Ask the Rabbi: Oral traditions

What is the controversy behind the 'suctioning' stage that concludes the circumcision ritual?

January 19, 2010 16:32
3 minute read.

brit suction 58. (photo credit: Courtesy)


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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 alike.

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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 (ritual 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 (Shabbat 133).

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), with 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).

While 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 55). While 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 OC 152).

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 Shabbat 19:2).

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 (, teaches at Yeshivat Hakotel.

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