| Book Review | Health and History, 8.2

Book Review

A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. By Robert Darby (University of Chicago Press, Chicago, 2005, ISBN 0-226-13645). 374 pp + Index.Index.

This is a serious book about the penis, the foreskin, and circumcision. Darby's central thesis is that during the nineteenth century the penis came to be associated with depravity and moral decay which in turn allowed the medical profession to promote circumcision as a legitimate medical intervention aimed at prevention of a sundry of conditions imagined and real.

Darby acknowledges that this study is flawed by lack of access to original documents in the United Kingdom. Darby's introductory chapter gives an excellent overview and provides the reader with his position on the topic. In setting out his thesis he relies heavily on contemporary scholars such as Geoffrey Miller and David Gollaher who have both written extensively on circumcision.blic.'

Darby uses Miller's description of physicians as norm entrepreneurs who demonised the phallus as 'polluted, unnatural, harmful, alien, effeminized and disfigured' (p. 4) as evidence of their role in circumcision. But Miller's essay, Circumcision: A Cultural-Legal Analysis, examined the legal and cultural meaning of circumcision in the United States at the end of the nineteenth century using a multifactorial approach to explain its popularity. The doctors were just one factor among many.

Gollaher like Miller also recognised the many factors at play in the rise of circumcision, not least that doctors and quacks in the nineteenth century were subject to cultural pressures and were not detached scientific observers but professionals who provided a service for a fee. While Darby says this is revealing he does not spend too much time examining the multiple factors other than the role of physicians that may have led to the rise of circumcision in nineteenth-century Britain. His obsession in this book is proving that the medical profession made circumcision a routine and popular procedure which until then 'was scarcely known in the Western world' (p. 4).

Darby introduces the reader to detailed historical events associated with male sexuality. He also reacquaints us with Victorian medical conditions such as congenital phimosis, spermatorrhea, and nerve force theory, terms long forgotten. This is a fascinating read with arguments well supported by appropriate referencing.

The main distraction is Darby's strong negative views about the medical profession. I thought this unnecessary given his very detailed and rigorous examination of the topic. Part of Darby's thesis is that during the nineteenth century the medical profession believed circumcision was a cure for certain diseases as well as a method for controlling sexual desires. His detailed account of nineteenth century doctors' take on morality and sexuality is persuasive and leaves me thinking that doctors then viewed the genitals differently from other parts of the human anatomy. But we know many areas of medicine that, looking back, seem absurd, callous, or negligent. Up to and including the nineteenth century, doctors believed in bleeding patients and themselves. We now know that bleeding caused illness and made conditions worse. Their practices are a reminder of the fallibility of the medical profession but we do not think worse of the profession for their use of bleeding.

I cannot help thinking Darby has not been able to separate his views about the power of the medical profession today from their position in nineteenth-century Britain. Nineteenth-century doctors were beginning to gain status but for many their incomes and reputations depended on patronage. Further, they were of the growing and diverse middle class and their views would have been as varied as their educational backgrounds. There are today medical procedures for which there is no evidence; history has shown that medicine is and will be error ridden. Darby did convince me that doctors played a role in the rise of circumcision but I am sure other social, economic, and political factors also played significant parts.

MERRILYN WALTON

UNIVERSITY OF SYDNEY

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