2008 Woodie Awards
'Metzitzah Be Peh': The Dangers of a Custom Intended to Heal
Tradition and Medicine Lock Horns in Ancient Circumcision Ritual
Ryan Nadel
Issue date: 3/8/05 Section: Features
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The death of a child from herpes, allegedly contracted from a mohel performing direct oral suction during circumcision, has left a permanent scar on the Jewish community. In recent weeks, the fallout from the tragedy, and the rift it has generated within the Orthodox community, has only worsened. As New York City health officials investigate the case, debate within the Jewish community surrounding the issue of metzitzah be peh, direct oral suction, has erupted. Rabbi Dr. Moshe Tendler, of Yeshiva University, is at the forefront of the controversy and has been vilified by the Chasidic community for his position on the issue.
The Mishnah in Masechet Shabbat (133a) records the practice of metzitzah as a secondary aspect of the circumcision process, and states that metzitzah must be performed at the end of the circumcision. The Gemara explains (ibid 133b) that refraining from performing metzitzah endangers the baby. The commentators elaborate that metzitzah is performed in order to hasten the healing of the wound. The implication of the Gemara is that metzitzah functions as a medical procedure and not a religious one.
In August of 2004, a team of twelve researchers published a study in the medical journal Pediatrics. The study documented a correlation between circumcised Jewish babies infected with herpes and the custom of metzitzah be peh. The study claims that mohelim infected with herpes represent a potential source of the disease to the infants through physical contact between the wound and the lips of the mohel.
The nature of the herpes contracted by these babies was not the more common genital herpes virus type 2, but herpes simplex virus type 1. When left untreated, 95 percent of survivors suffer from severe neurological effects. 30 percent of victims develop neurological impairments, which often manifest before two or three years of age. However, death from herpes type 1 is uncommon.
Based on their findings, the researchers concluded that the custom of metzitzah be peh should be modified to adhere to modern standards of hygiene, thus altering the custom from its ancient form. To support their recommendation from a religious perspective, the study cites the decision of rabbinic authorities in the late 18th century who ruled that metzitzah can be performed using instrumental suction. Using an instrument, in lieu of direct physical contact between the mohel and the baby, would eliminate any chance of infection of the baby by the mohel and still fulfill the halachic requirements of metzitzah.
The Mishnah in Masechet Shabbat (133a) records the practice of metzitzah as a secondary aspect of the circumcision process, and states that metzitzah must be performed at the end of the circumcision. The Gemara explains (ibid 133b) that refraining from performing metzitzah endangers the baby. The commentators elaborate that metzitzah is performed in order to hasten the healing of the wound. The implication of the Gemara is that metzitzah functions as a medical procedure and not a religious one.
In August of 2004, a team of twelve researchers published a study in the medical journal Pediatrics. The study documented a correlation between circumcised Jewish babies infected with herpes and the custom of metzitzah be peh. The study claims that mohelim infected with herpes represent a potential source of the disease to the infants through physical contact between the wound and the lips of the mohel.
The nature of the herpes contracted by these babies was not the more common genital herpes virus type 2, but herpes simplex virus type 1. When left untreated, 95 percent of survivors suffer from severe neurological effects. 30 percent of victims develop neurological impairments, which often manifest before two or three years of age. However, death from herpes type 1 is uncommon.
Based on their findings, the researchers concluded that the custom of metzitzah be peh should be modified to adhere to modern standards of hygiene, thus altering the custom from its ancient form. To support their recommendation from a religious perspective, the study cites the decision of rabbinic authorities in the late 18th century who ruled that metzitzah can be performed using instrumental suction. Using an instrument, in lieu of direct physical contact between the mohel and the baby, would eliminate any chance of infection of the baby by the mohel and still fulfill the halachic requirements of metzitzah.