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where the mohel sucks blood from the circumcision wound. The traditional reason for this procedure is to promote healing, although the practice has been implicated in the spreading of herpes to the infant. Metzitzah b'peh ("suction by mouth") is a practice in certain Haredi and Hasidic circles in which, after removing the foreskin, the mohel sucks out the blood from the wound to clean it. The mohel spits the blood into a receptacle provided. Afterwards the circumcised penis is bandaged, and the brit is considered complete. Because the practice may spread diseases to the babies from the mohel's mouth (such as herpes), most mohelim ensure that their mouths are sanitized and washed out by rinsing with alcohol to disinfect the mouth. However, because alcohol may not kill a virus such as herpes, washing the mouth with alcohol alone isn't regarded as a sufficient protective measure. Today, if it's performed, the mohel generally uses a sterilized glass tube. However, the practice has become a controversy in both secular and Jewish medical ethics.
   The foundation for the ritual of metzitzah is found in Mishnah Shabbat 19:2, which lists metzitzah as one of the four steps involved in the circumcision rite. Rabbi Moses Sofer (known as the "Chasam Sofer") observed that the Talmud states that the rationale for this part of the ritual was hygienic — for example, to protect the health of the child. As a result of these texts, the Chasam Sofer contended that Jewish tradition instituted metzitzeh solely to prevent danger to the infant and stated that metzitzah wasn't required to be applied orally, but nevertheless made the leniency conditional upon doctors testifying that the metzitzah with a sponge would accomplish the same purpose as oral suction. His letter was published in Kochvei Yitzchok. (External Link) On the other hand, Rabbi Moshe Schick, the Maharam Shik, one of the most prominent students of the Chasam Sofer, states in his book of Responsa, She’eilos U’teshuvos Maharam Shik (Orach Chaim 152,) that the Chasam Sofer gave the ruling in that specific instance only and that it may not be applied elsewhere. He also states (Yoreh Deah 244)that the practice is possibly a Sinaitic tradition, for example, Halacha l'Moshe m'Sinai, and one is required to have Mesiras nefesh for the practice. In addition, Rabbi Chaim Chizkiya HaLevi Medini the Sdei Chemed printed a 50 page section called Ma'areches Hametzitzah (External Link), also claiming the practice to be Halacha l'Moshe m'Sinai, quoting R' Yehudah Assad and others. He also elaborates more on what prompted the Chasam Sofer to give the above ruling: He tells the story, that a student of the Chasam Sofer - Rabbi Elazer Hurvitz, The author of responsa Yad Elazer and Chief Rabbi of Vienna at the time, (The incident is mentioned in responsa 54)- needed the ruling in defense of a governmental attempt to ban bris milah completely if it included Metztitzah b'peh, because of the concern of spreading disease to the baby. He therefore asked the Chasam Sofer to give him permission to do Brit milah without metzitzah b’peh and when he presented the defense in court they erroneously recorded his testimony to mean that the Chasam Sofer stated it as a general ruling. He then adds, "Nevertheless it's my opinion that the Chasam Sofer never even wrote this letter. It is a forgery, in my opinion, and even if the letter was written by the Chasam Sofer he certainly didn’t state it as a general ruling, given that it wasn't printed in his book of halachic responsa, as was the custom with all halachic rulings intended for the public." Included in Ma'areches Hametzitah is a pronouncement by several hundred noted Hungarian and Russian Rabbis not to change the procedure.

Medical controversy

Metzitzah b'peh was implicated in the transfer of herpes from mohelim to eight Israeli infants, one of whom suffered brain damage. When three New York City infants contracted herpes after metzizah b'peh by one mohel and one of them died, New York authorities took out a restraining order against the mohel requiring use of a sterile glass tube, or pipette. In September 2005, the city withdrew the restraining order and turned the matter over to a chasidic rabbinical court. In February 2006, after the rabbinical court hadn't met a deadline of 1 December 2005 for a decision on this case, Dr. Thomas Frieden, the Health Commissioner of New York City, wrote, "There exists no reasonable doubt that ‘metzitzah b'peh’ can and has caused neonatal herpes infection.…The Health Department recommends that infants being circumcised not undergo metzitzah b'peh." In May 2006, the Department of Health for New York State, issued a protocol for the performance of metzitzah b'peh. Dr. Antonia C. Novello, Commissioner of Health for New York State, together with a board of rabbis and doctors, worked, she said, to "allow the practice of metzizah b'peh to continue while still meeting the Department of Health's responsibility to protect the public health."

By tube

In three studies done in Israel, Canada, and the USA, oral suction following circumcision has been implicated in 11 cases of neonatal herpes. The RCA paper states: "Rabbi Schachter even reports that Rav Yosef Dov Soloveitchik reports that his father, Rav Moshe Soloveitchik, wouldn't permit a mohel to perform metzitza be’peh with direct oral contact, and that his grandfather, Rav Chaim Soloveitchik, instructed mohelim in Brisk not to do metzitza be’peh with direct oral contact. However, although Rav Yosef Dov Soloveitchik also generally prohibited metzitza be’peh with direct oral contact, he didn't ban it by those who insisted upon it,...". The sefer Mitzvas Hametzitzah by Rabbi Sinai Schiffer of Baden, Germany, states that he's in possession of letters from 36 major Russian (Lithuanian) rabbis that categorically prohibit Metzitzah with a sponge and require it to be done orally. Among them is Rabbi Chaim Halevi Soloveitchik of Brisk. It is interesting that of all the students of Rabbi Yosef Dov Soloveitchik and the many times he was asked to be sandek, only Rabbi Schachter seems to remember this prohibition.

Conversion and exceptions

A Brit milah could be circumvented with Dam Brit, or foregone altogether with a Milah L'Shem Giur:

Medical considerations

If a boy is born prematurely or has some other serious medical condition the Bris is generally postponed. The brit may only take place when a doctor or the parents deem the child healthy enough.
   Additionally, the Talmud explicitly notes that a male child is relieved of his responsibility to undergo circumcision if he's had three older brothers die due to complications from the procedure. This is mentioned specifically in the context of some sacrifices in which a priest was prohibited from participating if he was uncircumcised for this reason.

Hatafat dam brit

Medical circumcision alone, in the absence of the brit milah ceremony, doesn't fulfill the requirements of the mitzvah. In the case of a Jew who was circumcised outside of a brit milah, or an already-circumcised convert, the mohel draws a symbolic drop of blood from the penis. Hatafat dam brit (heb. "Drop of the blood [ofthe] Covenant") refers to the fulfillment of the mitzvah of a brit milah.

Blood

A brit milah isn't considered complete unless blood is actually drawn. This isn't the intentional spilling of blood. The standard medical methods of circumcision through constriction don't meet the requirements of the halakhah for brit milah, because they cause hemostasis, for example, they stop the flow of blood. A brit milah, to be conducted properly, requires the use of a specialized surgical knife, called an, which does allow for dam brit.
   Unlike the traditional Jewish method, when circumcision is performed by a urologist or other surgeon, the foreskin is removed by constriction, either with the use of clamps or a synthetic ring. This non-Jewish method works by crushing the skin until it's severed. The nerve endings and the blood vessels are severed in the same manner, causing pain and hemostasis.
   The expressly ritual element of circumcision in Judaism, as distinguished from its non-ritual requirement in Islam, is shown by the requirement that a child who either is born aposthetic (without a foreskin) or who has been circumcised without the ritual must nevertheless undergo a Brit milah in which a drop of blood (hatafat-dam, הטפת דם) is drawn from the penis at the point where the foreskin would have been or was attached.

Role in conversion

There are reasons not to perform a circumcision when a man has converted to Judaism. A circumcision isn't possible if a convert was already circumcised prior to conversion, or if he's a medical condition (such as hemophilia) which would cause a circumcision to potentially endanger his life. In these situations, a brit milah can't be performed, and instead a single drop of blood is extracted, in a practice called hatafat dam brit (Hebrew:).

Milah l'shem giur

A Milah L'shem giur is a "Circumcision for the purpose of conversion". In Orthodox Judaism, this procedure is done by adoptive parents for adopted children who are being converted as part of the adoption. The conversion of an infant is valid in both Orthodox and Conservative Judaism until the boy reaches the age of 13. At that time he's the option of renouncing his conversion and Judaism, and the conversion will then be considered invalid. He must be informed of his right to renounce his conversion if he wishes. If he doesn't make such a statement it's accepted that the boy is halakhically Jewish. Orthodox rabbis will generally not convert a non-Jewish child raised by a mother who hasn't converted to Judaism.
   The laws of conversion and conversion-related circumcision in Orthodox Judaism have numerous complications, and authorities recommend that a rabbi be consulted well in advance.
   In Conservative Judaism, the Milah l'Shem giur procedure is also performed for a boy whose mother hasn't converted, but with the intention that the child be raised Jewish. This conversion of a child to Judaism without the conversion of the mother is allowed by Conservative interpretations of halakha ("Jewish law"). Conservative Rabbis will authorize it only under the condition that the child be raised as a Jew in a single-faith household. Should the mother convert, and if the boy hasn't yet reached his third birthday, the child may be immersed in the mikveh with the mother, after the mother has already immersed, to become Jewish. If the mother doesn't convert, the child may be immersed in a mikveh, or body of natural waters, to complete the child's conversion to Judaism. This can be done before the child is even one year old. If the child didn't immerse in the mikveh, or the boy was too old, then the child may choose of their own accord to become Jewish at age 13 as a Bar Mitzvah, and complete the conversion then.
  • It doesn't have to be performed on a particular day.
  • The ceremony doesn't override and isn't performed on Shabbat or Jewish Holidays.
  • In Orthodox Judaism, there's a split of authorities on whether the child receives a Hebrew name at the Brit ceremony or upon immersion in the Mikvah. According to Zichron Brit LeRishonim, naming occurs at the Brit with a different formula than the standard Brit Milah. The more common practice among Ashkenazic Jews follows Rabbi Moshe Feinstein, with naming occurring at immersion.
Where the procedure was performed but not followed by immersion or other requirements of the conversion procedure (for example, in Conservative Judaism, where the mother hasn't converted), if the boy chooses to complete the conversion at Bar Mitzvah, a Milah l'shem giur performed when the boy was an infant removes the obligation to undergo either a full brit milah or hatafat dam brit.

Social context

According to the Hebrew Bible, it was "a reproach" for an Israelite to be uncircumcised (Joshua 5:9.) The name arelim ("uncircumcised" [plural]) is used opprobriously, denoting the Philistines and other non-Israelites (I Samuel 14:6, 31:4; II Samuel 1:20) and used synonymously with tameh (unclean) for heathen (Isaiah 52:1). The word arel ("uncircumcised" [singular]) is also employed for "unclean" (Leviticus 26:41, "their uncircumcised hearts"; compare Jeremiah 9:25; Ezekiel 44:7,9); it's even applied to the first three years' fruit of a tree, which is forbidden (Leviticus 19:23).
   However, the Israelites born in the wilderness after the Exodus from Egypt were not circumcised. Joshua 5:2-9, explains, "all the people that came out" of Egypt were circumcised, but those "born in the wilderness" were not. Therefore Joshua, before the celebration of the Passover, had them circumcised at Gilgal specifically before they entered Canaan. Abraham, too, was circumcised when he moved into Canaan. The opinion ascribed to Joshua contradicts the fact that in Exodus 4:26, Moses and his wife didn't know about circumcision. Deuteronomy 10:16 says: "Circumcise the foreskin of your heart," suggesting that ethical acts (among people) are as important as spiritual acts (between people and God). The prophetic tradition emphasizes that God expects people to be good as well as pious, and that non-Jews will be judged based on their ethical behavior. Thus, Jeremiah 9:25-26 says that circumcised and uncircumcised will be punished alike by the Lord; for "all the nations are uncircumcised, and all the house of Israel are uncircumcised in heart."

Reform Judaism

In contrast with traditional Orthodox, Conservative and Masorti Judaism, denominations within Progressive Judaism, consistent with their view that traditional ritual law imposes no obligations binding on modernity, have generally made this a recommendation as opposed to an obligation or requirement, consistent with the movement's stressing of autonomy of its members and clergy. Reform and Reconstructionist Judaism have often accepted medical circumcisions performed by doctors as sufficient to fulfill the commandment of brit milah. In recent years a traditionalist element within these movements has begun stressing the religious and ritual nature of circumcision, as part of a growing trend towards wider acceptance of tradition, and as an example Reform Judaism has started training their own experts (mohalim) in this ritual. .

Academic opinions

The Oxford Dictionary of the Jewish Religion, hypothesizes that the present form of circumcision, involving periah (peeling back the foreskin), was commenced during the Second Temple period. According to this hypothesis, Jewish hellenists, wanting to assimilate into Greek society, obliterated the sign of their circumcisions by finding ways to lengthen them, to make it look as if they hadn't been circumcised at all. This practice was unacceptable to the Jewish community at large, and led to the complete removal of the foreskin to expose the glans. The frenulum may also be cut away at the same time, in a procedure called frenectomy.
   Talmud professor Daniel Boyarin has proposed two explanations for circumcision. One is that it's a literal inscription on the Jewish body of the name of God in the form of the letter "yud" (from yesod"). The second is that the act of bleeding represents a feminization of Jewish men, significant in the sense that the covenant represents a marriage between Jews and (a symbolically male) God.

The anti-circumcision movement and brit shalom

The genital integrity movement, which condemns circumcision as genital mutilation, has not made significant inroads into any of the Jewish denominations with the notable historical exception of Reform Judaism. Many founding leaders of the Reform movement took a very rejectionist view of Jewish practice and discarded traditions and rituals, including ceasing circumcision, which was decried as barbaric. Some contemporary Jews choose not to circumcise their sons. They are assisted by a small number of Reform and Reconstructionist rabbis, and have developed a welcoming ceremony that they call the brit shalom ("Covenant [of] Peace") for such children, also accepted by Humanistic Judaism.
   This ceremony of brit shalom isn't officially approved of by the Reform or Reconstructionist rabbinical organizations, who make the recommendation that male infants should be circumcised, as well as all men who convert into Judaism, though circumcision of converts isn't mandatory in either movement.
   However, the connection of the Reform movement to an anti-circumcision, pro-symbolic stance is a historical one. From the early days of the movement in Germany, some classical Reformers hoped to replace ritual circumcision "with a symbolic act, as has been done for other bloody practices, such as the sacrifices." As a result, many European Jewish fathers during the nineteenth century chose not to circumcise their sons, including Theodore Herzl. In the US, an official Reform resolution in 1893 abolished circumcision for converts, and this ambivalence towards the practice has carried over to classical-minded Reform Jews today. In Rabbi Elyse Wechterman's essay A Plea for Inclusion, she argues that, even in the absence of circumcision, committed Jews should never be turned away, especially by a movement "where no other ritual observance is mandated". She goes on to advocate for an alternate covenant ceremony, brit atifah, for both boys and girls as a welcoming ritual into Judaism. With a continuing negativity towards circumcision still present within a minority of modern-day Reform, Judaic scholar Jon Levenson has warned that if they "continue to judge brit milah to be not only medically unnecessary but also brutalizing and mutilating...the abhorrence of it expressed by some early Reform leaders will return with a vengeance", proclaiming that circumcision will be "the latest front in the battle over the Jewish future in America."

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