Australia's new witchdoctors

Did ritual and religious circumcision arise from motives of hygiene?

What do African witchdoctors and a modern zoologist like Dr Roger Short have in common? What beliefs are shared by the superstitious moon priests of ancient Egypt and a contemporary expert in molecular biology such as Professor Brian Morris? What conviction animates a Brisbane GP like Dr Terry Russell as much as it gripped a nineteenth century medical quack and snake oil salesman like Dr Peter Remondino? At what point to the ritual practices of Aboriginal elders in the central Australian desert converge with the deeply-pondered recommendations of the New England Journal of Medicine?

There is a striking degree of unanimity among the traditional superstitions of ancient and tribal cultures, the nostrums of Victorian quackery and the certainties of an influential band of contemporary medical researchers and doctors on one sensitive point: that young males ought to have part of their penis cut off. The reasons offered by each category of enthusiast are slightly different: tribal uniformity and religious requirement in the first case; prevention and cure of nervous diseases and masturbation in the second, though not forgetting claims about protection against syphilis, tuberculosis, polio, epilepsy and many other problems; and in the third case reducing the risk of infection with intractable modern diseases such as HIV-AIDS (as well as cervical cancer in female partners), particularly among Third World populations.

Egypt: So long ago that nobody knows the truth

Surprisingly, modern medical researchers do not try to hide their continuities with the ignorant and superstitious past. Almost every article on routine male circumcision in medical journals opens with the same little mantra: that "circumcision is the oldest surgical operation known to man, practised by many ancient cultures etc", and some refer to an old Egyptian bas relief which is supposed to represent the operation on two adolescent boys. (1) Why the mysterious rites of a pre-scientific, priest-ruled culture like that of ancient Egypt should be hailed as a model for contemporary medicine is not entirely clear. Whatever its ritual significance to stone-age man and antique civilizations, circumcision as a medical procedure is a recent invention, dating from only the eighteenth century as a treatment for severe venereal sores on the penis; it was practised by relatively few pre-modern cultures; and the much-reproduced Egyptian bas relief is so eroded that it is impossible to make out even what is depicted, let alone to be sure about what is happening.

There is no evidence that the ancient Egyptians practised widespread circumcision (though it does seem to have been a ritual requirement for priests and possibly court officials – who were sometimes eunuchs, as the story of Potiphar's wife reminds us – at certain periods), and the actions shown in the relief look more like the shaving of the boys' pubic hair than the amputation of their foreskins. (2) If it is a representation of circumcision it reveals an important aspect of the procedure which its modern advocates always gloss over: one of the boys is being forcibly restrained, suggesting that whatever is being done to him is not something he is too eager about. Are the principles of contemporary medical ethics and personal freedom no further advanced than in the days of a despotic, divine-right monarchy like that of the pharaohs?

If it is surprising to see modern medical experts associating themselves with the coercive rituals of ancient priests and slave-driving kings, it is even stranger to observe the similarity of their warnings against the foreskin with the tub-thumping propaganda of a nineteenth century quack like Dr P.C. Remondino, author of History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (1891), in which the foreskin is vilified at length as a malign influence and "moral outlaw". According to Remondino its removal would not only discourage boys from masturbating, but immunise them against tuberculosis, cancer, syphilis, polio, idiocy, forgetfulness, impotence, unwanted erections, wet dreams and just about any medical problem you cared to mention.

Modern crusaders

Australia's leading crusaders for universal male circumcision are Dr Terry Russell, a GP in Brisbane whose whole practice consists of little more than excising the foreskins of baby boys by means of the Plastibell device; and Dr Brian Morris, a professor of physiology at Sydney University, who (not being medically qualified) just likes to talk about it. Both are frequently seen in the media urging parents to have their boys circumcised, and much of their routine is just a long list of nasty diseases, designed to terrify people into seeking urgent medical intervention. Russell apparently tells parents that an early circumcision is the equivalent of immunization against venereal disease, cancer of the penis and many other problems which, he implies, boys will be likely to contract unless they are liberated from the malevolent portion of their penis. He writes that, if they had been circumcised, "a vast number of neonates would have been saved from UTI [urinary tract infections] and its consequences of renal failure, septicaemia, meningitis, hypertension and death". Circumcision "may reduce the risk of STDs (syphilis, gonorrhoea, herpes and candida) and carcinoma of the cervix of female partners. It also prevents balanoposthitis and phimosis", not to mention such "potentially fatal conditions" as neonatal UTIs, HIV/AIDS and cancer of the penis. (3) Scary. You would think though, given that only about 12 per cent of Australia boys are circumcised these days, that if these claims were true the others would be dropping like flies. Seemingly not. (In fact, the Australian Institute of Health and Welfare reports that in the twenty years since 1983, as the incidence of circumcision has plummetted, there has been a dramatic improvement in child health outcomes.)

A hundred years ago Dr Remondino referred to: "The tight-constricted, glans-deforming, onanism-producing, cancer-generating prepuce that is ... at the bottom of the ills ... that may affect man" (4). He reminded his wide-eyed readers that:

the prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner; where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail or even in a lunatic asylum. (5)

Just as scary. Brian Morris concludes his own booklet on the necessity to circumcise all male infants with dire warnings that retention of the foreskin "confers a higher risk of death in the first year of life (from complications of urinary tract infections leading to kidney failure, meningitis and infection of bone marrow"; increases the danger of cancer of the penis; leads to "balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin"; and he concludes that being circumcised "will result in better sexual function" and "a penis that is generally regarded as more attractive" (6). How could he disagree with Dr Remondino's assurance that:

Circumcision is like a substantial and well-secured life annuity; every year of life you draw the benefit, and it has not any drawbacks .... Parents cannot make a better paying investment for their little boys, as it insures them better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor-bills, as well as increases their chances for an euthanasian death. (7)

Professor Morris admits his affinity with the Remondinos of this world by acknowledging that "the Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today", yet at the same time he denies that a major reason why they introduced it was to discourage boys from masturbating: that claim is "a falsehood that has been promoted by anti-circumcision groups". (8) Morris is very critical of the unscientific approach of such activists, but it is strange to see him endorsing the Victorian enthusiasm for circumcision as consistent with his own arguments in its favour, yet denying that control of masturbation had anything to do with the matter.

Remondino was quite definite that, in his view, even the ancient origins of circumcision lay in the desire of Judaic lawgivers first to discourage the idolatrous debaucheries practised among their free-spirited neighbours in the Middle East, and masturbation specifically; and secondly to encourage procreation. Referring to the story of the circumcision of Abraham and the impregnation of Sarah, he writes: "Here we have suggestions of a preventive to onanism, and a cure to male impotence when due to preputial interference" (9). Dr Morris follows this lead closely when he writes:

The Bible records that Abraham circumcised himself at age 99, along with his 13 year-old son Ishmael. Not long afterwards his wife Sarah, after many barren years, became pregnant and bore Isaac. Weiss speculates that Abraham had a foreskin problem, possibly exacerbated by the desert environment, and that this problem interfered with his sexual activity. The difficulties were solved by having a circumcision. (10)

It comes as a bit of a shock to see a modern scientist treating the Old Testament as though it were literal history. No serious scholar in biblical studies today believes that the early books of the Old Testament are a factual record of history, and it is now generally accepted that they are a collection of stories assembled by Jewish religious leaders in the 6th century BCE. It follows that Abraham et al are as much mythical figures as Hercules or Oedipus, and that Weiss's "speculations" are on a par with Archbishop Ussher's calculations of the age of the earth in the 17th century. Recent research also suggests that Judaic ritual circumcision did not become routine and privileged as a sign of the Covenant until the Babylonian exile of the 6th century (at about the same time as the first five books of the Old Testament – the Torah – were compiled), when the rationale was the maintenance of cultural identity and racial purity in a hostile social environment by the enforcement of physical distinctiveness. It had nothing to do with "foreskin problems", protection against disease or the irritation caused by desert sands. (11) The foreskin was more likely a protection against such irritation than a source of it, as Remondino himself conceded:

Nature – always careful that nothing should interfere with the procreative functions – had provided him [primitive man] with a sheath or prepuce, wherein he carried his procreative organ safely out of harm's way, in wild steeple-chases through thorny briars and bramble-brakes. (12)

Professor Morris apparently forgot this passage when he warned that yet another drawback of having a foreskin was that it might get caught in your zipper. Allowing the myth for a moment, if it was Abraham who had the foreskin problem, why did he also circumcise his son Ishmael, followed by his servants and slaves? And if this "problem" prevented him from begetting children, how come he already had a 13 year-old son?

Not surprisingly, Professor Morris' booklet has not been warmly reviewed by experts in paediatrics or sexual health.

Queensland is different?

Dr Russell, too, found it necessary to bolster a weak medical case by reference to religious prescription. Interviewed on the Australian current affairs program 60 Minutes in October 2000 he was caught out by the interviewer's awareness that no medical body in the world recommended routine circumcision.

Interviewer: Can you point to one international medical body which doesn't say maybe you should circumcise but says definitely.
Russell: Yeah, I think the American Academy of Pediatrics has said that. I've got a ....
Interviewer: No they don't. Can you think of one which says you absolutely should do it?
Russell: The Bible did. [giggles] No, not off the top of my head, no. (13)

Unfortunately the interviewer did not press Dr Russell on why an unexplained biblical precedent established a requirement for modern-day Australians. He was presumably referring to the Genesis story also cited by Professor Morris rather than St Paul's advice that Christians should not continue to practise the many rules imposed on the Jewish people by their exacting god. It is hard to see why the rules of the Old Testament should be relevant to modern medical practice in Queensland today.

Further information on the ritual/religious page

References

1. Robert Szabo and Roger V. Short, "How does male circumcision protect against HIV infection?", British Medical Journal, Vol. 320, 2000, pp. 1592-4

2. Frederick Hodges, "The ideal prepuce in Ancient Greece and Rome: Male genital aesthetics and their relation to lipodermis, circumcision, foreskin restoration and the Kinodesme", Bulletin of the History of Medicine, Vol. 75, 2001, pp. 375-405

3. Terry Russell, "Debate: Male circumcision remains a valid procedure—Yes", Australian Doctor, 24 May 1996, p. 54

4. P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance, Philadelphia and London, 1891, p. 187

5. Remondino, pp. 54-5

6. Brian Morris, In favour of circumcision, Sydney, New South Wales University Press, 1999 pp. 87-8

7. Remondino, p. 186

8. Morris, p. 57

9. Remondino, p. 201

10. Morris, p. 60, citing G.N. Weiss, "Prophylactic neonatal surgery and infectious diseases", Pediatric Infectious Diseases Journal, 1997

11. Lawrence W. Hoffman, Covenant of blood: Circumcision and gender in rabbinic Judaism, University of Chicago Press, 1996; Leonard Glick, "Jewish circumcision: An enigma in historical perspective", in Marilyn Milos, George C. Denniston and Frederick Hodges (eds), Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem, London and New York, Kluwer Academic and Plenum Press, 2001

12. Remondino, p. 8

13. "Fore and against", 60 Minutes, 8 October 2000, 9 Network (Australia), presenter: Ellen Fanning (video in possession of the author)