COMMENTARY

Long-Term Consequences of Castration in Men: Lessons

from the Skoptzy and the Eunuchs of the Chinese and
Ottoman Courts
JEAN D. WILSON AND CLAUS ROEHRBORN
Departments of Internal Medicine and Urology, University of Texas Southwestern Medical Center,
Dallas, Texas 75235-8857
Castration of men and males of other species was almost
certainly the first experiment in endocrinology (if not in
zoology), and the literature on the subject is vast. Indeed, the
Cumming Manuscript Collection of the New York Academy
of Medicine Library contains more than 1200 references, ab-
stracts, and documents concerning the early history of hu-
man castration (1). In antiquity the procedure was performed
for several reasons, including as punishment for prisoners of
war (2), and by the time of Aristotle in the fourth century BC
the physiological consequences of male castration were un-
derstood with remarkable exactitude (3). Some animals
change their form and character, not only at certain ages and
at certain seasons, but in consequence of being castrated; and
all animals possessed of testicles may be submitted to this
operation. 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 pro-
pensities 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. 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 mutilatedwhen, by reasonof 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 un-
changed in size, and the animal does not lose them. . . As a
general rule, mutilated animals growto 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 study), and
most studies of androgen deficiency focus on hypogonadal
states rather than castration (4). However, in the 1940s, Ham-
ilton 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 metab-
olism (5), and Bremer subsequently defined the relation be-
tween testicular secretions and male sexual drive and func-
tion in men who were castrated in Norway because of sexual
offenses (6). Most studies of castration in men have involved
relatively short termexperiences (usually men who had been
castrated for less than a decade), but 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 andOttomanempires (Table 1). According to Penzer
(7) three varieties of eunuchs were recognized in antiquity:
1) castrati, clean-cut, both penis and testicles were removed;
2) spadones, testicles only were removed; and 3) thlibiae,
testicles were bruised and/or crushed. The three groups of
eunuchs under consideration in this review fall into the cas-
trati category.
The Skoptzy
The Skoptzy (or Skoptsy, meaning the castrated), also
called the White Doves, were a Christian sect whose male
members, to attain their ideal of sanctity, subjected them-
selves 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 sup-
press the movement, and the theological underpinnings of
the religion were described by Pelikan (8), Grass (9), and
Pittard (10). Because they believed that the second coming of
Christ would occur only when the number of Skoptzys
Received June 25, 1999. Revision received September 15, 1999. Ac-
cepted September 17, 1999.
Address all correspondence and requests for reprints to: Dr. Jean D.
Wilson, Departments of Internal Medicine and Urology, 5323 Harry
Hines Boulevard, University of Texas Southwestern Medical Center,
Dallas, Texas 75235-8857.
0021-972X/99/$03.00/0 Vol. 84, No. 12
The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A.
Copyright 1999 by The Endocrine Society
4324
reached the apocalyptic number of 144,000, they became
ardent proselytizers. Their critics claimed that they used
coercion among children and prisoners, a charge that seems
warranted in viewof the fact that many were castrated below
the age of 10 yr, but others were religious enthusiasts who
underwent the procedure voluntarily as adults. Male mem-
bers of the sect were encouraged to take either the great
seal (removal of the penis, the scrotum, andthe testes) or the
lesser seal (removal of the scrotum and testes, leaving the
penis intact). 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 fire), but instruments of castration
included pieces of glass, razors, and knives. A cicatrix
formed, with healing in 46 weeks (Fig. 1). 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 set-
tlements, and the sect continued to perform castrations as
late as 1927 (11). Persecution of the Skoptzys persisted into
the Soviet era, and during the antireligious fervor in 1929
1930 they were subjected to sensational public trials and
publicity. It was estimated that there were between 1000 and
2000 Skoptzy in Soviet Russia in 1930, 500 of whom lived in
Moscow, but by 1962 none were thought to be alive (11).
Medical studies on the Skoptzy. Medical studies were per-
formed on the Skoptzy by at least three different groups of
investigators. At the turn of the century Pittard made mea-
surements in 30 Skoptzy men in 1 Romanian village and
noted that they appeared to be taller than their peers (10). In
1907 Tandler and Grosz examined 5 Skoptzy men in Bucha-
rest whose average age was 30 yr andwho hadbeencastrated
between ages 521 yr (12). 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 yr), who had been castrated for an average of
46 yr (13). Avariety of anthropomorphic measurements were
made, and skull x-rays were obtained in some (13).
The eunuchs of the Chinese court
The practice of employing eunuchs as court functionaries
in China and in other oriental countries goes back into pre-
history (14). The procedure by which the Chinese court eu-
nuchs were castrated in the late 19th century during the Qing
dynasty was described in some detail by Stent in 1878 (15),
and subsequent descriptions of the practice, including those
by Korasow (16), Matignon (17), and Wong and Wu (18),
appear to be paraphrases of Stent (15). 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 (14). Possession and employment
of eunuchs as servants in China were reserved for the im-
perial family and the 8 hereditary princes. The emperor
maintained approximately 2000 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 pov-
erty 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 (15).
Specialists (termed knifers) performed the operation in an
establishment maintained outside one of the palace gates in
the imperial city, andthe trade was handeddownfromfather
to son. The subject reclined on a broad bench, and the gen-
italia were anaesthetized with a secret agent known only to
the surgeon. Two assistants held the spread legs, and a third
FIG. 1. Anatomical preparation of the external genitalia of a Skoptzy
man who had received the greater seal. Reprinted from Koch (13).
TABLE 1. Medical studies of men after long term castration
Group Author(s) and Ref. Date of publication No. of subjects Average age (yr)
Average duration of
castration (yr)
Skoptzy Tandler and Grosz (12) 1910 5 30 18
Koch (13) 1921 13 64 30
Chinese court eunuchs Wagenseil (19) 1933 31 57 38
Wu and Gu (25, 26) 1987, 1991 26 72 54
Ottoman court eunuchs Wagenseil (33) 1927 10 43 34
COMMENTARY 4325
assistant secured the arms. The surgeon stood between the
legs armed with a curved knife (Fig. 2a), grasped the scrotum
and penis with his left hand, and asked the candidate or his
parents to consent to the procedure. If the answer was yes,
the genitalia (scrotum, penis, and testes) were removed with
a single cut. A plug made of pewter (Fig. 2b) was introduced
into the urethra to prevent stricture formation. 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 23 h. For the following 3 days, the
subject was not allowed to drink liquids or to urinate. 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 100 days, and eventu-
ally all that was left was a contracted scar (Fig. 3). Urinary
retention was treated with drugs, and if it persisted the
surgeon beat the patient on each visit. Complications in-
cluded hemorrhage, infection, and extravasation of urine,
but death was rare (estimated at around 2%). Until conva-
lescence 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 cas-
tration (1618). [According to Wagenseil, other castration
techniques were sometimes used, each involving the re-
moval of all the external genitalia (19).]
The amputated penis, testes, and scrotum, termed the
precious or the treasures, were preserved in alcohol and
either stored by the knifer or kept by the subject (1516).
Genitalia retained by the knifers were kept in jars labeled to
indicate from whom they came and when the amputation
was performed. The eunuchs were required to show the
preserved genitalia to a special court official at each promo-
tion (inspection of the precious) to document the com-
pleteness of the operation, and eunuchs who, through care-
lessness or misadventure, lost the items hadto borrowor rent
them for display at the time of promotion. 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, furni-
ture, etc.) Each department had a superintendent, usually of
FIG. 2. Some of the instruments used for creating and treating eu-
nuchs. a, Scalpel used by knifers for the removal of the external
genitalia of the Chinese eunuchs (the blade is described as 3.7 in. in
length, and the handle as 2 in. in length.) Redrawn from Wong and
Wu (18). b, A urethral dilator for insertion into the urethra of the
Chinese eunuchs (3 cm long and 0.9 cm in the widest portion of the
plug). Redrawn fromMatignon (17). c, Aurethral plug used to prevent
incontinence in the Ottoman Court eunuchs (5 cm long). A string was
placed in the eye to prevent it fromslipping into the bladder. Redrawn
from Millant (31).
FIG. 3. External genitalia of a young eunuch of the Chinese court.
Reprinted from Matignon (17).
4326 WILSON AND ROEHRBORN
JCE & M 1999
Vol 84 No 12
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 (20). Most
Chinese eunuchs were castrated as adults, but eunuchs cas-
trated before the age of 10 yr were considered thoroughly
pure and were prized as personal servants. 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. Those
who had families and children before castration rejoined
their families, and others married and adopted children. The
most frequent marriage partners were palace maids; such
wives were referred to as companions sitting at meals to
indicate a platonic relationship (21). [George Kates, an Amer-
ican, rented a house in the Imperial City in Beijing from one
such couple in the 1930s, the wife having been a maid to the
dowager empress (22). This couple survived until the Cul-
tural Revolution of 196676, the wife dying of malnutrition,
and the husband disappearing after being deported to the
countryside (23).]
After the revolution of 1911 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 (20). However, on
July 15, 1923, 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 be-
cause 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 (20). Although there is disagreement as to
whether the eunuchs were responsible (14, 20), corruption 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. 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 (24), and in 1930 he examined 31 eu-
nuchs at the German Hospital in Beijing (19). 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 1960 Wu and Gu (25, 26) performed
careful physical examinations, including palpation of the
prostate in 26 eunuchs (5 of whom had been castrated after
the revolution of 1911) who lived in Beijing. The average age
in the latter study was 72 yr, and the average duration of
castration was 54 yr.
The eunuchs of the Ottoman court
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 Otto-
man 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
(28). 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
castratedat a monastery inUpper Egypt where Coptic priests
performed the operation (29, 30). 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
dressedwith 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, presum-
ably because of strictures (7), and others used a removable
plug (Fig. 2c) to prevent incontinence (31). Owing to the high
death rate, the survivors were sold at high prices either to
Turkey or to Persia (29). The physicians to the harem in-
spected 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. Strict rules of behavior were
enforced for the eunuchs guild. Some took to learning and
literature and served as tutors to the royal children; others
rose to high administrative ranks (28). Some 200 eunuchs
were said to have lived in the palace of Topkapi in Istanbul
after the royal family had moved to other palaces (28), and
after the Turkish revolution the eunuchs continued to be
devoted servants until the royal family was sent into exile
in March of 1924 (32).
Medical studies on the Ottoman court eunuchs. Hikmet and
Regnault appear to have made the first medical observations
on the eunuchs in Istanbul in 1901 (30). During the first world
war Ferdinand Wagenseil had been assigned as a physician
to the German Red Cross Hospital in Istanbul, where he took
care of a 40-yr-old eunuch from the harem who died after a
febrile illness (presumably typhus) and subsequently exam-
ined 10 additional eunuchs, most of whom had voiding dif-
ficulties (33). 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.
COMMENTARY 4327
The medical consequences of long term castration
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 20-yr-old Skoptzy man, who had been
castrated at age 10 yr and observed that the sella turcica was
grossly enlarged (12). Koch obtained x-rays of the skull in 10
Skoptzy men and reported that the pituitary glands were
normal in size in 3, enlarged in 4, and particularly enlarged
in 3 (13). In the latter group, there was also erosion of the
dorsum sellae of the pituitary (sattellehne). The average
duration of castration was the same in the 3 groups studied
by Koch (46 yr), but the average age at which the castration
was performed (11 yr) was younger in the group with the
largest pituitaries. 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, andthe average duration of castration
was 44 yr in these 2 men (33). In the same study the pituitary
was normal at autopsy in the 40-yr-old man who had been
castrated for an uncertain duration (33). In his Beijing study
Wagenseil obtainedskull x-rays on 27 eunuchs andhadthem
reviewed at the University of Bonn where enlargement of
the sella turcica could not be found generally (19). The
reason for the apparent discrepancy between the findings in
the Chinese eunuchs and those in the Skoptzy and the Ot-
toman 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). Subsequently,
reactive hyperplasia of the pituitary was described in hy-
pogonadal men (3436), including men with Klinefelters
syndrome (37). There is in addition at least one instance in
which a large gonadotropin-secreting pituitary adenoma de-
veloped 35 yr after a man was castrated for cryptorchidism
(38).
Skeletal changes. Tandler and Grosz described failure of clo-
sure of the epiphyses in the skeleton of a eunuch (39) and
subsequently in a 35-yr-old Ottoman eunuch who had been
castrated at age 8 yr (12) Koch reported that thinning of the
bones of the skull was evident by x-ray in all of the Skoptzy
men examined and that kyphosis was common (Fig. 4) (13).
Likewise, Wagenseil observed that 20 of the 31 Chinese eu-
nuchs had kyphosis of the spine (Fig. 5) (18). These obser-
vations appear to have been made before it was recognized
that kyphosis is a manifestation of severe osteoporosis in
women (40). In the Wagenseil study, men with kyphosis
averaged 59 yr of age and had an average duration of cas-
tration of 42 yr, whereas the men who did not have kyphosis
were slightly younger (average age, 54 yr) and had a slightly
somewhat shorter average duration of castration (33 yr) (18).
Involvement of the spine is common in men with osteopo-
rosis of various etiologies (41), and in view of the fact that
bone mineral density decreases progressively with time after
castration, particularly in the first few years (42), it is sur-
prising that kyphosis was not even more common in the
Chinese eunuchs and the Skoptzy. Furthermore, an in-
creased incidence of fractures does not appear to have been
reported in the eunuchs, and Wagenseil had not observed
kyphosis in his earlier study of eunuchs in Istanbul (33). The
reason for the discrepancy between the Turkish study and
the other studies is not clear. The Turkish eunuchs were
FIG. 4. Photograph demonstrating ky-
phosis in a 54-yr-old Skoptzy man who
had been castrated at age 15 yr. Re-
printed from Koch (13).
4328 WILSON AND ROEHRBORN
JCE & M 1999
Vol 84 No 12
somewhat younger (average age, 44 yr), and were either
Ethiopian or Sudanese in origin and might have had higher
initial bone densities (43). Alternatively, osteomalacia due to
vitamin D deficiency was common in Northern China in the
early years of this century (44), and vitamin D deficiency
might have contributedto osteopenia in the Chinese eunuchs
(and possibly in the Skoptzy).
Gynecomastia. Hikmet and Regnault reported that the breasts
in the Ottoman court eunuchs became large and pendulous
(30) Although not commented on by either author, gyneco-
mastia is also evident in 5 of 9 photographs of Skoptzy men
publishedby Koch (13) andin 7 of 14 photographs of Chinese
eunuchs published by Wagenseil (19) (Fig. 5). Furthermore,
Wu and Gu reported that 9 of the 26 subjects in their study
had breast enlargement (25, 26). These observations of gy-
necomastia in castrated men are in keeping with the subse-
quent report by Heller, Nelson, and Roth that approximately
half of men with functional prepubertal hypogonadism de-
velop gynecomastia (45). In hypogonadal men, gynecomas-
tia develops when estrogen formed by extraglandular aro-
matization of adrenal androgens is sufficient to cause breast
enlargement in the face of profoundly low testosterone val-
FIG. 5. Photograph demonstrating ky-
phosis and gynecomastia in eight Chi-
nese eunuchs. The average age of these
men was 56 yr, and the average time
lapsed since castration was 38 yr. Re-
printed from Wagenseil (19).
COMMENTARY 4329
ues (46). The reason that gynecomastia develops in some but
not all men with primary hypogonadism is not known.
Apparent disappearance of the prostate. Androgen action is re-
quired for the development of the prostate gland during
embryogenesis (47), and the prostate does not develop in
men with mutations that profoundly impair the function of
the androgen receptor (48) or of steroid 5-reductase-2 (49).
Furthermore, it has been known since the 19th century that
prostatic hyperplasia does not develop in prepubertal cas-
trates and that castration causes regression of the hyperplas-
tic prostate (50). Hikmet and Regnault reported that the
prostate became atrophic in the Ottoman court eunuchs (30).
Likewise, in Wagonseils description of the autopsy of a
40-yr-old eunuch, the prostate gland was prepubertal in size
(16 24 13 mm, corresponding to a weight of approxi-
mately 4 g) (33), a finding that is hardly surprising. However,
the report by Wu and Gu that the prostate was completely
impalpable in 21 of 26 Chinese eunuchs (and very small in
the other 5) (25, 26) was unexpected and implies that viability
of the gland throughout life requires the continued presence
of gonadal hormones, presumably androgens. It is possible
that very small prostates were missed on physical examina-
tion by Wu and Gu (25, 26).
Alternatively, it is possible that disappearance of the pros-
tate is a function of time after castration, as the duration of
castration in their study was much longer than that in any
other report, recognizing that the durationof castrationinthe
subset of men with barely palpable prostates (55 yr) did not
differ from that of the group overall (54 yr).
Comment
Hopefully, it will never again be possible to repeat the
studies reviewed in this paper, as in more recent times we
have used different means of expressing mans inhumanity
to man. It is to the credit of the pioneering physicianscientists
involvedthat useful medical informationwas obtainedabout
the long term effects of castration, under circumstances that
must have been difficult, from the study of these now extinct
groups of castrated men, and it is impressive that all their
findings (osteoporosis, failure of closure of the epiphyses,
reactive pituitary hyperplasia, shrinkage of the prostate, and
development of gynecomastia) have been confirmed subse-
quently by studies of individuals or small groups of indi-
viduals with various forms of hypogonadism.
One question of interest concerning castration in men can-
not be resolved from the available data, namely the issue as
to whether the life span of men is shorter than that of women
because of the presence of testes or the absence of ovaries
(and menstruation) (5). Indeed, there are no valid data in-
dicating that castration has any effect on life span of men.
It is of some interest that no mention appears to have been
made of the relation between castration and singing in any
of the literature concerning the Chinese, Ottoman, or Skoptzy
eunuchs, whereas there was a long tradition in Italy that
associated the castrated state with phenomenal singing by
men both in choirs and the opera (2). The probable reasons
for this apparent discrepancy are several. First, the so-called
castrati singers were, in fact, a heterogeneous group consist-
ing of women who posed as castrated men, men with hy-
pogonadism and/or cryptorchidism, men with intact testes
who probably sang as counter tenors or falsetto, and a few
singers who either had their testes removed or crushed (51).
Consequently, it is difficult to interpret the literature on the
subject in medical terms. Second, in the instances in which
castration was performed, only boys with extraordinary
singing ability were chosen for such a procedure, and it is
likely that singing ability would be no different in men se-
lected for castration using other criteria than in the popula-
tion at large.
Acknowledgments
Cindy Karolikowski, Reference Librarian of the Shiffman Medical
Library in Detroit, provided invaluable assistance in the initiation of
these studies, andthe assistance of Caroline Duroselle-Melish, Reference
Librarian in the Historical Collections of the New York Academy of
Medicine Library, made it possible for us to broaden their scope. We are
also grateful to reference librarians at the New York Public Library and
at the University of Texas Southwestern Medical Center. Translations
from German were made by one of the authors (C.R.), and we are
indebted to Philippe E. Zimmern for aid with the French translations.
References
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