Article: The View from Israel | Sidebar: The Truth About HSV

Notes
    1. Kohelet 1:9.
    2. Benjamin Gesundheit et al., “Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition,” Pediatrics (August 2004): 114; 259-263, DOI: 10.1542/peds.114.2.e259. The article has come under considerable criticism by some physicians and rabbis. Daniel S. Berman, MD, FACP, an infectious-disease specialist, wrote a well-reasoned article arguing why the Pediatrics study was fraught with inaccuracies and unsubstantiated conclusions.
    3. The open letter is available online at http://www.nyc.gov/html/doh/downloads/pdf/std/std-bris-commishletter.pdf. A fact sheet entitled, “Before the Bris: How to Protect Your Infant Against Herpes Virus Infection Caused by Metzitzah B’peh,” is a follow-up to the open letter, and is also available online at http://www.nyc.gov/html/doh/html/std/std-bris.shtml.
    4. From Yated Ne’eman, 18 February 2005; also quoted in an article by Eric J. Greenberg in the 4 March 2005 issue of the Forward. For more quotes, articles and photos of posters, go to http://hydepark.hevre.co.il/hydepark/topic.asp?topic_id=1287989.
    5. The full policy statement can be found on the RCA web site at http://www.rabbis.org/news/article.cfm?id=100605.
    6. Mishnah Shabbat 19:2.
    7. Shabbat 133b.
    8. See Shu”t Avnei Nezer, Yoreh Deah sec. 338, where the author acknowledges that this is the simple understanding of the gemara, but then offers an alternate interpretation, which would define metzitzah as an integral part of the mitzvah. See also Shu”t Meshiv Nefesh 2, sec. 6. Regardless, the vast majority of authorities agree that if metzitzah is not performed, the circumcision is still kosher. How does suctioning the blood remove the health hazard? The following opinions are offered by Sdei Chemed 8 in Kuntres HaMetzitzah: Metzitzah prevents infection by cleaning the wound after contact with unclean fingers or an unclean blade; metzitzah also prevents swelling and closes the blood vessels, therefore reducing bleeding.
    9. Mishneh Torah, Hilchot Milah 2:2. See, however, Shu”t Meshiv Nefesh (ibid.), who—remarkably—provided a novel argument that even Rambam maintained that metzitzah is an integral part of the mitzvah and is not done merely because of sakanah.
    10. See Shulchan Aruch, Yoreh Deah 265:10, Rema’s commentary: “We spit the metzitzah blood into dirt.” This clearly indicates that the mohel had sucked the blood into his mouth.
    11. From Chesed LeAvraham, quoted in Rabbi Y. Goldberger, Sanctity and Science (Jerusalem, 1991).
    12. This letter was first printed in 1845 by Menachem Mendel Stern in the periodical Kochvei Yitzchak. It is quoted in a number of secondary sources, including Rabbi Rami Cohen, Bris Avraham HaKohen (New York, 1993), 192.
    13. Quoted in Jacob Katz, Divine Law in Human Hands (Jerusalem, 1998), 362. It is also possible that Dr. Wertheim mentioned this reason not because of any Reform leanings, but rather because he wished to divert attention from the mohel who was alleged to have infected children. Perhaps he simply wished to save the mohel from embarrassment and loss of livelihood.
    14. We refer the serious student to a number of compilation sources. One of the more important sources in Hebrew is Sdei Chemed 8, Kuntres Hametzitzah (pp. 236-450), which reviews the various opinions to date and forcefully defends metzitzah b’peh. Also extremely helpful is Katz (pp. 357-402). See also Rabbi Yosef Weisberg, Otzar HaBrit 4, “Milchemet HaMetzitzah.”
    15. Shu”t Binyan Tzion, sec. 23 and 24.
    16. See also Shu”t Maharam Shick, Orach Chaim, sec. 152 and Shu”t Mahari Asad, sec. 258. Katz (p. 401), quoting from a letter written by the Chatam Sofer to Rabbi Tzvi Hirsh Chajes, writes that under certain circumstances, the Chatam Sofer advocated the “elevation of the prohibition,” that is, overstating the prohibited nature of a certain practice when it had come under attack as one of the means of defending the practice against the Reform movement. It should not be surprising that this term can be used hyperbolically, for we find that Chazal themselves attributed certain practices as “halachah leMoshe miSinai” when these practices were in reality only of later, rabbinic origin. See commentary of Rabbi Chajes to Chagigah 3b; see also Tiferet Yisrael commentary to Mishnah Yoma 2:2 (end of note 12). Accordingly, the nineteenth-century rabbis were merely following Chazal’s example.
    17. Katz (pp. 376-377) quotes from an anonymously penned article, “Metzitzah from the Medical and Religious Perspective,” published in Der Treue Zions-Wächter, no. 46, 24 November 1846. The author warns against relying on the names of authorities like the Chatam Sofer, whose ruling was “forged or distorted.” This argument apparently caught on, as it was also cited in the 1870s by Rabbi Chaim Hirsch Mannheimer (a student of the Chatam Sofer), in his Ein HaBedolach, 13.
    18. See Katz, who calls this final argument “specious” because it was the Chatam Sofer’s family and students who compiled the rav’s responsa posthumously and chose what to include and what to exclude. Since by the time of the Chatam Sofer’s death metzitzah b’peh had become a battlefield issue, it is more likely that the family omitted it to avoid the controversy.
    19. Katz, pp. 401-402.
    20. This point is emphasized by Mordechai Breuer in Modernity Within Tradition: The Social History of Orthodox Jewry in Imperial Germany (New York, 1992), 259.
    21. Anyone who has the audacity to suggest that the Sages’ ruling that “any mohel who does not perform metzitzah [endangers the child and] is removed from his post” (Shabbat 133b) no longer applies to us … places himself on the side of the Reform. If one subscribes to this, then instead of bringing his son into the covenant of Avraham Avinu, he is bringing him into the covenant of the Reform.
    Once again, we are faced with a halachic responsum that is intertwined with polemical rhetoric against the Reform movement.
    22. Shu”t Shemesh Marpei, sec. 55.
    23. The counter-argument to this is that, indeed, the war is not over. It may be more than coincidence that the New York City Department of Health, which is comprised mostly of secular Jews, is the most vocal in its anti-metzitzah b’peh stance, while the New York State Department of Health, which is mostly non-Jewish, has not taken a position on the matter. This point was conveyed to me by a prominent Chassidic mohel who performs metzitzah b’peh. Perhaps because of its less oppositional stance, the state’s health department has been more successful in brokering a compromise, taking into account the health concerns of the medical community and the religious concerns of the Chareidi community. In June 2006, the Central Rabbinical Congress of the USA and Canada, a Chassidic group in Williamsburg, agreed to the state’s health commissioner’s order to self-regulate community mohelim with new standards. These standards entail that all mohelim sanitize their hands similarly to surgeons, clean their mouths with a sterile alcohol wipe and rinse for at least thirty seconds with mouthwash, cover the circumcised area with antibiotic ointment and sterile gauze and agree to be tested for HSV if a baby shows evidence of HSV following a brit milah where metzitzah b’peh was used, along with his parents and health care workers. As of this writing, negotiations are still ongoing with the New York City Department of Health, but it appears that the city’s more public opposition to metzitzah b’peh has made it difficult to broker such a compromise.
    24. Tiferet Yisrael to Mishnah Shabbat 19:2. Although he advocates the preservation of metzitzah, the author also concludes with a novel halachic position regarding metzitzah on Shabbat, which indicates some level of equivocation. See Shu”t Binyan Tzion (sec. 23 and 24) for a response to Tiferet Yisrael. While Tiferet Yisrael is prepared to argue nishtaneh hateva, he does not go so far as to argue that Chazal were simply relying on imperfect medical knowledge. This is in contradistinction to Rabbi Avraham ben HaRambam’s position on such matters. For more on this subject, see Yehudah Levi, The Science in Torah (Jerusalem, 2004).
    25. Yoreh Deah 263:1.
    26. All authorities agree that when the sakanah factor is clear and present, such as when either the baby or the mohel is known to have a communicable disease, metzitzah should not be done orally. Even Rabbi Yosef Shalom Elyashiv, who has been widely quoted as a defender of metzitzah b’peh, has ruled accordingly. The point of dispute is merely whether or not there is a sakanah when no known contagion is present. It has been communicated to me both by my beloved teacher, the late Rabbi Yosef Weisberg, former chief mohel of Jerusalem, and by several mohelim who meticulously perform metzitzah b’peh within the Orthodox community, that as a matter of course they do not perform metzitzah b’peh when the parents are not observant, even when there is no knowledge that either parent possesses a communicable disease. Apparently, in these cases the risk factor is too great even for the most ardent metzitzah b’peh advocates. Another issue to consider is that many authorities permit metzitzah to be done by someone other than the mohel (see Ketzot HaChoshen 382:2). Accordingly, a father who wishes to minimize risk and at the same time preserve the practice can perform metzitzah b’peh himself on his son (of course, after consultation with the mohel on how the procedure is done). It has been my personal practice as a mohel to offer this alternative to any interested parent.