Jonathan Hutchinson on the advantages of circumcision

1. A plea for circumcision, 1890

It is surely not needful to seek any recondite motive for the origin of the practice of circumcision. No one who has seen the superior cleanliness of a Hebrew penis can have avoided a very strong impression in favour of removal of the foreskin. It constitutes a harbour for filth, and is a constant source of irritation. It conduces to masturbation, and adds to the difficulties of sexual continence. It increases the risk of syphilis in early life, and of cancer in the aged. I have never seen cancer of the penis in a Jew, and chancres are rare".

"A plea for circumcison",  Archives of Surgery, Vol. II, 1890, p. 15; reprinted in British Medical Journal, 27 September 1890, p. 769

2. On circumcision as a preventive of masturbation, 1890

The appended letter has been sent to me from the Refractory Gallery of a lunatic asylum. The patient who sends it is himself a surgeon. I venture to bring it before my readers because I believe that the subject to which it refers is an important one, and that my correspondent's views on it are worthy of consideration.

 The subject is not a novel one. My late colleague, Mr Curling, I know held the opinion that circumcision was of advantage as preventing the tendency to masturbation. At one time he tried to collect facts in order to institute a comparison between Jews and others in respect to that habit, but the distasteful nature of the inquiry I believe caused him to abandon it. It is indeed one upon which it is impossible to collect statistics. General impressions are all that can be had. I have myself, from considerable experience, formed a strong opinion that Jewish young men do not suffer nearly so frequently as others from the maladies which we associate more or less definitely with masturbation and nocturnal emissions. We must remember, however, that in their case we are dealing with the circumcision of infants as preventive, not with that of adults as curative. Under the latter conditions the operation is far less hopeful. Still, I am inclined to believe that it may often accomplish much, both in breaking the habit as an immediate result, and in diminishing the temptation to it subsequently. I know that the reply from specialists will be that the disorder is in the nervous system, and not in the organs, and this no doubt is in part true. The reiterated complaints and confessions of young men, however, force on me the conviction that he habit in question is very injurious to the nerve-tone, and that it frequently originates and keeps up maladies which but for it might have been avoided or cured. I confess I see no reason why a man admitted into an asylum for ailments associated with that vice should not be allowed such chance of relief as the operation offers. I may indeed go further than this and avow my conviction that measures more radical than circumcision would, if public opinion permitted their adoption, be a true kindness to many patients of both sexes.

[Letter quoted]

The Hospital for the Insane, W —, E —
Oct. 31, 1890

Dear Sir, — The British Medical Journal of the 27th of September, 1890, on p. 769, under the heading "A plea for circumcision", gives this quotation:

"It is surely not needful to seek any recondite motive for the origin of the practice of circumcision. No one who has seen the superior cleanliness of a Hebrew penis can have avoided a very strong impression in favour of removal of the foreskin. It constitutes a harbour for filth, and is a constant source of irritation. It conduces to masturbation, and adds to the difficulties of sexual continence. It increases the risk of syphilis in early life, and of cancer in the aged. I have never seen cancer of the penis in a Jew, and chancres are rare".

"I have been an inmate here, Sir, for more than seven years, and shall feel exceedingly obliged if you will kindly tell me whether you are aware of any reason why, if I am a confirmed masturbator, circumcision should not be performed upon me?

"Will you kindly also tell me whether you think that any good reason can be advanced why Messrs L —, S —, H —, and D — (the first three quite young men), who have told me that they masturbate, should not also have circumcision performed upon them?

"I mention these gentlemen's names because it seems necessary to establish the facts I mention, so that in the event of an inquiry into the truth of my statement being made, you will find that the above gentlemen have been locked up here for many months past, that they have been masturbators during nearly, if not quite, all that time, and that nothing worth calling efficient medical or surgical treatment has been given them, or been done to them, by either of the medical men, for the cure of this imperious habit."

I trust it will not be supposed from what I have written above that I believe that the removal of the testes or ovaries will either completely or in all cases subdue the sexual passion. All that I contend for is that such operations are often and in most persons conducive to that end.

"On circumcision as a preventive of masturbation",  Archives of surgery, Vol. II, 1890, p. 267-9

3. On circumcision, 1893

1.  Under what circumstances is the operation of circumcision in infancy desirable?
2.  How should it be performed?
3.  What special risks attend it?

1.  It is imperatively required whenever the prepuce is unusually long and contracted at its orifice. The surgeon should, however, avail himself of every possible opportunity of inducing parents to have their male offspring circumcised. The operation confers great advantages in several different directions. If properly done it has no drawbacks whatever.

2.  For the performance of circumcision the surgeon should be provided with two pairs of straight scissors – one large, the other small. Drawing the prepuce a little forward, he should include all that is in front of the glans between the handles of his smaller scissors, and nipping it tightly, should then with the larger ones cut all the projecting part away. This will remove a broad ring of skin and leave the glans covered by only the mucous membrane. Next, with his smaller scissors, he should slit up the mucous membrane and cut it cleanly away level with the corona. Not more mucous membrane than a strip of about one eighth of an inch in width should be left. If any adhesions are present they should be carefully broken down. What remains of the fraenum should now be tied; no other vessels will need attention. Stitches are quite unnecessary, and generally inconvenient and injurious.

3.  By far the most important risk is haemorrhage, and very careful attention should be given to the ligature of the fraenum. Many children have died after the operation in consequence of carelessness in this matter. The only other risks are poisoning of the wound by unclean instruments, and the introduction of syphilis by the dressings, etc.

(Footnote:  In my work on syphilis I have recorded a series of cases in which a Jewish circumciser communicated syphilis by unclean lint. I have recently been consulted in a case in which, in all probability, an operating surgeon did the same by his instruments.)

"On circumcision",  Archives of surgery, Vol. IV, 1893, pp. 379-80

4.  The advantages of circumcision, 1900

The first advantage of removal of the foreskin is cleanliness. In childhood this is important. In adults the habit of withdrawing the skin and washing the glans has usually been learned, though often it is not practised with sufficient frequency. In children it is, as a rule, never attempted; most boys would regard the attempt as indecent, and in many paraphymosis would result.. Apart from this risk, the practice would be injurious to the morals of the child. Yet the accumulation of smegma and its decomposition is a source of annoyance and irritation to many boys. Any irritation of the surface of the glans penis is liable to produce reflex excitement of an undesirable character.

In middle life the possession of a prepuce is to many a source of more or less habitual annoyance. Seborrhoea, balanitis and herpes are common, and sometimes troublesome. As old age comes on the danger of cancer to those who suffer from phymosis is considerable. The number of middle-aged and senile persons who would be both more comfortable and more secure if they had been circumcised in infancy, is large. But the argument in favour of the general practice of circumcision which carries the most weight is that it would reduce the prevalence of syphilis. Mr Hutchinson [that is, yours truly!] many years ago collected statistics as to gonorrhoea and syphilis in Jews, which prove that whilst the former was quite as common [actually x times more common] amongst them as amongst Christians, the latter was much less frequent.

This seems to show, what perhaps scarcely needed proof, that it is not to stricter morality but to some adventitious advantage that the comparative immunity of Jews from syphilis is due. The only advantage which can be alleged is the absence of the prepuce. It  would, indeed, be difficult to contrive an appendage more likely to facilitate the implantation of the syphilitic virus than the prepuce. By it folds of delicate mucous membrane are kept constantly in a condition the most suitable for the retention and absorption of any virus which may be brought into contact with them. No other measure for the prevention of syphilis which has ever been proposed is so efficient as this. Its effects would be enormous.

Most other measures, such as the inspection of prostitutes, have a collateral influence prejudicial to morality. Professedly making irregular sexual intercourse less dangerous, they possibly increase its amount to an extent which more than counter-balances their supposed advantages. They are also injurious to the sense of decency, to say nothing of modesty, and detrimental to the moral conscience of a community.

It is not so with circumcision. Effected in early infancy, and with other avowed objects, it would silently become the means of preventing on a large scale the prevalence of a loathsome and misery-producing disease. The extent to which this diminution of risk might tend to increase sexual folly would probably be infinitesimal. The gain would be without any drawback. let it be remembered that a large proportion of the syphilis extant is contracted by young men who are by no means habitually incontinent.

It is an open question whether the removal o the prepuce tends appreciably to increase the power of sexual control. Its influence, so far as it has any, must be in that direction. The only function which the prepuce can be supposed to have is that of maintaining the penis in a condition susceptible of more acute sensation than would otherwise exist. It may be supposed to increase the pleasure of the act and the impulse to it. These are advantages, however, which in the present state of society can well be spared, and if in their loss some degree of increased sexual control should result, one should be thankful.

"The advantages of circumcision",  Medical Review, Vol. 3, 1900, p. 641-2

Note

Hutchinson was convinced that circumcision reduced the risk of contracting syphilis, but he had no proof of this, only dubious statistical correlations and impressions derived from the reportedly low incidence of syphilis among the Jewish population of east London. On the other hand, as this article and numerous others in the British Medical Journal from this period show, there was incontrovertible proof that circumcision itself was the cause of syphilis, tuberculosis and other diseases in an unknown number of cases (dozens reported, many more likely), as well as deaths arising from the operation itself. Given two sets of facts to choose from, one dubious, the other certain, Hutchinson's prior inclination towards circumcision is proved by his plumping for the former. His procedure is rather like those tunnel-visioned researchers today who, on the basis of some equally suspicious statistical correlations, say that little African boys should be forcibly circumcised to save them from AIDS; yet who, like Hutchinson, ignore the fact that circumcision itself is a significant cause of death among African boys. (Indeed, it is likely that more African teenagers die as a "complication" of circumcision than from sexually acquired AIDS.)