Lewis Albert Sayre
Lewis Albert Sayre (29 February 1820 – 21 September 1900) was a leading American physician and orthopedic surgeon of the 19th century. Sayre was a principal founder of the Bellevue Hospital Medical College and of the American Medical Association, of which he was elected vice-president in 1866, and president in 1880.
Sayre is famous for having performed the first circumcision of a boy for medical treatment in the United States.
Sayre and circumcision
The medical history of circumcision in the United States properly begins in New York on 9 February 1870. That morning Dr. Lewis A. Sayre was summoned by a colleague, the eminent New York gynecologist James Marion Sims, to consult on a perplexing case. "Please let me know at what hour you can come to my house to see the son of Mr. M_____, of Milwaukee," Sims wrote. "The little fellow has a pair of legs that you would walk miles to see." Sayre was at the time America's leading orthopedic surgeon, a renowned teacher and scholar, an authority on the anatomy of bones, joints, and muscles. Intrigued by the prospect of seeing some rare musculoskeletal pathology, he dropped what he was doing and went at once. When he arrived, Sayre encountered "a most beautiful little boy of five years of age, but exceedingly white and delicate in his appearance, unable to walk without assistance or stand erect, his knees being flexed at about an angle of 45 degrees." Sims, it turned out, had called him in to perform a tenotomy, the desperate remedy of severing the child's hamstring tendons. 
After he examined the patient though, Sayre concluded that "the deformity was due to paralysis and not contraction, and it was therefore necessary to restore vitality to the partially paralyzed extensor muscles, rather than to cut the apparently contracted flexors." But the cause of this paralysis was a mystery. There was no history of injury and seemed to be no other symptoms of disease. Puzzled and determined to trace the problem to its source, he finally decided to test the boy's reflexes by applying electric current to his legs. While he was doing this, the child's nurse exclaimed, "Oh, doctor! be very careful - don't touch his pee-pee - it's very sore." An examination of the patient's genitals showed that the penis was normal, except that "the glans was very small and pointed, tightly imprisoned in the contracted foreskin, and in its efforts to escape, the meatus urinarius had become as puffed out and red as in a case of severe granular urethritis." This was, according to the nurse, a chronic condition. Often the pain awaked him at night, the child's genitals having become so sensitive that even the slight friction of bedclothes caused painful erections. Pondering this information, Sayre suddenly imagined that he knew the source of the boy's problem. "As excessive venery is a fruitful source of physical prostration and nervous exhaustion, sometimes producing paralysis," he explained afterward, "I was disposed to look upon this case in the same light, and recommended circumcision as a means of relieving the irritated and imprisoned penis."
He was so confident of his diagnosis that he brought the boy to Bellevue Hospital in order to demonstrate the operation to his students there. The following day, after the patient was anesthetized, Sayre drew the foreskin forward and cut it with scissors. To his surprise, "the mucous portion [remained] quite firmly adherent to the glans nearly to the orifice of the urethra." So he finished the procedure by "seizing the thickened mucous membrane with the thumbs and finger nails of each hand" and tearing it away from the glans. Whatever it may have lacked in elegance, this operation seemed to produce a wonderful result. From the first day, the child's health began to improve. Color returned to his cheeks. Soon he regained his appetite, slept soundly and, most remarkable of all, within a few weeks "was able to walk with his limbs quite straight." Improbable as it seemed, Sayre postulated that "simply quieting his nervous system by relieving his imprisoned glans penis" circumcision had restored the young patient's health.
A short time later, Sayre was consulted on the case of a teen-age boy who suffered from partial paralysis. Gollaher reports:
While the five-year old was recuperating, the surgeon tried a similar experiment on the partially-paralyzed son of a prominent New York attorney. This boy was in his teens. For over a year Sayre had treated his paralysis with electricity, had "injected strychnia into the paralyzed muscles every tenth day," and had dosed him with iron and other tonics. Yet nothing had worked. Now, inspired by his new theory, Sayre recommended trying circumcision in this case as well. The worried father, who confided suspicion that his son "was guilty of masturbation," agreed without hesitation. Once again the outcome was marvelous. Within a few weeks of the operation, Sayre reported, every symptom of paralysis vanished and the lad's general health improved so dramatically that "his most intimate friends scarcely recognize him."
Sayre (1870) published a paper to report his apparent success in curing the boy of paralysis by circumcision.
Sayre (1870) also published a paper to report his apparent success in curing epilepsy by circumcision.
Sayre (1875) published a paper to report that the foreskin causes curvature of the spine, paralysis of the bladder, and clubfoot.
Thereafter he continued to promote male circumcision for the rest of his life. Gollaher (1994) reported:
For the better part of three decades, until his death in 1900, he continued zealously to promote circumcision, discovering an amazingly wide array of benefits connected with the operation. Not only orthopedic problems, but epilepsy, hernia, and even lunacy appeared to respond. In 1875 he issued a pamphlet, Spinal Anemia with Partial Paralysis and Want of Co-operation from Irritation of the Genital Organs, in which he proposed that "peripheral irritation" from the foreskin could produce "an insanity of the muscles," the muscles acting "on their own account, involuntarily... without the controlling power of the person's brain."
Sayre died at his home at 285 Fifth Avenue in New York City on September 21, 1900 at the age of eighty.
- Gollaher, David L. (September 1994): From ritual to science: the medical transformation of circumcision in America, in: Journal of Social History. 28 (1): 5-36. Retrieved 23 May 2020.
- Sayre, Lewis A. (1870): Partial paralysis from reflex irritation, caused by congenital phimosis and adherent prepuce, in: Transactions of the American Medical Association. 21: 205-211.
- Sayre, Lewis A. (15 July 1870): Circumcision versus epilepsy, etc; Transcription of the New York Pathological Society meeting of June 8, 1870, in: Medical Record. 5 (10): 231-234.
- Sayre, Lewis A. (1875): Spinal anaemia with partial paralysis and want of coordination, from irritation of the genital organs, in: Transactions of the American Medical Association. 26: 255-274.
Dr. Lewis A. Sayre Dead; Noted New York Surgeon Succumbs to Old Age. Retrieved 24 May 2020.