The Need for Metzitzah ba-Peh

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by R. Gidon Rothstein

10 Elul: The Need for Metzitzah ba-Peh During a Circumcision

Conflicts between modern science and halachah are nothing new, so when we find a respondent from a hundred years ago deal with an issue that is also still contemporary, it offers interesting light on the question. Shu”t Binyan Tziyyon 23, dated 10 Elul 5606 (1846), is an example, since it defends metzitzah be-peh, the practice of sucking out blood (by mouth) after a circumcision.

Today, that practice raises concerns, since some mohalim, men who perform circumcisions, still do it by applying their mouths directly to the site of the circumcision. (I think most mohalim now use a sterile tube, to protect against passage of germs). Sadly, there have been recorded cases of the mohel infecting the baby, and of babies dying of the disease they contracted.

R. Ettlinger knows something like the worry of infection (although he speaks of a foul moisture in the mouth, because the germ theory of disease had not yet become widely accepted; as we’ll see, his understanding of what causes infection differs from ours) and he addresses that concern, but the responsum also tells us about how we know we’re required to do metzitzah, and what constitutes a valid form of it.

Sucking Blood Out or Closing Up the Wound

He starts by quoting the second chapter of Rambam’s Laws of Circumcision, which says that the one performing the circumcision is motzetz the wound, in order to draw the blood out of distant places. That is to forestall danger to the patient, although Rambam does not clarify the nature of that danger.

R. Ettlinger points out that the goal would make squeezing by hand insufficient, since it won’t get to the distant blood. R. Shmuel Abohav, a 17th century Venetian rabbi, also gives the sense that the sucking is to pull blood out, not stop blood from flowing.

He noted a custom for the mohel to place wine in his mouth and apply it to the site. Since that’s a problem on Yom Kippur or Tisha B’Av, he recommends the mohel first do metzitzah without anything, then apply the wine by hand or with a cloth. Clearly, the wine is to staunch the bleeding, and the metzitzah is for something else, which can only be accomplished by suction.

The Root of Metzitzah

To explain how Rambam knew that’s what metzitzah is meant to accomplish, R. Ettlinger points to the language of Shabbat 133a. The Mishnah uses the verb motzetzin, and there are three verb roots that are very similar to each other. All of them use the letters mem and tzadi to indicate drawing one item out of another, but R. Ettlinger detects nuances of difference among them.

Mishlei 30;33 refers to mitz chalav producing butter, Vayikra 1;15 speaks of ve-nimtzah damo, squeeze its blood out, and Yeshayahu 66;11 uses the phrase le-ma’an tamotzu as a follow-up phrase to a mention of nursing like a baby. Similar as they are, the first two mean extracting one substance out of another by some kind of pressure or squeezing (I think he sees juicing as squeezing an item in on itself, or churning it, like for butter; the blood is squeezed out of a bird sacrifice by pressing it against the wall of the mizbeach), but the last verb means only drawing out by suction (like a baby at its mother’s breast).

When the Mishnah used the word motzetzin as opposed to matzin or motzin, it was telling us (and Rambam) that it meant a kind of suction rather than squeezing (which is the easier way to get blood out). Once he knew that, he understood that the purpose was to get out blood that could not be accessed by squeezing or pressing.

When Moderns Find Problems with the Practice

The reason the issue has arisen is that some doctors and even rabbis were arguing that metzitzah provides no benefit and carries a risk, in that the mohel’s mouth may have some kind of poison or bad liquid (here’s where he seems to struggle for the language of infection, which he does not yet have).

R. Ettlinger takes a classic traditionalist position, that there’s no reason to get rid of a practice set up by Chazal (the people he’s addressing assumed that Chazal did not understand the medical issues as well as they did, which clearly irked R. Ettlinger), and that their concerns can be addressed without stopping the practice. In that sense, this responsum shows us one way to react to attacks on tradition, to claims that we have to bring our halachic practices up to date.

He suggested avoiding the dangers of infection by checking the mohel’s mouth carefully, to be sure there is nothing in it that would cause problems for the babies (as I said, he doesn’t seem to be working with a fully formed theory of germs and infection, so he seems to think one check of the mohel’s mouth would avoid the problem. That solution would be too cumbersome today, since we’d need to check the mohel’s health before each circumcision).

That aside, the metzitzah-opponents still claimed it had no value, so much so that one of them said that a mohel who performs metzitzah on Shabbat is violating the Torah, since he’s pulling blood out of a body on Shabbat without a mitzvah to do so!

Resisting Change is Part of Respecting the Old

R. Ettlinger points out that the Shabbat problem isn’t an issue, since metzitzah either serves a purpose, in which case it’s allowed as part of the circumcision, or it does not, in which case it’s mekalkel, a destructive act (since the metzitzah is wounding the baby; we usually think it’s a wound worth making, since it has larger beneficial effects. But if it doesn’t, as they’re arguing, it’s just destructive). Destructive acts are not prohibited by the Torah, so that this becomes a question of a possible Rabbinic prohibition going up against our concern that it might be a required part of the circumcision.

R. Ettlinger then questions those convinced it has no value, in the face of Chazal saying it was a necessary part of the process. Jews have been doing this for two thousand years (which would suggest it’s not dangerous) yet the people of his time are certain it has no value. How do they know it doesn’t help one in a thousand or one in ten thousand; on the flip side, how do they know who instituted metzitzah—perhaps it goes all the way back to Moshe!

(This type of argument applies to many occasions when the new wants to get rid of the old, and can be quite convincing. On the other hand, if the value of metzitzah is one in ten thousand, and there’s also a one in a thousand danger, that hurts R. Ettlinger’s case. Fundamentally, he’s saying our respect for ancient practices and those who instituted them should foster a conservative approach, in that we resolve whatever problems such practices currently present while leaving them largely in place.)

Conflict with Doctors Isn’t Surprising

R. Ettlinger’s final set of points emphasize that doctors reject more than a few of Chazal’s claims, but we still follow Chazal. One example he gives is that Chazal assumed that five months and two days might be enough for a full-term pregnancy. That’s enough for him, so if doctors say it’s impossible, it shows that they often reject that which they shouldn’t.

(Again, while I have much sympathy for the basic idea—since I believe doctors today also accept or reject that which they have no solid evidence to decide—it can also be taken too far.)

For a good expression of that idea, he turns to R. Yehonatan Eybeschutz, whom he reports was respected for his scientific knowledge as well as his greatness in Torah knowledge. R. Eybeschuetz was discussing the possibility of a woman becoming pregnant in a bathtub (which the Gemara thought possible and doctors rejected). He said that doctors dismiss it because they can’t imagine how it could be true (meaning, I think, that until they understand how it works, they’ll say there’s no way it could be possible).

Yet they cannot cure much that Chazal could, as shown by their hiding away the sefer refu’ot, a book that contained so many remedies people were losing sight of the need to rely on Hashem for health and sustenance.

No Rejectionist

For all this full-throated defense of Chazal, R. Ettlinger does think we should avoid the health problems people have pointed out, by checking the mohel carefully before licensing him. While that wouldn’t work today, it shows R. Ettlinger’s approach, to accept Chazal in their greatness, maintain their recommended practices even if we’re no longer sure of their value, and forestall any problems we notice that those practices might create.

Listen to Rabbi Rothstein discuss this on OU Torah.

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