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Metzitza B’Peh — Obligation and Performance


This week’s article will discuss the Bris Mila — the mitzva given to Avraham Avinu 3736 years ago. Since then, the mitzva is performed by all Jewish males in full accordance with the Jewish tradition. One of the four steps of the Bris, Metzitza, has been the subject of controversy in the past two hundred years. What is point of contention? Is performing Metzitza B’pe actually dangerous, or is dangerous not to do so? Why would the same mohel insist on performing a traditional metzitza in one bris while refusing to do so in another? The Chasam Sofer’s leniency (heter), that some consider having been conditional, will also be discussed here. Was he the first to issue it? And why was it issued? Is metzitzh part of the actual mitzva of the bris, or is it a separate part which can be done after sunset? Of this and more, in the coming article.

The Mitzva of Bris Mila

In this week’s parasha we learn about the mitzva of Bris Mila (circumcision). The bris (lit: covenant) is a sign G-d requires us to make in a Jewish male’s body to indicate our relationship with G-d. The covenant, though, is not merely physical. The Midrash teaches us that Avraham Avinu stands at the gates of Gehenna and removes every circumcised Jew, granting him entrance to eternal life.

The bris has recently come under controversy and was even banned in several European countries. In others, it is severely restricted, especially the metzitza (suctioning). What are the different ways for performing metztitza, and why is it crucial? When is it done via glass tube or pipette and when orally? How is sterility ensured?

The Four Parts of the Bris

The bris is a minor surgical procedure performed by nearly 100% of the Jewish nation, as well as millions more around the world, including the British royal family, most Muslims, and Americans. Besides being very safe, it carries many medical advantages. The World Health Organization advanced a program to circumcise millions in third world countries to prevent spreading of AIDS (circumcised males carry a 60% less spreading rate), cancer, and other diseases. According to report done by the American Academy of Pediatrics in 2012, after considering more than 1000 medical papers on the matter, the advantages of circumcision outnumber the disadvantages by far. In this article we will only discuss the halachic bris, done solely for the mitzva and in accordance with halacha.

Although the bris usually takes less than 10 seconds, it includes several stages:

1) Mila — amputating the akroposthion

2) Priah — peeling off the epithelium and uncovering the atara

3) Metiztza – suctioning the incision site to ensure a new blood flow to the area

4) Dressing the wound. In early times ground cumin was used as an antiseptic. Today, other medicine is used.

The Rambam (Igeres Hashmad) quotes a Midrash describing how brissim were performed in Egypt before our redemption: Moshe Rabbenu made the incision, Yehoshua did the priah, and Aharon Hakohen did the metiztza.

Critical Role

Why is metzitzah necessary? What is the purpose of it, and can it be achieved otherwise?

The Gemara writes that any mohel who doesn’t do metzitza is promptly dismissed from his job because he endangers babies’ lives. Apparently, the purpose of the metzitza is to prevent danger to the baby if the blood that was present during the circumcision is not removed and a fresh blood flow is drawn to the site. While the Gemara doesn’t state the obvious – for example, that a mohel who fails to dress the wound should be fired, apparently mohalim didn’t understand the necessity of metzitza and some even skipped it, requiring the Sages to call the attention of communal leaders to the matter.

Here lies the question: Is metzitza a medically mandated stage, or is it a part and parcel of the actual mitzva?

Danger in Skipping Metzitza

While Chazal taught of the danger involved in skipping metzitza, they didn’t elaborate on the nature of the danger. It is, therefore, difficult to determine what substitutes can effectively eliminate the said danger.

The Klausenberger Rebbe (D’var Yatziv 148) writes that since Chazal didn’t inform us of the reason and nature of the danger that metzitza prevents, we are concerned that without metzitzah the child’s  general present or future health will be compromised. (Rabbi Avraham Rubin shlita, chief rabbi of Rechovot recounted that he was once accompanying Rav Shmuel Wosner zatal, who stopped to speak with a handicapped Jew sitting in a wheelchair. Later, Rav Wosner explained what he saw as the reason for the man’s handicap: when the man had been a baby he had a hemoglobin level, which Rav Wosner had deemed dangerous for the bris, and ruled the bris should be postponed. A doctor and another rabbi permitted it, and the parents chose to override Rav Wosner’s ruling and go ahead with the bris. In Rav Wosner’s opinion, it was a result of this decision that he later contracted the disease that caused him paralysis.)

The Rambam (Mila 2:2) who was a doctor as well as a rabbi, explains that the purpose of the metiztza is to draw blood from farther organs to the circumcision site. This action serves to protect the baby from danger. Still, the reason remains obscure.

In his famous work on the bris, the renowned 12th century mohel, Rabbi Yaakov Hagozer (Zichron Bris L’rishonim, Berlin 652, p.20) adds that the metzitza’s purpose is to ascertain there are no blood clots in the incision site. Dr Mordechai Halpern (Asia 79-80, volume 20) explains that according to current medical knowledge, skipping metzitza carries a slight risk of forming a blood clot which could, in extreme cases, even cause amputation of the atara. He continues and explains why metzitza is the best medical solution even in light of modern medical knowledge.

Despite the above explanations, the exact danger Chazal were rereferring to remains unclear, as well as how metzitza prevents this. Therefore, when exchanging the traditional metzitza for other alternatives there is no way to ascertain that the alternatives actually meet Chazal’s requirements.

Chazal were well aware of the dangers of salivary transmitted disease. They warn against sharing eating utensils (Nedarim 49b; Yerushalmi Teruma 8:3) placing coins in the mouth, and other health risks involving bacteria. As a result, there are several halachos recorded in the Shulchan Aruch that result from halacha’s demand for maintaining proper hygiene (YD 116:5). After science discovered the world of microbes, the Gemara’s knowledge became clearly evident — the Sages knew about germs long before Anton Van Leeuwenhoek observed microbes under his microscope. On the other hand, Chazal also mention cures that involve saliva of a healthy person – chewing certain elements and placing them on a wound, spitting into the eye as a cure for certain eye ailments. Chazal even go so far as to differentiate between the stages of the saliva – some diseases can be only cured with saliva obtained during the morning before eating (Shabbos 108b), for example. Current medical research has found that saliva contains antibodies and functions as an excellent digestive agent. While medical research still has a long way to go before announcing the benefits of common saliva and how to use it, it is not unreasonable to assume it may yet be discovered in the future. (This is an unresearched medical recommendation, but it works: try licking a common wort with morning saliva. It’ll dry up faster and easier than those treated topically.)

The Levush Mordechai (chapter 30) writes that specifically because of the Sages’ awareness and warning about the dangers of saliva, forbidding every transmission of saliva under the prohibition of “Bal Teshaktzu”, the procedure of metzitza must be carried out as they prescribed since it must be absolutely crucial.

The ancient Jewish practice of tasting a drop of wine before the metzitza allows the alcohol in the wine to disinfect the mohel’s mouth. Contemporary regulations require mohalim to disinfect their mouth with regular disinfectant before metzitza, and mohalim adhere to this rule.

Safety or Danger

Halachic authorities in Brisk and Vienna referred to possibility of transmitting disease through metiztza. Today, the main point of concern is transmission of AIDS and herpes. It is important to point out: most metzitza opposition comes from the far-left fringes of Judaism or blatant anti-Semites whose one and only agenda is bringing Torah and halachic Judaism to an end. Opposing metzitzah has a public appeal that appears humane, effectively masking their opposition as compassionate and humanitarian instead of what it really is: an attack on Torah and mitzvos. (A similar attack on shechita, for the same reasons, is an ongoing struggle throughout the Western World.)

Dr. Mordechai Halpern (Asia 79-80, volume 20) points out that while progressive groups advocate for a “more sterile” and “more medically appropriate” procedure, their hidden intent can be easily discerned: success of a surgical procedure depends on the amount of practice the surgeon has. While a doctor, even a surgeon, performs several circumcisions every month, a mohel performs hundreds in the same amount of time, spending his entire lifetime perfecting this one single procedure.

While AIDS is a life-threatening disease, herpes (HSV-2) is a relatively mild one, which in most cases, poses no danger to babies. Babies can contract it from any number of caretakers and only rarely is it harmful.

As for AIDS, the mohel and not the baby is the one stands the risk to contract the disease. AIDS is almost non-existent in Torah true communities but may be present among the non-Orthodox. While the baby cannot be infected with AIDS through saliva, the mohel can be infected by the baby if he is a carrier.

Herpes, explains Dr. Mordechai Halpern (ibid), used to be rampant in the past. Everybody had antibodies for it, and even those who didn’t were protected by herd immunity, and every baby had antibodies which he received from his mother. Due to better hygiene, nowadays, while 80% of the elderly have herpes antibodies, only 23% of women in childbearing age are carriers.

Since the ‘80s, the number of herpes infections among circumcised babies has been monitored. Only a few cases have been reported, and even those were inconclusive as to the source of contamination.

Professor Avraham Steinberg, member of the Interministerial Oversight Committee of Mohalim in Israel ascertains that behind the attempt to bring metiztza to an end stand political and personal agendas, while the only reason for rabbis to advocate for it is their real concern for Jewish babies’ lives and health. Current data suggests that only if a mohel has a bleeding ulcer can metzitzh be considered a risk. Statistically, thousands of years of metzitza have shown that this risk is far smaller than that of crossing a street, for example.

The Chasam Sofer’s Dispute

The Chasam Sofer, in a response to his disciple, Rabbi Eliezer Horowitz, chief rabbi of Vienna (published in Yad Eliezer 55), writes that since there is a risk of contracting disease, metzitza should be done through a sponge. He explains that since metzitzah is only done out of concern for the baby’s safety, where metzitza involves a risk, blood should be drawn with a sponge separating the mohel’s mouth and the baby. While he does mention that metzitza should be done, according to Kabbalistic sources, through direct oral contact, where a risk is involved we disregard any concern for mystic reasons.

In light of the Chasam Sofer’s letter, his disciple, Rabbi Eliezer Hurwitz zatal encouraged all mohalim in all communities to switch to metzitza through a sponge.

The Chasam Sofer’s other disciples, though, led by Rabbi Moshe Schick (1807–1879) (She’eilos u’teshuvos Maharam Schick, OC 152) insisted that the Chasam Sofer’s ruling was only given for that specific case, and only because the mohel, who had mouth ulcers, refused to step down from his position and had government connections that prevented his removal in favor of another mohel. Everywhere else in the world, where metzitza is known to be safe, metzitza must continue in its traditional form.

Rabbi Zalman Spitzer, the Chasam Sofer’s son in-law (Hame’asef 4, 8) explains that the ruling was prompted by a syphilis outbreak in Vienna. He also maintains that the ruling was temporary, not general.

Rabbi Shmuel Halvei Wosner (Shevet Halevi, II 131) notes that he saw the responsa in the Chasam Sofer’s own handwriting hanging in a wealthy London household, on which one of his leading disciples added that the ruling was temporary and should not be publicized.

Part or Protection

If metzitza is only done to prevent danger, can a different danger cancel it, or is it – in addition to being a protective measure – also a crucial part of the bris, without which the bris is not kosher, and should not be skipped without a life-threatening reason?

This question has practical ramifications. If a bris is performed close to sunset, does the metiztza also have to be performed before sunset? And if the father performs the bris, which is preferable, provided he knows the skill, should he also do the metzitza, or can that part be done by someone else?

The Ketzos Hachoshen writes (382:2) that metzitza is done for medical reasons. Therefore, if a father is a mohel, he should preferably be the one to perform the bris. The metzitza, however, can be offered to someone else. The Shoel Umeshiv (VI, 7); Meshiv Davar (volume II, 55); Igros Moshe (YD I, 223); Rav Elyashiv (Kovetz Teshuvos I, 102); and Minchas Shlomo (volume I chapter 7) all agree with this approach.

The Mahari Assad (volume I, YD 258), one of the Chasam Sofer’s leading disciples, however, disagrees and maintains that he has proof that metzitza is part and parcel of the mitzva. In his opinion, metzitza has two parts – the first drop, which is halacha l’Moshe m’Sinai (a Sinai tradition), and the rest is to protect the baby from danger. This is the meaning of the Gemara in stating that a mohel who doesn’t suction blood from farther organs should be fired.

The Hafla’a (Kesuvos 5b) and Avnei Nezer (YD 338:6) write slightly differently-that since a bris without metzitzah is considered dangerous, it is effectively part of the bris. The Avnei Nezer mentions several examples where something that is deemed necessary for a mitzva becomes an integral part of it. He quotes the Chiddushei Harim who draws a parallel from Hatafas Dam (a procedure in which the mohel draws a symbolic drop of blood performed when circumcised males undergo conversion): since bleeding is an integral part of the process, and a bloodless procedure is not a kosher bris, the metzitza is part and parcel of the bris. Practically, the Avnei Nezer is inconclusive, and since it is a halachic doubt involving a biblical mitzva, we rule stringently and the metzitza should be done before sunset along with the entire bris procedure.

Forbidding Non-Oral Metzitza

Many poskim forbid performing metzitza via barriers: the Maharm Schick (OC 152); Mahari Assad (YD 258); Binyan Tzion (I, 23-24); Rabbi Shlomo Kluger (Haelef Lecha Shlomo YD 262): Sdei Chemed (Kuntress Hametzitza); Beis Yitzchak (YD 98); Os Chaim Veshalom (YD 264:12); Aruch Hashulchan (YD 264:19); and others.

Suctioning via Pipette

While the original dispute involved suctioning via hand held sponge, a new device for meztitza was developed in Germany and Lithuania – a glass tube through which the mohel suctions out the blood. This ensures that the suctioning occurs orally, while preventing direct contact with the mohel’s saliva.

Rabbi Moshe Sternbuch opposes this tool venomously (volume I chapter 588). However, he adds, where there’s danger in oral suctioning, the pipette should be used. He notes that the Brisker Rav told him that his father, Rabbi Chaim Soloveitchik permitted suctioning via a short pipette during a tuberculosis epidemic in Brisk.

Rabbi Chaim Berlin (mentioned in Kovetz Tehsuvos I, chapter 102) writes that the Lithuanian leaders, specifically Rabbi Yitzchok Elchonon Spektor, the Marcheshes, Zecher Yitzchok, Aruch Hashulchan and Achezer, ruled that if there is even the slightest risk involved all customs should be disregarded.

The Divrei Malkeil writes (volume IV 86) that suctioning with a sponge is forbidden, but a pipette is permitted.

Practical Ruling

The Mishna Brura (Biur Halacha 331:1) quotes the Binyan Tzion who forbids non-oral metzitza and the Yad Eliezer who permits it, effectively leaving the matter undecided. Shevet Halevi understands from the sequence that the Mishna Brura agrees with Yad Eliezer. Nevertheless, the Shevet Halevi himself forbids it strongly. The Har Tzvi (YD 214), while permitting pipette metiztza, warns mohalim that using it requires great skill and practice.

Rav Elyahsiv writes (Kovetz Teshuvos I, 102) that practically, where there are no health concerns involved, metzitza should be done as the Gemara requires. However where there is even a slight possibility the baby might be an AIDS carrier, metiztza should be carried out via pipette.

In Brit Avraham Hakohen (p. 200) the author notes that medically, saliva kills AIDS and other bacteria, and the are no recorded cases of orally contracting AIDS. Regardless, Rabbi Moshe Feinstein ruled the pipette should be used for even the slightest hint of a risk.


Almost all poskim agree that metzitza should be performed orally. Where there is concern for the baby or mohel’s safety, metzitza should be done via pipette. While some opine it should always be done via pipette due to the distant possibility of danger, it is important to ensure that this deviation from tradition is not a result of anti-Mila and antisemitic propaganda.



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