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Jean D. Castration of men and males of other species was almost certainly the first experiment in endocrinology if not in zoologyand the literature on the subject is vast. Indeed, the Cumming Manuscript Collection of the New York Academy of Medicine Library contains more than references, abstracts, and documents concerning the early history of human castration 1.

In antiquity the procedure was performed for several reasons, including as punishment for prisoners of war 2and by the time of Aristotle in the fourth century BC the physiological consequences of male castration were understood with remarkable exactitude 3. Birds have their testicles inside, and oviparous quadrupeds close to the loins; and of viviparous animals that walk some have them inside, and most have them outside, but all have them at the lower end of the belly. Birds are castrated at the rump at the part where the two sexes unite in copulation. If you burn this twice or thrice with hot irons, then, if the bird be full-grown, his crest grows sallow, he ceases to crow, and forgoes sexual activity; but if you castrate the bird when young, none of these male attributes or propensities will come to him as he grows up.

The case is the same with men; if you mutilate them in boyhood, the later-growing hair never comes, and the voice never changes but remains high-pitched; if they be mutilated in early manhood, the later growth of hair quit them except the growth on the groin, and that diminishes, but does not entirely depart.

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The congenital growth of hair never falls out, for a eunuch never goes bald. In the case of all castrated or mutilated male quadrupeds the voice changes to the feminine voice… All animals, if operated on when they are young, become bigger and better looking than their unmutilated fellows; if they be mutilated when full-grown, they do not take on any increase of size. If stags be mutilated when, by reason of their age, they have as yet no horns, they never grow horns at all; if they be mutilated when they have horns, the horns remain unchanged in size, and the animal does not lose them… As a general rule, mutilated animals grow to a greater length than the unmutilated 3.

In contrast to the rapidity and sophistication of the early advances, studies of the physiological effects of castration in more recent times have been relatively limited presumably because fewer castrated men are available for studyand most studies of androgen deficiency focus on hypogonadal states rather than castration 4. However, in the s, Hamilton and his colleagues did pioneering work in the United States on mentally deficient men who were castrated as a consequence of eugenics laws, quantifying the effects on skeletal development, hemoglobin production, and metabolism 5and Bremer subsequently defined the relation between testicular secretions and male sexual drive and function in men who were castrated in Norway because of sexual offenses 6.

Most studies of castration in men have involved relatively short term experiences usually men who had been castrated for less than a decadebut in the 20th century the effects of long term castration have been studied in three groups of men: the Skoptzy and the court eunuchs of the Chinese and Ottoman empires Table 1. The three groups of eunuchs under consideration in this review fall into the castrati category. The Skoptzy or Skoptsy, meaning the castratedalso called the White Doves, were a Christian sect whose male members, to attain their ideal of sanctity, subjected themselves to castration.

Their origin in the 18th century, their spread through a large part of Russia and into Romania and Bessarabia, the attempts by the Russian government to suppress the movement, and the theological underpinnings of the religion were described by Pelikan 8Grass 9and Pittard Because they believed that the second coming of Christ would occur only when the of Skoptzys reached the apocalyptic of , they became ardent proselytizers. Their critics claimed that they used coercion among children and prisoners, a charge that seems warranted in view of the fact that many were castrated below the age of 10 yr, but others were religious enthusiasts who underwent the procedure voluntarily as adults.

Women were not castrated, but were subjected to mutilation of the breasts and external genitalia. In men the procedure was of great simplicity; namely, the operator seized the parts to be removed with one hand and struck them off with the other. In the early years of the sect the surgical instrument was a red-hot iron rod or poker hence the expression baptism of firebut instruments of castration included pieces of glass, razors, and knives.

A cicatrix formed, with healing in 4—6 weeks Fig. In some instances the procedure was performed in stages taking the lesser seal before the great seal. When the penis was removed, nails were inserted into the urethra to avoid strictures, and such men were said to urinate while sitting or squatting.

Many Skoptzys were deported to Siberia, where they formed settlements, and the sect continued to perform castrations as late as Persecution of the Skoptzys persisted into the Soviet era, and during the antireligious fervor in — they were subjected to sensational public trials and publicity. It was estimated that there were between and Skoptzy in Soviet Russia inof whom lived in Moscow, but by none were thought to be alive Anatomical preparation of the external genitalia of a Skoptzy man who had received the greater seal.

Reprinted from Koch Medical studies on the Skoptzy. Medical studies were performed on the Skoptzy by at least three different groups of investigators. At the turn of the century Pittard made measurements in 30 Skoptzy men in 1 Romanian village and noted that they appeared to be taller than their peers In Tandler and Grosz examined 5 Skoptzy men in Bucharest whose average age was 30 yr and who had been castrated between ages 5—21 yr Subsequently, during the German occupation of Romania in the First World War Walter Koch studied 13 Skoptzy men, all between 50 and 94 yr of age averaging 64 yrwho had been castrated for an average of 46 yr A variety of anthropomorphic measurements were made, and skull x-rays were obtained in some The practice of employing eunuchs as court functionaries in China and in other oriental countries goes back into prehistory The procedure by which the Chinese court eunuchs were castrated in the late 19th century during the Qing dynasty was described in some detail by Stent in 15and subsequent descriptions of the practice, including those by Korasow 16Matignon 17and Wong and Wu 18appear to be paraphrases of Stent However, on the basis of published interviews of surviving eunuchs, the surgical procedure appears to have been essentially the same in the later days of the dynasty Possession and employment of eunuchs as servants in China were reserved for the imperial family and the 8 hereditary princes.

The emperor maintained approximately in his service, the imperial princes and princesses each had about 30, and various family members were allowed 10 or so eunuchs each. On occasion, the castration was punitive, as in prisoners of war, but most were performed voluntarily in adults who, because of poverty or laziness, underwent castration to gain employment usually as young adults, but sometimes in men after having born children or in children under compulsion who were sold by their parents for the purpose of castration Specialists termed knifers performed the operation in an establishment maintained outside one of the palace gates in the imperial city, and the trade was handed down from father to son.

The subject reclined on a broad bench, and the genitalia were anaesthetized with a secret agent known only to the surgeon. Two assistants held the spread legs, and a third assistant secured the arms. The surgeon stood between the legs armed with a curved knife Fig. If the answer was yes, the genitalia scrotum, penis, and testes were removed with a single cut. A plug made of pewter Fig. The wound was washed three times with a solution of boiled pepper and covered with a piece of soft, moistened paper. With the support of two assistants the subject was made to walk around the room for 2—3 h.

For the following 3 days, the subject was not allowed to drink liquids or to urinate.

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On the fourth day, the dressing and plug were removed, and if the subject was able to urinate the operation was considered a success. Healing took approximately days, and eventually all that was left was a contracted scar Fig. Urinary retention was treated with drugs, and if it persisted the surgeon beat the patient on each visit.

Until convalescence was completed the pewter plug was only removed to allow urination. With time the opening of the urethra could become narrowed despite the use of dilators, resulting in urinary dribbling or retention, urinary tract infection, and bladder stones.

Urinary incontinence was said to be common and caused a characteristic odor in the unfortunate victims. The stoma sometimes required dilatation long after the castration 16 — Some of the instruments used for creating and treating eunuchs.

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Redrawn from Wong and Wu Redrawn from Matignon A string was placed in the eye to prevent it from slipping into the bladder. Redrawn from Millant External genitalia of a young eunuch of the Chinese court. Reprinted from Matignon Genitalia retained by the knifers were kept in jars labeled to indicate from whom they came and when the amputation was performed. Each eunuch was buried with the preserved genitalia, because of the religious need to be as complete as possible when departing into another world.

The palace eunuchs were divided into 48 departments for looking after gardens, courtyards, kitchens, armory, furniture, etc. Each department had a superintendent, usually of the sixth grade, and a chief eunuch served over the entire complement of eunuchs. At least in the last phase of the Qing dynasty, eunuchs were subject to the Imperial Household Department, which was not headed by a eunuch All eunuchs received a regular stipend as well as room and board. Most lived in the palaces until they were released from service in old age. Some spent their final days in monasteries.

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Those who had families and children before castration reed their families, and others married and adopted children. This couple survived until the Cultural Revolution of —76, the wife dying of malnutrition, and the husband disappearing after being deported to the countryside After the revolution of the emperor Pu Yi retained figurehead status and continued to reside in the Forbidden City. According to the articles of agreement with the new government, the existing eunuchs continued to be employed in the Imperial Household Department However, on July 15,the entire staff of eunuchs with the exception of about 50 household servants of elderly members of the imperial family was expelled from the Forbidden City because they were suspected of stealing and selling furniture and works of art and were believed to have burned a portion of the edifice as a protest against a planned inventory of the palace treasures Although there is disagreement as to whether the eunuchs were responsible 1420corruption in the Imperial Household Department was pervasive.

Medical studies on the Chinese court eunuchs. The expulsion of the eunuchs from the Forbidden City left most unemployed and many destitute.

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Ferdinand Wagenseil, from the Institute of Anatomy at Freiburg but then at Tungchi University in Shanghai, conducted anthropometric studies on normal men from northern China 24and in he examined 31 eunuchs at the German Hospital in Beijing The technique of study involved measurements of height, weight, and a variety of skeletal dimensions, radiographic studies of the skull, and descriptions of skin and body hair.

The average age in this group was 57 yr, and the average duration of castration was 38 yr. In Wu and Gu 2526 performed careful physical examinations, including palpation of the prostate in 26 eunuchs 5 of whom had been castrated after the revolution of who lived in Beijing.

The average age in the latter study was 72 yr, and the average duration of castration was 54 yr. The practice of employing eunuchs as palace functionaries in Constantinople Istanbul apparently began during the reign of the Emperor Justinian in the latter days of the Roman Empire and persisted through the Byzantine 27 and Ottoman eras 7.

In contrast to China, ownership of eunuchs in Turkey was not limited to the royal palaces; any citizen who could afford the purchase price was entitled. Some eunuchs of the Ottoman Empire were from Russia or the Balkans, but from the 16th century black eunuchs were in charge of the harem in the Ottoman court, most commonly individuals from Ethiopia or Sudan who had been castrated as children Slave dealers kidnapped some, and some were sold into slavery by their parents.

According to Penzer, stopping points were used by the slave exporters, and it was during the halts at such places that the castration of the boys took place 7. According to other reports many of the boys were castrated at a monastery in Upper Egypt where Coptic priests performed the operation 29 The child was restrained on a chair; the phallus and scrotum were tied with a cord which was pulled taught, and the phallus, scrotum, and testes were removed as close as possible with a single stroke of a razor.

Bleeding was stopped with boiling oil, and the wound was dressed with an extract of wax and tallow. In some instances hemostasis was achieved with hot sand, and the wound was dressed with an extract of acacia bark. The mortality was said to be high, only about one in three surviving. As in the case of the Skoptzy and the Chinese court eunuchs, a nail was introduced into the urethra to prevent stricture formation.

The eunuchs squatted to urinate, and both urethral strictures and incontinence must have been common, because some eunuchs carried silver quills for self-catheterization, presumably because of strictures 7and others used a removable plug Fig.

Owing to the high death rate, the survivors were sold at high prices either to Turkey or to Persia The physicians to the harem inspected the eunuchs on arrival to be certain that both penis and testes had been removed and reexamined them every few years to be certain that nothing was amiss 7. The eunuchs entered the court service at the lowest rank and passed successively through the grades of novice, middle grade, and highest rank.

Some took to learning and literature and served as tutors to the royal children; others rose to high administrative ranks Some eunuchs were said to have lived in the palace of Topkapi in Istanbul after the royal family had moved to other palaces 28and after the Turkish revolution the eunuchs continued to be devoted servants until the royal family was sent into exile in March of Medical studies on the Ottoman court eunuchs.

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Hikmet and Regnault appear to have made the first medical observations on the eunuchs in Istanbul in During the first world war Ferdinand Wagenseil had been ased as a physician to the German Red Cross Hospital in Istanbul, where he took care of a yr-old eunuch from the harem who died after a febrile illness presumably typhus and subsequently examined 10 additional eunuchs, most of whom had voiding difficulties An autopsy was performed on the man who died; the others average age, 43 yr; average duration of castration, 34 yr were subjected to detailed anthropological measurements and physical examinations, and skull x-rays were obtained on four of them.

Because the findings in the various studies overlap and are complementary, they will be discussed together. Enlargement of the pituitary. Tandler and Grosz obtained an x-ray of the skull in a yr-old Skoptzy man, who had been castrated at age 10 yr and observed that the sella turcica was grossly enlarged The average duration of castration was the same in the 3 groups studied by Koch 46 yrbut the average age at which the castration was performed 11 yr was younger in the group with the largest pituitaries.

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In his Istanbul study Wagenseil reported that 2 of 4 skull x-rays obtained revealed enlargement of the pituitary with thinning of the dorsum sella; the average age at castration was 11 yr, and the average duration of castration was 44 yr in these 2 men In the same study the pituitary was normal at autopsy in the yr-old man who had been castrated for an uncertain duration The reason for the apparent discrepancy between the findings in the Chinese eunuchs and those in the Skoptzy and the Ottoman eunuchs is not clear, but it is of interest that the average age at which castration was performed was older in the Chinese group average age at castration, 18 yr; less than a fourth had been castrated before age 14 yr.

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