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The United Kingdom (UK) was the scene of early efforts to promote male circumcision. It influenced the adoption of male circumcision in other English-speaking nations. Later it was the scene of efforts to reduce and eliminate the practice.

While Jews residing in the UK practiced ritual circumcision of boys on the eighth day of life in accordance with the Abrahamic covenant, the practice was nearly unknown among gentiles.

Introduction of circumcision as a medical practice

French physician Claude-François Lallemand (1790 – 1854) recommended circumcision as a treatment for spermatorrhea (excessive, involuntary ejaculation), which was then believed to be a disease. Lallemand influenced later English physicians such as William Acton.

Edward H. Dixon (1845) advocated circumcision to prevent masturbation.

Sir Jonathan Hutchinson (1828 – 1913) was an English surgeon, dermatologist, ophthalmologist, pathologist and venereologist. Darby describes Hutchinson as a puritanical and gloomy Quaker who disapproved of masturbation on moral grounds. Sir Jonathan advocated circumcision to prevent syphilis.

Nathaniel Heckford, a pediatrician at the East London Hospital for Children, wrote Circumcision as a Remedial Measure in Certain Cases of Epilepsy, Chorea, etc. (1865), in which he argued that circumcision acted as an effective remedial measure in the prevention of certain cases of epilepsy and chorea.

Sir Jonathan Hutchinson started to promote circumcision to prevent masturbation in 1890. He first published A Plea for Circumcison,, followed by On circumcision as a preventive of masturbation.

Sir Jonathan was not yet done. He published yet another article On Circumcision in 1893.

Sir Frederick Treves (1853 – 1923), a prominent Harley Street surgeon, who is known to us by The Elephant Man film, wrote an operative manual in 1903 to educate other surgeons in the performance of the circumcision amputation. The practice of male circumcision was well established in the United Kingdom as the nineteenth century ended.

The royal family and circumcision

There is a long-standing legend or legends about the royal family and its alleged practice of male circumcision that has long been circulated in the print media and orally. According to the legend:

Queen Victoria believed that she was descended from the Jewish King David of the Bible. She had her sons circumcised in accordance with Jewish practice. After Queen Victoria's death succeeding generations of the royal family continued the practice.

Both Edward VIII, later Duke of Windsor, and Prince Charles were ritually circumcised by Dr. Jacob Snowman, a medical doctor and mohel. The practice ended when Prince Charles and Princess Diana had children. Princess Diana objected to the practice, so Princes William and Harry were not circumcised. Prince George also was not circumcised.

Robert Darby and John Cozijn thoroughly investigated the legend and were unable to verify any of it. Moreover, they showed evidence that it cannot be true.

Although this long standing legend cannot be proved to be true, it was generally believed to be true. It is probable therefore, that many parents had their sons circumcised because the royal family was believed to do it.

Twentieth century

Sir Jonathan Hutchinson (1900) opened the twentieth century with an article advocating male circumcision as a way to decrease the pleasure of sex, and hence to discourage sexual immorality.

Cockshut (1935) published a letter in the British Medical Journal that urged circumcision of all male infants because the "glans of the circumcised rapidly assumes a leathery texture less sensitive than skin." The advantage, according to Cockshut, is that masturbation would be reduced.

Rickwood et al. (2000) reported that the incidence of boys circumcised reached 35 percent by the early 1930s.

Reduction of practice

A national election was held in the United Kingdom at the end of World War II. The Labour Party gained a majority of the seats in Parliament and its leader, Clement Atlee became prime minister. The party leaned to the left and supported social welfare. Aneurin Bevan was Minister of Health. The National Health Service (NHS) was created in 1948 to provide free medical treatment for all. Services were provided based on clinical need, not ability to pay.

Sir James Spence, a prominent senior British paediatrician, urged his younger colleague, Douglas Gairdner, to produce a paper on infant circumcision. The now famous classic paper, The fate of the foreskin: a study of circumcision, was published on Christmas Eve, 1949 in the British Medical Journal. The paper reported 16 deaths per year from non-therapeutic infant circumcision and concluded in part: "The prepuce of the young infant should therefore be left in its natural state."

The NHS provides male circumcision when there was a clinical need. There is no clinical need for infant circumcision, so infant circumcision is not provided.

The British Medical Journal, the house organ of the British Medical Association, in an unsigned editorial in 2979, slammed the practice of child circumcision, calling it unnecessary, and citing the danger of contracting staphylococcal infection in the newborn nursery. The editorial reported that the incidence of newborn circumcision in Britain had dropped from one-third in the 1930s to one fifth in 1949, to ten percent in 1963, and to six percent in 1975.

Phimosis diagnosis issues

Fewer boys were being circumcised so there were more foreskinned boys. The general practitioners (GPs) in the UK seemed to be unable to distinguish between true phimosis and developmentally non-retractile healthy foreskin and were referring numerous boys for unnecessary circumcision.

Rickwood et al. (1980) had provided guidance on diagnosis of phimosis. According to Rickwood et al. true phimosis occurs when the foreskin has been attacked by balanitis xerotica obliterans (BXO) (also known as lichen sclerosis). If BXO is not present then true phimosis does not exist.

Several papers critical of phimosis diagnosis practice in the UK were published in the late 1980s and early 1990s. Rickwood & Walker (1989) reported that in the Mersey region (northwest England) "many boys are circumcised for development non-retractability of the prepuce rather than for true phimosis and that in consequence some two-thirds of the operations are unnecessary." Griffiths & Frank (1992) also expressed concern regarding the apparent inability of general practitioners to distinguish between a true phimosis and a developmentally non-retractile foreskin. They pointed out, "Not surprisingly, the diagnostic inaccuracy was greatest when the referring doctor did not examine the patient." Gordon & Collin (1993) attempted to cast some light in the darkness by providing factual information about actual indications for circumcision and how to distinguish between physiological and pathological phimosis. Williams et al. (1993) complained that most of the 30,000 circumcisions that were being done in the UK were on boys under 15. They reported that of 69 boys referred by GPs, 29 had a healthy retractile foreskin, 30 had a healthy non-retractile foreskin, and only 9 had a phimosis requiring circumcision.

In defence of the much criticised British GPs, it should be stated that the data they were provided by Douglas Gairdner regarding development of foreskin retractability was very inaccurate, however this was not known at the time.