Medical circumcision in the US is performed almost exclusively on male infants. For ease of purpose, when circumcision is referred to in this essay it is only in reference to that demographic, unless explicitly stated otherwise. While I will talk about circumcision from a global perspective some, I want to focus primarily on my home region of Northern Appalachia and into the Mid-west and mid-Atlantic regions around me since it has some of the highest rates of medical circumcision in the world.
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First though, let’s explore what cultural/ritual circumcision and medical circumcision are in practice. A “milah” is a symbolic circumcision of the Jewish faith, where only the tip of the foreskin beyond the glans is removed. This is the type of circumcision referenced in the Old Testament of the Bible. It allows for continued natural development of the penis, and is relatively uninvasive compared to medical circumcision (Peron, 2000). However, male and female circumcision practices predate the Bible, and seem to have originated in Eastern Africa far earlier than the accounts of Abraham (DeMeo, 1989). Peri'ah was introduced by Jewish rabbis and mohels (Jewish circumcision practitioners) around 140 CE to further differentiate those of the Jewish faith from uncircumcised Greeks and Romans. This procedure is much more invasive than a milah, and strips much more of the foreskin away from the glans, making recovery much more difficult. This is the procedure performed today in US medical institutions (Peron, 2000). Why?
Well, it seems to rest heavily on the opinion of one Dr. Lewis A. Sayre (Gollaher, 1994). Of course, Dr. J Marion Sims plays a role in this story (as he seems to be an inescapable presence in all things related to American reproductive history), but in this at least he seems to have simply referred a patient to Dr. Sayre. Sayre hypothesized “irritation of the genitals was the source of many varieties of paralysis and hip-joint disease which stubbornly defied conventional treatments (1994).” "This slight operation," Sayre wrote, "answered all the purposes of circumcision, and at once quieted their nervous irritability… Many of the cases of irritable children, with restless sleep, and bad digestion, which are often attributed to worms, is solely due to the irritation of the nervous system caused by an adherent or constricted prepuce [foreskin]," he asserted. "Hernia and inflammation of the bladder can also be produced by the severe straining to pass water in some of these cases of contracted prepuce."
While Sayre was not the first to articulate such theories, he was the first to draw national and international attention to them. This had far more to do with who Sayre was than to the efficacy or utility of his claims. Sayre was a prominent New York City surgeon, and was appointed resident physician for the city when the Civil War broke out. “His professorship at Bellevue Medical College was the first chair in orthopedic surgery in the United States,” and his Lectures on Orthopedic Surgery and Disease of the Joints (1876) became a standard reference book for a generation of surgeons. He was the president of the American Medical Association (AMA) at one time and one of the original creators of that same organization’s journal, which is still in publication today (1994).
Sayre was an avid promoter of circumcision throughout his career, concluding it could not only cure orthopedic ailments, but had applications toward epilepsy, hernia, and even lunacy. The theory of “reflex neurosis” was popularized at this time, which in turn aided in the popularization of Sayre’s theories about circumcision.
Inspired by reflex theory, beginning in the early 1870s American gynecologists, led by James Marion Sims, invented scores of new genital surgeries intended to alleviate psychological symptoms. Cutting the body to cure the mind could lead to frightening practices. Robert Battey, a young Georgia surgeon, for instance, lent his name to the so-called "normal ovariotomy." With no apparent misgivings, he removed women's healthy ovaries to relieve symptoms ranging from hysteria and neurasthenia to backache. Accepted on both sides of the Atlantic, Battey's operation was especially popular in America where, according to one scholar, it "was not a marginal procedure conducted by a handful of crackpots, but central in the arsenal of late-nineteenth-century gynecology." Other doctors (including Sayre himself) revived the mutilating procedure of clitoridectomy, with the clitoris subjected to a variety of surgeries, manipulations, and chemical preparations. These practices were sustained in America long after they had fallen out of favor in Europe (1994).
Female sexual surgery gradually declined in the US though, while male sexual surgery became standard practice. Sayre’s contribution to this work lasted because he taught other medical professionals to look for genital irritation and phimosis when confronted by seemingly unrelated symptoms. Case-in-point, Norman A. Chapman (A Sayre disciple and professor of nervous and mental disease at UKC) wrote, since “"a long and contracted foreskin" was so often a source of "secondary complications... it is always good surgery to correct this deformity... as a precautionary measure, even though no symptoms have as yet presented themselves." In a nod to circumcision’s Jewish roots Chapman also wrote, "Moses was a good sanitarian, and if circumcision was more generally practised at the present day, I believe that we would hear far less of the pollutions and indiscretions of youth; and that our daily papers would not be so profusely flooded with all kinds of sure cures for loss of manhood." It should be noted however, that Moses and his sons were uncircumcised and the practice was apparently banned during the forty years in the wilderness (Exodus 4:25, Joshua 5:5).
Chapman’s words point to a shift in thought beyond Sayre’s initial assertions of circumcision as a remedy for an ailment to circumcision as a preventative and hygienic practice. This is where hypotheses about medical circumcision’s impacts on male masterbation, sensitivity and “sanitation” really took off (Gollaher, 1994).