10 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"> <h2>Why do we need a circumcision policy at all?</h2> Statement by Statement Analysis of the 2012 Report from the American Academy of Pediatrics Task Force on Circumcision: When National Organizations are Guided by Personal Agendas II by Robert S. Van Howe, MD, MS, FAAP Professor and Interim Chair of Pediatrics Central Michigan University College of Medicine <h3>Abstract</h3> In September of 2012, the American Academy of Pediatrics Task Force on Circumcision released its report, which concluded that the benefits of the procedure outweighed the risks. A close analysis of the report reveals the Task Force used a selective, subjective and biased bibliography to support their predetermined conclusions. The Task Force neglected to discuss the anatomy, function, and normal development of the foreskin, nor did they discuss the harm or ethical consequences associated with circumcision. The Task Force deviated from standard practices in its analysis of the medical literature thereby producing a report that falls far below the quality standards set by other AAP policy statements. The report promoted expansion of the procedure as well as the revenue streams for those who perform it. Since release of the report, other national medical organizations have rejected infant circumcision as unwarranted medically and as ethically unacceptable. No organizations outside of the United States have adopted their conclusions. The report is poorly written, poorly researched, makes unsubstantiated claims, and reaches an illogical conclusion. Introduction In the weeks following the release of the report from the American Academy of Pediatrics (AAP) Task Force on Circumcision in September of 2012, I went through the report statement and compiled my critique of their statement. I shared this critique with a handful of people at that time. In December 2014, the Centers for Disease Control and Prevention (CDC) subjected their “draft recommendation” to public comment. As a peer-reviewer selected by the CDC, I wrote and submitted a detailed commentary, which can be found at Academia.edu. Given the effort I had previously put into providing a critique of the AAP’s 2012 report, it is time to update my analysis of the AAP’s misguided statement and distribute it more widely. <h3>General Themes</h3> 1. Recommendations are predetermined and supported by a selective bibliography. 2. There is a failure to adequately research the topics and medical evidence. 3. There is a failure to assign the appropriate weight to the evidence with a tendency to give more weight to evidence that supports circumcision and less weight to evidence that does not support circumcision, even between studies of similar design. 4. There is a failure to evaluate the quality of individual publications using standard methods. 5. There is a failure to recognize or discuss the value and function of the foreskin. 6. There is a failure to recognize the value and human rights of the infant. 7. Conclusions are reached despite no evidence to support them. 8. The report is more reflective of the make-up of the committee rather than medical evidence. 9. A key element of this report is to assure that parents can continue to request infant male circumcision, so that physicians can continue to be paid for performing this procedure. 10. Consistent disdain is expressed toward males who have an intact penis: the term “uncircumcised” is pejorative, inflammatory, and a form of bias consistent with hate speech. 11. There is an underlying racist/anti-immigrant theme. 12. Pieces of information are extracted from citations and used to support their agenda, but other pieces of information from the same citation that do not support their agenda are ignored. 13. There is a failure to acknowledge studies that do not support the benefits of circumcision. 14. The work of scientists who question the validity of the medical benefits of circumcision is routinely attacked. 15. The report was two years out of date at the time it was released. <h3>Issues not properly addressed:</h3> 1. Human rights and bioethics, including the right to an open future. 2. The most common complication of circumcision, meatal stenosis, as well as the myriad of other complications. 3. The anatomy of the normal, complete, intact penis. 4. The histology, anatomy, and function of the foreskin. 5. The psychological sequelae of circumcision. 6. The harms and risks associated with circumcision. 7. Cost utility analysis. 8. Contrary evidence and opinions. 9. Incidence of phimosis and balanitis in intact boys. 10. Non-specific urethritis and the overall risk of sexually transmitted infections. 11. The impact of risk compensation. 12. Positions taken by other national medical organizations throughout the world. ABSTRACT Statement 1: “Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis.” Comment: Accurate, but incomplete, and below academic standards. It does not adequately describe the foreskin as functional, erogenous tissue. The Task Force fails to mention the anatomy, histology, physiology, or sexual functions of the foreskin. This is unacceptable since most medical reviews and discussions begin with a complete scientific discussion of the basic anatomy, histology, and physiology in regards to the organ, or disease, being discussed before moving on to other topics of pathophysiology, disease, epidemiology, and treatment. In the 1984 AAP pamphlet “Care of the Uncircumcised Penis” the functions of the foreskin are discussed. In subsequent versions of the same pamphlet dropped the discussion of the subsequent versions of the same pamphlet dropped the discussion of the functions of the foreskin as though they never existed. When contacted, officials from the AAP are unable identify why this information was removed from the pamphlet. <a href="http://www.circumcision.org/pamphlet.htm" rel="noopener" target="_blank">Old pamphlet available here</a> <a href="https://www.academia.edu/23431341/Statement_by_Statement_Analysis_of_the_2012_Report_from_the_American_Academy_of_Pediatrics_Task_Force_on_Circumcision_When_National_Organizations_are_Guided_by_Personal_Agendas_II" rel="noopener" target="_blank">Professor Van Howe's Academia page</a> <h2>Do we really need a policy on circumcision?</h2> The weaknesses and biases of the AAP policy are bad enough, but a more fundamental question is why and whether we need a policy on circumcision in the first place. No other AAP policy document focuses so obsessively on a particular procedure or on a particular element of a bodily organ – for make no mistake, any circumcision policy is really a report card on the foreskin itself. We don’t see policy statements on the liver, the nose or the heart, but rather on the diseases and other problems that affect those organs; we don’t find suspicious and hostile criticisms of those organs, but advice on how to manage such problems with a view to protecting and preserving them. The AAP has policies on sinusitis, the management of liver cancer and heart disease – and a policy on the foreskin, as though it was some sort of cancerous growth or disease that needed to be “dealt with”. Clearly, something very strange is going on here. The odd thing is that the original purpose of circumcision policy statements issued by paediatric bodies in the early 1970s was to stop circumcision. Routine circumcision had become entrenched in Anglophone medical practice during the first half of the twentieth century, but by the 1960s paediatricians (child health specialists) had become aware that the operation was causing much harm and not doing any obvious good. The harms were not merely a high incidence of complications, but a flood of damaged penises, so scarred and distorted that one Australian doctor reported that he was “appalled at the phallic mutilations exhibited by many of these children, some of whom have even been subjected to a subsequent “tidying up” procedure after being badly mauled in infancy” (A. Clements, Medical Journal of Australia, 29 April 1972, 946). Circumcision policy statements issued by paediatric bodies in Australia, Canada and the United States were intended to halt this butchery by reassuring parents and doctors that the foreskin was not pathogenic or any kind of problem, but a normal element of the male genitals that could safely be left to its own devices. These statements had a substantial impact in Australia, where circumcision incidence plummeted from more than 80% in the 1950s to less than 12% by the mid-1990s. There was a moderate decline in Canada, but only a slight fall in the USA, where incidence actually rose after the AAP’s first policy statement in 1971. It did not begin to decline until the mid-1980s, and even then only after agitation by community-based anti-circumcision groups. Why is the United States different? One of the reasons for this exceptionalism is that in the USA routine circumcision is not the province of paediatricians (who are left with the sad job of repairing the botches), but of obstetricians and gynecologists. They had taken over the operation in the 1930s, assisted by the invention of the Gomco circumcision clamp by obstetrician Hiram Yellen, and had incorporated it as a routine step in the childbirth process – a procedure no more optional or problematic than tying off the umbilical cord. As Miller and Snyder wrote rapturously in 1953, “the obstetrician finishes his episiotomy, walks across the hall and circumcises the infant, and is finished with the whole business. The time saved for both the physician and nursing staff is considerable”; even better, “no babies are forgotten and left uncircumcised.” For reasons of professional pride, emotional commitment and financial advantage, the obgyns have not been keen to give the practice up. Another reason was pressure from religious minorities, worried that if circumcision generally was abandoned it would become difficult to maintain traditional circumcision practices within their own communities. (Translated: if Jewish boys saw that other boys their age had their foreskin, they would want one too.) The fear became more intense after the passage of the United Nations Convention on the Rights of the Child in 1989, with its threatening provision in Article 24 (3): “States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children”. Even worse, this was followed by the passage of legislation in many countries to prohibit and criminalise any form of female genital cutting. Jewish and Muslim religious leaders were afraid that such legislation would lead to demands that similar protection be given to boys – a fear that has proved well-founded. In response to this threat, the conservatives took advantage of the obvious loophole in the CRC – the reference to “prejudicial to health”. If it could be shown that circumcision was not prejudicial to health (i.e. harmful) or, even better, that it was beneficial, the situation would be saved: genital cutting of girls could be banned as harmful (and condemned as FGM), while circumcision of boys was preserved, and even promoted as a boost to male reproductive health. The most masterly exponent of this strategy was Edgar Schoen, an MD employed by Kaiser Health (a leading supplier of circumcision equipment and services), a fervent believer in circumcision, and a prolific contributor to medical journals, among whose editors he had many friends. His presence on the AAP taskforce that produced the 1989 policy statement ensured that the document adopted a more positive stance towards circumcision, asserting that it had definite health advantages, while not going so far as to recommend it. The tone of the policy was, however, more hostile than previously towards the foreskin, tending to picture it as a source of disease and a difficult problem for parents. Skin wars The battle intensified during the 1990s, as the grass-roots anti-circumcision forces grew more confident, and the conservative believers in circumcision scratched around for additional medical benefits. Urinary tract infections were suddenly found to be more common in uncircumcised boys, and the arrival of HIV-AIDS offered hope that a foreskin-HIV link could be found if the researchers were given enough money and worked hard enough. The AAP’s 1999 policy statement was less pro-circumcision, reflecting the waning influence of Schoen (by then retired), and the rising importance of bioethical and human rights issues, the growing presence of the anti-circumcision movement, and an increasing body of circumcision-critical material in the professional literature. It was this Cold War stand-off that probably accounted for the long delay in the production of the next statement, not finalised and released until 2012. By then there had been two contradictory developments. On the anti-circumcision front, both the Royal Dutch Medical Association and the Royal Australasian College of Physicians released statements critical of circumcision. The Dutch policy was stronger, finding nothing positive to say about circumcision, and forcefully rejecting it as medically harmful and ethically impermissible. The RACP was more cautious, but nonetheless agreed with Dutch concerns about bioethical and human rights issues, and concluded that routine circumcision was not warranted and should not be recommended. On the pro-circumcision front, the researchers finally managed to find evidence that circumcision of adults in some regions of sub-Saharan Africa could reduce the risk of female to male transmission of HIV during unprotected intercourse, a discovery that rapidly led to the funding of massive circumcision programs in the epidemic areas. The discovery and programs were not short of publicity, especially not after a naïve geek called Bill Gates was persuaded to provide a few hundred million dollars from his charitable foundation. (Though some cynics wondered whether Microsoft was really quite the most appropriate source for an anti-virus program.) Out of Africa The question then became whether the African revelations were relevant to infants and boys in developed countries, where HIV was not a heterosexual epidemic but a relatively rare disease largely confined to homosexual men and injecting drug users. Considering that the African Random Clinical Trial results were released in 2007 and the policies of the Dutch and the RACP in 2010, it is evident that Dutch and Australian health authorities judged the answer to be NO, and this attitude was soon shared by health authorities in other developed countries, with one exception: yes, the United States (as usual). A series of softening-up articles on the benefits of circumcision published in the Journal of the American Medical Association and other forums prepared the way for the AAP’s 2012 statement. This claimed that the results of the African RCTs, and a few related studies, constituted enough “new evidence” to justify a more positive stance towards circumcision: while the AAP could not go so far as to actually recommend it, the Task Force asserted that “the benefits exceeded the risks”, and left the impression (by insinuation and omission, rather than by explicit statement) that any parent who failed to take the hint and get his boys circumcised was really pretty irresponsible. AAP strategy backfires It did not take long for the flaws and gaps in the policy’s reasoning and evidence to attract numerous critiques, a reaction that rather surprised (and hurt) the Task Force, which seems to have thought that the authority of the AAP (as a powerful American institution) would crush opposition in the Unites States and impress medical organisations in other countries. On the contrary, as Professor Van Howe points out in his latest critique, the most striking result of the AAP’s efforts has been to reanimate the anti-circumcision forces: “One of the unintended consequences of the release of the 2012 Report of the AAP Task Force on Circumcision is that it helped rally European physicians, ethicists, and legal scholars to protest the human rights abuses associated with the practice. In the wake of the report’s release, the Council of Europe and a number of national medical organizations in a variety of European countries have condemned the practice of newborn circumcision as a human rights violation. They have found the “benefits” of circumcision to be inconsequential. When responding to a letter written by 38 leading European medical experts that characterized the Task Force as “culturally biased,” instead of addressing the substantive issues raised, the Task Force responded with righteous indignation and issued a thinly-veiled accusation that the writers were anti-Semitic. … “The irony is that their reactionary approach backfired. When the Task Force led the charge to preserve infant circumcision, they were hoping to attract the attention of Americans and bring the Europeans, who had to that point remained silent on the issue, in line behind them. Instead, it woke up the sensibilities of the Europeans, which has now been noticed by many Americans, leading them to question the practice of infant circumcision in increasing numbers. By overreacting and putting out a statement based on cultural beliefs and personal preference rather than on science, the Task Force members have embarrassed themselves, the members of the American Academy of Pediatrics, and American physicians generally. What is interesting is the pro-circumcision physicians who have infiltrated the Centers for Disease Control and Prevention tried the same tactic in late 2014 by issuing a “draft recommendation,” which took seven years to develop, was short on science and execution, and it was based primarily on cultural factors. Unlike the Task Force report, a public commentary period was required for their “draft recommendations.” Of the thousands of comments submitted, over 95% exposed the scholarly dishonesty of their draft.” And not only European physicians: papers published by Australian child health experts have tacitly rejected the AAP position, and the cruelest blow was delivered by the Canadians: far from endorsing or following the US position, as was widely expected, the updated policy of the Canadian Paediatric Society maintained its recommendation against routine circumcision. Et tu, Brute? Now that the AAP is completely isolated in its (admittedly equivocal) support for circumcision, the question is how long the 2012 policy can survive. If its flaws are as great as Professor Van Howe contends, our conclusion must be that it should never have been issued, and that the AAP ought to get to work on a new one as soon as they can muster a competent team. Why have a policy on circumcision at all? But why have a policy on circumcision in the first place – remembering that it is really a policy on the foreskin: should it be allowed to survive, or should it be condemned as a menace to society (as Dr Peter Charles Remondino insisted in the 1890s)? Health authorities do not prepare policies on other bodily organs – liver, spleen, scrotum, breast etc – but rather on how to manage disorders that affect them. The only comparable policies are those condemning any form of female genital cutting, but these do not single out the clitoris, labia or female prepuce as objects of suspicion. What makes the genitals so special? Could it be, as Professor Van Howe suggests, their cultural, religious and social significance, rather than their role in the physiology and anatomy of the body, that makes the difference? Had circumcision not been introduced by anti-sex doctors in the nineteenth century it would not, of course, be necessary to have a policy on circumcision at all. Countries outside the Anglophone world, where circumcision did not become established, have never felt the need for a such a policy – at least, not until the increasing Muslim presence and the recent provocation from the AAP made them wonder. But in the Anglophone world doctors did introduce circumcision, and it is only right and proper that they should take responsibility for putting a stop to it. If we take Jonathan Hutchinson’s claim about the value of circumcision as a preventive of masturbation and syphilis, aired in the mid-1850s, as the starting-point of circumcision advocacy, we can see that it took about a century of medical propaganda for circumcision to become routine and ubiquitous, reaching its zenith of popularity in the 1950s and 60s. With that example in mind, we may reasonably infer that it will take another century for the practice to die out, along with the Old Guard generation that believes in it. If we take Douglas Gairdner’s celebrated paper of 1949 as the beginning of the end, we may reasonably expect circumcision to have been pretty much eradicated by the middle of this century. That may seem like the distant future, but there are only 34 years separating us from 2050, almost exactly a single generation. It took well over 100 years to abolish slavery, and I think we can be confident that we will be able to eliminate circumcision without the need for a civil war. </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 Critique of the AAP circumcision policy raises larger question 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 letter from Dr V. Raveenthiran in the Journal of Pediatric Surgery replies to the speculations of a certain Steven Moreton on the supposed “hygienic” or “health” origins of non-therapeutic circumcision. Dr. Moreton has placed many contentious arguments regarding circumcision. I agree with him that tracing the origins of this ancient procedure is not an easy task; however, the exercise is not completely irrelevant to modern medical practice. Circumcision is the only surgical operation that is either passionately patronized or vehemently condemned — not only by laity but also by medical practitioners [1]. Influence of lobbying groups is such that even the medical literature is more often distorted [2] as it is evident from frequent reversal of policy recommendations by professional bodies such as American Academy of Pediatrics [3]. Dichotomized circumcision politics, which potentially affects millions of children, can be better understood only by studying its historical evolution. Historically several hypotheses have been proposed regarding the origins and purpose of circumcision [1,4–8]. They include: (1) Religious sacrifice in fulfillment of the covenant with God; (2) Tribal rite of passage into adulthood; (3) Demonstration of leadership qualities such as courage and endurance of pain which are prerequisite of being elected as chieftains; (4) Deterrent of premature indulgence into procreative life; (5) Superstitious act of ensuring or enhancing virility and fertility; (6) Measure of personal hygiene in xeric environments; (7) Symbol of social status (paradoxically both nobility and slavery); (8) Symbolic emasculation – either humiliating or punitive – of war prisoners and slaves; (9) Mark of clan identification especially during exodus and riots; (10) Aesthetic procedure to enhance men's sexual attractiveness; (11) Imitation of a leader's malformation (aposthia) by his followers; (12) Modifier of sexual pleasure (paradoxically both enhancer and suppressor); (13) Dissuader of masturbation and sexual perversions; (14) Magical repellent of demons that were believed to dwell in preputial sac; (15) Castration substitute employed by jealous fathers to discourage sons from having incestuous affair with mothers; (16) Indigenous technique of creating gender awareness and masculine identity; (17) Superstitious act of separating males from androgynous child and (18) Method of oath taking by men enrolled to guard a particular primitive society. To the aforementioned long list, Moreton adds “his own theory” of ‘prophylactic origins of circumcision’. It is nothing new but a plagiarized version of an archaic concept that was originally expressed by Herodotus when he first saw circumcised Egyptians in circa 450 BCE. Since then this speculation has been repeated in many avatars — the latest of which claims that circumcision was originally intended to avoid irritation of desert sand accumulating underneath the foreskin [9]. However, Darby exposed the fallacies of hygiene theory and firmly laid it to rest [10,11]. Rhetoric on protective health benefits of circumcision has only camouflaged over time to match unconquered diseases of the given era. For example in late 19th century, when infectious and neurological diseases were poorly understood, Merrill Ricketts claimed circumcision to prevent or cure paralysis, neurasthenia, eczema, elephantiasis, tuberculosis, enuresis, impotence, epilepsy, hysteria and even acne [1,12,13]. Although all of them are now disproved, devotees of circumcision have not abandoned the worship; but simply moved on to build newer altars. They now claim circumcision to be preventive of penile cancer, sexually transmitted infections including HIV, cervical carcinoma, and urinary tract infection. Surprisingly, these misleading claims are often included in medical textbooks. It is now emerging that evidences for these claims are scant, invalid, weak and distorted [1–3]. As we snigger today at the impossible list of Merrill Ricketts, so will our successors chuckle at contemporary claims of hygiene and prophylaxis. From Merrill Ricketts to Moreton, misconception of foreskin hygiene is perpetuated by the dogma wherein the smegma is vilified as an irritant. It defies logic as to how a physiological secretion of body can be harmful [1]. Myths surrounding smegma have long been dispelled [14] and hence Moreton is trying to resurrect a buried lie. Moreton got his anthropological lessons wrong when he stated that this operation must have been adopted by primitive men on seeing the health benefits enjoyed by an occasional child born without prepuce (aposthia). It is widely acknowledged that primitive societies did not consider malformed children as human beings. Even minor anomalies were considered a bad omen and such babies were either killed or allowed to die by abandoning in wilderness [15]. Therefore a child born with aposthia in prehistoric times was unlikely to have survived long enough to demonstrate the benefits of preputial absence. I maintained that prehistoric men of paleolithic era were unlikely to have inflicted self-injuries as it would have been a survival disadvantage. I also cited Taves’ experiment wherein circumcision was hypothesized to increase glans friction during intromission. Moreton refutes both these assertions by citing tribal rituals and clinical studies finding infrequent coital injuries in circumcised men. Moreton appears to have mistaken ‘prehistoric men’ for ‘tribal men’ and ‘penile intromission’ for ‘sexual intercourse’. For example, intromission is just the act of inserting the penis into the vagina while intercourse is the full range of act that culminates in orgasm (Oxford English Dictionary). Circumcision certainly makes intromission unpleasant which is why it was projected as masturbation dissuader. Sexual pleasure and coital injuries are determined not only by the status of circumcision but by many other factors such as degree of vaginal lubrication, force of pelvic thrust, coexisting diseases, genital malformations, psychological inclination of partners and coital posture. Unfortunately none of the studies cited by Moreton take all these covariables into consideration. Further, an equally good number of “robust” studies published in high impact journals indicate that coital injuries and impaired sexual pleasure are more frequent in circumcised men [16–19]. This is what I dismiss as dichotomized literature. Moreton asks for more evidences of circumcision originating as a punishment or humiliation of war prisoners. They are plenty to fill an entire issue of the Journal of Pediatric Surgery; suffice I mention a few of them. Diodorus Siculus (circa 100 BC) in his magnum opus Bibliotheca Historica described a bas-relief seen in the Tomb of Ozymandyas (Hellenized name of Rameses II) [20]. The sculpture, probably commemorating the King's victory in the Battle of Kadesh (circa. 1274 BC), was said to depict chain-bound war prisoners registered by a royal scribe in preparation for amputation of right hand or ‘private parts’. A pile of these excised organs was also seen in the foreground [5]. A more explicit description is found in the Old Testament. Saul wanted to avenge both David and Philistines. Hatching a cleaver plan, he asked David to bring 100 foreskins of philistines as dowry to marry his daughter Michal; And David brought 200 of them and took her hands in wedlock (Samuel 18:25–27). In another story, when Shechemraped Jacob’s daughter Dinah, her enraged brothers deceitfully circumcised all their enemies and humiliatingly killed them while they were still recovering from the sore (Genesis 34:1–31). Forced circumcision of enemies is also well documented as late as in British India. The theory of punitive origin of circumcision is of some practical importance. I have observed that circumcision is more often promoted and defended by those who have undergone the procedure themselves [21]. Psychologically this appears to be a phenomenon of re-enacting the shame and trauma suffered during childhood [22]. In circumcised adults, I have seen this shame being sublimated into pride at some point of life. Perplexed by this paradox I looked into the history. Now, I could see the ‘shame’ in the punishment of captured enemies and the ‘pride’ in the sacrificial rites of Osiris cult. Osiris himself being punished by emasculation and its symbolic emulation by his followers could be the connecting links between the contrasting emotions of shame and pride. Finally, I wonder if Dr. Moreton's communication suffers from serious conflicts of interest (COI) as he is the editor and contributor of a blog ‘promoting circumcision’. Certainly, I have no prejudice in exploring and writing the history of circumcision V. Raveenthiran Department of Pediatric Surgery, SRM Medical College, 200, Fifth Street, Viduthalai Nagar, Kovilambakkam, Chennai 600117, India References [1] Gollaher DL. Circumcision: a history of the world's most controversial surgery. New York: Basic Books; 2000. [2] Boyle GJ, Hill G. Circumcision-generated emotions bias medical literature. BJU Int 2012;109:E11. [3] Frisch M, Aigrain Y, Barauskas V, et al. Cultural bias in the AAP's 2012 technical report and policy statement on male circumcision. Pediatrics 2013;131:796–800. [4] Friedman DM. A mind of its own: a cultural history of the penis. London: Robert Hale; 2001. [5] Remondino PC. Theories as to the origin of circumcision. History of circumcision from the earliest times to the present. London: FA Davis; 1891. p. 28–33. [6] Amin Ud Din M. Aposthia — a motive of circumcision origin. Iran J Public Health 2012;41:84. [7] Charles W. Motives for male circumcision among preliterate and literate peoples. J Sex Res 1966;2:69–88. [8] Kaicher DC, Swan KG. A cut above: circumcision as an ancient status symbol. Urology 2010;76:18–20. [9] Hutson JM. Circumcision: a surgeon's perspective. J Med Ethics 2004;30:238–40. [10] Darby R. The riddle of the sands: circumcision, history, and myth. N Z Med J 2005; 118:U1564. [11] Darby R. A surgical temptation: the demonization of the foreskin and the rise of circumcision in Great Britain. University of Chicago Press; 2005. [12] Ricketts BM. The last fifty of a series of two hundred circumcisions. N Y Med J 1894; 59:431–2. [13] Anonymous. Circumcision for the relief of acne. Hospital (Lond) 1902;31:339. [14] Van Howe RS, Hodges FM. The carcinogenicity of smegma: debunking a myth. J Eur Acad Dermatol Venereol 2006;20:1046–54. [15] Nun L. Neonaticide, infanticide and filicide. Israel: BN Publications; 2017. [16] Bronselaer GA, Schober JM, Meyer-Bahlburg HF, et al. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int 2013;111:820–7. [17] Masood S, Patel HR, Himpson RC, et al. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? Urol Int 2005;75:62–6. [18] Fink KS, Carson CC, De Vellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 2002; 167:2113–6. [19] Boyle GJ. Circumcision of infants and children: short-term trauma and long-term psychosexual harm. Adv Sex Med 2015;5:22–38. [20] Diodorus Siculus. Bibliotheca Historica (English translation); vol 1, sec 48:2. Available from http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Diodorus_Siculus/1C*.html, Accessed date: 30 September 2018. [21] Muller AJ. To cut or not to cut? Personal factors influence primary care physicians’ position on elective circumcision. J Men's Health 2010;7:227–32. [22] van der Kolk BA. The compulsion to repeat the trauma. Re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12:389–411. Source V. Raveenthiran. <a href="https://www.jpedsurg.org/article/S0022-3468(18)30664-X/fulltext" rel="noopener" target="_blank">Reply to letter to the Editor: Tracing the origins of circumcision</a>. Journal of Pediatric Surgery, early view, 2018 </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 Cultural/religious/ritual circumcision not related to hygienic or other practical considerations 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>The foreskin and circumcision</h1> In Australia today circumcision of baby boys is rare, and the uncut penis is the normal thing among young people, but many parents are still anxious about the subject. Because Australia has a past history of widespread circumcision, they may be unfamiliar with the normal penis and worried that they will not know how to look after it. They may also have been alarmed by reports in the media about the risks to health supposedly caused by the foreskin and wonder if it can be true that amputating a natural part of the body could really make a baby happier. Most parents instinctively know this could not be right. They would agree with an American mother who wrote recently: "When I gazed upon my newborn son's beautifully-formed body, I knew I could no more cut off a part of his penis than I could a part of his ear or toe. In time, I would learn I was not alone in my belief that little boys are perfect just the way they are". ( Laura Shanley, Pregnancy Today, 22 August 2002 ) This guide aims to cover the big questions asked by parents who are considering whether to circumcise their baby boy and to reassure them that boys are exactly right the way nature made them. <h2> <a id="what" name="what"></a>What is circumcision?</h2> To answer this question we must first understand what it cuts off. Circumcision is the surgical amputation of the foreskin - the soft, sensitive double-sleeve of tissue which covers the lower half of the penis shaft and the head (glans) and usually extends beyond to end in a tapering spout or nipple. There is no agreed anatomical definition about where the foreskin ends and the skin of the penis shaft begins, and hence no exact surgical definition of what circumcision is meant to remove. As a consequence, the amount of tissue cut off by the operation is highly variable (some doctors take more, some less), but a typical circumcision carried out in a western hospital will remove about 50 per cent of the surface tissue of the penis. <img alt="" class="image-center" height="119" src="https://www.circinfo.org/images/billboard1.gif" width="402"/> The foreskin is not just a flap of skin, but an important part of the penis. It is a complex web of mucous membrane, muscle fibres, blood vessels and nerves: in fact, it supports one of the densest concentrations of nerves in the whole body. Amputating it is not a simple "snip", but a delicate and often bloody operation, particularly difficult to do neatly in infants, when the parts are very small and not even fully formed. An early practitioner likened the operation to "resecting the femur of a grasshopper". In a baby boy the lower end of the foreskin (including the tapering spout or nipple which extends beyond the glans) can represent more than half the total length and bulk of the penis. This proportion decreases as the boy grows up and the rest of the penis grows into the foreskin. In infancy the foreskin is very tight and is normally fused to the glans, thus guarding the urethra (the urine passage) against the entry of dirt and protecting the glans from irritation by urine or faeces and from abrasion. It was never meant to be pulled back at this early stage. The first injury inflicted by circumcision in infancy is caused by forcibly separating the foreskin from the glans, a process which can be similar to tearing off a baby's fingernail. <a href="http://www.cirp.org/library/normal/">Further information</a> <h2> <a id="importance" name="importance"></a>Importance of the foreskin</h2> Little is known about the anatomy and neurology of the foreskin because medical researchers have been more interested in finding justifications for cutting it off than in studying it objectively. The state of medical knowledge is so poor that no doctor can say with confidence that circumcision does no harm, much less that it can do significant good. Common sense teaches that the foreskin has many important functions. <ul> <li> It contributes to the hygiene and cleanliness of the penis. Its long, tapering, spout-like shape works like a valve, letting urine out and keeping it away from the baby's body, but also blocking the entry of dirt. </li> </ul> <ul> <li> It protects and lubricates the glans, which is an internal organ that was never meant to be exposed to the abrasion of clothes etc. The foreskin works in much the same way as the eyelid protects and lubricates the eyeball: would your eyeball be cleaner if the eyelid was cut off? </li> </ul> <ul> <li> It provides the slack tissue necessary to accommodate the enlargement of the penis during erection This is particularly important after puberty, when the difference between the flaccid and the erect organ may be several hundred per cent. </li> </ul> <ul> <li> Recent research suggests that the natural secretions which lubricate the foreskin have useful anti-fungal and anti-bacterial properties. Further <a href="http://www.cirp.org/library/disease/STD/fleiss3/">information here</a>. </li> </ul> <ul> <li> It is so densely packed with nerve endings that it is by far the most sensitive part of the penis. It thus plays a major role in the generation of sexual pleasure. Unlike the nerve endings of the foreskin, which specialise in the reception of pleasure, the nerve endings of the glans specialise in the detection of pain and discomfort - another reason why it should not be exposed to abrasion and irritation. </li> </ul> <ul> <li> As a glance at any ancient Greek statue or Renaissance painting will prove, the normal penis, covered in its foreskin, is a beautiful part of the male body. Circumcision completely changes the look of the penis. In addition, it always leaves an ugly scar and either ragged flaps of skin or a shiny, scarred patch where the tissue was cut away. Bodily aesthetics may be a matter of personal taste, but if that is true, then the only person who can make a decision about how he wants his penis to look is its owner. </li> </ul> A fuller list of the functions of the foreskin is <a href="http://circumstitions.com/Functions.html">available here</a>. <h2>Where did circumcision come from?</h2> Circumcision began as a puberty initiation rite among a number of tribal peoples, all with an authoritarian and highly patriarchal social structure, in north-east Africa and central Australia. Later the Arab and then the Jewish peoples of the Middle East adopted the practice, followed by the Moslems, though they started performing the operation at a younger age: the Jews at eight days, the Moslems at between six and ten years. The reasons why these cultures adopted circumcision is not fully understood, but it had nothing to do with practical concerns like hygiene. Cutting flesh in primitive conditions was the about the least hygienic thing anybody could do, carrying a high risk of bleeding and infection. The orthodox position had been put in the thirteenth century by <a href="http://www.cirp.org/library/cultural/maimonides/">Moses ben Maimon</a>, who insisted that for Jews circumcision was strictly a test of faith, carried out not to correct a defect but to injure and chasten the penis, thus curbing sexual desire. Until this step was abolished in the late nineteenth century, Jewish circumcision also required the Mohel to suck the bleeding penis after he had cut the foreskin (the metsitsah phase); far from being a hygienic measure, this operation was a significant vector for the transmission of fatal diseases from the operator to the child, including tuberculosis and syphilis. The reason why metsitsah was abolished was because it was realised that many boys were being infected with these disease and a high proportion dying from them. The idea that Semitic and other tribal circumcision had a health or medical rationale was the invention of nineteenth century English and American doctors who wanted to introduce the operation for their own reasons and thought that the antiquity of the procedure conferred legitimacy. Nobody has ever suggested that circumcision as carried out by the Australian desert Aborigines had a hygienic rationale. For further details, <a href="http://www.historyofcircumcision.net/">go to History of Circumcision</a> <h3>"Health" circumcision</h3> Circumcision was first introduced as a medically-justified procedure on unwilling boys in the mid-nineteenth century, mainly as a means of discouraging masturbation, then wrongly regarded as the cause of many serious diseases. Many other medical reasons for doing it have been advanced over the last century and a half. These include prevention of syphilis, tuberculosis, polio, bed-wetting, epilepsy, burping, night terrors, phimosis, and cancer of the penis and cervix - and just any other problem that lay beyond doctors' power to cure. All these claims have been disproved. Recent assertions that circumcision may confer a degree of protection against HIV-AIDS and urinary tract infections (UTIs) are controversial and doubtful. Even if they were true, UTIs are easily cured with antibiotics, and babies do not engage in the sexual activities from which they can contract the AIDS virus. As for cleanliness, to amputate the foreskin to improve bodily hygiene is like extracting teeth or pulling off fingernails instead of cleaning them. Because it prevents the normal lubrication processes from occurring, circumcision actually makes the penis less hygienic than if it is left as nature intended. <h2>How common is it?</h2> Circumcision became common in Britain (though never affected more than about a third of boys) in the Edwardian period (just before World War I) and spread from there to Australia, where it became a normal or "routine" procedure carried out on newborn babies, usually within the first week of life. Britain dropped circumcision in the late 1940s, but in Australia it remained widespread until the 1970s. (See statistics at <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=category&sectionid=6&id=71&Itemid=50">History of Circumcision</a>.) As a result of better medical knowledge, its incidence has declined from about 50 per cent of babies in the 1970s to less than 12 per cent today. The United States, Canada, Australia and South Korea are the only countries in the world where parents and doctors continue to carry out routine circumcision, and in all these places the procedure is under attack and in decline. In Australia the practice is now rare, though there is a strong push from circumcision advocates to restore it to the levels of the 1950s, supposedly as a public health measure. The vast majority of the world's people are not circumcised and never have been. The largest single group of circumcised men in the world today are Moslems, among whom the operation is carried out as a religious custom, not a medical procedure. Many Moslem cultures also prescribe and carry out various forms of circumcision on girls and women. <h2> <a id="risks" name="risks"></a>Risks and complications</h2> Circumcision is a surgical procedure involving the cutting of skin, muscle, nerves and blood vessels, and it carries inherent risks, including bleeding, infection, gangrene and ulcers. Quite often too much tissue is removed and the growing boy experiences uncomfortable and even painful erections; in extreme cases erection may be impossible, as in the tragic cases recorded on the <a href="https://www.circinfo.org/account.html">Injury and Harm page</a> show. Doctors recognise that serious complications occur in at least five per cent of operations, but the real figure is probably much higher. Sometimes the glans is damaged or cut off, and occasionally the entire penis is a amputated. <a href="http://www.cirp.org/library/death/">Even death can occur</a> as a result of bleeding or infection, or in consequence of human errors, particularly when anaesthetics are used, or as a result of pain control drugs administered following the operation. As the circumcision wound is healing the raw edges can fuse to the glans, thus leaving skin bridges which have to be surgically removed later. Infections are common. Because the glans is no longer protected from urine, faeces and other dirt, ulcerations can form around the urinary opening and may be followed by scar tissue. Since there is rarely any follow-up with circumcision cases, the true level of complications and later problems is not known, and there has been no attempt to measure customer satisfaction. Since the foreskin represents at least one third of the sensation-receiving regions of the penis, its removal means a severe loss of sexual sensitivity. In addition, the glans itself becomes hard, dry and insensitive, when nature meant it to be soft and moist. The end result is a strikingly different-looking penis which usually carries an obvious and often ugly scar. <a href="http://www.cirp.org/library/complications/">Further information</a>. <h2> <a id="care" name="care"></a>Care of the normal penis</h2> <h3>Rule 1: Leave it alone</h3> The normal (uncut) penis requires no special care. Primitive humans managed to thrive with it in that condition for hundreds of thousands of years before circumcision was invented, and if primitive hunter gatherers were able to care for the natural penis of their babies, so can parents today. Some parents favour circumcision because Australia has a past history of widespread circumcision and they are not familiar with the normal (uncircumcised) penis. They may have heard stories that it is difficult to look after in infancy and childhood and are afraid of unknown but suspected problems. In reality nothing is easier: the foreskin should simply be left alone, and nature will do the rest. Because it is usually attached to the glans, an infant's foreskin should never be retracted (pulled back). Separation of the two surfaces occurs gradually during childhood, and the age at which full separation occurs will be different for each boy. The process should not be hurried! Boys naturally play with, tug and fondle their penis, especially the foreskin, and this helps the process along at the individual's own pace. The most common cause of penis problems in infancy and childhood are misguided attempts to retract the foreskin and wash underneath it. This may cause bleeding, scarring, infection and adhesion of the foreskin to the glans, and sometimes such severe injury that circumcision is necessary later on. The only washing the infant penis requires is (very gently) on the outside. Unless a serious malformation, injury or disease is present, the first person to pull a boy's foreskin back should always be the boy himself. Minor problems with the penis are not unusual in infancy and early childhood: it is subject to infection and in much the same way as lungs, nose, ears, throat, digestive tract etc, as the child grows up and his body learns to cope with the micro-organic world. These problems can nearly always be fixed by conservative methods. Any good paediatrician can advise on these. If you take your child to a GP and don't like what he says, especially if he seems biased against the foreskin, get a second opinion or arrange to see a specialist paediatrician. Nobody talks about amputating a boy's ears or lungs because he gets earache or bronchitis, or his leg because he often falls over and gets cuts or bruises on it. <a href="http://www.cirp.org/library/disease/hygiene/simpson1">Further information from Australian paediatricians</a>. <a href="http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=3715">Fact sheet from Royal Children's Hospital, Melbourne</a> <h3>Phimosis</h3> Phimosis is the name given to a foreskin that cannot be drawn back to expose the glans. All young boys have phimosis, and there is no definite age at which retractability should be achievable. Phimosis used to be regarded as an "indication" for compulsory circumcision, but that was an error arising from ignorance of normal genital anatomy. Even after puberty some men still have a phimotic condition, and most are not worried by it; if a man does experience discomfort he can gently stretch the foreskin opening. If that does not work he can always get himself circumcised if he really thinks it necessary: it does not have to be done for him at an age when the final condition of his penis cannot be known. Too many boys are still circumcised between the ages of three and six because their foreskins are not easily retractable, but genuine (pathological) phimosis can rarely be identified that early. Most cases of real phimosis can now be treated by topical steroid cream. Recent research shows that 85 per cent of boys with a problem phimosis respond to twice-daily applications of steroid cream within four weeks, and many within two weeks. Real (pathological) phimosis is now recognised as arising from injury or certain rare forms of infection. You can always cut the foreskin off, but once it's gone there is no getting it back. Circumcision should always be the last resort. <h3>Non-surgical treatments of penis problems</h3> For more details and information about how to handle penis problems without amputating anything, <a href="http://www.circinfo.org/alternatives.html">see Non-surgical tratment of foreskin problems</a> on this site. <h3>Smegma: beneficial lubrication</h3> In babies and young boys the natural shedding of the skin cells from the inner layer of the foreskin helps the process of separating the two structures. The shed cells form a harmless substance called infant smegma which is regularly extruded from the foreskin opening; it can then be wiped away during the boy's bath. There is nothing dirty or harmful about this. External washing is all that is required at this stage; attempting to wash under the foreskin of young boys can only do harm. Some parents get worried when they see smegma for the first time, mistake it for pus and think the boy has an infection. Obviously you want to wipe the stuff up, but there is nothing harmful about it, and it does not indicate infection or any other problem. When a boy reaches puberty his sebaceous (sweat) glands begin to function more vigorously, secreting an oily substance. This additional secretion in adult smegma protects and lubricates the glans. By this time most boys are perfectly capable of working out how to keep themselves clean, without the need for direction from adults, and the few who are not informed can be easily be shown what to do. Most boys produce very little or no smegma at all. A heavy accumulation of smegma will eventually get smelly, but a boy's mates will soon let him know if he is causing offence. <h2>Is circumcision ever justified?</h2> In the absence of a serious and health-threatening pathological condition (arising from malformation, disease or injury) it can never be justifiable to circumcise a person without his or her agreement. But any male over the age of consent may have himself circumcised if he prefers to be that way, and younger males too if they can convince their parents that they really want it. Parents may be justified in having their boys circumcised before they are able to give legal consent if they are affected by a seriously health-threatening condition and conservative means of treating it have failed or are not available. Most Australian doctors agree that the only conditions which may meet these criteria are: <ul> <li> acute cases of phimosis and paraphimosis - where the penis is being strangled by an extremely tight foreskin - which do not respond to cortisone cream (Betamethasone valerate) or other conservative treatments; </li> </ul> <ul> <li> recurrent balanitis xerotica obliterans (a fungal infection of the glans) which is not controlled by antibiotics. </li> </ul> (Martin J. Glasson, "Circumcision: A surgical perspective", Medicine Today, November 2001, p. 108) <h2> <a id="choice" name="choice"></a>Parental concerns</h2> Parents want the best for their children and would never subject them to the pain and loss of circumcision if they did not think the benefits gained outweighed the deprivation. The small minority of parents who seek to have their boys circumcised today do so for a number of different reasons, including social or religious custom, family tradition or the belief that the operation will immunise against them against certain diseases, particularly STDs. This used to be the big selling point, but it is now realised that pre-emptive amputation of normal body parts is neither ethically acceptable nor an effective disease control strategy. No other part of the body is ever amputated because it might cause trouble or get infected later. Fears about disease have recently been set to rest by the policy statemenst issued by the Paediatric and Child Health Division of the Royal Australasian College of Physicians in 2002, 2004 and again in 2009. Australian paediatricians have been advising against circumcision since 1971. In the latest review of their policy a working party made up of a broader group of doctors carefully examined the recent medical literature, including risks, harm and adverse outcomes, and claims about the supposed protective effect of circumcision against STDs, AIDS, urinary tract infections (UTIs), cancer of the penis and cervical cancer in female partners. In 2002 it concluded that there was "no medical indication for routine male circumcision" and that there was "no evidence of benefit outweighing harm for circumcision as a routine procedure". In 2009 it stated clearly that" After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed". The most recent and authoritative statement was issued by the Royal Australasian College of Physicians in October 2010. This document states clearly: “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.” The policy also points out that routine circumcision is under strong attack from bioethics and human rights advocates, “because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent.” The RACP (representing six Australian and New Zealand medical bodies) has thus sent a clear message to doctors and parents that they should not do it. <a href="http://www.racp.edu.au/page/policy-and-advocacy/paediatrics-and-child-health" rel="noopener" target="_blank">Latest policy statement from Royal Australasian College of Physicians available here</a> STDs like AIDS and human papillomavirus (HPV - wart viruses, some of which cause penile and cervical cancer) can easily be avoided by practising safe sex, and they are certainly not a reason for interfering with a boy's genitals long before he becomes sexually active. Even if circumcision did confer a slightly reduced risk, the loss of such a significant, interesting and beautiful part of the body would far outweigh the gain. The average age of first intercourse in Australia is about 16 years, when boys are old enough to understand the issues and capable of making their own decisions about how to manage risk. Some parents still say they are worried that their sons may be teased or embarrassed if they are different from other boys, but that is a reason for leaving his penis alone. With the rate of circumcision in Australia at only 12 per cent, it is the circumcised boy who will be the odd man out - and how much worse would he feel if he had been deprived of something other boys enjoyed than to have something extra that other boys lacked? <h2>Conclusion: Boys like their hoods</h2> There is no medical justification for routine circumcision. It is the privilege of parents to have the chance to recognise their children's right to a complete body and to protect them from harm. Circumcision of children and others incapable of giving informed consent to medical treatment is a violation of a person's human rights, a breach of medical ethics and, if it is done to girls in many western countries, an offence against the law. It costs nothing not to cut, and the benefits will last a lifetime. An increasing number of boys are angry at having been circumcised when they were too young to protest, and some of these are turning to the law to seek damages, but few reproach their parents for leaving them as nature intended. In the late 1980s a group of students at the Australian Defence Force Academy formed an amateur rock band called the 4Skins, so called (as you might guess) because none of the four players had been circumcised. At the annual Jazz and Review concert (a night of satirical sketches and musical numbers) they performed a few songs, and at the end of their segment they made a particular point of thanking their parents for making sure, when they were babies, that they would have foreskins to name their band after when they grew up. The looks of envy on the faces of the minority of other cadets who had not been so lucky was a sad and telling sight. <h2> <a id="info" name="info"></a>Further information</h2> <a href="http://www.racp.edu.au/page/policy-and-advocacy/paediatrics-and-child-health" rel="noopener" target="_blank">Royal Australasian College of Physicians leaflet: Circumcision: A Guide for Parents</a> <a href="http://www.cirp.org/pages/parents">Information for parents on the CIRP website</a> <a href="http://www.nocirc.org/publish/">Nocirc (USA): Answers to questions about foreskin care</a> <a href="http://www.circumstitions.com/Care.html">Care of the intact penis</a> <a href="http://www.circumstitions.com/Itsaboy.html">A leaflet for parents: It's a boy</a> <a href="http://www.foreskin.org/fleiss.htm">Paul Fleiss MD, The case against circumcision</a> <a href="http://www.cirp.org/library/anatomy">Detailed information on the anatomy and physiology of the penis</a> <a href="https://www.circinfo.org/baps.html">Management of foreskin conditions: Statement by British Association of Paediatric Urologists</a> <a href="http://circumcisiondecisionmaker.com/" rel="noopener" target="_blank">Circumcision Decision Maker</a>: A new interactive American website intended to help parents make the right decision when it comes to the circumcision decision. How to raise the subject with a circumcised father Vincent Bach offers <a href="http://www.stopcirc.com/vincent/vulnerability_of_men.html">a thoughtful discussion of why circumcised men are reluctant</a> to talk about the subject and why some are keen to see their own sons circumcised. He also has useful advice to women on how to raise the subject with their partners and dissuade them from this point of view. Videos and visual material Parents considering circumcision for their baby should various videos of the procedure available at <a href="http://www.intact.ca/">www.intact.ca</a> and <a href="http://www.circumstitions.com/">Circumstitions</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 Detailed guide for parents darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Concern at unnecessary circumcision</h1> <h3>Doctors worried by incorrect or fraudulent diagnosis of phimosis</h3> Even though routine neonatal circumcision is almost unknown in Britain and rare in Australia, New Zealand and Canada, too many boys between the ages of 4 and 10 are still circumcised because of "phimosis" - that is, because their foreskin cannot be fully drawn back. Many parents (and too many doctors) do not understand that it is quite common for the foreskin not to become fully retractable until the boy reaches puberty or even later, and that there is no need for any action unless he is suffering pain or discomfort. If he is and medical treatment is needed, the preferred treatment these days is application of steroid cream. A premature or (even worse) a fraudulent diagnosis of phimosis should not be used as an excuse to circumcise an otherwise healthy boy. <h3> <a id="mja" name="mja"></a>Medical Journal of Australia: Phimosis not a valid reason for circumcision</h3> Three important articles in Medical Journal of Australia (17 February 2003) argue that too many circumcisions are performed in Australia and that there is inadequate awareness of the value of the foreskin as a normal part of the male genitals. Dr Katrina Spilsbury and colleagues in Perth show that too many boys under six years old are being circumcised after a diagnosis of phimosis, but that most of these diagnoses must be mistaken or spurious because genuine (pathological) phimosis is very rare at that age. They suggest that parents and doctors need education on the normal development of the foreskin. This argument is confirmed by an editorial by Dr Paddy Dewan, a leading paediatric surgeon in Melbourne. In a historical article, "Medical history and medical practice", Dr Robert Darby dispels two persistent myths about the foreskin. He shows that circumcision as practised by tribal peoples did not arise as a health measure; and that it has been recognised since Greek antiquity that the foreskin plays an important role in the body's economy and makes a significant contribution to sexual function. The three articles are available from the <a href="http://www.mja.com.au/public/issues/178_04_170203/contents_170203.html">Medical Journal of Australia on-line</a> Comments in the media Young boys may be undergoing unnecessary circumcisions for a condition that can be effectively treated with creams, according to a study. The percentage of Australian boys being circumcised has fallen from 95 per cent in the 1930s to only 6.5 per cent 20 years ago. However, a West Australian report, published in the Medical Journal of Australia on Monday, reveals a high rate of circumcision for phimosis, a condition where the foreskin cannot be retracted, in boys under five. This is despite the condition - which can easily be confused with normal development of the penis - being rare among this age group. Dr Katrina Spilsbury, of the University of Western Australia's School of Population Health, reviewed the circumcision of boys in the state's hospitals between 1981-1999. Boys aged five and under had the highest rate of surgery for phimosis, representing about 300 circumcisions each year. More older boys were also being circumcised for phimosis, with a 70 per cent increase in the procedure among boys aged 10-14 during the period studied. "The past 19 years have seen a steady rise in the rate of medically indicated circumcision," Dr Spilsbury reports. "Most of the increase is the result of an increase in the rates of phimosis." Dr Spilsbury said if the current rate continued, about four per cent of boys would be circumcised for phimosis by the age of 15. This rate was seven times higher than the estimated occurrence of the condition, she said. "These findings imply a high rate of unnecessary surgery," writes Dr Paddy Dewan of the Royal Children's Hospital in Melbourne in an accompanying editorial. Dr Dewan suggests the high rates might be the result of "manipulation", either by parents who want to circumcise their child for cosmetic reasons or GPs who expect resistance from surgeons unless they give a medical reason for circumcision. Dr Spilsbury said phimosis could cause pain and urinary tract infections and was associated with sexual dysfunction and cancer in later life. However, there was evidence the use of steroid creams could reverse the situation in around four to six weeks, she said. The Age (Melbourne), Sunday 16 February 2003 DOCTORS have been advised to tell parents there is no medical reason to routinely circumcise boys. The policy statement developed by the paediatric and child health division of the Royal Australasian College of Physicians raises the prospect of future legal action if the surgery is performed. Parents who have their child circumcised and doctors who perform the surgery could face legal action when the child grows up. The stance follows a major review of existing information and reaffirms the position of the College of Paediatrics and the Australasian Association of Paediatric Surgeons. "Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure," the RACP says. "There is no medical indication for routine male circumcision." In Australia the circumcision rate has fallen in recent years to about 10 per cent of male infants. The rate of complications from neo-natal circumcision is between 1 and 5 per cent. The Advertiser (Adelaide) and Courier Mail (Brisbane), 19 May 2003 <h3> <a id="times" name="times"></a>Circumcision: Unnecessary, damaging and performed without consent</h3> The unkindest of cuts, by Simon Crompton Times on Line (London), 13 January 2003 THERE IS ONE OPERATION being carried out on thousands of British children by NHS doctors without any clinical need — and without the patient's consent. This procedure has an irreversible physical effect, yet there has been minimal public debate about the extent to which it is being performed. The procedure is non-religious circumcision, carried out on "therapeutic" grounds on 4 to 6 per cent of boys under 15. Increasingly, the expert consensus is that most non-religious circumcisions are carried out for reasons of family history, medical myth and professional laziness. Some campaigners claim that as many as five in six of these circumcisions are unnecessary and potentially traumatising. Circumcision has become the subject of bitter debate in the US, where 80 per cent of men are circumcised. Doctors Opposing Circumcision is one of a range of groups challenging the medical orthodoxy of circumcision at birth; their campaign has been buoyed by a statement from the American Medical Association that there is insufficient evidence of benefit to recommend routine neonatal circumcision. Here, the British Medical Association is reviewing its guidelines and is due to announce its findings in March; current guidance makes it clear that it is unethical to circumcise for therapeutic reasons where research shows that less invasive techniques are available. Norm-UK, an organisation which campaigns against circumcision, estimates that fewer than 1 per cent of boys require the operation, and that most of those performed on the NHS are unnecessary. Dr John Warren, a consultant physician and founder of Norm-UK, says that the main problem is that GPs and general surgeons are unaware of research indicating when circumcision is medically required. Specialist paediatric urological surgeons are better informed, but not all children are seen by these experts. Most non-religious circumcisions are performed on children whose parents are concerned about a tight foreskin that will not retract, a condition known as phimosis. "They think there is something wrong, even if it's causing the child no problems," says Warren, who works at the Princess Alexandra Hospital in Harlow, Essex. Yet research published as long ago as 1968 showed that 90 per cent of tight foreskins had resolved themselves by the age of four, and 99 per cent had developed normally by 17. "The message never filtered through, and a lot of people didn't accept it," says Warren. Family tradition also plays a part. Fathers and grandfathers who were circumcised may want their boys circumcised too (often on the basis that it is "cleaner"), and use the possibility of phimosis to get doctors to perform the procedure. Duncan Wilcox, consultant paediatric urologist at Great Ormond Street Hospital and Guy's Hospital in London, believes that this is the main reason why so many circumcisions are carried out unnecessarily. "As many as half of the parents who come to see me want their child to have a circumcision," he says. "But when I tell them that there is a risk, as with all operations, the majority are happy to wait and see if the foreskin retracts normally. Doctors are certainly pressurised, and there is always the occasional parent who will get through with pure persistence, or by saying that their child keeps getting infections." The issue would be less important if foreskin removal did not have physical and social implications which carry on into adulthood. Alex was circumcised at 25 during an operation to correct a bend in his penis. The surgeon decided — without Alex's consent — to remove the foreskin, an action that other surgeons have subsequently confirmed as unnecessary. "There was a huge reduction in erogenous tissue," says Alex, now 29, a systems analyst from Oxfordshire. "The feeling of pleasure has changed so much that I haven't been able to achieve orgasm since the operation. It had a disastrous effect on my relationship: my partner wondered whether it was her fault, and that contributed to the end of our relationship. Since then I've found it hard to get into a new relationship. "I am conscious of how I look, and girlfriends have given me quizzical looks. They are not used to seeing circumcised men. I haven't had the confidence to go into a public changing room since the operation." The foreskin contains a rich variety and concentration of specialised nerve receptors. In May 2002, a study in the British Journal of Urology reported that circumcision appears to result in decreased erectile function and penile sensitivity: 38 per cent of men circumcised as adults reported harm to sexual function. The practice of medical (as distinct from religious) circumcision began in Victorian times as a deterrent to masturbation, then thought to be the cause of insanity, epilepsy, hysteria, tuberculosis, short-sightedness and death. The practice became popular in the 1920s for reasons of hygiene and peaked in the 1940s. In 1949, researchers began to question whether a non-retracting foreskin was abnormal, and numbers have declined. Norm-UK has received hundreds of calls from men who feel ashamed or mutilated by the procedure. For young boys, the potential embarrassment of having a penis that looks different from those of their friends is obvious. Yet the psychological issues are complex: in a largely Jewish or Islamic community, this argument works as much in favour of circumcision as against it. Dr Lotte Newman, a former president of the Royal College of General Practitioners who chairs the circumcision working party of the Board of Deputies of British Jews, is troubled by developments in Sweden which may lead to a ban on child circumcision there. "The trend against circumcision affects those religions which practise it traditionally," she says. Such sensitivities may account for the neutral stance of mainstream medical organisations such as the General Medical Council, which states only that its soundings "demonstrated widely conflicting views in society, which neither doctors nor the GMC can resolve". But perhaps the issue ultimately comes down to one of consent. Adults need to know about the alternatives to have an accurate basis for decision-making. But Norm-UK's concern is that no one should consent to a circumcision on someone else's behalf, even if it is their own child. That means doing everything possible to treat conditions non-invasively until the patient can make an informed choice. "When I was a kid I had a circumcision and my brother didn't," says Warren. "It made me conscious of the issue as a medical student. Then I had to conduct the operation myself, and was horrified at what I was doing. I thought, one day I will stop this ridiculous practice." <a href="http://www.timesonline.co.uk/article/0,,589-540977,00.html">www.timesonline.co.uk/article/0,,589-540977,00.html</a> <h3> <a id="canada" name="canada"></a>Warnings from Canadian doctors</h3> Infant Male Circumcision The matter of routine infant male circumcision was a subject of discussion at a recent meeting of the College Council. The College has received repeated requests from special interest groups and individuals to "ban" this procedure. Their objections to routine infant male circumcision are based on a variety of factors including the lack of medical indications, the right of the newborn to make its own long term decisions, immediate risks, long term effects, ethical issues, and so on. The College's position on routine infant male circumcision is that it is a matter of patients' (or parental) choice, which may be based on traditional, religious, cultural or personal preference. The issue of perceived medical necessity is, in the opinion of most experts, no longer pertinent. Though some studies suggest slightly lower frequencies of urinary tract infection and decreases in HIV transmission in circumcised males, most physicians agree that the procedure should be regarded as a "cosmetic" procedure and in North America should be approached as such. Younger physicians (coming out of training programs) often do not have skill or experience in performing circumcisions and also may have little interest in acquiring such skills or being involved in the procedure. College Council did not identify any necessity to place restrictions on the availability of routine infant male circumcision, except to remind physicians that when performed routinely, this is a cosmetic surgical procedure which should only be considered after detailed discussion with the parents. This allows parental request and consent to be based on accurate and comprehensive information. Such discussions should include the fact that infant circumcision is not a medical necessity, that many experts including national pediatric associations do not recommend it, that there are risks such as bleeding and infection which can be significant in rare instances, and that currently the majority of male infants are not circumcised. Also, physicians should be aware that they are not required to accept the parents' request for routine circumcision if they are personally unable or unwilling to perform the procedure. Such requests should be referred to others in those situations. It is Council's opinion that the requests for this procedure will decrease through the natural evolution of public and medical opinion. As a uniquely North American cultural trend in the absence of medical indications, (except for requests based upon religious beliefs) routine infant circumcision will likely become an uncommon procedure. College of Physicians and Surgeons of British Columbia College Quarterly, Issue 38, Fall 2002 <a href="http://www.courtchallenge.com/letters/bccoll1.html%20">Further information</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 Doctors warn against misdiagnosis of phimosis 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>Does circumcision have a history?</h3> There is no single history of circumcision. A number of pre-literate societies adopted cutting procedures on the genitals of males and females (usually as children), at different times and for different reasons. At the end of the nineteenth century Britain (followed by its white colonies) and the USA took it up as a "health" measure for infants and young boys. Today the most likely reason for a male to be circumcised is because his parents are Muslims or Americans: together, these two categories account for the vast bulk of the 25 per cent or so of the world's male population who are circumcised. The two sorts of circumcision - ritual and medical - thus have different histories, though in recent times they have influenced each other. Defenders of ritual circumcision point to the health benefits claimed by those who perform it for medical reasons; while those who perform it for medical reasons try to justify it as an ancient operation, performed by many different cultures. The whole thing ends up rather circular. When doubt is thrown on the medical benefits of circumcision, supporters of the operation stress its cultural importance; when its cultural necessity is questioned, they stress the alleged health benefits. Although circumcision is not mentioned in the Koran and the prophet Mohammed did not name it as a pillar of the faith, Muslims inherited the custom from the tribal ritual of the desert Arabs. A boy born to Muslim parents may be circumcised any time between the ages of a few days and twelve years, though the traditional age is eight years. Yet Islam places no obligation on parents to circumcise their children: the prophet described circumcision as meritorious in both men and women, though required for neither; and he said nothing about parents having to do it to their sons or daughters, though these days many do it. Some Islamic societies (Egypt, the Sudan, Somalia, parts of Malaysia and Indonesia, for example) also practise circumcision of girls, though this is far less frequent than the operation on boys. For a boy born to American parents, the reason he is circumcised is because the USA, alone among English-speaking countries, has retained the nineteenth century practice of neonatal male circumcision as a heath precaution. Medically justified circumcision arose in the Anglo-American world in late Victorian times; but while Britain lost faith in the procedure in the 1940s and dropped it in the 1950s, to be followed by the British dominions (Australia, Canada and New Zealand) at a generation's delay, the incidence of circumcision in the USA continued to rise until the 1970s, when it affected as many of 90 per cent of males. Since then the rate has declined to between 50 and 60 per cent, but it has been a very slow process, despite repeated advice from the American Academy of Pediatrics that there is no significant medical benefit to be gained. How did this strange situation come about? <table border="1" cellpadding="9" cellspacing="0" width="100%"> <tbody> <tr> <td> Sovereignty of the individual ... every Man has a Property in his own Person. This no Body but himself has any Right to but himself. The Labour of his Body, and the work of his Hands, we may say, are properly his. - John Locke, An essay concerning the true, original extent and end of civil government (Second treatise on government), Book II, Chapter V </td> </tr> </tbody> </table> <h2>The demonisation of the foreskin</h2> To overturn millennia of tradition, both religious and secular, in favour of the normal and unaltered body was a slow and laborious process. The odd medico (usually a surgeon) can be heard muttering about the "benefits" of amputating the foreskin as early as the mid-eighteenth century, but it was not until the Victorian age - notorious for its anti-sexual impulses - that the mutterings grew to a chorus. The crucial step in forcing the acceptance of preventive circumcision (that is, the amputation of a normal body part in the absence of any medical indication or problem) was to blacken the reputation of the foreskin and blame it for the most feared diseases of the period. As <a href="http://www.cirp.org/library/legal/miller1/" rel="noopener" target="_blank">Geoffrey Miller has pointed</a> out, the essential precondition for routine circumcision was the demonization of the foreskin as a source of moral and physical decay. Between the mid-eighteenth and the late nineteenth century, but only in English-speaking countries, the status of the male foreskin fell disastrously. It was transformed from "the best of your property", as a popular rhyme of the period put it, and an adornment which brought pleasure to its owner and his partners, to "a useless bit of flesh", an enemy of man, and a "harbour for filth", as Dr Remondino and other scissors-happy doctors of the late Victorian period asserted. It is hard to think of any body part whose standing fell so far and so rapidly, nor one which came to be treated with such savage hostility; even today in countries with a history of routine circumcision doctors seem to regard the foreskin as guilty until proven innocent. Yet, as the Canadian pathologists <a href="http://www.cirp.org/library/anatomy/cold-taylor/" rel="noopener" target="_blank">Chris Cold and John Taylor point out</a>, the prepuce has been a prominent feature of the external genitals of all primate species for 65 million years, and the species in which it has developed most luxuriantly is precisely the one which has been most successful in the struggle for existence; despite this, since the nineteenth century it has been "the most vilified normal anatomical structure of the human body". But aside from calling the foreskin nasty names, have the supporters of involuntary circumcision really made much of a case for their favourite surgery? It is not, after all, the opponents of routine male circumcision who need to make a case against the procedure, but its supporters who must prove its necessity: they need to explain why a natural part of the human body, and one common to all primates, is so dangerous that it must be amputated before a baby can talk, crawl or do anything much except scream. As both <a href="https://www.historyofcircumcision.com/templates/pages/history_and_biology_evolutionary_perspectives_on_the_foreskin.html">William Paley and Charles Darwin</a> appreciated, what has naturally evolved must be presumed to be beneficial or harmless unless there is overwhelming evidence to the contrary. <table border="1" cellpadding="9" cellspacing="0" width="100%"> <tbody> <tr> <td> In all cases [of masturbation] circumcision is undoubtedly the physician's closest friend and ally, offering as it does a certain means of alleviation and pronounced benefit .... Those cases in which the glans presents a moist, semi-oily appearance ... long thickened foreskin, pliant and giving, large and often tortuous dorsal veins, go to make up a picture that is exceedingly tempting to the surgeon's scissors. - Dr Edgar Spratling, "Masturbation in the adult", Medical Record, Vol. 48, 1895, p. 443 </td> </tr> </tbody> </table> <h3>What is the foreskin?</h3> The penis consists of several major parts, but one useful way of looking at it is to divide it into an erectile portion (the part that gets stiff) and a non-erectile portion (the part that does not). The foreskin is the non-erectile portion. A more conventional definition would be to describe it as the soft, sensitive double-fold of tissue which covers the lower half of the penis shaft, extends in a sleeve over the head (glans) and usually ends in a tapering nozzle or spout. The outer layer is tender skin, the inner layer a sensitive mucous membrane. There is no agreed anatomical definition about where the foreskin ends and the skin of the penis shaft begins, and hence no exact surgical definition of what circumcision is meant to remove. As a consequence, the amount of tissue cut off by the operation is highly variable (some doctors take more, some less), but a typical circumcision carried out in a western hospital will remove about 50 per cent of the surface tissue of the penis. The foreskin is not just a flap of skin, but a complex web of mucous membrane, muscle fibres, blood vessels and nerves: in fact, it supports one of the densest concentrations of nerves in the whole body. The underside of the penis (just beneath the glans) is called the fraenum, and this carries ridged bands which are densely packed with fine-touch nerve receptors and a very rich blood supply. The main nerve supplying the penis goes down to the end and then doubles back, allowing the foreskin to slide backwards and forwards, and showing that this is exactly what it evolved to be able to do. To operate at its best, the penis is meant to be covered with a mobile sheath of responsive flesh. Further information: <a href="http://www.cirp.org/library/normal/" rel="noopener" target="_blank">Development of the normal foreskin</a> <a href="http://www.cirp.org/library/anatomy" rel="noopener" target="_blank">Anatomy of the adult penis</a> <h3>What is routine male circumcision?</h3> Circumcision is the surgical amputation of a some or all of this tissue. By routine male circumcision we mean the removal of the foreskin from the penis of normal male babies or boys, on the decision of adults (usually parents or guardians), without the boy's consent, and in the absence of any genuine medical indication, and particularly in the absence of the sort of critical injury, malformation or disease which would be required for the amputation of any other part of the body without the subject's consent. In the past the procedure was referred to as Routine Neonatal Circumcision or Routine Infant Circumcision, abbreviated here as RNC. Strictly speaking, RNC is no longer practised even in places where it was once common, since most doctors are opposed to the practice and only do it in response to parental insistence. Each case today is thus an individual decision, not a matter of mere routine. In the heydey of circumcision in the 1950s, doctors pressured parents to agree to have their baby boys circumcised and would automatically do it unless they strenuously objected; sometimes they did it without even parental consent, as still occurs in the United Sates from time to time. The essential elements of routine (medically unnecessary) circumcision as practised today are (1) decision by adults; (2) absence of medical indication or need; (3) lack of consent on the part of the boy. <h3>Why is it an issue all of a sudden?</h3> Although Britain abandoned RNC in the 1950s, New Zealand in the 1960s, Australia in the 1980s (with very little fuss or controversy), and Canada in the 1990s, the issue has suddenly become topical and controversial. A few die-hard circumcision enthusiasts and medical researchers, mainly from the USA and other cultures where routine male circumcision is the rule, are making strident claims for the protective effect of circumcision against a number of diseases which defy normal control strategies, and particularly the one for which there is still no cure and of which everybody is afraid: AIDS. They attempt to exploit this fear by demanding widespread (indeed, universal) circumcision of male infants as a public health measure, on the feeble and misleading analogy that it is just like immunisation, and thus the sort of harmless and effective medical intervention which should be made compulsory. The main objective of this propaganda is to halt the decline of RNC in the USA and to revive it in Australia, Canada and Britain. Recent extravagant claims that circumcison is the long-desired "silver bullet" against AIDS are mainly wish fulfilment: they reflect the wish for an effective means of halting the spread of AIDS, and they express the wish of circumcision enthusiasts to have an unanswerable reason to circumcise as many boys as possible. <a href="https://www.historyofcircumcision.com/templates/pages/south_africa_circumcision_not_a_silver_bullet.html" rel="noopener" target="_blank">In South Africa, experts in public health cast doubt </a>on the first hope, and question the ethics of the second. <h3>The cat which keeps coming back</h3> Circumcision was a Victorian medical fad which should have gone out with neck-to-knee bathing costumes, phrenology and the idea that children should be seen and not heard. Instead, a small band of medical researchers and moral fanatics keep coming up with new reasons for doing it. First there was the claim that it would stop masturbation and the imaginary disease of spermatorrhoea. Then it was suggested that it would protect men from syphilis. Then doctors forgot that all baby boys have a tight and non-retractable foreskin (phimosis) and declared that the natural condition of the infant penis was a pathological abnormality requiring urgent surgical correction. After that it was asserted that circumcision would give immunity to cancer of the penis in men and of the cervix in women. Some doctors seriously believed that circumcision would cure various forms of muscular paralysis, brass poisoning and whooping cough; others claimed it would prevent tuberculosis, polio, epilepsy and wet dreams. Then there was a lot of vague talk about hygiene, as though boys and men were too stupid to wash themselves, and ridiculous references to embarrassment in locker rooms. At no time did more than a handful men choose to have themselves circumcised; it was always something to done to babies and boys without their agreement or permission. In the 1990s the myth about syphilis was revived in a new form: that uncircumcised men having unprotected intercourse with an infected partner have a higher risk of catching HIV-AIDS (and that therefore all boys should be circumcised soon after birth). Most recently there has been an attempt to resuscitate the old claim (dating from the 1930s, refuted by studies in the 1960s and 70s) that early male circumcision is necessary so as reduce the incidence of cervical cancer in any female partners they may later consort with. One by one these claims for the harmfulness of the foreskin and the benefits of its amputation have been proven false or misguided, but new reasons keep being invented. <table border="1" cellpadding="9" cellspacing="0" width="100%"> <tbody> <tr> <td> Personal freedom The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient arrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right. ... The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mid, the individual is sovereign. - John Stuart Mill, On Liberty </td> </tr> </tbody> </table> <h3>Burden of proof</h3> It is not the opponents of routine male circumcision who need to make a case against the procedure, but its supporters who must prove its necessity: they need to explain why a natural part of the human body, and one common to all primates, is so dangerous that it must be amputated before a baby can talk, crawl or do anything much except scream. But since the operation has become entrenched in the medical culture of English-speaking countries over the past 120 years, it has come to be seen as reasonable, customary or even normal. As <a href="https://www.historyofcircumcision.com/templates/pages/the_sorcerers_apprentice.html">the sorcerer's apprentice</a> found to his alarm and cost, starting a practice ("seemed like a good idea at the time ...") is often much easier than stopping it. All you need is to get a majority of males over two generations circumcised, and the circumcised penis will come to be seen as both <a href="http://www.cirp.org/library/legal/USA/waldeck1/" rel="noopener" target="_blank">normal and normative</a>. The main reason for circumcision of children is a population of circumcised adults. Advocates of RNC particularly have to <ul> <li>demonstrate (1) that the benefits of the operation significantly outweigh (a) the risks of the procedure; (b) the injury inflicted; (c) the disadvantages of being deprived of the normal anatomy of the penis; and (2) that the operation must be done before the child is able to give legal consent;</li> <li>explain how a part of the body which has evolved over millions of years could be pathogenic (disease-producing) and must be removed to ensure a normal level of health.</li> </ul> <h3>Human evolution</h3> Advocates of RNC have never been able to explain why all primates (monkeys, chimps etc) have foreskins, or how humans became the most successful mammal on the planet while carrying this supposedly pathogenic burden. For 99 per cent of the million or so years during which modern humans have prospered, males have lived and died with their foreskins intact, and in that time our species managed to colonise just about every corner of the earth. Perhaps the foreskin was a factor in that triumph. There is good evidence that the human foreskin became longer, more luxuriant and more richly networked with sensory nerves than those of our near relatives, suggesting that it must have conferred a selective advantage: the more foreskin you had, the more offspring you left behind, and the more your extra-foreskin genes spread through the population. [1] This could not have happened if the foreskin had been as troublesome as its enemies claim: what has naturally evolved must be presumed to be beneficial or harmless unless there is overwhelming evidence to the contrary. [2] <table border="1" cellpadding="9" cellspacing="0" width="100%"> <tbody> <tr> <td> An individual choice The only freedom which deserves the name, is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs, or impede their efforts to obtain it. Each is the proper guardian of his own health, whether bodily, or mental and spiritual. - John Stuart Mill, On Liberty </td> </tr> </tbody> </table> <h3>Trying to come up with the goods</h3> It is this proof that circumcision advocates are obliged to provide, and which they have been struggling unsuccessfully to manufacture since the 1850s (when <a href="https://www.historyofcircumcision.com/templates/pages/the_crotchets_of_sir_jonathan_hutchinson.html">Jonathan Hutchinson</a> announced that his statistics showed that circumcised men were all but immune to syphilis). The world is still waiting for them to make a convincing case. Although there have been mountains of reports and studies (more than anybody could read in a lifetime), the issue is still inconclusive. The most that even a scaremongering evangelist like the Queensland GP Terry Russell can say is that RNC "may reduce the risk of STDs (syphilis, gonorrhoea, herpes and candida) and carcinoma of the cervix in female partners", as well as phimosis, paraphimosis, HIV-AIDS, neonatal UTIs and carcinoma of the penis". [3] These are the traditional Victorian excuses, but they are not good enough: "may" is not much different from "may not". Nor is it enough to claim that circumcision will reduce the risk if the risk is non-existent or infinitesimal in the first place. The issue is not whether circumcision can or might offer protection against these disease, but whether it is a necessary measure of protection, and so necessary that it must be performed without consent. It's pretty ridiculous, after all, to amputate part of the penis merely in the hope of reducing the risk of a minor infection, such as chlamydia, when the infection can be cleared up with a single pill. Further information on <a href="http://www.circinfo.org/hiv.html" rel="noopener" target="_blank">HIV-AIDS</a> and <a href="http://www.circinfo.org/cervical.html" rel="noopener" target="_blank">cervical cancer</a>. Australia's other prominent crusader for RNC, Professor Brian Morris, cites several studies which purport to show a higher incidence of gonorrhoea and syphilis among uncut males and reaches the dithering conclusions that (1) "based on the bulk of evidence it would seem that at least some STDs could be more common in uncircumcised males under some circumstances"; but that (2) "there may be little difference in most STDs between those with and those without a foreskin". [4] That's really helpful. Can these guys be serious? They want to circumcise all boys at birth because retention of the foreskin "may" increase the risk of their getting a few diseases they most likely would not get anyway; most of which are curable; and which, even if they did get them, do not strike until many years later. Except for infantile UTIs (which are usually cured easily by antibiotics), there is plenty of time for a boy to reach maturity and make his own assessment of the risks and choose the best means, for him, of managing them. To make a convincing case for RNC Russell, Morris and Co must do much better than they have done so far: we need proof that that if the foreskin is not cut off urgently the child will get seriously ill or die before he is old enough to make his own health decisions. Nothing like this has ever been achieved by the circumcision lobby, or even seriously attempted. Statistics are not available, but it is quite likely that more boys under the age of eighteen die as a result of circumcision, or its complications, than from any of the diseases circumcision is supposed to protect them against. Certainly <a href="https://www.historyofcircumcision.com/templates/pages/ritual_circumcision_in_south_africa.html">this is true in South Africa</a>, where scores of boys each year die as a result of tribal circumcision and hundreds are seriously injured. There are no proven cases of an infant, child or adult becoming sick or dyng because he had not been circumcised; but here are thousands of recorded cases where infants, children and men have been seriously injured, become sick or have died as a direct result of circumcision. Further information on <a href="http://www.cirp.org/library/complications/" rel="noopener" target="_blank">complications</a> and <a href="http://www.cirp.org/library/death/" rel="noopener" target="_blank">on deaths </a>and <a href="http://www.cirp.org/news" rel="noopener" target="_blank">recent news items</a> <h4>Medical scaremongering</h4> Both Dr Russell and Professor Morris are frequently seen in the media urging parents to have their boys circumcised, and much of their routine is just a long list of nasty diseases, designed to terrify people into seeking urgent medical aid. How different it is from the rantings of a Victorian quack is a matter of personal judgement. In 1891 <a href="https://www.historyofcircumcision.com/templates/pages/dr_peter_charles_remondino.html">Dr Peter Charles Remondino</a> wrote: <div>"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." [5]</div> Drs Russell and Morris are radicals and extremists: most doctors the world over (except for Islamic countries and parts of the USA) are opposed to RNC or undecided on the issue, and the Royal Australasian College of Physicians has recently issued <a href="http://www.circinfo.org/doctors.html" rel="noopener" target="_blank">yet another statement</a> against the practice . The truth is that RNC has never been supported by more than a small fraction of the world's medical establishment and remains a controversial and unproven therapy. Back in the 1890s an early opponent of RNC noted this confusion and uncertainty, not only over the risks and touted benefits of the operation but when and how to do it, how much tissue to excise, how to stop bleeding etc, and asked: "Where doctors differ, who shall decide?" [6] There can be only one answer to that question. <h4> References</h4> 1. J.R.Taylor, A.P. Lockwood and A.J.Taylor, <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, Vol. 77,1996, pp. 291-295; C.J. Cold and J.R. Taylor, <a href="http://www.cirp.org/library/anatomy/cold-taylor/" rel="noopener" target="_blank">"The prepuce"</a>, BJU International, Vol. 83, Supplement 1 (January) 1999, pp. 34-44; C.J. Cold and K.A. McGrath, "Anatomy and histology of the penile and clitoral prepuce in primates: Evolutionary perspective of specialised sensory tissue in the external genitalia", in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York and London, Kluwer Academic/Plenum Publishers, 1999), pp. 19-30 2. The argument holds even if you believe in the creationist account of human origins. If God created men with a foreskin it must be presumed that He intended them to have one. 3. Terry Russell, "Debate: Male circumcision remains a valid procedure - Yes", Australian Doctor, 24 May 1996, p. 54 4. Brian Morris, In favour of circumcision (Sydney 1999), pp. 38 and 39. See the <a href="https://www.historyofcircumcision.com/templates/pages/brian_morris_reviewed.html">scathing review by Basil Donovan</a> in Venereology, Vol. 12 (1999), pp. 68-9. Professor Donovan describes Morris as "a man on a mission to rid the world of the male foreskin" and some of his claims as "so dangerous" that the publishers ought to withdraw the book. 5. P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (Philadelphia and London 1891), pp. 54-5 6. Herbert Snow, The barbarity of circumcision as a remedy for congenital phimosis (London 1890), p. 32 <h4>Why does this Victorian invention persist?</h4> The reasons for the persistence of routine circumcision (that is, medically unnecessary circumcision of normal infants or boys at the request of parents) have been much debated. Only a few old fashioned fanatics seriously believe the various "health justifications", and the tendency is to see the operation as a cultural practice, not very different from a tribal ritual, which needs to be explained by sociologists and cultural theorists rather than doctors. As a result of US influence after the Korean war, circumcision also became prevalent in South Korea, though performed on boys between the ages of ten and thirteen rather than at birth. The continuing popularity of circumcision among American doctors is also connected with strong financial incentives for performing it, with the result that the USA remains a kind of centre for infection: American medical journals continue to publish articles extolling the health advantages of circumcision and minimising the adverse effects, and these are eagerly quoted by crusaders for circumcision in other countries. The vast weight of the American medical industry ensures that its cultural values have far more influence than their scientific value warrants. The strongest focus of this website will be on the medically rationalised variety of circumcision in Anglophone countries, as it emerged in the late nineteenth century, and as it faded away towards the end of the twentieth, but it will also offer leads on the other forms. <h3>Myths of smegma</h3> Despite the importance of avoiding smegma so frequently stressed by enthusiasts for routine circumcision, there is no evidence at all that smegma is harmful. Why would it be? It's just a natural secretion like saliva, found in the genitals of both males and females. <a href="http://www.cirp.org/library/disease/cancer/vanhowe2006/">The carcinogenicity of smegma: Debunking a myth</a> RS Van Howe,* FM Hodgesâ€¡ *Department of Pediatrics, Michigan State University School of Human Medicine, Marquette, MI and â€¡Berkeley, CA, USA, in Journal of the European Academy of Dermatology and Venereology, Vol. 20, 2006, pp. 1046-1054 Abstract Background: Smegma is widely believed to cause penile, cervical and prostate cancer. This nearly ubiquitous myth continues to permeate the medical literature despite a lack of valid supportive evidence. Methods: A historical perspective of medical ideas pertaining to smegma is provided, and the original studies in both animals and humans are reanalysed using the appropriate statistical methods. Results: Evidence supporting the role of smegma as a carcinogen is found wanting. Conclusions: Assertions that smegma is carcinogenic cannot be justified on scientific grounds. Extract from the conclusion The evidence does not support the theory that smegma is a cause of genital cancer. The smegma theory of disease was best stated by Boczko and Freed: "Smegma, a sterol, produced by Tyson's glands in the epithelium of the retroglandular sulcus, has been implicated as the causative agent. It may be converted to a carcinogen by the action of the Mycobacterium smegmatis." [69] From the medical literature we have found that smegma is not a sterol, that there are no Tyson's glands, that smegma is not converted to a carcinogen by M. smegmatis, and that M. smegmatis is not part of the normal genital flora. The myth is sustained only by its popularity among circumcision advocates. Some have extrapolated the smegma theory by hypothesizing that men with inadequate circumcisions may be at risk for cancer because smegma can accumulate under any foreskin remnants. [70] In similar fashion, Abraham Ravish expanded the smegma theory to indict smegma as the cause of prostate cancer by travelling upstream through the urethra to invade the prostate gland. [71] Davis-Daneshfar and Trueb speculated that chronic infection with M. smegmatis is the cause of plasma cell (Zoon's) balanitis, [72] but Yoganathan et al. could not isolate the organism in any of their cases. [73] Some have shown an unwillingness to abandon the smegma theory. When it was postulated that sperm proteins caused cervical cancer, it was the smegma mixing with the sperm proteins that were to blame. [74] When diaphragm use was found to decrease cervical cancer, it was postulated that it provided a barrier to contact with smegma. [75] When it was clear that cervical cancer resulted from a viral infection, some still postulated that smegma was a necessary part for the viral exposure to be carcinogenic. [45] Those promoting the â€˜cocoon' theory prefer to think of smegma as a cofactor in the development of penile cancer. There are two reasons to dismiss this speculation. First, there is no scientific evidence to support the assertion. Second, it is analogous to declaring saliva a cofactor in the development of lip cancer in those who chew tobacco. Both saliva and smegma are bodily fluids that serve a function and, like any other bodily fluid, are present in organs than can develop a malignancy. The purpose of the scientific method is to distinguish between wishful thinking, strongly held pinion, and provable fact. The smegma theory of disease, which began as wishful thinking on the part of circumcision zealots such as Abraham Wolbarst and Abraham Ravich, has evolved into irrefutable dogma, but as modern physicians, we need to recognize that, until proved otherwise, smegma is harmless. References 69. Boczko S, Freed S. Penile carcinoma in circumcised males. N Y State J Med 1979; 79: 1903â€“1904. 70. Culp D. Penile cancer. J Iowa Med Soc 1973; 63: 201â€“202. 71. Ravich A, Ravich RA. Prophylaxis of cancer of the prostate, penis and cervix by circumcision. N Y J Med 1951; 51: 1519â€“ 1520. 72. Davis-Daneshfar A, Trueb RM. Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis. Cutis 2000; 65: 395â€“398. 73. Yoganathan S, Bohl TG, Mason G. Plasma cell balanitis and vulvitis (of Zoon). A study of 10 cases. J Reprod Med 1994; 39: 939â€“944. 74. Sandler B. Sperm basic proteins in cervical carcinogenesis. Lancet 1978; 2: 208â€“209. 75. Sandler B. Contraceptives and cervical carcinoma. Br Med J 1969; 1: 356â€“357. <a href="http://www.cirp.org/library/disease/cancer/vanhowe2006/" rel="noopener" target="_blank">Full text available from CIRP.</a> <h4>Why mice don't live in the foreskins of horses</h4> The article by Boczko and Freed relied heavily on an eccentric experiment from 1947 in which A. Plaut and A. C. Kohn-Speyer tried to induce cancer in mice by doses of smegma harvested from horses. Despite persistent applications, it appears that they were successful in producing cancerous lesions in only about 60 of 400 victims, and I say "appears" because the presentation of their results is so confusing that it is very difficult to work out just what the results were. They also reported that up to 500 days the smegma-treated mice actually fared better than those who missed out: a survival rate of 47% and 30% respectively. Had they stopped the experiment at that point they would have been forced to conclude that horse smegma boosted mouse health. The most one can say about this preposterous exercise is that it explains one of the great puzzles of zoology: why mice don't live inside equine prepuces. Plaut A, Kohn-Speyer AC. Carcinogenic action of smegma. Science 1947; 105: 391â€“392. </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 Does circumcision have a history? 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>Words of up-to-the-minute wisdom from Morris Fishbein MD, editor of JAMA from 1924 to 1949</h3> The quotes are from Morris Fishbein (ed), Modern Home Medical Adviser (New York: Doubleday, 1969) The speed of medical progress continues to be one of the marvels of our scientific century .... Many new and brilliant young authors have kindly associated themselves with me in this work. I express appreciation to them. Sex Hygiene: The Teaching of Sex to The Young Child Within the first few days of life the genital organs of the baby should be carefully examined for evidence of defects or abnormalities. In case such defects are found they should be corrected when possible, as such peculiarities are often responsible for irritations or abnormal stimulations which may greatly complicate the sexual life of the child when he or she is older. The tissues of the infant are still highly plastic, and it frequently happens that corrections made early are surprisingly successful for this reason. The boy baby should be carefully examined to see if he needs circumcision. If the foreskin can be completely and easily retracted most authorities think that circumcision should not be done, but when there is the least doubt about the matter, decision should be made in favor of the operation, which is a trivial one when done within the first week or two of life. Later it is somewhat more serious, but never dangerous when performed by a competent surgeon. When the foreskin is tight or adherent there will accumulate under it secretions which will produce bad odors and cause pain and itching. The girl baby also should be carefully examined for abnormalities. In the washing of the female infant, care must be taken. Sometimes the hymen may be ruptured by rough handling. While it is true that the presence of an intact hymen is by no means proof of virginity, or the absence of it proof of sexual experience, a large percentage of people still believe that such is the case, and so care must be taken to prevent an accident which might later put the baby, grown to womanhood, in an embarrassing position. Washing the parts should be done in such a way that the friction will not cause erotic stimulation and in this way lead the child to the habit of playing with herself. Crying babies, male and female, will nearly invariably hush when the genital organs are manipulated. This old, old trick of careless nurses and ignorant mothers, should never be practiced, as it may lead to masturbation. Masturbation is probably far less harmful than has been supposed. The routine care of a child should never be delegated to someone else when it is physically possible for the mother to see to it herself. pp. 83-84 Sex Hygiene: The School Child Frequently children will get into the habit of playing with or pulling at the genitals. Such children - both boys and girls - may be in need of a thorough examination by a competent physician. Not unlikely circumcision or other special corrective measure is needed. If there is no pathologic basis for the habit, the child should be taught that it is bad manners to behave in such a way and that an ugly habit may be formed. With help, rather than scolding, he may soon correct the ugly practice .... Little boys and girls are occasionally found to have developed the practice of masturbation. Normal children of this age will rarely go into excess unless they are being stimulated by some older person. p. 90 Sex Hygiene: Abnormalities of Sexual Function: Masturbation When children are kept busy with wholesome play, work and planning, and when they are loved and understood in matters such as these, a little masturbation may occur but will be speedily forgotten. Be sure the children are healthily tired when they go to bed. Be sure that there is no need of circumcision, or if there is that it is corrected. Be sure the organs are clean so that they will not be irritated by foul secretions. Be sure that tight underwear does not demand constant pulling at the clothing. p. 115 Sex Hygiene: The Hygiene of the Reproductive System: Cleanliness The first principle in the hygiene of the reproductive system is cleanliness. By this we do not mean to imply that lack of cleanliness will often jeopardize the physical health of the individual. Actually there is more danger that meddlesome methods of attaining cleanliness will cause disease than that lack of cleanliness will cause it. This is particularly true in the case of the woman. The reproductive organs must be clean if they are to be held in high regard; they must be free of odor; they must be wholesome; they must not offend. They are exceedingly important to the welfare of the race, the self-respect of the individual, and the happiness of the family. Washing of the external genitalia is extremely important. The external organs need washing and not the internal. Much harm has been done by the excessive use of antiseptic or even cleansing douches. The normal vagina nearly always contains germs. These germs are not only harmless, but actually beneficial, because they prevent the growth of other germs which can cause trouble. If they are frequently washed away with cleansing douches or inhibited with antiseptics, abnormal conditions may develop in the vagina, and trouble may ensure. Further more, strong antiseptics frequently irritate the mucous membrane and make it more susceptible to invasion by other bacteria. Sometimes, particularly in the male, it is impossible to hold down odors merely by washing the external genitalia. In some men the foreskin is so tight about the end of the penis that it cannot be retracted and the groove beneath it cleaned of the white secretion - known as smegma - which accumulates there. This secretion is of an oily nature and easily becomes rancid, producing exceedingly bad odors and also irritation of the mucous membrane. At the time of birth every male child should be carefully examined to determine whether or not he is in need of circumcision which consists of removing the foreskin. When done in the early days of life the operation is a trivial one. Later it is somewhat more serious, but never dangerous when performed by a competent surgeon. Even those who are not in need of circumcision should retract the foreskin and clean the groove beneath it carefully at least once a day. A child in need of circumcision is often made nervous by the irritation of the rancid secretions and will be constantly twisting, squirming, and pulling at himself. He may also develop the habit of masturbation as a result of the irritation which induces him to handle his penis. pp. 118-19 Care and Feeding of the Child: Development of the Infant If the baby is a male and has not been circumcised, the foreskin should be gently retracted and cleansed beneath. Several months may pass before this retraction can be completely accomplished and force should never be used. It is easier to care for the penis of a newborn who has been circumcised, but even then, the small amount of foreskin left should also be retracted and the edge of the glans, or head of the penis, cleaned daily. p. 198 <h4>NOTE</h4> Morris Fishbein (1889-1976) was the editor of the Journal of the American Medical Association from 1924 to 1949, the key years in which routine circumcision established itself in American medical culture. He published many popular books on health (unfortunately), and his autobiography (505 pages of it!) in 1969. The continuity of his views on the supposed irritation and smell provoked by preputial moisture with Victorian agonising over secretions and masturbation will be noted. Also striking is the difference in his attitude to the female genitals, which (unlike the penis) must not be washed too much lest the soap cause irritation. This seems rather more plausible than the strange proposition that the body's own natural moisturisers could irritate the skin. Further information <a href="http://xroads.virginia.edu/~1930s/PRINT/time/06_1937.html" rel="noopener" target="_blank">His photo on the cover of Time, 1937</a> <a href="http://www.britannica.com/ebi/article?tocId=9311256" rel="noopener" target="_blank">Encyclopedia Britannica entry</a> <a href="http://www.rense.com/general19/enemy.htm" rel="noopener" target="_blank">Morris Fishbein - AMA Enemy Of American Health</a> There are dozens of web articles along the lines of this one, all more or less claiming (inter alia) that a certain Harry Hoxsey invented a cure for cancer, but that Fishbein, as President of the American Medical Association, tried to buy the formula in order to suppress it. This appears to be a favourite myth of the alternative therapists, <a href="http://www.acahf.org.au/articles/ausscience6.htm" rel="noopener" target="_blank">as Dr Peter Bowditch notes</a>. One can well believe their claim that Fishbein had failed anatomy, however, as his Victorian views on sex and sexuality make all too sadly clear. Interestingly enough, Fishbein was the author of a book called Fads and Quackery in Healing, published in 1932; some sceptics might wonder whether routine circumcision was yet another example of the same. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dr Fishbein's fantasies (1960s) 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 by the popular science writer, <a href="http://www.abc.net.au/profiles/content/s2193276.htm?site=science/k2">Dr Karl S. Kruszelnicki</a>, in Sydney's Good Weekend provoked a fierce attack from Australia's leading circumcision crusader, Professor Brian Morris. Circumcision goes back a long way - Egyptian male mummies dating back to 2300BC have been circumcised. Its popularity now varies from country to country - in Australia, between 10 and 20 per cent of newborn males are circumcised each year, compared with more than 60 per cent in the US and less than 2 per cent in Scandinavia. It has long been practised for religious reasons and as a rite of passage in various societies. But there's a (supposed) health issue, too: many parents have circumcised their sons in the belief that it is more hygienic. It's not. As Dr Robert Darby wrote in the <a href="http://www.mja.com.au/public/issues/178_04_170203/dar10676_fm.html">Medical Journal of Australia</a> in 2003, "in the days before aseptic surgery, any cutting of the flesh was the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and death." So how did this myth arise? Wars are very unsanitary, and uncircumcised soldiers were thought to be at risk of serious infection around the foreskin if they couldn't wash frequently. This claim was made in the First and Second World Wars, as well as in both Gulf Wars. In desert wars, it became known as the "sand myth." Dr Ken McGrath, a senior lecturer in pathology at the <a href="http://www.aut.ac.nz/">Auckland University of Technology</a>, could find no evidence to support it. And Sir Duncan Stout, who wrote a chapter on military medicine in the tome History of the Second World War, did not make any reference to circumcision being used to cure foreskin problems. In fact, his official records claimed the opposite - there was a great reluctance to perform circumcisions because the sand in the Sahara Desert was as fine as flour, and was almost impossible to keep out of clothing and away from the skin. But why remove the foreskin? Dr Paul Fleiss, assistant clinical professor of pediatrics at the University of Southern California Centre, says the foreskin is "a uniquely specialised, sensitive, functional organ of touch." It make proteins that fight bacteria and viruses, and produces a moisturiser that keeps the surface of the glans sensitive, soft and moist. Indeed, it has more <a href="http://www.cirp.org/library/anatomy/taylor/">specialised nerve endings</a> than any other part of the penis, and is as sensitive as the lips of the mouth. When did circumcision become linked to hygiene? Probably during the Victorian era, when it was promoted as a way to desensitise the penis to thwart masturbation, which was thought to cause headaches, paralysis, bed-wetting, insanity, epilepsy, tuberculosis, short-sightedness, criminality and heart disease. The hygiene that circumcision was meant to encourage was, it seems, not physical but moral. As far as personal hygiene is concerned, removing the foreskin to have a cleaner penis makes as much sense as removing the eyelid to have a cleaner eyeball. Karl S. Kruszelnicki, May the foreskin be with you, Sydney Morning Herald, Sydney, NSW, Saturday, 10 January 2004 <h2>Circumcision myths: Readers respond</h2> Good Weekend, 31 January 2004, Your Say Dr Karl Kruszelnicki ignores the massive scientific support for the benefits of circumcision (Weekender, January 10) and instead presents only extremist anti-circ nonsense from the likes of Paul Fleiss. Dr K fails to even mention that make circumcision prevents a raft of diseases in both sexes, as well as sexual problems in men. Bacteria abound under the foreskin,* accounting for 11-fold higher urinary tract infections. The foreskin is, moreover, an "HIV magnet". Its removal may reduce the risk of AIDS, penile cancer and cervical cancer. Professor Brian Morris University of Sydney Editor's note: In 2002 the Paediatrics and Child Health Division of the Royal Australasian College of Physicians reaffirmed its position that there is <a href="https://www.circinfo.org/doctors.html">no medical indication for routine male circumcision.</a> Good Weekend, 21 February 2004, Your Say The letter from Professor Brian Morris criticising Dr Karl Kruszelnicki's article on circumcision, and Morris's claim that it is "only extremist anti-circ nonsense" would best be consigned to the file for academic twaddle. Male circumcision, per se, does not prevent the raft of diseases he lists. Bacteria under the foreskin or anywhere else thrive only because of lack of personal hygiene. As my medico says, the greatest preventive or infection is lots of soap and water.** As for circumcision preventing "sexual problems in men", what bunkum. E. Armstrong Coff's Harbour There is no "massive scientific support for the benefits of circumcision" as Professor Morris alleges in his letter. The only medical reason for it is to treat phimosis (excessively tight foreskin), which affects about 1 per cent of boys.*** With good hygiene there is no increased incidence of HIV-AIDS, penile cancer, cervical cancer or urinary tract infections. The foreskin protects the sensitive glans of the penis and, rather than causing sexual problems, it increases sexual sensation. Dr Ian Arthur GP Sawtell, NSW I am 37, uncircumcised, and have not in my memory had a urinary tract infection or penis/sexual problem due to my well-designed crumpled end bit. We don't remove the appendix just because it may get infected. Why should circumcision be regarded any differently from the practice of female genital mutilation? Gary Daly Mosman <h3>Notes</h3> * <a href="http://www.cirp.org/library/anatomy/cold-taylor/">A recent scientific study of the foreskin </a>published in the British Journal of Urology found that sub-preputial moisture consisted of water, shed skin cells, secretions from the prostate, seminal vesicle and urethral glands, various sterols and fatty acids which protect skin surfaces in other contexts, and a variety of benign bacteria – i.e. bacteria which are either harmless or beneficial. ** Soap may not be such a good idea, especially in babies and boys, as it can easily irritate the glans and inner foreskin layer. It's often better just to use water. <a href="https://www.circinfo.org/alternatives.html">Further information.</a> *** Most cases of phimosis can now be treated without the need for surgery. <a href="https://www.circinfo.org/Treatment_of_phimosis.html">Further information</a>. <h2>Press Council dismisses complaint by circumcision professor</h2> Not content with writing a mere letter to the newspaper, Brian Morris tried to use his status as a professor at Sydney University to pressure the university to sack <a href="http://www.abc.net.au/profiles/content/s2193276.htm?site=science/k2" rel="noopener" target="_blank">Dr Kruszelnicki</a> from his position as Julius Sumner Miller Fellow in the School of Physics. He also filed a formal complaint of bias against the Sydney Morning Herald with the Australian Press Council. But as the following article in the Herald shows, he was not successful in these efforts to suppress free speech. Sydney Morning Herald, Tuesday, 13 April 2004 The Australian Press Council has dismissed a complaint by Professor Brian Morris against the Good Weekend magazine, published by the Sydney Morning Herald, over a column by Dr Karl Kruszelnicki. Professor Morris's complaint centred on a regular short column, Mythconceptions, in which Dr Kruszelnicki writes about 400 words on many different subjects which fall into the category of "life's myths, curiosities and absurdities". In particular, Professor Morris complained about a column on circumcision, "<a href="http://www.cirp.org/news/smh01-10-04/">May the foreskin be with you</a>", published on 7 January 2004, describing it as "a mischievous anti-circumcision" article and "blatantly biased propaganda". He said Dr Kruszelnicki was "deliberately deceptive" in not mentioning any of the health benefits of circumcision and criticised one of Dr Kruszelnicki's sources as an "anti-circ activist" and a "hero of the anti movement" who did not have appropriate medical qualifications. In response, Dr Kruszelnicki, who acknowledged that he is not a urologist,* pointed out that his column did not set out to discuss in detail the pros and cons of circumcision but rather discussed specifically what he saw as "the myth" that circumcision was originally performed for hygiene reasons and <a href="http://www.mja.com.au/public/issues/178_04_170203/contents_170203.html">how this belief later evolved.</a> Dr Kruszelnicki named four sources, including the one objected to by Professor Morris. In relation to the latter, Dr Kruszelnicki pointed out he quoted just eight words from that source: the foreskin is "a uniquely specialised, sensitive, functional organ of touch". The Press Council noted that Good Weekend offered Professor Morris an opportunity to air his views by publishing his letter to the editor on January 31. However, Professor Morris also believed that Good Weekend magazine, in later publishing three letters opposing the views in his letter, demonstrated editorial bias. Given the nature of the Mythconceptions column and the fact that Good Weekend published Professor Morris's letter, the Press Council said it believed the publication had adequately dealt with the matter. * Neither is Brian Morris. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dr Karl on the origins of circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>If cereal won't cool the libido, try surgery</h3> <h4>1. Circumcision</h4> The fold of integument called the prepuce, which has been previously described, has upon its inner surface a large number of glands which produce a peculiar secretion. [1] Under certain circumstances, and from inattention to personal cleanliness, this secretion may accumulate, and then often becomes the cause of irritation and serious disease. To prevent such disorders, and to insure cleanliness, the Jewish law required the removal of the prepuce, which constituted the rite of circumcision. The same practice is followed by several modern nations dwelling in tropical climates; and it can scarcely be doubted that it is a very salutary one, and has contributed very materially to the maintenance of that proverbial national health for which the Jews are celebrated. Eminent physicians have expressed the opinion that the practice would be a salutary one for all men. It is doubtful, however, whether as much harm as good does not result from circumcision, since it has been shown by extensive observation among the Jews that very great contraction of the meatus, or external orifice of the urethra, is exceedingly common among them, being undoubtedly the result of the prolonged irritation and subsequent cicatricial contraction resulting from circumcision in infancy. [2] The maintenance of scrupulous personal cleanliness, by daily cleansing, is an imperative duty. In some countries females are also circumcised by removal of the nymphae [i.e. the labia]. The object is the same as that of circumcision in the male. The same evils result from inattention to personal cleanliness, and the same measure of prevention, daily cleansing, is necessitated by a similar secretion. Local cleanliness is neglected by both sexes. Daily washing should begin with infancy, and continue through life, and will prevent much disease. Plain facts for young and old, pp. 106-7 <h4>2. Masturbation</h4> In younger children, with whom moral considerations will have no particular weight, other devices may be used. Bandaging the parts has been practised with success. Tying the hands is also successful in some cases; but this will not always succeed, for they will often contrive to continue the habit in other ways, as by working the limbs, or lying upon the abdomen. Covering the organs with a cage has been practised with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. ... [Infibulation] Through the courtesy of Dr Archibald, Superintendent of the Iowa Asylum for Feeble-Minded Children, we have become acquainted with a method of treatment of this disorder which is applicable in refractory cases, and we have employed it with entire satisfaction. It consists in the application of one or more silver sutures in such a away as to prevent erection. The prepuce, or foreskin, is drawn forward over the glans, and the needle to which the wire is attached is passed through from one side to the other. After drawing the wire through, the ends are twisted together, and cut off close. It is now impossible for an erection to occur, and the slight irritation thus produced acts as a most powerful means of overcoming the disposition to resort to the practice. [2] [Treatment of females] In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will power has become so weakened that the patient is unable to exercise entire self-control. The worst cases among young women are those in which the disease has advanced so far that erotic thoughts are attended by the same voluptuous sensations which accompany the practice. The author has met many cases of this sort in young women, who acknowledged that the sexual orgasm was thus produced, often several times daily. The application of carbolic acid in the manner described is also useful in these cases in allaying the abnormal excitement, which is a frequent provocation of the practice of this form of mental masturbation. Plain facts, pp. 294-6 J.H. Kellogg, Plain facts for young and old: Embracing the natural history of hygiene and organic life, 2nd edition, Burlington (Iowa), 1888, facsimile reprint (New York: Arno, 1974) <h4>NOTES</h4> 1. This is an instance of the myth of Tyson's glands, and a distortion of even that, since Edward Tyson claimed to have discovered the glands of the rim, or corona, of the glans, not on the foreskin at all. As Arthur Keith found in 1904, there are no glands on or under the foreskin or on any part of the penis normally covered by the foreskin; and if there are no glands, there cannot be any secretions. What Tyson called glands have since been identified as "pearly papules", a common and perfectly harmless anatomical variant. See Arthur Keith and Arthur Shillitoe, "The preputial or odoriferous glands of man", Lancet, 16 January 1904, pp. 146-8; and Arthur Hyman et al, "Tyson's 'Glands': Ectopic sebaceous glands and papillomatosis penis", Archives of Dermatology, Vol. 99, January 1969, pp. 31-6; and the letter from P.-H. Nexmand in Vol. 100, August 1969, p. 260, pointing out that the papules are harmless and should not be confused with genital warts. <a href="http://www.historyofcircumcision.net/templates/pages/for_and_against_circumcision_1935.html">See also my notes to the 1935 circumcision controversy in Britain.</a> None of these facts, known since 1904, has prevented ignorant enthusiasts for genital surgeries from claiming that the mere existence of these glands proved the necessity for circumcision. For a summary of the long career of the myth, <a href="http://www.cirp.org/library/anatomy/cold-taylor/" rel="noopener" target="_blank">see Cold and Taylor, The prepuce</a> 2. It is interesting to note that, although Kellogg acknowledges that circumcision probably did as much harm as good, the evils of masturbation were judged so great that it was always justified as a treatment in these cases. 3. It is not at all clear that infibulation was commonly employed in either Britain or the USA, and it was probably rare outside mental hospitals and other institutions. Its great champion in Britain was Dr D. Yellowlees, medical superintendent at the Glasgow Royal Asylum, who published two articles on the virtues of his treatment: "Masturbation", Journal of Mental Science, Vol. XXII, 1876, pp. 336-7; and "Masturbation", in A dictionary of psychological medicine, ed. D. Hack Tuke (London: Churchill, 1892), pp. 784-6 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dr Kellogg's prescription (1888) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Plus ca change ... American medical journals seem to have been as hospitable to verbose pro-circumcision tirades in 1902 as they have become since the 1990s. Here the prominent anti-foreskin activist, Peter Charles Remondino, attacks the enemies of circumcision as prejudiced, backward and unscientific. <h3>Circumcision and its opponents</h3> The preventive practice of medicine mentioned so very long ago by Xenophon as being something of the greatest importance, will only become a recognized necessity and practice when mankind, however seemingly enlightened or civilized, will cease to look upon diseases and their cure from the narrow and benighted point of view of the Congo Negro, and when the race will emancipate itself from that degree of irrationality that, figuratively speaking, permits men to swallow a camel without winking, whilst they go through fearful contortions of strainings when attempting to swallow a gnat. This rather uncomfortable and pessimistic view of persistent human irrationality in this particular line of our sociologic existence was forcibly impressed upon me by the perusal of an article in one of our medical journals which professed to see no benefit whatever in circumcision â€“ neither from an hygienic, preventive, pathologic or humanitarian pint of view â€“ whilst attending the deathbed of a middle aged man who, had he been fortunate enough either to have been born a Jew or a Turk, or to have fallen into the hands of an energetic and persistent advocate of circumcision when a child, would not only have been spared some long eight months of atrocious suffering, but would then in all probability have lived to a very comfortable age. <h4>[Details to make your flesh crawl]</h4> The patient was, at the time of the appearance of his misfortune, a compactly built man of some 49 years of age, robust and of an active disposition. His compact and muscular as well as active physique was what might have been looked for in a well-trained and athletic Roman legionary in the days of Rome's glory. He was possessed of more than usual intelligence, was quick witted, and was otherwise in a state of prime health, far above that of the average man at his age. Possessed of a good appetite, and of as good digestion as assimilation, he was of an optimistic and cheerful frame of mind, carrying his two score and ten years as if not more than thirty; with elastic step, strong physique in perfect physiologic action, this man entered and went through an agonizing existence of eight months duration, through the occurrence of preputial and penile cancer, ending in death, and all because he had not been circumcised, or, as has been said, had missed being born a Jew, a Turk or a Mohammedan. As an intelligent but irascible Scotch gentleman who had been raised in strict Scottish Presbyterian lines in his native land, and who had been brought up on oatmeal gruel, the scriptures and in a wholesome fear of the Lord, once expressed himself to me, after having been circumcised and convinced that much of his neurasthenia and resulting ill-health were all reflex conditions due to a tight prepuce: <div>I have been brought up and educated to look upon Saint Paul, the founder of Christianity, with awe and admiration, but, by God, Sir, if I had Saint Paul here now, Sir, I would shoot him, yes, Sir, I would shoot him. He had no biblical warrant nor no business to summarily abolish circumcision as he did. Our Lord was circumcised, so were the twelve apostles, even to that rascally Judas, and we should have all been circumcised instead of being baptized. I see that very plainly now. Saint Paul was more of an evangelist and not as scientific a man as Moses, and I may be wrong in wanting to shoot him. He probably did not know the harm he was entailing on gentile humanity by abolishing circumcision. Still, when I think of the agonies I have been made to suffer through his carelessness, I feel he ought to be shot, sir.</div> Saint Paul undoubtedly did humanity, especially Christian humanity, great wrong in every way when he failed to retain circumcision as a religious rite. <div> "Spilsbury et al [ 1 ] cite <a href="http://www.historyofcircumcision.net./templates/pages/sceptics_and_dissenters.html" rel="noopener" target="_blank">Wallerstein</a>, an anti-circumcision propagandist, failing to point out that many Victorian ideas favouring circumcision have since been confirmed (penile cancer, balanoposthitis, syphilis, etc.)." -- Brian Morris and Stefan Bailis, letter, ANZ Journal of Surgery, Vol. 74, 2004, p. 387 </div> I may say without any exaggeration that I have circumcised thousands, and that I have been consulted over more cases of unfavourable results from circumcision and complications arising in the course of the after-treatment than generally falls to the lot of the ordinary physician. I have seen both physical and mental suffering resulting from marplot operators and as a result of ignorance and inexperience as to the conduct of the dressings, but all of the resulting suffering due to properly and improperly performed operations, or to a too meddlesome idea of after-treatment and to very improper dressings, that I have so far witnessed as attending or following circumcision, could they all be rolled into one spasm of physical pain or concentrated into one pang of mental anguish, they could not be compared to the pain, anguish, and sufferings of body and mind of the uncircumcised victim of that preputial or penile cancer that slowly eats its way up from the affected prepuce or glans into the inguinal glands and thence into the abdominal walls and cavity. <h4>[Uses must be found for new medical technology]</h4> With the advantages offered by the employment of local anaesthesia and aseptic dressings, the patient, whether infant, adolescent or adult, need no longer suffer pain during the operation, nor run the seemingly needless risks that at times beset general anaesthesia. With modern methods and means of dressing the operative wound, the patient, if an adult, need no longer remain from his usual vocation, and if a child is no longer subject to the annoyances, dreads and torturing pains caused by the removal of hardened and adherent dressings, nor the interference to the healing by first intention by the repeated bathings that were formerly employed and very necessary to remove the soiled and agglutinated dressings. The stitch suppurative process and the painful ordeal of removing the sutures have been done away with by the discarding of the old silk suture material, a procedure that was wont to alarm and worry the little fellows into spasms. In place of the suppuration and infection-inducing silk, we now employ the absorbable chromacised catgut, which lasts sufficiently long for required purposes, causes no harm, and then disappears. In aristol we have an aseptic, adhesive and protective dry dressing that for young children is unequalled. The wound heals as kindly and thoroughly under aristol as it would under a dressing of asepticised collodion, with none of the drawbacks of the latter. <h4>[Circumcision is vaccination]</h4> Under these circumstances, which minimises the annoyances, pains and time of healing to the plane of an ordinary vaccination, I cannot well see why the operation of circumcision should be classed barbarous any more than vaccination. No intelligent parent who has seen the easily procurable statistics concerning the ratio in smallpox cases of unvaccinated to the vaccinated, the latter forming but the small average of less than 6 per cent of those attacked by smallpox, would permit his children to go unvaccinated. Smallpox, however, is a disease that falls under public care, and these statistical figures are easily and properly obtainable and classified, while cases of cancer, of hernia, and of the thousand and one complications that originate in the uncircumcised, are in private practice, and it is only by long and general experience that one can form even an approximate idea of the risks run by the latter class of cases; but from these an observer can easily conclude that, while the unvaccinated are only exposed to one danger, that the uncircumcised are exposed to many more, while the sufferings undergone by the uncircumcised when attacked by the maladies their condition invite, are altogether in greater excess and out of proportion to those suffered by those who have at some time in their lives undergone the operation of circumcision. <h4>[More or less, sooner or later]</h4> The history of the case of penile cancer mentioned above is not an uncommon occurrence for those who are the unfortunate possessors of an annoying prepuce. This organ or its tissues often become irritated, or rather the seat of an irritation on its mucous coat, followed with more or less inflammatory infiltration and thickening of the whole preputial tissues to an extent that it interferes with its retraction. Bathings, soothing lotions and rest generally cause this to subside, when some mild applications and lint, or some dry gauze interposed between the opposing mucous surfaces soon restore the parts to their usual state of health. At times, however, something which in these cases is liable to occur sooner or later, an unusually severe or persistent attack, and a more than usual thickening and induration of the affected tissues, causes the prepuce to press upon the glans with more than its former or usual degrees of constriction, and we have, as a result, more or less necrosis of tissue and a more or less resulting extensive suppurative and reinfecting inflammation. The sufferer often neglects to apply to a physician, considering the affair the customary trivial attack that will pass away in a day or two; but the recovery is now unaccountably postponed from day to day, and when at last he begins to think of consulting a physician, the latter finds that the prepuce has undergone some pathologic changes, and that a regular circumcision is for the time being out of the question. He slits up the hardened, thickened and lardaceous prepuce on its dorsum to liberate the compressed glans, which is then often found ulcerated and suppurating on its surfaces, and then trims off the remaining dog-ears which stand up erect on either side of the cut and whose edges refuse to hold sutures; and after a longer or shorter period of unsatisfactory local treatment the patient recovers with possibly a normal glans, and just possibly with one more or less disfigured as if it had gone through the pitting process of smallpox, and possibly with some segment of the corona permanently missing as a result of extensive suppurative destruction. ... [There follows a lengthy and increasingly lurid account of the progress of one case of penile cancer that Remondino claims to have observed.] Considering the many reflex disorders that do arise from the presence or existence of the prepuce, and the great diversity and far-reaching consequences of these disturbances, I cannot well see how one can rationally cry down circumcision as not being a most useful and salutary preventive measure. Hydrocele, hernia, hip joint disease, epilepsy, asthma, disturbances of speech or of sight, and a whole category of diseases can often be trace to their origins in some preputial irritation or cause. Some of these cases are most peculiar as well as instructive. <h4>[Circumcision prevents or cures blindness]</h4> Some years ago I was called to see a young man who was said to be going blind. I had known him for several years and could hardly account for such a calamity overtaking him. On examination I could perceive no change in the eyes, and, as he expressed it, he felt no pain, only that his sight had gradually dimmed and failed until now he could hardly distinguish light from darkness. Satisfied after a careful examination that there existed no organic defect in the eyes, and after eliminating all other possible causes, determined to examine the prepuce, as I had seen a number of cases of eye trouble resulting from preputial irritability. When asked to expose the parts the patient remarked that he knew what I referred to, but that as he had been circumcised, that the prepuce could not be looked to as the cause of his calamity. <div> "The Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today." -- Brian Morris, In favour of circumcision (Sydney: NSW University Press, 1999), p. 57 </div> Thinking perhaps that there might accidentally be some cicatricial constriction or malformation resulting from the operation that might cause the difficulty, I nevertheless insisted on examining the parts, especially as I had exhausted every other possible source of origin or cause for the eye trouble. Very reluctantly the young man disrobed, and to my surprise drew forth what looked like a yellow doll done up in thin and shiny garments. It was his circumcised organ done up in a wrapper of oiled silk with a tight rubber band about the fossa back of the corona to hold it in place. Without any hesitation I pronounced the constriction from the rubber band to be the cause of his eye trouble, and removing the oiled silk ulster and the rubber band, the patient regained his full scope of vision within the next hour. Upon being questioned as to the cause of his wearing that yellow jacket like a Chinese mandarin of high degree, he informed me that after his circumcision, some years previously, he had always carried the dÃ©colletÃ© member in a bag or sheath made of muslin, being under the impression that it needed protection. About one week previous to my being called, a friend had advised his wearing the yellow oil silk shirt with a rubber band to hold it in place. The band was smaller in diameter and stronger in texture than was actually necessary, and although he had noticed the constriction as being a little painful, and he now recalled that his eye difficulties had appeared soon after donning the yellow jacket, he had failed to make any connection between the unusual constriction and the failing sight. In a lad of twelve who came under my care for blurred vision, whose inability to read was supposed by his parents to be due to the presence of worms, as worms had previously caused other reflex difficulties, was found upon examination, and as proved by the results of the operation undertaken for his relief, to owe his eye difficulty to a tight prepuce and to the existence of some preputial adhesion. <h4>[Hip and bone diseases]</h4> With the effectual removal of the prepuce we certainly remove all possibilities for the occurrence of any cancerous disease having for its seat the preputial tissues or, for its cause, its irritating or constricting presence. Its removal will also do away with the possibility of being affected with one of those excruciatingly painful attacks of sciatica, which at times will lay up its victims for weeks or eventually cripple him with what Mauriac terms neuralgic herpes of the genito-urinary organs, who described these forms of sciatica as originating in an inflammatory vesicular eruption that is usually located on the inner lining or mucous coat of the prepuce, the nervous peripherae of this membrane giving rise through their irritation to this and to many other troubles that come from the same cause. Wherever any of these herpetic derangements of the preputial mucous membrane are met with as the easily excited results of heedless indiscretion either at the shrine of Venus or Bacchus, or a too indiscriminate indulgence in highly seasoned viands, we may feel assured of having in such cases an easy culture field for the occurrence of cancer whenever age and other favouring conditions meet in combination. Such a person will court safety by the constant practice of the virtues of continence, sobriety and studied abstemiousness. To make this doubly sure, however, I should advise him, especially if possessing what the late lamented Prof. S.D. Gross was wont to term a redundancy of preputial tissue, to follow the example of Timothy, the friend and companion of St Paul, and go and have himself circumcised, and thusly avoid the prospect of a painful and a questionable or disreputable death after a most uncomfortable malady, as the laity most always attach some venereal cause as the factor in such a death. <div>"If I were a top,* and I didn't like to use condoms, I would consider getting circumcised. If that person is not going to use a condom, maybe we'd all be better off if that person was circumcised." -- Daniel Halperin, <a href="http://www.circumcisioninfo.com/bay_area1.htm" rel="noopener" target="_blank">quoted in Bay Area Reporter</a>, San Francisco, 24 November, 1999 * That is, a gay male taking the active or insertive role in anal intercourse. Does Mr Halperin imply that he is not a top, that he does use condoms and that he is not circumcised?</div> It is these cases, combining herpetic attacks with nervous or neuralgic disorders, that form much of the groundwork or foundation for those annoying cases of coxalgia [pain in hip joint] that insidiously creep on, undermining the health and ending in crippling deformities after a protracted spell of femoral or of acetabular arthritis [in hip socket], with the resulting destructive process of osseous absorption and necrosis, the course of the initial points of the disorder being in every way analogous to those in which we observe the occurrence of simple sciatica originating in preputial herpes. It is very evident that if there is any virtue in the practice of preventive medicine that our duty here is to circumcise, and to do this promptly. While late operations and times and most unexpectedly give astonishingly happy results, we must not overlook the fact that we cannot logically look for results from preventive methods when conditions have progressed and passed to points where only other and curative methods are applicable. We should here be guided by the rule adopted and taught by Jonathan Hutchinson, that the most proper and considerate time to operate upon a cancer is in its pre-cancerous stages, and we should treat all easily irritated prepuces in the light of pre-cancerous or pre-coxalgic conditions. [ 2 ] Opponents of circumcision, when claiming that the operation has no well-defined hygienic or preventive benefits, seem to me to be arbitrarily ignoring many well known and established propositions in medicine and surgery. To argue thus in the face of the teachings of <a href="http://www.historyofcircumcision.net/templates/pages/dr_sayres_cure_fore_paralysis.html" rel="noopener" target="_blank">Lewis A. Sayre</a>, <a href="http://www.historyofcircumcision.net./templates/pages/the_crotchets_of_sir_jonathan_hutchinson.html" rel="noopener" target="_blank">Jonathan Hutchinson</a> and many other careful, accurate and conscientious observers, and in the face of daily occurring evidences where a timely performed circumcision relives many cases so effectually and so promptly as to leave no reasonable cause for believing but that the offending and removed prepuce was the exciting and maintaining cause of the disturbance, seems to me but additional cause for believing that those who so argue must deliberately shut their eyes as to all evidence, as well as to reason, are more intent on nourishing their prejudices than in exercising their reasoning faculties in an Aristotelian sense. <h4>[Circumcision cures cripples]</h4> I was once called to give an opinion over a case of femoral necrosis with suppuration following coxalgia in a young boy. The child, when beginning to favour the affected leg, had fallen into the hands of what might purely be termed a sample of the quintessence of the ignorant and irregular order of female practitioners with which the country abounds, a class of women who could not intelligently run a poultry yard, but who find in church associations and in the protected shades of medical sectarianism and faddism and social ignorance of medicine sample support and fields for the exercise of their peculiar order or want of talents [SIC]. It is needless to say that the serious gravity of the case here went unrecognised, and that the poor lad went from bad to worse. <h4>[Attack on women doctors]</h4> In time the lad fell under the notice of one of those curb-stone and street corner patient-recruiting doctors who, calling on the father of the child, so impressed him with the profundity and the superiority of his own knowledge over that possessed by the mentally irresponsible specimen of the irregular but solemn-visaged female practitioner, that he managed to assume charge of the case. He had charge of the case for several months when I was called in for an opinion. He had burrowed about the sinuses and necrosed tissues in a most indefinite and unsurgical manner at various times during the course of his attendance, to no good or to no ends, and at the time of my visit, at which he was present, seemed to have no clearly defined ideas as to what he intended to do or should do. On looking over the child, what was my surprise to find a long, tight and adherent prepuce, which in all probability was the original incentive of the whole disease processes which had eventually crippled the child and reduced it to a pitiable plight. Now, this disciple of Paracelsus Bombastus, or curb-stone and church lobby handshaking proclivities, was by no means an opponent of circumcision, only he was naturally and passively ignorant and unreceptive, and had never studied or understood the subject of coxalgia in all of its bearings and, in reality, was no more or only a little better fitted to assume charge of the case than was the solemn and owlishly wise-looking irregular female from whom he had so ingeniously swiped it. As observed, the failure to recognise the probable cause in this case was, in the hands of either of these two practitioners, pure ignorance, naturally leading to what, in better informed hands, would be criminal carelessness and inattention, but in many like cases men of small calibered minds are apt to be too easily influenced by the oft-repeated denials made by the opponents of circumcision as a general practice, that cancer, hypertrophies, excrescences, sciatica, coxalgia, reflex diseases and other derangements that at times accompany the existence of a prepuce, are either the direct or reflex outcome of the possible result of natural evolutionary growing out of the irritating presence of a prepuce. Under such misguidance they neglect to recognize the true state of affairs or to perform the operation early enough to act preventively; and at times when they do perform it later on, and at a time when the derangement for whose relief it is intended has become a settled disease, the operation is followed by no appreciable result, it only confirms them in the righteousness or correctness of their views and practice, that the prepuce was not an inciting cause, and that circumcision has no preventive value. Many of these reflex disturbances remain for a longer or shorter period easily removed, mere functional derangements, before becoming the actual seated disease which they or a time simply simulate; and the period when the actual change takes place from a simulated to a settled disease is as indefinite as the point or period when a benign wart or tumour reaches the precancerous stage, and from this swiftly passes into the cancerous. I have at times operated upon cases where great reflex disturbances had long existed, and where the operation was performed with no hope of their relief, but simply because the local preputial conditions demanded interference, when to my surprise the reflex difficulty has gradually disappeared. <h4>[Another miracle cure]</h4> Some 25 years ago, whilst in charge of a country hospital, I circumcised an inmate, a man of thirty, who was a cripple, seemingly, as the history told me, from the results of a coxalgia when a child. The right leg was neuralgic and apparently shortened, and drawn up in the peculiarly flexed and fixed position characteristic of such cases. It had been so for many years, was gradually going for the worse, and the helpless cripple had drifted into hospital. It was not, however, for the relief of this that he applied to me, but for the relief of a bladder affection which necessitated an examination. I found a long, tight, pin-holed, pendulous prepuce which he had never, even as a child, been able to retract. After questioning the man as to his previous physical history I gave it as my opinion that the crippled leg was the direct outcome of the preputial condition. I advised circumcision to relieve the bladder irritability and to make a urethral stricture more accessible for treatment, when, to my surprise, after the operation the neuralgic pain subsided and the deformity of over 25 years standing gradually lessened. Massage and passive motions were then instituted, and he recovered the almost perfect use of his leg, left the hospital and went to work. In this case some unseen and unusual constitutional resistance worked to prevent irreparable injury through the occurrence of arthritic inflammation. The least accident or taint of scrofula would here undoubtedly have turned the tables against him. Possibly the degree and nature of the persistent reflex muscular contraction were insufficient to induce serious injury to the head of the femur, but in any case the history of this case teaches us the benefits that may at times be derived from circumcision in the most seemingly hopeless cases. As observed, the results were here most unexpected, and I should be hardly be sanguine enough to see them repeated; but still, what has occurred in one case may in another, and the smallness of the percentages of these happy results should not prevent us from extending the benefits to others affected in analogous manner. Figure 2 represents a case of preputial hypertrophy somewhat similar to that of the celebrated case recorded many years ago in Paris by M. Nelaton. ... The photograph [of a freakish case of gross elephantiasis of the penis] speaks for itself as to the nature and degree of the deformity. The observed enlargement was wholly preputial in its origin and subsequent growth, and never involved the penile organ, and the operation taken for its relief was perfectly successful. To say that circumcision would not have prevented the occurrence of this condition is not a tenable proposition. It is equally certain that the hypertrophy might have entailed more serious concurrent affections than the single one operated on. Had the man been circumcised when a child, all this annoyance and risk would have been averted. <h4>[Anti-circumcision activists]</h4> The opponents of circumcision are by no means all blindly dogmatic and unreasonable in their opposition. Many only class such operations as unnecessary when performed on seemingly perfectly normal subjects. The danger from the opposition resides in those narrow, inelastic and unbending understandings who have made of uncircumcision such a creed, that they have so steeled themselves against its performance, that they will not and cannot under any circumstances ever see or realize the necessity of its performance. Like the Negro preacher and exhorter of "the sun do move" celebrity, they undertake to stick to what to them has become a religious tenet, a scriptural text or truism, no matter what may happen. Not alone are they an injury to themselves and others in their restricted conceptions of medicine and lines of practice, but carrying their prejudiced disbelief in other channels of our science, they at least reach that point where disease and medicine appear to them as purely empirical and unretroactive conditions, and only responsive to the most empirical penny-in-the-slot methods of practice. <div> "The RACP's statement on routine male circumcision is not evidence based and should be retracted". -- Brian Morris, Daniel Halperin, Stefan Bailis et al, "RACP's policy statement on infant male circumcision is ill-conceived", ANZ Journal of Public Health, Vol 30, January 2006, p. 16 </div> [Compared with the Remondinian outpourings of Prof. Morris and Co, the <a href="http://www.racp.edu.au/hpu/paed/circumcision/summary.htm" rel="noopener" target="_blank">RACP's policy statement (2002-4)</a> is a model of balance, and an obvious compromise between the pro-circumcision hawks, on one hand, and the advocates of genital integrity and a person's right to make his own health decisions on the other.] In many respects the opponents of circumcision as a general practice may be likened to the anti-vaccinationists, who magnify the risks and dangers as well as the accidental evil results of vaccination, while they attempt to minimize its immunities and advantages. History and experience do not side with either of these opponents, and it is only by adopting the most one-sided views that one can in the least arrive at anything like a comprehension of their views, or how these are reached by them. SOURCE: P.C. Remondino, "Circumcision and its opponents", American Journal of Dermatology and Genito-Urinary Diseases, Vol. 6, March 1902, pp. 65-73 <h3>References</h3> 1. Spilsbury K, Semmens JB, Wisniewski ZS, Holman C D'A J. <a href="http://www.cirp.org/library/procedure/spilsbury1/" rel="noopener" target="_blank">Routine circumcision practice in Western Australia 1981â€“1999.</a> ANZ J. Surg. 2003; 73 : 610â€“14. 2. Jonathan Hutchinson, "The pre-cancerous stage of cancer and the importance of early operations", British Medical Journal, 7 January 1882, pp. 5-6 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dr Remondino blasts anti-circumcision activists (1902) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> In 1870 the American orthopaedic surgeon, Lewis Sayre, finds that congenital phimosis can cause, and circumcision can cure, paralysis of the legs. [1] <h3>Lecture III: Deformities</h3> <h4>Etiology (continued) â€“ Congenital Phimosis and Adherent Prepuce â€“ Prognosis â€“ Diagnosis</h4> GENTLEMEN: I shall continue the study of the causation of deformities to-day by first directing your attention to another exceedingly important cause of acquired deformity, especially in children, namely, the reflex muscular contractions, caused by congenital phimosis and adherent prepuce. This is a cause which has been almost entirely overlooked by the profession in general. The first step in the process is an almost perpetual excitation of the genital organs. This excitation is followed by partial paralysis, and this paralysis is accompanied by deformity. It having been my fortune to see several of these cases, I can do no better than to give you the detailed history of the first which fell under my observation. On the 9th of February, 1870, I received the following note: Dear Sayre Please let me know at what hour you can come to my house to see the son of Mr. Mâ€“, of Milwaukee. The little fellow has a pair of legs that you would walk miles to see. Yours truly J. Marion Sims No. 18 East Twenty-eighth street I immediately went to the doctor's office, and found a most beautiful little boy of five years of age, but exceedingly white and delicate in his appearance, unable to walk without assistance or stand erect, his knees being flexed at about an angle of 45Â°, and the doctor had sent for me to perform tenotomy upon his hamstring tendons. After a very careful examination I discovered that, when I amused the child and distracted his attention from himself, I could with very little force easily extend both of his limbs to their normal length, but as soon as I released my hold of them they would instantly become flexed again, and no irritation that I could produce upon the quadriceps muscles was sufficient to extend the legs except in the very slightest degree. I soon satisfied myself, as well as Dr. Sims, that the deformity was due to paralysis and not contraction, and it was therefore necessary to restore vitality to the partially paralyzed extensor muscle, rather than to cut the apparently contracted flexors. I therefore had him sent to my office for the purpose of applying the constant current of the galvanic battery. In its application, while passing the sponge over the upper part of the little fellow's thighs, the nurse cried out, "Oh, doctor! be very careful! don't touch his pee-pee â€“ it's very sore"; and upon examining the penis I found it in a state of extreme erection. The body of the penis was well developed, but the glans was very small and pointed, tightly imprisoned in the contracted foreskin, and, in its efforts to escape, the meatus urinarius had become as puffed out and red as in a case of severe granular urethritis; upon touching the orifice of the urethra he was slightly convulsed, and had a regular orgasm. This was repeated a number of, times, and always with the same result. The nurse stated that this was his condition most of the time, and that he frequently awoke in the night crying because "his pee-pee hurt him," and the same thing had often occurred when riding in the stage or car; the friction of his clothes exciting his penis would cause erections. As excessive venery is a fruitful source of physical prostration and nervous exhaustion, sometimes producing paralysis, I was disposed to look upon this case in the same light, and recommended circumcision as a means of relieving the irritated and imprisoned penis. This I performed on the following day, assisted by Dr. Yale, who administered the chloroform, and Dr. Phillips, and in the presence of a number of my private students. The prepuce was pulled well forward and cut off with a pair of scissors, when the tegumentary portion readily glided back over the glans, leaving the mucous portion quite firmly adherent to the glans nearly to the orifice of the urethra. Seizing the thickened mucous membrane on either side of the glans with the thumb and finger nails of each hand, it was suddenly torn off from the glans penis, to which it was quite firmly adherent nearly to the corona. Behind the corona there was impacted a hardened mass of sebaceous material, almost completely surrounding the glans. This was removed; the mucous membrane which had been torn off from the glans was split in its centre nearly down to its reflection, and, being turned backward, was attached to the outer portion of the prepuce by a number of stitches with an ordinary cambric needle and very fine thread. The penis was then covered with a well-oiled linen rag, and kept wet with cold water. No untoward symptoms occurred, and in less than two weeks the wound had entirely healed, and the penis was immensely increased in size. The prepuce was sufficiently long to cover the glans, and could be readily glided over it without any irritation whatever. From the very day of the operation, the child began to improve in his general health; slept quietly at night, improved in his appetite, and, although confined to the house all the time, yet at the end of three weeks he had recovered quite a rosy color in his cheeks, and was able to extend his limbs perfectly straight while lying upon his back. From this time he improved most rapidly, and in less than a fortnight was able to walk alone with his limbs quite straight. He left for his home in the West about the 1st of April, entirely recovered; having used no remedy, either iron, electricity, or other means to restore his want of power, but simply quieting his nervous system by relieving his imprisoned glans penis as above described. (Footnote: D. Campbell Black, MD, in his work on "Functional Diseases of the Renal, Urinary, and Reproductive Organs," after reprinting some of my cases in full, says, (page 213): "I offer no apology for thus giving considerable prominence to the foregoing cases. I attach to them immense importance, as disclosing, possibly, a frequent source of infantile paralysis, and the numerous indications of nervous irritability in childhood, while, so far as known to me, Dr. Sayre's cases are unique in medical literature.") <h4>Case 2</h4> The case that just now presents itself before us is one of this description: CASE. Double Talipes Equino-Varus Paralytica, dependent upon Congenital Phimosis and Adherent Prepuce This boy, C.H.W., aged three years, has been under treatment in a public institution in this city for two or three years, with the hope of overcoming his deformity; and that treatment has been solely by the application of instruments to hold the feet in their proper position. The mother states that the deformity was present at birth; in other words, it is congenital. As soon as he began to walk, his feet began to get more crooked, and have at last got into the shape you see here. When I take the foot in my hand, I you see that it can be immediately restored to its normal position with the greatest possible ease; and when I let go it flops around the ankle like the loose end of a flail. This shows that the deformity is paralytic in its nature. In order to remove this paralytic deformity, he has worn all manner of machinery until both his tibial bones have been bent out of shape, and still he is as bad as he was at first. His general health is good, and he has never had any sickness which can account for this condition of things. In looking about for a cause of this paralyzed condition of the muscles of the lower extremities, I find that the head of his penis has never been uncovered; in other words he has congenital phimosis, and adherent prepuce, as proved by the introduction of a probe. The external opening of the prepuce is scarcely large enough to admit the smallest probe, and as the probe is made to sweep around the glans the prepuce is found everywhere adherent, except for a few lines back from the orifice of the urethra. This penis is in an almost constant state of erection, and the conclusion I have arrived at is, that this boy has been the subject of undue nervous irritation from genital excitement, which has resulted in partial paralysis of the lower extremities, and in consequence of this partial paralysis the deformity has been developed. This subject of nervous irritation and consequent exhaustion from undue genital excitement is one of a vast deal of importance, and has not received the attention at the hands of the profession that it justly deserves. The pressure continually exerted upon the glans penis by the contraction of the adherent prepuce keeps the organ in an almost constant state of irritation and erection. Such a constant genital excitement, no matter what its cause may be, whether occurring in a child or in an adult, is certainly detrimental to the best condition of the nervous system. In the class of cases before us, this undue genital excitement ends in paralysis, and the consequent deformity varies according to the manner in which the weight of the body is placed upon the foot. A simple mechanical support will restore the foot to its normal position, but the child can only be relieved permanently of the deformity by removing the cause which has given rise to the paralysis. The first step, then, to be taken toward curing this case is to perform the operation of circumcision, and liberate the glans penis from the adherent prepuce; for I am firmly of the opinion that the paralysis in this case is the result of nervous irritation from genital excitement which is caused by this adherent prepuce. (The operation was performed.) The child will be returned at the end of two weeks, and we shall then see whether any benefit has been derived from the operation. Meanwhile, no dressing whatever will be applied to the distorted feet, in order that we may see what effect this nervous affection had in producing the deformity. (Footnote: The mother returned at the end of the two weeks, stating that the child had been perfectly quiet every night since the operation, sleeping without any disturbance, and passing his water without difficulty, which had never occurred before. He ate well, was very much improved in his general appearance, and could stand flat on his feet without any assistance. Upon stripping the child's feet the mother's statement was fully corroborated, as will be seen by the annexed figure (Fig. 1), which was taken immediately after by Mr. Mason, photographer to Bellevue Hospital, just two weeks from the operation. As will be seen, the child stands perfectly flat upon the feet, with simple inversion of the great-toe of the left foot. The increased muscular power without the use of any electricity has been almost marvellous, and now by the application of the galvanic current to the peroneal muscles we have a prospect of the perfect recovery of the child without any further mechanical support.) We will add another case of reflex paralysis, which beautifully illustrates the rapidity with which the muscles regain their power of contraction, and also how readily they will respond to the directions of the will when the source of irritation is removed. <h4>Case 3</h4> CASE. T.B., aged three years and eight months, was brought to me by Dr. P. Brynberg Porter, of 65 West Forty-eighth Street, on the 1st of June, 1875, to be treated for paralysis of the lower extremities and prolapsus of the rectum. The doctor had detected the phimosis and constant priapism, and, suspecting that it might possibly be the cause of his trouble, brought him to me for examination. The child was very peevish and fretful, very costive, and the mother states that "in straining at stool and in making water his bowel would frequently come down, and give her great trouble in pushing it up." He began to tumble down very frequently about a year ago, and was growing more and more clumsy in walking. He could not stand alone without support, and even when supported his legs would bend in different directions, as seen in Fig. 2, from a photograph by O'Neil, June 1, 1875. He was circumcised on the 2nd of June. The lining membrane of the prepuce was firmly adherent to the glans, requiring section by the knife before it could be torn off. Behind the corona was the usual hardened smegma, which had produced erosion of the mucous membrane. The parts were dressed with an oiled rag and cold water. June 4th â€“ The boy could stand without support, and had slept quietly the past two nights. At the end of twelve days he was entirely well; could walk and run without tripping, and his bowels had become perfectly regular, without any prolapsus. The annexed photograph by O'Neil, taken July 1st, shows the improvement in his limbs. In the picture taken June 1st, his shoes had to be laced tightly around the ankle to enable him to stand even with support; but in that taken July 1st (Fig. 3), it will be seen that he stands erect without any assistance. One of his limbs is slightly abducted in the photograph, but that was on account of his restlessness â€“ it is not so constantly. (Footnote: For a more full report of injury to the nervous system by irritation of the genital organs of both sexes, see author's paper in "Transactions of the American Medical Association" for 1875.) In continuation of the subject of causation, we next observe that deformities of the spine occur most frequently during the period of growth and development. Young girls are more disposed to have the so-called lateral curvature of the spine than boys, for the changes which their systems undergo during this period of growth and development are more marked than those which take place in boys, and occur just at the time when the bony structures are more or less pliable and not fully developed. Certain derangements in the health are also to be noticed in this connection as causes for deformities. Diseases caused by sedentary habits, such as dyspepsia, hypochondriasis, melancholia, etc., frequently seem to give rise to rotary and lateral curvature. It is in this class of cases that your efforts toward effecting a cure will be most unsatisfactory; for you have to deal with a loss of power, and an extreme sensitiveness to all influences, especially heat and cold, which, combined with other derangements of the nervous system, render these cases very intractable. The last kind of cause of acquired deformity which I shall mention here is the traumatic. Under this head may be embraced blows, bruises, burns, wounds, etc. Most of those causes which have been indicated, as well as those which have not received special mention, will be more fully considered as we proceed with our lectures, for subsequently I shall dwell more fully upon the special causes of each deformity, which have thus far been referred to only in a general way. <h4>And now for something completely different ...</h4> PROGNOSIS â€“ In general, your prognosis should be extremely guarded. There are very many exceptions, it is true, to this general rule, but to those exceptions your attention will be directed further on in the course. In the treatment of deformities, particularly those of long standing, you will find that the practical application of the principles which are to guide you, however simple these principles may be, will in many cases be exceedingly difficult. You may be led, on account of the seeming simplicity of many principles which are to be laid down, to anticipate speedy relief and rapid recovery; but in a majority of cases you will really be very much disappointed. Your faith in being able to produce rapid improvement by the treatment of deformities of long standing will be very much weakened, when you come to have a few such cases under your own personal observation and care. Nevertheless, it may truthfully be said that, with patience and perseverance in the right direction â€“ these are words full of meaning â€“ you will be able, in a majority of cases, to accomplish such results as will be extremely satisfactory to the friends, and more than compensate you for your extra labor. In some cases, the improvement will be so rapid that it will become a source of great astonishment to you. In general, however, such results are not to be obtained. There is one exceedingly important element in the management of all cases of deformity, and it is one which will materially affect your prognosis, namely, the cooperation of the patient. If the hearty cooperation of the patient can be obtained, a long step has been taken toward effecting a permanent and complete cure. The lame, the crooked, and deformed, are all influenced mentally by their misfortunes. In many instances, I have seen the strongest evidence of this influence upon the mind: one in particular I will mention, which is that of a young girl who was brought to me, to be treated for chorea in a very aggravated form. As this case is a beautiful illustration of the principle we are now speaking of, I cannot do better than refer to it here, although I have already published it in the New York Journal of Medicine for 1849. CASE. Chorea induced by Anxiety, on Account of a Deformity; and cured by Removal of the Same. Mary Pheeny, Pearl Street, aged sixteen, was brought to me in March 1848, for chorea, with which she had been afflicted for two years previous; she had also had several epileptic convulsions. She was a large, robust, healthy-looking girl, but exceedingly desponding and gloomy, almost an idiot in appearance, wishing, to be by herself, and seldom speaking to anyone. She was strangely deformed in her feet and one hand; having ten toes on her left foot, and eight on the right, with their proper number of phalanges, and each articulated with a separate metatarsal bone, except the second and third on the left foot, which were joined together, so as to resemble one toe with two nails, which gave that foot the appearance of but nine toes; but after their removal I found a double row of phalangeal bones, inclosed in a common tegumentary envelope. On the right hand she had five fingers, besides an extra joint upon the thumb. Upon taking hold of her hand, my attention was drawn to her extra finger, and when I alluded to it she gave an hysterical sob, followed immediately by a severe convulsive fit, caused, as her I mother informed me, by my allusion to her deformity, as she was I exceedingly sensitive upon that point. After talking to her mother a few moments, she wished me to look at her feet, as they were also deformed; and, upon my examining them, another convulsive fit was induced, which led me to believe that the cause of disturbance in her nervous system, upon which these fits and the chorea depended, was anxiety of mind about her deformity; and she had pondered on it so constantly, and let it obtain such complete control of her nervous system, that any allusion to her misfortune would be immediately followed by a fit. After examining the case carefully, I found every organ healthy, and all their functions properly performed. She had been under treatment for some time past, for suppressed menstruation, which had been successful; and for the last two months her menstruation had been perfectly regular. (Footnote: Dr. Porcher, now of Charleston, who treated her for some time, has published the case in the Charleston Medical Journal and Review for March, 1848, and states that she was perfectly cured in four weeks, by the use of carbonate of iron and rhubarb. If he had reference to her menstruation simply, he would have been correct. But, in including in the word cure the chorea and epilepsy under which she labored (as I presume he does, for he has headed his article "St. Vitus's Dance "), he is evidently mistaken; for her gait was exceedingly unsteady when she came to my office, and the fact of her having two convulsive fits upon my alluding to her deformity proves that her epilepsy and chorea still continued; and it is to correct this statement that I have by the advice of several medical friends made the case public. She was not relieved of her chorea and epilepsy until she was assured that her deformity could be removed: from that moment her countenance assumed a cheerful aspect, and her chorea and epilepsy left her entirely, without any medical treatment whatever, and have never returned.) Therefore, finding no other cause to which I could attribute this derangement of her nervous system, I was compelled to believe it caused by anxiety on account of her deformity, and advised the removal of her extra toes and finger, to which she readily assented. From that moment her countenance assumed a cheerful, smiling aspect, she laughed and talked half hysterically, and walked about with almost a frenzied delight, and exhibited not the slightest evidence of chorea. She was exceedingly anxious to have the operation performed at once, but it was deferred in order to take the casts, from which the accompanying drawings were made. (See Figs. 4 and 6.) On the 9th of March, assisted by Drs. Trudeau and Van Buren, I removed her supernumerary toes, having first put the patient under the influence of ether, which had the desired effect of benumbing all sensation, and, when restored to consciousness, she expressed great surprise at their removal. The parts were brought in close apposition by sutures straps, and firm bandages, and dressed with cold water. Union of the whole wound, in each foot, took place by first intention without the formation of any pus, and in twenty-three days after the operation she walked to my office (nearly one mile), and the second casts were taken from her feet, from which the improved drawings were made. (See Figs. 5 and 7.) The most singular feature in this case is, that, from the moment she became convinced that her feet could be improved, her chorea left her, and has not returned; neither has she had a single epileptic convulsion. I removed the extra finger under the influence of chloroform, the carpo-metacarpal articulation, by a straight incision on the back of the hand. The wound united by first intention, and the hand looks quite natural, as is seen by contrasting Figs. 8 and 9. DIAGNOSIS. â€“ The rules for making a diagnosis will be considered in connection with the study of each deformity. Lewis A. Sayre MD, Lectures on orthopedic surgery and diseases of the joints, delivered at Bellevue Hospital Medical College during the winter session of 1874-1875 (New York: D. Appleton & Co, 1876), pp. 13-25 <h3>NOTES</h3> 1. According to David Gollaher, the history of routine circumcision begins with this discovery that a wide range of childhood illnesses was apparently caused by a tight and adherent foreskin and could be cured by circumcision. As Gollaher reports, Sayre performed this operation on a number of boys suffering from various forms of paralysis of the legs, all of whom were restored to health, and the future of the treatment was assured. What was the physiological basis for this miracle? Working with the nerve force theory of disease then current (which held that disease was caused by imbalances in the body's nervous forces), Sayre hypothesised that "peripheral irritation" from the foreskin could produce "an insanity of the muscles" which would then act on their own accord, without direction from the brain. As he wrote in 1870: <div>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.</div> Sayre eventually consolidated his convictions in a book entitled On the deleterious results of a narrow prepuce and preputial adhesions, published in Philadelphia in 1888. Similar problems in girls were often caused by the adherence of their clitoral prepuce, and could similarly be cured by its removal. Other doctors were quick to take up Sayre's findings and push them further. Soon adherent prepuces on infants and little boys were being discovered all over the country and their removal alleviating the symptoms of numerous childhood complaints; one doctor reported a case of "brass poisoning completely cured". Dr Norman Chapman, a disciple of Sayre, suggested that the incidence of adhesive foreskins, while it had never been calculated, was probably higher than people realised. Since "a long and contracted foreskin" was so often a source of "secondary complications", he went on to propose that it was "always good surgery to correct this deformity ... as a precautionary measure, even though no symptoms have as yet presented themselves". As Gollaher observes, this declaration represented an important transition in thought: circumcision became not just a treatment for existing problems, but an anticipation intended to prevent possible problems in the future. The preventive career of the operation was launched, and the path to routine infant circumcision was thus laid down. David L. Gollaher, "<a href="http://www.cirp.org/library/history/gollaher" rel="noopener" target="_blank">From ritual to science: The medical transformation of circumcision in America</a>", Journal of Social History, Vol. 28, 1994, pp. 5-36; and Circumcision: A history of the world's most controversial surgery (New York: Basic Books, 2000), chap. 4 It was for this momentous contribution to surgery that P.C. Remondino, the most fanatical crusader for universal circumcision of the late nineteenth century, hailed Sayre for discovering in the foreskin "this field of misery and suffering, disease and distortion, of physical and mental obliquity, presided over by this preputial Afrit of malignant disposition". His achievement was to "describe this vast territorial acquisition, and annex it to the domain of medicine, which, through its skill, could modify the influence of the evil genius that there presided and spare humanity much of the ills to which it had been subjected". Sayre was "to medicine what Columbus was to geography". P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (Philadelphia and London: F.A. Davis, 1891), p. 255 Gollaher's argument is convincing as far as it goes, but it took a lot more than the discovery that phimosis caused nervous derangements which led to paralysis to establish routine circumcision in the surgical repertoire; indeed, the nerve force theory of disease on which this connection was based was exploded long before circumcision became routine or even common. Certainly Sayre helped to establish the principle that preemptive amputation was an acceptable medical intervention, but it required another fifty years of health scares and professional politicking before it became widespread. The other vital developments were: <ul> <li>successfully publicised claims that the uncircumcised were significantly more vulnerable to the horror diseases of the period (cancer and syphilis), and that circumcision conferred immunity;</li> <li>the success of the obstetricians and <a href="http://www.historyofcircumcision.net./templates/pages/the_gomco_clamp_1935.html">gynecologists in gaining control</a> not merely of childbirth, but of the bodies of male infants in their first vulnerable few days. Since the 1930s it has mainly been the ob-gyns who have practised circumcision, and pushed its "benefits", materially assisted by their invention of a "simple" device (that even those who knew nothing about male bodies could use) called the Gomco clamp.</li> </ul> It should also be noted that Sayre was as alarmed at the boy's sexual excitability as with his adherent prepuce; indeed, the worst thing about the prepuce was that it seemed to stimulate erections and even orgasms. As he wrote of Case 1: <div>upon examining the penis I found it in a state of extreme erection. ... upon touching the orifice of the urethra he was slightly convulsed, and had a regular orgasm. This was repeated a number of, times, and always with the same result.</div> Quel horreur! And Case 2: <div>This penis is in an almost constant state of erection, and the conclusion I have arrived at is, that this boy has been the subject of undue nervous irritation from genital excitement, which has resulted in partial paralysis of the lower extremities, and in consequence of this partial paralysis the deformity has been developed.</div> This was simply Victorian revulsion at the evidence that a child could have sexual sensation, and reinforces the point that the main aim of the early circumcision advocates was to stamp out such manifestations. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Dr Sayre's cure for paralysis (1870) darby