Metzitzah B’peh Controversy: Rabbinic Polemics and Applying the Lessons of History

by | in Jewish World

metzizah bpehSome time ago, a series of babies became infected with serious, life-threatening sores in their groin areas shortly after they were circumcised. It was alleged both by physicians and by some local rabbis that the sores were the result of the mohel performing metzitzah b’peh—the ancient tradition of orally suctioning the wound after incision. The mohel, it was alleged, may have had a communicable disease and passed it on to the children, who, because of their underdeveloped immune systems, were more susceptible to the severe effects of this disease. As a result, some doctors condemned the practice of metzitzah b’peh, and sought government involvement to ban or at least regulate the practice. Some rabbis in the community reacted by defending the practice, and argued that A. This was a religious rite and therefore not within the purview of the medical community, B. That there was no conclusive proof that the children had been infected by their mohel and C. Under no circumstances could a religious Jew deviate from this age-old tradition of metzitzah b’peh.

All these details may sound familiar, because they have appeared in one form or another recently in our media. But the above is not a depiction of recent eventsall this occurred in the 1830s.

As we hope to demonstrate, in this particular area of Jewish life, “There is nothing new under the sun.”1 As a matter of fact, so much has been written about metzitzah b’peh in the last century and a half that it is difficult to condense all the material into one short article. Despite the voluminous material, we will still be left with the question of how much we can or cannot learn from the past. Although the facts of the present day seem identical to what went on in the nineteenth century, sometimes “the devil is in the details,” and certain details may drastically alter our perceptions and conclusions about this component of brit milah.

The Situation Today
We are presently facing a significant divide within the Orthodox community over this practice. In the summer of 2004, a clinical study from Israel appeared in Pediatrics, the journal of the American Academy of Pediatrics, apparently demonstrating that the practice of metzitzah b’peh increases the risk of an infant contracting the herpes simplex virus (HSV).2 Early in 2005, news broke that a prominent mohel in the New York area had allegedly transmitted HSV to a small number of infant patients through his practice of metzitzah b’peh. The mohel in question was ordered by the New York City Department of Health and Mental Hygiene to immediately desist from performing metzitzah b’peh. In December 2005, the commissioner of the same New York City department issued an “open letter to the Jewish community.” After documenting the statistically high number of HSV infections in infants who had had metzitzah b’peh the letter concluded:

During metzitzah b’peh the mouth of the mohel comes into direct contact with the baby’s circumcision cut, risking transmission of herpes simplex virus to the infant. While severe illness associated with this practice may be rare, because there is no proven way to reduce the risk of herpes infection posed by circumcision which includes metzitzah b’peh, the Health Department recommends that infants being circumcised not undergo metzitzah b’peh. To help protect their baby, parents should understand the risk of metzitzah b’peh—BEFORE the day of the bris, while there is time to explore other options….

The Department has reviewed all of the evidence and there exists no reasonable doubt that metzitzah b’peh can and has caused neonatal herpes infection. We have always maintained that it is our preference for the religious community to address these issues itself as long as the public’s health is protected. While some medical professionals and others in the Jewish community have called on the Department to completely ban metzitzah b’peh at this time, it is our opinion that educating the community through public health information and warnings is a more realistic approach.3

If anything, the attack on metzitzah b’peh only strengthened the practice within the Chareidi community, as now this was viewed as a milchemet mitzvah—a religious war to defend a centuries-old tradition.

The negative response by the Chareidi community to this governmental position was swift and passionate. Articles, signed open letters and kol koreh posters accused the Department of Health of overstepping its authority; as a religious rite, brit milah was within the purview of the rabbis, not the government. Additionally, there were insufficient data to correlate metzitzah b’peh to HSV. It was also argued that the motivations of the Department of Health were less than pure; the city department was comprised of secular, anti-religious Jews who had a much larger agenda: The recommendation to refrain from metzitzah b’peh was only one step removed from banning brit milah altogether, or at least banning non-physician mohelim. An editor in a Chareidi newspaper wrote:

Will we become like our Russian brethren in the past century who were forced under the Communists to conduct sacred bris[es] in underground bunkers with sentries standing guard…. Are we about to revisit those days in our own country?4

If anything, the attack on metzitzah b’peh only strengthened the practice within the Chareidi community, as now this was viewed as a milchemet mitzvah—a religious war to defend a centuries-old tradition.

In the meantime, the Rabbinical Council of America had already issued its own public policy statement, recommending, but not requiring, that mohelim desist from doing metzitzah b’peh, and instead suction the blood through other, safer methods. The article, quoting Rabbi Hershel Schachter, a rosh yeshivah of Rabbi Isaac Elchanan Theological Seminary, stated the following:

Rav Yosef Dov Soloveitchik reports that his father, Rav Moshe Soloveitchik, would not permit a mohel to perform metzitza b’peh with direct oral contact, and that his grandfather, Rav Chaim Soloveitchik, instructed mohelim in Brisk not to do metzitza b’peh with direct oral contact.5

And so, for the time being, two camps remain within our people: those who are pro-metzitzah b’peh, the most extreme of whom will not permit a brit milah unless it includes metzitzah b’peh, and those who are anti-metzitzah b’peh, the most extreme of whom will not permit metzitzah b’peh under any circumstances.

Back to the Source
To better understand the issues, we first need to examine the reason why blood suctioning is a part of the Brit in the first place. The mishnah in masechet Shabbat states:

We perform all necessary acts for the milah on Shabbat: We circumcise, tear the mucosal membrane [peri’ah], we suction, and we place upon the wound a bandage with cumin powder.6

In the ensuing gemara, Rav Papa states: “Any mohel that does not suction creates a health danger [sakanah], and we therefore remove him from his post.”7

The simple understanding of the gemara is that metzitzah is not part of the actual mitzvah of circumcision; instead, it is done to avoid any health hazard to the child after the circumcision.8

Rambam confirms this reading of the gemara by stating explicitly:

After [circumcision and peri’ah], the mohel suctions the area sufficiently until blood flows from places far away from the wound; he does this in order that the child not be endangered.9

It is implicit from the Talmudic and from post-Talmudic discussions that the method being advocated for suctioning the blood is via the mouth, that is, metzitzah b’peh.10 No one entertained an alternate method for metzitzah until the nineteenth century. At the same time, no special designation was given to the mouth by the halachic authorities other than that it was the most obvious and convenient method of suctioning.

However, sources in kabbalistic literature do make reference to the benefit of using specifically the mouth in the mitzvah of brit milah. For example, the seventeenth-century kabbalist Rabbi Avraham Azulai stated that man possesses a foreskin because of Adam’s sin in the Garden of Eden.

The same parts of the body which caused this distortion must restore the body to its natural perfection. Adam’s hands took the forbidden fruit and his mouth ate it, so the hands of the mohel remove the foreskin and the blood is removed with the mouth.11

The Chatam Sofer and the Sponge
In 1837, Rabbi Eliezer Horowitz, the chief rabbi of Vienna, was presented with a dilemma. A number of children had become infected with sores after their circumcisions, and some had even died. It was believed that their mohel had transmitted a disease to them, and so a certain Dr. Wertheim of Vienna asked Rabbi Horowitz if, instead of suctioning orally, it could be permitted to squeeze out blood from the Brit area using a moistened sponge. Rabbi Horowitz’s inclination was to permit the use of a sponge for metzitzah, but he did not want to dispense the heter without first consulting with his revered rebbe, Rabbi Moshe Sofer, the Chatam Sofer. In a letter to Rabbi Horowitz, the Chatam Sofer wrote:

We only find metzitzah b’peh as a requirement by the kabbalists, who assert that one must mitigate the strict attribute of justice with the mouth and lips. However, we have no dealing with hidden matters if there is at all even the slightest concern of a health hazard…. Therefore, as long as we can draw out the blood from the faraway places, it may be done in any way possible. We should believe the experts regarding which act is as effective as oral suctioning. I will go even further: Even if the Talmud had explicitly stated that one must suction with his mouth [I would still maintain that one may use a sponge], since the act of suctioning is not an integral part of the mitzvah of milah, but is rather merely done to avert danger to the child. To wit, according to the halachah, if one circumcises and does peri’ah but neglects to suction, he has completely fulfilled the mitzvah….12

The Chatam Sofer went on to demonstrate that applying cumin powder is also listed in the Mishnah as something done even on Shabbat, yet no one argues that only cumin must be used as a salve for the area. Since the Talmudic Era we have found more effective methods of achieving homeostasis and protection to the wound from infection, and this is why halachic authorities do not require the use of cumin alone. Similarly, contended the Chatam Sofer, based on the Mishnah, no one could argue that the mouth alone had to be used to suction the blood.

But here’s where the waters become murky. What was the true motivation for wanting to abolish metzitzah b’peh in the Viennese community? From a later letter from the same Dr. Wertheim who initiated the query to Rabbi Horowitz, it seems the doctor had another agenda. In communicating to the Jewish community Rabbi Horowitz’s and the Chatam Sofer’s ruling, he is motivated to abandon metzitzah b’peh by “the wish to remove from this important religious act any ugliness, which affronts the eye of the expert as it does the emotions of the layman.”13

It is possible that Dr. Wertheim’s motives were fueled by a desire, like so many Jewish Reformers of the time, to abolish certain traditional practices that appeared unsightly or primitive to the non-Jewish world. During much of the nineteenth century, there was a concerted effort in many communities that were under the influence of the Reform movement to either abolish brit milah entirely, or to have it done only by physicians, or to at least eliminate metzitzah b’peh. During this time, an alarming number of communities were doing away with metzitzah or brit milah entirely.

However, none of this changes the ruling of the Chatam Sofer. Apparently oblivious to the motivations of the questioner, the rabbi ruled, based on the cold facts of the halachah, that metzitzah could be performed in any way that would accomplish the health directive.

Metzitzah B’peh: Another Battlefront Against the Reform Movement
Dr. Wertheim’s and others’ motivations are important because the issue of motive may raise questions about those who disagreed with the Chatam Sofer and maintained that metzitzah was specifically with the mouth. Was the often-fiery defense of metzitzah b’peh based purely on halachic considerations, or was it also out of a sense of duty to preserve the mesorah (tradition) against the attacks of the Reform movement? Was there a sentiment that a concession on the metzitzah issue would open a slippery slope that would eventually do away with brit milah entirely? If so, we must look at the responsa of the era with a discriminating eye, and try to see where the halachic arguments end and rabbinic rhetoric and polemics begins. As we shall see, this may prove to be a difficult task.

While we cannot provide here an exhaustive list of authorities who fiercely debated this issue,14 we will cite one example of where anti-Reform rhetoric and halachic arguments are intertwined. Rabbi Yaakov Ettlinger, in his famous responsa work, Binyan Tzion, wrote two responsa on the issue of metzitzah, and in both he strongly defended the practice, calling metzitzah (not b’peh per se, just the act of suctioning) a “halachah leMoshe miSinai,” a necessary tradition dating back to Moses at Sinai.15 In his second responsum, he prefaces the issue with the following:

Ever since my ruling on metzitzah, they have come to fight against me. They furiously shoot arrows of falsehood and lies at me. Their words reveal three agendas: A. They speak arrogantly and disparagingly against the words of our Sages of blessed memory. B. They pour out humiliation and ridicule against me, and have made me the brunt of their injurious speech, both covertly and overtly. C. They are continuing with full intensity their deceitful campaign to abolish metzitzah.

Note that the issue of metzitzah is the third on a list of three grievances against the “enemy.” Clearly, the issue of the day was not only metzitzah, but also the general war against Reform Judaism and the Haskalah. Metzitzah was a major battlefront in this ongoing war.

Halachah LeMoshe MiSinai?
This is perhaps why we find that metzitzah is for the first time called “halachah leMoshe miSinai” only in the nineteenth century.16 Until then, there was no need to strongly defend it from its detractors. By maintaining that the practice was something dating back to Moshe Rabbeinu, it occupied an elevated status of being halachically imperative. Additionally, once something is a Mosaic tradition, it is much more difficult to suggest an alteration to that tradition. This was one further reason not to tamper with the age-old tradition of doing metzitzah orally.

We also find a number of rabbis of the era challenging the authenticity of the Chatam Sofer’s letter to Rabbi Horowitz, which permitted metzitzah with a sponge. One anonymous source went so far as to charge that the letter was forged or adulterated.17 Others minimized the significance of the ruling, in that it applied only to a situation where the city’s mohel was known to have a communicable disease. Others suggested that had the Chatam Sofer known the motivation behind the query and that the Jewish Reformers were seeking to abolish metzitzah entirely, he never would have issued a lenient ruling; the Chatam Sofer was, after all, one of the most ardent opponents of the Reform movement. Yet others argued that the fact that this pesak of the Chatam Sofer did not appear in his book of responsa, Shu”t Chatam Sofer, was proof that it was not to be taken seriously or applied to other situations.18

Since the students of the Chatam Sofer followed their rebbe’s tradition of battling against the Reform movement, it is ironic that they were faced with the task of minimizing their rebbe’s pesak. As Jacob Katz, author and editor of many books in medieval and modern Jewish social history, maintains:

Metzitzah by mouth, which to the observer appeared to be a part of the circumcision rite, was challenged for reasons that were tainted with reformist ideas. Whatever the purpose of metzitza according to its original halachic categorization, when it became the target of attacks by innovators, it aroused a defensive reaction by the Orthodox, irrespective of its halachic status. The Chatam Sofer advocated the “elevation of the prohibition,” that is, giving a higher status to any practice under attack than its original status in the halachic hierarchy, as one of the means of defending rituals and customs.… In the time of the Chatam Sofer, metzitza was not yet a controversial subject, so he could deal with it on its own terms, and did not need to employ the means of defense which he himself outlined. In the days of his descendants and students, metzitza was drawn into the whirlpool of confrontation between innovators and conservatives, and those who followed in the Chatam Sofer’s footsteps needed his method of defense.19

Public vs. Private Policy: Rabbi Hirsch’s Pesak

The Metzitzah Tube. This diagram first appeared in 1888 and was reprinted in the journal HaMayan, no. 5 (1965).

The Metzitzah Tube. This diagram first appeared in 1888 and was reprinted in the journal HaMayan, no. 5 (1965).

In 1888, reacting to a pervasive negative attitude toward metzitzah b’peh, Rabbi Samson Raphael Hirsch and Rabbi Azriel Hildesheimer, chief rabbis of Frankfurt and Berlin respectively, came out with a joint ruling that advocated doing metzitzah using a newly invented device, the metzitzah tube. This was a glass tube, about 6.5 centimeters long, that was wide on one end and narrow on the other (see diagram). It could be placed over the area of the Brit and the mohel could place his mouth over the narrow end of the tube and suction the blood with his mouth, without there being any physical contact between the mohel and the infant or the infant’s blood. This method was viewed as more in keeping with the tradition of suctioning with the mouth than the Chatam Sofer’s previous dispensation of using a moist sponge, and at the same time it protected both the infant and the mohel. In their public announcement to the Jewish community, the two rabbis emphasized the need for using the tube for medical reasons, and did not even intimate that it was any less desirable than metzitzah b’peh.20 The glass tube is used by many mohelim to this day.

Curiously, Rabbi Hirsch, in a scholarly responsum, permitted the metzitzah tube in a much more subdued tone. As a combatant against Reform Judaism, Rabbi Hirsch first attacked those elements within the community who sought to abolish metzitzah entirely.21 He then clearly stated that his endorsement of the tube was not meant for those who felt comfortable doing metzitzah b’peh, but only for those who have not to date been performing metzitzah at all, either because of a fear of contracting disease from the mohel, or because of governmental intimidation.22

Why the change in tone between the public announcement and the scholarly ruling? We can only speculate that on the one hand, Rabbi Hirsch felt duty-bound to the German community, which was already under tremendous pressure to abolish metzitzah, to find some solution that would make everyone feel comfortable again with brit milah practice. On the other hand, he may have felt a need to preserve the mesorah of metzitzah b’peh within a smaller enclave, as a means of combating the Reform movement. In other words, he may have taken a broader communal stance that was different from what he advocated for those in his inner circle.

The Present
Let us return to the present, where the division continues within our own community. If we look at how the two camps have reacted to HSV, we find history repeating itself … almost. Granted, one side seeks to abolish—or to at least diminish the practice of—metzitzah b’peh, and the other side argues that metzitzah b’peh is being maligned for all the wrong reasons. But is this really so? Can it be argued with the same vigor and conviction that medical professionals in the twenty-first century are motivated by a desire to sanitize brit milah (and Judaism by extension), and are therefore misrepresenting the results of the clinical studies? 2006 is not 1836. The war against the Reform movement is long over (or at least it has changed from war to frosty détente). Accordingly, using the often-rhetorical arguments of the nineteenth-century rabbis may be a misapplication of historical precedent.23

In 1989, a kol koreh—public announcement—was issued by gedolim in both Israel and the United States regarding the practice of metzitzah b’peh in light of the new AIDS virus. The letter called upon all Jews to continue the practice of metzitzah b’peh, unless the mohel or the infant was known to be a carrier of a communicable disease. It was signed by both admorim in the Chassidic community and respected roshei yeshivah in the Litvishe community.

This kol koreh is being cited again as a defense for metzitzah b’peh despite the new health concerns, and that may be a perfectly appropriate defense. On the other hand, it may also be that a new assessment is called for in light of the new medical data, not having to do with AIDS, but with HSV, which, although not as lethal, is much more prevalent within the adult population.

When Torah and Science Clash
One more matter deserves consideration. Around the same time of the Chatam Sofer’s responsum about metzitzah b’peh, the Tiferet Yisrael Mishnah commentary was first published. In it, Rabbi Yisrael Lipschutz initially argued that based on modern medicine, not only did the practice of metzitzah not reduce sakanah to the newborn, if anything, it endangered the child’s life further by increasing the risk of unstoppable bleeding. But does this mean that the rabbis of the Mishnah were wrong? How do we reconcile Talmudic science with modern science? Rabbi Lipschutz answers with the widely used principle of “nishtaneh hateva”—nature has changed since Talmudic times, and so what was dangerous then may not be dangerous today, and vice versa. Although the author concludes by defending metzitzah,24 his own conflict over the discrepancy between the medical knowledge of the Sages and of modern physicians becomes clear.

While the medical arguments today against metzitzah b’peh are different from those of the Tiferet Yisrael’s time, the tension between tradition and modernity is just as real. This, too, is part of the modern-day metzitzah b’peh controversy: How much credence should be invested in modern science when it contradicts rabbinic wisdom, and how are discrepancies between the two resolved? Is reliance upon today’s physicians a betrayal of our tradition, or is it in keeping with the Talmudic teaching that health issues supersede all other considerations? This thorny issue may also have contributed to today’s formation of two separate camps within the Orthodox community on the metzitzah b’peh issue.

Final Thoughts
It is important for mohelim and parents to always remember the Shulchan Aruch’s instruction that the baby’s health is the prime directive for the mohel:

One must be very cautious in these areas, and not to circumcise any child when there is even a suspicion of illness. Danger to life is the overriding concern, for it is possible to delay a Brit, but it is impossible to restore a Jewish life.25

Accordingly, the burden of proof is on those who would practice metzitzah b’peh to effectively demonstrate that the clinical studies are flawed, that their conclusions of a health hazard are not supported by the evidence, and that the alarms being raised are unfounded.26

While there is definitely basis for an insistence on metzitzah b’peh, primarily from kabbalistic sources, one should carefully consider the risks involved when contemplating the practice for one’s own newborn son. Certainly, it is worthwhile to consult one’s rabbinic authority. Additionally, one should pay careful attention to the reason why metzitzah b’peh is being advocated so strongly within certain circles. If the reason is predicated on halachic and kabbalistic imperatives, that is one thing. If, however, the reason to stand firmly on this practice is to preserve the greater good of a pristine mesorah for Klal Yisrael’s future, unadulterated and protected from a potential slippery slope, then a new parent may wish to consider: Do I wish to expose my newborn son to the minor infection risks, not because of a halachic imperative, not because it is really “halachah leMoshe miSinai,” but rather for the sake of protecting tradition in Klal Yisrael? The former is for the direct benefit to my own son’s soul; the latter is for the nation of Israel. Clarity on the issues, in this situation as in so many others, is one’s greatest ally.

In addition to being a mohel, Rabbi Korobkin is rabbi of Kehillat Yavneh of Los Angeles, and director of Community and Synagogue Services for the West Coast Orthodox Union. The author wishes to thank Rabbi Avrohom Teichman, Dr. Steven Weiss (both of Los Angeles) and Rabbi Alan Wiener (of Allentown, Pennsylvania) for their invaluable input.

Notes

1. Kohelet 1:9.

2. Benjamin Gesundheitet 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? Three opinions are offered by Sdei Chemed 8 in Kuntres HaMetzitzah: Metzitzah: 1. prevents infection by cleaning the wound after contact with unclean fingers or an unclean blade, 2. prevents swelling and 3. closes the blood vessels and therefore reduces 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 Bris Avraham HaKohen by Rabbi Rami Cohen (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), cited above. 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 Tzvi Hirsh 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, 24 November 1846, no. 46. 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 his responsa posthumously and chose what to include and what to exclude. Since by the time of his death metzitzah b’peh had become a battlefield issue, it is more likely that the Chatam Sofer’s 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 U.S.A. and Canada, a Chassidic group in Williamsburg, agreed to the state’s health commissioner that it would self-regulate its community mohelim with new standards. All mohelim would sanitize their hands similarly to surgeons, clean their mouths with a sterile alcohol wipe and rinse for at least 30 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 New York City’s health department, 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, shlita, 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.

This article was featured in Jewish Action Winter 2006.

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