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February 11, 2005/Adar 12 5765, Volume 57, No. 24
Circumcision rite under scrutiny
JOANNE PALMER
Jewish Telegraphic Agency
NEW YORK - The death of one infant boy from herpes and the infection of two others has focused attention on an ancient practice that is still used in some fervently Orthodox communities as they circumcise babies.
New York City health officials are investigating whether the mohel who operated on the three boys had infected them. The city's legal department has been granted a temporary restraining order against Rabbi Yitzchok Fischer until the investigation is complete.
Fischer practices a custom called metzitzah b'peh - loosely translated as oral suction - that is considered an integral part of the brit milah in parts of the Jewish world, though it is met with shock and distaste in others.
The Talmud describes the process of removing the baby boy's foreskin in three steps: The foreskin is cut, the mucous layer underneath is removed with a flick of the mohel's fingernail and then the blood is removed through oral suction.
Often the first two steps are combined, and the fingernail motion is abandoned in favor of a surgical clamp.
In the third step, the mohel traditionally takes a sip of wine in his mouth, quickly sucks the blood off through the wine and spits the mixture into a bowl to be discarded. That's metzitzah b'peh.
In some parts of the Orthodox world - mainly among Chasidim - metzitzah b'peh is still practiced.
Among other Orthodox Jews, however, metzitzah b'peh is considered unacceptable, and among more liberal Jews it's unthinkable.
Fischer can do the brit either way, said his lawyer, Mark Kurzmann. "It depends on the preference of the parents, and that depends on their particular religious community."
He added "tens of thousands" of circumcisions using metzitzah b'peh have been done in the last seven years, with very few adverse results.
Not true, concluded researchers writing in the August 2004 issue of the medical journal Pediatrics.
"Ritual Jewish circumcision that includes metzitzah with direct oral-genital contact carries a serious risk for transmission of HSV" - herpes simplex virus - "from mohels to neonates," the article said.
Signed by 12 medical doctors and Ph.D. researchers, the paper examined the cases of eight babies who had developed herpes within two weeks of being circumcised. The only disease vector shared by all the babies was the mohelim, all of whom tested positive for the herpes virus and all of whom had performed metzitzah b'peh.
One of the researchers was Rabbi Moses Tendler, who holds a doctorate in biology and teaches biology at Yeshiva University, teaches rabbinical students at Y.U.'s seminary, specializes in Jewish medical ethics and also is a pulpit rabbi.
Tendler minced no words when discussing metzitzah b'peh.
"What people don't understand is how widely disseminated the herpes virus is. Statistics say that 80 percent of the adult American population carries it, as you well know from how many people in their lives acquire a cold sore," he said. "It's an omnipresent danger, and for an infant, in the early days before his immune system kicks in, it's not necessarily localized. It can be a systemic infection.
"I'm particularly disturbed that once this information becomes available, the mohelim don't do what they're told, Tenderler continued.
"When the AIDS epidemic started the gadolim - the great rabbinic scholars of their day - concluded that the mohelim should use a sterilized glass tube so they could avoid catching AIDS from the baby. It never occurred to them to think that the baby could catch something from them."
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