Why Do Haredim Do Metzitzah B’Peh, The Dangerous Circumcision-Related Practice That Has Killed And Maimed Babies?
Shmarya Rosenberg • FailedMessiah.com
The Daily Beast has new coverage on metzitzah b’peh (MBP), the direct mouth-to-bleeding-penis sucking done primarily by haredi mohels after they cut off a baby’s foreskin. (The Daily Beast article extensively quotes me and Ben Hirsch from Survivors for Justice.)
For new readers landing here from the Daily Beast, here are two posts that explain what MBP is, the first from the perspective of halakha (Jewish law) and the second from the perspective of medical history and epidemiology.
To properly understand this issue you really have to understand that before approximately 1800 CE, the idea that disease is transmitted by contact with small organisms we can’t see with our naked eyes – germ theory – did not really exist. Instead, illness was thought to come from an imbalance of the body’s four “humors,” yellow bile, black bile, phlegm and blood.
This understanding of the human body and illness originated in ancient Greece, slipped out of fashion somewhat, and then was brought back to the fore by the famous ancient physician Galen, who is considered to be the most accomplished of all ancient medical researchers and was so considered in his time, as well, and was known all over the ancient Near Eastern world, both in areas Greece controlled or influenced and outside it.
To explain this system, let me quote from The Healing Hand — Man and Wound in the Ancient World, by Guido Majno (as quoted by Shlomo Sprecher in Mezizah be-Peh: Therapeutic Touch or Hippocratic Vestige?):
The Greek physicians studied disease primarily by giving it a lot of thought [as opposed to observation]. The result was an overall, synthetic, but wholly imaginary theory of disease, in which the basic disturbance, and therefore the treatment, was always of the same kind, even in the case of a wound. The reasoning went about as follows. In nature everything is balanced. “Too much” or “too little” causes an imbalance, which is disease. The actual components of the body that may go out of balance are the celebrated four humors: blood, phlegm, yellow bile, and black bile. In the normal body these humors are harmoniously mixed; disease ensues if they are mixed in the wrong proportions, or if they become unmixed …[A]ny pain or lump could be explained as a “distemper” or disharmony of the blend…[B]lood was regarded as the worst offender, because it was liable to spill out easily and therefore to “stagnate.” This was supposed to be dangerous, because one of the key propositions in Greek medicine maintained that stagnating blood will decay…and in decaying, it might even become pus…the parts around the wound will develop spasms, attract blood, become soaked with it, and decay. The beauty of this thought (corruption originates around the wound), however wrong it may sound today, is that it shows how the Greeks struggled to explain the mechanism of what we call infection—or in their terms, corruption. They could have no idea that the cause was something [micro-organisms] deposited on the surface of the wound. Therefore, using their principle that “stagnating blood decays,” they rationalized that the trouble had to arise all around the wound: blood was attracted there, and turned into pus. This thought is stated or hinted at may times in the Collection [Hippocratic Corpus]; for instance, “all wounds draw their inflammation and swelling from the surrounding parts, because of the blood flowing into them. In every recent wound…it is expedient to cause blood to flow from it abundantly, for thus will the wound and the adjacent parts be less attacked with inflammation …when the blood flows they become drier and less in size, as being thus dried up. Indeed what prevents the healing…is the decay of the blood.”
To heal wounds, physicians who relied on what became known as Galen’s theory thought that blood had to be drawn from the furthest parts of the body out through the wound to prevent blood “stagnation” which could lead to pus formation and we today know as an infection. And the way to achieve this was though suction.
Galen died sometime between 200 CE and 216 CE – exactly at the time of the codification of the Mishna, essentially the first code of Jewish law ever written and the foundation of the Talmud, which would be codified 550 to 750 years later.
The almost every other leaders in the known world at that time, the sages of the Mishna relied on Galen’s theory. Therefore they required that some form of metzitza – suction – be done after the baby’s foreskin was cut off to prevent danger to the baby.
While they did not specify how that suction was to be done, in practice often the only available ways to suction were the mouth or some type of absorbent cloth used to “draw” the blood out by absorption.
Because oral suction – MBP – was faster and drew out much more blood, it became the preferred method of suction.
Galen’s theory was the gold standard of medicine until the early- to mid-1800s, and therefore MBP was the gold standard of suction for mohels (Jewish ritual circumcisers) until then.
What changed that?
As germ theory began to be proposed and accepted in the medical community, doctors suddenly began to view MBP differently.
Before germ theory, infant mortality in and outside the Jewish community was appallingly high. Babies were expected to die. The minimum pre-modern infant mortality rate was 20% to 30%. When the rate jumped significantly higher inside or outside the Jewish community, it was thought to be caused by miasma (“bad air”) or by God.
When the Plague ravaged Europe, many non-Jews thought the Jews must have poisoned the wells because Jews seemed to be dying in fewer numbers proportionate to population than non-Jews. This perception led to pogroms. But the likely reason for the slightly lower death rate of Jews was that Jews ritually washed their hands before eating each meal containing bread – which in those days essentially meant every meal, because bread was used almost as a utensil, and people ate by scooping up or sopping up food with bread, or drinking it from a bowl if liquid, or holding it in their hands if it was solid, for example, like a bird leg. The ritual hand-washing, instituted by the rabbis of the Mishna to remember what the Kohanim (Jewish priests) did in the Jerusalem Temple, provided some protection from the plague and from other illnesses – although they did not know that when it was instituted. In fact, it wasn’t known by anyone until germ theory was widely proposed and subsequently proved true.
During epidemics in the early 1800s of Jewish babies dying or becoming seriously ill after circumcision, doctors started to tell community rabbis and mohels to stop doing MBP. In locations where the rabbis and mohels listened to the doctors and stopped doing MBP, the epidemics stopped. This helped confirm the validity of germ theory and it saved the lives of many babies.
So why do many haredim still do MBP?
There are two answers to that question, and both have essentially joined to become the haredi rationale for continuing MBP despite the danger it entails:
1. Opposition to non-Orthodox streams of Judaism and to modernity. Haredism is essentially a modern movement formed in opposition to the haskala (Jewish enlightenment) and to the early Reform Movement. Change of any type was strongly opposed by many haredi rabbis, especially hasidic rebbes and non-hasidic haredi rabbis from Hungary and surrounding areas where the Reform Movement and the haskala were strong. Even though the hasidic movement itself was an innovation in Judaism only established less than a half century before, it was founded before Reform and was essentially grandfathered into traditional Judaism which froze all further development in opposition to Reform. It is likely that if germ theory had been discovered and propagated 100 years earlier, no one would be doing MBP today. But because it was discovered and propagated just at the time being a secular Jew or a non-Orthodox Jew became possible and at a time when Jews were able to assimilate into wider society for the first time, and because that was when doctors – many of them secularized Jews – first proposed banning MBP, banning MBP was rejected by these haredi rabbis because it could be viewed as a deviation from the traditional Judaism they claimed to uphold.
2. Kabbalah and hasidut. MBP was given special kabbalistic significance in the late Middle Ages by a tiny handful rabbis. This aberration was picked up by the hasidic movement, which was founded in the late 1700s and which claimed to be based in large part on Kabbalah and on its founder the Ba’al Shem Tov’s own teachings. The Ba’al Shem Tov was an herbalist who acted as a type of native healer and physician in Eastern Europe. A contemporaneous tax record even refers to him as a doctor. But the type of medicine the Ba’al Shem Tov practiced was apparently a combination of native herbalism, spiritual healing and the medicine of his day – which was still based on Galen. If germ theory had been propagated while the Ba’al Shem Tov, who died in 1760, was still alive, would he have urged mohels to stop doing it? We can’t know for sure, but he did adopt a new form of slaughter knife and encourage others to do so, as well, even though many leading rabbis of the day opposed it. But the Ba’al Shem Tov argued that new knife was more humane because it cut better and caused less pain to the animals and wanted it adopted for that reason. That new slaughter knife is the knife used by shochets (Jewish ritual slaughterers) today. So perhaps he would have advocated stopping MBP, as well.
Do today’s haredi rabbis have any right under halakha to put babies at risk unnecessarily? After all, we know germ theory is true. We have extremely powerful microscopes and scanners and 150 years of medical studies, along with loads of empirical evidence, that have proved it true. Antibiotics work (at least until bacteria become resistant to them). Anti-fungal medication works. Anti-viral medication works. We are long past the time when it is possible to legitimately debate whether putting your mouth on a baby’s open wound is safe – it isn’t safe, and we know that with certainty.
So how do haredi rabbis justify doing MBP?
They essentially deny reality in order to uphold the two totems of MBP I mentioned above. They contend that MBP is safe, even though it absolutely is not, and they refuse to entertain what medical science has proven. If they did not do this they would have to admit that the haredi rabbis who fought against banning MBP almost 150 years ago were wrong. That would mean that hundreds of hasidic rebbes would be wrong – an existential threat to a movement that ascribes near-infallibility to their leaders the rebbes. Hungarian non-hasidic Orthodoxy has been highly influenced by the hasidic movement and adopted the hasidic movement’s view of its leadership and applied it in only slightly modified form to its own. Stopping MBP would also be a type of existential threat to it.
Eighty-five years ago, much of non-hasidic Lithuanian haredi Orthodoxy had long since stopped doing MBP. But today it is making somewhat of a comeback, in part because non-hasidic Lithuanian haredi Orthodoxy became influenced by the hasidic movement after the Holocaust, and in part because in past several years, doing MBP has become a sort of gold standard for proving how haredi you truly are. The more haredi you want to appear, the more likely MBP is. After all, resisting the evil city government and its informed request requirement for MBP circumcisions harks back to the original war against the Jewish Enlightenment and the Reform Movement. Haredim believe they are fighting the good fight for their own religious freedom and for the propagation of “authentic” Judaism – even though science, history, fact and empirical evidence all prove them wrong.
This is why MBP is still an issue today.
Why don’t more babies die from MBP-transmitted illness like they did 200 years ago and earlier?
Because today we have Bacitracin, antibiotics and anti-viral medication, and we have IVs and life support.
Modern drugs virtually ended MBP-syphilis transmission, which appears to have been alarmingly common 200 years ago, and most of the other MBP-transmitted infections.
Herpes – which is primarily what is killing and maiming MBP babies now – is widespread today in adults. But that was not true 200 years ago. However, based on reported symptoms, babies clearly got MBP-transmitted herpes 200 years ago and died from it. Today, many of those babies are saved by modern medical science (although it has been proposed but not yet proved that herpes causes “sub-clinical” or undetected cognitive impairment and learning disabilities in many babies).
Absent the existential issues mentioned above, Jewish law would ban MBP outright.
But those existential issues – themselves modern innovations – are not absent, and many haredim will not stop MBP as a result.