by Steve Jones

Chapter 5:

'In the Hereafter, Abraham will sit at the entrance of Gehinnom and will not allow the circumcised Israelite to descend into it. As for those who sinned unduly, what does he do to them? He removes the foreskins of children who had died before circumcision, places it upon them and sends them down to Gehinnom. ' As their sacred writings make clear, to Jews the prepuce is a symbol of rejection. Their identity is not complete until it has been removed.

NORM disagrees, as do BUFF and RECAP. The National Organization of Restoring Men, Brothers United for Future Foreskins, and RECover A Penis all trust in the Tugger - a traction device for prepuces - over the Talmud. To them, circumcision is no more than ritual child abuse. They strive to regain their birthright with weights, tapes and elastic bands which, with patience (it can take five years), restore a semblance of penile normality. Some appliances are more ingenious: as NORM points out, 'The mouthpieces of a number of the larger brass musical instruments are remarkably well suited for modification and may be worn comfortably within the developing foreskin. Tuba, trombone and Sousaphone are among the mouthpieces suggested. ' Such ideas are not new, for they descend from the Roman judeum pondum, a heavy copper tube placed around the male organ.

Theology hints that Jesus, too, regained his foreskin at the Ascension. Had he failed to do so, the Saved would themselves have to be operated upon in Paradise so as not to be more perfect than their Saviour. The prepuce of Christ was a relic so holy that it was on display in a dozen churches and was used by St Teresa of Avila as a wedding ring. The last example did not disappear until 1983.

For Jews the removal of the foreskin is a rite of passage and a true sign of the covenant and in ancient times even infants who died at birth were subject to it. Other societies are adamant that a presence, rather than an absence, is the true badge of affinity. The Greeks abhorred the whole idea, because it mutilated the human form. A long prepuce was much appreciated in their homoerotic society and athletes were happy to perform almost naked as long as they could wear a strategically tied string or kynodesme (a dog-leash; the penis was the kyon, or dog) to keep the glans hidden. The Romans were even less keen on the procedure. Mothers who allowed their children to be operated upon were to be garotted and hanged on crosses, their dead infants strung about their necks as a terrible warning.

Saul, as a test of David's suitability as a son-in-law, asked for the foreskins of a hundred Philistines (and received twice as many as a statement of just how suitable his daughter's intended really was). Because the Bible avoids as much as it can any mention of the male organs themselves, the text is often taken to refer to a victor's triumphant removal of a defeated enemy's entire genitalia. A thousand years before Saul, the Egyptians invaded what is now Libya - and a carved relief in Thebes shows a pile of phalli displayed before the king. Such treatment excluded its victims from any hope of salvation: 'He that is wounded in the stones, or hath his privy member cut off, shall not enter the congregation of the Lord. '

Some psychiatrists see a direct tie between the fate of the ancient Libyans and that of modern boys. The penis gets five hundred mentions in the works of Freud and the testicles a mere dozen, but he was certain that their loss sprang from the same source. In the famous case of Little Hans (which developed the idea of the Oedipus complex and of a child's anxiety about the fate of his genitals) Freud claimed that 'The castration complex is the deepest root of antisemitism as, even in the nursery, the little boy has heard that Jews cut something on the penis - he thinks, a piece of penis - and this gives him the right to think of the Jew with contempt. ' Other experts saw circumcision as a useful introduction to pain and a break in the maternal bond, both a great help in the hard adult world. The founder of modern sexology, Alfred Kinsey, cut holes in his foreskin for pleasure and, given his frequent attempts to obtain satisfaction by leaping from a chair with a rope tied around his testicles, risked the loss of other body parts as well.

Prominent as it might be in the works of Freud (a keen Darwinist) the foreskin does not appear in The Descent of Man, which is strange, as Darwin - as part of his failed attempt to understand inheritance - was convinced that operations carried out on one generation might manifest their effects in the next. It is an odd and apparently trivial appendage whose |, symbolism is more discussed than is its biology Even anatomy texts tend to ignore the structure and may dismiss it (without evidence) as a relict organ, rather like male nipples. As Aristotle noticed long ago, the prepuce resembles the eyelid, a fine membrane well supplied with blood and nerves, firm on the outside and moist on the inner surface. It covers a large part of the flaccid penis and in some men extends beyond the tip. When retracted, the inner surface reveals a ridged band, filled with sensory cells rather like those on the tips of the fingers and on the lips.

Like the hand and the mouth, the prepuce is a sense organ. Its sensitive self is more important to enjoyment than is the glans, which is less responsive to touch than is the sole of the foot. Quite what else it might do is not clear, although its cells pump out lots of prostaglandins, and in rats (if not in men) its secretions are so attractive to females that a male who lacks the structure finds it hard to obtain a mate.

In a newborn child, the foreskin is attached and may be difficult to draw back. Later in life it becomes looser, and in most boys the process is complete by the age of three. At the time of erection the sheath withdraws to provide the extra cover needed for the enlarged organ.

All mammals possess a prepuce, but Homo sapiens alone has the urge to destroy it. Nemesis comes in various styles, some more heroic than others. Americans go for a radical 'high and tight' option which removes more than half the skin of the penis, while the original Judaic method (used by much of Islam today, but abandoned at the end of biblical times by Jews because their rabbis were concerned that members of their flock were passing for Gentiles) was far less destructive. After the operation the glans thickens and loses some of its already limited sensitivity.

Maimonides, the twelfth-century philosopher and historian of Judaism, favoured circumcision on those very grounds. In his Guide for the Perplexed, he described the operation 'as a means to perfect man's moral shortcomings. The bodily injury caused to the organ is exactly that which is desired; it does not interrupt any vital function, nor does it destroy the power of generation. Circumcision simply counteracts excessive lust. ' More important, he thought, a wife with an unaltered lover would find it harder to leave him and to return, as was her duty, to her husband. The evidence is full of bias but gives Maimonides some support. One man improved [sic] in adulthood described copulation before and after the event as a film made in colour compared to one shot in black and white. Women (albeit a sample [some of whom were] recruited through an anti-circumcision newsletter) also claim to prefer the untouched. The altered, they report, have to work harder and their partners find it more difficult to attain orgasm.

The operation has been justified in many ways. It was once recommended as a specific against masturbation. A President of the Royal College of Surgeons of England in the 1890s was quite forthright: 'Clarence was addicted to the secret vice practised among boys. I performed circumcision. He needed the rightful punishment of cutting pains after his illicit pleasures. ' As self-abuse is in fact commoner among those who have been so treated the President was wrong. Kellogg (of cornflake fame, who was much exercised by the pastime and invented his cereal as part of a strict regime to stop it) was more radical. He recommended silver wire: 'The prepuce, or foreskin, is drawn forward over the glans, and the needle to which the wire is attached is passed through from one side to the other. After drawing the wire through, the ends are twisted together, and cut off close. It is now impossible for an erection to occur, and the slight irritation thus produced acts as most powerful means of overcoming the disposition to resort to the practice. ' Mr Graham, of Graham Crackers, had more confidence in diet and felt that biscuits alone would remove the temptation.

A fifth of the world's men - seven hundred million altogether - have been circumcised and in the time it takes to read this chapter about a thousand more will be added to the global figure. Although they make up but a small part of the total, the habit is best known among Jews. The ceremony -the bris - takes place on the eighth day after birth (which is why nuns wish each other a Happy Circumcision on New Years Day). In these days of advanced neonatal care parents are allowed to delay the event until a week or more after a premature baby leaves the incubator.

Jewish religious rules are strict (and a close reading hints that even their guests should be circumcised). Previously altered converts to Judaism must themselves suffer a stab to the penis, which upsets the Ethiopian Jews who move to Israel and who see themselves as fully Jewish already. Once, the surgery was done with the sharpened fingernail of an expert, the mohel, but now special instruments such as a heated wire, a Winkelman Clamp or a Plastibell inserted beneath the skin before the knife appears are used. Ritual sucking of blood by the mohel has been abandoned.

The Koran is silent on the practice, but Islam too insists upon it. In the Turkish royal court in Ottoman times, ten thousand boys were cut at once, and in some places group circumcision is still common. The procedure reached its peak in the Yemen, with the salkh, in which all the skin was removed from an adolescent's penis, and from his abdomen from umbilicus to scrotum (any flinching put paid to his marriage prospects). In Korea the habit did not begin until independence in 1945. It became common at the time of the Korean War with the influx of Americans, who were the nation's role models in both body and mind. Now nine out of ten boys experience it, often as teenagers.

The procedure is found in many societies who have had no contact with the Middle East or its American diaspora. Australian tribesmen once made cuts not just at the foreskin but across the base of the urethra, which caused urine and semen to emerge some inches before their natural exit. The task involves several operations, and in a few groups opens and splays out the entire tube of the urethra (which psychiatrists ascribe to vagina envy but which may instead be more related to a tribe's desire to identify with a kangaroo, which has a bifid organ).

Whatever excuse is used, the fashion is ancient indeed. An image at Saqqara from 2400 BC shows the temple priests hard at work on a duo of young nobles, with an inscription instructing them not to let their subjects struggle or faint until the job was done. Moses himself was adopted into the royal court and remained unaltered. This led to an awkward moment at the time of the Exodus, soon afterwards: 'Then it happened at a stopping place along the way that Yahweh met [Moses] and tried to kill him. Then Zipporah [Moses' wife] took a piece of flint and cut off her son's foreskin and touched his feet with it, saying, "You are my blood-bridegroom. " So Yahweh let him alone. ' This enigmatic text hints at a role of the operation as a fertility rite.

Others imagine an older and a darker history. Marks on the bones of our seven-hundred-thousand-year-old ancestors from the Atapuerca caves of northern Spain suggest that they were, perhaps, the victims of cannibals. In those days, a balanced diet involved the finest meat of all. For some of the sixty cultures known to have indulged in the practice, a fellow man was the second most important source of protein. Circumcision and the mass - wine into blood - may each be relics of a ritual anthropophagy that we prefer to forget.

For ritual, as for diet, fashions can change. The operation is still popular in the United States (President Lincoln, after all, referred to his nation as 'God's almost chosen people') but is in decline. From a 90 per cent rate in the 1960s, about half of American boys are now so treated (more among rich than poor, and among whites than blacks). Even so, two prepuces are lost every minute, and so common is the surgery that a third of those who undergo it do not realise what has happened to them (an even larger proportion of their partners fail to appreciate what their bedmates have been through). The procedure is rarer in Britain, at around one in five of the adult population, with the numbers in rapid decline. Most male members of the Royal Family are among the elect but Diana, Princess of Wales, is said to have abandoned the practice when it came to her own children.

Its predominance in the New World comes from science (or pseudoscience). Some doctors took a Darwinian view: the prepuce was a relict organ, and man, in his superiority over animals, no longer needed it. Lewis Sayre, the founder of the Journal of the American Medical Association, was a supporter of the nineteenth-century medical notion known as reflex neurosis, in which diseases were blamed on irritation elsewhere in the body. He became known as the Columbus of the Prepuce after he discovered that a quick cut with a scalpel restored movement to a paralysed boy. Soon after the publication of his paper 'Spinal Anemia with Partial Paralysis and Want of Co-operation from Irritation of the Genital Organs' his method was shown to cure hernia, constipation and brass poisoning. So successful was the Sayre school that its doctrine became part of normal childbirth.

In spite of such absurd claims, there is some evidence of a small health benefit among a minority of boys. Before birth, the prepuce is sealed onto the glans and, as a result, the foreskin of most newborn babies is hard to withdraw. Parents may become alarmed as the space beneath fills up into a balloon shape as their baby urinates, but this soon resolves itself. In about one in a hundred the non-retractile state persists to adulthood. It makes personal hygiene more difficult and may lead to infection. [There is no evidence for this claim.] Nobody cuts off their ears to avoid the buildup of wax, but to remove the prepuce does solve the penile problem (it can also be cured with a mild steroid cream).

Cancer of the penis affects about one unaltered man in a hundred thousand [per year] but is rarer among the circumcised. At least a hundred thousand operations would be needed to prevent a single case [this figure seems to be based on the assumption that the one in 100,000 figure is a lifelong risk. The number is, however in the hundreds or thousands.] (which in any event is almost certain to affect an already aged individual). Each death from penile cancer is matched by two hundred and fifty from cancer of the ovary or breast. Many girl babies at risk of those diseases could be diagnosed at birth with a genetic test and their prospects improved by surgery, but nobody would accept the removal of a child's breasts or ovaries on such grounds. Even women of thirty who have had children are advised about the risks and possible benefits before they decide whether or not to undergo the operation.

Young boys, it seems, do not merit such concern and the surgery is done without much thought for their feelings. The medical decision to do so is made by people who are not doctors, and some physicians feel that the level of pain involved js higher than would be tolerated by any adult. The children do not enjoy their experience, for after the bris [or surgery] is over, blood pressure and heart rate stay high and normal patterns of sleep do not return for several days. When it comes to vaccination a few months later, boys who have been operated upon are much less tolerant of the needle than are those for whom the injection is their first experience of the medical world.

Everywhere, surgeons (most of all those who are themselves circumcised) are keener on the practice than are physicians. Fewer than half of British general practitioners would recommend such treatment for a non-retractile foreskin, but nine out of ten surgeons are happy to do so. In the United States the procedure costs three hundred dollars for a few minutes' work and remains popular among those who undertake it. The attachment of their Canadian fellows to such surgery plummeted as soon as the insurance system withdrew payment, and on this side of the Atlantic the National Health Service now only pays in places with many immigrants, where boys treated for religious reasons might otherwise be exposed to amateur operators.

The procedure is not without danger. In the nineteenth century several epidemics of syphilis and tuberculosis were traced to infected mohels as they sucked blood from the wound. Infection is still a problem in the millions of operations carried out under unhygienic conditions in the less developed world. In Turkey, for example (where barbers often do the job), gangrene is sometimes a side-effect. Even after expert treatment, the urethra may narrow because its blood supply is interrupted and the urine emerges in a fine and painful spray. Damage caused by overenthusiastic carving is also a risk. It can lead to an erection curved because of a shortage of skin, or may generate flaps of tissue between the glans and the penile shaft.

As doctors often say, surgery begets surgery; and the adage applies below the waistline as much as elsewhere. In one famous case, identical twin boys were subjected to the treatment. One of them - John - was badly damaged and he was brought up as a girl, Joan. For a time she was happy, but two decades on decided on a second operation, married and adopted children. Large sums have been paid to boys who suffer this fate, and circumcisers are more circumspect than once they were.

Over the years, circumcision has been, like bloodletting, a treatment in search of a disease. The United Nations Convention on the Rights of the Child sets out to put an end to practices harmful to their health. It has been adopted by all nations except the United States and Somalia. The Swedes have passed a law to restrict such assaults on the young. Any medical treatment, they say, calls for informed consent, and if the operation is necessary on social grounds, why not wait until the child is old enough to make up its own mind? Nobody is born Jewish or Islamic; rather they have Jewish or Islamic parents and, at least in some places, are free to decide whether to follow in their parents' beliefs. And what right does one generation have to determine the erogenous habits of the next? Most people in the developed world abhor the mutilation of girls (once justified in the terms still used against boys), but their brothers are attacked almost without question.

The American Academy of Pediatrics, once keen amputators, has weakened its advice; mothers and fathers should, it says, determine what is in the best interests of the child. Today, no national medical organisation in the world is in favour. Only a quarter of unaltered fathers submit their sons to treatment and even those who have themselves undergone the procedure are less keen than once they were. A minor operation is surgery done on somebody else; but a large majority of American women still claim to find a reduced organ preferable on aesthetic grounds and their nation's noble tradition may survive.

Part of North America's obsession with the knife derives from dubious nineteenth-century medicine, but some comes from a study of venereal disease in Canada forty years ago, in which the circumcised were found to be less likely to be infected than those who retain their foreskins. The result was clear enough, but, as in later surveys, the researchers failed to notice that the two groups may also have differed in their sexual habits because Canadian Jews, in general, were rather more faithful than their Christian kin. This confuses the study's interpretation.

AIDS has brought the foreskin back to prominence, and to controversy. In a small study of Kenyan truck-drivers who use prostitutes, the circumcised were eight times less likely to become infected than were men from tribes who keep their prepuces. Childhood circumcision could explain, some say, why infection rates in the Philippines and Bangladesh (where the practice is widespread) are well below those of Thailand and Cambodia, where such surgery is rare.

Persuasive as the figures appear (and they are much publicised by surgeons), several factors confuse the issue. The use of astringent herbs to dry the vagina is common among some of the African peoples who do not circumcise, and this might increase the transmission rate. In addition, the rite is a Muslim habit, and Islamic culture, with its calls for fidelity, may help to slow the passage of the virus.

In some places, indeed, the data point in the opposite direction. Tanzania and Rwanda (where the procedure is common) have a great deal of HIV infection - and the United States, with the highest incidence of the illness in the developed world, has by far the highest rate of such operations. Some surveys even hint that the altered are more, rather than less, susceptible to disorders such as herpes. Most physicians now dismiss the whole idea of a fit between genital surgery and venereal infection.

Whatever the truth, many people believe that such treatment may protect against sexual disease. Private clinics have sprung up in Kenya (where more than half of the unaltered say that they would, given the chance, prefer to lose their foreskins). There and elsewhere, those without a prepuce are seen - in error - as safe from those diseases. Such beliefs increase the rate of spread of the human immunodeficiency virus as the local prostitutes are readier to accept unprotected intercourse with such clients.

Whether to protect against brass poisoning or AIDS, the medical case for removal of the prepuce is unproved at best and those who do it must realise that they do so for reasons symbolic rather than scientific.

Its metaphysical cousin, castration, itself began as a symbol, but went much further. To Aristotle, the testes were

a castrated slave was several times more expensive than an intact one. The high death rate among such valuable beasts of burden may have led to the replacement of the major mutilation with circumcision. The Old Testament itself is against castration

as he feared reincarnation as a dog.

To interfere with such organs diminishes the masculine frame, but parts of the male apparatus have remarkable powers of recovery. The millions of foreskins discarded each year could save myriad lives.

The prepuce has the useful property of almost infinite expansion, once removed. It can as a result be used to repair damage to its owner caused by burns or by inborn deformity. What is more, a baby's foreskin placed in a nutrient solution grows to make a sheet of tissue, which, because it comes from a child whose immune system is not yet mature, is accepted by people in need of a skin transplant.

Two types of cell, one from below the skin and the other on the surface, are used. Each is seeded onto a preparation of cow tendon, or onto a synthetic polymer. Soon they proliferate and, after a couple of weeks, the artificial skin is ready for use. The sheet of material is laid onto the burn. At once it helps to stop the loss of liquid, and in time the patient's own cells move in. In three months, the damage is almost healed. There is almost no limit to how large the expanse can grow and the potential of a single prepuce is measured out in football fields.

That modest structure has been much used to help those with damaged bodies. It assists not only burn victims but diabetics, who may suffer from ulcers which can, if not treated, . lead to amputation. Before the new material was invented, a transplant of their own skin (which, for people with severe burns, was not feasible), or of tissue from a corpse, was needed; but now medicine has the potential of an unlimited supply.

Tissue engineering is now big business. It may, some day, replace livers and even brains, but it began with the humble foreskin. The removal of that strip of flesh was once seen by some as an impious attack on the body (in ancient times clipped coins were called 'circumcised' - with a strong hint as to which segment of society was to blame). It may have evolved from an even greater mutilation of the human frame which came in turn from a desire to unman an enemy or] from disgust at man's sexual and unspiritual self. Such views; are not dead. Florida has an amateur and anonymous gelder who offers castration to those who would, for their own reasons, like to be reduced. He claims to have done the job on scores of volunteers. The gelder charges no fee. ...

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