Ask the Rabbi: Oral traditions

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

brit suction 58 (photo credit: Courtesy)
brit suction 58
(photo credit: Courtesy)

The ritual of circumcision has suffered from manycontroversies over the centuries. Christianity eradicated it, claimingthat God only desires a spiritual "circumcision of the heart" embodiedby faith. Early Reform Judaism vilified it as unaesthetic and barbaric,relegating it to the primitive ceremonies of the ancient Near East. Theritual, nonetheless, has retained its hold within Jewish culture,enjoying nearly universal practice among observant and non-observantalike.

The final element of the procedure, known as metzitza(suctioning), remains disputed and controversial within alldenominations. Classically, the rite of circumcision entails threestages: The primary excision (hituch), which removes the foreskin, the pria (uncovering), in which the mohel (ritualcircumciser) tears a thin membrane to fully expose the corona, andmetzitza, the act of drawing the blood out of the wound. (Followingthese stages, the mohel dresses the wound, allowing for full recovery.)While the metzitza does not contribute anything to the incision, thesages deemed it as indispensable to the child's safety.

Reflecting ancient medical concerns with inflammation andswelling, the sages demanded that the mohel draw blood to prevent theits excesses from decaying into pus. Based on this medical assessment,they allowed metzitza to be performed on Shabbat, and demanded theimmediate 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), withauthorities further demanding that the mohel rinse off any remnants ofblood before reciting the post-ritual blessings (YD 265). Kabbalisticsources further emphasized the mystical significance of performingmetzitza orally (Tikunei Zohar Tikun No. 18).

Whilethe first objection to the hygiene of oral metzitza occurred in thebeginning of the 19th century, the historically most significantmedical objection was leveled in Vienna in 1837, following a series offatalities among newborn babies. At the behest of local doctors,Vienna's chief rabbi, Elazar Horowitz, received permission from theeminent Hungarian decisor, Rabbi Moshe Sofer, to use gauze sponges asan alternative suctioning method (Shu"t Yad Eliezer 55). Whilecertain later authorities challenged the authenticity of this ruling,this allegation seems to be baseless, with Sofer's permissive rulinglater 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 Talmudnever specifies how to perform metzitza, there is no reason why analternative method cannot accomplish the same task. The slightdeviation from the customary practice does not preclude change in theface of health dangers. Moreover, this alternative seems just asinnocuous as a different "innovation" in the circumcision rite in whichthe first two stages of excision and uncovering came to be performedsimultaneously, as opposed to consecutively.

In the 1840s, the nascent Reform movementlaunched a blistering attack on the rite of circumcision as a whole,with metzitza serving as a particularly vulnerable target. One extremeand polemical response was adopted by Rabbi Moshe Schick (Maharam SchickYD 244). He contended that beyond its stated therapeutic purposes,metzitza represented an integral part of the circumcision ritual whichultimately derived from ancient oral traditions (Halacha le-Moshe mi-Sinai).Beyond its inherent value, this stage became sacrosanct as the targetof Reform attacks, and as such, could not be waved under anycircumstance (Maharam Schick OC 152).

Similarly strong declarations were declared throughout the 19thand early 20th centuries by many leading scholars. This type ofconservative argumentation further precluded other decisors fromdeclaring that either nature or scientific knowledge had changed fromtalmudic times, a historically well-trodden claim which would haveobviated 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 tubewhich facilitated oral metzitza while preventing direct contact withthe mouth. This suggestion was further endorsed by leading Lithuaniansages like Rabbis Yitzhak E. Spector and Chaim Soloveitchik, and becamethe preferred method in many communities across the world (Har Tzvi YD214), especially as the science of germs and the specter of AIDS andother disease became better understood.

The most recent flare-up of this debate occurred in 2004, when a group of Orthodox doctors alleged in a Pediatricsarticle that a few babies had contracted herpes after oral metzitza wasperformed at their circumcision. While some Orthodox writers fiercelydefended oral metzitza, with a few further disputing the medical basisfor these claims, it remains clear, in my mind, that the potentialdangers warrant the use of definitively safer alternate methods.

The writer, on-line editor of Tradition and its blog, Text & Texture (, teaches at Yeshivat Hakotel.