Circumcision: A History of the World's Most Controversial Surgery (review)

David L. Gollaher. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000. xiv + 253 pp. Ill. $U.S. 26.00; $Can. 39.50 (0-465-04397-6).

David Gollaher, president and CEO of the California Healthcare Institute, has written a compelling book on circumcision. He records that in 1996 more than 60 percent of boys born in the United States were circumcised, mostly by physicians during the first hours or days of the infant's life. Regions varied in the practice: Midwest, 81 percent; Northeast, 67 percent; South, 64 percent; and West, 36 percent. The question Gollaher poses is why physicians, who no longer view the procedure as having any significant health benefit, persist in the practice. His book provides a rich historical, religious, anthropological, and medical analysis.

Gollaher starts his story with the practice of circumcision among ancient Egyptians and with its appropriation by enslaved Jews, who recast it as a sign of God's covenant and a distinctive symbol of community membership, and who transformed the Egyptian practice of adolescent (rite of sexual passage) circumcision into a religious rite on the eighth day of life. In Christian times, Saint Paul argued that circumcision was not a sign of God's new covenant. Gollaher claims that Paul no longer wished to distinguish Jews from Gentiles; few Christians were routinely circumcised until the end of the nineteenth century. Muslims also practice circumcision, but it is not tied to a particular moment in a boy's life. Gollaher next discusses the anthropological elements of the practice in diverse societies outside the Western tradition.

For medical historians, the most intriguing aspect of this volume is how physicians, especially Americans, transformed this rare, religiously restricted practice into the nation's most commonly performed surgery. Gollaher argues for a rich coalition of influences: the view that a tight foreskin contributed to a wide variety of ills, both physical and psychological; a newly articulated public health concern for hygiene (which defines the uncircumcised penis as less clean); the desire for a preventive measure against cervical cancer in women, penile cancer in men, and a deterrent to venereal disease; the shifting of the practice to a group of patients too young to protest; and trivialization of the foreskin as a worthless remnant.

This volume is not as strong in answering why routine, newborn circumcision--once launched by physicians--has been so difficult to derail. Certainly, medicine has had other enthusiasms, which have waned. It is here that cultural history may have insights. When I ask prospective parents why they wish to circumcise their baby, most respond that they believe this is how a penis should look, and they often accompany their words with a facial grimace indicating that an uncircumcised penis lacks appeal. Parents go to great lengths to protect newborns from harm--but this does not extend to circumcision.

The book deserves a wide readership.

 

Peter C. English
Duke University

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