|Circumcison of girls, c.1900|
“I for one have circumcised as many girls as boys,
and always with happy results.” (1898)
After reading Dr Pratt’s article in the March Journal of Orificial Surgery I thought of a case which might be of some interest, bearing out the thought advanced, and as well showing how little those who are blind can see; or are any so hopelessly blind as those who absolutely refuse to see.
On February 15 1897 a young couple, bright, intelligent appearing people, came into my office with their only living child, a little girl of two years. She was large for her age, with an abundance of light golden hair, fair smooth skin, blue eyes, and a child who had never appeared to notice anything, could not sit alone, or help herself in the least, could not speak a word. Aggravated case of strabismus of one year’s standing. Every few moments she would grind her teeth, of which she had her full complement, squint her eyes, straighten out and utter a cry, not unlike the familiar one of an epileptic.
Parents had taken he to every doctor in town, as well as before the Missouri State Medical Society, where after careful examination they pronounced her about hopeless, but advised to do nothing and that at maturity she would probably improve. The parents were not satisfied, as that was the advice given to them with an older child, and it died at two and one-half, with symptoms identical to this one. Next they took her to an oculist to see if he could relieve the strabismus. He examined the eyes carefully and pronounced them perfect. Told the parents the trouble was of deeper origin, he did not know where, and advised bringing her to me, which they did as before stated.
The family history was nil, save mother had history of brain fever one year before marriage. Both parents very nervous. No other history of any severe illness for generations.
I had the child stripped and immediately saw that the body was covered with hair, as completely as if she were a fully developed woman instead of a two-year-old child. Knowing such a growth of hair came at puberty, and puberty meant an activity of the sexual system, I examined the clitoris, or where it ought to have been, but it was so neatly sealed in by a hypertrophied hood that I could not find a trace of it.
I told the parents I believed we had the key to the situation, and although it might not entirely cure her, still we had a good foundation upon which to build hope of a cure. As it was the first ray of hope they had ever received, they said by all means try.
We immediately administered chloroform and began to unearth the most completely bound-down clitoris I have ever seen. The hood where it was amputated was just one-half inch in thickness. From that day the child began to improve; and now fifteen months later, with no medicine whatever save possibly zinc phosphate and passiflora, she can walk, talk some, sleeps and eats well, eyes nearly straight, but little grinding of her teeth. Is still very nervous, but infinitely improved, and according to her mother’s statement of May 19th, she is getting better, stronger and in every way improving every day.
Some of the blind doctors have opened their eyes and are anxious to know what has brought about such a change. Only the circumcision of a girl, and as many little girls would be benefited by such treatment as boys. And I for one have circumcised as many girls as boys, and always with happy results.
T. Scott McFarland, “Circumcision of girls”, Journal of Orificial Surgery, Vol. 7, July 1898, pp. 31-33
Necessity for female circumcision, 1915
"Female circumcision just as necessary as male"
AJCM Editorial note: We have had several inquiries from readers regarding this operation, especially as to the method of performing it. In the most interesting paper which follows, Doctor Dawson answers all our correspondents' questions. Also, he shows that intervention of this kind is imperatively required in many conditions not understood.
* * * * * * * *
Baker Brown,  nearly half a century ago, recognizing the disastrous reflexes and nervous disturbances, often caused by the clitoris, boldly amputated the offending organ with excellent results in some cases, while in others great disaster followed and the work fell into disrepute. Naturally surgical attention to the clitoris sank into oblivion. Within the last two decades this much abused and neglected organ has received some consideration, and now it is much better understood and the proper surgery applied when required.
A large number of physicians fail to realize the importance of the proper condition of the foreskin in the male; that in order to avoid the dangers of convulsions, eczema, paralysis, constipation, tuberculosis, locomotor ataxia, rheumatism, idiocy, insanity, lust and all its consequences, the prepuce must be completely loosened; if too long, amputated; if too tight, slit open.
The same category of diseases having their origin in nerve-waste, caused by a pathological foreskin in the male, may be duplicated in the female.
A much larger number of physicians are seemingly ignorant of the fact that females have an organ anatomically corresponding to the penis in the male. They are both erectile; each consists of a glans, a body and two crura; the glans in each is partly covered by a prepuce with a frenum attached below; each has corpora cavernosa, separated by an incomplete septum; each is supplied by nerve filaments from the pudic nerve and hypogastric plexus; each produces a cheesy substance (smegma), which hardens under an adherent prepuce.
The clitoris is more richly supplied with nerve filaments than any other organ in the body in proportion to its size. The same category of diseases having their origin in nerve-waste, caused by a pathological foreskin in the male, may be duplicated in the female, from practically the same cause, and in addition, other diseases peculiar to females. Chorea, chlorosis, hysteria, and various nervous disturbances, nearly always have their origin in a faulty condition of the hood of the clitoris. The neglect of the clitoris is fraught with such disastrous results that the sin of omission, its neglect, which is almost universal, is painful to contemplate.
Importance of the Sympathetic Nerve
In the study of the waste and repair of the sympathetic nerve and the law of reflexes, we delve into a mine rich with precious, practical gems of truth; we harvest in a field rich with the golden grain of valuable knowledge. This study would readily show why a neglected clitoris is prolific of so much mischief.
Doctors are not easily educated out of well-worn ruts.
The sympathetic nerve concerns itself with the life of the viscera; it presides over the visceral economy. The sympathetic system performs the vital functions which are independent of mind and present to us the idea of life. It dominates absorption, secretion, sensation, nutrition, peristalsis and functions of the sexual organs. Pathology in tissues supplied by the sympathetic nerves is manifested by disordered function; in tissues supplied by the cerebrospinal nerves, by pain. Pathological conditions, flashing out the most disastrous reflexes, are usually subconscious. Doctors are not easily educated out of well-worn ruts. Because there is no pain, no gross pathology in the clitoris, it is ignored by many otherwise careful diagnosticians.
The Causes and Consequences of Genital Alteration
The blood stream is that which does all bodily repair, heals all diseases, removes all pathologic conditions, includes growth and sustains life. It is of such vast importance that its circulation is dominated by the vasomotor system, a combination of both sympathetic and cerebrospinal nerves. An increased supply of blood to any organ invites function.
The blood supply to any organ may be increased by either one of two methods, external irritation or internal emotions. A cinder in the eye will summon an increased flow of blood to the lacrimal glands, and tears come into the eyes; a message of sorrow or joy, that sweeps over the deep vibrant chords of the soul, will produce the same result.
There is no exception to this rule, even the sexual organs being included. Internal emotions may elicit a desire to functionate in these organs; so may external irritation. Masturbation in a child under the age of puberty is not provoked by internal emotions. It is downright cruelty to punish a little child for masturbating. It would be as reasonable to punish one for crying with a grain of sand in the eye, or for being fidgety with ants under his clothing.
Many neuroses and even psychoses have their origin in
pathological conditions of the hood of the clitoris.
Girls have been sadly neglected; therefore, I make a plea in their behalf.
Reflexes travel along the line of least resistance. Irritation in the sexual organs, therefore, may reach the mental or moral faculties, resulting in imbecility, sexual perversion or moral degeneracy. Many neuroses and even psychoses have their origin in pathological conditions of the hood of the clitoris.
The girls have been sadly neglected; therefore, I make a plea in their behalf. I feel an impulse to cry out against the shameful neglect of the clitoris and hood.
A Hooded Clitoris as a Factor in Marasmus
Some two months ago, a child two and a half years old, was brought to me from Ottawa, Kansas. It presented a bad case of marasmus, malnutrition, anemia. There was little development; the lower limbs hanging almost as useless as strings. The child made no effort at vocal articulation. The clitoris was completely snowed under with an adherent hood. The adhesions were broken up and circumcision performed. The mother was instructed to retract the hood each day, in order to prevent adhesions reforming. This was neglected to some extent. The child was bought back, since I began this article. While the hood had adhered to the clitoris again, yet the improvement in the baby's condition is very gratifying. Her muscles have filled out; her thighs enlarged; she can bear her weight on the limbs and use them in taking a few steps; she speaks plainly several words; a slight pinkish tint has flushed the previously chalky white skin, and there is a marvellous improvement in her general appearance. Under a general anesthetic the adhesions were again broken up. This child will recover.
Other Cases Relieved by Circumcision
A few months ago a little babe, three or four weeks old, had colic each time after taking the bottle. Examination revealed a hooded clitoris. The indicated work promptly and permanently cured her. In a few hours after circumcision the red, angry boils on her face had perceptively paled. Her kidneys began to act normally, and she was transformed from a cross, peevish, discontented child into a state of perpetual sunshine.
A girl baby, two years of age, had been troubled all her life with furunculosis, anuria, and malnutrition. She had been treated by different doctors for different diseases, but with no benefit. The clitoris was completely buried beneath an adherent hood. In a few hours after circumcision the red, angry boils on her face had perceptively paled; in thirty-six hours they were dried up. Her kidneys began to act normally, and she was transformed from a cross, peevish, discontented child into a state of perpetual sunshine.
A girl sixteen years of age, well developed but neurotic, had been troubled with nocturnal enuresis from babyhood. Circumcision, with some other indicated orificial work, at once stopped this embarrassing condition.
Another, Sarah C., seven years old; a bright, beautiful child, well-nourished, a masturbator. She was brought to me to have this evil habit corrected. Examination showed she needed circumcision, to relieve constant external irritation, which was exciting the sexual passion.
A widow of forty-six came into my office, heavily veiled and requested a private interview. She handed me a copy of the Journal of Orificial Surgery, with a request that I read page 83. On this page was an article giving the symptoms of nymphomania caused by a hooded clitoris. With deep mortification, she said she had been bound in chains by this demon since she was a little girl, and that I was the first person to whom she had ever mentioned it. She requested permission to remain veiled, while I circumcised her under local anesthesia. She afterward expressed her heartfelt gratitude for her release.
A girl of ten, following an injury to the hip, presented all the characteristic symptoms of hip-joint disease, tenderness, heat, swelling, pain in the knee with soreness in the hip-joint in pressing upon the knee, also, from pressing against the trochanter; slight elongation of the limb, with a tendency to throw the knee across the other limb. This case was presented to a doctor, who was an orificialist,  as well as a general surgeon. He found the clitoris in a very irritable condition and its hood firmly adherent. Following the needed attention to the clitoris, a few weeks in bed, without even using extension upon the limb, restored the limb to a perfectly normal state.
How to Circumcise the Female
Since beginning this paper, a surgeon of considerable prominence, with twenty years' experience, at the head of a reputable hospital, casually dropped into my office. I mentioned the subject, with my usual enthusiasm, when he asked what I meant by circumcision; was it amputating the clitoris? Another physician, with an experience of more than a score of years, acknowledged to me that he never saw a clitoris to recognize it. This reminds me that my paper would be incomplete without a description of the technic.
Before undertaking this work it is needful that one should have a clear conception of a normal clitoris and hood. Only two days ago a physician brought a lady to me for circumcision. Everything ready, I started to do the work, when a normal clitoris smilingly said, "Keep off the grass, please."
In a normal clitoris and hood the point of the glans is exposed and the complete retraction of the hood is easily accomplished. There is no smegma or irritable condition found between them. No tension of the hood is found upon stretching the parts laterally with the thumbs.
If the hood is so long as to cover the glans completely, it should be partly amputated; if adhesions exist, they should be thoroughly loosened; where smegma is found, it should be removed.
Circumcision is performed by cutting a V-shaped piece from the hood over the center of the clitoris. If very redundant, it will require a large piece; if tight, only a slit will be necessary. Grasp the hood in the center with Pratt's plug forceps or a pointed hemostat; lift it up from the clitoris and, with scissors, cut each side of the forceps, the cuts meeting above the point of the forceps, taking out a V from the hood. With a No. 0 or No. 1 plain catgut suture, take a stitch in the point of the V, uniting the under mucous membrane to the outer skin, just as in circumcision in the male. Usually an additional stitch will be required on either side to join the skin and mucous membrane. When strong adhesions have been broken up, it will be necessary to slide the hood up each day to prevent their reforming. What is preferable is to put a drop of flexible collodion on the clitoris, holding the hood up until it dries. It will then require no further attention.
This work can be done with local anesthesia. Cleanse the parts thoroughly and place a piece of cotton, saturated with a 10-percent solution of cocaine, over the hood and clitoris. After a few minutes you can inject a 4-percent solution of the cocaine with a hypodermic syringe in a fold of the hood pinched up between the thumb and finger. Massage for a moment and proceed with the work. Abbott's anesthaine will answer well, and in many ways is preferable to cocaine.
Benjamin E. Dawson AM, MD, “Circumcision in the Female: Its Necessity and How to Perform It”, American Journal of Clinical Medicine, Vol. 22, No. 6, June 1915, pp. 520-523
NOTES1. Isaac Baker Brown, the English obstetrician who was expelled from the Obstetrical Society in 1867 for his advocacy and practice of clitoridectomy as a cure for nervous maladies in females.
2. The Orificial Surgical Society was founded in 1890 by E.H. Pratt, a surgeon at the Cook County Hospital in Chicago. The organization was largely concerned with orifices below the waist, and provided training for surgery of the prepuce, clitoris and rectum, the latter organ being given special emphasis. It was obsessed with the idea that most diseases were caused by tightness of the preputial or anal sphincters. For further information, see Edward Wallerstein, Circumcision: An American Health Fallacy (New York, 1980), p. 38