ARC letters: Feb 1999

... Interest in the foreskin, foreskin-related problems and solutions to them have existed for a long time. Diderot's Grande Encyclopedie, published some 240-odd years ago, has an entry entitled Prepuce that, like much else in the Encyclopedie is enlightening. It states that the foreskin is the most variable organ in man, an observation that could be made in a country and time when all men had foreskins. Somewhere on your page is a comparison of the foreskin with the vermiform appendix, and I think it's an apt observation.

The point has been made somewhere that circumcision wouldn't have been invented if there were no use for it, and I think that point too is valid. Parts of the world where it has been practiced tend to be hot areas where water is often in short supply: Egypt, Pacific coastal Peru, and Australia, among others. Your point as to the usefulness of dorsal slit as a substitute for (or precursor to) circumcision is well taken, but you're not strictly correct when you state that dorsal slit is "simply unheard of."

Dorsal slit is not totally ignored, but I think it was more common in the USA a couple of generations ago. It's long been called "the French cut" by American physicians in the apparent belief that the French perform it in preference to circumcision where they consider intervention to be necessary. (I don't know if this belief is true; perhaps you, located in Europe, can make a better determination of its accuracy.)

A group of nude men with dorsal slits are quite unmistakable on an early Egyptian bas relief. (Of course, full circumcisions are recognisable in many examples of Egyptian art.) For hundreds of years dorsal slit was practiced by millions in Indonesia, Malaysia, and parts of the Philippines until the recent invention of the Tara clamp. Thor Heyerdahl (Ancient Man and the Sea) says dorsal slit is the "circumcision" traditionally practiced in the Pacific by many Polynesians and other islanders.

Between World Wars I and II it was done on a lot of kids born in the Orlando, Florida area. I went to school with some of these guys, and all of them appeared content with their lot. One of my roommates who I could see had a dorsal slit was convinced he was circumcised, and I didn't dispute his belief. I think the chief reason dorsal slit was more or less abandoned in the USA was the appearance of the Gomco clamp and the Plastibell, both of which made a total circumcision nearly as easy to perform as a dorsal slit, even by a less-than-skilled surgeon.

In regard to complaints that the dorsally slit penis is less aesthetically appealing than the circumcised, this may be questionable judging from the fair number I've observed (though it would be presumptuous for me to set myself up as an arbiter of penile beauty!). When the procedure is done on a young patient, however, the separate flaps of foreskin tend upon healing to more or less disappear behind and beneath the glans so that although obviously still there, the remaining foreskin is out of the way and not conspicuous. It totally disappears upon erection, so the penis appears identical with one that was circumcised. Your (Robin Stuart) point that dorsal slit can be done to eliminate foreskin problems and can always be followed later by circumcision if the owner of the dorsally slit penis so desires, is well taken.

... a couple of Texas paediatricians (Diaz, A. and H. I. Kantor, 1971. Dorsal slit, a circumcision alternative. Obstet. Gynecol. 37:619-622.) These doctors told the mothers whose kids they were treating that this was a "new kind of circumcision," which it definitely is not. They reported some follow-up on their first patients, but I don't know what has happened with dorsal slit in Texas since their work. If I were king of the world, however, I think I would decree that all newborn boys (except Jewish and Muslim kids, whose penile destiny is already determined) would be given a dorsal slit by a competent surgeon. If this were done, there would be no more routine neonatal circumcision, but also there would be no more problems with adhesions, phimosis and the like which the anti-circ boys (and girls!) claim don't exist. And I submit that a lot of human suffering (and hopefully also impassioned, ill-mannered contention!) would thereupon disappear from the earth....

... A dorsal slit at birth is a small price to pay to prevent these needless problems. ...

... All this talk has reminded me of a man, born in Washington State about the time WWII began (and thus now about 60 years old), who was not circed but shortly after birth had a tiny snippet (no more than 1/2 cm) of the foreskin slit open on top of his penis at the tip end. The slit was inconspicuous and hardly visible at very close range. At the same time he made the tiny cut the doctor had apparently also separated all of the internal foreskin from the glans and frenum with a blunt probe. The result was that the foreskin was completely free so that the glans became fully exposed whenever the penis was erect, but when flaccid the glans was fully covered and it was obvious that the penis was "normal" and was not circumcised.

Since erections are pretty common in growing boys and young men, smegma and dirt never had a chance to accumulate under the foreskin on the glans, and his penis stayed remarkably clean. As he grew up I doubt that he was ever aware of any foreskin problem, and certainly nobody could have convinced him that circumcision was a real need. I envy him because with a minimum of trauma he was freed at birth from any difficulties with his penis and any accompanying pain and embarrassment that many kids with phimosis & short frenulum have experienced. I don't know how the doctor who delivered him arrived at awareness of this minimally traumatic, highly conservative procedure, but I think if it were applied worldwide the question of ric or other bizarre penile treatments would never arise. And we'd all be better off for it! (Whether most frenular abnormalities could be relieved by similar conservative treatment shortly after birth I don't know, but have a strong feeling [not firm knowledge] that they could be.)