QLRC: Circumcision of Male Infants

Queensland Law Reform Commission Research Paper (Queensland Law Reform Commission, Brisbane), December 1993.


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2. THE HISTORY OF MALE CIRCUMCISION

(a) Origins

The practice of circumcising3 male infants dates at least back to 2340-2180 BC. Egyptian representations of Pharaonic times show the circumcised penis. It is apparent that male circumcision had been practised in Egypt for many thousands of years.4 Because of the uniqueness of Egyptian records, it is not possible to make any conclusive statements about either the origins of male circumcision or about its spread.

In Genesis 17 of the Old Testament God is said to have directed Abraham to circumcise himself, his son and all other males in his house.5

10 -- This is my covenant, which ye shall keep, between me and you and thy seed after thee; Every man child among you shall be circumcised.

11 -- And ye shall circumcise the flesh of your foreskin; and it shall be a token of the covenant betwixt me and you.

12 -- And he that is eight days old shall be circumcised among you, every man child in your generations, he that is born in the house, or bought with money of any stranger, which is not of thy seed.

13 -- He that is born in thy house, and he that is bought with money, must needs be circumcised: and my covenant shall be in your flesh for an everlasting covenant.

14 -- And the uncircumcised man whose flesh of his foreskin is not circumcised, that soul shall be cut off from his people; he hath broken my covenant ....

23 -- And Abraham took Ishmael his son, and all that were born in his house, and all that were bought with money, every male among the men of Abraham's house; and circumcised the flesh of their foreskin in the selfsame day, as God has said unto him.

24 -- And Abraham was ninety years old, when he was circumcised in the flesh of his foreskin.

25 -- And Ishmael his son was thirteen years old, when he was circumcised in the flesh of his foreskin.

26 -- In the selfsame day was Abraham circumcised and Ishmael his son.

27 -- And all the men in his house, born in the house, and bought money with the stranger, were circumcised with him.

In the Islamic religion, Abraham was the first Prophet to be circumcised.6 Dr S N Khan states:7

Circumcision, encouraged in Islam and widely practised by Muslims, is a tradition of the Prophet and an important ritual. It is recommended that it be performed on the newborn but in some communities, it is done just before puberty.

In a submission to the Commission, it was stated:8

We wish to emphasize that Muslim parents or guardians throughout the world enjoy the right to consent to circumcision of young boys on the ground of authentic religious reasons, although some doctors may support it on purely medical grounds.

Rabbi John Levi has summarised the mainstream Jewish attitude to circumcision as:9

Jewish male children must be circumcised on the eight day of life unless there is a danger to the child's life because of the operation, in which case it may be delayed. (The traditional eight days are counted by including the first day of life: a child born on a Sunday is circumcised the following Sunday). Circumcision in Jewish life is a religious ceremony and should, if possible, be performed by a Jewish doctor who has been trained to do it and will read the appropriate religious service and name the child.

Both Jews and Muslims circumcise in accordance with Abraham's covenant with God. Most of the major religions in Australia do not promote routine circumcision or consider it to be a mandated religious practice.10

Non-religious theories of the origin of male circumcision suggest that it was practised as a punitive measure, as a puberty or premarital rite, as an absolution against the feared toxic influences of vaginal (hymeneal) blood, for other health reasons, as a mark of slavery or for cosmetic reasons.

Some claim it as diminution of human sacrifice.11

Hosken observes:12

Some anthropologists also speculate how or if the tradition of male circumcision, the removal of the prepuce, is related to cutting off the entire penis which was offered as a sacrifice to the gods. This is said to have been practiced in ancient Egypt. The custom to use the male genitals as war trophies was also widespead as reported in Middle Eastern history, and has also been recorded by the ancient Egyptians.

The Gallas, Somalis and the Abyssinians, it is related, cut the complete genital apparatus off their enemies. Some warriers offered the genitalia of their enemies as trophies to the girls they chose to marry. To use male genitalia as war trophies continues to be present in some parts of Africa; for instance it was reported in the two recent upheavals in Zaire (Biafra and Shaba Province). It was also reported in Vietnam.

Circumcision of both boys and girls came into fashion long before Islam, and was practiced in many different areas of Africa. The practice was unknown to the Romans until they conquered Egypt and the Middle East. The Copts in Egypt, and the Abyssinians (Ethiopians) have practiced circumcision of boys and girls (at a much younger age than the typical puberty rites of Sub-saharan Africans) from prehistoric times.

It is stated that both the Jews and the Arabs learned circumcision in Egypt, rather than vice versa. The rule in the Middle East, as will as in Sub-saharan Africa, is that a boy cannot get married unless he is circumcised. The same rule applied to excision [in females], which has acquired much the same rhetoric and similar, though less important, rituals as the male operation. All rituals connected with men are more important in the Middle East, as well as most of Africa because of the dominant position of men. The purpose and result of excision and infibulation [in females] are quite the opposite of the male operation, though they are often correlated, a fact which was and is not at all known to the practitioners.

... excision [in females] is practiced to affirm the sex of the individual, because it is believed that the clitoris represents a male element in a female, and the prepuce of the penis represent femininity in a boy. Hence, the girls are excised and the boys circumcised in order to establish their sex in society.

(b) Western Cultures

In a number of Western countries such as the United States of America and Australia, the practice of male circumcision for non-religious reasons became prevalent by the beginning of the twentieth century.

Within the miasma of myth and ignorance [when the aetiology of most diseases was unknown], a theory emerged that masturbation caused many and varied ills. It seemed logical to some physicians to perform genital surgery on both sexes to stop masturbation.13

In 1891 P C Remondino, MD, advocated circumcision to prevent or cure alcholism, epilepsy, asthma, hernia, gout, rheumatism, curvature of the spine, and headaches.14

During the First World War circumcision was promoted for hygiene reasons and for prevention of venereal diseases.15

In the 1930's it was considered that circumcision prevents cancer of the penis.16 In the 1950's it was claimed that cervical cancer occurs in women because their partners are not circumcised.17

In World War II male troops were encouraged to be circumcised, given limited personal hygiene facilities in overseas combat zones. Circumcision is not now encouraged unless the person presents with a medical condition indicating a need for circumcision.18

By the 1960's the majority of Australian and virtually all United States and Canadian male infants were circumcised.19

(c) Aboriginal and Islander Culture

Circumcision of boys and adolescents is also a part of Australian Aboriginal culture, at least in certain area. John Cawte notes:20

Circumcision in adolescence will probably remain a feature of Aboriginal cultural life in the Centre. It provides an occasion for social integration, personal identity, and a holiday. But changes must be expected with growing westernisation. For example, requests are being heard for the operative procedure to be carried out with proper surgical and aseptic precautions ... with retention of the elaborate tribal ritual before, during and after the surgical ceremony.

Many educated Aborigines who have grown up without undergoing the circumcision ceremony, because of Mission affliations at the time, express an uncomfortable sense of incomplete tribal responsibility and status. They are asking for the operation, even at mature ages. The European doctor who offers his service finds himself questioning whether his own culture does not circumcise at the wrong time, when the little boys are too young to appreciate the psychological and social implications of the kind that Aborigines understand very well. Certainly he will have no wish to interfere with the Aboriginal view of the procedure's proper timing.21

Money et al have described the circumcision practices of the Yoingu Aboriginal community at Arnhemland. At the age of 8 or 9 boys go through an initiation ceremony of circumcision or `dhapi':22

The ceremonial initiates among the elders carry the boy off, safe from the view of girls and women, encircling him in close formation. One of them lies on his back on the ground, the boy lying face upward upon him and pinioned in a locked embrace. Another man holds down the boy's legs. A third does the actual cutting. In ancient times a stone knife was used. Today the instrument is a razor blade. The cutting is more likely to be a series of dissection movements rather than swift incision. The boy may cry out with the pain. Immediately the foreskin is removed, the men in charge carry the boy into the bush nearby where he is passed through the smoke of a fire for spiritual cleansing. The bleeding of his penis is stopped by cauterizing with a piece of hot charcoal and the application of hot, wet leaves. He returns to his home camp-fire and there rests and recuperates about a week.

The meaning of the ceremony is, like the origin of circumcision itself, lost in the unrecorded annals of prehistory. My own theoretical guess is that is represents a substitute for, and attenuation of, a still earlier practice of human sacrifice. One may see a similarity with the way in which the symbol of the Crucifixion became a substitute for, and attenuation of the animal sacrifice of Old Testament times.

Similarly, Meggit refers to the circumcision for boys between 11 and 13 in the Walbiri people of Central Australia.

The rite of circumcision and its attendant ceremonies firmly and unequivocably establish a youth's status in Walbiri society. Should he fail to pass through these rites, he may not enter into his father's lodge, he may not participate in religious ceremonies, he cannot acquire a marriage line, he cannot legitimately obtain a wife; in short, he cannot become a social person.

Meggit also notes that:24

The Walbiri explicitly equate circumcision with ritual killing.

Subincision is performed on youths of the Walbiri people at 17 years of age. Subincision has been described by Meggit as follows:25

To the accompaniment of loud chanting by the company, the man deftly slices open the youth's penis from the meatus to a point about an inch along the urethra. An elder brother also hold the penis, to ensure that the "inside bone" is not cut, while others brothers stand ready to kill the incisor if he bungles his task. The operator withdraws immediately he makes the cut ... it is not until he is betrothed, a couple of years after he has been sub-incised that he is regarded as an adult.

(d) Current practice

Over the last two decades the popularity of neonatal circumcision has decreased.26 By 1980 only 40 percent of Australian male babies were circumcised.27

It is unclear what the current rate of circumcision is in Australia, although estimates range from 25 per cent28 to 35 per cent.29

CIRP logo Note:

The Australian College of Paediatrics, Parkville, Vic., reported that in 1995-96 the incidence of male circumcision from birth to age 6 mos. ranged from a low of 5.4 per cent in Victoria to a high of 17.2 per cent in Queensland with the all Australia incidence being 10.6 per cent.

The number of circumcisions qualifying for Medicare reimbursement in Australia has remained fairly static over the last 5 years30 and may have actually decreased slightly on a per capita basis, given the increase in the number of live births over that time.

The highest proportion of circumcisions Australia-wide and in Queensland were performed on infants less than 6 months of age, which suggests that they were performed for religious, cultural or perceived prophylactic purposes.31 Relatively few circumcisions are performed on public patients in public hospitals in Queensland. Some public hospitals have adopted a policy of not performing routine neonatal circumcisions. When circumcisions are performed in public hospitals, they tend to be performed on older children.32 This may indicate a reluctance to circumcise newborns. It could also indicate a medical need to circumcise older infants.

In the United States, circumcision rates remain high at between 50 - 75 per cent.33 It has been estimated that between 75 per cent34 and 85 per cent of the world's male population are not and will not be circumcised.35 In most European countries circumcision is not a routine approved procedure.

CIRP logo Note:

The US government statistics show an overall rate of 60.2 per cent for 1996. The rate varied from a high of 80 per cent in the Mid West to 35 per cent in the West.??

References

  1. Circumcision, also referred to as prepucectomy, is the removal of the prepuce (foreskin) from the penis. See pp 11,12 below.
  2. Hosken F. The Hosken Report: Genital and Sexual Mutilation of Females (1982), at 51. There is speculation that female circumcision started in the same area as a parallel to the male operation or at puberty, although it is probably true to say that male circumcision is performed in many more societies than female circumcision, both in the past as well as the present. See Queensland Law Reform Commission Female Genital Mutilation Research Paper December 1993.
  3. The Holy Bible, The British and Foreign Bible Society. Historians have dated the covenant back to 1713 BC. But note The Epistle of Paul the Apostle to the Galatians. The Holy Bible, The British and Foreign Bible Society, Chapter 6 Verses 12-16:

    12 -- As many as desire to make a fair shew in the flesh, they constrain you to be circumcised; only lest they should suffer persecution for the cross of Christ.

    13 -- For neither they themselves who are circumcised keep the law; but desire to have you circumcised that they may glory in your flesh.

    14 -- But God forbid that I should glory, save in the cross of our Lord Jesus Christ, by whom the world is crucified unto me, and I unto the world.

    15 -- For in Christ Jesus neither circumcision availeth anything, nor uncircumcision, but a new creature.

    16 -- And as many as walk according to this rule, peace be on them, and mercy, and upon the Israel of God.

  4. Pridie ED, Lorenzen AE, Cruckshank Dr A, Hovell JS, and MacDonald DR. Female Circumcision in the Anglo-Egyptian Sudan (1945) from the Foreword by Skeikh Ahmed-El-Taher (The Mufti of the Sudan) referred to in Hosken F, The Hosken Report: Genital and Sexual Mutilation of Females (1982), at 5.
  5. Khan SN. The Islamic Viewpoint. Australian Family Physician, Vol 15 No 2, February 1986, 179.
  6. Islamic Council of Queensland.
  7. Levi JS. Religion and Medicine: Jewish Medical Ethics. Australian Family Physician, Vol. 15 No. 3, January 1986, 17 at 18.
  8. For example: Read H. The Salvation Army Viewpoint. Australian Family Physician Vol 15 No 3 May 1986 at 574.

    Circumcision is neither required nor prohibited by the Salvation Army; it is a matter for parents to decide. Circumcision is not under taken as a religious ritual ....

    Manning KM. A Catholic Viewpoint. Australian Family Physician Vol 15 No 4 April 1986 493 at 496:

    No great importance is attached to this in Christian tradition. Reasons such as hygiene justify its use.

    McClean D. Jehovah's Witnesses. Australian Family Physician Vol 15 No 6 June 1986 772.

    While circumcision was mandatory for Israelite males, it is not seen as applying to Christians but couples may have their child circumcised if they wish.

    Baliozian A. Armenian Church. Australian Family Physician Vol 15 No 8 August 1986 1024:

    Generally [circumcision] is opposed by the Church but accepted if a medical practitioner decides it is for the patient's benefit.

    Ewers GA. Churches of Christ. Australian Family Physician Vol 15 No 8 August 1986 1024:

    Few members, if any, would have objection to ... circumcision although there is no stated policy on these things.

    Archbishop Styllanos. Greek Orthodox. Australian Family Physician Vol 15 No 8 August 1986 1024-1025:

    Circumcision and the like constitute individual issues in Christian ethics and cannot be answered a priori, that is to say, without bearing in mind the person they relate to.

  9. See Milos MF and Macris D. Circumcision: A Medical or a Human Rights Issue? Journal of Nurse-Midwifery Vol 37 No 2 1992 at 875.
  10. Hosken F. The Hosken Report: Genital and Sexual Mutilation of Females 1982 at 55.
  11. Wallerstein E. Circumcision: the uniquely American Medical Enigma. Urological Clinics of North America 12(1) [1985]: 123-32. referred to in Milos MF and Macros D Circumcision: A Medical or Human Rights Issue? Vol 37 No 2 1992 Journal of Nurse-Midwifery at 875.
  12. Romandino (sic; should be Remondino) History of Circumcision from the earliest times to the present. Philadelphia: Davis, 1891 [Republished New York AMS Press 1974] 161-82.
  13. Surgeon-General's Office Canberra. Also, Milos MF. Body Ownership Rights of Children: the Circumcision Question (1992) American Atheist at 50.
  14. Wolbarst AL. Circumcision and Penile Cancer. Lancet Vol 1 (1932), at 150-153.
  15. Wynder EL et al. A study of environmental factors in carcinoma of the cervix. American Journal of Obstet. Gynecol. Vol 68(84) 1954 1016-1046; referred to in Milos MF, Macris D Circumcision: A Medical or a Human Rights Issue?
  16. Surgeon General's Office, Canberra.
  17. Leitch IOW. Circumcision - A Continuing Enigma Australian Paediatric Journal Vol 6 (1970), 59 at 63.
  18. Cawte J. Social Medicine in Central Australia: The Opportunities of Pitjantjara Aborigines. The Medical Journal of Australia (February 3, 1977), 221 at 227.
  19. Cawte also refers to the practice of subincision (described at p. 10 below). id at 227: Subincision is another matter; this is going a little far for European tastes; a subincised man makes a mess by spraying rather than squirting in toilets and urinals.
  20. Money J, Cawte JE, Bianchi GN, Nurcombe B Sex Training and Traditions in Arnhemland British Journal Med. Psychol. Vol 43 1970 383. See also Gray D A Revival of the Law: The Probable Spread of Initiation Circumcision in Religion in Aboriginal Australia: An Anthology 1986 at 419.
  21. Meggitt MJ. Initiation among the Waibiri in Religion in Aboriginal Australia: An Anthology (1986), at 241.
  22. Id at 253. At 261 Meggit describes the operation: A brother seizes the novice and places him face upward on the table, with his feet toward the fire. Another brother straddles him and presses his pubes against the lad's face to silence his cries, while a third grips his legs. A brother holds the shaft of the boy's penis, in order to protect `the inside bone' from injury; one of the circumcisers stretches the foreskin several inches, and another cuts it off with two or three quick slices. The rest of the brothers watch closely for it is there duty to kill the operator at once if he mutilates the boy. (it is small wonder that some men are literally grey with anxiety when they perform the their first operation.)
  23. Id at 265-256. Subincision has been abandoned in a number of communities. See Gray DA. Revival of the Law: The Probable Spread of Initiation Circumcision in Religion in Aboriginal Australia: An Anthology (1986), at 432-433. See also: Pounder DJ. Ritual Mutilation: Subincision of the Penis in Australian Aborigines The American Journal of Forensic Medicine and Pathology, Vol 4 No 3 (Sept 1983), 227.
  24. Although this is not evident from the small but seemingly increasing numbers of circumcisions performed in public hospitals on public patients in Queensland. See Appendix 2.
  25. Wirth JL. Current Circumcision Practices in Australia Medical Journal of Australia, Vol 1 (1982), at 177-179.
  26. Little K. Circumcision: Pros and Cons Modern Medicine, (September 1992), 37. Williams G. Newborn Circumcision - An Enigma of Health Paper delivered to the Second International Homebirth Conference 4-7 October 1992, Sydney.
  27. Little K. Circumcision: Pros and Cons Modern Medicine (September 1992), 37 suggests a total rate for Australia of approximately 30 to 35%: Overall there has been a slow but consistent decrease in the number of children being circumcised, and this trend is expected to continue into the future.
  28. See Appendix 1.
  29. See Appendix 1. The number of circumcisions performed on infants under 6 months of age in 1988/89 for which Medicare provided a reimbursement was 14,674. In 1992/93 the number 14,604. In 1988 there were 126,223 live male births in Australia. In 1992 there were 135,601 live male births. The number of infant circumcisions per live male births has decreased in that period from 11.6% to 10.76%.
  30. The most recent available figures, provided by the Health Information Services Unit of Queensland Health on 26 November 1993 are set out in Appendix 2. In 1988 15 babies under 6 months of age were circumcised as public patients in public hospitals. This rose to 77 (preliminary figures in 1991. For infants 6 months to 10 years of age, 250 were circumcised in 1988 and 304 in 1991.
  31. Schoen E. The Status of Circumcision in Newborns The New England Journal of Medicine 1990:1308, Williams G. Newborn Circumcision - An Enigma of Health Paper delivered to the Second International Homebirth Conference, 4-7 October 1992, Sydney.
  32. Williams G. Newborn Circumcision - An Enigma of Health Paper delivered to The Second International Homebirth Conference, 4-7 October 1992, Sydney.
  33. Milos MF and Macris D. Circumcision: A Medical or Human Rights Issue? Journal of Nurse-Midwifery, Vol 37 No 2 (1991): 875 at 905. See also Hirst G. Controversies Surrounding Circumcision Patient Management (September 1984 at 12 who suggests that a maximum of only 3 per cent of the world's population were subjected to routine circumcision at its peak incidence.

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