Many persons object to the direct allusion to the sexual organs of children, and urge that they should be left ... to the chapter of accidents, lest the mind of the child should be prejudiced, by directing its attention ... to what it is supposed not to recognise. This view of the case is not defensible when the advantages of interference so frequently preponderate over any imaginary evil which is advanced. The time has passed away when maudlin sentiment is to stand in the way of the appliances and teachings of medical science -- Dr George Beaney, Melbourne, 1872

In Aged Ignorance profound, Holy and cold, I clip'd the Wings Of all Sublunary Things -- Wiliam Blake, "The Gates of Paradise"

Doctors

Apart from the hints of Beaney and the suggestion of Springthorpe, the first explicit public advocacy of circumcision in an Australian professional journal I have located is in 1901 from H.G.H. Naylor, whose article "A plea for early circumcision" in the Australasian Medical Gazette ran the gamut of the dangers ascribed to the foreskin and the benefits arising from its removal. The "evil results of neglected foreskins" include frequent urination, loss of flesh, convulsions, phosphatic calculus, hernia, nervous exhaustion, dyspepsia, diarrhoea, prolapse of the rectum, balanitis, phimosis and masturbation; all these problems could be rapidly cured "by the simple operation of circumcision", while "disastrous results" would arise from avoiding the procedure. Naylor is apparently conversant with some of the British and US literature: he attributes the tendency to "self-abuse among young boys" to the irritation produced by secretions under the foreskin, tempting the lad to handle his penis, but he does not appear to have read (or has not been swayed by) some of the more extreme proponents of genital discipline in the US. The major advantages of circumcision are that "at the age of adolescence there is much less disposition to masturbation" and that in adult life "there is much less danger of contracting gonorrhoea and syphilis". The latter proposition goes back to Acton, and the evidence for it at this time was the belief that Jews had a lower level of venereal disease than the uncircumcised, and Naylor duly points out that very few Jews present with such complaints. (88) Not all the advocates of circumcision who followed Naylor made such extravagant claims for its therapeutic value, but nearly all followed him in listing its major benefit as the prevention (or reduction) of masturbation, and many also mentioned its value as a protection against VD.

The following year A.S. Joske, having noted that more children were being brought in to the Alfred Hospital to be circumcised, emphasised the value of the operation for adults as well:

it removes certain impediments to intercourse, and is a great preventative of chances of syphilis [sic: probably a printer's error for "chancres and syphilis"], of intestinal gonorrhoea, and possibly epithelioma, and under certain conditions removing the prepuce early may tend to keep boys from masturbation. (89)

Joske did not specify what those conditions might have been, but one gets his drift. Similar points were made by the better-known Philip Muskett, a prolific writer on a wide range of medical, diet and lifestyle matters. He was the author of several books on child rearing and diet, none of which discusses circumcision, and of the Illustrated Australian Medical Guide, a two-volume household reference work which first appeared in 1903 and reached a second edition in 1909. This includes a very positive entry on circumcision in which Muskett adds climate to the reasons why the operation should be generally performed: "In this semi-tropical Australian climate of ours it would be infinitely better if circumcision were the rule, and not the exception". As with Naylor, the problem was that troublesome foreskin: it was liable to phimosis; it accumulated smegma, a substance which soon acquired "a very unpleasant, even markedly offensive odour"; it was likely to adhere to the glans; its opening was inclined to be too small to urinate through comfortably; it was likely to become irritated and inflamed; it could led to bed-wetting; it could provoke nervous disorders; it could constrict the proper growth of the penis; and it led to masturbation—"bad habits are frequently induced by boys meddling with themselves, in consequence of the irritation produced". There was clearly only one thing to be done, and that was to follow the example of the Jewish race and "many other Eastern nations". (90) Muskett was not an extremist like some of the US doctors. His main concern seems to have been physical cleanliness, and on the surface at least he seems to have been worried only by long or tight foreskins, not foreskins per se. But as I suggest below, these formulations were not as limiting as they might seem: "cleanliness" was often as much a matter of sexual abstinence as soap and water, and in the absence of any studies of its anatomy and functions who was to judge whether a foreskin was too long or tight? (91) Muskett writes that "no male with a proper sense of cleanliness can feel that his bath has been complete, in the presence of a long or tight foreskin", (92) but it is difficult to see why a long (but retractable) one could not be scrubbed as thoroughly as its owner could withstand. If you wanted your foreskin to pass Dr Muskett's test, it had better be pretty modest.

The need for self-restraint in sexual matters, the problem of the foreskin, the dangers of masturbation and the value of circumcision were brought together at a conference on the teaching of sex hygiene, organised by the Workers Educational Association of New South Wales in November 1916. The main focus of the conference was on how sex education could be used to teach children and adolescents the value of self-control in relation to sex, "preparing the minds of the young and stiffening their moral fibre against the pitfalls that await those ignorant of their physical functions". (93) Hygiene was not just a matter of physical cleanliness; as an editorial in the Australasian Medical Gazette had pointed out, it was "a matter more of moral than of intellectual consciousness" (94) and primarily a moral issue: "Just as physical dirt causes disease of the body, so moral dirt causes disease of the soul. A clean mind is as necessary for our moral welfare as a clean body is for our physical welfare", as Power put it in the Boy Scouts Handbook. (95) Above all it was a matter of sexual purity and continence:

While the intensity and all-pervading influence of the sex instinct was constantly dwelt upon, almost every speaker urged the necessity and possibility of fostering self-restraint from the tenderest years. Despite the irregularities of youthful conduct, and the strength of the temptations that beset the adolescent, no speaker would abate one jot of the influence of healthy physical and moral training in its preventive action. (96)

The main concern of the conference was venereal disease, the spread of which had been accelerated by the war, but masturbation came in for its own share of condemnation and tended to be seen as a precocious awakening of the sexual instinct that would lead a young man to prostitutes later on. It is of course relevant that the medical profession at this time was powerless against VD. In an age which lacked antibiotics but believed that alternative forms of sexual gratification like masturbation were both sinful and physically damaging, the only cure for venereal infections was indeed not to contract them, so it is not surprising that continence was a policy urged by both the moral and the medical establishments. The medical profession believed that it was the duty of parents to teach children "the objects of marriage and the necessity for abstaining from the gratification of sexual desires until marriage", as well as "the prolonged and serious ill-health which may result from self-abuse", but it was up to the experts to educate the public as to the dangers of VD. (97) At the WEA conference itself the importance of the issue was underlined by the presence of that veteran purity campaigner, Richard Arthur, whose paper "Teaching control of the sex instinct" rehearsed his familiar theme that there should be no sexual activity of any kind before marriage. The sociologist H. Tasman Lovell likewise spoke about "the necessity for greater self-restraint" and referred specifically to self-abuse as one of the evils that must be inhibited. (98)

In this context the prophylactic value of circumcision was quickly recognised. In his paper "Sex irregularities of childhood and youth", W.A.T. Lind, a pathologist with the Victorian Lunacy Department, noted that masturbation was the chief problem and that the main cause was usually a "peripheral source such as local irritants". To deal with these, strict rules of personal hygiene should be observed, and girls should be prevented from riding bicycles. Lind commented that it was difficult to identify individuals addicted to the habit, as there was "nothing to distinguish the casual masturbator from the ordinary youth", though the former was usually unhappy, in poor health and suffered from weakness of attention. As to treatment, Lind recommended a combination of moral suasion and surgical intervention:

Every youth suspected of the practice should be sent for medical inspection. He will at first stoutly deny the habit, as all masturbators are liars for the shame of the thing. Kindly advice from the physician ... that no permanent damage to his brain ... will result, provided he ceases to practice the habit, will go far to restoring the lad's confidence in himself. If there are any physical conditions present, such as an adherent foreskin, piles etc. ... they should receive surgical attention so that the reflex irritation from them may not stimulate the sexual organs. (99)

Prevention of masturbation was also the prime concern of Sir Thomas Anderson Stuart, Dean of the Faculty of Medicine at Sydney University. After a brief recital of the damage resulting from the practice and the signs by which an educator could recognise a boy with bad habits, Stuart turns to the culprit: "All this inevitably brings up the question of the foreskin", and he goes on to praise the Semitic peoples for their approach to the problem:

many ancient races met the same difficulty, and quite independently got over it by cutting the foreskin off in the operation of circumcision. This was made into a sacred rite ... by the Jews, Mohammedans, and many Semitic and other races. The only important Semitic peoples who did not follow the rite were the Philistines, the Babylonians and the Assyrians, and we can imagine some Jew asking, where are these people now? (100)

Stuart's tone is a touch facetious, but it is clear that he admires and is urging emulation of Jewish practice; his allusion to Ninevah and Tyre (capitals of fallen empires named in Kipling's well known poem, "Recessional") would not have been lost on his wartime audience, and it is a suggestive confirmation of the link that Hyam has drawn between circumcision and imperial destiny. (101) Turning from geopolitics to personal hygiene, Stuart attributes the origin of masturbation to the secretions which accumulate under the foreskin if it "is at all long—and it often is", producing irritation and leading a boy to rub the parts. Careful washing sometimes works "if this is done as a matter of habit", but if the foreskin "gives rise to persistent trouble", then "the surgeon must procure relief by the little operation of circumcision". (102)

The discussion which followed this paper provides further illustration of the  extent to which Jewish custom was regarded as the right model. Geo. Lewis was concerned that the boys and girls of today were "growing up without the power of self-control" and believed that "if we could get back to the law of Moses regarding the cleanliness of our bodies—circumcision, I refer to—we would have a better class of men". He went on to regret that "our Christian laws" do not require "this small surgical operation [to be] performed on our boy children", even though we admit "it is clean and necessary". (103) Two features of these remarks deserve comment. First, although doctors certainly encouraged parents to treat their children like criminals when masturbation was suspected, I am not aware of anybody else in Australia who seemed to hint that circumcision should actually be required by law. Second, Lewis exemplifies the extent to which the advocacy of circumcision in Australia was part of a progressive and scientific movement, and how support for the practice was more widely diffused among the working class than in Britain. In the working man's paradise, health benefits available only to the rich at home would be the birthright of every boy and proof of his parents' aspirations to gentility. This conference was held by the Workers Educational Association, and Lewis himself was secretary of the NSW Branch of the Federated Millers' and Mill Employees' Association of Australasia. He was also a JP—all round, the very model of the respectable trade union leader.

The one child care expert at the conference was Zoe Benjamin, a lecturer in psychology at the Kindergarten Training College. She had read Holt (and in fact quoted from his Diseases of infancy and childhood in her paper), so she was well versed in the dangers of masturbation and not afraid to recommend heroic remedies:

The practice may be corrected by mechanical and physical means, such as tying the hands, smacking, etc., up to the age of about three years, but after that age severity rarely has any effect, as it may lead to secrecy and lying, with consequent debasing of the moral fibre of the child. ... Some harmless but unpleasant medicine, occasional bathing of the parts with cold water, would help this treatment, and for the rest one must reason with the child and encourage him in every way towards self-control. If such measures are fruitless, then a slight operation in the case of both boys and girls may be the only cure. (104)

Such comments certainly make one pause to reflect on how far the treatment of children has changed over the last eighty years, but also on how uneven the process has been. Nobody in the "permissive sixties" would have proposed that children should be tied up to prevent them from touching their genitals, but no voices were raised against the practice of cutting the foreskins off baby boys until the end of the decade, (105) and even then it took another fifteen years for the practice to become rare. And what does one make of Benjamin's suggestion that masturbating girls should also be the subject of an unspecified surgical attention? Although clitoridectomy had had a brief vogue in England in the 1860s the operation was quickly discredited and condemned by the Obstetrical Society, from which its leading exponent was expelled. (106) It was more popular in the US, but Benjamin's brief mention is one of the very few references to the practice I have encountered in the Australian literature.

Benjamin moderated her views slightly in later years. Although she continued to regard masturbation as a bad thing which must be stopped, she sought to discourage the practice of smacking children who did it, on the ground that this only drew attention to the habit. She also referred disapprovingly to the case of a mother who had "threatened her six-year old son that if he continued to touch himself the doctor would cut off his penis". (107) Yet who can blame the mother when the doctors and child care experts had done their work so well? They had been painting fearful pictures of the dangers of self-abuse for years, and while it was only a few doctors in the US who wanted to go this far, and then only in extreme cases, the medical profession generally did urge the routine removal of a significant proportion of the infant penis with precisely this consideration in mind.

Childcare advice

In the wake of doctors, academics and other opinion leaders came a host of child-rearing advisers who more or less repeated their prescriptions for a popular and information-hungry audience. Kerreen Reiger has shown how, in the Edwardian period, successful child-rearing ceased to be seen as a capacity natural to women and became a skill that had to be learned; mothers increasingly sought expert advice on how to do it properly. (108) A growing number of books on baby and child care were published, and many of these advised circumcision for male babies. One of these was by Ellice Hopkins, another veteran of the English purity campaigns, (109) who was more concerned with the moral training of boys than practical advice on baby clothes. Her book The power of womanhood went through two editions in Australia and was directed even at those who could not afford an experienced nurse. Hopkins urged mothers always to be present at their sons' bath, because "often evil habits arise from imperfect washing and consequent irritation; and many a wise mother thinks it best on this account to revert to the old Jewish rite of initiation by which cleanliness was secured". (110)  Writing specifically for a working class audience was Mary Gilmore, who used her regular column in The Worker (newspaper of the Australian Workers Union) to urge the provision of properly trained nurses in rural areas who knew how to handle problems common among little boys. Her language is a little coy, but her meaning is plain:

mothers will ask me about things in relation to their children which, had they had trained nurse, they would have been advised to have seen to at once. One cannot be too definite here, but cases have come under my observation ... where vicious habits were developed, and neither mother nor child knew why. Many a boy owes the ruin of his life to the lack of a small surgical attention in babyhood.

But it was as much a moral as a medical issue: to send the child forth "as God made him" was to let the Devil get him. (111) It would be interesting to know what Gilmore had been reading; she gives no references, but her paragraph is a telling indication of how far the case for circumcision had spread by 1908. Muskett might have been one source, as he probably was for Edith Aitken, who repeats a number of points that could have come from the Australian Medical Guide in her own treatise on child rearing, The Australian mothers' own book (1912). Circumcision, she writes, is necessary "in the case of a tight or redundant foreskin .... Mothers should not hesitate to have it performed if advised to do so by a medical man." Following Muskett (though the point had been made by dozens of authorities), Aitken observes that a tight foreskin will cause irritation that leads to masturbation and that it may inhibit urination. It may also be the cause of bed-wetting, in the case of which "an examination of the foreskin will undoubtedly reveal something abnormal, necessitating immediate circumcision". (112)

In The ladies handbook of home treatment, a popular guide for mothers which went through numerous editions between 1905 and 1930, F.C. and Eulalia S. Richards also took up these themes. They urged parents to guard against masturbation, pointing that it is "practised by children of all ages and of both sexes" and warning that it was both morally wrong and physically harmful. The "excitation of the nerves" enabled the child to enjoy the sensations which should "only be experienced by the fully-developed man or woman in the married state". Masturbation also injured the mind, leading to loss of self-control, immorality and drunkenness; in boys capable of ejaculation "the immature system is weakened by the premature loss of this most highly vitalised of body fluids". (113) To control the habit the Richards enjoined parental vigilance, moral admonition and surgical intervention:

Circumcision often effects a speedy cure in cases of boys addicted to self-abuse. We have no hesitation in saying that almost every boy who practises secret vice should be circumcised, as the operation usually exerts a very favourable influence on the child, apart from the good it accomplishes in correcting local defects. (114)

In discussing the contribution of the foreskin to genital irritation and hence masturbation, the Richards ran up against the problem that the infamous "adherent foreskin" is "so universal in new-born male infants that it can scarcely be termed a malformation", but they did not flinch from preferring the conclusions of medical science to the evidence of nature: however natural it may be, "it is a condition which requires treatment, as secretions collect under [it] ... and cause irritation"; if the foreskin cannot be retracted and permanently separated from the glans, circumcision is necessary. (115) Even if not adherent, tight foreskins could also cause endless problems: sleeplessness, night terrors, "spasms of the bladder", retention of urine, bed-wetting, epilepsy, frequent erections and, of course, masturbation; in such cases, whether the boy is masturbating or not, "circumcision should be performed at an early date". (116)

The same enthusiasm is displayed by Dr Gertrude C. Buzzard Dunlop, who told parents that "the bad habit of self-abuse (masturbation) is easily formed" and that "a tight foreskin" was often the cause. She noted that "some people believe that all baby boys should be circumcised" and agreed that the practice made it "easier for a boy to keep himself clean" and made youths less susceptible to venereal infection. So far these were medical commonplaces, but Dunlop added the novel point that treatment for VD was more difficult in the uncircumcised. She did not make clear whether all boys should be done as a matter of course, but she believed it was better to err on the side preventive caution: "If there is any doubt about the tightness of the foreskin or if the child is masturbating, have him circumcised". Dunlop also advised that the operation should be performed as early as possible: "it is less of a shock to a young baby and he is too young to interfere with his dressings". (117)

Frederic Truby King and congenital phimosis

Some of the tensions in the case for circumcision are apparent in the writings of Dr (later Sir) Frederic Truby King. He was possibly the doyen of the child care guidance experts in Australia and New Zealand in the 1920s and 30s, Director of Child Welfare, New Zealand, President of the Royal Society for the Health of Women and Children and widely read on both sides of the Tasman—the Dr Spock of the inter-war years, at least within the British Empire. King's international celebrity stemmed from the success of his organisation in reducing infant mortality in New Zealand. His most important book, The feeding and care of the baby, was first published in 1908, and by the 1920s it was "a virtual bible for many in infant welfare". (118)  His views on masturbation and circumcision were thus assured of a wide and attentive audience. King is impeccably orthodox in regarding masturbation as a "serious vice" that should be checked as soon as possible and quotes a number of British and US sources, including Professor Holt, on the injurious consequences of the habit and the need for preventive action. He even attributes the current vogue for circumcision to the impression that it "tends to lessen the tendency to Masturbation in boys", but at this point he surprisingly diverges from the views of his colleagues. On this crucial question he is sceptical and doubts whether there are sufficient data to warrant practising it "as a mere matter of routine". In fact he goes further and ventures that there were "reasons for regarding the normal foreskin rather as a protection ... than as necessarily a source of danger", as indeed it was generally viewed. King stops short of advising that boys should not as a rule be circumcised and turns to the problem foreskin, those that are "over-long", "tight" or "adherent" and runs into the difficulty that doctors had forgotten what a normal foreskin was meant to look like or what it was meant to do. Ignorant of the physiology of the penis and trapped by Sayre et al's categories, he is led rapidly back to the camp of the circumcisers: "a tight, too long, or adherent foreskin is objectionable, as being uncleanly, a source of local irritation and an incitement to bad habits". King assures his readers that it is only these problem foreskins that need to be removed: "If the foreskin can readily be drawn back in infancy there need be no anxiety"; if it cannot, the surgeon must be summoned without delay. (119)

But what looks like a large concession turns out to be a very small one. When the development and function of the foreskin were actually studied, it was found to be retractable in only 4 per cent of newborn babies and in only 20 per cent of those aged six months; separation of the foreskin from the glans was a gradual process, taking anything from six months to five years to complete. (120) King insisted that that the first duty of mothers and nurses was to try to separate the foreskin from the glans within the first month of life; we don't know how many followed this advice (probably most), but it must be recognised that they faced a dilemma: if this project was successful, it was likely to harm the tissue of both structures (bleeding, adhesions, skin bridges and other problems), often requiring removal of the damaged foreskin later; if it was unsuccessful, immediate circumcision was clearly necessary. In another text King was stricter and enjoined nurses and mothers to achieve complete separation of foreskin from glans within the first week, by which time "full uncovering of the acorn-like end of the organ should be accomplished". (121) King thus believed that circumcision would be needed only in the 5 per cent of cases where this was not possible; but given Gairdner's findings, on the basis of his own specifications the circumcision rate would have to be 96 per cent if carried out at birth, 80 per cent at six months, and so on down at higher ages as boys' bodies developed.

Like many others, King was also troubled by the problem of washing the genitals. Gollaher has pointed out that in the late Victorian period cleanliness became an essential component of respectability and an important means of distinguishing nice people from "the great unwashed"; (122) similar views were expressed in Australia by Muskett. Bodily cleanliness thus assumed great importance, but the hygiene of the genitals posed a problem. Obviously they had to be kept clean, but herein lay the equally obvious danger that the manipulation involved could be found pleasurable and give rise to the usual bad habits. Contrary to Acton, King believed that instructing parents to wash their children's genitals was bad advice; it was in fact "one of the best means of teaching the child self-abuse", and the "natural parental instinct to chide or slap a child for 'fingering the privates' is sounder and more wholesome". (123) Zoe Benjamin was also aware of this dilemma. In one of her later books on child rearing she considered the various causes of masturbation and advised: "When bathing children, great care should be taken in handling and drying those parts of the body. They should be touched firmly so that no tickling sensation is set up, but not so firmly that the child is hurt". (124) A fine line to tread. It was indeed this difficulty which lay behind the common concern that servants and nurses often taught young children bad habits by careless bathing procedures or deliberate fondling of the genitals to quieten them, a common complaint going back to Beaney, Acton and beyond. As William J. Robinson had so plainly put it in 1915:

The prepuce is one of the great factors in causing masturbation in boys. Here is the dilemma we are in: If we do not teach the growing boy to pull the prepuce back and cleanse the glans there is danger of smegma collecting and of adhesions and ulcerations forming, which in their turn will cause irritation likely to lead to masturbation. If we do teach the boy to pull the prepuce back and cleanse his glans, that handling alone is sufficient gradually and almost without the boy's knowledge to initiate him in to the habit of masturbation. ... Therefore, off with the prepuce! (125)

The final solution to the difficulty lay in removing the root of the irritation.

References

1. I think the term "preventive" is more accurate than the others currently in use because it captures the fact that the aim of the procedure was not only to prevent supposed medical problems, but also  to discourage sexual activity itself. The term also distinguishes the medically-based circumcision introduced in the late nineteenth century from ritual or religious circumcision, which is equally routine and forcible, but not performed with the same ends in view. Ritual circumcision is essentially a tribal initiation, intended to mark the initiate as belonging to a particular religious or ethnic group;  "routine neonatal circumcision" could equally describe Jewish circumcision as the medically rationalised variety, "involuntary routine circumcision" the Moslem practice and the procedures of some tribal cultures at puberty or other stages of life. "Preventive" does not quite convey the compulsory nature of the operation, but the term "forcible preventive infant (or neonatal) circumcision" is both too clumsy and too truthful to win wide acceptance.
2. Gollaher, David L. From ritual to science: The medical transformation of circumcision in America.Journal of Social History 1994; 28:5–36; Gollaher, David L. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000.
3. Acton, William.The functions and disorders of the reproductive organs. 3rd edition. Philadelphia: Lindsay and Blakiston; 1865 (reprinted from third London edition), p. 21.
4. Acton, William.The functions and disorders of the reproductive organs. 3rd edition. Philadelphia: Lindsay and Blakiston; 1865 (reprinted from third London edition). p. 22.
5. Acton, William.The functions and disorders of the reproductive organs. 3rd edition. Philadelphia: Lindsay and Blakiston; 1865 (reprinted from third London edition),p. 22 and footnote.
6. Acton, William.The functions and disorders of the reproductive organs. 6th edition. London: J. and A. Churchill; 1903. p. 7.
7. Gollaher DL. From ritual to science: The medical transformation of circumcision in America.Journal of Social History 1994; 28:5–36; Gollaher DL. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000. ch. 4; Hodges FM. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC and Milos MF, editors. Sexual mutilations: A human tragedy. New York: Plenum Press; 1997. pp. 17–40.
8. Eagle, Chester.Play together dark blue twenty. Melbourne: McPhee Gribble; 1986. p. 134.
9. Circumcision. Letter from S.P. Bellmaine, Honorary Secretary, Australian Paediatric Association. Med J Aust. 1971;1:1148.( 22 May).
10. Wallerstein, Edward.Circumcision: An American health fallacy. NY: Springer; 1980. p. 29.
11. Australian College of Paediatrics, Standing Committee on Perinatal Medicine. Statement on circumcision, 1983; reviewed 28 May 1991.
12. Australian College of Paediatrics, Standing Committee on Perinatal Medicine. Position statement: Routine circumcision of normal male infants and boys. 27 May 1996.
13. Communication from Dr Frances de Groen, University of Western Sydney, March 1999. I am pleased to report that in 1983 she said "No."
14. NOCIRC Australia. Statistics on the incidence of circumcision in Australia, 1994–95. Seen at www.cirp.org/library/statistics/Australia. 11 December 2000.
15. Statistics on the incidence of circumcision in Australia based on Medicare claims, 1994–2000. Seen at www.cirp.org/library/statistics/Australia. 11 December 2000. These figures are based on Medicare (public health insurance) claims and differ slightly from the NOCIRC figures, since they cover calendar rather than financial years.
16. Russell, Terry. Debate: Male circumcision remains a valid procedure—Yes.Australian Doctor. 24 May 1996. p. 54
17. Remondino, PC.History of circumcision from the earliest times to the present: Moral and physical reasons for its performance. Philadelphia and London: FA Davis; 1891. p. 186.
18. Review of Remondino,History of circumcision. Br Med J. 1892;1:391–2. (20 February).
19. Dreyfus, Kay editor.The farthest north of humanness: The letters of Percy Grainger. Melbourne: Macmillan; 1985. p. 246.
20. Davison, FD.The white thorntree. Sydney: Ure Smith; 1970. 2 vols. I, p. 173.
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22. Ward, Russel.A radical life: The autobiography of Russel Ward. Melbourne: Macmillan; 1988; pp. 2, 9.
23. Braddon, Russell.The naked island. London: Werner Laurie; 1952. p. 167.
24. Moran, Herbert.Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. p. 3; Beyond the hills lies China: Scenes from a medical life in Australia. Sydney: Dymocks; 1945; p. 128.
25. Joske, AS. Methods and management of circumcision. Intercolonial Medical Congress of Australia, Tasmania, 1902.Transactions of Sixth Session. p. 281.
26. Lucas, TP.Domestic medicine: How to live and how to avert and cure disease. Brisbane: Edwards Dunlop; 1906. p. 241.
27. Joske, AS. Methods and management of circumcision. Intercolonial Medical Congress of Australia, Tasmania, 1902.Transactions of Sixth Session.p. 281.
28. Reviews and notices of books.Australasian Medical Gazette. 1908;XXVII:362. (No. 7, 20 July).
29. Holt, L Emmett.The diseases of infancy and childhood. New York; 1897. p. 698; Spitz, RA. Authority and masturbation: Some remarks on a bibliographical investigation. Psychoanalytic Quarterly 1952; 21: p. 506; Gollaher DL. From ritual to science: The medical transformation of circumcision in America. Journal of Social History 1994; 28. p. 21.
30. King, Mary Truby.Mothercraft. Sydney: Whitcomb and Tombs; 1934. p. 213.
31. Reviews and notices of books.Australasian Medical Gazette. 1910;XXIX:250. (No. 5, 20 May).
32. Spitz. Authority and masturbation: Some remarks on a bibliographical investigation.Psychoanalytic Quarterly 1952; 21: p. 521; Hodges FM. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC and Milos MF, editors. Sexual mutilations: A human tragedy. New York: Plenum Press; 1997. p. 23.
33. Workers Educational Association of New South Wales.Teaching of sex hygiene: Report of a conference. Sydney: NSW Government Printer; 1917. p. 92.
34. James, W Howard.Home nursing and ailments of children: A handbook for mothers. Warburton (Australia): Signs Publishing Co; 1923. p. 352.
35. Sangster, JA. Letter: Circumcision of infants. Med J Aust. 1917;2:323. (No. 15, 13 October).
36. Vallack, A. Letter: Routine circumcision. Med J Aust. 1917;2:367. (No. 17, 27 October).
37. BMA News: Circumcision. Med J Aust. 1923;1:594. (No. 21, 26 May).
38. Peck, Muriel.Your baby: A practical guide for mothers and nurses. Melbourne: Woman's World; 1925, 1929, 1939.
39. Hufeland, Christoph Wilhelm.The art of prolonging human life. New edition, with notes by an English physician. London: Simpkin and Marshall; 1828. p. 231. (Translation of Die Kunst das menschliche Leben zu verlangen, 1797).
40. Remondino, PC.History of circumcision from the earliest times to the present: Moral and physical reasons for its performance. Philadelphia and London: FA Davis; 1891. pp. 254–5.
41. Walker, David. Continence for a nation: Seminal loss and national vigour.Labour History 1985; No. 48:1–14; Modern nerves, nervous moderns: Notes on male neurasthenia. Australian Cultural History 1987; No. 6:49–63; Energy and fatigue. Australian Cultural History 1994; No. 13.
42. Walker, David. Continence for a nation: Seminal loss and national vigour.Labour History 1985; No. 48: p. 7.
43. Personal recollection of the author. Grimwade House was one of the two junior schools of Melbourne Grammar, a leading private school, covering grades one to eight.
44. Bennett, Paula and Rosario, VA editors.Solitary pleasures: The historical, literary and artistic discourses of autoeroticism. New York and London: Routledge and Kegan Paul; 1995. p. 2.
45. Hospital Reports.Australian Medical Journal. 1860;V:233–4. (July).
46. 46.  Australian Dictionary of Biography. Vol. 3. pp. 124–6.
47. Beaney, George.Spermatorrhoea in its physiological, medical and legal aspects. Melbourne: Walker publishers; 1870.
48. Beaney, George.The generative system and its functions in health and disease. Melbourne: FF Bailliere; 1872. Because I make so many references to these books, pages numbers are inserted in the text.
49. Christoph Wilhelm Hufeland (1762–1836) was Professor of Medicine at University of Jena and author ofDie Kunst das menschliche Leben zu verlangen (The art of prolonging human life, 1797). A mixture of lifestyle advice and moral exhortation, it is hardly a medical work in the modern sense, but it was typical of its time, frequently reprinted, translated into French and English and widely read during the first three quarters of the nineteenth century.
50. Hufeland, Christoph Wilhelm.The art of prolonging human life. New edition, with notes by an English physician. London: Simpkin and Marshall; 1828. p. 231.
51. Springthorpe, John. On the psychological aspect of the sexual appetite.Australasian Medical Gazette 1884;V:8–13.
52. Melbourne Paediatric Society [Report of meeting, 12 March 1913].Australian Medical Journal. 1913;II (New series):1014–15. (26 April).
53. Power, M Danvers.Mother and child. No place of publication or publisher given. [Sydney?]: 1913; pp. 39–45.
54. Power, Frederick Danvers.Australian boy scouts handbook. Sydney: Angus and Robertson; 1922. 2 vols. I, pp. 45–6.
55. Hall, Lesley. Forbidden by god, despised by men: Masturbation, medical warnings, moral panic and manhood in Great Britain, 1850–1950, in Fout JC, editor.Forbidden history: The state, society and the regulation of sexuality in modern Europe. Chicago: University of Chicago Press; 1992. p. 301.
56. Piddington, Marion.Tell them! Or the second stage of mothercraft: A handbook of suggestions for the sex-training of the child. Sydney: Moore's Bookshop; n.d. [c.1926]. p. 226.
57. Neumann, RP. Masturbation, madness and the modern concepts of childhood and adolescence.Journal of Social History 1975;8:1–27.
58. Freeman, Howard and Dr Wallace.Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. Chapter 4, pp. 30–51.
59. Towle, WB.The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. pp. 107–8.
60. Freeman, Howard and Dr Wallace.Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. p. 98.
61. Freeman, Howard and Dr Wallace.Rescued at last: Being clinical experiences on nervous and private diseases. Sydney; No publisher or date of publication [1898?]. pp. 199–205.
62. Towle, WB.The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. p. 108.
63. Towle, WB.The sexual system in health and disease. Sydney; No publisher or date of publication [1898?]. 11th edition. p. 161.
64. Quaife, WF. Tinnitus connected with onanism.Australasian Medical Gazette 1896; XV:20–22 . Discussed in Walker D. Continence for a nation: Seminal loss and national vigour. Labour History 1985; No. 48: pp. 8–9.
65. Courtenay, FB.On spermatorrhoea and certain functional derangements and debilities of the generative system: Their nature, treatment and cure. London: Bailliere, Tindall and Co.; 1882; 12th edition.
66. Beaney.Spermatorrhoea in its physiological, medical and legal aspects. Melbourne: Walker publishers; 1870. p. x. Further references in this paragraph are inserted in the text.
67. Beaney.The generative system and its functions in health and disease. Melbourne: FF Bailliere; 1872. p. 146.
68. Lewis, Milton and Macleod, Roy. Medical politics and the professionalisation of medicine in New South Wales, 1850–1901.Journal of Australian Studies 1988; No. 22:69–82
69. Lewis M and Macleod R. Medical politics and the professionalisation of medicine in New South Wales, 1850–1901.Journal of Australian Studies 1988; No. 22: p. 79.
70. Lewis M and Macleod R. Medical politics and the professionalisation of medicine in New South Wales, 1850–1901.Journal of Australian Studies 1988; No. 22: pp. 78–9.
71. Moran.Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. pp. 102, 203–6.
72. Australian Dictionary of Biography. Vol 7. p. 103.
73. Arthur, Richard.Purity and impurity. Sydney: Australian White Cross League; n.d. [c.1900]. p. 8.
74. Arthur, Richard.The training of children in purity: A booklet for parents. Sydney: George Robertson; n.d. [c.1900]. p. 15.
75. Hyam, Ronald.Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. pp. 65–71.
76. Arthur, Richard.Purity and impurity. Sydney: Australian White Cross League; n.d. [c.1900]. pp. 10–11.
77. Arthur has evidently read his Acton, who had described nocturnal emissions "occurring once every ten or fourteen days" as "in the nature of a safety valve", but that if they were more frequent or "attended by symptoms of prostration" the "patient" should seek medical advice (William Acton.The functions and disorders of the reproductive organs. 6th edition. London: J. and A. Churchill; 1903. p. 105). The more hot-blooded Philip Muskett was willing to allow boys two wet dreams a week before apprehension need be felt: Muskett, Philip. The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, p. 203.
78. Cockshut, RW. Letter. Circumcision. Br Med J. 1935;2: 764. (19 October).
79. Hall, G. Letter. Circumcision. Med J Aust. 1971;2:223. (No. 4, 24 July).
80. Moran,Viewless winds: Being the recollections and digressions of an Australian surgeon. London: Peter Davies; 1939. p. 226.
81. Dr Lewis A. Sayre was a distinguished orthopaedic surgeon who discovered in 1870 that a wide range of childhood illnesses was apparently caused by a tight foreskin and could be cured by circumcision. He eventually consolidated his convictions in a book entitledOn the deleterious results of a narrow prepuce and preputial adhesions, published in Philadelphia in 1888. See Gollaher DL. From ritual to science: The medical transformation of circumcision in America. Journal of Social History 1994; 28. pp. 5–8; Gollaher DL. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000. ch. 4; Hodges FM. A short history of the institutionalization of involuntary sexual mutilation in the United States. In: Denniston GC and Milos MF, editors. Sexual mutilations: A human tragedy. New York: Plenum Press; 1997. pp. 17–40.
82. Walker D. Continence for a nation: Seminal loss and national vigour.Labour History 1985; No. 48: p. 57.
83. Beard, George.The new cyclopaedia of family medicine—Our home physician: A popular guide to the art of preserving health and treating disease. Sydney: McNeil & Coffee; 1884. pp. 793–805; 882–889.
84. Beard, George.The new cyclopaedia of family medicine—Our home physician: A popular guide to the art of preserving health and treating disease. Sydney: McNeil & Coffee; 1884. pp. 888–9.
85. Howe, Joseph.Excessive venery, masturbation and continence. New York: 1887.
86. Woolley, Geo. Talbot. Congenital phimosis and adherent prepuce. Intercolonial Medical Congress of Australasia, Melbourne, 1889.Transactions of Second Session. pp. 234–5.
87. Compare Sayre: "Many of the cases of irritable children, with restless sleep, and bad digestion, which are often attributed to worms, is [sic] solely due to the irritation of the nervous system caused by an adherent or constricted prepuce. ... Hernia and inflammation of the bladder can also be produced by the severe straining to pass water in some of these cases." (Transactions of the American Medical Association1870). Quoted in Gollaher DL. From ritual to science: The medical transformation of circumcision in America. Journal of Social History 1994; 28. p. 7.
88. Naylor, HGH. A plea for early circumcision.Australasian Medical Gazette 1901;XX; 239.
89. Joske, AS. Methods and management of circumcision. Intercolonial Medical Congress of Australia, Tasmania, 1902.Transactions of Sixth Session. p. 281.
90. Muskett, Philip.The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, pp. 219–20.
91. It was only in the late nineteenth century, with the pathologisation of male sexuality and the construction of links between the foreskin, masturbation and disease, that phimosis came to be seen as a problem at all. For an illuminating discussion, see Hodges FM. The history of phimosis from antiquity to the present. In Denniston GC, Hodges FM and Milos MF, editors.Male and female circumcision: Medical, legal and ethical considerations in pediatric practice, New York, Kluwer Academic/Plenum Publishers; 1999:37–62.
92. Muskett, Philip.The illustrated Australian medical guide. Sydney: William Brooks; 1903; 2 vols. II, p 220.
93. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. vii.
94. Sex hygiene and venereal disease [Editorial].Australasian Medical Gazette. 1914;XXXV:14. (No. 19, 9 May).
95. Power, Frederick Danvers.Australian boy scouts handbook. Sydney: Angus and Robertson; 1922. 2 vols. I, p. 46.
96. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. viii.
97. Sex hygiene and venereal disease [Editorial].Australasian Medical Gazette. 1914;XXXV:15. (No. 19, 9 May).
98. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. pp. 40–76.
99. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 85.
100. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 92.
101. Hyam, Ronald.Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. ch. 3.
102. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. pp. 92–3.
103. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 100.
104. Workers Educational Association of NSW.Teaching of sex hygiene: Report of a conference, Sydney: Government Printer; 1917. p. 147.
105. Morgan, WKC. Penile plunder. Med J Aust. 1967;1:1102–3. (No. 21, 27 May).
106. Mosucci, Ornella. Clitoridectomy, circumcision and the politics of sexual pleasure in mid-Victorian Britain. In Miller AH and Adams JE, editors.Sexualities in Victorian Britain, Bloomington: Indiana University Press; 1996. pp. 65–69.
107. Benjamin, Zoe.You and your children, Vol. 1: The young child. Sydney: Gayle Publishing; 1944. pp. 76–8.
108. Reiger, Kerreen.The disenchantment of the home: Modernising the Australian family 1880–1940. Melbourne: Oxford University Press; 1985. chs. 6 and 7, esp. p.128.
109. Hall, Lesley. Forbidden by god, despised by men: Masturbation, medical warnings, moral panic and manhood in Great Britain, 1850–1950, in Fout JC, editor.Forbidden history: The state, society and the regulation of sexuality in modern Europe. Chicago: University of Chicago Press; 1992. p. 299; Hyam, Ronald. Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. pp. 65–71.
110. Hopkins, Ellice.The power of womanhood; or, mothers and sons. A book for parents and those in loco parentis. Melbourne: George Robertson; 1902. 7th edition. p. 47.
111. Gilmore, Mary. Our women's page.The Worker. 10 September 1908. p. 7.
112. Aitken, Edith.The Australian mother's own book: A complete treatise on the rearing and management of Australian children. Sydney: George Philip and Son; 1914. p. 76.
113. Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 50, 348.
114. Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 349–50.
115. Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 49–50, 338.
116. Richards, FC and Richards, Eulalia S.Ladies handbook of home treatment: The ladies medical adviser. Melbourne: Signs Publishing Co; n.d. [c.1920]. pp. 339–40.
117. Dunlop, Gertrude C. Buzzard.Our babies. No publisher or place of publication. [Sydney?]; 1928. pp. 68, 78.
118. Reiger, Kerreen.The disenchantment of the home: Modernising the Australian family 1880–1940. Melbourne: Oxford University Press; 1985 p. 136. Both he and his daughter Mary wrote on child care issues. The well known radio author and playwright, Betty Roland, tried to get "the eight hours [sleep] prescribed by Dr Truby King" when she was pregnant in the late 1930s (The devious being. Sydney: Angus and Robertson; 1990. p. 27); and Robert Brain remarks that "in the 1920s in Tasmania Truby King was the baby king" (Rites black and white. Ringwood (Aust.): Penguin ;1979. pp. 60–61). In view of the links drawn by Walker between the danger of masturbation and the problem of maintaining national vigour, and those drawn by Hyam between the rise of circumcision in Britain and the fears of imperial decline, it is interesting that King turned his attention to infant welfare after a visit to Japan at the time of the Russo-Japanese war. The Japanese victory convinced him, like so many others, that the white races had better get their house in order; he would do his bit by helping to produce healthier babies (Reiger. Disenchantment of the home. p. 136). When in Japan, where breast-feeding was universal, King's enthusiasm for the practice was stimulated by what he saw of the "fitness and excellent physique of the Japanese Army". He had also been impressed by the concerns of Major-General Sir Frederick Maurice about the physical deterioration of the British race (King, Mary Truby. Truby King the man: A biography. London: Allen & Unwin; 1948, pp. 149, 155). Hyam notes that Maurice was an enthusiast for "Jewish child rearing practices" (Hyam R. Empire and sexuality: The British experience. Manchester: Manchester University Press; 1990. p. 77).
119. King, F. Truby.Feeding and care of baby. London: Macmillan; 1931. pp. 122–3.
120. Gairdner, Douglas. The fate of the foreskin: A study of circumcision. Br Med J. 1949;2:1433–1437. (24 December); see also Cold CJ and Taylor JR. The prepuce. Br J Urol 1999; 83 (Supplement 1): 34–44. (January).
121. King, F. Truby.The expectant mother and baby's first months. London: Macmillan; 1930. pp. 70–71.
122. Gollaher DL. From ritual to science: The medical transformation of circumcision in America.Journal of Social History 1994; 28:5–36; Gollaher DL. Circumcision: A history of the world's most controversial surgery. NY: Basic Books; 2000. ch. 4.
123. King, F. Truby.Feeding and care of baby. London: Macmillan; 1931. p. 123.
124. Benjamin, Zoe.You and your children, Vol. 1: The young child. Sydney. Gayle Publishing; 1944. p. 88.
125. Robinson, William J. Circumcision and masturbation.Medical World 1915:33. Seen on internet at "Historical medical quotes on circumcision", http://circquotes.tilted.com, 11 December 2000.