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Circumcision Revisited: An Historical Perspective

Until 1870, circumcision was a cultural practice limited primarily to Jews and Muslims. It became widespread in the United States at the turn of the 20th Century, and neither the practice nor the justifications have really evolved since then.

The Case

Circumcision became a medical procedure in 1870, instead of just a religious/cultural practice. That year, Dr. Lewis Sayre, a prominent orthopedist in New York City and the Vice President of the American Medical Association, made the practice commonplace in American society. 

A 5-year-old boy was referred to Dr. Sayre for severe contracture of the legs, which, in his words, left the patient, “unable to walk without assistance or stand erect.”

The doctor considered cutting the boy’s hamstring tendons, thinking that they were too short, and applying an electric current to the apparently paralyzed muscles. Fortunately, in passing, a nurse said to the doctor “Don’t touch his pee-pee, it’s very sore.”

Dr. Sayre examined the child’s penis and noticed that the opening of his foreskin was small and narrow. Dr. Sayre then performed a circumcision.

He continued in his report that as a result of the circumcision, the boy was “able to extend his limbs…and in less than a fortnight was able to walk alone.”

The Miracle Cure

Because of his experience with the 5-year-old boy, Dr. Sayre believed that circumcision could treat paralysis and cure weakness of the legs. He performed two more circumcisions with similar results.

Dr. Sayre became convinced that the benefits of circumcision extended to the treatment of neuromuscular disease and he argued in favor of this intervention for every male child. He spoke at many medical meetings from the New York Medical Society to the International Medical Congress.

In 1876, Dr. Sayre presented a paper titled, “On the Deleterious Results of a Narrow Prepuce and Preputial Adhesions.” He reported that many doctors sent him letters reporting similar results of the use of circumcision to cure neuromuscular disorders.

Dr. Sayre called his theory “reflex genital irritation.”  He wrote “peripheral irritation of the foreskin would ultimately…produce the loss of controlling power” even though he confessed an uncertainty as to the mechanism.  

He continued to extol the virtues of the procedure and did not limit the “power” to the musculoskeletal system. Dr. Sayre included behavior and intelligence. He believed that circumcision could transform a child who “was like a lunatic” to one capable of docility and civilization.

By postulating the concept of reflex genital irritation, the foreskin became viewed as a danger to the entire organism and doctors concluded that it would be healthier, safer and more civilized if the foreskin was removed, especially for young boys who had yet to be taught self-control.

For the next 25 years, doctors began performing circumcisions with increasing frequency, even though the theories of reflex neurosis were no longer credible. Doctors began to look for other medical evidence that supported circumcisions. 

A 19th Century Procedure in the 21st Century

To date no conclusive evidence-based data is available supporting the medical benefits of circumcision with regard to hygiene, cancer prevention, or HIV prevention.

Also, there are underreported complications of circumcision including:

Insurance companies often cover circumcision, which creates an inherent bias in the minds of surgeons when they report their results and conclusions. 

Additionally, circumcisions are performed on neonates with flaccid penises by obstetricians, who do not specialize in male anatomy. At the time of the procedure, doctors do not know what the eventual size of the penis will be. Doctors do not follow up and examine the penis in an erect state to determine whether or not too much skin was removed at the time of circumcision. 

It is perhaps the only surgical procedure performed without adequate follow up by the doctor who performs it.

Frequently, in the practice of medicine we continue to be tempted by appealing medical theories as well as easy interventions. In that respect, circumcision has not evolved from the 19th Century.

Elizabeth O'Connell

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