Metzitzah be-Peh and Protecting Jewish Infants

It is difficult to believe I am writing about meẓiẓah be-peh, that there is a necessity to address this topic once again. Apparently, yet ” title=”Brooklyn DA Looking into Infant Death” target=”_blank”>even now looking into the case. Even if this case of infant death turns out to be unrelated to the meẓiẓah be-peh, the practice of meẓiẓah be-peh among mohalim (Jewish ritual circumcisers) is on the rise, and inevitably, the death-toll will rise with it.

Basic Information
1) What is meẓiẓah be-peh?
It is the act of sucking the blood from the circumcised penis of the infant child by direct oral contact.

2) How do children get ill and die from this?
Since the penis has just been cut, the wound can be infected with any germs present in the mouth of the mohel (Jewish ritual circumciser). Nowadays, the main culprit is herpes, as documented by the ” title=”Metzitzah be-Peh – Therapeutic Touch or Hippocratic Vestige” target=”_blank”>“Meẓiẓah be-Peh – Therapeutic Touch or Hippocratic Vestige?” Ḥakirah 3 (2006): 15-66. I make much use of this excellent article in this blog-post. Also see some of the response letters in Ḥakirah 4, especially those of Dr. Marc Shapiro, Dr. Debby Koren and, of course, Dr. Sprecher’s response. For an approach similar to the one I am taking in this article, see Cantor Philip Sherman’s ” title=”Metzitzah be-peh Controversy – The View from Israel” target=”_blank”>Jewish Action called: “Metzitzah B’peh Controversy: The View from Israel,” the suggestion is to devise a method to ensure that the mohalim who perform meẓiẓah be-peh do not have any illnesses, including sores in the mouth, that can transfer disease. (I have heard that this is the practice in England among mohalim that perform meẓiẓah be-peh.) The mohel would have to go through whatever testing deemed medically necessary to ensure the meẓiẓah is safe, and he would need to constantly renew this clean bill of health. Any mohel without this “license” would be barred from performing meẓiẓah be-peh, and any who did so anyway would be banned from practicing by the community.
 
Although Halperin’s suggestion is commendable, I am personally uncomfortable with it. Since meẓiẓah be-peh has no medical benefit and no halakhic basis nowadays, I see no reason to continue with a practice that reflects antiquated medicine in such a graphic manner. I feel that doing so, even if it weren’t dangerous, sends the wrong message (this, I hear, is R. Moshe Tendler’s argument as well). Furthermore, I can’t help worrying that even with safeguards, the practice may still pose some threat to the infant; one need only consider the amount of germs and bacteria found in a person’s mouth and the fact that illnesses often come about unexpectedly.
 
Nevertheless, since there are those that stridently disagree with me and believe meẓiẓah be-peh to be either a halakhic requirement or of paramount qabbalistic significance, I have included the clean-bill-of-health model in the hope that the opposition may at least adopt this, thereby protecting the lives of the infant boys who are otherwise in harm’s way. 
 
2) The Meẓiẓah-Equivalent Model
R. Shlomo Ha-Kohen of Vilna (1828-1905) wrote in a responsum (Binyan Shlomo 2, YD 19) that there is no mitzvah to perform meẓiẓah. Instead, he argued, meẓiẓah should be viewed as part of the general requirement to keep the infant healthy. Therefore, he claims, whatever modern medicine determines to be the best medical practice for keeping the child healthy should be considered the equivalent of meẓiẓah.
 
According to R. Ha-Kohen, the practice he witnessed in his time period, where the mohel would wrap the penis in rags (smartutin), was the equivalent of meẓiẓah, and that he could not venture to say what the practice would look like in the future. This is because the practice is purely medical and, as he reminds the questioner, he is not a doctor.
 
Applying Ha-Kohen’s analysis to our times, the modern mohel should sterilize his equipment and use whatever bandages and antibacterial creams are necessary to reduce the risk of infection. In this way he has fulfilled the requirement that is at the root of the – now defunct – requirement to suck out the blood from the wound.
 
3) The Ritual-Meẓiẓah Model
Some authorities were less comfortable with cancelling the practice altogether, although they were certainly unwilling to risk the lives of Jewish infants to keep it. Hence the idea of a meẓiẓah performed without direct contact between the mohel’s mouth and the infant’s penis was suggested, and two basic forms of this practice were put forward. One idea, advocated by R. Moshe Schreiber (Sofer), known as the Ḥatam Sofer, was to use a sponge around the corona, with the mohel applying (slight) squeezing pressure to remove some blood.
 
Another method that is popular with a number of Modern Orthodox mohalim today was to use a glass pipet. The mohel would place the pipet upon the wound and suck from the other side, stopping when some blood would come out of the wound. This method was advocated (or at least permitted) by a number of halakhic authorities, such as R. Malkiel Tenenbaum, R. Elyakim Shapiro of Grodno and R. Avraham Kook. It also seems to be the preferred solution of R. Moshe Pirutinsky in his influential compendium, Sefer ha-Brit. 
 
Ancient Rabbis, Ancient Science
One popular response to the critique of the practice of meẓiẓah be-peh has been that if the Sages of old defended the practice, it must be safe and even life-sustaining. It would be beyond the scope of this post to respond in full to this argument, but it is important to note that such an argument suffers from the fallacy of granting the Talmudic Sages superhuman intelligence, making them not only the expositors of traditional Torah laws, but also the repository of all scientific knowledge, past and future. It reflects the belief that the rabbis knew all of science and natural law.
 
When faced with contradictions between the statements of the rabbis and the reality as described by modern science, some more extreme apologists will even argue that the Talmud is correct and modern physicians are mistaken. This, of course, conflicts with all evidence and any semblance of reason. It reflects the fear that if one admits that the Sages were humans – albeit very wise ones – and that they erred in scientific knowledge, someone could suggest that their views on religion were also in error.
 
One can appreciate the fear of these ultra-conservatives based on what is at stake. Nevertheless, to me, the very idea that someone would defend a practice that by any reasonable modern standard is dangerous to infants – that has in fact killed a number of infant Jewish boys over the years – in order to support a misguided view of the Talmudic Sages’ infallibility is unfathomable. One cannot hide one’s head in the sand and protect an outdated and fictitious worldview at the expense of the lives of our sons. No matter how small the percentage of deaths may be – and it is admittedly rather small – it is an unacceptable cost for such a paltry return.   
 
Additionally, it appears to me that claiming the performance of meẓiẓah is part of the mitzvah should be considered a distortion of the mitzvah itself. One who makes this claim, despite the obvious evidence from the Talmud to the contrary, is in serious danger of violating the prohibition of bal tosif – the prohibition of adding on to the mitzvot of the Torah. It is well known that one of the categories of this prohibition is changing the form of a mitzvah; the claim that meẓiẓah is a milah-requirement and not a safety-requirement does just that—it changes the form of the mitzvah.
 
Finally, the ḥillul ha-shem (desecration of God’s name) factor cannot be ignored. Religion in our society is constantly under a microscope. Although Judaism and Torah observance often requires acts that have no objective basis in empirical observation, stemming instead from revelation or tradition, we want to make evident that our religion is not harmful. In the current climate circumcision is controversial enough; the helpful vs. harmful aspects of the practice are being debated in a number of societies across the world even now.
 
Since circumcision is a Torah commandment as well as a core identity marker for Jews, we have defended this practice – and will continue to do so – in every conceivable manner. However, why should we defend meẓiẓah be-peh, a practice which is not a mitzvah and contains no material benefit to the child, only harm? With medical journals publishing pieces like Benjamen Gesundheit et al.’s Neonatal Genital Herpes Simplex Virus Type 1 Infection after Jewish Circumcision: Modern Medicine and Religious Tradition – ” title=”How to Protect your Infant against Herpes Infection” target=”_blank”>New York City Department of Health, and a gratuitous one.
 
The simple understanding of halakha is that meẓiẓah is not a mitzvah and there are other ways to accomplish it even if it were. Therefore, I suggest the following policies be established in our communities.

1. Our members will not use mohalim that do meẓiẓah be-peh. Only mohalim that follow either the meẓiẓah-equivalent model (i.e. no meẓiẓah just bandages and sterilization) or ritual-meẓiẓah model (pipet or some other indirect method) will be used.
2. Our rabbis will not officiate at any brit that has a mohel that does meẓiẓah be-peh.
3. Our synagogues will not allow the use of our sanctuaries, social halls or any part of our buildings for a brit if there will be meẓiẓah be-peh, at least until such time as these mohalim have instituted an acceptable clean-bill-of-health model.

This is a matter of the safety of our children, and we are accountable for any child that is hurt or dies because we were not strict about this. It is my fervent hope that in taking a strong stance on this issue, all Jewish communities will eventually follow suit. In a matter of life or death, with so much to lose and so little to gain, can we really afford to do less?
 
Rabbi Zev Farber, Atlanta