Brit Milah - Suction, metzitzah Technique

Suction, metzitzah Technique

In addition to milah (the actual circumcision) and priah, mentioned above, the Talmud mentions a third step, metzitzah, or squeezing some blood from the wound. As opposed to milah, a Divine law, and priah, a Rabbinic law, metzitzah is a Rabbinic injunction meant to protect the health of the baby: As understood by medical science of the time, this would prevent infection.

As Rabbinic injunctions regarding health are taken quite seriously- more so than even religious law- metzitzah came to be regarded as an essential part of the brit milah ceremony. In general, however, Rabbinic statements about medicine and health have long been regarded as non-binding when modern medical science contradicts them. In the case of brit milah, there are modern antiseptic and antibiotic techniques- all used as part of the brit milah today- which definitely accomplish the intended purpose of metzitzah, which is now known to not necessarily help itself. However, since metzitzah does not in and of itself cause any harm, and as it is so enshrined in practice, it is still generally practiced to this day.

Less commonly practiced, and more controversial, is metzitzah b'peh, (alt. mezizah), or oral suction, where the mohel sucks blood from the circumcision wound on the baby's penis. The traditional reason for this procedure is to minimize the potential for postoperative complications, although the practice has been shown to pose a serious risk of spreading herpes to the infant.

Beginning in around the 18th century, however, it was known that this technique itself can spread infection (ironically, prevention of which was the very reason metzitzah was instituted) and harm the baby. Thus, it became quite common in the Jewish world to perform metzitzah via a safe method, such as a sterilized glass tube. This removes all risk and is almost the universal practice today, although some ultra-Orthodox communities, most notably Hassidic Jews and some communities in Israel, continue to use the oral method. However, the practice has become a controversy in both secular and Jewish medical ethics. The ritual of metzitzah is found in Mishnah Shabbat 19:2, which lists it as one of the four steps involved in the circumcision rite. Moses Sofer (1762–1839) observed that the Talmud states that the rationale for this part of the ritual was hygienic — i.e., to protect the health of the child. The Chasam Sofer permitted metzitzah with a sponge to be used instead of oral suction in a case presented to him for a ruling. His letter was published in Kochvei Yitzchok. Moshe Shik (1807–1879), a student of Moses Sofer, states in his book of Responsa, She’eilos u’teshuvos Maharam Shik (Orach Chaim 152,) that Moses Sofer gave the ruling in that specific instance only and that it may not be applied elsewhere. He also states (Yoreh Deah 244) that the practice is possibly a Sinaitic tradition, i.e., Halacha l'Moshe m'Sinai.

Chaim Hezekiah Medini claimed the practice to be Halacha l'Moshe m'Sinai and elaborates on what prompted Moses Sofer to give the above ruling. He tells the story that a student of Moses Sofer, Lazar Horowitz, author of Yad Elazer and Chief Rabbi of Vienna at the time, needed the ruling because of a governmental attempt to ban circumcision completely if it included metztitzah b'peh. He therefore asked Sofer to give him permission to do brit milah without metzitzah b’peh. When he presented the defense in secular court, they erroneously recorded his testimony to mean that Sofer stated it as a general ruling.