7 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> by Kathryn Blaze Carlson, National Post (Canada), 19 August 2011 Rebecca Wald is “100% Jewish.” She celebrates the high holidays, her children attend Hebrew school, she lights candles on the sabbath and she was married to a “100% Jewish” man under a chuppah at a traditional Jewish wedding. But unlike most Jews, from the most secular to the ultra-orthodox, she did not circumcise her son. She has never attended — will never attend — a bris, the age-old ceremony where a Jew trained in circumcision (a ‘mohel’) removes the foreskin of an eight-day-old Jewish boy as a sign of his covenant with God. “All of the babies I saw growing up — whether cousins or the kids I babysat — were circumcised, and it seemed like that was the way things were supposed to be,” said Ms. Wald, who in December launched <a href="http://www.beyondthebris.com/">Beyond the Bris, a website for Jews who question circumcision</a>. “It took having a son, who is intact, for me to really accept how normal [the uncircumcised penis] is.” The South Florida mom is among a growing and vocal minority of Jewish “intactivists” who are challenging the 4,000-year-old ritual because, they say, the procedure inflicts unnecessary pain without any health gains, causes long-term psychological harm, hinders sexual function and pleasure, and strikes at the core of consent. They say there are Jewish women who silently pray they will not bear a son, and that the question, ‘When’s the bris?’ is too presumptive. Ms. Wald has not yet told her young son about her decision — she did not want to disclose his age. “Like many Jewish parents of intact sons, we’re not thrilled to publicly discuss the status of our own children’s sex organs,” she said — but said she assumes he will “at some point” learn about it. “I imagine he’s going to be thankful that we spared him from this mutilation,” said Ms. Wald, adding that had she been born a boy, her “forward-thinking” parents would not have circumcised her. Beyond the Bris has attracted more than 9,000 visitors from 89 countries in the past eight months, chiming into the burgeoning chorus of like-minded Jewish groups such as Jews Against Circumcision, the Jewish Circumcision Resource Center, the Israeli Association Against Genital Mutilation, and the Israel-based group Kahal. Intactivist organizations like these have existed for years — one of which was criticized as anti-Semitic for its comic series called Foreskin Man, with characters such as Dr. Mutilator and Monster Mohel. But this latest slew of opponents is unique in that they are led by people whose own religion demands circumcision. In the Book of Genesis, God told Abraham he would provide him with children, land, and a promise to be his God forever. In return, God said: “Every manchild among you shall be circumcised. And ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you.” Jews today know circumcision as Mitzvah 612, the second-most important of 613 commandments behind procreation. Even the least observant of Jews — even those who do not keep kosher, obey the sabbath, go to synagogue on Saturdays, or those who marry a gentile — still obey commandment 612. In accordance with Jewish law, they publicly appoint a shaliach, or agent, to perform the surgery. Some do so because they believe it is integral to the boy’s covenant with God, some do so out of tradition, some do so without question. Some do it because it is a physical marker in a private place that symbolizes their Jewish identity. Still others do so for what they consider health or esthetic benefits. For Susanna Garfein and her husband, Ross Goldstein, circumcising their son Bram in Baltimore, Md., this summer was first and foremost a matter of faith. It was also a matter of religion, tradition, and health — there are studies, they pointed out, that show circumcision lowers the chances of contracting sexually transmitted diseases and HIV. “Our practice and our love of Judaism is something we want to pass along to Bram, and this is the first ritual to begin that process,” Ms. Garfein said in a telephone interview with her husband on the line, too. "It’s not an act of violence,” Mr. Goldstein added, before his wife finished his sentence: “It’s an act of love.” Fewer and fewer American sand Canadians are joining Bram in being circumcised: Canada’s Public Health Agency says the rate of infant circumcision had dropped to 32% in 2006 from 47% in 1973. In three short years in the United States, hospital circumcision reportedly fell to 32% in 2009 from 56% in 2006, although the Centers for Disease Control said that number was not definitive. The latter rate does not include Jewish bris ceremonies, which are often done in the home, making it difficult to know whether the number of Jews who circumcise is shrinking. Beyond that, the discussion around circumcision is still mostly taboo within the community. One thing, though, is clear: The Jewish anti-circumcision movement is growing louder. Three Jews were on the committee that led the recent (failed) bid to have circumcision banned in San Francisco, CA. It was a Jewish filmmaker, who moved with his orthodox family to Israel when he was 13 and is now married to an orthodox convert, who created the controversial 2007 film Cut: Slicing Through The Myths of Circumcision. Now that the subject has traction, he was contacted by Abe Haim, a coordinator with intactivist group The Whole Network, to collaborate on a 30-city North American screening tour. It was a Washington D.C.-based rabbi, who considers himself a secular humanist, who said he has never been busier with alternative ceremonies for newborn boys, which are called a Brit Shalom or ‘covenant of peace’ and which is similar to the baby-naming ceremony for infant girls. “There is a growing number of people who have a cultural sense of Jewish identity,” Rabbi Binyamin Biber said. “There is also a growing movement to focus on the body as something good and natural, and therefore not in need of alteration.” And it was a Jewish author, who circumcised her two sons simply because she never thought not to, who last fall published the first fiction book on the controversial question: To circumcise, or not to circumcise? “I wanted to argue against circumcision in a way that couldn’t be dismissed as overly emotional, incendiary, or anti-Jewish,” author Lisa Braver Moss said, referring to her research of Jewish texts for the book The Measure of His Grief. “It was through railing against circumcision that I found deeper meaning in being Jewish.” They say neither they nor their sons are any less connected to God — or any less Jewish — than Jews who choose to circumcise. “If the Jewish identity comes down to whether or not you have a piece of skin on your penis, then that’s a very sad thing for the Jewish people,” Ms. Wald said, pointing out that a child is Jewish if he or she is born to a Jewish mother. “There are no religious consequences of not being circumcised — the boy could still have a bar mitzvah, for example,” echoed Eli Ungar-Sargon, the Jewish filmmaker whose tour starts in Los Angeles in September, with stops in Toronto, Montreal, and Vancouver in October. “The consequences are imagined and invented. They’re not actual.” He said there has been a “cultural shift” since his film launched four years ago, and said the issue “caught fire” with Lloyd Schofield’s attempt to ban circumcision in San Francisco this year — a ban he supports in principle. “I can’t oppose legislation against this because I think it’s a travesty that so many kids are being harmed on a regular basis with the complicity of the medical establishment,” said Mr. Ungar-Sargon, who is himself circumcised but says he does not blame his parents for partaking in what he calls a form of “social violence.” Actor Mario Lopez last fall became an accidental champion of the intactivist cause when, on his reality show about becoming a father, he said he would not circumcise his child if he happened to have a boy. “I don’t think God makes mistakes, and it’s not an optional part,” the intact Catholic star later said on the Wendy Williams show. Plus, he said, he would want his son to “be like” him. Mr. Goldstein, Bram’s father, scoffed at the suggestion put forth by some intactivists that Jewish fathers selfishly want their son to have the ‘same equipment’ as them, and said neither he nor his wife ever questioned whether or not little Bram would have a bris. The bris, also known as a brit milah, was on July 4, eight days after Bram’s birth on June 27. They, like many Jews, chose a physician-trained mohel to do the circumcision. Dr. Steven Adashek had come highly recommended in the Baltimore community for his personality and demeanour. It was an added bonus that the doctor used a local anesthetic, they said. Bram did not cry and the procedure took 40 seconds. But for other babies, whose circumcision is performed by a rabbi mohel, the base of the foreskin is not frozen. Dr. Adashek has done upward of 5,000 circumcisions, 1,500 of which were performed on Jewish babies at a bris. The rest of the circumcisions were done on Jews and non-Jews alike in the hospital. “I am often asked whether I circumcised my two boys, and what I say is, ‘I have many chances to scar my children as they age, so I’ll pass on this one and appoint an agent,’ ” he said of his two sons, now 19 and 22. He explained that a circumcision alone, in the absence of a brit milah ceremony, does not fulfill the religious requirements of Mitzvah 612. That poses a problem for a circumcised man looking to convert or for a circumcised man planning to marry into an orthodox family. And so mohels like Dr. Adashek perform what is called a hatafat dam brit — a covenant ceremony where a small 30-gauge needle is used to make a mark on the remnants of the old foreskin. Just three months ago, Dr. Adashek performed a hatafat dam brit on a 79-year-old man who is in the process of converting so he can someday join his daughter in the Jewish cemetery, where she was buried after she herself converted. Ms. Wald, for her part, said the decision of whether or not to circumcise should be left with men themselves. She said it should not be up to the parent to prescribe a procedure that, she believes, would have diminished her son’s sexual sensitivity. “I want my son to have a fully functioning penis,” she said. “If he ever decides that — for whatever reason — he wants to be circumcised, then that will be his choice.” <a href="http://news.nationalpost.com/2011/08/19/circumcision-mutilation-or-an-act-of-love/" rel="noopener" target="_blank">National Post (Ontario, Canada), 19 August 2011</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 National Post: Circumcision mutilation or an act of love? 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 Supreme Court of Canada has dismissed the appeal of a British Columbia man who tried to circumcise his four-year-old son on his kitchen floor with a carpet-cutting blade. The boy needed corrective surgery to repair the severe damage arising from the attack. In a 7-0 ruling, the justices left intact a Court of Appeal ruling that convicted the man of aggravated assault and assault with a weapon. The man was convicted at trial in October 2009 of criminal negligence causing bodily harm and acquitted on the two assault charges. The appeal court restored convictions on the assault counts and stayed the negligence charge, conditional on the conviction for aggravated assault. The man's appeal to the Supreme Court sought to have the assault charges thrown out again, but the justices dismissed the case. The original trial was told the man felt that his religious beliefs required that his son be circumcised. Doctors advised him to wait until the child was older and stronger before performing the procedure. The Crown dismissed the religious reasoning. “This is a case about child abuse,” the Crown argued. "This is not a case about the applicant’s religious freedom or circumcision generally." Source: Father who circumcised his son on the kitchen floor loses high court appeal, <a href="http://www.montrealgazette.com/news/Father+circumcised+kitchen+floor+loses+high+court+appeal/7561185/story.html">Montreal Gazette, 16 November 2012</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 Canada Supreme Court: circumcision "aggravated assault" and child abuse darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Canadian doctors reject circumcision</h2> In a statement released on 9 September the Canadian Pediatric Society confirmed its long-standing opposition to routine circumcision of male infants and boys. The new policy states clearly that the recommendation of the CPS is against circumcision because the benefits are small and outweighed by the risks. This outcome has surprised some observers, who were expecting the CPS to follow the American Academy of Pediatrics to conclude, while not recommending circumcision, that the benefits exceeded the risks, and that circumcision was a matter of “parental preference”. In rejecting this assessment as scientifically unsound, the new CPS policy aligns itself with those of the Royal Australasian College of Physicians and child health experts in Britain and all European countries. Their position leaves the Americans more isolated than ever as the only medical organisation in the world to think that there is anything worthwhile in routine circumcision. <a href="https://www.academia.edu/12035421/Risks_benefits_complications_and_harms_Neglected_factors_in_the_debate_on_non-therapeutic_circumcision" rel="noopener" target="_blank">Scholars have criticised</a> the risk/benefit calculus as inadequate for the “circumcision decision”, as it fails to consider the value of the foreskin and the likely future wishes of the boy, or to give adequate weight to bioethical and human rights principles. It is nonetheless significant that the CPS could recommend against circumcision after a narrow calculation of the strictly medical issues considered pretty much on their own. Once you add the functions of the foreskin and bioethical issues to the equation, the case against circumcision becomes overwhelming. <a href="http://www.cps.ca/en/media/release-communique/canadian-paediatricians-revisit-newborn-male-circumcision-recommendations" rel="noopener" target="_blank">Media release by Canadian Pediatric Society</a> <a href="http://www.arclaw.org/resources/press-releases/arc-press-release-praising-canadian-pediatrics-position-statement-circumcis" rel="noopener" target="_blank">Media release by Attorneys for the Rights of the Child</a> <h2>Strengths and weaknesses in the 2015 Canadian Pediatric Society statement on newborn male circumcision</h2> <a href="http://blog.practicalethics.ox.ac.uk/author/brian-earp/" rel="noopener" target="_blank">Brian Earp, University of Oxford</a> The following critique by Brian Earp, research fellow at the University of Oxford is forthcoming in the Canadian Journal of Pediatrics and is available at his <a href="https://www.academia.edu/15746362/Strengths_and_weaknesses_in_the_2015_Canadian_Paediatric_Society_statement_on_newborn_male_circumcision" rel="noopener" target="_blank">Academia.edu page</a>. The latest statement from the Canadian Pediatric Society (CPS) on newborn male circumcision exhibits both strengths and weaknesses. Strengths include (1) acknowledgement that the foreskin is not redundant skin; that it “serves to cover the glans penis and has an abundance of sensory nerves” (p. 4); that it is adherent at birth and may take several years to become fully retractile; that this is normal and should not be pathologized as phimosis; that true phimosis can be treated non-surgically; (2) acknowledgement that the absolute risk for UTIs in boys is low; that it would take 100+ circumcisions to prevent 1 case; that UTIs may be over-diagnosed in genitally intact boys; that UTIs can be treated non-surgically; that “UTIs in children with normal kidneys do not result in long-term sequelae” (p. 2); (3) acknowledgement that the absolute risk of female-to-male heterosexual transmission of HIV in countries such as Canada and the USA is low; that findings from African trials concerning adult men may not translate to newborn boys in developed countries; that circumcision does not reduce male-to-female transmission of HIV; that safe sex practices must continue to be emphasized; (4) acknowledgement that penile cancer is rare in developed countries; that its association with intact male genitalia is primarily explained by the presence of phimosis; that HPV vaccines are expected to “dramatically decrease the incidence rate of cervical cancer” (p. 3), thereby obviating a role for circumcision; (5) acknowledgement that circumcision is painful; that this pain may have long-term adverse sequelae; that circumcision is a procedure with “lifelong consequences … performed on a [healthy] child who cannot give [his] consent” (p. 4); that the “authority of substitute decision makers is … usually limited [to] interventions deemed to be medically necessary” (p. 4); that newborn male circumcision does not satisfy this condition. Weaknesses include (1) failure to engage seriously with the literature on negative sexual effects of circumcision.[1][2][3] This includes a recent analytic review by Bossio et al.[4] as well as several published critiques of the studies by Kigozi et al. and Krieger et al.,[5][6] the latter of which did not use validated instruments. The CPS authors also conflate adult circumcision and infant circumcision in this section.[5] (2) failure to state that the cited cost-effectiveness estimate concerning lifetime risk of HIV acquisition did not demonstrate cost savings for circumcision in the majority population of white males; (3) failure to explain the inclusion of a brochure by an Australian pro-circumcision lobbying group with no official status[7] as one of three “Selected resources” (p. 5), rather than the official brochure of the Royal Australasian College of Physicians (RACP),[8] which advocates against neonatal circumcision; (4) failure to consider analogous interventions in girls.[9] The non-therapeutic removal of any amount tissue from the female genitalia prior to an age of consent, including procedures that are less invasive than male circumcision, is a crime in Canada, notwithstanding any health benefits that might or might not ensue.[10] References [1] Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int J Epidemiol 2011;40(5):1367-1381. [2] Bronselaer GA, Schober JM, Meyer‐Bahlburg H F, et al. Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int 2013;111(5):820-827. [3] Dias J, Freitas R, Amorim R, et al. Adult circumcision and male sexual health: a retrospective analysis. Andrologia 2014;46(5):459-464. [4] Bossio JA, Pukall CF, Steele S. A review of the current state of the male circumcision literature. J Sex Med 2014;11(12):2847-2864. [5] Earp BD. Sex and circumcision. Am J Bioeth 2015; 15(2):43-45. [6] Frisch M. Author's response to: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? Int J Epidemiol 2012;41(1):312-314. [7] Earp BD, Darby RJ. <a href="https://www.academia.edu/9872471/Does_science_support_infant_circumcision" rel="noopener" target="_blank">Does science support infant circumcision? A skeptical reply to Brian Morris</a>. Skeptic 2015;25(3)23-30. [8] Royal Australasian College of Physicians. <a href="https://members.racp.edu.au/page/paed-policy" rel="noopener" target="_blank">Policy statement and brochure for parents</a>. [9] Earp BD. <a href="https://www.academia.edu/10270196/Female_genital_mutilation_and_male_circumcision_Toward_an_autonomy-based_ethical_framework" rel="noopener" target="_blank">Female genital mutilation and male circumcision: Toward an autonomy-based ethical framework</a>. [10] Earp BD. Do the benefits of male circumcision outweigh the risks? A critique of the proposed CDC guidelines. Front Pediatr 2015;3(18):1-6. <h3>Canadian circumcision policy criticised by children’s health and human rights group</h3> “On right track, but could do better” VICTORIA, BRITISH COLUMBIA – (Sept. 9, 2015) – A just released policy on infant male circumcision by the Canadian Paediatric Society (CPS) was judged today by the Children’s Health & Human Rights Partnership (CHHRP) to be a step in the right direction, but was “nevertheless ‘predictably inadequate’ with respect to several specific issues." CHHRP Medical Director Dr. Christopher Guest, MD, FRCPC, said the new policy is consistent with international paediatric associations that affirm infant boys should not have their healthy foreskins routinely removed. Citing the position of the CPS that recognizes the unique sensory functions of the male foreskin, Dr. Guest asserted that, “A growing number of medical associations now recognize that an intact penis with a foreskin contributes to sexual pleasure for the male and his partner.” According to Guest, in 2010 the Royal Dutch Medical Association concluded, “the foreskin is a complex erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts.” “Circumcision alters the structure of the penis, which inevitably alters function. Long term harm to men from infant circumcision has never been studied” Guest said. Despite this, Guest says men are reporting long-term adverse consequences at the Canadian-based online Global Survey of Circumcision Harm. Although the CPS failed to include it, Guest says scientific evidence has emerged that supports these men’s claims. In 2011, Dr. Morten Frisch published findings in the International Journal of Epidemiology showing that in Denmark, where circumcision is rare, ‘circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in their female partners, notably orgasm difficulties, dyspareunia [difficult or painful sexual intercourse] and a sense of incomplete needs fulfilment.’ Guest faulted the CPS for inclusion of “convenient untruths,” most notably a discussion of HIV being lower in circumcised men. He says such claims are based on methodologically weak African trials, which contradict global HIV trends, for example the United States, which has a high circumcision rate, yet a significantly higher rate of HIV infection than Sweden and Japan where circumcision is rare. “Even if the African trials were scientifically valid, they cannot be used to justify infant circumcision because infants are not sexually active persons,” he said. “Soap and water and safer sex practices, including condoms, can prevent disease.” According to Guest, the CPS failed to include crucial information from a 2012 report by the International NGO Council on Violence Against Children, which CHHRP sent to the CPS in 2014. The report stated that “non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence.” “Medical associations in the Netherlands, Finland, Sweden, Norway, Denmark, Germany, and others confirm that there is no justification for circumcising infants in the absence of medical urgency,” Guest stated. “The CPS is out of step with those medical associations, who also urge an end to the practice due to ethical and human rights concerns.” Although the CPS concluded that routine infant circumcision is not recommended, and that the benefits of the surgery do not outweigh the risks (contrary to a 2012 claim by the American Academy of Pediatrics), Guest contends that the position statement is still insufficient due to its ambiguity in leaving the decision up to parents. “Parents are not physicians. They do not have the medical knowledge to decide if surgery is medically indicated for their child,” Guest asserted. He went on to say that, “Leaving a decision about medically unnecessary surgery up to parents is an ethical failure on the CPS’ part. Where else in medicine do physicians place this burden on parents, in order to obviate their own professional responsibility?” “Preservation of bodily integrity is a basic and universal human right that the CPS must articulate clearly in future statements,” Guest said. “We Canadians, as well as our institutions and government, have an obligation to protect that right for all citizens, regardless of gender or age.” <a href="http://chhrp.org/" rel="noopener" target="_blank">The Children’s Health & Human Rights Partnership</a> was established in 2012 as a partnership of professionals in the fields of medicine, ethics, and law to further public education regarding non-therapeutic genital surgery on Canadian children. <a href="http://chhrp.org/index.php/news/canadian-childrens-rights-group-questions-new-circumcision-policy/" rel="noopener" target="_blank">The CHHRP statement is available here</a>. <h2>Revised circumcision policy issued by British Columbia, 2009</h2> Like Australia, Canada has a past history of widespread circumcision, but a dramatically falling incidence over the past couple of decades. Also as in Australia, it has been the medical profession itself, led by paediatric health authorities, that has taken the initiative to discourage the practice. In recent times Canadian medical authorities have been among the most outspoken opponents of routine (prophylactic) circumcision, and they have issued several <a href="http://www.cirp.org/library/statements/sask2002/">cautions against the practice</a>. Parallel with this attitude, State health authorities in the Canadian provinces (Manitoba partially excepted) do not pay for medically unnecessary circumcision operations, nor reimburse parents through the Canadian equivalent of Medicare unless the procedure is essential to correct a problem. Among the Canadian health authorities that have issued policies that recommend against circumcision is the College of Physicians and Surgeons of British Columbia, which released a revised policy in September 2009. The following points are highlights of the statement. “Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western counties. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention.” The new policy states clearly that “routine removal of normal tissue in a healthy infant is not recommended.” It also points out that: <ul> <li>proxy consent by parents is now being questioned. Many believe it should be limited to consent for diagnosis and treatment of medical conditions, and that it is not relevant for non-therapeutic procedures;</li> <li>an infant has rights that include security of person, life, freedom and bodily integrity.</li> </ul> The policy recommends that doctors should: <ul> <li>Advise parents that the current medical consensus is that routine infant male circumcision is not a recommended procedure; it is non-therapeutic and has no medical prophylactic basis; it is a cosmetic surgical procedure; current evidence indicates that previously-thought prophylactic public health benefits do not outweigh the potential risks.</li> <li>Provide objective medical information about the risk of complications and potential harm in infant male circumcision.</li> <li>Discuss the new ethical considerations of infant's rights and proxy consent in a non-therapeutic procedure.</li> </ul> The full text of the policy appears below. <h3>The College of Physicians and Surgeons of British Columbia</h3> <h2>Circumcision (Infant Male)</h2> Until recently, only public health and religious views were taken into consideration in the debate over infant male circumcision. However, our understanding of medical practice must change as research findings become available. The College is issuing this guide for physicians regarding routine infant male circumcision in light of evidence-based medicine and contemporary principles in ethics, law and human rights. Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention. From a religious standpoint, infant male circumcision is acknowledged to be an important ritual and an integral part of Jewish and Islamic religions. Male circumcision is also practiced in other parts of the world as a rite of puberty. A wider societal discussion on infant male circumcision is warranted based on a current understanding of bioethics that takes into account the non-therapeutic nature of the procedure as well as the high importance it plays in religious and traditional customs. This paper provides a discussion on current medical perspectives as well as relevant legal, human rights, and ethical considerations. Medical Perspectives Circumcision removes the prepuce that covers and protects the head or the glans of the penis. The prepuce is composed of an outer skin and an inner mucosa that is rich in specialized sensory nerve endings and erogenous tissue. Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death. The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended. Legal Considerations To date, the legality of infant male circumcision has not been tested in the Courts. It is thus assumed to be legal if it is performed competently, in the child’s best interest, and after valid consent has been obtained. At all times the physician must perform the procedure with competence and at all times, the parent and physician must act in the best interests of the child. Signed parental consent for any treatment is assumed to be valid if the parent understands the nature of the procedure and its associated risks and benefits. However, proxy consent by parents is now being questioned. Many believe it should be limited to consent for diagnosis and treatment of medical conditions, and that it is not relevant for non-therapeutic procedures. Human Rights Considerations The matter of infant male circumcision is particularly difficult in regards to human rights, as it involves consideration of the rights of the infant as well as the rights of the parents. Under the Canadian Charter of Rights and Freedoms and the United Nations Universal Declaration of Human Rights, an infant has rights that include security of person, life, freedom and bodily integrity. Routine infant male circumcision is an unnecessary and irreversible procedure. Therefore, many consider it to be “unwarranted mutilating surgery”. Many adult men are increasingly concerned about whether their parents had the right to give consent for infant male circumcision. They claim that an infant’s rights should take priority over any parental rights to make such a decision. This procedure should be delayed to a later date when the child can make his own informed decision. Parental preference alone does not justify a non-therapeutic procedure. Others argue that this stance violates the parents’ right to religious or cultural expression, and that adherence to their religious and cultural practices would be in the best interests of the infant. Ethical Considerations Ethical considerations regarding infant male circumcision centre on the welfare (or “best interests”) of the infant and the potential benefit and harm associated with the procedure. Ethics points us to corrective vision, i.e. to question practices that have become routine, or which we take for granted. Therefore, each request for the procedure should be carefully evaluated, and an agreement to perform the procedure should take into consideration the ethical principles of beneficence (duty to benefit); non-maleficence (do no harm); veracity (accurate information); autonomy (consent); and justice (fairness). These principles are articulated in specific responsibility statements in the CMA Code of Ethics. Also included below are items relating to physicians rights and care of the patient. <h3>Canada Medical Association Code of Ethics</h3> Beneficence (duty to benefit) 1. Consider first the well-being of the patient. 14. Recommend only those diagnostic and therapeutic procedures that you consider to be beneficial to your patient and not others. For consideration Medical evidence is that the benefits of routine infant male circumcision do not outweigh the risks of complications from the procedure. Best interests also take into account the infant’s social circumstances. Non-maleficence (do no harm) 33. Refuse to participate in or support practices that violate basic human rights. For consideration Routine infant male circumcision does cause pain and permanent loss of healthy tissue. Veracity (adequate information) 13. Make every reasonable effort to communicate with your patients in such way that information exchanged is understood. For consideration Discussion should include the new understanding that there is a lack of evidence of a real medical benefit in routine infant male circumcision, that it is non-therapeutic, and that only in rare situations is there any clinical indication for the procedure. Specifics of potential risks and complications should also be explained. It is important to ensure a meaningful discussion between physician and parents, and that the information provided is understood. Autonomy (informed consent) 12. Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability. For consideration Parents must be given accurate and impartial information to assist them in making an informed decision. The infant, the actual patient, is unable to give consent. Proxy consent by parents for a non-therapeutic procedure is debatable. Justice (fairness) 29. Recognize that community, society and the environment are important factors in the health of individual patients. For consideration Physicians should understand the basis for the request and consider the infant’s social and cultural circumstances and what might be in the infant’s best interest. Physicians’ Rights 8. Inform your patient when your personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants. For Consideration If your personal beliefs dictate against infant male circumcision, this should be made known to your patients, with an offer of referral to another physician competent in performing the procedure. Care of the Patient 3. Provide for appropriate care for your patient, including physical comfort and spiritual and psychosocial support. 4. Practice the art and science of medicine competently and without impairment. 6. Recognize your limitations and the competence of others, and, when indicated, recommend that additional opinions and services be sought. For consideration As with any medical procedure, if for religious or cultural reasons you decide to perform an infant male circumcision, ensure that your skills are current. Expertise can be maintained only if a sufficient number of such circumcisions are performed. Recommendation Best medical practice includes the following standards of practice for doctors who are asked to circumcise male infants: <ul> <li>Keep up-to-date on the issues surrounding infant male circumcision, including the therapeutic medical indications and legal and ethical issues.</li> <li>Advise parents that the current medical consensus is that routine infant male circumcision is not a recommended procedure; it is non-therapeutic and has no medical prophylactic basis; it is a cosmetic surgical procedure; current evidence indicates that previously-thought prophylactic public health benefits do not outweigh the potential risks.</li> <li>Provide objective medical information about the risk of complications and potential harm in infant male circumcision.</li> <li>Discuss the new ethical considerations of infant’s rights and proxy consent in a non-therapeutic procedure.</li> <li>Listen to parents and consider the basis of their request, which may be based on religious or cultural practices.</li> </ul> [Conclusion] This paper is intended to help physicians use their professional judgement when a request is made for routine infant male circumcision. While parental preference is important, factors like the best available evidence regarding potential benefits and complications, alternatives to this intervention, the infant’s best interest, and current understanding of bioethics should be taken into consideration. You are not obliged to act upon a request to circumcise an infant, but you must discuss the medical evidence and the current thoughts in bioethics that dissuade you from performing this procedure. You must also inform the parents that they have the right to see another doctor. If you decide to perform the procedure for religious, cultural or other reasons: <ul> <li>Ensure that you have the necessary skills and experience, or ensure that the parents and child are referred to a physician who has these skills.</li> <li>Obtain valid consent from both parents and ensure that both parents sign a consent form.</li> <li>Provide the procedure under hygienic conditions with appropriate analgesia and aftercare.</li> </ul> RESOURCES CITED American Academy of Pediatrics. Task force on Circumcision. Circumcision Policy Statement. Pediatrics 1999; 103: 686-693 British Medical Association Committee on Medical Ethics: <a href="http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp">The Law and Ethics of Male Circumcision: guidance for doctors</a>, March 2003 Canadian Medical Association. Code of Ethics. Can Med Assoc J 1996; 155: 1176A-B Canadian Paediatric Society. <a href="http://www.cps.ca/english/statements/FN/fn96-01.htm">Neonatal circumcision revisited</a>. Can Med Assoc J 1996: 154(6): 769-780 College of Physicians and Surgeons of BC. Code of Ethics. Policy Manual. College of Physicians and Surgeons of Manitoba. Neonatal Circumcision. Winnipeg: College of Physicians and Surgeons of Manitoba 1997 College of Physicians and Surgeons of Saskatchewan. Caution against Circumcision of Newborn Male Infants. Feb 2002 Christakis DA, Harvey E, Zerr DM et al. A Trade-off Analysis of Routine Newborn Circumcision. Pediatrics 2000. 105: 246-249 Goodman J. <a href="http://www.cirp.org/library/cultural/goodman1999/">Jewish Circumcision: an alternative perspective</a>. BJU International 1999. 83: Suppl. 1, 22-27 Paton M. The Ethics of Circumcising Male Babies. The Bioethics Bulletin (June 1992). Edmonton, University of Alberta. Richards D. <a href="http://www.cirp.org/library/legal/richards/">Male Circumcision: Medical or Ritual?</a> Journal of Law and Medicine 1996. 3:371-376 Somerville M. <a href="http://www.intact.ca/canary.htm">Altering Baby Boys’ Bodies: the ethics of male circumcision</a>. The Ethical Canary: Science, Society and Human Spirit. Toronto: Viking, 2000:202-219 Szasz T. <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=70&Itemid=0">Routine Neonatal Circumcision: Symbol of the Birth of the Therapeutic State</a>. Journal of Medicine and Philosophy 1996:21:137-14, 8 September 2009 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Canadian Pediatric Society: recommends against 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>Canadian urologists reject routine circumcision</h3> In a major statement based on a comprehensive survey of the medical literature in January 2018, the Canadian Urological Association has concluded that routine prophylactic circumcision of male infants and boys is not justified as a preventive health measure. The statement is of particular interest because it reaches this conclusion on the basis of a very narrow calculation of medical benefits, costs and risks, pays little attention to the harms of circumcision (such as effect on male sexuality, moral harm of denying choice etc) and largely ignores bioethical and human rights issues. The statement emphasises that the results of clinical studies in underdeveloped regions with acute health and social problems cannot be mapped onto developed nations with quite different epidemiological and social environments, and point out that “The effect of MC has to be analyzed at the individual and societal level.” The statement is at pains to point out that the evidence as to the benefits and risks of circumcision is contradictory and inconclusive, and that much of it is of poor quality, especially studies claiming to show that circumcision has little impact on sexual sensation and function. The final conclusion is that while circumcision does offer some advantages, they are small, can be achieved by other, non-surgical means, and are outweighed by the risks and harms. This being the case, routine circumcision is not justified as a health measure and cannot be recommended. INTRODUCTION “Circumcision is the oldest planned operative procedure in the history of the human civilization but there continues to be a lack of consensus and strong opposing views on whether universal neonatal circumcision should be adopted as a public health measure. … A review of the literature on MC shows evidence of a vehement debate, often clouded by strong personal biases and lack of high quality evidence. Creation of a guideline specific to the need of Canadian infant males is therefore difficult given the level of evidence provided for each potential benefit, the lack of data directly applicable to the Canadian population, the inability to quantify the true complication rate of routine circumcisions accurately, uncertainty about the health benefits of a circumcision compared with other health interventions, the ethical issues and acceptability of a surgical procedure done by parental consent for future benefits, and the costs of training and implementation of any universal neonatal circumcision policy in Canada.” In its conclusion the statement emphasises that the results of clinical studies in underdeveloped regions with acute health and social problems cannot be mapped onto developed nations with quite different epidemiological and social environments, and point out that “The effect of MC has to be analyzed at the individual and societal level. For the individual Canadian neonate, there are definite advantages of a circumcision, but the exact estimates of the effect are unknown, the protection provided is not comprehensive, accrue over a life-time and can be achieved by other preventive health measures. … There are also clear risks associated with this surgical procedure and parents will continue to have to weigh the potential benefits and risks of neonatal circumcision. In an overall societal perspective, given our health care system and the socio-economic and educational status of our population, universal neonatal circumcision is not justified based on the evidence available." Source: Sumit Dave, Kourosh Afshar, Luis H. Braga, Peter Anderson. <a href="http://www.cuaj.ca/index.php/journal/article/view/5033/3371" rel="noopener" target="_blank">CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants</a>. Canadian Urological Association Journal 2017 Dec. 1; Epub ahead of print. http://dx.doi.org/10.5489/cuaj.5033. Earlier policies and policies issued by the various provincial medical bodies and the Canadian Pediatric Society <a href="http://www.cirp.org/library/statements/">are available from CIRP</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 Canadian Urological Association: routine circumcision "not justified" darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>USA</h2> <h3>Circumcision in the United States of America</h3> In the United States circumcision emerged at the same time as in Britain and for much the same reasons: hostility to masturbation, delusions about congenital phimosis, fear of diseases like syphilis and cancer. But it got its biggest boosts from the two world wars and from the medicalisation of childbirth. The importance of both the obstetricians/gynecologists and the the military in the promotion of circumcision in the USA cannot be overestimated. Although experts in venereal diseas such as Abraham Wolbarst had called for universal circumcision as early as 1914 [1], it was the obstetricians and gynecologists who were responsible for realising his dream. It may seem strange that the most important advocates of routine male circumcision within the medical profession were experts in women's health, who knew little and cared less about male anatomy, but from the 1930s onwards it was the obstetricians and gynecologists who most vigorously touted the advantages of the procedure and performed most of the operations. Symptomatic of their power was the introduction of <a href="https://www.historyofcircumcision.com/templates/pages/the_gomco_clamp_1935.html">the Gomco clamp</a> by the obstetrician Hiram Yellen, who wanted a device that was so simple to use that his colleagues would be able to claim the circumcision procedure from fussy and expensive surgeons who still insisted on anaesthetics and strict control of bleeding. The result was that circumcison came to be seen as part of the birth process, often performed within a day or even a few hours of the boy's arrival in the world - a procedure no more surgical or problematic than tying his umbilical cord [2]. So obsessed did these specialists in women's bodies become with altering male bodies that it was not unknown for them to circumcise the poor boy before he had even fully emerged from the womb. The authors of a book on childhood diseases report: "The practice of circumcision has become almost universal in the United States.... Some obstetricians have made early circumcision almost a fetish, reaching it to a reductio ad absurdum in one instance with which we are familiar in which the operation was performed when the hips been delivered and pending expulsion of the upper half of the body." [3] <h3>Military discipline</h3> The US military was another important influence. Around the turn of the last century, circumcision of infants was still rather rare, though circumcision of older boys was gaining in popularity. During World War I, the military led a concerted effort to circumcise soldiers and sailors because it was believed that this would make them less susceptible to venereal disease; military discipline forced men to submit to a procedure they would never have agreed to had it been left to their own decision. Thousands of men were circumcised in their late teens and early 20s. When these men returned home and became fathers, doctors began asking whether they wanted their newborn sons circumcised. Many, remembering the pain that they or their buddies endured from the operation as adults, said yes, thinking it would avoid having to do it later, when the pain was thought to be worse than in infancy. Most babies, however, continued to be born at home and were not circumcised. By the outset of World War II, the USA had circumcision rates of about 40-50 per cent and Britain 30 to 40 per cent. Most sources agree that circumcision in the UK continued its climb until just about the outbreak of war. After the Second World War, there was a remarkable split in circumcision rates in the USA and Britain. The UK was absolutely ravaged from war - there were no spare resources anywhere. The National Health Service, which had originally been planned for the 1930s and delayed, finally came into being quite shakily in July 1948. Most people predicted its imminent failure. While circumcision was theoretically "included" in the free procedures, most physicians had real trouble justifying it in the climate of near-poverty. There was thus no financial incentive for unnecessary surgery. <h3>Role of medical insurance</h3> In the USA, there was rapid development and prosperity after World War II. One consequence of this was the shortage of labour for all the newly-created jobs. From the early 1950s, companies began offering lavish benefits packages to lure employees, and it became standard for them to include full, private health insurance as a condition of employment. Thus, there was no need for the US government to even investigate starting a national health scheme as long as there was full employment and companies were falling over each other to provide the most lavish plans. Almost all of these private insurance packages paid for male infant circumcision, then considered to be quite a progressive and good thing to do. The USA saw a tremendous rise in the number of hospital births after the war, and it became a sign of backwardness to have a child at home. Even the poorest citizens arranged to have their babies in hospital. During the 1950s the rate of routine infant circumcision exploded from about 50 per cent to about 90 per cent. This was also fuelled by the popular press, such as Dr. Benjamin Spock's Baby and Child Care. Nearly every American family had (has!) this bible of child care on their bookshelf. In the earliest editions, appearing just after World War II, Dr. Spock argued that circumcision is a very good idea, particularly if the other boys in the neighbourhood were also cut. Caring for the baby would then be easy, and he'll grow up feeling "regular" (i.e., not eccentric, different or in any other way un-American - it is a very conformist culture). In the 1980s Spock recanted this advice and suggested that being intact was just fine and that parents should leave baby boy's penises alone. But it was harder to stop a trend than to start it. In 1959 the circumcision rate in the USA was about 90 per cent. It was very rare to see a foreskin in the changing room. Those that did have one also usually had a story: born premature, to immigrant parents, or overseas and came to the USA as children. In Britain the incidence of neonatal circumcision declined to less than 5 per cent by the early 1950s. During this same period, it was skyrocketing in the USA. The biggest difference was probably around 1960, when hardly any British boys were cut and nearly every American boy got circumcised. The difference is illustrated in the contrasting answers given to the question "Should the baby be circumcised?" by the American obstetrician <a href="https://www.historyofcircumcision.com/templates/pages/should_he_be_circumcised_1941.html">Alan Gutttmacher in 1941</a> and the British surgeon <a href="https://www.historyofcircumcision.com/templates/pages/sir_daniel_whiddon_should_baby_be_circumcised.html">Sir Daniel Whiddon in 1953</a>. Although there had always been American <a href="https://www.historyofcircumcision.com/templates/pages/sceptics_and_dissenters.html">critics of the ever-spreading circumcison fashion</a>, they did not begin to have much infuence (as evidenced by a fall in the incidence of the practice) until the 1970s. <h3>A correspondent in the USA reports:</h3> This past weekend I was up in Vancouver, Canada for their last good beach days of the summer. Wreck Beach is one of North America's largest nude beaches, and it sits right on the campus of the University of British Columbia. I've been going there every summer for the past 16 years, and have noticed a marked change in the college students. They guys now seem to be about 50/50 cut/uncut, which is very different from the 80% cut I was seeing in the 1980's. By my estimates, most undergraduates at UBC are now intact, and soon it will be something like 3/4 uncut. This reflects the rapid decline of circumcision in Canada in the early 1980s. This is such a contrast to the USA for various reasons. One, of course, is that more than a million baby boys still get circumcised every year in the USA - most within the first 24 or 48 hours of life. Second is the fact that "modesty" has reached insane levels in the newly-conservative USA, unlike most other countries. High schools have been ripping out shower rooms with a vengeance during the past 10 years as boys refuse to undress in front of one another, and parents have begun to sue school districts for invasion of privacy (forcing boys to reveal their private bits to one another in gym class). Now kids just stink as they go from gym class to history class. Even the athletes do not shower after practice after-school: they ring Mom to come get them so they can shower alone at home, out of view of their mates. The net effect of this is that most American males born today will never see another male naked in their lives until, and if, they have a son of their own. If they see him at birth they will certainly view his long, tapering penis as something quite strange and probably regard it as unnatural. Even then, quite a few American males will go to their graves never having seen a penis other than their own. My guess is that this is going to turn the country even more neurotic than it is, and makes issues like stopping circumcision more difficult. Whilst the "locker room" argument now holds no water, circumcised men are more afraid than ever of the unknown. <h3>A puzzling situation</h3> Why routine circumcision persists in the USA, long after it has been largely or entirely abandoned by the other anglophone countries which originally took it up, remains a puzzle. How deeply embedded in modern American culture it seems to be is indicated by a story told by the paediatrician Robert Van Howe, who reports that he once spent hours resuscitating and assessing the injuries of a boy who had been born unable to breathe, without a pulse, and with a broken humerus and depressed skull fracture resulting from a difficult forceps delivery. He then visited the mother, whose first question was "When can he be circumcised?" Such a sense of priorities sharply indicates the privileged place of male circumcision in modern America and highlights the difficulties in explaining what Edward Wallerstein has called "the uniquely American medical enigma". Despite <a href="http://www.cirp.org/library/statements/" rel="noopener" target="_blank">statements from the American Academy of Pediatrics</a> and the College of Obstetricians and Gynecologists in 1971, 1975, 1978 and 1983, he noted in 1985 that the practice had abated little. Even today, after further statements in 1989 and 1999, the operation is performed on well over half of all of newborns. Van Howe suggests seven lines of inquiry. (1) The foreskin is the focus of myths, misconceptions and irrationality affecting medical profession and public alike. (2) Lack of respect for the rights and individuality of children. (3) A contrasting exaggerated delicacy with respect to the presumed sensibilities of religious minorities which practise circumcision for cultural reasons. (4) The reluctance of physicians to take a firm stand against circumcision and to refuse parental requests. (5) Bias in American medical journals, which tend to favour articles with a pro-circumcision tendency and are reluctant to publish critiques, much less developed arguments against. (6) Failure to subject circumcision to the normal protocols for surgery, such as the need for informed consent, evidence of pathology and proof of prophylactic benefit. (7) Strong financial incentives to perform the operation, usually guaranteed by medical insurance coverage. The last of these points has been stressed by a number of critics. In their <a href="http://www.icgi.org/" rel="noopener" target="_blank">analysis of Medicaid funding</a>, Amber Craig and colleagues found that low and declining rates of circumcision correspond to regions where the procedure is not funded, most noticeably in California. <h3>The market for medical services</h3> As David Gollaher and any analysis of the economics of medicine have shown, doctors are not disinterested scientific observers, but professionals selling a service in return for a fee. The rapid spread and obstinate survival of circumcision in the USA may thus be related to a probable chronic oversupply of doctors there, an aspect of the bloated medical industry which the vast wealth of the world's richest nation is able to sustain. American physicians seem have always been short of well-paying patients, sharply on the look-out for little jobs offering a good return, and consequently liable to invent new disease conditionss requiring frequent trips to the surgery. Many of the nervous syndromes of the late Victorian period - hysteria, neurasthenia, spinal irritation, reflex neuroses, congenital phimosis and preputial adhesions in male and female - can be accounted for in no other way. Dr Robert Morris suggested in 1892 that since 80 per cent of American women suffered from adhesions which bound the clitoris to the prepuce and produced many bodily disturbances, female physicians should be required to inspect the genitals of all schoolgirls to ensure that proper separation between prepuce and clitoris had occurred. He was confident that most of the girls would require surgery, and this was a good thing, since it provided work for female doctors: "The separation of adhesive prepuces in young unmarried women should be done by female physicians anyway, and such physicians can be abundantly occupied with this sort of work". [4] This desperate search for something to do, and someone to do it to (in a word, new and bigger markets for medical services) in turn feeds and is fed by the illusion that universal perfect health is an achievable goal: all that is needed are more funds for medical research, more health services, more doctors, more programs etc. Alas, the goal of perfect health for all is as unattainable as perfect happiness or a perfect partner for everybody: with avoidable medical accidents the eighth most common cause of death in the USA, it is probable that more illness and injury are caused by chasing this chimaera than by accepting the limits of health and beauty that one's genes and environment have determined. On the inflated importance of both health and sickness in the world today, see: <a href="http://www.spiked-online.com/Articles/0000000CA958.htm" rel="noopener" target="_blank">Frank Furedi, "Our unhealthy obsession with sickness"</a> <a href="http://www.spiked-online.com/Sections/health/Column/index.htm" rel="noopener" target="_blank">Dr Michael FitzPatrick's astringent observations in his health column for Spiked-online</a> <h3>But the times, they are a-changing</h3> Even in the USA, however, more doctors are realising that it is unnecessary, harmful and unethical to deprive baby boys of their foreskin unless there is an immediate medical problem that can only be corrected in that way. For an indication of the trend of American mendicalthinking, see <a href="https://www.historyofcircumcision.com/templates/pages/american_doctors_today.html" rel="noopener" target="_blank">a recent article by Dr Roxanne Allegretti</a>, of Fredericksburg, Virgina. <h3>Notes</h3> 1. Abraham Wolbarst, "Universal circumcision as a sanitary measure", Journal of the American Medical Association, Vol. 62, 1914, p. 92-7 2. Richard Miller and Donald Snyder, "Immediate circumcision of the newborn male", American Journal of Obstetrics and Gynecology, Vol. 65, 1953, p. 1-11 3. Schaffer and Avery, Diseases of the Newborn (4th edn, Philadelphia: W.B. Saunders, 1977), p. 420 3. Robert Morris, "Is evolution trying to do away with the clitoris?", Transactions of the American Association of Obstetricians and Gynecologists, Vol. 5, 1892, p. 293. Morris had of course been inspired by the argument of P.C. Remondino, in his History of circumcision from the earliest times: Moral and physical reasons for its performance (1891), that this was exactly what evolution was trying to do with the male foreskin - though found itself in need of a helping hand from surgeons like him. <h3>Further reading</h3> Frederick Hodges, "A short history of the institutionalization of involuntary sexual mutilation in the United States", in George C. Denniston and Marilyn Milos (eds), Sexual mutilations: A human tragedy, New York, Plenum Press, 1997 Robert Van Howe, "<a href="http://www.nocirc.org/symposia/fourth/vanhowe.html" rel="noopener" target="_blank">Why does circumcision persist in the USA?</a>" David Gollaher, "From ritual to science: the medical transformation of circumcision in America", Journal of Social History, Vol 28, 1994, pp. 5-36 <a href="http://www.cirp.org/library/history/gollaher/" rel="noopener" target="_blank">Full text available here</a> Geoffrey P. Miller, "Circumcision: Cultural-Legal Analysis", Virginia Journal of Social Policy & the Law, Vol. 497, 2002, pp. 497-585 <a href="http://www.cirp.org/library/legal/miller1/" rel="noopener" target="_blank">Full text available here</a> Sarah Waldeck, "Using male circumcision to understand social norms as multipliers", University of Cincinnati Law Review, Vol. 72, Winter 2003, pp. 455-526 <a href="http://www.cirp.org/library/legal/USA/waldeck1/" rel="noopener" target="_blank">Full text available here </a> Edward Wallerstein, "<a href="http://www.cirp.org/library/general/wallerstein/" rel="noopener" target="_blank">Circumcision: The Uniquely American Medical Enigma</a>", Urologic Clinics of North America, Vol. 12, 1985, p. 123-32 Lawrence Dritsas, "<a href="http://www.cirp.org/library/general/dritsas1/" rel="noopener" target="_blank">Below the belt: Doctors, debate and the ongoing American discussion of routine neonatal male circumcision</a>", Bulletin of Science and Technology, Vol. 21, 2001, pp. 297-311 Robert van Howe, "<a href="http://www.cirp.org/library/procedure/vanhowe2004/" rel="noopener" target="_blank">A cost-utility analysis of neonatal circumcision</a>", Medical Decision Making, Vol. 24, 2004 (December), pp. 584-601 Robert Darby, "The sorcerer's apprentice: Why can't we stop circumcising boys", <a href="http://www.contextsmagazine.org/" rel="noopener" target="_blank">Contexts magazine</a> (USA), Vol. 4, No. 2, Spring 2005. <a href="https://www.historyofcircumcision.com/templates/pages/the_sorcerers_apprentice.html">Expanded version available on this site</a>. <a href="http://nsrc.sfsu.edu/Index.cfm?SID=0AA92552A799311BADA7FC483B1CD665&DSN=nsrc_rev2&Page=1" rel="noopener" target="_blank">American Sexuality Magazine</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 History of circumcision - USA darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h4>Medical science in the service of Victorian morals</h4> The following article was originally given as a paper to the Fourth International Symposium on Sexual Mutilations, held at Lausanne, Switzerland, in August 1996. Although it may seem rather dated today, it blazed the research trail for others, and remains a milestone in the excavation of the true history of medically rationalised circumcision. It is a remarkable pioneering effort to uncover the truth by going back and reading the almost incredible things that doctors did not so long ago, and about which they reported, often with grisly detail, in their own professional journals. The thoroughness of the bibliography alone makes this paper one that no student of the history of circumcision can afford to ignore. <h2>A short history of enforced circumcision in the United States</h2> For the past 130 years the American medical industry has been involved in the business of removing part or all of the external sexual organs of male and female children. While the origins of sexual mutilations among prehistoric and primitive peoples is a matter for theory and speculation, the origin and spread of sexual mutilation in American medical practice can be precisely documented. Seen in the proper context of the entire scope of western history, the modern American enigma of institutionalized sexual mutilation is an historic aberration of profound significance and degree, one that could never have been predicted, and one that perhaps could not have been avoided. <h3>1. Modernization</h3> The introduction and spread of institutionalized secular sexual mutilation was a response to the tremendous social and cultural anxieties engendered by the effects of the rapid modernization and industrialization of the early decades of the nineteenth century. As the traditional rural-agrarian economy was transformed into an urbanized capitalist economy, parallel changes occurred in social structure, governmental and non-governmental institutions, demographics and technology. One significant result of these changes was the ascendancy of the middle class to positions of economic and political power. The emergent middle class was now in a position to reinterpret social mores and redefine the individual for all of society. As an outgrowth of the middle class, the medical establishment reflected and validated these social changes and offered treatment for the anxieties they inevitably produced, thereby laying the foundations of the modern therapeutic state â€“ defined by Thomas Szasz as the political order in which social controls are legitimized by the ideology of health [1]. For instance, in traditional agrarian society adulthood was considered to begin at puberty. Industrialized, middle class society extended the boundaries of childhood by ore than a decade so that middle class males could receive the specialized professional and academic training required by a modern industrialized society. The formidable anxieties engendered by this transformation found expression in an intensified focus on childhood sexuality. In conformity with middle class social mores, physicians theorized that childhood should be a period of complete asexuality and, consequently, that children should be kept ignorant of sexual and reproductive information until their delayed marriage. The functional significance of this change was that young people, who in previous generations had been expected to marry and commence sexual activity in early adolescence, were now required to restrain themselves from sexual activity and remain continent until they were in their twenties. Young people who were unable to suppress their sexual drives were subjected not only to social censure, but to medical interventions as well. <h3>2. Supporting medical theories</h3> <h4>2.1 Degenerative theory of disease and the notion of reflex neurosis</h4> For reasons unrelated to the rise of the American middle class, two French physicians in the 1820s, Xavier Bichat (1771-1802) [2] and Francois Broussais (1771-1838) [3], developed a new model of disease â€“ the theory degenerative disease. This model postulated that the human body was allotted a finite amount of vital energy which could either be conserved through correct living or permanently lost through wrong living. Energy depletion led to degeneration, which in turn led to the production of disease. Middle class American physicians readily adopted this theory, but they expanded it to imply that manifestations of sexuality necessarily represented life-threatening losses of vital energy. Non-procreative use of the sexual organs, even within marriage, was viewed as dangerous. The result was the formulation of the Reflex Neurosis Theory of Disease, which postulated that the sexual organs and the erotic sensations they produced were the cause of all human disease. To validate this theory, American physicians redefined normal human sexual behaviour, reproductive anatomy and sexual function in terms of pathology. Pathologization of sexual behaviour The pathologisation of normal sexual behaviour resulted in the masturbation hysteria. The term masturbation was frequently used in a generalised way to describe any sexual activity outside the context of heterosexual marital coitus for the purpose of procreation, but in practice a diagnosis of masturbation generally followed the discovery of a child's either having sexually stimulated him/herself or having engaged in sexual activity with another person. Physicians relied on spurious logic to support the pathologisation of sexual behaviour. Clinical interviews with patients suffering from what would today be ascribed to the effects of malnutrition, overwork, venereal disease, bacterial or viral infections, mental disorders, and tobacco or alcohol poisoning invariably revealed a past history of masturbatory activity. On this basis it was easy to conclude that masturbation had brought on these conditions. The inhabitants of the United States were at first reluctant to accept the theory that masturbation was harmful, and many resisted doctors' interference in the lives of their children; but the rising flood of articles in medical journals that allegedly proved the harm of masturbation gave physicians the power to overcome this resistance and enforce their own convictions. Pathologization of sexual anatomy In order to validate the Reflex Neurosis Theory of Disease, physicians were compelled to pathologize the three distinguishing features of the normal juvenile foreskin, namely, generous length, adherence to glans and narrowness of the preputial orifice. These perfectly natural qualities were demonized under the general diagnosis of phimosis. Physicians coined the term "congenital phimosis" to specify that the adhesion of the immature foreskin to the glans in infants was really a congenital birth defect. They adopted the term "acquired phimosis" to indicate a fictitious condition in which a previously detached foreskin became adherent as a result of masturbation. The term "hypertrophic phimosis" or "redundancy" indicated a type of phimosis whose sole symptom was a foreskin that doctors arbitrarily deemed to be "too long". Since the foreskin is the most highly innervated part of the penis, and since masturbation among normal (not circumcised) boys generally involves manually stimulating and manipulating the foreskin, and sliding the mobile sheath of the penile skin up and own the shaft (the structure of the foreskin facilitated a wide range of motion), masturbation was seen as a cause of reflex disease through the medium of the foreskin. In the absence of the germ theory of disease, American physicians who did not regard masturbation alone as the primary cause of disease, attributed bacterial, viral and fungal diseases, as well as the pathological symptoms of malnutrition, overwork etc, to phimosis. Even in the absence of a diagnosis of phimosis, the foreskin itself was indicted as a cause of disease. Phimosis in females, defined as adherence of the clitoral prepuce to the clitoris, was viewed in much the same light. Pathologization of sexual function In accordance with the Reflex Theory of Disease, erotic sensation was redefined as irritation, orgasm was redefined as convulsion and erection was redefined as priapism. Physicians argued that these manifestations of sexual function were both symptoms and cause of disease and, likewise, that stimulation of the genitals could cause problems in distant parts of the body, such as the heart, brain, back, digestive organs and eye. The pathologization of normal male sexual function soon led to the invention of spermatorrhoea. Physicians defined spermatorrhoea as a serious venereal disease whose sole symptom was the ejaculation of sperm under any condition other than marital intercourse. The release of sperm in nocturnal emissions or masturbation was now classified as a venereal disease as dangerous as any other â€“ if not more dangerous because more people suffered from it more often. Hundreds of case reports published in medical journals all over the western world proved, to the satisfaction of most physicians, that spermatorrhoea was a real and dangerous disease. French physicians such as Claude-Francois Lallemande (1790-1853) and Leopold Deslandes (1797-1852) [4] were the acknowledged world authorities n the treatment of spermatorrhoea. Their preferred treatment was to insert long steel rods, also known as bougies, up the urethra and cauterize the passage, as well as the prostate and seminal vesicle, with silver nitrate. This was supposed to slow the production and halt the loss of sperm. Lallemande also advised amputation of the foreskin in difficult cases of spermatorrhoea and in order to stop masturbation among boys. In the United States Lallemande's enthusiasm for circumcision caught the attention of Edward H. Dixon (1808-1880). In his Treatise on the Diseases of the Sexual Organs (1845) he became one of the first north American advocates of both therapeutic foreskin amputation (to correct an existing problem) and of the universal imposition of the ancient Hebrew rite of infant circumcision (as a prophylactic against possible future problems). [6] Dixon claimed that phimosis, which he defined as an elongation of the foreskin, was the primary cause of most serious diseases. At first Dixon and Lallemande were largely ignored, and for the next two decades circumcision was overlooked while other surgical treatments for masturbation, phimosis and spermatorrhoea were developed and trialled. <h4>2.2 Castration</h4> Since surgical amputation of body parts in general was considered thoroughly modern and advanced, physicians experimented with specific amputations of the sexual organs to treat masturbation. In 1842 the Boston Medical and Surgical Journal (now the New England Journal of Medicine) reported that Dr Winslow Lewis of Boston had severed and tied the left spermatic artery of a young man being treated for "excessive masturbation" [7]. In 1843 one of the first reports of castration for masturbation was published by Dr Josiah Crosby of Meredith Bridge, New Hampshire. After cathartics and emetics had failed to cure a 22-year old man, whose health had reportedly been ruined by masturbation, Crosby castrated him and pronounced him cured. [8] The American medical profession responded with interest. Two years later Dr Samuel McMinn published, in the Boston and Medical Surgical journal, a revolutionary report about an insane woman living near Tuscaloosa, who had taken a razor and amputated "the whole of her external organs of generation." McMinn arrived at the scene and fully expected the woman to die from her massive wounds, but she survived. As her wounds healed, her reason miraculously returned. Fascinated by this outcome, McMinn speculated: <div>And the results of this case may suggest a remedy. Whether it was the great loss of blood, the removal of the organs and the counter-irritation consequent that cured the patient is a question for the consideration of the profession. [9]</div> The title he gave to his report, however, betrayed his own, and presumably the journal editor's opinion as to the source of the cure. The report was dramatically entitled "Insanity cured by excision of the external organs of generation". Ten years later, in 1855, Dr William Taylor published a similar report involving a cigar-maker from Philadelphia who had gone insane and hacked off his penis and testicles with a broken bottle. [10] Although he bled profusely, his wounds healed, and his reason returned. No further proof was needed. A revolutionary new surgical approach to masturbatory insanity had been established just as the innovation of aseptic surgery was opening new vistas for surgical ambition. Orthodox American medicine now embarked upon the wholesale amputation of sexual organs as a the preferred cure for a wide range seemingly unrelated conditions. In mental hospitals inmates were castrated on a massive scale in order to stop them from masturbating and thereby restore their sanity. Right up until the beginning of the twentieth century boys caught masturbating were frequently committed to insane asylums where they could be circumcised, castrated and shackled in their cells [11, 12]. Females were subjected to "female castration", a surgery involving the removal of the ovaries, aimed at curing them of hysteria, epilepsy or nymphomania. <h4>2.3 Spermectomy, neurectomy and other treatments</h4> Various other surgeries aimed at eliminating sexual desire and thereby stopping masturbation also were developed. "Spermectomy" was invented as a less drastic alternative to castration, and consisted in the surgical removal of the spermatic ducts rather than the testicles. [13] Neurectomy had a certain vogue in the 1890s. Commonly performed on boys who had been caught masturbating, this involved the physician severing the dorsal nerves of the penis in order to destroy sensation and function completely and permanently. [14, 15] American physicians also resorted to relatively less drastic measures, such as slitting open the urethra [16}, cauterizing the prostate [17], corporal punishment [18], blistering the penis with caustics, acids or heat [19], flaying the skin of the penis with razor blades [20], sewing the penis shut with metal wire (infibulation) [21], encasing the genitals in plaster or lockable metal cages [22, 23], or fitting the penis with rings studded with sharp teeth to discourage erections [24]. In the case of females, the preferred treatment for epilepsy and masturbation was clitoridectomy. One of the first reports of therapeutic clitoridectomy was published in the San Francisco Medical Press in 1862, the abstract of which explained: <div>Dr E.S. Cooper, editor of the San Francisco Medical Press, relates two cases of removal by the scalpel of the clitoris in young girls who were inveterately addicted to the habit of masturbation, and for whom there was apparently no alternative but hopeless insanity or an early grave. The result was a perfect cure in one case, and in the other the practice was broken up, and all the mental faculties improved, except the memory, which is not restored. [24]</div> In the late 1860s the British obstetrician Isaac Baker Brown developed and promoted clitoridectomy as a cure for epilepsy and other mental problems in women. His claims of miracle cures aroused widespread interest at first, but his methods eventually alarmed professionals in the new specialty of obstetrics, and in 1867 his conduct was called into question and expelled from the Obstetrical Society. Although many continued to believe in the value of clitoridectomy, Brown's main offences were an unprofessional degree of self-promotion and failure to obtain informed consent from his patients. (He was in the habit of chloroforming any patients who came to his surgery and performing the operation on them, no matter what the problem they complained of, without telling them what he was going to do.) The British medical press was overwhelmingly in favour of banning Baker Brown, but he was vigorously defended in the United States. The editor of the influential Medical Record strongly criticised the anti-clitoridectomy crusade in England and demanded, "What now will be the chance of recovery for the poor epileptic female with a clitoris?" [26] <h3>3. Circumcision as therapy</h3> On 1 December 1855 the English surgeon Jonathan Hutchinson (1828-1913) published a paper that was to become one of the most influential texts in the history of circumcision advocacy, "On the influence of circumcision in preventing syphilis" [27]. During the 1850s London experienced a massive immigration of Jewish settlers from the ghettos of eastern Europe, attracted by the liberal and tolerant attitude prevailing in England. Hutchinson reported that at the Metropolitan Free Hospital in east London, where many of the immigrants settled, fewer Jews than Englishmen sought treatment for syphilis. Being innocent of any awareness of the principles of statistical analysis, epidemiology, the germ theory of disease or the quarantine effect of ghetto living, Hutchinson asserted that only circumcision could account for the difference in the incidence of the disease. Despite its obvious flaws, Hutchinson's paper was widely reported in foreign medical journals and continued to be cited as authoritative right up until the 1940s. In 1857 it was used as evidence at medical tribunal in Vienna, where a certain Dr Levit (under the influence of a modern western education and possibly impressed by the anti-circumcision movement in reform Judaism in Germany at that time) refused to allow his newborn son to be circumcised. The local rabbinate, under the influence of Dr Joseph Hirschfeld, held up Hutchinson's paper as proof that circumcision was not an outmoded rite, but a modern and scientifically valid means of avoiding disease. It was sufficient justification for the rabbinate to seize Levit's son and forcibly circumcise him against his father's wishes. Levit was left without legal recourse to protect his own child. [28] On the strength of Hutchinson's figures, circumcision as a prophylactic intervention now made a cautious reappearance in orthodox American medicine. At a meeting of the Boston Society for Medical Improvement on 12 August 1861, a Dr White presented a paper in which he mentioned that circumcision could prevent masturbation. [29] Seven years later Dr Charles Bliss, of Syracuse, New York, published an account of his success in curing masturbation by partial amputation of the prepuce. [30] In 1869 a learned article by the Baltimore physician A.B. Arnold described the history of circumcision in the religious context of Jews, Muslims and certain African peoples. [30] The new surgery was being legitimised by being placed in a long history, even though it was a non-western and largely Asiatic history. <h4>3.1 The American Medical Association</h4> Hailed in his lifetime as the father of orthopaedics and indeed as one of "the most distinguished benefactors whom the American medical profession has produced for the glory of medicine and the good of mankind" [32], Dr Lewis A. Sayre (1820-1900) was certainly among the most distinguished believers in the therapeutic powers of circumcision. He served as vice-president of the American Medical Association in 1870 and as president in 1880. At the annual meeting of the AMA in 1870 he delivered a remarkable paper entitled "partial paralysis from reflex irritation, caused by congenital phimosis and adherent prepuce" [33]. Supporting his claims with numerous case studies and clinical evidence, and deploying the most scientific methodologies available at that time, Sayre proved to the satisfaction of his audience that a long, adherent foreskin could not only cause paralysis in various limbs, but also hip-joint disease (probably tuberculosis of the hip-joint), hernia, bad digestion, inflammation of the bladder and clumsiness. In each case Sayre reported that amputation of the foreskin had cured the problem. For the rest of his career Sayre urged physicians always to examine a boy's prepuce in all cases of disease. Whenever phimosis, as defined by reflex theory, was found, Sayre advised immediate amputation of the foreskin. Because of his professional reputation and impeccable credentials, major American medical schools steadily incorporated Sayre's theories and therapies into their curricula. During the late 1860s and throughout the next decade epilepsy was increasingly the focus of medical interest, as indicated by the growing number of articles on the subject published in medico-scientific journals. Capitalising on the new anxiety, Sayre reported to the New York Pathological Society in 1870 that phimosis was also the cause of epilepsy [34]. A few English physicians had been experimenting with circumcision as a treatment for epilepsy since 1865 [35], but they attributed the problem to the tendency of the foreskin to encourage masturbation, and thus cited prevention of masturbation as the key to curing the condition. Sayre maintained that a long foreskin alone had the power to induce violent epileptic convulsions, and that circumcision had cured every case of epilepsy that he had encountered. As with paralysis, hundreds of case reports were published over the next 75 years, all validating Sayre's advocacy of circumcision as a cure for epilepsy. At the annual meeting of the AMA in 1875 Sayre delivered another important lecture on phimosis. Here he informed his audience that he had discovered that a long and adherent foreskin could cut off the circulation of blood to the spinal column, thereby causing lameness, curvature of the spine, paralysis of the bladder and club foot. [36] Miraculously, he reported, circumcision brought an immediate cure to all these patients, including the patient with the club foot. In the same lecture he also described several cases in which clitoridectomy brought instant relief to paralytic girls. <h4>3.2 Masturbation hysteria and circumcision</h4> Alarm amounting to hysteria about masturbation reached a climax in the last decades of the nineteenth century. From 1800 to the early 1870s there was an astounding 750 per cent increase in the number of articles in medical journals on masturbation. From the 1870s to the 1880s the number of papers on masturbation increased by 25 per cent, and from the 1880s until 1900 by a further 30 per cent. Among the more influential American physicians who noticed this obsession, and who contributed to it, were Abraham Jacobi (1830-1919) and M.J. Moses. Jacobi was the founder and first president of the American Pediatric Society, the first chairman of the Section on Diseases of Children of the AMA, and president of the New York State Medical Society, the New York Academy of Medicine and the Association of American Physicians. Both Jacobi and Moses asserted that Jewish boys were immune to masturbation because they were circumcised, and that non-Jews were especially prone to masturbation, and all the terrible diseases that resulted form it, simply because they retained their foreskin. Moses and Jacobi's studies acquired canonical authority, and their claims that the foreskin was the prime risk factor for epilepsy, paralysis, malnutrition, hysteria and other nervous diseases, were regularly cited by medical writers for the next few decades. [37] In 1871 Moses published a very influential and widely-cited article, "The value of circumcision as a hygienic and therapeutic measure", in the New York Medical Journal. In a key passage he cited his experience "as an Israelite" as giving him the authority to speak on the value of circumcision as a health, and specifically as an anti-masturbation, measure: <div>As an Israelite I desire to ventilate the subject, and as a physician have chosen the medium of a medical journal, that I may not be trammelled in my expressions ... I refer to masturbation as one of the effects of a long prepuce; not that this vice is entirely absent in those who have undergone circumcision, though I never saw an instance in a Jewish child of very tender years, except as the result of association with children whose covered glans have naturally impelled them to the habit. [38]</div> It is quite clear from the context that the title word "hygienic" has a different meaning from today. At that time circumcision advocates used words such as hygiene to denote moral hygiene, not personal cleanliness. Moses' paper had a big impact on American physicians, who now argued that castration should be abandoned in favour of circumcision, since circumcision cured all the same diseases, but did so without affecting the power to procreate. An article in the Medical Record in 1895 explained the power of circumcision to stop masturbation thus: <div>In all cases [of masturbation] ... circumcision is undoubtedly the physician's closest friend and ally. ... To obtain the best results one must cut away enough skin and mucous membrane to rather put it on a stretch when erections come later. There must be no play in the skin after the wound has thoroughly healed, but it must fit tightly over the penis, for should there be any play the patient will be found readily to resume his practice, not begrudging the time and extra energy needed to produce the orgasm. It is true, however, that the longer it takes to have an orgasm, the less frequently it will be attempted, and consequently the greater the benefit gained. [39]</div> <h4>3.3 More miracle cures</h4> The list of previously incurable diseases that orthodox physicians now claimed to be able to cure or prevent by means of circumcision continued to grow. A textbook from 1895 declared: Only within recent years, since the physiology of nervous reflexes has become better understood, has [circumcision] become a generally accepted operation with thinking surgeons. Not alone for local conditions is the operation demanded. In all cases in which male children are suffering nervous tension, confirmed derangement of the digestive organs, restlessness, irritability and other disturbances of the nervous system, even to chorea, convulsions and paralysis, or where through nerve waste the nutritive facilities of the general system are below par and structural diseases are occurring, it should be considered as among the lines of treatment. [40] Thousands of such reports and opinions were published in reputable American medical journals. In 1890 Dr William D. Gentry (1836-1922) produced a typical example, "Nervous derangements produced by sexual irregularities in boys", which detailed the frightening and varied consequences of phimosis, as well as the miracle cure offered by circumcision: <div>Whilst I was physician to the children's home at Kansas City in 1884-85, there was brought to the home from some similar institution in Chicago a child of two and half years, who was blind, deaf and dumb. It was nervous, fretful, and caused the matron a great deal of trouble. It was dwarfed and presented the peculiar general appearance which nearly every boy will present who is afflicted with sexual derangement. As soon as I saw the child the thought came into my mind that his trouble had some connection with such derangement, and on making an examination I found that he had phimosis. With the consent of the father of the boy I operated and removed the derangement. In two months the child could see and make sounds as if trying to speak. In six months he could hear, see and speak. [41]</div> Where today do we hear this gushing tone? <h4>3.4 Anti-sexual nature of circumcision</h4> The early promoters of circumcision fully acknowledged the sexual functions of the foreskin and advocated circumcision as the intentional destruction of those functions. One of many such acknowledgements was published in an issue of the Medical News in November 1900: <div>Finally, circumcision probably tends to increase the power of sexual control. The only physiological advantage which the prepuce can be supposed to confer is that of maintaining the penis in a condition susceptible of more acute sensation than would otherwise exist. It may be supposed to increase the pleasure of the act and the impulse to it. These are advantages, however, which in the present state of society can well be spared, and if in their loss some degree of increased sexual control should result, one should be thankful. [42]</div> In 1902 an editorial in the American Practitioner and News made clear the anti-sexual motivation behind the doctrine of circumcision as a hygienic measure: <div>Another advantage of circumcision is ... the lessened liability to masturbation. A long foreskin is irritating per se, as it necessitates more manipulation of the parts in bathing. ... This leads the child to handle the parts, and as a rule pleasurable sensations are elicited from the extremely sensitive mucous membrane, with resultant manipulation and masturbation. The exposure of the glans penis following circumcision ... lessens the sensitiveness of the organ. It therefore lies with the physicians, the family adviser in affairs hygienic and medical, to urge its acceptance. [43]</div> <h3>4. Early twentieth century</h3> After the germ theory of disease had become widely accepted and vitamins had been identified, most bacterial diseases, such as tuberculosis, were silently removed from the list of diseases caused by phimosis. Even so, most American physicians tenaciously clung to the belief that phimosis was pathogenic and the cause of diseases, such as epilepsy, in ways not yet understood. Year by year the list of diseases blamed on phimosis continued to grow. Doctors even attributed suspicions deaths to phimosis. [44] <h4>4.1 Abraham Wolbarst and the cancer scare</h4> Abraham Wolbarst (1872-1952) was a urologist practising, among other places, at the Beth Israel Hospital and the Jewish Memorial Hospital in New York. In January 1914 he published, in the Journal of the American Medical Association, the first of series of papers indicting the foreskin as the culprit in the diseases that were to haunt the imagination of the twentieth century. Wolbarst was a prominent and influential member of both the AMA and the notorious American Society of Sanitary and Moral Prophylaxis, a reform organisation dedicated to the abolition of childhood and extra-marital sexuality. His views on sexuality were characteristically extreme. In the 1930s he argued that adult masturbators should be sterilized and forbidden to marry, and in 1914, in his influential paper, "Universal circumcision as a sanitary measure", he added his own statistics to those of Hutchinson in order to prove that circumcision conferred immunity to syphilis, and to argue that it should be made compulsory as a means of reducing the incidence of masturbation and many other problems as well. He stated that it was "generally understood that irritation derived form a tight prepuce may be followed by nervous phenomena, among these being convulsions and outbreaks resembling epilepsy. It is therefore not at all improbable that in many infants who die in convulsions, the real cause of death is a long or tight prepuce". He added that it was "the moral duty of every physician to encourage circumcision in the young" [46, 47]. In this paper it is clear that the title word "sanitary" denotes moral restraint rather than the absence of germs or dirt. It is important to note that until this time circumcision was primarily imposed as a therapy for children and adults, but not as prophylaxis for infants. As a result of Wolbarsts's ceaseless lobbying and agitation, however, the radical notion of universal, non-therapeutic, involuntary circumcision of young babies slowly gained acceptance among American physicians. (The procedure was non-therapeutic because it was performed on normal, healthy children showing no signs of deformation or disease.) Medical textbooks were rewritten to instruct obstetricians and pediatricians to examine the penis of every newborn boy to determine whether the foreskin was retractable. If not )as was usually the case), the advice was that it be removed immediately. By the mid-1930s, when most of the medical profession had converted to the theory that epilepsy was a problem of the brain, Wolbarst clung to his conviction that the most likely cause was a tight foreskin. [48]. While he never abandoned this idea, he must have sensed the need to reformulate his arguments against the foreskin in order to tailor them to appeal to the changing interests and fears of the public. In the early decades of the twentieth century the number of articles on cancer in popular magazines rose dramatically, indicating a shift in the national focus. The Readers Guide to Periodical Literature listed thirteen articles on cancer between 1900 and 1904, but by 1909 the number had doubled, and by 1928 it had increased by 569 per cent. At the peak of this surge in popular anxiety about cancer in 1932, Wolbarst published what was long regarded as the definitive paper on circumcision as the most reliable preventive of cancer of the penis. Based on his "observation" (read contention) that Jewish men never got penile cancer, Wolbarst theorised that the disease was caused by "the accumulation of pathogenic products in the preputial cavity". [49] Wolbarst offered no scientific validation in support of this notion, yet, based on this paper, the proposition that smegma was carcinogenic became widely accepted as a proven fact in the United States. <h4>4.2 Advances in understanding the anatomy and development of the foreskin</h4> In 1932 a research team at the University of Pennsylvania led by Dr H.C. Bazett published a detailed anatomical description of the innervation of the foreskin. They observed that the foreskin was richly networked with nerves and nerve endings and capable of detecting fine distinctions of touch and temperature. [50] The following year Dr Glenn A. Deibert, of the Daniel Baugh Institute of Anatomy at Jefferson Medical College, made a careful investigation of the development of the foreskin in utero and the process by which it separated from the glans after birth. [51] Deibert demonstrated that the adherence of the foreskin to the glans was neither phimosis nor a birth defect, but a normal stage of penile development. In 1935 the British anatomist Richard Hunter at Queen's University, Belfast, published a similarly detailed description of the embryological development of the foreskin. No doubt because these findings did not support the prevailing orthodoxy that the foreskin was a useless, pathological defect, all three studies were completely ignored by the medical establishment. [52] <h4>4.3 The Gomco clamp</h4> The profit margin for circumcision procedures rose with the mass manufacture and wide distribution of the now ubiquitous Gomco clamp, invented in 1934 by Aaron Goldstein and Dr Hiram S. Yellen. Gomco is an acronym for the GOldstein Manufacturing COmpany, which later changed its name to the Gomco Surgical Manufacturing Corporation of Buffalo, New York. This cruel stainless steel device is still widely used today to crush the foreskin and isolate it so that it can be excised by scalpel. The standardization of its surgical technique facilitated the rapid institutionalisation of neonatal circumcision as a routine hospital procedure and led to the acceptance of the "high and tight look" (since the clamp usually produced a maximum loss of tissue) that came to be regarded as the normal appearance of the penis. <h4>4.4 Popular perceptions</h4> The September 1941 issue of Parents Magazine included the first published article on the advisability of routine circumcision that had ever appeared in a popular magazine with such a wide readership. The author was Dr Ian F. Guttmacher, an obstetrician at Johns Hopkins University Medical School, and he fed the public with many of the same myths and scare stories that had been in circulation since the nineteenth century. Like his predecessors, he admitted that circumcision "causes blunting of male sexual sensitivity", but (like Hutchinson) argued that this was an advantage. As well as citing Wolbarst's discoveries about penile cancer, Guttmacher reiterated the Edwardian myth about the necessity for daily scrubbing of the glans. Although this had been a clichÃ© of British Empire baby care guides from the 1890s until the 1930s, in Britain it had just been exposed as a myth by Douglas Gairdner. The idea was new to American medical literature, however, and just as a better understanding of normal infant anatomy triumphed in Britain, old myths became consolidated in the United States; with all the authority conferred by his professional title and institutional connections, Guttmacher told the public: <div>Present-day hygiene require that the prepuce, the hoodlike fold of skin which covers the end of the penis (glans) be drawn back daily and the uncovered glans thoroughly washed. Trouble occurs if this is neglected, for the secretion from the multiple glands lining the inside of the hood becomes caked, and within a few days the material may set up an inflammation. Such inflammation may lead to the growth of slender, strandlike bands of tissue between the inside of the prepuce and the glans, gluing the two together, thus forming an adherent foreskin.</div> Thus we see the Victorian myth of acquired phimosis taking on a new lease of life in the New World of space travel. To avert this frightening scenario, Guttmacher advised parents to have their boys circumcised at birth because doing so "makes care of the infant's genitals easier for the mother", and because "it does not necessitate handling of the penis by the infant's mother, or the child himself in later years, and therefore does not focus the male's attention on his own genitals. Masturbation is considered less likely". Guttmacher succeeded in validating the perceived associations between the foreskin, difficult hygiene, inevitable masturbation, genital defects and the fear of touching the baby's penis. It also served to legitimise the increasingly common practice on the part of large urban hospitals of instituting programs of automatic circumcision of the newborn, irrespective even of parental wishes [53-55]. <h4>4.5 Abraham Ravich and the myth of cancer of the prostate</h4> Abraham Ravich was a urologist at Israel Zion Hospital, Brooklyn, from which position he became one of the most rabid crusaders for mass involuntary circumcision since Jonathan Hutchinson and Peter Charles Remondino. In 1942, expanding upon Wolbarst's theory of smegma as a carcinogen, and repeating the myth of Jewish men's immunity to such disease, he postulated a causal link between the foreskin and cancer of the prostate. He also restated the obscure theory (first suggested, without much evidence in 1926 [56]), that cervical cancer in the female was caused by smegma from the male [57]. The popular magazine Newsweek gave sympathetic coverage to Ravich's claims and quoted his demand that there be "an even more universal practice of circumcising male infants" [58]. Among the many achievements that he listed for his entry in Who's Who in America, Ravich credited himself with being the first to report on the value of neonatal circumcision as a preventive of genital cancers. [59]. <h3>5. World War II</h3> Mass recruitment and conscription during World War II put a lot of men under the power of military doctors with the authority to institute a campaign of near-routine circumcision of servicemen in all branches of the armed forces. Even at the height of the war, Navy physician Lt Marvin L. Gerber confidently stated in he pages of the United States Naval Medical Bulletin that circumcision was one of the most commonly performed surgical operations in the navy, even more common than trauma surgery [60]. Military doctors alleged that epidemics of phimosis and paraphimosis among soldiers justified the mass circumcision campaign. Men were regularly humiliated by unannounced examinations of their penises (called short arm inspections), and many who had not been circumcised were declared to be suffering from phimosis and sent off to get cut; court martials were threatened if they showed reluctance. <h4>5.1 Sexually transmitted diseases and the scapegoating of Blacks</h4> Military records reveal that Black Americans were blamed for spreading venereal disease in the military and were thus made particular targets of circumcision campaigns. Military doctors such as Eugene A. Hand (1909-c.1972), a dermatologist (VD expert) at the naval hospital, St Albans, New York, were responsible for the military's adoption of the view that Blacks were dangerous carriers of disease, and that the low rate of circumcision among them was the main reason for this. Capt Leonard Heimoff, US Army Medical Corps, declared that Negro troops were "causing 70 per cent of all new cases of venereal disease", and he organised covert military police units to monitor the sexual life of civilian Black communities. [61] Heimoff's report, like that of Hand and others, concluded that Blacks could not be taught to practise personal hygiene nor trusted to take precautions against contracting STDs â€“ presumably a euphemism for claiming that they were too stupid and/or sex crazed to use condoms. Where else today do we find this assumption guiding health policy? The war coincided with an increased national obsession with the danger of VD. From 1930 to 1940 the number of articles on VD in popular magazines increased by 192 per cent, and at an annual rate of 17 per cent from 1940 to 1947, after which interest trailed of â€“ presumably in response to the discovery of an effective cure for syphilis in the form of penicillin. At the height of this hysteria Hand delivered a paper called "Circumcision and venereal disease" at the annual meeting of the AMA in June 1947. Comparing the incidence of VD among Jews, gentiles and Blacks, and reporting that it was rare among Jewish men, Hand theorised that circumcision had a major protective effect: <div>Circumcision is not common among Negroes. ... Many Negroes are promiscuous. In Negroes there is little circumcision, little knowledge or fear of venereal disease, and promiscuity in almost a hornets nest of infection. Thus the venereal rate in Negroes has remained high. Between these two extremes there is the gentile, with a venereal disease rate higher than that of Jews, but much lower than that of Negroes. [62]</div> In the same study Hand reported that cancer of the tongue was more common among men with foreskins than among Jews. Newsweek gave generous coverage to these sensational findings, thereby fuelling the popular perception that a policy of mass circumcision was both scientifically valid and of critical importance to the future security of the nation. [63] <h4>5.2 Douglas Gairdner saves the British foreskin</h4> In December 1949 the British Medical Journal published "The fate of the foreskin", a landmark study by Cambridge pediatrician Douglas Gairdner (1910-1992). Drawing on the research of Deibert ad Hunter, and presenting his own meticulous observations on preputial development, adhesion and retractability, Gairdner debunked the phimosis myth and demonstrated that non-retractability, adhesion and length were the normal conditions of the infant foreskin, and that separation occurred gradually as the boy got older. His paper also reviewed the standard list of the benefits of circumcision (cancer, syphilis) and rejected them as spurious. Circumcision rates in Britain had been declining since the 1930s, when doctors had become concerned at the high incidence of injury and death, and Gairdner's paper gave it the death blow. [64] Under the new National Health Service established in 1948, parents who asked to have their boy circumcised were told that it was not an approved procedure and that if they wanted it they would have to pay to get it done privately. As you would expect, when a price was put on the operation most parents decided that it was not really necessary after all, and the incidence of circumcision declined rapidly. References are included in Part 2 </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A short history of circumcision in the United States: Part 1 darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>6. Corporate institutionalisation of circumcision in the Cold War era</h3> In the United States, however, Gairdner's paper was ignored, and the old myths repackaged by doctors such as Guttmacher held sway instead. Medical textbooks became even more insistent that obstetricians should examine every newborn boy to check whether his foreskin was adherent, unretractible or too long , and to perform an immediate circumcision if such symptoms of "phimosis" were present â€“ as they nearly always were. In 1953 obstetricians Richard L. Miller and Donald C. Snyder published an influential paper in the American Journal of Obstetrics and Gynecology, calling for the immediate circumcision of all males straight after birth. Ignoring Gairdner and relying heavily on the writings of Wolbarst, they insisted that "phimosis" required immediate surgical correction, and asserted that circumcision would "reduce the incidence of onanism", heighten male libido and "increase longevity and immunity to nearly all physical and mental illness." They also stated that circumcision immediately after birth was convenient for the doctor and in the financial best interests of the hospital. Leading obstetrical textbooks were soon rewritten to include Miller and Snyder's recommendations. [65, 66] <h4>6.1 The new cancer scare</h4> During the 1950s, with syphilis under control thanks to penicillin, cancer regained its position as the most feared disease. Between 1943 and 1951 the number of articles on cancer in popular magazines increased by 182 per cent, a further 32 per cent between 1951 and 1955, and another 72 per cent from 1955 to 1957. In keeping with this renewed and increased alarm, Ravich published a new paper, "Prophylaxis of cancer of the prostate, penis and cervix by circumcision", in which he alleged that 25,000 deaths annually from cancer were really caused by the foreskin, and that between 3 and 8 million American men then living had contracted prostate cancer through the influence of their foreskin. Ravich concluded that a program of mass compulsory circumcision was necessary as an "important public health measure". [67] Ravich's theory of cervical cancer was taken up by Dr Ernest Wynder at the Manhattan Memorial Centre for Cancer and Allied Diseases, and in 1954 he published a lengthy paper that purported to show that universal neonatal circumcision of males could eliminate cervical cancer in women. [68} Again, a popular news magazine (in this case, Time) gave warm coverage to Wynder's claims, thus giving them both publicity and credibility, and encouraging public support for the burgeoning circumcision industry. [69] Meanwhile, there were also a few calls for circumcision of girls and women. During the 1950s some American physicians stepped up their efforts to popularise circumcision of adult females â€“ here meaning excision of the clitoral hood as a hygiene measure. In 1959 Dr W.G. Rathmann published an article in which he promoted the idea of female circumcision as a cure for psychosomatic illness and marital problems. He also took the opportunity to tout his newly-patented female circumcision clamp. [70] <h4>6.2 Kaiser, Gomco and Europe</h4> In the 1950s an increasing number of corporation-managed hospitals and insurance companies entered the now profitable business of routine neonatal circumcision. Private hospitals instituted policies of immediate and automatic circumcision of all male neonates, often in the delivery room. At the Kaiser Foundation Hospital in 1950, out of 889 live male births, 812 (92 per cent) were circumcised immediately after birth. [71] Likewise, many urban hospitals adopted the policy of circumcising any boys who missed out at birth when they were brought in for other common procedures, such as having their tonsils removed. In the late 1950s the American circumcision industry sought to spread the practice to Europe, with a particular focus in east and west Germany, the latter under extensive American influence as a result of the post-war occupation. Around 1957 the Gomco corporation established a distribution network in Ulm [72], and in the same year Kaiser worked with Otto Dietz, a minor official in the East Berlin secret police, to introduce circumcision in east Germany [73]. In 1959 150 babies born in a state-run clinic in Darmstadt, west Germany, were experimentally circumcised without anaesthesia a publicity stunt for the Gomco clamp [74], and in1963 Dr H. Koester arranged for the maternity clinic at the University of Giessen to adopt a policy of automatically circumcising all boys born there, again using the Gomco clamp. In 1968 a further demonstration of its speed and efficiency was arranged in east Germany [ 76]. By the early 1970s, however, the experiments had aroused the disfavour of both east and west German authorities, and the experiments came to an end. Gomco promptly turned its attention to Denmark and in 1973 arranged for 18 Danish newborns to be cut. [77]. Along with publicity photos of the clamp, the results were praised by the Danish medical press. The Danish public, however, were less impressed and strenuously resisted the idea of allowing their children's sexual organs to be surgically altered for any reason, and the campaign faded away. It is easy to see that Gomco's attempted push into Europe had nothing to do with health, but was entirely a commercial venture. <h4>6.3 Professional opposition to circumcision</h4> There was some opposition to forcible circumcision. In 1956 and 1959 Dr Richard K. Winkelmann, a fellow in dermatology at the Mayo Clinic, published two studies which documented the intense innervation of the foreskin and identified it as specific erogenous zone. [78, 79] In a period that was intensely hostile to sexual enjoyment, however, his studies were ignored. In 1954 Ravich's theory that the foreskin caused cancer of the prostate was disproved [80], and in 1962 the hypothesis that it caused cervical cancer in women was falsified [81]. In 1963 a further study invalidated Wolbarst's contention that smegma was carcinogenic. [82] In 1965 the trend towards scepticism was boosted when the Journal of the American Medical Association published Dr William Morgan's provocatively titled paper, "The rape of the phallus". In this article Morgan debunked all the then current arguments used by hospitals to justify involuntary circumcision and initiated a controversy within the American medical profession that continues to this day. [83] An even more significant article, on the nature of the juvenile foreskin, was published in 1968. The British pediatric journal, Archives of Diseases of Childhood, carried an account of the exhaustive research of the Danish pediatrician Jakob Oster, who had examined the incidence of preputial adhesions in 9,545 Danish schoolboys aged 6 to 17 years. [84] Like Gairdner, Oster's findings disproved the phimosis myth and demonstrated that adhesions between the foreskin and glans were not a birth defect, but a perfectly normal stage of penis development. He further showed that separation between glans and foreskin was a gradual biological process that often took ten years or more to complete. His research revealed that no interventions were needed in normal cases and, more importantly, that inappropriate attempts to hasten development (e.g. by tearing the foreskin from the glans) could damage both structures and actually bring about the phimosis it was supposed to fix. Oster's study significantly advanced scientific understanding of the foreskin was widely read by the British and European medical community; in the United States it was pretty much ignored. In 1970, however, the spark ignited by Morgan was fanned into flame in an article by Noel Preston, "Whither the foreskin?", in JAMA. [85] The paper debunked all the reigning circumcision myths and influenced the American Academy of Pediatrics to publish the following revolutionary statement in the fifth edition (1971) of its Standards and Recommendations for Hospital Care of Newborn Infants: "There is no valid medical indications for circumcision in the neonatal period." [86] In the late 1970s, as Americans became increasingly aware of the abuses of power rampant in the nation's social institutions, grass roots movements against the forced circumcision of American children began to emerge. In the face of ridicule and hostility from health care professionals, many American parents began to refused to allow their sons to be circumcised. At the same time, developments in medical ethics that brought the concept of informed consent into the surgical arena required doctors to explain the probable outcome of any surgery, state the known risks, offer alternative treatments for the problem and obtain written consent from the patient. Circumcision, too, now required a consent form, but since the person being operated on was not capable of giving informed consent, spokesmen for the circumcision industry claimed that parents could give consent by proxy. By presenting involuntary circumcision the parents' choice, circumcision advocates obscured the vital fact that the person who ran the risks and had to bear the lifelong consequences of the surgery was still not permitted a choice in the matter. Critics countered that doctors had no legal power to concede control of the baby's genitals to the parents because doctors had no legal power over his genitals in the first place. <h4>6.4 Backlash from the circumcision industry</h4> The high-water mark of involuntary circumcision was reached in the 1970s. With or without parental consent, hospital practice raised the incidence of neonatal circumcision to 90 per cent in the late 1970s and early 1980s. Circumcision advocates from urban areas took positions in small rural hospitals in America's heartlands and instituted new circumcision programs in regions of the country where it had not been known. At the same time, baby care guides, popular medical magazines and health texts circulated myths to the effect that a boy not circumcised in infancy would suffer terrible psychological damage if he ever saw that his father's circumcised penis differed from his own. [87-89] (Oddly enough, this had not been raised as a problem when the father was uncircumcised and the boy cut, though you would think that a person would be more upset at lacking something his father possessed than possessing something his father lacked.) Another myth that was particularly effective in exploiting middle class anxieties about conformity and social status was that an uncut boy would be made to feel weird and inferior to his circumcised classmates in school locker-rooms. [90] Accurate information on the anatomy and physiology of the foreskin was omitted from American textbooks and replaced with the pseudo-science of the circumcision lobby. [91, 92] Even anatomical representations of the penis in standard urology texts silently omitted the foreskin and showed the penis as circumcised, as though it were that way by nature [93]. The few drawings of the anatomy of the natural penis that could be found generally represented the foreskin incorrectly. The normal human penis became a strange and alien anomaly to the new generation of Americans â€“ physicians and laymen alike â€“ most of whom had never seen one. As an example of the outdated information being given to American medical students, here is a quote from the 1970 edition of Campbell's Urology, the standard urology textbook: <div>Phimotic stenosis causes extreme difficulty of urination, with straining and crying; hernia or rectal prolapse may be secondary end results. Urinary infection is a frequent complication, and is often directly predisposed to by the preputial obstruction. Malnutrition, epistaxis, convulsions, night terrors, chorea and epilepsy have all been reflexly attributed to phimosis.</div> Consistent with these Edwardian notions, it also advised circumcision as a precaution against masturbation: <div>Parents readily recognise the importance of local cleanliness and genital hygiene in their children and are usually ready to adopt measures which may avert masturbation. Circumcision is usually advised on these grounds. [94, 95]</div> The Victorian masturbation hysteria was apparently still alive and well in American medical textbooks in the scientific seventies. In October 1972 the American Academy of Pediatrics appointed a committee to discuss circumcision in order to provide guidance to health insurers who had been asking whether neonatal circumcision should be covered in their insurance policies. The outcome was never officially released, but the conclusion was unofficially presented by Dr Thomas Guthrie to an AMA conference in June 1973. He argued for even more widespread neonatal circumcision and the continuation of insurance coverage. [96] Female circumcision had not entirely disappeared from American medical practice. In 1973 Dr Leo Wollman, a gynaecological surgeon at Maimonides Hospital, Brooklyn, published an article in which he argued for female circumcision (meaning excision of the clitoral hood) as a cure for frigidity. [97] Wollman's appeal was geared to the ethos of the sexual revolution of the 1970s, when sexual pleasure was at last becoming recognised as a legitimate part of life and even the responsibility of the medical profession. Surgical modifications of the male and female genitalia, it was argued, would improve the quality of orgasm. This was the exact opposite of the message communicated a century before, when one of the chief virtues of circumcision was (correctly) held to be its effect in reducing sexual sensation. The sudden reversal of argument convinced critics that American circumcision advocates were willing to say anything in order to push circumcision onto a gullible but increasingly suspicious public. To make matters worse for the circumcision lobby, in 1975 the American Academy of Pediatrics issued a further policy on circumcision that concluded: <div>There is no absolute medical indication for routine circumcision of the newborn. ... A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk. Therefore, circumcision of the male neonate cannot be considered an essential component of adequate total health care. [98]</div> <h4>6.5 Legal action for children's rights</h4> In the 1980s men finally began to wake up to what had been done to them as infants, and several lawsuits against doctors and hospitals in California were filed, charging that hey had violated the constitutional rights of the plaintiffs by circumcising them without consent. [99, 100] The cases were filed in order to establish that parents do not have the right to consent by proxy to medically unnecessary surgery on their children, basing their claim on the 1975 AAP policy that circumcision was not medically necessary. The acknowledged lack of medical justification for circumcision put circumcisers at risk of litigation, but more importantly the constitutional challenge to the legality of subjecting children to involuntary circumcision threatened to dismantle a lucrative medical sideline â€“ which in 1986 was estimated to generate some $200 million annually. [101] If neonatal circumcision were to survive, new medical excuses would have to be found. <h4>6.6 The urinary tract infection scare</h4> In the mid-1980s the new excuse was provided by urinary tract infections (UTIs). Although nothing on this rare condition had ever appeared in a popular magazine, the medical literature reflected a surge of research interest. A search of Medline uncovered only four publications on UTIs for the period 1966 to 1974; 65 from 1975 to 1979; and 350 from 1980 to 1984. While the national incidence of UTIs had not altered from 1966 to 1989, the astounding 8,650 per cent increase increase in the number of published studies showed clearly that UTIs were the next big thing, and it was not long before the foreskin was being blamed as a risk factor. In 1982 Drs Charles Ginsburg and George McCracken published a report of a study of 100 infants with acute UTIs. Because only 3 of the 62 males were circumcised, the authors speculated that lack of circumcision might increase susceptibility, though they admitted that "perineal hygiene was inadequate in many patients". [102] In 1985, evidently intrigued by this lead, Dr Thomas Wiswell, then a neonatologist at Brooke Army Medical Centre, Texas, sought to verify it with his own studies, and soon published in Pediatrics the first of many studies promoting the theory that the foreskin increased the risk of UTIs and that circumcision was therefore a valuable prophylactic. [103] Wiswell's first review of hospital charts implied a UTI incidence of 1.4 per cent in uncircumcised boys and 0.14 per cent in circumcised boys, though he did not take into account such relevant factors as whether the babies were breast-fed (breast milk carries powerful antibodies) or the fact that many of the uncircumcised boys had been subjected to premature retraction of their foreskin, thus making it likely that the infection had been communicated by the doctor or nurse. Such questions were simply not asked. Although the difference between the two groups was very small (1.2 percentage points), it was made to appear much larger by being described as a 10 per cent increase. Circumcision enthusiasts hailed the results of Wiswell's research as a new indication for circumcision and just what they needed to defeat the emerging legal and human rights challenges. Indeed, a letter in response to Wiswell's study addressed the lawsuits directly. The author, Dr Aaron Fink (1926-1994) was a urologist in the mould of Wolbarst and Ravich and a long-time agitator for universal neonatal circumcision. He was clearly disturbed at the possibility that circumcisers might face the risk of legal action from their victims and ridiculed the idea that circumcision required the consent of the person on whom it was performed. [104] In his reply, Wiswell agreed that the medical indication he had discovered removed the need to obtain consent before operating. [105] McCracken was less convinced, however, and commented that "because the long-term outcome of UTI in uncircumcised male infants is unknown, it is inappropriate at this time to recommend circumcision as a routine medically indicated procedure." [106] Nonetheless, medical texts and popular magazines quickly incorporated UTIs into their list of why the baby should be circumcised [107-109]. Magazines such as Newsweek and US News and World Report ran feature stories on Wiswell's discoveries and hailed them as the answer to those who were trying to stop circumcision. [110, 111] Since few males ever experience a UTI the UTI myth had little power to influence fathers, but research had shown that it was the mother, more often than the father, who signed the circumcision consent form. [112-114] Among girls, however, unpleasant and painful bouts of UTI are relatively common [115, 116], and the new UTI scare proved quite effective in frightening young mothers into agreeing to the circumcision of their sons. Unlike STDs and cancer, which did not affect men until they were sexually active adults and old men, UTIs could affect infants. Wiswell's warning that the foreskin posed a serious threat to the baby's health, and even his life, in the first few weeks, and that it could increase the risk of complications such as kidney failure, meningitis and death, naturally alarmed many parents and convinced them that they had better get the baby done "just to be on the safe side". [117-118] At this point Wiswell tried to turn the legal tables by suggesting that if insurers did not cover circumcision they might be held legally liable if a baby contracted UTIs. "If ten years from now there are uncircumcised children on dialysis with kidney damage associated with UTI , insurers who would not pay for circumcision might be held liable," he wrote [119]. At the same time, oddly enough, he stated that "I tell them [parents] that I personally don't like the procedure and don't recommend it, but if they want it performed I will do it." A further effect of the UTI scare was to persuade pro-circumcision forces in the AAP to agitate for a new circumcision policy. In 1989 a new task force was established under the chairmanship of Dr Edgar Schoen (b. 1925), a pediatrician at the Kaiser Foundation Hospital, Oakland, since 1954, and a fanatical advocate of universal circumcision. (Kaiser, it will be recalled, was the commercial medical services company that tried to sell Gomco circumcision clamps to Germany and Denmark in the 1960s.) After intense debate the Task Force produced a new and highly equivocal statement that took Wiswell's UTI hypothesis into account but stopped short of recommending a return to routine circumcision: <div>Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained. [120]</div> By closing the legal loophole in the 1975 statement, the new policy protected circumcisers from legal action while avoiding any overtly unscientific or unverifiable claims. Sensitive to the awkward fact that European countries had steadfastly rejected American attempt to export circumcision, Schoen (from his office in the Kaiser Permanente Medical Centre) made another attempt to badger northern European countries into adopting programs of routine circumcision on the United States model. [121] The terse reply to his overtures, written by two of Sweden's most eminent physicians and published in a leading Swedish medical journal, invoked a number of critical issues that he had never considered: fairness, human rights and medical ethics. Pointing out that it was a violation of a person's human rights to be subjected to such a procedure without informed consent, the authors observed that it was only fair to postpone a decision on the matter until the boy was old enough to make his own decision. The authors explained that since an ethics committee on experimental animals would never accept clinical trials involving circumcision without anaesthetic on laboratory animals, Europe could hardly justify subjecting its own children to such pain and suffering. [122] <div>* * * * * * * * * * *</div> <h4>NOTE</h4> In relation to the following two sections it should be noted that this study was written in 1995-96 when the notion that the foreskin was a major risk factor for HIV-AIDS, and that circumcision was therefore an important part of any anti-HIV strategy, was no more than the speculation of cranks. At that time there was no predicting that the idea would be seized upon by the international AIDS industry, given massive funding, and presented to the world as the definitive solution to the AIDS problem in Africa, and probably in other underdeveloped regions as well. What we can observe is the consistency of the historical pattern: as soon as a new disease leaps to the forefront of public anxiety, circumcision enthusiasts suggest that the foreskin has something to do with it and yet more circumcision is the answer. In fact, the claim that mass circumcision is necessary to control AIDS is largely a re-run of the nineteenth century conviction that mass circumcision was necessary to control syphilis; in each case, an incurable disease had so terrified the public that they were ready to accept almost anything if it offered the possibility of increasing their safety without the need to change their habits. What gets forgotten is that AIDS is not a particularly contagious disease and that you have to go to some trouble to contract it; apart from blood transfusions, tattoos, surgery and intravenous drug use (where circumcision would obviously make no difference), the only way you can get AIDS is through unprotected intercourse with an infected partner. The simplest way to run no risk of HIV infection, therefore, is not to be promiscuous and to practise safe sex. This policy has successfully kept HIV infection at a low level in countries such as Australia, Germany and Britain, but western health agencies seem to have much the same attitude towards Africans as Eugene Hand exhibited towards American Blacks: because they are too stupid to use condoms and too sex crazed not to be promiscuous, the only thing that can be done is to circumcise them in the hope of slightly reducing the risk. The foreskin is targeted not because it is a particularly useful point of intervention, but because it is an easy target for surgical removal and a once-off procedure, after which the agencies can congratulate themselves that they have done all they can. It should also be remembered that there are strong cultural pressures to use the AIDS scare as the latest means of preserving circumcision as a routine procedure among the cultures that traditionally practise it. The billions poured into the World Health Organisation and UNAIDS represent a bizarre alliance between American medical research money, African tribalism and Muslim religiosity, all of which forces have an emotional commitment to finding new and "scientific" justifications for continuing their traditional practices. <div>* * * * * * * * * * *</div> <h4>6.7 The HIV scare</h4> In the early 1980s the arrival of a new and terrifying infection in the form of HIV-AIDS (as it later became known) gave the circumcision lobby a juicy new opportunity to incriminate the foreskin in the generation of disease. First to capitalise on the opportunity, as early as 1986, was the egregious Aaron Fink, who was able to persuade the New England Journal of Medicine to publish his speculation that the presence of the foreskin made men more susceptible to infection. [123] On the basis of this theory, throughout 1987 and 1988 Fink lobbied the California Medical Association to adopt a resolution endorsing routine neonatal circumcision as "an effective public health measure". His efforts were rejected by the Scientific Committee of the CMA in 1987, but in 1988 he managed to get his resolution passed on the voices at a CMA meeting. This attracted some national attention, unlike his other new reasons for circumcision â€“ group B-streptococcal disease and "sand balanitis" [124, 125] These connections were evidently too far out even for the gullible American media. Fink's theory about the foreskin and AIDS, however, was eagerly taken up by other American circumcisionists, such as Francis Plummer and Stephen Moses, who have campaigned tirelessly for new programs of neonatal circumcision as a precaution against HIV acquisition in later life. <h4>6.8 The future of involuntary circumcision</h4> Since the 1980s private hospitals have been in the business of supplying the foreskins they harvest to private biological research laboratories and pharmaceutical companies that require human tissue as raw research material, as well as manufacturers of cosmetics and artificial skin. They have also supplied foreskins to transnational corporations such as Advances Tissue Sciences (San Diego), Organogenesis and BioSurface Technology, companies that have recently emerged to reap profits from the sale of products made form harvested human tissues. [126-129] Despite the efforts of Schoen, Fink, Wiswell etc, the incidence of circumcision in the United States began to fall in the early 1980s, and the downward trend accelerated in the 1990s. The fall was not due so much to the policies of the AAP, which most doctors ignored, but to the educational efforts of popular and professional anti-circumcision groups. Official figures show that the incidence of neonatal circumcision in the western states, where such groups were most active, fell from 64 per cent in 1979 to 34 per cent in 1994. As a result of an increase in the rate in the Midwest, however, the national figures fell much less â€“ from 64 per cent to 62 per cent over the same period. In February 1996 a research team at the University of Manitoba led by Dr John Taylor published the results of the most significant investigation of the anatomy and physiology of the foreskin since Winkelmann. Their paper, "The prepuce: Specialized mucosa of the penis and its loss to circumcision", described the structural and functional components of the foreskin and established its rich innervation and vascularisation, clearly evolved to constitute an erogenous zone and to enhance erotic experience. Since circumcision had originally been instituted precisely for the purpose of destroying these very features, it is not surprising that the medical establishment was reluctant to acknowledge Taylor's work, let alone face the obvious implications. Other bodies, however, have paid attention, including the Australian College of Paediatrics and the Canadian Pediatric Society, both of which published policies on circumcision in 1996. Each recommended that circumcision of newborns be not performed, and pointed out that circumcision without informed consent was a violation of accepted principles of both medical ethics and human rights. [131, 132] Around this time, too, prominent figures from the world medical community condemned the American practice of routine circumcision of infants as both medically unnecessary and morally wrong. The consensus among critics was that irrespective of the validity of the health arguments for circumcision, the fact that it was done without consent made it an unacceptable intrusion into the personal lives of individuals and an unwarranted deprivation of their private property. [133-138] The constitutional conflict between human rights and the American medical establishment's assumption that it knows best what's good for boys may be settled in the courts. <h3>7. Conclusion</h3> The historical record makes it clear that in the late nineteenth century American physicians sought to institutionalise genital mutilation of both boys and girls as a means of eliminating childhood sexuality, and that their efforts were successful in the case of boys, unsuccessful in the case of girls. Doctors circumcised boys to denude, desensitise and disable the penis to such an extent as to make masturbation impossible, or at least not worth the effort. Clitoridectomy of girls was introduced for the same reason. While the medical establishment's use of popular fears about masturbation to justify mass circumcision has remained pretty constant since Victorian times, the subsequent supplementary excuses offered to justify circumcision follow a clearly defined pattern: whatever incurable disease happens to be the focus of national attention at any given time will be the disease that circumcision advocates will cite as a reason for circumcision. In the 1870s, when epilepsy was the disease of the moment, circumcision advocates claimed that circumcision could cure and prevent epilepsy. In the 1940s, when STDs were the focus of national health fears, they claimed that circumcision could prevent the spread of STDs. In the 1950s, when everybody was obsessed with cancer, circumcision advocates claimed that circumcision could prevent all sorts of cancers â€“ of the penis, of the tongue of the prostate and of the cervix. Since the late 1980s, when HIV-AIDS became the greatest health scare since the Black Death, circumcision advocates have predictably claimed that circumcision is the answer to AIDS control. Ironically, and despite these claims, the United States, for all that most of the men are circumcised, does not have a particularly good health record, and on most indicators is well behind places such as Japan and Scandinavia, where circumcision is practically unknown. Today the USA has both the highest percentage of sexually active, circumcised men and one of the highest rates of genital cancers and STDs in the western world. The paradox implicit in this history is that even though mass circumcision has been ineffective as a public health measure, and has done little to control either cancers or STDs, the American medical establishment has clung to its faith in circumcision and consistently sought to find new justifications for it. Their priority does not seem to have been maximising public health, but maximising their foreskin harvest. Such unscientific allegiance to an ineffective and harmful surgical procedure, when good sense would suggest the adoption of more conservative and more effective strategies, suggests that there may be a deeper, non-rational dynamic behind circumcision advocacy, and that it is not just matter of simply applying, as they so often claim, the discoveries of medical science to public health policy. [139] The history of the institutionalisation of involuntary circumcision in the United States demonstrates that American society has been willing to apply what it takes to be scientific measures at the expense of personal liberty. It is tempting to dismiss circumcision as merely a quaint example of medical quackery pursued by a handful of zealous doctors. We would do better to remember that in the name of scientific progress, millions of American citizens have been subjected to genital mutilation and deprived of an integral, functional and beautiful part of their body. In the face of increasing international criticism and constitutional challenges we must wonder how much longer the medical establishment will be able to continue to indulge in the kinds of illogical thinking and disregard for human rights that underpin their commitment to circumcision as prophylaxis and therapy. <h3>References</h3> 1. T.S. Szasz, Law, Liberty and Psychiatry, Syracuse 1989, 212 2. X. Bichat, General Anatomy, Applied to Physiology and Medicine, Boston, 1822 3. F.J.V. Broussais, A Treatise on Physiology Applied to Psychology, Philadelphia, 1826 4. L. Deslandes, De l'Onanisme et des Autres Abus Veneriennes Considerees dans leurs Rapports avec le Sante, Paris 1835 5. Claude-Francois Lallemande, Des Pertes Seminales Involuntaires, Paris 1836, 465 6. E.H. Dixon, A Treatise on Diseases of the Sexual Organs, New York 1845, 158-65 7. Tying the spermatic artery, Boston Medical and Surgical Journal 26, 1842, 321 8. J. Crosby, Seminal weakness, Boston Medical and Surgical Journal 29, 1843, 10 9. S.N. McMinn, Insanity cured by the excision of the external organs of generation, Boston Medical and Surgical Journal 32, 1845, 131 10. W.T. Taylor, Castration: Recovery followed by phthisis pulmonalis, American Journal of the Medical Sciences 30, 1855, 85 11. Castration for masturbation, Medical Record 46, 1894, 534 12. J.A. Gilbert, An unusual case of masturbation, Medical Record 88, 1915 608 13. T. Haynes, Surgical treatment of hopeless cases of masturbation and nocturnal emissions, Boston Medical and Surgical Journal 109, 1883, 130 14. A.C. Clark, Neurectomy: A preventive of masturbation, Lancet 1899:2, 838 15. J.H. M'Cassey, Adolescent insanity and masturbation; with exsection of certain nerves supplying the sexual organs as the remedy, Cincinnati Lancet-Clinic 37, 1896, 341 16. B. Edson, Concerning a case for circumcision, Medical World 20, 1902, 476 17. Cauterization by injection for spermatorrhoea, Transactions of the American Medical Association 4, 1851, 264 18. A. Garwood, Onanism in a boy 7 years old, American Journal of the Medical Sciences 27, 1854, 553 19. J.M. Keating, Masturbation, in Cyclopedia of Diseases of Children, Philadelphia 1890, III, 710 20. C.E. Warren, Genocatachresia, St Louis Medical and Surgical Journal 63, 1892, 201 21. J.H. Kellogg, <a href="http://www.stayfreemagazine.org/10/graham.htm" rel="noopener" target="_blank">Plain Facts for Old and Young</a>, Burlington 1888, 295 22. E. Flood, An appliance to prevent masturbation, Boston Medical and Surgical Journal 119, 1888, 34 23. Masturbation harness, Medical World 28, 1910, 133 24. Treatment of spermatorrhoea, Boston Medical and Surgical Journal 48, 1861, 121 25. E.S. Cooper, Excision of the clitoris as a cure for masturbation, Boston Medical and Surgical Journal 66, 1862, 164 26. Clitoridectomy, Medical Record 2, 1867, 71 27. J. Hutchinson, <a href="http://www.historyofcircumcision.net./templates/pages/the_crotchets_of_sir_jonathan_hutchinson.html" rel="noopener" target="_blank">On the influence of circumcision in preventing syphilis</a>, Medical Times and Gazette 2, 1855, 542 28. J. Hirschfeld, The Jewish circumcision before a medical tribunal, American Medical Monthly 9, 1858, 272 29. Phimosis in new-born children, Boston Medical and Surgical Journal 65, 1861, 121 30. C. Bliss, Spermatorrhoea: A new method of treatment, Boston Medical and Surgical Journal 77, 1868, 536 31. A.B. Arnold, Circumcision, New York Medical Journal 9, 1869, 514 32. M. Fishbein (ed), A History of the American Medical Association 1847-1947, Philadelphia 1947, 636 33. L.A. Sayre, Partial paralysis from reflex irritation, caused by congenital phimosis and adherent prepuce, Transactions of the American Medical Association 21, 1870, 205 34. L.A. Sayre, Circumcision versus epilepsy, Medical Record 5, 1870, 233 35. N. Heckford, Circumcision as a remedial measure in certain cases of epilepsy, chorea etc, Clinical Lectures and Reports by the Medical and Surgical Staff of London Hospital 2, 1865, 58-64 36. L.A. Sayre, Spinal anaemia with partial paralysis and want of coordination, from irritation of the genital organs, Transactions of the American Medical Association 26, 1875, 255 37. A. Jacobi, On masturbation and hysteria in young children, American Journal of Obstetrics 8, 1876, 595 38. M.J. Moses, The value of circumcision as a hygienic and therapeutic measure, New York Medical Journal 14, 1871, 368-74 39. E.J. Spratling, <a href="http://www.historyofcircumcision.net./templates/pages/treating_masturbation_1895.html" rel="noopener" target="_blank">Masturbation in the adult</a>, Medical Record 48, 1895, 442-3 40. C.E. Fisher, Circumcision, in A Handbook on the Diseases of Children and their Homeopathic Treatment, Chicago 1895, 875 41. W.D. Gentry, Nervous derangements produced by sexual irregularities in boys, Medical Current 6, 1890, 268 42. The advantages of circumcision, Medical News 77, 1900, 707 43. E.G. Mark, Circumcision, American Practitioner and News 31, 1901, 122 44. A.S. Taylor, A case of congenital phimosis leading to death at the age of 83, Lancet 1891:1, 1040 45. A.L. Wolbarst, Persistent masturbation, Journal of the American Medical Association 90, 1932, 154 46. A.L. Wolbarst, Universal circumcision as a sanitary measure, Journal of the American Medical Association 62, 1914, 92 47. ibid 48. A.L. Wolbarst, Does circumcision in infancy protect against disease? Virginia Medical Monthly 60, 1934, 723 49. A.L. Wolbarst, Circumcision and penile cancer, Lancet 1932:1, 150 50. H.C. Bazett et al, <a href="http://www.cirp.org/library/anatomy/bazett/" rel="noopener" target="_blank">Depth, distribution and probable identification in the prepuce of sensory end-organs</a>, Archives of Neurology and Psychiatry 27, 1932, 489 51. G.A. Diebert, <a href="http://www.cirp.org/library/anatomy/deibert/" rel="noopener" target="_blank">The separation of the prepuce in the human penis</a>, Anatomical Record 57, 1933, 387 52. R.H. Hunter, Notes on the development of the prepuce, Journal of Anatomy 70, 1935, 68 53. A.F. Guttmacher, <a href="http://www.historyofcircumcision.net./templates/pages/should_he_be_circumcised_1941.html" rel="noopener" target="_blank">Should the baby be circumcised?</a>, Parents Magazine 16, September 1941 54. ibid 55. ibid 56. J. Ewing, The causal and formal genesis of cancer, in Cancer Control, Chicago 1927, 168 57. A. Ravich, The relationship of circumcision to cancer of the prostate, Journal of Urology 48, 1942, 298 58. Circumcision vs cancer, Newsweek 21, 1943, 110 59. Who's Who in America, 42nd edn, 1982-83, 2752 60. M.L. Gerber, Some practical aspects of circumcision, United States Navy Medical Bulletin 42, 1944, 1147 61. L.L. Heimoff, Veneral disease control program, Bulletin of the US Army Medical Department 3, 1945, 93 62. E.A. Hand, Circumcision and venereal disease, Archives of Dermatology and Syphilology 60, 1949, 341 63. Circumcision and VD, Newsweek 30, 1947, 49 64. D. Gairdner. <a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">The fate of the foreskin: A study of circumcision</a>, British Medical Journal 1949:2, 1433 65. R.L. Miller and D.C. Snyder, Immediate circumcision of the newborn male, American Journal of Obstetrics and Gynecology 65, 1953, 1-11 66. J.P. Greenhill, Obstetrics, 13th edn, Philadelphia 1960, 1049; N.J. Eatman and L.M. Hellman (eds), Williams Obstetrics, 12th edn, New York 1961, 1101 67. A. Ravich and R.A. Ravich, Prophylaxis of cancer of the prostate, penis and cervix by circumcision, New York State Journal of Medicine 51, 1951, 1519 68. E.L. Wynder et al, A study of environmental factors in cancer of the cervix, American Journal of Obstetrics and Gynecology 68, 1954, 1016 69. Circumcision and cancer, Time 63, 1954, 96 70. W.G. Rathmann, <a href="http://www.historyofcircumcision.net/templates/pages/female_circumcision_in_the_1950s.html" rel="noopener" target="_blank">Female circumcision: Indications and a new technique</a>, GP 20, 1959, 115 71. O. Dietz and E.C. Dougherty, Vergleichende studie zur frage der beschneidung in Deutschland und in den Vereinigten Staaten, Deutsche Gesundheitswesen 12, 1957, 193 72. A. Kelami, Die sogennante Gomecotomie als methode der wahl fur circumcision, Der Chirug 37, 1966, 512 73. Dietz and Dougherty, as cited 74. K.B. Hofmeister, Uber erste erfahrungen mit der routinemassigen beschneidung des neugeborenen in Deutschland, Geburtshilfe und Frauenheilkunde 19, 1959, 20 75. H. Koester, Zur frage der Zirkumzision neugeborenen knaben, Geburtshilfe und Frauenheilkunde 23, 1963, 934 76. O. Dietz, Erfahrungsbericht uber 2800 Zirkumzisionen, Dermatologische Monatsschrift 156, 1970, 1029 77. J.E. Bock and H. Rebbe, Neonatal circumcisio, Ugeskrift for Laeger 135, 1973, 1890 78. R.K. Winkelmann, <a href="http://www.cirp.org/library/anatomy/winkelmann2/" rel="noopener" target="_blank">The cutaneous innervation of the human newborn prepuce</a>, Journal of Investigative Dermatology 26, 1956, 53 79. R.K. Winkelmann, <a href="http://www.cirp.org/library/anatomy/winkelmann/" rel="noopener" target="_blank">The erogenous zones: Their nerve supply and its significance</a>, Proceedings of the Mayo Clinic 34, 1959, 39 80. E.C. Gibson, Carcinoma of the prostate in Jews and circumcised gentiles, British Journal of Urology 26, 1954, 227 81. E. Stern and P.M. Neely, Cancer of the cervix in reference to circumcision and marital history, Journal of the American Medical Women's Association 17, 1962, 739 82. D. Govinda Reddy, Carcinogenic action of human smegma, Archives of pathology 75, 1963, 414 83. W.K.C. Morgan, <a href="http://www.cirp.org/library/general/morgan/" rel="noopener" target="_blank">The rape of the phallus</a>, Journal of the American Medical Association 193, 1965, 223 84. J. Oster, <a href="http://www.cirp.org/library/general/oster/" rel="noopener" target="_blank">Further fate of the foreskin: Incidence of preputial adhesions, phimosis and smegma among Danish schoolboys</a>, Archives of Diseases of Childhood 43, 1968, 200 85. E.N. Preston, <a href="http://www.cirp.org/library/general/preston/" rel="noopener" target="_blank">Whither the foreskin? A consideration of routine neonatal circumcision</a>, Journal of the American Medical Association 213, 1970, 1853 86. American Academy of Pediatrics, Hospital Care of Newborn Infants, 5th edn, Evanston 1971, 110 87. Boston Children's Medical Centre, Pregnancy, Birth and the Newborn Baby, Boston 1971, 285 88. V.E. Pomeranz and D. Schultz, The Mothers and Fathers Medical Encyclopedia, Boston 1977, 109 89. B. Livermore, Like father, like son, Health 19, 1987, 15 90. S. Barton, Your Child's Health, New York 1991, 113 91. W.H. Masters et al, Human Sexuality, 4th edn, New York 1992, 58 92. M.A. Miller et al (eds), Kimber-Gray-Stackpole's Anatomy and Physiology, 17th edn, New York 1977, 577 93. R.S. Snell, Atlas of Clinical Anatomy, Boston 1978, 136 94. M.F. Campbell, The male genital tract and the female urethra, in M.F. Campbell and J.H. Harrison (eds), Urology, 3rd edn Philadelphia 1970, Vol. 2, 1836 95. ibid 96. R. Burger and T.H. Guthrie, Why circumcision?, Pediatrics 54, 1974, 362 97. L. Wollman, Female circumcision, Journal of the American Society of Psychosomatic Dentistry and Medicine 20, 1973, 130 98. <a href="http://www.cirp.org/library/statements/aap/" rel="noopener" target="_blank">Report of the ad hoc task force on circumcision</a>, Pediatrics 56, 1975, 610 99. Two suits charge circumcision malpractice, Contemporary Ob/Gyn 28, 1986, 150 100. Calif suit raises liability questions in circumcision, ObGyn News 21, 1986, 1 101. Two suits 102. C.M. Ginsburg and G.H. McCracken, Urinary tract infections in young infants, Pediatrics 69, 1982, 409 103. T.E. Wiswell and J.W. Bass, Decreased incidence of UTIs in circumcised male infants, Pediatrics 75, 1985, 901 104. A.J. Fink, In defence of circumcision, Pediatrics 77, 1986, 265 105. T.E. Wiswell, Reply, Pediatrics 77, 1986, 266 106. G.H. McCracken, Options in antimicrobial management of UTIs in infants and children, Pediatric Infectious Diseases Journal 8, 1989, 552 107. F.W. Burch, Baby Sense, New York 1991, 226 108. A. Santesteban, Child Care for the 90s, Bedford 1993, 18 109. D. Dollemore et al, Symptoms: Their Causes and Cures, Emmaus 1994, 199 110. Doubts about circumcision: Fewer boys are now cut, Newsweek 109, 1987, 74 111. J. Silberener, Circumcision, US News and World Report 104, 1988, 68 112. C.S. Rand et al, The effect of an educational intervention on the rate of neonatal circumcision, Obstetrics and Gynecology 62, 1983, 64 113. G.O. Bean and C. Egelhoff, Neonatal circumcision: When is the decision made?, Journal of Family Practice 18, 1984, 883 114. J.E. Lovell and J. Cox, Maternal attitudes towards circumcision, Journal of Family Practice 9, 1979, 811 115. N.H. Eriksen et al, UTIs infection, etiology, diagnosis and treatment with effective antibiotics, Nordisk Medicin 104, 1989, 35 116. A.L. Shabad et al, The pathogenesis and treatment of UTIs in women, Urologiia I Nefrologiia 4, 1995, 8 117. T.E. Wiswell, Risks from circumcision during the first month of life, Pediatrics 83, 1989, 1011 118. T.E. Wiswell, Routine neonatal circumcision: A reappraisal, American Family Physician 41, 1991, 859 119. S. Ahman, Academy holds fast to position on circumcision, Pediatric News 20, 1986, 38; <a href="http://www.cirp.org/library/disease/UTI/" rel="noopener" target="_blank">more recent studies of UTIs can be found here</a>. 120. <a href="http://www.cirp.org/library/statements/" rel="noopener" target="_blank">Report of the task force on circumcision</a>, Pediatrics 84, 1989, 388 121. E.J. Schoen, Is it time for Europe to reconsider newborn circumcision?, Acta Paedatrica Scandinavica 80, 1991, 573 122. I. Bollgren and J. Winberg, <a href="http://www.cirp.org/library/disease/UTI/winberg-bollgren2/" rel="noopener" target="_blank">Reply to Schoen</a>, Acta Paedatrica Scandinavica 80, 1991, 575 123. A.J. Fink, A possible explanation for heterosexual male infection with AIDS, New England Journal of Medicine 315, 1986, 1167 124. A.J. Fink, Is hygiene enough? Circumcision as a possible strategy to prevent group B streptococcal disease, American Journal of Obstetrics and Gynecology 159, 1988, 534 125. A.J. Fink, Circumcision and sand, Journal of the Royal Society of Medicine 84, 1991, 696 126. B. Manson, Forget pork bellies, now its foreskins, San Diego Reader, 4 May 1995, 12 127. S. Brewer, New skin twin life, Longevity, September 1992, 18 128. R. Rosenberg, Companies see $1.5b market in replacement skin products, Boston Globe, 19 October 1992, 22 129. C.T. Hall, Biotech's big discovery, San Francisco Chronicle, 25 October 1996 130. J.R. Taylor et al, <a href="http://www.cirp.org/library/anatomy/taylor/" rel="noopener" target="_blank">The prepuce: Specialized mucosa of the penis and its loss to circumcision</a>, British Journal of Urology 77, 1996, 291 131. <a href="http://www.cirp.org/library/statements/acp1996/" rel="noopener" target="_blank">Position statement on routine circumcision</a>, Australian College of Paediatrics, Parkville, Vic, 1996 132. Canadian Pediatric Society, <a href="http://www.cps.ca/english/statements/FN/fn96-01.htm" rel="noopener" target="_blank">Clinical practice guidelines: Neonatal circumcision revisited</a>, Canadian Medical Association Journal 307, 1996, 769 133. J. Menage, Male genital mutilation, British Medical Journal 307, 1993, 686 134. L. Sorger, To ACOG: Stop circumcisions, ObGyn News 1 November 1994, 8 135. P.M. Fleiss, Female circumcision, New England Journal of Medicine 322, 1995, 189 136. S. Mullick, Circumcision, British Medical Journal 310, 1995, 259 137. J.P. Warren et al, <a href="http://www.cirp.org/library/general/warren1/" rel="noopener" target="_blank">Circumcision of children</a>, British Medical Journal 312, 1996, 377 138. P.M. Fleiss, More on circumcision, Clinical Pediatrics 34, 1995, 623; <a href="http://www.foreskin.org/fleiss.htm" rel="noopener" target="_blank">a more recent statement by Paul Fleiss available here</a>. 139. J. Bigelow, The Joy of Uncircumcising, Aptos 1995, 89 <h4>Source</h4> Originally published as "A short history of the institutionalization of involuntary sexual mutilation in the United States", in George C. Denniston and Marilyn Milos (eds), Sexual Mutilations: A Human Tragedy (New York: Plenum Press, 1997). The paper has been slightly edited in places for brevity and clarity. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource A short history of circumcision in the United States: Part 2 darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>The Orificial Surgery Society and orthodox medicine</h3> A symptom of the late Victorian vogue for surgical solutions to health problems was the Chicago-based Orificial Surgery Society, which was active from the late 1880s until the early 1920s and published a number of textbooks by prominent members (all with MDs), and the Journal of Orificial Surgery from 1892 to 1901. Its particular obsession was the influence of the lower orifices on the nervous system, meaning that it targeted the foreskin (in both males and females) and the rectum as the focal points for disease generation and control. Any tightness or other disorder in these sphincters caused nervous irritation, and the cure was forcible dilation or amputation. The society was particularly insistent on the need for circumcision, in both males and females, and was concerned that, while its health advantages for boys was well understood by the medical profession, there was less appreciation of its value for girls. As one textbook advised: <div>The condition of the foreskin of boys has received more or less attention, at least since the days of Moses. But the girls have been neglected. ... I do feel an irresistible impulse to cry out against the shameful neglect of the clitoris and its hood, because of the vast amount of sickness and suffering which could be saved the gentler sex, if this important subject received proper attention and appreciation at the hands of the profession. Circumcision for the girl or woman of any age is as necessary as for the boy or man. [1]</div> No matter what a person was suffering from, if he or she went to an orificial physician , the diagnosis was always the same: tight sphincters requiring dilation (in the case of the rectum) and dilation or amputation in the case of the clitoral or penile prepuce. Edward Wallerstein notes the following treatments, as detailed in the journal [2]: Dr Cora Smith Eaton circumcised two women to treat headaches. Dr M.K. Kreider circumcised a boy to cure spinal curvature. Dr C.B. Walls treated "hip joint disease" by circumcision, and commented that Jews rarely suffered from this problem. he added that "60 per cent of the insane are so because of some abnormal condition of their sexual organs". Dr T.E. Costain recommended circumcision as a treatment for hydrocephaly. Alex Comfort further reports that, like many of those who think they have discovered the master-key to one of the major problems of the day, [3] the orificial surgeons brought a fair load of evangelical zeal to their mission. Claiming that by genital and rectal operations "the body shall be released from every fetter that binds and the spirit directed Godward", they urged clergymen to direct their languishing charges to submit to circumcision and related procedures. [4] The temptation is to regard the orificialists as eccentrics or just plain loopy, but the fact is that they were largely orthodox by the standards of their day, and there was very little to distinguish either their theory or their practice from mainstream Anglo-American medicine. As Wallerstein remarks, "The essence of much American medical thinking from 1870 to 1920 was that surgery was a quick solution and/or preventive for a host of physical and emotional problems". [5] The impact of the foreskin on the nervous system was drawn from standard nerve force theory and the demonstration by Lewis Sayre that a tight or adherent foreskin could cause epilepsy, convulsions, paralysis of the limbs and other problems which could be cured by circumcision; P.C. Remondino had claimed to restore madmen to sanity by circumcision; and all authorities of the period agreed that phimosis in infancy or childhood was a serious threat to health. Only in its advocacy of operations on the female genitals did the orificialists go out somewhat on a limb, and even here they were following a surgical theory that had been in fashion the generation before. The authoritative Boston Medical and Surgical Journal (now known as the New England Journal of Medicine) regularly published articles like "Seminal weakness: Castration" (Vol. 29, 1843), "Insanity cured by excision of the external organs of generation" (Vol. 32, 1845), "Surgical treatment of hopeless cases of masturbation and nocturnal emissions" (Vol. 109, 1883), and "Excision of the clitoris as a cure for masturbation" (Vol. 66, 1862). But while spermatorrhoea as a disease and clitoridectomy as a treatment fell out of favour as the twentieth century advanced, circumcision of boys elicited one new justification after another. It should be noted that the orificialists rarely practised clitoridectromy; their focus was flaps, not knobs. Even their distinctly kinky obsession with the rectum (loosening those tight anal sphincters) does not seem all that way out when it is remembered that the champion of universal circumcision as a sanitary measure, Abraham Wolbarst, was the proud inventor of a kind of electric dildo, to be inserted into the anus with a view to massaging the prostate. [6] It is perhaps a sign of how embarrassing the American medical establishment still finds the orificial surgery episode that no history of this movement has been published, nor even any substantial journal articles. The only item which turns up in the vast Pro-Quest database is a scrappy note by Ira Rutkow, who completely ignores the strongest feature of the movement (its advocacy and practice of male circumcision) and states that it focused on "the treatment of chronic disease processes through surgical operations on the rectum, vagina, cervix, urethra, nares, mouth, etc." It would be truer to say that it was obsessed with the foreskin and rectum (parts of the body that were exciting to play with and easy to do things to) and had a good deal less interest in these other organs. Rutkow seems to be a victim of the strange amnesia about the male body which seems to affect so many Americans; do they think that normal boys these days are born without foreskins? The articles on this site provide both the genuine orificial flavour and an indication of how close the society was to the medical mainstream. <a href="http://www.historyofcircumcision.net/templates/pages/miracle_cures_1898.html">N. Bergman, Report of a few cases of circumcision</a> <a href="http://www.historyofcircumcision.net/templates/pages/circumcision_of_girls_c1900.html">T. Scott McFarland, Circumcision of girls</a> <a href="http://www.historyofcircumcision.net/templates/pages/preputial_irritation_1898.html">J.H. Beaty, Some peripheral irritations common in young boys</a> <h4>NOTES</h4> 1. B.E. Dawson, Orificial surgery: Its philosophy, application and technique (Newark: The Physician's Drug News Co, 1912), p. 402 2. Edward Wallerstein, Circumcision: An American health fallacy (New York, Springer, 1980). pp. 38-9 3. Such as Jonathan Hutchinson's crusade for universal circumcision as the solution to the syphilis problem; William Chidley's crusade for "natural coitus" as the royal road to health and happiness; Roger Short's crusade for universal circumcision as a solution to the African AIDS crisis; Brian Morris's crusade for universal neonatal male circumcision as a preventive of nearly every health problem known to man. Aah, the fragrance of snake oil! 4. Alex Comfort, The anxiety makers: Some curious preoccupations of the medical profession (London: Nelson, 1967), p. 105 5. Wallerstein, p. 39 6. Abraham Wolbarst, "Universal circumcision as a sanitary measure", Journal of the American Medical Association, Vol. 62, 1914, pp. 92-7; Abraham Wolbarst, "Method of applying vibratory massage to the prostate: Preliminary report", Journal of the American Medical Association, Vol. 91, 3 November 1928, p. 1371 <h3>Ira M. Rutkow, the moment of Orificial Surgery</h3> THE MOST INFLUENTIAL of the late 19th century American unorthodox medical sects was the homeopathic movement. It grew out of the experimental pharmacologic studies of German physician Samuel Hahnemann (1755-1843) and within a few decades had won over numerous converts, primarily in urban middle and upper classes. Among the more interesting yet bizarre clinical schemes to emerge from the practice of homeopathy was orificial surgery. This philosophy, the treatment of chronic disease processes through surgical operations on the rectum, vagina, cervix, urethra, nares, mouth, etc, evolved from the personal practice beliefs of Edwin Hartley Pratt (1849-1930), an Illinois homeopathic general practitioner. Pratt obtained his medical degree from Chicago's Hahnemann Medical College in 1873. For the first 10 years of his career, he was engaged in general practice and saw patients in Cook County Hospital or his own private clinic. Pratt's theories about orificial surgery had been undergoing maturation since the early 1880s, but their first formal presentation to the medical profession did not occur until 1886. Pratt gave a lecture on the orificial philosophy that was published in The Medical Era, a trade publication managed by 2 homeopathic pharmacists. As he stated: A vigorous sympathetic nervous system means health and long life. What surgical interest have we in this fact? It can be told in just one sentence. The weakness and the power of the sympathetic nerve lies at the orifices of the body. Surgery must keep these orifices properly smoothed and dilated. Pratt rarely saw an orifice that was not in need of a surgeon's scalpel. In this surgical manner, problems such as constipation, dysmenorrhea, eczema, insanity, insomnia, tuberculosis, and vomiting could be treated. Like any savvy promoter, Pratt authored a lengthy monograph on orificial surgery (1887). The work was a tremendous success in that it provided his new branch of surgery with both direction and content. A year later, Pratt and his acolytes organized the American Association of Orificial Surgeons. As Pratt's proselytizing met with increasingly receptive audiences, he began to design and sell surgical instruments intended strictly for orificial operations. By 1891, and becoming independently wealthy, Pratt began construction of his own private hospital known as the Lincoln Park Sanitarium in Chicago. With growing numbers of practitioners of orificial surgery nationwide, the necessity for its own specialty journal became paramount. In mid 1892 the Journal of Orificial Surgery commenced publication with Pratt as its editor-in-chief. The orificial philosophy attracted a large following whose advocates were, in every sense of the word, surgeons. Their technical skills allowed Pratt's followers to perform many formidable operations, including hysterectomy, repair of complicated cervical and perineal lacerations, and radical hemorrhoidectomy. Although it is an impossible task to estimate how many Americans were victims of this unorthodox surgical philosophy, they must have numbered in the tens of thousands. The allure of orificial surgery was, for 2 to 3 decades, quite strong and paralleled the achievements in overall homeopathy. However, this appeal would decline just as rapidly as did homeopathic therapeutics. In 1901, the Journal of Orificial Surgery abruptly ceased publication with little explanation. Annual meetings of the American Association of Orificial Surgeons continued through World War I, but the end was in sight for the aging population of orificial surgeons. By the 1920s, orificial surgery had become little more than a vague memory in the minds of most American health care professionals. Ira M. Rutkow MD, MPH, DrPH, "Orificial Surgery", Archives of Surgery, Vol. 136, Sept. 2001, p. 1088 </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 Orificial surgery 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 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>Yet another advantage of circumcision</h2> In the 1880s there were suggestions that African Americans should be forcibly circumcised as part of a campaign against venereal disease. It was asserted that they were irredeemably promiscuous and impossible to educate in the laws of hygiene. In the 1890s some white doctors went further, arguing that Negroes committing sexual assaults should be summarily castrated, while Dr P.C. Remondino thought it would be both more effective and more humane to pass a law requiring all Negro boys to be routinely circumcised, since the surgery was guaranteed to keep their innate lust within reasonable bounds. <h3>1. Compulsory circumcision to control syphilis</h3> <h4>"Enforced circumcision of the colored race", 1889</h4> We call attention to this article in the present number of the Journal. It is contributed by an intelligent physician, Dr Vandavel, and is quite creditable for his first effort at writing for the press. The doctor makes a strong argument in favour of circumcision in his race as a prophylactic measure, and thinks that a long train of evils, beside syphilis, may thus be avoided. It is true, the rhetoric of the article might be improved, the subject more elegantly, perhaps, but not more forcefully put. He makes a plea, also, that the coloured people, being ignorant of the laws of hygiene, should be enlightened, while taken under a kind of sanitary protectorate. The paper was read at the annual convention of the Coloured Physicians' Association. â€” Nigger doctors, as Fisher called them, at Houston, on 25th ult. [1] Editorial, Daniel's Texas Medical Journal, Vol. 5, July 1889, p. 28 Circumcision Enforced by Law By J.M. Vandavel, MD, Waco (Read at Convention, Loue State Medical Society, Houston, June 25, 1889) While we agree in a measure with the statement that the world is governed too much by prohibitory or implied prohibitory acts, we must also agree in the fact that governments are organized, fostered and perpetuated for the general welfare of the constituency, individually and collectively. It is the duty of the civic or municipal, state and national governments to look after the habits and customs of their citizens respectively, and direct in a legal way whenever it is apprehended, or discovered, that general prosperity is crippled, general health injured and the sanitary status are of such a character as to impede sanitary invironment [sic] and healthfulness; dwarf the civilian in physique and thought; degenerate robust muscularity and mental acumen, legislative action becomes s paramount as the quarantine to prevent yellow fever, small-pox, cholera Asiatica, and as absolutely necessary as the interstate commerce bill to prevent discrimination in freight rates and railroad travel; because these affect the general welfare. It is a fact known to all and doubted by few, if any at all, that the rapid advancement of the most learned science during the past three decades has been almost phenomenal, and to speak of the various indices showing this progress is too laborious for the hour, too comprehensive for your servant to grapple with on this occasion. Going back three thousand years, many years before the fathers of medicine were born, to the days of the Astrologer, we present you with a rite as old as the Bible: the taking of the "fore-skin" of each male child; and in Egypt the circumcision of females was also practiced. We trust that each scientific mind will lay aside his orthodox teaching on our subject and view it primarily from a medical, or more specifically, as a sanitary measure or necessity. In all past ages of the world's history, as well as the present, the Hebrew has stood as impregnable to the common scourges and devastation which have swept away the earth's inhabitants that we have been force to ejaculate, "God's peculiar people truly". [2] A lower mortality than any race now on the face of the earth (in proportion to number), and this of course means longer life on the average; freedom or comparative freedom from the diseases which prey upon the common herd of humanity, viz., tubercle, phthisis pulmonaris, adenitis, carcinoma, scrofula, rachitis and venereal cachexia and of all diseases constitutional in their terrible ravages which come in direct harmony with and in obeisance to that scriptural injunction which says, "the sins and iniquities shall visit the children unto the third and fourth generation"; and until the malignancy of these blood taints shall have been exhausted in destroying general health and happiness, and depopulating some of the most densely inhabited sections of the southern states. It is a fact found in my own everyday work and in conversation, and by reading the scanty literature on this subject, that out of every five males suffering from venereal taint, four will have the long prepuce. Besides not adding anything to the looks of the organ, this elongated prepuce in the first places renders venereal disease much easier caught; and in the second place makes it decidedly much worse to treat. This proposition being granted as true, the question of the enforcement of circumcision is the one most needed to be discussed. That circumcision should be enforced by law only obtains in so far as we can show that consumption, scrofula, glandular enlargements, rheumatism, heart trouble and eczema are sequelae in any manner of syphilis. [3] The transmission of syphilis is one of the medical axioms: i.e., syphilis often pure and simple in the offspring â€” often syphilis in a modified form, for we see daily, syphilis transmitted and assuming the form of dermal eruptions, osseous dyscrasia, deformations, and in whatever way this taint manifests itself, it carries along with it deterioration of a physique which otherwise might have been an admirable specimen of God's handiwork. If we can check the ravages of disease, cut off inherited diseases transmitted by marriage and illegitimate cohabitation, calm excited brain and vaso-motor nerve centres, soothe supra reflex nerve excitation, we will have, in a measure, cured in advance many diseases and imagined diseases, both of mind and body, originating in an elongated prepuce, bringing on onanism, early cohabitation, phimosis, paraphimosis, and syphilis and sequelae. The good such a law would bring to the people of this country, especially the coloured people of the South land, where virtue is so slovenly and so loosely worn by our women, morality so little valued, and the marriage relationship so easily adulterated, or sullied, can be better appreciated by comparing the American races with the Sandwich Islanders. It is said that one hundred years ago there were (400,000) four hundred thousand inhabitants on these islands, healthy, prolific, and, in their peculiar way, prosperous; but since the importation and propagation of syphilis amongst that people, they have dwindled to (40,000) forty thousand, with a death rate equal to, if not exceeding, the birth rate; and as matter of fact it will be only a few decades when these people must become extinct, unless a check is made to the depopulating disease which is now threatening them, or unless the islands are peopled by a foreign element whose mode of living will be within the limits of a sanitary surveillance worthy of the name. Beside a very heavy death rate, there is another factor working against the islanders, and that is sterility, which is common to a very large number, both male and female, owing primarily to the thorough work of this disease, which has been described as "riding a man through the world and then jumping on his ghost and riding it through eternity". It is but right, looking these facts sternly in the face, for the government to look after the welfare of the races, black and white, and especially our own race, because as yet the race is infantile in the correct mode of living, ignorant of sanitary laws, and often heedless when known, and blind yet as to the daily and inexorable laws of nature to which all humanity must conform in order to be healthy and happy; the importance of this the race has not yet been taught. The Jew is well provided for. His dietary is on a higher and more wholesome basis than the most fastidious American can boast of, and he sees that his food is not only prepared well for the table, but that it is killed scientifically. They hold circumcision in high esteem only as an ordinance enjoined as a sanitary necessity â€“ a health safeguard. At the present rapidity by which the venereal taint is being propagated among the coloured people, even mere children being the worst sufferers, owing to fear and an attempt at secrecy, it will only be a matter of time when we will wish to call a halt; but it will be too late. [4] Daniel's Texas Medical Journal, Vol. 5, July 1889, pp. 7-11 <h4>Comment from Kansas</h4> Apropos of Dr Vandavel's article in Daniel's Texas Medical Journal, entitled, "Circumcision enforced by law", we do not think the people of Kansas would submit to such an apparent infringement of their personal rights, even if they are all willing to have their meat and drink restricted by temperance and prohibitory amendments. Some medical writers claim that the tonsils are not essential to mankind; other organs are likely to be attacked soon in a similar manner; the capillary adornment of many of our scientific heads is rapidly becoming a thing of the past, and we must call a halt in the near future, or we will answer to the melancholy Jacques' description: "Sans teeth, sans eyes, sans taste, sans everything". But, without adding constitutional amendment, it would be well if about half our male population were in the condition of the Shechemites when they were attacked by Simeon and Levy (Genesis xxxiv, 24 and 25). [5] False modesty too often manifests itself in a neglect of the toilet of the prepuce, and we heartily agree with Dr Vandavel that the elongated foreskin predisposes to venereal disease and adds not a whit to the beauty or utility of the organ. Kansas Medical Journal, Vol. 1, 1889, p. 208 <h3>2. Compulsory circumcision to solve "the Negro rape problem"</h3> In the 1880s, compulsory circumcision was urged as means of helping the "coloured race" overcome its infantile ignorance of the laws of hygiene and protect it from syphilis and many other diseases. In the 1890s, however, the emphasis shifted: circumcision was now to be enforced as a means of curtailing and controlling Black sexuality and protecting white women from assault by sex-crazed niggers. The charge was led by long-time circumcision crusader, <a href="http://www.historyofcircumcision.net./templates/pages/dr_peter_charles_remondino.html" rel="noopener" target="_blank">Dr Peter Charles Remondino</a>. <h4>Dr Remondino's surgical option, 1894</h4> The study of anthropological science in its broadest sense and in its applicability, or as a basis for preventing ill-conditions, is something that is very much neglected. The intimate relations â€“ suggestive, reflex and retroactive â€“ that exist between the body and the mind are things not sufficiently taken into account. The mind is not so much to be praised or always held to be as culpable as many affect to believe. Zimmerman, the eminent Hanoverian physician, relates in his works the case of a wonderfully bright German boy, whose quick and penetrating intellect was the pride of his village, who lost all his great mental gifts and soon relapsed into the stupidity of the average village lad of his surroundings on the removal of a tapeworm, which had for years inhabited his intestinal canal. An overflowing bladder as well as an irritating and ulster-proportioned and over-generously sebaceoused and generally too robust prepuce, will often cause the simulation of the evidences of an over-exuberant and impatient virility, something which should have for its only prompters over-filled or distended seminal vesicles. From our observations and experience in such cases, we feel fully warranted in suggesting the wholesale circumcision of the Negro race as an efficient remedy in preventing the predisposition to discriminate raping so inherent in that race. We have seen this act as a valuable preventive measure in cases where an inordinate and unreasoning as well as morbid carnal desire threatened physical shipwreck; if in such cases the morbid appetite has been removed or at least brought within manageable and natural bounds, we cannot see why it should not â€“ at least in a certain beneficial degree â€“ also affect the moral stamina of a race proverbial for the leathery consistency, inordinate redundancy, generous sebaceousness and general mental suggestiveness and hypnotizing influence of an unnecessary and rape, murder and lynching breeding prepuce. It would certainly be more humane for a State legislature to pass an act legalizing and enforcing circumcision as a preventive measure, just as it would enforce either vaccination or quarantine regulations, than to enact laws to castrate or eunuchize the accused after his infraction of the laws. The many burnings, hangings, shootings and stonings that have of late taken place should suggest the search of the physical cause of this law-breaking and of some preventive measures; the radical means adopted by mobs certainly cure the burned, hung, shot or stoned to death, but they seem in no wise to act as preventative in others. Circumcision, as a preventive measure, certainly stands at the head of all possible suggested measures. Were criminal anthropology a more advanced or practised science we should have had a cast of the prepuces of Col. Valentine Baker as well as that of the Rev. Mr Bell. When Clothaire subdued a Saxon rebellion he caused all the Saxon prisoners who exceeded in height the length of his good double-handed sword to be immediately decapitated. If on examination the prepuces of these two moral anarchists should have shown any proportionate relationship to those sported by the natives of Senegambia, they should then at once have been judicially excised â€“ a procedure which would have effectually prevented any moral relapse and which, in the end, would only have gained for them a moral, mental and physical betterment. Although the male Jews are much given to unholy and unedifying carnal pursuits, and in that field make records only equalled by the great Nimrod as a hunter, still, we never hear of a Jewish rapist. It would be well for the legislative Solons of our border and our Southern States to seriously investigate this question. in all of its bearings. With the discovery of cocaine and idioform gauze, catgut sutures and of the artistic and serviceable dressings that can be made from a combination of aseptic gauze and of dextrine in alcoholic solution, circumcision can no longer be termed either barbarous, dangerous, annoying, painful, nor labour or occupation interfering; the operation is simple, quickly done, and with a permanent dressing that will need no renewing, the circumcised may go to work in the field, store, at the desk or in the court or pulpit â€“ the sutures and healing taking care of themselves â€“ the patient himself often being able to remove the dressing on the sixth or seventh day and find perfect recovery. If an infant, the wound should be simply dusted with a powder composed of two thirds boracic acid and one third aristol, care being taken to keep the parts perfectly dry by dusting with the above several times daily and avoiding the contact of any cloth and not bathing the parts until complete union and cicatrization have taken place. In the South negro male children are much more subject to nervous disorders than girls. Tetanus and ailments of a kindred nature, convulsions, strabismus and like disorders which we have been induced by preputial irritation are not uncommon affections with the little negro males. Tetanus is especially a very sudden, severe and fatal disease with our little African cousins, and the relations that preputial adhesions and such like irritations bear as etiological factors have not as yet been sufficiently investigated, although their position as such factors are obvious. An uncontrollable degree of zealous piety and fervour at the shrine of Venus Porcina as a racial trait should most certainly lead us to look for its cause in the same lines wherein we should look for a like condition in the average female. To simply look upon it as a racial immoral trait or as a furor Africanus only to be cured by the stake and the faggot or the contents of half a dozen Winchester magazines can hardly be considered sanity or being abreast of fin de siecle nineteenth century scientific and humane advancement. Such remedies are rather more in keeping with thought and actions that prevailed before the revival of medicine, when the unfortunate demented were chained like demoniacs in out-of-the-way dungeons or chased about the streets like made dogs. There are anatomical or pathological reasons for this condition â€“ which is akin to epilepsy â€“ that should remove it from being investigated from the single plane of the moralist, and the subject I assuming such proportions that it should be worthy of an investigation at the hands of a scientific and competent commission. The sociologist will naturally ask, "Was the condition existing in ante-bellum days? Has it a since-the-war foundation? What sociological changes have the coloured raced undergone since the war that would develop such a trait, or has unconfined and riotous liberty reawakened traits that prevailed in the race before their transportation from the wilds of Africa? Have they lost the affinity that should attract them to the female of their own race, or what are the causes that drive them to seek the females of the white race?" The purely medical man will look for pathological causes or in differing physiological conditions. The purely sentimental moralist has no legitimate position in such an inquiry any more than a bull in a china shop. We here see the constant need of the existence in our nation of a body analogous to the French Academy. Such a body composed of tried and seasoned scientists â€“ not mere dilettantes who simply join this or that scientifically presumed body to give them the airs of men of science â€“ from literature, the arts, and from the three sister sciences, would investigate such a subject from some tangible base. Were such a body to exist, their deliberations and findings would, on being transmitted or reported to Congress, receive the attention of that body, and some other solution for the subject be found for their remedy besides kerosene and tar saturated faggots or hangings and bullet riddling . ... [etc etc etc] P.C. Remondino MD, "Questions of the day: Negro rapes and their social problems", National Popular Review, Vol. 4, January 1894, p. 3-6 <h4>The Maryland Medical Journal agrees</h4> A great deal has been said and written upon the question of rape by the Negro in the south. The brutal and uncontrollable passion of the Negro has been traced to a variety of causes, the chief of which has been referred to a perversion of his sexual instincts and ungoverned sexual passion. The treatment for this peculiar crime has been, so far, extremely radical. The individual has, with rare exceptions, paid for his lust by accepting violent forms of death. Lynching and other forms of torture have shown no tendency to check the criminal practices of this unfortunate class. Among the remedies proposed, legal castration has very warm advocates. It is quite doubtful whether this method could be made to reach any large number of cases, nor is it probable that a law could be enforced with any degree of justice or humanity that would be practicable and efficient. A recent suggestion has been made by Dr P.C. Remondino, in the National Popular Review (January 1894), which throws some light on this question, and is, at least, worthy of consideration. Dr Remondino is a well known student and writer on the subject of circumcision. He has made researches into the origin and practices of this religious rite by the Jewish and other races, and has studied its influences from a physical, moral and religious standpoint. He has observed that whilst male Jews are noted for their strong sexual proclivities, such a character as a Jewish rapist is never heard of. He attributes this fact to the practice of circumcision, and he now suggests that the legal enforcement of circumcision among the Negro race would effectually remedy the predisposition to aping inherent in this race. He says: "We have seen this act as a valuable preventive measure in cases where an inordinate and unreasoning as well as morbid carnal desire threatened physical shipwreck; if in such cases the morbid appetite has been removed or at least brought within manageable and natural bounds, we cannot see why it should not â€“ at least in a certain beneficial degree â€“ also affect the moral stamina of a race proverbial for the leathery consistency, inordinate redundancy, generous sebaceousness and general mental suggestiveness and hypnotizing influence of an unnecessary and rape, murder and lynching breeding prepuce. "It would certainly be more humane for a State legislature to pass an act legalizing and enforcing circumcision as a preventive measure, just as it would enforce either vaccination or quarantine regulations, than to enact laws to castrate or eunuchize the accused after his infraction of the laws." The male Negro child, he claims, is subject to many nervous disorders from slight irritation. This characteristic follows him through life. An enlarged prepuce is assigned as the most frequent cause of irritation, and its removal, he believes, will lead to the stopping of sexual crimes and to the moral improvement of the race. There is much good sense in this suggestion, as there is much good sense in the practice of circumcision among neurotic male children of the white race. The general adoption of circumcision as a legal measure for any class would, no doubt, meet with violent opposition. It seems practicable, however, to secure much success in this direction from the co-operation of the medical profession. If circumcision was more frequently advised and practised as a hygienic and preventive measure in selected cases, we feel assured much good would result to society from such a measure. Such suggestions are entitled to careful reflection and consideration. "Circumcision for the correction of sexual crimes among the Negro race", Maryland Medical Journal, Vol. 30, February 1894, pp. 345-6 <h4>So does the Boston Medical and Surgical Journal</h4> (Now the New England Journal of Medicine) The solution to the yearly more serious problem of Negro rape in the south is a most difficult but important task. Lynching, with its attendant tortures, has proved as useless as it is atrocious. In the November number of the Virginia Medical Monthly, Dr Lydston strongly advised legal castration as a remedy; and he is supported in a more recent issue of the Texas Medical Journal, by Dr Daniel. The quieting effect of this treatment upon each criminal would, of course, be efficient for that one man, but it is doubtful how far it would carry a deterrent warning to other Negroes in the blinding heat of lust. Dr P.C. Remondino, in the January number of the National Popular Review, urges the adoption, not of expiatory laws, but of preventive legislation. It is not rational, he claims, to look upon the unbridled licentiousness of the Negro solely as a racial trait. The Negro child, especially the male, is subject to many nervous disorders from slight irritation, and this characteristic he carried with him to adult life. Accordingly, Dr Remondino sees in the removal of "an irritating and ulster-proportioned prepuce" the efficient and gentle means of stopping the sexual crimes and improving the moral system of the Negro race. He says: "Although the male Jews are much given to unholy and unedifying carnal pursuits, and in that field make records only equalled by the great Nimrod as a hunter, still, we never hear of a Jewish rapist. "From our observations and experience in such cases, we feel fully warranted in suggesting the wholesale circumcision of the Negro race as an efficient remedy in preventing the predisposition to discriminate raping so inherent in that race. We have seen this act as a valuable preventive measure in cases where an inordinate and unreasoning as well as morbid carnal desire threatened physical shipwreck; if in such cases the morbid appetite has been removed or at least brought within manageable and natural bounds, we cannot see why it should not â€“ at least in a certain beneficial degree â€“ also affect the moral stamina of a race proverbial for the leathery consistency, inordinate redundancy, generous sebaceousness and general mental suggestiveness and hypnotizing influence of an unnecessary and rape, murder and lynching breeding prepuce. "It would certainly be more humane for a State legislature to pass an act legalizing and enforcing circumcision as a preventive measure, just as it would enforce either vaccination or quarantine regulations, than to enact laws to castrate or eunuchize the accused after his infraction of the laws." "The solution of the Negro rape problem", Boston Medical and Surgical Journal, Vol. 130, February 1894, pp. 126-7 <h3>Circumcision and castration: The contribution of Dr G. Frank Lydston</h3> "Sexual crimes among the southern Negroes â€“ Scientifically considered" Virginia Medical Monthly, May 1893 (extracts) Dear Dr Lydston, â€“ After reading your paper on "Sexual Perversion" I am induced to ask you to give me ... some scientific explanation of the sexual perversion in the Negro of the present day. Before the late War between the States, rape by a Negro of a white woman was almost unknown; now the newspapers tell us how common it is. The crime of a Negro assaulting a white woman seems to be growing in frequency. ... It is not the legal, moral or political aspect of this perverted sexuality in the Negro upon which I ask your opinion. The subject has been discussed in these ways, and without any good. I want you ... to investigate it as a scientific physician â€“ one who has devoted much time to this and kindred matters. I do not know, in all this land, one so capable of making the examination complete, and I sincerely hope the investigation may result in some benefit to the negro race. ... Sincerely your friend Hunter McGuire "I'm glad you asked me that, Dorothy ... " [In a lengthy and verbose reply, Lydston first enumerated seven "special causes" which accounted "for the frequency with which the crime of rape is perpetrated by the Negro in this country."] 1. Hereditary influences descending from the uncivilized ancestors of our Negroes. When we take into consideration the ancestry of the American Negro, and reflect upon the peculiar sexual relations sustained by that ancestry, it is by no means surprising that ancestral traits crop out occasionally. Marriage among certain Negro tribes is as close a simulation to what is designated rape in civilized communities as could be well imagined. ... 2. A disproportionate development of the animal propensities associated with a relatively low differentiation of type. ... [Thanks to white blood and association with the white race] the mulatto may be much less liable to sexual crimes than his Negro ancestor. 3. A relatively defective development of what may be termed the centers of psychological inhibition. This defect is characteristic of all races of a low grade of civilization and a relatively low grade of intellectual development. ... 4. Physical degeneracy involving chiefly the higher and more recently acquired attributes, with a distinct tendency to reversion to type, which reversion is especially manifest in the direction of sexual proclivities. ... 5. The removal of certain inhibitions placed upon the Negro by the conditions which slavery imposed upon him; these were removed by liberation. ... It should be by no means surprising that the Negro, when thrown upon his own responsibility, with a complete removal of all the inhibitory influences of his previous bondage, should be unable to adapt himself to his new environment. This is by no means apologetic for the criminal acts of the Negro, but is simply an argument worthy of the consideration of those sentimental idiots who believe that the Negro question is one entirely of skin and political complexion. Such sentimentalists will one day awaken to a realization of the fact that the Negro question is one of the most serious with which we are confronted at the present time, and one which may be settled by the physical degeneracy and death of the Negro race, but which can only be settled in that way. It certainly cannot be settled by political manipulations of any kind, or by sentimental arguments. 6. An inherent unadaptability to his environment both from a moral and legal standpoint, the result of his unadaptability being an imperfect or perverted conception of his relations to his environment. ... 7. An incapacity of appreciation of the dire results to himself of sexual crimes. This incapacity is quite characteristic of individuals of a low type of organization, and such little sense of personal responsibility as a large proportion of the Negro race possess is readily inhibited by excitement of the lower brain centers, such as may be produced by anger, alcohol or the furor sexualis. ... When all inhibitions of a high order have been removed by sexual excitement, I fail to see any difference from a physical point of standpoint between the sexual furor of the Negro and that which prevails among the lower animals in certain instances and at certain periods. ... The furor sexualis in the Negro resembles similar attacks in the bull and elephant, and the running amuck of the Malay race. [What to do?] [Turning to the question of the remedy for these problems, Lydston asserted that he was not going to discuss the question "from the standpoint of political buncomb [?bunkum], maudlin sentimentality and intentional bias of certain blatherskite newspapers in the North", but was going to be "entirely utilitarian". While he felt that Judge Lynch had "accomplished great good in many isolated instances", Lydston was not in favour of capital punishment because it was manifestly not a deterrent. What he favoured was something lingering that would present a constant spectacle of fear to others â€“ namely, both castration and circumcision of the offender.] I object to any method of punishment which is followed by forgetfulness on the part of surviving prospective criminals. With them, current events soon obliterate all recollections of the criminal, his crime, and its punishment. To my mind there is only one logical method of dealing with capital crimes and criminals of the habitual class â€“ namely, castration. This method of punishment leaves behind it evidence which will prove a wholesome warning to criminals of like propensities. It prevents the criminal from perpetuating his kind. The murderer is likely to lose much of his savageness; violator loses not only the desire, but the capacity for a repetition of his crime, if the operation be supplemented by penile mutilation according to the Oriental method. A few emasculated Negroes scattered around through the thickly-settled Negro communities of the South would really prove the conservation of energy, as far as the repression of sex crimes was concerned. Executed, they would be forgotten; castrated and free, they would be a constant warning and ever-present admonition to others of their race. "Sexual crimes among the southern Negroes â€“ Scientifically considered â€“ An open correspondence between Hunter McGuire MD, LLD of Richmond, Va, and G. Frank Lydston, MD, of Chicago, Ill", Virginia Medical Monthly, Vol. XX (2), May 1893, pp. 105-125 G. Frank Lydston Lydston was Professor of Genito-Urinary Surgery and Syphilology at the State University of Illinois. He was the author of many books and articles on sexual pathology and a prominent advocate of both castration of Negroes for sexual offences and of surgical eugenics, as well as universal circumcision of boys as a deterrent against masturbation and a prophylactic against other diseases. This meant sterilization of criminals and other forms of the unfit as a means of controlling various "social diseases". In his book Diseases of Society (1905) he wrote: "not only crime, but all of the diseases of society [are] ... more or less remediable by castration or resection of the vasa differentia and the Falloppian tubes". ("Sex mutilations in social therapeutics", New York Medical Journal, Vol. XCV (14), 6 April 1912, pp. 677-85.) For further details, see Philip Reilly, The surgical solution: A history of involuntary sterilization in the United States (Johns Hopkins University Press, 1991), pp. 37-8. Lydston was also a keen supporter of Cesar Lombroso's theories of hereditary criminality and of his belief that character could be determined by skull measurements, the so-called science of craniometry. See G. Frank Lydston, "Studies of criminal crania", in Addresses and Essays, 2nd edn (Louisville, Ky: Renz and Henry, 1892), pp. 65-92. He was frequently cited as an authority by other circumcision advocates, such as Abraham Wolbarst, particularly in his "Universal circumcision as a sanitary measure", Journal of the American Medical Association, Vol. 62, 1914, p. 95 <h4>JAMA enters the debate:</h4> <h4>Circumcision and prophylaxis of syphilis</h4> The Negro springs from the southern race, and as such his sexual appetite is strong; all of his environments stimulate this appetite, and as a general rule his emotional type of religion certainly does not decrease it. Both Quillian [6] and Murrell [7] state that they have never examined a Negro girl over 16 years of age who was a virgin, and the leading Negro physicians of Washington admit that virginity is very rare among the poorer members of their race. ... [What to do?] The prophylaxis of syphilis in the Nero race is especially difficult, for it is impossible to persuade the poor variety of Negro that sexual gratification is wrong, even when he is in the actively infectious stage. It is probable that sex hygiene lectures will not have the slightest effect on this type, especially when one considers the risks that many of our own medical students run. As regards personal prophylaxis, all male babies should be circumcised, both for the purpose of avoiding local irritation which will increase the sexual appetite and for preventing infection. It is questionable whether adult Negroes should not be taught the use of prophylactic packages, which appear to have worked much good in certain quarters. H.H. Hazen, "Syphilis in the American Negro", Journal of the American Medical Association, Vol. LXIII (6), 8 August 1914, pp. 463-468 <h3>Racist stereotyping lives on</h3> The same racist assumptions about Negro promiscuity, licentiousness and ignorance were apparent in Eugene Hand's promotion of circumcision as a preventive of venereal disease in 1949. It is easy to see the same white fear and jealousy of Black sexuality, and the same determination to limit and suppress it, in contemporary suggestions that African blacks should be circumcised to "protect them" from HIV-AIDS. As Dr Eugene Hand wrote: Through the ages, Jews have universally been circumcised on the eighth day after birth. This procedure as given them protection against venereal disease even when they have been exposed. Though they may be promiscuous in their own race, Jews certainly are less promiscuous than Negroes. When infected they tend to seek medical advice early. Thus venereal disease has not been introduced into the Jewish race generation after generation. Instead the rate has remained the same or decreased, so that the chance of Jews' being infected has decreased. Circumcision is not common among Negroes. When done it often is later in life and frequently is due to recurrent venereal disease. The sex education of most Negroes is meager. They tend to accept venereal disease with less fear or social taboo than do most Jews and gentiles. Many Negroes are promiscuous. In Negroes there is little circumcision, little knowledge or fear of venereal disease and promiscuity in almost a hornet's nest of infection. Thus the venereal rate in Negroes has remained high. Eugene Hand, "Circumcision and venereal disease", Archives of Dermatology and Syphilology, Vol. 60, 1949, pp. 345-6 <h3>FURTHER INFORMATION</h3> <a href="http://www.historyofcircumcision.net./templates/pages/dr_peter_charles_remondino.html" rel="noopener" target="_blank">Peter Charles Remondino</a> <a href="http://www.circinfo.org/hiv.html" rel="noopener" target="_blank">AIDS and circumcision</a> Robert Darby, "Where doctors differ: The debate on circumcision as a protection against syphilis, 1855-1914", Social History of Medicine, Vol. 16, Spring 2003 Laura M. Bogart and Sheryl Thorburn, "Are HIV/AIDS Conspiracy Beliefs a Barrier to HIV Prevention Among African Americans?", Journal of Acquired Immune Deficiency Syndrome, Vol. 38, No. 2, February 2005, pp. 213-18 <a href="http://www.ph.ucla.edu/epi/faculty/detels/Epi227/Davis_JAIDS_2005.pdf" rel="noopener" target="_blank">Full text available here</a> <a href="http://www.prb.org/Template.cfm?Section=PRB&template=/ContentManagement/ContentDisplay.cfm&ContentID=12346" rel="noopener" target="_blank">Discussion of article here</a> <h3>NOTES and REFERENCES</h3> 1. The journal was edited by Dr. F.E. Daniel (d. 1914), a fanatical crusader for surgical solutions to both medical and social problems. He particularly advocated the castration of "insane criminals and sex perverts", and supported a Texas bill providing that persons found guilty of rape, attempted rape or incest should be castrated â€“ a measure that was passed by the House, but rejected by the Senate in 1907. He also lent his weight to the widespread movement to introduce sterilization of the insane and otherwise "unfit" on eugenic grounds. In 1894 he gave his warm support to Dr Pilcher, the superintendent of the Asylum for Idiots and Feebleminded Youths at Winfield, Kansas, when he revealed that he had castrated 44 boys and 14 girls for persistent masturbation. Daniel's editorial praised the salubrious effects of castration and asserted that "these operations are occurring constantly". Details from Philip Reilly, The surgical solution: A history of involuntary sterilization in the United States (Johns Hopkins University Press, 1991), pp. 37-8, 29. See also Ronald Hamowy, "Medicine and the crimination of sin: 'Self-abuse' in 19th century America", Journal of Libertarian Studies, Vol. 1, 1977, pp. 229-270, and Robert Darby, "Circumcision as a preventive of masturbation: A review of the historiography", Journal of Social History, Vol. 36, Spring 2003. 2. On the medical construction of the ancient Jewish prophets as forward-looking sanitarians, see Leonard Glick, Marked in your flesh: Circumcision from Ancient Judea to modern America (New York: Oxford University Press, 2005) 3. An assumption common among medical researchers with a cause, and underlying the position of many circumcision advocates today: that if they can show that a procedure, no matter how costly, risky or mutilating, has or may have some prophylactic effects against a feared disease, it is perfectly acceptable to enforce it on children or other ignorant persons without any requirement of informed consent, and without having to offer equally effective, but non-injurious, alternatives. The case of circumcision as a protection against AIDS comes to mind. 4. The sort of doomsaying alarmism typical of medical scaremongers: the situation is so critical that unless the world quickly adopts my own patent solution to the problem, we face certain ruin. A line popular among old style quacks, who were fond of painting lurid scenarios of the disasters that would inevitably befall unless people bought their liniment or paid them for certain intimate surgical procedures. 5. In this well known Bible story, the Hebrews agreed to let the Hivite men marry some of their women on condition that they submitted to circumcision. While they were recovering from their wounds, and thus helpless, Hebrew warriors attacked and massacred them all (Genesis xxxiv, 24 and 25). 6. Quillian, Med. Era. St Louis, xx, 1911, p. 416; Am. Jour. Dermat. and Genito-Urin., x, 1906, p. 277 7. Thomas W. Murrell, "Syphilis and the American Negro: A medico-sociological study", JAMA, Vol. LIV (11), 12 March 1910, pp. 846-49. This article drew heavily on, though did not cite, Lydston's comments in the article, "Sexual crimes among the southern Negroes", Virginia Medical Monthly, May 1893. </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 Solving the "Negro rape problem" (1880s) darby