CRImes

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GenItal mutIlatIon

METAMORPHOSIS
- from Pain to Pleasure .

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PUBLISHER The Truth Seeker Co., Inc. PRESIDENT Bonnie Lange EDITOR James W. Prescott GUEST CO-EDITOR Marilyn Fayre Milos EDITORIAL BOARD Gareth Branwyn, Edd Doerr Robert T. Francoeur, Roger E. Greeley John Holmdahl, Barbara Honegger Lillian Starr, Gordon Stein GRAPHIC ARTISTS David Mettey Debbie Mitchell

In this issue of THE TRUTH SEEKER we are addressing the irrational forces of religion and social customs that support the torture of children (male and female) through the mutilation of their genitals; and which oppose sexual pleasure. There could hardly be a better issue for FREETHINKER's support and involvement. As science supported the truth that Galileo discovered, so too does science support the truth of the incalculable injury, pain and suffering that is needlessly inflicted upon children through the dogma of irrational religious beliefs that dictate genital mutilations. No religion has the right to engage in torture, mutilation or human sacrifice, yet all of these have been justified through religious beliefs at one time or another. Tragically, the mutilation and torture of children continues today in "primitive" and so-called "civilized" countries through the rituals of circumcision and other forms of genital mutilation. In order to bring an end to this torture and mutilation of children the First International Symposium On Circumcision was held on March 1-3, 1989 in Anaheim, California. Leading authorities in these various medical, scientific, legal and religious disciplines summarized their state-of-the-art findings that unequivocally rejected and condemned the ritual mutilation of the genitals of children. Of particular significance was the finding that the destruction of sexual passion and pleasure was a common motive for genital mutilation in both tribal and religious belief systems. The control of sexual passaion and pleasure in both males and females was considered essential for personal morality and social order. Additional scientific evidence was summarized that established a strong causal relationship between deprivation of physical affectional relationships, including the sexual relationship, with violent and authoritarian behaviors and cultures. These deeply rooted moral value systems were recognized as a significant barrier to social change. A Metamorphosis from a pain/violent valued society to pleasure/peaceful valued society, where women are truly equal with men, was considered essential if the genital mutilation of children and other forms of human violence are to be eliminated.
TH E TR UTH SEEKER is privileged and honored to be the first to publish the core proceedings ofthis International Symposium that provides for the first time, in a single document, the leading medical, scientific, legal and religious thinking on the ritual genital mutilation of children. It is through the pioneering efforts of Marilyn Fayre Milos, R.N., Director, National Organization ofCircumicision Information Resource Centers (NOCIRC) that made this International Symposium possible and who has agreed to serve as a Guest Co-Editor for this issue of THE TR UTH SEEKER.

PRI TER United Printing Services
ADDRESS The Truth Seeker P.O. Box 2832 San Diego, California 92112-2832 SUBSCRIPTION RATES Single Issue: $ 4.00 Yearly: $20.00 International $25.00

Because of the complexity of this subject matter some of the essays are more technical than usual, as is the length of this Special Edition of THE TRUTH SEEKER. It is the objective of this edition of THE TRUTH SEEKER to provide unequivocal scientific and moral evidence to health professionals and political/ religious leaders of the world that would help bring an end to the genital mutilation of children worldwide. Your support in this quest is invited and how you can help is outlined in "A Call For Action" and on pages 53-54.

FRONT COVER: Circumcision was practiced in Egypt as long ago as 4000 B. C. According to the inscription on this bas-relieffrom the Ankh-Mahor tomb at Sakkara, the youth balks and must be held by the doctor's aide. Adopted from: Sixth Dynasty basrelief from the tomb of Ankh-ma-hor at Saqqara.

Freethinker's Publication Since 1873

A Bimonthly Journal of Free Thought and Inquiry

FEATURE ARTICLES
Religious-PsychologicalPerspectives:
3 4 9 14 INFANT CIRCUMCISION: "WHAT I WISH I HAD KNOWN RELIGIOUS TRADITIONS AND CIRCUMCISION THE GEOGRAPHY OF GENITAL MUTILATIONS GENITAL PAIN VS GENITAL PLEASURE: WHY THE ONE AND NOT THE OTHER? Marilyn Fayre Milos Gerald A. Larue James DeMeo James W. Prescott

Social-Cultural Perspectives:
22 31 FEMALE GENITAL MUTILATIONSTRATEGIES FOR ERADICATION EPIDEMIOLOGY OF FEMALE SEXUAL CASTRATION IN CAIRO, EGYPT Fran P. Hosken Mohamed Badawi

Medical Perspectives
35 39 43 46 FIRST, DO NO HARM THE PROBLEM OF CIRCUMCISION IN AMERICA CULTURAL BIAS AND THE URINARY TRACT INFECTION (UTI) CIRCUMCISION CONTROVERSY LETTERS '" George C. Denniston James L. Snyder Martin Altschul

Paul M. Fleiss; David S. Bate & John A. Erickson

Legal Perspectives
47 50 THE FIRST CIRCUMCISION CASE NEWBORN CIRCUMCISION RESOLUTION Richard W. Morris John W. Hardebeck

PHILOSOPHICAL/SOCIAL TRANSFORMATIONS
51 52 52 53 54 TESTIMONY AGAINST CIRCUMCISION DECLARATION OF THE FIRST INTERNATIONAL SYMPOSIUM ON CIRCUMCISION CIRCUMCISION NIGHTMARE A Case Report UNIVERSAL DECLARATION ON CIRCUMCISION, Resolution of The First EXCISION AND INCISION International Symposium On Circumcision AN ACT TO PROHIBIT GENITAL MUTILATIONS A Citizen's Petition James L. Snyder

DEPARTMENTS
55 56 SUPERIOR MEN. Chapter IV ACKNOWLEDGEMENTS AND RESOURCES James Hervey Johnson

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CAll FOR ACTioN Hence He Who Values His Body More Than Dominion Over the Empire Can Be Trusted With The Empire

The greatest crime against humanity is the torture and mutilation of children. Child abuse and neglect, particularly in its extreme forms, represents a form of torture and mutilation. Not commonly recognized as child abuse and neglect and a form of torture and mutilation is the ritual mutilation of genitals of children (male and female). One reason for the non-recognition of these crimes of genital mutilation and torture of children is their common occurrence and their support by religious and social traditions of various kinds. Another reason is the denial and/ or indifference to the pain that is being inflicted upon these children. This edition of THE TR UTH SEEKER provides critical information on the truth of genital mutilations with dramatic illustrations of the horrors that children experience when their genitals are mutilated. The long-term devastating consequences ofthis torture and mutilation upon the lives of these children are also reviewed.
It is the intent of this edition of THE TRUTH SEEKER in conjunction with the NATIONAL LEAGUE FOR SEPARATION OF CHURCH AND STATE; the NATIONAL ORGANIZATION OF CIRCUMCISION INFORMA T10N RESOURCE CENTERS (NOCIRC); and the WOMEN'S INTERNATIONAL NETWORK NEWS to inform the world of these atrocities and to bring an end to the genital mutilation of children worldwide.

He Who Loves His Body More Than Dominion Over The Empire Can Be Given Custody Of The Empire

Lao Tzu Tao Te Ching Book One, XIII:31

Our strategy is to petition the World Court, The Hague, through a national government, to have declared that all genital mutilations of children are violations of Article V, United Nations Declaration of Human Rights which states: i'NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL INHUMAN OR DEGRADING TREATMENT OR PUNISHM ENT" (see p. 53). All professional, health, scientific and freethought organizations that are concerned with the well-being of children are requested to place this resolution on their agenda at their next annual meeting for endorsement. These completed endorsements will be submitted to the World Court in support of the petition to end the genital mutilation of children worldwide. A second effort will be directed at the State Legislatures to inform them of the child abuse nature of genital mutilations and that such genital mutilations constitute an act of torture of children. Appropriate legislation will be sought to end these crimes against children. Readers of THE TRUTH SEEKER, professional, health, scientific and freethought organizations concerned with the well-being of children are urged to endorse the citizen's petition to State Legislatures to bring an end to the genital mutilation of children. (see p. 54). Your individual and collective support of NOCIRC, The Womens International Network News and the National League For the Separation ofChurch and State to achieve these objectives is invited. Be not ashamed, woman - your privilege encloses the rest, and is the exit, of the rest; You are the gates of the body, and you are the gates of the soul.

Walt Whitman I Sing the Body Electric James W. Prescott
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JULY/AUGUST 1989

Infant Circumcision: "What I Wish I Had Known"
by Marilyn Fayre Milos
I didn't know what circumcision was when I consented to hllVe my three sons circumcised. My doctor had told me the surgery was a necessary health measure, that it didn't hurt, and that it only took a moment to perform ... like cutting the umbilical cord, I thought. I certainly wasn't prepared when, in nursing school several years later, I saw the surgery for the first time. We students filed into the newborn nursery to find a baby strapped spread-eagle to a plastic board on a counter top across the room. He was struggling against his restraints - tugging, Whimpering, and then crying helplessly. No one was tending the infant, but when I asked my instructor if I could comfort him she said "Wait till the doctor gets here." I wondered how a teacher of the healing arts could watch someone suffer and not offer assistance. I wondered about the doctor's power which could intimidate others from following protective instincts. When he did arrive, I immediately asked the doctor it I could help the baby. He told me to put my finger into the baby's mouth; I did, and the baby sucked. I stroked his little head and spoke softly to him. He began to relax -and was momentarily quiet. The silence was soon broken by a piercing scream - the baby's reaction to having his foreskin pinched and crushed as the doctor attached the clamp to his penis. The shriek intensified when the doctor inserted an instrument between the foreskin and the glans (head of the penis), tearing the two structures apart. (They are normally attached to each other during infancy so the foreskin can protect the sensitive glans from urine and feces.) The baby started shaking his head back and forth - the only part of his body free to move - as the doctor used another clamp to crush the foreskin lengthwise, which he then cut. This made the opening of the foreskin large enough to insert a circumcision instrument, the device used to protect the glans from being severed during the surgery. The baby began to gasp and choke, breathless from his shrill continuous screams. How could anyone say circumcision is painless when the suffering is so obvious? My bottom lip began to quiver, tears filled my eyes and spilled over. I found my own sobs difficult to contain. How much longer could this go on? Duringthe next stage of the surgery, the doctor crushed the foreskin against the circumcision instrument and then, finally, amputated it. The baby was limp, exhausted, spent. I had not been prepared, nothing could have prepared me, for this experience. To see a part of this baby's penis being cut off - without an anesthetic - was devastating. But eyen more shocking was the doctor's comment, barely audible several octaves below the piercing screams of the baby, "There's no medical reason for doing this." I couldn't believe my ears, my knees became weak, and I felt sick to my stomach. I couldn't believe that medical professionals, dedicated to helping and healing, could inflict such pain and anguish on innocent babies unnecessarily. What had I allowed my own babies to endure? and why?
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The course of my life was changed on that day in 1979. I have now dedicated my life to bringing an end to this horrendous practice.
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Copyright 1988, Reprinted with permission of the author. Marilyn Milos is the mother of three circumcised boys, grandmother of one intact child and is the Director of the National Organization of Circumcision Information Resource Centers. She has spoken widely and is frequently featured on radio and television shows across the United States, including the Phil Donahue Show. Her work has been covered by numerous newspapers and magazines, from the New York and London Times to small-town papers. On April 9, 1988, the California Nurse's Association Region 9 presented Marilyn Milos, R.N. with its highest honor, the Maureen Ricke Award, "for her dedication and unwavering commitment to righting a wrong" and for her work on the behalf of children "to raise public consciousness about America's most unnecessary surgery."
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:: :: IF ANYTHING IS SACRED THE HUMAN BODY IS SACRED
Walt Whitman The Children of A dam

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Religious Traditions and Circumcision
by Gerald A. Larue

Just when and why circumcision was first practiced in the ancient Near East is not known, but it was widely attested in antiquity.
The practice of the painful mutilation of the foreskins of infant males in A merica rests upon biblical and religious traditions plus spurious medicalfiction (prevention ofpenile infection, penile cancer, cervical cancer in partners of uncircumcised males). It is my intention to examine the biblical background for the practice of circumcision.
Just when and why circumcision was first practiced in the ancient Near East is not known, but it was widely attested in antiquity. Bodies from 4000 Before the Common Era (B.C. E.) exhumed in Egypt disclose evidence of circumcision (Breasted. 353, p.IO). Ancient Egyptian art, on those occasions when the genitals of Egyptian males were depicted, provide pictorial evidence of male circumcision. For example, the carpenter portrayed in a Sixth Dynasty (2350-2000 B.C. E.) tomb at Saqqara with his loin cloth pulled to the rear clearly reveals his circumcised penis. (Figure I) A relief from the Sixth Dynasty tomb' of Ankh-ma-Hor at Saqqara portrays the circumcision of two puberty-aged youths. (Figure 2) A mortuary priest squats on his haunches before one standing youth whose hands are firmly held by an assistant. In the left hand, the priest holds the boy's penis and in the right is what appears to be a circular flint with which he is removing the prepuce. The priest says to his assistant, "Hold him and don't let him faint. "The assistant responds, "I will do as you request."

The second youth also stands before a squatting mortuary priest (Figure 3). H is left hand rests on the priest's head; the right hand is by his side. He says to the priest, "Thoroughly rub off what is there." The priest who holds the penis in his left hand and is prepared to operate with the large flint knife (Figure 4) held in his right hand, responds, "( will cause it to heal." Two separate individuals seem to be represented, but it has been suggested that perhaps two stages of the rite of circumcision are being portrayed.

Figure 2: Circumcision ritual.

A stele from the 23rd century B.C.E. indicates that Uha, the author, was circumcised in a mass ritual. He wrote: When 1was circumcised, together with one hundred and twenty men, there was none thereof who hit out, there was none thereof who was hit, and there was none thereof who scratched and there was none thereof who was scratched. (Wilson, Circumcision)

However, not all Egyptians were circumcised.
The fact that one youth in the Sakkara relief is being held suggests that it was not uncommon for a youth to faint or perhaps to flail violently during the operation. Uha indicates that during the mass circumcision ceremony, the participants reacted without any untoward physical responses. Herodatus, who visited Egypt in the fifth century B.C.E., reported that "they practice circumcision for the sake of cleanliness, for they place cleanliness before comeliness" (II, 37). A mythological reference in Chapter 17 of the Egyptian Book of the Dead states that the sun-god Ra circumcised himself and that from the drops of blood two protective deities came into being, so that perhaps there was a prophylactic symbolism in the Egyptian practice. However, not all Egyptians were circumcised. X-rays of the mummy of the Eighteenth Dynasty Pharaoh Ahomse (16th century B.C.E.) prove that he was not circumcised. It is possible that his successor, Amenhotep I, also was uncircum(Col1linued on nex( page)

Figure 1: Circumcised carpenter

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Religious Traditions and Circumcision (Continued)
Circumcision was practiced by some Semitic groups.
cised (Harris, Weeks, 126-130). It has also been suggested that although circumcision was common among the upper classes and may be recognized as a puberty rite, it was not a requirement. The poorer, common folk did not necessarily undergo circumcision. folk-tale (written prior to Genesis 17) associated with Moses: Then it happened, at a stopping place along the way. that Yahweh met him (Moses) and tried to kill him. Then Zipporah (M oses' M idianite wife) took a piece of Oint and cut off her son's foreskin and touched his feet (genitals) with it, saying. "You are my blood-bridegroom." So he let him alone. At that time she said "blood-bridegroom" in reference to circumcision. (Exod. 4:24-26). This strange insertion into the fenth cenfurr B.C.£. temple fiction about Moses suggests that circumcision became Hebrewcustom through contact with the Midianites. Yahweh's demonic intention to kill Moses was magically thwarted by the rite of circumcision performed on the infant son (the beginning of infant circumcision')). Pcrhaps the reference to "blood-bridegroom" reOects the custom of circumcision bcfore marriage. Just as t he vi rgi n bride would lose her hymen. testified to by bloody wedding-night sheets (Deut. 22: 13-19), the removal of the prepuce would be the groom's parallel loss. Just how the Hebrew word for father-in-law which means, literally, "the circumciser" may be related to pre-marital circumcision is not known. The reference to the use of a Oint blade in an age when copper, bronze and iron were known and used, suggests the antiquity of the ritual and may indicate a link to the Egyptian custom of using Oint tools for circumcision. Figure 4: Flint blade from A seventh century about 3000 B.C.E. B.C. E. reference to circumcision, which also refers to the use of a Oint cutting tool, appears in biblical conquest-of-Palestine fiction:

Assyrians and Babylonians were not circumcised. Nor were the Philistines who are derogatively defined in the Bible as "the uncircumcised"...
Circumcision was practiced by some Semitic groups. Jeremiah, in the seventh century, included Edomites, Ammonites and Moabites as among the circumcised (9:25). Assyrians and Babylonians were not circumcised. Nor were the Philistines who are derogatively defined in the Bible as "the uncircumcised"(Judg. 14:3; 15:18; I Sam. 14:6, etc.) An eleventh century B.C. E. ivory from Megiddo, portrays a ruler, seated on his throne between cherubim (Figure 5). Among those in the approaching procession is a soldier leading two nude captives, presumably Semites, both of whom are circumcised. (Figure 6)

N or is it possible to know for certain just why or how circumcision originally came into being.

Figure 3: Circumcision rite
Herodatus suggested that other peoples, including the Jews, borrowed the custom from the Egyptians (II, 104), but there is no way to verify this statement. Nor is it possible to know for certain just why or how circumcision originally came into being.

Circumcision in the Jewish Scriptures
The earliest reference to circumcision in the Bible is in a
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Yahweh's demonic intention to kill Moses was magically thwarted by the rite of circumcision performed on the infant son (the beginning of infant circumcision?).
(Conlinued on nex/I}{/Ke)

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JULY/ AUGUST 1989

Re/(f{ious Traditions and Circumcision (Continued)
Certainly, there could be no significance to a massive pile of foreskins!
At that time Yahweh said to Joshua, "Make yourself flint knives and squat down and circumcise the people of Israel for a second time." So Joshua made flint knives and circumcised the people of Israel on the hill of foreskins. (Josh. 5:2-3) Subsequent verses form an apologia explaining that the reason the Hebrews had not been circumcised was that for forty years they had been wandering in the desert wilderness. Now, in an ethnic ritual, they would affirm their cultural unity as a circumcised people. The reference to the squatting or sitting position (based on the Greek Septuagint rather than the Hebrew Mascretic text), the use ofa flint tool and the fact ofa mass circumcision, once again ties the custom to ancient Egypt. The site of the rite at Gilgal may indicate a hillock where mass circumcision rituals were enacted. Certainly, there could be no significance to a massive pile of foreskins! Although it is not specified, it may be assumed that all males were circumcised at this time - both adult and infant.

The Abrahamic covenant, invented by priests, transformed circumcision from an ethnic custom into a theological divinely ordained legal requirement.
their inclusion in the divine promises. Failure to circumcise or be circumcised marks a breach of the covenant. The story concludes with the 99-year-old Abraham circumcising himself, his son Ismael, who was 13 years old, and all male members of his extended household. A year later, when 90-year-old Sarah bore Isaac, Abraham had the boy circumcised on the eighth day (Gen. 21 :4). During the last quarter of the fourth century S.C E., Alexander the Great conquered the ancient Near East and he and his successors introduced Greek customs and culture into the expanded empire. One of the innovations was the gymnasium. The Greeks did not circumcise and when young Jews, enamoured by Greek culture, entered the gymnasium where exercises were performed in the nude, they were embarrassed when their physical deformity became apparant. To conform, they underwent an uncircumcision process. The Maccabean report, which was written about 100 B.C E., reads: They constructed a Gentile-style gymnasium in Jerusa-

Figure 5: Megiddo Ivory
A still later tradition (post-sixth centurl' S.C.E.) traced Hebrew circumcision back to Abraham. According to this fiction, the deity made a religious-legal covenant with Abraham, the father of the Jewish people, by which Yahweh would be the unique god oftheJews and they would worship him alone. In ancient times, covenants were sealed with marks and symbols; the seal of this covenant was the mark of CircumCISion: ... for your part, you must keep my covenant, you and your descendants ... every male among you must be circumcised. You shall cut off the flesh of your foreskin, and that will be the symbol of the covenant between us. Throughout all your generations every male shall be circumcised at the age of eight days ... (Gen. 17: 10-12). The regulation included slaves whether Jewish or foreign. Failure to be circumcised resulted in excommunication (17: 14). The Abrahamic covenant, invented by priests, transformed circumcision from an ethnic custom into a theological divinely ordained legal requirement. It is not a puberty rite nor a pre-marital ritual, it is a covenantal sign to be inflicted on infant males on the eighth day after birth to signify
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lem. They also pulled forward their prepuces thereby repudiating the holy covenant (I Macc. I: 15).

... they also hid the circumcision of their genitals, that even when they were naked they might appear to be Greeks.
The Jewish historian Josephus, who wrote during the late first century of the Common Era (C E.), commented: ... they also hid the circumcision of their genitals, that even when they were naked they might appear to be (Antiquities, X II, v.I). Greeks. Dependant upon how completely the foreskin had been removed, it was possible to cut and pull forward the loose skin of the penis (epispasm) to form a partial foreskin. However. such an act, as the author of Maccabees noted, constituted a denial and rejection of both their circumcision heritage and their Jewish heritage thereby placing such persons outside of the covenanted community. As we shall see, much later, when Christianity developed, the reversal of circumcision, while perhaps no longer common, was apparantly still practiced.
(Conlinued ol1nex' page)

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Religious Traditions and Circumcision (Continued) The first Christians were Jews and were therefore circumcised.
Anti-Judaism became a major issue under one of Alexander's successors named Antiochus IV, who ruled Judea from Syria. He forbade circumcision and his agents killed those whose infants were circumcised together with the circumcised baby (I Macc. 1:48, 60f). After a bitter struggle, the Jews experienced a brief time of freedom, before they came under Roman domination. Interestingly enough, towards the close of the second century RC.E., when the Jewish prince Hyrcanus invaded and conquered Idumia, he offered the Idumenas a choice: to be exiled or to become Jews. They chose the latter, were circumcised, and thus became instant Jews. They were not truly accepted by traditional Jews, and when Herod the Great - the strongest Jewish ruler - assumed the throne, his Idumean background earned him the label of "half-Jew." Circumcision was not enough. Other reasons for circumcision that were advanced by Jewish Philosophers were to curb sexual desire. Philo, an Alexandrian Jewish Philosopher, born in the last quarter of the 1st Century, B.C., justified circumcision to reduce sexual desire since engaging in intercourse for pleasure was being "like pigs and goats;" and Moses Maimonides in The Guide ofthe Perplexed taught that circumcision would "bring about a decrease in sex ual intercourse and a weakening ofthe organ in question" ... and that "The bodily pain caused to that mem ber is the real purpose of circumcision (Part III, Chapter 49).

Paul argued that "in Christ Jesus neither circumcision nor uncircumcision count for anything"
Paul established new Christian groups in the Greek world. His pattern seems to have been as follows: he would speak in a Jewish synagogue concerning the end of the age and Jesus as the Christ and means of salvation. Some Jews would listen; others rejected him. Among those attending the synagogue were non-Jewish Greeks, attracted perhaps by the monotheistic faith and ethical ideals. Some were drawn to Christianity but, when they wished to join the new group, they were informed by the conservative elements in the church that before they became Christians they had to become Jews and be circumcised. Paul saw this demand as a stumbling block inasmuch as adult male Greeks had no intention of being circumcised. Therefore he wrote to the Christian church he had founded in Galatia. In this letter he challenged the validity of circumcision as a criterion for membership in a Christian church. He castigated the leaders in Jerusalem. He pointed out that Cephas (Peter) had been two-faced in the matter by swaying to the conservative side when confronted by the circumcision party after agreeing that Paul's mission was to the circumcised (Gal. 2). Paul argued that "in Christ Jesus neither circumcision nor uncircumcision count for anything" (5:6), and expresses the wish that for members of the circumcision party the circumcision blade might slip and more than the foreskin be removed so that they might "mutilate themselves"{5: 12). The same issue appears to have surfaced among the Christians in the city of Corinth. Paul wrote a letter to this group in which he stated: Was anyone already circumcised when he was called (to be a Christian)? Let him not seek to remove the marks of circumcision. Was anyone uncircumcised when he was called? Let him not seek circumcision. (I Cor. 7: 18). Obviously, there were some who sought to disavow their Jewish heritage by removing the mark ofcircumcision, just as their ancestors had done during the time of the Maccabees. For Paul neither circumcision nor uncircumcision counted for anything. Ultimately the matter was referred to the Jerusalem council where, after serious debate, it was decided that circumcision was not a requirement for membership in the Christian community (Acts: 15).

For present day Jews, circumcision is both a covenant rite and a naming ceremony.
Figure 6: Artist's enlargement of figures.

Conclusion
For present day Jews, circumcision is both a covenant rite and a naming ceremony. Orthodox Jews follow ancient practices. On the eighth day, the infant son is taken to the Mohel (the circumciser) for a rite performed according to a primitive ritual. The blood flow is stopped by wine, held in the Mohel's mouth - a custom which some Jews find revolting. These believers are fulfilling Torah requirements. Non-orthodox Jews may have their sons "done" in a hospital setting. Even Jews who have moved away from Judaism toward a secular or humanistic way of life, continue to have their sons circum(Continued on next page)

Circumcision in the Christian Scriptures
The first Christians were Jews and were therefore circumsised. The Gospel of Luke reported that Jesus was circumcised on the eighth day (2:21). The apostle Paul was also circumcised on the eighth day (Phil. 3:5). As the Christian church began to move out into the Mediterranean world and attract non-Jews, circumcision became a problem for converts. The issue came to a head (no pun intended!) in the Galatian controversy.
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Religious Traditions and Circumcision (Continued)
cised. Christians, too, have their male offspring circumcised in some cases because Jesus was circumcised but far more often in an unthinking, uncritical way as something that is done fo newborn malesAs better information regarding cir-

References:
Breasted, James H, (1933): THE DA WN OF CONSCIENCE, N.Y., Scribner. Bullough, V. (1976): Sexual Variance In Societl' and History. Wiley: Interscience. New York. Harris, James E. and Weeks, Kent R. (1973): X-RA YING THE PHARAOHS. Scribners, N.Y. Maimonides, Moses (1963): The Guide 0/ The Perplexed. (Shlomo Pines, Trans). Vols. I & II. University of Chicago Press. Chicago. Wilson, John (1950): Circumcision in Egypt, in James E. Pritchard, edit, ANCIENT NEAR EASTERN TEXTS RELA TING TO THE OLD TESTAM ENT, Princeton University Press, p. 326.

cumcision is circulated, outmoded beliefs concerning medical or health benefits will be discarded. Only ancient beliefs will remain as a stimulus for the continuation of this barbaric custom.

Dr. Gerald Larue is professor emeritus of biblical history and archeology at the University of Southern California and chairman of the Committee for the Scientific Examination of Religion. A prolific author, Larue's books include Ancient

M.I'th amI Modern Man, Sex and the Bihle, Euthanasia and Religion, and, most recently, Ancient M.I'th and Modern Lili'. He is the recipient of the American Humanist Association's 1989 Humanist of the Year Award.

Blood SACRiFiCE ANd ATONEMENT

"The delusion of blood pollution in the Hebrew religion was carried over into Christianity and accounts for the Testament edict: lew

'Indeed. according /0 the Lall', it might almas/ be said e\'eIT/hing is cleansed hI' h/ood and lI'i/hoUi the shedding o/h/ood there is no forgi\'eness. '(Hebl'l'\\'s 9:22)" The !\'hole scheme 0/ Chris/ian sall'a/ion is based upon the belie/ tha//he crucifi'xion a/Jesus was a blood a/onell1el7l for the redemp/ion 0/ man for ha\'ing been born in sin: "In iniquitl' I lI'as brough/ /0 birth and 111.1' 1II0ther concei\'ed me in sin"
(Psalms 51:5). Joseph Lewis

In The Name

0/ Hwnani/.I'
From: Passion

Photo Credit: Albrecht Durer
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0/ Christ

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JULYIAUGUST 1989

ft The Geography of Genital Mutilations ~
by James DeMeo

Genital mutilations elicit severe pain and terror in infants and children and are often very dangerous to health.
This paper summarizes portions of a prior study of the geographical aspects of human behavior among subsistencelevel aboriginal peoples (De Meo, 1986, 1988). Thefocus here will specifically be on the phenomenon of male genital mutilations. Genital mutilations are often classified as a "cultural practice," but there is growing evidence that this benignsounding label merely serves to dismiss or evade the painful and contractive effects the mutilations have upon the psyche and soma of the child. Genital mutilations elicit severe pain and terror in infants and children and are often very dangerous to health, which raises important questions how they could have gotten started in the first instance. People who do not engage in such practices view them almost always with horror and disbelief, while people who do them often have difficulty imagining life without the practice. Oftentimes, the presence or the absence of the rites are seen as important requirements for the selection of a marriageable partner, and very powerful emotions focus upon them. Genital mutilations are among the most strongly defended, or defended against, of all cultural practices. Among the various theories developed to account for the mutilations, their geographical distribution has only rarely been discussed (DeMeo 1986).

Northeast Africa and the Near East, with a subsequent diffusion outward into sub-Saharan Africa, Oceania and possibly even into parts of the New World. They have generally been transmitted from one region to another by virtue of relocation diffusion, accompanied by phases of military conquest of cultures which do not mutilate by invading cultures which do, or by voluntary adoption in association with other cultural changes of an antisexual and antichild nature. One must keep in mind the premarital, pubertal character of the mutilations as originally practiced by most cultures, performed at a time of otherwise great sexual interests and passion. I have dem-

onstrated elsewhere that the global distributions of genital mutilations are similar to that of other patrist antichild, antifemale, and antisexual cultural factors, such as infant cranial deformation, swaddling, the virginity taboo, vaginal blood taboo, male domination of kinship and inheritance, and so on (DeMeo 1986). Figures 1 and 2 show the overlapping distributions of
various types of male and female genital mutilations, respectively, as they existed among aboriginal, subsistence-level peoples within the last several hundred years. As such, the maps greatly minimize or eliminate the influences of the diffusion of European peoples within the last several hundred years. For example, the maps do not reflect the existence of male circumcision as adopted in the USA over the last 100 years; North and South American data is composed from aboriginal peoples only. The various forms of the mutilations, and the source for the mapped data, are discussed below. A detailed discussion offemale genital mutilation will be given later by Fran Hosken, whose work (1979) provided the basis for the map of female mutilations.

Genital mutilations are among the most strongly defended, or defended against, of all cultural practices.
The global distributions of the male and female genital mutilations among native, non-Western peoples, along with history and archaeology, suggest their genesis in the deserts of

Circumcision only gained the status of being a "hygienic operation" in relatively recent times.
(Continued on next pal?e)

Figure 1: Male Genital Mutilations

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The Geography of Genital Mutilations (Continued)

Male Genital Mutilations
Incision, the least harsh of the male genital mutilations, consists of either a simple cut on the foreskin to draw blood, or a complete cutting through of the foreskin i.n a singl.e place so as to partly expose the glans. Incision eXisted pnmanly among peoples of the East African coast, in Island Asia a~d Oceania, and among a few peoples of the New World. Circumcision, a harsher mutilation where the foreskIn of the penis is cut or torn away, was and is practiced across much of the Old World desert belt, and in a number of Sub-Saharan, Central Asian and Pacific Ocean groups. When performed during pUbert~, circumcision was largely a premarital rite of pain endurance. . . . Circumcision only gained the status of beIng a "hygienic operation" in relatively recent times, although the most recent and best medical evidence has in fact shown that routIne circumcision has neither short nor long-term hygienic benefits; indeed, it has mild to severe negative psychological and physiological effects. Particularly in the bush,. under less than sanitary conditions, the circumcised boy mfant or chIld would have been at greater risk than the uncircumcised boy. The most severe male genital mutilation, a form of skinstripping, was practiced along the Red Sea coast in Arabia and Yemen at least into the 1800s. Here, In an endurance ritual perfo;med on a potential marriage candidate, skin was flayed from the entire penile shaft as well as from a regIOn of the pubis. The community blessing would only be bestowed upon the young man who could refrain from expreSSIng . . . emotion during the event (DeMeo 1986). Another harsh ritual, subincision, was practiced pnmanly among Australian aborigines and on a few Pacific Islands. It consisted of a cutting open of the urethra on the unde.fSld~ of the penis down to as far as near the s~rotum? the subIncIsIOn ritual was generally preceded by a CircumCISion ntual. The practice did not confer any contraceptive adv~ntage, an? no claims as such were made for it by the Austrahan abongmes. The geographical aspects of the Australian genit~l mutilations has been studied previously, and two competIng theor-

ies were developed: Northwest Australia, specifically the Kimberly region, was identified as a location where genital skin stripping was performed, and some beheved that circumcision and subincision spread into Australia from that region, diffusing to the east and south. C?n .the other hand, independent development of the traits WithIn Austraha has been argued, based upon the observation that the most intense forms of subincision occurred in the desert center of the continent, being absent in a few border regions where only circumcision was practiced (DeMeo 1986). The Ethnographic AtlasofG.P. Murdock (1967) provided most of the data for Figure l. Murdock's A tlas also contains raw data on the age at which the mutilations were customarily done among a globally-balanced sa~ple of 350 cultures: A map of that data which I constructed Indicated that genital mutilations possessed a widespread distribution, centered on Northeast Africa and Arabia. Furthermore, the greater the distance from those central regions, the older was the male at the time of the mutilation (DeMeo 1986, p. 159). As one moves farther and farther east from Africa and the Near East,

genital mutilations possessed a widespr~ad distribution, centered on Northeast Africa and Arabia.
the males are progressively older at the time of the mutilation. Furthermore, the practices occur less frequently and undergo a gradual dilution of harshness as distance from those cen~ral regions increases. Genital skin stripping, t~e harshest mutIlation was centered on the Red Sea region, and was surrou~ded by a region practicing only male circumcision. Circumcision, in turn, gives way to the less harsh practice of incision as one moves eastward across the Pacific. Genital mutilations were not practiced at all among most of the aboriginal peoples of the Americas or Eastern Oceania. It was precisely in these regions of mutilation absence where the decorative "penis tops" were most frequently found aJ?ong native peoples, indicating a similar interest in the genltaha,
(Continued on nexl page)

Figure 2: Female Genital Mutilations

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The Geography of Genital Mutilations (Continued)
but only in a decorative and pleasurable sense. mads, and culturally transformed around 3100 BC These invaders, who possessed Asian and Semitic characteristics, ushered in an era of divine kings, ritual widow murder, a military and priestly caste, massive graves and fabulous grave wealth, temple architecture, and other trappings of extreme patriarchal authoritarian culture (De Meo 1986, p.218-294). As discussed below, cultural tendencies of a similar direction, but of lesser intensity, are positively correlated with genital mutilating cultures of more recent times.

Genital mutilations were not practiced at all among most of the aboriginal peoples of the Americas or Eastern Oceania.
From the standpoint of the pain involved in circumcision as a puberty or premarital rite, the easterly decline in mutilation frequency and dilution of the rite towards less painful methods, and to older ages, makes perfect sense if we also assume that the emotional attitudes, beliefs, and cultural institutions which originally mandated the painful ritual were likewise diluted as they were carried eastward from a Northeast African or Arabian point of origin (DeMeo 1986). With the social and emotional root reasons for the rituals becoming diluted with time and distance, less painful methods such as incision were substituted, or it was put off as long as possible, certainly well past the period just before marriage, preferably into the period of old age. Or it was relinquished altogether. In the Near Eastern desert regions where the social institutions and emotional roots for the ritual remained, but where the pain of the mutilation was feared as a puberty / premarital rite, it was occasionally shifted into infancy, or adopted as such from the start. There have been several phases of diffusion of the mutilations. Egyptian bas-reliefs give the earliest known unambigu-

According to biblical scripture, the Hebrews institutionalized the mutilations after the Exodus from Egypt, and it thereafter became a special mark of the tribe.
According to biblical scripture, the Hebrews institutionalized the mutilations after the Exodus from Egypt, and it thereafter became a special mark of the tribe. The mutilations appeared widely across the Near East prior to the eruptions of Moslem armies in the 600s AD, but were subesquently spread wherever Moslem armies ventured. While neither male nor female genital mutilations have any specific Koranic mandate, Mohammed thought them to be "desirable," and they predominate in Moslem areas. Still, there are regions of non-Moslem Africa and Oceania which possess the mutilations as a probable diffusion from ancient, pre-Moslem times. Diffusion from these earliest periods may also yet account for isolated, rare examples of the traits in the ew World (DeMeo 1986, p. 358-426).

it seems probable that genital mutilations, were introduced before 2300 BC, when the Nile Valley was invaded by militant pastoral nomads, and culturally transformed around 3100 Be.
ous evidence of male genital mutilations, performed as a puberty rite during the early Dynastic era, about 2300 BC (Paige 1978, Montagu 1946). However, it seems probable that genital mutilations, were introduced before 2300 BC when the Nile Valley was invaded by militant pastoral no~

Male genital mutilations were never adopted widely in Europe, European Australia, Canada, Latin America, in the Orient, or by Hindus, Southeast Asians, or Native Americans.
Male genital mutilations were never adopted widely in Europe, European Australia, Canada, Latin 'America, in the
(("omint/I'd on nl'.n page)

Figure 3:

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ISO

Areas Influenced or Occupied by Arab Armies Since 632 AD (after Pitcher 1972). The Islamic empire spread genital mutilations into many new areas of the globe, and reinforced it in others. However, genital mutilations had spread into sub-Saharan Africa, Oceania, and the New World, prior to the Islamic period, notably among caste, high god, and warrior-emphasizing peoples.

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JULY/AUGUST 1989

The Geograpl7l' of Genital Mutilations (Continued)
Orient. or by Hindus, Southeast Asians, or 'ative Americans. The spread of the rite of infant circumcision to the United States during the late 1800s and early 1900s is a most recent phenomcnon not reOected on the maps. Circumcision High narcissism index Slavery and Castes are present Class stratification is high Land inheritance favors male line Cognatic kin groups are absent Patrilineal descent is present Female barrenness penalty is high Bride price is present Father has family authority Polygamy is present Marital residence near male kin Painful female initiation rites are present Segregation of adolescent boys is high Oral anxiety potential is high Average satisfaction potential is low Speed of attention to infant needs is low High God present, active, supportive of human morality

gained in importance in the USA only after allopathic medical doctors, playing upon prevailing sexual anxieties, urged it as a "cure" for a long list of childhood diseases and "disorders, "to include polio, tuberculosis, bedwetting, and a new syndrome which appeared widely in the medical literature known as "masturbatory insanity, " Circumcision was then
advocated along with a host of exceedingly harsh, paininducing devices and practices designed to thwart any vestige of genital pleasure in children (Paige 1978).

Reich saw the real purpose of circumcision, and other assaults upon the child's sexuality, to be the reduction of the child's emotional fluidity and energy level, and their ability to experience maximal pleasurable genital excitation later in life ...
Freud and other psychoanalysts have discussed male genital multilations as inducing a form of "castration anxiety" in the child by which the taboo against incest and parricide is pathologically strengthened (DeMeo 1986). Montagu (1946) and Bettleheim (1962) have discussed their connections to the male fear of vaginal blood, where menstruation is imitated (subincision), or where the male must be ritually absolved of contact with poisonous childbirth blood (infant circumcision), or hymenal blood (pubertal circumcision). Reich identified genital mutilations as but one, albeit a major one, of a series of brutal and cruel acts directed toward infants and children which possess hidden motives designed to cause a painful, permanent contraction of the child's physical and emotional self. Reich saw the real purpose of circumcision, and other assaults upon the child's sexuality, to be the reduction of the child's emotional Ouidity and energy level, and their ability to experience maximal pleasurable genital excitation later in life, a major step in, as he put it, transmuting Homo sapiens into armored Homo normalis. Reich argued

One cannot extract a list of correlated prochild, profemale, or sex-positive traits from Textor's work as cultures which mutilate the male genitalia do not generally possess such characteristics. Male genital mutilations are found present in a cultural complex where children, females, and weaker social ethnic groups are subordinated to elder, dominant males in rigid social hierarchies of one form or another. While the cross-cultural analysis contrasted only aboriginal, subsistence-level cultures, many of the factors identified in the above list are or once were applicable to the USA, where male circumcision predominates. It must be noted, however, that many or most of those patristic characteristics may be present in cultures where genital mutilations are absent, but which can be accountedfor by deprivation ofphysical affection in the maternalinfant and adolescent sexual relationships (Prescott, 1975, 1979, 1989).

The underlying psychology of genital mutilations is anxiety regarding sexual pleasure, mainly heterosexual genital intercourse, Summary:
The underlying psychology of genital mutilations is anxiety regarding sexual pleasure, mainly heterosex ual genital intercourse, as indicated by the associated virginity taboos and ritual absolutions against vaginal blood. In the final analysis, these mutilations say more about predominant attitudes regarding sexual pleasure than anything else.

that parents and doctors blindly advocated or performed the genital mutilations, and other painful shamanistic medical procedures, in proportion to their own emotional armoring and pelasure-anxiety, in order to make children more like themselves: obedient, docile, andreducedin sexual vigor and emotional vitality (Reich 1967,1973). These ideas, as disturbing as they may be, find support in cross-cultural comparisons of cultures which mutilate the genitals of their males, Textor's Cross-Cultural Summary
(1967) demonstrates positive correlations between male genital mutilations and the following other cultural characteristics (also see Prescott 1975, DeMeo 1986):

female infibulations and other forms of female genital mutilation persist in accordance with the arranged marriage system, and other vestiges of a powerful and hysterical virginity taboo.
Given their similar distributions, similar cross-cultural aspects, and similar psychological motifs, the time and location of origins of male and female genital mutilations are probably identical, the use of each being mandated and' widely expanded by groups where dominance of the sexual lives of children by adults, and of females by males, was most extreme. The use of eunuchs has died out over the last
(Continued on ney( fJa~e)

Male genital mutilations are found present in a cultural complex where children, females, and weaker social ethnic groups are subordinated to elder, dominant males in rigid social hierarchies of one form or another.
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The Geography of Genital Mutilations (Continued)
100 years with the decline of the harem system, but female infibulations and other forms of female genital mutilation persist in accordance with the arranged marriage system, and other vestiges of a powerful and hysterical virginity taboo.
Pitcher. D. (1972): An Historical Geography oj the Ottoman Empire, E.J. Brill, Leiden, Map V. Prescott, J. W. (1975): "Body Pleasure and The Origins of Violence," The Futurist. April, p.64-74. Prescott, J. W. (1979): Deprivation of Physical Affection As A Primary Process In The Development Of Physical Violence. In: Child Abuse and Violence. (David G. Gil, Ed). AMS Press New York pp 66-137. Prescott, J.W. (1989): "Affectional Bonding for the Prevention of Violent Behaviors: Neurobiological, Psychological and Religious/Spiritual Determinants. In: Violent Behavior Vol. I: Assessment and Intervention. (Hertzberg, L.J., et aI., eds) PMA Publishing Corp. New York 1989, p.109-142. Reich, W. (1967): Reich Speaks oj Freud. Farrar, Straus & Giroux, p.27-31. Reich, W. (1973): Ether. God & Devil. Farrar, Straus & Giroux, p.67-70. Textor, R. (1967): A Cross-Cultural Summary. HRAF Press, New Haven.

The urge to mutilate the genitals of children stems from deeply ingrained cultural anxieties regarding sexual pleasure and happiness.
The genital mutilations of young males and females are major examples of cultural "traits" or "practices" which, on deeper analysis, reveal roots in severe pleasure-anxiety, with sadistic overtones. The parent or tribal elder who cuts the genitals of young children, was subject to the rite himself as a child, and is made very anxious or angry when confronted with a child whose genitals are not mutilated. This incapacity to tolerate pleasurable movement or feeling in others (pleasure anxiety) was first identified for Homo sapiens by Reich, who also identified the role that social insititutions play in demanding a systematic recreation of trauma and damage in each new generation; primatologists have identified similar processes of abuse transmission at work in monkeys deprived of maternal love in infancy (DeMeo 1986). Prescott (1975) previously confirmed many of these relationships in a crosscultural manner. The materials summarized here in geographical form further confirm these processes which possess historically identifiable roots in specific regions. The urge to mutilate the genitals of children stems from deeply ingrained cultural anxieties regarding sexual pleasure and happiness. Genital mutilations always exist within a complex of other social institutions that provide for the socially sanctioned expression of adult sadism and destructive aggression towards the infant and child, with unconscious motivations aimed at destroying or damaging the capacityfor pleasurable emotional/sexual bonding between mothers and babies, and between young males and females. In the absence of such deeper motivations, genital mutilations would not be welcomed or championed by parents or birth attendants.
James DeMeo, Ph.D., earned his doctorate at the University of Kansas and has served on the Faculty of Geography at Illinois State University and the University of Miami. He is currently the Director of the Orgone Biophysical Research Laboratory, P.O. Box 1395, EI Cerrito, CA 94530, Editor ofthe environmental journal, Pulse oJthe Planet. and author of The Orgone Accumulator Handbook.

The village women splash water on seven year old Adizetu's wound after the exisor has performed the clitoridectomy.

References:
Bettleheim, B. (1962): Symbolic Wounds. Collier Books, NY. DeMeo, J. (1986): "On The Origins and Diffusion of Patrism: The Saharasian Connection," Dissertation, U. of Kansas, Geography Department. University Microfilms, Ann Arbor; see section on "Male and Female Genital Mutilations," p. 153-178. DeMeo, J. (1987, 1988); "Desertification and the Origins of Armoring: The Saharasian Connection," 1. Orgonomy, 21(2): 185-213, 22(1): 101-122,22(2):268-289. Hosken, F. (1979): The Hosken Report on Genital and Sexual Mutilation oj Females. 2nd Edition, Women's International Network News, Lexington, Mass. Montagu, A. (1945): "Infibulation and Defibulation in the Old and New Worlds," Am. Anthropologist. 47:464-7. Montagu, A. (1946): "Ritual Mutilation Among Primitive Peoples," Ciba Symposium, October, p.424. Murdock, G.P. (1967): Ethnographic Atlas. Pittsburgh, HRAF Press. Paige, K. (1978): "The Ritual of Circumcision," Human Nature. May.
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Infibulated girl, external genitalia and normal vaginal orifice have been obliterated.
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Photos from: James DeMeo
JULY/AUGUST 1989

Genital Pain vs. Genital Pleasure: Why The One and Not The Other?
by James W. Prescott

Male circumcisions is not primarily a medical issue but rather has its roots in deeply held religious beliefs and social customs that defy rational and humane understanding.
Genital mutilations of both males and females have been a common practice in many cultures and have existed from the earliest days of recorded history. These excruciating painful procedures have been inflicted upon newborns and adolescents for a variety of reasons. Religious beliefs and socialcultural customs, particulary "rites of passage ceremonies" have been historically the primary reasons for both male and female genital mutilations. Only recently has one form of genital mutilation, male circumcision, come under a different rubric of justification, i.e. modern medicine. It is a major thesis of this presentation that male circumcision is not primarily a medical issue but rather has its roots in deeply held religious beliefs and social customs that defy rational and humane understanding. The devastating practices and consequences of female genital mutilation that have been so well documented by Fran Hoskin (see page 22 in this conference report) provides a context for understanding the religious forces of toleration and support for male genital mutilations, i.e. circumcision. Why is it that certain elements of the medical profession can offer support for male genital mutilation (circumcision) but not female genital mutilation that is so widespread in other cultures of the world? And why have the medical professions, until very recently, ignored and denied the extraordinary and excruciating pain that the newborn experiences when part of its skin (the foreskin) is shredded and cut from the rest of its body?

The key to understanding this pain and violence is to be found in understanding its converse, i.e. pleasure and peace ...
the salvation of the soul and society. This understanding of the reciprocal relationship between pain and pleasure; our tolerance and support for the torture and mutilation of the human body and intolerance for the physical pleasures of the body involves profound issues of moral philosophy of good and evil, of the moral theology of pain and pleasure; and how these morClI value systems become encoded in the developing human brain and thus, behaviors which includes the social-moral values and ideologies of human culture. In brief, it is my contention that the ultimate resolution of the circumcision issue and other forms of male/female genital mutilations will involve primarily the ethical, moral and neuropsychological issues involved in torture and mutilation and less in the presumptive medical and social benefits of genital mutilations. Before proceeding with a summary of the religious, philosophical and scientific data in support of this thesis, I would like, to comment very briefly on two medical studies that purport to provide statistical medical evidence for the practice of circumcision and which raises serious ethical/ moral issues when findings from presumptive pathological groups are generalized to healthy groups to justify surgical procedures on healthy groups in the guise of"preventive medicine." First, is the study of Dr. William Cameron of the University of Manitoba where it was reported in a sample of292 men who had patronized prostitutes in Nairobi, Kenya that 20% of uncircumcised men became infected with AIDS virus, whereas, only 3% of circumcised men became infected with the AIDS virus. It was also reported that 85% of the prostitutes were infected with the AIDS virus. Some have suggested that circumcision may offer a degree of prevention against the AIDS virus. Assuming that circumcision vs. non-circumcision, and not other variables, can account for this difference, how can the

This indifference to human pain and suffering of the circumcised newborn is not confined to the medicalprofession
but is widespread throughout many cultures, particularly where other forms of male and female genital mutilations are practiced. In this psychologist's opinion, all forms of genital mutilation that are inflicted upon unconsenting children are de facto acts of torture and mutilation which are in violation of Article 5 of the United Nations Universal Declaration of Human Rights which states that "NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT." This position statement has been unanimously approved as a resolution by the General Assembly of this Conference (see page 53). It is my conviction that the acts of newborn and adolescent torture and mutilation which occurs in ritual male and female genital mutilations must be understood within the broader context of human torture, mutilation and violence against the human body which is pandemic throughout the world. The key to understanding this pain and violence is to be found in understanding its converse, i.e. pleasure and peace where physical pleasures of the body, particularly sexual pleasures, are considered inherently dangerous by many fundamentalist/ orthodox religious traditions which they believe threatens
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grossly negligent and irresponsible sexual behaviors andpoor personalhygienepractices ofOTHERS be used to justify the genital and sexual mutilation of the INNOCENT? Another
example of the the misuse of statistical inference from medical data is provided by the studies of Dr. Thomas Wiswell. In one of Dr. Wiswell's studies where he evaluated the incidence of Urinary Tract Infections (UTIs) in 422,238 boys born to Army families he found a ten-fold increase in UTls in uncircumcised vs. circumcised boys. The incidence was 1.1 % vs .. 11 % respectively, where one third of the 1.1 % later developed serious medical complications. This finding of 1.1 % and/ or the .034% serious medical complications in uncircumcised newborns is now being used to justify the routine genital mutilation of 99% of healthy male newborns who do not develop UTIs. Since female infants were found to have a 0.57% incidence of UTls which is 50% of the uncircumcised males (1.1 %) it is clear that there are other variables unrelated
(Continued on next page)

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Genital Pain vs. Genital Pleasure (Continued)
to circumcision that contribute to UTIs. I will leave to other investigators the exploration of these other uncontrolled variables that contribute to UTIs. tures that have High Gods. In general, these cultures are patrilineal, subordinate women to men, have low nurturance of children, are sexually repressive, punish abortion, are violent and have a high god that supports human morality.

Early Sensory Influences Upon Brain Development and Behavior
There is a well established body of scientific data that documents the role of sensory stimulation and deprivation upon brain development and emotional-social, psychological and mental development. From the perspective of the developmental neuropsychological sciences there can be little question that the extraordinary pain experienced by newborns, children and adolescents who are subjected to ritual genital mutilations has a profound influence upon the brain and later behaviors. It is this writer's conviction that the extraordinary pain and trauma experienced through genital mutilations - an organ and brain system that is designed for the experience of sexual pleasure and the expression of sexual love - has permanently altered normative brain development for the normal expression of sexual pleasure and love. It

In summary, the confounding ofpain and pleasure in the developing brain provides the neuropsychological foundationfor individuals who must experience pain to experience pleasure, or who derive pleasurefrom the experience ofpain.
One of the most recent studies that is particularly germane to this thesis was reported by Jacobson, et. al in Acta pSI'chiatr. scand. (2987:76-364-371), entitled Perinata! Origin o{ Adult Self Destructive Behavior. The summary of this study is provided by the abstract which reads as follows:

is proposed that this genital pain has long-term developmental consequences for the ability of such individuals to differentiate pain from pleasure in love relationships and to develop intimate sexual relationships.
It is not without psychobiological consequence that the brain system which is designed for the experience of pleasure and the expression of sexual love is first encoded with extraordinary and excruciating pain. In such individuals, all subsequent acts or experiences of genital pleasure are experienced upon a background of genital pain that is now deeply buried in the subconscious/ unconscsious brain.

The studl' was undertaken to test ,\'hether obstetric procedures are o{ importance for eventua! adult hehavior u{the newborn, as eculogical data from the United States seem to indicate. Birth record data were gathered fur 412 forensic victims comprising suicides, alcoholics and drug addicts hum in Stockholm afier 1940, and who died there in 1978-1984. The births o{the victims were uneven!\' distributed among six hospitals. Comparison with 2,901 contro!s, and mutual comparison o{categuries, shu wed that suicides invu!ving asphl'xiation were closely associated H'ith asphl'xia at hirth. suicides b\' viulent mechanical means were associated \\'ith mechanic~1 birth trauma and drug addiction was associated with opiate and/ or barbiturate administration to mothers during lahar. Irrespective o{the mechanism trans{erring the hirth trauma to adulthood - which might he analoguus to imprinting - the results show that ohstetric procedures should be careful/\' evaluated and possihl\' modified to prevent eventual selfdestructive behavior.
Specifically, the authors reported that a perinatal event of Asphyxia (a lack of oxygen) carried a risk factor for suicides from hanging, strangulation, drowning and gas poisoning that was five times greater than for controls; for perinatal mechanical trauma, e.g. breech presentations, forceps delivery and multiple nuchal loops, the risk factor for suicides from hanging and other mechanical injuries was twice as great as controls; for perinatal events of opiate/ barbiturate use the risk factor for drug addiction was approximately

It is this developmental neuropsychologist's conviction that these early experiences of genital pain contribute to the encoding of the brain for sado-masochistic behaviors. The
brain system that has been designed for pleasure has first and foremost become saturated or encoded with pain that now limits and qualifies all subsequent experiences of pleasure. When these early experiences of genital pain are followed by a developmental deprivation of physical affectional pleasure in the maternal-infant relationship and in the adolescent sexual relationship, then violent destructive behaviors are the inevitable outcome. Equally significant is the prediction that the cumulative consequences of these developmental experiences of genital

three times greater than the controls.
In an earlier study of 52 adolescent suicides, Salk, et. aI., (1985) reported three prenatal/ perinatal risk factors that significantly discriminated the suicide group from the two matched non-suicide control groups. These were: I) respiratory distress for more than one hour at birth; 2) no antenatal care before 20 weeks of pregnancy; and 3) chronic disease of the mother during pregnancy which were found in 81 % of the suicide cases. These authors were quite uncertain as to the mechanisms by which prenatal/ perinatal birth trauma were linked to suicidal behaviors. David Levy in a 1945 study on the "Psychic Trauma of Operations in Children" reported on three cases of male circumcision at ages 12 months (2 cases) and 6 % years. Psychological trauma included the development of night terrors, temper tantrums and rage. In the 6% year old, suicidal impulses developed. Levy reports: "... a circumcision at the age 0{6 years 7 months. was preceded by a struggle o{ the patient with his father and the

pain and affectional deprivation precludes the possibility of realizing the spiritual dimensions of human sexuality. These
relationships have been discussed elsewhere and need not be repeated here. Suffice it to note that it has been possible to predict with 100% accuracy the torture, mutilation and killing of enemy captured in warfare in 49 primitive cultures from the two variables of deprivation of physical affection in the maternal-infant relationship and in the adolescent sexual relationship; and that brain dysfunction underlies this SAD (Somatosensory Affectional Deprivation) induced violent behaviors. (Prescott, 1975, 1979, 1989; Heath, 1975). (See March/ April issue of The Truth Seeker) Tables I and II summarize the social-behavioral characteristics of primitive cultures that engage in male and female genital mutilations. Tables III and IV provide a similar summary for those cultures that punish pre-marital sex and extramarital sex. Similarily, for Table V which characterizes culTHE TRUTH SEEKER

anesthetist before they overpowered him. Immediatelvafter the anesthesia wure off, he said over and over, 'They cut my penis. I wish I were dead. .The rest a/the day the patient never left his mother's side. Thereafter his previous temper tantrums
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TABLE I
SOCIAL-BEHAVIORAL CHARACTERISTICS OF CULTURES WHERE MALE GE IT AL MUTILATION IS PRESENT (N=83) VS BEING ABSENT (N=242) N Var. Social- Behavioral Characteristics P % 01 Castes Are Present 78 .0000 304 78 02 Weaving By Males .0000 100 75 .0000 168 03 Games of Strategy 04 Metal Working Is Present 71 .0000 238 05 Exclusively Patrilineal 69 .0000 325 .0000 314 06 Slavery Is Present 65 07 High Bride Price 56 .0000 322 51 .0002 325 08 Husbandry Is Present 09 High God Supports Human Morality 64 .0007 086 10 High God is Present 54 .0009 257 316 56 .003 II Class Stratification Is Present 12 Leather Working By Males .005 081 65 13 Polygamous Rather Than .004 321 Monogamous 60 082 14 High Exhibitionistic Dancing 57 .03 .04 026 15 Totemism Is Present 65 16 Early Infant/ Child Satisfaction .06 035 Is Low 69 124 17 Longer Post-Partum Sex Taboo 67 .06 .06 048 18 High Oral Socialization Anxiety 63 19 Exclusive Mother-Son Sleeping.07 042 67 I year 20 High Incidence of Theft 035 66 .06 137 21 Patrilineal Cultures 58 .06 22 High arClSSlsm 58 .08 086 155 23 High God Active 55 .08 24 Wife Lending and Exchange 71 .09 028 25 Infanticide Is Present 63 .09 030 TIME OF CIRCUMCISION: A) 1st & 2nd months: 4 eullures; B) 2 months to 2 years: 4 ('ullures; C) 2 to 5 years: 7 ('ullures; D) 6 to 10 years; 23 ('ullures; E) II to 15 years: 2/ ('ullures; F) 16-25 years; 7 ('ullures.

TABLE III
SOCIAL-BEHAVIORAL CHARACTERISTICS OF CULTURES WHERE PREMARITAL SEX IS STRONGLY PUNISHED Var. Social-Behavioral Characteristics P N % 01 Community size is larger 73 .0003 80 02 Societal complexity is high 87 .01 15 03 Class stratification present 60 .01 III 04 Slavery is present 59 .005 176 05 Low female income 71 .09 24 06 Personal crime is high (392) 71 .05 28 07 Incidence of theft is high (392) 31 68 .07 08 Kin group exclusively patrilineal 62 .04 114 09 Kin groups patrilineal or double descent rather than matrilineal 64 .002 62 10 Small extended family 70 .008 63 II Wives are "purchased" 54 .02 114 12 Women have property rights 100 .008 9 13 Longer post-partum sex taboo 62 .03 50 14 Extramarital sex is punished 71 .005 58 15 Sex disability is present 83 .004 23 16 Castration anxiety is high 65 .009 37 37 17 Bellicosity is extreme 68 .04 18 Killing, torturing, mutilating is high 69 .07 35 19 High God in human morality 81 .01 27 66 .04 20 Narcissism is high 38 21 Exhibitionistic dancing 65 .04 66

TABLE IV
SOCIAL-BEHAVIORAL CHARACTERISTICS OF CULTURES THAT PUNISH EXTRAMARITAL SEX Var. Social-Behavioral Characteristics 01 02 03 04 05 06 07 08 09 10 Slavery is Present Personal Crime is High Theft is High Abortion is Highly Punished Premarital Sex Strongly Punished Castration Anxiety is High Military Glory Emphasized Bellicosity is Extreme High Killing, Torture, Mutilation Aggressive Supernaturals

%
67 80 81 76 71 87 62 77 78 79

P .002 .02 .008 .05 .005 .0001 .002 .002 .002 .02

N 83 20 21 17 58 30 53 43 42 19

TABLE II
SOCIAL-BEHAVIORAL CHARACTERISTICS OF CULTURES WHERE FEMALE INITIATION RITES ARE PAINFUL (N=9) VS NOT BEING PAINFUL(N=29) Var. Social-Beha vioral Characteristics P N % .006 36 01 Male Genital Mutilation Present 83 .01 38 02 High Bride Price 61 .02 38 03 Cultures Are Exclusively Patrilineal 79 04 Segregation of Adolescent Boys 75 .02 28 20 .03 05 Youth Sex Expression Restricted 80 78 .04 27 06 High Mother-Child Households 07 High Child Anxiety Over Nurturant 91 II Behavior .05 08 Torture, Mutilation & Killing of 70 .07 20 Enemy 13 09 Incidence of Theft Is High .08 85 10 Low Infant Protection From 13 Environment 75 .08 NOTE: Initiation Rites Mandatory For All Girls Between 8th & 20th Years, Does Not Include Betrothal Or Marriage Customs. From: R.B. Textor. A Cross-Cullural Summarr. (1967) HRAF PRESS: New Haven.

TABLE V
SOCIAL-BEHA VIORAL CHARACTERISTICS OF CULTURES WHERE A HIGH GOD IS PRESENT Var. Social-Behavioral Characteristics 01 02 03 04 05 06 07 08 09 Caste System Present Slavery is Present Patrilineal Rather Than Matrilineal Wives Purchased High Aggression Socialization Anxiety High Infant Pain By Caretaker Early Independence Training Male Genital Mutilation Present Premarital Sex Strongly Punished

%
52 60 68 65

P .0004 .0002 .0006 .0015 .01 .08 .06 .0009 .05

N 244 251 167 258 45 57 29 257 149

71
63 69 54 59

The % column reflects the percentage of cultures that share in common the behaviors listed; the P column states the probability level of statistical significance, e.g. a value of .003 means that the probability that the behavioral relationships being compared could occur by chance is 3 times out of a thousand; and the N column indicates the number of primitive cultures involved in the comparison of the paired behaviors.
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Genital Pain vs. Genital Pleasure (Continued)
developed into destructive rages. During the treatment he played numerous killing games. in which his/ather was the principal victim. The operation represented a castration by his/ather. "(p.IO). Questions must be raised as to the extent to which rage and suicidal behaviors are engendered by the assaults of circumcision whether conducted during the newborn or child/ prepubertal periods. (There are approximately a third more suicides than homicides in the U.S.). Is there a link between circumcision and the willingness to kill oneself or others for one's religious/ national beliefs, particularly when circumcision occurs at the age of puberty, as it does in the Muslim cultures? The willingness of many Muslim men to die or kill for their religious beliefs is well known, e.g. the cases of Salman Rushdie and Sirhan Sirhan may be representative here. Jacobsen, et. al (1987) noted in their study that hypoxia during birth might cause minimal brain damage that could result in destructive behaviors. However, these authors questioned whether neurological injuries due to hypoxia could be the main factor, "since altogether rather few victims suffered from asphyxia during birth. None of the 86 suicides from poisoning by solid or liquid substance and none of the 53 alcoholics were reported to have been asphyxial."
process or mechanism which can acount for the linkage between prenatal/ perinatal trauma and suicides that have been reported by Salk, et aI., and by Jacobson, et. al. Specifically, Somatosenory Affectional Deprivation (SAD) theory is based on the nature of brain processes where it has been well established that activation of the pleasure circuits of the brain inhibit the activity of the violence circuits of the brain. This normative reciprocal relationship ceases to function when the neuronal circuits of the brain that mediate pleasure are insufficiently developed - a form of brain dysfunction/ damage - due to sensory deprivation of physical affectional pleasure, specifically, somesthetic (touch) and vestibular (movement) sensory stimulation. Gentle touch and rocking of the infant are powerful sensory stimuli for pleasure, comfort and a sense of"basic trust"for the infant/ child. When these sensory stimuli are absent and, in addition, are replaced by painful sensory stimulation, then the neurobiological foundations for depressive, addictive and violent behaviors are established. In brief, the emotional pain of affectional deprivation (the failure of love in the maternal-infant and parent-child relationships, and in our sexual relationships) seeks relief through drugs, alcohol and violence - in the rage of our physical assaults against others; beatings, rape, homicide and assaults against our own bodies where the final solution is suicide - one of the leading mental health problems of our children and youth. Why should our children and youth be committing suicide in such great numbers - a 112% increase from 1980 to 1985 for children aged 10 to' 14 years? Does genital mutilation and sexual abuse in combination with SAD facilitate suicidal and assaultive behaviors?

There is a delayed "time bomb" of brain damage that occurs long after the initial injury or insult.
There are several points to be made concerning these two studies. First, Faro and Windle (1969) in their experimental asphixal studies in monkeys documented both immediate and delayed brain damage by as much as 10 years in these monkeys. In short, there is a delayed "time bomb" of brain damage that occurs long after the initial injury or insult. It would appear that later stages of brain development are dependent upon earlier stages of brain development which must be normal if later stages of development are to be normal. Secondly, there are a variety of traumas/ injuries that can simulate or mimic asphyxial effects. For example, sensory deprivation (like asphyxia) can damage the sensory receptors and sensory pathways of the brain. This neuronal damage from sensory deprivation

It is for these reasons that the pain of genital mutilation is tolerated and supported and why the pleasure of genital stimulation is forbidden - with all the developmental neuropsychological and moral consequences that such events have upon the individual and culture.
A further correlate to the above relationships and why certain postnatal traumas are tolerated (e.g. genital mutilations) is to be found in our cultural mores that places a high moral value on pain, suffering, deprivation; and immorality upon the physical pleasures of the body, particularly the sexual pleasures of the body. It is for these reasons that the pain of genital mutilation is tolerated and supported and why the pleasure of genital stimulation is forbidden - with all the developmental neuropsychological and moral consequences that such events have upon the individual and culture. I will now review the real reasons for circumcision as given by certain moral traditions and the anti-pleasure ethic that is endemic to many religious traditions that supports the painpleasure reciprocity principle and provides the linkage to violent behaviors.

prevents normal sensory stimulation of the brain which is essentialfor normal brain development andfunction. This is why the experiencing of sensory pleasure - physical affection and sexualpleasure - is essentialfor normative brain development, function and behavior.
The effects of sensory deprivation or altered and abnormal sensory environments upon brain development and behavior are well documented. This is the mechanism which I will now focus upon since it is my conviction that a variety of early traumatic events of pain, deprivation and stress, including asphyxia, damage the affectional neuronal systems of the brain. It is this damage that compromises or prevents the development of affectional bonds of pleasure since these brain systems for pleasure have been damaged by these early insults and injuries. This thesis constitutes the neuropsychological foundation of my SAD (Somatosensory Affectional Deprivation) theory of alienation, depression, addictive and violent behaviors. It is for these reasons that SAD is proposed to be the

PHILOSOPHICAL/RELIGIOUS BASES FOR GENITAL MUTILATIONS
It is well recognized that circumcision in the Jewish religious tradition represents a covenant with God (see Gerald Larue's article in this issue). It is less well recognized that the
(Continued on next page)

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1Befo1re (9i1rcumcision
YOUR COMMENTARy

Is INViTEd
The charge that circumcision is either unnecessary or harmful must confront contemporary evidence. While the 1971 report ofthe American Academy of Pediatrics ruled circumcision unnecessary, it is important to note that the Academy is reviewing its earlier decision because of new evidence. Of fifty thousand known cases of penile cancer in North America only nine have occurred in circumcised males. Urinary tract infections occur less frequently when the foreskin is removed. And ninety-five times as many uncircumcised males contract AIDS as do the circumcised. If all these assertions are true, then the pain and trauma, if they indeed exist, may be worth enduring ... Quite frankly, the fury of many anticircumcision militants is out of proportion to the provocation. Given the horrendous proportions of child abuse, a little foreskin removal (which may, in the end, turn out to be beneficial) hardly deserves the hostility it receives.

Peaceful, Blissful and Trusting - Credit: Marilyn F. Milos, R.N., NOCIRC

Afre1r (9i1rcumcision

- Sherwin T. Wine Rabbi, First Humanistic Jewish Congregation, Birmingham Temple. Farmington Hills, MI From: Circumcision. Humanistic Judaism 1988 (Summer), V.XVI Number III
Pain, Fear and Betrayal- Credit: Marilyn F. Milos, R.N., NOCIRC
It is almost impossible to believe that parents who love their children could stand by and see them so unmercifully tortured for a religious purpose. Can religion so stultify the brain that it even makes us callous to the cries of our loved ones when being so outrageously assaulted?

"As TIiE body is pRioR iN oRdER of GENERATioN TO TIiE soul, so TIiE iRRATiONAl is pRioR TO TIiE RATioNAl. TIiE pRoof is TIiAT ANGER ANd wisliiNG ANd dESiRE ARE iMplANTEd iN cliildREN fROM TIiEiR VERy biRTIi, bUT REASON A~d UNdERSTANdiNG ARE dEVElopEd AS TIiEy GROW oldER. WIiEREfoRE, TIiE CARE of TIiE body oUGIiT TO PRECEdE TIiAT of TIiE soul, ANd TIiE TRAiNiNG of TIiE AppETiTiVE pART sliould follow; NONE TIiE lESS OUR CARE of iT MUST bE fOR TIiE sAkE of TIiE REASON, ANd OUR CARE of TIiE body fOR TIiE SAkE of TIiE soul." ARiSTOTlE, 1Jolitca

- Joseph Lewis
From: In The Name Of Humanity. 1949, p. 120.
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Genital Pain vs. Genital Pleasure (Continued)
diminution of sexual pleasure is another major reason for circumcision in the Jewish religious tradition. This reason is clearly stated by Moses Maimonides in the Guide G!f The Perplexed (1190) which merits its full reproduction: ON CIRCUMCISION On Masturbation

"As regards circumcision, I think that one ofits objects is to limit sexual intercourse, and to weaken the organ ofgeneration asfar as possible, and thus cause man to be moderate. Some people believe that circumcision is to remove a defect in man's!ormation; but everyone can easily reply: How can products of nature be deficient so as to require external completion, especially as the use oftheforeskin to that organ is evident. This commandment has not been enjoined as a
complement to a deficient physical creation, but as a means for perfecting man's moral shortcomings. The bodily injury caused to that organ is exactly that which is desired; it does

9. The traditional Catholic doctrine that masturbation constitutes a grave moral disorder is often called into doubt or expresslv denied today. It is said that ps\'cholog.l' and sociology show that it is a normal phenomenon oj"sexual development, especialll' among the young. ... This opinion is contradictory to the teaching and pastoral practice ofthe Catholic Church. Whatever theforce oj"certain arguments oj"a biological and philosophical nature, which have sometimes heen used by theologians, in fact both the Magisterium oj" the Church - in the course o/a constant tradition - and the moral sense of thefaithful have declared without hesitation that masturbation is an intrinsicalll' and seriousll' disordered act.
Elsewhere, the Roman Catholic church affirms the moral value of pain and suffering in The Spiritual Exercises of St. Ignatius of Loyola (the founder of the Society of Jesus):

not interrupt any vitalfunction. nor does it destroy the power of generation. Circumcision simply counteracts excessive
lust; for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when it

loses blood and is deprived ofits coveringfrom the beginning. Our Sages say distinctly: It is hardfor a woman, with whom an uncircumcised had sexual intercourse, to separate from him. This is, as I believe, the best reason for the commandment concerning circumcision. "
(Part III, Chapter 49) Elswhere in the Jewish religious tradition clear warnings are given concerning the dangers of sexual pleasure. The following quotations are taken from the Code ofJewish Law: Chapter 150 The Sin of Discharging Semen in Vain

"The third kind ofpenance is to chastise the bodl', that is to inflict sensible pain on it. 771is is done by wearing hair shirts. cords, or iron chains on the bod\', or h\' scourging or wounding oneself, and by other kinds G!f austerities" (1541).
Many other examples could be cited, the most significant of which is the Crucifixion itself. God the Father's Divine Plan of Incarnation for his Son: "So the Word was made flesh;" (J ohn I: 14); and "I did not come of my own will; it was He who sent me" (John 8:42) was a plan for the mutilation, torture and murder of His only-begotten Son on the cross (euphemistically called "sacrificed") - for the ulterior motive of human salvation! The ultimate psychopathology of this event is equating this mutilation, torture and murder with LOVE! Clearly, Christian Love is as much an expression of pain and suffering as pleasure. It is this fusion of pain and suffering with love that forms one of the roots of sado-masochism which is so prevalent in monotheistic and patristic cultures. Given the violence that this Father inflicted upon the Son He loved (and others), is it so surprising to find so much violence of other Fathers inflicted upon their sons (and daughters)? If "Man" is made "Unto the Image and Likeness of God," then the violence of "Man," becomes more understandable. Remember, it is this same God the Father that demanded the torture of helpless male newborns through the ritual mutilation of their genitals, called circumcision - a practice that continues today in many monotheistic cultures. Why was pain and violence and not pleasure and peace selected as the primary path for establishing the "bond" between God and Man and for human salvation? In all His Wisdom, Power and "Love" could He not have found a different solution to the enigma of human "salvation"? The answers to these questions lie elsewhere. It should be recognized that the roots of the morality of pain and suffering and the immorality of physical sensual/sexual pleasure antedate the Crucifixion and the rise of monotheism. These basic concepts existed in parallel civilizations where, for example, the ancient Greek philosophers provided a clear metaphysical theory of good and evil that was directly related to a moral theology of pain and pleasure. Greek Metaphysical Dualism provided the following equations: MATTER=Bo~\', Evil, Wickedness, Darkness, Chaos=FEMALE;

I: It isforhidden to discharge semen in vain. This is a graver sin than an)' other mentioned in the Torah. Those who practice masturbation and cause the issue of semen in vain, not onll'do they commit a grave sin, but they are under a ban, concerning whom it is said (Issiah 1:15):" Your hands arefull 0/ blood, " and it is equivalent to killing a person. See what Rashi wrote concerning Er and Onan in the Sidrah of Vayeshev (Genesis 37), that both Er and Onan diedfor the commission ofthis sin. Occasiona/~l', as a punishmentfor this sin, children die I"..hen young, God forbid, or grow up to be delinquent. while the sinner himself is reduced to poverty.
Chapter 151 Laws of Chastity 17. Semen is the vitality G!fman's body and the light of his

e\'es. and when it issues in abundance, the bod\' weakens and life is shortened. He who indulges in having iniercourse, ages quickly, his strength ebbs, his eyes grow dim, his breath becomesfoul, the hair of his head, eyelashes and brows fall out, the hair G!fhis beard, armpits andfeet increase, his teeth fall out. and many other aches besides these be/all him. Great physicians said that one out of a thousand dies from other diseases, while nine hundred and ninety-nine die from sexual indulgence. Therefore, a man should exercise self-restraint.
The Roman Catholic Church is equally affirmative on the moral dangers of masturbation whose only purpose is sexual pleasure. In the Vatican's "Declaration on Sexual Ethics," published by the Sacred Congregation For The Doctrine Of The Faith (December 29, 1975), formerly the Holy Office of The Inquisition, the following is stated:
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FORM=Soul, Goodness, Godlike. Lightness. Order=MALE;
(Continued on next page) -19JULY/AUGUST 1989

Genital Pain vs. Genital Pleasure (Continued)

MATTER

= Body, Evil, Wickedness, Darkness, Chaos = FEMALE; FORM = Soul, Goodness, Godlike, Lightness, Order = MALE;

~

It was Pythagoras (c.582-c.507 B.C.) who provided the sex gender equivalents of maleness with goodness; and femaleness with evil:

"There is a Kood principle which has created order. light and man; and a bad principle which has created chaos, darkness and woman."
Given this formulation is it so surprising to find thefollowing in Ecclesiasticus (25:33): "From the woman came the beginning of sin, and by her we all die." And in Paul, I Corinthians (7: I); "Now concerninK the thinKS whereofyou wrote me: It is Kood/or a man not to touch a woman. .. Many other examples could be mentioned that are too numerous to cite which reflect this absurd and most erroneous dualistic moral theory of human nature, gender and behavior. Moses Maimonides has perhaps provided the clearest exposition of these metaphysical/ moral/ gender relationships in The Guide Of The Perplexed (When the word "matter" occurs think "female," when the word "form" occurs think "male"):

down upon man every impelfection and corruplion; He granted it - I mean the human/arm - power, dominion. rule, and control over maUer, in order that it subjugate it, quell its impulses, and bring it back to the best and mosl harmonious slate Ihat is possible (111.'8, pp. 430-432).
(Part lll, Chapter 8)

Ecclesiasticus (25:33): "From the woman came the beginning ofsin, and by her we all die. "... in Paul. I Corinthians (7:1); "Now concerning the things whereofyou wrote me: It is goodfor a man not to touch a woman."
Perhaps it is now more clear how philosophical and theological moral dualism has conspired against the human body, particularly the female body and the sensual/ sexual pleasures that they represent. This moral dualism of Western Civilization is one of the great roots of violence against the human body and the female body in particular. And these moral traditions are not confined to the cultures of Western Civilization which subordinate female to male; assures the continuing inequality of woman to man and supports the violence of man against woman and her children. (Reich, 1971). This fundamentalist/ orthodox morality of Western Civilization requires that the sensual/ sexual pleasures of the body must be extremely limited if not destroyed to achieve "salvation of the soul" (re, the "virtues" of celibacy, virginity and chastity). What better place to begin than with the mutilation and destruction of the genitals which are designed to exper(Conlinued on nexi page)

"All bodies subject to generation and corruption are auained by corruption anI\' because o.ftheir maUer; with reKard to/ann and with respect to the lauer's essence, they are not auained by corruption. but are permanent . .. Similarll' every living being dies and becomes ill solely hecause ofits maUer and not because a/its/arm. All man's acts of disohedience and sin are consequent upon his maue~ and not upon his/arm. whereas all his virtues are consequent upon his/arm . .. consequent~v it was necessary that man's very noble form, which as we have explained, is the image of God and His likeness, should be bound to earthy, turbid and dark matter, which calls

Pain and "Salvation"
"The third kind ofpenance is to chastise the hodI'. Ihat is 10 inf7ict sensihle pain on il. This is done hy H'earinK hair shirts. cords. or iron chains on the hodI'. or hy scourKinK or woundinK oneself, and hy other kinds of austerities. "
On "Good" Friday the Crucifixion and scourging/flagellation of the body are commonly re-enacted in many primitive Catholic cultures throughout the world. This moral theology of pain and suffering is a major root cause of supporting and tolerating violence against the human body. Quote: St. Ignatius of Loyola

The Spiritual Exercises
Photo Credit: Ingmar Bergman

The Seventh Seal
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Genital Pain vs. Genital Pleasure (Continued)
ience sensual pleasure and share sexual love? It is not without reason that the monotheistic religions
Hosken. FP. (1979): Female Sexual MWilatio/ls: The FaclS and Proposals For Action. Women's International Network News. Lexington, MA. Ignatius of Loyola (1556): The Spiritual Exerci.\l's oj SI. Ig/latius or

(Judaism, Christianity, Islam) have carried the/r religions on the edge of the sword - the same sword that cuts the genitals of children (male and female); and which mutilates their souls.
It is clear to this writer that before genital mutilations of our children can cease; before male violence against women can end; and before human violence can be eliminated that a moral revolution must take place. Pain rT1USt be declared immoral and pleasure must be declared morally necessary if we are to become moral persons. In the words of Walt Whitman:

LOl'ola.
Jacobson. B.. Eklund, G .. Hamberger. L. Linnarsson. D.. Sedvall. G .. and Valverius, M. (1987): Perinatal origin of adult sclf-destructive behavior. AC/ll PSl'chiatrica Scatlllil/{I\·ia. 76.364-371. Levy, D.M. (1945). Psychic Trauma Of Operations in Children. American Journal Of Diseases Of Children (January) 69, (I). 7-25. Lewis, J. (1949). In The Name Or Humanit.". Freethought Press. San Diego. Maimonides. Moses (1963): The Guide or The Perplexed. (Shiomo Pines. Trans.) Vols I & II. University of Chicago Press. Chicago. Porter. F.L.. Miller. R.H. and Marshall. R.E. (1986) Neonatal Pain Cries: Effect of Circumcision on Acoustic Features and Perceived Urgency. Child Del'elopmel1l 57,790-802. Prescott, J.W. (1975): Body Pleasure and The Origins of Violence. The Fwurisl. April 1975. Prescott, J. W. (1979): Deprivation of physical affection as a primary process in the development of physical violence. In (,hild A huse and Violence (Gil. D.G .. Ed). AMS Press New York pp 66-137. Reich. W. (1971): The Mass PITcholog.!' ol'Fascism Farrar Straus Giroux New York. Salk. L, Lipsitt. LP .. Sturner. W.Q .. Reilly. B.M. & Leva!. R.H. (1985): Relationship of maternal and perinatal conditions to eventual adolescent suicide. The Lancet March 15. 1985. Textor. R. B. (1967): A ('ros.I·-('ultural SUII II 1101'.1' Human Relations Area Files (H RAF) Press: New Haven. Vatican. The. (1975): Declaration on Sexual !:'thics. Sacred Congregation For The Doctrine of The Faith. (December 29. 1975). United States Catholic Conference. Washington. D.C Wiswell, T E. and Roscelli. J. D. (1986): Corroborative evidence for the decreased incidence of urinary tract infections in circumcised male infants. Pediatrics. V. 78, No. I. July 1986.

"IF ANYTHING IS SA CRED THE HUMAN BODY IS SACRED" In summary, the dualistic/theistic moral foundations of Wester~ Civilization must be transformed if human equality, compassion, justice and love are to be realized; and if the human species is to survive.

REFERENCES
Anand, K.J.S. and Hickey, P.R. (1987) Pain and its Effects in the . Human Neonate and Fetus. The Nell' England Journal of Medicine (Nov. 19). V 317 0.21. Bullough, V. (1976) Sexual Variance in Socien' and Histor.!'. Wiley: Interscience, New York. Bullough, V. and Bullough, B. (1987) Women and ProstitUlion. Prometheus Books, Buffalo. Faro, M.D. and Windle, W.V. (1969): Transneuronal degeneration in brains of monkeys asphyxiated at birth. Experimel1lal Neurologl'. 24, 38-53. Ganzfried, S. (1963). Code 0/ Jell'ish Lall' (Holdin, H.E.. Translator). Hebrew Publishing Company Brooklyn. Heath, R.G. (1975): Maternal-social deprivation and abnormal brain development: Disorders of emotional and social behavior. In Brain

Function and MalnUlrition; Neurops.!'chological Methods ofAssessment. (Prescott, J. W., Read, M.S .. & Coursin, D.B.. Eds.) John
Wiley New York.

Genital Pain As Punishment For Genital Pleasure
Figure I: A man's scrotum is being nailed to a public bench for committing the "sexual sin" of fornication. From: A 17th Century Woodcut. Dr. Prescott's personal collection.

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Female Genital Mutilation - Strategies For Eradication
by Fran P. Hosken

According to a conservative estimate, at least 84 million womenanrl girls are mutilated today in Continental Africa and similar operations are practiced along the Persian Gulf and the southern part of the Arab Peninsula.
Female Genital Mutilation - the descriptive terms for the different types of operations are "Excision" and "Infibulation" - continues to be practiced in large regions of Africa from the Red Sea Coast to the shores of the Atlantic. According to a conservative estimate, at least 84 million women and girls are mutilated today in Continental Africa and similar operations are practiced along the Persian Gulf and the southern part of the Arab Peninsula. In Indonesia and Malaysia, less drastic forms of "female circumcision" are practiced by some of the Moslem populations of this region and sporadic occurrences have been registered among other mainly Moslem groups.

There is no doubt, and anecdotal evidence exists, that immigrants from Somalia, Sudan, Ethiopia, or certain ethnic groups of Kenya, Nigeria, etc., are having their small daughters mutilated in the U.S.
None of these conditions exist where these operations are done in Africa and the Middle East on struggling, screaming children held down byforce on the ground, in dark huts, with crude knives or any other cutting tools. What is done in
reality is cutting away whatever the operator can get hold of, part or all of the clitoris and often part of the labia minora (small lips). Excision or clitoridectomy, the operation most frequently done throughout Africa, consists of the removal of the entire clitoris, usually together with the adjacent parts of the labia minora (small lips) and sometimes all of the external genitalia, except parts of the labia majora (large lips). Some operators make additional cuts to enlarge the opening of the vagina as this is believed to make childbirth easier. (The opposite is true.) Infibulation or pharaonic circumcision (excision with infibulation) means that the entire clitoris and the labia minora are cut away and the two sides of the labia majora are partially sliced off or scraped raw and then sewn together, often with catgut. In Sudan and Somalia, thorns are used to hold the two bleeding sides of the vulva together, or a paste of gum arabic, sugar and egg is used. The introitus or entrance to the vagina is thus obliterated which is the purpose of the operation, except for a tiny opening in the back to allow urine, and later menstrual blood, to drain. The legs of the girl are tied together immediately after the operation, and she is immobilized for several weeks until the wound of the vulva has closed, except for a small opening that is created by inserting a splinter of wood or bamboo.

With increasing mobility of African and Middle Eastern immigrants to Europe, the U.S. and also to Australia, these mutilations are being exported all over the world.
With increasing mobility of African and Middle Eastern immigrants to Europe, the U.S. and also to Australia, these mutilations are being exported all over the world. Indeed, Britain had to pass special legislation recently to prohibit the operations (which were carried out by obliging physicians for a high fee). In France, the Criminal Courts had to finally initiate proceedings against African fathers and families after three little girls died as a result of the operations performed in France. One father brought to court had "operated" on his baby daughter with a pocket knife - the child bled to death. In most European countries and also in Australia, health services have been alerted to warn people and especially immigrants. In the U.S.,immigrants from affected African countries have not been warned by immigration services that these mutilations are categorized as gross child abuse and would result in having children removed from parents by the Social Services. There is no doubt, and anecdotal evidence exists, that immigrants from Somalia, Sudan, Ethiopia, or certain ethnic groups of Kenya, Nigeria, etc., are having their small daughters mutilated in the U.S. A systematic survey has yet to be done to document the facts on how many children are involved or are at risk - and this is long overdue. (See below.) But first, the medical and health facts need to be established. The medical literature describes Circumcision or Sunnacircumcision as the removal of the clitoral prepuce and the tip of the clitoris. "Sunna" means tradition in Arabic. But to remove the prepuce of the clitoris, which is a very delicate operation especially if done on a child would require great skill, good light, surgical tools, an anesthetized, motionless body, quite aside from a thorough knowledge of anatomy.
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The objective of infibulation is to make sexual intercourse impossible. At present, infibulation is practiced mostly by Moslems, according to all available sources, because ofthe importance and value they attach to virginity.
The mortality of girls and women due to all these operations no doubt is high; but no records are kept anywhere. Primary fatalities are not recorded and death in childbirth, due to obstructed labor, is never related to genital operations anywhere. But the terrible psychological trauma that is lifelong has never been investigated from a woman's view. The objective of infibulation is to make sexual intercourse impossible. At present, infibulation is practiced mostly by Moslems, according to all available sources, because of the importance and value they attach to virginity. Infibulation is

performed to guarantee that a bride is intact - the smaller her opening, the higher the bride price. A girl is often
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JULY/AUGUST /989

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Female Genital Mutilation - Strategies For Eradication (Continued) Women who are infibulated have to be cut open to allow sexual intercourse and more cuts are needed for delivery of a child.
inspected by the female relatives of the husband-to-be before the bride price is paid. The bride price, whereby the husband or his father pays the father of the girl a considerable sum in cash or kind, is still a marriage requirement almost everywhere in Africa and the Middle East. Infibulation may also occur spontaneously by adherence of the wounded sides of the labia, especially where extensive excision operations are performed. For instance, in parts of Mali and Burkina Faso as well as other areas of West Africa. Women who are infibulated have to be cut open to allow sexual intercourse and more cuts are needed for delivery of a child. Wives, traditionally, are re-infibulated, for instance in the Sudan, after the baby is born; and when the child is weaned, they are opened again for intercourse. During her reproductive life, a woman used to go through this process with each child; and in some areas it still continues today. In West Africa infibulation is usually not done by sewing or other fastening devices but by tying the legs of the girl together (after the operation) in a crossed position, the same results are achieved. On a visit to Ouagadougou, Burkina Faso in 1977 while I was at the maternity hospital, a woman in labor with her first child was brought in; she could not deliver; she was almost completely closed. There was nothing at all left of her external genitalia. She had evidently conceived through a tiny opening. All the operations are performed on the ground, under septic conditions, with the same knife or tool used on all the girls of a group operation, which is still the custom among many ethnic groups in rural areas. In cases of fatalities,

blamed. Rather, it is claimed that an evil spirit is responsible or the ritual was not performed properly according to the wishes of the ancestors - or the girl herself is at fault because she had sex before she was operated on.
Infibulation or pharaonic circumcision is practiced in the Sudan and adjoining areas throughout Somalia, parts

All girls, without exception, must undergo this mutilation as it is a requirement for marriage.
of Ethiopia, Southern Egypt and Northern Kenya and in some areas of West Africa for instance, Mali. Infibulation or

pharaonic circumcision is the most drastic and damaging operation. It is called "Pharaonic. as the operation according to historic documents was already recorded in ancient Egypt more than 2000 years ago in pharaonic times.
The term infibulation is derived from fibula which means clasp or pin in Latin and goes back to the old Romans: a fi bula was used to hold toget her the folds of t he toga - the loose garment all Roman men wore. The Romans also fastened together the large lips of slave girls to prevent them from having sexual intercourse as becoming pregnant would hamper their work. Here is an eyewitness description of an operation In Somalia:

neither the operator nor the operation are ever

Figure 1: Tribal Genital Mutilation. The nude girls legs are forcibly held apart at the thighs as her external genitalia are being cut away by a sharp instrument. No anestheitc or antiseptic is used. From a "freeze-frame" of a 16 mm. file documentary.
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"With the Somalis, the circumcision olgirls takes place in the home among lI'omen relati\'e,\ and neighbors. The grandmother or an older lI'Ollwn officiates. A t each occasion. usual/I' onll' one little girl. or att illles tll'O sisters are operated; hUl aI/ girls, lI'ithoUl exception. must undergo this mUlilation as it is a requirement for marriage. . The operation itself is not accompanied hI" an.r ceremonr or ritual.. The child. completell' naked. is made 10 sit on a lOll' stoo!. Several lI'oman take hold 0/ her and open her legs lI'ide. A/tel' separating her outer and inner lips. the operator, usual/I' a woman experienced in this procedure, sits dOl\'l1/acing the child. With her kitchen kl1l/e the operatorjirst pierces and slices open the hood a/the clitoris. Then she hegins to CUI it OUI. While another lI'oman lI'ipes on' the Mood with a rag, the operalOr digs II'ith her sharpjingernail a hole the length a/the clilOris to detach and pul/ oUlthe organ. The lillIe girl. held dOH'n bI' the II'omen helpers, screams in extreme pain; but no one pays the slightest al/ention. The operatorjinishes thisjob bl' entirelr pulling OUI the clitoris, cUl/ing it to the bone lI'ith her kl1l/e. Her helpers again I,ripe all the spurting blood with a rag. The operator then removes the remaining flesh. digging with her ./i"nger to remove ani' remnant a/the clitoris among the/lowing blood. The neighbor lI'omen are then invited to plunge their.fingers into the bloodl' hole to verifl' that even' piece o./the clitoris is removed. BUI this is not the end. The most important part 0./ the operation begins onl.r now. A/tel' a short moment. the 1I'0man takes the kni/e again and cuts offthe inner lips (labia minora) a/the victim. The helpers again wipe the blood with their rags. Then the operator, with a
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JULY/AUGUST 1989

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Female Genital Mutilation - Strategies For Eradication (Continued)
Most often, men refuse to marry girls who are not excised. Since marriage is still the only career for a woman in most of Africa and the Middle East, the operations continue.
mOlion 0/ her knife, begins 10 scrape Ihe skin from Ihe inside ollhe large lips. Wilh Ihe abrasion o/Ihe skin compleled, according 10 Ihe rules. Ihe operalOr closes Ihe bleeding large lips and fixes Ihem one againsllhe olher wilh long acacia Ihorns. Allhis slage oflhe operalion Ihe child is so exhausled Ihal she slaps crying. bUI often has convulsions. The women Ihen/orce down her Ihroal a concoclion olplams. The operalor's chiel concern is 10 leave an opening no larKer Ihan a kernel ol corn or jusl big enoughl 10 allow urine. and laler Ihe menslrualflow. 10 pass. Thefamilv honor depends on making Ihe opening as small as possible because wilh Ihe Somalis, Ihe smaller Ihe arlifical passage is, Ihe grealer Ihe value ollhe girl and Ihe higher Ihe bride price. When Ihe operalion isJinished, Ihe woman pours waler over Ihe genilal area 0/ Ihe girl. and wipes her wilh a rag. Then Ihe child. II'ho was held down all Ihis lime. is made 10 sland up. The u'omen Ihen immobilize her Ihighs by lying Ihem IOgelher lI'ilh ropes 0/ goal skin. This bandage is applied/rom Ihe knees 10 Ihe waisl oflhe girl. and is left in placelor abOUilwo weeks. The girl muSI remain Iving on a matfor Ihe enlire lime, while all Ihe excremem evidem/l' remains wilh her in Ihe bandage. Afier Ihal lime. Ihe girl is released and Ihe bandage is cleaned. Her vagina is now closed. and remains so umif her marriage. Comrary 10 whal one would assume, nol many girls die from Ihis IOriure. There are, of course, various complicalions which frequemlr leave Ihe girl crippled and disabled/or Ihe reSI a/her life. " Many colorful myths are related all over Africa as reasons for the operations. Though all the myths are still believed by the ethnic groups involved in the rural areas, many of the reasons are contradictory, and none of them are compatible with biological facts. Most Africans who practice these operations believe that excision is a custom decreed by the ancestors; therefore, it must be complied with. Most often, men refuse to marry girls who are not excised. Since marriage is still the only career for a woman in most of Africa and the Middle East, the operations continue. "No proper Kiku.l'u would dream ofmarrying a girl who has nol been circumcised. "slaled lama Kenyalla, Ihe revered leader ol Kenya in his book. "Facing Mount Kenya," which was wrillen in Ihe 1930s and cominues 10 be published and is also sold in lOurisl shops in Nairobi. As President of Kenya for life, Kenyatta had great influence on Africans well beyond the borders of Kenya, and his much quoted statement is responsible for the mutilation of many thousands of helpless little girls and untold suffering and deaths.
The successor of Kenyatta, President Arap Moi categorically prohibited female genital mutilation operations in 1982. He also alerted the Health Services that no more operations may be done in hospitals, which shows that the Kenyan Health Services were involved in the mutilations. Unfortunately, there has been no follow-up, teaching or educating the people against the mutilations. As a result, they have gone underground.

Excision, by cutting out the most sensitive tissues of a woman's body, extinguishes sexual sensitivity, pleasure and response to touch. The elimination of female sexual pleasure is the reason most frequently given for the genital mutilations, which is to keep "moral behavior of women in society" and "to assure the faithfulness of women to their husbands" - who usually have several wives.
Excision, by cutting out the most sensitive tissues of a woman's body, extinguishes sexual sensitivity, pleasure and response to touch. The elimination of female sexual pleasure is the reason most frequently given for the genital mutilations, which is to keep "moral behavior of women in society" and "to assure the faithfulness of women to their husbands" who usually have several wives. In many ethnic groups, for instance in Mali and Francophone West Africa, the operation traditionally is performed just before marriage, as a puberty rite; it is claimed that a woman can be accepted into adult society and get married only after she is operated upon.

I
,

Women who do not have their genitals mutilated are considered to be prostitutes.
In the Sudan and the Middle East, and in Moslem societies, for instance in Somalia, it is said that a woman is incapable of controlling her sexuality - hence she must be excised or infibulated or she will disgrace her family. Women who do not have their genitals mutilated are considered to be prostitutes.

It is said that women's external genitalia are ugly and must be removed to make her acceptable to a man.
Excision is also perceivedas a way to increase/ertility; and the wish 0/ most women is to have as many children as possible, especially sons, on which their status in society depends. The biological facts about reproduction are unknown or ignored. It is widely believed, for instance, in Mali and Burkina Faso, and all over West Africa, that the clitoris connotes maleness, and the prepuce of the penis, femaleness. Hence, both have to be removed before a person can be accepted as an adult in his/ her sex and society. It is also believed that a girl who is not operated on will run wild and disgrace her family. In Egypt, aesthetic reasons are sometimes cited for the operation, and this is occasionally said in other areas of Africa as well. It is said that women's external
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The successor of Kenyatta, President Arap Moi categorically prohibited female genital mutilation operations in 1982.
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JULY/AUGUST 1989

9{g:turaf 115. Infi6ufation

Natural

Infibulated

INFIBULATION: IMMEDIATE RESULTS Cutting away the exterior genital organs and infibulating a girl can start bleeding that cannot be stopped and may kill your child. Dangerous infections may also result that may make your daughter very ill. Later, it may prevent her from having children of her own. The damaging operations cause much needless suffering.

Natural

Infibulated

1

INFIBULATION / PHARAONIC CIRCUMCISON Infibulation - cutting a way the external genital organs and then closing the opening to the vagina by scarification - is a very dangerous operation that causes many life-long health problems. It interferes with a woman's natural sexuality. In the top row, you see the natural genitals of a girl and a woman. In the pictures below, you see a girl bleeding after the operation and a woman who is infibulated: only a tiny opening is left.
From: The Universal Childbirth Picture Book; by Fran P. Hosken; pictures by Marcia L. Williams, published by Women's International Network News.
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Female Genital Mutilation - Strategies For Eradication (Continued)

The Catholic Church has sanctioned the genital mutilation of all female children of its converts on those grounds since the 17th century when the Pope sent a medical mission to Ethiopia.
genitalia are ugly and must be removed to make her acceptable to a man. Hypertrophy of the clitoris - by which is meant an unusual enlargement of that organ - is cited as reason for excision in Ethiopia and also in parts of igeria. The Catholic Church has sanctioned the genital mutilation of all female children of its converts on those grounds since the 17th century when the Pope sent a medical mission to Ethiopia. Health reasons are often cited, especially in urban areas where the traditional myths are forgotten. Cleanliness is the reason given also by middle class women in areas as far apart as Cairo and Bamako.

A Iso, in Sudan, genital mutilations are connected with cleanliness and is called "Tahur" which in Arabic means purity. A woman is considereddirty andpolluted unless she is mutilated The same is often said in Somalia.

Figure 2: Tribal Genital Mutilation. A later scene from Figure 1 showing the raw bloody flesh of the excised genital area.

Obviously, all of the myths are designed to justify and continue the female genital mutilations, from which men derive power and control over women as a group.
Many of the reasons given by local populations are quite similar, though they have been arrived at quite independently, as no connection or communication exists between the population groups involved. Most of these myths are promoted by men, which once more documents the amazing world-wide similarity of male attitudes concerning female sexuality. Obviously, all of the myths are designed to justify and continue the female genital mutilations, from which men derive power and control over women as a group. This is, of course, the real reason why these operations continue today, and why they are being rapidly introduced into the modern sector throughout the African continent with the collusion of Western men, and especially the male-dominated health system. Though the social rites and ceremonies are minimized or forgotten, the surgery continues: and a lot of money can be made from this. The genital mutilations are now performed on much younger children especially in the towns, as it is feared by men that the girls will resist once they go to school. Even in areas where traditionally the operations were a coming-ofage custom, they are now done on very young children, sometimes a few years old, or even shortly after birth. The stated purpose of the operation - introduction to adult life - has disappeared. Nevertheless, the mutilations continue to be practiced even in families of government officials

and political leaders where many of the men have been to European or Western universities. The reasons given by these men are "tradition" - yet the men have rejected all African traditions for their own Westernized personal lives.

The patriarchal family structure and ideology of male supremacy supported by religion provides the under-pinning for genital mutilations both past and present.
The patriarchal family structure and ideology of male supremacy supported by religion provides the under-pinning for genital mutilations both past and present. It is wellrecog-

nized that religious beliefs are invariably cited to support the "necessity" for having the genitals of daughters excised and/or infibulated. The operations are practiced by animists
- those who believe in ancestor worship - stating that "the ancestors decreed these operations and their wishes must be followed." They are practiced by Moslems - indeed in the Sudan and also in West Africa the local sheiks and marabouts claim that excision or infibulation is a required or "preferable" Moslem rite. But Egyptian Moslem religious authorities at the recognized El Azhar University state there is no requirement for female genital mutilation in the Koran. Male circumcision, however, is an absolute command. Excision and infibulation are practiced by Christians of all denominations. As stated earlier the Papacy of the Roman Catholic Church has officially supported the genital mutilations ever since a medical mission was sent from Rome to Ethiopia in the 18th Century which declared that genital mutilations are "necessary."
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The genital mutilations are now performed on much younger children especially in the towns, as it is feared by' men that the girls will resist once they go to school.
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But Egyptian Moslem religious authorities at the recognized EI Azhar University state there is no requirement, for female genital mutilation in the Koran. Male circumcision, however, is an absolute command.
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Female Genital Mutilation - Strategies For Eradication (Continued) Over the centuries and due to their isolation, women have come to believe that the mutilation of their genitals are "necessary."
done all over the world. Thus, they are accepted as "natural." Some African women even now cannot believe that the operations are not done in other parts of the world.

The wholesale support ofcultural traditions by anthropologists without critical evaluations of the often terrible damage done to the most vulnerable members ofeach community - children, especially female children and women - is completely irresponsible. There is hardly a major development program in Africa by the U.S. Agency for International Development - especially in health -that does not consult an anthropologist. I have frequently run into those "development advisers" who impose their ethnocentric views on multi-million dollar health programs in Africa. As a result, the terrible health damage done to girls and women by traditional practices is ignored because it is the "culture." I testified repeatedly before Congressional Committees - especially those concerned with appropriations for Foreign Aid to attract attention to the health needs of women, especially in Africa, about the modernization of female genital mutilations which are a violation of human rights. I stated in my Congressional testimony, "My research in Africa shows that genital mutilations are increasingly performed in the modern sector in Africa, including hospitals, often on small babies, stripped of all traditional rites. This is a gross abuse of modern medicine. As Editor of WIN NEWS, I must advise this Committee that frequently health equipment, tools and training contributed by the U.S. and other Western donors is used to mutilate female children. Speaking for American women and taxpayers, I strenuously object to the use of U.S. monies and contributions to carry out sexual castrations - that is clitoridectomies and infi bulations - on non-consenting children in Africa and the Middle East."

;<;:;;

Figure 3: Tribal Genital Mutilation. The pain and shock of a young girl as she stands up after her external genitalia have been cut away.

Thefollowers of the Ethiopian Christian Church and the Copts in Egypt (more than 7 million adherents) have always mutilated the genitals of their female children.
Indeed, all religions (with the exception of the Scottish Protestant Church in Kenya in the 1920s) have actively supported or tolerated the mutilation of girls to make them pliable subjects of the dominant patriarchal community that vests all rights in the males. There is no doubt that genital mutilation does permanent life-long physical and psychological damage to women. The full impact of the often terrible psychological consequences have never been systematically investigated though it is known that numer-

ous young women commit suicide, asfor instance reported in Burkina Faso.

Patriarchal Religions - there are no others in Africa/The Middle East - provide the intellectual basis for men to keep their power and privileges in society. Who is going to question "the hol~ religious beliefs expressed by men?
Patriarchal Religions - there are no others in Africa/The Middle East - provide the intellectual basis for men to keep their power and privileges in society. Who is going to question "the holy religious beliefs expressed by men? Certainly not women - the vast majority in Africa and the Middle East are still illiterate (in some countries up to 90%). And men from Western countries especially those concerned with development, have been warned by the militant male politicians to keep hands off their "culture" which in Africa and the Middle East sanctions polygamy, wife beating (the diameter of the stick is specified in some countries), the bride price (selling of young girls into marriage by their fathers), unilateral divorce, child marriage and female genital mutilations. Over the centuries and due to their isolation, women have come to believe that the mutilation of their genitals are "necessary." Indeed, many women think that they are
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African women have now started to organize to fight against these terrible genital mutilations in a systematic way.
The desire for modernization and especially all kinds of imported equipment and tools, especially by men, provides a unique opportunityfor men to teach their African brothers that these genital mutilations are not acceptable. Only
men can reach their African counterparts on this subject - especially since sexuality is involved, to teach them the biological facts in a persuasive way and from their own experience. Unfortunately, no one has ever really tried to reach African men who make all the decisions in each family about the truth regarding female genital mutilations. Men also have been left out where family planning programs are concerned - which are all imported by Development and Population experts. As a result, family planning in Africa has and is failing. It is up to the male development and health advisers and all those who have contact with African men - for instance, the way many students from Africa at Western
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Female Genital Mutilation - Strategies For Eradication (Continued)
Universities - to talk to them about excision and infibulation and to explain to them why these genital mutilations are unacceptable. But unfortunately, such educational programs have not been tried. African women have now started to organize to fight against these terrible genital mutilations in a systematic way. The Inter-African Committee was created in 1984, five years after the ground breaking seminar, organized by WHO, on the "Traditional Practices Affecting the Health of Women and Children" held in Khartoum, Sudan. As a temporary adviser to WHO - the sponsor of the meeting - I provided an overview of female child genital mutilations around the globe. This meeting opened up the international discussion on female genital mutilations which had been a tabu subject until then. That was in 1979. The seminar attracted world-wide attention with delegations and observers from the health departments of nine African and Middle Eastern countries, as well as many Sudanese physicians and health officials. Unfortunately, limited action followed this seminar. tioners of traditional medicine, to demonstrate the harmful effects of female circumcision, with a view to enlisting their support along with general efforts to abolish this practice. The Inter-African Committee, formed in 1984 at an international meeting and headed by Berhane Ras-Work, by now has affiliated National Committees in 14 African countries and has offices in Addis Ababa (at the ECA - Economics Commission of Africa) and Geneva. They held several overflow meetings at the 1985 UN Decade Conference for Women in Nairobi and have published an "Action Plan"that provides an excellent set of guidelines for the National Committees to follow - who have held meetings in many African countries. A ground breaking International Seminar on "Strategies to Bring About Change" was held in June 1988, in Mogadishu, to draw world attention to the Somalian 01mpaigne to Eradicate Infibulation - which was started two years ago. The SWDO (Somali Women's Democratic Organization), jointly with AIDoS (The Italian Association for Women in Development) has organized a national campaign, fully supported by the Somalian Government, to eradicate these damaging traditional practices. Indeed, every department of the Somalian Government is involved in this national initiative led by the outspoken president of the S W DO, Muraio Garad Ahmed, who wields considerable political power. AIDoS, led by Daniela Colombo and with the assistance of the Italian Government, has worked jointly with the SWDO in Somalia to develop viable strategies and extensive teaching aids for all different kinds of programs addressed to different sectors of the population. The secrecy surrounding infibulation has only recently begun to be lifted in Somalia. It took considerable courage for the SWDO to take up this issue. Thanks to the perseverance of its leadership, it now has become a national campaign supported not only by the health ministry, but also by all other ministries, especially education. The campaign to eradicate female child genital mutilation is going on in all the schools; it is discussed on the radio and TV. Indeed, no occasion is missed to create awareness among the population about the damage done by infibulation. All families are urged to stop having their daughters "done." This international seminar had been preceded by a national meeting which had developed a program of action for the joint SWDO-AIDoS Information Campaign. At the international seminar in Mogadishu, many influential national and international leaders gave speeches at the opening and closing sessions in the great hall of the Parliament. The speakers included a representative of the President of Somalia, the Minister of Health, the SWDO President, the Italian Ambassador, representatives of UNICEF, WHO, AIDoS and others. Delegates from several African countries, including Egypt, Sudan, The Gambia and igeria presented outlines about the successful campaigns and strategies to eradicate female child genital mutilations in their countries. Egypt, with a program sponsored by the Cairo Family Planning Association, led by Aziza Kamel, has the most extensive experience in conducting a multitude of successful grassroots initiatives. From
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Figure 4: Tribal Genital Mutilation. A pre-pubertal male has his foreskin stretched far over the glans where the tip of the foreskin is cut away. This form of circumcision is one of the more benign procedures which produced little blood flow (as could be detected from the film) and is substantially less painful and traumatic than the genital mutilation of the pre-pubertal girls.

Four recommendations were unanimously voted by the delegates at the end of this fateful meeting: • Adoption of clear national policies for the abolishment of female circumcision; • Establishment of national commissions to coordinate and follow up the activities of other bodies involved including, where appropriate, the enactment oflegislation prohibiting female circumcision; • Intensification of general education of the public, including health education at all levels, with special emphasis on the dangers and the undesirability of female circumcision; • Intensification of education programs for traditional birth attendants, midwives, healers and other practiTHE TRUTH SEEKER

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Circumcision: The Legal and Constitutional Issues
by Charles A. Bonner and Michael J. Kinane

INTRODUCTION
Circumcision has origins dating back 4,000-5,000 years, to a time before Abraham and his covenant with God to circumcise his people. Through the ages, civilization has witnessed numerousforms of child abuse enjoying significant popularity, including sterilizations, female circumcision, infanticide, ritual sacrifice, binding of the feet, and ritual piercing and mutilations. While almost 80% of the world's populations have ceased or avoided the ritual of circumcision, nearly 60% of American infant males and the majority of Moslems and Jews still suffer this mutilation.

With the exception ofJews, for whom circumcision has long been a tribal sign, widespread circumcision in the United States appears to be largely a late nineteenth-century development.
Anthropologists, psychologists, and psychiatrists have offered a variety of explanations for the practice: enhanced sexual performance, decreased sexual pleasure to prevent moral degeneration, social prestige, sacrifice to fertility gods, tribal signs, tests for endurance, reincarnation, and hygienic reasons. However, with the exception of Jews, for whom circumcision has long been a tribal sign, widespread circumcision in the Unit.ed States appears to be largely a late nineteenth-century development. For non-Jews, it serves neither as a~means of tribal integration, or separa.tion and identification, nor as an initiation rite to establish male identity. The customary justificationfor malegenital mutilation is hygienic, but it seems to have been primarily grounded in anti-masturbation hysteria of the late 1800s andjlourished following mass military circumcisions during WWlI. (23 FAML 337).

CONSTITUTIONAL AND LEGAL ISSUES
Circumcision, as an unnecessary medical treatment, raises four major legal issues, beyond the traditonal malpractice cause of action for a negligent procedure. 1. Do parents have the authority, constitutional or statutory, to consent to unnecessary medicalsurgeryfor theil infant son? 2. What is the extent of the State's interest in protecting children from unnecessary surgery? 3. What is the standardfor thirdparty consent to intrusive surgery? 4. What civilor criminalremedies are available to victims of circumcision?

LIMITATIONS TO PARENTS' CONSENT
Decisions regarding child rearing, care and education have been recognized as being entitled to protection as a fundamental right of personal liberty under the Constitution. [Walen v. Roe (1977) 429 U.S. 589,599-600; Peoplev. Privitera (1979) 23 Cal. 3d 697, 702; In re Roger S. (1977) 19 Cal. 3d
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921,928.] However, this parental duty and right is subject to limitations "if it appears that parental decisions will jeopardize the health or safety of the child, or have a potential for significant social burdens." [Wisconsin v. Yoder (1972) 406 U.S. 205, 234; Peoplev. Privitera, supra, 703; In re Roger S., supra, 928.] If these conditions are present the state may assert important interests in safeguarding health and safety and in maintaining medical standards. [Roe v..Wade (1973) 410 U.S. 113, 153-154; People v. Privitera, supra, 703.] In Privitera, the Supreme Court recently held that when important interests of health and safety are involved the State's regulations shall be tested under the rational basis test. [People v. Privitera, supra, 702, fn. 2, 703.] A parents' right to consent to medical treatment is not statutory in California, butl rather derives from the common law. In Kate's School v. Department of Health (1979) 155 Cal. Rptr. 529, - a case regarding a parents' right to prescribe their treatment of choice for their mentally disordered children, the court held that "the regulation of intrusive and possibly hazardous forms of treatment of mentally disordered children, such as involved in behavior modification therapy through corporal punishment, is a proper exercise of the states' police power and bears a rational relation to the state's interest in the protection of the health and safety ofthe children ... " This decision establishes that parents' rights to consent to treatment are not unlimited. Surgical removal of an infant'sforeskin, without medicaljustification, presents a more serious threat to the health and safety of the child than corporalpunishment, thereby justifying exercise ofthe state's police power. In an unpublished 1987 decision of the Court of Appeal, 1st District, No. A032040, London v. Glassner et aI., petition for review denied, parental consent to "any . . . medical treatment" is found to be without apparent limitation, regardless of purpose. Civil Code §25.8 cited as authority for this decision provides: "Either parent if both parents have legal custody, or the parent or person having legal custody or the legal guardian, of a minor may authorize in writing any adult person into whose care the minor has been entrusted to consent to ANY X-ray examination, anesthetic, MEDICAL OR SURGICAL diagnosis or TREATMENT and hospital care to be rendered to the minor under the general or special supervision and UPON THE ADVICE OF A PHYSICIAN AND SURGEON licensed under the provisions of the Medical Practice Act or to consent to an X-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the minor by a dentist licensed under the provisions of the Dental Practice Act." (emphasis added.) This court then held "(a) circumcision is a medical, surgical treatment," rejecting plaintiffs public policy argument that children should be protected from suffering unjustifiable pain or risk - based on the premise that parents cannot consent to surgical procedures which have no medical purpose." While this section does not specifically grant any direct authority for parental consent, the trial court found the legislative history was to extend the common law/authority of parents. (Continued on next page)
JULY/ AUGUST 1989

-SI-

Circumcision: The Legal and ConstitutionaHssues (Continued)
Infants, legally mentally incompetent, are therefore protected from nonrequired medical treatment under the Probate Code.
The London decision is unsupported and contradicted by the California Supreme Court's decision in Conservatorship of Valerie N. v. Valerie N. (1985) 219 Cal. Rptr. 387). The case deals with the rights of parents of a mentally incompetent adult to consent to sterilization, a recognized medical treatment. The court found that the parents as "conservators, were not entitled to have conservatee, who was unable to consent to sterilization, sterilized inasmuch as there was neither evidence of necessity ... nor sufficient evidence that less intrusive means were not presently available to conservatee." This ~ourt further holds "... as to those medical procedures permitted after court authorization the Legislature has required ajudicial determination that the condition of the conservatee 'require the recommended course of medical treatment'" as provided in Cal. Probate Code section 2357, subd. (h)(I). Infants, legally mentally incompetent, are therefore protected from nonrequired medical treatments under the Probate Code. 443 U.S. 622 (1979); Carey v. Population Service International, 431 U.S. 678 (1977). Ibid. The essence of the Prince decision is captured in the statement that "parents may befree to become martyrs themselves. But it does notJoUow they are Jree . .. to make martyrs oj their children beJore they have reached the age oj full and legal discretion when they can make that choiceJor themselves. " Prince, supra, 170. Under Yoder, supra, 234, parental authority and discretion may be challenged "if it appears that parental decisions will jeopardize the health or safety ofthe child ..." This demonstrates that the child's right to safety overcomes parental constitutional rights.

"The preservation of one's bodily reproductive functions is a fundamental right, and the termination thereof constitutes a serious invasion of the sanctity of the person."
In California, Valerie N., supra, the court held that "The courts have ... recognized individual Liberty in things of the body as a touchstone," (Note, Due Process Privacy and the path of progress (1979) U.III. L. Forum 469, 504-505, 515; see Union Pacific R. Co. v. Botsford (1981) 141 U.S. 250,251252 (common law right of personal injury plaintiff to be free of compulsory physical examination), cited in Roe v. Wade (1973) 410 U.S. IB, 152; Schmerberv. California (1966) 384 U.S. 757, 778-779 (dis. opn. of Douglas); Breithaupt v. Abram (1957) 352 U.S. 432, 441-442 (dis. opn. of. Warren, C.] .); Id., at 443-443 (dis. opn. of Douglas,].). "The preservation of one's bodily reproductive functions is a fundamental right, and the termination thereof constitutes a serious invasion of the sanctity of the person." Guardianship of Tulley (1978) 83 Cal. App. 3d 698, 705. "Liberty means more than freedom from servitude, and the constitutional guarantee is an assurance that the citizen shall be protected in the right to use his powers of mind and bpdy in any lawful calling." Smith v. Texas (1914) 233 U.S. 630, 636. "Although the Court has not assumed to define 'liberty' with any great precision, that term is not confined to mere freedom from bodily restraint. Liberty under the law extends to the full range of conduct which the individual is free to pursue, and it cannot be restricted except for a proper governmental objective." (BoIling v. Sharpe (1954) 347 U.S. 497, 499-500. There is no proper government objective which justifies restricting the infant's right to keep his bodily parts intact and enjoy a full range of use of his sexual organs.

The State's interest in an infant's First Amendment constitutional rights of Safety, Liberty, Privacy, and Happiness exceed the State's interest in protecting parents' constitutional rights. THE STATE'S INTEREST IN CIRCUMCISION
The State's interest in circumcision, beyond financial considerations of Medi-Cal coverage and the maintenance of ethical medical standards and procedures, involve the protection of an infant's constitutional rights to Liberty, Privacy, Safety, and Happiness under the California Constitution Article I, the Federal protection against arbitrary deprivation of Due Process and Equal Protection under the Fourteenth Amendment, and the violation of criminal statutes against child and sexual abuse. The State's interest in an infant's First Amendment constitutional rights to Safety, Liberty, Privacy, and Happiness exceed the State's interest in protecting parents' constitutional rights. Parental rights to the custody and control of their minor children are as old as civilization itself. Modern judges refer to parents' custodial rights as "sacred," as a matter of"natural law" and as "inherent natural rights, for the protection of which, just as much as for the protection of the rights of the individual to life, liberty, and the pursuit of happiness, our government is formed." 23 ]FAML 337. The generalized claims of parental constitutional rights have not been without challenge; courts aLall levels of the judicial hierarchy have occasionally intruded into the family relationship to protect children. Ibid. The most important Supreme Court cases reflecting state and judicial intervention are Prince v. Massachusetts, 321 U.S. 158 (1944), and the cases involving the rights ofteenage females to have abortions, Bellotti v. Baird,
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There is no proper government objective which justifies restricting the infant's right to keep his bodily parts intact and enjoy a full range of use of his sexual organs.
In the California discussion of sterilization of mental incompetents, Valerie N., supra, it cites with approval In Matter of Guardianship of Hayes (198) 93 Wash. 2d 228 where the Washington court concluded: "In the rare case sterilization may be indeed in the best interest of the retarded person ... However, the court must exercise care to protect the individual's right ofPRIVACY, and thereby not unneces(Continued on next page)
JULY/AUGUST 1989

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Circumcision: The Legal and Constitutional Issues (Continued)
sarily invade that right. Substantial medical evidence must be adduced, and the burden on the proponent ... will be shown by clear, cogent and convincing evidence that such a procedure is in the best interest of the retarded person." Valerie N., supra, goes on to find that it is necessary to "preserve the right ... to be free of intrusive medical and surgical procedures ... " The State's interest in protecting an infant's rights to due process and equal protection is derived from the incompetency of his age and the accident of birth, his sex. To deprive a baby boy of his constitutional rights of Liberty, Safety, Privacy and Happiness must serve a "compelling state interest." While ensuring the constitutionalrights ofparents in care and child rearing is an important state interest, that interest is subordinated to the child's when the parental discretion may jeopardize the health or safety of that child A reasonable method to protect a child's due process rights, would be to provide for ajudicial hearing, with the child represented by a disinterested guardian ad litem, to insure the necessity of a medical procedure risking the health and safety of the incompetent minor. See Hayes, supra. In order to justify routine circumcisions for male infants which are not required or allowed for femakinfants, requires a "compelling state interest" to meet established equal protection analysis requirements. No state interest ofany kind is served by the policy of sexually discriminatory routine circumcisions, and it therefore violtiLes both the State and Federal Equal Protection clauses of the Fourteenth Amendment.

Neonatal circumcision shares sufficient characteristics with sterilization of mental incompetents to justify utilizing the same standards to approve third party consent. Both practices remove a natural, healthy part of the anatomy without therapeutic necessity, in an irreversible procedure. Both restrict the full and complete enjoyment of the reproductive organs. Both have a tradition of government supported abuse. Both force the acceptance of an involuntary risk of surgical complications and death. Both restrict the patient's individual constitutional rights to Privacy, Liberty, Safety, Happiness, Due Process, and Equal Protection. The primary difference between thirdparty ~onsent in the cases ofneonatal circumcision and involuntary sterilizations of incompetents is that infants will one day be competent to make their own choices.

This justification for granting third party consent for circumcision can not survive review.
The court in Valerie, supra, 448, justifies the necessity of granting a third party consent for mental incompetents to protect their constitutional right to procreative choice. "We do not pretend that the choice of the (incompetent's) parents, her guardian ad litem, or a court is her own choice. But it is ... one designed to further the same interests she might pursue had she the ability to decide herseIf." In re Grady, supra, 426 A.2d at 481. This justification for granting third party consent for circumcision can not survive review.

STANDARD FOR THIRD PARTY
WARENTA~CONSENT

An operation or medical procedure without valid consent constitutes battery and false imprisonment. CIVIL AND CRIMINAL REMEDIES FOR NEONATAL CIRCUMCISION
Critical to the issue of civil liability, absent medical negligence, is the lack of actual or "informed consent." The well recognized legal incompetence of an infant precludes direct or personal consent. An operation or medical procedure without valid consent constitutes battery .and false imprisonment. (See Rainer v. Community Memorial Hospital. (1971) 18 Cal. App. 3d 240, 255; City of Newport Beach v. Sasse (1970) 9 Cal. App. 3d 803, 810.) Third party consent to a surgical procedure can be granted with validity, conditional upon the circumstances, by a parent, guardian ad litem, or the courts. (See Valerie N., 219 Cal. Rptr. 387) The substituted consent doctrine is often invoked to permit consent by parents or guardians for surgery on an incompetent conservatee or minor. (See Probate Code §2353, 2355,2357) However, "even as to those intrusive medical procedures permitted after court authorization, the Legislature has required a judicial determination that the condition of the conservatee 'REQUIRES THE RECOMMENDED COURSE OF MEDICAL TREATMENT.'''(emphasis added) (Valerie N., Supra, 452.) Civil Code §25.8 which generally provides a right for parents to extend consent for any medical treatment rendered, UPON THE ADVICE OF A PHYSICIAN AND SURGEON must meet the same standard as specified under the Probate Code, that is the child "requires the recommended course of medical treatment."
(Continued on the next page) -S3JULY/AUGUST 1989

Hayes, supra, cited with approval in Valerie N., supra, provides a reasonable framework establishing a standard for third party consent to intrusive medical and surgical procedures. While Hayes and Valerie concern cases of sterilization is medically indicated as the last and best resort for the individual. Can it be shown by clear, cogent and convincing evidence, for example that other methods of birth control are inapplicable or unworkable?" ... "The decision can only be made in a superior court proceeding in which (I) the incompetent individual is represented by a disinterested guardian ad litem, (2) the court has received independent advice based upon a comprehensive medical, psychological, and socia' evaluation of the individual, and (3) to the greatest extent possible, the court has elicted and taken into account the view of the incompetent individual." "Within this framework, the judge must first find by clear, cogent and convincing evidence that the individual is (I) incapable of making his or her own decision ... , and (2) unlikely to develop sufficiently to make an informed judgement ... in theforseeablefuture." "Next, it must be proved by clear, cogent and convincing evidence that there is a need ..." "Finally, there must be no alternative ... The judge must find clear, cogent and convincing evidence (I) all less drastic .. methods, ... have been proved unworkable or inapplicable, and (2) the proposed method ... entails the least invasion ofthe body of the individual. Valerie N., supra, 466-467.
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Circumcision: The Legal and Constitutional Issues (Continued)

Charles A. Bonner, J.D. is in private practice in San Francisco, California, with a -speciality in personal injury and medical malpractice. Michael J. Kinane is a law student at the Hastings School of Law, San Francisco, California.

The Code of Medical Ethics prohibits a physician from advising unnecessary medical or surgical treatment.
The Code of Medical Ethics prohibits a physician from advising unnecessary medical or surgical treatment. The AA P has declared there is "no absolute medical indication for routine circumcision." Certainly, ifthere is a recognized medical indication for an individual neonatal circumcision, the attending physician would have no difficulty advising that the procedure is required. This medical determination and advice would allow the parents, guardians, or court to make a valid "informed consent" on the part of the minor, for the surgical procedure of circumcision. Absent a recognized medical indication and physician advice, no third party would be in a position to make a valid "informed consent." Absent a valid "informed consent" the physician and those assisting (parents, staff, hospital) in the non-consensua~ intentional confinement and operation on a minor can be held liable for battery and false imprisonment.

The Politics of Reproductive Ritual
Karen Ericksen Paige and Jeffery M. Paige
"The single most important work on the subject to date." - Morris Zelditch, Jr.

The civil law presently offers more fruitful avenues of approach to prevent genital mutilations.
Suits for damages against surgeons, hospitals, and conceiva bly parents, are possible because malice in the sense of iii will or a desire to cause injury is not essential to sustain a recovery for intentional wrong doing. It is enough for the plaintiff to show that the defendant knowingly and intentionally did the act which caused the damage and that damage was substantially certain to follow. The limitation posed by suits for negligence in this area is grounded in societally determined assumptions and expectations. which are slowly changing to recognize circumcision as mutilations. (See 23 JFAML 337) Once it is shown that a childhas been subject to an injury to his sexual organ, without valid "informed consent" or medicalnecessity, a case may be madefor enforcement ofexisting state laws prohibiting assault and battery, conspiracy to assault and batter, childabuse, andsexualabuse. However it will be extremely difficult to get a conviction, since circumcision is not culturally acknowledged as child abuse at the present time. Additionally, in some jurisdictions it may be difficult to establish the requisite criminal intent. For this reason, the civil law presently offers more fruitful avenues of approach to prevent genital mutilations. Perhaps a promising approach would be a civil rights classdaction against hospitals designed to prevent routine neonatal circumcisions, that is, in cases where circumcision is not medically warranted. A class action suit wouldfocus on the individuals most culpable since competent surgeons are aware that routine neonatal circumcision is not goodmedical practice. It would also avoid the constitutional issues of parental rights, as well as religious issues, since the Orthodox Jewish circumcision ceremony is not normally performed in medical centers by medical personnel. (23 JFAML 337)
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"A welcome addition. They argue that rituals of reproduction in preindustrial societies are essentially political. In these societies, they say, men need to control the reproductive power of women in order to establish political power; where there is no law or central government, ritual is used as a way of gaining control. The type of ritual will vary, they conclude, accord~ ing to the economic base of the society ... for those who are interested in the subject, this book is indispensable. Its thesis is challenging and the documentation is excellent. Paige and Paige have made an essential contribution to a long debate, and their theory is sure to stir new and lively controversy." _ Science Digest

University of California Press Berkeley - Los Angeles - London Berkeley, CA 94720

$11.95
JULY/AUGUST 1989

~S4-

CliTORidECTOMY: A NiNETEENTIt CENTURy ANSWER TO MASTURbATiON
by John Duffy

It was not until the second half of the

19th century that masturbation became one of general concern.

I

I

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In the early 19th century perceptive physicians were becoming increasingly dubious of the traditional medical theories and began turning to clinical experience. Unfortunately, lacking an understanding of physiology and with no knowledge of bacteriology, they were frustrated in their attempts to prevent or cure disease. In desperation physicians intensified their use of the traditional therapeutics - bleeding, blistering, vomiting, purging and sweating, heroic therapy which only served to increase public suspicion of the profession. Seeking to compensate for their inability to deal with disease, physicians increasingly began assuming the role of moral leaders. In the process they seized upon issues such as abortion and masturbation. The prudishness of Victorians and veil of silence they cast over sexuality is well known, but what is not so well known is their preoccupation with masturbation. Little attention had been given to masturbation until late in the 18th century, and it was not until the second half of the 19th century that masturbation became one of general concern. It first came to public attegtion through the efforts of a few moralists, but it was not until the medical profession, seeking to bolster its status in society, transformed the moral question of masturbation into a medical condition that it became a significant issue. In the case of males, the apprehensions about masturbation were engendered by a widespread assumption that the loss of semen endangered the brain and nervous system. In America the superintendent of the Massachusetts Lunatic Asylum gave credence to this belief when in his 1848 annual report he asserted that 32 per cent of admissions were for "self-pollution," one of several euphemisms for masturbation. Reflecting in part the Victorian preoccupation with sexuality, by the late 19th century medicaljournals in Europe and America were attributing almost every conceivable medical condition to this "secret vice."

least one extreme case, at the request of a desperate patient who feared for his sanity, his physician castrated him. The physician in his report of the case declared that the patient was gaining weight, somewhat lethargic, but morally sound. Reprehensible as was masturbation among males, it was an even graver problem among Victorian females, who were viewed as delicate, sensitive, frail, and emotional creatures. In response to an article in a local paper urging the medical regulation of prostitutes, the editor of the New Orleans Medical and Surgical Journal began by pointing out that the morality of American women was much higher than that of women in other countries. Most prostitutes in New Orleans, he observed, were foreigners. Having settled this point, he turned to "onanism" or masturbation, a practice "very injudicious to the health of both males and females." Men, he wrote, occasionally admitted to it, but the case with women was far different.

"In my opinion, neither theplague, nor war, nor smallpox, nor a crowd of similar evils have resulted more disastrously for humanity, than the habit of masturbation: it is the destroying element of civilized society. "
To ask for or expect information from adult females about this practice, he wrote, "is altogether useless and vain, although many of their diseases, as leucorrhoea, uterine haemorrhage, falling of the womb, cancer, functional disorders of the heart, spinal irritation, palpitation, hysteria, convulsions, haggard features, emaciation, debility, mania - many symptons called nervous - un triste tableau. have been referred to masturbation as the cause." Even ifthese disorders did not originate in masturbation, he continued, "its practice would certainly aggravate them." The editorial concluded with a quote from a French physician: "In my opinion, neither the plague, nor war, nor smallpox, nor a crowd of similar evils have resulted more disastrously for humanity, than the habit of masturbation: it is the destroying element of civilized society." 2

Loss of semen was considered a real danger to males ...

J

Since loss of semen was considered a real danger to males, then it followed that nocturnal emissions were equally hazardous. To solve both ofthese problems, a whole array of mechanical devices were constructed. They included such items as strait jackets, genital cages, and penis rings with sharp points on the inside. Most of these objects were devised by laymen, but the medical profession, which has generally reflected prevailing beliefs, was not to be outdone. Young men driven by guilt who sought a physician's help, or who confessed to masturbation under close questioning by their physician, were treated with blistering agents, mild acid solutions, or leeches applied to the genitals. Bloodletting and cutting the foreskin were also used in serious cases. 1 In at
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Dr. Isaac Brown Baker, who claimed success in treating epilepsy and other nervous disorders in female patients by excising the clitoris.
In 1866 an American medical journal discussed the work of a British physician, Dr. Isaac Brown Baker, who claimed success in treating epilepsy and other nervous disorders in female patients by excising the clitoris. After noting that the great mass of English medical opinion was strongly opposed to Baker's ideas and had "unqualifiedly condemned" his operation, the American editor concurred with the English medical profession, declaring that to remove the clitoris "to allay sexual irritability is about as unphilosophical as to remove the analogous organ of the male." 4
(Continued on next page)
JULY/AUGUST 1989

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Clitoridectomy: (Continued)

"SexuaIPervers;on;n the Female" (1894) referred to female masturbation as a "moral leprosy. "
While the clitoridectomy was only rarely performed in the English-speaking nations, the subject of female masturbation continued to intrigue the public and the medical profession. As the century drew on, more articles on the subject began appearing in medical journals and the clitoridectomy was revived. In 1889 Dr. Joseph Jones, a former president ofthe Louisiana State Board of Health and a medical professor, stated that "hopeless insanity" was one of the many consequences of masturbation and that the child of a masturbator was liable to hereditary insanity. 8 Dr. A.J. Bloch of New Orleans in an article entitled "Sexual Perversion in the Female" (1894) referred to female masturbation as a "moral leprosy. "In one of his cases, he described how a schoolgirl of fourteen suffering from nervousness and pallor had been cured by "liberating the clitoris from its adhesions" and by lecturing the patient on the dangers of masturbation. 10 As far as can be ascertained, Dr. Bloch was one ofthe last American surgeons to report taking such drastic measures. By this date medical studies were beginning to demonstrate that masturbation caused no serious functional disturbances and that the psychological problems involved arose from the social attitude towards the practice rather than the act itself. As these ideas gained medical acceptance during the next thirty years, the subject of masturbation in normal individuals gradually disappeared from medical journals.

References:
I. Haller, John S. and Robin M., The Physician and Sexuality in Victorian America, Urbana, Chicago, and London, 1974, pp. 195,207-209. 2. Editorial: Review of European Legislation for Control of Prostitution, New Orleans Medical Surgical Journal 1I: 700-705, 1854- I855. 3. Castellanos, J.: Summary Prepared from French Journals, South J Med Sci 1:495-96, 1866-1867. 4. Editorial: Clitoridectomy, South J Med Sci 1:794, 1866-/867. 5. West, D.C.: Clitoridectomy, Brit Med J 2:585, 1866. 6. DownJ., and Langden, H.: Influence of Sewing Machine on Female Health, New Orleans Med Surg J 20:359-360, 1867-1868. 7. Comment: New Orleans Med Surg J (new series) 9:67, 1881-1882. 8. Jones, J.: General Medicine - Diseases of Nervous System, Trans La Med Soc 1889, pp. I7o-I7I. 9. Tait, L.: Masturbation, Med News 53:1-3,1888. 10. Block, A.J.: Sexual Perversion in Female, New Orleans Med Surg J (new series) 22:1-7,1894-1895. II. Duffy, J.: Masturbation and Clitoridectomy. The Journal of The American Medical Association. October 19, 1963, Vol. 186, pp. 246-248.

ACTION GVIDE Published by WINNEWS $5.00 per copy prepaid, please add $2.00 for air abroad.

This ACTION GUIDE is based on research of the: Hosken Report: Genital/Sexual Mutilation ofFemales. Published by WIN NEWS 117.00per copy prepaid, please add 15.00 for air abroad.

John Duffy, Ph.D. is Clinical Professor Emeritus, Tulane University School of Medicine and Professor Emeritus of History, University of Maryland. Dr. Duffy is a medical historian with some nine published books and 80 articles. His newest book is The Sanitarians: A History ofAmerican Public Health. University of Illinois Press to be released in February 1990.
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-56JULY/AUGUST 1989

Social-Behavioral Characteristics Of Affectionate/Nurturant And Non-Affectionate/Non-Nurturant Primitive Cultures
by James W. Prescott

SOCIETAL CHARA CTERISTICS
HIGH AFFECTIONATE/NURTURANT CULTURES
I. Martrilineal

LOW AFFECTIONATE/NURTURANT CULTURES
I. 2. 3. 4. 5. 6. 7. 8. 9. 10.
II.

2. 3. 4. 5. 6. 7. 8. 9. 10. II. 12. 13. 14. 15.

Polygyny has low incidence Women's status not inferior Low avoidance of In-Laws Low incidence of Mother-Child households Small community size Low societal complexity Large extended family Wives are not purchased Slavery absent Grand-parental authority over parents is absent Subsistence is primarily by food gathering Low class stratification Political integration at community and family level Metal working is absent

12. 13. 14. 15.

Patrilineal Polygyny has high incidence Women's status inferior High avoidance of In-Laws High incidence of Mother-Child households High community size High societal complexity Small extended family Wives are purchased Slavery present Grand-parental authority over parents is present Subsistence is primarily'by food production High class stratification Political integration at state level Metal working is present

INFANT/CHILD CHARACTERISTICS
HIGH AFFECTIONATE/NURTURANT CULTURES
16. 17. 18. 19. 20. 21. 22. 23.
24. 25. 26. 27. 28. 29.

LOW AFFECTIONATE/NURTURANT CULTURES 16. 17. 18. 19. 20. 21. 22. 23.
24. 25. 26. 27. 28. 29.

High infant physical affection Low infant physical pain High infant indulgence High reduction of infant needs Immediate reduction of infant needs Low infant / child crying Prolonged breast-feeding over 2% years Low child anxiety over performance of responsible behavior Low child anxiety over performance of obedient behavior High smiling, laughter, humor Low anxiety over transition: infancy/childhood High number of food taboos during pregnancy Abortion permitted Strength of desire for children is low

Low infant physical affection High infant physical pain Low infant indulgence Low reduction of infant needs Delayed reduction of infant needs High infant / child crying Breast-feeding less than 2% years High child anxiety over performance of responsible behavior High child anxiety over performance of obedient behavior Low smiling, laughter, humor High anxiety over transition: infancy/childhood Low or no food taboos during pregnancy Abortion highly punished Strength of desire for children is high

SEXUAL BEHA VIORAL CHARACTERISTICS
HIGH AFFECTIONATE/NURTURANT CULTURES
30. 31. 32. 33. 34. 35. 36. 37. LOW AFFECTIONATE/NURTURANT CULTURES 30. 31. 32. 33. 34. 35. 36. 37.
-57-

Premarital coitus permitted Extramarital coitus permitted Post-partum sex taboo less than one month Sex disability absent Castration anxiety is low Low sex anxiety Narcissicism is low Low exhibitionistic dancing

Premarital coitus punished Extramarital coitus punished Post-partum sex taboo greater than one month Sex disability present Castration anxiety is high High sex anxiety Narcissism is high High exhibitionistic dancing
JULY/AUGUST 1989

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Social-Behavioral Characteristics of Primitive Cultures (Continued) WAR/VIOLENCE/CRIME CHARACTERISTICS
HIGH AFFECTIONATE/NURTURANT CULTURES 38. Low adult physical violence 39. Low or no warfare
40. 41. 42. 43. 44. Low military glory Bellicosity is low Low or absent killing, torture, mutilation Low personal crime Incidence of theft is low LOW AFFECTIONATE/NURTURANT CULTURES

38. High adult physical violence 39. High warfare
40. 41. 42. 43. 44. Military glory emphasized Bellicositiy is extreme High killing, torture, mutilation High personal crime Incidence of theft is high

JUSTICE/RELIGIOUS/SUPERNATURAL CHARACTERISTICS
HIGH AFFECTIONATE/NURTURANT CULTURES
45. High God is mainly absent LOW AFFECTIONATE/NURTURANT CULTURES 45. High God is present

46. Low or no religious activity
47. 48. 49. 50. 51. 52. 53. Superordinate justice absent Supernaturals are benevolent Fear of humans rather than fear of supernatural Belief in reincarnation absent Low ascetecism in mourning Witchcraft low or absent Religious specialists are part-time

46. High religious activity
47. 48. 49. 50. 51. 52. 53. Superordinate justice present Supernaturals are aggressive Fear of supernatural rather than fear of humans Belief in reincarnation present High ascetecism in mourning Witchcraft highly present Religious specialists are full time

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NOTE: The above social-behavioral characteristics of primitive cultures have been derived from: R.B. Textor (1967) A Cross-Cultural Summary, HRAF Press New Haven. Matrilineal cultures are those where inheritance follows the female line; Polygynous cultures are those where men have several wives and is a measure of sexual exploitation and control of women by men; High desire for children is a measure that reflects exploitation of children: high value of

male and female fertility; and use of children as economic resource, thus, its linkage with abortion being punished. Presence of a Supernatural (High God) with high religious activity in low affectionate/nurturant cultures reflects the need for "divine love" when human love is absent or significantly diminished. Similarily, God is made unto the image and likeness of man - violent cultures have violent Gods; peaceful cultures have peaceful/ benevolent Gods.

)

James W. Prescott is a developmental neuropsychologist and a cross-cultural psychologist who received his doctorate in psychology from McGill University, Montreal, P.Q. Canada. He served as Assistant Head, Physiological Psychology Branch, Office of Naval Research (1963-1966); as Health Scientist Administrator, Developmental Behavioral Biology Program, National Institute of Child Health and Human Development, NIH (1966-1980); and President, Maryland Psychological Association (1970-1971). He was the recipient of the "Outstanding Contributions To Psychology Award, Maryland Psychological Association (1977); the CINE GOLDEN EAGLE AWARD for his contributions, as Scientific Director, to the award winning Time-Life film, "Rock A Bye Baby" (1971); and has given expert testimony on the origins of human violence, particularly domestic violence, before the Senate of Canada; the U.S. Congress; and many other legislative and professional organizations. Dr. Prescott is currently President, BioBehavioral Systems; Director, Institute of Humanistic Science; Editor, THE TRUTH SEEKER; and is residing in San Diego, CA.

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Female Genital Mutilation - Strategies For Eradication (Continued)
London, Stella Efua Graham, a native of Ghana and President of FOR WARD (the Foundation for Women's Health), outlined her educational work among African immigrants to the U. K. A doctor from Indonesia discussed how female circumcision in Indonesia had now been changed into a purely symbolic rite. Berhane Ras Work, the president of the Inter-African Committee (lAC) on "Traditional Practices Affecting the Health of Women and Children" founded in 1984, talked about its work all over Africa. Women's International Network (WIN) was represented at the Seminar by Fran P. Hosken, who spoke about the actions against female child genital mutilations all over the world, and about the UNIVERSAL CHILDBIRTH PlCTU RE BOOKS with additions to prevent excision and infibulation that WIN has developed and introduced all over Africa with much success. The books are currently being translated into Somali and will be used by the SWDO for their campaign, by the Family Planning Program, the Health Ministry, etc.

These damaging traditions of genital mutilations must be eradicated as a prerequisite for normal healthy development and to protect the basic human rights of children and women.

Figure 5: Tribal Genital Mutilation. The excised tip of the foreskin is placed on the toe of the boy as a symbol of the completed puberty ritual. Again, no blood on this foreskin could be detected in the film of this circumcision.
have their daughters' genitals mutilated and to teach their family and neighbors about the damage done by these mutilations. We offer books to anyone who is willing to sign such a statement. The success of this grass roots initiative has been remarkable. We are mailing more and more small packages of books and many of the requests, as well as letters describing their efforts to teach in their own communities against excision, are from men. Excerpts of some of the letters received are printed in several issues of WIN NEWS.

)

The successful joint SWDO-AIDos education campaign, highlighted by this international meeting, should be an example to both governmental and non-governmental organizations that the time has come to address these problems, and to provide more international support for the eradication of these harmful, traditional, cultural practices. These damaging traditions of genital mutilations must be eradicated as a prerequisite for normal healthy development and to protect the basic human rights of children and women. Most importantly, it is the wish of African women and men concerned about their children's health and future.

Men must become involved in this international campaign to end the genital mutilation of female children.
African women are working, supported by women worldwide, to protect their daughters and to eradicate these damaging traditions of female genital mutilations that have no place in our world. But where are the African men and other men in the rest of the world to support those African men who are openly opposing thesb mutilations? Men must become involved in this international campaign to end the genital mutilation of female children. WIN NEWS has been sending Childbirth Picture Books (C B PBs) with the Additions to Prevent Excision and Infibulation to midwifery schools all over Africa, to community health workers, secondary schools, indeed to all who write for copies. The CBPBs are now circulating on the grass-roots level- as our growing correspondence and requests for more books confirms. In each book with the A ddition to Prevent Excision. we enclose a short note to ask the receiver to write a short statement that they will not
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It is possible to create a network of participants and of support groups much like Amnesty International has successfully done. Such a man-to-man consciousness-raising network is long overdue. This suggestion will, I hope, encourage men to use their imagination and to support this world-wide goal to end female genital mutilations.
Professional men in the u.s. should contact male professionals and leaders in Africa in affected countries and help them to organize and speak to the issue publicly - to make it known that, as community leaders, they reject these female genital mutilations and that they do not practice them in their own families. This can also be done without going to Africa, without raising large amounts of money first, but on a personal basis. It is possible to create a network of participants and of support groups much like Amnesty International has successfully done. Such a man-to-man consciousness raising network is long overdue. This suggestion will, I hope, encourage men to use their imagination and to support this world-wide goal to end female genital mutilations. Genital mutilations are a violation of human rights.
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Female Genital Mutilation - Strategies For Eradication (Continued)

RESOURCE LIST:
Women's International Network News (WIN NEWS) publishes
a column on "Female Circumcision/Genital and Sexual Mutilation" in every issue (quarterly) since 1975, where information - including names and addresses - contacts are reported from all over the world. For subscriptions write to: WINNEWS, 187GrantSt., Lexington, MA02173 The Hosken Report: Genital/Sexual Mutilation of Females by Fran P. Hosken (Third Revised and Updated Edition), Published by WIN NEWS, Winter 1982/83, 344 pages, with case histories from: Sudan/ Egypt/Somalia/ Kenya/ Ethiopia/Nigeria/Mali/Upper Voltajlvory Coast/Senegal/ Sierra Leone/ Arab Peninsula. Asia: Malaysia/ Indonesia. The Western World.

Investigation of Genital Mutilation Practiced in USA by Immigrants
WIN NEWS has a proposal for a systematic investigation to be conducted by members of each ethnic community to research and record the facts. For more information, please write to Fran P. Hosken, Editor, WIN NEWS, 187 Grant Street, Lexington, MA 02173 USA.

Female Genital Mutilation in the World Today: A Global Review, by Fran P. Hosken, International Journal of
Health Services, Editor-in-Chief: Vincente Navarro, Johns Hopkins University, Baywood Publishing Co., 120 Marine St., P.O. Box D, Farmingdale, NY 11735 (Vol. II, No.3, 1981, pp. 415-530). The Childbirth Picture Books: by Fran P. Hosken, pictures by Marcia L. Williams, published by WIN NEWS, 187 Grant St., Lexington, MA 02173. Available in English/French/ Arabic with Additions to Prevent Excision and Infibulation/ and Spanish. Printed in India by CHETNA, 2nd Floor, Drive-in Cinema Bldg., Thaltej Road, Ahmedabad 380054, in Hindi and other Indian languages. Inter-African Committee: Africa Hall, Room 605, P.O. Box 3001, Addis Ababa Ethiopia. Or: 147 rue de Lausanne, CH-1202 Geneva, Switzerland. A Newsletter is available in English or French (2x year).

ON Crime and Punisfimmt
You. cmmot separate thejust jium the tu9ust aru! the 900c! jium the wicWi For thty staIu! t!J9et11er 6efore thefaa 'ifthe sun. even as the 6fack tftmu{ aru! the wfiite. are woven t!J9etFter. And wlien the 6fack tIiread &reaRs, the weaver sliaf[ fook. inW the wlioCe c£otFt, aru! lie sliaf[ e;wmine the foam l1&J.

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1(aIiBI (jiDran

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AFRICA
1 ETHIOPIA 2 SUDAN 3 SOMALIA 4 KENYA S EGYPT , UGANDA 7 TANZANIA I DJIBOUTI 9 CENTRAL AFRICA. 10 NIGERIA 11 GHANA 12 UPPER VOLTA 13 IVORY COAST 14 MALI IS GUINE A " SIERRA LEONE 17 SENEGAL \I THE GAMBIA 19 MAURITA~IA 20 LIBERIA 21 TOGO 22 BENIN 23 CAMEROON H CONGO 2 S GABON 21 ZAIRE 27 CHAO 21 NIGER 29 LIBYA 30 ALGERIA 31 SOUTH YEMEN 32 SAUDI AR A BIA :>3 ANGOLA 34 ZAMBIA 3S MOZAMBIOUE J& SAHARA 37 MOROCCO 31 RWANDA 39 BURUNDI 40 MALAWI

_EXCISION

Copyright@ 1982 Fran P. Hosken

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Epidemiology of Female Sexual Castration In Cairo, Egypt
by Mohamed Radawi

INTRODUCTION
In 1985 a group of 350 urban Egyptian women were selected to self-report on their recall of their female sexual castration (FSC) which they experienced as children. Two years of field observations of female genital mutilations in Cairo have resulted in a wealth of quantitative, qualitative and photographic information on the various aspects of female genital mutilations, as observed and practiced through 1985. The purpose of this pilot study was to provide preliminary baseline information for a future epidemiological study of female genital mutilations and its relationship to female fertility and psychological trauma, particularly psychosexual functioning. This report summarizes selected descriptive findings from the pilot study that was conducted in Cairo, Egypt in 1985 and were reported at the First International Symposium on Circumcision held at Anaheim, CA (1989). This pilot study has provided some insights into the public health aspects of female genital mutilations; the social- religious factors that compel these practices; age, socio-economic and other factors that place children at risk for FSC; nature and circumstance of genital mutilations; and the personal psychological trauma experienced from these genital mutilations.

their husbands or a male figure. Women who willingly participated in this study were either alone or accompanied by a younger person of a lesser age or in the presence of another woman.

PREVALENCE OF GENITAL MUTILATION
In this study, a majority of women reported being subjected, at least once, to genital mutilations Almost 8 out of 10 (81.6%) Egyptian women reported being subjected to genital mutilations. This incidence is in agreement with findings from other investigations that have been made over the past 12 years. The average incidence of FSC in these studies is 80.5% (See Table I). Although these surveys are not without methodological problems, they are all reasonably consistent in their report of the prevalence offemale genital mutilations. A true national survey has yei to be conducted on the incidence and characteristics of female genital mutilations.

Almost 8 out of 10 (81.6%) Egyptian women reported being subjected to genital mutilations.
SOCIAL-BEHA VIORAL CHARACTERISTICS OF FEMALE GENITAL MUTILATIONS
The social-behavioral characteristics of female sexual castration in Egypt with respect to age, place, agent and form of genital mutilations are summarized in Table 2. The majority offemale genital mutilations occur between 6-11 years of age: 81.2%; 4.5% occur under 6 years of age; and 14.3% occur after age of II years. Virtually all genital mutilations occur before the age ofmenstration, i.e. it is a pre-menstrual or pre-fertility ritual.

METHODOLOGY
A non-random sample of women were selected from various communities and socio-economic sectors in Cairo, Egypt. Participants were not drawn from clinical patient populations. The characteristics of the female participants that were interviewed are summarized as follows: AGE (Years): <l20: 16%; 20-29: 60%; 30-39: 16%; 40-49: 5%; 50+ 3%. RELIGION: Muslim: 94%; Coptic: 6%. MARIT AL STATUS: Single: 59%; Married: 37%; Divorced: 2%; Widowed: 2%. EDUCA nON: High School: 52%; College: 27%; Elementary: 8%; Illiterate: 2%. WORK: Employed: 46%; Housewife: 27%; Student: 27%. INCOME: <lL.E. 100 Month: 78%; L.E. 100-500 Month: 19%; L.E. 1,000+ Month: 3%. In brief, the female sample studied can be described as young, Muslim, single, educated, employed and of lower incomes in Cairo. The data was collected during a single interview with each female participant with no follow-up interviews. A three page semi-structured questionnaire developed by the author was used to obtain information in the following areas: a) personal/ family data; socio-economic status; conditions and characteristics of the genital mutilation experience; and its effects upon their psychological and psychosexual functioning. The data collected was coded and edited to protect the privacy of each participant. Computer encoded data included no references to the identity of the participants. 93% of the subjects completed the interview. Women who refused to participate in this study were almost always accompanied by
THE TRUTH SEEKER

The majority offemale genital mutilations occur between 6-11 years of age: 81.2%;
The home of the girl is the primary place for genital mutilations where 79.3% of genital mutilations occur; 13.5% occur in clinics; 4.1% in street booths, and 3.0% in hospitals.

The home of the girl is the primary place for genital mutilations where 79.3% of genital mutilations occur;
The primary person that inflicts the genital mutilations is the midwife - Daya (60.9%); followed by physicians (22.9%); and then barbers (16.2%). It must be emphasized that physicians who perform these genital mutilations are not following medical procedures that are taught in the medical schools; and that they are violating their medical oath and ethics that prohibit unnecessary medical practices. These physicians have abused and exploited their medical knowledge and skills to compete with traditional healers for the people's limited money.

The primary person that inflicts the genital mutilations is the midwife - Daya (60.9%);
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Epidemiology of Female Sexual Castration In Cairo, Egypt (Continued)
NATURE OF FEMALE GENITAL MUTILATIONS
I have personally observed over 100 completed female genital mutilations with photographic documentation. The

"They told me: YOU MUST BE PURIFIED LIKE THE REST OF YOUR SISTERS, YOU ARE NO EXCEPTION"
"/ was terrified to say No" "/ dare not say NO" "/ wasn'tfully comprehending what was happening to me. / wanted someone very much to explain what was being done to me in vain. " "/ was shocked and never was I able to comprehend until it was over. "Please don't make me remember what happened, / am trying to forget" "/ cried and screamedfor help and no one helped" "/ cried like mad, shouting YOU ALL CHEATED ME ..
" (then the respondent wept silently with a choking voice). "They told me: YOU MUST BE PURIFIED LIKE THE REST OF YOUR SISTERS, YOU ARE NO EXCEPTION" "They attacked me by surprise" "I saw the Daya holding a razor, then she hurt me" "I couldn't believe my mother was with them; they all attacked me one early morning while I was still sleeping" The above are some of their emotional recalls of what had happened to them. The intensity of their recall, as I remember well, was very strong and vivid and commonly associated with weeping and remembered pains and humiliation. The lifelong psychological effects of these genital mutilations needs to be systematicaly studied.

genital mutilation technique almost always involves the removal of the clitoris and labia minora and to a lesser extent slashing the labia majora when it is bulky and protruding. In
practice there is a wide range of technical variation of genital mutilations which differ within the same practitioner across time, instrumentation used, and with the socio-economic status, age, location, traditionalism, and ethnicity of the child and her family. This issue of variation of degrees of genital mutilations has yet to be systematically studied and documented.

INFORMED CONSENT
The majority of children (77.4%) subjected to genital mutilations were never informed as to what they were being subjected to, let alone given the opportunity to give informed consent. The women reported that they were deceived,

assaulted, chased and violently immobilized to be forced to have their genitals mutilated. The remaining percentage of
women (22.6%) reported that they were deceived, misinformed, and misled as to the imminent danger of physical violence and genital mutilation. Their "consent" was not "informed" in any legal sense of the word.

"I couldn't believe my mother was with them; they all attacked me one early morning while I was still sleeping"
EFFECTS OF GENITAL MUTILATIONS UPON PSYCHOSEXUAL FUNCTIONING
The effects of genital mutilations upon responses to sexual stimulation was examined in a subset of FSC women compared to non-mutilated (normal) women. There were 133 FSC women and 26 normal women who were compared with respect to sexual excitement in response to stimulation of the clitoris or clitoral area; stimulation of the labia areas; and intercourse. It was found that 7.7 times as many normal women experienced sexual excitement to stimulation of the clitoris/ clitoral area than did the genitally mutilated women. Masturbation (involving labia as well as clitoral areas) was the method of choice for sexual satisfaction that was 2.2 times more frequent in normal women than in the genitally mutilated women. Manual stimulation ofthe clitoris/clitoralarea

Figure 1: An Egyptian girl shows shock, pain, trauma and angUished disbelief as she views her genitals being mutilated. The shock In her eyes cannot be shown In order to protect her Identity.

PERSONAL RESPONSES TO FEMALE GENITAL MUTILATION
The following personal comments were recorded from the women who were interviewed:
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resulted in the experience of orgasm in 50% of the normal women and in 25% of the genitally mutilated women.
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Epidemiology of Female Sexual Castration In Cairo, Egypt (Continued)
Mothers are directly responsible for arranging the genital mutilation of their daughters.
There are two notable findings from this preliminary survey. The first is that only 50% of normal (non-mutilated) women experienced orgasm with manual stimulation of the clitoris; and as much as 25% of the genitally mutilated women were able to experience orgasm in response to stimulation of the clitoral area. The extent to which orgasmic potential in the mutilated women is related to the nature and degree of genital mutilation is a subject for future research.

There is no clear and definite statement in the Koran, the principal religious authority of Islam, that supports the practice offemale genital mutilations.
in the Southern regions of Egypt (upper Egypt which is closer to African Cultures), whether Muslim or Coptic. are at a higher risk for genital mutilations and other forms of religious physical mutilations than are Muslim or Coptic women located in the Northern or coastal regions of the country (lower Egypt). Finally. there is no clear and definite statement in the Koran, the principal religious authority of Islam. that supports the practice of female genital mutilations.

SUMMARY
In overview, the majority of women with genital mutilations came from modest and low socio-economic family status (SES); illiterate and partially educated parents (although the majority of daughters who were subjected to genital mutilation had a high school or college education (79%); and came from rural regions, particularly southern communities. Girls of urbani rural areas (living in urban areas but raised in rural areas) remain at a higher risk for genital mutilation than urbani urban girls. Girls of rural( rural families remain at the highest risk for genital mutilation. Regional factors involving peer and ancestral pressures influence the family's decision to have their daughter's genitals mutilated.

Religious institutions and ancient social customs are primarily responsible for the genital mutilation of female children.
CONCLUSIONS
Female genital mutilation is a common and popular practice throughout Egypt where every day thousands of young girls are subjected to this torture and mutilation. Religious institutions and ancient social customs are primarily responsible for the genital mutilation of female children. The full social and psychological consequences of mutilating the genitals of female children have yet to be evaluated. Preliminary evidence, however, suggest that the psychological consequences of female genital mutilation is very similar to that of rape victims. What can be done to bring an end to female genital mutilation in Egypt and other countries? The use of force would only drive it underground and increase the resistance to cultural change. Educational programs that are directed to Egyptian families; the agents that perform the genital mutilations (midwives. doctors. barbers); and the social-political and religious leaders on the harmful and devastating effects that these procedures have upon women will contribute significantly to the elimination of female genital mutilations. Specific attention must be given to the effects of genital mutilations upon reproductive processes, the birth of the child and the marital sexual relationships. Men need to

Religious beliefs are a strong predisposing factor for female genital mutilations.
Mothers are directly responsible for arranging the genital mutilation of their daughters. However, without a male authority (marital dissolution, separation, sickness, labor migration and death), mothers are likely to have second thoughts about subjecting their daughters to genital mutilation. Also, daughters of financially independent mothers are seldom exposed to genital mutilation, as a mother's financial independence seems to allow her parity in family decisionmaking. Religious beliefs are a strong predisposing factor for female genital mutilations. A large percentage of women whose genitals are mutilated are affiliated with the Islamic religion despite the fact that female genital mutilation is not prescribed by the Islamic religion. Female genital mutilation

is apre-Islamic religious practice with its roots in the officially banned Africanfaiths and practices which dominated Egypt for thousands of years in pre-historic times.
In the dawn of monotheism - Judaism, Coptism and Islam - many Egyptians who converted to monotheism have assimilated their predominant traditional (African) beliefs and practices with their chosen monotheism. To a keen observer, many features of "Muslim" Egyptian faith lifestyle and religious practices (such as ancestral worship, Zar cults, circumcision and many other forms of blood and flesh sacrifices) meet earlier African faith standards and not current monotheistic beliefs (except for Judaic male circumcision). By understanding African religions and faith practices many of the traditional religious behaviors of "monotheistic" Egyptians become meaningful. Forexample, women located
THE TRUTH SEEKER

understand that their maritalsexual relationships and happiness will be significantly enhanced when the female genitals are not mutilated. Finally, the education of women must be
accelerated if these objectives are to be realized.

BIOGRAPHICAL NOTE
MOHAMED BADAWI, M.D., M.P.H., is a graduate of Cairo University, School of Medicine (1973); a graduate of the University of Michigan, School of Public Health (1981); a graduate of AI-Azhar University School of Medicine, Cairo (1985); and is currently completing a doctoral program at the Johns Hopkins University School of Public Health. This pilot study was supported by the personal funds of Dr. Badawi.
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Epidemiology of Female Sexual Castration In Cairo. Egypt (Continued)
REFERENCES:
Assaad, M. (1980) Female circumcision in Egypt. Studies in Famill' Planning, January II (I): 3-6. Baasher, T. (1982) Psycho-social aspects of female circumcision. In: Baasher, T., Bannerman, R., Rushwan, H., Sharaf, I. (Eds). Traditional Health Practices AffeCling The Health of" Women and Children. WHO Regional Office for the Eastern Mediterranean. EHO EMRO Technical Publication. 2(2): 162-180. and

PS.I'chological Aspects of Female Circumcision WHO East Mediterranean Regional Office, Alexandria (1977).
EI-Saadawi, N. (1977): Women and Sex. Madbouly Publishers. Smith, E. (1980) Female Circumcision in £,'{I'Pt. Higher Institute for Nursing (Unpublished).

Figure 2: Female Sexual Castration (FSC) and Circumcision Booth. This unlicensed booth is located on one of the busiest streets in Cairo. Although, most FSCs occur in the home, some FSCs are conducted in the booth since a public declaration of the daughter's FSC is desired by the family. Male circumcisions are commonly performed in these booths. If complications occur, the operators disclaim all knowledge of the event.

TABLE 1. THE PREVALENCE OF FEMALE CASTRATION IN EGYPT ABSTRACT OF STUDIES FROM 1977-1985
FINDINGS BADAWI (1985) Percent* Sample Size Population Location 81.6% n=350 General Cairo SMITH (4) (1980) 77% n=125 Students Alexandria STUDY ASSAAD (1) (1979) 90.8% n=54 Patients Cairo BAASHAR (2) (1979) 70.0% n=70 Patients Alexandria SAADAWY (3) (1977) 81.8% n=160 Patients Cario

*80.5% is the average of female genital mutilation in the above studies.

TABLE 2. SOCIAL-BEHAVIORAL CHARACTERISTICS OF FEMALE SEXUAL CASTRATION IN EGYPT: AGE, PLACE, AGENT AND FORM OF GENITAL MUTILATIONS AGE: PERCENT PLACE: PERCENT AGENT PERCENT GENITAL MUTILATIONS PERCENT <16 YEARS 4.5% HOME 79.3% MIDWIFE 60.9% CLITORAL CIRCUMCISION NONE

PERCENTAGES 6-8 YEARS 38.7% CLINICS 13.5% PHYSICIANS 22.9% CLITORAL REMOVAL 100% 9-11 YEARS 42.5% STREET BOOTHS 4.1% BARBERS 16.2% LABIAL REMOVAL 100% INFIBULATION NONE 12 YEARS + 14.3% HOSPITALS 3.0%

THE TRUTH SEEKER

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JULY/AUGUST 1989

FIRST, DO NO HARM!
by George C. Denniston

Physicians are, for a fee, cutting off a normal body part. They are causing newborn American boys incalculable pain arising in their most sensitive pleasure organ.
Now that more and more men are willing to express their feelings about their own circumcision, lawmakers, doctors, third party payers, and certainly parents will want to take a new look at this procedure.

Figure 1

The small number of A merican doctors who still perform circumcision are violating the first rule ofgood medical care -PRIMUM NON NOCERE-First, do no harm! Physicians are, for a fee, cutting off a normal body part. They are causing newborn American boys incalculable pain arising in their most sensitive pleasure organ. They are doing it without the consent of the person being operated on. And they often do it without the full understanding and consent of his parents.

Circumcision is truly foreskin amputation.
Most parents are not fully informed about circumcision before it is performed on their newborn son. Circumcision is truly foreskin amputation. If they really understood this, would they really want to convey to him that this is the way those who love him are going to treat him? Do they really want to permit someone else to inflict excruciating pain in his most sensitive organ? The painful message of circumcision can stay with him throughout his life, according to many scientists, and some of the victims.

The penis at eight weeks.

Illustration from R. Hunter

gins to develop two downward growing folds of tissue. like the twin hulls of a catamaran. (Fig. 2) By the 15th weck these folds have fused at the bottom creating a tube within the glans. (Fig. 3) Now the urethra is extended to the tip*
Figure 2

The painful message of circumcision can stay with him throughout his life,
Being fully informed about circumcision includes having both parents watch a videotape as it will be performed on their son. There is no other way that they can know what is actually being done. Without this actual witnessing, there cannot be informed consent. Few doctors really understand what they are doing when they amputate the foreskin, for they have never studied how the penis develops before birth.' The penis begins its development as a microscopic protuberance in the male fetus six weeks after conception. As it grows outward, a thick layer of epithelial cells, which will become skin, piles up at the base in folds during the next two weeks. (Fig. I) At this stage, the tube within the shaft, the urethra, has developed only part of the way down the shaft.

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Cross-section near tip of penis - 10 weeks Illustration from R. Hunter

Few doctors really understand what they are doing when they amputate the foreskin, for they have never studied how the penis develops before birth.
Then, at the 10 week horizon, the glans, seen head on, beTHE TRUTH SEEKER

With further growth of the shaft and of the glans penis, the skin comes forward to completely cover it by the 15th week. (Fig. 4)
*/fthis sfep.fails to take IJlace, a conditiun knoll'n as 17.I'fJospadias, lI'here the lIrethra upens shuI'! ufthe tip, lI'il/ he presel1l at hirth.

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JULY/AUGUST /989

First, Do No HannI (Continued)

Beginning around the 15th week and continuing gradually for as long as 17 years, a process begins which ultimately separates the foreskin from the glans.
From the 15th week on. the skin covers the glans completcly, with a small opcning at the tip. A distinct layer of cells attaches the skin most firmly to the entire surface of the glans. This skin is the skin of the glans penis. It has not yet separated to create two distinct organs. the glans and the foreskin.
Figure 3

Figure 5

Whorl of cells between foreskin and glans Illustration from R. Hunter

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cess begins with the flattening of some cells in the area between the glans and the foreskin. These flattened cells round up into a ball, containing many layers of cells. The central cells are necessarily cut off from nutrients, and die, forminga space filled with the products of dead cells. (Fig. 5) Many such whorls of cells form in this area between the glans and the foreskin. and create spaces; these spaces coalesce. and eventually create the preputial space, permitting full retraction of the foreskin from the glans.

Cross-section near tip of penis - 15 weeks Illustration from R. Hunter

Beginning around t he 15th week and continuing gradually for as long as 17 years, a process begins which ultimately separates the foreskin from the glans. This fascinating proFigure 4

At birth, virtually all males have a glans penis covered with skin. In almost all of them (96%), this skin is still attached to the glans like normal skin. Only 4% have a fully retractable foreskin at birth.
At birth, virtually all males have a glans penis covered with skin. In almost all of them (96%). this skin is still attached to the glans like normal skin. Only 4% have a fully retractable foreskin at birth. 2 The implications of this finding are enormous. Any doctor or other person who inserts a probe into this space between the foreskin and the glans thinking that he is breaking adhesions is mistaken. Anyone who attempts to forcibly retract the skin is tearing the skin off an extremely sensitive organ. This person is literally skinning tht penis alive. The facts of penis development tell us so. lt is not until the third year of life that 90% ofyoung boys

have fully retractable foreskins, and it is not until seventeen years of age before virtually all boys have fully retractable foreskins. 2

Penis at 15 weeks (wax plate reconstruction) Illustration from R. Hunter

Anyone who attempts to forcibly retract the skin is tearing the skin off an extremely sensitive organ. This person is literally skinning the penis alive. The facts of penis development tell us so.
(Co/llil1l1ed
017

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First, Do No Harm! (Continued)
Since the penis is used for procreation only a few times in the entire life of the individual, sexual pleasure must also be one of it's major functions, and the foreskin is an integral part ofthat sexual pleasure.
The facts of penis development demonstrate to us that an unusual process separates the foreskin from the glans in its own good time, covering the infant glans tightly to protect it from fecal contamination; covering the glans to protect it when, while its owner is a child, it is not required for procreation; and finally, freeing up the cover when it is needed for reproduction. There is no reason to interfere with this natural process. What is the most important function of the foreskin? To answer that, it is first necessary to look at the function of another organ - the penis. The penis has two obvious main functions. It is used for urination and for procreation. But the penis is not required for urination. Witness the female of the species. She does not have a penis, and yet she is perfectly capable of urination. The penis may be a convenient organ for urination, but it is certainly not required. We can then say that the major function of the penis is procreation - the perpetuation of the species including sexuallove. Without the penis, there would be no more humans. The penis cannot procreate nor engage in sexual love in the relaxed or flaccid state. It must be erect, engorging with blood, to perform its major functions. With this change in condition, from flaccidity to rigidity, comes an increase in length of approximately 50% Now where does this enlarged erect penis obtain skin to cover its elongated shaft? From the foreskin! In the relaxed state, the tip of the penis of the intact adult male is covered by the foreskin, which consists of a long tubular fold of skin. As the shaft of the penis elongates with erection, this double fold of skin becomes a single layer which covers it. Some have tried to argue that the foreskin does not have a function. When I was a medical student, several decades ago, it was thought that the appendix was the one organ without a function. I was taught that the appendix was a vestigial organ, left over from the remote past. We now know that this is not true. The appendix functions as part of the immune system, producing large numbers of lymphocytes. Since the known parts of the body have a function, the probability of the foreskin not having one is low indeed. The foreskin covers the elongated shaft of the penis during erection; at other times it protects the sensitive glans penis. The foreskin contains many minute muscle fibers which give it tone. This helps it to cover the glans snugly, and helps prevent the glans from developing a thick, many layered epidermis, which happens in the absence of the foreskin. This thickened epidermis reduces sensitivity. Since the penis is used for procreation only a few times in the entire life of the individual, sexual pleasure must also be one of it's major functions, and the foreskin is an integral part of that sexual pleasure. Many psychologists and anthropologists believe that sexualpleasure with an available mate contributes to the
THE TRUTH SEEKER

"There's something very wrong and very frightening about a society that systematically tortures and mutilates babies. "
stability ofthe pairbond. Surely it is not the aim ofdoctors to interfere in matters of such vital importance.

"Butchers!"
Listen carefully to what men have to say about their own circumcisions. These are direct quotes, compiled by John Erickson and Jeffrey Wood. "I think I could have accepted a deformity that was an accident of nature, but I can't accept that someone did this to me." "My feelings about the doctor who circumcised me are too violent to describe." "I have never been able to accept the fact that when I was a baby someone cut part of my penis off. The sheer monstrousness of it haunts every waking moment of my life. Sometimes I'm beginning to make some sort of adjustment to it, but then I see an unmutilated man in a shower or magazine and I become overwhelmed by uncontrollable feelings of outrage and disbelief that I was made the victim for life of something so sick." "There's something very wrong and very frightening about a society that systematically tortures and mutilates babies." "I am Jewish and I hate the tradition that robbed me of my best part." "I was circumcised when I was five - seventy years ago. I felt rage then and I still feel rage now." "The worst thing about circumcision is that it produces circumcisers. " "I wish I could circumcise every uncircumcised man in the world, so they'd all be like me. I don't have a foreskin and no one else should have one either." "Butchers!" "I was circumcised by force when a child, and it has ruined my entire life as far as I'm concerned." "Fear, pain, crippling, disfigurement and humiliation are the classic ways to break the human spirit. Circumcision includes them all." Despite the foreskin's important functions, the amputations continue. Doctors who do them try to justify their actions. Prevention of cancer of the penis and prevention of urinary tract infections in infant males are now cited as possible reasons for amputating the foreskin.

"Fear, pain, crippling, disfigurement and humiliation are the classic ways to break the human spirit. Circumcision includes them all"
There is general agreement that the hygiene of men who develop cancer of the penis has been poor. If the simple act of cleaning beneath the foreskin could prevent cancer of the penis, doctors could wait until the man is of age, and let him choose!
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First, Do No Harm! (Continued)
Cancer of the penis is very rare - one case in 100,000 - usually in older men.
Cancer of the penis is very rare - one case in 100,000 - usually in older men. Even if circumcision could prevent it, 100,000 foreskin amputations would be necessary to prevent one cancer of the penis. One hundred thousand infants would be mutilated, and several infants would die to prevent that one case of cancer. Who could scientifically advocate foreskin amputation for this reason? The same argument applies to the alleged prevention of urinary tract infection in male infants. 3 The largest number of infections that could be prevented by foreskin amputation, according to the author Dr. Thomas Wiswell, is 20,000 per year in the United States. So we should do 1,500,000 foreskin amputations to prevent infections, now treatable with antibiotics, in less than 2% of these infants?

Dr. Spock recently retracted his support of circumcision and expressed the wish that he had had the foresight to recommend against circumcision in earlier editions.
The irony is that this mutiliation is perpetuated by a small percentage of the doctors in America - perhaps five or six percent. The vast majority of doctors have nothing to do with it, and most do not approve of it. Yet those few who continue the outdated practice are giving the entire profession a bad name. Operating on a human being without a medicaljustification and without his consent is indeed malpractice.

Operating on a human being without a medical justification and without his consent is indeed malpractice.
Circumcision, or foreskin amputation, is big business. Each one costs over $100, divided between the doctor and the hospital. At its peak, there were over one million a year. This added up to well over 100 million dollars every year. Those who decide how our health care dollars will be spent should identify circumcision as unnecessary surgery, and refuse to pay for it.

In an intact infant, the proper care is to do nothing.
Besides, this type of infection may well be caused by two improper medical procedures. Swedish scientists from the Karolinska Institute in Stockholm claim that such infections are caused by colonizing the newborn infant with foreign bacteria from the hospital nursery. They recommend strict rooming-in to permit colonization of the infant by its own mother which would thus prevent these infections. 4 Second, Wiswell's colleagues taught the mothers in the study to retract the foreskin - perhaps tearing the skin off the glans - in the mistaken belief that this was proper care. This raw surface may then become a good site for the growth of bacteria which can ascend the urethra causing urinary tract infection. In an intact infant, the proper care is to do nothing. If the infants who had not been circumcised had been left alone, they might not have developed nearly as many urinary tract infections.

Circumcision, or foreskin amputation, is big business.
References:

It is sometimes argued that removal of the foreskin prevents masturbation. Dr. Leonard Marino points out that only coma prevents masturbation!
It is sometimes argued that removal of the foreskin prevents masturbation. Dr. Leonard Marino points out that only coma prevents masturbation! Dr. Benjamin Spock, in the early edition of his influential book on child-rearing, recommended circumcision for appearance and to help prevent masturbation. Dr. Spock recently retracted his support of circumcision and expressed the wish that he had had the foresight to recommend against circumcision in earlier editions. Virtually all European males are intact. Europeans recognize that there are no medical indications for routine neonatal circumcision. The American Academy of Pediatrics has also been saying that for 18 years, and they continue to say it, even though in their most recent pronouncement in March 1989, they hedge a bit. This latest pronouncement seems to be an attempt to protect those doctors who have failed to follow their recommendations these past two decades.
THE TRUTH SEEKER

I. Hunter, Richard H (1935): Notes on the Development of the Prepuce, J. Anal., 70:68-75. 2. Gairdner, Douglas (1949): The Fate ofthe Foreskin, Brit. Med. J., 2:1433-1437. 3. Wiswell; T.E., Smith F.R., Bass J.W. (1985): Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics, 75:901-03. 4. Winberg, Jan et al (1985): The prepuce: a mistake of nature? Lancet, 1:598-9 Mar 18.

George Clinton Denniston; M.D., M.P.H., specializes in Preventive Medicine and Gynecology and has published extensively in his field of speciality. He has produced a number of medical training films and documentaries and has served with many medical and professional organizations. He was formerly Associate Medical Director of Planned Parenthood, Federation of America, New York. He is currently Medical Director, Population Dynamics, Seattle, W A; President, Population Dynamics and Consultant, Alaska Womens Health Service.

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JULY/AUGUST /989

The Problem of Circumcision in America
by James L. Snyder

"First, do no harm. "
In the matter of circumcision of newborn males, it must be recognized that the child is normal as born, and that circumcision inflicts loss of a normal body part and leaves a scar. This is contrary to the motto of medicine which is "First, do

Contrary to the recommendations of the American Academy of Pediatrics, circumcision continues to be performed in rates varying from 50% to 90% of newborns in various parts of the country.
benefits, continues to be ignored by physicians and to be unknown to the lay public. As a result, and contrary to the recommendations of the American Academy of Pediatrics, circumcision continues to be performed in rates varying from 50% to 90% of newborns in various parts of the country. Just why this is tragic is what I propose to show. Initially, it must be recognized that the statement of the AAP, "There is no

no harm."

"There is no absolute medical indication for routine circumcision of the newborn. "
In the United States alone of industrialized societies, and in the two generations born since about 1940, routine newborn circumcision has become such an accepted routine in the process of birth and delivery that for some people it is a surprise to discover that there is controversy over the desirability of the procedure. In 1975, The American Academy of Pediatrics (AAP) published the report of a committee formed to study circumcision, whose opinion was that "There is no

absolute medical indication lor routine circumcison of the newborn, "has been perceived to mean that, while circumcision is not necessary, it is perfectly all right to continue to do it. Therefore, physicians who would refuse to give a child an unnecessary shot of penicillin simply because it was requested by parents are continuing to perform an operation on the request or by the compliance of parents.

absolute medical indication for routine circumcision of the newborn. " This statement is contained in the body of the
Report of the Ad Hoc Task Force on Circumcision from the Committee on Fetus and Newborn of the AAP (Published in Pediatrics, Vol. 56 No.4, October 1975, and modified in March 1989). The body of the report addresses most of the commonly voiced concerns, such as phimosis, hygiene, care of the penis, cancer, balanitis and venereal disease, surgical risks, and contraindications to circumcision. The Report also called for "true informed consent" and a "... program of education leading to continuing good personal hygiene

Sadly, there have even been instances when a child was circumcised without the parents' wishes or consent.
It must be acknowledged that there are numerous reasons why circumcision continues to be performed upon children. Some parents request the operation because of the influence offamily or friends and find that their physician will comply. Some physicians continue to insist that th'e operation be performed on children in their care and persuade young and impressionable parents that they have no choice, or that it is in the child's best interest. Sadly, there have even been instances when a child was circumcised without the parents' wishes or consent. In the case of adult circumcision, the operation is never performed unless the individual seeks the procedure for genuine medical need or for his own aesthetic reasons. This is a choice that less than 10% of uncircumcised adults will ever make. In Europe, more than 90% of men who are fortunate

(which) would offer aI/the advantages of routine circumcision without the attendant surgical risk. " And finally stated, "Therefore, circumcision ofthe male neonate cannot be considered an essential component of adequate total health care.

"Circumcision of the male neonate cannot be considered an essential component of adequate total health care. "
Almost immediately the American College of Obstetricians and Gynecologists and the American Urological Association - medical specialty societies with an immediate interest in the question - published positions which in very nearly the same words supported the position of the AAP. The expected result should have been an immediate drop in the number of newborns subjected to routine circumcision. The procedure would have been discarded or, at least, physicians who continued to perform significant numbers of circumcisions would have been under the same critical review as those who continued to perform large numbers of unnecessary tonsillectomies when that operation fell into disrepute. Curiously and, in some instances, tragically, no such thing occurred. Even today, more than thirteen years after the AAP made its findings known, the Report, only slightly modified in March 1989 to emphasize balance of risks versus
THE TRUTH SEEKER

enough to have their normal anatomy willfind no reason to seek a circumcision.
The proponents of circumcision in recent years have published articles which are claimed to show as a scientific fact that uncircumcised males are at greater risk of acquiring a number of benign diseases and one rare malignancy. It has been stated, for instance, that circumcision would reduce the opportunity to acquire syphilis, gonorrhea, herpes, venereal warts, urinary infections, and other benign conditions. The fact is that circumcision confers no immunity to any of these diseases, which any physician treating large numbers of circumcised American men - as in the military services - can readily observe, If all men were circumcised, only circumcised men would contract these diseases, for most of which there
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JULY/AUGUST 1989

The Problem of Circumcision in America (Continued)

The fact is that circumcision confers no immunity to any of these diseases,
are satisfactory antibiotic treatments. Most recently, there has been speculation that circumcision would offer protection from infection by Human Immunodeficiency Virus, the suspected causative agent of the disease AIDS. The stated basis for this is the observation of the AI DS infection pattern in a small number of African men who frequented AIDS infected prostitutes. The proponents of this speculation choose to ignore the obvious fact that AI DS infections were first recognized in American homosexual men who were overwhelmingly Caucasian, middle class, and circumcised.

Circumcision must be recognized as an'equally serious mutilation of men with equally insubstantial justification for continuing the practice.
seriously advocates removing the breasts of female infants to prevent this more common malignancy of breast cancer. Almost certainly such a proposal would be greeted by howls of outrage over such a mutilation of women to prevent breast cancer. Circumcision must be recognized as an equally serious mutilation of men with equally insubstantialjustification for continuing the practice.

Thousands of men with AIDS fill the hospital beds of our major cities and are testimony to the failure of circumcision to offer any degree of immunity to AIDS infections.

The child who simply has been cut too short will then become a sexually dysfunctional adult.
The risks of newborn circumcision are ail underreported and ignored factor in this argument. Most often a poor surgical result is not recognized until years after the event. By the time a child reaches the age of maturity and discovers how he has been mistreated, the surgeon cannot be found, and parents may be beyond the age of interest in such matters. The child who simply has been cut too short will then become a sexually dysfunctional adult. Some of the men who have realized that they have been deprived of a normal part of their bodies have sought plastic surgical procedures to reconstruct their bodies with the same motivation as persons who have lost other portions of their bodies by accident or disease, and who have sought to regain normal bodily integrity. The more serious complications of circumcisions are increasingly being reported in the lay press:

Circumcision is the only surgery which is used to prevent disease.
The most significant argument that has been put forth for circumcision is that it prevents cancer of the penis. This may be true, but even proponents of circumcision admit that there have been occurrences of penile cancer in men circumcised as infants. Cancer of the penis occurs, on average, in men aged 55 years, and is one of the least common malignancies in men, representing Y2 of I % of all cancers in men and occurringat a rate of less than one case per 100,000 per year in the United States. This is the same incidence as in the countries of Northern Europe, where infant circumcision is almost unknown. Proponents of circumcision would like to have the public believe that the low incidence of penile cancer in the United States is due to infant circumcision, but they ignore the fact that the population of American men born before 1940, who are now in the over 50 age group at risk for this cancer, is a group of predominantly UNCIRCUMCISED men. It is known that the rate of occurrence of penile cancer in the men of India, China, and the Caribbean areas (where circumcision is not customary and where sanitary facilities are primitive) is 20-30 times more common than in the uncircumcised men of Northern Europe. Therefore it is apparent

The Des Moines Register (Iowa) Saturday, Nov. 201982,
reported a grand jury investigation of the bleeding death of a Des Moines infant after circumcision.

The East Cobb Neighbor (Marietta, Georgia) of Nov.,
1985, reported that "In September, two male infants were burned and horribly mutilated in a 'routine circumcision' at Northside Hospital (Atlanta). One of the infants has had a necessary sex change operation and the other is still under doctors' care. "

that the variable of circumcision or non-circumcision is not the primary variable influencing the occurrence of penile cancer. Referring again to the Report of the American
Academy of Pediatrics, it must be concluded that " . . .

The Lake Charles A merican Press (Louisiana) of Wednesday, May 28,1986, reported a $2.75 million award in the case of a young boy whose penis had to be amputated after it was severely burned during a routine circumcision.

continuing good personal hygiene . .. "may be a significant factor protecting the uncircumcised men of Europe and A merica from penile cancer.

The Times Picayune (New Orleans, Louisiana) of Thursday, May 15, 1980, reported on a Mineola, N.Y. boy who was mistakenly circumcised four days after his birth in 1976. It was reported that the family had not wanted the circumcision performed, and that the hospital officials tried to "cover-up" the error by falsifying records to show that the circumcision was done for "medical reasons." An out-of-court settlement for $ I5,000 was reported in a suit over the matter. The above reports, drawn from the lay press, almost
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No-one seriously advocates removing the breasts of female infants to prevent this more common malignancy of breast cancer.
Circumcision is the only surgery which is used to prevent disease. In contrast, consider that in absolute numbers over a ten-year period (1943-1953) the Danish Cancer Registry reported 25 I cases of penile cancer and for the same period reported 10,000 cases of breast cancer in women. Yet, nobody
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JULY/ AUGUST 1989

The Problem of Circumcision in America (Continued)
On balance, circumcisiun is an unjustifiable preventive for penile cancer with an unacceptable number of serious complications.
certainly represent only a small part of the number of unfavorable results of routine newborn circumcision, as most of the families in such incidents shun publicity. My own personal experience as a urologist with nearly 25 years of practice has included two children who must be numbered in these tragedies and are likely to be genital cripples. In Florida, in 1976, I was called to see a newborn immediately after his circumcision with a Gomco clamp. This child had suffered complete removal of the skin of the penile shaft, but the surgeon had left the foreskin in place. In panic, he had discarded the skin and tried to conceal the mishap. The obviously raw surface of the penile shaft required an urgent surgical procedure to cover its surface by grafting (for a similar child see Figures I and 2.) In 1982, I was called to see a Virginia infant who had been circumcised using a Gomco clamp and electrocautery. The result was complete loss of the glans and shaft of the penis due to a full thickness burn. After this child's penis fell off at the level of the scrotum, he underwent a series of surgical procedures at major medical centers which have created a tube for urination through a pedicle skin graft. There is, of course, no tissue to create an erection and no nerves for genital sensation in this graft (see Figure 3) Although this child's tragedy cannot be measured in dollars alone, he will recover $1 million in the out-of-court settlement of a lawsuit. He will never fully recover his sexual functions, which had been destroyed in the circumcision tragedy. These two personal experiences in the career of one physician, together with a number of lesser complications of circumcision should be compared with the fact that in the same period of time I have only encountered four patients with

Figure 1: illustration of a surgical repair of a circumcision In which excessive penile skin was removed.

In summarizing the complications of circumcision accidents, I would like to state that they are not uncommon.
newly diagnosed penile cancer, two of which were in men of truly advanced years or who died within a year of other causes. On balance, circumcision is an unjustifiable preventive for penile cancer with an unacceptable number of serious complications. In summarizing the complications of circumcision accidents, I would like to state that they are not uncommon. Because of their sensitive and confidential nature, however, they are usually unrecognized by outside parties and they have not been seriously studied in the medical literature except on an occasional or anecdotal basis. I believe that the cases I have presented in this paper represent only the tip of the iceberg in terms of the size of this problem. The adverse long-term consequences of infant circumcision on the sexual health of American men must be recognized by physicians, parents, and legislators. The con-

tinued practice of infant circumcision must be recognized as the unjustified mutilation of the bodies of children largely for the cosmetic or aesthetic gratification of other persons - a serious assault and battery on children who are poweless to resist.

Figure 2: Showing the completion of the surgical repair in Figure 1. Even though this child's own skin has been replaced, he will have scarring which will likely make him a genital/sexual cripple.
THE TRUTH SEEKER

The adverse long term consequences of infant circumcision on the sexual health of American men must be recognized by physicians, parents, and iegislators.
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The Problem of Circumcision in America (Continued)

Ethical and Legal Issues
Religion plays an important role in the growth and development of many children and families. However, when parental practices have potentially harmful consequences for the child, state intervention may be warranted. The boundary between parental freedom in child rearing and the interest - or even basic rights - of the child is unclear. However, the constitutional guarantees of freedom of religion do not sanction harming another person in the practice of one's religion, and they do not allow religion to be a legal defense when one harms another.

RECOMMENDATIONS
The American Academy of Pediatrics recommends that all pediatricians, pediatric surgeons, and AAP state chapters vigorously take the lead to (I) increase public awareness of the hazards to children growing out ofreligious exemptions to child abuse and neglect legislation; (2) support legislation in each state legislature to correct statutes and regulations that permit harm to children under the shield of religious exemption; (3) work with other child advocacy organizations and agencies to develop coordinated and concerted public and professional actions for recision of religious exemptions. The Academy must unequivocably defend the rights of all children to the protection and benefits of the law and medicine when physical harm - or life itself - is in the balance. Committee on Bioethics, 1986-1987 Norman C. Fost, MD, Chairman William G. Bartholome, MD William Reed Bell, MD Alan R. Fleischman, M D Arthur F. Kohrman, MD William B. Weil, Jr, MD Liaison Representative Kenneth J. Ryan, M D AAP Section Liaison Anthony Shaw, MD From: Religious Exemptions From Child Abuse Statutes. Pediatrics January 1988

Figure 3: This child suffered the complete loss of the glans and shaft of the penis due to a full thickness burn from a circumcision using a Gomco clamp and electrocautery. A pedicle skin graft creates the appearance of a penis. In this graft there Is no tissue to create an erection and no nerves for genital sensation or pleasure.

J ames Leigh Snyder, M. D., F.A.C.S., is a 1961 graduate of the Jefferson Medical College of Philadelphia, a member of the Alpha Omega Alpha Honor Medical Society, and a Fellow of the American College of Surgeons. He is a diplomate of the American Board of Urology and past President of the Virginia Urologic Society. He holds the rank of Commander in the Medical Corps of the United States Naval Reserve and practices Urology in Clifton Forge, Virginia.

Having conducted dozens of discussions on this subject. I have found one reaction typical among Jewish physicians. I will paraphrase their comments: "I agree that there are no health benefits. 1 even feel that it may be wrong to do it. Yet, if 1 have a son, 1 will have him circumcised. Please don't ask me why. I am not in the least bit religious. 1 know it is irrational, but 1 will do it." Will the liberal rabbinate, in view of the impending changes in the medical approach to nonreligious circumcision, also suggest changes in the Jewish ritual? Let us hope that sanity, not hysteria, will prevail in approaching this potentially vexing problem. From: Edward Wallerstin. Circumcision and Anti-Semitism: An Update. Humanistic Judaism Winter 1983.
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JULY/AUGUST 1989

Cultural Bias and The Urinary Tract Infection (UTI) Circumcision Controversy
by Martin S. Altschul

It is first necessary to understand that child-

hood UTI is in general a difficult and confusing diagnosis.
Recently much discussion in the circumcision controversy has centered on the issue of infant urinary tract infections (UTI). This is largely a technical question but it has some bearing on the larger ethical and social issues of routine newborn circumcision. In order to discuss infant UTI intelligently, it is first necessary to understand that childhood UTI is in general a difficult and confusing diagnosis. If a careful physician and an adult patient have a telephone conversation that leads to the diagnosis of UTI, the diagnosis will usually, though not always, be correct. But if the same conversation passes between the physician and the parent of a healthy pre-school girl, the UTI diagnosis has, in my experience, an 80% chance of being wrong. The comparable figures for a pre-school boy approaches 95%

We are a long way from understanding the relationship, if any, between infant UTI and circumcision.
technical nature, a controversy erupted over Wiswell's result, and Wiswell responded with more data by doing an indirect review of all available hospitalized Army cases. This review also showed a twenty-to-one ratio between the two groups of boys but with different rates (1.0% and 0.05%). I then did a similar review in Northwest Permanente Hospitals.1 found not a single confirmed case of UTI

in a normal male infant. A II of the confirmed cases occurred in infants who had clear-cut urinary birth defects.
Not only is my result dramatically different from Wiswell's, my result is perfectly consistent with "common knowledge." Now "common knowledge" can be wrong - flat earth and so on. But we should never jump to the conclusion that it is wrong without hard evidence. In the present case, we have some unconfirmed evidence of infants with bacteria in their urine. The evidence that the infants are actually harmed by these bacteria is practically nonexistent. Indeed, if Wisell's 4% figure was correct, there would have been 80 uncircumcised infant boys with UTI in my study. What happened to these patients if they never got diagnosed? They didn't die, they didn't turn up with sepsis (blood poisoning) or meningitis, they didn't have kidney transplants. It might be supposed that the undiagnosed babies turn up as adults with urinary problems, but neither scientific evidence nor "common knowledge" supports this notion. It is "common knowledge"that girls who have recurrent UTI in childhood and are "lost to follow-up" in adolescence sometimes turn up in adulthood with serious kidney problems. The closest we get to this in the medical lore of the male is that middle-aged men often suffer urinary problems due to teen-age gonorrhea. We are a long way from understanding the relationship, if any, between infant UTI and circumcision. The incidence of UTI seems to vary widely depending on whether the investigator passively collects cases or goes fishing for them. How then can this confusing and ambiguous scientific question be factored into the larger social and ethical controversy over the legitimacy of routine newborn circumcision. I believe one must start by establishing a basis for discussion that is free of cultural bias. Although the numbers vary somewhat, the U.S. is about 75% circumcised in the post-war period. However, white middle class "baby-boomers" are almost all circumcised. It is not so long since the "routine" circumcision was "Routine" with a capital "R," done without discussion or parental consent. Many parents still expect it to be done this way. Also, the (male) physicians in the U.S. who discuss this issue are almost all circumcised. It is therefore inevit(Continued on next page)
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Even if the child is examined and a urine specimen is obtained, UTI misdiagnosis rates are stillsubstantial because of the difficulty of obtaining "clean" urine specimens from small children. The physician who wishes to avoid mistakes
either of over- or under-diagnosis must be prepared to make the best possible initial diagnosis (UTI or not UTI) and then mistrust his (her) first impression sufficiently to make the correct diagnosis in the end. This caveat applies both to individual clinical cases and to research projects. This brings us to newborn circumcision, a surgical procedure that is now alleged to prevent UTI. Until recently the state of medical "common knowledge" regarding infant male UTI was as follows: In all age grou ps except earll' infancy, females have a much higher rate of UTI than males. Male infants are more likely to be born with abnormalities of the urinary tract. Although such abnormalities are rare, they are the predominant cause of infant UTI. Infant UTI is therefore a serious condition that often requires surgical correction of an underlying cause. Now enter Dr. Thomas Wiswell, Army pediatrician who did a prospective study of UTI in infants, targeting the role, if any, of circumcision. The result, which drew widespread attention both inside and outside the medical community, was that the uncircumcised boys appeared to have twenty times as many UTI's as the circumcised ones (4% YS. 0.2%). Obviously this result does not fit with our "common knowledge." A condition with 4% incidence is no longer rare. And perhaps more disturbing, the crucial connection between UTI and urinary birth defects is broken. Circumcision could conceiveably prevent UTI but it cannot prevent birth defects without violating Einstein's Law of Relativity. Because of these concerns and others of a similar
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Cultural Bias and The Urinary Tract Infections (UTI) Circumcision Controversy (Continued)
It is therefore inevitable that these circumcised physicians have an "I'm OK, you're OK" attitude about the state of being circumcised.
able that these circumcised physicians have an "I'm OK, you're OK" attitude about the state of being circumcised. I can vividly recall seeing a Hispanic boy with an intact foreskin exactly 30 years ago. I though he had a weird abnormal growth. Bible stories notwithstanding, it took me a couple of years to figure out the truth. In an attempt to escape this bias, I have put newborn (male) circumcision on a list of primitive cultural practices that can be discussed together. Starting with the most obnoxious: I. Castration 2. Foot binding 3. Radical female circumcision or infibulation 4. Scarification 5. Ubangi lip stretching 6. Limited female circumcision 7. Male circumcision 8. Mayan head deformation 9. Maori tatooing 10. Ear and nose piercing It takes awhile for the white middle class American physician to digest the fact that newborn (male) circumcision fits on this list. It also takes awhile to digest the fact that circumcision was introduced into this country not as a physical hygiene measure but as a mental hygiene measure to prevent masturbation. In this context, male circumcision was promulgated in the same breath with clitoridectomy (removal of the clitoris) and frontal lobotomy. When an American physician says that circumcision prevents UTI or cancer of the penis, he is sincere. But, it is like a medieval Chinese physician saying that foot binding prevents flat feet. If someone asks me, "What rate ofpreventable UTI wouldjustify male circumcision?"I respond by asking, "What rate of preventable UTI would justify routine female circumcision?" The second question is patently absurd unless one's cultural bias allows a sympathetic view of female circumcision. Therefore, the first question can be only slightly less absurd. To put it another way, if newborn circumcision were introduced as a new procedure, it would have to be proven "safe and effective." It is conceivable that circumcision could be proven effective, i.e., that the significant UTI prevented might exceed the significant complications of

circumcision was introduced into this country not as a physical hygiene measure but as a mental hygiene measure - it was supposed to prevent masturbation.
the procedure. But to prove safety, it is necessary to prove that circumcison does not interfere with the sexual functioning of the penis. In the "I'm OK, you're OK," culturally-biased discussion, this point is easily overlooked. For example, one hears the following argument: The foreskin may have been useful to early man who ran naked through the brambles but modern man wears clothes and has no need of the thing, so he might as well get rid of it and cut down the cancer risk. My response to this argument is a slight change in the wording: Breasts may have been useful to early woman who had no choice but to suckle her babes. But modern woman has many infant feeding options and therefore has no absolute need of breasts. She might as well get rid of them and cut down the cancer risk. Incidentally, breast cancer is 5,000 times more common than foreskin cancer. Ounce for ounce, the rate might be the same.

Incidentally, breast cancer is 5,000 times more common than foreskin cancer. Ounce for ounce, the rate might be the same.
Finally, what is the relationship between the cultural bias in this country and the religious aspect of circumcision? The history of religious circumcision contains some positive elements. It appears that circumcision spread in the early Hebraic period as part of a campaign of religious reform that suppressed pagan religions that practiced human sacrifice. Medieval Jewish writings specifically denied any hygienic function for circumcision. Jewish physicians were forbidden by law to perform "secular" circumcison of gentiles. Therefore the promulgation of secular circumcision in this country from 1880 to 1950 cannot have been a "Jewish" activity.

It is a mistake for Jews, Christians, or Moslems to buy into the notion that these secular arguments are a legitmate part of their cultural heritage.
On the other hand, the modern secular Jew likes to explain religious law as a reflection of practical considerations: The eating of pork was forbidden because pigs carry Trichinosis. This statement probably does not contain a grain of historical truth, but its tidy logic is appealing. So we may just as well say:
(Continued on next page)

\\T~EREfoRE, T~E ~iG~EST Good is SOME SORT of
plEASURE, dESpiTE T~E fACT T~AT MOST plEASURES ARE bAd, ANd, if you likE, bAd iN T~E UN9UAlifiEd SENSE of T~E wORd."

ARisTOTlE,

Vlichomachean ethics,
Book

7

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JULY/AUGUST /989

Cultural Bias and The Urinary Tract Infections (UTI) Circumcision Controversy (Continued)
(1930 version) Biblical circumcision was performed in order to improve penile hygiene and prevent venereal disease. or: (1890 version) Biblical circumcision was performed in order to prevent wicked masturbation and the mental illness that it causes. Any day now I expect to see the following update in print: (1990 version) Biblical circumcision was performed in order to decrease the risk of contracting AIDS.
It is a mistake for Jews, Christians, or Moslems to buy into the notion that these secular arguments are a legitimate part of their cultural heritage.

Cl1rCUmC1Slon
we have btroken a child's spitrit he looked at me befotre we began and knew me fotr who i am hey he said to me in his gentle smile of trecognition hey you atre the same as me you must be who i am and then i held down his legs as we cut off his fotreskin infinitely sotre tendetr life of otrgasm we trejected his life fotrce powetr he could not Aght us off despite the fact that he fought with all his might he gave up the Aght his legs lay beneath the ten ton Atre of my hands and stayed thetre with all his might dtrained even afretr i had let him up
i cannot believe that it does not hatrm so tendetr a life to have his spitrit btroken at this tendetr time hf his life

Martin S. Altschul, MD received his doctorate in medicine from TheJohns Hopkins University Medical School; an M.S. degree in statistics from the Massachusetts Institute of Technology; and is currently a staff pediatrician at the Northwest Region Kaiser Foundation Hospital, Salem, Oregon.

American Academy of Pediatrics

Report of the Task Force on Circumcision

at my hands who has ushetred in his life
Karen Hope Erlich birth song
~~---

==-

~

Submitted by: John Erickson, Biloxi, MS

~

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JULY/AUGUST 1989

Care of The Intact Male
by Paul M. Fleiss, M.D., M.P.H.
Every newborn infant is special. Amazing is the newborn in that he is born intact with eyes that see, ears that hear, a nose that smells, and skin that feels. The healthy newborn infant has needs to be loved. to be held, to be talked to, to be touched. He does not need to have the agonizing pain of part of his body surgically removed without any anesthesia inflicted upon him for non-existing health reasons. He does not need to be circumcised for reasons of religion or social customs or superstition. An ancient ignorance has made the care of the newborn's penis quite complicated when it should be quite simple, "Leave it alone" is the commandment to all parents and health workers that should be heard around the world. The newborn needs to be appreciated for the amazing being he is and the care of his penis should be: Do not hurt it! Do not amputate it! Do not attempt to retract it! One may wash the entire organ without attempting to pull back or clean the foreskin. One can easily wait until the boy can take care of his own penis. The foreskin has a function. It does keep the glans of the penis warm, moist, and sensitive. It protects from infection and it keeps the opening of the penis adequate. Complications of "routine" newborn circumcisions are grossly underreported. The medical literature does report the major mutilations, the major hemorrhages, and the major infections, however many males that are left with a deformed gland or a meatus (opening) too small or an insensitive glans have never been counted. The procedure has many risks even when performed with the skill of the most able surgeon. Repeating the advice of the American Academy of Pediatrics 1984 brochure on Care of the Uncircumcised Male is good advice to all parents, to all nurses, doctors, and health care workers LEAVE IT ALONE! Let the newborn male take care of his own foreskin when he is able to do it without any trauma or pain. Leave the penis of the newborn infant alone.

Circumcision Is Fascism?
Yes. a not her "circumcision" letter. This is in response to the responders whose letters you printed Dec. 8,1988. I am shocked and amazed by what passes for intelligence in our most compassionate profession. In my view, these opinions are at best idiotic, at worst fascist. What these folks are supporting is the expenditure of hundreds of millions of dollars to torture newborn babies (of thei r own sex) because, as a society, we are too morally bankrupt. disorganized. and/ or lazy to teach little boys and their parents how to wash a penis, or to conduct thorough sex education. We are told that all little boys should have a mutilating and excruciating experience in their first days of life, to prevent a few men (who have the understanding to deal with the operation and the guarantee of receiving anesthesia) from having cancer or YO, which can be prevented in cheap and painless ways. One can only guess at the sort offundamental emotional outlook which can calmly rationalize this cold-blooded, wholesale cruelty. And isn't it amazing how often people turn to the Old Testament to support violence and intolerance - certainly not the best of use of the highest wisdom of a people. I applaud the resolution of ACOG (the American College of Obstetricians and Gynecologists) to oppose this recurrent atrocity. I encourage all of us to look to the society we continue to create; we show little or no respect or understanding for children nor for the lessons they begin to learn, so early in life, about the treatment they will receive at the hands of those who love them. Those who consider this "much ado a bout nothing" have stepped over the boundary separating responsible intellect from hubrisprone ego, leaving humility and compassion behind. How much woe comes from that little step! David S. Bate, M.D. Skyland, N.C. Letter To The Editor, Medical Tribune 23 February 1989,30:6
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Circumcision Of Infants Misguided
The American Academy of Pediatric's recent statement

(The Sun Herald. March 6) about infant circumcision
misses the point with a precision that can only be deliberate. The foreskin is a highly specialized, uniquely sensitive, multifunctional organ of touch. When you cut off a baby's foreskin, you are cutting off one of his means of perceiving, experiencing, sharing and enjoying his existence. You are literally censoring his life. The vast majority of males who are not circumcised value their wholeness and keep their foreskins intact, for the same reason they keep the rest of their body intact. When you circumcise a baby, in other words, you are, in effect, cutting his foreskin off by force. Many males circumcised as babies see themselves as harmed by that amputation - regardless of the reason they were circumcised. The endlessly debated "health benefits" of infant circumcision are therefore a false issue and would not justify depriving a baby of his foreskin even if they were real. If the American Academy of Pediatrics isn't aware of those considerations, why isn't it? If it is aware of them, why does it remain silent? John A. Erickson Biloxi Letter To The Editor, The Sun Herald March 27,1989
-46JULY/AUGUST /989

TItE FiRST CiRCUMCisioN CASE
by Richard W. Morris

This was strictly an issue of law since the physician's own form stated that circumcision had no medical purpose, all we had to argue about was whether or not a parent can consent to surgical procedures which had no medical purpose.
The first case to challenge circumcision anywhere, the United States or any other country, was the Adam London case. The challenge was decided first in the Superior Court of California, Marin County, then heard by the Court of Appeal. A petition to have the California Supreme Court review the rulings of the lower courts was summarily rejected by the Supreme Court. This is the story of the issues and the happenings. The lawsuit was begun by Adam's mother, as guardian ad lileJl1 for Adam (the plaintiff). Just before the circumcision, she had signed an "informed consent" form provided by the medical facility. On the form it stated that there was no

and carrying plaintiff from one location in the Medical Center to another location within the Medical Center for the sole purpose of committing mayhem and mutilation of the body of plaintiff in violation of California Penal Code Section 207. VIOLATION OF MAYHEM STATUTE (Penal Code 203) Defendants, and each of them, committed a tort by willfully, unlawfully and maliciously depriving plaintiff of his foreskin and of permanently disfiguring plaintiffs penis in violation of California Penal Code Section 203. The defendants brought a motion to have all of these causes of action stricken. The court struck all except the battery and the kidnapping and false imprisonment causes of action. A -decision then had to be made as to whether to appeal at that time or go forward on the remaining two causes of action. The decision was made to proceed on the two. The defendants then brought a motion for summary judgment saying that all of the facts were agreed to and that the mother's consent excused both the charge of battery and of kidnapping and false inprisonment. The case now revolved around this sole issue: DOES A PARENT HAVE THE LEGAL POWER TO CONSENT TO A SURGICAL PROCEDURE WHICH HAS NO MEDICAL PURPOSE? The Superior Court ruled in the favor of the defendants without ever really dealing with the only issue in the case. We, of course were faced with how to give an enlightened response to judicial absurdity. The case now had to go to the Court of Appeal. This was strictly an issue of la w since the physician's own form stated that circumcision had no medical purpose, all we had to argue about was whether or not a parent can consent to surgical procedures which had no medical purpose. In the Court of Appeal we fared no better. The brief was extensive. You may obtain a copy of it from Marilyn Milos. During the oral argument one of the Justices of the Court of Appeal asked me if the Court ruled as I argued would it not infringe upon religious freedom. My response was the "Cocker Spaniel" answer. A cocker spaniel is born a cocker spaniel and will remain a cocker spaniel all of its life. A human being is not born as a

medical purpose for circumcision. She does not remember the form or having signed it. She was upset at the time regarding the circumcision. Adam's father did not sign the form.
The lawsuit against the physician who performed the circumcision (and the medical facility where it was performed) alleged eight separate causes of action. I will list them with a short explanation. COM MON LAW BATTERY In that without the knowledge and consent of plaintiff, they forcibly removed the foreskin from plaintiff's penis by cutting the foreskin completely off. VIOLATIO OF WILLFUL CRUELTY STATUTE (Penal Code 273a), in that in doing the circumcision they inflicted unjustifiable physical pain upon plaintiff in violation of California Penal Code Section 273a. VIOLATION OF INFLICTION OF PAIN STATUTE (Penal Code 273d) in that in doing the circumcision they inflicted unjustifiable physical pain upon plaintiff in violation of California Penal Code Section 273d. VIOLATIO OF WILLFUL CRUELTY STATUTE [Health and Safety Code 11165, Penal Code Section 273a( I) and Penal Code Section 273a(2)] in doing the circumcision they willfully inflicted unjustifiable physical pain upon plaintiff in violation of California Health and Safety Code, Section 11165, subparagraph (c), subsection (2), sub-subsection (d), in violation of Penal Code Section 273a, subsection (I) and Penal Code 273a, subsection (2). VIOLATION OF CHILD ABUSE STATUTE (Health and Safety Code 11165) that in doing the circumcision they committed a tort of willfully inflicting unjustifiable physical pain upon plaintiff in violation of California Health and Safety Code, Section 11165, subparagraph (g). . VIOLATION OF KIDNAPPING STATUTE (Penal Code 207) in that when they took Adam to the circumcision room they committed a tort Of willfully taking
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Christian, a Moslem, a Jew, or any other religion. The fact that the child is born from parents of a particular religion does not make the child a member of that religion by choice.
Yet it is by choice that a person selects either the religion of the child's parents, some other religion, or no religion at all. The issue then, is not the religious freedom of the parents as presented by the Court but the religious freedom of the child.

Keeping in mind the religious freedom of the child, some religions (such as Hindu) ostracize or prohibit a male who is circumcised to become a member ofthe religion. However, if
(Conrinued on nex[ paKe)

The issue then, is not the religious freedom ofthe parents as presented by the Court but the religious freedom of the child.
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The First Circumcision Case (Continued)

The issue here deals only with the limitation placed upon the legal power of parents to consent to surgical procedures to be conducted upon their children.
the child (for example) was born of Jewish parents and elected at the age of majority to become a member of the Jewish religion, he could then cut off his foreskin to join.

ties cited herein and this Court's ruling is necessary because an important question of law is at issue herein requiring settlement by this Court.

3. INTRODUCTION
Both the Superior Court and the Court of Appeal apparently understood the case of Appellant to be that of arguing the merits of circumcision. That is not, and was not the issue, presented. The relative merits of the surgical procedure are to be argued at the trial court after the presentation of evidence. The issue here deals only with the limitation placed upon the legal power of parents to consent to surgical procedures to be conducted upon their children.

Asfar as the religiousfreedom ofthe parents is concerned, they could do a symbolic ritual of circumcision rather than the actual circumcision (as they do for other religious ceremonies), This would leave the child free to choose which religion, if any, the child would like to choose when the child became of the age to do so. The three Justices of the Court merely chuckled, looked at each other, and moved on. We received a ruling from the Court that the lower court's Summary Judgment was sustained, and an opinion that a parent could do whatever the parent wanted to do to the child. We then moved onward, and upward, to the California Supreme Court. Here is what we argued to the Supreme Court. To the Honorable Chief Justice, and to the Honorable Associate Justices of the Supreme Court of the State of California:

Section 25.8, however, permits parents to consent to any surgical procedure, regardless of purpose.
Appellant here desires only a statement on the law of the State of California by petitioning this Court to answer one question: DOES A PARENT HAVE THE LEGAL POWER TO CONSENT TO A SURGICAL PROCEDURE WHICH HAS NO MEDICAL PURPOSE?

4, SUMMARY OF FACTS
Respondent Mark Glasser, acting within his scope of employment as an employee of Permanente Medical Group, removed the foreskin from Appellant Adam London's penis. Appellant brought an action for assault and battery, among other causes of action, against Respondents. Respondents defended on the sole ground that the parents of Appellant consented to the removal of the foreskin. The Superior Court granted a motion for Summary Judgment based upon the consent of the parents.

J.STATEMENTOFISSUEPRESENTEDFORREVIEW
Does a parent have the legal power to consent to a surgical procedure which has no medical purpose?

2. PETITION FOR REVIEW
Appellant London hereby petitions for review of the decision of the Court of Appeal of the State of California, First Appellate District, Division Four, filed in this action on May 20,1987, affirmingthejudgment of the Superior Court of the Suite of California in favor of Respondents. A copy of the decision of the Court of Appeal showing the date of its filing is set forth herein as Appendix I. Review by this Court is necessary on the ground that the decision of the Court of Appeal is not in line with the authori-

It is the position of Appellant, that to grant a

parent the legal power to consent to a surgical procedure which has no medical purpose is to grant a parent an unlimited license to abuse their children.
The Court of Appeal affirmed the Superior Court, stating the "Plaintiffs public policy argument - that children should be protected from suffering unjustifiable pain or risks - is based on the premise that parents cannot consent to surgical procedures which have no medical purpose. Section 25.8, however, permits parents to consent to any surgical procedure, regardless of purpose.'" Appellant disagrees with the Court of Appeal, and contends that parents do not have the legal power to consent to any surgical procedure regardless of purpose, and that the purpose sets the limit upon the parental authority.

A

MAN'S MiNd STRUcilEd by A NEW idEA

CAN NEVER GO bAck TO iTS ORiGiNAl diMENSiONS. OliVER WENdEll HolMES
(1841.19J~)

U.S. SUpREME COURT JUSTiCE QUOTEd by RobERT M. HUTcltiNS

5, THE ONLY ISSUE:
DOES A PARENT HAVE THE LEGAL POWER TO CONSENT TO SURGICAL PROCEDURES WHICH HAVE NO MEDICAL PURPOSE?
(Col1/inued on nex{ paKe)

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JULY/AUGUST 1989

The First Circumcision Case (Continued)
The Court of Appeal holds that Civil Code Section 25.8 grants to a parent the legal power to consent to surgical procedure upon their children "regardless of purpose." It is the position of Appellant, that to grant a parent the legal power to consent to a surgical procedure which has no medical purpose is to grant a parent an unlimited license to abuse their children. Since parental autonomy is not absolute, what defines the limit? Appellant's position is that the limit must be defined by the definition of medical treatment, not mere "procedures." Appellant's safety was placed at risk. and Appellant was permanently deformed, by the circumcision in violation of the Constitution of the State of California, Article I. Section I, and in violation of the Civil Code, Section 43. POINT 2 IF IT AI IT BROKE. DONT FIX IT A parent's legal power to consent to acts to be done to their children must have limits. The limits have been defined by other courts as being limited to the power to consent to medical treatment. The Texas Court of Appeal faced this very same issue in the context of a kidney transplant. A 14 year old. mentally incompetent but otherwise perfectly healthy, daughter applied (through a guardian ad litem) for an order authorizing the mother to consent to the removal of a kidney from the daughter's body, for the purpose of transplanting the kidney to the body of a son who was suffering from endstage renal disease. The Texas court held: NO. The court, in so ruling. stated: "Significantly, however, for our purposes, this power of parents ... to consent to surgical intrusions upon the person of the minor ... is limited to the power to consent to medical 'treatment. '" Little v Little, 576 S. W.2d 493. at page 495. This is the very same rule Appellant asked the Court of Appeal, and now asks this court to rule. This Review of the Court of Appeal is not concerned with arguing the merits of the particular surgical procedure involved in Appellant's case: that is an issue for the trial court. Appellant contends that the error of both the Trial Court and the Court of Appeal is they concerned themselves with the merits of the surgical procedure itself and not with the rule of law which must first be addressed before the evidence regarding the merits of the surgical procedure can be considered. Other than the Little case in Texas, only one other appellate level court has, to the knowledge of Appellant, even considered the issue of defining the limits of parental power to consent to surgical procedures. That other court was the Louisiana Court of Appeal. Again, the Court was dealing with whether or not a guardian could consent to a surgical procedure to remove an organ from a healthy child and have that organ transplanted to an ill child. The surgical procedure had no medical treatment value for the healthy child.

For example, amputation is a surgical procedure. Appellant finds it impossible to believe that any court would grant to a parent the legalpower to consent to the amputation ofall the healthy limbs of a child, making a healthy, normal, child into a quadriplegic.
In other words, Appellant contends that there are limits upon the power to consent to surgical procedures, and that the limit should be the power to consent to surgical procedure only for medical purpose.

6. BRIEF IN SUPPORT OF REQUEST FOR REVIEW
POINT I APPELLANT HAS SUFFERED A LOSS OF HIS CONSTITUTIONAL RIGHT OF SAFETY AND PRIVACY The Constitution of the State of California, Article I, Section I, provides: I. Inalienable rights. Section I. All people are by nature free and independent and have inalienable rights. Among these are enjoying and defending life and liberty, acquiring, possession, and protecting property, and pursuing and obtaining safety, happiness, and privacy." This constitutional principle has been implemented in Civil Code Section 43: 43. General personal rights. The right of safety and privacy must necessarily limit the power of parents to consent to surgical procedures which have a medical purpose.

Appellant's individual constitutional right of safety must be paramount to all rights ofparents regarding their children. Parental autonomy is not absolute. The Court of Appeal of the State of California has so ruled. 2

"However, the constitutional guarantees of freedom of religion do not sanction harming another person in the practice ofone's religion, and they do not allow religion to be a legal defense when one harms another." C90mmittee on 13ioethics ..American ..Academy of1Oedicatrics "Pediatrics, " January /988

The Louisiana Court ruled that the surgery could not take place, and that the Court owed "protection to a minor's right

All courts have held that the surgical removal of any normal, healthy, non-diseased, uninjured part of the body is not treatment.
(Conlinued on next page)
1. Opinion of the court of Appeal, page 42

2. In Re Phillip B, 92 Cal.App.3d 796, 801. Cert. Denied as Bothman v. Warren B., 445 U.S. 949.
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The First Circumcision Case (Continued)
to befree in his personfrom bodily intrusion to the extent of the loss of an organ unless such loss be in the best interest of the minor." In re Richardson 284So.2d 185, at page 187.
This, again, is the same rule Appellant asks this Court to Rule. Medical treatment defines the limits of a parents power to consent. Black's Law Dictionary. (Rev. 4th Ed., St. Paul: West Publishing Co. 1951) p. 1673, citing cases. Medical treatment is universally defined as: "A broad term covering all the steps taken to effect a cure of any injury or disease; the word including examination and diagnosis as well as application of remedies. "3 The Little case adopted this very definition, saying: "Even ascribing to the word 'treatment' its broadest definition, it is, nevertheless, limited to the steps taken to effect a cure of an injury or disease ... including examination and diagnosis as well as application of remedies." 4 To be termed "treatment," all courts require that there be a disease, an injury, or an abnormality of some sort which is sought to be corrected. The process of that correction is "treatment. "

Newborn Circumcision: Medical Necessity Or Useless Mutilation?
- Resolution WHEREAS The California Medical Association is looked to by Californians for authoritative medical advice and the responsibility of the CMA is to give the public the most enlightened, factual, evidence-supported modern medical advice available and newborn male circumcision is a procedure without factual, demonstrable, supportable medical indications in the overwhelming majority of cases and newborn male circumcision has many complications rarely communicated to the parents and most medical authorities worldwide feel that newborn males have a right to remain "intact" except in rare instances,

WHEREAS

All courts have held that the surgical removal of any normal, healthy, non-diseased, uninjured part of the body is not "treatment. "
Whether or not the circumcision in Appellant's particular case was or was not "treatment" is an issue for the court to determine after hearing evidence. It was the function of the Court of Appeal to set forth a clear rule defining the limit of the legal power of parents to consent to surgical procedures by setting the limit at medical treatment. The error of the Court of Appeal is that it specifically ruled that a parent has the power "to consent to any surgical procedure, regardless of purpose." Even if there is no medical treatment connected with the purpose of the surgical procedure. Appellant contends that this is not, and should not be, the law of the State of California. That a parent has the legal power to consent only to surgical procedures which have a medical purpose, and that the standard is, and should be: "If it ain't broke, don't fix it." WHEREAS

WHEREAS

WHEREAS

The California Supreme Court denied our Petition for Review. This was done without comment as to why it was denied There is now only one place to go: The United States Supreme Court. The only problem was that there was no money left to pay for the filing fees and the printing of the brief We had come to the end of the line.
3. Black's Law Dictionary, (Rev. 4th Ed., St. Paul: West Publishing Co. 1951) p. 1673, citing cases. 4. Little v Little, supra.

RESOLVED: That the CMA withdraw its 1988 endorsement (305-88) of newborn circumcision as an effective public health measure and state that newborn circumcision is mostly unnecessary and contraindicated, and wherever done be accompanied by a parents' informational brochure or video and an informed consent.

Richard E. Morris is an Attorney-at-Law in private practice, San Diego, California.

Resolution submitted by John W. Hardebeck, M.D. March 4-8, 1989

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JULY/ AUGUST 1989

by James L. Snyder
Mr. Chairman, Delegates and Guests, thank you. My name is James L. Snyder. I am a Fellow of the American College of Surgeons from Virginia and the past President of the Virginia Urologic Society. In 1986, I presented to the Virginia Urologic Society two infants who had been circumcised with disastrous results. One had suffered a degloving injury with loss of all the skin of the penile shaft and required further surgery. The second infant suffered gangrene and necrosis of the entire glans and penis due to electrocautery. I was called as a consultant to see both of these infants within hours of their injuries and can tell you that both of these children will be lifetime genital cripples. As a result of this presentation, the Virginia Urologic Society adopted a unanimous resolution against routine newborn circumcision. Imagine my surprise to learn the the California Medical Association had adopted a resolution endorsing newborn circumcision as a measure to prevent herpes, syphilis, gonorrhea, chancroid and lymphogranuloma venereum. Each of these diseases has a known etiologic agent and as a physician in the United States Navy I have treated circumcised American servicemen for each of these conditions, using specific and effective antibiotics to cure what circumcision did not prevent. Recent speculation that routine newborn circumcision can reduce urinary tract infections or prevent infection due to the A IDS virus stretches reason. Over 95% of male children never have urinary tract infections - regardless of the state of their foreskins. The article on AIDS by Simonsen, et aI., cites the experience of 38 African men who became infected with the AI DS virus after consorting with AIDS-infected prostitutes. Delegates, American parents do not want to hear speculation about 38 African men and their prostitutes. American parents want to know why thousands of their children, brothers, and cousins in Los Angeles, San Francisco, New York, and Miami were not protected from AIDS infections by the fact that 60-90% of them have been circumcised at birth since 1940. Routine newborn circumcision has failed to prevent each of the conditions for which it has been proposed as a cure - even masturbation. If there is any condition that merits consideration it is penile cancer. The proponents of this practice themselves admit to the occurrence of penile cancer even in men circumcised early in life. After almost 25 years of urologic practice, I have seen only four penile cancers de novo. My general surgical colleagues, however, see many more women with breast cancer, a disease equally preventable by minor surgery on unconsenting infant girls. Since my two personal experiences witnessing tragic infant circumcision, I have gathered data which I bring here before you on other tragic results of infant circumcision. In 1982, an Iowa infant bled to death after circumcision.
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In 1983, another Virginia child suffered a degloving with his circumcision, requiring skin grafting. In 1984, a Louisiana child's penis was destroyed by a circumcision and sex-change surgery was advised. In 1985, two children in an Atlanta hospital suffered destruction of their penis at circumcision. One underwent sex-change surgery. In 1986, an Alaska child's infected circumcision led to convulsions and massive brain and kidney damage. Numerous children are cut so short that their sexual functioning is compromised and recently the medical literature and the lay press have reported on significant numbers of adult men who were so displeased with the fact of their circumcisions that they have sought and submitted to plastic surgical reconstruction of their penis. Gentlemen, I bring before you documentation of these facts by photographs, articles from the press and the medical literature, and by the personal testimony of individuals and parents of seriously injured children. The part of the baby that we have been throwing out with the bathwater is the birthright of the child and should not be destroyed by the collusion of physicians and parents. In parting, I would like to paraphrase the words of the Emperor Charles V who viewed the destruction of the Great Mosque of Cordoba and said "What you have done could be done anytime - but what you have destroyed can never be replaced." PRESENTATIO TOTHE CALIFORNIA MEDICAL ASSOCIATIO SCIENTIFIC AND EDUCATIONAL ACTIVITIES COMMITTEE 118TH ANNUAL SESSION AND WESTERN SCIENTIFIC ASSEMBLY ANAHEIM, CALIFORNIA MARCH 4, 1989

Dr.spocft
On Circumcision
"I usel! to ltan towan! routine circumcision. at 6irth. Now that circumcision. is not T'eCOITUtlDUfed to stop
mastwfution ant! now

that the tfteory a60ut cervicaC cancer lias 6een. disproved; there is no excuse for the operation - except as a rellgious rite. So, 1 strollgo/

reconunenl! feaving the j"orfsfdn alOnL"
'.BfJI.'.B'Y MfP CJiIDIJ CMt;£

(1985)

-51-

JULY/A UGUST 1989

DEClARATioN Of TItE FiRST INTERNATioNAl SyMposiuM ON CiRCUMCisioN
We recognize the inherent right of all human beings to an intact body. Without religious or racial prejudice, we affirm this basic human right. We recognize the foreskin, clitoris and labia are normal, functional body parts. Parents and/ or guardians do not have the right to consent to the surgical removal or modification oftheir children's normal genitalia. Physicians and other health-care providers have a responsibility to refuse to remove or mutilate normal body parts. The only persons who may consent to medically unnecessary procedures upon themselves are the individuals who have reached the age of consent (adulthood), and then only after being fully informed about the risks and benefits of the procedure. We categorically state that circumcision has unrecognized victims. In view of the serious physical and psychological consequences that we have witnessed in victims of circumcision, we hereby oppose the performance of a single additional unnecessary foreskin, clitoral, or labial amputation procedure. We oppose any further studies which involve the performance of the circumcision procedure upon unconsenting minors. We support any further studies which involve identification of the effects of circumcision. Physicians and other health-care providers do have a responsibility to teach hygiene and the care of normal body parts and explain their normal anatomical and physiological development and function throughout life. We place the medical community on notice that it is being held accountable for misconstruing the scientific database available on human circumcision in the world today. Physicians who practice routine circumcisions are violating the first maxim of medical practice, "PRIMUM NON NOCERE," "First, Do No Harm," and anyone practicing genital mutilation is violating Article V of the United Nations Universal Declaration of Human Rights: "NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL, INHUMAN OR DEGRADING TREATMENT ... "
Adopted by the General Assembly

C9i1fcumcision Vlightma1fe

June 25, 1989 Dear Jim: It's so hard for me to put my thoughts down, just tell your readers the truth. Our son will grow to be a man in a wheelchair, he is blind, he may never speak, he may never say "Mommy, Daddy," or "I love you." Sincerely, Parents of "John Doe"

In a lawsuit filed in the Superior Court for the State of Alaska, August 28, 1987, parents claim that circumcision constitutes an assault and battery upon their son's body. Allegedly, the baby's wound became infected by bacteria while he was in the hospital. He was returned to the hospital for treatment of the acute infection, developed toxic shock, which led to seizures, and was improperly treated. By virtue of the medical negligence and delay in proper treatment, the suit claims the baby sustained profound brain damage, retardation, palsy, lack of brain growth, damage to his vision and other related damages. To add to the horror of the story, the boy was born with a condition that requires circumcision not be done. The parents say the boy would not have been circumcised had they been told that the surgery is not necessary, causes pain, and has risks.

First International Symposium on Circumcision
March 1-3, 1989, Anaheim, California
THE TRUTH SEEKER

From: NOCIRC NEWSLETTER, Fall 1988 Vol. 3, No. I, page 2
-52JULY/AUGUST 1989

UNivERSAl DEClARATioN ON CiRCUMCisioN, ExcisioN ANd INCisioN
WHEREAS, the Geneneral Assembly of the United Nations on December 10, 1948 adopted and proclaimed the UNIVERSAL DECLARATION OF HUMAN RIGHTS; and WHEREAS, said Declaration affirmed to "strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance ... ;" and WHEREAS, Article 2 of said Declaration affirms that "Everyone is entitled to all the rights and freedoms set forth in this Declaration without distinction of any kind, such as race, colour, sex, language, religion, politicaJ or other opinion, national or social origin, property, birth or other status;" and WHEREAS, Article 5 of said Declaration affirms that: "NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT;" and WHEREAS, the practice of medically unnecessary surgical circumcisions, excisions and incisions on male and female genitalia that are conducted: a) without anesthesia, inflicts incalculable pain and human suffering, constitutes an act of TOR TU R E within the terms of Article 5 of the Universal Declaration of Human Rights; and b) with anesthesia, constitutes an "act of cruel, inhuman and degrading treatment" within the terms of Article 5 of the Universal Declaration of Human Rights; and WHEREAS, other forms of male and female genital mutilation that are conducted as a matter of social and religious custom, e.g. as in "ritual rites of passage," constitute acts of "TORTURE (A D) CRUEL, I HU MAN OR DEGRADI G TREATMENT OR PUNISHMENT" within the language and intent of Article5 of the United Nations Universal Dec/aration of Human Rights; and WHEREAS, the above violations of Articles 2 and 5 of the Universal Dec/aration of Human Rightsfrequel1l/l' involves helpless newborns and adolescents - religious and social customs notwithstanding;

litE FiRST INTERNATiONAl SyMposiUM ON CiRCUMcisiON:
a) Calls upon all persons and institutions to engage in "progressive measures" to end the practice of torture, cruelty, inhuman and degrading treatment that is inherent in circumcisions and other forms of male and female genital mutilation that are conducted as a matter of social-cultural and religious custom and which are defacto violations of Articles 2 and 5 of the United Nations Universal Dec/oration of Human Rights; and b) Calls upon all humane nations to pass legislation prohibiting the practice of torture, cruelty, inhuman and degrading treatment that is inherent in circumcisions and other forms of male and female genital mutilation that are conducted as a matter of social-cultural and religious custom which are de facto violations of Articles 2 and 5 of the United Nations Universal Dec/oration of Human Rights; and c) Calls upon all humane nations to petition the INTERNATIONAL COURT OF THE HAGUE to formally render an advisory opinion and judgment that the practice of medically unnecessary surgical circumcisions, with or without anesthesia; and other forms of male and female genital mutilation that are conducted as a matter of social-cultural and religious custom, e.g. in "ritual rites of passage" constitute defacto acts of violation of Article 5 of the United Nations Universal Declaration of Human Rights which specifically states: "NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT."

Submitted to the General Assembly, The First International Symposium on Circumcision, March 1-3, 1989, Anaheim, California by James W. Prescott, Ph.D. which was passed unanimously. The substance of the above resolution was also passed unanimously at the 1988 Annual Meeting of The Humanist Fellowhsip of San Diego.

I,
Signature

(name) support the Universal Declaration on Circumcision, Excision and Incision.
_ Date _

THE TRUTH SEEKER

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JULY/AUGUST 1989

/

ft AN ACT To PRoltibiT GENiTAl MUTilATioNS ~
Preamble
The Legislature of the State of , having reviewed the expert evidence on the medical and nonmedical claims for justifications of male and female genital mutilations of infants and children; and recognizing that genital mutilation of female children is being increasingly practiced in this country by certain religious and ethnic groups; and noting the extraordinary pain and suffering inflicted upon these infants and children who are subjected to ritualistic genital mutilations (circumcision, excision, incision, and infibulation) which produce long-term psychological and psychosexual trauma and dysfunction; and recognizing that genital mutilations of male and female children constitute a defacto violation of Article Vofthe United Nations Universal Declaration of Human Rights which states: "NO ONE SHALL BE SUBJECTED TO TORTURE OR TO CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT,"

Hereby enacts the following legislation:

''A II genital mutilations of male andfemale infants and children are expressly prohibited except for medical necessity that involves clearly demonstratedpathology which requires surgery for correction and unanimously affirmed, as such, by a committee ofthree physicians who shall represent expertise in the medical disciplines of urology, gynecology, and pediatrics.
Violation of this provision is a felony punishable by imprisonment not to exceed three years and a fine of $100,000 that will be placed in trust for the benefit of the mutilated infant or child In addition, the infant/child who is violatedunder this statute will have the right ofrecovery of civil damages for tort until the age of majority plus the statute of limitations. "

I,

, petition the Legislature of the

State of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , to enact the above human rights legislation.

Signature Address

_

Date

This petition is sponsored by the National League for Separation of Church and State, P.O. Box 2832, San Diego, CA 92122-2832, and by the National Organization of Circumcision Information Resource Centers (NOCIRC), P.O. Box 2512, San Anselmo, CA 94960. Please send signed petition to NOCIRC for forwarding to the appropriate state legislature. Your support of this project is requested through your membership in the National League for Separation of Church and State. Annual dues are $25 which includes a subscription to The Truth Seeker.

THE TRUTH SEEKER

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JULY/AUGUST 1989

Contin ued from last issue.
Book of Reason For the Man of Vision

Serialization of Superior Men

Superior Men
by James Hervey Johnson
Publish ed By James Hervey Johnson , San Diego 1949

Chapter III (Continued)

The Probable Origin of Religious Festivals
There is little doubt that the origin of the folk stories of spirits and fairies develop ed from the phospho rescent lights of the swamps and fens, from the lightnin g bugs, fireflies, the phospho rescent minute sea life, and. from the pho~phorescent fungus in the forest. The strange lIghts, the ongIn of which was unknow n to man for centurie s must have filled him with a feeling of fear and forbodin g. Some of the Irish, and Scandin avian stories of fairies and spirits can be traced to such origin. Thus, it is understa ndable how religion evolved and develop ed from these simple but mysteno us natural phenom ena, and, as is explaine d in another c?apter, these imagina tions and ideas, once started, were dIfficult to stop. Primitiv e man feared to express any doubt as to the power of any of these spirits or gods or devils. At times beinginv isible, they might know what he was thinking about or talkIng about and might harm him. Today the more primitiv e tribes of the South Seas, Africa North and South America , and India, carry a great many kinds of amulets , tokens, stones, chains, ~eads, and a~l manner of such things to protect them from the ImagIned evIl influenc e of the spirits of the stones and trees, animals and even other human beings. Many soldiers, fliers, and others also carry these tokens of good luck as a protecti on against possible evil happeni ngs. And many of them belIeve. In It. One craftily devout compan y went so far as to advertis e a steel covered Bible to be worn over the heart, probabl y recogmzIng that the bullet-p roof steel would offer more protecti on than the Holy Word. The average man has never made a scientific study of the success of those who wore the charms and amulets as compared to those who did not. As a matter of fact, for the most part natural things, such as the trees and stones and rivers and seas and strange lights never injured the average man and so it was easy for him to believe, especially when he was so told, that these charms protecte d him. Even lightnin g struck only occaSIOnally a~d struck a person very rarely, and thus it was easy to explaIn that that individu al had done somethi ng wrong. Most everybody has commit ted a sin of some kind and so disease and acciden tal natural disaster s could be explaine d by the pnmltive witch-d octor, the priest or the religious leader as the result of some transgre ssion by the individu al. So by these simple steps evident and obvious ~o the simple minds of early and uncultur ed men, more comphc ated customs , practice s, and religious systems graduall y grew through the ages to those of the present day.

Chapter IV

Dreams, Nightmares, VISIO NS
Once I dreamed of elephan ts fighting over me. Primitiv e man, living in the midst of wild animals , probabl y had very
THE TRUTH SEEKER

vivid nightma res of near death and attempt s to escape from wild and horrid animals . Probabl y he saw lizards and reptiles which impress ed and greatly scared him. Probabl y real escapes in daytime were horribly exagger ated and repeated at night in his dreams. It is natural for primitiv e man to believe that the souls or spirits of the animals were after him. Hence the efforts of primitiv e man to appease the spirits of reptiles and other animals . The Hindus fear to kill the monkey s, the cobras and tigers for fear the spirits of these offensive, destruct ive and dangero us beasts will cause them death and injury. Hence the depreda tions of the vast multitud e of animals which are not extermi nated in India grows to great heights. Witch doctors were swift to prey upon the imagina tion of their weaker minded fellow men. They talked of their own gods, manufac tured from their own dreams, nightma res and visions. It was only a step to the manufa cture of horrible looking devils and gods, often half men and half beast. Even the Christia n devil has horns and tail. The primitiv e races in China, Tibet, Japan, I ndia and the savages of Africa, the South Seas and the Indians of the America s and totems, tiger and animal gods, devIls, are probabl y outgrow th of nightma res, visions, dreams and imagina tion. The savage primitiv e and medieva l rites of many religions practice d today, accentu ate the worship of all of these fetishes, gods, devils and images. The dancing around them, the sacrifice, the night rituals, the music, the tomtom 's repetitions all served to impress the images of the spirit - devil gods in the minds of the people and as they had little else to think about they would dream and have VISIOns of these things and that would serve to make them believe still more the claims of the priests and witch doctors. The great ritual and impress ive ceremon ies of the Catholic Church cannot help but impress childish minds and weak minds. Hence it is very reasona ble to attribut e the visions of Saints, the Virgin Mary, and Christ to the dreams and nightma res of those who have been subjecte d to the influence of these rituals and ceremon ies. This probabl y explains the many so-calle d visitatio ns whic~ appear from time to time in the press where chIldren or pnests or Simple minded people are visited by saints and gods with messages which are claimed to verge on the miraculo us. From time to time I dream of my father, who was my partner and close associat e all my life until his death. Sometim es the dreams are very vivid and I dream that I am discussi ng various matters with him as I did when he was alive. The dreams of ignoran t people may seem to them to be meeting s with those in the spirit world. Knowin g that their friends and relatives are dead, it is easy for ignoran t or insane or eccentri c (off-cen ter emotion ally or mentally ) people to believe that they are talking to the souls of the dead. (This serialicalion olthe Superior Men \I'ill he cul1linued in our next issue.)
JULY/A UGUST 1989

-55-

Resources
BOOKS:
Anne Briggs (1985), Circumcision: What Every Parent Should Know. Virginia, Birth & Parenting Publications. Lightfoot-Klein, Hanny (1989), Prisoners of Ritual, An Odyssey Into Female Genital Mutilation In Africa, The Haworth Press, Inc., New York. Paige, K.E. and Paige, J.M. (1981), The Politics of Reproductive Ritual. University of California Press, Berkeley. Romberg, Rosemary (1985), Circumcision: The Painful Dilemma, Bergin & Garvey Publishers, Inc., Massachusetts, (out of print). Wallerstein, Edward (1980),Circumcision: An American Health Fallacy, Springer Publishing Co., New York.

HumanisticJudaism, Becoming Parents. Society for Humanistic Judaism, Michigan, Summer 1988.

VIDEOTAPES:
A Matter ofChoice. Orion Express, 39 Marie Street, Sausalito, CA 94965, 415/332-8489. Newborn Circumcision. Foresight Productions, 1302 Oakland Avenue, Durham, NC 27705, 919/286-2793. NOCIRC Conference Tape. P.O. Box 2512, San Anselmo, CA 94960, 415/488-9883. The Circumcision Questions. Perennial Education, Inc. 930 Pitner, Evanston, IL 60202, 1-800-323-9084. The First International Symposium on Circumcision. Promo Video, 2240 Morely Street, #7, San Diego 92111.

PAMPHLETS:
Paige, K. E. (1978), The Ritual of Circumcision, Human Nature May 1987,40-48. Wallerstein, Edward (1986), Circumcision: Information, Misinformation, Disinformation, NOC/RC, 1986, California. Wallerstein, Edward (1985), Circumcision: The Uniquely American Medical Enigma, The Pennypress, Washington. Wallerstein, Edward (1980), The Circumcision Decision, The Pennypress, Washington. Wallerstein, Edward (1982), When Your Baby Boy is Not Circumcised. The Pennypress, Washington. Circumcision. Mothering Special Edition. Mothering 1988, New Mexico. Circumcision Why? NOC/RC 1986, California. (Available in Spanish.)

AUDIOTAPES:
The First International Symposium on Circumcision, Master Duplicators, 11042 Bettes Place, Garden Grove, CA 92640, 714/530-1838.

NEWSLETTERS:
NOCIRC Newsletter, P.O. Box 2512, San Anselmo, CA 94960. WIN Women's International Network News, Fran Hosken, Editor, 187 Grant Street, Lexington, MA 02173.

DO YOU KNOW THE TRUTH - ABOUT AMERICAN CHILDREN?
DO YOU KNOW that in 1980 the United States ranked #6 in infant mortality rate among the advanced industrialized nations of the world; and this ranking deteriorated to #18 by 1988? In other words more infants under one year of age DIED in the U.S. than in 17 other countries of the world! DO YOU KNOW that since 1980 the leading cause of injury death for American Infants under one year of age is homicide? DO YOU KNOW that suicide among American Children ages 10-14 rose 112% from 1980 to 1985? DO YOU KNOW that the National Institute of Child Health and Human Development, NIH has abandoned its agency responsibility to support studies on the causes and consequences of violence against infants and children and has supported no new research on child abuse and neglect and the developmental origins of violence since 1980? DO YOU KNOW that Surgeon General C. Everett Koop, M.D. stated in his address on "Violence and Public Health" before the A merican A cademy ofPediatrics (October 26, 1982) that: "... violence... is one of the most extensive and chronic epidemics in the public health of this country"; and that the Institutions closest to being able to provide a multi-disciplinary approach to research in the prevention of family violence, for example, would be the National Institute of Mental Health and the National Institute of Child Health and Human Development?"
(Corrected Copy - The Truth Seeker - Vol. I, No.2)
THE TRUTH SEEKER

II
" /I

HELPl
-56JULY/AUGUST /989

PRISONERS OF RITUAL
An Odyssey Into Female Genital Circumcision in Africa
• "Thi. i. an illuminative book ... It i" abo an illustriou.sly fair. minded book. Among writing. on genital mutilalion., therefore, it i, unique in giving the reader a 360 degree underaJanding of the .ocial and peraonal.igni/icance of,uch prcretice•. It Jell, the truth and the truth i. devastating. For .mall gir", it i. catastrophically traumatizing. Yet, becau,e the book doe. not .enllationalize, wrath doe. not override compollSion, and the gateway to change i, unlocked and kepi open. In addition to being a contribution to the .cholar.hip of anthropological .exolog" Prisoners of Ritual i, an adventure .toryan extroordinory mid/ife odyney of a .010 woman', de,erl 'walkaboul'through the spaces and the mind, of Nilotic Africa. There', nothing el.e quite like itt"
John Mlrley, PhD, Dore<:lOO' Psychohofmonal Resea.-cn UM. prores<OO' 01 Medoc.aI Psychology. and proresso<01 PlKlIalflCS,Eme-<llUs. TneJonnsHopklnsUnvefSlrySchoololtAlKhClne,
Tlle...lohm;HopIunIHo$p"al.~!ImOfe.Maryland

PRl5DNt'RS

QFRITUAL

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~

ABOUT THE AUTHOR
Hanny ligntloot·Klein studied the tOPiC ollemale genital circumcision during a six· year trek through Sudan, Kenya, and Egypt, during which time she lived with African families. An educator and family counselor, she is the author of numerous articles on the subjec1 of temale genital circumcision that have been published in scien:ilic and popular publications in England,the United Slales, Germany, Denmark, Norway, and Sweden. She is a member 01 the Sociely for the Scientific Study 01 Sex and the Association for Women in Psychology. Ms. Lightfoot·Klein received her MA in social psychology Irom the American University in Washington, DC.

~ ~------11"I
~

.

An Odyssey into Female Genital Circumcision in Africa

.... ....
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Harrington Park Press , ,
10 Alice Street. Binghamton, NY 13904·1580

ISBN 0-918393-68-X

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put the matter ofabortion into clear perspective. "
H •••

Abortion Rights and Fetal 'Personhood'
Edited by Edd Doerr & James W. Prescott
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1989

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