In 1949, Douglas Gairdner, a pediatrician in Cambridge, England, published “Fate of the Foreskin: A Study of Circumcision,” hereafter, “Fate of the Foreskin,” in the British Medical Journal. In the article, Gairdner highlights what he saw as a seriously understudied topic, the natural development of the foreskin in males. Although physicians were then circumcising tens of thousands of male infants annually in England, data on the normal anatomy and function of the foreskin were scarce. In “Fate of the Foreskin,” Gairdner assembles those data and uses them to argue against performing circumcision to treat conditions like phimosis. Phimosis is when the foreskin tightly encases the glans, or head, of the penis and cannot retract. Gairdner finds that an unretractable foreskin is actually the normal state for newborn males, and that the foreskin will become retractable on its own over a period of months to years. By showing that phimosis is not a pathological condition, “Fate of the Foreskin” questioned the legitimacy of routine circumcision, and ultimately led to a steep decline of the practice in England.

In 1870, Lewis Albert Sayre, an orthopedic surgeon, published “Partial Paralysis from Reflex Irritation, Caused by Congenital Phimosis and Adherent Prepuce,” hereafter “Partial Paralysis,” in the journal Transactions of the American Medical Association. In the article, Sayre describes using circumcision, or surgical removal of the prepuce, or foreskin, of the penis, to treat muscle paralysis in several young male patients. While circumcision has a long history as a religious and cultural practice, “Partial Paralysis” was one of the first articles to articulate a medical reason for performing circumcision. Sayre reports that each of his patients were experiencing muscle paralysis or hip joint pain and also had phimosis, a condition in which the foreskin tightly encases head of the penis, or adherent prepuce, a condition in which the foreskin fuses to the head of the penis. Suspecting a connection between the conditions, Sayre circumcised each patient and concluded that circumcision cured the boys’ medical problems. While doctors no longer use circumcision to treat muscle paralysis or hip pain, the medical justification for circumcision that Sayre articulates in “Partial Paralysis” helped to popularize its use among physicians at the end of the nineteenth century in the US.