Invariably, the indirect, involuntary cause is given all
the blame, and the decision to circumcise, none. So circumcision
continues to be promoted as "safe" and babies continue to die. The suicide of David Reimer
after a ruined life was ultimately due to his botched, unnecessary
The actual rate of death from "medical" circumcision is
unknown. A rate can be calculated from Gairdner's paper
of one death in 5600 circumcisions, but that was in England in the
1940s, and it must be lower now. Grimes
(1978) gave a figure of two deaths per million, but citing a 1953
study. A Brazilian study
finds a rate of one death in 7692 circumcisions. It is certainly more
than one in 1,200,000 since there is on average more than one in the US
every year. The problem is that deaths indirectly due to circumcision,
such as that of Dustin Evans Jr,
are not attributed to it as they should be, since it is unnecessary
surgery. (If it were necessary, the death could be ultimately blamed on
the condition that made it necessary.)
THYMOS: Journal of Boyhood Studies,
Vol. 4, No. 1, Spring 2010, 78-90
LOST BOYS: AN ESTIMATE OF
U.S. CIRCUMCISION-RELATED INFANT DEATHS
- Dan Bollinger
Abstract: Baby boys can and do succumb as a result
of having their foreskin removed.
Circumcision-related mortality rates are not known with certainty; this
estimates the scale of this problem. This
study finds that approximately 117
neonatal circumcision-related deaths
(9.01/100,000) occur annually in the
United States, about 1.3% of male neonatal deaths from all
infant circumcision is elective, all of these deaths are avoidable.
also identifies reasons why accurate data on these deaths are not
some of the obstacles to preventing these deaths, and some solutions to
A significant number of youths die from infection after
tribal circumcision every year in Africa
An average of 39 a year (80 in
2009) in Eastern Cape province alone.
Ryleigh McWillis - death from blood loss
MEDICAL CAUSE OF DEATH
(1) Immediate cause of death: a) Multi-organ
ischemia, due to or as a consequence of b) exsangination [loss of blood],
due to or as a
consequence of c) circumcision
(2) Other significant conditions contributing to death: Post-surgical
Classification of the event: Accidental
Date signed: 19 January 2004
T.E. Chico Newell, Coroner
THE DADE COUNTRY MEDICAL EXAMINER
DEPARTMENT, Miami, Florida
The body is that of a 25-1/2
inch, 15 pound, very pale appearing Negro male appearing consistent
with the stated age of 6 months. ... No anomalies are evident.
When initially viewed, a large
amount of congealed blood covers the head of the penis. Removal of this
disclosed a circumcision site that appears unremarkable along the
dorsal surface of the penis. Ventrally, however, a gaping defect of
approximately 12 x 14 millimeters is evident with a large amount of
extravasated blood in the subcutaneous tissues extending along the
shaft of the penis nearly to the scrotal sac.
CAUSE OF DEATH:
Charles V. Wetli, M.D.
Deputy Chief Medical Examiner
In this case, unlike the one above, the cause of
death is correctly attributed, yet there is no record of any further
action being taken.
Joshua Haskins - weakened by a heart condition
Jill and Shane Haskins' baby Joshua was born on
August 16, 2010 with a major heart defect (Hypoplastic Left Heart
Syndrome, HLHS). He had heart surgery at 3 days old, and
was circumcised on October 5, 2010. He died on October 6.
and accepted comments before, during and after the birth, surgery,
circumcision and death. (Most strikingly, she blogged after the
circumcision, while Joshua was still struggling against haemorrhage, "I
Almost Killed My Son". Her blog now contains no reference to
Nobody will ever be able to say with certainty
that Joshua would have lived if he had not been circumcised. The
doctors insisted that his circumcision had nothing to do with it, but
they would say that, wouldn't they? What we can say (and even Amy
Tuteur admits) is that circumcising him could not have helped. For the
doctors to go ahead with the surgery in his weakened condition does
illustrate the compulstion to circumcise that has been called the Toxic
KQED on August 29 2012, the ethicist for
the American Academy of Pediatrics, Dr Douglas Diekema, grossly
misstated the case (starting at 12:40):
"There's at least, y'know, one of these
cases that gets trotted out, involved a very sick baby that was likely
to die anyway, and his parents wanted him circumcised before, ah, his
death, and to attribute that to a circumcision is silly, um, that kind
of a death."
His mother's blogs give the lie to that
Brayden Tyler Frazier - blood-loss
March 8, 2013
Another circumcision death
An 11-day-old boy has died died at UC Davis
Children's Hospital in Sacramento, California, two days after being
circumcised in the nearby town of Lodi.
According to his grandfather, Brayden Tyler
Frazier had been taken to the doctor when he was a week old because he
had been sleeping constantly and not eating. His parents had also
noticed that his neonatal sticks and pricks had not healed quickly, and
had to stay bandaged for two days or more.
The doctor in Lodi sent them home with
instructions to monitor his condition and after two days, he was
circumcised. It was later discovered that the wound had continued to
bleed. He was taken back to the doctor, then to Urgent Care, then to
the ER, and then transferred to UC Davis Medical.
He had "generalized bleeding" and an unidentified
Over the two days after his circumcision, he went
into seizures and a coma, and died.
It was claimed online that the baby should have
been tested for haemophilia, but a paediatric haematologist/oncologist
Coagulation studies are not routinely done
before many types of surgeries,
including circumcisions. ...
studies are not a part of routine newborn screening tests.
Coagulation is complex, and involves the
platelet cell and a couple dozen
chemicals / proteins, to clot when needed but also not to clot in
inappropriate locations, or excessively, and to additionally reabsorb
after they have done their jobs.
Plus hemophilia isn't a single disorder;
there are two main types of
"hemophilia" (deficiency of Factor 8 or Factor 9 ). But there are many
other reasons to bleed excessively. However, a combination of several
functional tests can narrow down the list of specific aspects of the
coagulation system that need testing, in a given individual whose
screening functional tests are abnormal, in order to identify what
to be done to treat that individual's bleeding/risk.
However it is more complicated in newborns:
1) Of the couple dozen chemicals, many are
in different levels in
newborns. For several reasons, some aspects of the newborn's system are
hypo-coagulable [blood won't clot] while others are hyper-coagulable
[blood clots very easily] and it generally balances out. So there are
different normal ranges for results in
2) Most tests of the coagulation system
involve drawing blood from a vein
or artery and simultaneously mixing it with anticoagulants (different
anticoagulants for different tests). These tests also involve a
large amount of blood.
Additionally the tissue factors, that
trigger the initiation of the
clotting system in injuries, are released from a heel stick and affect
3) It is however easy to do extensive or
specific coagulation tests in
When planned, the blood is correctly drawn
at delivery from the umbilical
cord, taking the blood otherwise left in the placenta...
can be planned when a family history [of haemophila] is present or
there are other reasons
Surgeries / procedures that have no medical
necessity, [such as] circumcision,
should not be done.
Dustin Evans Jr. - death from anaesthetic
Dustin Evans Jr was born in Cleveland, Ohio in
October 1998. He was circumcised by a Dr Russell soon after, who took
so much shaft skin that the scar healed as a wideband stricture (a
tight "collar") around his penis, preventing him from urinating. When
he was given sevoflourane, an anaesthetic, in order to "revise" his
circumcision, he immediately died of cardiopulmonary arrest.
His father said, "You think, 'What could go wrong with a circumcision?'
next thing I know, he's dead."
Oddly, the report of Cuyahoga County Coroner,
Elizabeth Balraj MD, says
MARKS AND SCARS: None
EVIDENCE OF RECENT THERAPY: [does not mention his circumcision]
EVIDENCE OF RECENT INJURY: None
A FAMILY doctor who killed a nine-year-old boy by
giving him a massive
overdose of a pain-killing drug during a circumcision operation, was
given a one-year suspended jail sentence yesterday. Dr. Mahbubul Alam,
59, of Handsworth Wood, Birmingham, admitted the manslaughter in July
1991 of Raju Miah, of Smethwick, who died in hospital six days after
being given diamorphine (heroin).
Timothy Barnes QC, for the prosecution, told
Stafford Crown Court that the
boy was taken for the operation by his grandfather. Dr. Alam, who had
performed four circumcisions that day, administered 10mg of
diamorphine, "five to six times the appropriate dose."
Mr. Barnes said: "Raju was given 10mg of
diamorphine, which sedates the
brain and also tends to depress breathing. After the operation the boy
unconscious and when he was driven back to the family home, Dr. Alam
tried to arouse him by sprinkling water on his face and lightly
smacking his face." He said shortly after the doctor left, the boy's
condition worsened and he was taken by ambulance to hospital. After six
days, he was certified brain dead and the life-support machine was
Mr. Barnes said the cause of death was narcotic
poisoning. "The choice of drug was wholly inappropriate and on a boy of
his age was grossly negligent," he said. Mr. Justice Buckley said: "I
only hope Raju's family can find it in their hearts that sending Dr.
Alam to prison...would serve no public interest and do nothing good for
the memory of Raju."
Body of 9-Week-Old Infant Allegedly Found Dead;
Parents Under Custody
by Regina Inonog
The Sarasota County Sheriff’s Office has
recovered the body of an infant believed to be ... Chance Walsh ... in
North Port, Florida. ... Chance, who was only 9 weeks old,
was first reported to be missing a month ago ... [Chance's
mother, Kristen] Bury’s stepmother, Kimberly Millwater.
said that ... Bury told her ... she “despised Chance ... because he
[Kristen] Bury gave birth to Duane Jacob Walsh on March 13, 2014, only
paramedics to find him dead 22 days later. Medical examiners found out
that Duane died of a kidney
infection that resulted from a botched
[So cutting one baby may be said to have caused two deaths.]
A child was born without incident in a West
Virginia hospital and was circumcised before discharge. Two days later,
the baby boy was brought to a health center where the doctor did a
follow-up examination. Four days after that, the child was rushed to a
hospital emergency room after developing a fever and undergoing
seizures. The ER physician telephoned the doctor who had performed the
circumcision and decided not to admit the child. The next morning, the
mother brought the infant back to the ER where he suffered more
seizures and was noted to have a greenish cast to the penis. That
afternoon the child was transferred to a medical center, where he died
4 hours later.
The cause of death was found to be septicemia
derived from an infection secondary to the circumcision. Both
physicians were sued for negligence for failure to admit the child to
the hospital on the first visit to the ER. After 6 months, a settlement
of $150,000 was reached.
Paediatric Death Review
Committee: Office of the Chief Coroner of Ontario
A male infant at 37 weeks' gestation was born ...
weighing 3.9 kg, with Apgar scores of seven at 1 min and nine at 5 min,
Prenatally mild bilateral dilation of renal pelvises and ureters was
noted on ultrasound. A urology consultation at 36 weeks' gestation
suggested a possible normal variant ...
The baby was bottle-fed and was reported to he
doing well when he was circumcised using a PlastiBell ring
(Hollister, USA) at 10:00 on the seventh day of life (Figure 1).
Local anaesthetic was not used. Some slight
oozing was noted during the procedure but it was not a problem at
Five hours later, the parents returned to their
family doctor with the infant, reporting that he was very irritable
and had blue discolouration below the umbilicus [navel] when he cried.
The doctor confirmed this observation and noted that the penis was
slightly swollen. ... He had several loose stools, and it could not be
determined with certainty whether he had voided [emptied his bladder].
...The baby was subsequently discharged home.
The infant was brought to a different hospital 14
h after the circumcision. He was now noted to be extremely irritable,
with marked swelling of the penis and with marked swelling and cyanosis
[blueness] of the scrotum and perineum [region behind the scrotum]. He
had grunting respirations and was cyanotic below the umbilicus ... He
was transferred to a tertiary care centre, where the bladder was
identified as being distended to the level of the umbilicus, The
PlastiBell ring was removed 16 h after the circumcision and a catheter
was passed. The bladder was drained and the bluish coloration below the
umbilicus subsided. Urine volume was not recorded. Over the next few
hours, the infant went into septic shock with purpura
fulminans, and went on to develop multiorgan failure and disseminated
intravascular coagulopathy [a state of increased propensity
for blood-clot formation] ... He died seven days after his circumcision
encephalopathy [damage to cells in the brain and spinal cord
from getting too little oxygen]. ...
Complications of meatal obstruction [blockage of
the urinary opening of the glans]
with the PlastiBell technique have been previously described in the
literature (1,2). Necrotizing
fasciitis as a complication of circumcision is rare, and all
cases reported seem to be associated with the PlastiBell technique
(2,3) The finding of cyanosis below the umbilicus after circumcision
due to meatal obstruction caused by a misplaced PlastiBell ring
resulting in bladder distension and obstruction of venous return has
also recently been described (1). A review of circumcision
complications suggest that these may occur mote frequently than is
conventionally believed (2,4)
The members of the Paediatric Death Review
Committee of the Office of the Chief Coroner of Ontario were
collectively aware of complications from their own institutions,
including two children with necrosis of the glans, two infants
requiring transfusion, one infant with a buried penis secondary to
circumcision, numerous cases of retention of a PlastiBell ring, one
infant with a slipped PlastiBell ring causing a penile tourniquet, and
one infant with meatal obstruction due to a misplaced PlastiBell ring
(Figures 2A and 2B).
None of these complications were reported in the
medical literature and are therefore not available in a retrospective
literature review. It is concerning that none of the initial three
physicians who saw this infant, including the physician who performed
the procedure, identified this problem as a meatal obstruction,
although they were all concerned about, a possible link with the recent
In this infant, there was no description of the
glans by the physician removing the PlastiBeil ring. If the foreskin is
pulled too tight, then there will be considerable tension pulling the
ring against the glans, thus compressing the urethra and making
urination difficult or impossible. This is the mechanism described in
the case report by Ly and Sankaran (I) We propose the mechanism shown
in Figure 2B, given the rapid onset of symptoms, suggesting a complete
obstruction. These coukl be differentiated clinically. In Figure 2A,
the meatus would be visible in the middle of the ring and a catheter
would be difficult or impossible to pass. In Figure 2B, the meatus
would not be visible. The management of both complications would be the
immediate removal of the PlastiBell ring. Perhaps a prospective
surveillance study by the Canadian Paediatric Society of the
complications of circumcision is warranted. Such a study would provide
more accurate information for the ethical requirement of informed
a ban on non-therautic neonatal circumcisions by members of the
Canadian Paediatric Society is warranted. As the headline implies, this
is not a minor procedure.]
In reply to a complaint, the College of Physicians
and Surgeons of Ontario completely exonerated the doctor. In fact so
excellent did they make his work seem, you would think the baby was
...The Paediatric Death Review Committee felt
that Baby A had a urethral meatal obstruction secondary to the
Plastibell ring, which it noted was not a common complication. They
questioned whether the family physician who performed the circumcision
was aware of this potential complication....
...Dr. X ... did not believe there was anything
he/she could have done differently. When he/she examined the infant
when the parents returned later in the day, there was no meatal
he/she had tried using local anaesthetic over
the years but found that the infant appeard to be in just as much pain,
if not more
the needle to inject the anaesthetic is very
painful, as is the local anaesthetic itself
there is a concern about the increased chance
of infection with the injecting of local anaesthetic, as the puncture
holes from the needle would be in the diaper area surrounded by urine
and faeces, below the area of the circumcision [...which
raises questions about the risk of infection at the much bigger
circumcision wound itself...]
there is a concern regarding potential allergic
reaction to the anaesthetic
local anaesthetic tends to distort the site of
the circumcision and make it more difficult to perform
the period of restraint for the infant in the
cirucmsion board is prolonged when using local anaesthetic, and the
restraint causes the infant distress
in the community, local anaesthetic is not
used, and not the standard of care
[This will all
be of interest to parents who assume that circumcision is made painless
...it is not possible to determine with any
certainty how the urethral meatus became obstructed by the Plastibell
Committee's final comments
The Committee has the utmost sympathy for the
parents of Baby A, given the very tragic outcome in this case. However,
we are satisfied that the care provided by Dr. X in this case was
conscientious and appropriate, and in compliance with the relevant
legal and ethical standards in place at the time the circumcision was
WHY IS THE CHILD DEAD?]
... no further action will be taken with respect
to this matter.
Circumcisions for medical reasons in the
Brazilian public health system: epidemiology and trends.
Korkes F, Silva Ii JL Pompeo AC
To evaluate the epidemiological factors associated to medical
based on data from the Brazilian public health system.
Using the Unified Health System public database between 1984 and 2010,
hospital admissions associated with surgical treatment of phimosis were
searched. A total of 668,818 men admitted to public hospitals who
circumcision were identified and included in the present study.
A mean±standard deviation of 47.8±13.4 circumcisions/100,000 men/year
performed through the Unified Health System for medical reasons. During
27-year period evaluated, 1.3% of
the male population required circumcision
for medical reasons. [So
98.7% of routine circumcisions are wasted on boys and men who will
never need it.] Total number of circumcisions
and circumcision rate
increased in childhood, declined progressively after 5 years of age and
again progressively after the sixth decade of life. In the regions of
country with better access to healthcare, 5.8% of boys aged 1 to 9
required circumcisions. [Or
were circumcised whether they needed it or not.]
From 1992 to 2010 there were 63
with circumcisions (mortality rate of 0.013%).
one death in 7692 circumcisions. In this USA, that would amount to 156
circumcision deaths per year.]
In conclusion, yearly circumcision rates could be estimated in Brazil,
very low mortality rate was associated with this procedures.
mostly performed in children in the first decade of life and a second
of incidence of penile foreskin diseases occurs after the sixth decade
life, when circumcision is progressively performed again.
study was circulated by Prof. Brian Morris, who presumably thinks this
is an "acceptable" death rate.]
Death by circumcision, in South Africa a
Male circumcision morbidity and mortality
Eastern Cape, South Africa, 2001-5