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.

Comments

[Anonymous]

Thank God. I now feel fully edified! :-)

Peace.
Fun Joel

[Anonymous]

So, um, how does a Mohel learn his craft? And on whom or what does he practice?

Howard

[Dr Dave]

Metzitzah update
Two years of research have yielded the following:
1) Neonatal herpes is typically the result of a primary infection. The definition of Primary infection is: "virus positive seronegative" i.e., no antibodies to indicate a previous infection.
2) "Asymptomatic primary infection is the rule rather than the exception".
- Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses. Clin Infect Dis. 1998 Mar; 26(3):541-53

3)An 18 year study of 58,000 women indicates primary infection carries more than double the risk of neonatal infection, than non- primary or recurrent HSV.
) Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L, Effect of Serologic Status and Cesarean Delivery on Transmission Rates of Herpes Simplex Virus From Mother to Infant JAMA 2003 Jan 8;289(2):203-209

4) Timing of 1-28 days is typical of maternally transmitted herpes.(Some other sources say as late as 8 weeks)
AAP Pediatric Redbook, & Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev. 2004 Jan;17(1):1-13. These 2 sources BTW are mentioned in NYC DoH 2005 Alert #46. The author of the Alert cites these sources regarding Acyclovir antiviral treatment but ignores the rest of the paper which describes their cases as typical maternally transmitted NHSV.

4) Tendler's paper used 23 year old American HSV-1 statistics to blame the Mohel for orally infecting newborns in 7 Israeli and 1 Canadian cases. Current information indicates:

62.5% of known neonatal herpes types were HSV-1
Kropp RY., et al. Neonatal Herpes Simplex Virus Infections in Canada: Results of a 3-Year National Prospective Study, Pediatrics 2006 117:1955-1962

75% of genutal herpes in Tel Aviv is HSV-1.
Samra Z, Scherf E, Dan M. Herpes simplex virus type 1 is the prevailing cause of genital herpes in the Tel Aviv area, Israel. Sex Transm Dis. 2003 Oct;30(10):794-6.
Every test that could have proven or disproven the source was avoided by Temndler and the NYC DoH. Follow up serology, serologic testing for discordant partners, DNA comparison where one Mohel was accused in two cases, etc. All were meticulously avoided.

Additionally none of the authors have ever done a paper on neonatal herpes, but many have been critical of traditional circumcision.

This does not include many of the lies concerning history in the paper, i.e., the Chasam Sofer who died in 1839, was influenced by Ignacz Semmelweis' May 1847 discovery of disease transmission (in an obstetrics ward, not because a baby got tuberculosis from a mohel) and therefore permitted instrumental suction, even thouh the instrument was not invented until 1887.