Circumcision: Another Expert Speaks Out Against Metzitza B’Peh

Dr. Sherwin Nuland, a clinical professor of surgery at Yale University, is the author of the recent well-received biography on the Rambam.  He is also a National Book Award-winning author of "How We Die: Reflections on Life’s Final Chapter" (Knopf, 1994) and the author of a memoir, "Lost in America" (Knopf, 2003), among many others. He has written a blistering attack on metzitza b’peh, the oral-to-genital suction of the open circumcision wound done by many haredim as part of the circumcision ceremony:

Under normal conditions, the human mouth is home to streptococcus, staphylococcus and about five other forms of bacteria, several of which are capable of causing serious — and even lethal — infections. Every emergency room physician knows that these germs make a human bite more dangerous than a similar wound inflicted by a dog or cat, so much so that standard medical protocol demands that all such injuries be surgically explored and the damaged tissue cut out. The only exception is a bite on the face, where cosmetic considerations allow some leeway, but only with careful discrimination and close follow-up.

These precautions are in place because of the highly dangerous bacteria, but the herpes simplex virus adds problems of its own. To quote a standard textbook used by medical students and residents in training, "[U]ntreated neonatal herpes simplex has a case fatality rate exceeding 60%, with half of survivors severely damaged," frequently as the result of encephalitis. Other texts provide similar figures.

Fortunately, the disease is rare in the general population — but the general population does not suck on the newly cut penises of its neonates. Who knows the real number of fatalities and illnesses among ultra-Orthodox infants from either viral or bacterial infection, a figure on which the recently reported cases shed no light?

… The Shulhan Arukh, the code of Jewish law, could not be clearer on the matter of circumcision: "The fulfillment of all ordinances [of the brit milah] are suspended if there is danger to human life."

The danger of metzitzah b’peh has been more than amply demonstrated. Were the Rambam alive today, he would certainly agree.

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6 Comments

Filed under Circumcision Controversy

6 responses to “Circumcision: Another Expert Speaks Out Against Metzitza B’Peh

  1. Yochanan Lavie

    What has not been discussed is the homoerotic and pedophillic nature of this practice.
    The groups that do this are highly sex-segregated, patriarchal, and one might argue, mysogynistic. Is there a psycho-anthropological need for metzisah b’peh?
    (Such as an initiation rite similar to those pracitised by Kukuku tribe or the ancient Greeks).
    I defend the idea of circumcision, and recognize the divine origin of the Torah, but where is it written that you must do must do metzizah b’peh?
    Modern Orthodox do not do it (to the best of my knowledge). Why does this practice persist in the “black hat” world?

  2. Ron Berman

    This is a fairly clear cut (sorry for the pun) issue.

    Metzizah b’peh is a brutal homosexual act of genital mutilation.

    There is no reason on earth for a black hat or anyone else to have their mouth on a boy’s penis.

    NONE!!!

    They cannot claim to be victims of anything when they commit such atrocities themselves.

    If it was anyone else we know what the reaction would be.

  3. Michael

    Wow. So, are all proctologists butt fiends, and all urologists homosexuals (except for the females of course). And gynacologists must be perverts…

    Granted, they don’t use their mouth, but then again, they didn’t have Betadine solution several hundred years ago.

    I don’t get it. If you’ve been to a bris, there is nothing sexual about it in any way (to the average person) so what are you talking about? Any proof? Any shread of evidence other than your own strange feelings towards you penis? It’s just an organ. This is a custom. The people who do it are not the devients of our society but are some of the more reknowned and respected among us. I have met many and hold them in high esteem. They treat the issue as a technical and halachic one. Many do not do MBP as a result, and this is correct. Some continue to based on halacha, and this too may be correct (minhag though it is).

    So, even joking, the accusations and asserstions here are counter-productive not to mention baseless.

  4. Dovid

    Well said Michael!

  5. sam

    So now Nuland is a disciple of Maimonides too! When I was in college, I took an honors class on philosophy of Maimonides and the approach was going through 15 or 16 schools of thought and showing how each of them fervently belived they were the intellectual and spiritual heirs of the rambam. Kind of reminds me of the Rav.

    I think sherwin (whose book on the rambam was rather superficial) is wading a bit too deep into the waters of judaism. There’s a surgeon’s arrogance about his claim that there are numerous cases not being reported. I’m all for using a pipet, but I’m curious – where are the thousands of transmissions of staph, strep, anaerobes etc infections to neonates. The odds are, if you put in a foley catheter withou wearing gloves, you’ll cause a UTI. I’ve caused a few myself with technique that probably wasnt as sterile as it should have been. So why isnt it the case that 50% of haredi babies end up in the NICU with sepsis or viral infections?

    The answer is that this is a remote probability of infection, for whatever reason. The followup question is whether that small risk is worth it, and I believe the answer is no. But I really get annoyed when ivory tower medical academics like nuland pontificate on issues like this when he’s not even proficient in hebrew.

    I’m curious – anecdotally – shmarya – how many cases of neonatal infection do you know of personally from MBP? I dont know of any. It took a neonatology ward years to cobble together the 8 cases it did for the Pediatrics article – IN A COUNTRY WHERE 15% of the population performs this practice.

    Shmarya, dont worry, I’m not against your anti-mbp crusade, I’m just against intellectually arrogant and wrongheaded help that the crusade has enlisted.

  6. There is no mandatory reporting, and many cases are handled by pediatricians linked to haredi communities. Additionally, as the virus spreads, more and more mohelim will become carriers. I believe we are seeing more cases today because the virus has penetrated the haredi world and is now spreading. Look for many more cases, especially with mandatory reporting.

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