation of circumcision in America.Journal of Social History 1994; 28:5â€“36; Gollaher, David L. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000.</li> <li style="font-weight: 400;">Acton, William.The functions and disorders of the reproductive organs. 3rd edition. Philadelphia: Lindsay and Blakiston; 1865 (reprinted from third London edition), p. 21.</li> <li style="font-weight: 400;">Acton, William.The functions and disorders of the reproductive organs. 3rd edition. Philadelphia: Lindsay and Blakiston; 1865 (reprinted from third London edition). p. 22.</li> <li style="font-weight: 400;">Acton, William.The functions and disorders of the reproductive organs. 3rd edition. Philadelphia: Lindsay and Blakiston; 1865 (reprinted from third London edition),p. 22 and footnote.</li> <li style="font-weight: 400;">Acton, William.The functions and disorders of the reproductive organs. 6th edition. London: J. and A. Churchill; 1903. p. 7.</li> <li style="font-weight: 400;">Gollaher DL. From ritual to science: The medical transformation of circumcision in America.Journal of Social History 1994; 28:5â€“36; Gollaher DL. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000. ch. 4; Hodges FM. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC and Milos MF, editors. Sexual mutilations: A human tragedy. New York: Plenum Press; 1997. pp. 17â€“40.</li> <li style="font-weight: 400;">Eagle, Chester.Play together dark blue twenty. Melbourne: McPhee Gribble; 1986. p. 134.</li> <li style="font-weight: 400;">Circumcision. Letter from S.P. Bellmaine, Honorary Secretary, Australian Paediatric Association. Med J Aust. 1971;1:1148.( 22 May).</li> <li style="font-weight: 400;">Wallerstein, Edward.Circumcision: An American health fallacy. NY: Springer; 1980. p. 29.</li> <li style="font-weight: 400;">Australian College of Paediatrics, Standing Committee on Perinatal Medicine. Statement on circumcision, 1983; reviewed 28 May 1991.</li> <li style="font-weight: 400;">Australian College of Paediatrics, Standing Committee on Perinatal Medicine. Position statement: Routine circumcision of normal male infants and boys. 27 May 1996.</li> <li style="font-weight: 400;">Communication from Dr Frances de Groen, University of Western Sydney, March 1999. I am pleased to report that in 1983 she said "No."</li> <li style="font-weight: 400;">NOCIRC Australia. Statistics on the incidence of circumcision in Australia, 1994â€“95. Seen at www.cirp.org/library/statistics/Australia. 11 December 2000.</li> <li style="font-weight: 400;">Statistics on the incidence of circumcision in Australia based on Medicare claims, 1994â€“2000. Seen at www.cirp.org/library/statistics/Australia. 11 December 2000. These figures are based on Medicare (public health insurance) claims and differ slightly from the NOCIRC figures, since they cover calendar rather than financial years.</li> <li style="font-weight: 400;">Russell, Terry. Debate: Male circumcision remains a valid procedureâ€”Yes.Australian Doctor. 24 May 1996. p. 54</li> <li style="font-weight: 400;">Remondino, PC.History of circumcision from the earliest times to the present: Moral and physical reasons for its performance. Philadelphia and London: FA Davis; 1891. p. 186.</li> <li style="font-weight: 400;">Review of Remondino,History of circumcision. Br Med J. 1892;1:391â€“2. (20 February).</li> <li style="font-weight: 400;">Dreyfus, Kay editor.The farthest north of humanness: The letters of Percy Grainger. Melbourne: Macmillan; 1985. p. 246.</li> <li style="font-weight: 400;">Davison, FD.The white thorntree. Sydney: Ure Smith; 1970. 2 vols. I, p. 173.</li> <li style="font-weight: 400;">Marr, David.Patrick White: A life. Sydney: Random House; 1991. p. 4.</li> <li style="font-weight: 400;">Ward, Russel.A radical life: The autobiography of Russel Ward. Melbourne: Macmillan; 1988; pp. 2, 9.</li> <li style="font-weight: 400;">Braddon, Russell.The naked island. London: Werner Laurie; 1952. p. 167.</li> <li style="font-weight: 400;">Moran, Herbert.Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. p. 3; Beyond the hills lies China: Scenes from a medical life in Australia. Sydney: Dymocks; 1945; p. 128.</li> <li style="font-weight: 400;">Joske, AS. Methods and management of circumcision. Intercolonial Medical Congress of Australia, Tasmania, 1902.Transactions of Sixth Session. p. 281.</li> <li style="font-weight: 400;">Lucas, TP.Domestic medicine: How to live and how to avert and cure disease. Brisbane: Edwards Dunlop; 1906. p. 241.</li> <li style="font-weight: 400;">Joske, AS. Methods and management of circumcision. Intercolonial Medical Congress of Australia, Tasmania, 1902.Transactions of Sixth Session.p. 281.</li> <li style="font-weight: 400;">Reviews and notices of books.Australasian Medical Gazette. 1908;XXVII:362. (No. 7, 20 July).</li> <li style="font-weight: 400;">Holt, L Emmett.The diseases of infancy and childhood. New York; 1897. p. 698; Spitz, RA. Authority and masturbation: Some remarks on a bibliographical investigation. Psychoanalytic Quarterly 1952; 21: p. 506; Gollaher DL. From ritual to science: The medical transformation of circumcision in America. Journal of Social History 1994; 28. p. 21.</li> <li style="font-weight: 400;">King, Mary Truby.Mothercraft. Sydney: Whitcomb and Tombs; 1934. p. 213.</li> <li style="font-weight: 400;">Reviews and notices of books.Australasian Medical Gazette. 1910;XXIX:250. (No. 5, 20 May).</li> <li style="font-weight: 400;">Spitz. Authority and masturbation: Some remarks on a bibliographical investigation.Psychoanalytic Quarterly 1952; 21: p. 521; Hodges FM. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC and Milos MF, editors. Sexual mutilations: A human tragedy. New York: Plenum Press; 1997. p. 23.</li> <li style="font-weight: 400;">Workers Educational Association of New South Wales.Teaching of sex hygiene: Report of a conference. Sydney: NSW Government Printer; 1917. p. 92.</li> <li style="font-weight: 400;">James, W Howard.Home nursing and ailments of children: A handbook for mothers. Warburton (Australia): Signs Publishing Co; 1923. p. 352.</li> <li style="font-weight: 400;">Sangster, JA. Letter: Circumcision of infants. Med J Aust. 1917;2:323. (No. 15, 13 October).</li> <li style="font-weight: 400;">Vallack, A. Letter: Routine circumcision. Med J Aust. 1917;2:367. (No. 17, 27 October).</li> <li style="font-weight: 400;">BMA News: Circumcision. Med J Aust. 1923;1:594. (No. 21, 26 May).</li> <li style="font-weight: 400;">Peck, Muriel.Your baby: A practical guide for mothers and nurses. Melbourne: Woman's World; 1925, 1929, 1939.</li> <li style="font-weight: 400;">Hufeland, Christoph Wilhelm.The art of prolonging human life. New edition, with notes by an English physician. London: Simpkin and Marshall; 1828. p. 231. (Translation of Die Kunst das menschliche Leben zu verlangen, 1797).</li> <li style="font-weight: 400;">Remondino, PC.History of circumcision from the earliest times to the present: Moral and physical reasons for its performance. Philadelphia and London: FA Davis; 1891. pp. 254â€“5.</li> <li style="font-weight: 400;">Walker, David. Continence for a nation: Seminal loss and national vigour.Labour History 1985; No. 48:1â€“14; Modern nerves, nervous moderns: Notes on male neurasthenia. Australian Cultural History 1987; No. 6:49â€“63; Energy and fatigue. Australian Cultural History 1994; No. 13.</li> <li style="font-weight: 400;">Walker, David. Continence for a nation: Seminal loss and national vigour.Labour History 1985; No. 48: p. 7.</li> <li style="font-weight: 400;">Personal recollection of the author. Grimwade House was one of the two junior schools of Melbourne Grammar, a leading private school, covering grades one to eight.</li> <li style="font-weight: 400;">Bennett, Paula and Rosario, VA editors.Solitary pleasures: The historical, literary and artistic discourses of autoeroticism. New York and London: Routledge and Kegan Paul; 1995. p. 2.</li> <li style="font-weight: 400;">Hospital Reports.Australian Medical Journal. 1860;V:233â€“4. (July).</li> <li style="font-weight: 400;">46. Australian Dictionary of Biography. Vol. 3. pp. 124â€“6.</li> <li style="font-weight: 400;">Beaney, George.Spermatorrhoea in its physiological, medical and legal aspects. Melbourne: Walker publishers; 1870.</li> <li style="font-weight: 400;">Beaney, George.The generative system and its functions in health and disease. Melbourne: FF Bailliere; 1872. Because I make so many references to these books, pages numbers are inserted in the text.</li> <li style="font-weight: 400;">Christoph Wilhelm Hufeland (1762â€“1836) was Professor of Medicine at University of Jena and author ofDie Kunst das menschliche Leben zu verlangen (The art of prolonging human life, 1797). A mixture of lifestyle advice and moral exhortation, it is hardly a medical work in the modern sense, but it was typical of its time, frequently reprinted, translated into French and English and widely read during the first three quarters of the nineteenth century.</li> <li style="font-weight: 400;">Hufeland, Christoph Wilhelm.The art of prolonging human life. New edition, with notes by an English physician. London: Simpkin and Marshall; 1828. p. 231.</li> <li style="font-weight: 400;">Springthorpe, John. On the psychological aspect of the sexual appetite.Australasian Medical Gazette 1884;V:8â€“13.</li> <li style="font-weight: 400;">Melbourne Paediatric Society [Report of meeting, 12 March 1913].Australian Medical Journal. 1913;II (New series):1014â€“15. (26 April).</li> <li style="font-weight: 400;">Power, M Danvers.Mother and child. No place of publication or publisher given. [Sydney?]: 1913; pp. 39â€“45.</li> <li style="font-weight: 400;">Power, Frederick Danvers.Australian boy scouts handbook. Sydney: Angus and Robertson; 1922. 2 vols. I, pp. 45â€“6.</li> <li style="font-weight: 400;">Hall, Lesley. Forbidden by god, despised by men: Masturbation, medical warnings, moral panic and manhood in Great Britain, 1850â€“1950, in Fout JC, editor.Forbidden history: The state, society and the regulation of sexuality in modern Europe. Chicago: University of Chicago Press; 1992. p. 301.</li> <li style="font-weight: 400;">Piddington, Marion.Tell them! Or the second stage of mothercraft: A handbook of suggestions for the sex-training of the child. Sydney: Moore's Bookshop; n.d. [c.1926]. p. 226.</li> <li style="font-weight: 400;">Neumann, RP. Masturbation, madness and the modern concepts of childhood and adolescence.Journal of Social History 1975;8:1â€“27.</li> <li style="font-weight: 400;">Freeman, Howard and Dr Wallace.Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. Chapter 4, pp. 30â€“51.</li> <li style="font-weight: 400;">Towle, WB.The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. pp. 107â€“8.</li> <li style="font-weight: 400;">Freeman, Howard and Dr Wallace.Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. p. 98.</li> <li style="font-weight: 400;">Freeman, Howard and Dr Wallace.Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. pp. 199â€“205.</li> <li style="font-weight: 400;">Towle, WB.The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. p. 108.</li> <li style="font-weight: 400;">Towle, WB.The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. p. 161.</li> <li style="font-weight: 400;">Quaife, WF. Tinnitus connected with onanism.Australasian Medical Gazette 1896; XV:20â€“22 . Discussed in Walker D. Continence for a nation: Seminal loss and national vigour. Labour History 1985; No. 48: pp. 8â€“9.</li> <li style="font-weight: 400;">Courtenay, FB.On spermatorrhoea and certain functional derangements and debilities of the generative system: Their nature, treatment and cure. London: Bailliere, Tindall and Co.; 1882; 12th edition.</li> <li style="font-weight: 400;">Beaney.Spermatorrhoea in its physiological, medical and legal aspects. Melbourne: Walker publishers; 1870. p. x. Further references in this paragraph are inserted in the text.</li> <li style="font-weight: 400;">Beaney.The generative system and its functions in health and disease. Melbourne: FF Bailliere; 1872. p. 146.</li> <li style="font-weight: 400;">Lewis, Milton and Macleod, Roy. Medical politics and the professionalisation of medicine in New South Wales, 1850â€“1901.Journal of Australian Studies 1988; No. 22:69â€“82</li> <li style="font-weight: 400;">Lewis M and Macleod R. Medical politics and the professionalisation of medicine in New South Wales, 1850â€“1901.Journal of Australian Studies 1988; No. 22: p. 79.</li> <li style="font-weight: 400;">Lewis M and Macleod R. Medical politics and the professionalisation of medicine in New South Wales, 1850â€“1901.Journal of Australian Studies 1988; No. 22: pp. 78â€“9.</li> <li style="font-weight: 400;">Moran.Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. pp. 102, 203â€“6.</li> <li style="font-weight: 400;"> Australian Dictionary of Biography. Vol 7. p. 103.</li> <li style="font-weight: 400;">Arthur, Richard.Purity and impurity. Sydney: Australian White Cross League; n.d. [c.1900]. p. 8.</li> <li style="font-weight: 400;">Arthur, Richard.The training of children in purity: A booklet for parents. Sydney: George Robertson; n.d. [c.1900]. p. 15.</li> <li style="font-weight: 400;">Hyam, Ronald.Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. pp. 65â€“71.</li> <li style="font-weight: 400;">Arthur, Richard.Purity and impurity. Sydney: Australian White Cross League; n.d. [c.1900]. pp. 10â€“11.</li> <li style="font-weight: 400;">Arthur has evidently read his Acton, who had described nocturnal emissions "occurring once every ten or fourteen days" as "in the nature of a safety valve", but that if they were more frequent or "attended by symptoms of prostration" the "patient" should seek medical advice (William Acton.The functions and disorders of the reproductive organs. 6th edition. London: J. and A. Churchill; 1903. p. 105). The more hot-blooded Philip Muskett was willing to allow boys two wet dreams a week before apprehension need be felt: Muskett, Philip. The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, p. 203.</li> <li style="font-weight: 400;">Cockshut, RW. Letter. Circumcision. Br Med J. 1935;2: 764. (19 October).</li> <li style="font-weight: 400;">Hall, G. Letter. Circumcision. Med J Aust. 1971;2:223. (No. 4, 24 July).</li> <li style="font-weight: 400;">Moran,Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. p. 226.</li> <li style="font-weight: 400;">Dr Lewis A. Sayre was a distinguished orthopaedic surgeon who discovered in 1870 that a wide range of childhood illnesses was apparently caused by a tight foreskin and could be cured by circumcision. He eventually consolidated his convictions in a book entitledOn the deleterious results of a narrow prepuce and preputial adhesions, published in Philadelphia in 1888. See Gollaher DL. From ritual to science: The medical transformation of circumcision in America. Journal of Social History 1994; 28. pp. 5â€“8; Gollaher DL. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000. ch. 4; Hodges FM. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC and Milos MF, editors. Sexual mutilations: A human tragedy. New York: Plenum Press; 1997. pp. 17â€“40.</li> <li style="font-weight: 400;">Walker D. Continence for a nation: Seminal loss and national vigour.Labour History 1985; No. 48: p. 57.</li> <li style="font-weight: 400;">Beard, George.The new cyclopaedia of family medicineâ€”Our home physician: A popular guide to the art of preserving health and treating disease. Sydney: McNeil & Coffee; 1884. pp. 793â€“805; 882â€“889.</li> <li style="font-weight: 400;">Beard, George.The new cyclopaedia of family medicineâ€”Our home physician: A popular guide to the art of preserving health and treating disease. Sydney: McNeil & Coffee; 1884. pp. 888â€“9.</li> <li style="font-weight: 400;">Howe, Joseph.Excessive venery, masturbation and continence. New York: 1887.</li> <li style="font-weight: 400;">Woolley, Geo. Talbot. Congenital phimosis and adherent prepuce. Intercolonial Medical Congress of Australasia, Melbourne, 1889.Transactions of Second Session. pp. 234â€“5.</li> <li style="font-weight: 400;">Compare Sayre: "Many of the cases of irritable children, with restless sleep, and bad digestion, which are often attributed to worms, is [sic] solely due to the irritation of the nervous system caused by an adherent or constricted prepuce. ... Hernia and inflammation of the bladder can also be produced by the severe straining to pass water in some of these cases." (Transactions of the American Medical Association1870). Quoted in Gollaher DL. From ritual to science: The medical transformation of circumcision in America. Journal of Social History 1994; 28. p. 7.</li> <li style="font-weight: 400;">Naylor, HGH. A plea for early circumcision.Australasian Medical Gazette 1901;XX; 239.</li> <li style="font-weight: 400;">Joske, AS. Methods and management of circumcision. Intercolonial Medical Congress of Australia, Tasmania, 1902.Transactions of Sixth Session. p. 281.</li> <li style="font-weight: 400;">Muskett, Philip.The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, pp. 219â€“20.</li> <li style="font-weight: 400;">It was only in the late nineteenth century, with the pathologisation of male sexuality and the construction of links between the foreskin, masturbation and disease, that phimosis came to be seen as a problem at all. For an illuminating discussion, see Hodges FM. The history of phimosis from antiquity to the present. In Denniston GC, Hodges FM and Milos MF, editors.Male and female circumcision: Medical, legal and ethical considerations in pediatric practice, New York, Kluwer Academic/Plenum Publishers; 1999:37â€“62.</li> <li style="font-weight: 400;">Muskett, Philip.The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, p 220.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. vii.</li> <li style="font-weight: 400;">Sex hygiene and venereal disease [Editorial].Australasian Medical Gazette. 1914;XXXV:14. (No. 19, 9 May).</li> <li style="font-weight: 400;">Power, Frederick Danvers.Australian boy scouts handbook. Sydney: Angus and Robertson; 1922. 2 vols. I, p. 46.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. viii.</li> <li style="font-weight: 400;">Sex hygiene and venereal disease [Editorial].Australasian Medical Gazette. 1914;XXXV:15. (No. 19, 9 May).</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. pp. 40â€“76.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 85.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 92.</li> <li style="font-weight: 400;">Hyam, Ronald.Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. ch. 3.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. pp. 92â€“3.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 100.</li> <li style="font-weight: 400;">Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 147.</li> <li style="font-weight: 400;">Morgan, WKC. Penile plunder. Med J Aust. 1967;1:1102â€“3. (No. 21, 27 May).</li> <li style="font-weight: 400;">Mosucci, Ornella. Clitoridectomy, circumcision and the politics of sexual pleasure in mid-Victorian Britain. In Miller AH and Adams JE, editors.Sexualities in Victorian Britain, Bloomington: Indiana University Press; 1996. pp. 65â€“69.</li> <li style="font-weight: 400;">Benjamin, Zoe.You and your children, Vol. 1: The young child. Sydney: Gayle Publishing; 1944. pp. 76â€“8.</li> <li style="font-weight: 400;">Reiger, Kerreen.The disenchantment of the home: Modernising the Australian family 1880â€“1940. Melbourne: Oxford University Press; 1985. chs. 6 and 7, esp. p.128.</li> <li style="font-weight: 400;">Hall, Lesley. Forbidden by god, despised by men: Masturbation, medical warnings, moral panic and manhood in Great Britain, 1850â€“1950, in Fout JC, editor.Forbidden history: The state, society and the regulation of sexuality in modern Europe. Chicago: University of Chicago Press; 1992. p. 299; Hyam, Ronald. Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. pp. 65â€“71.</li> <li style="font-weight: 400;">Hopkins, Ellice.The power of womanhood; or, mothers and sons. A book for parents and those in loco parentis. Melbourne: George Robertson; 1902. 7th edition. p. 47.</li> <li style="font-weight: 400;">Gilmore, Mary. Our women's page.The Worker. 10 September 1908. p. 7.</li> <li style="font-weight: 400;">Aitken, Edith.The Australian mother's own book: A complete treatise on the rearing and management of Australian children. Sydney: George Philip and Son; 1914. p. 76.</li> <li style="font-weight: 400;">Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 50, 348.</li> <li style="font-weight: 400;">Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 349â€“50.</li> <li style="font-weight: 400;">Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 49â€“50, 338.</li> <li style="font-weight: 400;">Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 339â€“40.</li> <li style="font-weight: 400;">Dunlop, Gertrude C. Buzzard.Our babies. No publisher or place of publication. [Sydney?]; 1928. pp. 68, 78.</li> <li style="font-weight: 400;">Reiger, Kerreen.The disenchantment of the home: Modernising the Australian family 1880â€“1940. Melbourne: Oxford University Press; 1985 p. 136. Both he and his daughter Mary wrote on child care issues. The well known radio author and playwright, Betty Roland, tried to get "the eight hours [sleep] prescribed by Dr Truby King" when she was pregnant in the late 1930s (The devious being. Sydney: Angus and Robertson; 1990. p. 27); and Robert Brain remarks that "in the 1920s in Tasmania Truby King was the baby king" (Rites black and white. Ringwood (Aust.): Penguin ;1979. pp. 60â€“61). In view of the links drawn by Walker between the danger of masturbation and the problem of maintaining national vigour, and those drawn by Hyam between the rise of circumcision in Britain and the fears of imperial decline, it is interesting that King turned his attention to infant welfare after a visit to Japan at the time of the Russo-Japanese war. The Japanese victory convinced him, like so many others, that the white races had better get their house in order; he would do his bit by helping to produce healthier babies (Reiger. Disenchantment of the home. p. 136). When in Japan, where breast-feeding was universal, King's enthusiasm for the practice was stimulated by what he saw of the "fitness and excellent physique of the Japanese Army". He had also been impressed by the concerns of Major-General Sir Frederick Maurice about the physical deterioration of the British race (King, Mary Truby. Truby King the man: A biography. London: Allen & Unwin; 1948, pp. 149, 155). Hyam notes that Maurice was an enthusiast for "Jewish child rearing practices" (Hyam R. Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. p. 77).</li> <li style="font-weight: 400;">King, F. Truby.Feeding and care of baby. London: Macmillan; 1931. pp. 122â€“3.</li> <li style="font-weight: 400;">Gairdner, Douglas. The fate of the foreskin: A study of circumcision. Br Med J. 1949;2:1433â€“1437. (24 December); see also Cold CJ and Taylor JR. The prepuce. Br J Urol 1999; 83 (Supplement 1): 34â€“44. (January).</li> <li style="font-weight: 400;">King, F. Truby.The expectant mother and baby's first months. London: Macmillan; 1930. pp. 70â€“71.</li> <li style="font-weight: 400;">Gollaher DL. From ritual to science: The medical transformation of circumcision in America.Journal of Social History 1994; 28:5â€“36; Gollaher DL. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000. ch. 4.</li> <li style="font-weight: 400;">King, F. Truby.Feeding and care of baby. London: Macmillan; 1931. p. 123.</li> <li style="font-weight: 400;">Benjamin, Zoe.You and your children, Vol. 1: The young child. Sydney. Gayle Publishing; 1944. p. 88.</li> <li style="font-weight: 400;">Robinson, William J. Circumcision and masturbation.Medical World 1915:33. Seen on internet at "Historical medical quotes on circumcision", http://circquotes.tilted.com, 11 December 2000.</li> </ol> </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 source of mischief (Part 3) 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>Legal reforms needed to protect boys from assault</h3> A shameful incident in Bundaberg, Queensland, in 2002 highlights the need for better protection of boys against unwanted interference with their genitals. In this case a Moslem father forced circumcision on his two sons, aged five and nine, against their own wishes, against the wishes of their mother, and in breach of a specific order by the Family Court. The father was separated from his former partner (an Australian woman of indigenous origin), who had sole custody of the boys, but who allowed them to visit him on the understanding that the man's sister would ensure that they were not harmed. He took advantage of this generosity during one stay to race the boys off to a doctor and have their foreskins amputated. Although the case was investigated by the Queensland Police child abuse unit, which sought to prosecute the man for assault, the case was dismissed in the Bundaberg magistrate's court on legal technicalities. The case shows up the shameful state of medical ethics in Queensland. How was it possible to find a doctor to perform this unnecessary and harmful surgery on two normal boys merely because an adult preferred them to be like him? And not an adult with any legal rights over the boys: had the surgeon done his homework, he would have discovered that the father did not have custody of he boys, and that the Family Court had specifically ordered that they were not to be circumcised. That it was possible is partly a tribute to the destructive influence of circumcision advocates like Professor Brian Morris at Sydney University and the maverick Queensland GP Dr Terry Russell. They are forever popping up in the media to urge parents to have their sons circumcised. Russell's own medical practice consists almost entirely of severing the foreskins from baby boys by means of the plastibell device. No medical organization in the world recommends circumcision, and in Australia both the Australian College of Paediatrics and the Australian Medical Association have issued strong statements against the practice How effective is Queensland and Australia law in protecting the bodily integrity of children? In several European countries, including Sweden and Norway, the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. A simple rule like that in Australia that could have prevented this tragedy. The case also shows up the sexist and discriminatory double standard by which female circumcision is condemned with horror as female genital mutilation while male circumcision is tolerated as a trivial or even beneficial adjustment. Yet Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation. If these boys had been girls there would be universal outrage and demands for education programs and legal reform to prevent such cases in the future. Why the sexist double standard? Do boys not have the same right to a complete set of genitals as girls? The father's right to practise his religion and culture does not extend to the right to inflict injury or disfiguring bodily alterations on other people, especially if they are defenceless children. In this special report we print a number of items relating to this tragic and disturbing case. Because new charges may still be laid against the man, it is not possible to reveal his name or that of his ex-partner and the boys. <h3> <a id="media" name="media"></a>Report in News-Mail, Bundaberg, Friday 9 August 2002</h3> Dad escapes charges By Tanya Moore A MAN who had his two young sons circumcised without their mother's permission had charges of grievous bodily harm against him dismissed yesterday. The Bundaberg father, who cannot be identified for legal reasons, had his case dismissed when the prosecution revealed they were not ready to proceed. Bundaberg Magistrates Court was told the man had taken the boys to a Bundaberg hospital while their mother was on holidays to have the operation performed on the six- and nine-year-old boys. Defence barrister Tim Ryan said the doctor had no problems with the "routine operation" because both the boys and the father had given their consent. The court was told the father was "sincere in his religious beliefs" that the boys should be circumcised. But the court was also told the mother, who is separated from the man, disagreed with the procedure and had been involved in a Family Law Court matter, which was the centre of the prosecution's case. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution was unable to go ahead without the certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But Mr Ryan said the request was "simply outrageous" given the case had been set down for a hearing since May and the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, on which charges could still be laid. <h3>Report in News-Mail, Bundaberg, Saturday 10 August 2002</h3> Cutting anger By Tanya Moore DOUBLE standards allowed two boys to be circumcised without their mother's permission, an outraged Australian health group said yesterday. Circumcision Information Australia spokesman Shane Peterson said the case in which a six- and nine-year-old boy were circumcised by their Bundaberg father, despite their mother's opposition, was "a tragedy". "In European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys", Mr Peterson said. "This rule should be implemented in Australia to prevent such tragedies." Mr Peterson said the case illustrated a double standard whereby female circumcision was condemned as mutilation while male circumcision was viewed as trivial or even a beneficial adjustment. He said the case also highlighted the lack of implementation of the UN Convention on the Rights of the Child by Australian law. The mother of the boys is also angry at what she sees as a double standard on circumcision. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged," said the woman, who cannot be identified for legal reasons. "Because it is my two sons who have been harmed, few people seem to care." She said her estranged husband had performed the operation during an access visit to the children last year. Grievous bodily harm and unlawful wounding charges were laid against the boys' father, but these were dropped on Thursday when the prosecution revealed they were not ready to proceed with their case. Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still pursue the case, on which charges could still be laid. <h3>Article in Sunday Mail (Brisbane), Sunday 11 August 2002</h3> Mother's fury as boys circumcised by Elissa Lawrence A MOTHER has spoken of her anguish at discovering her two young sons were circumcised without her knowledge. The woman, 27, who cannot be identified, said she was devastated to learn her former partner and father of her sons had arranged for the boys, then aged nine and five, to be circumcised at a Bundaberg hospital last October for religious reasons. The man appeared in Bundaberg Magistrates Court on Thursday facing charges of grievous bodily harm (for the circumcision). The court was told the Muslim man had taken his sons to hospital to have the operations performed while their mother was on holidays and was "sincere in his religious beliefs" that they should be circumcised. The court was also told the mother objected to the procedure and was involved in a Family Law Court matter central to the prosecution's case. But the charges were dropped when the prosecution revealed missing Family Law Court paperwork meant it was not ready to proceed with the case. An adjournment request was denied, forcing the police prosecutor to offer no evidence against the man. Outside court, arresting officer Detective Senior Constable Peter Cormack from the Gold Coast child abuse investigation unit said police would pursue the case and that charges could still be laid. The boys' mother, who now lives on the Gold Coast, said in a statement she believed her sons had been assaulted. "My sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs", she said. "If I had been in this situation with two daughters who were circumcised ... the Australian public would be outraged. Being of indigenous Australian descent, I understand the importance of freedom of personal beliefs in a multicultural society." Circumcision Information Australia spokesman Shane Peterson said circumcision was a form of mutilation. "For a long time Australia has had a double standard on male and female circumcision", he said. "Female circumcision is illegal yet male circumcision continues to be unregulated. It's morally wrong. An adult is surgically inflicting their religious, cosmetic or sexual preferences on a child. Surgery of any kind is one of the most invasive and high-risk forms of medical intervention possible, and it should always be the last resort. In European countries, the permission of both parents is necessary before a doctor can legally perform a circumcision on boys." <h2> <a id="release" name="release"></a>Media release by Circumcision Information Australia</h2> <h3>Dropping of charges on father who forced circumcision on sons shows double standard on genital mutilation</h3> A committal hearing for charges of grievous bodily harm and unlawful wounding was scheduled in Bundaberg yesterday against a father who forced his two sons to undergo circumcision during an access visit to his family home last year. The father, of Muslim faith, arranged for his sons aged 5 and 9 to be circumcised for non-medical reasons. This was against the expressed wishes of their mother. "Being of indigenous Australian descent I understand the importance of freedom of personal beliefs in a multicultural society", she said. "I believe my sons have a right to grow into adult men with intact bodies and choose their own religious and other beliefs; I am devastated that the father has stolen that opportunity away from my boys." The charges were dropped yesterday as documents from 1998 needed as evidence for the case could not be located. Prosecutor Senior Constable Wayne Puxty explained to the court that the prosecution could not proceed without certified Family Law Court documents that were supposed to be supplied by the mother, and requested an adjournment to receive them. But defence barrister Tim Ryan said the request was "simply outrageous" given the case had been scheduled for a hearing since May and claimed the documents wanted by the prosecution had been in existence since August 2000. He added his client had not seen his two sons since the charges were laid on October 3 last year as part of his bail conditions and said any further delaying of the case would be a "misuse of the criminal justice system". Acting Magistrate Neil Lavaring rejected the application for an adjournment, which forced Snr Const. Puxty to offer no evidence against the father. Outside court, arresting officer Detective Senior Constable Peter Cormack, from the Gold Coast child abuse investigation unit, said police would still be pursuing the case, and charges could still be laid. By arranging circumcision of the boys, the father was in breach of orders by the Family Court, Brisbane. After a long documented history of physical abuse by the father to the mother, the Family Court ruled that the boys would reside with their mother, and she would have the day to day care and control of their welfare and development. Despite the Court's rulings and the issue of protection orders, on a number of occasions the father threatened to abduct the children, force them to undergo circumcision, and accompany him to Turkey. The father tried to fulfil the first part of his threats by applying to the family court for the boys to be circumcised. The mother of the boys said that the man had a history of substance abuse and psychiatric illness, and that the Family Court "justly dismissed his application for my boys to be forcibly circumcised." The mother feared for her family's safety and moved from Bundaberg to an anonymous address in the Gold Coast to escape the father's continued threats and harassment. For her boys' well-being, she preferred that they have no contact with their father. "I only allowed my boys to stay with their father during the recent access visit as his sister agreed she would be responsible for their care and well-being", she said. It seems the mother's trust was misplaced, as the boys' aunt did not prevent the circumcision that went ahead. The mother believes this was due to the family's Muslim faith. "The father always used his Muslim religion as an excuse for his violence", she said. "He treated us as though we were less than human; he saw us as objects or property for him to do with as he pleased. And now he has assaulted and mutilated my two boys in the worst possible way, by cutting off part of their sexual organs and depriving them of future sexual pleasure". The boys are reluctant to speak of their experience, but have expressed that their father misled them to believe they were going to the doctor for an examination. They are very upset that part of their bodies was removed and do not want any contact with their father. Despite the obvious trauma and breach of court orders, the father's barrister argued that the circumcision should be treated as a moral rather than a criminal issue. This has outraged the mother, who is adamant that her sons have been assaulted. "If I had been in this current situation with two daughters who were circumcised by their Muslim father, the Australian public would be outraged. Because it is my two sons who have been harmed, few people seem to care". A spokesman for Circumcision Information Australia, Mr Shane Peterson, said that the case highlighted the lack of implementation of the United Nations Convention on the Rights of the Child by Australian law. "In several European countries the written permission of both parents is necessary before a doctor can legally perform a circumcision on boys. This rule should be implemented in Australia to prevent such tragedies." Mr Peterson also said that the case illustrated the double standard by which female circumcision is condemned as mutilation, yet male circumcision is viewed as a trivial or even beneficial adjustment. "Amnesty International defines genital mutilation as the removal of any part of the genital organs. By this definition, these boys are victims of genital mutilation." <h3>Further comments on multiculturalism</h3> Stricter rules governing consent for non-therapeutic circumcision could have prevented this sad and all too common occurrence. A high proportion of marriages in Australia are between men and women of different ethnic/cultural backgrounds, and the children of such unions cannot be said to belong strictly to one or the other group; this is all the more true in the many cases where marriages end in separation while the children are still young. Children in such situations will eventually decide which (if any) of the parental cultures they wish to identify with, or whether they wish to choose a cultural identity of their own, and we recognize their right to make a free choice. In a multicultural society, freedom of religion means that each individual must have the freedom to adopt his or her own religion and not have it imposed on them. In order to ensure that this right is real, their bodies should be protected from tell-tale and irreversible alterations. Although these children may choose to identify with the culture of one or other of their parents, they are not only members of that culture; they are also Australian citizens who are entitled to the protection of Australian law and custom. Individual determination has a physical as well as a mental dimension. Multiculturalism was intended as a policy to make people from non-English speaking backgrounds feel more at home in Australia; it was never meant as a carte blanche for the retention of customs that Australian society finds abhorrent. In the <a href="http://www.cirp.org/library/legal/Re_J/">United Kingdom</a> and <a href="http://www.circumstitions.com/Sweden.html">Sweden</a> the judicial systems have intervened in instances where Moslem fathers have sought or arranged for the circumcision of boys without maternal consent. In two cases the fathers were convicted, and in one of these cases the father was gaoled for three months. The practitioner who performed the circumcision was also charged with an offence, though acquitted, by the National Board of Health and Welfare. The United Nations Convention on the Rights of the Child and other international treaties which protect the physical and moral integrity of individuals are available at <a href="http://www.arclaw.org/">http://www.arclaw.org</a> <h2> <a id="rej" name="rej"></a>Important British case upholds child's right to physical integrity</h2> <h3>In re J (1999) confirms that child's physical integrity is more important than desires of parent</h3> J was a five-year old boy living in England, born of a mixed marriage. J's father is a Turkish Moslem, his mother is British. The father wanted him brought up as a Moslem and circumcised. The mother did not, and she took the father to court to prevent that from happening. In a landmark decision she won on both issues. Here are some significant quotes from the judgement of Wall J, delivered in England on 6 May 1999. What the judge said Where there was disagreement between those who had parental responsibility for the child, including a local authority exercising parental responsibility under a care order, circumcision was not to be carried out without the leave of the court. The question of the father taking J to Turkey on holiday is, however, linked with the question of his circumcision. If I decide that J should not be circumcised, the question arises as to whether or not the father's family and/or a Turkish court would accept that decision and feel themselves bound by it. The father assured me in evidence that he would respect the English court's decision, however much he might disagree with it, and would not seek to have J circumcised in Turkey. The father also recognised that if J returned from Turkey circumcised that would constitute a clear contempt of the English court. It is, therefore, clear to me that in Islamic law, J is to be regarded as a Muslim. According to Dr Hinchcliffe, circumcision is not mentioned in the text of the Koran, but in the Sunna (the practice of the Prophet Mohammed), which is the second recognised source of law, it is strongly recommended, and sayings from the Prophet himself are cited in support of the practice. J is plainly not in a position to give an informed consent to his circumcision. There is also ... a body of medical opinion which regards both male and female circumcision as invasive procedures involving unnecessary mutilation of the genitals, and which calls for male circumcision to be criminalised, except in the rare cases where it is medically called for. A case can be made for describing ritual male circumcision without any medical need for it as an assault on the bodily integrity of the child; indeed, that is the case which is made in much of the medical literature to which I was referred. If J were to be circumcised this could be carried out as a day case. J would be likely to be unconscious for about 20 to 30 minutes. It would be a painful procedure. The medical benefits arising from circumcision (apart from the three conditions identified by Dr S for which surgery is indicated) are highly contentious. There is a powerful body of medical opinion which puts strongly in issue any suggestion that male circumcision prevents or reduces the risk of urinary tract infection, penile cancer, or sexually transmitted disease. Equally contentious is the suggestion that it reduces the incidence of cervical cancer in women. There is evidence that tissue loss during circumcision removes or destroys the function of tissue which plays an important part in the overall sensory mechanism of the penis, and that there is a consequential loss of sexual sensory pleasure during sexual intercourse. Dr S's view, as a paediatrician, was that circumcision should only be carried out if medically indicated. I should add, in parenthesis, that amongst the documents shown to me was material from an organisation called Norm UK, the aims of which are to provide education about (1) the need to avoid circumcision and (inter alia) (2) about foreskin restoration. Within this material was an article on foreskin restoration which indicates that it is possible, although restoration cannot give back the erotogenic nerves amputated at circumcision. Equally, there was nothing in the medical evidence I read and heard which indicated that J could not be circumcised as an adult. The father simply could not understand the objections to circumcision. It was a means of demonstrating and reinforcing J's relationship with him: they had to be the same. The procedure for a child of J's age carries small but identifiable physical and psychological risks. It is an invasive procedure, which therefore carries with it risks shared by all surgical interventions: pain, bleeding, infection, surgical mishap and complications of anaesthesia. The father did not accept the risks, either physical or psychological, outlined in the medical evidence by Dr S; and I have to say that, despite his obvious sincerity, there was an element of exaggeration in the father's account of his own circumcision (no doubt as a result of the passage of time), and in my judgment he minimises its painful aspects and underestimates the likely effect of the procedure on J. In my judgment, the strained relationship between the parents, and the fact that as a circumcised child J would be unlike most of his peers, increases the risk that J will suffer adverse psychological effects from being circumcised. The disadvantages are that despite the father's passionate defence of the procedure, J may be traumatised by it. Thus, contrary to the father's perception, circumcision may in fact weaken rather than strengthen his relationship with J. Circumcision carries with it the small but definite risks of both physical and psychological harm to which I have referred. Furthermore J, as a circumcised child, would undoubtedly be different from the majority of his peer group. The consequential possibility that he may be picked on or teased by his peers cannot be excluded as a risk. I think that, because of his strong feelings and the passage of time, the father minimises the pain and discomfort likely to be suffered by J if the operation is performed. Circumcision is an effectively irreversible surgical intervention which has no medical basis in J's case. It is likely to be painful and carries with it small but definable physical and psychological risks. Under art 9 [of the Human Rights Act 1999], the father says that his right to manifest his religion in practice includes the right to arrange for the circumcision of his son in accordance with the tenets of his religion. That seems to me plainly correct. It follows that any limitations on that freedom imposed by a court must be (1) as are prescribed by law; and (2) as are necessary in a democratic society for the protection of the rights and freedoms of others - in this case, the rights and freedoms of both the mother and J himself. … I therefore see nothing inconsistent with the proper operation of arts 8 and 9 of the Convention in a decision of the court which, on the particular facts of this case and in the exercise of a judicial discretion, refuses to make a specific issue order permitting J's circumcision, alternatively prohibits the father from causing J to be circumcised. … Equally, given the balance which the court has to strike between the competing rights of the mother, the father, and the child, it does not seem to me that an order prohibiting circumcision in the circumstances of this case could properly be described as discriminatory under art 14. In my judgment, the argument put forward by the Official Solicitor on this point is sound. Circumcision is an irrevocable step in a child's life. Changes of surname, which require applications to the court in cases of disagreement are reversible: circumcision is not. In my judgment, therefore, where there is a dispute between parents or other persons having parental responsibility for a child over the child's circumcision, that dispute should be referred to the court. For all these reasons, there will be no order on the father's application for J to be brought up as a Muslim and there will be a prohibited steps order preventing the father from arranging or permitting J to be circumcised without the leave of the High Court. I propose to invite counsel to agree the precise terms of the order. Order accordingly. Leave to appeal granted. Re J (child's religious upbringing and circumcision) FAMILY DIVISION, Judge WALL J. 2, 3, 4 MARCH, 6 MAY 1999 Justice Wall's decision was confirmed on appeal. <a href="http://www.cirp.org/library/legal/Re_J/">The full text of the judgement</a> <h2> <a id="muslim" name="muslim"></a>The truth about Muslim circumcision practices</h2> Although the father in the Bundaberg case, and his barrister, tried to excuse his actions by reference to the Moslem religion, Islam does not impose an obligation on parents to circumcise their children. Furthermore, its recommendations about circumcision apply to women as much as men. The Koran, the Moslem bible, makes no mention of circumcision at all, but the prophet Mohammed is reported to have stated that "Circumcision is a sunnah for the men and a makrumah for the women". (Note the reference to men and women: nothing about boys and girls.) The term sunnah means customary or traditional; the term makrumah means meritorious. The most you could conclude is that circumcision was customary for men and meritorious for women, and thus desirable for both but obligatory for neither. In these respects Islam is quite different from Judaism, which requires the head of the household not only to circumcise his baby sons at eight days, but also his male servants and employees, which makes no mention of women in this context, and in which the rule of circumcision is stated prominently in the first book of the Jewish bible. Mohammed further laid down five rules for Moslem men: shaving the pubic hair; circumcision; trimming the moustache; plucking the hairs from the armpits; and clipping the nails. These constitute the fitrah, or laws of personal deportment, to which a pious man in pursuit of perfection must conform. According to Sami Aldeeb, "They are not compulsory, but simply advisable". The vital point about this list is that circumcision is a recommendation for adult men, perhaps no more important than trimming their moustache or shaving their pubic hair. It is thus less obligatory than the rule of prayer five times a day, the pilgrimage to Mecca, fasting at Ramadan or abstention from alcohol and pork. There is certainly nothing in the fitrah which requires a father to circumcise his children. Before assuring the Bundaberg magistrate's court that the man in this case was "sincere in his religious beliefs", his barrister should have established that he scrupulously observed all these requirements, not just the observance that his sons, rather than he himself, had to pay for. There is no unanimity among Islamic theologians as to whether Mohammed himself was circumcised and how it happened. Some say that he was born without a foreskin, others that he was circumcised by an angel or his grandfather. It is thus obvious that, whatever traditions may have evolved in particular cultures over the centuries, Islam does not require parents to have their boys and girls circumcised; and that parents who do have them circumcised cannot appeal to rules of their religion as a justification for this assault. Some Moslems even question whether circumcision itself is necessary and suggest it was merely a custom taken over unthinkingly from desert Arabs when Islam arose in the seventh century. The Egyptian Dr Nawal El-Saadawi writes: "If religion comes from God, how can it order man to cut off an organ created by Him as long as that organ is not diseased or deformed? God doe not create the organs of the body haphazardly without a plan. It is not possible that He should have created the clitoris in woman's body only in order that it be cut off at an early stage in life." As a woman and a victim of circumcision herself, she was referring to the female genitals, but the point is equally applicable to the male foreskin - the part of the penis removed by circumcision. References Sami A. Aldeeb Abu-Sahlieh, <a href="http://www.nocirc.org/symposia/fourth/aldeeb.html">Jehovah, his cousin Allah and sexual mutilations</a>, in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy, New York, Plenum Press, 1997 Dr Sami Aldeeb, <a href="http://www.cirp.org/library/cultural/aldeeb1/">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Medicine and Law, Vol 13, No 7-8, 1994, pp. 575-622 Also available at <a href="http://www.quran.org/CIRCUMCISION.HTM">http://www.quran.org/circumcision.htm</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://go.to/samipage">Dr Aldeeb's home page</a> Sami A. Aldeeb Abu-Sahlieh, Male and female circumcision among Jews, Christians and Muslims: Religious, medical, social and legal debate, Warren PA, Shangri-La Publications (Marco Polo Monographs, No. 5), 2001 <h3>The marsh Arabs: Report by an English traveller</h3> When he was travelling through the marshy region of the lower Euphrates River in the 1930s (present-day Iraq), the British traveller Wilfred Thesiger encountered many Arab people who did not practice circumcision, and others who did and suffered nasty injuries and infections as a result of the operation. His report makes a mockery of the ill-informed statement by the Australian College of Pediatrics (1996) that circumcision "probably originated as a hygiene measure in communities living in hot and dry environments". On the contrary: cutting flesh in primitive conditions was about the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and permanent disability or death, as Thesiger found. Thesiger writes: Circumcision, although nowhere mentioned in the Koran, is generally regarded as obligatory for Moslems following the example of the prophet Mohammed himself, who was circumcised in accordance with Arab custom. No uncircumcised person may lawfully make the pilgrimage to Mecca. Among the tribes in southern Iraq … the operation was often deferred until manhood … and was seldom performed before puberty. It was done by specialists who travelled round from village to village in the summer. Their traditional fee was a cock [!], but more often they charged five shillings. The examples of their work which I saw were terrifying. They used a dirty razor, a piece of string and no antiseptics. Having finished, they sprinkled the wound with a special powder, made from the dried foreskins of their previous victims, and then bound it up with a tight rag. People living under these conditions acquire a remarkable resistance to infection, but they could not resist this, and boys sometimes took two months to recover, suffering great pain in the meanwhile. One young man came to me for treatment ten days after his circumcision, and although I am fairly inured to unpleasant sights and smells, the stench made me retch. His entire penis, his scrotum and the inside of his thighs were a suppurating mess from which the skin was sloughing away, the pus trickling down his legs. I cured him eventually with antibiotics. In spite of the social stigma of being uncircumcised, some boys not unnaturally refused. In other cases the fathers would not allow their sons to be operated on because there was no one else to look after the buffaloes. A few maintained that they had been circumcised by an angel at birth, a superstition that is also current in Egypt. Later I visited villages … where I heard that hardly anyone was circumcised. Wilfred Thesiger, The marsh Arabs, London 1964, pp. 101-2 <h3>Further information on Islamic circumcision</h3> <a href="https://www.circinfo.org/sattouf.html">Riad Sattouf's account of his circumcision as 8-year old in Syria</a> Dr Sami Aldeeb, <a href="http://www.quran.org/CIRCUMCISION.HTM">To mutilate in the name of Allah or Jehovah: The legitimation of male and female circumcision</a> Also available at <a href="http://www.cirp.org/library/cultural/aldeeb1/">http://www.cirp.org/library/cultural/aldeeb1/</a> <a href="http://www.fgmnetwork.org/samialdeeb/">http://www.fgmnetwork.org/samialdeeb/</a> <a href="http://www.quran.org/khatne.htm">A site maintained by Moslems who oppose circumcision</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Abduction and forced circumcision of Queensland boys darby