A Surgical Temptation

The University of Chicago Press

Contents

Chapter One

The Willful Organ Meets Fantasy Surgery

[The penis] disputes with the human intellect, and sometimes has an intellect of its own. And though the will of man may wish to stimulate it, it remains obstinate and goes its own way, sometimes moving on its own without the permission or intention of a man.... Many times a man wants to use it, and it does not want to; many times it wants to, and man forbids it. LEONARDO DA VINCI

It has been urged as an argument against the universal adoption of circumcision that the removal of the protective covering of the glans tends to dull the sensibility of that exquisitely sensitive structure and thereby diminishes sexual appetite and the pleasurable effects of coitus. Granted that this may be true, my answer is that ... sensuality in our time needs neither whip nor spur, but would be all the better for a little more judicious use of curb and bearing-rein. E. HARDING FREELAND, "Circumcision as a Preventive of Syphilis and Other Disorders," 1900

The condition of our organs and our senses greatly influences our metaphysics and our morals, and ... our most purely intellectual ideas ... are largely derived from the shape of our bodies. DENIS DIDEROT, "Letter on the Blind"

This study is an attempt to explain the sudden vogue for male circumcision in Victorian Britain. Although the causes reach deep into the history of medicine, disease, religion, and morality, the fundamental reason was a change in attitude toward male sexuality and the male body: between the mid-eighteenth and the late nineteenth century, the foreskin was transformed from an adornment that brought pleasure to its owner and his partners ("the best of your property") to "a useless bit of flesh" and an enemy of society. Much of the responsibility for this development lies with the efforts of Victorian physicians as "norm entrepreneurs," as Geoffrey Miller calls them, who set out consciously and resolutely to convince parents that their little boys would be better off without a feature their fathers had enjoyed. The result was that "during the last decades of the nineteenth century ... a remarkable shift occurred in the English-speaking world. Physicians acting as norm entrepreneurs reconceived the phallus." Where the uncircumcised penis had been regarded as pure, healthy, natural, beautiful, masculine, and good, writes Miller, they succeeded in portraying it as "polluted, unnatural, harmful, alien, effeminized and disfigured," while spinning the circumcised penis, formerly regarded as ugly and chaotic, as "true, orderly and good." The demonization of the foreskin as a source of moral and physical decay was the critical factor in the emergence of circumcision and its acceptance as a valid medical intervention, and it is the central theme of this book. Necessary conditions were the rise of medical objections to masturbation; the conceptualization of "congenital phimosis" and spermatorrhea as pathological conditions; confused and erroneous theories of infectious disease; dread of syphilis; an atmosphere of sexual Puritanism in which non-procreative sex was regarded as immoral and sexual pleasure feared; and the emergence of a new professional elite keen to assert its social authority by proving such pleasures were dangerous as well. In their construction of sex as a risky business for men, doctors characterized the normal male sexual function-the production and emission of sperm-as a life-threatening illness that demanded drastic treatment if there was to be any hope of cure.

These developments were such a surprising departure from traditional attitudes to male sexuality that they demand detailed explanation.

Until Victorian physicians discovered its moral efficacies, circumcision was scarcely known in the Western world. Revering the male body, the Greeks and Romans admired the foreskin and tried to ban the operation among the few of their Eastern subjects who performed it. Although Genesis enjoined the rite on the children of Abraham, the early Christians decided that it was not necessary for converts; the Church Fathers condemned it; and in 1442 the Catholic Church determined that circumcision was incompatible with salvation. Renaissance artists celebrated Christ's unscarred penis in their many paintings of Madonna and naked child, and until the nineteenth century anatomists and advisers on sexual matters held that the foreskin was necessary for normal sexual function and the satisfaction of both partners, and that circumcision was thus contrary to the intent of nature. In the eighteenth century British men valued their foreskin as "the best of your property," and Edward Gibbon described circumcision as "a painful and often dangerous rite" and the result as "a peculiar mark." Well might Sir Richard Burton comment that "Christendom practically holds circumcision in horror."

The sudden transformation of this attitude is reflected in successive editions of the Encyclopaedia Britannica. In the third edition (1797) circumcision is described as "the act of cutting off the prepuce; a ceremony in the Jewish and Mahometan religions." The entry makes reference to remarks by Herodotus on the strange customs of Middle Eastern tribes; expresses uncertainty as to whether circumcision was practiced among the ancient Egyptians; and considers female circumcision to be no different from male: "Circumcision is practised on women by cutting off the foreskin of the clitoris, which bears a near resemblance and analogy to the praeputium of the male penis." The ninth edition (1876) maintains this perspective: it makes no mention of circumcision as a medical procedure and rejects sanitary/hygienic explanations of its emergence in favor of religious ones: "Like other bodily mutilations ... [it is] of the nature of a representative sacrifice.... The principle of substitution was familiar to all ancient nations, and not least to the Israelites.... On this principle circumcision was an economical recognition of the divine ownership of human life, a part of the body being sacrificed to preserve the remainder." By the eleventh edition (1910) the entry has been turned on its head: "This surgical operation, which is commonly prescribed for purely medical reasons, is also an initiation or religious ceremony among Jews and Mahommedans." Suddenly circumcision is primarily a medical procedure and only after that a religious rite. The entry explains that "in recent years the medical profession has been responsible for its considerable extension among other than Jewish children ... for reasons of health." By 1929 the entry is much reduced in size and consists merely of a brief description of the operation, which is "done as a preventive measure in the infant" and "performed chiefly for purposes of cleanliness"; readers are then referred to the entries for "Mutilation" and "Deformation" for a discussion of circumcision in its religious context.

What accounts for this dramatic shift in sensibility? It is a remarkable fact that although there is a substantial anthropological literature on tribal circumcision practices, our ignorance about the rise of medically rationalized circumcision in Anglophone countries is still profound; as Ronald Hyam remarked in 1990,we know less about the history of routine infant circumcision in Britain (and its colonies) and the United States than about the rituals of some of the most obscure African tribes. In this study I hope to dispel some of this darkness, at least in relation to Britain, and explain how an operation formerly regarded as a humiliating disfigurement came to be seen as a mark of manliness, respectability, and health. It was one of the most rapid and surprising developments in Victorian bodily management practices, and in Britain one of the most short-lived: rising to prominence in the 1890s, routine circumcision of young males reached its peak of popularity in the late 1920s, declined in the 1930s and 1940s, and all but vanished in the 1950s. As well as explaining its rise, I hope to shed light on its rapid fall from grace. Although the direct literature on this process is slight, I have been assisted by a number of important studies that have appeared over the past decade: Ronald Hyam's survey of sexuality and empire; Frederick Hodges' research into the history of spermatorrhea and circumcision in the United States; and important studies by David Gollaher.

Although several studies have analyzed the survival of routine circumcision in the United States, the first serious attempt to account for the rise of the practice in Britain was made by Ronald Hyam, who relates the popularity of circumcision at the turn of the century to three main factors. The first was the fear of racial decline and falling physical fitness standards, giving rise to a host of anxieties and countermeasures, including the belief that circumcision would produce healthier and more self-confident males and "contribute to the general improvement of the ... manliness of the future guardians of empire." The second was the sudden enthusiasm for Jewish child-rearing practices in response to reportedly low rates of syphilis and masturbation among Jewish (and thus circumcised) men and boys, and especially following the discovery by the Committee on Physical Deterioration in 1904 that such children were better nourished and healthier. The third was the necessity for colonial administrators to work in hot or humid climates, where hygiene of the uncircumcised penis was presumed to be difficult. Hyam notes that it was widely believed that normal males were more susceptible to venereal disease in hot climates and that British Army doctors in India were vigorously in favor of the procedure and operated on their soldiers at the first sign of trouble. Hyam's account is constructive but not without serious gaps. He does not explain why hygiene in hot climates came to be seen as a problem only after the rise of circumcision in a cool climate, nobody having worried about the issue when the British first entered India in the eighteenth century; nor does he explain why it was believed that removal of the foreskin would produce healthier males; and he discounts the supposed value of circumcision in curbing masturbation as an explanation for its rise. On this point he is seriously mistaken, and his own discussion makes little sense without the conviction that masturbation was in itself a major health hazard and one of the factors contributing to national decline. The main reason for the sudden enthusiasm for Jewish child-rearing practices was the impression that Jewish boys did not masturbate, a contention that would have surprised Alex Portnoy but one that was widely debated in the medical journals of the time and eagerly confirmed by Jewish physicians, who were understandably pleased that the gentile world was at last beginning to see virtue in a rite it had traditionally abhorred. More convincing on this point is Ornella Moscucci, who shows that circumcision was increasingly recommended as a cure for male masturbation from the 1850s onward. She points out that part of this process was the demonization of the foreskin as a source of nervous and physical disease and agrees with Hyam that circumcision was central to the late Victorian redefinition of manliness in terms of self-restraint and cleanliness: "Widely believed to dampen sexual desire, circumcision was seen positively as a means of both promoting chastity and physical health." Moscucci also discusses the contrasting case of female circumcision and clitoridectomy, and explains how, after a brief vogue in the early 1860s for treating masturbation, "hysteria," and epilepsy, the procedures fell rapidly into disfavor. Although the latter operation continued to be performed in the United States until the 1950s, it disappeared from the English surgical repertoire following the disgrace of its chief advocate, Isaac Baker Brown, in 1867. The debate over clitoridectomy was a vital stage in the acceptance of circumcision for naughty boys.

Frederick Hodges locates the origins of circumcision in Europe and Britain specifically in the masturbation phobia of the eighteenth century and in theories of reflex neurosis, which held that disturbances of nervous equilibrium could cause disease and which thus targeted sensitive parts of the body as the guilty parties. In this scenario, particularly according to the work of Claude-Franois Lallemand on spermatorrhea, erotic sensation was redefined as irritation, prepubertal orgasms misinterpreted as epilepsy, and erections viewed as pathological; as the dynamic and most sensitive part of the penis, the foreskin was particularly suspect. Hodges confirms Hyam's argument that Jewish practice offered inspiration to English doctors: they sought evidence for the effects of circumcision in the only available circumcised population, whose doctors assured them that their boys did not masturbate, or not as much as Christians. Support for preventive circumcision was strengthened by reports that Jewish men also presented with lower rates of syphilis and cancer of the penis, and it was assumed that the absence of the foreskin must account for the difference. These were powerful selling points in Abraham Wolbarst's influential call for universal male circumcision in 1914, but he was equally insistent on its value as a "prophylactic against masturbation." Hodges has also emphasized the importance of erroneous theories about penile development in infancy and childhood ("congenital phimosis"),emerging during the 1840s,in legitimizing the demand for early circumcision.

In his essays on "the world's most controversial surgery," David Gollaher also stresses the importance of reflex neurosis theory, particularly as developed by the orthopedic surgeon Lewis Sayre, in explaining the rise of circumcision in the United States. Sayre claimed that many childhood illnesses were caused by a long or constricted prepuce ("phimosis") and could be cured by circumcision and that the same result in girls could be achieved by separation (sometimes removal) of the clitoral hood. He performed the operation on many boys suffering from various forms of paralysis, all of whom were apparently restored to health, and the future of the treatment was assured. Gollaher recognizes the importance of their determination to prevent masturbation in doctors' efforts to introduce widespread circumcision, but he is imprecise as to the chronology and does not seem to appreciate that it was their prior conviction that masturbation was harmful that inspired them to seek the etiology of common diseases in the condition of boys' genitals. He places the masturbation issue after the work of Sayre (1870s) and the hygiene fad that followed the discovery of germs (1890s onward), but medical concern with masturbation dates back to the eighteenth century: to Onania (ca. 1716),and Tissot's Onanism (1758), from which much of the nineteenth century's invective against the practice can be sourced. The proposition that circumcision could be used to discourage masturbation was first suggested by Lallemand, and later physicians recommended chastity devices, cauterization of the urethra, blistering of the penis, and even castration. Gollaher recognizes the puritanism and indeed the sadism of many doctors from this period, but he does not relate masturbation to the wider problem of spermatorrhea, an imaginary disease that designated almost any loss of semen other than in intercourse with one's wife as pathological, and of which masturbation or a long foreskin was held to be an important cause.

Gollaher is particularly revealing on the cultural pressures to which doctors were subject. He shows that they were not detached scientific observers but professionals who delivered a service in return for a fee. They complained that their quack rivals, in the days before the profession secured a legislative monopoly over health provision, stirred up people's fears about genital disorders in order to sell them patent medicines, but Gollaher notes that the doctors did much the same thing: projecting lurid scenarios of the disasters that would befall a child in later life unless they were paid to remove his foreskin in infancy. What emerges clearly from Gollaher's book is how much opposition there has always been to the procedure from those whom it is meant to benefit. Despite their enthusiasm for the health benefits of circumcision, doctors were unable to convince more than a few adult men to undergo the procedure, and they thus focused their attention on the younger generation. What emerges from this analysis is that the operation was less about health than power: priests over laymen, parents over children, doctors over parents. "Circumcision became a token of the medicalization of childbirth [and] a symbol of the rising authority of the medical profession over the laity," he writes. Gollaher also shows that doctors knew little about the anatomy and physiology of the penis, were heavily influenced by their religious values, and had an opportunistic attitude to scientific evidence. They embraced circumcision as a miracle-working cure-all with much the same thoughtless enthusiasm with which they would greet Thalidomide in the 1960s,and sometimes with comparably tragic results: until surgical techniques were refined and aseptic conditions achieved, the incidence of complications (bleeding, gangrene, transmission of disease, loss of the glans, ulcers, and scarring) was high, and as late as the 1940s some sixteen boys a year in Britain died as a direct result of the operation. One might think that the surprisingly blas attitude toward this wastage was the result of the fact that, before effective antibiotics, all operations had a high casualty rate, but to this day remarkably little attention is paid to the risks of such a "safe" operation, even in South Africa, where ritual circumcision claims hundreds of teenage lives each year.

(Continues...)

Excerpted from A Surgical Temptationby ROBERT DARBY Copyright © 2005 by The University of Chicago. Excerpted by permission.
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