Medical Myths

Shaw’s attack on doctors who performed useless operations by removing the ‘Nuciform Sac’ may have had its origin in a contemporary vogue procedure for removal of the uvula, the dangly thing at the back of the palate. At least one surgeon seems to have made a very good living from this ‘ideal operation’, and was able to purchase a country estate, and live the life of a gentleman.

Such an ideal operation needed to be easy to perform, have no obvious side-effects, and be generally safe. It didn’t matter so much that patients derived any actual benefit from it, as long as they believed that they had. And they had to believe in the ability of their surgeon; and the more experience the surgeon had of the efficacy of his procedure, the more his patients could believe in him and it; a virtuous vicious circle.

Today’s gold standard is the ‘randomised double-blind trial’, in which neither the doctor nor the patient know what treatment has been given. It’s harder to do this for surgical procedures; there was a trial of gastric cooling as a treatment for bleeding from the stomach, and this showed that it didn’t work. A trial of arthroscopy of the knee showed, even if the arthroscopy hadn’t actually been done, that it was just as effective as real interventions. This (apparent) improvement is called the placebo effect — crudely put, just by doing something, a significant benefit can be expected. The placebo effect made it hard to determine whether the patient was really any better off. And of course, before the full extent of the placebo effect was known, pretty well any operation could be expected to bring improvement. So it’s no surprise that 19^th century operations were mostly successful; and remember, that at that time, there were practically no pills with any real benefit. If you had a problem, the only way it could be properly fixed was by having an operation.

The sexual mores of the 18^th century seem to have resembled todays; but gradually attitudes ‘hardened’, and medical opinion (at least in the UK) was conflated with religious orthodoxy. Several diseases, previously unrecognised, were described: spermatorrhoea, masturbation¹ and redundancy of the prepuce or foreskin². None of these are diseases, but they all exercised the mind of the Victorian medical man — there were no medical women in those days. The consequences of masturbation were legion, including debility, blindness, insanity, pimples, impotence, pain in the hand (!), you name it, and ultimately death.  Fortunately, a simple remedy for all three was available: circumcision, which was also advised for epilepsy.

The logical basis for advocating circumcision seems, at least in part, to have come from the Jewish practice, whereby newborn males are ritually circumcised by the mohel on the eighth day — in a reference back to the time of Abraham and sacrifice. Since Jewish boys apparently did not suffer from the fearsome effects of these (non-existent) diseases, clearly it was simply because they were circumcised. A similar logic recognised the benefits in the followers of the Prophet.

To all of this, there was the rise of ‘hygiene’ and the recognition of the ‘filth’ that lay under the foreskin; and this ‘filth’ naturally produced ‘irritation’, and irritation clearly caused masturbation. And, as Jews had a lower rate of syphilis than Gentiles, clearly removal of the foreskin could act as a preventative.

From roughly mid-Victorian times to the second World War, circumcision was heavily promoted. And, if not done soon after birth — without anaesthetic, as clearly ‘infants did not feel pain’³, then when symptoms (of masturbation) became apparent. Doing the procedure without anaesthetic was felt to provide a salutary lesson.

A simple, safe operation? Not exactly; in 1940, sixteen boys died directly after circumcision; the numbers who suffered significant physical side effects before then is unknown.

And don’t think that any side-effects were purely physical. These men were all circumcised: AE Housman, John Maynard Keynes and his brother Geoffrey, Tom Driberg, WH Auden and Alan Turing. All of them resented having had it done, forced on them. You might like to reconsider some of what they said and wrote in this light.

1. Onanism was invented in 1710 as an advertising device to sell patent medicine, was reinforced half a century later in an influential text, and became an English epidemic early in the 19^th century. 

2. I was dismayed to find that one of my surgical textbooks still clung to the concept of ‘redundancy of the foreskin’.

3. Likewise, another textbook suggested that circumcision could be done in infants without anaesthesia.