brit suction 58.
(photo credit: Courtesy)
The ritual of circumcision has suffered from many
controversies over the centuries. Christianity eradicated it, claiming
that God only desires a spiritual "circumcision of the heart" embodied
by faith. Early Reform Judaism vilified it as unaesthetic and barbaric,
relegating it to the primitive ceremonies of the ancient Near East. The
ritual, nonetheless, has retained its hold within Jewish culture,
enjoying nearly universal practice among observant and non-observant
The final element of the procedure, known as metzitza
(suctioning), remains disputed and controversial within all
denominations. Classically, the rite of circumcision entails three
stages: The primary excision (hituch
), which removes the foreskin, the pria
(uncovering), in which the mohel
circumciser) tears a thin membrane to fully expose the corona, and
metzitza, the act of drawing the blood out of the wound. (Following
these stages, the mohel dresses the wound, allowing for full recovery.)
While the metzitza does not contribute anything to the incision, the
sages deemed it as indispensable to the child's safety.
Reflecting ancient medical concerns with inflammation and
swelling, the sages demanded that the mohel draw blood to prevent the
its excesses from decaying into pus. Based on this medical assessment,
they allowed metzitza to be performed on Shabbat, and demanded the
immediate demotion of any mohel who failed to perform this stage
While the Talmud never specifies how to remove the blood,
historical evidence indicates that mohelim orally suctioned the wound.
This is taken for granted in many early medieval sources (Mahzor Vitri 505),
authorities further demanding that the mohel rinse off any remnants of
blood before reciting the post-ritual blessings (YD 265). Kabbalistic
sources further emphasized the mystical significance of performing
metzitza orally (Tikunei Zohar Tikun No. 18).
the first objection to the hygiene of oral metzitza occurred in the
beginning of the 19th century, the historically most significant
medical objection was leveled in Vienna in 1837, following a series of
fatalities among newborn babies. At the behest of local doctors,
Vienna's chief rabbi, Elazar Horowitz, received permission from the
eminent Hungarian decisor, Rabbi Moshe Sofer, to use gauze sponges as
an alternative suctioning method (Shu"t Yad Eliezer
certain later authorities challenged the authenticity of this ruling,
this allegation seems to be baseless, with Sofer's permissive ruling
later affirmed by Rabbi Tzvi Hirsch Chajes and later scholars (Shu"t Maharatz Chajes 60).
Sofer's and Chajes's argument was quite simple: Since the Talmud
never specifies how to perform metzitza, there is no reason why an
alternative method cannot accomplish the same task. The slight
deviation from the customary practice does not preclude change in the
face of health dangers. Moreover, this alternative seems just as
innocuous as a different "innovation" in the circumcision rite in which
the first two stages of excision and uncovering came to be performed
simultaneously, as opposed to consecutively.
In the 1840s, the nascent Reform movement
launched a blistering attack on the rite of circumcision as a whole,
with metzitza serving as a particularly vulnerable target. One extreme
and polemical response was adopted by Rabbi Moshe Schick (Maharam Schick
YD 244). He contended that beyond its stated therapeutic purposes,
metzitza represented an integral part of the circumcision ritual which
ultimately derived from ancient oral traditions (Halacha le-Moshe mi-Sinai)
Beyond its inherent value, this stage became sacrosanct as the target
of Reform attacks, and as such, could not be waved under any
circumstance (Maharam Schick
Similarly strong declarations were declared throughout the 19th
and early 20th centuries by many leading scholars. This type of
conservative argumentation further precluded other decisors from
declaring that either nature or scientific knowledge had changed from
talmudic times, a historically well-trodden claim which would have
obviated the need for preserving the ancient procedure (Tiferet Yisrael
In 1885, the Frankfurt Jewish community, led by Rabbi Samson R.
Hirsch, adopted an alternative method of using a glass pipette or tube
which facilitated oral metzitza while preventing direct contact with
the mouth. This suggestion was further endorsed by leading Lithuanian
sages like Rabbis Yitzhak E. Spector and Chaim Soloveitchik, and became
the preferred method in many communities across the world (Har Tzvi YD
214), especially as the science of germs and the specter of AIDS and
other disease became better understood.
The most recent flare-up of this debate occurred in 2004, when a group of Orthodox doctors alleged in a Pediatrics
article that a few babies had contracted herpes after oral metzitza was
performed at their circumcision. While some Orthodox writers fiercely
defended oral metzitza, with a few further disputing the medical basis
for these claims, it remains clear, in my mind, that the potential
dangers warrant the use of definitively safer alternate methods.
The writer, on-line editor of Tradition and its blog, Text & Texture (text.rcarabbis.org), teaches at Yeshivat Hakotel.