History of circumcision

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Circumcision and/or subincision, often as part of an intricate coming of age ritual, was a common practice among the Aboriginal peoples of Australia and Pacific islanders at first contact with Western travellers. It is still practiced in the traditional way by a proportion of the population.^[13][14]

In

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The origin of circumcision is not known with certainty. It has been variously proposed that it began

• as a religious sacrifice;
• as a rite of passage marking a boy's entrance into adulthood;
• as a form of sympathetic magic to ensure virility or fertility;
• as a means of reducing sexual pleasure;
• as an aid to hygiene where regular bathing was impractical;
• as a means of marking those of higher social status;
• as a means of humiliating enemies and slaves by symbolic castration;
• as a means of differentiating a circumcising group from their non-circumcising neighbors;
• as a means of discouraging
  proscribed sexual behaviors
  ;
• as a means of increasing a man's attractiveness to women;
• as a demonstration of one's ability to endure pain;
• as a male counterpart to menstruation or the breaking of the hymen;
• to copy the rare natural occurrence of a missing foreskin of an important leader;^[16][17]
• as a way to repel demonesses;^[18] and/or
• as a display of disgust of the smegma produced by the foreskin.

Removing the foreskin can prevent or treat a medical condition known as phimosis. It has been suggested that the custom of circumcision gave advantages to tribes that practiced it and thus led to its spread.^[19][20][21]

Darby describes these theories as "conflicting", and states that "the only point of agreement among proponents of the various theories is that promoting good health had nothing to do with it."^[20][22] Freud believed that circumcision allows senior men to constrain the incestuous desires of their juniors, and mediates the tension inherent in the father-son relationship and generational succession. Youth are symbolically castrated, or feminized, but also blessed with masculine fruitfulness.^[23]

Prior to the

North Africa

At

The Nomoli figurines, which were created by the Mende people in Sierra Leone and depict male circumcised genitalia,^[28] have been dated between the 7th century CE and the 8th century CE.^[29]

Central and East Africa

Prior to 300 CE, male circumcision, which is a

Herodotus (5th century BCE) indicated that ancient Ethiopians practiced circumcision.^[31]

Southern Africa

In the 19th century CE, Shaka, a Zulu king, prohibited male circumcision due to concerns that young circumcised men might be less interested in joining as warriors in the military force he was amassing and uniting in the region of southern Africa and might be more interested in seeking opportunities for having sex.^[24]

Egypt

According to studies, the Egyptian rite of circumcision, which was performed at the age of puberty, did not involve the amputation of an annular piece of the foreskin as in the Jewish rite. Instead, it would have involved excising a triangular section, or alternately just creating a longitudinal incision, in the dorsal face of the foreskin.[32]^[33] This is supported by artworks and statues showing foreskins, some of which present an incision on the glans, not an annular circumcision.^[33] However, there is also evidence of individuals circumcised the traditional way.^[33] The rite might have mutated into this variation by the time Herodotus visited Egypt.^[34]

Circumcisions were performed by priests in a public ceremony using a stone blade. It is thought to have been more popular among the upper echelons of the society, although it was not universal and those lower down the social order are known to have had the procedure done.^[35]: 3 On the other hand, medical historian Frederick Hodges argues there is evidence against the purported prevalence of circumcision in Egypt, proposing it was limited to priests, functionaries and some workers.^[34]

Based on engraved evidence found on walls and evidence from mummies, circumcision has been dated to at least as early as 6000 BCE in ancient Egypt.^[36] Ancient Egyptian mummies, which have been dated as early as 4000 BCE, show evidence of having undergone circumcision.^[37][38]

At the mastaba of Ankhmahor in Saqqara, an engraved wall provides an account of Uha, dated to the 23rd century BCE, which indicates that he and others underwent male circumcision.^[37][26]

The

Egyptian hieroglyph for "penis" (𓂸

) depicts either a circumcised or an erect organ.^{[citation needed}

Herodotus, writing in the 5th century BCE, wrote disparagingly that the Egyptians "practise circumcision for the sake of cleanliness, considering it better to be cleanly than comely."^[39] David Gollaher^[40] considered circumcision in ancient Egypt to be a mark of passage from childhood to adulthood. He mentions that the alteration of the body and ritual of circumcision were supposed to give access to ancient mysteries reserved solely for the initiated. (See also Clement of Alexandria, Stromateis 1.15) The content of those mysteries are unclear but are likely to be myths, prayers, and incantations central to Egyptian religion. The Egyptian Book of the Dead, for example, tells of the sun god Ra cutting himself, the blood creating two minor guardian deities. The Egyptologist Emmanuel vicomte de Rougé interpreted this as an act of circumcision.^[41]

Archaeological or further literary records do not support that circumcision was truly widespread among Semites.[44] In the case of the Phoenicians, it has been proposed that Herodotus and successors like Aristophanes might have mistaken Jews for them, as Biblical sources describe Phoenicians and other peoples like the Philistines as uncircumcised.^[45] Roman authors do not mention circumcision in Carthage or other Phoenician settlements in Africa,^[44] even although it would have added to the colourful Punic stereotype entertained in Roman literature.^[46] Other authors believe Phoenicians abandoned the practice at some point,^[47] although it might have not fully died out, as proved by Philo's record.^[43]

Josephus seems to suggest that the Edomites were uncircumcised until being forcefully converted to Judaism by John Hyrcanus. It has been also interpreted, however, that up to that point they actually practiced a different kind of circumcision that was superseded by the Jewish form.^[32]

Judaic culture

According to

According to Hodges, ancient Greek aesthetics of the human form considered circumcision a mutilation of a previously perfectly shaped organ. Greek artwork of the period portrayed penises as covered by the foreskin (sometimes in exquisite detail), except in the portrayal of

In Egypt, only the priestly caste retained circumcision, and by the 2nd century, the only circumcising groups in the

First Maccabees tells us that the

Seleucids

forbade the practice of brit milah, and punished those who performed it – as well as the infants who underwent it – with death.

The 1st-century Jewish author

division in Pharisaic Judaism between Hillel the Elder and Shammai on the issue of circumcision of proselytes

.

King Izates who having been persuaded by a Jewish merchant named Ananias to embrace the Jewish religion, decided to get circumcised so as to follow Jewish law. Despite being reticent for fear of reprisals from his non-Jewish subjects he was eventually persuaded to do it by a Galileean Jew named Eleazar on the grounds that it was one thing to read the Law and another thing to practice it. Despite his mother Helen and Ananias's fear of the consequences, Josephus said that God looked after Izates and his reign was peaceful and blessed.^[61]

Medieval Judaism

The Jewish philosopher Maimonides (1135–1204) insisted that faith should be the only reason for circumcision. He recognised that it was "a very hard thing" to have done to oneself but that it was done to "quell all the impulses of matter" and "perfect what is defective morally." Sages at the time had recognised that the foreskin heightened sexual pleasure. Maimonides reasoned that the bleeding and loss of protective covering rendered the penis weakened and in so doing had the effect of reducing a man's lustful thoughts and making sex less pleasurable. He also warned that it is "hard for a woman with whom an uncircumcised man has had sexual intercourse to separate from him."^{[35]: 21 [62][63][64]}

A 13th-century French disciple of Maimonides, Isaac ben Yediah, claimed that circumcision was an effective way of reducing a woman's sexual desire. With a non-circumcised man, he said, she always orgasms first and so his sexual appetite is never fulfilled, but with a circumcised man she receives no pleasure and hardly ever orgasms "because of the great heat and fire burning in her."^{[65][35]: 22}

Decline in Christianity

Cathedral of Chartres

) early Christians soon dispensed with the ritual.

See also: Circumcision controversy in early Christianity

The

Iudaea Province also had some Jews who no longer circumcised and some Greeks (called Proselytes or Judaizers) who did, (along with a few Nabataean Arabs Judaized by Hasmoneans, Ethiopians, and the rare Egyptian priest). According to the Gospel of Thomas saying 53, Jesus

says:

"His disciples said to him, "is circumcision useful or not?" He said to them, "If it were useful, their father would produce children already circumcised from their mother. Rather, the true circumcision in spirit has become profitable in every respect."" SV[68]

Parallels to Thomas 53 are found in Paul's

Colossians

2:11–12.

In John's Gospel 7:23 Jesus is reported as giving this response to those who criticized him for healing on the Sabbath:

Now if a man can be circumcised on the sabbath so that the Law of Moses is not broken, why are you angry with me for making a man whole and complete on a sabbath? ( Jerusalem Bible)

This passage has been seen as a comment on the Rabbinic belief that circumcision heals the penis (Jerusalem Bible, note to John 7:23) or as a criticism of circumcision.^[67]

Europeans, with the exception of the Jews, did not practice circumcision. A rare exception occurred in

Eritrean Orthodox Churches, and also some other African churches.^[3]

As part of an attempted reconciliation of

Coptic and Catholic practices, the Catholic Church condemned the observance of circumcision as a moral sin and ordered against its practice in the Council of Basel-Florence in 1442.^[70] According to UNAIDS, the papal bull of Union with The Copts issued during that council stated that circumcision was merely unnecessary for Christians;^[71] El-Hout and Khauli, however, regard it as condemnation of the procedure.^[72] The Catholic Church currently maintains a neutral position on the practice of non-religious circumcision, as the church has a policy of inculturation.^[73]

In the 18th century, Edward Gibbon referred to circumcision as a "singular mutilation" practised only by Jews and Turks and as "a painful and often dangerous rite" ... (R. Darby)^[74]

In 1753 in London there was a

proposal for Jewish emancipation. It was furiously opposed by the pamphleteers

of the time, who spread the fear that Jewish emancipation meant universal circumcision. Men were urged to protect:

"the best of Your property" and guard their threatened foreskins(!). It was an extraordinary outpouring of popular beliefs about sex, fears about masculinity and misconceptions about Jews, but also a striking indication of how central to their sexual identity men considered their foreskins at that time. (R.Darby)[74]

These negative attitudes remained well into the 19th century. English explorer

Christian denominations are neutral about ritual male circumcision, not requiring it for religious observance, but neither forbidding it for cultural or other reasons.^[73] Today male circumcision is commonly practiced in many predominantly Christian countries and among many Christian communities.^{[75][76][77][11]} The United States and the Philippines are the largest majority Christian countries in the world to extensively practice circumcision.^[11] Christian communities in some Anglosphere countries, Oceania, South Korea, the Philippines, the Middle East and Africa have high circumcision rates,^[78] while Christian communities in the United Kingdom, Europe and South America

have low circumcision rates.

Revival in the English-speaking world

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Although negative attitudes prevailed for much of the 19th century, this began to change in the latter part of the century, especially in the English-speaking world. This shift can be seen in the account on circumcision in the Encyclopædia Britannica. The ninth edition, published in 1876, discusses the practice as a religious rite among Jews, Muslims, the ancient Egyptians and tribal peoples in various parts of the world. The author of the entry rejected sanitary explanations of the procedure in favour of a religious one: "like other body mutilations ... [it is] of the nature of a representative sacrifice".^[74]

However, by 1910 the entry [in the Encyclopædia Britannica] had 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 Muslims".^{[citation needed]}

Now it was primarily a medical procedure and only after that a religious ritual. The entry explained that "in recent years the medical profession has been responsible for its considerable extension among other than Jewish children ... for reasons of health" (11th edition, Vol. 6)^{[full citation needed]}.

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". Ironically, readers are then referred to the entries for "Mutilation" and "Deformation" for a discussion of circumcision in its religious context.^[74]

There were two related concerns that led to the widespread adoption of this surgical procedure at this time. The first was a growing belief within the medical community regarding the efficacy of circumcision in reducing the risk of contracting sexually transmitted diseases, such as syphilis. The second was the notion that circumcision would lessen the urge towards masturbation, or "self abuse" as it was often called.^{[citation needed]}

The tradition of circumcision is said to have been practiced within the

Prince electors were circumcised.^[79] This is highly dubious since there is no evidence that Victoria was a supporter of the British Israeli movement, and the links between the royal family and the ancient House of David were only first proposed by its followers in the 1870s, long after she bore her sons (there is also evidence lacking that her sons, particularly Edward, had circumcisions); there is also no indication that the prince electors (or George himself) were circumcised and that the king introduced it upon his arrival to Britain and his ascension to the throne in 1714.^[79] If members of the royal family were circumcised, the reason was due to their embrace of a custom popular amongst the upper-classes in the late 19th and 20th centuries.^[79]

Prince Harry, Duke of Sussex is reported to have been circumcised.^{[80][81][relevant? – discuss]}

Medical concerns

The first medical doctor to advocate for the adoption of circumcision was the eminent English physician, Jonathan Hutchinson.^[82] In 1855, he published a study in which he compared the rate of contraction of venereal disease amongst the gentile and Jewish population of London. Although his manipulation and usage of the data has since been shown to have been flawed (the protection that Jews appear to have are more likely due to cultural factors^[83]), his study appeared to demonstrate that circumcised men were significantly less vulnerable to such disease.^[84] (A 2006 systematic review concluded that the evidence "strongly indicates that circumcised men are at lower risk of chancroid and syphilis."^[85])

Hutchinson was a notable leader in the campaign for medical circumcision for the next fifty years, publishing A plea for circumcison in the

British Medical Journal (1890), where he contended that the foreskin "... constitutes a harbour for filth, and is a constant source of irritation. It conduces to masturbation, and adds to the difficulties of sexual continence. It increases the risk of syphilis in early life, and of cancer in the aged."^[86] As can be seen, he was also a convert to the idea that circumcision would prevent masturbation, a great Victorian concern. In an 1893 article, On circumcision as a preventive of masturbation he wrote: "I am inclined to believe that [circumcision] may often accomplish much, both in breaking the habit [of masturbation] as an immediate result, and in diminishing the temptation to it subsequently."^[87]

Nathaniel Heckford, a paediatrician at the East London Hospital for Children, wrote Circumcision as a Remedial Measure in Certain Cases of Epilepsy, Chorea, etc. (1865)^{[full citation needed]}, in which he argued that circumcision acted as an effective remedial measure in the prevention of certain cases of epilepsy and chorea.

These increasingly common medical beliefs were even applied to females. The controversial

obstetrical surgeon Isaac Baker Brown founded the London Surgical Home for Women in 1858, where he worked on advancing surgical procedures. In 1866, Baker Brown described the use of clitoridectomy, the removal of the clitoris, as a cure for several conditions, including epilepsy, catalepsy and mania, which he attributed to masturbation.^[88][89] In On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females, he gave a 70 per cent success rate using this treatment.^[89]

However, during 1866, Baker Brown began to receive negative feedback from within the medical profession from doctors who opposed the use of clitoridectomies and questioned the validity of Baker Brown's claims of success. An article appeared in

nymphomania

, and in young girls what was called "rebellion" or "unfeminine aggression".

Lewis Sayre, New York orthopedic surgeon, became a prominent advocate for circumcision in America. In 1870, he examined a five-year-old boy who was unable to straighten his legs, and whose condition had so far defied treatment. Upon noting that the boy's genitals were inflamed, Sayre hypothesized that chronic irritation of the boy's foreskin had paralyzed his knees via reflex neurosis. Sayre circumcised the boy, and within a few weeks, he recovered from his paralysis. After several additional incidents in which circumcision also appeared effective in treating paralyzed joints, Sayre began to promote circumcision as a powerful orthopedic remedy. Sayre's prominence within the medical profession allowed him to reach a wide audience.^{[citation needed]}

As more practitioners tried circumcision as a treatment for otherwise intractable medical conditions, sometimes achieving positive results, the list of ailments reputed to be treatable through circumcision grew. By the 1890s,

bedwetting, Bright's disease, erectile dysfunction, syphilis, insanity, and skin cancer had all been linked to the foreskin, and many^[who?] physicians advocated universal circumcision as a preventive health measure.^{[citation needed}

]

Specific medical arguments aside, several hypotheses have been raised^[by whom?] in explaining the public's acceptance of infant circumcision as preventive medicine. The success of the germ theory of disease had not only enabled physicians to combat many of the postoperative complications of surgery, but had made the wider public deeply suspicious of dirt and bodily secretions. Accordingly, the smegma that collects under the foreskin was viewed as unhealthy, and circumcision readily accepted as good penile hygiene.^[91] Secondly, moral sentiment of the day regarded masturbation as not only sinful, but also physically and mentally unhealthy, stimulating the foreskin to produce the host of maladies of which it was suspected. In this climate, circumcision could be employed as a means of discouraging masturbation.^[92] All About the Baby, a popular parenting book of the 1890s, recommended infant circumcision for precisely this purpose. (However, a survey of 1410 men in the United States in 1992, Laumann found that circumcised men were more likely to report masturbating at least once a month.) As hospitals proliferated in urban areas, childbirth, at least among the upper and middle classes, was increasingly under the care of physicians in hospitals rather than with midwives in the home. It has been suggested that once a critical mass of infants were being circumcised in the hospital, circumcision became a class marker of those wealthy enough to afford a hospital birth.^[93]

During the same time period, circumcision was becoming easier to perform. William Stewart Halsted's 1885 discovery of hypodermic cocaine as a local anaesthetic made it easier for doctors without expertise in the use of chloroform and other general anaesthetics to perform minor surgeries. Also, several mechanically aided circumcision techniques, forerunners of modern clamp-based circumcision methods, were first published in the medical literature of the 1890s, allowing surgeons to perform circumcisions more safely and successfully.^{[citation needed]}

Born in the United Kingdom during the late 19th century, John Maynard Keynes and his brother Geoffrey, were both circumcised in boyhood due to parents' concern about their masturbatory habits.^[94] Some mainstream pediatric manuals continued to recommend circumcision as a deterrent against masturbation until the 1950s.^[20]

Spread and decline

Infant circumcision was taken up in the United Kingdom, the United States, Australia, New Zealand, and the English-speaking parts of Canada and South Africa. Although it is difficult to determine historical circumcision rates, one estimate^[95] of infant circumcision rates in the United States holds that 30% of newborn American boys were being circumcised in 1900, 55% in 1925, 72% in 1950, 85% in 1975 and 60% in 2000.

In South Korea, circumcision was largely unknown before the establishment of the United States trusteeship in 1945 and the spread of American influence.^[96] More than 90% of South Korean high school boys are now circumcised at an average age of 12 years, which makes South Korea a unique case.^[97] However circumcision rates are now declining in South Korea.^[98]

Decline in circumcision in the English-speaking world began in the postwar period. The British paediatrician Douglas Gairdner published a famous study in 1949, The fate of the foreskin,^[99][100] described as "a model of perceptive and pungent writing."^[101] It revealed that for the years 1942–1947, about 16 children per year in England and Wales had died because of circumcision, a rate of about 1 per 6000 circumcisions.^[99] The article had an influential impact on medical practice and public opinion.^[102]

In 1949, a lack of consensus in the medical community as to whether circumcision carried with it any notable health benefit motivated the United Kingdom's newly formed

out-of-pocket cost to parents, and the proportion of circumcised men is around 9%.^[103]

Similar trends have operated in Canada, (where public medical insurance is universal, and where private insurance does not replicate services already paid from the public purse) individual provincial health insurance plans began delisting non-therapeutic circumcision in the 1980s. Manitoba was the final province to delist non-therapeutic circumcision, which occurred in 2005.[104] The practice has also declined to about nine per cent of newborn boys in Australia and is almost unknown in New Zealand.^[105]

See also

• Bioethics of neonatal circumcision
• Children's rights
• Circumcision controversies
• Ethics of circumcision
• Prevalence of circumcision

References

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   • "The Coptic Christians in Egypt and the Ethiopian Orthodox Christians— two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision. Circumcision is not prescribed in other forms of Christianity... Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual, while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice."
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5. ^
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Further reading

• Ephron JM (2001). "In Praise of German Ritual: Modern Medicine and the Defense of Ancient Traditions". Medicine and the German Jews. New Haven: Yale University Press. pp. 222–233.
  ISBN 0-300-08377-7
  .
• Dunsmuir WD, Gordon EM (January 1999). "The history of circumcision". BJU International. 83 (Suppl 1): 1–12.
  S2CID 32754534
  .
• Remondino PC (1891). History of Circumcision from the Earliest Times to the Present. Philadelphia and London: FA Davis.

External links

• Jewish Encyclopedia: Circumcision
• VIDEO – Male Circumcision: History, Ethics and Surgical Considerations Dr. Benjamin Mandel speaks at the University of Wisconsin School of Medicine and Public Health, December 2007.
• The History of Circumcision website