Metzizah B’Peh: Ethic Or Barbaric?

By Sruli Schochet – Los Angeles

“A Bris,” explained comedian Joey Russell (late father of Chabad’s very own, Reuven Russell yl”t), “is a minor surgical procedure, which our people have turned into a major catered affair.”

Having merited to have already made several brisos in the past, ka”h, it was always a rushed event, caught up in the chaos of newborn child, recovering mother and other little ones that needed our attention.

However, recently Hashem blessed my wife and I with twin boys. Being born at 34 weeks, while Boruch Hashem both mother and children are at home and doing well, being born premature, the brisos for these two new precious bundles was delayed. As a result, this gave me a slight reprieve from the usual bedlam, and allowed me to contemplate about the concept of a bris in general, as well as to further investigate some of its more controversial aspects, namely, metzitzah b’peh (hereinafter “MBP”).

Some quick preliminary research on the subject, will quickly inform the reader that the controversy is not a new one. The dispute first reared its ugly head about 250 years ago, right along the same time as the enlightenment and reform movement really began to gather steam. Wanting to do away with circumcision altogether, but not having the audacity (at that time) to attempt to undermine such an ingrained age-old tradition, the attack took on another form. That of science, modern medicine and the safety concern for the newborn child.

The part that appeared most prone to attack, was the visually unappealing and seemingly archaic, if not barbaric, tradition of MBP. Medical concerns as to the transmission of various diseases, along with anecdotal evidence of infants protracting said diseases, and even dying r”l, were raised. This caused a volley of responsa throughout the highest echelons of rabbinical scholars, each spending pages if not volumes, addressing the topic.

I will not attempt to summarize them all here, as they involve detailed and intricate analysis of the Talmud and subsequent halachic authorities. Let’s suffice it to say that there were some halachic authorities that insisted that the metzitzah part of the circumcision must be done B’Peh – with the mouth, while others found workarounds – albeit only in terms of danger to the child, not that this was the accepted norm of how it should be done. Others even went so far as to claim that “nishtanu hateva” – our human biological makeup changed over the years and thus metzitzah as a whole was no longer necessary.

It’s important to note, that not always what a halachic authority wrote in the form of a public letter was necessarily the way they held in private. By way of example, one of the early adopters of the glass tube alternative to MBP, something that is so often used today, was R’ Samson Raphael Hirsch (1808 – 1888), who issued a joint public ruling in favor of using the glass tube.

However, in more private responsa, he clearly indicated that he did so to mitigate the risk of the German government banning bris milah altogether. He even went to far as to rule that a mohel should not do a bris for a child whose father did not want him to do metzitzah and twice mentioned how his contemporary, R’ Yacov Ettlinger (1798 – 1871) has already shown how metzitzah has to specifically be done with the mouth. (Shu”t Shemesh Merapa 54-55)

But it still begs the question: why are the ultra-orthodox, especially the Chassidic community, so particular about doing MPB specifically? Surely if there is a risk to the health of the child, as many medical specialists are claiming, who do we keep insisting that it by done with direct oral contact? In fact, the Talmud in Shabbos 133b seemingly allows metzitzah to be done on Shabbos precisely because it was to prevent endangerment of the child, thereby overriding any concern of chilul Shabbos. If that is so, and many medical professionals say there is a real health risk today to the child, why do we insist on taking a chance with the wellbeing of our newborn babies?

There are several approaches one can use to explain this. But first we need to understand, what is the real nature of the risk we are talking about. I apologize in advance if this gets a little mathematical or technical, but it is imperative information in order to put the whole issue into perspective.

It’s important to note that the vast majority of responsa that went back many years, pertained to the concern about babies contracting syphilis or tuberculosis. At the time, both those illnesses were extremely life-threatening, and lacked proper medical treatment to combat them.

Today, thanks to modern medicine, both those diseases have pretty much been eradicated in first world countries, not to mention that they are easily treated with antibiotics. So, when for instance, the Chasam Sofer wrote his famous responsa allowing metzitza to be done by a sponge, that was regarding a syphilis outbreak that had taken place in Vienna in 1837. Even though the mohel was allegedly cleared from being a carrier, there are those that claim that the mohel was well connected with the Imperial Court, had refused to resign his position and thus could not be removed from his post without causing a potential political crisis.

Point being, the diseases the majority of the responsa pertained to, either doesn’t apply today, or are easily curable should the need arise.

The real medical concern today, is the transmission of HSV, otherwise known as the herpes simplex virus. There are two types, HSV-1 and HSV-2. HSV-1 is latent in about 80% of the US population today. Furthermore, 50% of children are infected with HSV-1 by age 5. About 90% of newborn infections occur while the child is passing through the birth canal and exposed to infected secretions. As for HSV-2, about 20% of the US population is infected with this virus. Should a newborn contract a widespread infection of HSV, it can have some devastating effects.

That is the bad news. However, in life, when making decisions, it is imperative that we be consistent and logical. The parameters we apply towards assessing risk for one aspect of our lives, we should logically apply those very same parameters to other risk scenarios. Therefore, it is important to look at what the statistical risks are for a newborn infant to contract HSV via MBP and see how that same data applies to other parts of our lives.

Per the National Institute of Health website, the chances of contracting neonatal HSV from MBP is 1 in 4098 (or a likelihood of 0.0244%), versus the likelihood of contracting neonatal HSV when there is no MBP, which is 0.0072%. It should be noted, that all the cases reviewed for the above study, the article makes clear that all the babies involved made a healthy recovery and none of the HSV infections could be fully proven to have resulted from the MBP. Nevertheless, assuming the data is accurate, MBP only increases the likelihood of an infant contracting HSV by 0.0172%, a miniscule number at best.

Now contrast that with other risks in our lives. Studies show that the lifetime odds of dying from a motor vehicle crash is 1 in 102 (0.98%), from drowning is 1 in 846 (0.12%) and from riding a bicycle is 1 in 4050 (0.025%). Each one of these potential risks are from 2 times to over 50 times more likely to r”l end in fatality. Do we halachically rule that people should avoid driving in cars or riding on bicycles? Where is the outcry calling for change?

Needless to say, the risks are so infinitesimal, that we don’t even factor them into our decision-making process. Yet, somehow when it comes to an age-old tradition like MBP, that some say may even be Halacha l’Moshe m’Sinai, somehow that gets thrown to the wayside. Are we looking for an out because of the risks, or are we looking for an out because MBP sounds and looks so unappealing, and medically indefensible, that we are desperately trying to reconcile Judaism with modern medical science?

Now, anyone reading this will ask an obvious question. How can I make such a flawed analysis? Whenever one considers taking a risk, you weigh the possible risks versus the potential rewards. In today’s society, driving a car is pretty much a necessity. Even riding a bicycle or swimming has so many other health benefits that surely outweigh its minute risk factors. But what benefit, medical or otherwise, is there to MBP? What is the real-world upside to performing this ritual, that can possibly offset the risks, regardless of how minimal they may be?
To that, there are two answers, that come from two different perspectives.

The Talmud in Shabbos 133b clearly tells us that metzitzah is done to prevent sakanah – danger – to the baby. However, the Talmud does not specify exactly what danger it is coming to prevent. All we know is that the Talmud takes it so seriously, that Rav Pappa declared that any mohel that does not do metzitzah, we stop him from being a practicing mohel.

Many religious medical professionals over the years (and some say the Rambam as well) have attempted to analyze what exactly was the true medical benefit the Talmud was referring to. However, by doing so, one runs a very significant risk. What is considered sound medical science today, may very well be debunked tomorrow. In fact, many of the medical reasons provided for MBP in some of the older halachic responsa, are mocked by todays medical community for their lack of knowledge of infectious diseases and how they are transmitted. Furthermore, that also lends to the argument of ‘nishtanu hativim’ – our biological nature changed and therefore the remedies of old no longer apply, and thus metzitzah itself is no longer needed.

However, R’ Yacov Moelin (1365-1427) takes a very interesting and enlightening approach. In his magnum opus, Sefer Maharil, in the Lekutim at the end, he forbids anyone from trying any of the myriad of medical remedies that are brought down in the Talmud. Not because they no longer work. On the contrary! They all work to this very day. Rather, it’s because the Talmud, while providing the remedy, was very scant on the details. In other words, knowing the ingredients does not a pharmacist make!

There is the quantity of the ingredients, how it should be mixed and then how it should be applied. Not knowing all the specifics, will result in people applying the remedies incorrectly, and then when it doesn’t work, that will cause them to deride the sages of the Talmud as not knowing what they are talking about. This in turn, will then lead them to mock the sages in other matters as well.

Put another way, the words of our righteous sages are true and live on forever. Just because we don’t understand the details, does not mean they were incorrect. Likewise, with metzitzah, if the sages tell us it is necessity to offset danger for the baby, but consistent with other Talmudic remedies, they did not specify the details of the type of danger and how it rectifies it, we cannot challenge it. Had they just suggested metzitzah as a possible voluntary remedy, then it would probably fall under the category of all the other remedies the Maharil forbade. However, the sages insisted on metzitzah being done, and just because we don’t understand or know the medical who, what, or why, that does not diminish from its veracity one iota!

However, someone may very well ask, while that explains why we need to do metzitzah in general, why must be done specifically with our mouth? Why don’t we look for alternate methods, such as the glass tube and the like? Therefore, a second approach is also needed to help understand the necessity of this custom.
Everything that we are required to do, has an exoteric and esoteric aspect to it. The simple and straightforward exoteric reason given for metzitzah is to prevent danger to the newly circumcised child. While we may not know what that danger is, we certainly understand the concept of avoiding danger.

On the esoteric side, what is truly the real meaning behind the whole ritual of circumcision? Is it just a simple and small medical procedure, a mark on our skin to remind us of our covenant with G-d? Or is there an additional and loftier matter at play?

R’ Mosher Cordevero (1522 – 1570) and R’ Avraham Azulai (1570-1643) are some of the most well-respected kabbalist of our millennium. They both expound on the deeper meaning of the circumcision ritual.

Originally, Adam was create already circumcised. At that time, good and evil were clearly delineated. However, when Adam sinned by eating from the fruits of the Tree of Knowledge, he caused that good and evil should mix together, thereby causing a covering, so to speak, to occur in the world. G-d then banished Adam from Gad Eden and put angels with swords to bar reentry, lest Adam try to eat from the Tree of Life.

This sin manifests itself on every male child with the foreskin that he is born with. In order to help atone for Adam’s sin, we must take a knife (symbolic of the angel’s swords) and just as Adam took the fruit in his hands and ate it with his mouth, we must take the knife in our hands and cut away the orlah, and then suck the blood with our mouth. (Chesed l’Avraham, Mein Sheni, Sec 51). That is why the orlah that is removed, as well as the blood that is sucked out, is supposed to be placed in dirt. This is to symbolize that we have removed the orlah that was caused by the nachash hakadmoni, the evil serpent that caused Adam to sin and whose punishment was that he now crawls with his belly on the earth, and his food taste like dirt.

Similarly, the Avnei Nezer (R’ Avrohom Bornsztain, 1838 – 1910) wrote: “Who is he, that has a root and spark of Judaism in him, whose forefathers stood at Har Sinai, that would hold back from their son the mitzvah of metzizah that the Kabbalists wrote great and wondrous secrets how it saves a Jewish soul from all evil things.” (Shu”t Avnei Nezer Yoreh Da’ah 338:23).

Therein lies the reward, that offsets any of the miniscule risks put forth by the opponents of MBP. To be sure, if one is certain that a mohel is infected with a disease, we don’t throw all caution to the wind and use them anyway. That is no longer a minimal risk. But when weighing the real-world miniscule risk caused by MBP, versus its incredible purpose; the fear mongering versus powerful and esoteric recompense, there should be no doubt that we should follow our tradition to the very letter of the law, how it was done for millennia.

In Judaism, the esoteric part of our religion is the soul to our body. Without it we are nothing but a cold corpse. These are not just fantastic or, G-d forbid, fictional stories we tell our children, but real life everyday reality. The world and all its cosmos are all serving a higher and sometimes seemingly mysterious purpose. Yet we accomplish our purpose by adhering to the words of our holy sages, who are like angles in comparison to the people of today (Shabbos 112b).

One final point, with which I will conclude. Some may ask, does Kabbalistic literature really have any basis in Halachic decisions? Do we actually pay heed to Kabbalistic inferences when dealing with everyday life decisions?

The sefer Keneses Hagedolah (R’ Chaim Benveniste, 1603–1673) outlines the hierarchy of how we come to decisive halachic rulings. For example, when there are contradictory statements between a Talmud Bavli and Talmud Yerushalmi, the Talmud Bavli will supersede the Yerushalmi. He also discusses how we view Kabbalah versus Halacha and it is nicely summarized by the Mishna Berura in the laws of Tefillin (OC 25:42). When the words of Kabbalah seemingly go against a statement of the Talmud or Poskim, we follow the Talmud and Poskim. If Kabbalah says something and there is no conflicting statement in the Talmud or Poskim, we follow the words of the Kabbalah. Furthermore, if there is a disagreement between different halachic decisors, the words of Kabbalah will be the deciding factor as to whose opinion we follow!

In other words, if we have a difference of opinion between the different halachic authorities whether to do MBP or not, and Kabbalah clearly states that we do, then that is the deciding factor in the argument.

As Chabad chassidim, we have written assurances from our Rabbeim that we do MBP and we have nothing to fear. (Reshab, Igros Kodesh Vol. 1 Pg 387 and others). However, it is always good to familiarize oneself with a subject, especially one as common and relevant as MBP, in order to be able to talk intelligently with those who don’t take our Rabbeim’s words at face value.

May it be Hashem’s will that in the merit of the new souls being born into the world, after 2000 years of continuous exile, that are still making sure to etch His covenant unto their skin and adhere to the words of His righteous sages, that Hashem permanently remove the ‘orlah’ from this world, with the coming of Moshiach, speedily, Amen.

Written in the zechus of Tinok ben Aliza Kreindl and Tinok ben Aliza Kreindl, may they merit to speedily and properly enter the covenant of Avraham our forefather and grow to be a source of nachas to their family, community and Klal Yisroel