By PAUL LUNGEN
An ancient procedure that is part of ritual circumcisions, and which has been found to spread herpes and other dangerous illnesses is still used in Toronto, though infrequently.
Oral metzitzah, the practice in which a mohel sucks blood from an infant’s circumcised penis, has been supplanted by more hygienic and effective ways of cleaning the wound, said Dr. Aaron Jesin, a Toronto-based mohel. While metzitzah remains a required part of the circumcision ritual, most practitioners employ a glass tube to clean the wound, he said.
However, there are groups in Toronto today who continue to employ mohels who use oral metzitzah, said Rabbi Moshe Mordechai Lowy, a spokesman for the Orthodox Va’ad Harabonim in Toronto. “Those in the Torah world, the yeshiva world, use the procedure, unless there’s a problem,” he said.
Last month, a group of researchers in Canada and Israel published a report in the medical journal Pediatrics, which found eight babies who were infected with the herpes virus likely contracted their illnesses through oral metzitzah. Most of the infants were found in Israel but one, who was circumcised in 1994, was from Toronto.
The researchers’ report, published in the journal’s Aug. 2 edition, stated that in the cases studied, infection was transmitted by the mohel to the infant orally. All the mohels involved in the circumcisions tested positive for the herpes antibody.
One of the children became seriously ill with encephalitis, while the Toronto baby spent 26 days in hospital, the report noted.
“Our findings provide evidence that ritual Jewish circumcision with oral metzitzah may cause oral-genital transmission of HSV infection, resulting in clinical disease...Furthermore, oral suction may not only endanger the child but also may expose the mohel to human immuno-deficiency virus or hepatitis B from infected infants. The same conclusion that led the talmudic sages once to establish the custom of metzitzah for the sake of the infant could now be applied to persuade the mohel to use instrumental suction,” the researchers concluded.
Dr. Gideon Koren, professor in the department of clinical pharmacology and toxicology at the Hospital for Sick Children and the University of Toronto, is one of the authors of the report. He believes “some mohels still use their mouths for suction, but [they] use plastic pipes.”
Even in Israel, he said, oral suction is employed “by a small minority and by all accounts, the rabbinut (rabbinic councils) told them to stop it. It’s not a system that mainstream Judaism uses. I wouldn’t even imagine a backward and primitive procedure [like that] still exists.”
Given the existence of anti-Semitism, “the last thing we need is people to say Jews are abusing children,” Koren added.
Jesin said he used oral metzitzah a few times when he first began as a mohel in 1978 but soon gave it up. He now uses a glass tube, which he said complies with the Gemarah requirement “to draw the blood from the far places (within the wound),” he said.
Jesin cited renowned halachic authority Rabbi Moshe Tendler of Yeshiva University’s department of talmudic law and Jewish medical ethics, who asserts it is forbidden to perform metzitzah without an instrument.
Speaking from New York, Rabbi Tendler, one of the report’s co-authors, said the procedural elements of ritual circumcision are contained in the Talmud, which breaks down circumcision into three parts. In the first, orla, the foreskin is removed, while in the second, priah, the mucous layer is removed. The third part, metzitzah is clearly “a medical requirement, not a ritual requirement,” and so, can even be performed on the Sabbath, he said.
With advances in medical techniques and knowledge, mohels are required by Jewish law to do what is in the baby’s best interests, and that would mean following current medical thinking and avoiding oral suction of the penis, Rabbi Tendler said.
Rabbi Tendler said most mohels comply with this approach, but some chassidic groups, including Satmars and Lubavitch, still employ traditional methods.
Rabbi Lowy acknowledged that “haredim or those who feel they still want to go with the old way of thousands of years [of tradition] and they feel the mohel is careful” accept oral metzitzah.
He mentioned the Satmar, Bobov, Lubavitch and other communities who generally comply with the traditional way of performing metzitzah.
A 1990 book by Rabbi Yonason Binyomin Goldberger made the case for oral metzitzah and included kabbalisitc reasons for doing so, he continued. At the time, the practice was endorsed by a number of doctors, Rabbi Lowy said.
In 1994, when the Toronto baby took sick, the Va’ad Harabonim investigated the case and issued a brief statement saying “there is no clinical basis in ceasing to perform metzitzah b’peh (orally).” However, the rabbinical council also stated if the mohel exhibits cold sores, lesions or flu, oral metzitzah should be avoided, he added.
Koren suggested that as good consumers, Jewish parents should ask mohels what technique they plan to use and govern their choices accordingly.
Dr. Rochelle Schwartz, Toronto’s second female mohelet, said Reform practitioners employ a clamp that permits a small amount of bleeding and then draw the blood with sterile gauze. She also uses a powder to cauterize the wound.
Schwartz, who has performed ritual circumcisions for eight years, said there are safer ways of performing metzitzah than by using the mouth. “It’s really very unhygienic. I can’t see a value in it.”
The mouth, she continued, is loaded with bacteria and most mohels would be unaware if they are developing a cold sore.
“Yes, it’s traditional but it’s also a surgical procedure. You want to keep the area as clean and hygienic and sterile as possible,” she said.
Schwartz’s father, Harry, recalls how the practice of metzitzah was performed on his brother, with disastrous consequences. In 1919 in the small Polish town of Tyrava, between Cracow and Lvov, an older brother was born. As his parents related the story to him, a mohel employed the traditional method of metzitzah on his brother. Unfortunately the mohel had a mouth full of rotting teeth and an infection was passed on to his brother, who died a few days later.
There was nothing to be done for his brother, Schwartz recalled, but times have changed since then. “My grandmother was 65 years old, got pneumonia and the doctor said there was nothing to do and she passed away. Now, a pneumonia is nothing,” he said, noting the advances in medical science.
The Pediatrics report was published as the collaborative effort of several researchers: Benjamin Gesundheit; Galia Grisaru-Soen; David Greenberg; Osnat Levtzion-Korach; David Malkin; Martin Petric; Koren; Tendler; Bruria Ben-Zeev; Amir Vardi; Ron Dagan; and Dan Engelhard.
Christ...I'll bet this is something they don't advertise much. Imagine trying to fit this somewhere into a pamphlet summarizing the faith. Brrrrr. And it's not surprise it's sitll happening in canada. You just can't trust those people. Living up in the baren hinterlands of the north, it's no wonder that they should develop barbaric practices. I wonder if the next thing we'll find is that people who do this sort of thing have a high pedophile population. I mean...it's like taking candy from a baby. Ever few weeks parents actually present their kid to you so you can hack off a chunk of his weiner and then suckle on it. Once news of this gets out I imagine some of those catholic priests will be converting to judism. You don't even have to spend all that time and effort grooming the kid.