As new reports have surfaced of the potentially fatal herpes virus striking babies who had undergone metzitzah b’peh (oral suction) during their circumcisions, the public debate over the safety of the practice has continued to simmer, with experts on both sides of the heated issue staunchly defending their beliefs.
In the latest case, two infants in New Jersey were infected with HSV-1, but fortunately did not succumb to the virus. As Dr. Margaret Fisher, chair of pediatrics at Monmouth Medical Center, noted to the Forward, both boys – one of whom was admitted to the hospital just recently while the other was a patient approximately one to two years ago – had herpes lesions on their genitals of “extremely mild” status, and each was treated successfully with intravenous anti-viral medication over a ten-day period. The hospital is located near the heavily Orthodox community of Lakewood.
This newest revelation comes soon after the news that the Brooklyn District Attorney is conducting a criminal investigation into the death of a newborn at Maimonides Hospital from the same virus last September, which was allegedly acquired after his mohel performed metzitzah on him. Adding fuel to the fire, The Jewish Week reported last week that Rabbi Yitzchok Fischer, a well-known mohel who became embroiled in controversy in 2005 when a baby he had done the procedure on died from HSV-1, is apparently continuing to engage in oral suction despite being banned by the New York State Department of Health from doing so. This information was obtained from a recorded telephone conversation, wherein Rabbi Fisher told a caller who was hiring him to perform a Brit that it was “not a problem” for him to do metzitzah b’peh on the infant. In response to Rabbi Fischer’s comment, a State Health Department spokesman stated, “The Department of Health will be contacting Rabbi Fischer to advise him that the order prohibiting him from practicing this ritual in New York State remains in effect.” At the same time, New York State Governor Andrew Cuomo held a meeting on March 12 to discuss the latest developments in this issue with state health department officials and leaders of the Chareidi community. No information about the meeting’s deliberations was immediately forthcoming.
Within the Orthodox community, a spirited debate has ensued over whether metzitzah b’peh should be maintained as an essential halachic aspect of Brit milah, or whether – as a procedure supposedly “recommended” by Talmudic sages for the purpose of cleansing the blood from the circumcision wound – it should either be modified by the use of a glass tube, or abandoned altogether due to contemporary health concerns. “There is no requirement to make metzitzah b’peh. The Talmud says plainly it is not part of the ritual but belongs to the medical, post-surgical component,” declares Rabbi Moshe Tendler, a medical ethicist and a dean of Yeshiva University’s rabbinical school, where he gives a class on the topic of circumcision. “There is no doubt that insistence on metzitzah b’peh is wrong,” says Rabbi Tendler, who has a doctorate in microbiology. “I firmly believe that making metzitzah b’peh is a criminal act.”
But other experts in the field have a decidedly different viewpoint. “According to a mishnah in Mesechta Nedarim, Brit Milah is the biggest mitzvah in the Torah,” Rabbi A. Romi Cohn, a leading mohel and authority on circumcision, told the Jewish Voice in an exclusive interview. “Those who hate Torah will do anything to disgrace it. The American Board of Ritual Circumcision – which is comprised of the most prestigious medical experts and rabbinic sages – endorses metzitzah b’peh, with strict provisions to ensure the health of the child.” Rabbi Cohn was adamant about both the safety of the procedure, and its importance as an integral part of milah. “There has not been one case that has actually proven that metzitzah b’peh caused a child’s death,” he said. “There have only been accusations and assumptions to that effect. The fact is that metzitzah b’peh is one of the three halachically required parts of the circumcision ritual.”
Commenting on the opinion of some mohelim that the procedure is just as valid under Jewish law when performed with a glass tube, Rabbi Cohn asserted that the renowned German sage Rav Shamshon Raphael Hirsch authoritatively ruled that the device should only be used to prevent a herpes infection when there are suspicions about the religious propriety of the mohel, or if the baby and / or his parents have serious health issues. Rabbi Cohn was also quick to dismiss critics who cite halachic decisions by leading sages as “proof” that metzitzah b’peh can be left out of the brit milah process. “The heter (dispensation) that is quoted from the Chasam Sofer was only given in a special case where it was called for,” he insisted. “And Rav Moshe Feinstein ruled clearly that the mohel must perform metzitzah b’peh – he only approved of abstaining from it when there are questions about the health of any of the parties involved.”
In another strong defense of the practice, Dr. Daniel Berman, an infectious disease specialist, recently wrote in the Orthodox journal “Dialog” that – contrary to the opinion of public health officials – parents and health care workers, not mohelim, are often the source of the potentially fatal HSV-1 virus. According to Berman, only a genetic DNA analysis that matches the baby’s virus with the mohel’s can absolutely prove that the mohel caused the infection. “There is no reason to refrain from metzitzah b’peh without such proof,” Berman states.
But health officials such as Dr. Fisher of Monmouth Medical Center remain convinced that the mohel bears the responsibility to prevent the transmission of herpes to the infant. Responding to the claim that the mohel’s use of antiseptic mouthwash can greatly reduce the danger of infection, Dr. Fisher said, “Other than the mohels being on constant antiviral medication, there is nothing they can do except not do the practice.”