Curing Cut or Ritual Mutilation?

: Some Remarks on the Practice of Female and Male Circumcision in Graeco-Roman Egypt Author(s): Mary Knight Source: Isis, Vol. 92, No. 2 (Jun., 2001), pp. 317-338 Published by: The University of Chicago Press on behalf of The History of Science Society Stable URL: http://www.jstor.org/stable/3080631 . Accessed: 21/05/2011 21:41
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Curing

Cut

or

Ritual

Mutilation?

Some Remarkson the Practiceof Female and Male Circumcisionin Graeco-Roman Egypt
By Mary Knight*

ABSTRACT

Ancient texts and archaeologicalartifactsprovide the startingpoint for a review of the surgical aspects of female genital mutilation (FGM) in ancient Egypt. Analysis of the ancientsurgicalprocedureincorporates moder experienceon the subjectas well as ancient literary and culturalperspectives. Comparisonof FGM with ancient Egyptian male cirof to cumcision andconsideration motivationsfor the practicecontribute ourunderstanding of FGM. In particular,the documentedassociation between male circumcision and generative ability suggests a novel comparison with a naturalprocess in the female-the breaking of the hymen on first intromission-and ultimately a new hypothesis for the origin of ancientFGM.

LONG VIEWED AS AN ANCIENT and exotically perplexing land, Egypt frequently

harbored customs, notably those marked by gender, the opposite of Greek and Roman ones. Thus women were said to run the markets in Egypt while their men did the weaving; daughters were obliged to maintain their parents in old age while sons were absolved; and men were dedicated to the gods while women were not. Public, private, and religious customs were not the only ones identified as "upside down" by classical writers; personal, physical matters were also affected. Herodotus notes, for example, that Egyptian women urinated standing up, while their men squatted to perform the same act.' Some of these claims must surely be viewed with skepticism, particularly in light of archaeological and philological studies of Egyptian culture; yet one practice continues to be considered an
* AmericanUniversity in Cairo, 113 Shari'a Qasr al-'Aini, P.O. Box 2511, Cairo 11511, Egypt. I would like to thank the anonymous referees of this essay, who provided valuable suggestions for its improvement.An earlierversion,presentedat the AmericanPhilologicalAssociation's annualmeetingin December 1998, was selected as best oral paper for the year by the Women's Classical Caucus, whose supportand encouragementI would like to acknowledge publicly. Special thanks are also due to Dr. Fayza Haikal for her advice and encouragement.All translationsare my own, except as indicated. 1Herodotus,Historiae, 2.35. In 2.64 Herodotusremarksthat sometimesEgyptiansand Greekstogetherfollow certain customs the opposite of those of the rest of the peoples of the world: e.g., Egyptians and Greeks both abstainfrom having sexual intercoursein temples, whereaseverywhereelse such sexual practicesare a common featureof temple ritual. Isis, 2001, 92:317-338 ? 2001 by The History of Science Society. All rights reserved. 0021-1753/01/9201-0001$02.00 317

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CURINGCUT OR RITUALMUTILATION?

ancient Egyptiancustom, in partbecause of its persistencein Egypt to this day. aberrant Thatcustom is excision of the clitoris and otherexternalfemale genitalia,sometimescalled female circumcision but now usually referredto in Egypt as female genital mutilation (FGM); the first extant literary mention of it is by the Greek geographerStrabo, who visited Egypt in about 25 B.C.E.: "This is one of the customs most zealously pursuedby them [the Egyptians]:to raise every child that is born and to circumcise the males and excise the females."2 Moder commentatorshave frequentlyconsidered FGM in Egypt an ancient solution to venery-that is, excessive sexual desire and indulgence of sexual desire. The assumption that the custom was rooted in extinguishingfemale desire has found favor especially in the West, in partbecause a similarmotivationis occasionally cited in Egypt today.3 Was FGM really practicedin antiquityas a preventativetreatmentfor venery? Since FGM has long been consideredan operationthat mirrorsmale circumcision,were males likewise circumcisedto preventexcessive sexual indulgence?This essay will firstexplore surgical aspects of FGM as revealed in ancient medical sources to determinewho was operatedon and why. Next, a comparisonwith male circumcision and considerationof studies of the moder practice of FGM in Egypt will highlight some of the various rationales for such surgical procedures,including the preventionof venery. Finally, a hypothesis for the origin of FGM will be proposed.
THE PROBLEMATIC NATURE OF THE EVIDENCE

Before examining the ancient evidence, such as we have, for FGM, it is prudentto take of into account the problematicnatureof the evidence and interpretation it as a whole. It is patentlydifficultto investigateconclusively surgicalproceduresconductedat a distance of more than two thousand years and in the absence of the living patients themselves. Significantly,we have no textual sources by women, only by men, although it must be grantedthat the medical sources as a rule "containprivilegedinformationobtainableonly from women [and] were directed at a female clientele," since a numberof gynecology manualsare thoughtto have been writtenfor midwives.4 A related issue is the discrepancybetween how ancient male physicians and surgeons
TxoOo6 Tc&v Tro Strabo,Geographika,17.2.5: Kai patdA-ra Tpe(petv x kLougg:vcov ntap'abcxolq zavrta To zEptxi;vestv Tr 0f)Xa cKai In Egypt today the procedure is more 9taKreiveiv. y?vvcfueva zat&a icia or than as (Tahaara), commonly characterized a mutilation(batr, lit. "mutilation" "amputation") as a purification because there is general agreementthat removal of an organ (as opposed to purely cutaneoustissue) constitutes a mutilationand that most instancesof khitaanal-binaat ("femalecircumcision")in fact involve removal of the clitoris-not mere cutaneoustissue. 3 In a 1997 survey of fourteenthousandEgyptianwomen, 9.1 percentof respondentssaid thatFGM preserves a girl's chastity, yet it is an assumptionthat this preservationresults from a decrease in desire. For the results see MuhammadFayyad,Al-batr al-tanasuli li-l-inath (Cairo:Dar al-Shuriiq,1998), p. 146. Popularwriterson ancient Egypt in particulartend toward simplistic analyses of FGM-see, e.g., Joyce Tyldesley, Daughters of Isis: Womenof Ancient Egypt (New York: Penguin, 1994), p. 289 and n. 2 (cf. her comments on p. 150); and Dominic Montserrat, and Society in Graeco-RomanEgypt (New York:Kegan Paul, 1996), pp. 42-44-but Sex their works, because they are accessible to nonspecialists,are frequentlyconsulted by researchersinterestedin the modem situation. 4 Leslie Dean-Jones,Women'sBodies in Classical Greek Science (Oxford:Oxford Univ. Press, 1994), p. 27. See also the discussion of the female medica and midwives in Gillian Clark,Womenin Late Antiquity(Oxford: Oxford Univ. Press, 1993), pp. 67-70. On the absence of sources by women see ibid., pp. 64-66; and Helen King, "Boundto Bleed: Artemis and GreekWomen,"in Images of Womenin Antiquity,ed. Avril Cameronand Am6lie Kuhrt(Detroit,Mich.: Wayne State Univ. Press, 1983), pp. 109-127, esp. pp. 109-110. King explores the implicationsof this biased recordingof women's bodies and diseases in Hippocrates' Woman:Reading the Female Body in Ancient Greece (New York: Routledge, 1998).
2

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319

viewed the female body and how women viewed theirown bodies-how they understood the functioning of their own parts, as it were. Yet even if we had clear-cut evidence of of ancient Greek women's understanding their bodies, we would still be hardpressed to this view wholesale to Graeco-Egyptianfemale groups throughoutthe centuries apply during which Greek was the language of the ruling classes. Not only were Greeks and Egyptiansliving largely separatelives, but Greeksin majorcities such as Alexandriaand Ptolemais may have differed significantly,both materiallyand culturally,from theircousins in smallercities and in villages. Equally problematicis the issue of Greek inheritanceof FGM as a custom from the Egyptians. We note that Strabo considers the practice a distinctively Egyptian one. (He attributesit to the Jews of Judaeaas well-but, notably, he considers them Egyptians.5) Did Greeksin Egypt practiceFGM, and, if so, were thereculturalpressuresfor accepting it either as a surgical procedureor as a custom akin to circumcision?As we shall soon see, the paucity of evidence, even by male writers,raises more questions than it answers. Culturalbias-both ancient and modern-is anotherelement that furthercomplicates ourreadingof the past. This elementcannotbe satisfactorilyevaluatedwithouta reasonable estimate of the extent to which Greeks embracedthe practice of FGM. The fact that the extant surgicaldescriptionsdo not appearin any language familiarto Egyptianaudiences until after the Islamic conquest is telling in this regard,althoughprecisely what it tells us is similarlyproblematic:assumingthattherewere no surgicaldescriptionsin the Egyptian literature-a reckless assumption,to be sure-it could be that only the ruling Greek and Romanclasses engaged surgeonsor othersproperlytrainedto performthe procedure, while resortedto folk practitioners trainedorally and by experience or to individuals Egyptians invested with the duty of ritualtradition. More darkly,it is possible that Greekand Romanwriterswere biased againstEgyptians as pdappacpot inclusion of FGM in their manualscould thus be construed ("foreigners"); as a fetishizingof the colonized, but only if the Greeksin Egypt themselvesdid not embrace the practice.6There is some evidence that, just as the female was viewed as "different" from the male, the woman of Egypt may have been considered"different" from her counterpartin Greece or Rome. Women in Greece were thoughtto be predisposedto hysteria,one cause of which was a lack of sexual intercourseand of interest in it; treatmentfor the condition frequently involved fumigations.7 contrast,women in Egypt were renownedfor their sexual proBy clivities, and, thus, excision and other forms of FGM may have been conceived by male Greek medical authoritiesas primitiveEgyptian solutions to an Egyptianproblem.8Cers In 16.2.37 Strabo describes circumcisions and excisions as 6ion'tSatgoviat of ("superstitions") Jews who had forgottenthe pious religion of Moses; in 16.2.34 and 17.2.5 he considers the Jews a tribe of Egyptians.His source for these passages and anotherthat refers to the practice of male circumcision among people bordering the Red Sea (16.4.17) appearsto be Artemidoros(cf. 16.4.16, 19), who lived in the late second and early first centuriesB.C.E. Strabodid not visit the Red Sea coast or Judaea,althoughhe spent several years in Egypt. 6 The hypothesisaboutbias againstforeignersshouldnot be dismissedlightly, given thata numberof Egyptian and Arab intellectuals today express such opinions when reviewing the ancient testimony. Another opinion commonly heard is that since the evidence is in Greek and not in Egyptian, only the Greeks were practicing FGM. The custom is then seen as anotherdegeneratecolonialist import. 7 Hippocrates,Gynaikeia, 1.7. Lesley Dean-Jones, "The Politics of Pleasure:Female Sexual Appetite in the HippocraticCorpus,"Helios, 1992, 19:72-91, esp. p. 79 f., commentson the practicaland political implications of the Hippocraticmodel of female sexual appetiteas describedin this passage. See also Helen King's comments on the ambiguitiessurrounding hysteriain Hippocrates' Woman(cit. n. 4), pp. 212-222. 8 Strabo,17.1.16, refers to the wantonness(kaolupia) of the women and men who engaged in sexual escapades at Canobusin Egypt. The activity had become proverbial,being dubbedthe "Canobiclife" (Kavop3tayl6g).See also Montserrat, and Society in Graeco-RomanEgypt (cit. n. 3), pp. 106-135, on the sex industryin Egypt. Sex

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CURINGCUT OR RITUALMUTILATION?

tainly, the licentiousness of Egypt was a topos contrasted,especially in Augustus's propaganda,with Roman virtue and modesty; the countrywas depicted as morally loose, its last queen (actually a MacedonianGreek) as an Aphroditewho seduced a drunkenDionysos.9 Yet there is no explicit differentiationof the Greek/Romanwoman from the nonwoman in the medical literature,and it appearsthatordinary Greek/Roman Egyptiansand Greeksin Egypt may have valued female modesty as much as theirRomancounterparts.'0 of The rhetoricalandfetishizingcharacter manyof the GreekandLatinworkson foreign customs is itself filteredby moder interpreters throughyet anotherlayer of culturalbias. In the case of FGM, how much of the classical traditiona readermay be willing to reject out of handas mererhetoricmay correlatewith how willing he or she is to considerancient from their Arabizeddescendants,especially when the topic in quesEgyptians"different" tion is unpleasant,shameful,or culturallyunacceptableby the reader'sstandards. There is still anotherproblemposed by the evidence that ties in with culturalbias, and this problemforces us to focus on the very root of our word "medicine"(the artof healing or curing). We tend to frame our understandingof the medical proceduresof another of culturewith the medical standards our own cultureor society, and this essay will be no uniformlyconsiderthe ritualexcision (litexception: moder Egyptianmedical standards ratherthan healing the patient because the erally, cutting out) of the clitoris as harming clitoris is an organ and not superfluoustissue." Likewise, moder Egyptianmedical standards suggest the use of variousterms,includ"femalegenital mutilation."As background,it may be helpful for readersto note that ing Africa and Egypt today, is FGM, althougha widespreadpracticethroughoutsub-Saharan not universallythe same operation.(See Figure 1.) Rather,there are severalrecognizable "degrees"of mutilation, with the preferredchoice depending on local custom.12 Some authoritiesaccept the mere pricking of the clitoris with a needle as a true circumcision,
9 Plutarch, the referencepoint for understanding earlyAugustan Antonius,26. The topic has become a standard period. See also Peter Green,Alexanderto Actium: The Historical Evolutionof the Hellenistic Age (Berkeley: Univ. CaliforniaPress, 1990), p. 678 f.; Paul Zanker,The Power of Images in the Age of Augustus(Ann Arbor: Univ. MichiganPress, 1990), pp. 57-65; and SarahB. Pomeroy,Goddesses,Whores,Wives,and Slaves: Women in Classical Antiquity(New York: Schocken, 1975), p. 188. 10 That young women should remain virgins before marriageseems to have been the rule-see Montserrat, Sex and Society in Graeco-RomanEgypt (cit. n. 3), p. 87-though less is known about the sex life of native women, who are frequentlyrepresentedin the literatureand papyri and on Egyptian than of Graeco-Egyptian archaeological artifacts.For references on modesty in Roman life see Elaine Fanthamet al., Women in the Classical World (Oxford: Oxford Univ. Press, 1994), pp. 295-306; and Paul Zanker,ibid., pp. 156-166. See also Jody RubinPinault,"TheMedical Case for Virginityin the EarlySecond CenturyC.E.: Soranusof Ephesus, Gynecology 1.32," Helios, 1992, 19:123-139, on the emergence in the imperialperiod of lifelong virginity as a healthy goal. I One survey of doctorsfound that 98.5 percentopposed the circumcisionof girls; the remaining1.5 percent, Fayyad, althoughthey claimed to accept the practice,would not performthe operationon their own daughters: Al-batr al-tanasuli li-l-inath (cit. n. 3), p. 152. 12 On the extent of the practice of FGM see Fran P. Hosken, The Hosken Report, 4th rev. ed. (Lexington, see Network News, 1993), p. 13. Classificationschemes vary among authorities; Mass.: Women's International the discussion in Mahmoud Karim, Female Genital Mutilation (Circumcision):Historical, Social, Religious, Sexual, and Legal Aspects (Cairo: National Population Council, 1998), pp. 26-34. See also Nahid Toubia, "FemaleCircumcisionas a Public Health Issue," New EnglandJournal of Medicine, 1994, 331:712-716; Otto Meinardus,"Mythological,Historical,and Sociological Aspects of the Practiceof Female Circumcisionamong the Egyptians,"Acta EthnographicaAcademiae ScientiarumHungaricae, 1969, 16:387-397; and A. Huber, "Die weibliche Beschneidung," und ZeitschriftfiirTropenmedizin Parasitologie, 1969, 20(1):1-9. Surgicaltechniques and complicationsof the modem procedureare outlined in Karim,Circumcisionsand Mutilations,Male and Female: MedicalAspects (Cairo:Dar el-Ma'aref, 1995), pp. 45-66; see also Ahmed Abu-el-FutuhShandall, of of "Circumcision Infibulation Females:A GeneralConsideration the Problemand a Clinical Study of the and Complicationsin SudaneseWomen,"SudaneseMedical Journal, 1967, 5(4):178-212, for a complete review of FGM, including surgical aspects, in Sudan.

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321

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PRACTICE FGM OF AFRICA THROUGHOUT ANDSAUDI PENINSULA

-I

DEGREE THIRD FIRST SECOND OR DEGREE

practicedin manyparts of Africaand in the south of the Arabian Figure 1. FGMis stillcommonly it of Peninsula;significantly, is not practicedin the Kingdom SaudiArabia.In Egypt,first-or secondin are circumcision third-degree degree circumcisions the normforthose girls who are circumcised; J. by Egyptis rare.(Illustration Patricia Wynne.)

the it or if damage disfigurement performed correctly; apalthough causesno permanent is thenof intactfemalegenitalia. this type aside,the mildestformof Leaving pearance FGMusuallyrecognized suchinvolvesremovalof the hood of the clitorisonly, the as and The labiaminora only,orboththehoodof theclitoris thelabiaminora. second-degree it of of formentailsthe removal the entireclitorisandusuallyportions the labiaminora; than that is theremoval theclitoris characterizes seconddegreeas moreradical the of this first,sincethe clitorisis an organandnot merelyskin,like the labiaor the hood of the formof FGM,calledinfibulation, clitoris,labiaminora, the clitoris.In the mostradical area shut andportions thelabiamajora all excised; addition, genital is sutured of are in the

322

CURINGCUT OR RITUALMUTILATION?

with threador, often, with thorns, leaving only a tiny orifice for urinaryand menstrual flows. (See Figure 2.) This last type of FGM is relatively rare in Egypt today but not unknown,being found primarilyin the far south, where it is dubbed "Sudanesecircumcision."13
THE MEDICAL SOURCES: THE SORANUS "FAMILY"

One question that arises from a review of the modern clinical classificationsof FGM in Egypt today is whethersimilar distinctionswere apparentin antiquity.Did ancientoperators consciously choose what parts of the anatomy would be excised and were there distinctive degrees of mutilation?As we shall see, ancient evidence of the surgical proof cedure in fact demonstratesa clear understanding certaincomponentsof female anatin particular distinctionbetween the clitoralorganand nearbytissue. Notably,there a omy, is no extant descriptionof infibulation,the most radicalform of FGM. One of the earliestextant notices of the procedureis but a rubric,or chaptertitle, Ilpi unsppey80ou; v6p?qT; ("Onan excessively large clitoris"),from the Gynecologyof Soranus, a second-centuryC.E.physician. It is importantto note that the original Greek text of this chapter,with Soranus'sown words, has not survived,nor is there any referenceto excision of the clitoris or any other form of FGM in his extant works. Confusion on this issue occasionally arises for moderninvestigatorsof FGM because of a certainMuschio or Mustio, probablyof the sixth century,who translatedSoranus'swork into Latin;Muschio's work apparentlygained currencyat least by the ninth century, and, in addition,a the into poor, very late retranslation Greekwas made.This work,notwithstanding fact that the words are not Soranus'sown, gives a fair indicationof what his accountactuallywas. Section 2.25 says:
On the excessively large clitoris, which the Greeks call the "masculinized" [reading"yos" as a Latinized Yril/Ya;, the god of fertilizing moisture] nymphe [clitoris]. The presenting feature [a6ow~rxpa]of the deformityis a large masculinizedclitoris. Indeed, some assertthat its flesh becomes erect just as in men and as if in search of frequentsexual intercourse.You will remedyit in the following way: With the woman in a supineposition, spreadingthe closed legs, it is necessaryto hold [the clitoris] with a forceps turnedto the outside so that the excess can be seen, and to cut off the tip with a scalpel, and finally, with appropriate diligence, to care for the resultingwound.14
13 circumcision":see H. M. Hathout,"Some Interestingly,in Sudan infibulationis referredto as "Pharaonic Journal of Obstetricsand GynaeAspects of Female Circumcisionwith Case Reportof a Rare Complication," cology of the British Commonwealth,1963, 70:505-507; and Shandall,"Circumcisionand Infibulationof Females," (cit. n. 12) p. 179. Shandall's article thoroughly reviews the practice in Sudan, although it is now and somewhatoutdated.See also Allan Worsley, "Infibulation Female Circumcision:A Study of a Little-Known Custom,"Journalof Obstetricsand Gynaecologyof the BritishEmpire,1938,45:686-691; andHannyLightfootKlein, Prisoners of Ritual: An Odyssey into Female Genital Circumcisionin Africa (New York: Hanworth, 1989). 14 Soranus, Gynaikeia,4.9 (370), in Sorani Gynaeciorumlibri IV, ed. JohannesIlberg (CorpusMedicorum Graecorum, (Leipzig: Teubner, 1927), p. 147 (chaptertitle). For Muschio's Latin version see Sorani Gynae4) ciorumvetustranslatiolatina, ed. ValentinRose (Leipzig:Teubner,1882): "De inmoderata landica,quamGraeci yos nymphin appellant. (76) Turpitudinissymptoma est grandis yos nymfe. quidam vero adseverantpulpam ipsam erigi similiter ut viris et quasi usum coitus quaerere.curabis autem eam sic. supinamiactantespedibus clusis myzo quod foris est et amplius esse videtur, tenere oportet et scalpello praecidere,deinde conpetenti diligentia vulnus ipsum curare."This Latin translationbecame the most frequentlyused source for translations of Soranusinto modem languages;see the Bude text of Soranus:Maladie des femmes, trans. and commentary by Paul Burguiere,Danielle Gourevitch,and Yves Malinas (Paris:Belles Lettres, 1988-1994), Vol. 1, pp. xlix1. For an example of modem confusion regardingSoranus'swork see Hosken, HoskenReport (cit. n. 12), p. 7.

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323

FEMALE GENITALIA EXTERNAL

CLITORIS

URETHRAL ORIFICE

LABIA MINORA

VAGINAL ORIFICE.

OF DEGREES MUTILATION DEGREE FIRST DEGREE SECOND THIRD DEGREE

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CLITORIS REMOVED REMOVED MINORA LABIA

REMOVED LABIA MAJORA MINORA REMOVED LABIA REMOVED CLTORIS

with 2. external female degrees genitalia arecontrasted thethreemostcommon (top) Figure Intact in circumcisions practiced ancient were There no evidence third-degree is that of mutilation (bottom). this is J. and (IllustrationPatricia Wynne.) by Egypt, eventoday form rare.

324

CURINGCUT OR RITUALMUTILATION?

A betterperspectiveon Soranus'soriginal accountmay be taken from the Gynaeciaof Caelius Aurelius, a fifth-centuryC.E.physician from Sicca Veneria (modem el-Kef in Tunisia) who synthesized much of Soranus's work. In a chapterentitled "De immodica landica"("On an excessively large clitoris"),he wrote,
A dreadfulsize attendsto certainclitoridesand it upsets the women with the ugliness of the parts,and, as many relate, when it is affectedby immoderatetumescence,these women acquire an appetitelike men, and when [the clitoris] is so driven, they come into venery. The woman is placed in a supine position with her thighs slightly togetherso they do not have recourseto too much of the space of the female cavity. Then the superfluousamountshould be held with a forceps and an appropriate amount cut off with the scalpel. For if it is stretchedout to its greatestlength, ** may follow, and it may cause hurtto the patientwith a very large discharge from the cuttingoff. But aftersurgery,a remedythatkeeps [the wound]undercontroland [that] ** should be applied.15

Roundingout perspectiveson Soranus'soriginalaccountis a medieval Arabicdescription of the operation,by the eleventh-century physician al-Zahrawi,which is thoughtalso to derive from Soranus:
The clitoris may grow in size above the order of natureso that it gets a horribledeformed appearance;in some women it becomes erect like the male organ and attains to coitus. You must graspthe growthwith your handor a hook and cut it off. Do not cut too deeply, especially at the root of the growth, lest hemorrhageoccur. Then apply the usual dressing for wounds until it is healed.16

This excerpt by al-Zahrawiis intriguing not only because it underscoreshow popular Soranus's work must have been, but also because it is the earliest extant account of the
15 et landicis horrida comitatur 2.112:"Quibusdam Caelius Aurelius, magnitudo feminas partium Gynaecia, et virorum similemappetentiam sumant in feditate confundit ut plerique memorant, adfectetentigine et, ipse ne mulierlocanda conductis est venerem coacteveniunt. femoribus, febresinusdistantiam denique suppina

sumant. tunc [in] midio est tenenda superfluaatque pro modo alienitatis sue scalpello precidenda. si enim longitudinesequetur** atqueita inmodicedecissionis largofluoreafficitpatientem. ponrecta plurimumextenditur set post cirurgiamerit adhibendacohercensatque** curatio."The most accessible editionof this work is Caelius AurelianusGynaecia:Fragmentsof a Latin Versionof Soranus'Gynaeciafroma Thirteenth-Century Manuscript,

F. and E. Bulletin theHistory Medicine ed. Miriam Drabkin Israel Drabkin, 13), of of (Suppl. 1951(seep. 113).
16

Al-Zahrawi(often called Abu al-Qasim or Abucasis in the West), Surgery,2.71:

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A in Text and translation Abucasis On Surgeryand Instruments: DefinitiveEditionof theArabic TextwithEnglish Translationand Commentary,ed. and trans. M. S. Spink and G. L. Lewis (Berkeley: Univ. CaliforniaPress, and 1973), p. 456 f. For al-Zahrawi'srelianceon Greeksources see Sami KhalafHamarneh Glenn Sonnedecker, A PharmaceuticalView ofAbulcasis al-Zahrawiin Moorish Spain (Leiden:Brill, 1963), p. 54.

MARY KNIGHT

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procedurein Arabic and the first time a description of the operation would have been accessible, to one degree or another,to the native populationof Egypt.'7 In the extantwork of Soranusthereis a discussionof cuttingaway a irpijv,or membrane, that obstructedvaginal flows, but this was not a form of FGM. A close readingclarifies that the operationhe recommendsis indicatedin girls not involved in exercise who still one do not menstruate."As for those who on accountof some disease do not menstruate, must treatthem accordingto the disease thathas caused the suppressionof the menses. In those who lack a vaginal opening, cut aroundthe membraneor flesh, soften and adjustthe shapeof the callous overgrowth,relieve the inflammation gentle means,reduceas much by as possible the scarred-overwound, relieve [undesirable]closures or deviations." The conditionis caused, most commonly, by an imperforate hymen or labial adhesionsor, less commonly, by genetic defects that result in the lack of a vaginal opening. In such cases, as Soranusindicates, one should cut away the obstructingmembrane-Greek 6giIv, not equivalentto the structureknown in Fnglish as the hymen-and cosmetically repairthe area.18 Paul of Aegina, a seventh-century physician of Alexandria,is known to have borrowed heavily from Galen and Oribasiusfor his seven-book EpitomElatrikU,of which Book 6 is devoted to more than 120 surgical operations;it is more likely, however, that Soranus was the source for his discussion of surgeryfor an excessively large clitoris. This conclusion is based on the fact that the descriptionaccords in most of its particulars with those Paul states: passages alreadycited whose lineage to Soranusis more firmlyauthenticated. An immense clitorisoccursin somewomen, suchthatthere a becoming shameful ugliness, arereports someof thewomenhaveerections thispart likemenandeagerly that of desire just sexualintercourse. we Thus,withthe womanin a supineposition, takeholdof the excessof the clitoriswitha smallforcepsandcut it off witha surgeon's knife,whileguarding against state doesnot developfromit. too cutting deeplyso thata rhyadikos [urinary fistula] The Soranus family of medical reports all highlight the excessively large clitorides of affected patients as well as the shamefulnessthat resulted from erections and the desire for sexual indulgencethatattendedsuch physical,but natural,deformities.19 placement The
17 It should be noted that female circumcision is not an Islamic religious practiceand that it is not practiced by the Arabsof the Kingdomof SaudiArabia.The primarysupportfor it as Islamic derives from a hadith(report of the Prophet'ssayings) that was consideredunreliableby the collector, Abu Dawud. It is found in his Kitaab al-sunan (Jidda:Dar al-Qibla li-l-Thaqaafaal-Islaamiya, 1998), Vol. 5, section on adab, no. 182, no. 5229, p. 456. See also the discussion on the Islamic sources in Fayyad,Al-batral-tandsuli li-l-inath (cit. n. 3), pp. 109117. 18Soranus, Gynae., 3.2b.9 (Ilberg ed. [cit. n. 14]): Tas;6 6tadxt rdaOogiTlKaOatxpougivaq aKokou60x; Tx(nCicotil6KOTi nd0dt Tiiv bcoX'qvT&Yv v uteva f TxivJapKa itp4vomv 0epareuxerov, xepiK6xTovra ev b5v ti Tv raTpfTrov, 8e paXdacovra 8E Kalci eTraaouycp(vovTa ReptT6X.oxnv icai TOvotpov, xaXZvTa TIV Tiv (p.e?'yov'iv, XeInivovra 8e '. CrOTIV oiU5iv, avItvTa i T U6at5 5Kai crapeyTx1v ra; inap1yoOptK<;q ; ickoct;. The obstructionof menstrualflows because of the lack of an outlet was noted by other ancientmedical writers-e.g., Oribasius,latrikon synagogon, 24.32-and by medieval ones as well-al-Zahrawi, Surg., 2.72. The modem solution is similarto the ancientone describedby Soranus:a simple cruciateincision into the hymen. See J. RobertWillson et al., Obstetricsand Gynecology (St. Louis: Mosby, 1987), p. 99. 19 Paul of Aegina, De re medica, 6.70, ed. I. L. Heiberg(CorpusMedicorumGraecorum, Heiberg(Leipzig: 9.2) :iesav KaOdx8E xtVe; Teubner,1924): 'YceppsytOTj; tv(at; yiverat v4u<ptKai eig dtip atiXrv6q; anQavx.* q ouvouoiav O6pAt&nv. icrtopoatv, tvtcat Sta TOO) pepoiu; Kca opOtdaouotv iv6pdctv 6ooifo Kral tcpo5; TbO Tf; It6oiep Tixtai; goXaTattopgvT1;xf; yvvatuKcb u5i&p KaTacaXa6vre; eptTTOv vu6p5r; cxKTEoa)ev aif.I ic (ppuXaTT6pevot ti c jd0ou; abTiv xKT?ivetv, Iva nh puaSIKucv Txo6Tou y:vixrat RdOo;.On Paul of Aegina see E. F. Rice, "PaulusAegineta," in Catalogus translationumet commentariorum: Mediaeval and Renaissance Latin Translationsand Commentaries,Vol. 4, ed. F. E. Cranz and P. 0O.Kristeller(Washington,

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of the passage in Paul's text, immediatelyafter a descriptionof surgeriesfor hermaphroditism, may be significant,suggesting that clitoridectomywas a procedurefor intersexed persons, although this is far from certain;by comparison,the context for the passages taken from the works of Muschio and Caelius Aurelianusis cancer-like growths in the uterus. Because nymphotomywas known among Greeks as somethingpracticedby the Egyptians, and because Paul of Aegina himself lived in Alexandria,it has been assumed that he is describingEgyptianpractice,thoughhe does not specifically say so. As an aside, we might note here that thereis otily one citation from antiquitythat suggests thatFGM may have been practicedoutside Egypt. Extantfragmentsfrom a fifth-century B.C.E.historyof of Lydia by Xanthos of Lydia, a contemporary Herodotus,say: TheLydians arrived sucha stateof delicacy theywereeventhefirstto "castrate" at that their women ... ThusXanthos in his secondbookon theLydians Adramytes, kingof that the says theLydians, the usedtheminstead maleeunuchs.... Inthesecond of book, castrating women, he reports Gyges,the kingof the Lydians, the firstwho "castrated" that was women,so that he mightuse themwhiletheywouldremain forever youthful. There is a problem,however, with equatingthe "castration" referredto here with FGM. The operationis not described,for one thing; and the explicit purposeof the "castration" was to keep the women youthful,presumablyso that the Lydianking could have frequent intercoursewithoutfear of causing pregnancy,since the verb Xpdooat (here translated as a form of "to use") means "to be intimatewith someone."20 FGM does not have any effect on reproductive ability or on fertility.Althoughthis is mere speculation,it is possible that the Lydians had invented a means of permanentlysterilizingwomen.
THE ANCIENT MEDICAL SOURCES: GALEN AND AETIOS

More remarkablethan the Soranus family of descriptionsof the surgical procedureare two accounts that definitively place the practicein Egypt. The first is a brief mention of the operationin a work (Eiaaycoyi i] ia'p6o; ["Introduction; Physician"])that has or, been ascribed to Galen (fl. mid-second century C.E.) but whose authenticityis suspect: "Betweenthese [labiamajora],a small bit of flesh, the clitoris, grows out at the split.When it sticks out to a great extent in their young women, Egyptiansconsider it appropriate to cut it out."21(Galen may have describedthe operationin detail, but such an accounthas not survived.)
D.C.: CatholicUniv. AmericaPress, 1980), pp. 145-191; andLawrenceJ. Bliquez, "TwoLists of GreekSurgical Instrumentsand the State of Surgery in Byzantine Times," in Symposiumon Byzantine Medicine, ed. John Scarborough(DumbartonOaks Papers, 38) (Washington,D.C.: DumbartonOaks, 1984), pp. 187-204. See BernadetteJ. Brooten, Love between Women:Early ChristianResponses to Female Homoeroticism(Chicago: Univ. Chicago Press, 1996), pp. 162-168, for a probing,well-researched analysis of the Soranusfamily of texts and the "culturally problematicsexual behavior"that is at the root of these texts. 20Die Fragmente der griechischen Historiker, ed. Felix Jacoby (1923-1958; Leiden: Brill, 1993), 3C 765.F.B4: Au6oi 8' si; xoforov4~uov Tpixpfq;, x Ica! tpaixroit yuvatCaq; euvouxrat ... 6 8' oUv Xdv0oo ?v Tft SsuTcpat t6bvAuStaic&v 'ASp t'Tq,v (P1oai amkoa ipo&ov yuvaiKaq s6vouXiaavra Xpf0Oat It sEoT'pcot 6 Te' To0UT'v iCaopel, bx; auTactt;avxi av6p&v s6voU%ov.... Ev 6 ipro; rF6Xa;q AuS&6v paatI?bu;TUvatKaq; usvo6Xtasv, 6oto a6atq; xp6tro aei vsacou6aatq. On the verb see Henry George Liddell and RobertScott, comps., A Greek-EnglishLexicon, rev. by Henry StuartJones with RoderickMcKenzie (Oxford: Oxford Univ. Press, 1996), Xpadotat,IV.b. 21 Karl Gottlob Kiihn, ed., Medicorumgraecorum opera quae extant (Leipzig: Cnoblock, 1921-1933), Vol. KaTa 6 a6 14, p. 706: Tr be jA.oov TOUTcoV rTivStaacXia KlCs(puKO;g aapKislov, vU.pqnI, Kcai8a TppOKURTEtv iti nokU ?KTOcfA; v 4ato&rat nap' Aiyuxifot; tid TV nap09vov. On the ascriptionto Galen and its questionable authenticitysee ibid., Vol. 1, p. cxlviii.

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The second passage that places the practice in Egypt is by Aetios, a Greek physician and comes obsequii (official attendantphysician) of the emperorJustinianI (ruled 527in 565 C.E.).Aetios was born in Amida (now Diyarbakir Turkey)and studiedmedicine in Alexandriain Egypt. He compiled a sixteen-book encyclopedic medical treatise ptikia iaTpucta cKKaiSi,a, also known as the Tetrabiblon,that drew on more ancient authors' works that in many cases are no longer extant. These earlier medical writers,including Oribasius,Soranos, Galen, and many others, are listed as his sources in the 7civat (index list) of each book. Aetios's descriptionof FGM appearsin book 16, which was devoted to obstetricsand gynecology; he cites Philomenes, a Greekphysician at Rome thoughtto be eithera contemporary Galenor to have lived a little later,as his source.22 nymphe, of The or clitoris, was the primaryfocus of Aetios's operation,which was indicatedin girls whose excessively large clitorides were viewed both as a deformity and as a source of sexual stimulusthat would predispose"victims"to venery. Aetios's account of the procedureis the fullest that is extant from antiquity.The girl is seated in a chairwhile a strongyoung man restrainsher legs and the rest of her body from behind. The operator,positioned in front of the girl, grasps the v6cpTr,or clitoris, with a forceps held in his left hand, pulling it toward him. Then he cuts it off just above the pincers of the forceps. Aetios warns that the base of the organ should not be removed, since there is a risk of cutting into the urinaryoutlet. The surgeon next wipes the wound with wine or cold water, and a sponge soaked in vinegar can be bandaged in place to staunchthe bleeding. He then discusses postoperativeointmentsand powders for a recuperativeperiod lasting about a week.
that lies above the The so-called nymphe[clitoris]is a sort of muscularor skinlike structure junctureof the labia minora;below it the urinaryoutlet is positioned. [This structure] grows in size and is increasedto excess in certainwomen, becoming a deformityand a source of shame. its Furthermore, continualrubbingagainstthe clothes irritatesit, andthatstimulatesthe appetite for sexual intercourse.On this account, it seemed properto the Egyptiansto remove it before The it became greatlyenlarged,especially at thattime when the girls were aboutto be married. surgery is performedin this way: Have the girl sit on a chair while a muscled young man standingbehind her places his armsbelow the girl's thighs. Have him separateand steady her legs and whole body. Standingin front and taking hold of the clitoris with a broad-mouthed forceps in his left hand, the surgeon stretchesit outward,while with the right hand, he cuts it off at the point next to the pincers of the forceps. It is properto let a length remainfrom that cut off, about the size of the membranethat's between the nostrils,23 as to take away the so excess materialonly; as I have said, the partto be removedis at thatpointjust above the pincers
22 See the discussion of Aetios in James V. Ricci, Aetios Amida: The of Gynecologyand Obstetricsof the VIth Century,A.D., Translated from Cornarius' Text of 1542 (Philadelphia:Blakiston, 1950), pp. 5-9; and MarieHelene Marganne,La chirurgiedans l'Egyptegreco-romained'apres les papyrus litterairesgrecs (Leiden:Brill, 1998), pp. xx-xxi. The Greek edition of his work-Gynaekologie des Aetios, sive sermo sextus decimus et ultimus, zum erstenmale aus Handschriftenveroffentlicht,ed. Skevos Zervos (Leipzig: Fock, 1901)-gives Latintranslation or Philomenes as the source in the vt'vat, index list; no source is cited in the sixteenth-century of Comarius.We have one extant treatise by Philomenes in Greek-Philumeni De Venenatisanimalibuseorumqueremediis,ed. MaximilianWellmann(CorpusMedicorumGraecorum,10.1.1) (Berlin:Teubner,1908)on animalpoisons and their remedies, which was used as a source for Aetios's book 13, chs. 1-44. In addition, a numberof fragments and several translationsthat were made into Latin are extant. See Wellmann, "Philumenos," Hermes, 1908, 43:373-404. 23 Cf. the 1549 translationinto Latin by Johannes Comarius, Aetii Medici graeci contractae ex veteribus medicinae Tetrabiblos,hoc est quaternio, id est libri universales quatuor, singuli quatuorsermones complectentes, ut sint in summa quatuor sermonumquaterniones,id est sermones XVI (Basel: Froben, 1549), p. 902: "Mensura aiuntresectioniseandemquamin columellae sectione servareoportet,ut ne funditusipsamresecemus." ['"hey assert that it is necessary to preservethe same measureof the partcut off as that in the resection of the uvula, so that we do not cut it off completely."]

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of the forceps. Because the clitoris is a skinlike structureand stretchesout excessively, do not cut off too much, as a urinaryfistula [poti;q] may result from cutting such large growths too deeply. After the surgery,it is recommendedto treatthe wound with wine or cold water, and wiping it clean with a sponge to sprinklefrankincensepowder on it. Absorbentlinen bandages dipped in vinegar should be secured in place, and a sponge in turn dipped in vinegar placed above. After the seventh day, spreadthe finest calamine on it. With it, either rose petals or a genital powder made from baked clay can be applied. This [RX] is especially good:24Roast and grinddate pits and spreadthe powderon [the wound]; [this compound]also works against sores on the genitals.25

Apartfrom its being both detailed and derivedfrom a traditionseparatefrom the Soranus family of manuscripts,Aetios's account is remarkablefor two furtherreasons. First, he identifiesprecisely a physical mechanismthatpromotesclitoralstimulation-namely, the rubbingof the organ against the clothing, a feature that highlights the excessive size of this organ in affected patients-and notes that this irregularstimulationis an indication for surgery.Second, he states categoricallythat Egyptiansperformthis clitoralreduction surgery on their girls before they are marriedto prevent excessive enlargementof the organ.
MEDICAL PROCEDURE OR TEMPLE RITE?

Strabo's statementthatEgyptians Thus, Aetios's account appearsstronglyto corroborate excise their females, but with the furthersuggestion that the proceduremay have been for performedin preparation marriage.Yet equally remarkableis the highly developed characterof Aetios's surgicaloperationand its assignmentto the realm of male operators, which suggests that excision may not have been the exclusive provenanceof midwives, at least not in Egypt (Muschio's work, cited earlier, was a handbookfor midwives, but Aetios is describing a clearly Egyptianpractice where the customaryoperatormay have
24Cf. ibid.: "linimentum posca madefactumindatur.Et spongia ex posca expressa superdeligetur. Post septimam vero, cadmiamminutissimetritamper se, aut cum rosarumfloribusinsperge.Aut sic cum ex lapide phrygia fissurasdescriptum.Aut cineremossium palmularum insperge."["A linimentmoisparatum,et ad pudendorum tened with posca (a mix of egg, vinegar, and water) is put on, and a sponge squeezed out of posca is fastened above. Moreover,afterthe seventhday, sprinklefinely groundcalamineby itself or with rose powder,or likewise a powderpreparedfrom Phrygianstone (modernidentificationnot known;Pliny, Historia Naturalis, 36.36.143, mentionedits use in dyeing), describedat fissures of the pudendum.Or sprinkleon ashes of date pits."] 25Aetios, 16.105 (Zervos ed. [cit. n. 22]): 'H ayop&:vrI otov & SeppaTMSe; ioTi ouycptvUtgpTi piu5S;
Pdattov Ktp?Lvov T Kara XV dvo)eV Tv

i5a xkov TCOV yuvaLIKIcv a6ffl'atv %atjpavov, KaQi te; peettavKai aiaXUv6tv Si TIatV Wli yYE?06verTai To&Vi uaTriov ipeOiet, icai TilV cp6o; uvouiav 6pnilv yivsrat. ak&ka tcaparpt6pOtvov ovvex;, n6O Kai 0 X? 6O6OT o504e Toiq apatpeTv auTb66OT a~taoa, S6Ioep 7pO Tfq; 0oys0oo0tq0caox; AiyuxTiotq; rCysdipst, fS TbOV Tp6Oov TOOTOV. kSpac4Tx y6yeoal I XXotsv ai 0aXp0evoI. :IEtteXstTalt q X&tpoupy(a cp6; yd4aov ? Toru iSioug; u6opdXXcov lAv I1nap0gvoq Cri 8i(ppou, xapeCaTo; 8 6oaOEv veaviaicog UTovoq; xcic;tq Xn KalTO 6Xov a'- oTdx5q vVavTiov Lvspy(bv : uSi(p cai 8 Ta C&o 6 Kal S8tKpaTsiTco TaT; eK:eivi; iyvuatq, t, vT Tv stuvutou XsipbOaCOTEIstvE 'SSei4ta roxTe?vETxw prIv Sta Tfqq tcXaTUxTO6p au).Xapdv apa va xtpooqKce KaTcXatvox TObU KltOVtiO0, TO6 gi tf|; aTxOTeaVOg?VTi; 66vtaQ; ToO gu?iou. eT:pov Se nap8a S Tob; 66vTag TOtO IPuSou TiV 4KpaipcaivetiTov y?vgoOati,sta T6 IEptTTOoV &qV govov tpaef* imKTfl; RepITTOTtEpa; 6Xoevat Tliv vt5pnTPvKai x0apeKTviCoveoalt lApt tXesfCTTo. 6drT?e ih 8spgaT6MSI' cb xTiv MeTa Se Xetpoupytav pota; 7EaK:oXou0eTv. Tf5; ?yK:av0iStov iKTOtfqg; KO07cf; CK pa60VTpa;TC&V cKa TiIv OtVqw tpocrKEcst rtxTqEstv 'licotv iq VuXp iSzaTt, a&iouatavTa; (rM6yyqpadvvav wrtnaxxsv, cat 3pp 0oTov6ui)paTxqp xovTag E;iTI0OvEat,dvo)Ov cx6TTyov Kaltcc 6Kpcptq p3ppeyt vov ixdXtvsi:t0Ovat? atfl P6. ov T'O 8tl c8Ka6Liav tTa i'sTiV ep6giv XeioTd0Trv bticaCoetv. 1oiUv avOOq, fi Sa ppUyo00q06ou TOTO- 6oaa q(oitviov Ka6aaq edavaq; crinttaasE Ttv Kait Cxno6V, xotIe ,Tlpov aiSoticbv. icakov 8Kaical
? Ta Ical ppO6q V aiSotqot eKi.

xv tepuycoldstov

ruglpoXiiv.

Tr6ov KaO' 6v

q otpi'p0pa TxtaKTxa

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differed). In Egypt today FGM is frequentlyperformedby males, either medical professionals or-more commonly, since it is now illegal-barbers and butchers.26 The male gender of the operatormay be significantin that it suggests that the proceBoth genderdure-at least in Graeco-Roman Egypt-was surgical,and not obstetrical.27 specific tasking and the surgicalcharacterof the procedurecould theoreticallyhave strong FGM in ancientEgypt. Surgicaltools similarto those used implicationsfor understanding in the operationdescribed by Aetios-the forceps, surgeon's knife, and bandages-are present in a panel from the rear wall of the Temple of Sobek and Horns at Kom Ombo. It is thought that such surgical tools were not available to Egyptian physicians until the arrivalof the Greeks and Romans;the Kom Ombo panel dates to the second centuryC.E. and appearsto depict typical Roman tools. Most Egyptian surgical procedureswere very simple, and, by one accounting,some "30,000 mummieshad been investigatedwithouta single surgical scar being reported."28 Depictions of only three surgical proceduressurvive from pre-HellenisticEgypt. One such procedureis male circumcision,representedby a scene from the Old Kingdom (ca.
2613-2181
B.C.E.) and another from the New Kingdom (ca. 1567-1085 B.C.E.). In the

first of these, from the tomb of Ankh-ma-hor,the implement employed may be a stone knife or a razor, according to various authorities.And although the words of the panel have led to a debateover whethera priest is circumcisingor being circumcised,some sort That is, the proceduredepicted may not be of ritual initiation seems to be taking place.29 strictlysurgical, exclusively for medical indications. Given that surgical (medical) proceduresmay have been relatively rare in pre-Greek Egypt and that Aetios suggests that FGM was performedbefore any clear medical indication necessitatedthe surgery,it is certainlypossible that, if FGM was practicedbefore the arrivalof the Greeks, it was viewed not as a medical procedureper se, but perhapsas a religious rite associatedwith temple life.30It is thenplausiblethatthe GreeksandRomans shifted the custom into the realm of physician-surgeons; conceivably, two types of operators may have coexisted, one traditionaland the other informedby Graeco-Romanscientific theory and practice. A papyrusnow in the British Museum suggests that this may have been the case, since its subject, an Egyptiangirl named Tathemis,was authorizedby the Temple of Sarapisof Memphis to collect alms. The letter concerns money earmarkedfor Tathemis's circumcision, for which she needed a dowry and a suitable dress, all indicationsof her entering into womanhood:
26In the mid 1990s, male medical doctors and surgeons as well as barbersand others who work at mulids (festivals honoring Muslim popular"saints")accountedfor 64 percent of operators,while midwives accounted for 36 percent:Fayyad,Al-batral-tandsuli li-l-inath (cit. n. 3), pp. 140-141. Gender-specifictaskingis common in many areas where FGM is practiced;see Worsley, "Infibulation and Female Circumcision"(cit. n. 13), p. 687, which describes the situationin Sudan. 27Cf. Hdt., 2.84: il 5e iTxptKi: KaTa Td5a CqPt6:acrxatftqf; vo6aou hicxacrog irqtp6o; ot Kclai o
Xos6vcov. dvTat 8' ibrTpCov catt rnkca oSv oi yap o6pa6(IXaiI)v irlTpol Katcaoeaca, oi S KC(plaf;qq,oi &e

IKara vouoaov.["Medicineis dividedaccordingto the following 6oovtov, oi S6 TcOV vr6v, oi U8 T6)V&qpavio)v way: Each doctor specializes in a single illness and no more. (Egypt) is full for doctors for everything.So there are doctors for the eyes, doctors for the head, doctors for the teeth, doctors for the belly, doctors for diseases that are not apparent."] 28John F. Nunn, Ancient EgyptianMedicine (Norman:Univ. OklahomaPress, 1996), p. 164 f., describes the panel in detail and provides the relevantbibliography;for the quotationsee p. 165. 29Ann Macy Roth, Egyptian Phyles in the Old Kingdom:The Evolution of a Systemof Social Organization (SAOC, 38) (Chicago: OrientalInstitute,1991), pp. 66-68. 30See Montserrat,Sex and Society in Graeco-RomanEgypt (cit. n. 3), p. 43. Some scholars favor a strictly medical interpretation even for the pre-Greekperiod;see Roth, EgyptianPhyles in the Old Kingdom,p. 68.

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Sometime afterthis, Nephoris defraudedme, being anxious that it was time for Tathemisto be circumcised,as is the custom among the Egyptians.She asked that I give her 1,300 drachmae from what [Tathemis]had paid me ... to clothe her ... and to provide her a marriagedowry, and [she promisedthat] if she didn't do each of these or if she did not circumciseTathemisin she the month of Mecheir,year 18 [163 B.C.E.], would repay me 2,400 drachmaeon the spot.31 It may be helpful to bear in mind that marriage did not disqualify priests and others affiliated with the temples from continuing their service. Archaeologically, there may be confirmations that FGM existed even during the preGreek period. One tantalizing text is found on the sarcophagus of Sit-hedj-hotep, dating to the Middle Kingdom (12th dynasty, ca. 1991-1786 B.C.E.) and now preserved in the Egyptian Museum. The passage details a magical spell that is effected by the anointment of the spellcaster with certain body substances (b3d; exact meaning unknown) of an uncircumcised girl and an uncircumcised bald man. As for any man who knows it while it is sealed, he is more glorious thereby than Osiris: He has passed every tribunalin which Thoth is, but Thoth will be in the tribunalof Osiris. If a man, a great one, who is on his lake of death,going to the BeautifulWest, should recite it four times as a purification,then on the fourth day, he will go (die). [This] is correct more than anything.But if a man wants to know how to live, he should recite it every day, afterhis flesh has been rubbed with the b3d of an uncircumcisedgirl and the flakes of skin [Fnft]of an uncircumcisedbald man.32 The presence of the word for uncircumcised male ('m') supports the translation of the word relating to the female, 'm't, as "uncircumcised," as most scholars have done.33 This reading makes sense and is reasonable, although some Egyptologists are uncomfortable
31PLond (= Greek Papyri in the British Museum,ed. F. G. Kenyon [London:British Museum, 1893]), 1.24 SC 11.9-18 (164/163 B.C.E.): PETCa Ttva Xp6vov Tfi; N8(p6ptToq;apaXoy7tao vi5; pe ai xpoesveyic?acvlq T'i 5ou6vataurfit TTiv TdOrlZtv 6pav ;X&tv 90oq;oTi rTO;AiTyuwnot;xeptTplVCa0 at tadoi d)q ' .... s .... Gcrata5tinv avSpi pepvietv, ?av S6 ph drT ipatetsi acTrjv cKat Taq; ?qp Torto OctTeXs,crara tv ot5rcov l grlvito6 tqL atroxTei(st oi rapapesfp iotfit Kicac0 TOUTv ef Trilph espe It Tipv TdirtOU tn& Bausteine zu Xplpua < PIu,Karl Sudhoff, "Beschneidung,"in Arztliches aus friechischen Papyrus-Urkunden einer medizinischenKulturgeschichtedes Hellenismus (Leipzig: Barth, 1909), p. 178 f., sees an association between female circumcisionand temple service. This view is not universal.PaulWendland,"Die hellenistischen Zeugnisse iiber die 'gyptische Beschneidung,"Archivfar Papyrusforschung.1903, 2:22-31, finds no ground for assumingthatTathemis'sassociationwith a temple was connectedwith her excision, since the letterindicates to ari thatthe rite was an Egyptiancustom preparatory marriage(dxq S0oq; TOr; AiyutMiotq-"as is the custom among the Egyptians"). 32Egyptian Museum sarcophaguscat. no. 28085. The passage reads, "[448d]" ir s nb rh(t) sy sd3ti [448e] 3h sw im r Wsir [449a] iw sw3-n-f d3d3t nb(t) wnnt Dhwty im-s wnn swt Dhwty [449b] m d3d3t nt Wsir [449c] ir wnn s wr ht s-f n hpt r imnt nfrt [449d] sd sy ? s4m-f w'bt nt tp hrw 4 [449e] hpp-f m fdn-nw-f [450a] mty r hp nbt. [450b] ir swt mrr-frh s'nh [450c] sdd-f sy r' nb [450d] sin-n-f 'wf-f m b3d [lacuna] [idyt] 'm't hn' snfw nt i3s 'm'." The hieroglyphictext is in Pierre Lacau, Sarcophages extirieurs au nouvel empire (no. 28001-29086 (Cairo:IFAO, 1904), sarcophagusno. 28085 (innercoffin), Vol. 1, p. 217. It is CoffinText spell 1117, 448d-450d; see the variorumedition by Adriaande Buck and Alan H. Gardiner,The Egyptian Coffin Texts (Chicago:Univ. Chicago Press, 1961), Vol. 7, pp. 448-450. 33 Adolf Erman and Hermann Grapow, comps., Worterbuchder aegyptischen Sprach (Berlin: Akademie, 1982), Vol. 1, p. 185; Dimitri Meeks, Annie lexigographique.Vol. 2 (Paris:Favard, 1978), p. 70; Alexandre Piankoff, The Wanderingof the Soul (Princeton,N.J.: PrincetonUniv. Press, 1974), p. 32; and HermannKees, der Totenglaubenund Jenseitsvorstellungen alten Agypter(Berlin:Akademie, 1956), p. 300 f. Eugen Strouhal, Life of the Ancient Egyptians(Norman:Univ. OklahomaPress, 1992), p. 29, likewise concludes on the basis of this text that FGM was practiced.See also the commentsby Emmanuelde Rouge, "Inscription historiquedu roi Pianchi-Meriamoun," BibliothaqueEgyptologique, 1911, 24:263-307, on p. 281 n 1; Frans Jonckheere, "La circoncisiondes anciens egyptiens,"Centaurus:International Magazineof the Historyof Science and Medicine, 1950-1951, 1:212-234, esp. p. 216 f.; and Constant de Wit, "La circoncision chez les anciens 6gyptiens," (ZAS), 1972, 99:41-48, esp. p. 43. Zeitschrift AgyptischeSprache und Altertumskunde fir

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with it. As with the English word "uncircumcised," word 'm't obviously does not tell the us anythingaboutthe circumcisedstate-the degree of circumcisionpracticedat thattime. To resolve this conundrum, Saphinaz-Amal Naguib analyzedthis text and,with herreading of a hieroglyphthat shows the position of the ancientEgyptianwoman in labor,concluded thatinfibulation,or third-degree FGM, was not practicedin Egyptin antiquity,a hypothesis that accords well with the Greek descriptionsof the clinical procedurealreadynoted.34 This conclusion was supportedby physical examinationof female mummies. G. Elliot Smith, an Australianpathologistin the early decades of the twentiethcenturywho visually inspected hundredsof mummies, observed that infibulationhad not been performed.In his remarkson the techniqueof mummificationduringthe 21st dynasty, he statedthat in most cases the skin of the labia majora,"while still soft and flexible, was pushedbackward towardthe anus so as to form an aproncovering the rima pudenda"that gave the appearance of infibulation.We might speculatethatthis curiousprocedure was designedto ensure thatthe deceasedwas not violated, a hazardcited by Herodotus.3Smithdid not specifically address the question of first- or second-degreecircumcision, at least not in print;he recorded that soft tissues frequentlywere removed by the embalmers,either accidentallyor deliberately,or deterioratedto a point where it was impossible to determinewhether a In lighter circumcisionhad been made.36 light of the fact that only rarely have scientific researchersautopsyingmummies specifically looked for the presenceor absence of FGM, conclusive remarksabout the prevalence of the practice must await a detailed study of a large cohort of female mummies. (For scientific purposes, it is necessary for researchers to state negative findingsas well as positive ones; the absence of remarksregardingFGM cannot be held as proof that it was not practiced,since we have no indicationthat most investigatorseven looked for signs of it.)
CIRCUMCISION OF MALES

A parallel surgical procedure,male circumcision,may help us understand practicein the females, especially if motivation for it can be satisfactorilyidentified.Certainly,it must be grantedthat several of the earliest male mummies yet found prove that male circumcision was alreadya familiarprocedurein the Old Kingdom.Investigationof latermummies links the practicewith priestsandroyalty.37 This positive verificationof the procedure contrasts with the situation with female mummies. As already noted, however, several factors may account for the lack of evidence in females: the manipulationof female external genitalia during the process of mummificationaltered the appearanceto such a
34Saphinaz-AmalNaguib, "L'excision pharaonique-une appelationerronee?" Bulletinde la Societe d' Egyptologie, Geneve, 1982, no. 7, pp. 79-82. So-called pharaoniccircumcision is thus a gross misnomer, since it appearsnot to have been practicedat any time in ancient Egypt. 35G. Elliot Smith, A Contributionto the Studyof Mummification Egypt. (Mtmoires PrMsent6s l'Institut in a Egyptienet Publies sous les Auspices de A. A. Abbas II, Khedived'Egypte, 5[1]) (Cairo, 1906), p. 30; and Hdt., 2.89. 36This opinion was echoed by anotherearly pathologist,who commentedthat "the bodies are in such a state that it would often be difficult to state with certaintywhethersuch an operationhad been done":Marc Armand Ruffer, Studies in the Paleopathologyof Egypt (Chicago:Univ. Chicago Press, 1921), p. 171. 37Reportsof uncircumcisedmales are not unusual,especially among nonroyalnonpriestlypersons. See, e.g., GeraldD. Hartet al., "Autopsyof an EgyptianMummy(Nakht-ROM)," CanadianMedicalAssociationJournal, 1977, 117:461-476; and Aidan Cockbum et al., "Autopsyof an EgyptianMummy,"Science, 1975, 197:11551160, who reporton a mummy (Pum n) from ca. 700 B.C.E. More thaneight thousandmummieswere autopsied in the early part of the twentieth century (ibid., p. 1155), but the autopsies were often conductedcarelessly or in such haste that we do not have a reliable estimate of the percentageof males that were circumcised.

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can degree thatno determination be made regardinglighterforms of FGM;female corpses may have been delivered for mummificationin a relatively putrefiedstate, as Herodotus notes; and, finally, researchershave not been specifically looking for the presence or it absence of signs of FGM. Furthermore, can be hypothesizedthat if circumcisionwere primarilyritualisticor associatedwith temple activities, given thatfewer roles are attested for women thanfor men, then relativelyfewer women may have undergonethe procedure. Two male circumcisionscenes are attestediconographically;the first, as alreadymentioned, is from the tomb of Ankh-ma-horin Saqqarathat dates to the Old Kingdom. A second panel portrayingthe operation, from the Temple of Amenhotep III beside the Temple of Mut at Karnak,dates to the New Kingdom. This latter scene is interestingin that the mummy presumedto be AmenhotepIII, the man who dedicatedthe panel, was found to be circumcised.Although the mummy thoughtto be that of this pharaoh'sprethe decessor,AmenhotepII, likewise shows thatcircumcisionhadbeen performed, practice does not appearto have been universaleven amongroyal title holders,since the mummies held to be Amenhotep II and Ill's dynastic predecessors,Amenhotep I and Ahmose I, were not circumcised.38 of Identification mummiescannotusually be verifiedwith 100 percentcertainty,yet the overall trend-some apparentlyroyal corpses show circumcision while others from the same period do not-calls into doubt any historicallycomprehensivestatement,such as The Herodotus'sAtiylCTtot8e CS ptTatvovtat ("theEgyptianscircumcise").39 popularity of circumcisionmay well have varied,but it nonetheless seems likely that priests,temple attendants,and royal and other high-rankingpersonagesadheredfairly rigidly to the custom.40

Apartfrom the ritualnatureof male circumcision,otherobservationstangentialto FGM public and open character may be broached.First, it must be conceded thatthe apparently of the operationin males, as depicted in the two wall panels, contrastsstrikinglywith the lack of public works celebratinga female's circumcision.It is worthnoting, however, that male and in Egypt today there is a clear-cutdistinctionin the circumstancessurrounding female circumcisions:the boy's event is public and widely celebratedwith great cheer, whereasthe girl's event is private,carriedout with little fanfareor ostentation.In the case
38On the scene from the tomb of Ankh-ma-horsee Bertha Porterand Rosalind L. B. Moss, Topographical Bibliographyof AncientEgyptianHieroglyphicTexts,Reliefs, and Paintings (Oxford:OxfordUniv. Press, 19271951), Vol. 3, p. 514. A thoroughdiscussion with bibliographyis in Roth, EgyptianPhyles in the Old Kingdom (cit. n. 29), pp. 62-68. On the panel from the Temple of Amenhotep see F. Chabas, "De la circoncision chez les 6gyptiens,"Revue Archeologique,N.S., 1861, 3:298-300; and MauricePillet, "Les scenes de naissance et de circoncision dans le temple nord-estde Mout, AKamak,"Annales du Service des Antiquitesd'Egypte, 1952, 52:93-104. AmenhotepIH's mummywas very badly damaged,with most of the flesh of the head missing, along with much of the other soft tissues: Salima Ikramand Aidan Dodson, The Mummyin Ancient Egypt (London: Thames & Hudson, 1998), p. 324; it has been presumedthat he was circumcised since he was the dedicantof the circumcisionscene at Karnak.On AmenhotepII see G. Elliot Smith, Royal Mummies(Cairo:IFAO, 1912), that AmenhotepI and Ahmose I were not circumcised,althoughearlier p. 37. X-ray imaging has demonstrated investigatorshad presumedthat they were. See James E. Harrisand Kent R. Weeks, X-raying the Pharaohs (New York: Scribner's, 1973), pp. 126, 130. 39Hdt., 2.36.3; cf. Meinardus,"Mythological,Historical,and Sociological Aspects of Female Circumcision" (cit. n. 12), p. 389 f. I am remindedof a modem reverse parallel:when interviewedby Westernresearchers,a numberof upper-classEgyptian women firmly denied that they had been circumcised, yet an Egyptiangynecologist who examined them found that in fact about 90 percent of them were circumcised (MahmoudKarim, personalcommunication). 40See, e.g., de Wit, "Circoncisionchez les anciens egyptiens" (cit. n. 33), p. 43; Jonckheere,"Circoncision des anciens 6gyptiens" (cit. n. 33), p. 231 f.; Sudhoff, "Beschneidung"(cit. n. 31), pp. 177-180; and Ulrich Arch. Papyrusforschung,1903, 2:9-12. Most scholars Wilcken, "Die agyptischen Beschneidungsurkunden," agree that the practicewas more obligatoryfor the priestly class than for the common people.

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of boys, the extendedfamily and neighborsof both sexes freelyjoin in a publiccelebration; the girl, by contrast,usually receives only immediatefamily members,and often only the females, at home. (This was the case even before female circumcision was made illegal and even when the practicewas supportedby the government.)41 It is notable that circumcisionwas practicedon boys at aboutthe same age as FGM in girls. The boys depicted in the two circumcisionscenes I have discussed arejust entering puberty;certainlythey are not infants. Two ancient authors,Philo Judaeusand Ambrose, indicate that the operationwas done when children entered adulthood,for girls at about fourteenyears of age. Philo, commentingon Genesis 17:10, says, "Whydoes He command thatonly the males be circumcised?In the firstplace, the Egyptiansby the custom of their countrycircumcise the marriageable youth and maid in the fourteenth(year) of their age, when the male begins to get seed, and the female to have a menstrualflow." Ambrose, bishop of Milan (d. 397 C.E.),largely echoes Philo's words: 'The Egyptians circumcise their males in the fourteenthyear and the females among them are broughtto be circumcised in the same year, because certainly from that year, the passion of manly sensation Ambrose, however, seems to begins to burn and the monthly courses of women begin."42 a moral purpose in circumcising males, in that they begin to experience sexual suggest desire at aroundthe age of fourteen. This leads to the question of motivation:What was the likeliest motivatingfactor for FGM in ancientEgypt?
A MENU OF MOTIVATIONS

Given that the evidence suggests two generaltheatersof operationfor FGM, one medical and curativeand the other ritualin nature,it is likely that more than a single motivating factor accounts for the practice in antiquity. Aetios, Galen, and the Soranus family of sources provide a strictly clinical indication for excision, namely, an excessively large clitoris. It should be noted that the clitoris appearsrelatively larger in the prepubescent girl than in the adultwoman: as she maturesthe organdoes not grow substantially,in fact often becoming slightly smaller.43 Aetios is not referringto a child's normalclitoris, Yet since he gives the instructionthata muscled young man shouldrestrainthe girl undergoing surgery.Even today, a greatly enlarged clitoris-say, about 1.5 inches in length-is an
41 Hamed Ammar,Growing Up in an EgyptianVillage, Silwa, Province of Aswan (London:Routledge, 1954), p. 116; and John G. Kennedy, "Circumcisionand Excision in Ancient Nubia,"Man, 1970, 5:175-191, on p. 180. 42Philo Judaeus, Quaestiones et solutiones in Genesim, 3.47, in Philo: Questions and Answers on Genesis, Translated from the AncientArmenianVersionof the Original Greek,trans.Ralph Marcus(Cambridge,Mass.: HarvardUniv. Press, 1953). The Greek version of this work is now lost. Ambrose, De Abrahamo2, 11.78 EcclesiasticorumLati(348A-B), in Sancti Ambrossiopera, pars prima, ed. Karl Schenkl (CorpusScriptorum norum, 32) (Vienna: Tempsky, 1897): "deniqueAegyptii quartodecimo anno circumciduntmares et feminae apud eos eodem anno circumcidi feruntur,quod ab eo videlicet anno incipiat flagrarepassio motus virilis et feminarummenstruasumantexordia." 43 The clitoris at birthis life, especially at puberty: very nearto its adult size, althoughit does grow throughout Kumud Sane and Ora Hirsch Pescovitz, "The Clitoral Index: A Determinationof ClitoralSize in Normal Girls and in Girls with AbnormalSexual Development,"Journal of Pediatrics, 1992, 120:264-266. Thus the clitoris frequentlyappearslargerin girls thanin women because of the relativelysmallersize of girls andyoung children. A second growth spurtin the organ is associated with childbirth,with parous women having slightly, but still significantly, larger clitorides than nulliparouswomen: Barry S. Verkauf, James von Thron, and William F. O'Brien, "ClitoralSize in NormalWomen," Obstetricsand Gynecology, 1992, 80:41-44. Occasionally,growth is found in elderly women-John W. Huffman,"Some Facts aboutthe Clitoris,"PostgraduateMedicine, 1976, 60:245-247-presumably because of the relative increase in male to female hormonesafter menopause.

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indicationin both Egypt and the United States for a proceduresimilarto the one described by Aetios and Paul of Aegina.44 These two surgeonsremarkon one of the complicationsof such a large clitoris:tactile contact with clothing stimulatesthe organ, making the patient subjectto excessive desire there for coitus. It seems significantthat the descriptionmentions a physical deformity;45 is no indication that excessive desire in females with normal clitorides can be corrected or even preventedby excision. It may be remarkedhere that there is a common misconception that FGM removes sexual desire; in fact, modem studies have found that women whose clitorides were excised at puberty or before experience a pronounced(normal) increase in desire in adulthoodbut that it is not matchedby correspondingsexual satisfaction.6 Physiologically, FGM does not treat venery, and the ancient Graeco-Roman surgical testimony does not indicate it as a surgical solution for a woman who is overly licentious or as a measureto preventsuch licentiousness from developing. the Nevertheless, chastity may have entered into the traditionssurrounding procedure even at an early period, especially since Aetios suggests that it was performedto prevent a physical deformity from developing. Here, a comparisonwith modem experience in Egypt, where both curativeand ritual theatersexist, may be enlightening.When queried about their motivationfor circumcisingtheir girls, modem Egyptianinformantshave offered primaryexplanationsthat vary widely over large blocks of time (say, from decade to decade); but if all given explanationsare trackedover time, a menu limited to a few Some reasonswax and wane in popularity,whereasothersarecited motivationsemerges.47 for a shorttime andthen disappear. Althoughmodem motivationscannotserve as evidence the for ancientcounterparts, modem situationsuggeststhe most satisfactory comprehensive statement:as the traditionof FGM became embedded within the culture, new reasons mixed with old ones to favor continuationof a practice whose original motivationmost likely had long been forgotten.Medical, clinical, and curativemotivationsprobablymixed with ritual, social, and moral reasons to favor the continuationand spread of a practice that initially may have been narrowlyperformed. We may nonetheless be able to identify a menu of ancient motivations,apartfrom the strictly medical, curativemotivationsdescribedin Aetios, Galen, and the Soranusfamily of manuscripts, especially if we makereferenceto male circumcision.Most commentators, such as Herodotus,refer to cleanliness or hygiene as the principalreason why Egyptians to practicedthe custom. Complementary this is the idea of perfection-that is, the circumcised were free not only of transitoryfilth and pollution but also of inherentblemishes or flaws.48 These qualities were very importantto the priests and other temple personnel,in
See, e.g., the reductionmethod describedin J. Engert, "SurgicalCorrectionof Virilised Female External Genitalia,"Progress in Pediatric Surgery, 1989, 23:151-164, esp. pp. 161-163. Like the ancient surgeons, of Engertstronglyunderscoresthe need to maintainsensitivity in the organ:"Fora woman, preservation clitoral . sensitivity is essential to a satisfying sexual life. All techniquesinvolving total clitoridectomy. .must therefore be discarded"(p. 151). 45 An excessively large clitoris was recognized by laypersons even in Rome, although they tended to treat women so afflictedwith derision.E.g., an inscription(Corpusinscriptionum latinarum,4.10004 [Berlin:Reimer, 1892-]) describes one such woman: "Euplialaxa landicosa."["Eupliahas a clitoris that's big and loose."] Cf. Martial,Epigrammata,1.90,1.8; and Priapea, 12.14. Genital 46 Shandall, "Circumcisionand Infibulationof Females" (cit. n. 12), p. 193 f.; and Karim, Female Mutilation(cit. n. 12), p. 113. Shandall(p. 195) furthernoted that circumcision,and especially infibulation,did see not deter young women from seeking multiple sexual partners; the discussion by Karim(p. 128 f.). 47Karim,Female Genital Mutilation, 66. p. 48Regardingcleanliness see Hdt., 2.37.2: Ta re ai6ota icepxdgvovrai KaOapet6iTroqei've?cV, i7potgladvIf Teq;KaOapot etVact sunpeirxeTSpot. ['They circumcise the genitals for cleanliness, preferringto be clean
44

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In whom, it has alreadybeen noted, circumcisionwas primarilypracticed.49 this vein, we add that the priests may have valued the procedurefor its ritual character,which might would have contributedto its propagationand continuation. The widest menu of motivations for circumcision is provided by Philo Judaeus,who cites four reasons in his work De specialibus legibus ("On the special laws") for the practice among the ancients, including the Egyptians. One, of course, was hygiene, but anotherwas that circumcisionprevents what was called in Greek divOpa4, equivalentto Modem clinical studies have found that, contitay to Philo's assertion, moder phimosis.50 circumcisiondoes not significantlyreducethe occurrenceof this disease, providedordinary hygienic practices, such as washing, are observed.5 In any case, this reason cannot find a parallelin FGM.52 Philo then states thatcircumcisionmakes the generativeorgansimilarto the heart.Both heartand sex organswere designed by the deity for generation:the heartfor new spiritual life through the divine and the sex organs for new materiallife blessed by the divine.
ratherthan very good looking."] Cf. Plutarch,On Isis and Osiris, 4-5 (= Moralia, 352 c-f). With respect to perfection see AgyptischeUrkundenaus den kiniglichen [Staatliche] Museen zu Berlin (Berlin: StaatlicheMud seen PreussuscherKulturbesitz,1895-), 13.2216, 11.25-28: 'Aya9orqg; m5Oexro, xiva -crnpFla EXounv ei CiO oi esio6vtxo ao'plou; aooibS eivat, KXau6to; 'Ilpo6oou icpoypagaxrrx; tat6Sq 0i0LaTo;* ?v ti naT ipp6bv napanslae(osdevo; T OvnmtarooXv IIc6U 'Aya9olcKXj6 apXtepEi Kicat x&v Aiylwrq) iKaTr atotS oi uioi cou 'AplayadOlg icai 'AvxbcptSlcai Escev. s6vavrat Kca' &t c;TOTrof4tI 7eptTrlfqivat or T6 S0o;. ["Agathoklesasked whetherthe boys had any birthmarks other blemishes on theirbodies; when the said hierogrammateus they were withoutany, ClaudiusAgathokles,the high priestandthe overseerof the temples in Egypt, putting his seal on the letter, said, 'Your sons, Harpagathesand Anchophis, and Stotoetis, at your request, are able to be circumcisedaccordingto custom."'] 49Inscriptionalevidence indicates that women in priestly families were expected to serve as priestesses; see Adolf Erman,Life in Ancient Egypt (New York: Dover, 1971), p. 291 n 13. 50For the four reasons in their entirety see Philo, De specialibus legibus, 1.1 (pp. 210-211M), in Philonis Alexandriniopera quae supersunt,ed. Leopold Cohn and Paul Wendland(1896-1930; Berlin: Reimer, 19621963). On cleanliness see ibid., 1.1.5: 8s6Tepov 8e TiV 1t' 6Xou ToOadsa'co; Ica0apt6';rxa npo;qT apxc onpacatppoc)sneppUovxre; oi ?v AiyxrcTp -T&Vitsp&ov Tated itapo:evi, napo Kai aupovrat 6'oxTov Ta&V opesto6vcov Ka0aipeaO0a. ["(CirUooUX)ye'XcTya KcaiuxocrurXet KaltOpt4i Kai iaoaiaat; vla yap cumcision provides), secondly, cleanliness of the whole body in accordancewith what is fitting for the priestly class. As a result, carrying it to an extreme, some of the priests in Egypt also shave the body, since certain substances(e.g., smegma) that must be removed graduallycollect and even drawback both hair and foreskin."] v6aou icai urtadou, xoaivrTj;, d&akXayiv, fiv dvOpaKa On ivepa4 see ibid., 1.1.4: Ev ggv XaXkerxq oijat, xau6Mg; Kaietv eVTrWixp6vov, OK 6rep KakoOrtv,alcio ToO Tf; pocniyopiaq uXo6vra, ?UiKoXdrepov toSI a&KponrocOia; XouCtv Eyytivras. ["(Circumcisionprovides), first, a way of avoiding a difficult and incurabledisease, thatof the prepuce,which they call anthrax('charcoal,'equivalentto modernphimosis),taking its name, I believe, from its smolderingbum. It occurs more readily in those who have a foreskin."] 51Results of one study demonstratedthat "regularhygiene with retractionof the foreskin significantly deHeatherKruegerand creased the incidence of phimosis, adhesions, smegma accumulation,and inflammation": Journal of Family Practice, 1986, 22:353-355, Lucy Osborn,"Effectsof Hygiene among the Uncircumcised," on p. 355. Patients who did not retractthe foreskin in washing had significantlyhigher rates of phimosis and other associated conditions (p. 354). Educationon what constitutesproperhygiene appearsto be crucial, since anotherstudy that did not include patient instructionin hygiene as a variablefound that penile problems were significantlyhigher in a groupof uncircumcisedboys than in a circumcisedgroup:Lynn W. Herzog and Susana AmericanJournal of Diseases R. Alvarez, "The Frequencyof ForeskinProblemsin UncircumcisedChildren," of Children, 1986, 140:254-256. The American Academy of PediatricsTask Force on Circumcisionhas recgenital hygiene, advising that it "be emphasized as a preventive health ognized the importanceof appropriate Pediatrics, 1999, 103:687. Policy Statement," topic throughouta patient's lifetime":"Circumcision s2 A search of the literaturerevealed a single case study of female phimosis: D. G. McLintock,"Phimosisof Journalof the Royal Societyof Medicine, 1985, the Prepuceof the Clitoris:Indicationfor Female Circumcision," 78:257-258. It is noteworthy that the patient had type 1 diabetes, since certain conditions associated with diabetes, such as polycystic ovarian syndrome, are linked with clitoral hypertrophy:Jan Hofejsf, "Acquired Annals of the New YorkAcademyof Sciences, 1997, 816:362ClitoralEnlargement: Diagnosis and Treatment," 369. In addition,removalof the hood of the clitoris alone, while it is theoreticallypossible, has not been reported in the literature; Toubia, "FemaleCircumcision"(cit. n. 12), p. 712. see

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CURING CUT OR RITUALMUTILATION?

Circumcisioneffectively removes the seal on the physical generative organ, permitting reproductionto take place, just as an uncircumcisedheart cannot produce good, moral thoughts.Almost as a corollaryto this idea, Philo stateshis fourthreason:thatcircumcision makes the man more fertile because the path of the semen is not obstructed.53 The association between circumcision and generative ability is likewise reflected in Egyptian textual evidence, as in the Book of the Dead, chapter 17, which glorifies and praises the creatorRa and all his creation:"Whatis this? It is the blood that fell from the phallus of Ra when he mutilated himself. It became the gods Hu (Authority) and Sa (Wisdom), who follow Ra and who accompanyAtum daily and every day." This chapter is one of the oldest and most fundamentalamong the Book of the Dead texts. Ra's selfas mutilationis understoodby most commentators a referenceto circumcision.The visible sign of blood from circumcisingbecomes the physical sign of generativepower. Furthermore, returningto the text found on the sarcophagusof Sit-hedj-hotep,there may be an association between sealing and ritual magic involving uncircumcisedpersons. The spell detailed in the text was partof a longer series, now called The Book of Two Ways(Coffin Texts spells 1029-1185), intended to guide the deceased past the hazardson the trip to One key station was judgmentby the gods, especially Thoth, the realm of the afterlife.54 1117 appearsto guaranteethe deceased the ability to pass this tribunalwith ease. and spell There may be some sympatheticmagic in using partsof persons-whether young or old, male or female-whose generative organs are still sealed as an aid in knowing what is sealed or perhapseven knowing how to hide somethingfrom the scrutinyof the wise judge Thoth.
UNSEALING THE GENERATIVE ORGAN

The perceived causal link between circumcisionand generative ability, whetheror not it is physiologically accurate,is certainlypowerful validationfor the practicefrom the point of view of ritual.I would also like to suggest that it may be a clue to the origin of FGM, although my analysis is merely hypothetical. Given that male circumcision is attested iconographically,textually, and physically from a very early date and that evidence for female circumcision does not appearuntil the Middle Kingdom at the earliest, scholars
53Philo, Spec. Leg., 1.1.6: Trpiov 6e TTIv ToO pcpitgP09vTO(q o6oot6TrTa AspovU;* ipqO ytp zp6; KcapSiav TO6 7tapsEDaCCaTait, T'O tV yicdp6tov zve?0pavoqTidxtCv, S yOvtJov opyavovv(qxov 6tiy:vectv QdAupo Kai 6parov, ?t' Kcaixocav yap oi rtp(Rxot &paveTKai picpElTovt, ou Ta voqTtaoauvfoTaTaat,TO ugpavhg tCp 4) Ta aia0xTa yevvaal 7gUpKcev,tolooitbaat. ["Third,(circumcisionprovides) resemblanceto the heart, since both are designed for creation,the spirit in the heartfor (producing)thoughtand the generativeorganfor (producing) living beings. The first people rightly claimed that the material and visible element, by which perceptiblethings come into being, should be assimilatedto the unseen and the betterelement, by which thought exists."] On the uncircumcisedheartsee Ezekiel 44.7; Romans2.29; and Quran,2.88. For the fourthreason see 6? Philo, Spec. Leg., 1.1.7: T&rapTov Kai avayicatOTatovTTIV xipO;so3XuyoviavnapaowsKUcv- 3Xyetat yap O60ev K:ai tZE Tqg; too9ia; KOctXou;(x); suo6et T6 oxTgpa AqTe IcKtSvadtvovjT?TstSptpp&ov si5 ToUI; TOV 90ve)viroXuyoviraTa Kai noXuav0poTnrtaraeival SOKsI.["(Circumcision provides), rsptTcsv6Oesva for fourth and most necessary, the preparation fecundity, since it is said that the sperm thus has a free course, neither scatteringnor slipping away into the folds of the foreskin. As a result those of the peoples who are circumcisedseem to be the most fecund and the most populous."] 54Book of the Dead, 17.60-63. The passage reads "pftrirf sw. snf pw pr(w) m hnnw n R' mbtw3-f r irt s'd im-f ds-f. 'h'-n-w bpr m ntrw imyw-bt R', Hw hn' Si3, wnn-sn m-tt 'Itmw m bit hrw nt hr'w nb." On Ra's act as circumcision see Chabas, "Circoncisionchez les 6gyptiens"(cit. n. 38), p. 300; Jonckheere,"Circoncision des anciens 6gyptiens"(cit. n. 33), p. 215; and de Wit, "Circoncisionchez les anciens dgyptiens"(cit. n. 33), p. 42. Cf. Ursula Verhoeven, Das saitische Totenbuchder Iahtesnacht(Bonn: Habelt, 1993), p. 100 n 1. On the spell see Piankoff, Wanderingof the Soul (cit. n. 33), pp. 7-11; and LeonardH. Lesko, The Ancient Egyptian Book of Two Ways(Berkeley:Univ. CaliforniaPress, 1972), pp. 2-7.

MARYKNIGHT

337 PAROUS INTROITUS

DIFFERENT FORMSOF THE HYMEN

ANNULAR

SEPTATE

CRIBRIFORM

in reveal the diversity this Figure 3. Threeformsof intacthymen (annular, septate, and cribriform) membranoustissue. Nevertheless,in spite of the individual the variation, contrastwiththe same area in a womanwho has given birth(farright,parous introitus) clear,pronounced,and readily is J. perceived. (Illustration Patricia Wynne.) by

that have long assumedthatthe practicein females was inventedto mirror in males. Taking the oldest recordedmotivation we have for Egyptian male circumcision-that circumcision unsealed the generativeorgan-as a startingpoint, I would like to propose thatmale circumcisionoriginally was invented to mirrora naturalprocess in females. Indeed, this process usually is marked with a sign of blood, and it effectively opens the womb to production of new life: it is the breaking of the hymen that normally occurs on first intercourse,especially if the female is fairly young. (See Figure 3.)55 The hymen in young female humans is a unique sexual feature not found in other primates. It has been speculated that sexual selection accounts for its evolution, on the theory that girls with hymens were preferredover those without them because the former could "prove"their virginal status. A more plausible theory is that the hymen is an emretainedthroughout bryonic structure infancy and childhood as a means of protectinggirls into the vaginathrough from infection, a barrier againstorganismsthatmight be introduced The protectivebarrierbecomes less importantas the girl maturesand inadequatehygiene. and the loss of the hymen can serve as a biologic is able to clean herself appropriately, markerof a female's adult status.More pointedly stated,the hymen has been found in all normalfemale infants, althoughit is recognized that the vaginal orifice and surrounding tissue become distensible with adult levels of circulating female hormones, a fact that In makesthe hymen unreliablefor virginitytests in oldergirls.56 prepubertal girls, however,
55 human variation types;see in to The illustrated Figure areintended showsomeof thegeneral in 3 hymens on Circumcisions Mutilations n. 12), p. 21 f. See also the followingarticles hymenvariation and Karim, (cit. of in andterminology normal (i.e., nonsexually "Configurationthe Pregirls:SusanFerrell Pokomy, abused) et and American Journal Obstetrics Gynecology, 1987,157:950-956;AbbeyB. Berenson Hymen," of pubertal of Pediatrics,1992, 89:387-394; andJ. JaneGardner, al., "Appearance the Hymenin Prepubertal Girls," in J. of Nonabused Premenarchal Variation Healthy, 1992,120:251Girls," Pediatr., Study Genital "Descriptive 257. 56A. J. Hobday, Haury, Medical L. andP. K. Dayton, "Function the Human of 1997, Hypotheses, Hymen," Female in and Infants," Arakawa, 49:171-173;Carole "Hymens Newborn Jenny,MaryL. D. Kuhns, Fukiko of Pediatrics, 1987,80:399-400;andPokomy, "ConfigurationthePrepubertal Hymen," 954. p.

338

CURINGCUT OR RITUALMUTILATION?

the presence and the appearanceof the hymen are useful indicators,althoughphysicians and other health-careprofessionals in the United States today are trainedto assess appearanceprimarilyin cases of suspectedsexual abuse. The most strikingpoints to be takenfrom modem researchon the hymen are these. The hymen is not directly related to virginity; this is a false construct.But it is always conversely relatedto fertility, in that absolutely no female humanbeing who has given birth (proof of fertility) has an intact hymen. From that perspective, an ancient theoristcould indeed have assertedthat the breakingof the hymen "unseals"a young woman's genital blood sign, is a precursorof (potential) organs, since this breaking,with its characteristic fertility. Although the hymen structurewas apparentlynot known to Greek or Roman medical specialists until a fairly late period, it is not unknown among many so-called primitive peoples.7 It is possible thatancientEgyptiansbeforerecordedhistorynotedthe association between the broken hymen and a subsequentpregnancy and created circumcision as a symmetricsign to celebratethe adult capabilitiesand responsibilitiesof young men; such an association could account for the motivation for male circumcision,noted earlier,of making a man more fertile. We know in fact that a significantnumberof Old Kingdom rituals were lost, misconstrued,or adaptedby the Middle Kingdom and later regimes.58 Stretchingthe analysis farther,it is possible that the original symmetryof brokenhymen and circumcisedprepucewas forgottenand that a new ritual-FGM-was developed to of maintainthe appearance symmetry.
57The existence of a hymen was denied by Soranus (1.17); see comments in Giulia Sissa, Greek Virginity (Cambridge,Mass.: HarvardUniv. Press, 1990), p. 113 f., which also explores the idea of hymenless virginity in ancient Greece (pp. 168-173). On knowledge of the hymen among "primitive" peoples see HerantA. Katchadorianand Donald T. Lunde,Biological Aspects of HumanSexuality(New York:Holt, 1975), p. 19. See also Elisha P. Renne, "VirginityCloths and Vaginal Coverings in Ekiti, Nigeria," in Clothingand Difference: EmbodiedIdentitiesin Colonial and Post-ColonialAfrica, ed. Hildi Hendrickson(Durham,N.C.: Duke Univ. Press, 1996), pp. 19-33, for a discussion of how the physical hymen has been conflatedwith a materialobject (cloth) in a traditionalsociety undergoingtransitionto a more Westernizedpattern.The intellectualrecognitionof an associationbetween the physical hymen and virginityis not lost, however. Even in more developed cultures,the hymen remains the focus for determiningvirginity. For example, GuillermoUribe Cualla, a Colombianlegal expert,concluded that only complete ruptureof the hymen, not injuryor incompleterupture,should be takenas the medicolegal standardfor defining deflorationin his country:Uribe Cualla, "Cual debe ser la base para el diagn6stico mddico-legal de la desfloraci6n,"Zacchia, 1971, 46:1-6, esp. p. 4. Another remarkablesituation exists in Egypt today, where surgeons have discoveredhow lucrativehymen repaircan be for less-than-perfect brides-to-be;see Peter Kandela,"Egypt'sTradein Hymen Repair,"Lancet, 1996, 347:1615. Recently, religious for authoritiesat al-Azharhave wisely affirmedthatthe presenceof a hymen is not a valid precondition marriage; see Nevene M. Shawki, "Hymenor No Hymen, MarriageRuled Valid,"EgyptianGazette, 19 Sept. 2000, p. 7. 58 See A. Rosalie David, TheAncientEgyptians(New York:Routledge, 1982), Ch. 3, esp. pp. 92 f., 105-112; and Klaus Koch, Geschichteder dgyptischenReligion von den Pyramidenbis zu den Mysteriender Isis (Stuttgart: Kohlhammer,1993), pp. 209-240.