masturbation is a cause of epilepsy is doubted. But there ean bernno doubt of its injurious effect. . .. Circumcision should alwaysrnbe practiced. It may be necessary to make the genital so sore byrnblistering fluids that pain results from attempts to rub thernpart.”rnIt requires education to see the world through disease-coloredrnglasses. Thus, members of the upper classes are the mostrnardent consumers of medical fables, while members of the lowerrnclasses tend to be skeptical of health information, both validrnand invalid. The role of medical misinformation is humorouslyrnmocked in Knock, a 1920’s masterpiece by Jules Romains thatrnis all but forgotten today. Dr. Knock explains his views as follows:rn”Get sick” is an old idea. It can’t stand up to modern science.rn”Health” is a word which we could just as wellrnerase from our vocabularies. For me there are only peoplernmore or less sick of more or less numerous diseasesrnprogressing at a more or less rapid rate…. A profoundlyrnmodern theory, M. Mosquet. If you think it over, you’llrnbe struck by its relation to the admirable concept of thernnation in arms, a concept from which our modern statesrnderive their strength.rnThis parody has become our social reality. We conceptualizernevery problem in living—from the misbehavior of youth tornthe melancholia of the elderiy—as a disease. Given this mindset,rnit is not surprising that circumcision became medicalizedrnand that RNC proved to be especially popular in the UnitedrnStates. About the same time (in the 1950’s) that the BritishrnNational Health Service stopped paying for RNC, Americanrnthird-party payers, including welfare programs, began to reimbursernthe procedure and circumcision became the Americanrnstandard. By 1993, the rate of circumcision dropped tornbetween five and six percent in Britain, and stood at 80 to 90rnpercent in the United States. Despite this, the incidence ofrnthe cancer of the penis is higher in the United States than inrnDenmark and Japan, “where circumcision is done only for clearrnmedical indications.”rnWhy is RNC legal? Because it is defined as preventivernmedicine. Why is it defined as preventive medicine?rnTo avoid having to ban it as male genital mutilation. This reciprocalrnrelationship between language and law is intrinsic tornour concept of legality. Whether a particular act is legal or illegalrndepends on what we call it. Killing in the name of “self-defense”rnis legal; “murder” is a crime. We call the removal of thernforeskin of the male newborn “routine neonatal circumcision,”rnand the removal of parts of the female genitalia “female genitalrnmutilation” (FGM). Language thus prejudges the legitimacyrn(or illegitimacy) of the practice.rnAlthough female circumcision is not the subject of this essay,rnand although it is an anatomically far more serious mutilationrnthan RNC, I wish to add two brief remarks. First, becausernFGM is banned in many Western countries and is not an acceptedrnmedical procedure in the United States, RNC at homernis a more important civil rights issue than FGM is abroad.rnSecond, although most Americans refuse to compare the twornprocedures, the similarities are obvious (and apparent to Europeans):rnboth interventions alter the normal anatomy of therngenital organs, and the people who practice them attributernhealth benefits to both (Americans to male circumcision.rnAfricans to female circumcision).rnNeither the risk of cancer of the penis nor the risk of otherrnproblems associated with the male urogenital organ justifiesrnroutine circumcision. Cancer of the penis is a rare conditionrnthat occurs only in middle age or later, affording young malesrnwho fear developing the disease time to submit to prophylacticrncircumcision. Other pathological conditions associated withrnthe uncircumcised penis, such as phimosis severe enough to interferernwith urination and urinary tract infections, are indicationsrnfor treating the affected children, not for RNC.rnVirtually all medical texts atrnthe end of the 19th centuryrnand the beginning of the 20thrnprescribed circumcisionrnfor a variety of ills.rnIt requires more credulity than befits us to believe the absurdrnpremise on which the practice of RNC ultimately rests, namely,rnthat the only mammal in creation born in a condition thatrnrequires immediate surgical correction is the human male. Accordingly,rnit is not enough for physicians to conclude, as doesrnthe author of a comment in the prestigious New England ]ournalrnof Medicine, that “The benefits [of circumcision] appear tornbe uncertain. It, therefore, seems prudent to consider neonatalrncircumcision a procedure to be performed at the discretion ofrnparents, not as a part of routine medical care. Omitting circumcisionrnin the neonatal period should not be consideredrnmedical neglect. Parents should be informed of the currentrnstate of medical knowledge regarding the risks and benefits ofrnthe procedure. Their ultimate decision may hinge on nonmedicalrnconsiderations.” (Emphasis added.)rnIf the parents’ ultimate decision to circumcise their male infantrnhinges on nonmedical considerations, then RNC is a medicallyrnunjustifiable practice. It is relevant to note that observantrnJewish parents still employ mohels to circumcise their male infants,rna practice the American Medical Association explicitlyrnendorses.rnIf RNC is medically unjustifiable, does it constitute a form ofrnchild abuse? Persons unbound by Jewish and Islamic religiousrnrules might reach that conclusion. Should it be illegal? Thereinrnlies our ethical dilemma. We must balance the (relativelyrnsmall) harm RNC does to the individual against the (potentiallyrnvast) harm that strengthening the state at the expense of thernfamily does to everyone. Because the family remains our mostrnsecure shield against the encroachments of the therapeuticrnstate, the dilemma calls for compromise. Preventing RNG doesrnnot warrant enlisting the coercive apparatus of the state againstrnthe religious values of parents. It does warrant, however, enlistingrnthe persuasive powers of physicians—and the media—rnin the task of informing parents of newborn males about thernmedically dubious and morally problematic nature of thisrnostensibly hygienic procedure. trn20/CHRONlCLESrnrnrn