Circumcision
From Professor H. C. McLaren ,children are not circumcised may I Sir: Lest readers of Dr John Ling' later's article are worried if the reassure them. 1 Cancer of the male penis is verY rare indeed. 2 Having read all the available literature I feel confident that there iS valid evidence that male circa'', cision prevents cancer of the neck 01 the womb. 3 As Dr Linklater states, however. cancerof the cervix is almost unknoWn in the virgin whereas the appearance, of pre cancer detected by a 'smear-test is common at a young age in wothe„11 who commence to have coitus at a" early age (fourteen or fifteen). Wi,t,11 the present so-called permissive at'ltude to coitus in all grades of society may be as Dr Linklater says that in the, 1980s there may be more cervical cancer afflicting women in their OW' ties or even in their twenties. 4 Cancer of the cervix is a dreadfa,! form of cancer affecting about 5.0" women in these islands each year' Despite all our efforts to encourage, women to report any kind of unusual bleeding, despite surgery an.' radiotherapy the cure rate overall Is about 50 per cent. 5 Prevention: As Dr Linklater. states promiscuity is a factor in causing cancer and pre cancer and now that our women folk are expected to tate the pill the men may be content at tnisi arrangement with the disappearance °, the cOndom, itself a prophylactic 0,1 gonorrhoea and possibly for viro' ' transmission, another 'suspect' in the cause of fenale cervical cancer. 6 Cytology: Dr Linklater mentions the British Smear Campaign aimed at detecting pre cancer in healthY women. Some one and a half million tests are done in England and Wale5 each year. Alas, there are seventeetd million tests to be done so that u h the value of this test is advertised W,.it'; the same skill as industry uses chocolates or beer the impact of the test on British cervical cancer is sniall' fi To Mrs Birmingham or Mrs Newcastle however, the test taken every Olvt,) 9 years will prevent her from gettin,;, cancer of the cervix. Moreover if ti does produce malignant cells or) hei fr smear she will be cured by a snla', ti operation which allows furthe'
children if desired. ol)
In Leviticus XV, 19 Moses with oh g knowledge of ovulation time Wit" great skill arranged for Jewesses t°,1(1 allow intercourse at the time °:4I maximum fertility "She shall be 1341,,'1 apart for 7 days" i.e. after the cessatio' LI of menstruation. His motive for cil, re cumcision however is not clear. It is myth that this quite serious operation opectator May 18, 1974 improves" sexual relations or prevents cervical cancer.
Hugh Cameron McLaren ePartment of Obstetrics and Ynaecology, Birmingham Maternity Hospital, Birmingham. prom Dr J. Miller Sir: John Linklater's line of argumentation (Forewarned or Foreskinned — 145Y 4, 1974) is difficult to follow. The prrPose of the article as stated in the ei,st paragraph and elaborated in the 'ollowing two is "to review ritual circumcision." But in the final paragraph ;_ve find the conclusion that "the ualance of medical and psychological advantages lies in favour of routine circumcision." By mixing puppies' tails, !radition, scripture, and medicine, Dr Linklater seems to be discussing ritual and routine circumcision as though theY were the same which they are not.
Ritual circumcision (Bris Milah) is !'ased on scripture and its importance !! Jewish Law is neither increased or 'eel-eased by any sort of medical arthment. There is no hint in scripture at circumcision is just so much Tedicine and consequently a Jewish dris is performed by a mohel (not by a °ctor) as a part of a religious cerernony. The defence of ritual cirtUtricision should it be necessary (as it uas been under anti-semitic regimes) is rPrpPerly found in the principle of eVgious freedom and freedom of ,nice not in medicine.
uut Dr Linklater's conclusion concerns fa routine circumcision. The f°urable conclusion appears to onoW because the case against routine `eircumcision and the case for the rrePuce are not stated. As a summary of current pro-routine circumcision arguments, the article is quite correct. t, There exists, however, a conservai sve medical reply (conservative in the tterise of tending to conserve and avoid !•rail IlnecessarY surgery) to each of these
• •
e cations. Plumes's, paraphimosis, Vid balanitis can be treated therapeu,cally instead of prophylactically. • ncer of the penis (which is not ,`mon) can be lessened by proper 'fl'rePutial hygiene. The assertion that `Ircumcision results in a delayed orsgasM is a theory that lacks empirical itIPPort (Cf. Masters and Johnson, r 4,?nan Sexual Response). Finally the tiellation of circumcision to cancer of itle cervix is not proved. Contradictory vestigations on this point abound. silk case against routine circumcision II's° exists. Circumcision itself can eca.ve complications. Its immediate tiornplications can be bleeding, infeceon, and damage to the glans. Remote strnPlications include meatal uker and s ,of °sIs. There is also a case in favour th the foreskin. The argument is that es prepuce has a protective function re,Pecially in neo-nates and that it friuuces the danger of injury from It u.„ction, and various irritants. Granted, y' ▪ complications of circumcision are Irequent and the protective func4 of the foreskin is not essential. e2Ile conclusion is therefore: (1) Cir411ci5ion may prevent or lessen the
Of some diseases, (2) Circumcision
lead to complications, (3) Possescn Of a foreskin may lead to Le ,„ fr;rnPlications, (4) Possession of a
' i'reskin may protect from some in
k) qtti e rieS. The medical case is actually , nt• "e balanced. Consequently, it does tlfaj`, seem to be "misplaced sentimen"i; 'fre-r,'sdrrl" at all to invoke "individual orn of choice" on an issue that is 4 -:ear IY medically disputed.
James Miller
11°Ipsloaazian de los Sauces, No. 2, Pampluna,
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