The Jerusalem Quadrilateral

What every family member needs to know
Irrespective of any religious inclination:    Read All About It!

Around 50 AD – some twenty years after Jesus Christ was put to death, some fifteen years and six years respectively after the executions of Saint Stephen and Saint James (Saint John’s brother) and some ten years after Saint Peter’s revelation at Caesarea that all kinds of animal killed and eaten are clean and must not be called profane (Acts ch 10) – a pivotal meeting of the church at Jerusalem with the elders and the Apostles, including James (Jesus’s brother), Peter, Paul, Barnabus, Judas Barsabbas, Silas and some from the sect of Pharisees, convened (Acts ch 15 v 6). This was because Gentile followers at Antioch had become disturbed and troubled at being told that, to hold communion with their Jewish brothers, it was necessary that they should be circumcised (Acts ch 15 v 1-2 & v 5), a perceived necessary compliance with Abrahamic Covenant and Moses’ Law, ultimate bastions for the Jews developed out of the Noahide Laws and subsequent events and experience. Argument, suspicion and war had raged for centuries around this subject (see, for example, 1 Maccabees ch 1 v 60-61 and ch 2 v 46-48; and also Genesis ch 34 v 13-31).

The conclusion of the Jerusalem meeting sent by letter to believers of Gentile origin in Antioch, Syria and Cilicia was the Jerusalem Quadrilateral essentials (Acts ch 15 v 20, v 29 & ch 21 v 25 – NRSV). Namely, imposition of “no further burden than these essentials: that you abstain [keep free]

from what has been sacrificed to idols; and from blood; and from what is strangled; and from fornication.”

This means: abstain from or keep free of:

things that pollute the first commandment (You shall love the Lord your God with all your heart, and with all your soul, and with all your mind) and probably also the second commandment (you shall love your neighbour as yourself); paraphimosis (strangulation, a medical emergency of the prepuce foreskin where retracted but damagingly tight and stuck – for which circumcision is a cure); torn slender frenulum breve (a painful and distressing condition of the inner prepuce area, causing bleeding, a sore and, if it heals, painful or uncomfortable scar tissue – for which circumcision or, more conservatively, frenuloplasty are cures); and sexual immorality (risking disease and community disharmony).

It is as simple as that.

When the members of the congregation at Antioch read the letter they rejoiced at the exhortation. If you keep to the Jerusalem Quadrilateral you will, as the original letter says, do well. And re the first commandment, a good start towards getting to know the Lord your God is in community with others and to seek to familiarise yourself with the Bible.

N.B. Do not be misled by mistaken, flawed and confused interpretations of what the Jerusalem Quadrilateral means. Most commonly these are: keep free of eating non-kosher food; keep free of eating meat from animals killed in the field; keep free of eating meat with blood in it; keep free of blood transfusions. All pretty bizarre given that the subject of the debate was whether or not circumcision is an absolute requirement.

To give a modern science understanding as to why these matters are important to know: Grewel was the first medical scientist practitioner (a psychiatrist) to describe the frenulum anatomy in detail (1958); Whelan (1977) concludes that frenulum breve should be sought as cause of male dyspareunia in patients who may erroneously be labelled as having psychosexual problems; the deep and terrifying darkness of full-blown psychosis brought on by consciousness of risk or actuality of dyspareunia through paraphimosis or torn slender frenulum breve and lack of understanding and attention to these matters is avoidable; Dockray, Finlayson and Muir (2011) find that frenuloplasty, a conservative procedure (instead of full circumcision) for frenulum breve, receives 97% patient satisfaction (including in the criteria, would the patient recommend it to a friend?); any surgical procedure carries risk – complications, to a greater or lesser extent, arise in c. 5% of circumcisions, causing distress and physical problems to a greater or lesser extent. As a urologist (one who uses surgery only when medically indicated) once said to me of circumcisions of males circumcised as children, “I’ve seen too many bad ones”.

The subjects are taboo, of course. With Grewel, Whelan, Dockray and others overlooked or unknown – too many afflicted men are left languishing in mental healthcare systems having been unable to access the necessary understanding or connection or language or words concerning their foreskin/frenulum problem to prevent themselves from falling into that system.

In terms of simple statistics around one in ten or twenty intact adult males has a problem foreskin/frenulum; surgery poses a risk (one in twenty) of complications. Thus, a blanket universal circumcision policy may relieve (or prevent problems arising in) some, but a similar number as may be relieved would be left with a different problem.

If, however, all males of the species are given information to make them aware of how their foreskin/prepuce/frenulum should work and be comfortable (and how to manage it if it’s not) and are checked as appropriate when they are able to understand and speak for themselves (or when a symptom or sign becomes evident when not so able) and the one in ten or twenty who need treatment are treated, with only half of those needing surgical treatment that would leave a one in twenty risk (surgical risk) for one in twenty to forty, i.e. a complication remaining for one or two in four/eight hundred (rather than one in ten or twenty).

This is still not great for the one or two in four/eight hundred, but at least, assuming they are given good information and counselling and care, they would have made their decisions aware of the benefits and the risks involved, having weighed them up for themselves accordingly.

To you, my family members and friends, I recommend keeping this information and guidance going through the generations now that this renewed understanding has emerged having been made possible by the conjunction of the experience of others, personal experience, much information and communication now available via the internet, and, ultimately, faith.

God bless.

jquad page

P.S. Let us hope, too, that any link between continuing the practice of religious circumcision and the territorial claims and disputes of Israel and Palestine, that arises from pre-Christian understanding of Abraham’s story, will soon be a thing of the past.
P.P.S The 5% risk of surgical complications includes: temporary or fatal excessive bleeding; need for subsequent corrective surgery; bacterial infection; viral infection; complications arising from such infections; and surgical accident.

NRSVA – The New Revised Standard Version Bible 1989 National Council of the Churches of Christ in the USA
F Grewel – The Frenum Praeputti and Defloration of the Human Male – Folia Psychiatrica, Neurologica et Neurochirurgica Neerlandica 61(2) p 123-126 1958
Whelan P – Male dyspareunia due to short frenulum: an indication for adult circumcision. BMJ 1977; 24-31: 1633-4
Dockray, J., Finlayson, A. and Muir, G.H. (2011), Penile frenuloplasty: a simple and effective treatment for frenular pain and scarring. BJU International. doi: 10.1111/j.1464-410X.2011.10678.x

JQuad © 2014 Edwin M Douglas