It is all down to the masturbation panic that began in Britain in the eighteenth century and intensified in the nineteenth. That, in brief, is the explanation for the rise of circumcision in Britain between 1860 and 1930 according to historian Robert Darby. Physicians, worried that infants, boys and men might touch, tug or tickle their genitals and thus cause physical or moral harm, advocated the removal of the foreskin in order to make the penis less sensitive and to eliminate the need for a cleansing regimen that might inadvertently lead to arousal. The foreskin was thus demonized and its removal widely promoted.

In making the case that the vilification of male sexuality in general and masturbation in particular brought about the rise of circumcision, Darby's focus is the medical knowledge that made the foreskin a vulnerable target for surgical intervention. He shows how circumcision gained acceptance only after the foreskin was interpreted simultaneously as useless and dangerous. He suggests that the foreskin became expendable because physicians ‘lost’ or ignored previous knowledge about the form and function of the normal penis. Understanding of the critical importance of the foreskin in sexual pleasure gave way, he contends, to the fallacious belief that the foreskin was a superfluous flap of skin. Darby further claims that the lost knowledge of penile form and function led to the invention of diagnoses of non-diseases which could be treated, at least sometimes, with circumcision. He explores in detail two of these: ‘spermatorrhea’, understood as any involuntary seminal loss, and ‘congenital phimosis’, the condition of infants whose foreskin does not retract. Thus, in Darby's view, did circumcision provide a surgical solution to problems created by medical ignorance.

Although concentrating on circumcision, Darby along the way makes several provocative claims about the nature of medicine and medical practice. He firmly believes, for example, in a ‘modern’, ‘scientific’ medicine that emerged between the 1860s and the early twentieth century, qualitatively different from what came before. For Darby, circumcision's arising at the same time that medicine become scientific demonstrates ‘how easy it is for modern medicine to retain irrational elements from its variegated past’ (p. 319). The promotion and acceptance of circumcision, he argues, came about through a potent mix of sexual moralism, ‘medical errors’ and ‘imaginary diseases’ (p. 318). Darby complicates his argument, however, by suggesting that while much of the justification for circumcision reflected a medical ‘regression’ (p. 318), the rise of public health efforts, which he sees as part of medicine's modernizing trend, is also implicated. According to Darby, as disease prevention became more urgent after 1860, aided by both filth theories and germ theories of disease, circumcision gained popularity as a way to keep the soul pure and the penis clean. As a result, circumcision was held simultaneously to prevent syphilis, tuberculosis, cancer and damnation.

Darby also suggests that the status of the medical profession was not dependent on its most rational developments. He argues, for example, that the ‘masturbatory hypothesis’ – the idea that masturbation could cause a variety of physical and mental diseases – ‘was a crucial step in the rise of the medical profession’ (p. 61). His claim is that because the theory emerged at a moment when medicine's grip on disease aetiology and therapeutics was so weak, masturbation provided an all-too-rare explanation for disease and a variety of strategies for treatment, including circumcision.

Perhaps Darby's boldest move is his challenge of the feminist mainstay that women's sexuality was more carefully controlled by medical intervention than men's. Describing the simultaneous rejection of clitoridectomy and acceptance of male circumcision in the 1860s, Darby acknowledges a sexual double standard, whilst insisting that in the case of genital interventions ‘it worked to women's advantage’ (p. 144). Although readers may not be convinced, Darby usefully points out that historians who argue that men were largely free from genital surgeries overwhelmingly ignore male circumcision.

Darby is not a disinterested chronicler of this history. He makes it clear that he regards circumcision as a mutilation that has disfigured countless boys and men and diminished their sex lives. His outrage may sometimes colour his reading of the sources, but his passion also adds urgency and poignancy to the narrative. A Surgical Temptation is a fascinating and provocative read that connects the history of circumcision to larger social and cultural developments in Britain and beyond. It has much to offer contemporary debates on male circumcision, urging us to hear with scepticism the claim that circumcision improves penile hygiene or that it inhibits the transmission of HIV. It will also be useful to readers interested in medical understandings of sexuality and the history of the body. And since Darby shows that the rise of circumcision is also a story of medical innovation and the construction of medical expertise, his claims deserve to be considered by historians of medicine more generally.