New York – A Mohel Raises Again The Issue Of ‘Metzitzah B’peh’ Practices

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    file photoNew York – Relative to other surgeries, bris milah is a simple procedure, with a surprisingly low risk rate. At the same time, an incision, an open wound and the removal of skin tissue necessitate precautions which will minimize danger to the child. The parents and the mohel must be on the same page on this latter point.

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    In an operating room, a surgeon takes many precautions to minimize the chance of bacterial infection reaching the patient. Mohels should be held to these same standards when operating on infant boys. It is understood, of course, that the public nature of the ceremony makes complete sterility an impossibility. Nonetheless, we are a far cry from where standards should be.

    The sterility litmus test can be broken down to five components: how instruments are sterilized, how they are laid out for bris use, how the mohel cleans his hands, whether sterile gloves are worn when dealing with the open wound and how metzitzah is done.

    Surgeons sterilize packaged instruments in a machine at 273° Fahrenheit, and avoid opening the “sterility guaranteed” package until surgery time. Mohels should do the same. Cold sterilization in a solution or in rubbing alcohol is less than ideal, and the five minute soaking some mohels employ before the bris is substandard. It may produce a nice alcohol aroma, but real cold sterilization requires hours of soaking to be completely effective.
    Instruments laid out on a freshly laundered diaper cloth may be quite comfortable, but they have lost any claim of sterility. A pre-packaged sterile drape is easily accessible and should be standard for every mohel to use.

    A mohel who washes his hands and is careful not to shake others’ hands should be commended. But when he adjusts his pants, head-covering, lab coat or tallis, not to mention his instrument bag or a bottle of wine while laying out instruments, he has negated any previous hand washing.

    Some mohels will operate with bare hands “sterilized” by alcohol or Purell. Nice as this is, touching the pillow, baby, sandak, and baby’s diaper make previous efforts meaningless. Additionally, it is virtually impossible to completely clean under the fingernails, unless (with a big ‘perhaps’) the mohel soaks in a chlorinated pool for 20 minutes immediately before the bris. This is an uncommon practice.

    Mohels should be required to wear sterile gloves, donned immediately before touching sterile instruments and the sterile field of the bris. If it is time consuming, he can wear two pairs, removing the outer pair immediately prior to beginning. Non-sterile gloves are a step up from “no gloves,” but they are still less than ideal.

    “Metzitzah” is defined as drawing “deeper” blood from the circumcision spot, which some view as a medical necessity while others view it, based on modern medical knowledge, as a ritualistic remnant of what may have once been deemed a medical requirement (Shabbat 133a-b).

    Over time the idea of doing metzitzah with the power of the mouth was introduced, which is defined in two ways: either put a mouth directly on the wound, or use the power of the mouth through a sterile pipette. The latter avoids direct contact and the sharing of body fluids between mohel and baby.

    Both are halachically sanctioned, while only one meets the approval of any unbiased modern medical sensibility. Arguments such as “saliva heals” and “one’s first instinct is to suck a cut on your finger” are irrelevant to the case of a mohel’s mouth touching a fresh wound in a newborn.

    Any parent who insists that metzitzah be done with direct oral contact should do the metzitzah himself.

    Maimonides writes, “It is impossible to restore the lost life of a Jewish child” (Milah 1:18). While he says this to allow delaying a bris on a child who is not physically ready, certainly the same dictum should be followed when circumcising a child: no step in the bris procedure should allow the slightest possibility that its inclusion can open the door to giving the baby an infection.

    It is our responsibility and right to demand the best for our children. For the sake of the health of our children, let us begin with insistence that the bris maintains the highest standards of sterility.
    High standards of sterility for a bris

    When the following precautions are taken, the possibility of infection is reduced to the smallest percentage.

    * All instruments, drapes and bandages are completely sterile
    * The sandak, who holds the baby during the bris, does not touch the baby directly. Baby’s legs are covered with a blanket or wrapped with a conform bandage.
    * Mohel wears sterile gloves for the bris and every time he touches the baby’s open wound thereafter
    * When metzitzah is done, there is no direct bodily contact between mohel and baby
    * No one who is ill participates in the bris ceremony
    * Those who care for the wound after the bris wash hands with soap and water before opening the diaper
    * After bandage is removed, anti-infection ointment, such as bacitracin, is applied to the healing wound for a few days

    Rabbi Avi Billet has been a mohel for 10 years.


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    88 Comments
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    Yossi
    Yossi
    15 years ago

    Here we go again, another obscene fighter against our holy traditions (by one of our own!).

    Why can’t these “rabbis” leave this for the anti-semite human rights idiots in the government?

    Actually, even the government doesn’t seem to have a problem with it anymore, so WHAT THE HELL is this idiot pandering about?!?!?!?!?!?!?!?!

    robroy560
    robroy560
    15 years ago

    All I know is this rabbi and mohel performed the mitzvah on my nephew. He was great and raises some great issues and caution. Pay attention to him.

    Anonymous
    Anonymous
    15 years ago

    they r making very good points has nothing to do with anti-semites. they r informing that the bris should b clean the person who is doing it should b careful that he is doing a bris on a newborn their bodys can’t fight off infections as easly as a adult or child. the rabbis should b thanked that they r looking to b so careful with ones newborn baby boy.

    Anonymous
    Anonymous
    15 years ago

    Everthing which he said we hassidic people do; except, the wearing gloves and mtsisa bkala that cant be changed because of tradition only if it would be 100% direct sacana.

    Hatzolah
    Hatzolah
    15 years ago

    Great, another anti-metzitza guy. Anyone who thinks medical science knows everything is way off. Anyone who has the slightest medical knowledge knows that medical procedures are constantly changed and revised. Just look at how many times they changed CPR, a basic thing, in the past ten years.

    grandma
    grandma
    15 years ago

    There is nothing in Jewish tradition against sterilizing instruments and wearing gloves. Germs today are smarter than people.

    Anonymous
    Anonymous
    15 years ago

    Unfortunatly for Rabbi Billet, whoi has been a Mohel for 10 years, his practice is rather small compared to other Mohels. Perhaps, he believes, this is his opportunity to become popular.

    Zach Kessin
    Zach Kessin
    15 years ago

    If an autoclave unit is not available to sterilize equipment a standard kitchen pressure cooker will do a good job. 5 minutes at 15psi and any bacteria will be quite dead.

    Lets not welcome new members into our family with avoidable infections, PLEASE

    I hate blood
    I hate blood
    15 years ago

    Better he says it than PETA..(even if his last name is Billet)

    Baruch
    Baruch
    15 years ago

    It all sounds fine and well until one considers the clear proof from hundreds of generations and millions of brisim that his extra stringencies are not necessary. I often wonder about what prompts such musings? What are the motives? Is it simple ignorance of history, the embellishments of a showman or some emergent need to over-inflate the importance of a profession? Never the less, taking additional precautions to prevent harm to the child is admirable until it trespasses into the area of halacha.

    Dag
    Dag
    15 years ago

    He is 100% right. The only issue of contorversy here IS MBP. He doesn’t say that people can not do it, if they feel it is neccesarry, he says that they should do it themslelves as opposed to the Mohel.

    Anonymous
    Anonymous
    15 years ago

    This is typical of a NON-Frum Mohel. I am not saying the writer is not frum, I am saying it is the typical remark of the non frum.

    First of all, did YOU ever try to use a scalpel with gloves on?
    Personally, I would rather have the feel of bare hands, along with the extrememly slight risk on infection. Better to need an antibiotic than have an accident because of poor “feel” due to the gloves. Yes, I know surgeons use gloves all the time. But their training and experience is different. Plus they have no choice. They also do it for their own protection.

    Secondly, Metzitza needs to be directly with the mouth, according to many poskim. Yes, today, with the risk of HIV there are many rabbonim who are allowing an intermediate tool. I do not like the pipette, as suction is only applied to blood which has already left the body. If one has the NEED to use an intermediate tool, better to use a hypodermic syringe “body”… in other words, a syringe, with the plunger and needle end removed. What you have left, if you choose the correct size, can go right over the bris, and the needle end can be used to draw suction, resulting in metzitziz “almost” b’Peh. I still prefer all the way b’Peh, but those who insist on something inbetween, or when there is, chas v’sholom a NEED to use something inbetween, this works fine. Of course, once you know the correct size on the syringe, use the disposable ones, and maintain sterility.

    All the other things he mentions are good, and are usually done pretty well.

    Sure, there are some imperfections. But we have such an almost perfect record of no problems from the bris, that I believe our statistics speak for themselves.

    I believe the mohels have a better record statistically than the doctors performing this in the hospital.

    But, there is certainly much good in this letter.
    It is certainly good that the mohel use a disposable sterile “cloth” or Paper to rest his instruments on.
    Best to use a disposable scalpel.
    If you forgo those shields, you don’t need to worry about sterilizing them. I believe they are not good anyway. They are mostly to make the family happy, as a skilled mohel really does not need one, and they create problems (ask the mohel about this).

    There is no reason not to use disposables all the way.

    And, many mohels get everything “READY” including tying their tallis and gartels, etc., to be secure, and then with everything laid out and “ready to go” wash their hands again.

    But, bottom line, in the Chassidish world we do it the old fashioned way, and have fewer problems than the doctors in the hospitals. And, certainly better records than the “Modern” mohels.

    Brisman Says
    Brisman Says
    15 years ago

    The Rabbi/Mohel did not attack anyone for doing a Bris the way they want to do it. He did not critique mouth to organ contact. He made some helpful suggestions for those to whom they are relevant. Using a suction cup is more sterile than direct oral contact for those who worry about sterility. Using a suction cup is halachically considered metzitzah ba’peh by most poskim. This mohel does a lechatchila bris. He does not use a clamp like some mohalim. All of his equipment is sterilized by the highest medical standards.

    Anonymous
    Anonymous
    15 years ago

    Can somebody explain how Perioh can be done with gloves on? Are we better than the troika mentioned in the Medrosh “Yehoshua Mol, Elozor Poreia UPinchos Motzeitz”?

    Concerned Member
    Concerned Member
    15 years ago

    How is advocating for the health of a baby “fighting against our holy traditions”???

    Is he wrong about the gloves too? Is he wrong about the sterile instruments? I expect no less from my dentist, why shouldn’t I expect as much from someone performing a procedure on my infant?

    Stop throwing around ridiculous statements. He’s done nothing wrong and in the end his efforts will protect our children.

    I’ll go with the guy with the sterile instruments, thank you. You can stick with someone who thinks that wiping it down with a towel is enough to sterilize.

    Anonymous
    Anonymous
    15 years ago

    Does any of you realize that the risk of infection in a newborn includes encephalitis–that means BRAIN DAMAGE, DEATH, PERMANENT DISABILITY!??!?!?!

    Anonymous
    Anonymous
    15 years ago

    There is a reason why a few of you think the writer is an anti_semite, because you don’t like to be clean. the word steerile creeps you out.

    number one, some mohels are gay, how come we cnt get an evalutation for their gayness so that a child isn’t gay.

    number two there has been a small percentage of babies who have died from a brit mila and the mohel wasn’t charged with neglegaance!?

    Anonymous
    Anonymous
    15 years ago

    The only mohel who objects to this artical is one that no one should use. He is risking your child life and therefore it is osser to use him.

    medic
    medic
    15 years ago

    Being an active Hatzolah member for many years I’ve come across many instances of infection following surgery and procedures that were done in first class hospitals, but not once did I even hear of a new born with an infection due to a bris.

    Anonymous
    Anonymous
    15 years ago

    All those who are saying precautions aren’t necessary forget the case about four or five years ago when an infant died after a “traditional” bris from a herpes simplex infection that was inavertently transmitted by the mohel. Herpes simplex is the virus that causes cold sores – most adults are carriers. It is harmless in adults and older children but in rare cases can kill a baby or, as the prior commentor noted can cause encephalitis and brain damage.

    Would you let your child have a tooth pulled by a dentist who didn’t wear gloves, didn’t use properly sterilized equipment and used his mouth to remove the blood?

    Doctor
    Doctor
    15 years ago

    How many babys have acutally died because of me metziza bpeh? that they are making such a big deal out of it?. If they would start doing precedures based on these stats, then Docs would probably not have much to do!.

    Kogan
    Kogan
    15 years ago

    The risks are not significant enough to institute the mandatory changes for everybody. Boruch Hashem we do not hear a huge amount of problems after brisim. This is with many performed by different mohelim in different places. I have ka”h 4 sons and have a medical background and I do want a metzitzah baal peh. My mohelim all washed sandok’s hands with alcohol and washed their hands with alcohol. Which could be even better than gloves. They used sterile bandages and had instructions for aftercare to prevent bacterial infection.

    I believe that the metzizah option should be left up to the parents. Those that don’t want it will surely find a mohel who will not do it and vice versa. No need to globaly ban or enforce it.

    Anonymous
    Anonymous
    15 years ago

    go back to sleep thousands were done the right way and it won’t chane with tendler or without

    Anonymous
    Anonymous
    15 years ago

    This fight has been ongoing for the last 200 years between the reformers who didn’t want metzitza bpeh, and All the gedolim from the Chasam Sofer to R Moshe ZTL who all said that it should be done directly bpeh . See also the sefer bris kerusa lisfasa’im, also in english, which documents this fight.
    Also beware of those mohalim who use the asur clamp, which causes much pain to the infant.

    Concerned Member
    Concerned Member
    15 years ago

    #22 , if you are indeed a Hatzolah member (which I doubt based on your comments) then you would know that one thing that has absolutely NOT changed over the years is the concern against spreading germs. Why do you think the first item on every practical exam is “Body Substance Isolation.” You have taken those exams haven’t you?

    The author of the article is simply suggesting precautions be taken.

    As far as those of you who are saying “we’ve been fine for generations”… well… can you tell me if it’s ok for me to use that statement to explain why you don’t need a water filter to get rid of microscopic organisms that were not visible “for generations” or do we only pull that argument out when it suits us.

    Part of being “frum” is having a responsible outlook on how one conducts one’s life day to day. It sure looks like there’s a lot of that lacking today.

    eddie
    eddie
    15 years ago

    as a mohel can someone please explain to me how to do preia with gloves on unless someone has made gloves with sharp nails!

    science
    science
    15 years ago

    The chazal would be very upset if one would not not follow the latest technology for our well being. They would not want us to follow old technology. For instance the chazal believed that the sun travels above the sky at night; therefore they definitely had to believe that the moon has its own light. Even when they said that the Umois Ho’olom belief that the sun goes under the earth at night is right, this was because of ocean temperture, not because of the light that the moon gets. Rashi in Rosh Hashana daf 24 line 13 says clearly that at night the sun is over the sky. They also believed that all over the world there is only one time zone, as we see when they talk about that at midday the sun is over everyones head, and also regarding when does Hashem keep Shaabos, do all of us follow that Z’man or where we live. Also when do the Malochim say Shira at night, which night.

    Reb Yid
    Reb Yid
    15 years ago

    What’s the infection rate that we’re trying to reduce? If it’s zero, or nearly so, these interventions may not be too effective.

    Yosef Midat Yesod
    Yosef Midat Yesod
    15 years ago

    1. The Bris is the one mitzvah that a Jewish Male has 2/47 seven.
    2. Its the only Ois , sign that we have every day
    3. Its the foundation , yesod
    4. There are big Enyuinim al pi Sod regarding every aspect of the Bris ceremony that correspond to the names of Hashem , particularly metzitza bpeh.
    4. Anyone who attacks this mitzvah should be very careful, they know not what they do, and with what they play with – they place themselves and their family in danger – Hashem Yerachum

    Anonymous
    Anonymous
    15 years ago

    Rabbi Billett is 100% right – you would not want open heart surgery outside a sterile ER by a surgeon who is prepped.

    We live in a time where a Mohel or an infant can spread deadly incurable illness that may be spread unknowingly to many people – all avoidable with small minor halachicly accepted modifications.

    Happy Mom
    Happy Mom
    15 years ago

    Rabbi Billet performed the brisses on my three sons. I couldn’t have asked for a better mentsch of a mohel. Wonderful experience.

    Anonymous
    Anonymous
    15 years ago

    How much did Rabbi Billet pay for this full page infomercial?

    Michoel Zylberstein
    Michoel Zylberstein
    15 years ago

    Here we go again. My friend Avi Billet is mindlessly attacked for what?
    For offering an opinion – which I last heard was something the US allowed individuals to do – about how to preserve and protect babies who undergo a bris.
    No, he is not Reform. No he is not a female mohel. And he certainly does not attack the mitzvah of Bris Milah, as suggested by #41 .
    To the mohel out there wondering about how to do priah with gloves – use very thin “examination gloves.” Or do milah u’priah b’vas achas, as suggested by Rav Hai gaon in the She’iltos, and as sanctioned by Rav Moshe Feinstein and Rav Ovadya Yosef.
    To #11 – There is no difficulty in using a scalpel with gloves. I don’t understand the problem. If there is difficulty in doing a “tefisah” – then make sure the “eiver” is dry before pulling it to cut. It is also helpful to mark the “makom hachituch” in order to know where to cut. This will minimize the chance of cutting off too much skin.

    Medic (#36) – your insights are appreciated, but your statistics are meaningless. I know of six cases (at last count that came to my attention) of babies who were hospitalized, and one who had recurring problems for 2 years(!) on account of the nonsterility of the bris done.
    If any of you want to take up any of the issues presented in this article with Rabbi Avi Billet, you can find his email address with a simple Google search. I know he would love to have the conversation. He’s commented to me on a number of occasions, that he will not respond to anonymous questions – so you will have to (shock!) identify yourself (!).
    As far as those of you who misquote the Chasam Sofer and Rav Moshe, I only wish you would check up your sources inside once in a while. It will only make you more of a talmid chacham, instead of a rambler. Neither did not allow metzitzah through a medium.
    The earliest records of metzitzah being done with the mouth are not 5000 (sic) or even 3000 years old. it is less than 1000 years old.
    Rabbi Billet does not say not to do “metzitzah b’peh” – his opinion is that it should be done “B’peh” – namely, with the “power of the mouth” (which is a valid TRANSLATION of the word “b’peh”, by the way) (Oh My – a different translation – I must be a card-carrying kofer!)

    FINALLY – The gemara in Chulin daf 9 says we should all be trained to do milah. As is, in fact, the mitzvah – for every father to do his son’s bris. So, my friend suggests, as metzitzah is the easiest component of the bris (it actually requires ZERO training to “draw blood through suction”), the father – whose mitzvah it is to DO the bris, should partake. Let HIM share germs with his son, instead of a mohel who has been doing this to other babies all week.

    Mizhoel Z
    ps. the comment about Rabbi Billet having a small milah practice (#20) is the most ridiculous comment, not to mention childish. First of all, just because he doesn’t come to Brooklyn, and YOU’ve never heard of him, doesn’t mean you are right. Secondly, he is highly respected in his community and is quite popular.

    Anonymous
    Anonymous
    15 years ago

    To #45 and #36
    Most people are usually quiet about these things because they don’t want to embarrass themselves or their child.
    To call the mohel into question would be absolute “lashon hara and rechilus” (which some people on this website seem to have no problem justifying in their attacks on Rabbi Billet) while the TRUTH is he should be called to task for the damage he did to a child. Too many ‘bad stories’ are shoved under the table.

    Went to school with Billet
    Went to school with Billet
    15 years ago

    The Modern Orthodox have effectively divorced Hashem from the mitzvos! Our Torah is not subject to change by anyone. Billet is not the first person in history ho has thought that he will protect the mitzvos by making them more safe. The mitzvos are given to us by Hashem and passed down from generation to generation by the chachomim. The Torah has survived many attacks and will outlive billet and his kind. Just as Moses Mendelshon has no Jewish descendants left, the modern “reformists” will also drift away. Avi Billet is the son of Hershel Billet who attacked Rav Aaron Schechter Shlita in an article that was published on this site.
    I would love to hear responses.

    dovy
    dovy
    15 years ago

    The main point here is that this Rabbi/mohel/cantor/whatever guy only seems to be able to write about things that will get him free publicity and exposure. (Slifkin and metztzah next probably will be Lipa and NK). He is clearly an attention defficient, sad soul. Anyway, we oppose all Rabbinic bans, right? So we will oppose bans on metzitzah, as well.

    Nissy
    Nissy
    15 years ago

    I find it very sad that so many responses attack the person rather than the positions taken. Last I checked V’ahavta L’reiacha Kamocha even applies to people with whom we disagree. Bearing in mind that Kol Haposel B’mumo posel there are unfortunately a great number of angry,publicity seekers out there. I know Rabbi Billett as well as his father for many years and while I don’t always agree with them I can attest that their kavanos are l’shem shomayim I also note that many of the same people who refuse to do more hishtadlus for the well being of babies are the saame who don’t hesitate to be melaben p’nei chaveiro b’rabim.

    Dag
    Dag
    15 years ago

    He did NOT say not to do MBP, he said to have the father do it.

    logic
    logic
    15 years ago

    The Chazal would be furiuos if they found out that people touch saliva to open wounds just because doctors in the time Chazal believed that to be beneficial.
    The Chachomim used the latest available medical info in their time, to guide us how to avoid deseases; they did not look back to doctors of a thousand years before their time.

    Anonymous Parent
    Anonymous Parent
    15 years ago

    Rabbi Billet performed the brissim on our two sons (twins). He’s a kind hearted soul and the brissim were wonderful. It’s shameful to hear talk like this.

    Anonymous
    Anonymous
    15 years ago

    how about the father/mother donning sterile gloves while washing/feeding/changing a baby. think about it 😉

    Prove Me Wrong
    Prove Me Wrong
    15 years ago

    Edinburgh Medical Journal 2 (1856-57) #555
    “Syphilitic and cancerous ulcers may also infect the child through the bleeding wound. Rust has related the case of a circumciser who had syphilitic ulcers of the mouth, who infected four children in the manner.”

    Pediatrics, Volume XXXIV, Page 186-190, March 1917
    “Tuberculosis Following ritual Circumcision” by Mark S. Reuben
    “A review of he literature shows that there are 42 cases (including our case) of tuberculosis infection following ritual circumcision. The incidence of such infection must have been greater and many cases have probably not been reported. It seems reasonable to suppose that the same operator (mohel) would probably infect a majority of the infants on whom he performed circumcision…
    In 37 cases the wound was sucked in the usual way; in 3 the wound was sprinkled with wine from the mouth of the operator; in one case a dressing was applied to the wound on which wine from the mouth of the operator was poured on; in our case the wound was aspirated through a glass tube….
    Of the 42 cases reported, 11 recovered, 16 died, and of 15 the final outcome is not known…”

    Earliest reference to Oral MBP in in Rav Yaakov Hagozer (12th century) who writes
    אחר הפריעה מיד מכניס האבר לתוך פיו ומוצץ את הדם בכל כוחו משום שהדם נקרש כפי האמה וסכנה הוא אם אינו מוצץ…

    I challenge anyone to find a legitimate earlier source for MBP orally.
    I challenge anyone to prove that “brisses for millennia” were risk free.
    I submit that until recently infantile deaths were accepted as normal and people did not report them, and things have only changed BECAUSE of modern notions of sterility.

    Even if you study the words I’ve quoted above, you see his definition of MBP is purely medical. And as medical science is different now, his definitions are not relevant.

    As a matter of fact, anyone who believes and follows ancient medical science can not be considered a shomer halakha, and is probably a closet Scientologist, or one of those extreme religious sects (non-Jewish) which does not believe in medicine.

    I’ve brought REAL information. Not speculation. Not hyperbole. Not “my gut feeling” because “I believe be’emunah shleimah that the author of the article is a kofer” but because I believe beemunah shleimah that those who comment on this website and mudsling the good name of a better Jew than all of you combined need to be put in their place.

    I am not arguing there is no place for MBP. Like Rabbi Billet, however, I believe there are two ways to look at things. And you have to remove your blinders. Because the way you have them on, it’s a wonder how you see anything at all.

    Anonymous
    Anonymous
    15 years ago

    I remember Avi Billeet’s father and his grandparents from Sheepshead Bay in the early 70s. They were good upstanding folk.

    Anonymous
    Anonymous
    15 years ago

    >Just as Moses Mendelshon has no Jewish descendants left, the modern “reformists” will also drift away. < Have you ever seen a list of past Gedolim who's children and descendents went totally off the derech and are today even Goyim? I have and it's quite long. My father even recalls Rabbi Abramsky's sons in london becoming top Commie officials.

    haldol prn
    haldol prn
    15 years ago

    Prophylactic antibiotics can also be employed o further reduce risks.

    Oneg Shabbos
    Oneg Shabbos
    15 years ago

    The pressure to do a bris quickly, because the “oilam” is hungry has also proven to be too much for some.

    this is a time to be VERY careful.
    here’s a bracha for those who think that this is anti-Torah Chas v’sholom:

    “Shomer Pesayim HaShem.”
    by the way…. that’s not a compliment.

    Avraham der Mohel
    Avraham der Mohel
    15 years ago

    As a mohel who does mbp, and who knows alot about the story in Monsey, I have to ask, don’t you think it’s a little strange that the mohel who was accused of having been a herpes vector to cause the death (R”L) of 2 children is still practicing as a mohel and still does mbp. He is a talmid chochom and definitely”on the ball” and still continues. The truth is that he was tested and found not to be the one responsible for those tragic deaths.

    I don’t know R’ Billet, but in the sefer Bris Avraham Hakohen, there is a lengthyessay on the inyan of metzitzah bepeh and the teshuvos of R’ Moshe, R’ Eliyashiv and others (who didn’t live in the middle ages, HIV and herpes were known about) and they state that there is still no reason to get rid of this halacha (unless there is a KNOWN risk from the side of the baby or the mohel.)

    For all those “big scientists” who throw around the HIV inyan like they are top doctors, I will let you into a little secret, HIV CANNOT BE TRANSMITTED BY SALIVA, IT IS FROM OTHER BODILY SECRETIONS/LIQUIDS!!!

    With regard to the suggestions made about “compromises” to halacha based on people’s fears:

    I performed the brissen on all of my sons, in the presence of my good friend who is a cardiac surgeon with 25 years experience. He is not completely observant and watched as I prepped myself by using surgical scrub (under the nails aswell), washing my mouth out with chlorhexidine gluconate (a VERY powerful antibacterial mouthwash), the disposable, sterile sheets to put the instruments on. He also watched me perform the brissen without gloves, with metzitzah bepeh. He told me that owing to the minor severity of this procedure, the precautions that I had taken put the baby at minimal risk, and that he wished that pediatricians could perform a circ. with as much speed and skill.

    We have been performing this mitzvah 4000 years in the same way. The fact that there is a “modern orthodox” Rabbi, who thinks that he knows more than Moshe Rabbeinu, the tannaim, amoraim, Geonim, Rishonim and Acharonim with regard to inyanim such as these, seems to be rather arrogant.

    Where are the hard statistics about infection rate and mortality for brissen done by a qualified, traditional mohel????
    Not to put light on a tragic situation, there is no question that 2 deaths (Lo Oleinu) does not constitute a statistical probability to be used to uproot halachos, chas veshalom.

    Another tidbit for all of the armchair quarterbacks, who obviously have little knowledge about halacha or medical inyanim. In halacha, there is a problem doing a mitzvah with a chatzitzah (gloves)!!! And of course there is the issue of periah b’tziporen (uh oh, another excuse to try and outdo the above mentioned halachic authorities!!) being possible with gloves!!!!

    Get an education before you start handing out piskei dinim sitting in front of your computer. Open a sefer and find out what the real issues are.

    P.s. The heter of the Chasam sofer for doing metzitzah bepeh, was a horoas sho’oh, because of a problematic mohel in his town. Of course, if there is a KNOWN problem, then appropriate precautions should be taken.

    Dovid Shatz, Monsey
    Dovid Shatz, Monsey
    15 years ago

    Please reread the three medical papers sugesting a link between MBP and herpes. The papers are not written by Hindus, Pakistanis, Koreans, or Roman Catholic Irishmen, they are written by a closeknit group of modern orthodox doctors all associated with Dr. Moshe Dovid Tendler who has tried to push Chareidi Mohelim out of NYC city hospitals and NYC in general for 40 years beginning with his establishment of the Mt Sinai school of circumcision in 1968 (NYT 3/19/68 p.51) Through his proxy the Brith Milah Board of NY, he excluded mohelim who were not members from NYC hospitals. Members did not do MBP, so you know who this excluded. The medical papers themselves (listed at the end of this comment)do not state the mohel was the source, they merely suggest the possibilty of such a link: WE believe/ has the possibility/ Has the potential/ most likely/ etc. The then avois every standard test that has a possible result differing from their thesis. Asst NYC health commissionor Dr. Julia Schillinger herslef an author of 4 papers on HSV seroprevalance concludes that the Mohel was the source and proceeds to contradict her own sources and her own published papers demonstrating her complete lack of understanding of the disease. Inorder to fins all the cases of neonatal herpes that the orthodox community was hiding, she pushed to have HSV made a reportable disease in NYC, Then she pushed to have NHSV made reportable in NYS. The n she broaden the scope of her investigation to include and additional IDC disease code, the she did a retrospective study covering the whole of NYS going back to 1994, and found NOTHING. In her latest report 2 out of 5 cases of maternally transferred NHSV were HSV-1, 2 out 3 fatalities were HSV-1 (and if they hadn’t been girls you can be sure there would have been another expensive investigation) with an average onset of 9.5 days of life (range 0-49) yet she maintains that HSV-1 and onset at 11-20 days indicates that the mohel is the soiurce. The paper she cites in her 2005 NYC health alert #46 by leading NHSV researcher Dr David Kimberlin says typical onset for SEM NHSV is 10-12 days, and CNS NHSV is 16-19 days, matching all the published cases except one. The second two articles about Israeli and Canadian cases use 1980 United stated HSV statistics in making their assesments, ignoring Israeli and canadian studies which tell a very different story. Dr. Schillinger, an author of 4 papers on the demographics and geography of HSV infection is unmoved by the use of US stats in canadian and Israeli cases. My favorite line in the Pediatrics paper co-authored by Dr Moses Dovid Tendler, is the assertion that the Chasam sofer who died in 1839, being influenced by Dr. Ignacz semmelweis’ 1847 discovery of disease transmission, after a baby got tuberculosis from a mohel (first cases reported 1883) was matir the tube which was invented in 1887. More information will be available shortly.
    Rubin LG, Lanzkowsky P. Cutaneous neonatal herpes simplex infection associated with ritual circumcision.
    Pediatr Infect Dis J. 2000, 19(3): 266-8;
    —–
    Distel R, Hofer V, Bogger-Goren S, Shalit I, Garty BZ.
    Primary genital herpes simplex infection associated with Jewish ritual circumcision.
    Isr Med Assoc J. 2003, 5: 893–894:
    —–
    Gesundheit B, Grisaru-Soen G, Greenberg D, Levtzion-Korach O, Malkin D, Petric M, Koren G, Tendler MD, Ben-Zeev B, Vardi A, Dagan R, Engelhard D.
    Neonatal Genital Herpes Simplex Virus Type 1 Infection After Jewish Ritual Circumcision: Modern Medicine and Religious Tradition.
    Pediatrics. 2004, 114(2):e259-e263
    ——
    Kimberlin DW.
    Neonatal herpes simplex infection.
    Clin Microbiol Rev. 2004 Jan, 17(1): 1-13

    Dovid Shatz
    Dovid Shatz
    15 years ago

    #82 ,
    I wrote comments 80 and 81.
    &#82 12;&#82 12;-
    &#82 20;A. not 100% of brisses are done with MBP. B. Bad stories (though they may be a low percentage) are pushed under the table. C. Your statistics are self-promoting and are not based on any real facts.&#82 21;
    &#82 12;&#82 12;&#82 12;-
    Julia schillinger presented her review on May 10, 2006 of all NYS neonatal HSV disharge records from 1994-2003 at the national STD prevention conference in Jacksonville Fl.
    NYC DoH&#82 17;s Shoshana Handel delivered her dissertation on the first year of mandatory NHSV reporting in NYC, at the international society of STD researchers conference in seattle in 2007. asst commisionors Schillinger and Blank were co-authors. I would not write that Schillinger and Blank are Ignorant, incompetent, inept and derelict in their duty, and then sign my name to it if I wasn&#82 17;t prepared to defend it court, which I fully expect to do.

    Yonasan Gelbtuch
    Yonasan Gelbtuch
    15 years ago

    Sorry Professor Shatz.
    I did not notice your sarcastic tone in 81. Shkoiach