THE ORIGIN OF MALE CIRCUMCISION

IN THE UNITED STATES

On February 9, 1870, Dr. Lewis Sayre was summoned by Dr. James Sims to consult on a perplexing case: a 5-year old boy pale and delicate in appearance, unable to walk or stand erect without assistance.  Sayre diagnosed the boy's condition as resulting from his penis being unduly constricted by the surrounding foreskin and recommended that the boy be circumcised.  The child's health actually improved.  Sayre tried the same technique on a few other children and discovered that their health also improved.  He then published his astonishing results in the Transactions of the American Medical Association, convinced that he had discovered the cure to a whole variety of childhood maladies.  Sayre wrote that "many of the cases of irritable children, with restless sleep, and bad digestion, which are often attributed to worms, is solely due to the irritation of the nervous system caused by an adherent or constricted prepuce."

            Sayre's work attracted a great deal of interest.  The interest stemmed not only from the surprising conclusion, but also from the fact that Sayre was one of the most prominent physicians in the United States at the time.  In 1880, he was to be elected president of the American Medical Association (AMA).

            For nearly 30 years, Sayre zealously promoted circumcision as a cure for a wide variety of maladies, including but not limited to orthopedic problems, epilepsy, hernia, and "lunacy."  In 1875, he issued a pamphlet titled Spinal Anemia with Partial Paralysis and Want of Co-operation from Irritation of the Genitals in which he proposed that "peripheral irritation" from the foreskin could produce "an insanity of the muscles," meaning that the muscles would act involuntarily "without the controlling power of the person's brain."

            Sayre's claims led to others trying similar experiments.  Sims and other physicians developed a whole host of new genital surgeries designed to alleviate psychological problems  --"cutting the body to cure the mind."  Some of the procedures included ovariotomy  --removing a woman's healthy ovaries in order to relieve the symptoms ranging from hysteria and neurasthenia (nervous exhaustion) to backaches;  Cliterectomies were also performed.  Significantly, these procedures were not marginal medical procedures practiced by a handful of crackpots; rather they were "central in the arsenal of late-nineteenth-century gynecology."  Moreover, they were still being practiced in the U.S. long after they were abandoned in Europe.

What is notable in retrospect, though, is that while female sexual surgery gradually declined, male circumcision eventually became standard practice..  Moreover, procedures like cliterectomy and "normal ovariotomy," even in the days of their greatest acceptance, were performed on a small minority of American women.  Yet circumcision, quietly democratized in the last decade of the nineteenth century, was subsequently extended to a majority of the male population.

            Before the 1870's circumcisions were performed when cancerous lesions appeared and in the presence of phimosis, an abnormal constriction or tightening of the foreskin that interferes with normal bodily function.  Such cases were rare.  However, in the late 19th century, circumcision became seen as a cure for a whole host of physical and behavioral problems.  Norman Chapman, a disciple of Sayre's and professor of nervous and mental diseases at the University of Kansas City stated that

if circumcision was more generally practiced at the present day, I believe that we would hear far less of the pollutions and indiscretions of youth; and that our daily papers would not be so profusely flooded with all kinds of sure cures for loss of manhood.

          With Chapman and others, circumcision was no longer viewed as a means of alleviating specific genital problems, but as a preventative, hygienic procedure, with much broader social and medical implications.  Just as Americans were making efforts to clean up and improve the health of their urban environments, so also were they making changes in their personal standards of cleanliness.  All sorts of programs and publications were emerging to promote personal hygiene.  Amid epidemics of polio and typhoid fever, the newly developed germ theory of disease produced a heightened concern for both community and personal hygiene.  Amidst this hysteria, adenoids were removed from children in order to inhibit the spread of childhood diseases and cholecystectomies were performed on carriers of typhoid fever.  Medical writers at this time began portraying the penis as an intrinsic course of contamination, and circumcision soon became viewed widely as a safeguard against a variety of possible diseases.  Reacting to what were perceived as primitive and medically unacceptable circumcision procedures currently being performed among the Jews, the medical profession worked to "medicalize" the practice of circumcision at the same time that it promoted it among the general population.

Significantly, medical research after World War I mostly discredited the medical justification that caused circumcision to become so widely accepted and practiced in the United States prior to the war.  Yet, circumcision did not disappear, as did so many other medical fads and as did the practice of circumcision in Europe..  Instead, as late as 1970, approximately 80% of American males were still being circumcised. Moreover, the practice of male circumcision in the U.S. continued despite an article in the prestigious New England Journal of Medicine that insisted that there was "insufficient evidence to justify any surgery as a preventive measure (emphasis added)," and that cutting in the absence of disease "violated the most cherished tenet of medical ethics, primum non nocere (first do no harm)."  The following year, another review article concluded that none of the medical benefits attributed to circumcision could withstand scrutiny.  The author concluded that the best that could be said for circumcision was that it "is a beautification comparable to rhinoplasty."

Excerpted from:   David Gollaher, "From Ritual to Science: The Medical Transformation of Circumcision in  America.  Journal of Social History.  (Fall 1994)