|Sceptics and dissenters|
Critics of the harmless little operationThe rapid spread of circumcision in the United States from the 1930s onwards did not go unchallenged. As early as 1941, the year of Guttmacher’s recommendation that the baby should be circumcised so as to promote hygiene and deter masturbation, the physician and surgeon Miles Atkinson attacked the growing trend. He particularly criticized surgeons for making the operation fashionable, and parents for giving no thought to the matter but accepting it all too readily as a “custom, an unthinking habit”. Atkinson singled out the widespread misunderstanding of normal penile development as offering the main justification for early circumcision – the idea (promoted by Morris Fishbein and others) that circumcision was necessary, in the interests of cleanliness, if the foreskin could not be retracted “quickly and easily” a few days after birth. He pointed out, in words that are still not properly understood by many American medical personnel, that a non-retractable foreskin in infancy and childhood was perfectly normal and proper:
Sub-preputial ablutions are of no great importance in infancy, the necessity arises only as the child gets older. By that time, however, the normal processes of maturation will, in the great majority of cases, have converted what was a phimosis in babyhood into a normally retractile prepuce. It would seem to be the course of wisdom to await the workings of Nature, rather than presume that they will not occur. … The only phimosis in an infant which absolutely demands treatment is that which is so extreme that it interferes with urination. Such cases are not common. All others can be left alone in the expectation of normal maturation. We do not advocate the destruction of nailbeds on the fingers of all male infants lest dirt collect beneath the nails. Rather, we teach children the principles of cleanliness …. Yet the removal of nails would be just as logical as circumcision when the latter operation is performed on the usual excuse.
Atkinson concluded that “the weight of factual evidence is strongly against circumcision. … Aesthetically it is undoubtedly bad – at best a mutilation, at worst a tragedy". 
In the name of humanityAtkinson was followed by the humanist Joseph Lewis, who roundly attacked circumcision as a barbaric blood ritual which should have no place in a modern and civilized society which respected the humanity and rights of individuals. Reflecting the fact the circumcision advocates had still not conquered the whole of the medical terrain, he was able to cite letters and published comments from numerous physicians criticising the practice, including one from Julius Weingart of the Iowa Lutheran Hospital, who wrote:
Circumcision as a routine procedure is to be condemned. There are no general grounds, exclusive of ritualistic ones, to justify it. Unless indicted by definite surgical considerations, it becomes mere mutilation, as senseless as it is unworthy of a humane profession.
With chapters on the anthropology of circumcision as a blood rite, the medicalisation of the operation in the late nineteenth century, the justifications offered (prevention of venereal disease and cancer), the dangers and harms arising from the operation, including the risk of psychological damage, and the “Anatomy, mechanism and function of the prepuce”, Lewis had prepared the most comprehensive critique of the case for circumcision to be published before Edward Wallertsein’s celebrated expose in 1980. It is still worth reading, if only to show how little the debate on the “pros and cons” of circumcision has changed over the past half century. 
The rape of the phallusFurther murmurs of dissent emerged in the 1960s, including W.K.C. Morgan’s well known polemics, The rape of the phallus, and Penile plunder,  and a more detailed critique by John M. Foley, The practice of circumcision: A revaluation. He was spurred into action by a letter from a Baltimore physician, published in the Medical Tribune on 20 July 1964, demanding the compulsory circumcision of all men seeking to get married; and, not content with that, federal legislation requiring the circumcision of every male infant within eight days of birth. Foley wondered why such legislation should be necessary, given that over 90 per cent of boys born in American hospitals were already routinely circumcised, and suggested that the proposal had much to do with the desire to avoid legal liability for injury, and with even darker psychological impulses:
One answer, of course, is that if circumcision were made compulsory, the circumciser would be protected whenever he happens to cripple or kill the little boy he operates on – a “complication” that is not so very uncommon. Another answer must be sought in the darker regions of the human mind, because circumcision is nothing but wanton and unnecessary mutilation. The annual 2 million assembly-line circumcisions in this country are a monument to the gullibility and stupidity of the American public.
Foley covered the usual arguments offered in favour of routine circumcision, found them all pathetically inadequate, and then devoted the bulk of his critique to the origins of circumcision as a blood sacrifice and the psychological needs which seemed to drive the circumcision advocates.  A shorter version of his essay was published in the magazine Fact.
Several influential articles appeared in 1970, including Noel Preston’s reconsideration of neonatal circumcision, which elicited an approving letter from C.J. Falliers, a European immigrant to the USA who was appalled at what he found being done to baby boys in maternity hospitals. Preston observed that “routine neonatal circumcision had been advocated as a means of preventing genitourinary diseases and genital cancers”, but pointed out that
the procedure has been found to have been of questionable benefit and to be associated with both immediate and delayed risks and complications. These in turn may produce undesirable psychological, sexual, and medico-legal difficulties. Circumcision is considered with respect to carcinoma of the cervix, penis, and prostate; there is little evidence that circumcision of the newborn affords protection against subsequent development of these cancers in individuals who practice good personal hygiene.
He concluded that “routine circumcision of the newborn is an unnecessary procedure. It provides questionable benefits and is associated with a small but definite incidence of complications and hazards. These risks are preventable if the operation is not performed unless truly medically indicated. Circumcision of the newborn is a procedure that should no longer be considered routine.” 
If Preston had stuck to the straight and narrow calculus of claimed benefit vs. risk of “complications” (that is, damage beyond what was intended), Falliers brought up the inherent value of the body part removed by the operation. Since the foreskin played a significant role in male sexual responsiveness, its destruction must also be factored into the cost-benefit equation. 
Another significant intervention was Sylvia Topp's article in the Village Voice (16 June 1975), "The argument over circumcision: The case against". Written by a New York journalist who had declined to allow her own baby to be circumcised and who then decided to look into the whole question, the article is of particular interest for what it reveals about the state of contemporary knowledge as to genital structure and function, and its insights into why circumcision still happened. While the obstetricians said they only did it because they thought the mothers wanted it done, the mothers said they only had it done because the obstetricians suggested it. The fact that each party sought to blame the other suggests that neither thought it a very good idea.
Full text of article available on this site.
Doubts emerge in the establishmentAnd at last the medical establishment began to take some notice. For all the effect they had on the incidence of circumcision, which kept climbing throughout the 1950s and 60s, the protests of Atkinson, Lewis et al might have been put in a bottle and thrown out to sea. But after Capt. Preston’s measured dissent, the American Academy of Pediatrics, Committee on Fetus and Newborn, cautiously inserted the following sentence in the 5th edition of its Standards and Recommendation for Hospital Care of Newborn Infants:
There are no valid medical indications for circumcision in the neonatal period.
It did not say that circumcision should not be performed, or that the foreskin had value, or that infants had rights, or that circumcision was harmful or might be a breach of medical ethics, but it was a start, and it marked the beginning of the end for routine circumcision, however slow that end has been in arriving.
Statements from the American Academy of Pediatrics
After a few years the doubts entertained by the AAP spread to the body responsible for performing most circumcision operations, the obstetricians and gynecologists. In an equally cautious paper, one of their number concluded that although “the existing literature [unbelievably vast though it be] is inadequate to evaluate appropriately routine circumcision of the newborn infant”, the practice “appears to lack sufficient justification”. Until the benefits “can be proved worth the risk and cost, medical resources probably should be allocated to measures of demonstrated value".
A notable feature of Grimes’ paper was his identification of the anomalous position of the operation, which stoutly resisted classification as a category of modern medicine. Grimes commented that it lay “outside the province of modern surgery” and “frequently features illogical bases for patient selection, neglect of the requirement to obtain informed consent, an inappropriate operator, needlessly radical technique, disregard for pain, dubious objectives, and unknown cost-effectiveness.” Preventive circumcision did not fall within any recognised objective or definition of surgery:
Physicians’ reasons for advocating routine circumcision include cleanliness; prevention of balanoposthitis, future phimosis, or cancer (in men and women); failure of the foreskin to retract; and custom. Welch has classified surgery as follows: repair of wounds, extirpation of diseased organs or tissue, reconstructive surgery, and physiologic surgery (e.g. sympathectomy*). Predictably routine newborn circumcision eludes classification. Contemporary surgery has yet to embrace the philosophy of purely prophylactic surgery. If, however, the scope of surgery broadens to encompass preventive operations, the prepuce of the neonate will likely rank low on a list of bodily parts requiring ablation. 
* Sympathectomy: “the surgical interruption of part of the sympathetic nervous system, cutting off sympathetic impulses to a part, organ or region”. The sympathetic nervous system regulates the involuntary functions of the body, such as dilation of the pupils, stimulation of sweat, dilation or constriction of arteries. (Oxford Companion to Medicine, Vol. II, p. 1368.) Obviously, you would never interfere with such a system except in grave emergencies or where an intractable problem had defied other methods of treatment.
Wallerstein's American health fallacyThe major event of 1980 was the release of Edward Wallerstein’s painstaking study, Circumcision: An American health fallacy, published by the international science publishers, Springer. Wallerstein did not really do anything different from the earlier efforts of Lewis, Foley and Preston, but he did it in a lot more detail, and with both a far greater depth of research and a far wider range of reference, embracing cultural and ethical considerations as much as narrowly medical ones. He also reviewed the case of female circumcision and clitoridectomy, finding them not so different from what was done to boys. The result was a formidable and, as it proved, unanswerable case against circumcision: there has been no successful attempt to refute the arguments and data presented in his study, though circumcision advocates have done their best to ignore it, or belittle the author as medically unqualified. (Why should he need a licence which permitted him to perform circumcisions in order to produce a critique of the practice? Wallerstein’s independence from the sort of indoctrination experienced by those who had attended American medical schools was a decisive factor in his ability to see that the Emperor had no clothes.)
At nearly 300 densely references pages, Circumcision: An American health fallacy is too long and detailed to summarise, but worth quoting is the opening of his final chapter, “An appeal to reason” which identifies the strange progress of the operation from social rite to a medical procedure and back again:
Circumcision is a unique phenomenon. It origins in antiquity are obscure, its original objectives unknown … yet this operation, the first ritual surgery devised by humans, is still in use. … But circumcision is more than merely ritual surgery. As a therapeutic measure, to correct a true defect, it is accepted worldwide. In the USA, circumcision is allegedly employed therapeutically – to correct a pseudo-defect. A third aspect, prophylaxis, has taken on even greater significance in the United States, where many more operations are performed for prophylactic reasons than for religious or therapeutic ones. Thus the American practice is trifaceted: a religious rite, a therapeutic measure, and a prophylactic operation. No other surgical procedure can make such a claim. …
A century ago, ignorant of disease etiology, physicians introduced male circumcision to cure every disease imaginable. Despite later knowledge that most diseases did not have the remotest connection with this surgery, the practice was continued with ever-increasing frequency. Now, when all claims for ills supposedly prevented by circumcision, have been shown to be illusory, the surgery still continues unabated. The prophylaxis theories are myths; they are no longer acceptable hypotheses. In fact, the entire concept of “health” circumcision in the United States is beyond the bounds of medicine. Dr Lendon Smith claimed that: “Circumcision now seems to be a national cultural trait”.* This “national cultural trait” endows circumcision with mystical prophylactic powers, and an entire health philosophy has been accreted around it. 
And indeed, an entire “health” industry.
* Lendon Smith, The Children’s Doctor (Englewood Cliffs, Prentice Hall, 1969), p. 195
The trickle grows to a floodSince 1980 the trickle of dissent from circumcision has grown to a torrent, with books and journal articles appearing regularly, and organizations dedicated to curbing, discouraging or even banning the operations springing up all over the place. To list all of these would be a monumental job, and further articles are available here, but particular mention should be made of the following:
Paul Fleiss, “Where is my foreskin? The case against circumcision”, Mothering: The Magazine of Natural Family Living, Winter 1997, pp. 36-45
Joseph Zoske, “Male Circumcision: a gender perspective”, Journal of Men’s Studies, Vol. 6, Winter 1998, pp. 189-208
Paul Fleiss and Frederick Hodges, What your doctor may not tell you about circumcision: Untold facts about America’s most widely performed – and most unnecessary – surgery (New York: Time Warner Books, 2002)
For details and to purchase a copy
Leonard Glick, Marked in your flesh: Circumcision from ancient Judea to modern America (New York: Oxford University Press, 2005)
This remarkable study is a scholarly yet readable account of how a ritual practised by a small society of semi-nomadic herders in the distant past became the bodily signature of the world’s most modern and technologically advanced superpower. An anthropologist by training, and himself Jewish, Professor Glick disentangles the strange process by which the ancient Hebrew rite of circumcision lost its religious significance while taking on the medical arguments advanced by Victorian doctors. His argument is that, these days, most American Jews circumcise primarily because they are Americans, not because they are Jewish, but conversely, that since the time of the First World War, Jewish physicians have been disproportionately prominent and vocal among American circumcision advocates.
Leonard Glick: Why I wrote Marked in your flesh
Further sources of informationThe following collections of conference papers also contain a wealth of material, often fully referenced:
Denniston, George C., and Marilyn Milos (eds), Sexual mutilations: A human tragedy (New York and London: Plenum Press, 1997)
Denniston, George C., Frederick Hodges and Marilyn Milos (eds), Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem (London and New York: Kluwer Academic and Plenum Press, 1999)
Denniston, George C., Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (London and New York: Kluwer Academic/Plenum Publishers, 2001)
Denniston, George C., Frederick Hodges and Marilyn Milos (eds), Flesh and blood: Perspectives on the problem of circumcision in contemporary society (London and New York: Kluwer Academic and Plenum Press, 2004)
Available in many libraries, and also from Nocirc.
Links to organisations and websites concerned with circumcision
References1. Miles Atkinson, Behind the mask of medicine (New York: Scribners, 1941), pp. 177-83
2. Joseph Lewis, In the name of humanity (New York: Eugenics Publishing Co, 1949)
3. Journal of the American Medical Association, Vol. 193, 19 July 1965, pp. 123-4; Medical Journal of Australia, 27 May 1967, pp. 1102-3
4. John M. Foley MD, The practice of circumcision: A revaluation (New York: Materia Medica, 1966); “The unkindest cut of all”, Fact Magazine, Vol. 3, July-Aug. 1966, pp. 2-9
5. E. Noel Preston, Whither the foreskin: A reconsideration of neonatal circumcision, JAMA, Vol. 213, 14 September 1970, pp. 1853-8
6. C.J. Falliers, Circumcision, JAMA, Vol. 214, 21 December 1970, p. 2194
7. David A. Grimes, Routine circumcision of the newborn infant: A reappraisal, American Journal of Obstetrics and Gynecology, Vol. 130, 15 January 1978, pp. 125-9
8. Edward Wallerstein, Circumcision: An American health fallacy (New York: Springer 1980), pp. 191-2