Metzitzah VIII

I've been meaning to put up another post about metzitzah be-feh for a while but I haven't had the time. However, I just came back from the first day of that AOJS conference and there was a symposium on Metzitzah Be-Feh. So I'll push off my post on last week's Torah portion for at least another day and go back to this issue.

I. History

There is an excellent book on circumcision called Otzar Ha-Beris by R. Yosef David Weisberg. In volume 4 of the book, the author has an extensive treatment of the halakhic debate over metzitzah be-feh throughout history. Interestingly, he has a footnote giving credit to historian Jacob Katz for much of the material. It is abundantly clear from the voluminous material that great posekim (halakhic decisors) fall on both sides of this issue. There are posekim who say that metzitzah be-feh is absolutely required and posekim of equal stature who say that it is not. I could not scan the entire section in but here are four pages (click to enlarge).





I have in my possession a forthcoming article in the Journal of Halacha and Contemporary Society on this subject. While I have not yet found the time to read it, I spoke briefly with the author today and he basically comes to the same conclusion -- really the only conclusion: there are great posekim on both sides.

II. Rav Herzog

Let me just add one more voice to the discussion that I have not yet seen quoted in this context, although I might have missed it. The following is R. Yitzhak Herzog's position, as described by R. Itamar Warhaftig in the Orthodox Forum book Engaging Modernity: Rabbinic Leaders and the Challenge of the Twentieth Century, pp. 315-316:

Rav Herzog received a pamphlet from an expert who was religious and decided, "Since the medical experts have found great danger to the child from the mohel," the drawing of blood must be performed by a cloth attached to a glass instrument and one who "insists upon performing it orally is making a grave error in a matter of life and death.... In the past, they performed it orally and were Divinely protected (based upon the verse shomer p'tayim hashem). However, once the knowledge has been established, it is forbidden to stubbornly insist [that the tradition be maintained]" (Yoreh De'ah, chap. 84).

III. AOJS Conference

Some notes from the symposium at the AOJS conference. Keep in mind that I'm not a doctor and did not attend each presentation. I'm only relaying some highlights from selected presentations. The entire symposium was recorded and will be made available to the public.

1. Dr. Robert Schulman clarified exactly how a mohel was reported to the health department, and it was done by the head of Pediatric Infectious Diseases at Columbia Hospital. In other words, and Dr. Schulman did not say this explicitly but I understood as much, it was not R. Moshe Tendler who did the reporting to the health department.

2. Newspapers in favor of metzitzah be-feh quote a famous pediatric urologist who says that he never saw a case of herpes. Dr. Schulman said that this is meaningless because such cases would be taken to a pediatrician or an infectious disease specialist, not a urologist.

3. Dr. Jacob Fleischman gave the presentation about the medical aspects of the issue. He pointed out that the "gold standard" of identifying the source of the herpes -- isolating the virus in the infant and the mohel was never done, so there is no absolute proof to the highest standard. He did not say why it was never done, but I didn't stay around for the question period at the end so maybe he explained it then.

4. Dr. Fleischman said that there were major problems with the medical paper in which R. Moshe Tendler participated. However, the paper dealt with 8 cases in Israel, implying that the problem is very rare and unlikely. A recent study in Israel found 2 wound infections from circumcision out of a sample of over 19,000 circumcised babies, not all of whom had metzitzah be-feh. None of those wound infections were herpes. With some basic statistics -- emphatically tentative -- he compared the probability of transmitting herpes via metzitzah be-feh with that of being struck by lightning or dying in the bathtub (in other words, that the probability of a baby contracting herpes from a mohel is in the same ballpark as the probability of a person being struck by lightning or dying in a bathtub).

5. Dr. Fleischman concluded that the "gold standard" of proof was not available but that the clinical evidence strongly implies that herpes is transmitted through metzitzah be-feh, albeit very rarely.

6. Afterwards, I overheard a famous pediatrician complaining about Dr. Fleischman's presentation. This doctor thought Dr. Fleischman should have been more emphatic about the clinical evidence. You need three things to transmit herpes: a wet surface (mouth or genitalia), direct contact, and an incubation period (of which the vast majority is around 8 days). In the reported cases, the mohel was the only one who fulfilled all of those criteria.

7. R. Yisroel Reisman said something puzzling. He stated that the Jewish people -- Knesses Yisrael (what Solomon Schechter inelegantly termed Catholic Israel) -- had ruled that metzitzah be-feh is required. I found this startling when he said it, but his later remarks indicated that he only meant that certain elements of the Jewish people have accepted this ruling as absolutely binding while other communities did not. But if that's what he meant, his terminology seemed out of place. So I don't quite know what he meant.

8. R. Reisman further emphasized that the current debate should not be about whether metzitzah be-feh is required or not, but whether the government should be intervening in this matter. He said that we are currently losing the public relations battle over it. I was thinking that if the various rabbinic organizations would do something to indicate that they cared about the matter, some sort of self-regulation of mohalim, then maybe that battle could be won.