Indian Medical Gazette (Calcutta), vol.56, no2 (February 1921): pp. 48-49

A BARBARIC METHOD OF CIRCUMCISION AMONGST SOME OF THE ARAB TRIBES OF YEMEN.

By Dr. Y.V. CHABUKSWAR, Senior Grade Second Class Sub-Assist. Surgeon, in sub-charge, Civil Hospital, Aden.

It is enjoined in the Koran by the Prophet that an infant should be circumcised on the seventh day after its birth [this is erroneous: the Qu'ran does not mention circumcision] , but this is not observed in many places, even in Arabia. The common practice amongst all Mahomedans and Jews, as is well known, is to remove the redundant portion of the prepuce only. There is a district in Yemen called Al Hoora, about 15 days journey from Aden. In this province of Al Hoora there are six villages, viz., Hijaji, Mugrasi, Udebli, Ukabi, Wahagari and Mugawiya, governed by an Arab ruler, by name Ali Murgayeh. The circumcision is performed, not in infancy or childhood, as is usually done, but amongst the grown-ups, who are about to marry. Unless the man is circumcised in this particular manner, he cannot obtain a bride. The circumcision is done with religious ceremonies as follows:--

The man who is to undergo the circumcision sends invitation to all his relativesand friends in his town and in the surrounding villages named above; a day is fixed and the would-be bridegroom is taken up to a high building, open to view on all sides and specially erected for this purpose. He is well dressed like a bride-groom, the guests, males and females, together with other spectators watching him from below; the victim is made to stand with his right arm lifted up, holding a dagger and looking straight forward with steady eyes. One Arab is appointed to watch the movements of his face and eyelids, and the operator, called Rayis (barber) or Khadim, commences the operation of circumcision at about one inch below the umbilicus, dissecting the skin downwards, peeling off the entire skin of the penis, leaving that of the scrotum intact, without any local or general anaesthetic. If, during this operation, the man undergoing the circumcision even winks a little, or shows any sign of pain of the operation, it is at once abandoned, and one of the following punishments is given to the victim:-- (a) Killed on the spot; (b) deported from the district in disgrace; or (c) sold as a slave to outsiders. Of course, the bride, for the sake of whom he was undergoing circumcision, is totally lost to him. Very often the would-be bride is also one of the spectators. If the operation is successfully finished, and the man goes through the ordeal with courage and without showing signs of pain or cowardice, the occasion is celebrated with great rejoicings and feasting, with beating of drums and firing of arms. The man is congratulated by all who are gathered, and the Rayis finishes off his work by imparting a kiss on his forehead. The man is taken to his house and receives presents of ghee, cloth, goats, etc. The wound takes about two to eight months to heal, or even longer, and suppuration always takes place. The dressings used by the patient are simple: a daily wash in the morning and applying to the wound leaves of a shrub, called by the Arabs "Sulla", smeared with a little oil. The operator`s fee in the case is only one Riyal – a silver coin worth Rs. 2-4 , and the Hakim`s, i.e., the Rulers` fee is also the same as that of the Rayis. The very commonly expected bad results of the circumcision are hernia and urethral fistula – the latter is one in every ten such operations. The deaths from sepsis are also very common.

As will be seen from the accompanying photos, the whole of the skin from a point just below the umbilicus to the root of the penis, with all the hair-bearing area, and all the skin of the penis, as far as the scrotum, is removed . In some cases, as in photo No.2, a portion of the penile urethra is also removed, of course unintentionally. Several such cases of loss of a portion of the urethra, in one case fully one inch, have been treated at this hospital.

Case No.1, photo No.1, -- An Arab, aged 25, resident of Mugawiya, the slave of case No.2, was circumcised 12 years ago. The wound took about seven months to heal, resulting in left inguinal hernia, with extensive scarring. This man was operated on by Major M.S.Irani, I.M.S., the Acting Civil Surgeon, Aden, on 8th November, 1920, and was discharged cured on 25th November, 1920.

Case No.2, photo No.2, -- An Arab, aged 40, resident of Mugawiya, was circumcised 12 years ago. The wound took about two months to heal, resulting in urethral fistula two months after the operation, the fistula being situated at the root of the penis. This man was operated on 17th November, 1920, by Major M.S.Irani, I.M.S., The Acting Civil Surgeon, Aden, who secured a flap from the skin of the scrotum to form the floor of the urethra, taking over flaps from either side of the scrotum to cover up this inverted flap. The wound exhibited healthy signs of healing, but the man, being very anxious to see his native land, and, probably, his bride, left this hospital of his own accord, on 25th November, 1920, equipped with simple surgical dressings.

I submit the above notes, with a hope that these will be of some interest to the profession, because it is not likely that such cases will be seen in other Mahomedan countries. The above notes are published with the kind permission of the operator, to whom I am very much thankful.