THE CIRCUMCISION REFERENCE LIBRARY

SUMMARY: This study examines the evolution of Greek and Roman medical conceptualizations of preputial aesthetics, utilizing evidence found in classical medical texts as well as clues from literature, legal sources, and art. A conclusive picture emerges that the Greeks valued the longer prepuce and pathologized the penis characterized by a deficient prepuce—especially one that had been surgically ablated—under the disease concept of lipodermos . The medical conceptualization of lipodermos is also placed in the historical context of the legal efforts to abolish ritual circumcision throughout the Seleucid and Roman empires.

KEYWORDS: lipodermos , penis, prepuce, aesthetics, classics, Greek art, Roman art, circumcision

Introduction

It is a biological norm in Homo sapiens that, in youth, that part of the penis known as the prepuce often runs to impressive lengths, frequently representing more than three-quarters of the length of the penis.1 This anatomical fact is not without its cultural or artistic consequences. In his survey of images of the phallus in Greek vase painting, K. J. Dover [Page 376] comments that depictions of attractive, virtuous, heroic, or divine subjects feature a prepuce that can comprise up to three-quarters the entire length of the penis.2 This may be an accurate representation of an ethnic norm; a broad-based, culturally significant idealization of the penis; or, in some cases, the representation of a prepuce that has been deliberately lengthened. Whatever the case, the well-proportioned prepuce was the longer prepuce, with its distinctive taper.

An iconographic representation of this feature of male excellence can be seen in the well-known masterpiece of Attic red-figure vase painting, attributed by J. D. Beazley to the Sosias painter, in which Achilles binds the wounded arm of Patroklus.3 The frontality of Patroklus and the linear arrangement of his legs and upper body directs the gaze to his penis, the most prominent feature of which is the prepuce, which decorously drapes itself across his right foot. It is also a convention of vase painting that, even when in a state of erection, the prepuce of paragons of male beauty should retain its proportionality to the rest of the penis; despite erection, therefore, it is almost invariably represented as unretracted, long, and finely tapered.4

The special value accorded to the prepuce in Greek culture is mirrored in the medical literature, where Galen (ca. 129–210 C.E.) singles it out as being among the most brilliantly useful adornments of the body:

Nature out of her abundance ornaments all the members, especially in man. In many parts there is manifest ornamentation, though at times this is obscured by the brilliance of their usefulness.The ears show obvious ornamentation, and so, I suppose, does the skin called the prepuce [ποσθη] at the end of the penis and the flesh of the buttocks.5

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Galen is content here to leave his admiration for the prepuce unqualified by allusions to its length, but he nonetheless provides us with powerful corroboration of the fact that the Greeks prized the prepuce on its own merits while simultaneously associating it with other aspects of male beauty.6

As I will demonstrate, the aesthetic preference for the longer, tapered prepuce is a reflection of a deeper ethos involving cultural identity, morality, propriety, virtue, beauty, and health. Accordingly, the violation of this ethos by the specter of a deficient prepuce was addressed through individual, political, legal, and medical remedies. Here as elsewhere, medicine reinforced cultural values and their political application.

Posthe and Akroposthion

As would be expected in a culture that valued the prepuce, the Greek language reflected this esteem through precise terminology. The Greeks understood the prepuce to be composed of two distinct structures: the posthe (ποσθη) and the akroposthion (ακροπσθτου). Posthe designates that part of the prepuce that covers the glans penis, but Greek writers occasionally used this word (or any of its variations, such as ποσθιη or ποσθια) in a general sense to designate the entire prepuce or, by extension, the entire penis. Akroposthion (or any of its alternative forms, such as ακροποσθια and ακροποσθιη) designates the tapered, tubular, visually defining portion of the prepuce that extends beyond the glans and terminates at the preputial orifice. When we speak of the iconographic representation of the long prepuce, we are really speaking of the long akroposthion for the posthe can never be larger than the unchanging surface area of the underlying glans penis. Rufus of Ephesus, a physician under Trajan (98–117 C.E.), describes the penis accordingly:

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The tip of the shaft is called the glans [ balanos ], and the skin around the glans [is called the] prepuce [ posthe ], and the extremity of the prepuce is called the akroposthion .7

In the Hippocratic Aphorisms , the akroposthion is presented as having a special nature:

When a bone, cartilage, sinew, the slender part of the jaw, or the akroposthie is severed [διακοπη], the part neither grows nor unites.8

This aphorism, most likely a reflection of the limits of reparative surgery during the fifth century B.C.E. seems to imply that a completely severed (circumcised) akroposthion could not be successfully reattached to the penis from which it was amputated.9 The seventh-century commentary of Stephanus of Athens, referring to the blood vs. semen dichotomy in the Galenic theory of embryology,10 explains that the akroposthion does not unite or grow because it originates from semen.11 Aristotle, having the advantage of living closer to the era in which the Aphorisms made their first appearance, attempts to explain it through comparative anatomy:

Now the eyelid is encased with skin; and that is why neither the eyelid nor the akroposthia will reunite, because both are skin without flesh.12

Although in later centuries Greek physicians would demonstrate that a severed akroposthion could be repaired—at least in a limited sense—the deeper meaning that underlies this aphorism is that the akroposthion shares characteristics with anatomically and physiologically analogous structures, such as the eyelid—thus providing a solid scientific foundation for a preexisting common high regard for the prepuce.

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Positive References to the Prepuce in Literature

The cultural significance of the prepuce is also reflected in literature. In the domain of pleasures, for instance, the longer prepuce often serves as the object of erotic interest and as a signifier of the sexually attractive male, as demonstrated by the following ribald passage from the Lexiphanes of Lucian:

"Surely," I said, "you don't mean that notable Dion, that lusty, low-scrotumed, cuntish, and mastic-chewing youth who masturbates and gropes whenever he sees someone with a large penis [πεωδη] and a long prepuce [ποσθωνα]?"13

Lucian is not satirizing the fact that a long prepuce should function as the visual cue that triggers Dion's erotic responses. On the contrary, he is satirizing Dion's general lack of decorum and self-control in the face of such self-evident visual stimulants. The desirability of the long prepuce, hence, remains beyond question.

The eroticization of the prepuce is also evident in the Thesmophoriazusae of Aristophanes, where the lusty father-in-law, pressing to his face a garment owned and worn by the young and handsome poet Agathon, exclaims: "By Aphrodite, this has a pleasant smell of [a little] prepuce [ποσθη]!"14 The diminutive posthion (ποσθιον), as opposed to the standard word posthe (ποσθη), is most likely used here as a term of endearment.

In addition to a diminutive form of posthe , the Greeks had a form to express the opposite state. In the Peace of Aristophanes, the descriptive noun posthon (ποσθων), meaning a male with a large prepuce, is used to designate a little boy: "Tell me, O large foreskinned one [ποσθων], are you singing about your father?"15 The scholiast notes that posthon was a common nickname for young boys.16 In his commentary on this word, Jeffrey Henderson draws our attention to Freud's observation of the widespread tendency to equate children with the genitals and the genitals with children.17 Here as elsewhere, the prepuce serves as a sign for the boy's whole being and as a synecdoche for the whole penis.

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This process is most clearly attested in a hortatory verse in Aristophanes' comedy Clouds . In the first prescriptive part of the oration, Socrates' Better Argument states:

If you follow my recommendations,

And keep them ever in mind,

You will always have a rippling chest, radiant skin,

Broad shoulders, a wee tongue,

A grand rump and a petite posthe [ποσθη].18

Here, the allusion to the posthe clearly, although humorously, summons up an image of the entire penis, albeit one that conforms to the aesthetic ideal seen in artistic depictions of gods and heroes. The imprecise use of the word posthe serves the humorous context because, as others have shown, the Greeks valued the longer over the shorter prepuce in relation to the length of the entire penis, and the smaller over the larger penis as a whole.19 Even if one were to argue that the word posthe was being used precisely here, the rules of proportion, as deduced from art, would require that a petite posthe be part of a proportionally even more petite penis.

For comedic purposes, it seems also to have been possible for the prepuce to serve as a visual hereditary link between father and son, and, in this capacity, as proof of paternity. In the Thesmophoriazusae again, the father-in-law tells a racy story in which an old nurse tries to deceive a man, her former charge, into believing not only that his wife has just given birth to a child, but that the child is his. She cries out:

You're the father of a lion, a lion! He's the very spitting image of you in every way, including his [cute little] prepuce [ποσθων] —it's just like yours, twisted like a pine catkin.20

Given that this is a humorous context in which the audience is meant to laugh at the old woman's impertinence and colorful language, the notion that the prepuce could serve as a standard against which to measure family resemblance should not be injudiciously extrapolated to Athenian society as a whole. Still, whatever the case may have been, the larger issue [Page 381] here is the remarkable frequency with which the prepuce is referenced in various contexts.

The Kynodesme as Protector of Public Morals

The association between the longer prepuce and respectability was so strongly felt that Greeks took steps to prevent unwanted exposure of the glans. In this regard, the consistent artistic portrayal of the adult penis with a generously proportioned akroposthion may well represent an anatomical ideal peculiar to Greeks, but, in some cases, it could accurately represent a penis whose akroposthion has been elongated—either deliberately or accidentally—through the continuous, long-term application of traction. Such traction may have come from the use of the kynodesme (κυνοδεσμη, literally a "dog leash"), a thin leather thong wound around the akroposthion that pulled the penis upward and was tied in a bow, tied around the waist, or secured by some other means.

Tethering the akroposthion with the kynodesme is frequently confused with preputial infibulation, which had different objectives and was achieved by surgically piercing the prepuce and using the holes so created for the insertion of a metal clasp ( fibula ) in order to fasten the prepuce shut. Celsus, whose work was most likely composed during the reign of Tiberius (14–37 C.E.), disapprovingly describes infibulation as being performed on adolescents "for the sake of the voice, or for health's sake."21 There is no suggestion that it improves the appearance of the penis.

Vase paintings and statues frequently portray nude athletes wearing the kynodesme .22 One of the most informative iconographic representations is found on an Attic red-figure calyx-krater painted by Euphronios, [page 382] dating from 520–510 B.C.E. which shows a young athlete in the process of grasping the lips of his akroposthion with the fingers of his left hand and pulling the prepuce taut while his right hand is poised ready to loop the kynodesme around the neck of the akroposthion .23

Because of the frequency with which the kynodesme is seen in athletic settings, some scholars have speculated that it was worn for athletic protection24—but, as Paul Zanker maintains, this explanation fails to encompass all of the facts.25 Athletes are not the only group regularly depicted wearing the kynodesme .The case for its more general use is supported by the nonspecific definitions recorded by ancient lexicographers. For instance, Julius Pollux, the second-century C.E. grammarian and sophist, states simply: "The cord with which they tie up the foreskin, they call the dog leash,"26 while Hesychius, the fifth-century C.E. grammarian of Alexandria, defines it merely as an " akroposthion band."27 The second-century C.E. grammarian Phrynichus Arabius, however, in an etymological and demographic mood, defines kynodesmai as "the thing with which the people of Attica who have their glans exposed bind their penis. They call the penis kyon [dog]."28 The lexicon of Photius (ca. 820– 91) goes even further and adds a moral dimension, stating that the kynodesme is "the little piece of hide with which the prepuce of those is bound, who in undressing disgrace themselves."29 Photius is unspecific about the exact nature of this disgrace, but we can safely assume that it [Page 383] lies in the unseemly externalization of the glans that a deficient or loose-lipped prepuce is unable to prevent. The kynodesme , then, is a means by which any male so affected can maintain his dignity when in the nude.

In komos scenes, mature komasts , or revelers, are frequently portrayed wearing the kynodesme as well.30 A striking example is a statue of the poet Anacreon, in the guise of a komast , in which his akroposthion is bound with a kynodesme and drawn upward.31 Noting that this custom was widely practiced, Zanker observes that preventing unwanted exposure of the glans was a "sign of the modesty and decency expected in particular of the older participants in the symposium."32

Satyrs are sometimes painted wearing the kynodesme , though certainly the intent is a humorous depiction of an unsuccessful imitation of human komasts .33 Additionally, the hair-skirted satyr character of the theater wears the kynodesme .34 This is most clearly illustrated in a quartet of larger-than-life marble satyr telamon figures from the theater of Dionysos in Athens (now on display in the Louvre) in which the kynodesme , which is clearly visible, is noosed around the akroposthion , pulling the penis upward, and the cord is secured to the belt of the hair skirt.35

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For those who continuously wore the kynodesme , the resulting traction on the akroposthion would have the benefit of permanently elongating it. It is conceivable, then, that the lengthening of the prepuce could have been the primary object, at least in some cases: aesthetics would be improved, and morals preserved.

Greco-Roman Views on Alien Rites of Preputial Ablation

The intensity with which the Greeks esteemed the prepuce was equalled by the intensity with which they deplored its ablation as practiced in certain communities scattered throughout the southeastern fringes of the known world. Indeed, medical writers such as Oribasius and Paul of Aegina found but a single medical use for circumcision, mentioning it only as part of the surgical management of dire cases of penile gangrene.36 Celsus similarly states:

Sometimes through such an ulceration the penis is so eaten away underneath the foreskin that the glans falls off; in which case the foreskin itself must be cut away all round. It is the rule, whenever the glans or any part of the penis has fallen off, or has been cut away, that the foreskin should not be preserved, lest it come into contact, and adhere to the ulceration, so that afterwards it cannot be drawn back, and further perhaps may choke the urethra.37

This rare instance of medical circumcision is clearly not a rationale for the indiscriminate amputation of the healthy prepuce of healthy infants in any context.

The Greeks were highly skeptical about any of the religious rationales used by certain foreigners in an attempt to justify their blood rites of penile reduction. The History of Herodotus (484–420 B.C.E.) is the earliest Greek text reporting the practice of genital mutilation of various degrees, such as circumcision. Herodotus ascribes circumcision to the Colchians, Ethiopians, Phoenicians, Syrians, and Macrones, as well as to the Egyptian priestly caste.38 He also reports, however, that the salutary influence of Greek culture induced the Phoenicians to abandon circumcision.39 In an oft-repeated passage, always quoted out of context, [Page 385] Herodotus describes the topsy-turvy world of the Egyptian priestly caste with obvious disapproval:

Everywhere else in the world, priests have long hair, but in Egypt they shave their heads. In times of mourning, it is the norm elsewhere for those most affected by the bereavement to crop their hair; in Egypt, however, in the period following a death, they let both their hair and their beards grow, when they had previously been shaved. Everywhere else in the world people live separately from their animals, but animals and humans live together in Egypt. Other people live off barley and ordinary wheat, but Egyptians regard it as demeaning to make those grains one's staple diet; their staple is hulled wheat, or "emmer" as it is sometimes known. They knead dough with their feet and clay with their hands, and they pick up dung with their hands too. Other people, unless they have been influenced by the Egyptians, leave their genitals in their natural state, but the Egyptians practise circumcision.40

Later in the following paragraph, Herodotus repeats the revelation about the circumcision of the priests and places it in the context of their impenetrable cultic fastidiousness:

Because they are exceedingly religious, more so than any other people in the world, they have the following customs. Everyone, without any exceptions, scrubs clean the bronze cup he uses for drinking every day. The linen cloaks they wear are always freshly washed; this is something they are very particular about. Their concern for cleanliness also explains why they practise circumcision, since they value cleanliness more than comeliness.41

The ironic tone of this passage, which has hitherto been poorly appreciated, underscores Herodotus's dismay at the Egyptian priestly caste's illogical notions of cleanliness and religiosity and their unfathomable disregard for physical beauty. Clearly, he is emphasizing that the notions of genital cleanliness that he ascribes to a people who routinely handle dung bare-handed and prepare food with their bare feet are necessarily at variance with those of the civilized Greeks.

An important clue to the Greeks' assumptions about the association of circumcision with the Egyptian priesthood is to be found on the fifth-century B.C.E. Attic red-figure pelike by the Pan painter, depicting Herakles overthrowing Busiris, a mythological priest-king of Egypt, and his bald-headed priestly attendants who have attempted to make of Herakles a human sacrifice.42 The painter has taken great pains to depict the priests [Page 386] as having fat, ugly, wrinkled, circumcised penises with a bulbous externalized glans, which contrast sharply with the neat and attractive penis of Herakles, with its elegantly long and tapered prepuce. Likewise, the snubbed noses and monkey-like faces of the Egyptians could hardly be more dissimilar to the heroic Greek profile of Herakles. To paraphrase K. J. Dover, if a circumcised penis goes with a hideous face and a long and tapered prepuce goes with a handsome face, it is the long and tapered prepuce that was admired.43

Later Greek writers, such as Strabo (b.64 B.C.E) and Diodorus Siculus (first century B.C.E, horrified their readers with accounts of the genital mutilation practices of various primitive, sometimes cave-dwelling tribes living around the Red Sea, as well as those of the Hebrews and Egyptians.44 While some of these tribes amputated only the prepuce, others amputated the glans,45 and still others amputated the entire penis.46 Strabo also provides a secular account of the origin of circumcision among the Hebrews. He writes that they are partly descended from Egyptians who left their homeland to follow an apostate priest named Moses, who was displeased with the state of affairs in Egypt and sought to worship his "Divine Being" divorced from animal imagery. Moses led his followers to Judaea and established an autocratic theocracy at what is now Jerusalem:

His [Moses'] successors for some time abided by the same course, acting righteously and being truly pious toward God; but afterwards, in the first place, superstitious men were appointed to the priesthood, and then tyrannical people; and from superstition arose abstinence from flesh, from which it is their custom to abstain even to-day, and circumcisions and excisions [of females] and other observances of the kind.47

Strabo's statement that the Hebrew priesthood imposed male and female circumcision for tyrannical and superstitious reasons supports Wilhelm Reich's theory of circumcision as a mechanism of social con- [Page 387] trol.48 Additionally, these Greek accounts of the bodily mutilations practiced by some primitive Near Eastern tribes underscore the association between circumcision and more severe penile mutilations. They also highlight the association between the circumcised penis (and, therefore, the exposed glans) and the linked concepts of primitiveness, barbarity, backwardness, superstition, and oppression.

The association between the circumcised penis and slavery is illustrated in an unusual sixth-century Corinthian painted clay tablet that depicts four slaves at work in a mining excavation, heaving pickaxes and gathering lumps of stone or clay into baskets.49 One slave, a pickax-wielding, Herculean mammoth, is clearly circumcised. His enormous penis swings between his legs. The glans is externalized and painted black like the rest of his body, and the artist has inscribed two fine, wrinkled, cicatrix lines behind the weathered corona glandis. The other workers, though not obviously circumcised, have stumpy little penises without the elegant taper of a Greek prepuce; perhaps the painter meant to portray these slaves as sexually disfigured in some way as well. It is quite clear that these mutilated, misshapen, and misfortunate slaves fail to live up to Greek ideals of male beauty.

Another source, albeit an unobjective one, that attests to the Greeks' ethical opposition to circumcision is the Special Laws of Philo Judaeus of Alexandria (d.ca.50 C.E). Philo claimed that circumcision was the "object of ridicule among many people."50 His dismissal of opposition to circumcision as "childish mockery " betrays his failure to understand the philosophical and aesthetic underpinnings of the Greeks' high regard for the cultivation of physical health and beauty—that is, the philosophy of kalokagathia .51 Similarly, the Greeks would have found incomprehensible, ludicrous, and chilling the alien ideological milieu in which Philo could formulate a rationalization for the circumcision of children by an appeal to the alleged necessity for "excising pleasures" and "banishing conceit."52 Circumcision for Philo was a surgical means of obtaining moral objectives through a deliberate numbing, desexualization, [Page 388] disinvigoration, and uglification of the body. The Greeks did value modesty, moderation, and restraint, but the idea of cutting off part of the genitals to achieve these moral objectives would have appeared to be counterproductive, to say the very least, for by permanently and artificially externalizing the glans, the remnant penis and its possessor would be cast into a permanent state of lewdness. Considering the antithetical nature of the Hebrews' concept that morality could be surgically engineered, it is immediately apparent why the Greeks would have viewed the circumcision of children, the ideology behind the circumcision of children, the advocates of the ideology of circumcision, and the circumcised penis with antipathy.

Legal Responses to Genital Disfigurement

Considering that the name of the part being cut off— posthe —could also designate the whole penis, the idea of circumcision might well have evoked the same feelings aroused by penile castration. Freud points out the widespread tendency to equate penile castration with circumcision, which, he maintained, must have been a relatively milder substitute that was designed to take the place of penile castration in primeval days.53 Thus, to the Greeks and Romans, both mutilations must have seemed to be the ultimate in mindless, barbaric irreverence, excess, and depravity. In this context, it is immediately understandable why the Seleucid and later the Roman imperial administrations, charged with the self-imposed task of civilizing the known world, unhesitatingly criminalized the ritualized disfigurement of the penis.

For instance, in the Hellenistic era, the Seleucid king Antiochus IV Epiphanes (175–165 B.C.E.) consolidated the empire of Alexander and, according to Tacitus, "endeavoured to abolish Jewish superstition and to introduce Greek civilization."54 Although the corroborative accounts of Josephus and the first book of Maccabees are afflicted with a bias that undermines their value as historical sources, it is notable that one product of superstition that these sources name as being banned by Antiochus was the ritual circumcision of infants.55 Clearly, the Hebrew religious [Page 389] element emphatically disagreed with the Greeks' positive evaluation of the prepuce. Although it is most likely a convenient post hoc rationalization of ritual male circumcision rather than the original reason for its introduction into Hebrew religious ritual, there can be no escape from the devastating cultural implications of the Talmudic dictum, echoing the Mishnah: "The foreskin is disgusting."56 Here we witness one of the fundamental and irreconcilable points of discord between the Greek and Hebrew views of the body.

With evident hostility, Josephus and the authors of 1 Maccabees also report that circumcised Hebrew males during this era voluntarily sought foreskin restoration therapies, interpreting this as an illicit attempt at assimilation into Greek culture.57 It is regrettable that, if any Hellenophile Israelites committed alternative perspectives to writing, nothing of this nature seems to have survived. What has survived, however, is documentary evidence that the Romans picked up where the Greeks left off in the campaign to rid the world of sexual disfigurements of all degrees.58 Upholding a standard of beneficence all their own, the Romans united the Greeks' high regard for the intact body with a greater gift for administration. Accordingly, Emperor Domitian (81–96 C.E.) and his successor Nerva (96–98) issued proscripts against the castration of citizens and slaves.59 Although there remains no direct and indisputable contemporary Roman legal or literary confirmation for it, Hadrian's late biographer, Aelius Spartianus, as well as modern scholars, have argued convincingly that, around 132 C.E., Hadrian issued a universal decree [Page 390] outlawing circumcision, under penalty of death.60 There is, however, conclusive documentation that Hadrian reiterated the ban on castration, and he and his successors seem not to have made any ethical distinction between castration and circumcision, for the wording of the laws as well as the extreme penalties for both crimes are nearly identical: forfeiture of all property and execution of the perpetrators—or, for those of higher rank, deportation to an island.61 The fact that circumcision was punished with the maximum penalty allowed under the law attests to the strength of Greek and Roman views on the subject.

Taking into account the compassionate spirit of the almost identically framed laws banning castration, the ban on circumcision was most certainly motivated by humanitarian and ethical considerations rather than by a purely theological discord with those groups, such as the Hebrew priesthood, whose rationale for the ritualized circumcision of infants was defended (ineffectively, as far as the Greeks were concerned) by an appeal to the supernatural. Yet, of the various peoples affected by this ruling, apparently only the conservative religious element among the Hebrews took umbrage, leaving behind a series of elaborated, mythologized, and, not untypically, contradictory accounts, alleging the interdiction to have been religiously motivated.62 It is interesting to note, however, that the abundance of special rules and regulations regarding the cultic activities of "uncircumcised" Hebrew priests, as preserved in the Talmud, strongly hints that even in the highest circles of the Hebrew ruling classes there existed, for a period, a measure of active pluralism on the question of infant circumcision that was independent of Roman legal persuasion.63

The Digest of Justinian (a legal compilation collected by learned jurists at the behest of Justinian in 533), however, documents that, around 140, [Page 391] Emperor Antoninus Pius at least modified the ruling of Hadrian to allow only the Hebrews to circumcise their children, while upholding the legal protections from circumcision for all other peoples:

Jews are permitted to circumcise only their sons on the authority of a rescript of the Divine Pius; if anyone shall commit it on one who is not of the same religion, he shall suffer the punishment of a castrator.64

While Pius limited the exemption to Hebrews, papyrological documents in Greek, dating from 155 to 189 C.E. indicate that complex bureaucratic mechanisms were provisionally established to grant individual exemptions to this edict for certain members of the Egyptian priestly caste.65 Few such exemptions, however, appear to have been granted. The widespread approval for the abolition of circumcision was limited by neither space nor time, for by the end of the third century, Pius's interdiction against circumcision was enhanced by the enactment of an additional legal prohibition:

Roman citizens, who suffer that they themselves or their slaves be circumcised in accordance with the Jewish custom, are exiled perpetually to an island and their property confiscated; the doctors suffer capital punishment. If Jews shall circumcise purchased slaves of another nation, they shall be banished or suffer capital punishment.66

The incorporation into the Digest of Pius's more recent revisions of the law banning circumcision would explain why the sixth-century compilers of the Digest did not include the obsolete original decree of Hadrian. The two rescripts of Pius, coupled together, were reenacted under Constantine the Great in the fourth century,67 and, of course, under Justinian in the sixth century. Simultaneously, the church adopted these as well as additional bans on circumcision into canon law and into its regional legal codes. Furthermore, the secular Roman law of the Byzantine Empire and the countries of Western Europe, at least through the Middle Ages, preserved and enhanced laws banning Hebrews from circumcising [Page 392] non-Hebrews and banning Christians or slaves of any religious affiliation from undergoing circumcision for any reason.68

It is important to note that one of the reasons for the seemingly continuous need to reenact laws banning Hebrews from circumcising non-Hebrews stems from the unavoidable conflict that arose over the issue of Hebrew religious freedom. From the pagan reign of Emperor Antoninus Pius and through the Christian imperial administrations of the Middle Ages, with a few notable and isolated exceptions, the freedom of the Hebrews to practice Judaism was guaranteed by law.69 Hebrew law, however, requires that Hebrews circumcise their slaves and servants, although this circumcision does not constitute a conversion to Judaism.70 The Torah, the Talmud, and the later Schulchan Aruch all attest to the Judaistic imperative for forcibly circumcising non-Hebrews in this context.71 Although the periodic need to reenact anticircumcision laws indicates that they were frequently violated (and specific instances of violation have been preserved),72 Roman and church law agreed in principle that the absolute freedom of the Hebrews to practice Judaism ended at the beginning of the preputial epidermis of non-Hebrews.

The Psolos Male

In the classical era, the association between the denuded glans and criminal impropriety is reflected in the vernacular, for in the plays of Aristophanes we find use of the derisory adjective psolos (ψωλος).73 The [Page 393] scoliasts suggest that psolos can simply mean "having an erection,"74 a situation that can inadvertently cause the prepuce to evert, exposing the glans, but this definition does not take into account the varied contexts in which the word is used. The psolos male need not necessarily be circumcised either, as in the following slander: "He's come back here with an old man who's filthy, hunchbacked, wretched, wrinkled, bald, toothless, and, by God, I think he's psolos too!"75 When applied to certain foreigners of ill repute, however, psolos can very well imply that circumcision is the cause of the offender's lewdness. In the Birds , for instance, in the context of an uncharitable speech dealing with the Egyptians and the Phoenicians, a reading of "circumcised" for psolos , when it is used here to denote these peoples, may well be intended.76 Whether the glans was exposed through preputial slackness, inappropriate erection, or preputial amputation, the affront to good taste was the same. The public exposure of the glans was unsightly and indecent.

In vase painting, except in some erotic scenes or in humorous depictions of old men, the eversion or amputation of the prepuce to expose the glans was, as Zanker has observed, "shameless and dishonorable, something we see only in depictions of slaves and barbarians."77 Greek artists also took pains to represent ugly, decrepit old men, barbarian slaves, lecherous old satyrs, and comics as having a large, ungainly penis, sometimes with an exposed glans, even when unerect, lending an effect of comic lewdness.

Even in the private sphere, eversion of the prepuce and exposure of the glans seems to have been desirable only under certain exceedingly intimate circumstances. For instance, there are only a small handful of vases depicting an exposed glans (albeit only partial exposure) in an attractive youth who, in these instances, is erect and about to engage in [Page 394] irrumation.78 Portrayals of irrumation by attractive, young, human males generally depict the prepuce as unretracted, teat-like, and neatly tapered;79 consequently, preputial eversion alone, without erection, must have been deemed unseemly in public precisely because it was so strongly associated with erection. An exposed glans was also undesirable because of its superficial resemblance to the permanently externalized glans of the circumcised penis. Hence, we see that in the Greek cultural constellation of symbols, the image of the exposed glans was remarkable for the intensity and sheer abundance of negative imagery associated with it.

One final note on the word psolos , however, would be in order. The definition in the tenth-century Byzantine Suidae Lexicon , which, like the earlier lexicon of Photius, was most likely compiled to clarify the meanings of increasingly obscure words in classical texts, reads: "ο λειποδερμος [ ho leipodermos ]"—that is, one suffering from lipodermos .80 Thus, we have concrete evidence, although from a late source, that the condemnatory moral view of the penis with an exposed glans—the lewd psolos penis—had at some point been subsumed into a new framework: it had been transformed into a medical concept, but it was more than this. Immorality, impropriety, and genital unattractiveness were now diseases, for which the medical profession offered cures.

The Appearance and Definition of Lipodermos

As we have seen, a mutually reinforcing synthesis between preexisting Greek cultural views of the prepuce and Greek reactions to the anti-preputial practices of certain Near Eastern peoples who had been incorporated into the Seleucid and Roman empires converges in a single medical concept: lipodermos (λιποδερμος, or, alternatively, λειποδερμος) literally, "lacking skin"—the pathological disorder of the penis whose symptom was an artificially or congenitally externalized glans penis.

The spurious but genuinely ancient Definitiones medicae , a work written by an unknown hand but frequently cited by Renaissance scholars of [Page 395] Galen, provides the following definition of lipodermos , linking it with this useful distinction between posthe and akroposthion

Lipodermos is a defect of the skin cover of the glans such that it can be laid bare no further. That which covers the glans (balanos is called the posthe or the akroposthia.81

Lipodermos could be used as an adjective, describing a male (or a penis) characterized by a deficient prepuce, and it could also be used as a noun, signifying the name of this disorder.

The Treatment of Lipodermos

lipodermos

lipodermos

lipodermos

The extant writings of a significant number of Greek and Roman physicians feature discussions ofand its treatment. According to Galen, the now-lost medical work of Crito, a physician at Trajan's court, contained a section on the treatment ofas well.In accordance with the severity of the condition or its cause,was treated with topical medications, traction, or surgery.

Medicinal Treatment

In his Materia medica , Dioscorides of Anazarbus (41–68 C.E.) recommended the curative and soothing properties of honey in combination with repeated soakings of the affected part in warm water to make the penile skin more supple and to allow stretching of the prepuce: " Lipodermos , if not due to circumcision, is cured by honey, if for thirty days the posthe is softened with honey, especially after a bath."83 Dioscorides' second herbal treatment for congenital lipodermos involves a preparation from the rubefacient plant thapsia ( T. garganica ). Physicians attributed to this plant the property of augmenting the volume of the parts onto which it was applied: "[Thapsia] is useful for the prepuce (επαυωυιον) of those suffering from lipodermos , providing it not be as a result of circumcision. It induces swelling, which when bathed and anointed, restores the defect of the posthe ....84

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Galen also advocated the use of thapsia and hinted that there were several topical preparations that were helpful for the treatment of lipodermic men. In De compositione medicamentorum per genera , Galen attributes such a preparation to a certain Epidauros:

Another of Epidauros' Treatments for the Lipodermic

Ingredients:

thapsia root, 3 drachms

black or long pepper, 1 drachm

fat of a calf, 12 drachms

frankincense, 4 drachms

balsam, 2 drachms

pine resin, 16 drachms

beeswax, 8 drachms

Pour the melted [ingredients] over the dry..85

The ingredients in this cerate were commonly used in medicinal preparations, especially emollients.86 The fat as well as the aromatic pine resin, frankincense, and balsam were thought to have, among other things, cleansing properties. The beeswax was a carrier, and the thapsia and pepper (the dried berries of Piper nigrum , as opposed to the New World Capsicum were counterirritants used to treat bruises and other complaints, when applied externally. This cerate presumably would have facilitated the manual stretching of the penile skin while simultaneously inflaming it.

Tractional Treatment

The medical sources affirm that the use of the preputial ligature was not limited to athletes or komasts . The Ephesian physician Soranus, who lived under the reigns of Trajan and Hadrian (98–138 C.E.), has left us indication of both a wider use of a ligature and the more general cultural diffusion of the concept of lipodermos . In his Gynecology , Soranus justifies the medically prescribed stretching of the foreskin by an appeal to aesthetics. He advises wet nurses to massage the newborn child periodically, and to pay particular attention to performing manipulations designed to improve the appearance of the congenitally lipodermic penis:

If the male neonate appears to be lipodermic (λειποδερηος), she [the wet nurse] should gently draw the akroposthion forward or even hold it together with a strand of wool to fasten it. If gradually stretched and continuously [Page 397] drawn forward, it easily stretches and assumes its normal length, covers the glans penis and becomes accustomed to keep the natural good shape.87 Preserved in their original setting in De methodo medendi ,88 Galen's nonsurgical methods of elongating the prepuce involve different applications of traction and tension. The abridged account of Galen's exposition that appears in Oribasius's compilation states:

When the skin of the penis needs only a short stretch in order to give it a natural appearance, I have often obtained the desired result through simple tension: I roll around the circumference of the penis a strip of strong and soft papyrus, after having coated the skin with glue. It is clear that it is necessary to glue the end of the strip of papyrus to the part of the same strip placed on the underside of the end. In effect, this device dries quickly and pulls without discomfort. One places under the skin of the posthe , on the interior fold, a rounded object of suitable dimension, that one can easily remove when the strip of papyrus is adhered. When I have no such object at my disposal, I often roll up and introduce a piece of papyrus of average size to serve as a support for the one with which I surround the penis. I want to be careful to provide the patient with a way to urinate easily when the paper rolled around his penis is completely solidified and the supporting one is removed. Some of those who use thapsia to return the posthe over the glans construct the round object in question in the form of little lead spout. They stretch the skin of the posthe over the exterior of this spout and secure it with a soft leather cord.This procedure can sometimes also be useful for those individuals who are missing a large amount of posthe . I also treat this surgically.89

The alternative method that Galen outlines, that of inserting a lead spout under the prepuce and holding it in place by binding the enveloping prepuce with a leather cord ( himas [ιμας]), would have added weight and perhaps tension, depending on the length of the lead spout, to the restorative technique.

Like the technique of Soranus, Galen's method of manually stretching the deficient preputial skin over the glans and winding a leather cord around the " akroposthion " would have a similar effect to that of the kynodesme . These techniques depend for their efficacy on the principles of tissue expansion, today a major reconstructive technique. Given sufficient application of constant tension, new and permanent skin can be induced to grow. Penile skin, noted for its great elasticity, is especially responsive to expansion techniques.

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Surgical Treatment

The surgical techniques developed in antiquity to repair the lipodermic penis have been described in modern medical journals,90 but these papers erroneously portray these operations as having the sole objective of surgically repairing the circumcised penis rather than the lipodermic penis, which, as the ancient sources show, need not necessarily have been caused by circumcision. For instance, Celsus prefaces his account of his surgical technique by specifying that it is to treat "those in whom the defect is natural,"91 rather than those in whom it is caused by circumcision. The Latin translation omits the term lipodermos , but the subject matter and composition fit so well with other explicitly denominated descriptions of lipodermos repair (see below)that the attribution may be taken to be legitimate:

And, if the glans is bare and the man wishes for the look of the thing to have it covered, that can be done; but more easily in a boy than in a man; in one in whom the defect is natural, than in one who after the custom of certain races has been circumcised; and in one who has the glans small and the adjacent skin rather ample, while the penis itself is shorter, rather than in one in whom the conditions are contrary.

Now the treatment for those in whom the defect is natural is as follows. The prepuce around the glans is seized, stretched out until it actually covers the glans, and there tied. Next the skin covering the penis just in front of the pubes is cut through in a circle until the penis is bared, but great care is taken not to cut into the urethra, nor into the blood vessels there. This done the prepuce slides forwards towards the tie, and a sort of small ring is laid bare in front of the pubes, to which lint is applied in order that flesh may grow and fill it up. <It is seen that a large enough part of the penis has been bared, if the skin is distended little or not at all, and if> the breadth of the wound above supplies sufficient covering. But until the scar has formed it must remain tied, only a small passage being left in the middle for the urine. But in one who has been circumcised the prepuce is to be raised from the underlying penis around the circumference of the glans by means of a scalpel. This is not so very painful, for once the margin has been freed, it can be stripped up by hand as far back as the pubes, nor in so doing is there any bleeding. The prepuce thus freed is again stretched forwards beyond the glans; next cold water affusions are freely used, and a plaster is applied round to repress severe inflammation. And for the following days the patient is to fast until nearly overcome by hunger lest satiety excite that part. When the inflammation has [Page 399] ceased, the penis should be bandaged from the pubes to the corona; over the glans the plaster is applied with the other end of the probe. This is done in order that the lower part may agglutinate, whilst the upper part heals without adhering.92

In addition to the surgical technique outlined by Celsus, the compilations of Paul of Aegina and Oribasius contain abridged accounts of a similar surgical treatment, originally from the Cheirourgoumena (preserved only in fragments), a lost work by Antyllus, a second-century C.E. Greek physician.93 Unlike Celsus, Antyllus freely uses the term lipodermos , but like Celsus, he stresses that this operation is of little value in circumcision-caused lipodermos . In a brief commentary, however, Paul of Aegina voices his disapproval of Antyllus's operation, expressing his doubt that anyone would choose to submit to its dangers.

The Identity of Lipodermic Patients

Having marshaled the evidence, a few general questions left unanswered in the sources can be posed. It is worth asking who would have been a candidate for lipodermos treatments and surgical restoration of the prepuce at this time, and what their motivation would have been.

Hebrews

The available sources do not specify the demographics of treatment seekers, but the most obvious candidates among those whose lipodermos was attributable to circumcision would seem, at first, to have been Hebrew males, circumcised involuntarily at eight days of age, who wished to solidify their assimilation into Greco-Roman society. The ban on Hebrew circumcision instituted by Antiochus Epiphanes in Jerusalem could not have lasted long, and the Seleucids soon lost control over the region. Still, then, as now, not all Hebrews lived in Palestine, and even among those who did, it is difficult to imagine that all would have been indifferent to the reinstatement of compulsory circumcision. If we are to trust the account of Josephus (37–100? C.E.), "many of the Jews, some willingly, others through fear of the punishment which had been prescribed, followed the practices ordained by the king."94 In his first epistle to the Corinthians (1 Cor. 7:18), Saul of Tarsus (St. Paul) alludes to Hebrews [Page 400] who stretched their remnant penile skin to create a facsimile prepuce, but without mentioning the cure of lipodermos as the incentive. The Talmud as well, which traditionally dates, in its oral form, from about this period, alludes to Hebrew priests among others in whom "the prepuce is drawn forward to cover up the corona."95

Given that the native Hebrew sources on Hebrew history are almost exclusively biased toward the religious perspective, it is easy to lose sight of the possibility that these sources may not represent a majority view. There is little basis for the assumption that Israelite society was any less pluralistic than any other. The religiously oriented sources (and Josephus, as an apologist for the religious oligarchy, must be included in this category as well) acknowledge the existence of a divergent view on infant circumcision within Israelite society, but they denigrate that view.

The situational nudity in the transplanted culture of the Greek conquerors of the Near East and the prevalence of the nude in public art throughout the Greek and Roman cities of the Empire would have served as a reminder to the Hebrew of the physical alienation that had been imposed upon him by his hieratic overlords. From the medical point of view, however, circumcision had not merely alienated the Hebrew: it had afflicted him with a sexual pathology as well. A regular regime of thapsia-laced unguents, a discreet weight suspended from the remnant penile skin, or even reparative surgery may have seemed a fair price for the restoration of a more biologically natural-looking penis and access to the cultural advantages that it represented.

Slaves

The second group of candidates that comes to mind is manumitted slaves of Hebrews (or unmanumitted slaves, once owned by Hebrews and later sold to non-Hebrews) who had been forcibly circumcised in accordance with Mosaic law. Bearing the mark of Hebrew slavery, it is understandable that they might have been eager to erase the physical reminder of their degradation. A self-deprecating verse of Martial (40–104 C.E.) hints at a complex tale of an unmanumitted slave who was in the process, it is tempting to think, of curing his lipodermos :

Your slave stands with a black strap round his loins whenever you submerge your whole self in the warm water. But my slave, Laecania, to say nothing of me, has a Jewish weight under his lack of foreskin.96

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We see in this verse documentation that the conical, leaden antilipodermos weight described by Galen may have been known as the pondus judaeus , which indicates that Hebrews were more closely identified with its use. That the presumably Roman speaker of this poem should also be wearing the pondus judaeus raises interesting questions that should be considered, at least in part, in relation to lipodermos .

Egyptians

It is often alleged that male circumcision was a widely observed custom among the Egyptians, and if this were so, one would expect some Egyptians of the Greco-Roman era to have sought treatment for lipodermos . On closer inspection, however, it emerges that there is no concrete proof at all that circumcision was widely practiced in Egypt.97 It is not necessary for our purpose to consider this question in detail, but a general survey of the evidence has to be presented before one can fully understand the impact in Egypt of both the Roman legal prohibitions on circumcision and the Greco-Roman medical concept of lipodermos .

The modern assumption that circumcision was widely practiced in Egypt originated, for the most part, in the work of early-twentieth-century scholars whose primary interest was in confirming the classical sources (especially their misreading of Herodotus)and in confirming and authenticating the "historical basis" of the Bible. A few examples of Old Kingdom (2649–2134 B.C.E.) statuary present some adult males—usually priests, functionaries, or low-status workers98—as having under-gone a vertical slit on the dorsal aspect of the prepuce, although no flesh has been removed.99 Similarly, a sixth-dynasty (2323–2150) tomb relief—the Mastaba of Ankhmahor at Saqqara—depicts something happening in the vicinity of the penis of a " ka -priest": no flesh has been cut, and there is little reason to imagine that a preputial amputation must follow; the hasty interpretation of this as a "circumcision scene" and as "proof" that circumcision was routine in ancient Egypt would seem to be an [Page 402] injudicious and unwarranted extrapolation.100 Ann Macy Roth convincingly argues that at least the right side panel of the Mastaba of Ankhmahor most likely depicts the ritual pubic shaving of the ka -priest rather than a circumcision.101 She suggests that the left scene could involve penile cutting, but the vertical angle of the oval object in the right hand of the squatting man—assuming that it is a knife—shows that the incision about to made cannot be a circumcision, which requires a horizontal cut; if any cutting is about to take place, and this is by no means definite, it can only be a vertical dorsal slit. Roth conventionally translates the caption to this left-hand scene as "circumcising ka -priest," but acknowledges that there are unusual problems with the hieroglyphics that make a conclusive translation impossible.102

By the time Herodotus visited Egypt, sometime after 460 B.C.E. the dorsal slit may have indeed mutated into a full preputial amputation, but it seems to have been restricted to certain males of the priestly caste. Still, some skepticism about the accuracy of Herodotus's observation seems pardonable and prudent. The opportunities to make a detailed and comprehensive examination of the penises of members of the Egyptian priesthood are likely to have been severely limited, especially for a foreigner. And whether they experienced full preputial amputation or merely a dorsal slit, there is still disagreement on how prevalent such practices were among the priests, and how long they persisted. Egyptian civilization spanned millennia: it is unwise to assume that any customs, especially ones as restricted as penile incision or circumcision, would necessarily have endured unchanged over such a long time span. The only indisputable documentary support for the existence of circumcision among the Egyptian priesthood remains the Roman-era papyrological evidence cited above.

Evidence suggesting that, at least in later centuries, the Egyptian masses enjoyed freedom from any degree of penile cutting is manifested, among other places, in the thirtieth-dynasty (380–343 B.C.E.) limestone relief of Horhotep, which shows a scantily clad procession bringing tribute to Horhotep, the high priest of Buto.103 Apart from the seated [Page 403] priest, who wears a kilt, all of the males in this scene, young boys as well as strapping adult men, are indisputably in full possession of robust prepuces. It may also be observed that the remarkable wealth of statues, statuettes, and reliefs of nude Egyptian youths and young gods such as Horus and Harpocrates, dating as early as the Old Kingdom, uniformly feature a generously proportioned akroposthion .104 It is not surprising, then, that modern radiological methods have disproved the early-twentieth-century claims that Egyptian mummies bear the mark of circumcision.105

Further corroboration is provided by Josephus, himself an Alexandrine, who, in defending ritual Judaistic circumcision against criticism voiced by Apion, an Alexandrine Egyptian academician, declares that the Egyptian priests of his day were circumcised—implying that all other Egyptian males were free from circumcision.106 Support for this .nal point can be deduced from Josephus's ungracious allegation about the fate of Apion's prepuce.107 Thus, we have a strong case that even before the edict of Hadrian, outside the priestly caste, circumcision was not a feature of secular Egyptian life. Few if any Egyptians would have been diagnosed with circumcision-induced lipodermos , although some could well have been diagnosed with a degree of congenital lipodermos .

Miscellaneous Near Eastern Peoples

What of the other peoples at the fringe of the Empire who circumcised children prior to Hadrian's abolition of circumcision? Intriguing evidence is fortuitously preserved in a unique Syriac text, The Book of the Laws of Countries , a dialogue concerning Bardaisan of Edessa (154–223 C.E.), written down by his pupil Philippus. Bardaisan states:

Recently the Romans have conquered Arabia and done away with all the laws there used to be, particularly circumcision, which was a custom they used. For a man of his sovereign free-will submits himself to the law laid upon him by another, who also possesses sovereign free-will. But I shall tell you another [Page 404] thing too, more convincing than all the rest to fools and unbelievers: all the Jews that have received the law of Moses, circumcise their male children on the eighth day, without waiting for the coming of stars and without regard for the local law.108

Evidently, even by the beginning of the third century, the news that the Roman authorities had exempted Hebrews from the abolition had not yet reached this corner of the world. No sources have yet emerged to verify whether Greco-Roman physicians practicing in Arabia diagnosed or treated lipodermos . Still, given that Greek medical texts found currency here, it would be surprising if lipodermos were not occasionally diagnosed, at least in the few remaining centuries before the rise of Islam.109

Conclusion

After this survey of the evidence, some conclusions about Greek views of the prepuce can now be drawn. In the multinational Seleucid and Imperial Roman eras, the medical support for a preexisting ethos of male genital aesthetics that favored the longer, securely closed prepuce was confirmed and intensified. This led to concerted and concerned action to address violations of that ethos.

Through the development of the concept of lipodermos , Greek medicine gave to Greek civilization a scientific reinforcement of its disapproval of the violations of genital integrity occurring in the Near East. This ethos posited not only that a circumcised penis is a deviation from the natural—although that is of real importance—but that a circumcised penis is a defective and disfigured penis, one that can be repaired by medical treatment. Medicine and law thereby entered into a mutually supportive relationship: circumcision was against the law because it mutilated its victims, but, taken to the next logical level in this medico-ethical argument, it was also against the law because it necessarily inflicted a state of lipodermos on its victims.

The effect of recognizing the circumcised penis as defective through the concept of lipodermos was not merely the addition of a medical dimension to the Greeks' critical view of circumcision: it also led the Greeks to view the intact penis in a more critical light. While a circumcised penis would necessarily have been considered lipodermic and thus [Page 405] pathologically disfigured, the intact penis with a congenitally insufficient akroposthion that risked exposing the glans was also regarded as suffering from a degree of lipodermos . The lipodermic penis, as we have seen, was not only the stigma of slaves and unpopular foreigners from the Near East, but a provocative focal point for criticism. Moreover, during the Roman era, where circumcision was a capital crime that was associated with the rejection of Greek or Roman civilization, the poorly proportioned lipodermic but intact penis with its glans exposed to one degree or another, because of its superficial resemblance to the circumcised penis with its surgically externalized glans, would have been seen as a sign of criminality, apostasy, and unpatriotic rebellion. These must have been impelling incentives to seek treatment. Mercifully, Greek medical writers reassured their readers that congenital lipodermos was much easier to alleviate than accidental or surgically induced lipodermos .