SUCKS TO BE JEW: CIRCUMCISION ABSTRACT

Since everyone’s been captivated by the Tale of the Mohel and the Herpes (a messed-up fairy tale title if e’er there was one), when I found this medical abstract about oral suction used as a medical technique in ritual circumcision, I thought I’d post it here for your edification.

The abstract, which lists among its contributors YU’s Moshe Tendler and Hadassah Hospital’s Dan Engelhard, is courtesy of House of Hock:

For the abstract-reading-impaired-or-averse, here’s the bottom line (emphasis is mine):

Indeed, after our first cases, the Chief Rabbinate of Israel pronounced in 2002 the legitimacy of using instrumental suction in cases in which there is a risk of contagious disease. We support ritual circumcision but without oral metzitzah, which might endanger the newborns and is not part of the religious procedure.

Unafraid of a little education? Check out these additional background paragraphs. (You can absolutely read the whole thing, complete with footnotes and sources, if you want, but I'm warning you: there are photographs.)

According to Biblical law, a male infant should be circumcised at the age of 8 days as a sign of the eternal covenant between God and the Jewish people (Genesis 17:10–14; Leviticus 12:3). According to classical rabbinical interpretation, performance of this religious ritual offers medical advantages, a view upheld by many modern medical authorities, as noted earlier. The Babylonian Talmud (Sabbath 133b), the main rabbinical literature completed in the fifth century of the common era, states that for the sake of the infant, the mohel is obliged to perform the metzitzah" so as not to bring on risk." The nature of the risk was not specified. It specifically states that "this procedure is performed for the sake of the infant's safety and if a mohel does not perform the suction [of the wound], this is deemed dangerous and he is to be dismissed." To prevent medical complications, the Talmud permits only an experienced and responsible mohel to perform the ritual circumcision. The Talmud (Tossefta Shabbath 15:8) was aware of potential medical problems that could arise from ritual circumcision and in fact provided the first description of hemophilia in the history of medicine, manifested as a familial bleeding disorder that required circumcision to be postponed.

In the 19th century, Ignaz Philipp Semmelweis (1818–1865) established the principles of hygiene and disease transmission, after neonatal tuberculosis was documented after circumcision by an infected mohel. Since then, most rabbinical authorities modified their approach in response to these findings. Because the Talmudic injunction to perform metzitzah did not explicitly stipulate oral suction, >160 years ago, Rabbi Moses Schreiber (Pressburg, 1762–1839), a leading rabbinical authority, ruled that metzitzah could be conducted by instrumental suction, a ruling quickly adopted by most rabbinical authorities.

Consequently, the great majority of ritual circumcisions are performed today with a sterile device and not by oral suction by the mohel. However, some orthodox rabbis have felt threatened by criticism of the old religious customs and strongly resist any change in the traditional custom of oral metzitzah. The cultural process of replacing ancient customs by modern wound care has to be encouraged by a heightened awareness of this potentially life-threatening medical complication.

On the basis of our observations, the medicolegal impact of neonatal infection by the mohel has to be redefined. Our findings provide evidence that ritual Jewish circumcision with oral metzitzah may cause oral–genital transmission of HSV infection, resulting in clinical disease including involvement of the skin, mucous membranes, and HSV encephalitis. Furthermore, oral suction may not only endanger the child but also may expose the mohel to human immunodeficiency virus or hepatitis B from infected infants. The same consideration that led the Talmudic sages once to establish the custom of the metzitzah for the sake of the infant could now be applied to persuade the mohel to use instrumental suction.

Indeed, after our first cases, the Chief Rabbinate of Israel pronounced in 2002 the legitimacy of using instrumental suction in cases in which there is a risk of contagious disease. We support ritual circumcision but without oral metzitzah, which might endanger the newborns and is not part of the religious procedure.

SUCKS TO BE JEW: CIRCUMCISION ABSTRACT

Since everyone’s been captivated by the Tale of the Mohel and the Herpes (a messed-up fairy tale title if e’er there was one), when I found this medical abstract about oral suction used as a medical technique in ritual circumcision, I thought I’d post it here for your edification.

The abstract, which lists among its contributors YU’s Moshe Tendler and Hadassah Hospital’s Dan Engelhard, is courtesy of House of Hock:

For the abstract-reading-impaired-or-averse, here’s the bottom line (emphasis is mine):

Indeed, after our first cases, the Chief Rabbinate of Israel pronounced in 2002 the legitimacy of using instrumental suction in cases in which there is a risk of contagious disease. We support ritual circumcision but without oral metzitzah, which might endanger the newborns and is not part of the religious procedure.

Unafraid of a little education? Check out these additional background paragraphs. (You can absolutely read the whole thing, complete with footnotes and sources, if you want, but I'm warning you: there are photographs.)

According to Biblical law, a male infant should be circumcised at the age of 8 days as a sign of the eternal covenant between God and the Jewish people (Genesis 17:10–14; Leviticus 12:3). According to classical rabbinical interpretation, performance of this religious ritual offers medical advantages, a view upheld by many modern medical authorities, as noted earlier. The Babylonian Talmud (Sabbath 133b), the main rabbinical literature completed in the fifth century of the common era, states that for the sake of the infant, the mohel is obliged to perform the metzitzah" so as not to bring on risk." The nature of the risk was not specified. It specifically states that "this procedure is performed for the sake of the infant's safety and if a mohel does not perform the suction [of the wound], this is deemed dangerous and he is to be dismissed." To prevent medical complications, the Talmud permits only an experienced and responsible mohel to perform the ritual circumcision. The Talmud (Tossefta Shabbath 15:8) was aware of potential medical problems that could arise from ritual circumcision and in fact provided the first description of hemophilia in the history of medicine, manifested as a familial bleeding disorder that required circumcision to be postponed.

In the 19th century, Ignaz Philipp Semmelweis (1818–1865) established the principles of hygiene and disease transmission, after neonatal tuberculosis was documented after circumcision by an infected mohel. Since then, most rabbinical authorities modified their approach in response to these findings. Because the Talmudic injunction to perform metzitzah did not explicitly stipulate oral suction, >160 years ago, Rabbi Moses Schreiber (Pressburg, 1762–1839), a leading rabbinical authority, ruled that metzitzah could be conducted by instrumental suction, a ruling quickly adopted by most rabbinical authorities.

Consequently, the great majority of ritual circumcisions are performed today with a sterile device and not by oral suction by the mohel. However, some orthodox rabbis have felt threatened by criticism of the old religious customs and strongly resist any change in the traditional custom of oral metzitzah. The cultural process of replacing ancient customs by modern wound care has to be encouraged by a heightened awareness of this potentially life-threatening medical complication.

On the basis of our observations, the medicolegal impact of neonatal infection by the mohel has to be redefined. Our findings provide evidence that ritual Jewish circumcision with oral metzitzah may cause oral–genital transmission of HSV infection, resulting in clinical disease including involvement of the skin, mucous membranes, and HSV encephalitis. Furthermore, oral suction may not only endanger the child but also may expose the mohel to human immunodeficiency virus or hepatitis B from infected infants. The same consideration that led the Talmudic sages once to establish the custom of the metzitzah for the sake of the infant could now be applied to persuade the mohel to use instrumental suction.

Indeed, after our first cases, the Chief Rabbinate of Israel pronounced in 2002 the legitimacy of using instrumental suction in cases in which there is a risk of contagious disease. We support ritual circumcision but without oral metzitzah, which might endanger the newborns and is not part of the religious procedure.