History of Circumcision and Foreskin Research

The history of secular circumcision is surprisingly unknown in the United States. It is presumably unknown because the sordid history reveals it has always been a fraud.

Foreskin excision enters recorded history with religious ritual genital surgery. Many cultures of the southern and eastern banks of the Mediterranean Sea performed various genital surgeries on male and female adolescents since prehistory. These cultures include the Semitic cultures, Arabs and Jews as well as many others. The Jews were exceptional among these cutting cultures for cutting only boys and not also girls. DeMeo (1997) considered the origin and geographical spread of genital mutilations.

Ancient History

586 BCE

The Babylonians conquered Judea, destroyed the Temple, the Hebrew monarchy, and exiled the priests and aristocrats to Babylon for the next sixty years.

526 BCE

On their return to Judea the newly established priestly caste assumed control of the small region and it’s population by establishing a theocracy. (To clarify, these are priests, not rabbis. Rabbis will take a larger role later on.) This can be seen in many of the laws of Leviticus and Deuteronomy such as temple-centered sacrifice, ritual bathing, forbidding intermarriage, strict control over male ejaculation, and circumcision.

These priests invented the holy covenant, or bris milah (literally ‘covenant of cutting’) performed on male children on the eighth day of life.

Circumcision was performed by other Semitic tribes at the time, sometimes as ritual blood sacrifice, sometimes on slaves, sometimes on prisoners of war. But this invention by the priests worked as an initiation to the father, not the son.

Judaism existed as an intensely patriarchal culture. And a man’s sons represented his future lineage, especially his son’s penis. As the priests devised it, it was the father who performed the operation. In this way, the father was forced to submit his sons, his future lineage, to the will of the tribal elders as he cut into the flesh of his foreskin, the blood being a ritual sacrifice to the Lord as symbol of the covenant.

If the father refused, he would be cut off from his people, which in ancient times was akin to a death sentence. Similar to the psychological effects of hazing, after sacrificing part of his child to ensure his place in society, it is very difficult to turn away from it. Those who have studied economics may recognize this as the sunk cost fallacy or effect. “Well, I’ve already put in so much money/time/effort into this, if I left now it would all have been for nothing. I should keep putting into it to salvage my investment rather than quitting to prevent further loss.” What better way to promote social cohesion in an ethnically exclusive tribe in hostile territory?

c. 200 BCE

Some Jewish men, looking for more acceptance in the greater Hellenistic culture, perform foreskin restoration using tension to grow the skin of the penis into a makeshift replacement for the foreskin. Nude athletics in gymnasia and public arenas were a key feature of Hellenistic culture. Jewish men were mocked and ridiculed for the indecency of showing the glans, which was perceived as a sign of arousal.

“They built a gymnasium in Jerusalem, according to Gentile custom, and removed the marks of circumcision, and abandoned the holy covenant.”

[1 Maccabees 1:14–15]

170 BCE

Antiochus outlaws circumcision on penalty of death.

125 BCE

John Hyrcanus conquered Idumea. The Idumeans were required to convert to Juadism and to be circumcised as a token of their acceptance.

Hyrcanus took also Dora and Marissa, cities of Idumea, and subdued all the Idumeans; and permitted them to stay in that country, if they would circumcise their genitals, and make use of the laws of the Jews; and they were so desirous of living in the country of their forefathers, that they submitted to the use of circumcision, and the rest of the living Jewish ways of living; at which time therefore this befell them, that they were thereafter no other than Jews.

[Josephus, Antiquities of the Jews]

70

The Romans capture the city of Jerusalem during the First Jewish Revolt and destroy the second Temple. With it’s destruction cam an end to the priestly era. Leonard Glick describes the transition from a centralized authority to decentralized communities led by studious men who took up the mantle of social and spiritual leaders within the local communities

Priestly Judaism was a sacrificial religion, appropriate to a settled agricultural economy. Ordinary people brought animals and crops to the Temple for sacrifices conducted by priests, either as communal offerings or offerings by individuals seeking absolution for sins and transgressions. This way of life persisted for more than five hundred years, through the Hellenistic period and into the era of Roman rule. But, as I’ve noted, by the second century BCE large numbers of Jews had left Judea and settled throughout the eastern Mediterranean, particularly in such urban centers as Alexandria, Damascus, and Antioch. Since these emigrants could attend sacrificial rituals in Jerusalem seldom, if ever, they developed their own version of Judaism, centering on synagogues, where they met for everything from communal prayer and Torah study to family celebrations and casual socializing. Men rose to leadership in these communities not through patrilineal descent, and obviously not through claims to priestly authority, but because their fellow Jews recognized and respected their learning and wisdom. It was these men who were called rabbis: ‘masters’ or ‘teachers.’ (Glick, 2005)

132

Hadrian outlawed circumcision in the Roman Empire under penalty of death and reiterated the ban on castration. Circumcision received the same penalty as castration attesting to the view of circumcision as a morally equivalent mutilation.

[Scrpitores historiea Augustae: Hadrian 14.2]

140

Emperor Antoninus Pius modified the ruling of Hadrian allowing only Hebrews to circumcise their children, while upholding the legal protection for all others.

Jews are permitted to circumcise only their sons on the authority of a rescript of the Divine Pius; if anyone shall commit it on one who is not of the same religion, he shall suffer the punishment of the castrator.

[Digesta 48:8:11. Trans. Amnon Linder]

Roman citizens, who suffer that they themselves or their slaves be circumcised in accordance with the Jewish custom, are exiled perpetually to an island and their property confiscated; the doctors suffer capital punishment. If Jews shall circumcise purchased slaves of another nation, they shall be banished or suffer capital punishment.

[Paulus, 5:22:3–4, in Linder, *(n. 64), pp. 117–20. 67. Ibid., pp. 138–44.]

339

The Christian Emperor Constantine outlawed the circumcision of slaves.

[Schäfer. The History of the Jews in Antiquity.]

c. 830

Rabbi Eleizer, a ninth century Italian rabbi, makes statements why Abraham circumcised every member of his household, including his slaves, in the Midrash

Because of purity, so that they should not defile their masters with their food and with their drink, for whosoever eateth with an uncircumcised person is as though he were eating flesh of abomination. All who bathe with the uncircumcised are as though they bathed with carrion, and all who touch an uncircumcised person are as though they touched the dead, for in their lifetime they are like (the) dead; and in their death they are like the carrion of the beast, and their prayer does not come before the Holy One, blessed be He, as it is said, “The dead praise not the Lord” (Psalm 115:17). But Israel who are circumcised, their prayer comes before the Holy One, blessed be He, like a sweet savor.

[Friedlander, Rabbi Eliezer]

1190

Moses ben Maimon, better known as Maimonides, philosopher and personal physician to the Sultan Saladin, described circumcision as sacrificial of sexual pleasure for both partners.

As regards circumcision, I think that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate. Some people believe that circumcision is to remove a defect in man’s formation; but every one can easily reply: How can products of nature be deficient so as to require external completion, especially as the use of the fore-skin to that organ is evident. This commandment has not been enjoined as a complement to a deficient physical creation, but as a means for perfecting man’s moral shortcomings. The bodily injury caused to that organ is exactly that which is desired; it does not interrupt any vital function, nor does it destroy the power of generation. Circumcision simply counteracts excessive lust; for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when it loses blood and is deprived of its covering from the beginning. Our Sages (Beresh. Rabba, c. 80) say distinctly: It is hard for a woman, with whom an uncircumcised had sexual intercourse, to separate from him. This is, as I believe, the best reason for the commandment concerning circumcision.

[Maimonides, The Guide for the Complex, 3.49 (118a), 609.]

c. 1280

Rabbi Isaac ben Yedaiah, a follower of Maimonides who lived in Southern France in the late 13^(th) century has a great deal to say on male and female sexual desire.

She too will court the man who is uncircumcised in the flesh and lie against his breast with great passion, for he thrusts inside her a long time because of the foreskin, which is a barrier against ejaculation in intercourse. Thus she feels pleasure and reaches an orgasm first. When an uncircumcised man sleeps with her and then resolves to return to his home, she brazenly grasps him, holding on to his genitals, and says to him, ‘Come back, make love to me.’ This is because of the pleasure that she finds in intercourse with him, from the sinews of his testicles—sinew of iron—and from his ejaculation—that of a horse—which he shoots like an arrow into her womb. They are united without separating, and he makes love twice and three times in one night, yet the appetite is not filled. And so he acts with her night after night. The sexual activity emaciates him of his bodily fat, and afflicts his flesh, and he devotes his brain entirely to women, an evil thing. His heart dies within him; between her legs he sinks and falls. He is unable to see the light of the King’s face, because the eyes of his intellect are plastered over by women so that they cannot now see light. But when a circumcised man desires the beauty of a woman, and cleaves to his wife, or to another woman comely in appearance, he will find himself performing his task quickly, emitting his seed as soon as he inserts the crown. … He has an orgasm first; he does not hold back his strength. As soon as he begins intercourse with her, he immediately comes to a climax. She has no pleasure from him… and it would be better for her if he had not known her and not drawn near to her, for he arouses her passion to no avail, and she remains in a state of desire for her husband, ashamed and confounded, while the seed is still in her ‘reservoir.’ She does not have an orgasm once a year, except on rare occasions, because of the great heat and the fire burning within her. Thus he who says ‘I am the Lord’s’ will not empty his brain because of his wife or the wife of his friend. He will find grace and good favor; his heart will be strong to seek out God. He will not fear to behold that which is beyond, and when He speaks to him, he will not turn away.

[Isaac ben Yedaiah. Translation in: Marc Saperstein Decoding the Rabbis: A Thirteenth Century Commentary on the Aggadah. Cambridge, Mass, and London. England: Harvard University Press. 1980: 97-98. — excerpt]

c. 1300

Moses de León (Moshe ben Shem-Tov in Hebrew) was a Spanish rabbi and Kabbalist who is considered the redactor of the Zohar, the foremost text of Jewish mysticism. Unsurprising, this too has imaginative text by rabbis on the question of circumcision.

“You must know that the uncircumcised nations have no soul except from the side of impurity, for they are immersed in the foreskin, and on account of this their spirits are impure. … When they remove from themselves this filth, which is the foreskin, their impurity departs from them. … Thus the convert is called the righteous convert … and this is the secret of the covenant and the eternal life.”

[Wolfson, Occultation, 128.]

1492

After over a century of turmoil in Spain between reconquest of the lands from the Muslims, mobs, assaults, and forcible conversion to Catholicism, the Edict of Expulsion, issued that year by Ferdinand and Isabella, charged Jews with trying “by whatever ways and means possible” to seduce decent Christians away from the Catholic faith and to “attract and pervert them to their [Jewish] injurious belief and opinion, instructing them in their ceremonies and observances of the Law.” Among the specific charges was “trying to circumcise them and their children.”

[Gerber, Jews of Spain, 286.]

1543

Martin Luther, despite being sympathetic regarding Jews most of his life, turned against them in his final years when he published On the Jews and Their Lies. His section on circumcision is ninety pages long. “[The Jews] despise all mankind,” he declares, simply because they are not circumcised.

My God, what we Gentiles have to put up with in their synagogues, prayers, songs, and doctrines! What a stench we poor people are in their nostrils because we are not circumcised! [They] disdain, despise, and curse the foreskin on us as an ugly abomination which prevents us from becoming God’s people, while their circumcision, they claim, effects all.

For it is one and the same circumcision, decreed by one and the same God, and there is one and the same father, flesh and blood or descent that is common to all. … Therefore it is not a clever and ingenious, but a clumsy, foolish, and stupid lie when the Jews boast of their circumcision before God, presuming that God should regard them graciously for that reason.

In addition to cutting off the foreskin of a male child, the Jews force the skin back on the little penis and tear it open with sharp fingernails, as one reads in their books. Thus they cause extraordinary pain to the child, without and against the command of God, so that the father, who should really be happy over the circumcision, stands there and weeps as the child’s cries pierce his heart. We answer roundly that such an addendum is their own invention, yes, it was inspired by the accursed devil, and is in contradiction to God’s command.

Rather they think that God should behold their proud circumcision in the flesh and hear their arrogant boasts. … These blind, miserable people do not see that God condemns their uncircumcised heart … and thereby condemns their physical circumcision together with their boasting and their prayer. They go their way like fools, making the foreskins of their heart steadily thicker with such haughty boasts before God and their contempt for all other people.

[Luther. On the Jews]

1622

The Portuguese Friar Jaono dos Sanctos claimed that, annually in Algiers in the 1620s, more than nine hundred Christian slaves were converted to Islam, "besides about fifty boys yearly circumcised against their wills."

[Davis. Christian Slaves, Muslim Masters. p. 22.]

Modernity

1780

In the aftermath of the 1780 Battle of Pollilur, Haidar Ali and Tipu Sultan of Mysore imprisoned British soldiers in the fortress of Seringapatnam. More than 300 were forcibly circumcised.

Cromwell Massey, an English sailor who kept a secret diary during his captivity, wrote:

I lost with the foreskin of my yard all those benefits of a Christian and an Englishman which were and ever shall be my greatest glory.

[Colley. Captives.]

1787

A pamphlet by an anonymous author circulated England denouncing circumcision as

…a barbarous violation of the principles of Humanity, and an insult to the God of Nature. For what can be more unhuman, than to punish an Infant by a cruel operation on a part of its body, done by a bungling Butcher of a Priest! Or what can be more insulting to the all wise Creator, than for a stupid Fool of a Fellow, to presume to correct His workmanship…

[Felsenstein. Anti-Semitic. 146.]

1824

James Scurry, another prisoner of war, confirms in his book, The Captivity, Sufferings, and Escape of James Scurry, that English soldiers, Mangalorean Catholics, and other prisoners were forcibly circumcised.

[Brewer. The Greek War of Independence: The Struggle for Freedom from Ottoman Oppression.]

1829

Ottoman soldiers kidnapped a 9-year-old Greek boy Alexandros Kitos and other young boys and sold them into slavery in Egypt. They were all circumcised against their will.

1837

All babies circumcised by a particular mohel in Venice died. The historian Jacob Katz remarks that other observers “could tell of similar tragedies, and there is no doubt of the veracity of their testimony.” He continues, it is likely “that these incidents were nothing new, and that similar tragedies had occurred throughout the generations”—although people were so inclined to accept such infant deaths as “natural” events that there had been no public reaction.

[Jacob Katz. Struggle. 323.]

1838

Olry Terquem, an assimilated French Jew and respected religious reformer, called for liberation of Judaism from “Asiatic forms and formulas” preventing Jews from integrating into “the great French family.”

If I were to tell you that, in a certain country, there exists a population which attaches a religious importance to mutilating, to slashing, to lacerating the weak creatures as soon as they enter life, to submitting them to so painful an operation that sometimes death follows it … with no protest ever being raised in favor of the victims, if I let you guess the country, would not your ideas naturally point to an African country, inhabited by some savage race? Such is not the case. It concerns our patrie, France, and a notable segment of its inhabitants.

The authority of the Talmud ceases where the rights of humanity begin.

[Berkovitz. Shaping.]

1840s

By the 1840s, the Jews were abandoning circumcision in large numbers, and it became rare among the educated classes.

This abandonment provided the impetus for medicalizing ritual genital mutilation within Judaism.

It may have also provided the impetus for the promotion of medicalized genital mutilation that followed. If this was not the reason, then we are left to wonder why all the English-speaking medical communities who had previously known infant phimosis to be a normal part of development became convinced that it was a pathological condition at this time.

[Ephron JM. Medicine and the German Jews. 2001.]

1840

Abraham Rice is the first ordained Rabbi to arrive in America. Before his arrival, Jewish Americans had to make do with what was at hand as far as religious ceremonies and rites.
Isaac Leeser, leader of the Philadelphia Jewish community, lamented that parents were leaving their Jewish children intact

[Sharfman, First Rabbi]

1842

The Society of the Friends of Reform, a small assembly and the first to full endorse Jewish Reform meet in Frankfurt. They declared their intention to renounce “allegiance to all objectionable commands and to all antiquated customs”: to endow their religion with “a worthier form” by preserving only its “pure content” and removing “everything which has degraded and dishonored it in the eyes of thinking men.” They felt no longer bound by the various dietary and other regulations connected with “corporal practices” deriving from the “ancient polity”; thus they considered circumcision no longer “binding as a religious act or a symbol.”

[Michael Meyer. Alienated. 62. Philipson. Reform. 118.]

1843

The Frankfurt Health Department, aware that several prominent Jewish physicians publicly opposed circumcision on medical grounds, and having been informed that several infants had died after being circumcised, announced that in the future everyone performing this operation would have to demonstrate appropriate medical knowledge and surgical skill, and that a licensed physician must be in attendance.

Rabbi Solomon Trier appealed to the Frankfurt Senate for a decree

“namely, that no child of Jewish parents may be admitted into the local Jewish association as a member of the Jewish community and the son of an Israelite citizen if he has not been circumcised.”

1844

Rabbi Trier publishes his book Rabbinic Opinions on Circumcision. Opinions varied but included shunning fathers who failed to circumcise their sons, communally shunning them, forbidding marriage contracts between them and Jewish daughters, and burying those who failed to repent separately like executed criminals.

1844

The first conference of Reform Rabbis dismissed a resolution declaring that “those who do not observe the command of circumcision are to be considered members of the Jewish religious community despite this.” Instead, everyone accepted the president’s proposal that, since circumcision aroused so much emotion, it would be wise to avoid exciting passions that might disrupt the conference.

[Philipson, Reform, 154.]

1844

Samuel Holdheim argued that although the Scriptures were divinely inspired, they were a human creation subject to interpretation in the light of modern reason and ethical standards. In a pamphlet entitled Concerning Circumcision, Primarily in Religious-Dogmatic Consideration, Holdheim presented responses to three fundamental questions. First, was an uncircumcised man born to Jewish parents a Jew nonetheless? Definitely yes, he said: Circumcision was a sign of the national component of Judaism, the part that was no longer operative, since modern Jews were not an independent nation. It is birth to a Jewish mother, not circumcision, that makes a man Jewish (an accepted rabbinic principle). Second, was a father who refused to have his son circumcised, or a youth older than thirteen who insisted on remaining uncircumcised, still to be considered a Jew? Obviously the answer was again yes, for the same reason. Finally, how should rabbis respond to someone who did not circumcise an infant? Should they try to force him to do so, perhaps even calling on civil authorities for assistance? Of course not, declared Holdheim; the duty of rabbis was to teach, not to attack those acting according to the dictates of conscience. He did not argue that circumcision should be entirely eliminated; but since it was no longer integral to Judaism, it had become a matter for personal choice. Arabs and others practiced circumcision, he noted, but of course that did not make them Jews. It was birth to Jewish parents, for women and men alike, that constituted entry into a particular covenant with God.

[Holdheim, Ueber die Beschneidung, 6. Philipson, Reform, 8-11, 136–37.]

1845

Edward H. Dixon claimed infant phimosis was a common deformity in infancy that required circumcision to correct.
While it's true pathological phimosis can make the surgery necessary, pathological phimosis is unheard of in infants. And as research from many countries has shown, doctors routinely misdiagnose normal developmental phimosis as pathological.
Phimosis is a perfectly normal part of development during infancy. Gairdner (1949) found 95% of infants have normal developmental phimosis, and it is self-correcting for all but around 1% by the age of 15.

[A Treatise on Diseases of the Sexual Organs. p. 158]

1846

At the third Reform conference, a physician informed the rabbis that his first son had almost bled to death following circumcision, and that the second had in fact died. Must a future infant son, he asked, also be circumcised? “Will it not suffice if I have him named in the synagogue and have the customary benediction pronounced? Can the state, can the congregation, raise any objection to such an initiation of my sons into Judaism, considering the experiences I have had?” Following a discussion, the conference adopted a set of resolutions on circumcision: First, every mohel was to “take a thorough course of instruction from a competent physician,” pass an examination, and be licensed. “Permission to circumcise must be denied to any mohel who, because of bodily defect, such as trembling of the hands, nearsightedness, etc., is unfit to perform the operation.” The mohel or the physician could decide whether to perform peri’ah with a sharpened thumbnail (“as is the traditional custom”) or with a surgical instrument; but metzitsah was to be no longer permitted. Medical examination should precede a circumcision to make certain that the child was able to endure the operation; and a physician was to conduct the “after-treatment.” Finally, whenever a physician testified that “a child has died or has sustained lasting injury from circumcision, and it is therefore a fair supposition that danger to life and health threaten a second child of the same parents,” the circumcision was to be postponed until it was certain that the second child was out of danger.

1848

antisepsis introduced to medicine

Ignaz Semmelweis, a young Hungarian doctor determined puerperal infections (childbed fever) which caused doctor-assisted obstetric mortality rates as high as 30% were caused by germs especially from obstetricians examining cadavers without washing their hands—sometimes immediately prior to deliveries. He recommended doctors wash their hands with antiseptic solution to prevent these often fatal infections. Though considered perfectly obvious today, his ideas were regarded with contempt in his lifetime (1818-1865). Prior to his innovation antiseptic methods were not used during surgery including infant genital surgery.

[Encyclopedia Britannica: Ignaz Philipp Semmelweis]

1855

British doctor Jonathan Hutchinson was one of the most influential doctors of his time and also the first dedicated circumcision activist. Among his contributions to medicine listed by Darby were the convictions that circumcision was necessary to discourage masturbation and promote continence; contraception was morally objectionable and physically harmful; leprosy was a form of tuberculosis caused by eating bad fish; and Jews were immune to syphilis. He recommended castration for intractable masturbation.

He invented the claim that circumcision prevented syphilis. In promoting circumcision for syphilis prevention, he ignored the fact that his data showed his circumcised sample (London Jewish men) had much higher risk of contracting gonorrhea. While circumcision may have some minor benefit in reducing risk of syphilis, the effect he found was most likely from men utilizing different venues for non-marital sex rather than an effect of the surgery because Jews and gentiles tended to associate in separate groups.

[On the Influence of Circumcision in Preventing Syphilis. Medical Times and Gazette.]

1860

British surgeon Athol Johnson related fearsome stories of masturbation-induced diseases including tuberculosis and a masturbation-induced fatality For treating masturbation, he recommended dreadful surgical treatments for both boys and girls including circumcision—and clitoridectomy if “considered unavoidable”:

quote

In such cases [masturbation] we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice being continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably with future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate. In the female, Dr. Gros has advocated, in like manner, complete or partial amputation of the clitoris; this, however, would seldom be called for, except, perhaps, in those cases where furious masturbation is associated with congenital malformation of the organ. In both sexes, if the use of the knife should be considered unavoidable, and the practice [masturbation] still continues after all obviously exciting causes have been removed, various irritating applications may be used locally, so as to render any movements of the parts painful.

John Harvey Kellogg later repeated Johnson's and Hutchinson's claims and promoted their ideas in the United States.

[On An Injurious Habit Occasionally Met with in Infancy and Early Childhood. Lancet.]

1865

British doctor Nathaniel Heckford claimed circumcision cured epilepsy.

Lewis Sayre would later repeat this claim, expand the idea to include paralysis too and promote these ideas in the United States for 17 years—at the height of his career—before recanting in the face of all the evidence against it.

[Circumcision as a remedial measure in certain cases of epilepsy and chorea. Clinical Lectures and Reports by the Medical and Surgical Staff of the London Hospital.]

1866

Isaac Baker Brown, a talented British surgeon published a book promoting his “operative procedure” which was his term for partial clitoral excision supposed to cure hysteria, epilepsy and insanity. He was strongly denounced by European colleagues as a mutilator the next year.

[On the Curability of Certain Forms of Insanity, Epilepsy and Hysteria in Females. London: Hardwicke.]

1870

Renowned American surgeon Lewis A. Sayre published a paper “proving” circumcision cured epilepsy and another paper about it preventing paralysis.

[Circumcision versus epilepsy, etc. Medical Record.]
[Partial paralysis from reflex irritation, caused by congenital phimosis and adherent prepuce. Transactions of the American Medical Association.]

1871

M. J. Moses claimed “the solitary vice” (masturbation) was caused by long foreskin and that circumcision rendered Jewish men immune to it.

“I never saw an instance [of masturbating] 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.”

He noted that to minimize risk of injury or death:
“The amount of tissue sacrificed should be only just enough to divide the muco-dermoid junction. … The frænum should not be wounded nor lacerated.”

While he wrongly minimized both the loss inherent in excising the foreskin and the risks of injury, to his credit, he did at least advocate for a less severe mutilation rather than the more extensive surgery practiced by doctors in the United States. He discouraged the frenulum excision that is a common feature of medicalized infant genital mutilation.

[The value of circumcision as a hygienic and therapeutic measure. New York Journal of Medicine.]

1871

A New York City Jewish periodical published a tactfully worded notice from the registrar of medical records:

“Within about a month some half dozen deaths have occurred in this City from haemorrhage after circumcision of Hebrew infants. I am informed that numerous unskilled and unscrupulous persons have taken to performing this operation for a small fee among the poorer Jews. I write to you to beg that you call attention to those having authority in your denomination to so unwarrantable a sacrifice of human life. Permit me at the same time to assure you that no one has a greater respect than myself for all religious observances.”

[Berman, Trends in Jewish Religious Observance]

1872

Richard Barwell, a British surgeon wrote an alarming article on paralysis in children from phimosis. After describing his experimental treatment for paralysis, a twisted combination of strychnine and electric current, he talked about the evils of masturbation in children. He included such vague symptoms as to include the majority of children in his definition of pathology.

The child, though at times it may be lively and chattering, has periods of apparently causeless oppression and taciturnity, generally frowning heavily; the whole system appears depressed, yet it is easily excited or alarmed by any unusual sight or noise … In such cases it is necessary to watch the boy when stripped with great attention—to tap over the loins and sacrum, to look at the condition of the penis, when it will generally be found that a narrow phimosis exists…. These irritant causes in either sex may, I am sorry to say do, occasionally induce in young children the habit of themselves exciting or irritating the genitals. I am, however, anxious to avoid diving into subjects so abhorrent, and would rather refer to a paper in the Journal für Kinderkrankheiten (vol. xl., p. 335 [1863]) [a German article about the “treacherous evil” of masturbation], and to a lecture by Mr. Athol Johnson. I do this the more readily as genital irritation naturally, not artificially, produced frequently gives rise to the loss of power I am describing without any fault whatever on the child's part. In boys phimosis is generally the cause….

[Infantile paralysis and its resulting deformities. Lancet.]

1874

Ephraim Epstein, a Jewish immigrant and physician in Cincinnati denounced circumcision activism.

In common with others… once I believed that circumcision affords a protection against venereal [disease], but my practice in Vienna… and in this country since 1862 persuaded me fully to the contrary. The apparent immunity which the Jews of [Russia, Europe and Turkey]… seem to enjoy from venereal diseases arises from their greater chastity and the practice of early marriage. The singular pre-eminence of the Jews in health is a mere fiction, propounded either by those who are not acquainted with the Jewish race in this country, or by certain Jewish enthusiasts who have a special axe to grind.

[Have the Jews any immunity from certain diseases? Medical and Surgical Reporter.]

1874

An anonymous Jewish surgeon wrote: “the removal of the prepuce reduces in an extraordinary degree the sensitiveness of the glans penis; and, apart from biblical reasons, which have necessarily no place in your journal, I believe that the intention of the rite was to enhance and advance as far as possible the chastity of the race by blunting mechanically the sensibility of the organ of sexual appetite.”

[Letter, Lancet, 12 December 1874, p. 856. quoted in Darby, 2005]

1874

Eugene Levit, a physician from a town in Bohemia, wrote with anger and passion rooted in painful personal experience in a pamphlet entitled Israelite Circumcision, elucidated from a medical and humane standpoint. Levit declared that he was writing “to oppose a barbaric custom of our nation and to protect thousands of innocent creatures from torture and mutilation.” Levit said that in his thirty-five-year medical practice he had witnessed six deaths and more than twenty mutilations. His first son died after his circumcision became infected and had chosen not to circumcise his second son. After discussing the medical argument, he turns to the cultural and religious consideration in what is some of the strongest condemnation of the practice from within the Jewish community

Fanatical zealots, supposedly honoring God or from a sense of guilt, may punish their own bodies with fasting, waking vigils, lashing, all sorts of self-denial and mortification; but to impose asceticism on the body of someone else, especially an innocent, defenseless child—that no one has the right to do.

What cultivated people would ever consider regarding bloody, mutilated genitals as a divine cultural symbol? Indeed, whenever I have attended this ceremony, I have never perceived a devout, solemn attitude in any participant. Every time, to be certain, I have seen the pale, trembling father offering his sacrifice to the mohel, while the shocked, delicate mother awaits in anxious agony the return of her passionately loved infant. I have seen many of those in attendance fall in a faint—yes, even a simple, coarse peasant servant girl, the wet nurse, shedding tears at the scene she witnessed. … A ceremony dripping with blood, eliciting cries of pain and agony, arousing pity and dread in some, revulsion in others, a sacrificial oath offered with a body part, overcoming considerations of purity, good breeding, modesty, and sensitive feelings, something that only anatomists and physicians should discuss openly, and that even lascivious jesting in frivolous conversation hardly dares allude to—only fanatic Oriental zealots could call such an event a consecration.

The contemporary generation, whose feelings and ways of thought have been conditioned by education, upbringing, scientific knowledge, art, lectures, and the radiating influence of enlightened, purified European culture, and who have been permeated by the Christian-Germanic moral environment, cannot be edified by, reconciled to, or divinely inspired by a horrible blood symbol.

Only by doing away with this last remnant of Asiatic custom will every boundary wall finally fall, and Israelites will step openly into the European community. Finally, I hope still to witness [a time when] governments will prohibit circumcision on sanitary principles, and the perpetrators of this grave physical assault will be brought to account.

[Levit, Die Circumcision der Israeliten beleuchtet vom dirztlichen und humanen Standpunkte von einem alten Arzte.]

1875

Rabbi Abraham Geiger writes in a private letter:

I am unable to support circumcision with any conviction, just because it has always been so highly regarded. It remains a barbaric, bloody act which fills the father with anxiety and subjects the mother to morbid stress. The idea of sacrifice, which once consecrated the procedure, has certainly vanished among us, as it should. It is a brutal practice that should not continue. No matter how much religious sentiment may have clung to it in the past, today it is perpetuated only by custom and fear, to which surely we do not want to erect temples.

[Geiger, Nachgelassene Schriften, 5:181–82.]

1875

Lewis Sayre claimed the foreskin caused curvature of the spine, paralysis of the bladder, and clubfoot.

[Spinal anaemia with partial paralysis and want of coordination, from irritation of the genital organs. Transactions of the American Medical Association.]

1875

John Davenport wrote in Curiositates eroticae physiologiae, or tabooed subjects freely treated:

The pleasure of the sexual union is greatly increased by the prepuce, for which reason women prefer cohabiting with those who retain it than with the Turks or the Jews.

[John Davenport. Curiositates eroticae physiologiae, or tabooed subjects freely treated. London. reprinted as Aphrodisiacs and other love stimulants. Edited by Alan Hull Watson. London: 1965. p. 179.]

1877

William A. Hammond debunked one of Lewis Sayre's claimed successes with more information about the case explaining how it had nothing to do with circumcision.

[On a hitherto undescribed form of muscular in-coordination. Transactions of the American Neurological Association.]

1880

F. N. Otis of New York recommended circumcision for hygiene especially moral hygiene and other vitalistic ideas about wasting nerve energy:

A common difficulty that I find as a result of this redundant prepuce is sexual weakness. I find cases troubled with frequent seminal emissions, with imperfect erections and general weakness of the sexual apparatus most commonly associated with elongated prepuce. The parts are kept in a sodden condition and a certain amount of heat is generated through the constant poulticing of the glans penis by the redundant prepuce. I am satisfied that there is a loss of nerve power in such cases through the chronic engorgement and hyperaesthesia which results. The redundant prepuce not unfrequently sets up an irritation which is transferred to the seminal apparatus, inducing involuntary emissions, premature ejaculations, and mental depression.

[Clinical lecture on syphilis and a case of circumcision. Medical Gazette.]

1881

John Harvey Kellogg promoted irrational fear of masturbation and “spermatorrhoea” in boys. For girls, he warned masturbation caused breast atrophy, uterine cancer and insanity. He recommended circumcision and other surgical punishments for both boys and girls to punish and discourage masturbation. He also wrote positively of cauterizing the clitoris with acid to alleviate masturbation in girls.

It's notable but often forgotten that he was promoting cutting the genitals of older children rather than infants. He wrote positively of the Jewish practice but also noted its tendency to scar the meatus (meatal stenosis). He advanced the propaganda that ancient genital surgery had always been performed for health. He also advocated the use of male chastity belts.

The next entry after circumcision is castration to imply it was the next genital surgical option if circumcision fails to arrest masturbation. Hutchinson had previously suggested castration as the next option to cure masturbation when circumcision fails.

EFFECTS [of masturbation] IN FEMALES.

Local Effects.—The local diseases produced by the vice in females are, of course, of a different nature from those seen in males, on account of the difference in organization. They arise, however, in the same way, congestions at first temporary ultimately becoming permanent and resulting in irritation and various disorders.

General Effects.—The general effects in the female are much the same as those in the male. Although women suffer no seminal loss, they suffer the debilitating effects of leucorrhoea, which is in some degree injurious in the same manner as seminal losses in the male. But in females the greatest injury results from the nervous exhaustion which follows the unnatural excitement. Nervous diseases of every variety are developed. Emaciation and debility become more marked even than in the male, and the worst results are produced sooner, being hastened by the sedentary habits of these females, generally. Insanity is more frequently developed than in males. Spinal irritation is so frequent a result that a recent surgical author has said that “spinal irritation in girls and women is, in a majority of cases, due to self-abuse.” (52. Davis.)

A Common Cause of Hysteria.—This, too, is one of the most frequent causes of hysteria, chorea, and epilepsy among young women, though not often recognized. A writer, quoted several times before in this work, remarks as follows:—

This is not a matter within the scope of general investigation; truth is not to be expected from its habitués; parents are deceived respecting it, believing rather what they wish than what they fear. Even the physician can but suspect, till time develops more fully by hysterias, epilepsies, spinal irritations, and a train of symptoms unmistakable even if the finally extorted confession of the poor victim did not render the matter clear. Marriage does, indeed, often arrest this final catastrophe, and thus apparently shifts the responsibility upon other shoulders, and to the 'injurious effects of early marriages,' to the 'ills of maternity,' are ascribed the results of previous personal abuse.

For statistics and further information on this all-important subject, we must refer the reader to the opinions of physicians who have the charge of our retreats for the insane, lunatic asylums, and the like; to the discriminating physicians of the families of the upper classes—stimulated alike by food, drinks, scenes where ease is predominant, where indolence is the habit and novel-reading is the occupation—for further particulars on a subject here but barely alluded to.

[Results of Secret Vice and Treatment for Self-abuse and Its Effects in Plain Facts for Old and Young, Burlington, Iowa, F. Segner & Co. — a longer excerpt from this work]

1881

N. M. Shaffer opposed indiscriminate circumcision especially for the idea of reflex symptoms. He lists cases he saw where circumcision was performed for the reflex theory but provided no relief for symptoms that due to “joint disease and spinal affections especially lateral sclerosis.” He added that, in agreement with Dr. Seguin, a neurologist, he had “never seen a case of reflex paralysis in a child from genital irritation.”

[On genital irritation. Annals of Anatomy and Surgery.]
He later produced this 6-page pamphlet opposing indiscriminate circumcision.

1881

William M. Mastin found some degree of meatal stenosis in 95% of circumcised men writing of the “almost universal” prevalence of meatal stenosis among Jewish men.

To Dr. Claudius H. Mastin, of Mobile, is due the recognition of this fact. In an extended urethral practice his attention was first drawn to the very large number of Jewish youths and adult males who sought advice for gleety or chronic urethral discharges, and irritable urethrae, and in each case he was surprised to find the meatus narrowed to a degree entirely out of proportion to contractions generally observed.

Another point of value in this connection is the general opinion among the Jews themselves in this section. They have been so thoroughly convinced of this “smallness” among their race, and the benefit to be derived from a free division of the outlet, that the operation has been designated by many of them as their “Second Circumcision,” and, on several occasions, young men of this class who were not suffering from any trouble, but fearing it, have applied for operation to prevent any future annoyance from this defect.

[Infantile Circumcision a Cause of Contraction of the External Urethral Meatus. Annals of the Anatomical and Surgical Society.]

1882

Landon Carter Gray, of Brooklyn, wrote of circumcision:

The profession itself, I am tempted to say almost in proportion as it is intelligent and studious, has a strong tendency to mistake novelty for progress.

Some [circumcision] enthusiasts have carried the matter so far as almost to look upon circumcision as a panacea, and one well-meaning gentleman of my acquaintance, who had charge of a general clinic several years ago, made such slaughter among the innocents that the mothers of his section of the city ceased bringing their male children to him.

The fact that operations on the genital organs will, for the time being, ameliorate the symptoms of organic lesions should make us cautious in accepting the conclusion to which we would otherwise be naturally led by the cases of Mr. Bryant and Dr. Otis [promoters of circumcision for the reflex neuroses theory].

Dr. E. C. Spitzka writes me that he has seen the prepuce in some way anomalous in eight cases of infantile spinal paralysis, and in all cases of paralysis from spinal disease in male children, and makes the interesting suggestion that it may be only one effect of the generally defective development.

In summary… there is no proof that genital irritation can produce a reflex paralysis.

[The effect of genital irritation in the production of nervous disorders, continued in a second part.]

1884

Elizabeth Blackwell, the first woman to earn her medical degree in the United States, published The Human Element in Sex: Being a Medical Inquiry into the Relation of Sexual Physiology to Christian Morality, a progressive revision of Victorian Christian sexual mores.

She denounced “indiscriminate” (i.e., routine/non-therapeutic/“preventative”) circumcision on ethical grounds based in Christianity.

[Counsel to the Parents on the Moral Education of Their Children in Relation to Sex. 1884.]

1887

Lewis Sayre, after promoting preventative circumcision for almost 20 years, finally limited his circumcision advocacy to therapeutic circumcision only rather than indiscriminate circumcision.

His idea of therapeutic circumcision still meant overdiagnosing infantile phimosis, but this was still an enormous improvement from his previous influential recommendations of totally non-therapeutic, “preventative” / indiscriminate circumcision.

[On the deleterious results of a narrow prepuce and preputial adhesions. Transactions of the Ninth International Medical Congress.]

1887

M. A. Rust addressed circumcision in writing about the history of cultural mutilations:

There is not a single tribe of savages on the face of the globe who do not disfigure parts of their bodies, and hardly a part of the body susceptible of disfigurement which has not been disfigured. This is not done in accordance with individual fancy, but in strict conformity to inexorable tribal rule.

Ornamentation lies at the root of many, but not of all of these mutilations.

Ornamentation lies at the root of many, but not of all of these mutilations. A great number of them entail such an amount of suffering and torture that, in order to establish them, to enforce submission and co-operation, potencies awful and mysterious must have been at work, striking fear into every individual heart. Once established, the obligation became as automatic as the daily walks of an ant.

Circumcision is the most ancient and widely spread mutilation in existence, and it is practiced in all the five parts of the world, though to the greatest extent in Asia, Africa, and among the savages of Australia. Of civilized nations we note about one hundred and thirty millions of Muhamedans, and about ten millions of Jews, and the Christians of Abyssinia. It was practiced in Mexico at the time of the conquest of Cortez, and, according to the accounts of modern travelers is still in use among Indian tribes in Nicaragua and on the Amazon.

No wonder that the origin of a mutilation so barbarous, so repulsive, and, at the same time, so widely spread and so tenaciously adhered to should have so repeatedly formed an object of inquiry and speculation. Muhamed found circumcision already an ancient usage among many of the Arabian tribes; he took it up for reasons akin to those for which Paul dropped it. It had prevailed, since time immemorial, among the Abyssinians, when they embraced Christianity. Travelers who make inquiries among savage tribes generally obtain for answer that it is a tribal custom which has always been; they cannot conceive why other reasons should be demanded.

[Mutilations. Gaillard's Medical Journal v. 45.]

Peter Remondino and The Orificial Surgical Society

1888

The Orificial Surgical Society “was founded by Edwin Hartley Pratt, a surgeon at the Cook County Hospital in Chicago. The organization was largely concerned with orifices below the waist, and provided training for surgery of the prepuce, clitoris and rectum, the latter organ being given special emphasis. It was obsessed with the idea that most diseases were caused by tightness of the preputial or anal sphincters. … By the 1920s many of the member physicians had their licenses revoked.” —Wallerstein, Circumcision: An American Health Fallacy, 1980:38

See also: Rutkow IM. Edwin Hartley Pratt and orificial surgery: unorthodox surgical practice in nineteenth century United States. Surgery. 1993. and Moments in surgical history: orificial surgery. Archives of Surgery. 2001.

1889

Peter Remondino read his “A Plea for Circumcision; or, the Dangers that Arise from the Prepuce” at the meeting of the Southern California Medical Society.

quote

The subject of the paper was itself suggested by a long and personal observation of the changes made in man by circumcision. From the individual observation of cases, it was but natural to wish to enlarge the scope of our observation and comparison; this naturally led to a study of the physical characteristics of the only race that could practically be used for the purpose. This race is the Jewish race. On carefully studying into the subject, I plainly saw that much of their longevity could consistently be ascribed to their more practical humanitarianism, in caring for their poor, their sick, as well as in their generous provision for their unfortunate aged people. The social fabric of the Jewish family is also more calculated to promote long life, as, strangely as it may seem, family veneration and family love and attachment are far more strong and practical among this people than among Christians, this sentiment not being even as strong in the Christian races as it is in the Chinese or Japanese. … Actual observations show them [the Jews] to be exempt from many diseases which affect other races; so that it is not only that they recover more promptly, but that they are not, as a class, subjected to the loss of time by illness, or to the consequent sufferings due to illness or disease, in anything like or like ratio with other people. There is also a less tendency to criminality, debauchery, and intemperance in the race; this, again, can in a measure be ascribed to their family influence, which even in our day has not lost that patriarchal influence which tinges the home or family life in the Old Testament. Crimes against the person or property committed by Jews are rare. They likewise do not figure in either police courts or penitentiary records; they are not inmates of our poor-houses, but, what is also singular, they are never accused of many silly crimes, such as indecent exposures, assaults on young girls….

Cohen (2011) wrote in reference to the promotion of genital cutting by men like Hutchinson, Johnson, Remondino, Freeman, Lehman and others like them, “one of the most fascinating stories of the institutionalization of medical male circumcision is the discursive use of the Jews as racial proof of the benefits of circumcision, with a complete ignorance of sociological factors.”

1890

London surgeon Herbert Snow published a 57-page book, the first intactivist volume.

He called for “the abolition of an antiquated practice involving the infliction of very considerable suffering upon helpless infants; and sanctioned, on very questionable grounds, by men of eminent authority.”

He summarized the issue succinctly:

“No sane man who possessed the advantages of a sound and entire prepuce would willingly sacrifice it without just and sufficient cause being shown.”

[The Barbarity of Circumcision as a Remedy for Congenital Abnormality. London: J. & A. Churchill.]

1890

William D. Gentry declared that phimosis in men and uterine disorders in women caused insanity, blindness, deafness, dumbness, epilepsy, paralysis and criminal behavior adding that “the genitals of either male or female are the centres of the nervous system”.

[Nervous derangements produced by sexual irregularities in boys. Transactions of the American Institute of Homeopathy. v.43.]

1890

Jonathan Hutchinson wrote that the foreskin encouraged masturbation and “adds to the difficulties of sexual continence” and can even cause insanity. For evidence of the latter point, he pointed to the case of an anonymous surgeon committed to an insane asylum for compulsive masturbation. Adult circumcision was useful, he wrote, for breaking men of the habit of masturbation, but early childhood circumcision was ideal in his opinion. In closing, he wrote: “Measures more radical than circumcision would, if public opinion permitted their adoption, be a true kindness to many patients of both sexes” referring to the difficulty of getting the general public to accept the idea of doctor's electing to sterilize patients without their consent.

[On circumcision as preventive of masturbation. Archives of Surgery.]

1890

A review of Pogorelsky's Ritual circumcision of the Hebrews stated:

quote

“As regards the predisposition to the acquirement of neuroses, the foreskin plays the same part in the male as the ovaries in the female.” Sayre traced reflex paralysis and contracture of the lower extremeties; Erichsen, spasmodic diseases, to congenital phimosis.

Further, hypochondriacal persons with inclination to commit suicide, individuals who suffer from uro-paraplegia, nervous tremor, chorea minor, neuralgia, hysteria, hallucinations and paresis have been cured by circumcision.

Although circumcised persons contract gonorrhea more easily than uncircumcised, yet syphilis less often; the sexual desire is less in the former, hence crimes against morality are rarer.

[Review of Pogorelsky M. Ritual circumcision of the Hebrews in The Medical Times. v.17. 1890.]

1891

Peter Remondino, a San Diego physician and literal snake oil promoter published a book of circumcision activism in which he vilified the foreskin at length as a malign influence and “moral outlaw.” Repeating the false claim that circumcision prevents masturbation, Remondino wrote, “the practice of [masturbation] can be asserted as being very rare among the children of circumcised races.” He claimed circumcision would not only discourage boys from masturbating, but would immunize them against tuberculosis, cancer, syphilis, polio, idiocy, forgetfulness, impotence, unwanted erections, wet dreams and practically every medical problem.

quote

The prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner: where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings, and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail or even in a lunatic asylum. Man's whole life is subject to the capricious dispensations and whims of this Job's-comforts-dispensing enemy of man.

[Remondino PC. History of Circumcision… moral and physical reasons for its performance… and of the different operations practiced upon the prepuce Philadelphia: F. A. Davis. 1891.]

1893

Mark J. Lehman claimed Jewish boys were healthier. He noted it was “an open question” whether tuberculosis, cancer, syphilis, and “scrofula” were not “one and the same disease,” and whether “such a simple measure as general circumcision” would not be the answer to all “insidious and filthy diseases.” He called for immediate universal circumcision of all male infants.

This was the second “plea for circumcision” after Remondino's in 1889.

[A plea for circumcision. Medical Review.]

1893

An unnamed author for The Journal de Medicine de Paris provided a look into popular thought of the day on female circumcision (meaning only non-excisive incision here) writing:

quote

A certain Dr. Morris, of Boston, the land of Yankee notions, has discovered an ingenious method of making the most waspish and shrewish women models of gentleness and modesty. He proves by statistics that eighty out of one hundred American women of Aryan origin in New England have the gland of the clitoris adherent, in part or totality, to the prepuce. The result of these adherences is an imperfect development of the gland, and to this is due a weakness of sexual desire and various nervous perturbations. These troubles are dependent, in the first place, on an irritation of the terminal branches of the erectile nerves of the gland brought on by the adherences, and in the second place to irritation caused by the retention of smegma. This double irritation leads to masturbation, to the perversion of sexual desire, and finally to reflex neuroses.
The preputial adherences of the clitoris are, according to Dr. Morris, the only and direct cause of the reflex neuroses from which thousands of New England women suffer, and he adds: “We can now understand how the most irritable young girl, the one who is most disagreeable and hysterical, may be made gentle, charming, and become endowed with a thousand feminine graces, by the simple rupture of the bands that bind down the clitoris [clitoral incision].” The therapeutic deduction is perfect, and we do not doubt that all husbands in New England who have shrewish wives will now employ Dr. Morris to break up these adhesions of the clitoris, and bring peace to many a suffering Boston household.

[Adherent Clitoris in all Shrewish Women. Cincinnati Lancet-Clinic. Translated from Journal de Medicine de Paris.]

1894

Peter Remondino claimed circumcision would curb the “predisposition” of black men to rape white women. Remondino's proposal was supported by several medical journals including the Maryland Medical Journal and the Boston Medical and Surgical Journal (now the New England Journal of Medicine).

quote

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 [white girls] 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—at least in a certain beneficial degree—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.

[Negro rapes and their social problems. National Popular Review.]

1894

Darby (2005) wrote: “eleven boys confined in a Kansas mental institute were castrated for persistent masturbation.” When the press was critical of this, “the Kansas Medical Journal defended the institute's action” writing “this abuse weakened the already imbecile mind and destroyed the body.”

1895

Edgar J. Spratling began his article explaining that part of the great evil of masturbation was that it could lead to being sodomized in an insane asylum. He advocated tight circumcisions to prevent the skin from being able to move, a natural feature of the human penis which facilitates masturbation. If not tight circumcision, cutting the nerves to the penis could also be used to blunt the individual's sexuality, and he advocated that surgery as well, but it was a more delicate surgery compared to circumcision.

quote

In women the road to its cure is an endless and monotonous journey, for nothing short of ovariotomy will be found to deserve even the term palliative; clitoridectomy, anatomically and physiologically, could be but a failure, blistering [i.e., cauterization is] only [a] cruelty.

Among men the case is not so hopeless, for there anatomy is partly in the operator's favor [meaning male erogenous sensitivity is easier to destroy]. Of the treatments we might speak of blistering the glans penis, but only to condemn it as an uncalled for cruelty; the possible beneficial effect is so transient, while the untoward effect is often so lasting upon the patient mentally in the way of a feeling of resentment, that it is doubtful if one could ever justify such a proceeding.
Complete section of the dorsal nerves of the penis (as I have previously advocated) is a rational procedure, but rather too radical for constant routine practice. The cases require the greatest care in the selection for this operation, and even then with all due care one will generally have to encounter the most strenuous objections and later the bitterest reproach and condemnation from the patients and from their relatives—though the object sought may have been obtained [at the expense of causing penile numbness and impotence].

[In cases of masturbation] circumcision is undoubtedly the physicians' closest friend and ally…. To obtain the best results one must cut away enough skin and mucous membrane to rather put it on the 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 to readily resume his practice….”

[Masturbation in the Adult. Medical Record.]

1895

Charles E. Fisher, a homeopathic doctor, wrote:

quote

In all cases in which male children are suffering nerve 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 circumcision should be considered as among the lines of treatment to be pursued.

A like rule obtains with reference to female children. In general practice the sexual organs in both sexes should be carefully examined by the general practitioner in early infancy, and at various times throughout child-life, with reference to the correction of deformity or unnatural conditions that may be present. …the clitoris is often firmly bound down by an adherent hood; numerous reflexes arising therefrom. It has become quite the rule [to] examine the sexual organs of male children at or soon after birth, but, on the other hand, it is equally the rule to neglect to examine girl babies. As children of the weaker sex grow their more delicate nervous systems begin to show the effect of genital irritations, and many a case of chorea, confirmed headache, nervous jactitations, paralytic weakness, unusual irritability, melancholia or other abnormal state of the nervous system long remains uncured because of the failure to make careful examination of the condition of the genitalia and relieve irritations and adhesions at this site.”

[A Hand-Book On The Diseases of Children And Their Homeopathic Treatment. Chicago: Medical Century Co. 1895]

1895

T. Ritchie Stone strongly advocated circumcision for all male infants in his pro-surgery review.

[Circumcision. Maryland Medical Journal.]

1897

S. G. A. Brown of Pennsylvania repeated the same philosemitic sentiment as Remondino:

quote

The Jews, who perform this operation on the eighth day after birth, are, from actual observations, known to be exempt from many diseases which afflict other races. Their children are hardy, and grow up to manhood and womanhood strangers to disease, perfect in body, sound in mind, and with a morality above condemnation. It is rare that they figure in silly crimes, police or divorce courts. That an appendage like the prepuce which under various conditions, as phimosis, short frenum or preputial adhesions, is the leading factor in the production of enuresis, dysuria, impotence, calculi, cancer, syphilis, phthisis or various other reflex neuroses, can be considered as a natural physiological appendage, is absurd in the extreme. In order to render the rising generation healthy, mentally morally and physically, we must pay attention to this redundant tissue, and advise its early removal. Fully three-fourths of all male babies have abnormal prepuces.”

This was the third “plea for circumcision” after Remondino's in 1889 and Lehman's in 1893. The titles of the three papers were identical. Four years separated each one from the previous one. They appear to be a coordinated effort, and connect Remondino to the Orificial Surgical Society.

[A Plea for Circumcision. Journal of Orificial Surgery quoted in The Medical World]

1898

T. Scott McFarland of Missouri reported on the circumcision of a two-year-old girl with precocious puberty and anomalous symptoms of irritation. In closing he added that he had “circumcised as many girls as boys, and always with happy results.”

[Circumcision of girls. Journal of Orificial Surgery.]

1898

Edwin H. Pratt praised female circumcision for its supposed beneficial effect on the nervous system:

quote

The condition of the foreskin of boys has received more or less attention, at least since the days of Moses, who is reported to have inaugurated the practice of circumcision of the male portion of the human race. But the girls have been neglected. Without presuming to pose as their Moses, 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 medical profession.

All up-to-date doctors realize the importance of the proper condition of the foreskin in the male and of securing it during infancy. The foreskin must be completely loosened, if it is too long amputated and if it is too tight slit open, in order to avoid the dangers of infantile convulsions, of hip-joint disease, of kidney disease, of paralysis, of eczema universalis, of stammering, of dyspepsia, of pulmonary tuberculosis, of constipation, of locomotor ataxia, of rheumatism, of idiocy and insanity, and of lust and all its consequences. But the poor girls, who have an organ called the clitoris, anatomically corresponding to the penis of the male, with a hood corresponding to the foreskin of the male and just as sorely in need of [surgical] attention, and just as prolific of mischief when neglected as the corresponding parts of the male, have been permitted to suffer on in silence. The same list of diseases which have their start in nerve waste caused by a faulty foreskin in the male is duplicated by the female sex from identically the same cause, in addition to other troubles peculiar to the female organization from which, of course, the male are exempt, and yet it goes on almost entirely unrecognized. Chorea, so frequent in young girls, chlorosis, which comes a little later on, and hysteria, which is also a common affliction, in addition to the same diseases from which boys whose foreskin have been neglected are liable to suffer, have their origin almost invariably in faulty conditions of the hood of the clitoris. It is such a simple matter to secure a normal condition of the hood and its clitoris, and its neglect is fraught with so much and such serious mischief to the gentler sex, that the sin of omission which is being constantly and everywhere committed is painful to contemplate. Doctors are not easily educated out of their beaten tracks.

So let both sexes have a start in life and be entirely freed from the sexual self consciousness which inevitably comes from impinged nerve fibres about the clitoris and its hood as well as at the glans penis and its foreskin. … 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.

[Circumcision of Girls. Journal of Orificial Surgery.]

1899

Denslow Lewis, a Chicago gynecologist, presented evidence for the benefits of female circumcision (prepucectomy) at a meeting of the AMA in 1899. In “a large percentage” of women who failed to find marital passion “there is a preputial adhesion, and a judicious circumcision, together with consistent advice, will often be successful.” He treated 38 women with circumcision reporting “reasonably satisfactory results in each instance.”

[The Gynecologic consideration of the sexual act.]

1900

Jonathan Hutchinson advised circumcision as way to decrease the pleasure of sex hoping to discourage sexual immorality. He also recommended genital cutting as a way of avoiding teaching a child about hygiene because “the practice [of hygiene] would be injurious to the morals of the child.”

[The advantages of circumcision. The Polyclinic. — summarized in International Medical Magazine]

1900

M. O. Terry, an Orificial Surgical Society member, reported seven cases of “insanity” cured with emulsified animal brains or orificial work, including prepucectomy for both men and girls, rectal dilation, and even one use of clitoridectomy for a case of insanity and masturbation.

[On the cure of insanity by the operative procedure: Reflex action to the brain from pathological organs now recognized as a frequent cause of insanity. Journal of Orificial Surgery.]

1901

Ernest G. Mark noted that the “pleasurable sensations that are elicited from the extremely sensitive” foreskin may encourage a child to masturbate, which is why he recommended amputating it because it “lessens the sensitiveness of the organ”.

[Circumcision. American Practitioner and News.]

1901

A. S. Waiss reported applying his knowledge of male phimosis to the female and “a narrow strip of skin and mucous membrane was removed with scissors” from an 18 year-old girl with “abnormally long” prepuce to “cure” her of masturbating and social anxiety.

[Reflex neuroses from adherent prepuce in the female. Journal of Orificial Surgery.]

1902

Roswell Park recommended “radical operations” to cure epilepsy including circumcision.

[The surgical treatment of epilepsy. American Medicine. — summarized in The International Journal of Surgery.]

1902

Peter Remondino claimed infant circumcision is just like a vaccine so its opponents “may be likened to the anti-vaccinationists”.

[Circumcision and its opponents. American Journal of Dermatology and Genito-Urinary Disease.]

1902

Elizabeth Blackwell did not mince words warning parents that circumcision is an ugly mutilation based on the idea that nature created the male body wrong.

quote

A serious warning against the unnatural practice of circumcision must here be given. A book of 'Advice to Mothers,' by a Philadelphia doctor, was lately sent me. This treatise began by informing the mother that her first duty to her infant boy was to cause it to be circumcised! Her fears were worked upon by an elaborate but false statement of the evils which would result to the child were this mutilation not performed. I should have considered this mischievous instruction unworthy of serious consideration did I not observe that it has lately become common among certain short-sighted but reputable physicians to laud this unnatural practice, and endeavour to introduce it into a Christian nation.

Circumcision is based upon the erroneous principle that boys—i.e., one-half the human race—are so badly fashioned by Creative Power that they must be reformed by the surgeon; consequently, that every male child must be mutilated by removing the natural covering with which Nature has protected one of the most sensitive portions of the human body.

The erroneous… custom (which originated amongst licentious nations in hot climates) has been carried on for many hundred generations…

Appeals to the fears of uninstructed parents on the grounds of cleanliness or of hardening the part are entirely fallacious and unsupported by evidence.

It is a physiological fact that the natural lubricating secretion of every healthy part is beneficial, not injurious, to the part thus protected, and that no attempt to render a sensitive part insensitive is either practicable or justifiable. …bad habits in boys and girls cannot be prevented by surgical operations. …bad habits can only be forestalled by healthy moral and physical education.

The plea that this unnatural practice will lessen the risk of infection to the sensualist in promiscuous intercourse is not one that our honourable profession will support.

Parents, therefore, should be warned that this ugly mutilation of their children involves serious danger, both to their physical and moral health.

[Essays in Medical Sociology. 1902.]

1904

Jacob Snowman explained the utility of stimulating an erection in performing infant circumcision.

When the penis of an infant is in a state of erection the operation of circumcision can be more easily performed and the dressing more efficiently applied. The manipulation of the organ necessary to grasp the prepuce is generally sufficient to stimulate the increased blood supply requisite for an erection.

[The Surgery of Infant Circumcision.]

1910

Elizabeth Hamilton-Muncie's Four Epochs of Life was published. The title was nearly identical to Anna Mary Galbraith's The Four Epochs of Woman's Life: A study in hygiene (1901), but unlike Galbraith who never mentioned genital cutting, Hamilton-Muncie was one of Pratt's Orificial Surgical Society members, so she extolled the virtues of female genital cutting at length.
According to Rinehart (1921), Hamilton-Muncie regularly applied court-ordered corrective genital surgeries to those who were convicted of an act of sexual deviancy in New York.

[Muncie EH. Four Epochs of Life. Self-published/Gospel Publishing House. 1910.]

1910

Wallerstein (1985) wrote of Kistler (1910), “an article in J.A.M.A. described a new circumcision clamp. The author/inventor claimed that with this device, the operation was so simple that men and women could now circumcise themselves.”

1911

“Dr. Joseph Preuss, in a monumental tome, Biblical-Talmudic Medicine, claimed that Jewish ritual circumcision endowed health benefits; his sole source was Remondino” (Wallerstein 1985).

1912

Douglas H. Stewart in New York City saw a “fairly robust woman” who, though desirous for sexual intercourse, when the act was attempted found “there ‘was nothing in it.’” Upon examination, Stewart found the clitoris of the patient to be “buried” and preceded to circumcise the woman to reveal the organ.

[quote from Rodriguez, 2014]

1912

Benjamin E. Dawson published a 650-page textbook of orificial surgery, Orificial Surgery: It's Philosophy, Application and Technique. It included Pratt's “Circumcision of Girls” and Elizabeth Muncie's “Preputial Adhesions in Little Girls” as chapters 63 and 64.

[Orificial Surgery: It's Philosophy, Application and Technique.]

1914

Abraham Wolbarst said that circumcision “should be encouraged in every possible case, whether it be done as a ritual act or as a purely sanitary measure.” Finding statistics that suggest circumcised men were at increased risk of gonorrhea and decreased risk of syphilis, Wolbarst ignored the former fact concluding that “universal circumcision is, in my opinion, an absolute necessity, when we consider the general welfare of the race.” He also valued circumcision for preventing masturbation: Circumcision “offers a diminished tendency to masturbation, nocturnal pollutions, convulsions and other nervous results of local irritation.”

[Universal circumcision as a sanitary measure. Journal of the American Medical Association.]

1914

James Brown Thornton very weakly rebutted Wolbarst's enthusiastic plea for non-therapeutic foreskin mutilation for all infants. In Thornton's view, circumcision was only indicated for the longer half of foreskins (CI-8 to CI-10).

quote

I believe that there are many of us who do not fully agree with Dr. Wolbarst in his sweeping denunciation of non-circumcision [intact foreskin]. Obviously, this operation is indicated when phimosis exists, and the earlier the better. It is also indicated in elongated conditions of the prepuce, even if not constricted. Most excellent reasons have been advanced for the operation in such cases. But in the man whose foreskin is of such character as partly, or even wholly, to cover the glans when the penis is in a quiescent state, but automatically withdraws at the time of sexual excitement, I can see no valid reason for mutilating the penile organ. An exception might be made to this view of the matter in those who are neglectful of all laws of cleanliness and hygiene, but in this class circumcision is only one of a number of local attentions indicated, provided so extreme a method becomes necessary to keep such part of the person's anatomy clean.

[Correspondence. Journal of the American Medical Association.]

1914

H. H. Hazen recommended circumcision as a method of limiting the spread of syphilis among the African-American community. Claiming the race had heightened sexual desire he wrote, “all male babies should be circumcised, both for the purpose of avoiding local irritation which will increase the sexual appetite and for preventing [syphilis] infection.”

[Syphilis in the American Negro. Journal of the American Medical Association.]

1914

Rowland Freeman explained the popular concern of the day with infant masturbation in girls and female circumcision (prepucectomy) as the only treatment:

quote

The masturbation of female infants while not common occurs with moderate frequency and is a condition which if neglected leads to a considerable amount of depravity. It may be controlled by proper treatment. In the female infant there exists fairly regularly marked adhesions between the sensitive clitoris and the surrounding tissues so that on examination the clitoris is frequently found to be buried in these adhesions. In a normal robust child they seem to cause little irritation but in the nervous, sensitive child they may cause intense irritation and lead to the formation of a [masturbation] habit which, if untreated, may become permanent and exert a most injurious influence over the future development of the child. … The only curative treatment is that applied to the removal of the source of irritation, the adhesions of the clitoris. These may be separated without the use of an anesthetic. The operation under these conditions is very painful and is apt to be followed by the formation of other adhesions. The only satisfactory method of treating this condition is by circumcision, an operation which should be performed by one accustomed to doing it, the [clitoral] foreskin being removed as completely as possible.

As he explained it, adhesiolysis was insufficient and prepucectomy was necessary because the clitoris would re-adhere as it healed from adhesiolysis.

[Circumcision in Masturbation in Female Infants American Journal of Obstetrics and Diseases of Women and Children]

1914

J. A. Burnett. of London wrote:

quote

Circumcision has been practiced for ages and has an interesting history. Most every one has heard of male circumcision but many have never even heard of female circumcision. It is now a well established fact that female circumcision is as important as male circumcision. Many physicians do not know anything of the value of male circumcision except when it interferes with passing the water. Circumcision is of most value in both male and female to prevent reflex conditions. In order to understand the value one must know something of both nervous systems and reflex actions. In some eye troubles circumcision is of value. Dr. C. A. Weirick reported a case of partial atrophy of the optic nerve in a man aged 34 years. The case was of eight years' duration. He could not see to read except large print, and then but a few minutes at a time. In one month after circumcision he was able to read a page of small print without any unpleasant results. I could go on and on, and mention cases of nervousness, convulsions, bed wetting, stomach trouble—as well as a great many other diseases that have been cured by circumcision of both sexes.

[Burnett JA. Circumcision. California Eclectic Medical Journal. v.7. 1914.]

1915

J. A. Burnett of London wrote:

quote

Circumcision is an old operation, but its value is not as generally known as it should be. The Bible speaks of circumcision in many different places. It is an evident fact to all experienced physicians of the present day that if circumcision is not correctly done, that it may be necessary to perform another circumcision. …

In my opinion, circumcision is more important for children than adults. This seems to have been known long ago, and early circumcision has been practiced by the Jews for centuries.

I do not find any reference in the Bible to female circumcision, but it has been practiced for many years in different parts of the world. It is now an established fact by physicians who have devoted special attention to orificial surgery that female circumcision is as important or more important than male circumcision. In Dr. B. E. Dawson's “Orificial Surgery” (1912), E. H. Pratt, the founder of orificial surgery has a chapter on “Circumcision of Girls.” If anyone will read even the first and second paragraphs in Dr. Pratt's chapter, they can see that female circumcision is really more important than male circumcision.

There is another chapter in this book on “Preputial Adhesions in Little Girls,” by Dr. Elizabeth H. Muncie, which gives valuable information. I mention Dawson's “Orificial Surgery” because I meet so many physicians that have read little or nothing on female circumcision and most of them do not know where to find such literature.

Only a few days ago I received a letter from an old physician who had learned the value of female circumcision by an accident when he was a medical student. He had been doing the operation for several years with good results in a large number of conditions. He stated he had never been able to find any literature on the subject in any book or journal. There is quite a lot of literature on female circumcision scattered through various books and journals; still the average physician outside of orificial surgeons could not point out half a dozen articles on the subject. Personally, I am a strong believer in male and female circumcision in certain conditions. I fully believe that circumcision of both sexes is capable of preventing or assisting in the prevention and curing or assisting in a cure of more diseases and diseased conditions than any other one operation known in surgery In many cases of reflex conditions caused by preputial adhesions contractions elongations or other abnormal conditions of the prepuce circumcision is absolutely essential In many cases in boys or girls men or women circumcision is necessary in aiding to bring about the condition suggested by the poet who said:

“We often sing of the beautiful land As a land that is far away; But why not make it near at hand, And live in it every day.”

Of course, circumcision is not a “cure-all,” or as a rule the only treatment needed when it is indicated; other forms of treatment are most always needed in addition to circumcision. In some instances circumcision, like any other operation or mode of treatment, will fail to be of any value. We have no absolute methods of curing all cases, hence all treatment in some cases fails to do any good, and the patient either remains the same, gets worse, or goes down and passes to the great beyond through the “dark valley and shadow of death” and the earth “once more receives us and piously covers our remains with her bosom, thus admonishing us that as from it we came, so to it we must shortly return.” But in all cases the patient, as the defendant in criminal court, should have the benefit of the doubt. In Dawson's “Orificial Surgery” Dr. J. W. Means has a chapter on “Constipation and Diarrhea as a Neurosis: Treatment from an Orificial Standpoint.” In this chapter he says, “In cases of marasmus in children, clipping the foreskin often completely cures a long-standing diarrhea. In twenty-four operations for circumcision, at least 50 per cent. of these cases had diarrhea, all of which were cured.”

In my opinion there are hundreds of children, both boys and girls that die each summer with stomach and bowel troubles that could be easily saved by the treatment that was given in addition to circumcision. It is surprising why the value of circumcision and especially female circumcision is so little known. […]

It is often hard for some people to understand the value of circumcision when a physician suggests the operation. Of course when a new form of treatment to the patient or parents of a child is suggested, as for instance circumcision for convulsions, nervousness, hysteria, bed-wetting, diarrhea, indigestion, retarded development in children stammering, idiocy, etc., they wish to know how such treatment aids the condition, and many of the intelligent class must be informed of such before they submit to the operation. “As the sun rules the day and the moon governs the night,” so should the physician “with equal regularity endeavor to rule and govern the “knowledge of his patients who are in need of circumcision.” False sympathy or ignorance often keep parents from having a child circumcised.

[Burnett JA. Circumcision. Medical Summary: A Monthly Journal of Practical Medicine. v.37. 1915.]

1915

Benjamin E. Dawson said the clitoral hood is the source of “many neuroses and even psychoses” making female circumcision (prepucectomy) necessary. “The same category of diseases having their origin in nerve-waste, caused by a pathological foreskin in the male, may be duplicated in the female, from practically the same cause, and in addition, other diseases peculiar to females. … Girls have been sadly neglected; therefore, I make a plea in their behalf.”

[Circumcision in the Female: Its Necessity and How to Perform It. American Journal of Clinical Medicine.]

1915

William J. Robinson explained how intact foreskin caused masturbation from learning normal hygiene.

The prepuce is one of the great factors in causing masturbation in boys. Here is the dilemma we are in: If we do not teach the growing boy to pull the prepuce back and cleanse the glans there is the danger of smegma collecting and of adhesions and ulcerations forming, which in their turn will cause irritation likely to lead to masturbation. If we do teach the boy to pull the prepuce back and cleanse his glans, that handling alone is sufficient gradually and almost without the boy's knowledge to initiate him into the habit of masturbation … Therefore, off with the prepuce!

[Circumcision and Masturbation. Medical World, vol. 33 (1915): p. 390.]

1918

Belle Eskridge concluded circumcision (prepucectomy) will relieve one of the greatest causes of masturbation in girls. She wrote of Middle Eastern female genital cutting practices positively as well as her own experiences with female genital cutting:

quote

In Egypt all girls of true Egyptian origin are circumcised. It is an Egyptian custom, practised as a ritual event even on Mohammedan girls of Fellah (that is, of true Egyptian) origin. Circumcision of the male child has been practised as a religious custom or ritual by Jews since the early ages. Putting it under the cloak of religion is the only way they felt sure of its perpetuation.

Of the large number of girls whom I have circumcised, and the boys circumcised by the other members of staff, there is as much improvement in the girls as in the boys. The superintendent says that the girls show even a greater improvement than the boys. Some of them are quite changed in character. The improvement in health and general appearance of the girl is surprising. I have examined the genitalia of over 250 girls in this home. Less than a dozen were normal…. The glans should be free from adhesions. When the prepuce is stretched latterly [sic]. These girls are wholesome, normal girls of better mental balance, judging from observation alone….

The operation of circumcision of the girl is a very simple surgical procedure. The prepuce can invariably be separated from the glans by the thumb and index finger covered with gauze, placed directly opposite on each side of the clitoris, with gently steady pressure outward from the glans. If a little irregular point still remains adherent, it can easily be stripped back with gauze. No cutting instrument will be required up to this point. When the glans is entirely free, seize the prepuce at the median line with a small forceps and lift it up free of the glans clitoris; then with a sharp pair of scissors, remove a V-shaped piece, extending upward large enough to uncover the glans well back. The skin and mucous membrane are then united as in the operation on the male. I cover the united edges of the hood, but not the glans, with compound tincture of benzoin about the consistency of cream. The nurse is instructed to keep it clean and pushed back twice a day until healed.

I hope you will not infer from this paper that I believe or recommend circumcision of the female as a cure-all, but I do insist that it will give as good results to the girl as to the boy, and that the female genital organs should receive as careful attention at birth as those of the male child.

[Why not circumcise the girl as well as the boy? Texas State Journal of Medicine. 1918.]

1921

Jacob S. Rinehart, a Missouri physician, wrote of circumcision for both sexes enthusiastically:

quote

Orificial surgery is not a theory, fad or hobby. It is eminently practical, based upon anatomical and physiological facts, easily confirmed in all standard text-books. The effects, both moral and physical, of the circumcision of the boy has been recognized and given more or less attention since the time of Moses. But few today—including physicians—recognize the fact that girls are equally benefited by circumcision; and, furthermore, that there are many other irritations of the lower orifices of the body that have equally far-reaching effects upon the physical and moral life of the individual.

…The sympathetic nervous system furnishes the motive power that runs all physical machinery, including the capillary circulation—and we marvel that all interested in the relief of human ills do not search for irritations of the sympathetic nerve. Just as pressing upon an electrical button exhausts the electric current, so does irritation or impingement of the sympathetic nerve terminal exhaust sympathetic nerve force, or the very life of the force.

Ninety-nine per cent. of the babies, both boys and girls, require circumcision at birth.

Please understand that this is not a theory, but is an established fact. The probation officers in New York are now sending incorrigible children, moral degenerates and sexual perverts to Dr. Elizabeth Muncie for orificial corrections.

He also wrote of orificial results including a woman with “paranoia (insanity with delusions)” who he “found suffering from nerve waste.” He “circumcised her, amputated both labia, dilated the cervix and rectum… Her recovery has been complete, both mental and physical. She has been saved to her family.”

Some of the moral effects (as well as the physical) of the circumcision of the boy has long been recognized. But few, today, including physicians, recognize the fact that girls are equally benefited by circumcision, and, furthermore, that any of the forms of irritation (already mentioned) of the sexual system or even of the rectum may be the source of sexual self-consciousness. This frequently leads to masturbation in both girls and boys. Such children need pity; they are usually nervous and irritable, and possibly willful. These conditions are responsible for the immorality of our schools, for the prostitution in society, for gonorrhea and syphilis, and for many of the unworthy marriages and divorces. Hence, while we are solving the problem of chronic diseases we are also solving the problems of society. It has been agreed, by all physicians with years of experience in this line of work, that every prostitute has some form of sexual irritation producing sexual self-consciousness. The proof of this phase of the orificial philosophy, as with the chronic physical and mental diseases, lies in its manifold cases of practical application, the many who have thus been restored from a life of shame and disgrace to one of purity and hope.

[The Relation of Orificial Surgery to Social Hygiene. The Eclectic Medical Journal.. 1921.]
[Why Chronic Diseases? Medical Standard. 1922.]

Jewish circumcision activism

While some Jewish doctors had advocated for gentile circumcision since the 1850s—and some wrote against it—with the collapse into obscurity of the Orificial Surgical Society, the majority of circumcision activism has since the 1920s been the product of Jewish doctors.

1926

Abraham Wolbarst claimed circumcision prevented penile cancer.

[Is circumcision a prophylactic against penis cancer? Cancer.]

1930

Norton Henry Bare claimed to have cured a boy of epilepsy by amputating his foreskin.

[Surgical treatment of epilepsy with report of case. The China Medical Journal.]

1932

Abraham Wolbarst repeated his claim that amputating foreskin prevents penile cancer based on only a few case reports of cancer in India and the United States.

[Circumcision and penile cancer. Lancet. 150-3.]

1934

Aaron Goldstein and Hiram S. Yellen invented and marketed the popular Gomco™ clamp inspired by rim clamp tire changing machines. It made it easier than ever for doctors to cut off more skin than in circumcisions without clamps. And it reduced the risk of death that attended such extreme surgery using sutures or a compression bandage without tissue-fusing pressure from the clamp.
The design of the clamp encourages doctors to perform more excisive surgeries. The clamp was promoted with events like promotional circumcisions of children in orphanages.

Wan (2002) calculated the Gomco clamp crushes the clamped tissue with 8,000 to 20,000 pounds of force.

[Bloodless circumcision of the newborn. American Journal of Obstetrics and Gynecology.]

1935

R. W. Cockshut recommended that all males be circumcised in order to desensitize the penis to promote chastity.

I suggest that all male children should be circumcised. This is 'against nature', but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that 'God knows best how to make little boys.'

[Circumcision. British Medical Journal:764.]

1940

Charles Lane, a physician in Poughkeepsie, New York, believed the clitoris “a very important organ to the health and happiness of the female,” and performed circumcisions on women unable to reach orgasm. In a 1940 article concerning his use of circumcision on a patient—Mrs. W., a 22-year-old woman who had recently married but had yet to experience an orgasm—Lane noted “that little trick did it all right.”

[quote from Rodriguez, 2014]

1941

Allan F. Guttmacher promoted mass circumcision as a means of “blunting male sexual sensitivity.” He also implied incorrectly that an infant's intact foreskin needs to be forcibly retracted to be scrubbed daily. This was an imperative to damage children's genitals from a medical authority, the doctor-editor of a parenting magazine and the founder of Planned Parenthood. He claimed that failing to treat a child by damaging his foreskin would inevitably lead to phimosis.

Defending the anti-masturbation rationale for the surgery, he wrote: “[Circumcision] does not necessitate handling of the penis by the child himself and therefore does not focus the male's attention on his own genitals. Masturbation is considered less likely.”

He minimized the importance of consent to the point of non-existence by mentioning some doctors performed the surgery without parental permission: “Some doctors make a practice of routine circumcision unless specific objection is raised by the parents, while others first consult the parents in order to discover their wishes.”

When consent was not even a consideration, there must not have been much concern about concealing doctors' financial motivation to perform the surgery: “When the obstetrician performs the operation he ordinarily adds 10 to 15 percent to his bill, although some include it in their original fee.”

[Should the baby be circumcised? Parents Magazine.]

1942

Abraham Ravich claimed that circumcision prevented prostate cancer.

[The relationship of circumcision to cancer of the prostate. Journal of Urology.]

1946

Benjamin Spock recommended circumcision in his popular book for new parents, which was a best-seller for three decades.

He later recanted the recommendation, but his retraction received little publicity.

[Baby and Child Care, NY:Dutten. 1946-76]

1947

Navy doctor Eugene A. Hand successfully advanced the idea within the military that black men were dangerous carriers of disease and that their low rate of circumcision was the main reason for this.

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 hornet’s 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.

1949

Eugene H. Hand declared that circumcision prevented venereal disease and cancer of the tongue.

Darby wrote of Hand's dubious research, “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.”

American popular media has always been strongly biased in favor of circumcision, a trend that continues today.

[Circumcision and venereal disease. Archives of Dermatology and Syphilology.]

1949

Douglas Gairdner reported that the foreskin develops entirely normally and free of all problems in all but 1% of boys by the age of 15 correcting the popular misconception phimosis was normal, a key part of the pathologization of the foreskin.

quote

It is a curious fact that one of the operations most commonly performed in this country is also accorded the least critical consideration. In order to decide whether a child's foreskin should be ablated the normal anatomy and function of the structure at different ages should be understood; the danger of conserving the foreskin must then be weighed against the hazards of the operation, the mortality and after-effects of which must be known. Though tens of thousands of infants are circumcised each year in this country, nowhere are these essential data assembled. The intention of this paper is to marshal the facts required by those concerned with deciding the fate of the child's foreskin.

Male circumcision, often associated with analogous sexual mutilations of the female such as clitoric circumcision and infibulation, is practised over a wide area of the world by some one-sixth of its population. Over the Near East, patchily throughout tribal Africa, amongst the Moslem peoples of India and of South-East Asia, and amongst the Australasian aborigines circumcision has been regularly practised for as long as we can tell. Many of the natives that Columbus found inhabiting the American continent were circumcised. The earliest Egyptian mummies (2300 B.C.) were circumcised, and wall paintings to be seen in Egypt show that it was customary several thousand years earlier still.

It is often stated that the prepuce is a vestigial structure devoid of function. However, it seems to be no accident that during the years when the child is incontinent the glans is completely clothed by the prepuce, for, deprived of this protection, the glans becomes susceptible to injury from contact with sodden clothes or napkin. Meatal ulcer is almost confined to circumcised male infants, and is only occasionally seen in the uncircumcised child when the prepuce happens to be unusually lax and the glans consequently exposed (Freud, 1947).

[Cultural genital cutting in the UK appears to be performed primarily for social class distinction.]
Amongst the Western nations the circumcision of infants is a common practice only with the English-speaking peoples. It is, for the most part, not the custom in continental Europe or Scandinavia, or in South America. In England the collected data of various colleagues* who have kindly made observations on infants, school-children, and university students reveal wide variations as between different districts and between different social classes. For instance, in Newcastle-upon-Tyne 12% of 500 male infants aged 12 months were circumcised; in Cambridge the comparable figure was 31% of 89 male infants aged 6 to 12 months. Boys coming from the upper classes are more often circumcised, 67% of 81 13-year-old boys entering a public school had been circumcised, whereas only 50% of 154 boys aged 5 to 14 in primary and secondary schools in the rural districts of Cambridgeshire, and 30% of 141 boys aged 5 to 11 in primary schools in the town of Cambridge, had been circumcised. The influence of social class is shown also by some figures analysed by Sir Alan Rook from a group of university students. Whereas 84% of 73 students coming from the best-known public schools had been circumcised, this was so of only 50% of 174 coming from grammar or secondary schools.

About 16 deaths in children under 5 years occur each year from circumcision. In most of the fatalities which have come to my notice death has occurred for no apparent reason under anaesthesia, but haemorrhage and infection have sometimes proved fatal. Haemorrhage is not uncommon after circumcision. F. J. W. Miller and S. D. Court (1949, personal communication), who followed 1,000 infants in Newcastle-upon-Tyne for their first year, found that 58 were circumcised, and two of these bled sufficiently to require blood transfusion. In my own experience about two out of every 100 children circumcised as hospital out-patients will be admitted on account of haemorrhage or other untoward event. Blood losses in the first year are particularly apt to lead to anaemia, and several infants have been seen with severe iron-deficiency anaemia following haemorrhages after circumcision. Reference has already been made to meatal ulcer, which, in so far as it is so much more frequent in circumcised male infants, should be counted a sequel of the operation.

[Common ignorance of proper hygiene damages the infant's foreskin. Until it becomes retractable, only the outside of the penis needs to be cleaned.]
Through ignorance of the anatomy of the prepuce in infancy, mothers and nurses are often instructed to draw the child's foreskin back regularly, on the supposition that stretching of the foreskin is what is required. I have on three occasions seen young boys with a paraphimosis caused by mothers or nurses who have obediently carried out such instructions; for, although the size of the prepuce does allow the glans to be delivered, the fit is often a close one and slight swelling of the glans, such as may result from forceful efforts at retraction, may make its reduction difficult.

[Developmental errors causing foreskin abnormalities may be promoted by wearing soiled diapers too long.]
Inflammation of the glans is uncommon in childhood when the prepuce is performing its protective function. Posthitis - inflammation of the prepuce - is commoner, and it occurs in two forms. One form is a cellulitis of the prepuce; this responds well to chemotherapy and does not seem to have any tendency to recur; hence it is questionable whether circumcision is indicated. More often inflammation of the prepuce is part of an ammonia dermatitis affecting the napkin area. The nature of this condition was firmly established by Cooke in 1921, bit is still not universally known. The urea-splitting Bact. ammoniagenes (derived from faecal flora) acts upon the urea in the urine and liberates ammonia. This irritates the skin, which becomes peculiarly thickened, while superficial desquamation produces a silvery sheen on the skin as if it were covered with a film of tissue paper. Such appearances are diagnostic of ammonia dermatitis, and inquiry will confirm that the napkins, particularly those left on through the longer night interval, smell powerfully of ammonia. Treatment consists in impregnating the napkins with a mild antiseptic inhibiting the growth of the urea-splitting organisms. When involved in an ammonia dermatitis the prepuce shows the characteristic thickening of the skin, and this is often labelled a “redundant prepuce” - another misnomer which may serve as a reason for circumcision. The importance of recognizing ammonia dermatitis lies in the danger that if circumcision is performed, the delicate glans, deprived of its proper protection, is particularly apt to share in the inflammation and to develop a meatal ulcer. Once formed, a meatal ulcer is often most difficult to cure.

[Phimosis concerns have been wildly overstated.]
A number of symptoms of obscure cause, such as enuresis, masturbation, habit spasm, night terrors, or even convulsions, have from time to time been attributed to phimosis, and circumcision has been advised. No evidence exists that a prepuce whose only fault is that it has not yet developed retractability can cause such symptoms.

Conclusions
It has been shown that, since during the first few year of life the prepuce is still in process of developing, it is impossible at this period to determine in which infants the prepuce will attain normal retractability. In fact, only about 10% will fail to attain this by the age of 3 years. [Estimates of this age have varied.] In a very few this may prove impossible and circumcision might then be considered a justifiable precaution. Higgins (1949), with long experience of paediatric urology, also concludes that circumcision should not be considered until “after the age of, say, 2 to 3 years.”
[Correction: Thorvaldsen and Meyhoff (2005) carried out a survey in Denmark reporting the average age of first retraction at 10.4 years, which was identical to the findings of Øster (1968). The age of first retraction typically varies between 3 and 16 years, with the average age being 10.]

The prepuce of the young infant should therefore be left in its natural state. As soon as it becomes retractable, which will generally occur some time between 9 months and 3 years, its toilet [hygiene] should be included in the routine of bath time, and soap and water applied to it in the same fashion as to other structures, such as the ears, which are customarily treated with special assiduousness on account of their propensity to retain dirt. As the boy grows up he should be taught to keep his prepuce clean himself, just as he is taught to wash his ears. If such a procedure became customary the circumcision of children would become an uncommon operation. This would result in the saving of about 16 children's lives lost from circumcision each year in this country, besides saving much parental anxiety and an appreciable amount of the time of doctors and nurses.

[The Fate of the Foreskin: a study of circumcision. British Medical Journal 1949;2:1433-7.]

Darby wrote of the unfortunately minimal impact of Gairdner (1949) in the United States and continued medical fascination with circumcision activism:

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 – as they nearly always were.

1949

Jewish atheist Joseph Lewis published his book against infant circumcision.

[In the Name of Humanity.]

1951

Abraham Ravich theorized that circumcision prevented cervical cancer in women, that 25,000 deaths annually from cancer were caused by the foreskin, and that between 3 and 8 million American men then living had contracted prostate cancer from having their foreskin intact.

[Prophylaxis of cancer of the prostate, penis, and cervix by circumcision. New York State Journal of Medicine.]

1953

Richard L. Miller and Donald. C. Snyder suggested routine neonatal circumcision for all males immediately after birth while still in the delivery room to provide “immunity to nearly all physical and mental illness.”

They insisted that normal congenital “phimosis” required immediate surgical “correction,” and asserted circumcision would “reduce the incidence of onanism” (masturbation), 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 (Darby, 2005).

[Immediate circumcision of the newborn male. American Journal of Obstetrics and Gynecology.]

1954

Ernest L. Wydner claimed universal circumcision prevented cervical cancer in women.

Wydner subsequently showed his study to be invalid 6 years later, because the cervical cancer patients incorrectly reported their husbands were uncircumcised without actually having any idea whether they were or not. They were just giving the answer they thought the doctor wanted to hear. Wynder later recognized and admitted his error in Wynder & Licklider (1960) showing most women didn't know the difference and even many men were not aware. This circumcision to reduce cervical cancer hypothesis was also disproved by Stern & Neely (1962).

[A study of environmental factors of carcinoma of the cervix. American Journal of Obstetrics and Gynecology.]

1956

Raymond Creelman invented the Circumstraint™ which straps down and immobilizes the baby's arms and legs.

[USPTO patent number RE24,377]

1958

C. F. McDonald wrote “the same reasons that apply for the circumcision of males are generally valid when considered for the female.”
Curiously, this doctor used “circumcision” to refer to the separation of clitoral adhesions with a probe, technically this is non-amputative preputial adhesiolysis and female circumcision had until then been used only to mean (excisive) prepucectomy. Performed on an infant, adhesiolysis would be likely to cause skin bridging as noted by unisex prepucectomy advocate Edwin H. Pratt in 1898 in Circumcision of Girls.

[Circumcision of the female. General Practice.]

1959

W. G. Rathmann wrote that among the “benefits” of female circumcision (prepucectomy), it cured psychosomatic illnesses and would help marital problems and would “make the clitoris easier to find” for the husband. He favored only therapeutic surgery though writing, “Routine circumcision because of a functional problem alone, without the proper anatomic indications, will probably be of no benefit and might be harmful.”

[Female Circumcision: Indications and a New Technique [NSFW]. General Practice.]

1960

Wynder and Licklider showed Wynder's previous research on circumcision on cervical cancer was flawed. Circumcision did not have an effect on cervical cancer.

[TITLE. JOURNAL.]

1962

Stern & Neely refuted Ravich's hypothesis that foreskin caused cervical cancer in women.

[Stern & Neely. Cancer of the cervix in reference to circumcision and marital history. Journal of the American Medical Women’s Association.]

1963

D. Govinda disproved Wolbarst’s theory that smegma was carcinogenic

[D. Govinda Reddy. Carcinogenic action of human smegma. Archives of Pathology.]

1965

William Morgan’s provocatively titled paper debunked all the arguments then used to justify infant circumcision.

[The Rape of the Phallus. Journal of the American Medical Association.]

1966

John M. Foley's The Practice of Circumcision: A Revaluation (New York: Materia Medica, 1966) was published.

1966

Masters and Johnson made the false but highly influential claim there were no differences in sensitivity between penises with and without intact foreskin. Their work established the false dogma that circumcision had no effect on sexual function, which then went unquestioned for the next 40 years.

[Human Sexual Response. Boston: Little Brown.]

1969

Morris Fishbein called for circumcision to prevent nervousness and masturbation.

[Sex hygiene in Modern Home Medical Adviser. Garden City, NY: Doubleday.]

1970

Noel Preston drew attention to how unscientific the claims that foreskin caused cancer were and the other supposed preventative benefits of foreskin destruction.

[Whither the foreskin? Journal of the American Medical Association.]

1970

I. O. W. Leitch published a paper that eventually lead to the de-normalization of the practice in Australia as Gairdner (1949) had done in the UK and New Zealand.

quote

A review of the literature suggests that many of the traditional indications remain unproven. In the light of this study, and other surveys which indicate the hazards of the operation, it is suggested that circumcision should be confined to those with a genuine medical indication.

Nowadays, in Australia, despite a state of enlightened civilization that average Australians are thought to enjoy, circumcision is still the rule. The exposed glans is the fashion. The undressed penis stands as a social symbol, and the foreskin is still a schoolboy's curiosity, viewed secretly with wonder and awe. Circumcision now performed as a social ritual, and those in favour of the operation have justified its performance on medical grounds.

It has been said that circumcision is a simple operation with little associated morbidity and mortality, and that benefits include increased hygiene, and prophylaxis against malignancy. Opinion against the performance of the operation of circumcision is just as certain that if the foreskin is subjected to adequate toilet [hygiene], carcinoma is not a problem, neither is balinitis.

In the belief that the operation of circumcision is not without risk, it was decided to analyse some of the case records of circumcision performed at this Hospital to obtain statistics concerning the actual morbidity. Should a significant morbidity exist, then it seems obvious that there are no grounds for the present-day practice of social circumcision.

The incidence [of complications] was rather high (Table II), and for convenience they have been analysed in 2 groups, early and late, according to whether they occurred before or after 2 weeks. Late complications occurred in 15 (7.5%). One of the 2 cases of meatal stenosis eventually required a meatotomy; in one healing was delayed for 5 1/2 weeks; and in 2, too little skin was removed at operation.

The total complication rate was 31 in 200 cases, i.e. 15.5%.

In an attempt to evaluate these complications, several aspects were analysed. The first of these was the experience of the operator; surgeons had a complication rate of 14.9%, surgical registrars 17.6% and resident medical officers 50%. Perhaps this would not suffer statistical scrutiny, but it probably reflects the residents' lack of experience.

Haemorrhage was the most common complication, and on clinical grounds was classified as mild, arterial or brisk venous haemorrhage as moderate, while clinical signs of blood loss and/or the need for transfusion were classified as severe. The procedures required to control this haemorrhage were also listed.

Meatal ulcer was the second most common complication, and an attempt was made to correlate it with the type of dressing or any adjunct smeared on the glans after circumcision. It was assumed that management after circumcision was similar in most instances, and in fact the type of dressing used had no significant effect on the incidence of meatal ulcer.

Two deaths from routine circumcision occurred in Australia during the period 1960-1966. Speert (1953) in a survey of the period 1939-1951 quoted one death in a series of 566,463 circumcisions, and 243 deaths from carcinoma of the penis during the same period. In England and Wales, between 1942 and 1947, 16 children died annually as a result of routine circumcison (Begg, 1953), while Gairdner (1949) reported 16 deaths in a series of 90,000 circumcisions, high mortality figures for a simple operation.

Mortality aside, circumcision is accompanied by a considerable number of less serious complications (15.5%) including haemorrhage, meatal ulcer, meatal stenosis and infection in the series reported here. Other complications included laceration of the glans during operation, delayed wound healing, and ineffectual circumcision. A less serious delayed complication of circumcision is ammoniacal dermatitis causing a meatal ulcer and stenosis, a sequel which only occurs in the circumcised. Other less common but more serious complications not seen in this survey are urethral fistula, amputation of the glans, avulsion of the scrotum and septicaemia (Patel, 1966).

Severe haemorrhage, also absent from this series, may require tranfusion with its attendant occasional complications, or further surgical intervention with the possibility of an additional anaesthetic. Meatal stenosis may require a meatotomy, and the rarer severe complications may require elaborate plastic surgical procedures. A second operation because of the failure or complication of the first is not unusual and constituted 9.5% of this series.

A circumcision, then, is an operation which is accompanied by a not inconsiderable risk which should be seriously considered when the operation is entertained.

With proper counseling, circumcision becomes an unnecessary operation, even more so when it is realized that the prepuce plays an important part in protecting the glans during the period of urinary incontinence in the first years of life.

Finally, from a review of the recent literature and the results of this survey it is deduced that routine circumcision is largely unwarranted, and that adequate personal hygiene… has exactly the same effect as circumcision with none of the complications.

[Circumcision: A Continuing Enigma. Australian Paediatric Journal 1970;6:59-65.]

1971

Abraham Ravich theorized circumcision prevents cancer of the bladder and the rectum.

[Viral carcinogenesis in venereally susceptible organs. Cancer.]

1971

The AAP Committee on Fetus and Newborn stated, “There are no valid medical indications for circumcision in the neonatal period.”

[Committee on Fetus and Newborn Issues. Circumcision. Hospital Care of Newborn Infants 5th Edition. Evanston, Ill: AAP]

1973

R. Dagher, Melvin Selzer, and Jack Lapides declared anyone who disagreed with imposing mass infant circumcision was deluded.

[Carcinoma of the penis and the anti-circumcision crusade. Journal of Urology.]

1973

Abraham Ravich published a book promoting circumcision:

[Preventing V.D. and Cancer by Circumcision.]

1973

Leo Wollman reported statistics on 100 female circumcisions he performed to cure “hooded clitoris.”

[Hooded Clitoris: Preliminary Report. Journal of the American Society of Psychosomatic Dentistry and Medicine.]

1973

Cathrine Kellison wrote an article promoting female prepucectomy for Playgirl magazine.

[Circumcision for Women. Playgirl. Oct.]

1975

Cathrine Kellison penned a second article promoting female prepucectomy for Playgirl magazine.

[$100 Surgery for a Million-Dollar Sex Life. Playgirl. May.]

1975

The AAP Task force on Circumcision reported, “There are no medical indications for routine circumcisions and the procedure cannot be considered an essential component of health care.”

[Report on the ad hoc task force on circumcision. Pediatrics.]

1977

Takey Crist reported on his circumcision of fifteen women, and provided a list of four conditions for when the surgery would be indicated: “a) they could achieve orgasm only by masturbation and/or oral sex, b) they could have orgasm in the lateral or female-superior positions only, c) they stated, “it feels good, I get there, but suddenly it's over,” d) they had a positive cotton-tip test, where patients felt a distinct difference when a cotton-tipped applicator was applied directly to the clitoris when the foreskin was retracted as opposed to application to the foreskin”. Crist's study concludes, “Patients who have undergone this procedure have generally commented that they have enhanced sexual response.”

[“Female Circumcision.” Medical Aspects of Human Sexuality. Aug.]

1977

The insurance company Blue Shield Association recommended individual plans stop covering 28 surgical and diagnostic procedures considered outmoded including female circumcision (prepucectomy/removing the hood of the clitoris).

[“Blue Shield Acts to Curb Payment On Procedures of Doubtful Value”, New York Times, 1977]

1978

Sydney S. Gellis wrote, “It is an uncontestable fact at this point that there are more deaths from complications of circumcision than from cancer of the penis. … Physicians should become more vociferous than they have been in discouraging circumcision of the newborn.”

[Circumcision. American J Dis Child.]

1980

Edward Wallerstein published Circumcision: An American Health Fallacy detailing the sordid history of the medicalized genital cutting movement.

1982

Former U.S. Surgeon General C. Everett Koop, M.D. wrote in the Saturday Evening Post: All of the Western world raises its children uncircumcised and it seems logical that, with the extent of health knowledge in those countries, such a practice must be safe.

1983

Hugh C. Thompson recognized there did not appear to be any good reason to continue circumcision.

Neonatologists have regarded the operation [circumcision] as without merit. Physicians in all fields agree on the necessity for careful explanation to the parents, preferably before the infant is born. They deplore the occasional grave complications that are largely produced by poor technique and inexperienced operators. One major reason formerly used to justify neonatal circumcision—correction or prevention of phimosis—has been shown to be untenable by serial studies from birth to adulthood. The major indications now proposed as justifying the procedure are prevention of penile [skin] cancer [which is rarer than male breast cancer] and balanitis and a reduction in herpes genitalis and, possibly, cancer of the uterine cervix [disproved and more recently shown to be caused by HPV]. These diseases are decades removed from the neonatal period, and opponents of circumcision regard them as lacking incontrovertible proof or as inconsequential.

[The Value of Neonatal Circumcision: An Unanswered and Perhaps Unanswerable Question. American Journal of Diseases of Children. — [full text]]

1983

Money & Davison found that four of the five men circumcised as adults in their study rated penile sensitivity as diminished. They didn't describe the difference very articulately but they noted differences included “diminished penile sensitivity, less penile gratification, more penile pain, and cosmetic deformity”.

quote

Removal of the entire foreskin, or even part of it, may require a change in masturbatory technique, insofar as there is less or no redundant [sic] skin to be stretched forward or backward [the eversion of the foreskin is more like rolling but with more fluidity]. Thus, there needs to be more reliance on some other surface, for example, the lubricated skin of the fingers or palm, to provide ether rotary or longitudinal friction directly to the shaft of the penis. What has been lost in circumcision is the stretch effect and hypothetically, receptors that provide proprioceptive stretch sensation from the foreskin. Inside the vagina, the penis must move in and out in the fashion of a finger, rather than being sometimes able, like the head of a turtle to pull in and out of the carapuce of its own foreskin, while the pubococcygeal muscles at the vaginal entrance grip the lower part of the shaft. Stretch sensations may be additionally altered if the frenulum is severed in the circumcision.

[Adult penile circumcision: erotosexual and cosmetic sequelae. Journal of Sex Research.]

1984 to the present:
Thomas Wiswell, Edgar Schoen, Brian Morris

A new wave of genital cutting was begun with Wiswell in the 1980s based on neonatal UTI incidence. He reached his conclusions by comparing children born in a hospital with universal infant circumcision who were born prematurely and whose poor health had prevented routine circumcision at birth. Notably he also commanded parents to treat the child's foreskin destructively for hygiene to use the resultant damage as evidence to support circumcision. The bigger question about this unfortunately successful infant genital surgery promotion is how was it ever accepted as valid science?

To (1998) found the rate of UTI in Canadian infants was reduced 3.5 times but that was really from only 0.7% to 0.2%. So while it sounds like a lot as a relative rate, it would take almost 200 surgeries to prevent a single UTI that could be easily treated with antibiotics. Roughly 70% of the infant UTI benefit is derived from groups with anatomical defects that increase risk of UTI, especially hypospadias and vesicuretal reflux. Excluding those groups, the infant UTI benefit is nil.

In the mid-1980s, circumcision activists began to insinuate themselves into positions of influence in American medical organizations to promote infant circumcision including most notably with the appointment of Edgar Schoen to the American Academy of Pediatrics Task Force on Circumcision committee in 1987.

1985

Thomas E. Wiswell, a military doctor, used flawed methods to show that circumcision decreased incidence of urinary tract infections by comparing infants born prematurely to infants born at term.

[Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics.]

1985

Benjamin Spock finally updated the his best-selling parenting book (first published in 1946): “I strongly recommend leaving the foreskin alone. Parents should insist on convincing reasons for circumcision—and there are no convincing reasons that I know of.”

Later in a 1989 interview in Redbook, he stated “My own preference, if I had the good fortune to have another son, would be to leave his little penis alone.”

1986

Aaron J. Fink claimed that circumcision prevented AIDS.

[A possible explanation for heterosexual male infection with AIDS. New England Journal of Medicine.]

1988

Aaron J. Fink invented the idea that circumcision prevented neonatal group B streptococcal disease.

[Is hygiene enough? Circumcision as a possible strategy to prevent group B streptococcal disease. American Journal of Obstetrics and Gynecology.]

1989

Edgar J. Schoen lead the AAP Task Force on Circumcision that declared infant circumcision necessary.

[Report of the Task Force on Circumcision. Pediatrics.]

1991

Edgar J. Schoen implored European doctors to institute mass circumcision.

[Is it time for Europe to reconsider newborn circumcision? Acta Pediatrica Scandinavica.]

1991

Aaron J. Fink declares mass circumcision is necessary to prevent sand from getting into the soldiers' foreskins.

[Circumcision and sand. Journal of the Royal Society of Medicine.]

1994

Legal victory: Miltex, one of several Mogen clamp manufacturers, stopped distributing the devices in 1994. “Although no obvious defect has been found with the clamp's design or manufacturing we have concerns over the possible mishandling of the instrument by practitioners and our inability to ensure the instrument's proper use,” Miltex's then-president Saul Kleinkramer wrote in a letter announcing the decision. The manufacturer was then in default on millions of dollars in lost lawsuits before millions more were lost in additional lawsuits, in total over $23 million.

[“Injuries linked to circumcision clamps” Hennessy-Fiske. Los Angeles Times. 2011.]

1996

J. R. Taylor et al. found the average amount of foreskin amputated was 51% of the total penile skin on average. They identified the “ridged band contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa.”

The 'ridged band' may be key to the persistent mislabelling of the inner lining of the prepuce as 'skin'; it is clearly visible on inspection of the retracted prepuce, it is continuous with the wrinkled true skin of the tip of the prepuce, and it looks like skin. Histology aside, the 'wrinkles' of the ridged band are regularly transverse and are difficult to efface by gentle stretching. A vascular blush is usually present.

The vascular ridges of the 'ridged band' and its Meissner's corpuscles firmly separate preputial epithelium from true skin and place preputial mucosa amongst other mucocutaneous mucosae. Winkelmann emphasized the structural and functional importance of junctional regions of the body and focused on mucocutaneous end-organs, or 'genital corpuscles', of the glans penis and prepuce. Some of these end-organs resemble Krause end-bulbs; others resemble Meissner's corpuscles.

Meissner's corpuscles of the prepuce may be compared with similar nerve-endings in the finger-tips and lips, which respond in a fraction of a second to contact with light objects that bring about deformation of their capsules. However, complex sensation, at least in the glans penis, may be mediated by free nerve-endings rather than by specialized end-organs.

[The prepuce: Specialized mucosa of the penis and its loss to circumcision. British Journal of Urology.]

1996

Non-therapeutic female genital cutting in all forms were made illegal in the United States by federal law.

[United States Code, 2010 Ed., Title 18, Chapter 7 (Assault), §116 - Female genital mutilation]

1997

Edgar J. Schoen again suggested European countries should institute non-therapeutic circumcision.

[Benefits of newborn circumcision: Is Europe ignoring the medical evidence? Archives of Disease in Childhood.]

1997

Lander et al. found that circumcision without anesthesia was extremely traumatic for babies. Before this, almost all neonatal cutting were done without anesthetic due to increased risks involved with using it and the prevalent false belief babies were not capable of feeling significant pain or can't remember it.

[Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. Journal of the American Medical Association.]

1997

Taddio et al. wrote on the effect of the pain of infant circumcision being measurable later:

Preliminary studies suggested that pain experienced by infants in the neonatal period may have long-lasting effects on future infant behaviour. The objectives of this study were to find out whether neonatal circumcision altered pain response at 4-month or 6-month vaccination compared with the response in uncircumcised infants [….]

Multivariate ANOVA revealed a significant group effect (p < 0.001) in difference (vaccination minus baseline) values for percentage facial action, percentage cry time, and visual analogue scale pain scores. Univariate ANOVAs were significant for all outcome measures (p < 0.05): infants circumcised with placebo had higher difference scores than uncircumcised infants for percentage facial action (136.9 vs 77.5%), percentage cry duration (53.8 vs 24.7%), and visual analogue scale pain scores (5.1 vs 3.1 cm). There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla [topical anesthetic], to those circumcised with placebo.

Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend [anesthetic] treatment to prevent neonatal circumcision pain.

[Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet.]

1997-1998

Immerman and Mackey proposed that male genital cutting reorganizes the brain to restrain sexuality and positively influence both social and pair bonding. They noted: “It appears that any sensory deprivation of a system can also lead to cortical changes.”

They assumed desensitizing the penis should reduce sexuality, but that ignores the fact that genital cutting permanently externalizes the orgasmic interior parts of the penis. This sensorial change could as easily be thought to promote sexual thoughts.

[A Proposed Relationship Between Circumcision and Neural Reorganization. Journal of Genetic Psychology.]

[A Biocultural Analysis of Circumcision. Social Biology.]

1999

Cold & Taylor studied the foreskin's specialized innervation and concluded that it is “primary erogenous tissue necessary for normal sexual function.” It is specialized, protective, erogenous tissue. A description of the complex nerve structure of the penis explains why anesthetics provide incomplete pain relief during circumcision.

[The prepuce. British Journal of Urology.]

1999

The AAP Task Force on Circumcision reviewed 40 years worth of medical studies and concluded the “potential medical benefits of newborn male circumcision… are not sufficient to recommend routine neonatal circumcision.” This report was the first time the AAP acknowledged that circumcision without anesthesia is traumatic and that if circumcision is to be done, anesthesia should be used. Some highlights from the report:

Role of Hygiene: “there is little evidence to affirm the association between circumcision status and optimum penile hygiene.”

STDs including HIV: “behavioral factors appear to be far more important than circumcision status.”

Penile Cancer: “in a developed country such as the United States, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, is low.”

Urinary Tract Infections: “breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. However, breastfeeding status has not been evaluated systematically in studies assessing UTI and circumcision status.” meaning that the earlier UTIs studies results were confounded. Even if their numbers were accurate, in order to prevent one UTI during the first year of life by circumcising a baby boy, approximately 195 babies who will not get a UTI would need to be circumcised. Curiously, while female infants develop UTIs at higher rates than boys, the standard treatment is antibiotics not surgery. The AAP concludes this section noting that “the absolute risk of developing a UTI in an uncircumcised male infant is low (at most, ~1%)”.

[Task Force on Circumcision. Circumcision Policy Statement. Pediatrics. 1999.]

1999

O'Hara and O'Hara (1999), a small study in America, found the female partners of intact men reported the average duration of coitus was 39% longer and intact foreskin was a boon to stimulating female orgasm.

[The effect of male circumcision on the sexual enjoyment of the female partner. British Journal of Urology International.]

2000

The U.S. FDA “issued a public health notice about the Mogen and Gomco clamps after receiving 20 injury reports per year since 1996, including lacerations, hemorrhaging, penile amputation and urethral damage. Instead of recalling the devices, the FDA advised users to make sure they were using the correct size Mogen clamp and that the space between the clamp's jaws met manufacturer's specifications. The agency also cautioned against using replacement parts on the Gomco clamp, which led it to malfunction.

But complications continued. In the 11 years between the FDA warnings and the Hall settlement, the agency has received 139 additional reports of problems related to circumcision clamps, including 51 injuries, said spokeswoman Amanda Sena. Twenty-one of those reports were related to Mogen clamps, all but one of which involved injuries.

[“Injuries linked to circumcision clamps.” Hennessy-Fiske. Los Angeles Times. 2011.]

2000

Circumcision is described as an intervention with long-term neurobehavioral effects: “The brain of the newborn infant is particularly vulnerable to early adverse experiences, leading to abnormal development and behavior. Although several investigations have correlated newborn complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral types depending on the timing and nature of the adverse experience. The mechanisms mediating such changes in the newborn brain have remained largely unexplored. Maternal separation, sensory isolation (understimulation), and exposure to extreme or repetitive pain (overstimulation) may cause altered brain development. These changes promote two distinct behavioral types characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical importance of these mechanisms lies in the prevention of early adverse experiences and effective treatment of newborn pain and stress.”

[Anand, K. and Scalzo, F. Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biology of the Neonate]

2001

Kenneth McGrath detailed the anatomy of the frenular delta.

[The frenular delta: a new preputial structure. In: Denniston GC, Hodges FM, Milos MF, editors. Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem]

2001

McCredie found circumcision increased the odds of moderate-to-severe prostate-related urination problems by 50% in old men (aged 40-69) in Australia (n=1216).

[Prevalence of urinary symptoms in urban Australian men aged 40-69. Journal of Epidemiology and Biostatistics.]

2002

Taves tested the hypothesis the foreskin reduces friction finding it did so more than 10 times (when friction is great enough to engage this feature).

[The intromission function of the foreskin. Medical Hypotheses.]

2002

Fink surveyed 123 men circumcised as adults. Indications for the surgery were mostly phimosis (64%) and diseases (27%). Only 7% were considered elective. They found worsened erectile function (p = 0.01) and decreased penile sensitivity (p = 0.08) among the most common results. Nearly half (38%) of the men reported harm despite the fact that the surgery was performed for therapeutic purposes.

[Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. Journal of Urology.]

2003

Edgar J. Schoen pressured the AAP to reverse its policy on circumcision, claiming it prevents AIDS.

[It's wise to circumcise: time to change policy. Pediatrics.]

2003

Bensley & Boyle found circumcision contributes to vaginal dryness. Women reported they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men.

[Effects of Male Circumcision on Female Arousal and Orgasm. New Zealand Medical Journal.]

2004

Meislahn and Taylor hypothesized the ridged band should be the most orgasmic and pleasurable part of the penis based on its histology.

[The Importance of the Foreskin to Male Sexual Reflexes. In: Denniston G.C., Hodges F.M., Milos M.F. (eds) Flesh and Blood.]

2004

Denniston (2004) surveyed men who had been sexually active for at least two years before circumcision. Of 38 men sampled, the majority (58%) felt that the pleasure of intercourse diminished.

[Circumcision in adults: effect on sexual function. . Urology.]

2004

Gallup & Burch confirmed the hypothesis of O'Hara (1999) that the shape of the glans extracts lubrication from the vagina contributing to vaginal dryness and dyspareunia (painful sex), but the authors did not acknowledge the confirmation. Instead they hypothesized the human penis evolved the shape it has for sperm competition. In their reasoning they confused circumcision, a cultural practice, with genetic evolution.

[Semen Displacement as a Sperm Competition Strategy in Humans. Evolutionary Psychology.]

2005-2007

Johns Hopkins three studies were all ended early with the conclusion that circumcision is “like a vaccine” that prevents HIV infection. These three African studies were widely reported falsely to be “gold-standard evidence” of major HIV benefit from circumcision.
To be the highest quality evidence they were claimed to be, the studies would need to be double-blind, which is impossible with a surgical body modification. The results of the African RCTs could easily be explained by the varying levels of STI awareness counseling between the two groups because the counseling was provided along with the surgery.
In all the studies, more than seven times more participants dropped out than seroconverted.

[Auvert, 2005; Bailey & Moses, 2005; Gray, 2007]

2007

Sorrells tested the fine touch sensitivity of the penis and found the foreskin is the most sensitive part of the penis, while the glans is the least.

The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds [i.e., were more sensitive] than the ventral scar of the circumcised penis.

[Fine touch pressure thresholds in the adult penis. British Journal of Urology International.]


click to show full diagram

2007

The American College of Obstetrics and Gynecology (ACOG) recommended against performing female circumcision or other non-therapeutic female genital cutting surgeries, because the promotion of the surgery as sexually enhancing was not based on empirical evidence and the surgeries were not medically indicated. This was the first assertion of what had become common wisdom over only the past 30 years. Female cutting for benefits was being promoted in American popular media into the 1970s.

2010

The American Academy of Pediatrics published a policy statement on female genital cutting proposing allowing parents to provide permission for medical professionals to perform a “ritual nick”. Outrage ensued, and the policy statement was retracted a month later. This ritual nick meant incision, so it would presumably include both incision and minor excision of the clitoral hood and the adhesiolysis that is common in some cultures.

2010

The Royal Dutch Medical Association (KNMG) stated the foreskin is “a complex, erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation”. They also stated “circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.”

[KNMG Circumcision Policy Statement.]

2011

Frisch et al. examined associations of male circumcision with a range of measures of sexual dysfunction in a large sample of both sexes.

Age at first intercourse, perceived importance of a good sex life and current sexual activity differed little between circumcised and uncircumcised men or between women with circumcised and uncircumcised spouses. However, circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors [11 vs 4%, OR(adj) = 3.26], and women with circumcised spouses more often reported incomplete sexual needs fulfilment (38 vs 28%, OR(adj) = 2.09) and frequent sexual function difficulties overall (31 vs 22%, OR(adj) = 3.26), notably orgasm difficulties (19 vs 14%, OR(adj) = 2.66) and dyspareunia [painful intercourse] (12 vs 3%, OR(adj) = 8.45).

Our study shows hitherto unrecognized associations between male circumcision and sexual difficulties in both men and women. Additionally, since it appears from our study that both men and women may have fewer sexual problems when the man is uncircumcised, and because preputial plasties may sometimes serve as suitable alternatives to standard circumcision, our study may stimulate a more conservative, tissue-preserving attitude in situations where foreskin pathology requires surgical intervention.

To summarize, compared to intact men and their female partners, they found 2-8 times higher odds of negative sexual outcomes in circumcised men and their partners.

[Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. International Journal of Epidemiology.]

2012

Podnar found the ability to elicit the involuntary erectile penilo-cavernosus reflex was suppressed by foreskin mutilation. This reflex was present in 92% of healthy intact men but only present in 27% of healthy men with circumcised foreskin.

[Clinical elicitation of the penilo-cavernosus reflex in circumcised men. British Journal of Urology International.]

2012

In a short-lived political victory followed by a loss, a Cologne District Court ruled that a boy's non-therapeutic circumcision constituted bodily harm. In response to this legal precedent and resultant pressure from religious groups on politicians, the German legislature legalized non-therapeutic infant foreskin mutilation within the year against the opinion of German pediatricians and the majority of the nation.

2013

G. A. Bronselaer et al. surveyed more than 1,000 intact and 300 circumcised men in Belgium. They found:

For the glans penis, circumcised men reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis). For the penile shaft a higher percentage of circumcised men described discomfort and pain, numbness and unusual sensations. In comparison to men circumcised before puberty, men circumcised during adolescence or later indicated less sexual pleasure at the glans penis, and a higher percentage of them reported discomfort or pain and unusual sensations at the penile shaft.

This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality.

They found circumcised men reported significantly less sexual pleasure from stimulation than intact men at the dorsal side of the glans (p<0.001), the lateral side of the glans (p<0.001) and the ventral side of the glans (p=0.02). And orgasm was less intense for circumcised men from stimulation at the dorsal side (p=0.006) and lateral sides (p=0.02). The results of this study demonstrate the foreskin is both very pleasurable and the foreskin or its sensitivity contribute to the sensitivity the glans.

[Male circumcision decreases penile sensitivity as measured in a large cohort. British Journal of Urology International.]

2015

A YouGov survey found younger Americans are much less likely to say that circumcising male children should be routine. Only 33% of under-30s think it should be done routinely, something that increased to 43% of people aged 30-44, 52% of people aged 45 to 64 and 63% of over-65s.

Ten percent of circumcised men wish they had not been circumcised.

[Young Americans less supportive of circumcision at birth.]

2015

The Canadian Paediatric Society reviewed all the medical literature on circumcision and released a policy statement saying neonatal circumcision has no significant benefits.

They reasserted this policy in 2018.

[Canadian Paediatric Society Position Statement.]

2016

Bossio, Pukall and Steele (2016) confirmed the results of Sorrells (2007) finding the foreskin is the most sensitive part of the penis.
Bossio et al. added circumcision activist conclusions that were not supported by their data. The media widely reported the unsupported circumcision activist conclusion and ignored the confirmation of Sorrells's finding that the foreskin is the most sensitive part of the penis.

[Bossio, Pukall and Steele. Examining Penile Sensitivity in Neonatally Circumcised and Intact Men Using Quantitative Sensory Testing. Journal of Urology.]

2017

Daughtry & Byler found circumcised American men had double the risk of acquiring high-risk HPV (OR=2; P=0.03; n=1,520).

[HPV prevalence in males in the United States from penile swabs: results From NHANES. Journal of Urology.]

2018

A study of American men found that the more that men know about the foreskin, the less satisfied they are with being circumcised.

[Earp B. False beliefs predict increased circumcision satisfaction in a sample of US American men. Culture, Health and Sexuality.]

2019

Elhaik, a Jewish doctor, noted the rate of unexplained death (SIDS) in male infants is 35% higher in U.S. states where Medicaid pays for infant circumcision. The infant circumcision rates are 50% higher in those states. That means infant circumcision could cause between 189 and 378 male infant deaths per year that are currently recorded as SIDS. This would mean the risk of death from infant circumcision is between 1 in 5,000 and 1 in 2,500.

[Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS). Journal of Clinical and Translational Research.]

Compiled from the following sources.