Neonatal CircumcisionrnPreventive Medicine or Mutilation?rnby Thomas SzaszrnDuring most of human history, religious explanations andrnrituals imparted meaning to people’s lives and justifiedrncontrolling their conduct. Today, medical explanations and ritualsrnoften perform those functions. For example, masturbationrnand homosexuality were first forbidden on religious grounds,rnthen on medical grounds. Being a male infant is, of course, notrnbehavior. Accordingly, routine neonatal circumcision (RNC) isrnjustified—if and where it is justified—not by the subject’s behaviorrnbut by the significance his parents and society attach tornhis foreskin. Remarkably, the United States is the only modernrnWestern country in which most parents and society in generalrnview RNC as a good thing, and hence where the majority ofrnnewborn males is circumcised.rnWebster’s defines circumcision as “The cutting off of the prepucernof males being practiced as a religious rite by Jews andrnMuslims and as a sanitary measure in modern surgery” (emphasisrnadded). For Jews, the ritual removal of the infant’s foreskinrnsymbolizes his entrance into the Jewish community. Forrneducated Americans, its prophylactic removal symbolizes hisrnentrance into the community of medically enlightened persons.rnThe biblical origin of circumcision is the covenant betweenrnGod and Abraham (Genesis, 17:9): “And God said to Abraham,rn. . . ‘This is my covenant, which you shall keep, betweenrnme and you and your descendants after you: Every male amongrnyou shall be circumcised. . . . Any uncircumcised male who isrnnot circumcised in the flesh of his foreskin shall be cut off fromrnhis people; he has broken mj- covenant.” That the practice ofrncircumcision has its origin in religious ritual is so incontrovert-rnThomas Szasz is Professor of Psychiatry Emeritus at the SIJNYrnHealth Science Center in Syracuse, New York.rnible that not even the most zealous ad’Ocatcs of the procedurerntry to deny it. They do, however, try to rationalize it (much asrnpeople have tried to rationalize the Jewish dietary laws) as anrnexpression of primitive insight into its hygienic character. However,rnthere is no basis, in either religious history or medicine, forrnthis contention.rnHow and when did ritual circumcision become prophylacticrncircumcision, and why did it become especially popular in thernUnited States? For millennia, neither circumcision nor the deliveryrnof the pregnant woman was considered to be a medicalrnprocedure. The penile foreskin was regarded as a normal bodyrnpart, and pregnancy was regarded as a normal event. Womenrngave birth unassisted or were delivered by female relatives or byrninformally trained midwives. So long as that remained thernpractice, circumcision could not become a medical procedure.rnMuch has been written about the conquest of pregnancy andrndelivery for medicine, male professionals displacing female amateursrnas the sole, legally authorized providers of so-called obstetricalrnseryices. Along with this change, the place of deliveryrnwas transferred from the home to the hospital, and normalrnbirth itself became seen as a surgical intervention, supposedlyrnfacilitated by routine episiotomy. The stage was set for the routine,rnsurgical circumcision of the normal, male infant bv thernobstetrician, rationalized as prophylaxis. Against what? Thernanswer is masturbation, a plague that could be prevented asrnwell as cured by circumcision.rnVirtually all medical texts at the end of the 19th century andrnthe beginning of the 20th prescribed circumcision for a varietyrnof ills, ranging from epilepsy and hydrocephalus to malnutritionrnand tuberculosis, and confidently asserted that it was a cure forrnthe “disease” of masturbation. The following statement from arnstandard medical text published in 1887 is typical: “WhetherrnOCTOBER 1996/19rnrnrn