How did the practice of circumcision spread in the United States in the late 1800s?

1. How a religious ritual became a medical trend that doctors recommended

In the late 1800s American physicians recast circumcision from a primarily religious rite into a medicalized intervention, arguing that removal of the foreskin reduced infection risk and improved hygiene. Medical literature and professional advocacy pushed this reframing by citing contemporary understandings of disease transmission and by portraying the foreskin and its secretions as potential sources of infection. This movement aligned with hospital births and the professionalization of obstetrics, putting surgical procedures like neonatal circumcision on the menu of routine medical care. Critics note that this shift involved powerful cultural assumptions about cleanliness and modernity as much as clinical evidence, and that financial and institutional incentives for doctors likely accelerated adoption ^{[3] [2]}.

2. The Sayre effect: a single doctor's dramatic influence on practice

Dr. Lewis A. Sayre, an eminent orthopedic surgeon, played an outsized role in popularizing circumcision by promoting the notion of “reflex genital irritation” as a cause of paralysis and hip disease in boys, asserting that circumcision relieved these conditions. Sayre’s clinical anecdotes and public reputation lent authority to a procedure whose mechanistic rationale lacked rigorous proof. His advocacy sparked debate within the medical community but also encouraged other physicians to view circumcision as therapeutic rather than purely ritual. This personal championing demonstrates how influential clinicians could shift standards of care by coupling striking clinical claims to prevailing anxieties about childhood illness and disability ^{[2] [5]}.

3. Victorian moral panic and the medical case against masturbation

Victorian-era concerns about masturbation—seen as a moral failing and medical hazard—provided a powerful cultural rationale for circumcision’s spread, with doctors and moralists claiming the procedure reduced sexual stimulation and therefore prevented a host of illnesses. This moral-scientific framing merged with emerging medical theories to portray circumcision as preventative medicine, not merely surgery. The linkage of sexuality, hygiene, and disease allowed circumcision to be presented as protecting both bodily health and moral character, reinforcing its appeal to parents anxious about raising “proper” children. The result was a popular intervention promoted by both medical authority and cultural anxieties, despite weak empirical backing ^{[6] [4]}.

4. Germ theory, hygiene, and claims of infectious danger

The ascent of germ theory reframed many body conditions as preventable infections, and circumcision proponents argued that smegma and the foreskin could harbor pathogens, making removal a logical hygienic measure. This scientific language provided a veneer of modernity and objectivity to what had previously been culturally motivated practice. Medical publications of the era used this framework to justify neonatal circumcision as part of the broader medicalization of childbirth and infant care. However, subsequent historical analyses emphasize that early claims about infection risk were often speculative and that the linkage between foreskin flora and generalized disease lacked robust data at the time ^{[3] [7]}.

5. Institutional momentum, financial interest, and the road to routine practice

Beyond ideas and ideologues, practical incentives boosted circumcision’s diffusion: hospitals increasingly performed deliveries, surgeons profited from procedures, and professional norms hardened as more practitioners adopted the practice. The combination of financial motives and institutional routines converted circumcision into a common hospital procedure by the early 20th century. Historians caution that medical endorsements were not entirely evidence-based but reflected broader patterns in which profitable, institutionally convenient interventions become normalized. This dynamic helps explain why circumcision rates rose steeply even without conclusive randomized data supporting the many claimed benefits touted in the late 1800s ^{[3] [8] [7]}.

6. Conflicts, agendas, and how historians weigh competing explanations

Scholars identify multiple, overlapping drivers—charismatic clinicians like Sayre, Victorian sexual morality, germ-theory hygiene, economic incentives, and professionalization of obstetrics—each emphasized differently by sources with varied agendas. Medical proponents of circumcision often framed their case around public health and therapeutic necessity, while later critics highlight moral panic and financial motives. The historical record shows no single cause but a confluence of scientific rhetoric, cultural anxieties, and institutional incentives that together produced rapid adoption in the United States by the turn of the century. Close reading of contemporary and retrospective accounts reveals how claims of cure and prevention served both professional authority and broader social aims ^{[1] [4] [5]}.