Lewis Albert Sayre (1820–1900)

Lewis Albert Sayre was an orthopedic surgeon who practiced medicine in New York City, New York, during the second half of the nineteenth century and held a number of leadership positions in his profession. Over the course of his nearly fifty-year career, Sayre developed a number of surgical and nonsurgical treatments of bone problems including scoliosis and other forms of spinal curvature, club foot, and hip-joint disease resulting from tuberculosis infection. He also helped popularize circumcision, or surgical removal of the foreskin of the penis, as a treatment for a variety of medical conditions, including muscle paralysis and epilepsy, based on the theory, discredited as of 2025, that a chronically irritated foreskin could lead to diseases in other parts of the body. By providing a medical justification for circumcision, Sayre helped to embed the surgical procedure within US medicine, even as the medical rationales for its use would change periodically in the decades that followed.

1. Early Life and Education
2. Professional Career in Orthopedics
3. Role as Public Health Officer
4. Circumcision as a Treatment for Paralysis
5. International Travels and Fame 

Early Life and Education

Sayre was born on 29 February 1820 in Bottle Hill, now Madison, New Jersey, to wealthy farmers Martha and Archibald Sayre. Sayre’s paternal grandfather, Ephraim Sayre, was a soldier and quartermaster in the American Revolutionary War. One of twelve children, Sayre attended a local academy in Bottle Hill and later Wantage Seminary in Deckertown, New Jersey. His cousin, Edward A. Stiles, a graduate student at Yale University in New Haven, Connecticut, also tutored Sayre. His father died when he was ten. After his father’s death, Sayre and his family went to live with his uncle, David Sayre, a silversmith and banker in Lexington, Kentucky.

Sayre attended Transylvania University in Lexington from 1837 to 1839. According to a relative’s account, Sayre’s uncle wanted him to become a banker, but Sayre decided to pursue medicine instead. In 1839, Sayre moved to New York City to attend the College of Physicians and Surgeons, which, as of 2025 is, the Vagelos College of Physicians and Surgeons at Columbia University. While in school, Sayre began to study disorders of the spinal cord and eventually wrote a dissertation on the subject of spinal irritation, which the Western Journal of Medicine and Surgery published in 1842. Sayre graduated from the College of Physicians and Surgeons with his medical degree in 1842.

Professional Career in Orthopedics

Following his graduation from the College of Physicians and Surgeons, Sayre obtained a job as Prosector of Surgery under that medical school’s chief surgeon, Willard Parker. A prosector is someone who prepares dissections for surgical demonstrations, often at medical schools. While still working as a prosecutor, in 1847, Sayre became a charter member of the American Medical Association, or AMA. Two years later, in 1849, he married Elizabeth Ann Hall. Sayre and his wife later had four children, three boys and one girl. All three sons became doctors, pursued orthopedic surgery as a career, and practiced with their father. The oldest, Charles, died of a fractured femur at twenty-nine. Louis, the middle son, traveled with his father on international trips, but also died young due to a heart condition. The youngest son, Reginald, practiced medicine with his father and assumed the chair of orthopedic surgery at Bellevue Hospital in New York City, New York, in 1898. His daughter, Mary, became a linguist and translator.

In 1853, Sayre left his prosector position to begin a surgical practice at Bellevue Hospital where he pioneered the use of both surgical and nonsurgical treatments for a variety of musculoskeletal conditions. For scoliosis and other forms of spinal curvature, he devised a system of ropes and pulleys to suspend a patient vertically with their arms raised above their head while he then encased the patient in a plaster of Paris mold, dubbed a “Sayre jacket.” Once dried, the plaster mold would hold the straightened spine in place and the patient would wear the mold for several months, in the hopes that the spine would realign itself in that period. Orthopedists used the Sayre jacket well into the first quarter of the twentieth century. As of 2025, orthopedists doubt whether the Sayre jacket was curative, though many agree it may have relieved symptoms. Sayre’s jacket contributed to the modern techniques of body casting and bracing for scoliosis. For clubfoot, a condition in which the foot is twisted and pointed downward, he developed a variety of orthotic shoes that helped correct and maintain the position of the foot. For hip-joint disease, often caused by tuberculosis, a bacterial infection, he developed a technique for surgically removing the diseased and dying head of the femur bone. The New York Times obituary for Sayre notes that because of its delicate and complicated nature, the surgery brought Sayre acclaim in the medical world, both in the US and in Europe.

Sayre first performed the hip-joint procedure in 1854. The patient was a nine-year-old girl named Ellen Guion. She had a long recovery period complicated by infection at the surgical site, but was able to walk with crutches eight months after the operation. Sayre was operating at a time after the discovery of anesthesia but before the advent of antibiotics. While surgeries were less painful, infections often occurred following surgery. Sayre reported a fatality rate of thirty-four percent for his hip-joint surgery. As of 2025, doctors typically start with nonsurgical techniques then perform a total hip replacement, if necessary, rather than remove the head of the femur to treat similar conditions.

Role as Public Health Officer

Beyond his surgical practice at Bellevue, Sayre played several other roles in the New York medical world. In 1859, he became surgeon of the Charity Hospital on Blackwell’s Island, known, as of 2025, as Roosevelt Island, in New York City. In 1861, Sayre helped found Bellevue Hospital Medical College, a new medical school built beside Bellevue Hospital. Sayre joined the faculty and became Professor of Orthopedic Surgery, the first such position in the US according to Jay Zampini and Henry Sherk, orthopedic surgeons from Drexel University College of Medicine in Philadelphia, Pennsylvania. From 1860 to 1866, during the US Civil War, Sayre served as Resident Physician, or public health officer, of New York City. Working under three mayoral administrations, Sayre instituted improved sanitation practices such as the proper handling of sewage, lobbied for compulsory vaccination for smallpox, and mandated quarantines for communicable diseases such as cholera. In 1865, as Resident Physician, Sayre detained and quarantined the ship Atlanta whose passengers had come down with cholera, a highly contagious and often fatal disease that causes severe vomiting and diarrhea. According to historian David Gollaher, Sayre’s order likely spared the city another cholera epidemic like one that had occurred in 1849. An early advocate for the creation of the AMA, Sayre became vice president of the organization in 1867. Later, in 1869, he used his connections to the New York Board of Health to obtain a ban on the use of lead-based dyes in women’s cosmetics, after treating a twenty-one-year-old woman who suffered from weakness and paralysis in her hands and forearms due to her cosmetic products.

According to a relative’s account, Sayre’s outspoken nature and enthusiasm for surgical interventions sometimes got him into trouble. In their 2008 article, Zampini and Sherk state that Charles Fayette Taylor, a peer of Sayre’s, accused Sayre of unethical conduct, namely, performing unproven and dangerous surgeries on patients. Taylor requested that the New York Academy of Medicine censure Sayre, but the organization declined. In another incident, in 1870, the parents of six-year-old Margaret Walsh sued Sayre, accusing him of negligence in the way he performed an operation to drain pus from the girl’s infected hip joint. Five witnesses, all surgeons studying under Sayre, testified on his behalf and the jury decided the case in his favor.

Circumcision as a Treatment for Paralysis

Sayre began performing circumcision as a treatment for musculoskeletal problems in 1870. His first case was a five-year-old boy who was unable to walk or stand without assistance. A colleague of Sayre’s, the obstetrician J. Marion Sims, referred the boy to Sayre for evaluation. Sayre reports in his published account of the case that Sims suspected a muscle contraction problem and suggested cutting the boy’s hamstring tendons, a procedure called tenotomy. Sayre examined the boy and concluded that his inability to walk was due to paralysis rather than to an abnormal contraction of the muscles. He began performing a battery of tests to determine the source of paralysis. One test involved applying an electric current to the boy’s legs to test his reflexes. Sayre reports that as he was hooking up the wires, the boy’s nurse told him to be careful not to touch the boy’s sore penis. He therefore examined the boy’s penis and found that the head, or glans, was very irritated and constricted by a tight foreskin, a condition termed phimosis. The boy’s nurse said the constricted foreskin was a chronic condition, often interfering with the boy’s sleep and causing painful erections. In Sayre’s article, “Partial Paralysis from Reflex Irritation, Caused by Congenital Phimosis and Adherent Prepuce,” Sayre reports that in that moment he had a flash of inspiration that perhaps the constricted foreskin was the source of the boy’s muscle paralysis. His reasoning was that excessive sexual activity, including masturbation, could lead to nervous exhaustion and sometimes even paralysis. Sayre wrote that perhaps by relieving the boy’s irritated penis through circumcision he could restore proper muscle function in the legs.

Sayre’s rationale for linking genital irritation to muscle paralysis was the then-popular notion of reflex neurosis, the idea that the organs of the body are all connected by nerves and that chronic irritation in one organ can cause dysfunction in another. Many scientists in the nineteenth century subscribed to the notion of reflex neurosis, also sometimes called reflex irritation. In fact, the notion was the basis for the variety of gynecological surgeries, from removal of the uterus, or hysterectomy, to removal of the clitoris, or clitoridectomy, that doctors performed on women at that time in order to cure supposed psychological disturbances like hysteria and nymphomania.

Having concluded that phimosis was the cause of his patient’s paralysis, Sayre circumcised his patient the next day. With the help of two other physicians, and while the boy was under anesthesia with chloroform, Sayre pulled the foreskin forward and cut it with scissors. The foreskin is a double layer of tissue. In adults, the foreskin is typically easily retractable and glides smoothly over glans. In infants and young boys, however, the inner layer of the foreskin is fused to the glans and is not yet retractable. Thus, when Sayre cut the foreskin, the outer layer of the foreskin retracted, but the inner portion remained adhered to the glans, a condition Sayre termed adherent prepuce. Prepuce is another word for foreskin. Sayre used his fingers to physically tear the inner foreskin from the glans. Once he had freed the inner foreskin, he split it down the middle, folded it back on itself, then sutured it to the cut edge of the outer foreskin with a needle and thread. He then covered the penis with a well-oiled linen rag and applied cold water. Sayre reports that within two weeks, the wound had healed, and the section of foreskin that remained was freely mobile, able to glide back and forth over the glans. A little over a month later, Sayre reports, the boy was able to walk alone with his legs straight.

After that first circumcision, over the next few weeks, Sayre operated on the foreskin of several more patients suffering from paralysis or joint diseases, on the theory that relieving the irritation would cure those other problems. He claimed success in each case. Sayre published his findings in 1870 in the article “Partial Paralysis from Reflex Irritation, Caused by Congenital Phimosis and Adherent Prepuce,” in Transactions of the American Medical Association. That journal is the precursor to what is, as of 2025, the Journal of the American Medical Association.

As of 2025, doctors no longer subscribe to Sayre’s beliefs about the power of circumcision to treat paralysis and other nervous conditions, and they have long since abandoned the notion of reflex neurosis that supported the premise. However, doctors in the US still, in 2025, commonly perform circumcision for other reasons, including improved hygiene, prevention and treatment of phimosis, and what some argue is a reduced risk of acquiring sexually transmitted infections. Most commonly, US doctors perform circumcision on newborns with healthy foreskins on the grounds that the procedure will prevent problems later in life. Doctors in other industrialized countries generally oppose such routine, non-therapeutic infant circumcision.

What Sayre meant by circumcision differs from what US doctors typically perform as of 2025. As historian Leonard Glick has observed, Sayre did not typically remove the entirety of a boy’s foreskin, only a portion, as is clear in his description of the first circumcision he performed in 1870. In an article Sayre published in 1887, he criticized the emerging trend of removing the entire foreskin during a circumcision, leaving the glans entirely exposed and, as he said, unprotected, a state he referred to as mutilated and disfigured.

International Travels and Fame

Having achieved a measure of professional success in New York, Sayre began traveling nationally and internationally to lecture and demonstrate his surgical expertise. In 1871, he traveled to Europe where he demonstrated his signature hip-joint operation before several medical societies. On that same trip, King Charles XV of Sweden bestowed knighthood on Sayre in appreciation of the medical care he gave the King’s son. Several English medical societies also bestowed him with honorary membership as well. In 1876, the AMA appointed Sayre a delegate to the International Medical Convention, held in Philadelphia, Pennsylvania, where he performed his hip-joint surgery in front of an audience of doctors. One year later, in 1877, Sayre again traveled to Europe as a delegate of the AMA to a meeting of the British Medical Association, held in Manchester, England. During that trip, Sayre lectured on spinal diseases in several cities in England, and also traveled to Ireland, Scandinavia, Germany, and Russia.

Sayre became president of the AMA in 1880. During his presidential address, he argued that the organization’s journal, Transactions of the American Medical Association, then published yearly, should be published more frequently to put its findings into the hands of practitioners in a more timely fashion, much as the British Medical Journal was already doing. The organization listened, and as a result began publishing two years later the weekly Journal of the American Medical Association.

Sayre influenced medicine in several different ways. As the first professor of orthopedic surgery in the US, he trained hundreds of medical students in the discipline. As a practicing orthopedic surgeon, he developed a number of both surgical and non-surgical methods to treat diseases of the muscles, bones, and joints that many other orthopedists adopted. According to the New York Times, some of his best-known treatments include the “Sayre Jacket” for spinal curvature and his hip-joint surgery, which he performed a total of seventy-four times in his life, including for audiences in Europe. Sayre was an active member of the AMA and held several leadership positions within that organization, including vice president and president. He also authored hundreds of publications over the course of his career, including books, articles, and lectures.

Sayre’s writings and lectures on circumcision also left a mark on US medical culture. According to David Gollaher, author of the book Circumcision: A History of the World’s Most Controversial Surgery, Sayre’s theorization of a connection between genital irritation and muscle paralysis opened the door to doctors’ use of circumcision to treat medical conditions beyond those afflicting the penis itself. If phimosis or adherent prepuce could cause a serious condition like paralysis, then it behooved doctors to intervene earlier rather than later to fix what they saw as a problem. Doctors would learn much later, in the mid-twentieth century, that the foreskin typically does not detach from the glans until about age ten. Therefore, there is nothing inherently unhealthy about a tight or non-retractable foreskin before that time. But in Sayre’s day, doctors increasingly viewed phimosis as inherently pathological and in need of correction, which led to increased popularity of circumcision to treat it.

Sayre practiced medicine late into life, serving as a consultant to various New York hospitals and maintaining his position as professor of orthopedic surgery at Bellevue Medical College until 1898, when the medical school joined with New York University, at which point he retired.

Sayre died on 21 September 1900 at the age of eighty.

Sources

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2. Glick, Leonard B. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. Oxford University Press, 2005.
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10. Sayre, Lewis Albert. “Partial Paralysis from Reflex Irritation, Caused by Congenital Phimosis and Adherent Prepuce.” The Transactions of the American Medical Association 21 (1870): 182–9.
11. Sayre, Lewis Albert. Spinal Anaemia: With Partial Paralysis and Want of Co-ordination, from Irritation of the Genital Organs. Philadelphia: Collins, 1875.
12. Sayre, Lewis Albert. On the Deleterious Results of a Narrow Prepuce and Preputial Adhesions. Philadelphia: Wm. F. Fell & Company, 1888.
13. Shorter, Edward. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. The Free Press, 1992.
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