Surgical Temptation: A chance to cut, a chance to cure? 

To Victorians, masturbation was a crime that merited forced surgery. The history of the masturbation scare offers plenty of information, often written in a tone of justified indignation, about mutilating operations on women. Such texts, though, are usually silent about similar surgery on men’s genitals, which were introduced first and were far more common.

The circumcision vogue had roots reaching deep into the history of medicine, disease, religion, and sexual morals, and it emerged as the attitude toward the male body changed. Between the mid-18th and the late 19th century the foreskin was transformed from an adornment that brought pleasure to its owner and his partners (“the best of your property,” according to an 18th century rhyme), to “a useless bit of flesh” (in the words of circumcision crusader Dr. Peter Remondino) and an enemy of society. Much of the responsibility for this development lies with the efforts of Victorian physicians as “norm entrepreneurs,” as the legal scholar Geoffrey Miller calls them, who set out to convince parents that their little boys would be better off without the feature their fathers had enjoyed. The result was that “during the last decades of the nineteenth century … a remarkable shift occurred in the English-speaking world. Physicians acting as norm entrepreneurs reconceived the phallus.” They succeeded in portraying the uncircumcised penis as “polluted, unnatural, harmful, alien, effeminized and disfigured,” while spinning the circumcised penis, formerly regarded as ugly and chaotic, as “true, orderly and good.”

Was circumcision a scientific medical advance, another dubious Victorian health fad, or an attempt to control sexuality?

My book, A Surgical Temptation, attempts to explain the vogue for male circumcision in Victorian Britain. I became interested in this subject as part of a wider interest in the history of male sexuality and contrasting ways in which it has been viewed and managed by societies. The study of circumcision seemed a useful guide to how a society perceived and valued masculinity and how it judged or categorised sexual behavior. It also provided sharp focus on the point where culture and biology, society and nature, steel and flesh, came together.

As I read more deeply into the literature on this topic I realized the serious imbalance in sex and gender studies—all too often seen as the history of women, and all too often focused on the mind rather than the body. I decided that one of my aims would be to redress this bias by bringing men into the picture and correcting the tendency to neglect the physical body. Many studies of masculinity, and even of the penis—particularly those written by Americans—neglect the fact that most penises throughout history have included foreskin. Ignoring the fact that the biologically, and on a world scale numerically, a normal penis was not circumcised seemed an example of cultural blindness, and one that ought to be countered.

The fall of foreskin

The demonization of the foreskin as a source of moral and physical decay was the critical factor in the acceptance of circumcision as a valid medical intervention. Necessary conditions were the rise of medical objections to masturbation; anxiety about childhood sexuality; the conceptualisation of “congenital phimosis” and spermatorrhoea as pathological conditions; confused and erroneous theories of "filth," infection, and germs; dread of venereal disease, especially syphilis; an atmosphere of sexual Puritanism in which nonprocreative sex was regarded as immoral and sexual pleasure feared; and the emergence of a new professional elite keen to assert its social authority by proving that it was dangerous as well. In their construction of sex as risky business for men, doctors characterised the normal male sexual function—the production and emission of sperm—as a life threatening illness that demanded drastic treatment.

These developments were a surprising departure from traditional attitudes toward the male genitals and male sexuality. Western culture had traditionally abhorred circumcision as a humiliating disfigurement peculiar to Jews and Turks, but during the 19th century, attitudes to the male foreskin soured to the point where Victorian sexologist William Acton described it as no more than “a superfluous piece of skin … which serves no other purpose than acting as a reservoir for the collection of dirt.”

It is hard to think of any body part whose standing fell so far and so rapidly, nor one which came to be regarded with such suspicion and treated with such savage hostility. Even today, in countries with a history of routine circumcision, doctors seem to regard the foreskin as guilty until proven innocent. As pathologists Chris Cold and John Taylor point out, the prepuce has been a feature of the external genitals of all primate species for 65 million years, and the species in which it has developed most luxuriantly is precisely the one that has been most successful in the struggle for existence. The demonization of the foreskin was a paradoxical process by which its anatomical and physiological significance was belittled at the same time as its role in the generation of illness was inflated.

The fundamental reason for the establishment of preventive circumcision of boys (and, to a lesser extent, of girls) was the rise of medical anxiety about masturbation. One of the major "discoveries" of 18th century medicine was that this practice was the real cause of many organic and mental diseases. Both the loss of semen and the shock of orgasm to the brain and nervous system were believed to debilitate the body. This illusion transformed the normal fondling of the penis observed in nearly all young boys, and of the clitoris by young girls, from acceptable juvenile behavior into a wicked and harmful vice that had to be stamped out. This, in turn, gave rise to the medical error whereby the normal phimotic condition of the immature penis was characterised as a pathological abnormality requiring urgent surgical correction.

Nobody had worried about phimosis (constriction of the foreskin) in childhood until masturbation became an issue, but once that was seen as a danger, phimosis also became a problem because the “secretions” the foreskin was supposed to trap were thought to cause irritation, thus leading boys to scratch and handle their penis. It was asserted that scrupulous cleanliness would help to deaden the penis and thus guard against premature sexual arousal. But the secretions could not be washed away and the glans regularly scrubbed so long as it was covered by a long or tight foreskin. The main reason advanced for circumcision in Britain from 1840s onwards was to cure “congenital phimosis” (that is, to surgically correct the natural condition of the penis) and thereby discourage masturbation.

The notion that the foreskin trapped “secretions” was itself the product of another error of 18th century anatomists, who claimed that there were glands under the foreskin (Tyson’s glands or Glandulae odoriferae), which poured out masses of smegma. It was realized as early as 1904 that there were no glands under the foreskin or on the glans, but the horror of smegma remained an article of faith for many years yet. When Cold and Taylor analyzed the content of subpreputial moisture they found that it consisted simply of water; shed skin cells; secretions from the prostate, seminal vesicle, and urethral glands; various sterols and fatty acids that normally protect skin surfaces; and a variety of benign bacteria. Few men, and even fewer boys, generate any visible smegma. Other researchers have found that the moisture contains lysozymes which actually fight microorganisms and may thus guard against disease.

Once the foreskin had been demonized there was no end to the problems it was alleged to generate. Later claims that it caused or was a major risk factor for diseases including tuberculosis, cancers, syphilis, epilepsy, paralysis, whooping cough, convulsions, and hernia, and that circumcision could prevent these conditions, were all based on the original misconceptions that masturbation was harmful and juvenile phimosis pathological. Various theories were advanced as to causation: first that the foreskin pressed on the glans and caused imbalances of nerve force, leading to the reflex neurosis theory particularly associated with Lewis Sayre; then that the “secretions” putrefied and generated disease poisons (the zymotic or fermentation theory of disease); and finally, as germ theory took hold, that the foreskin trapped and provided a breeding ground for harmful bacteria. All these ideas turned out to be wrong, but by that time circumcision had become well established in the surgical repertoire. Even those who did not support circumcision believed that the infant foreskin had to be separated from the glans and forced to retract within a few weeks of birth, usually by means of laborious and agonizing dilations. It was not until the 1930s that this dogma was questioned, and not until research by Douglas Gairdner in the 1940s that the error was dispelled.

Victorian doctors also made a less successful effort to demonize the clitoris and introduce widespread female circumcision. Although the justifications for clitoridectomy were similar to those offered for circumcision (cleanliness, deterrence of masturbation, control of nervous diseases), the practice remained rare. Doctors generally held that women’s lower sex drive meant they were less given to self-abuse than males, and thus, that drastic surgery was rarely necessary. There are occasional reports of masturbating girls being subjected to involuntary clitoridectomy, but it was only in the late 1850s that a few doctors started to apply to women the theories of nervous disease that already legitimized circumcision in boys. The most famous of these was the prominent London obstetrician, Isaac Baker Brown, who specialized in the surgical treatment of disorders such as epilepsy, catalepsy, and hysteria induced by “irritation of the pudic nerve” (that is, masturbation). Although he attracted considerable interest at first, his procedures fell rapidly into disfavor, and he was expelled from the Obstetrical Society in 1867. While his critics condemned clitoridectomy as a “questionable, compromising, unpublishable mutilation” which would ruin the women’s sex lives, leave them permanently maimed, and cast an indelible slur on their honor, Brown defended himself by claiming that masturbation caused hysteria, epilepsy, mania, insanity, and death, and he argued that clitoridectomy was no more mutilating than male circumcision, as proved by the subsequent pregnancy of several 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.

Brown’s disgrace put a stop to clitoridectomy in Britain, and there are no reliable reports of its performance after the 1860s. Looking back on the controversy, his principal antagonist, Charles West, commented that “all right-minded men” were compelled to reject both the operation and its leading proponent, but that “happily we need not now dwell further on the subject, for all practitioners are agreed that the only indication for removal of the clitoris is furnished by the disease of the organ itself.” Since the debate had been fought largely on the question as to whether the clitoris was the equivalent of the foreskin, and thus whether clitoridectomy was the female version of circumcision, the effect of the negative decision on these points was to clear the way for circumcision of boys at the same time as it protected the genitals of women. The outcome has been a tenacious double standard on genital mutilation that still dominates discussion of these issues.

The age at which circumcision was done in Britain varied widely. It was probably most common in early childhood, particularly just before a boy started school, as a precaution against picking up bad habits from his new mates. Many boys were not circumcised automatically, but rather received the operation after adults discovered that their foreskin did not retract easily or had caught them masturbating. The style and technique of circumcision was never standardized, complications were common, and deaths regularly reported. Doctors disagreed about the right technique, how much tissue should be excised, and the best ways to avoid bleeding and infection. Many purpose-built devices were patented, the tendency of which was to make the operation more radical. In fact, English and American circumcision techniques turned out to be significantly more severe than most ritual or tribal varieties, involving the loss of considerably more penile tissue and often damage to the glans, particularly if the operation was performed before the foreskin’s natural separation had taken place. The results were often both unaesthetic and sexually disabling.

My approach to this study has been that of traditional empiricism, with scepticism toward modern theorizing and a rejection of relativism. It is not good enough for scholars to accept the erroneous beliefs of Victorian medicine, with postmodern resignation, as just another way of understanding the world. Victims of this medical fad—the infant forced to endure agonising retractions of his foreskin and the scrubbing of his sensitive glans in the name of hygiene; the toddlers who wailed with a contemporary Australian, “I wish I had my old willy back”; the boys who were flogged for masturbating; and the men whose penises were disfigured and whose sex lives were blighted in ways which had rarely been recorded and never studied—deserve rescue from oblivion and indifference.

References for quotes
C.J. Cold and J.R. Taylor, “The prepuce”, BJU International, Vol. 83, Supplement 1 (January), 1999
Geoffrey Miller, “Circumcision: Cultural-legal analysis”, Virginia Journal of Social Policy and the Law, Vol. 9, 2002

Robert Darby holds a Ph.D. from the University of New South Wales and is currently an independent cultural and medical historian. In 2004 he was a Visiting Fellow in the School of Social Sciences, Australian National University. He lives in Canberra on a bushy block of land, with magpies, parrots, a colony of bowerbirds, and a possum. A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain is published by University of Chicago Press. Robert’s website is http://www.historyofcircumcision.net.