C I R C U M C I S I ON This page intentionally left blank C I R C U M C I S I ON ** A H I S T O RY OF THE W O R L D 'S M O ST C O N T R O V E R S I AL S U R G E RY •*"*- D A V ID L. G O L L A H ER H BOOKS A MEMBER OF THE PERSEUS BOOKS GROUP Copyright © 2000 by David L, Gollaher Published by Basic Books, A Member of the Perseus Books Group All rights reserved. Printed in the United States of America. No part of this book may be reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information, address Basic Books, 10 E. 53rd Street, New York, NY 10022-5299. Library of Congress Cataloging-in-Publication Data Gollaher, David, 1949- Circumcision: a history of the world's most contro versial surgery / David L. Gollaher. p. cm. Includes index. ISBN 0-465-02653-2 1. Circumcision—History. I.Title. GT2470.G65 2000 392.21— dc21 Bcok design by Victoria Kuskowski 10 9 8 7 6 5 4 3 FOR MY PARENTS This page intentionally left blank C O N T E N TS ** Acknowledgments ix Preface xi Chapter 1 The Jewish Tradition 1 Chapter 2 Chri stians an d Muslims 31 Chapter 3 Symbolic Wo unds 53 Chapter 4 From Ritual to Science 73 Chapter 5 The Fabric of the Foreskin 109 Chapter 6 Circumcision and Disease: The Quest for Evidence 125 Chapter 7 Backlash 161 ChapterS Female Circumcision 187 Appendix: Evaluative Research and the Nature of Medical Evidence 209 Notes 213 Index 241 This page intentionally left blank A C K N O W L E D G M E N TS HF* Circumcision, persisting for thousands of years, flowing from tribal rituals through the world's great religions into modern medicine, presents the histo rian with an unusual array of challenges. In trying to manage them, I've in curred a variety of fortunate debts. First, I had a chance to develop and present in a preliminary way the idea that medical circumcision in the United States was a product of profound so cial and cultural forces. I published "From Ritual to Science: The Medical Transformation of Circumcision in America" in the Journal of Social History, and I benefited greatly from editor Peter N. Stearns's comments and questions. Subsequently, over the course of the next few years, I engaged in extended, wide-ranging discussions with historians Ronald L. Numbers, Donald Flem ing, William R. Hutchison, Howard Kushner, Andrew Scull, and with John Seely Brown, the polymath director of Xerox Palo Alto Research Center. As I became more intrigued with the continuing controversy surrounding neonatal circumcision, and began to wade through the immense body of med ical research on the subject, I enjoyed help from a distinguished group of physicians and surgeons. These include my former colleagues at Scripps Clinic, Roger Cornell, Ruben Gittes, Peter Walther, and the late Tony Moore. George W. Kaplan, a pediatric urologist who served on the American Academy of Pediatrics Task Force on Circumcision, was generous with his time and sug gestions, helping balance my account. Activists opposing what they consider genital mutilation are integral to the story told here. Among them, Marilyn Milos and Tim Hammond were espe cially helpful in explaining their cause and providing source materials. Of the many libraries and archives I visited in search of evidence, I recall with special gratitude the staffs at Harvard Medical School's Countway Li brary, the National Library of Medicine, the Biomedical Library at the Uni versity of California, San Diego, and the Centro Internazionale per la Storia delle Universita e della Scienza at the Universita di Bologna.