FEATURESSATURDAY, 13 JANUARY 2001
Foreskin lament for babies
09 JANUARY 2001
Circumcision became widespread in New Zealand after World War 1, but later in the 20th century the practice diminished sharply. Yvonne Martin looks at an unusual chapter of medical history.
It was like a tsunami that began around World War 1, swept over the nation's nurseries, and receded just as quickly.
Yet no-one seems sure why New Zealand embraced circumcision so enthusiastically and rejected it with similar zest, all within one generation.
Over the last five years, Auckland University of Technology senior lecturer in pathology Ken McGrath has tracked the history of circumcision in New Zealand as best he can, with the scant medical records that exist.
He uncovered a surreal story of medical fashion, unquestioned authority of doctors, and a lack of ethical awareness. Throw into the mixture strong forces of social conformity and rapid change, and the result is a unique slice of New Zealand medico-cultural history.
Mr McGrath presented his findings to the Sixth International Symposium on Genital Integrity at the University of Sydney in early December.
Among experts, the foreskin is recognised for its important sensory function. In the 1890s, boys were circumcised to discourage masturbation, which was thought to overstimulate the spinal chord and lead to a plethora of diseases.
Circumcision gained momentum during World War 1 for other reasons. The army medical branch believed that hygiene was a major factor behind a rise in sexually transmitted diseases during major wars—and the foreskin had to go.
According to a Dunedin doctor who had performed circumcisions since 1916, the operation was rare in New Zealand before the World War 1, says Mr McGrath.
"The foreskin came to be considered as enclosing a space which would act as a `cultural medium' for bacterial growth and a trap for pollution — a veritable cesspool," he says.
Its removal was seen as a way of getting a man well enough to return to the frontline, with the added bonus of reducing his sexual capacity and therefore his risk of reinfection.
This hygiene argument for circumcision appears to have reached NZ's civilian population through the many doctors who served in the army, says Mr McGrath.
By the late 1930s, New Zealand rates of circumcision appear to have equalled Britain's. A survey of British men born between 1934 and 1944 found 38 per cent were cut. Of New Zealand fathers born around the same time, 40 per cent were done, says Mr McGrath.
But during the early years of World War 2, New Zealand's rates rocketed to probably as high as 95 per cent, says Mr McGrath. From his own observations, men born between 1941 and 1948 were rarely left intact.
"This suggests that the rate of early-childhood circumcision went from about 35 per cent just before World War 2 to over 90 per cent by 1942, a rise of over 50 per cent in three years," he says.
"We have tried for some time to find an account of why this sudden enthusiasm occurred, and from where it originated, by searching official medical and wartime records, without finding anything that even hints at what happened."
A recurring theme, though, from medical student surveys in the 1960s and 1970s was hygiene problems for troops in desert theatres and prisoner-of-war camps.
The fear that sons who were not "fixed" would have serious foreskin problems should they find themselves in another desert war, has become known as the sand myth. Mr McGrath says he has found no evidence to support this notion.
The official record of World War 2 military medicine (by Sir Duncan Stout) makes no mention of circumcision or foreskin problems. It also reports a great reluctance to cut skin because of the extreme difficulty keeping out the irritating fine flour-like dust in the Sahara.
Mr McGrath believes the sand myth somehow became an unquestioned truth among doctors and parents in New Zealand and Australia.
Britain's circumcision rate had begun to fall during World War 2 and plummeted when its new National Health Service decided against funding the procedures in 1947 (having judged it unnecessary and cosmetic).
If some parents very strongly wanted their children circumcised, we would be happy to do that. -- Professor Spencer Beasley, president of the NZ Society of Pediatric Surgeons
Two years later a study by a prominent British pediatrician Douglas Gairdner on foreskin development in children disputed the common reasons for circumcision.
The NHS decision had little impact in New Zealand, but Gairdner's and other British medical articles against circumcision eventually filtered back to doctors here.
Mr McGrath says that by 1961 the Otago Medical School was teaching that circumcision had little or no place in medical practice. The few doctors who remained in support of routinely cutting babies were mostly older, more senior, and the subjects of circumcision in their own infancies.
However, it took two decades for parents to drop circumcision, says Mr McGrath. Doctors generally tried to dissuade parents, but in the end if a parent demanded it, doctors did it or referred them to someone who did, he says.
"What doctors had not anticipated was the extent to which the public had taken to the practice."
Most parents surveyed around this era still believed circumcision was essential for hygiene. Others considered it necessary for family conformity.
Having a circumcised father, a grandmother in favour, or circumcised brothers were highly significant risk factors for intact baby boys.
"There was, and probably still is, a national reluctance to stand out, and intolerance of anyone who did, from the perceived social norms—the Tall Poppy Syndrome," says Mr McGrath.
"This may partially explain why parents thought their sons should be the same as their peers, as well as resemble their fathers and brothers."
Christchurch, well known for its conservatism, was a hotbed of circumcision, he says.
When national rates had fallen to low levels, one Christchurch study of 590 boys born in 1977 found that one in four had been cut, mostly before they were five months old. By comparison, in Dunedin—where doctors trained—only 5 per cent of boys were cut that year.
As the public system gradually reduced the number of circumcisions it performed, the private sector took over. Public hospitals still do circumcisions for medical reasons.
National health statistics for all hospitals show that by 1995 less than 1 per cent of boys under four years were circumcised, says Mr McGrath.
New Zealand now has one of the lowest rates of circumcision in the world. Circumcision is still the norm for Samoans, Tongans, Jews, and Muslims.
Spencer Beasley, professor of pediatric surgery at Christchurch Hospital, says most pediatric surgeons do not believe in doing circumcisions routinely.
But they do see medical advantages in some cases, says Professor Beasley, president of the New Zealand Society of Pediatric Surgeons.
"If some parents very strongly wanted their children circumcised, we would be happy to do that," he says. "One of the difficulties is that there are actually some advantages in being circumcised in terms of being able to clean under the foreskin. There may also be a reduced risk of getting sexually transmitted diseases."
A study of circumcision in Pacific Island families living in Christchurch found they strongly embraced the practice, as have their predecessors for the last 150 years, mostly for cultural and religious reasons.
Most circumcisions are now performed by pediatric surgeons, using both general and local anaesthetic. They cost $800 to $2000.
"They have a light anaesthetic so they don't have the trauma of the experience and when they wake up they are not in much pain," says Professor Beasley.
The Royal Australasian College of Physicians is drafting guidelines for circumcision in New Zealand and Australia.
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