This past month, the Daf Yomi cycle worked its way through the 19th chapter of Mesechet Shabbat, titled Rebi Eliezer D’Milah. This chapter is the basis for almost all of Hilchot Milah (the laws of circumcision) and since I am Pardes’ resident Mohel, I thought I’d take the oppurtunity to clarify a few things.
On Daf 133b, Rav Pappa brings down an interesting Halachah. The Mishna states that one may do Metzitzah (the process of drawling out blood during a Brit Milah, traditionally done orally) on Shabbat. Interestingly, Rav Pappa departs from the Shabbat issue and states that anyone who neglects to do Metzitzah must be removed from his position. The Gemara learns from this that the issue Rav Pappa deals with is Sakanah (danger). Rav Pappa believes that not doing Metzitzah would put the newborn child in life-threatening danger, akin to not putting on the bandage, and therefore the Mohel was no longer fit to practice. An interesting point to note is that neither the Mishna nor the Gemara outlines how to do Metzitzah. It is simply required to draw out the blood. The tradition of doing it orally is not mandated.
On the whole, people treat Brit Milah like a broken piece of electronic equipment—they want to know as little as possible about the inner workings; they just want the whole thing over with. This is an understandable reaction to this highly sensitive procedure, but it has led to a major problem—Metzitzah B’Peh (by mouth). Since people have no idea what the Mohelim are doing, they don’t realize that they’re actually putting their newborn baby in harm’s way.
Since the 19th century, there have been numerous documented cases of disease transfer due to direct oral contact between the Mohel’s mouth and the open cut. Just as recently as last year a baby in Brooklyn contracted herpes and died from the Mohel performing Metzitzah B’Peh. And in the 1980s, there were cases of Mohelim dying from AIDS they contracted from the children they circumcised. Doing Metzitzah B’Peh is not safe for anyone involved. So, if it is so dangerous, then why did it become the practice of Israel to do so?
Shlomo Sprecher deals with the question of the historicity of the practice in his article titled “Mezizah be-Peh—Therapeutic Touch or Hippocratic Vestige?” He writes that the Greek physicians believed that ailments of the body where due to a lack of balance, and blood was the worst offender because it could spill out so easily, thus causing an imbalance. Another key proposition of Greek medicine was that stagnant blood would decay and could then turn into puss, so the parts around it would develop spasms, attract blood, become soaked with it and decay. According to this logic, one can see why it would seem highly advisable to draw out blood in an attempt to decrease its collection and thus decrease the incidence of what today is called an infection.
Unfortunately, even with all the evidence of its danger, there is still a great deal of resistance from the Mohalim to abolish the practice. As with everything in Judaism, change is slow. But the solution to this problem is in your hands. There are two completely acceptable methods of Metzitziah that do not involve direct contact between the child and the Mohel. The most common sterile method is using a glass/plastic tube to do the suction. The other, less common method is simply touching gauze to the wound, which draws out the blood.
And all you have to do is ask.
Many Mohelim have a tube with them at each Bris and say that, if the family would ask, they would have no problem using it. So ask your Mohel not to do Meztiztah B’Peh. And if they refuse, find another Mohel.
What’s most striking about this controversy is that those who are so ardent to hold on to tradition for tradition’s sake have actually forgotten just that — the tradition. Rav Pappa, in the Gemara, was concerned with one thing, and one thing alone — the child’s safety. What’s clear is that the current practice is diametrically opposed to Rav Pappa’s opinion. If he were alive today and brought up to speed on our current medical knowledge and the diseases we face, there is no doubt that his statement would read more like this: Anyone who does Metzitzah B’Peh should be removed from his position.
And I would agree with him.