ellauri180.html on line 197: Baillie (1833) also describes gonococcal phimosis and recommends that the initial treatment is nugatory' (inoperative) involving the washing of the penis (and under the prepuce with soap and tepid water, followed by the application of calomel ointment. Abernathy also warns against immediate circumcision in the face of a morbidly sensitive surface' (and declares that Sir Edward Home agrees with him!). He advocates that the posthitis (inflamed foreskin) should be allowed to soothe and allay' before surgical intervention. We can assume that the complications recognized by both Abernathy and Baillie were re-phimosis, re-stricture or suppuration; what is clear is that circumcision was not a procedure taken lightly at that time. Interestingly, neither author mentions circumcision in the neonate, suggesting that it had not yet significantly entered the domain of English surgeons.
ellauri180.html on line 198: By the middle of the 19th century, anaesthesia and antisepsis were rapidly changing surgical practice. The first reported circumcision in the surgical accounts of St Bartholomew's Hospital was in 1865; although this comprised only one of the 417 operations performed that year, it was clearly becoming a more common procedure. Indeed, this was a time when surgical cures were being explored for all ails and in 1878 Curling described circumcision as a cure for impotence in men who also had as associated phimosis. Many other surgeons reported circumcision as being beneficial for a diverse range of sexual problems. Walsham (1903) re-iterates the putative association of phimosis with impotence and suggests that it may also predispose to sterility, priapism, excess masturbation and even venereal disease. Warren (1915) adds epilepsy, nocturnal enuresis, night terrors and precocious sexual unrest' to the list of dangers, and this accepted catalogue of phimotic ills' is extended in American textbooks to include other aspects of sexual erethisms' such as homosexuality.
ellauri180.html on line 224: Literary assaults such as these have served to fuel the debates and even a Medline® search today reveals that in the last year alone, 155 reviews or letters have been published arguing for or against routine circumcision. However, studying the evolution of the medical indications provides us with a pleasing demonstration of how controversy drives scientific enquiry. We have already described how the surgeons of 100 years ago advocated circumcision for a wide variety of conditions, such as impotence, nocturnal enuresis, sterility, excess masturbation, night terrors, epilepsy, etc. There can be no doubt that a large element of surgical self-interest drove these claims. However, most of the contemporary textbooks also included epithelioma (carcinoma) of the penis amidst the morass of complications of phimosis. Although rare, once this observation had been made, it presumably filtered down through the textbooks by rote, rather than scientific study. A few reports had appeared in the early 20th century indicating that carcinoma of the penis was rare in circumcised men, but not until the debate over neonatal circumcision erupted in the medical press in the 1930s that this surgical `mantra' was put to the test. In 1932, the editor of the Lancet challenged Abraham Wolbarst, a New York urologist, to prove his contention (in a previous Lancet editorial), that circumcision prevented penile carcinoma. Wolbarst responded by surveying every skin, cancer and Jewish hospital in the USA, along with 1250 of the largest general hospitals throughout the Union. With this survey, he was able to show that penile cancer virtually never occurred in circumcised men and that the risk related to the timing of the circumcision. Over the years this association has been reaffirmed by many research workers, although general hygiene, demographic and other factors such as human papilloma virus and smoking status are probably just as important. However, Wolbarst established that association through formal scientific enquiry and proponents of the procedure continue to use this as a compelling argument for circumcision at birth.
ellauri180.html on line 230: Finally, controversy has arisen over who should perform the procedure. Once circumcision had been medicalized' in the 19th century, many surgeons were keen to take paying customers away from the religious men. As such, doctors were often quick to highlight the unforseen risks attendant on a non-medical procedure. For instance, Cabot (1924) described tuberculosis of the penis occurring when Rabbis with infected sputum sucked on the baby's penis to stop the bleeding. However, it has often been claimed that the incidence of complications in Jewish children is very low and that the final result is usually better than any hospital doctor can produce.
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