|Girls as well as boys: Texas 1918|
Belle Eskridge MD thinks that an early circumcision improves girls just as much as boys.
Why not circumcise the girl as well?Social custom has drawn a veil so darkly over the external genitalia of the virgin, both in Europe and America, that a very scientific study of these organs by the male surgeon on the living subject has been obstructed by it. Ignorance, as well as superstition exaggerated by prudery, handed down from ancient times, promulgated and encouraged by man for his own selfish gratification, forbade any interference, lest it be used as an excuse to cheat him of what he assumed to be his inalienable rights. To remove this prejudice would be as hard as to remove the AD from the history of Christianity.
Greater opportunity for the study of children in numbers is being extended to the profession by appointments in schools for public health work and institutions for the care of children. In these institutions each individual child may be controlled and studied. Fortunately, here is a field in which neither the travelling quack, the ebullient druggist or the officious neighbour can interfere with investigation. It has been my privilege for 27 years daily to examine and study the female, and I have been requested to bring my findings to you.
I need not remind you that the male and female genital organs are developed from one and the same origin, the Wolffian bodies, and that no sex distinction can be determined until the seventh week of fetal life. Our anatomies describe the clitoris as being developed from the genital eminence, which in the male becomes the penis, the clitoris being an erectile structure which is the morphologic homologue of the penis. The glans clitoris, like the glans penis, is covered by a very sensitive membrane that the genital fold bounds latterly [sic: laterally?] The genital furrow on the under surface of the genital ridge becomes in the female the labiae minorae. The upper margin unites to form the prepuce in the female and the covering of the scrotum in the male. Both are remarkable for the complete absence of adipose tissue. Both have projecting from the free surface a number of small, highly sensitive papillae. In the retroglandular sulcus of both the clitoris and the penis are found numerous small glands that secrete a sebaceous material. This is found as frequently under the adherent prepuce of the girl as under the adherent prepuce of the boy. Clitoris, like the penis, is richly supplied with nerve filaments. Each have the same arterial and venous blood supply. The lymphatic system is the same. 
The blood supply may be increased in any organ by two processes – internal emotion and external irritation. The sexual organs have a rich blood supply. We know that an increased blood supply invites function, an excess of which invites increased reflex phenomena. As we understand reflexes in this day, they travel along the line of least resistance. Is it reasonable to believe that an irritation produced by an adherent prepuce, that can reach the mental or moral faculties of the boy, resulting in physical discomfort or sexual perversion, and mental or moral degeneracy, would not have the same effect upon the girl? 
In Egypt all girls of true Egyptian origin are circumcised. It is an Egyptian custom, practised as a ritual event even on Mohammedan girls of Fellah (that is, of true Egyptian) origin. Circumcision of the male child has been practised as a religious custom or ritual by Jews since the early ages. Putting it under the cloak of religion is the only way they felt sure of its perpetuation. Circumcision of boys is universally practised by the Mohammedans, although it is not mentioned in the Koran. 
At this time circumcision is considered by the profession to be a beneficial procedure for the welfare of the man-child, ignoring the fact that the girl child has an organ anatomically corresponding to that of the boy. This is strange, when we reflect that the girl may have all the diseases, originating in nerve irritation caused by an adherent prepuce, that a boy can have, with some added that is [sic] peculiar to the female. Over half a century ago, the reflex nervous disturbance caused by irritation of the adherent prepuce of the female was recognised, and the removal of the clitoris, with some of the surrounding structures, advised – a few going so far as to trace and dissect out a large part of the nerve supply.  So radical a procedure failed to have the support of the conservative surgeons, and rightly the operation fell into disrepute. Would it not have been as reasonable to recommend the removal of the male organ for a like condition.
In the last few years attention has been directed again to the clitoris as a cause of reflex irritation. I fear many of us have had our minds so centred on the internal female organs that we have neglected to some extent to study the external. There being no evidence of pathologic change in the organ itself, it has been overlooked as a disturbing factor by an otherwise capable diagnostician. We are learning more and more to go behind results and deal with the primary cause of reflex irritation. The multiplicity of complaints in the female is such as to tax our best efforts to correct them and give relief.
Observers have long ago learned that a great many symptoms arise from some underlying cause, often obscure and not easy to determine by even the most competent clinician. The home in Houston with which I am connected averages about 140 children under thirteen years of age, boys and girls. There are some splendid normal children in the home, but most of them are problem children. The home is under a trained worker of great experience, one who is efficient and a good observer.
Of the large number of girls whom I have circumcised, and the boys circumcised by the other members of staff, there is as much improvement in the girls as in the boys. The superintendent says that the girls show even a greater improvement than the boys. Some of them are quite changed in character. The improvement in health and general appearance of the girl is surprising. I have examined the genitalia of over 250 girls in this home. Less than a dozen were normal, and by this I mean a clitoris with a prepuce short enough to expose the glans clitoris with no smegma in evidence. The glans should be free from adhesions. When the prepuce is stretched latterly [sic]. These girls are wholesome, normal girls of better mental balance, judging from observation alone and not from the Benit test.
[Digression: The hymen]
It may interest you to know that of this number of girls which I have examined, I have not found two with the hymen correspondingly alike; in two the hymen was entirely absent; in some very irregular and tense; in others very smooth and tense; in some very narrow, only a line; in some narrow and relaxed; in a few, wide and very dilatable, when allowed to fall into place it entirely filled the opening; one covered the opening but contained three perforations; another was divided by a narrow strip of mucous membrane; one was imperforate; there were a few with pinpoint openings; some were oval; some crescentic, and others were quite round in contour.
This part of the human body does not conform to an exact rule any more than the hands or feet or any other part of the body. The anatomical artists draw on their artistic imagination in producing the picture of the so-called normal hymen of our text book. It was a crime against the womanhood of the world to draw an anatomic myth and set it up as a standard by which the chastity of our young women should be judged. It will be a good day for humanity when some of our profession, as well as the laity, get the truth about this more clearly. Howard A. Kelly, in his Medical Gynecology, makes a statement that he cannot substantiate: “If a well oiled finger can be readily introduced into the vagina without eliciting a cry, the conclusion may be drawn that some penetrating body has entered the same channel.” I am sure that there is not a surgeon here but will agree with me when I say that this is not a fair statement founded on facts. I insist that it is an unjust and unfair statement and should never have appeared on the pages of any text book.
Among this number I found one hypertrophied clitoris. I do not agree with the men who say this condition is caused by masturbation. We have both girls and boys who have masturbated. I am sure masturbation in a child before puberty is not due to an internal emotion, but to external irritation or outside influences. There were two baby girls in the home under one year who were masturbators; one rubbed the vulva almost continually. She could not remain quiet even while taking her food, but would turn over on her abdomen and keep in motion while nursing her bottle. At the request of Dr N.N. Allen I circumcised her and removed a piece of smegma as large as a grain of wheat. She soon began to improve and discontinued the habit; and while she is an abnormal child, there is general improvement since I circumcised her eighteen months ago. The other baby received the same attention and was relieved.
Several of the larger girls who had this habit for a long time showed the effects in various ways I cannot go into here. I will give you one of the many cases met with in handling these girls.
The superintendent reported to me that one of the caretakers had found a girl of nine years with a large wash rag packed tightly in the vagina and in the act of masturbation. One year after circumcision she has not been found masturbating. She is far below normal, yet she is more biddable and easier to handle than before the operation.  I was surprised to find the hymen of this girl very elastic and filling the opening so symmetrically that observation alone would lead one to believe that it had never been interfered with, yet I could introduce two fingers without making undue tension, showing that the dilatation had been gradual, extending over several years.
Circumcision will relieve one of the greatest causes of masturbation. Yet it is well to remember that the human family are all creatures of habit, and that care must be exercised over the child that has contracted the habit, for it will relapse for weeks or even months, but with less and less frequency as time goes on, until finally the habit is discontinued. Children should never be whipped for this habit, for it only stamps the habit more firmly on the subconscious mind. It is about as sensible to whip a child for rubbing the eye that has a cinder in it, or to insist upon a child sitting with ants and bugs crawling under the clothing, as to whip a child for the habit of masturbation caused from external irritation.
The operation of circumcision of the girl is a very simple surgical procedure. The prepuce can invariably be separated from the glans by the thumb and index finger covered with gauze, placed directly opposite on each side of the clitoris, with gently steady pressure outward from the glans. If a little irregular point still remains adherent, it can easily be stripped back with gauze. No cutting instrument will be required up to this point. When the glans is entirely free, seize the prepuce at the median line with a small forceps and lift it up free of the glans clitoris; then with a sharp pair of scissors, remove a V-shaped piece, extending upward large enough to uncover the glans well back. The skin and mucous membrane are then united as in the operation on the male. I cover the united edges of the hood, but not the glans, with compound tincture of benzoin about the consistency of cream. The nurse is instructed to keep it clean and pushed back twice a day until healed. 
I hope you will not infer from this paper that I believe or recommend circumcision of the female as a cure-all, but I do insist that it will give as good results to the girl as to the boy, and that the female genital organs should receive as careful attention at birth as those of the male child.
Belle C. Eskridge, “Why not circumcise the girl as well as the boy?”, Texas State Journal of Medicine, Vol. 14, May 1918, pp. 17-19
NOTESIn this article, Dr Eskridge defines circumcision of girls as meaning the removal of the clitoral hood or prepuce.
1. Eskridge does not seem to have caught up with research showing that there are no glands under the foreskin, but it is interesting that she acknowledges that girls produce smegma just as abundantly as boys. She refers to the similar innervation of the penis and clitoris, without showing awareness of other research suggesting that the nerves detecting fine touch are concentrated in the foreskin (and where else but the skin would you expect to find them?)
2. Reference is to the Victorian theory of reflex neurosis, particularly associated in the USA with Lewis Sayre. It was rather out of date by 1918, but is interesting to see it hanging on tenaciously in institutional settings.
3. It is not clear why the customary practices of a backward country like Egypt should have been be a model for the go-ahead United States.
4. A reference to the London obstetrician Isaac Baker Brown, disgraced in 1867.
5. It will be noted that Eskridge praises circumcision for its impact on the girl’s behaviour – she becomes easier to manage – not because it makes any improvement in her health.
6. As with boys, the supposed ease and simplicity of the operation is presented as a positive reason for performing it.