The masturbation taboo and the rise of routine male circumcision: a review of the historiography

- Review Essay

Although it is becoming rare as a routine procedure on newborn males, circumcision in both a medical and cultural/religious context has been the focus of increasing attention from medical historians. With the publication of David Gollaher's path-breaking investigations into its history, international efforts to ban the circumcision of women (female genital mutilation) as performed by some traditional Islamic and east African cultures, continuing protests against the survival of routine circumcision of male infants in the United States and parts of Canada, and a contrasting campaign on the part of some medical conservatives in Britain, the USA and Australia to restore the practice as a public health measure, scholarly interest in the origins and evolution of the world's most controversial surgery has never been more intense. Not that many definitive answers have emerged. Contrary to the mantra which opens nearly every article on the subject in medical journals (that circumcision is the oldest surgical operat ion known to man, practised by many ancient cultures etc), circumcision as a medically rationalised procedure is a recent invention, dating from the eighteenth century. Even as a religious ritual, circumcision was practised by only a few tribal societies, mostly living in desert regions: the Semtitic and Hamitic peoples of north and east Africa and the Middle East, and the Aboriginal people of central Australia are the most notable.¹ Therapeutic circumcision was first introduced as a treatment for severe venereal infection of the penis (often causing scabs which fused the foreskin to the glans) and was no more than a last-ditch amputation of incurably diseased tissue; even then it was not performed often because most men were reluctant to lose part of their most prized possession.² The concept of circumcision as a preventive, and then routine, procedure emerged in the mid-nineteenth century, though the reasons for this development remain contested. In a recent historical survey, Dunsmuir and Gordon cite prevention or cure of impotence, phimosis, sterility, priapism, masturbation, venereal disease, epilepsy, bed-wetting, night terrors, precocious sexual unrest and homosexuality as among the contradictory benefits urged by Victorian and Edwardian physicians in Britain and the USA, without offering any firm suggestions of their own as to the relative weight of these factors.³ Circumcision as a routine (that is, involuntary) operation on male infants was practised only in the English-speaking world; in its place of origin, Britain, it lasted only from the 1870s to the 1940s and probably affected no more than a third of boys at its peak--points which emphasise the importance of cultural and religious factors in explaining its rise and fall.⁴ Other authorities, however, stress the medical origins and continuing value of the procedure as a health precaution. According to Brian Morris, the Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today, while the idea that mass circumcision was introduced in the nineteenth century to discourage boys from masturbating is in fact a falsehood that has been promoted by anti-circumcision groups.⁵ As a contemporary champion of the routine circumcision of male infants, Professor Morris is very critical of the unscientific approach of anti-circumcision activists, but it is strange to see him endorsing the Victorian enthusiasm for circumcision as consistent with today's arguments in its favour, yet denying that control of masturbation had anything to do with the matter.

It is this issue that I wish to address here. By means of a review of the historiography of both the masturbation phobia and the rise of routine circumcision I hope to shed light on how significant the aim of preventing masturbation was in this process. To anticipate my conclusions, I shall argue that it has been widely accepted by medical historians since the 1950s that discouraging masturbation was a major reason why doctors, educationists and childcare experts sought to introduce widespread circumcision of both boys and girls in the nineteenth century, a campaign which was successful in the former case, unsuccessful in the latter--an outcome which still colours popular concepts about what constitutes genital mutilation. I suggest that a result of the partial character of this victory has been a high degree of blindness on the issue: while the treatment of hysteria and masturbation in women by clitoridectomy was noticed early on (and condemned with indignation), the comparable operation on boys (amputation of the foreskin) has been either ignored or given only fleeting attention, and has rarely been regarded with the same degree of abhorrence. I will also attempt to show the theological basis for much of the medical argument against masturbation and suggest that moral concern has always been an important element of the motivation for circumcision.

In searching for the link between the Western prohibition of childhood masturbation and the rise of routine circumcision, the psychoanalysts seem to have been the first on the trail. In a study of children with psychological and behavioural problems in the 1930s, Mabel Huschka reported that a high proportion of the boys had been threatened with mutilating operations on their penis if they masturbated. In her introduction to the data she makes reference to a small sample of medical literature which recommended circumcision for girls who persisted in the habit, and a rather more popular German book which recorded that some doctors armed with great knives and scissors threaten boys with a painful operation or even to cut off the genital organs. The same authority added that small operations were sometimes helpful: one physician cured a young fellow in whom ... no punishment had proved effective, by simply cutting off the anterior part of the foreskin with jagged scissors. He also mentioned infibulation a nd chastity cages to block access to the penis.⁶ Huschka seems unaware that infant male circumcision had become quite common in the USA by the 1930s (between 50 and 60 per cent of newborns--about the same as today),⁷ but the high incidence of mutilation threats received by boys, mostly picturing the doctor coming to cut their penis in some unspecified but painful way, would be possible only in a medical culture in which the surgical removal of (part of) the penis was frequently recommended and widely performed. There are no reports of such horror stories before the nineteenth century, and the cautionary tale for children with which these threats share the most affinity, The story of little suck-a-thumb, in Heinrich Hoffmann's Struwwelpeter, was not published until 1847, near the height of the masturbation scare in Germany.⁸ Discussing the prevalence of flogging in nineteenth century England, Ian Gibson comments that threats of castration for many varieties of bad behaviour, including playing with the genitals, were probably not uncommon and adds: Circumcision, too, must have also seemed a castration threat to many children and been looked upon as a terrible punishment for having a penis.⁹ It would seem that the boys' fears were no more than an expression of medical/moral realities.

After the war, in a much-cited article, Rene Spitz surveyed the medical literature on masturbation and related the increasing condemnation the practice to traditional Christian prohibitions against non-procreative sex and the publication of two alarmist texts in the eighteenth century: the anonymous Onania, or the heinous sin of self pollution (c. 1716), and Simon-Andre Tissot's Onanism, or a treatise on the disorders produced by masturbation (1758), from which nearly all the nineteenth century's invective against solitary vice can be sourced.¹⁰ Spitz quantified the greater prominence of punitive methods in the treatment of masturbation, in both girls and boys, in anglophone countries, and observed that sadism became the foremost characteristic of the campaign in the second half of the nineteenth century, including such drastic measures as surgery, restraint, severe punishment and fright; the surgery included blistering of the genitals, clitoridectomy in girls and circumcision in boys.¹¹ Spitz notes that circumcision was consistently urged as a disincentive to masturbation in successive editions of L. Emmett Holt's influential textbook on paediatrics, The care and feeding of children, from 1895 until 1936, and points out that it was not generally known that these sadistic practices found support among many authoritative physicians and ... were recommended up to a decade ago in official textbooks. They were not the obsession of a lunatic fringe.¹²

A decade later, in an article cited even more often than that by Spitz, R.M. Hare traced the history of the masturbation phobia in more detail, especially the idea that it caused neuroses and insanity, a proposition which survived longer in Britain and the USA than in Europe.¹³ In this connection Hare drew attention to the importance of Claude-Francois Lallemand (1790-1853), Professor of Medicine at Montpellier, whose 3-volume work Involuntary seminal losses (1836-42) seemed to confirm the reality of a disease later called spermatorrhoea. To cure this condition, which was often caused by masturbation, Lallemand recommended cauterisation of the urethra with silver nitrate, and circumcision in cases where the problem was the result of an excessively long or sensitive foreskin, and he exerted an enduring influence on British doctors, particularly William Acton. On the question of treatment, Hare observed that, by the second half of the nineteenth century, surgical and pharmacological methods of preventing ma sturbation were certainly widespread, mentioning depressant drugs and chastity devices for both sexes; infibulation of the foreskin, castration and severing the dorsal nerve of the penis in males; and clitoridectomy and ovariotomy in females. But he concluded that these interventions were either ineffective or too extreme to win wide acceptance. Like Spitz, he was horrified by the brief vogue for clitoridectomy which flared in Britain in the 1860s, but relegated to a footnote his awareness that the eminent surgeon and expert on syphilis, (Sir) Jonathan Hutchinson, in his well known paper On circumcision as a preventive of masturbation, nor only advocated universal circumcision of male infants, but considered that measures more radical than circumcision would, if public opinion permitted their adoption, be a true kindness to many patients of both sexes.¹⁴ Hare's reticence on the growing acceptance of the compromise procedure on boys, which promised to curb undue lust while leaving the reproductive function intact, is puzzling.

The sceptical mood and anti-puritanism of the 1960s found expression in Alex Comfort's light-hearted but reliable survey of medical manias, The anxiety makers (1967). curious preoccupations of the profession he listed the crusade for continence, an obsession with constipation, hostility to drinking tea, moralistic theories of venereal disease and the campaign against self-abuse. Following Spitz and Hare, Comfort observed that punitive treatments for the vice introduced in the second half of the nineteenth century included chastity belts and genital infibulation for both sexes, and spiked collars to wrap around the penis of boys afflicted by nocturnal emissions, as recommended by J.L. Milton in his much-reprinted book on spermatorrhoea.¹⁵ Comfort was more interested in and shocked by clitoridectomy than the circumcision of boys, but he points out that the latter was regularly recommended as a prophylactic against masturbation, notably by Jonathan Hutchinson. Comfort also drew attention to P.C. Remondino's tub-thumping advocacy of mass circumcision in his History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (1891), according to which the procedure would not only discourage boys from masturbating, but immunise them against tuberculosis, cancer, syphilis, polio, idiocy, forgetfulness and just about any medical problem you cared to mention. Comfort makes the now obvious but then novel point that belief in the health benefits of circumcision is really the belief that the portion of the penis cut off is by nature pathogenic, an assumption which lay behind the medical profession's endorsement of routine circumcision in the nineteenth century, and which received forceful expression in Remondino's manifesto, where the foreskin is vilified, at tedious length, as a malign influence and moral outlaw.¹⁶

Even more sceptical than Comfort was Thomas Szasz, who compared the cruel treatment of masturbators in the nineteenth century with the persecution of witches at an earlier period and related the obsession with masturbation as a illness-generating vice to the decline in the belief that diseases were the result of divine punishment for sin or the operations of witchcraft; in an age trying to be scientific, but when the cause of diseases was not understood, blaming them on personal habits was both morally satisfying and consistent with the nerve force theories then being developed by Albrecht von Haller (1708-77) and William Cullen (1710-90) as alternatives to traditional explanations based on humoral balance which stretched back to Hippocrates and Galen.¹⁷ Szasz also pointed out that much of the medical analysis of masturbation was no more than moral exhortation dressed in medical rhetoric. He accepted as an uncontroversial fact that mutilating surgical operations on the penis were standard sanctions against masturbation, citing both Hutchinson's paper, including his suggestion of castration in chronic cases, and E.J. Spratling's equally extreme tactic of cutting the dorsal nerve of the penis. Szasz identified a paradox in surgical treatment of the habit becoming more frequent as belief in the theory of masturbatory insanity declined, and explains this by suggesting that the phenomenon was related to the development of surgical skills and aseptic operating techniques which allowed safe surgical mutilations1 not to new medical indications.¹⁸ Szasz also recorded the persistence of the advice to circumcise as a precaution against masturbation in textbooks such as Emmett Holt's and found the same recommendation in Griffith and Mitchell's Diseases of infants and children (1938). They present a paradox he was unable to explain: although they admit that masturbation does little damage, even when indulged in to an extreme degree, they devote a page to treatments and conclude by endorsing circumcision for both boys and girls as a wise precaution.¹⁹

H. Tristram Engelhardt further developed Spitz's and MacDonald's²⁰ point that masturbation was originally sin rather than sickness by exploring the process by which a religious transgression was transformed into a medical disease without losing any of its immoral connotations, and drawing attention to the punitive character of the therapies evolved. He applied the ironic term heroic methods to cover such treatments as infibulation of the foreskin, vasectomy, cauterisation of the urethra, insertion of electrodes into the bladder and rectum, puncturing the prostate with needles, castration and circumcision.²¹ Engelhardt does not go into as much detail on the last of these as his sources warrant, and tends to leave the impression that it was a rare intervention instead of the routine procedure it soon became, but at least he identified it as a mainstream response to the problem. Arthur Gilbert provided further evidence on such remedies and also the nature of the diseases that masturbation was supposed to provoke. He suggested that the centrality of masturbation in accounts of organic disease was related to doctors' rising prestige and their tendency to take over the role of the priest; the cycle of sin, confession, penance and redemption was transferred from confessional to consulting room. At the same time, there was very little that physicians could actually do about most diseases, and blaming them on masturbation was often found more satisfactory than admitting their own impotence.²² Despite this, the authority of the medical profession increased steadily during the nineteenth century, and in 1889 an article in the Lancer compared them to the old type of priests who combined moral and medical functions.²³

The moral mission of the medical profession was also the focus of a densely researched but little known paper by Ronald Hamowy, who shows how US doctors in the late nineteenth century successfully extended their ambit from the cure of disease to the enforcement of puritanical standards of sexual morality, and exerted a powerful influence on public law. He argues that psychological medicine, in particular, substituted the treatment of disease for the punishment of moral transgression and became both the arbiter and enforcer of virtuous conduct. By the end of the century, he suggests, it had succeeded in convincing the literate public as to the connection between sexual conduct and mental disease and been able to persuade US legislatures to pass laws which embodied the conclusions of the medical profession and criminalize[d] sexual immorality under the guise of legislating in the area of preventive medicine.²⁴ Hamowy documents the remedies proposed for masturbation, and goes into greater detail than many w riters on the use of clitoridectomy in girls, and infibulation, chastity devices and castration in boys. Among other examples, he describes a case in 1894 when eleven boys confined in a Kansas mental institute were castrated for persistent masturbation; when the local press raised an outcry at such severity, the Kansas Medical Journal defended the institute's action on the ground that the boys were confirmed masturbators.... This abuse weakened the already imbecile mind and destroyed the body. The practice is loathsome, disgusting, humiliating and destructive of all self-respect and decency, and had a bad moral effect on the whole school.

It was backed up by doctors from all over the country.²⁵ The puzzling omission from Hamowy's account is any discussion of circumcision. Many of the dozens of medical articles he cites (for example, those by C. Frank Lydston, E.J. Spratling and George Beard) are explicit and detailed about the preventive and curative value of such a therapy, and indeed regard it as the primary weapon, but Hamowy's only mention of it is in the form of an allusion by Lydston, who in 1893 called for the castration of sex perverts, especially Negro rapists, if the operation be supplemented by penile mutilation according to the Oriental method.²⁶ Hamowy does not explicate this roundabout reference to circumcision, nor suggest why Lydston felt it was a necessary adjunct to castration in the control of Negroes. His discussion is thus not as complete as it could and, given his sources, should have been, but his detailed and fully documented discussion of castration alone should have made it impossible for later historians of nineteenth century sexuality to make bland statements such as this by Thomas Laqueur: There was no male castration, no removal of healthy testes, except in a few rare and quite specific instances for criminal insanity or to treat cancer of the prostate.²⁷ Cancer of the prostate was one disease from which those Kansas boys had been guaranteed permanent protection.

R.P. Neuman added fresh dimensions to the discussion by relating the concern with masturbation to demographic factors. He argued that with the Industrial Revolution the average age of puberty declined while the normal age of marriage rose, creating an interval between childhood and adulthood which had not existed before. This led to a new concern with child-rearing and a far closer supervision of sexually mature children, who now spent a longer interval between puberty and marriage than used to be the case; the question (rarely spoken) was whether adolescents (as they later became known) were entitled to sexual activity during this time, and the puritanical tendencies of the period ensured that the answer was no. Associated with these developments was a denial that young children had any sexual feelings at all, with the result that manifestations like fondling and masturbation were categorised as pathological and attributed to local irritation (such as a tight foreskin, worms or secretions), to bad influe nces (particularly at school) or to servants' tickling a child's genitals as a tranquilliser. As Neuman puts it

In order to preserve the respectable sexual fantasy that sex was for adults, not children, and for the purpose of procreation rather than pleasure, doctors had to explain masturbation in the very young as the product of certain organic problems or as the result of bad habits taught by others. So it was suggested that infants scratched their genitals because of local irritations caused by uncleanness or worms.²⁸

William Acton's opinion that childhood ought to be a period of absolute sexual quiescence²⁹ was an important influence here. If any manifestation of sexual capacity before puberty was pathological rather than normal, it had to be eliminated, and corrective surgery, including circumcision, was one of the usual means. None of this meant that masturbation after puberty was any less reprobated: Neuman reports the particularly chilling case of a 23-year old American man who was diagnosed as suffering from masturbatory insanity in the 1880s, sent to a mental hospital, confined for two months in a straitjacket and finally subjected to an operation on his prepuce calculated to interfere with or stop his vice, as Dr Spitzka (his gaoler/physician) put it. After this treatment he did not masturbate again for four months but, strangely, became no less paranoid.³⁰ Neuman's argument also explains why the early sex educators, although regarded as dangerously advanced for their time, were actually seeking to curb adolescent sexual activity by telling them the truth about how harmful it was.

In a particularly interesting article which showed that there were two sides to the familiar Victorian double standard on sexual morality, Gail Pat Parsons took issue with feminist historians who argued that while women in the nineteenth century were the victims of humiliating and invasive surgical procedures at the hands of (male) doctors) who left them raw and bleeding, men were treated differently and with more respect. No, she points out, men as well as women suffered excruciating treatment at the hands of physicians, whose limited knowledge reduced them to punitive, at times brutal, methods, including chastity devices, circumcision and castration.³¹ She shows that belief in spermatorrhoea as a real disease was widely held by the medical profession and not just the obsession of a few cranks; she points out that cures were often modelled on treatments originally devised for uterine disorders, including the insertion of needles into the perineum and testicles, and the urethral cauterisation recommend ed by Lallemand, favoured by Acton and widely employed in both Britain and the USA.³² Parsons includes a telling discussion of the confused theories of disease on which the designation of masturbation as pathological and circumcision as curative were based. Some doctors favoured the new nerve force theories associated with Haller and Cullen, while others stuck to the traditional view, popularised by Tissot but going back to Hippocrates, Galen and Avicenna, that it was the loss of a precious animating secretion like semen which debilitated the system. Acton himself could never decide whether it was the shock of orgasm to the nervous system or the loss of vital fluid which did themost damage.³³

Whatever the mechanism, as Barry Smith points out in his history of public health in nineteenth century Britain, doctors after 1870 generally advocated universal circumcision of boys, preferably done soon after birth. He does not go into details as to why, but cites Hutchinson for the main reasons then given: the foreskin was a harbour of filth, a source of irritation, an incitement to masturbation and an obstacle to continence; circumcision not only corrected these problems, but reduced the risk of syphilis in the young and cancer in the aged. The endorsement of the procedure by one of England's most eminent physicians, and President of the Royal College of Surgeons, carried weight.³⁴ In assessing the significance of masturbation in this list it is not a matter of asking whether routine circumcision was introduced as a deterrent to secret vice or as a health measure; the main health benefit of the procedure was the lessened tendency to masturbation, then regarded as a serious disease. Most doctors also believed in the virtue of continence (Acton was particularly eloquent on this topic), but few aimed explicitly to reduce sexual pleasure; that was a minor side-effect of a necessary precaution against seminal loss and nervous excitement. The new pressures of the modern age were also problems. In the United States Michael Kimmel identified a crisis in masculine identity brought about by rapid industrialisation, leading to the replacement of old models of manhood (the genteel patriarch and the heroic artisan) with the marketplace man. In this model, self-control and conservation of the body's energies were vital, and masturbation was inevitably seen as a waste of resources and a threat to success. In a context of both medical and moral warnings against the practice, Kimmel reports the invention of various devices contrived to prevent it, and refers particularly to J.H. Kelloggs' best-selling prescriptions for clean and healthy living in the 1880s. These included a list of 39 signs by which masturbators co uld be detected, and a set of remedies, including bandaging and caging the genitals; tying the hands to prevent touching; sewing up the foreskin with silver wire to prevent erection and create sufficient discomfort to make sexual impulse unwelcome; and finally circumcision--to be performed without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment.³⁵

During the 1970s several historians of childhood and the family realised that modernisation of attitudes to children was an uneven process: they might have been freed from their swaddling cloths in the eighteenth century, but other constraints were soon imposed. Lloyd De Mause, who was unusual in recognising that circumcision of boys as carried out by Jews, Egyptians, Arabs and others was a mutilation of children by adults, noted that parents began punishing their children for masturbation in the late eighteenth century and that doctors began to spread the myth that it would cause insanity, epilepsy, blindness and death, a campaign which reached a climax in the late nineteenth century. In response circumcision, clitoridectomy and infibularion were sometimes used as punishment; and all sorts of restraint devices ... were prescribed. Circumcision became especially widespread; as one American child psychologist our it, when a child of two rubs his nose and can't sit still for a moment, only circumcision works. Another doctor, whose book was the bible of many an American nineteenth century home, recommended that little boys be closely watched for signs of masturbation, and brought in to him for circumcision.³⁶

De Mause was more willing than many of his colleagues to face ugly facts, but a trifle optimistic in believing that such methods died out in the 1920s. Nonetheless, such perceptions had some influence on mainstream historians, such as J.H. Plumb, who felt obliged to modify his otherwise genial account of childhood in the eighteenth century with the acknowledgment that the masturbation phobia meant a partial return to brutality: by 1800 crimes of unbelievable cruelty were being practised on young boys in order to cure them, such as circumcision without anaesthetic.³⁷ Lawrence Stone likewise wrote:

Inspired by fears of physical debilitation and even of insanity, some surgeons in the third quarter of the nineteenth century were performing clitoridectomy on masturbating girls and deliberately painful circumcision on boys, while agitated parents were attaching toothed rings to the penis and locking adolescents into chastity belts and even strait-jackets for the night.³⁸

In his study of English purity movements, Edward Bristow noted that during the nineteenth century doctors joined the quacks in designing douches to cool the genitals and devices to restrain them, like the spiked penis ring, but that they then went a step further to clitoridectomies and circumcision as treatment for masturbation.³⁹ The same limited evidence was still being recirculated (mainly drawn from Spitz and Hare), but the sentiment of outrage was new.

Plumb got the start rather than the end date wrong, but the relevant point is that the basic information had emerged from the specialist journals and been published in mainstream publications with a general readership. Even though there had been no dedicated study of the issue and scholars had barely scratched the surface of the medical literature, by the early 1980s it was well established that widespread circumcision of young boys was introduced in English-speaking countries in the late nineteenth century, and that the main reason for the procedure was the desire to discourage masturbation in both childhood and adolescence. Given the horror of circumcision which had prevailed only a century before,⁴⁰ this represents a revolution in medical attitudes and body-related practices which demands explanation, so it is both surprising and disappointing that a major study of the Victorians' love lives, Peter Gay's much-praised Education of the senses (1984), does not even mention the phenomenon. Gay does include a brief discussion of masturbation but does not go beyond the standard secondary sources: he follows Spitz in describing some of the remedies as draconian and sadistic, likewise noting that after the 1850s the innocuous cures⁴¹ favoured by earlier physicians gave way to a formidable armamentarium of mechanical restraints resembling ... mediaeval torture instruments and surgical procedures like cauterisation of the sexual organs, infibularion, castration and clitoridectomy.⁴² But Gay exhibits his own double standard in waxing indignant at the case (cited from Spitz) of a girl treated for masturbation by the last of these therapies, while remaining silent about the fact that the amputation of the foreskin became a standard procedure on boys.⁴³ It was one of the most distinctive and enduring of all the Victorian contributions to sexual health and bodily management, at least within the anglophone world, and you might think he would wish to analyse it in detail. Gay exaggerates the extent to which warnings against the dire results of masturbation disappeared after 1910, and also implies that the end of the panic was partly to the credit of Freud and psychoanalysis. Although their influence may have been significant, other factors, such as the acceptance of a valid theory of organic disease (germs) were probably more important, and it is misleading to suggest that the campaign against masturbation was spent. One of Gay's own sources (Spitz) makes clear that the old alarm bells were still being rung in the 1930s, while Freud himself, as Gay acknowledges, had no doubts as to the pathological nature of the habit and cautioned his own son against it.⁴⁴ Even Lesley Hall, in her discussion of brutal remedies for [male] self-abuse recommended by the Victorian medical profession, does not mention circumcision, though she is aware that their aim was to guard the penis against improper manipulation and keep the organ sufficiently sore to render erection painful, as the Lancet put in 1870.⁴⁵ Yet many of the sources she cites (such as James Copland's Dictionary of practical medicine, 1844-58) are emphatic on the prophylactic or curative value of circumcision, and letters she quotes from anxious men to Marie Stopes in the 1920s reveal that many of them been told at some stage of their lives that masturbation was a well accepted indication for circumcision.As CW wrote from Belfast in 1923:

I shall be much obliged for your advice on a disease which has troubled me for the last 10 years, that of self-abuse. I started it when a boy at school, and it seems impossible for me to shake off the vice now.... Would you advise me to be circumcised?.... If you advise circumcision could I do it myself as I don't wish to approach a doctor on the subject as I am thoroughly ashamed of myself.⁴⁶

With silences like these, it is hardly surprising that it was not until the 1990s that scholars began to acknowledge that forcibly amputating part of boys' genitals was morally no different from doing the same to girls.⁴⁷ Morris's disapproval notwithstanding, it was the agitation of anti-circumcision campaigners in the late 1980s which finally brought the issue out into the open.

Anticipating this change of mood was Wallerstein's remarkably temperate study of the survival of routine infant circumcision in the USA (Britain having abandoned the practice in the early 1950s, New Zealand in the 1960s, and Australia and Canada relinquishing it more slowly from the 1970s). Wallerstein includes a discussion of circumcision as one of the milder solutions to the disease of masturbation and refers to the excitable Dr Remondino as one of those who popularised the concept of a link between the foreskin and proneness to the habit. He also points out that the religious prohibition on masturbation dates back beyond Christianity to ancient Judaic theologians, many of whom held it to be a reprehensible sin and even a capital crime.⁴⁸ The most astonishing of Wallerstein's revelations is that advocacy of circumcision as a disincentive to masturbation did not die with Emmett Holt. In 1941 Dr Alan Guttmacher, in a widely-read article in a popular magazine, recommended it because the simplified penis was easier to wash, but the aim was moral as well as physical hygiene: It does not necessitate handling of the penis by the infant's mother, or the child himself in later years, and therefore does not focus the male's attention on his own genitals. Masturbation is considered less likely. As late as 1956, in Pregnancy and birth, Guttmacher reiterated his conviction that the handling of the genitalia made necessary by the retention of the foreskin encourages masturbation.⁴⁹ Summarising his understanding of the origins of modern circumcision a fewyears later, Wallerstein wrote:

So-called health circumcision originated in the nineteenth century, when most diseases were of unknown etiology. Within the miasma of myth and ignorance, a theory emerged that masturbation caused many and varied ills. It seemed logical to some physicians to perform genital surgery on both sexes to stop masturbation; the major technique applied to males was circumcision.⁵⁰

It is remarkable how persistent that miasma has proved.

The first focused attempt to account for the rise of routine male circumcision in Britain was made by Ronald Hyam, in his study of sexuality and empire, 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 counter-measures, 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, especially in response to reports of a low rate of syphilis and masturbation among Jews. 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, in particular, that it was widely believed that normal males were more susceptible to venereal disease in hot env ironments, and that British Army doctors in India were vigorously in favour of the procedure and operated on their soldiers at the first sign of trouble.⁵¹ Hyam's account is 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 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 spread. On this point he is clearly 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 widely debated in the medical journals of the time but eagerly confirmed by Jewish doctors, who were understandably delighted that the gentile world was at last beginning to respect a ritual it hadtraditionally despised.

More convincing on this point is Ornella Moscucci, who shows that circumcision was increasingly recommended as a cure for male masturbation from the 1850s onwards. She points out that part of this process was the demonisation 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.⁵² Moscucci also discusses the contrasting case of female circumcision and clitoridectomy and explains how, after a brief vogue in the 1860s for treating masturbation and hysteria, the procedures fell rapidly into disfavour. Although the latter operation continued to be performed in the USA until the 1950s, it was effectively outlawed by the British medical profession and had disappeared from their surgical repertoire by the 1880s. Moscucci's article is particularly significant as one of the first to identify the double standard whereby female circumcision and clitoridectomy are denounced as mutilations which must be stopped, while male circumcision is accepted as a mild and harmless adjustment, even if irrelevant to health. When the London doctor, Isaac Baker Brown, was expelled from the Obstetrical Society in 1867 for treating masturbation in women by clitoridectomy, his opponents referred to the operation as a questionable, compromising, unpublishable mutilation which would affect the women's sex lives, leave them permanently maimed and cast an indelible slur on their honour. Brown defended himself by claiming that masturbation caused hysteria, epilepsy, mania and, eventually, insanity and death, and argued that clitoridectomy was no more mutilating than male circumcision, as proved by the subsequent pregnancy of one of his patients. His critics did not dissent from the proposition that masturbation could provoke the ills he mentioned, but they insisted that the practice was so rare in women that radical interventions of this kind were not necessary. The thing that outraged the society most, and the issue which probably sealed Brown's disgrace, was the fact that the operation was per formed without informed or any other kind of consent; but this was not a consideration which exercised their professional consciences in the case of little boys.⁵³ Drawing a modem parallel, Moscucci refers to an article by a US doctor on the horrors of female genital mutilation in Africa,⁵⁴ and the commentary of a colleague who reported that her own son was circumcised, against her wishes and audibly against his own, at the insistence of her husband, despite paediatric advice that the operation conferred no health benefits: in other words, it was a cultural ritual like the ordeal of the African girls. Referring to Gordon's indignation, she asked whether those who lived in glasshouses had the right to throwstones:

Where are the passionate voices of our Western, male medical anthropologists ... speaking out on the practice of male genital surgery in the United States? Why isn't male circumcision also one of the places, to cite Mel Konner, where we ought to draw the line?⁵⁵

It is only the rituals of other peoples that seem strange and barbarous.

A similar question was asked by Szasz, returning to the fray in 1996 with a typically provocative article on the ethics of male routine neonatal circumcision (RNC). Pointing out that the similarities between RNC and female genital mutilation are obvious to anybody who has not been culturally conditioned to accept the former as normal and the latter as bizarre, he asks: Why is RNC legal? Because it is defined as preventive medicine. Why is it defined as preventive medicine? To avoid having to ban it as male genital mutilation.⁵⁶ Turning to the origins of the practice, Szasz refers to the transformation of childbirth in the late nineteenth century, from home deliveries assisted by (female) midwives to hospital births managed by (male) physicians, setting the stage for the circumcision of the normal male infant by the obstetrician--a practice rationalised as prophylaxis ...against ... masturbation. He comments that

Virtually all medical texts at the end of the nineteenth century and the beginning of the twentieth century prescribed circumcision for a variety of ills, ranging from epilepsy and hydrocephalus to malnutrition and tuberculosis, and confidently asserted that it was a cure for the disease of masturbation.⁵⁷

Szasz commends US critics of RNC for recognising that the determination to stamp out masturbation played an important part in the establishment of the practice, but also points our that masturbation was only one of a long line of religious transgressions that were converted into medical diseases, and refers particularly to the severity with which it has been condemned in traditional Jewish theology, which regards it as a sin more serious thanall the sins of the Torah.⁵⁸

The most focused account of the rise of routine circumcision in the USA is provided by Frederick Hodges, who pays particular attention to the significance of masturbation in this process. Dr Hodges is associated with groups in the USA which oppose male and female genital mutilation, and he has been a prominent speaker at Nocirc conference since 1996--thus one of the mythmakers condemned by Professor Morris. But there is nothing in his exhaustive survey of the medical literature and his meticulous documentation of the medical profession's developing views and practices to suggest that he is inventing anything; if the conclusions of his research seem highly-coloured or gruesome, that is in the nature of the source material, which does yield dark truths which contemporary advocates of routine circumcision naturally find embarrassing. It is not, however, the cruelty or moralism of early enthusiasts which Hodges finds most disturbing, but their sloppy reasoning, poor science, lack of ethics, and the authoritarian zeal which many of them brought to their task. A telling quote isthis by Dr Spratling in 1895:

In all cases [of masturbation] ... circumcision is undoubtedly the physicians' closest friend and ally.... To obtain the best results one must cur away enough skin and mucous membrane to rather put it on a 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, not begrudging the time and extra energy required to produce the orgasm.⁵⁹

Spratling went on to suggest that a supplementary circumcision might be necessary as the remaining skin stretched.

Hodges traces the origins of routine circumcision to the masturbation phobia of the eighteenth century, but more specifically to theories of degenerative disease and 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, erotic sensation was redefined as irritation, orgasm as convulsion and erection as priapism; as the most sensitive part of the penis, the foreskin was particularly suspect. In the work of Lallemand and his many followers the normal male sexual function--the production and emission of sperm--was categorised as a life-threatening disease which demanded drastic treatment. If all this sounds too incredible, we must remember that it was a time when the causes of most diseases were not understood, treatments were ineffective, and mortality (especially in children) was high; belief in witchcraft or spirits as causes of illness had been discredited by the Enlightenment, and m asturbation at least offered a materialist explanation. At the same time, theologians and other public moralists were advocating increased sexual purity, a demand which grew more insistent in the nineteenth century and reached a crescendo in the syphilis scare of the early twentieth. Lallemand recommended circumcision for serious cases of spermatorrhoea, and this idea caught on in the USA, where castration (not unusual in cases of epilepsy and insanity) was obviously too extreme a measure to become popular. The theory of the reflex neurosis was developed by the distinguished orthopaedic surgeon, Lewis Sayre, who claimed that many cases of muscular paralysis were caused by a long, tight or otherwise constricted prepuce and could be cured by circumcision; the same result in girls could be achieved by clitoridectomy. In seeking evidence for the effects of circumcision, the medical profession naturally looked to the Jewish community, whose own doctors were only too happy to assure them that Jewish boys did not ma sturbate, or not as much as the uncircumcised. As Dr M.J.Moses advised:

As an Israelite, I desire to ventilate the subject.... I refer to masturbation as one of the effects of a long prepuce; not that this vice is entirely absent in those who have undergone circumcision, though I never saw an instance 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.⁶⁰

Support for preventive circumcision was strengthened by reports that Jews 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.⁶¹ Among the most disturbing of Hodges' findings is the insularity of the American medical profession, which clung to the old theory of congenital phimosis long after it had been debunked in Britain and Europe; and among the most astonishing is that masturbation was still being listed as an indication for circumcision as late as the 1970s. Although paediatricians had dropped this notion, the third edition of a standard urological textbook, Campbell's urology (1970) stated: Parents readily recognise the importance of local cleanliness and genital hygiene in their children and are usually ready to adopt measures which may avert masturbation. Circumcision is usually advised on these grounds.⁶²

The influence of politically inspired scholars like Hodges is apparent in the illuminating research of David Gollaher on the history of circumcision, and particularly in the difference between his path-breaking journal article of 1994 and his later book. In his article Gollaher focuses on the discoveries of Lewis Sayre and his subsequent theories on the link between problem foreskins and various paralytic illnesses, codified in his book On the deleterious results of a narrow prepuce and preputial adhesions (1888). He shows that other doctors were quick to take up Sayre's findings and push them further. Soon adherent prepuces were being discovered all over the country and their removal alleviating the symptoms of numerous childhood complaints; one doctor reported a case of brass poisoning completely cured. Dr Norman Chapman suggested that the incidence of adhesive foreskins was probably higher than people realised; since a long and contracted foreskin was so often a source of secondary complications, he went on to propose that it was always good surgery to correct this deformity ... as a precautionary measure, even though no symptoms have as yet presented themselves. Chapman suggested in 1882 that Christians had much to learn from Jews in this respect:

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 cures for loss of manhood.

As Gollaher observes, this declaration represents an important transition in thought: circumcision becomes not just a treatment for existing problems, but an anticipation designed to prevent possible complications in the future. Thus the preventive career of the operation waslaunched.⁶³

Gollaher discusses masturbation as a separate causative factor, noting Remondino's convictions that the foreskin was always to blame for childhood masturbation and that the children of circumcised races were neither as prone to the habit nor as susceptible to wet dreams. He also reports that childcare handbooks were recommending circumcision to prevent the vile habit of masturbation from the mid-1890s.⁶⁴ Gollaher does not integrate masturbation with the theory of reflex neuroses which lay behind Sayre's adoption of circumcision as a cure for many nervous ailments, but the irritabilities supposedly provoked by either a constricted foreskin or the act of masturbation were remarkably similar, and each had such equally harmful effects that it was difficult to distinguish the two aetiologies: in the case of one teenage patient, it was suspected that the real cause of his paralysis was in fact masturbation.⁶⁵ What is apparent throughout Gollaher's discussion is that a puritanical animus against sexual in dulgence was woven deeply into the texture of the doctors' clinical arguments and that it is impossible to separate their moral theology from their medical science. The same doctor who could not explain why circumcision cured brass poisoning nonetheless resolved that whether it be curative or not it is conservative, and removes one source of irritation from an exquisitely sensitive organ. I would favour circumcision, however, independent of existing disease, as a sanitary precaution....

1. The exposure of the glans to friction etc. hardens it, and renders it less liable to abrasion in sexual intercourse, and consequently venereal ulcer.
2. It is acknowledged to be useful as a preventive of masturbation.
3. It certainly renders the accident of phymosis and paraphymosis impossible.
4. It prevents the retention of sebaceous secretion and consequent balanitis.
5. It probably promotes continence by diminishing thepruriency of the sexual appetite.⁶⁶

Two of the five points are not medical considerations at all, but mere moral assumptions.

In his more wide-ranging book on the history of circumcision Gollaher follows the same line of argument, but his discussion of masturbation is considerably expanded, and it plays a more central role in his explanation for the rise of routine circumcision. He cites Hutchinson, Kellogg and paediatricians such as Angel Money as fervent advocates of the intervention, and notes the importance of the Jewish example in encouraging doctors to believe that circumcised boys did not masturbate. He follows Szasz in recognising the severity of the ancient Jewish prohibition against the practice, notes the Lancet's discoveries in the 1860s that masturbation and bed-wetting were rare in Jewish communities, and describes M.J. Moses as a crusader against the foreskin as the primary cause of masturbation. He also appreciates that doctors around the turn of the century were perfectly aware that circumcision reduced sexual pleasure and that they approved of it for precisely this reason.⁶⁷ The inescapable conclusion of his t horoughly documented studies is that deterrence of masturbation was a major motivation for the introduction of widespread male circumcision in the late Victorianperiod.

Whatever the balance between the various factors leading to this triumph, it is obvious that such an immense shift in medical thinking needed the conjunction of many causes. It is equally clear that routine circumcision arose from a mire of ignorance and now discredited theories of disease, including outright quackery (the pathologisation of male sexuality as spermatorrhoea); medical delusions (theories of reflex neuroses and masturbatory illness); puritanical zeal (the determination to suppress sexual activity in childhood and adolescence); loss of knowledge about the normal anatomy and physiology of the penis, with the result that the adhesion and non-retractability of the foreskin in young boys was classified as a congenital defect instead of being recognised as its natural condition;⁶⁸ and wild hopes that a miracle cure had been found for such rapacious diseases as tuberculosis, syphilis, polio and cancer. Whether the desire to prevent masturbation was 30, 60 or 90 per cent responsible for the institut ion of routine circumcision, there is no basis for the claim that the connection is a lie put about byanti-circumcision activists.

In summary, it can be seen that doctors in English-speaking countries introduced widespread circumcision of male infants in the late nineteenth century. At the time this innovation was justified largely in terms of discouraging masturbation, then regarded as a serious disease in its own right and as the cause of many more, but this rationale was increasingly overlaid by others in the early twentieth century, including protection against syphilis and cancer, freedom from phimosis (seen as a problem mainly because it was thought to provoke masturbation), and a general contribution to both moral and physical hygiene. To justify circumcision on the ground that it discouraged masturbation was to acknowledge that the operation reduced the sensitivity of the penis and curtailed sexual pleasure, a powerful argument to use at a time when most respectable people believed that excessive sexual indulgence was morally wrong as well as physically harmful; mainstream paediatric and child care manuals continued to assert the value of circumcision as a disincentive to masturbation right up until the 1950s. With the advance of the sexual revolution in the 1960s (by which time routine circumcision survived only in the USA, Canada and Australia) this ceased to be a strong selling point; if a doctor there wanted to persuade parents to let him amputate part of their baby's penis he now had to reassure them that the procedure would significantly increase health without noticeably reducing sexual functionality or pleasure, and the original logic of its introduction was lost in a welter of social, aesthetic and medical rationalisations. At the scholarly level, the significance of the original link between masturbation and circumcision was rediscovered in the 1950s, when belief in the harmful effects of the former was declining, and as medical historians began to investigate the origin, course and effects of the onanismscare during the eighteenth and nineteenth centuries.

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This original of this article may be found on line at:  http://www.findarticles.com/p/articles/mi_m2005/is_3_36/ai_99699493.

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