Thursday, November 28, 2013

Metzitzah and the Rav


Metitzah - the suction of blood from the circumcision - is prescribed by the Gemara as a medical necessity. Today, however, medical opinion states that not only is it not of medical benefit, it is actually potentially harmful, when done in the traditional manner of using oral suction. What, then, are we to do?

According to Rabbi Moshe Meiselman, in Torah, Chazal and Science, whenever Chazal make a statement about realia, and do not indicate that they are speaking tentatively, then they are correct, and to doubt them is heresy. Rabbi Meiselman thus states, with regard to metzitzah (pp. 239-40), that "Chazal's assessment overrides that of modern medicine," because "Chazal understood the situation better than the physicians." He stresses that "we rely upon their judgment unswervingly, even if medical opinion says otherwise."

Following from this, Rabbi Meiselman states that "the mohel must suction the wound in a traditionally prescribed manner." Now, this could only mean that the mohel must suction the wound with his mouth. It is exceedingly strange, though, that Rabbi Meiselman avoids using the word "mouth" in this entire discussion. What is the reason for this? I'm not sure. Perhaps it is politically inexpedient for him to explicitly insist on metitzah b'peh, in the light of all the scandal revolving around the infant illness that it is has caused. Perhaps Rabbi Meiselman is trying to leave himself wiggle room to claim that he is not insisting on metzitzah b'peh but only on metzizah. But his meaning is clear. First, there is the context of the entire discussion - the entire controversy revolves around doing it with the mouth. Second, every reader will assume and understand that this is the intent - if he did not mean metzitzah b'peh, he would have to say so. Third, the phrase "traditionally prescribed manner" does not leave any room for doubt regarding his intentions.

In any case, while Rabbi Meiselman's views on this topic will be anathema to those who accept contemporary medical science and reject his extreme view regarding Chazal's authority, at least it is consistent with his overall approach. One cannot fault him for inconsistency.

Except that one can.

Dr. Shlomo Sprecher pointed out to me that Rabbi Meiselman is in fact revealing a fundamental problem here. Throughout the book, Rabbi Meiselman makes reference to "mori v'rebbi," his uncle and alleged mentor Rav Yosef B. Soloveitchik. A review of the book that appears in The Jewish Press claims that Rabbi Meiselman "had unlimited access to his uncle and rebbe, Rav Yosef Dov HaLevi Soloveitchik, zt”l, who guided him in attaining a profound, thorough and Torah-true perspective on this topic." But Rav Soloveitchik had a very different approach to metzitzah b'peh.

Rabbi Gil Student reports that "the following was written by R. Hershel Schachter in Nefesh Ha-Rav (p. 243) about R. Joseph B. Soloveitchik's position on this matter, and was confirmed by R. Fabian Schoenfeld as having happened at his son's circumcision:"
Our teacher's view was that nowadays there is no need for metzitzah at all, like the Tiferes Yisrael's view in the Mishnah [sic!] (see the Sedei Hemed for a long treatment of this). He told us how a mohel once wanted to perform metzitzah be-feh and our teacher asked him not to. When the mohel refused, our teacher told him that if his father, R. Moshe Soloveitchik, were there, he would definitely not have allowed him to perform metzitzah be-feh. However, I am more tolerant and since you are refusing, I will let you.
Rav Soloveitchik's view was also included in the statement made by the RCA:
The poskim consulted by the RCA (Rabbi Gedalia Dov Schwartz, Av Beit Din of the Beth Din of America and of the Chicago Rabbinical Council; Rabbi Hershel Schachter of RIETS/YU and the Union of Orthodox Congregations of America; and Rabbi Mordechai Willig of RIETS/YU and Segan Av Beit Din of the Beth Din of America) agree that the normative halacha undoubtedly permits the third view, and that it is proper for mohalim to conduct themselves in this way given the health issues involved in the fourth view. Rabbi Schachter even reports that Rav Yosef Dov Soloveitchik reports that his father, Rav Moshe Soloveitchik, would not 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 did not ban it by those who insisted upon it, and neither does the RCA advocate any such ban. 
Rabbi Meiselman does not follow his rebbe's view regarding metzitzah b'peh. Worse, he does not even mention it. But even more significantly, Rav Soloveitchik's views on metzitzah b'peh show that he had a very different approach to Chazal's scientific knowledge than does Rabbi Meiselman.

52 comments:

  1. the following was written by R. Hershel Schachter in Nefesh Ha-Rav (p. 243) about R. Joseph B. Soloveitchik's position on this matter, and was confirmed by R. Fabian Schoenfeld as having happened at his son's circumcision:"
    Our teacher's view was that nowadays there is no need for metzitzah at all, like the Tiferes Yisrael's view in the Mishnah [sic!] (see the Sedei Hemed for a long treatment of this).


    Sorry, I don't remember where I saw this now, but apparently R. Schachter corrected that to say that the Rav didn't insist on Metzitzah B'Feh/Peh, but did require Metzitzah as you might expect. Where I saw it, it wasn't one of these apologetic, history-cleansing explanations; it was a true correction. Someone will give the specifics, or I'll dig it up at some point.

    ReplyDelete
  2. My prior comment doesn't contradict the point of your post, but it may help people avoid other errors.

    ReplyDelete
  3. Not having read the book, I am curious whether Rav Meiselman applies the same rules to all of the other medicine mentioned in the Gemara. Gittin 68-69 contains many cures for different ailments. As far as I can tell there is complete agreement from the Geonim, through Rishonim and to the Acharonim (including Rav Shlomo Zalman) that one should NOT use these cures (though there is variation as to why. E.g. Geonim claim that Chazal had no knowledge of medicine and were simply saying contemporary wisdom. Rav Shlomo Zalman says that they did know medicine and their cures work, but we cannot use them because we are not sure of the terms which they use).
    Does Rav Meiselman recognise that we should not use the other cures mentioned in the Gemara? If so, why does he insist on this one. Or would he claim that all of the cures are effective and should be used (and if so, does he give medical advice based on this)?

    ReplyDelete
  4. I have no doubt that you are correct that R' Meiselman is referred to direct oral suction. But there are, indeed, those who claim that metzizah is simply not required at all. Was it you who added the "sic" and note in that quote? Because it's not so ridiculous to believe that. Quite the contrary, in fact.

    ReplyDelete
  5. Rabbi Sedley - regarding the other medical cures of Chazal, Rabbi Meiselman insists that the reasons for not using them are because we don't understand them and/or nishtaneh hateva. He claims that nobody, not even the Geonim, claimed that they are medical errors, and he adds that to say so would be considered "mocking the words of the Chachomim."

    ReplyDelete
  6. If any of Rav Meiselman's talmidim are reading this, perhaps they could direct him to Otzar HaGeonim (Levin) on Gittin 68b where it says:

    צריכין אנן למימר לכון דרבנן לאו אסותא אינון ומילין בעלמא דחזונין בזמניהון... ולאו דברי מצוה אינון הילכך לא תסמכון על אלין אסותא.
    We must say to you that the Rabbis were not doctors, and [they were reporting] concepts that they saw in their times... and they are not words of mitzvah, therefore one should not rely on these remedies.


    This sounds fairly explicit to me. Of course there are many others who say either that nature has changed, or that they we no longer know what these cures are. But does Rav Meiselman actually deny the Geonim said what they said? Or is Otzar HaGeonim a forgery?

    Also, (excuse my ignorance here) how do we know that metziza be-peh actually means that literally, if we do not know what the other remedies/medicines of the Gemara mean? And/or perhaps nishtane hateva regarding metzitza (this is not only a question on Rav Meiselman, but on anyone who insists that metzitza bepeh is essential)

    ReplyDelete
  7. Sorry, I don't remember where I saw this now, but apparently R. Schachter corrected that to say that the Rav didn't insist on Metzitzah B'Feh/Peh, but did require Metzitzah as you might expect. Where I saw it, it wasn't one of these apologetic, history-cleansing explanations; it was a true correction. Someone will give the specifics, or I'll dig it up at some point.

    You probably read the article by מ"ש (his wildest one I've read so far) at seforim.blogspot.co.il/2013/01/hakirah-metzitzah-and-more.html

    ReplyDelete
  8. R. Sedley - R. Meiselman claims that the Geonim just mean that we don't know how to apply Chazal's medicine, not that it is mistaken.

    His reconciliation of this with the phrase "Our sages were not doctors" in the Geonin responsum is completely unsatisfactory.

    ReplyDelete
  9. I don't see the problem here.

    All R' Meiselman has to do is to say that his massora from teh Rav is different, that the Rav told him the opposite.

    Then he could say that his massorah is more authoritative, given that he is a relative and had unlimited access.

    Not only that, but just as Rav Meiselman is the only real expert in science and Torah, he is also the only real expert in Rav Soloveitchik.

    ANd, in addition, everyone else is a superficial amateur, driven by a questionable agenda, while he, Meiselman is an objective expert who has no interest other than the truth.

    ReplyDelete
  10. I haven't seen it inside for context, and it seems like a slight push to fit it into the words, but perhaps, where he said:

    "the mohel must suction the wound in a traditionally prescribed manner."

    he means to include indirect oral suction (via a tube), and to the exclusion of indirect non-oral suction (via gauze, which has a drawing effect). and thus does not write out the Chasam Sofer.

    or maybe he is saying that in most cases it must be done in the classic traditional manner, not using a tube.

    just thinking out loud...

    ReplyDelete
  11. As I wrote in the post, his meaning is clear. First, there is the context of the entire discussion - the entire controversy revolves around doing it with the mouth. Second, every reader will assume and understand that this is the intent - if he did not mean metzitzah b'peh, he would have to say so. Third, the phrase "traditionally prescribed manner" does not leave any room for doubt regarding his intentions.

    ReplyDelete
  12. I spoke to Rav Schachter after I read Marc Shapiro's post and he insisted that Rav Soloveitchik did not require metzitzah at all (he mentioned the Sdei Chemed to me when I asked him how Rav Soloveitchik could say such a thing).

    When I mentioned Marc Shapiro's post to him, he said one or two of the Rav's talmudim in Israel insisted that the Rav never said metzizah is unnecessary, so Rav Schachter added a footnote to this effect in the next edition of Nefesh Harav. However, Rav Schachter in his conversation with me was insistent that the Rav, indeed, did not require metzitzah at all.

    ReplyDelete
  13. "Chazal understood the situation better than the physicians."
    The word "situation" is so vague. I can interpret it so that this statement is true, but I can also interpret it so that it's false.

    ReplyDelete
  14. Are not we supposed to follow the majority? If Jews were deciding what in mesorah is applicable in their time and what is not, hardly Judaism would survive 2K years. Just look at conservative and reform as a proof.

    ReplyDelete
  15. The following comment from Marc Shapiro appears in his post

    I just received this from someone who wishes to remain anonymous. To me it is a real chiddush and shows that R. Schachter was right the first time and didn't need to update his book.

    I am not into writing reactions (Israelis call them "talkbacks") on blogs, since I have not become accustomed to the 21st Century. But I want to give you a bit of information that is relevant to your discussion of Metzitza. I attended Rav Aharon Lichtenstein's shiurim at Gruss for a number of years, and I clearly remember what he said on the subject during what the guys called "a press conference." He said very clearly that the Rav was against any Metzitza at all, and he expressed this view explicitly at the brit of one of Rav Aharon's sons. To me such a view makes lots of sense, if one understands that it is required in the gemara only because it was then thought that the lack of Metzitza was dangerous.(כי לא עביד סכנה הוא (שבת קלג,ב

    ReplyDelete
  16. Re the Rav's shita: Marc Shapiro did in fact write that he thought the Rav did require metzitza, just not oral. But then in the comments he posted something that someone wrote him which indicated that the Rav in fact did not require metzitza at all.
    I have been trying to get some clarity on the Rav's position. So far I have gotten contradictory statements - one boger of Yeshivat Har Etzion who is a mohel said (based on conversation with Rav Lichtenstein) that the Rav did not require metzitza at all, Rabbi Rakefet said that he did.
    Yehuda, who said he spoke to Rav Schechter - can you please email me? yfk1 at yahoo.com

    ReplyDelete
  17. gh500 said...
    Sorry, I don't remember where I saw this now, but apparently R. Schachter corrected that to say that the Rav didn't insist on Metzitzah B'Feh/Peh, but did require Metzitzah as you might expect. Where I saw it, it wasn't one of these apologetic, history-cleansing explanations; it was a true correction. Someone will give the specifics, or I'll dig it up at some point.

    You probably read the article by מ"ש (his wildest one I've read so far) at seforim.blogspot.co.il/2013/01/hakirah-metzitzah-and-more.html


    Yes that was it, thank you for finding the reference.

    Yehudah said...
    I spoke to Rav Schachter after I read Marc Shapiro's post and he insisted that Rav Soloveitchik did not require metzitzah at all (he mentioned the Sdei Chemed to me when I asked him how Rav Soloveitchik could say such a thing).

    When I mentioned Marc Shapiro's post to him, he said one or two of the Rav's talmudim in Israel insisted that the Rav never said metzizah is unnecessary, so Rav Schachter added a footnote to this effect in the next edition of Nefesh Harav. However, Rav Schachter in his conversation with me was insistent that the Rav, indeed, did not require metzitzah at all.


    Prof. Shapiro also claims that the Tiferet Yisrael is misquoted in that section. Did you ask R. Schachter about that as well?

    Personally, I have no idea what the Rav actually said or thought, but I agree with Prof Shapiro's surprise that he could have said that we can simply dispense with metzitzah. Even if are fully invested in the notion that metzitzah was added for medical purposes (as the Gemara implies) and that there is no longer a medical purpose (if there ever was one), this doesn't imply that it would we would just discard it. It has been part of the Bris process for too long for us to just say that we can ignore it; that just isn't how the religion works. At the very least, it is possible that in the intervening years, the process has acquired a religious significance as a Minhag despite it's origins in medicine.

    So I can see how he could have said that the original reason doesn't compel us any more, but I would be surprised that he would simply discard it.

    But reality is not determined by what is surprising to me.

    ReplyDelete
  18. "...like the Tiferes Yisrael's view in the Mishnah [sic!]"

    Seems to me that the "sic" was inserted because the statement makes it sound like the Tiferes Yisrael's comment appears in the text of the Mishnah itself, as if he were a Tanna.

    ReplyDelete
  19. The Chasam Sofer is clear that suction is not necessary and squeezing with gauze is sufficient.

    ReplyDelete
  20. forgot to add:

    forcefully. So also do Radak and R. Ibn Ezra explain, ibid. If so, we need to draw the blood
    from the distant points by whatever method, and one may trust the experts regarding which
    method is as effective as drawing with the lips. Furthermore, I declare that even if it had
    been stated explicitly in the Gemara “Draw with the mouth,” nevertheless this is not part of
    what validates the circumcision, it is rather for the purpose of medical danger. If one
    circumcised and uncovered the corona but did not squeeze out the blood, he has already
    completed performing the commandment; the child may eat Terumah, and his father may
    arrange the Pascal sacrifice. It is just that the child remains in danger until one takes
    measures to extract the blood from distant points. In the Chapter R. Eliezer de-Milah
    (Shabbat 134b) R. Pappa deduces similarly that a bandage and cumin are necessary to
    prevent danger. This applies to meẓiẓah as well. Now as to the bandage and the cumin—we
    do not use cumin at all, nor the particular bandage mentioned in the Gemara by Abaya and
    Rava. Thus we see that since it is only for therapeutic purposes we need not be concerned if
    doctors devise other methods in their stead. The same applies to meẓiẓah. Even if the
    Mishnah had mentioned that meẓiẓah is performed with the mouth we would still be able to
    substitute something similar. However, they should exhort the expert doctors to testify
    truthfully whether the sponge has the same effect as meẓiẓah with the mouth. More than this,
    according to my humble opinion, we need not be concerned. May Hashem heal you and
    strengthen you—in accordance with the wishes of your precious soul and the wishes of your
    devoted friend who desires your constant well-being.
    Moshe ha-Katan Sofer of Frankfort-on-the-Main

    ReplyDelete
  21. I just received this from someone who wishes to remain anonymous. To me it is a real chiddush and shows that R. Schachter was right the first time and didn't need to update his book.

    I am not into writing reactions (Israelis call them "talkbacks") on blogs, since I have not become accustomed to the 21st Century. But I want to give you a bit of information that is relevant to your discussion of Metzitza. I attended Rav Aharon Lichtenstein's shiurim at Gruss for a number of years, and I clearly remember what he said on the subject during what the guys called "a press conference." He said very clearly that the Rav was against any Metzitza at all, and he expressed this view explicitly at the brit of one of Rav Aharon's sons. To me such a view makes lots of sense, if one understands that it is required in the gemara only because it was then thought that the lack of Metzitza was dangerous.(כי לא עביד סכנה הוא (שבת קלג,ב


    This report strains credulity. On what basis would the Rav have been "against" Metzitzah? This goes beyond R. Schachter's "no need" for Metzitzah, which is completely understandable on a theoretical basis.

    On further thought, there are lots of potential pathways for confusion on this issue. Suppose that a Posek states the following orally: "Since the Gemara implied Metzitzah is a medical issue only, and Metzitzah does not appear to provide medical benefit, it is not really needed. Therefore, since we see that Metzitzah B'Peh introduces some danger, no one should perform Metzitzah B'Peh".

    A listener who is not being precise could say "he is against Metzitzah". A more precise listener could say "we don't need to do Metzitzah any more". But even this second listener may be going beyond what is really meant. Just because something is not longer really required "M'Ikar HaDin" doesn't mean that we would stop doing it. The statement of "not needed" was in the context of a train of reasoning and itself not a practical conclusion.

    I'm not asserting that is what happened here; I'm just demonstrating how you can easily get a bunch of different messages out of the same source.

    ReplyDelete
  22. The Teferet Yisrael does require metzita. But only because it seems he thought there were doctors on both sides of the issue. He questions the practice. I don't know that he would still require it, but I understand the [sic].

    ReplyDelete
  23. David Ohsie wrote:
    Even if are fully invested in the notion that metzitzah was added for medical purposes (as the Gemara implies) and that there is no longer a medical purpose (if there ever was one), this doesn't imply that it would we would just discard it. It has been part of the Bris process for too long for us to just say that we can ignore it; that just isn't how the religion works.


    Here's from R' DR. Avrohom Steinberg's אינציקלופדיה הלכתית רפואית ע' שינויי טבע accesible @ yeshiva.org.il/wiki/index.php?title=השתנות_הטבעים


    אם רופא אחד אומר שאין סכנה נגד מה שחז"ל קבעו לא סומכים עליו, אבל אם הוא דבר מוסכם אצל כל הרופאים שאין סכנה, אז סומכים על הרופאים[206]

    Footnote 206:
    ^ הגרי"ש אלישיב, הובאו דבריו בס' שמירת הגוף והנפש, ח"א, מבוא סופ"ו. ומה שיש להקשות על דבריו, שיהא מותר לבטל את המציצה, שכן כל הרופאים סבורים כיום, שאין במניעתה משום סכנה, ואדרבה ייתכן שיהא בזה סכנה של זיהום, י"ל ששיטתו כאותם הסבורים שעיקר טעם המציצה איננו משום סכנה, אלא מטעמים אחרים. וראה ע' מילה, הע' 281 ואילך.

    Rav Elyashiv in the above source was regarding to Magen Avrohom OC או"ח קע"ג regarding eating fish w meat, and still the MA didn't say it's binding because of Minhag, but then even he seems inconclusive ע"ש.

    ReplyDelete
  24. David Ohsie, you wrote:

    "Therefore, since we see that Metzitzah B'Peh introduces some danger, no one should perform Metzitzah B'Peh". "

    But then you also wrote:


    "A listener who is not being precise could say "he is against Metzitzah".


    No, that listener was precise because your person said, "no one should perform it"
    "No one should perform it" means he's against it. There is no way in this world for that exhortation to mean he is in favor of it.

    A more precise listener could say "we don't need to do Metzitzah any more". But even this second listener may be going beyond what is really meant. Just because something is not longer really required "M'Ikar HaDin" doesn't mean that we would stop doing it.
    Your hypothetical person didn't say " it's not necessary" or "not required mIkar haDin." He said, "No one should do it." You are changing the meaning of the words and language in general to say that the person wasn't against it. Your second listener is in accurate, but for the opposite reason you suggest. Saying it's "not needed mIkar haDin" does not accurately convey the message your person gave, which was "Don't do it!"

    ReplyDelete
  25. David Ohsie wrote:
    Even if are fully invested in the notion that metzitzah was added for medical purposes (as the Gemara implies) and that there is no longer a medical purpose (if there ever was one), this doesn't imply that it would we would just discard it. It has been part of the Bris process for too long for us to just say that we can ignore it; that just isn't how the religion works.


    Here's from R' DR. Avrohom Steinberg's אינציקלופדיה הלכתית רפואית ע' שינויי טבע accesible @ yeshiva.org.il/wiki/index.php?title=השתנות_הטבעים


    אם רופא אחד אומר שאין סכנה נגד מה שחז"ל קבעו לא סומכים עליו, אבל אם הוא דבר מוסכם אצל כל הרופאים שאין סכנה, אז סומכים על הרופאים[206]

    Footnote 206:
    ^ הגרי"ש אלישיב, הובאו דבריו בס' שמירת הגוף והנפש, ח"א, מבוא סופ"ו. ומה שיש להקשות על דבריו, שיהא מותר לבטל את המציצה, שכן כל הרופאים סבורים כיום, שאין במניעתה משום סכנה, ואדרבה ייתכן שיהא בזה סכנה של זיהום, י"ל ששיטתו כאותם הסבורים שעיקר טעם המציצה איננו משום סכנה, אלא מטעמים אחרים. וראה ע' מילה, הע' 281 ואילך.

    Rav Elyashiv in the above source was regarding to Magen Avrohom OC או"ח קע"ג regarding eating fish w meat, and still the MA didn't say it's binding because of Minhag, but then even he seems inconclusive ע"ש.


    Thank you for this source.

    There is a distinction between the two cases, IMO. The fish and meat issue (besides being over-extended by people to extreme lengths) is a purely medical issue. If you were convinced that it was not dangerous, then you might stop be concerned about it (I'm personally not concerned about it). It is not part of the process of any Mitzvah. I believe that are plenty of Poskim who will say that you need not worry about this today.

    The Metzitzah has been part of the Milah process, and so getting rid of it, even if we think that the original reason is Batel, is more of an issue, which is why many Poskim will go against Metzitzah B'Peh, but getting rid of Metzitzah altogether is something you don't see in practice, even if it makes some sense in theory.

    The question in the footnote, is slightly different. While he says "ומה שיש להקשות על דבריו, שיהא מותר לבטל את המציצה", in his actual description, he mentions "ואדרבה ייתכן שיהא בזה סכנה של זיהום". So it appears that he is really asking about Metzitzah B'Peh, not "plain" Metzitzah with a tube or sponge. This is a really a contradiction, because if you believe the doctors, then you should make an affirmative change to get rid of the oral suction to avoid the danger. So he says that R. Elyashiv must hold that it is part of the Mitzvah (if I'm reading it right and he required "B'Peh").

    If someone simply maintained that 1) You can eat meat and fish, but 2) You should do Metzitzah with a tube, I don't think that this would be a contradiction to begin with.

    I have no proof of my position, nor much evidence, but I believe that it is true that many will leave off the various stringencies due to health like meat and fish and the various stringencies about washing in the morning, but almost no one (or no one) will just say get rid of Metzitzah completely.

    ReplyDelete
  26. arguer said...
    David Ohsie, you wrote:

    "Therefore, since we see that Metzitzah B'Peh introduces some danger, no one should perform Metzitzah B'Peh". "

    But then you also wrote:


    "A listener who is not being precise could say "he is against Metzitzah".

    No, that listener was precise because your person said, "no one should perform it"
    "No one should perform it" means he's against it. There is no way in this world for that exhortation to mean he is in favor of it.


    You are proving my point :). In my hypothetical, the Posek said not to do "Metzitzah B'Peh". The listener transformed it into "don't do Metzitzah", because he also heard that part of the reasoning was that "Metzitzah" is not needed for it's original purpose, or he didn't listen carefully enough.


    A more precise listener could say "we don't need to do Metzitzah any more". But even this second listener may be going beyond what is really meant. Just because something is not longer really required "M'Ikar HaDin" doesn't mean that we would stop doing it.

    Your hypothetical person didn't say " it's not necessary" or "not required mIkar haDin." He said, "No one should do it."


    As above, he was talking about Metzitzah B'Peh, when he said "don't do it".

    You are changing the meaning of the words and language in general to say that the person wasn't against it. Your second listener is in accurate, but for the opposite reason you suggest. Saying it's "not needed mIkar haDin" does not accurately convey the message your person gave, which was "Don't do it!"

    Again, he said don't do Metzitzah B'Peh and that Metzitzah "Stam" seemed to be no longer necessary.

    But thank you for providing some evidence that my theory might be true :).

    ReplyDelete
  27. Meat and fish is not mentioned by Rambam, and he was a doctor. Based on this, and other evidence (such as gentiles eating meat and fish without injury) the Rishonim already discuss the applicability of this law. Conversely, some people extend it to include fish and milk, based on (what the Shach says is) a typo in the Beit Yosef.
    However, Rambam (who was a doctor) explicitly mentioned metzitza (hilchot mila 2:2) and as far as I know, (and which David Ohsie implied) was never challenged by the Rishonim.
    For this reason it seems to me that it is not unreasonable (from a lamdus point of view) to eat meat and milk and yet require metzitza bepeh

    ReplyDelete
    Replies
    1. I am sure you mean to write in your last paragraph "meat and fish", not "meat and milk."

      Delete
  28. Dear gh500,

    Do you know if this source available online?

    Rav Elyashiv in the above source was regarding to Magen Avrohom OC או"ח קע"ג regarding eating fish w meat, and still the MA didn't say it's binding because of Minhag, but then even he seems inconclusive ע"ש.

    ReplyDelete
  29. While your point is about R' Miesalman and Metzitza B'peh, I want to comment that Metzitza B'peh has been the target of a scandal, which does not mean it is dangerous. MBP in it self is not dangerous, if a infected individual is careless and does not cleans his mouth and performs MBP, then it may pose a danger. But to vilify the practice on a media scandal, is very irresponsible. Also Chazal say "Maavirim oso" on someone who does not perform it, so obviously it is very important. Also have you looked into the rational of MBP from a medical perspective, that you are dismiss it?

    ReplyDelete
  30. Rabbi Sedley said...
    Meat and fish is not mentioned by Rambam, and he was a doctor. Based on this, and other evidence (such as gentiles eating meat and fish without injury) the Rishonim already discuss the applicability of this law. Conversely, some people extend it to include fish and milk, based on (what the Shach says is) a typo in the Beit Yosef.
    However, Rambam (who was a doctor) explicitly mentioned metzitza (hilchot mila 2:2) and as far as I know, (and which David Ohsie implied) was never challenged by the Rishonim.
    For this reason it seems to me that it is not unreasonable (from a lamdus point of view) to eat meat and milk and yet require metzitza bepeh


    R. Sedley, you are right that this is another possible distinction.

    However, I highly doubt that anyone that was not careful about fish and meat would allow Metzitza B'Peh, since if they take the modern view seriously enough to allow fish and meat, they would certainly not allow the risk of Metzitzah B'Peh. I do think it likely though that they would likely still require Metzitzah with a tube or sponge or somesuch to avoid changing Milah too drastically for no important reason.

    So I easily see the following combinations:

    1) Eat Meat + Fish & Metzitzah with tube
    2) No Meat + Fish & Metzitzah with tube
    3) No Meat + Fish & Metzitzah B'Peh

    Again, my hunches are not particularly good evidence. A survey of Poskim would be the right methodology here.

    ReplyDelete
  31. That strikes me as a romantic approach to Jewish practice. Might it be that he viewed it in halachic categories. If it wasn't part of the mitzvah but was driven by medical beliefs, then why do am unnecessary act,which in and of itself has no halachic value? So would, or might, go the thought. Especially since non oral suction is a fairly recent innovation, not something with thousands of years behind it, which came on the scene only because of a belief that some suction was halachically required

    ReplyDelete
  32. That strikes me as a romantic approach to Jewish practice. Might it be that he viewed it in halachic categories. If it wasn't part of the mitzvah but was driven by medical beliefs, then why do am unnecessary act,which in and of itself has no halachic value? So would, or might, go the thought.

    I agree 100% with the reasoning, or possible reasoning. But there is a long way from that to "We need to stop doing Metzitzah" which seemed to be the implication of some of the testimony here. That said, if the Rav really said it or believed it, then he did.

    I don't think that it's romantic to say the following: "Metzitzah is not really needed, but changing it is the kind of thing that would cause a lot of unnecessary conflict for little gain.". Or "Metzitzah is not really needed, but it has become part of the way we do the Mitzvah, and I don't want to give the impression that we just change our practices because we don't feel they match modern sensibilities". Or whatever other things that a Posek considers beyond the theory. I don't think that this is a "Romantic" view.

    Especially since non oral suction is a fairly recent innovation, not something with thousands of years behind it, which came on the scene only because of a belief that some suction was halachically required

    Maybe it came about because of a belief that it was halachically required, or maybe it came about because there was a concern to avoid introducing too radical of a change, or to distinguish ourselves from the Reform movement, or any of the considerations that I mentioned above. If so, then it would make sense to continue settling on that, even if, in theory, we could just dispense with the practice.

    ReplyDelete
  33. I agree with Rabbi Sedley. If you are going to require Metzitzah B'Peh, you might as well eat milk with meat.

    ReplyDelete
  34. Didi Brook said...
    While your point is about R' Miesalman and Metzitza B'peh, I want to comment that Metzitza B'peh has been the target of a scandal, which does not mean it is dangerous.


    I think that we all understand that putting your mouth on an infants open wound is not a sound health practice. So if you are doing it as a health practice, then it is counterproductive and then really makes no sense to be part of the Milah.

    Now that we have ways of detecting rarer and rarer bad outcomes, and we are careful about risks that would not have made sense at earlier times when infant mortality was so much higher, it is clear that this is a bad practice from a medical point of view.

    An rare actual case of Nishtanu Hativim, if you will.

    MBP in it self is not dangerous, if a infected individual is careless and does not cleans his mouth and performs MBP, then it may pose a danger.

    Except that we really don't have enough evidence to know that this would be effective, and you can have a subclinical infection, and the Mohel can make an error.

    Also, you are also assuming the status quo. What happens when, God forbid, we get a slightly different strain of some virus that infects much more easily.

    But to vilify the practice on a media scandal, is very irresponsible.

    No vilification, it's just not a good idea medically.

    Also Chazal say "Maavirim oso" on someone who does not perform it, so obviously it is very important.

    The Gemara also explains very clearly that reason is Sakanah, and if not for Sakanah, it would not be Docheh Shabbos.

    Also have you looked into the rational of MBP from a medical perspective, that you are dismiss it?

    Yes, this has been looked into. We have known for a long time that it is a good idea to keep a sterile field around an open wound.

    There are those that think that this is part of the Mitzvah and must be done B'Peh, and therefore we must do the Mitzvah and take a small risk. That is at least sound reasoning given the premises.

    To say that we have been doing it all these years, and therefore, it is totally safe and it's just all those evil media folks stirring things up, is to succumb to biased reasoning.

    ReplyDelete
  35. oops. Typo. I meant (of course) fish with meat. How ironic.

    ReplyDelete
  36. Do you know if this source available online?

    Sorry about the delay.

    I couldn't find one but i'll try to post a copy.

    However, I'm not sure why just the juxtaposition of Metzitzah to a Mitzvah would differentiate it from meat w fish.

    ReplyDelete
  37. However, I'm not sure why just the juxtaposition of Metzitzah to a Mitzvah would differentiate it from meat w fish.

    As I mentioned, it is merely a theory, but I mentioned some reasons why it might be different in prior posts. My evidence is that you simply don't find poskim that just dismiss Metzitzah altogether in practice, although it might make sense in theory. Again, I could be wrong about that, but that is what Prof. Shapiro seemed to indicate in his post.

    ReplyDelete
  38. For those who wish to rely on metzitza b'peh, couldn't mohelim be required to be tested for herpes on a monthly basis? Could a pathologist or epidemiologist give his/her two cents and let us know if monthly testing would be adequate?

    ReplyDelete
  39. G. Berry said...
    For those who wish to rely on metzitza b'peh, couldn't mohelim be required to be tested for herpes on a monthly basis? Could a pathologist or epidemiologist give his/her two cents and let us know if monthly testing would be adequate?


    I'm not a physician, but according to the articles by physicians on the "con" side that I've read, the answer is no. Since I'm not a physician, please take this with a grain of salt:

    1) Once you are infected with the virus, you have it for life. Testing doesn't help, because a very high percentage of people will test positive for the antibodies because a very high percentage of people are infected.

    2) You don't have to be symptomatic to shed the virus. (The defenders of the practice claim that this has only been proven for genital herpes).

    3) Generally speaking, transmission of herpes is one kind of known negative result. We have no idea if in the past or future other infections were or could be transmitted. It is never going to be the case that this is good medical practice. So if you are agin it, you are agin it.

    Those on the pro side who are willing to accept the risks (or they deny the risks) do have some kind of proposed protocol (not involving testing, I don't think) based on symptoms and cleaning out the mouth. So if you insist on the practice, it is probably better to ask the Mohel about what he does to try to reduce the chances of transmission than to not ask about this.

    ReplyDelete
  40. G. Berry - Absolutely not. Herpes simplex type 1 is a common infection affecting over 90% of adults by age 40. Once present, it persists for life. It is most commonly asymptomatic and may be shed intermittently, even in the absence of symptoms. Spot checks would be of no use as a negative test at one time has no bearing on shedding at another time.

    ReplyDelete
  41. Thanks for clarifying. I kbow there are some viruses/diseases that remain in one's system for life. But can a test not reveal whether the illness is active or dormant if one is asymptomatic?

    ReplyDelete
  42. G. Berry -
    No, the virus is shed intermittently even in the absence of symptoms. There is no test that would eliminate the risk of transmission.

    David Ohsie -
    There is no protocol for doing MBP that is known to eliminate the risk of HSV transmission. As you correctly noted, lack of symptoms does not preclude shedding. There is no evidence that "cleaning" the mouth prior to MBP reduces the risk of transmission. I'm not sure why asking a mohel without medical training would be of benefit here. If you have a question, ask a non-partial physician or virologist their opinion on this.

    ReplyDelete
  43. There is no protocol for doing MBP that is known to eliminate the risk of HSV transmission. As you correctly noted, lack of symptoms does not preclude shedding. There is no evidence that "cleaning" the mouth prior to MBP reduces the risk of transmission. I'm not sure why asking a mohel without medical training would be of benefit here. If you have a question, ask a non-partial physician

    I don't disagree, but the physicians on the pro side have put together some kind of protocol, probably based in some common sense. If I was going to have Metztzah B'peh done, I probably would at least want some common sense precautions taken, even if they are of unproven effectiveness. I was suggesting that the mohel be asked if he was following such a protocol, not one of his own invention.

    ReplyDelete
  44. David Ohsie -
    The problem is that any protocol used here is made up. There is no real protocol to follow. Asking your mohel is no better than asking your accountant. There is only one infectious diseases physician on the "pro side", a medical daat yachid so to speak, and he is quite nogea ledavar. Ranged against that is the entire medical community including the leading experts in the area of HSV. There is no common sense involved here minei u'bey. It does intrigue me though that the "pro side" would come up with a protocol to prevent something that they so strenuously deny exists.

    ReplyDelete
  45. It does intrigue me though that the "pro side" would come up with a protocol to prevent something that they so strenuously deny exists.

    I have to look back at the Dialogue issue where they discussed this to see where the protocol came from. My memory may be bad.

    But part of the "pro" argument is that since this is a Mitzvah and since were are talking about a "low" risk (just an any Milah implies some reisk), the low risk is minimized, but not considered enough to push off the Mitzvah. So it is not internally inconsistent, if you hold that Metzitah B'Peh is mandated.

    ReplyDelete
  46. Indeed, the argument is that a few dead or brain damaged babies every decade is a worthwhile toll for keeping this chumrah.

    ReplyDelete
  47. Aryeh Baer said...
    Indeed, the argument is that a few dead or brain damaged babies every decade is a worthwhile toll for keeping this chumrah.


    I'm not endorsing the "pro" side, but it is also important not to demagogue the issue. There are small risks to everything. My kids play youth baseball, yet "The Chicago Tribune, while cautioning that no comprehensive account of injuries exists, cited a limited study commissioned by USA Baseball. That review showed that between 1989 to 2010, 18 children younger than high school age died of baseball injuries."

    Milah itself has some small risk. If the HSV risk were not preventable, would you stop doing Milah altogether?

    The reasons that I am on the "anti" side is that it seems clear that Metzitzah is for health purposes, and because I think that the risk, while small, is significant and is being downplayed. But I don't expect the world to adhere to my opinions.

    ReplyDelete
  48. I have to look back at the Dialogue issue where they discussed this to see where the protocol came from. My memory may be bad.

    The copy of Dialogue that I usually consult seems to have gone missing from the Shul, so I can't report back anything now...

    ReplyDelete
  49. I can save you some time. It is based on a part of the now defunct NYS protocol that was instituted in 2006 based on a study done in 2005. The study showed a decrease to zero of recoverable HSV virions after a listerine rinse. The problem with that of course is that no one knows how that translates clinically - ie whether or not that prevents transmission in clinical scenarios. That is why the NYC DOH never accepted the protocol and why NYS subsequently dropped it. My question regarding the MBP cases that we know have occurred since 2006 is whether the wonderful mohelim who were involved utilized this rinse. Either they did and it didn't work or they didn't comply - not sure which would be worse.

    Here is the link to an abstract of the above mentioned article.

    http://www.ncbi.nlm.nih.gov/pubmed/15811049

    Here is a link to the full text of the decision on the lawsuit. A lot of good information there. In particular it shows how the sides stack up - one ID doc with an agenda vs. all the major physician organizations and experts in the area of HSV. It is a worth while read for those interested in the topic.

    http://docs.justia.com/cases/federal/district-courts/new-york/nysdce/1:2012cv07590/402785/52/0.pdf?1357917759

    Please bear in mind, what we are talking about here is not outlawing the practice, but rather requiring consent. I am sure you had to sign a legal waiver for your kids to play in the youth baseball league, no? What I personally would like to see is my co-religionists stepping up to the plate and stopping this of their own volition. The risk is low enough in individual cases that it likely does not warrant a legal ban. However, I would like to believe that human life means enough in Judaism that it would outweigh a chumra. Give whatever argument you would like, but at the end of the day, there are children who are dead because this was done. I doubt their parents consider them statistically insignificant. Neither should we.

    ReplyDelete
  50. The study showed a decrease to zero of recoverable HSV virions after a listerine rinse. The problem with that of course is that no one knows how that translates clinically - ie whether or not that prevents transmission in clinical scenarios. That is why the NYC DOH never accepted the protocol and why NYS subsequently dropped it. My question regarding the MBP cases that we know have occurred since 2006 is whether the wonderful mohelim who were involved utilized this rinse. Either they did and it didn't work or they didn't comply - not sure which would be worse.

    Thank you for that information. I think that this confirms my point, which is that if you are going to have Metzitzah B'Peh done, it may be worthwhile to at least see if the Mohel is following that protocol as there is some theory behind it.

    Please bear in mind, what we are talking about here is not outlawing the practice, but rather requiring consent.

    On the legal issue, I agree that the informed consent is probably a good idea, although I also doubt that it will appreciably dent the number of children affected.

    I am sure you had to sign a legal waiver for your kids to play in the youth baseball league, no?

    I don't have the text in front of me, but while there is a waiver of liability, I don't think that there is "informed consent" language warning of danger of death. But I agree that it is not wrong for Metzitzah B'Peh.

    Give whatever argument you would like, but at the end of the day, there are children who are dead because this was done. I doubt their parents consider them statistically insignificant. Neither should we.

    Everything you said was 100% correct and factual until those last 3 sentences. There are undoubtedly kids dead because of Milah itself. It is not possible for you or I to decide what is important for other people, and yes, we risk our lives and our children's lives through our proxy decisions (at low risk levels) for "important" things all the time.

    ReplyDelete

Comments for this blog are moderated. Please see this post about the comments policy for details. ANONYMOUS COMMENTS WILL NOT BE POSTED - please use either your real name or a pseudonym.