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How did 19th-century medical theories (e.g., antisepsis, masturbation prevention) influence circumcision adoption in the US and Europe?
Executive summary
Nineteenth‑century medical theories — especially antisepsis/anesthesia that made surgery safer and antimasturbation moral‑medical crusades — were central to turning circumcision from a primarily religious rite into a routinized medical intervention in parts of the Anglophone world; leading advocates argued it prevented “smegma”‑linked disease, venereal illness, and masturbation [1] [2]. At the same time historians show competing motives — class‑status signaling, professionalization of surgery, and public‑health rhetoric — so the medical argument was rarely the only driver of adoption [3] [4].
1. Medicine made circumcision practicable — antisepsis, anesthesia and surgical zeal
The adoption of antisepsis and anesthesia in the mid‑ to late‑1800s “dramatically lowered the threshold for using the scalpel,” creating an environment in which previously rare surgical procedures could be proposed for routine infants and children [5]. Medical historians note that once surgery became safer and hospitals promoted interventions, doctors were able to medicalize circumcision and perform it as part of hospital birthing practices — a shift documented for the United States and other Anglophone countries [6] [1].
2. Masturbation panic: a moral panic recast as medical rationale
A powerful strand of nineteenth‑century medical theory held that masturbation caused a wide range of moral and physical ills; many physicians advocated circumcision as a prophylactic to reduce sexual stimulation or curb “masturbatory” behavior in boys [7] [8]. Contemporary surveys of the historiography show this rationale was explicit and widespread in medical and child‑care manuals from the 1860s well into the early 20th century [9] [10].
3. Germ theory and the demonization of the foreskin
The rise of germ theory fed a new hygiene rationale: surgeons and public‑health writers described smegma and the unretracted prepuce as “pathogenic,” arguing that removal reduced infections and venereal disease risk [1] [2]. This allowed proponents to recast a moral intervention as preventive medicine — an argument pushed in influential texts and by physicians who urged routine neonatal circumcision [4] [11].
4. Professional and social incentives: doctors, class and the “civilized” body
Medicalization also served professional and social ends. Surgeons benefited financially and reputationally as they claimed the domain of ritual procedures; middle‑class families adopted circumcision to mark modern, “civilized” childrearing and distance themselves from immigrant or lower‑status groups [1] [3]. Historians link uptake in the U.S. to social signaling as much as to pure clinical evidence [3] [4].
5. Diverging European trajectories and lingering medical debates
While English‑language countries embraced routine circumcision in late 19th–early 20th centuries, many continental European medical bodies were more skeptical and later abandoned nonreligious circumcision — a split reflected in differing modern prevalence rates and professional positions [11] [12]. Medical critiques of the reflex neurosis/masturbation theories gained traction in Britain and elsewhere after 1900, producing more debate and gradual decline in routine use [13] [14].
6. Long‑term effects: routine practice, later reassessments and new rationales
Once established, routine circumcision persisted for decades even after the original mechanistic theories (reflex neurosis; antimasturbation) fell from favor; supporters later emphasized other health claims (reduced UTIs, lower HIV/HPV acquisition risk) while opponents stressed bodily integrity and lack of consent [1] [15]. Modern public‑health endorsements in some jurisdictions rest on later epidemiological findings rather than nineteenth‑century moral theories [15] [16].
7. Limits of current reporting and contested interpretations
Available sources agree that antisepsis/anesthesia and the antimasturbation movement were important catalysts [5] [8], but they also show multiple, sometimes competing motives — class, professionalization, religion and hygiene — and disagree about which was primary in each setting [4] [3]. Sources do not provide a single causal graph tying specific policy decisions in every country to one theory; regional differences and the role of individual advocates (e.g., Remondino, Sayre) complicate any simple narrative [4] [17].
8. What to watch for in further reading
To deepen this account, consult historical monographs cited in these reviews (e.g., David Gollaher) and archival medical journals that record contemporaneous arguments for and against routine circumcision; the historiography contains extended debate over motives and the empirical weight of early claims [1] [10]. Available sources do not mention detailed quantitative links between the arrival of antisepsis/anesthesia and exact increases in circumcision rates by year in every country — that granular data is not in the current reporting (not found in current reporting).