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.

In 1949, Douglas Gairdner, a pediatrician in Cambridge, England, published “Fate of the Foreskin: A Study of Circumcision,” hereafter, “Fate of the Foreskin,” in the British Medical Journal. In the article, Gairdner highlights what he saw as a seriously understudied topic, the natural development of the foreskin in males. Although physicians were then circumcising tens of thousands of male infants annually in England, data on the normal anatomy and function of the foreskin were scarce. In “Fate of the Foreskin,” Gairdner assembles those data and uses them to argue against performing circumcision to treat conditions like phimosis. Phimosis is when the foreskin tightly encases the glans, or head, of the penis and cannot retract. Gairdner finds that an unretractable foreskin is actually the normal state for newborn males, and that the foreskin will become retractable on its own over a period of months to years. By showing that phimosis is not a pathological condition, “Fate of the Foreskin” questioned the legitimacy of routine circumcision, and ultimately led to a steep decline of the practice in England.