It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing (or enhancing) sexual pleasure, as an aid to hygiene where regular bathing was impractical, as a means of marking those of lower (or higher) social status, as a means of differentiating a circumcising group from their non-circumcising neighbors, as a means of discouraging masturbation or other socially proscribed sexual behaviors, to increase a man's attractiveness to women, as a symbolic castration, as a demonstration of one's ability to endure pain, or as a male counterpart to menstruation or the breaking of the hymen.
Circumcision in the Ancient World
The oldest documentary evidence for circumcision comes from Egypt. Tomb artwork from the Sixth Dynasty (2345 - 2181 BC) shows men with circumcised penises, and one relief from this period shows the rite being performed on a standing adult male. The Egyptian hieroglyph for "penis" depicts either a circumcised or an erect organ. The examination of Egyptian mummies has found both circumcised and uncircumcised men.
Circumcision was common, although not universal, among ancient Semitic peoples. The Book of Jeremiah, written in the sixth century BC, lists the Egyptians, Jews, Edomites, Ammonites, and Moabites as circumcising people. Herodotus, writing in the fifth century BC, would add the Colchians, Ethiopians, Phoenicians, and Syrians to that list.
Except in the portrayal of satyrs, lechers, and barbarians, ancient Greek artwork portrayed penises covered by foreskins. In the aftermath of Alexander the Great's conquests, Greek dislike of the circumcised penis led to a decline in the incidence of circumcision among many peoples that had previously practiced it. The writer of 1 Maccabees wrote that under the Seleucids, many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia.
Similar cultural pressures operated throughout the Hellenistic world: when the Judean king John Hyrcanus conquered the Idumeans, he forced them to become circumcised and convert to Judaism (note: their ancestors the Edomites had practiced circumcision in pre-Hellenistic times). In Egypt, only the priestly caste retained circumcision, and by the second century, the only circumcising groups in the Roman Empire were Jews, Egyptian priests, and the Nabatean Arabs. Circumcision was sufficiently rare among non-Jews that being circumcised was considered conclusive evidence of Judaism in Roman courts.
Male Circumcision in the Greco-Roman World
According to Hodges, ancient Greek aesthetics of the human form considered circumcision a mutilation of a previously perfectly shaped organ. Greek artwork of the period portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of satyrs, lechers, and barbarians.[1]
This dislike of the appearance of the circumcised penis led to a decline in the incidence of circumcision among many peoples that had previously practiced it throughout Hellenistic times. By the second century, circumcision was sufficiently rare among non-Jews that being circumcised was considered conclusive evidence of Judaism in Roman courts—Suetonius described a court proceeding in which a ninety-year-old man was stripped naked before the court to determine whether he was evading the head tax placed on Jews. The first-century Alexandrian Apion denounced circumcision as a barbaric custom in his diatribe against the Jews, notwithstanding that it was still practised among the Egyptian priestly caste.
Roman satirists including Horace and Juvenal equated the exposure of the glans that results from circumcision to its exposure during erection, and they caricatured Jewish men as being lustful or lecherous, sometimes in an incestuous or homosexual sense, often implying that Jewish men had unusually large penises and were of great sexual potency.
Techniques for restoring the appeareance of an uncircumcised penis were known by the 2nd century B.C. In one such technique, a copper weight (called the Judeum pondum) was hung from the remnants of the circumcised foreskin until, in time, they became sufficiently stretched to cover the glans. The first-century intactivist writer Celsus described two surgical techniques for foreskin restoration in his medical treatise De Medicina. [2] In one of these, the skin of the penile shaft was loosened by cutting in around the base of the glans. The skin was then stretched over the glans and allowed to heal, giving the appearance of an uncircumcised penis. Jewish religious writers denounced such practices as abrogating the covenant of Abraham in 1 Maccabees and the Talmud [3].
Male Circumcision in the Renaissance
Europeans, with the exception of the Jews, did not practice male circumcision, which generally was regarded with horror.
The Church issued a papal bull in 1442 that prohibited the practice of circumcision for all Christians [4].
Male Circumcision in the 18th Century
Circumcision was not practiced amongst Christians in Europe in the 18th Century. It was regarded with repulsion.
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Edward Gibbon had referred to it as a "singular mutilation" practised only by Jews and Turks and as "a painful and often dangerous rite" ...(R. Darby) [5]
In 1753 in London there was a proposal for Jewish emancipation. It was furiously opposed by the pamphleteers of the time, who spread the fear that Jewish emancipation meant universal circumcision. Men were urged to protect:
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"the best of Your property" and guard their threatened foreskins. It was an extraordinary outpouring of popular beliefs about sex, fears about masculinity and misconceptions about Jews, but also a striking indication of how central to their sexual identity men considered their foreskins at that time. (R.Darby) [6]
Male Circumcision in the 19th Century and beyond
Until well into the Nineteenth Century, the same sentiments prevailed.
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Richard Burton observed that "Christendom practically holds circumcision in horror". This attitude is reflected in the ninth edition of the Encyclopaedia Britannica (1876) which discusses the practice as a religious rite among Jews, Moslems, the ancient Egyptians and tribal peoples in various parts of the world. The author of the entry rejected sanitary explanations of the procedure in favour of a religious one: "like other body mutilations ... [it is] of the nature of a representative sacrifice". (R. Darby) [7]
Then, a change of attitude began, something that was reflected in successive editions of the Encyclopaedia Britannica:
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By 1910 the entry had been turned on its head: "This surgical operation, which is commonly prescribed for purely medical reasons, is also an initiation or religious ceremony among Jews and Mahommedans": now it was primarily a medical procedure and only after that a religious ritual. The entry explained that "in recent years the medical profession has been responsible for its considerable extension among other than Jewish children ... for reasons of health" (11th edition, Vol. 6). By 1929 the entry is much reduced in size and consists merely of a brief description of the operation, which is "done as a preventive measure in the infant" and "performed chiefly for purposes of cleanliness". Ironically, readers are then referred to the entries for "Mutilation" and "Deformation" for a discussion of circumcision in its religious context (14th edition, 1929, Vol. 5). (R. Darby) [8]
Historically, routine neonatal circumcision was promoted during late Victorian times in the English-speaking parts of Canada, Australia, New Zealand, the United States and the United Kingdom and was widely practiced during the first part of the 20th century in these countries. However, the practice declined sharply in the United Kingdom after the Second World War, and somewhat later in Canada, Australia and New Zealand. It has been argued (e.g., Goldman 1997) that the practice did not spread to other European countries because others considered the arguments for it fallacious. In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case [9].
From the late Victorian era, circumcision became more common in the higher classes in the United Kingdom. Queen Victoria had the notion that her family was descended from King David of Israel, and mandated that her sons, including the future King Edward VII be circumcised. King Edward continued the practice, and among the English royal family, the practice is still widespread: Prince Charles, Prince Andrew, and Prince Edward, were all circumcised. Reportedly, the late Diana, Princess of Wales rebelled against the royal tradition and refused to allow her sons, Prince William and Prince Harry, to be circumcised.
Routine infant circumcision has been abandoned in New Zealand and Britain, and is now much less common in Australia and in Canada (see table 1). The decline in circumcision in the United Kingdom followed the decision by the National Health Service (NHS) in 1948 not to cover the procedure following an influential article by Douglas Gardiner which claimed that circumcision resulted in the deaths of about 16 children under 5 each year in the United Kingdom. [10]. In most of the rest of the world, circumcision is done either as a religious or cultural practice.
Routine infant circumcision in the United States grew out of a widespread fear that masturbation caused various diseases, a view now universally rejected by the medical community. Circumcision was thought to reduce masturbation and other sexual behavior considered undesirable. Circumcision, depending on how it is practiced, can have a significant impact on masturbation; see masturbation for a detailed discussion.
Anti-masturbation panic and male circumcision
Non-religious circumcision in English-speaking countries arose in a climate of sexual fear, especially concerning masturbation. In her 1978 article The Ritual of Circumcision,[11] Karen Erickson Paige writes: "In the United States, the current medical rationale for circumcision developed after the operation was in wide practice. The original reason for the surgical removal of the foreskin, or prepuce, was to control 'masturbatory insanity' - the range of mental disorders that people believed were caused by the 'polluting' practice of 'self-abuse.'"
"Self-abuse" was a term commonly used to describe masturbation in the 19th century. According to Paige, "treatments ranged from diet, moral exhortations, hydrotherapy, and marriage, to such drastic measures as surgery, physical restraints, frights, and punishment. Some doctors recommended covering the penis with plaster of Paris, leather, or rubber; cauterization; making boys wear chastity belts or spiked rings; and in extreme cases, castration." Paige details how circumcision became popular as a masturbation remedy:
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"In the 1890s, it became a popular technique to prevent, or cure, masturbatory insanity. In 1891 the president of the Royal College of Surgeons of England published On Circumcision as Preventive of Masturbation, and two years later another British doctor wrote Circumcision: Its Advantages and How to Perform It, which listed the reasons for removing the 'vestigial' prepuce. Evidently the foreskin could cause 'nocturnal incontinence,' hysteria, epilepsy, and irritation that might 'give rise to erotic stimulation and, consequently, masturbation.' Another physician, P.C. Remondino, added that 'circumcision is like a substantial and well-secured life annuity...it insures better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor bills.' No wonder it became a popular remedy." [12]
At the same time circumcisions were advocated on men, clitoridectomies (removal of the clitoris) were also performed for the same reason (to treat female masturbators). The US "Orificial Surgery Society" for female "circumcision" operated until 1925, and clitoridectomies and infibulations would continue to be advocated by some through the 1930s.
One of the leading advocates of circumcision was John Harvey Kellogg, who is well known for his pseudoscientific views on human sexuality. He advocated the consumption of Kellogg's corn flakes to prevent masturbation, and he believed that circumcision would be an effective way to eliminate masturbation in males.
- "Covering the organs with a cage has been practiced with entire success. A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed. If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection. If he is only partially watched, he soon learns to elude observation, and thus the effect is only to make him cunning in his vice."
Robert Darby, writing in the Australian Medical Journal, noted that 19th Century circumcision advocates—and their opponents—were both well aware of the sexual sensitivity of the foreskin:
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In the 19th century the role of the foreskin in erotic sensation was well understood by physicians who wanted to cut it off precisely because they considered it the major factor leading boys to masturbation. The Victorian physician and venereologist William Acton (1814–1875) damned it as "a source of serious mischief", and most of his contemporaries concurred. Both opponents and supporters of circumcision agreed that the significant role the foreskin played in sexual response was the main reason why it should be either left in place or removed. William Hammond, a Professor of Mind in New York in the late 19th century, commented that "circumcision, when performed in early life, generally lessens the voluptuous sensations of sexual intercourse", and both he and Acton considered the foreskin necessary for optimal sexual function, especially in old age. Jonathan Hutchinson, English surgeon and pathologist (1828–1913), and many others, thought this was the main reason why it should be excised. [13]
Medical circumcision in the 19th century
Until 1870, medical circumcisions were performed to treat conditions local to the penis: phimosis, balanitis, and penile cancer. In that year, Lewis Sayre , a prominent New York orthopedic surgeon and vice president of the newly-formed American Medical Association, examined a five-year-old boy who was unable to straighten his legs, and whose condition had so far defied treatment. Upon noting that the boy's genitals were inflamed, Sayre hypothesized that chronic irritation of the boy's foreskin had paralyzed his knees via reflex neurosis . Sayre circumcised the boy, and within a few weeks, he recovered from his paralysis. After several additional incidents in which circumcision also appeared effective in treating paralyzed joints, Sayre began to promote circumcision as a powerful orthopedic remedy.
Sayre's prominence within the medical profession allowed him to reach a wide audience. He lectured widely in the United States and the United Kingdom, and his ideas influenced physicians throughout the English-speaking world. As more practitioners tried circumcision as a treatment for otherwise intractable medical conditions, sometimes achieving positive results, the list of ailments reputed to be treatable through circumcision grew. By the 1890s, hernia, bladder infections, kidney stones, insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bedwetting, Bright's disease, erectile dysfunction, syphilis, insanity, and skin cancer had all been linked to the foreskin, and many physicians advocated universal circumcision as a preventive health measure.
Specific medical arguments aside, several hypotheses have been raised in explaining the public's acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene.[14] Secondly, moral sentiment of the day regarded masturbation as not only sinful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation.[15] All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. Thirdly, with the proliferation of hospitals in urban areas, childbirth, at least among the upper and middle classes, was increasingly undertaken in the care of a physician in a hospital rather than that of a midwife in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.[16]
During the same time period, circumcision was becoming easier to perform. William Halstead 's 1885 discovery of hypodermic cocaine as a local anaesthetic made it easier for doctors without expertise in the use of chloroform and other general anaesthetics to perform minor surgeries. Also, several mechanically-aided circumcision techniques, forerunners of modern clamp-based circumcision methods, were first published in the medical literature of the 1890s, allowing surgeons to perform circumcisions more safely and successfully.
By the 1920s, advances in the understanding of disease had undermined much of the original medical basis for preventive circumcision. Doctors continued to promote it, however, as good penile hygeine and as a preventive for a handful of conditions local to the penis: balanitis, phimosis, and penile cancer.
Routine infant circumcision was successfully promoted in the English-speaking parts of Canada, Australia, New Zealand, the United States and the United Kingdom. Although it is difficult to determine historical historical circumcision rates, one estimate[17] of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, and 72% in 1950.
Circumcision since 1950
In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly-formed National Health Service to remove routine infant circumcision from its list of covered services. Since then, circumcision has been an out-of-pocket cost to parents, and the fraction of newborns circumcised in the hospital has fallen to less than one percent.
Similar trends have operated in Canada. Individual provincial heath services began delisting circumcision in the 1980s; at present, only Manitoba and the Northwest Territories pay for the procedure. The infant circumcision rate in Canada has fallen from roughly half in the 1970s to its present value of 11%, albeit with strong regional variations.
In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945 and the spread of Christianity. More than 90% of South Korean high school boys are now circumcised, but the average age of circumcision is 12 years, which makes South Korea a unique case [18].
In the United States, statistics collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision has remained near 65% since data collection began in 1979 [19]. However, strong regional differences in the circumcision rates have developed during this time. While more than 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to about 37% in the West in 1999. [20]. This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise [21].
Circumcision in the 21st century
The major medical societies in America[22], Britain[23], Canada[24], Australia and New Zealand[25] do not recommend routine non-therapeutic infant circumcision. Major medical organizations in the United States and Canada now say that parents should decide what is in their child's best interests, declining to make a recommendation one way or another.
In recent years, some have voiced ethical concerns about the procedure. See Bioethics of neonatal circumcision for more information.
As of January 2005, thirteen US states no longer pay for the procedure under Medicaid; the other 37 still do.
Neonatal circumcision nonetheless still remains the most common pediatric operation carried out in the U.S. today.
For current circumcision rates, please see this table.
External links
Hodges FM. The Ideal Prepuce in Ancient Greece and Rome: Male Genital Aesthetics and Their Relation to Lipodermos, Circumcision, Foreskin Restoration, and the Kynodesme. Bull. Hist. Med., 2001 Fall; 75(3): 375-405. URL: http://www.cirp.org/library/history/hodges2/
Gollaher DL. From ritual to science: the medical transformation of circumcision in America. Journal of Social History 1994;28(1):5-36. URL: http://www.cirp.org/library/history/gollaher/
Dunsmuir WD, Gordon EM. The history of circumcision. BJU Int 1999;83 Suppl. 1:1-12. URL: http://www.cirp.org/library/history/dunsmuir1/
John M. Ephron. In Praise of German Ritual: Modern Medicine and the Defense of Ancient Traditions. In: Medicine and the German Jews. New Haven: Yale University Press, 2001: 222-233. (ISBN 0-300-08377-7) URL: http://www.cirp.org/library/history/ephron1/
The History of Circumcision website URL: http://www.historyofcircumcision.net/
Reference
- David L. Gollaher, Circumcision: A history of the world's most controversial surgery, New York, Basic Books, 2000, ISBN 0-465-04397-6, hardback
- Paul M. Fleiss, M.D. and Frederick Hodges, D. Phil. What Your Doctor May Not Tell You About Circumcision. New York: Warner Books, 2002: pp. 118-146, paperback (ISBN 0-446-67880-5)
Last updated: 05-23-2005 01:31:07
