New York, NY – With a swift swipe of his scalpel, Rabbi A. Romi Cohn circumcises the baby boy, then leans down and sucks the blood from the wound as prayers in Hebrew fill the Brooklyn synagogue.
Join our WhatsApp groupSubscribe to our Daily Roundup Email
The Orthodox Jewish tradition known as oral suction circumcision reaches back to biblical times but it has created a modern-day dilemma for New York City health officials, who have linked it to 17 cases of infant herpes since 2000. Two died and two others suffered brain damage.
Mayor Bill de Blasio’s administration, which came into power a year ago with a promise to reconsider an existing regulation on the ritual, is now negotiating with a group of rabbis over how to protect children’s health while still preserving religious freedom.
“The talks are ongoing but I cannot go into particulars,” said Avi Fink, the mayor’s deputy director of intergovernmental affairs who has been leading the talks. “Our goal is to achieve awareness of the risks.”
Such oral suction circumcisions are relatively rare, even in New York City, which is home to more than a million Jews — the largest Jewish population outside Israel. City health officials estimate more than 3,000 babies are circumcised each year using the oral suction method — formally called metzitzah b’peh in Hebrew.
A 2012 report by the federal Centers for Disease Control and Prevention advised against the practice, saying it increases the risk of herpes infection in baby boys by 3.4 times that of other male newborns.
Oral suction circumcisions first came under scrutiny during Mayor Michael Bloomberg’s administration, and the city’s health board voted in 2012 to regulate the practice by asking a parent or guardian to sign a consent form indicating possible risks.
Health officials point to a number of factors they say have linked the known cases to the ritual. They look for lesions on the genitalia, indicating that’s where the virus started. In addition, lab tests have showed that the timing of the infection coincides with the circumcision.
Two cases were recorded after oral suction in 2013 and four last year. In the most recent case, diagnosed in November, a baby boy was found to have lesions on his penis. But of those six cases, parents refused to identify the person who performed the circumcision — called a mohel — in four.
In the two cases in which the circumcisers were identified, both declined to be tested, the Health Department said. They were banned from performing the ritual.
The consent forms remain the regulatory standard for now, but most ultra-Orthodox rabbis have told their faithful not to comply, and the city acknowledges it does not collect them unless there is suspicion of herpes.
Cohn, an 85-year-old Holocaust survivor and native of what today is called Slovakia, is chairman of the American Board of Ritual Circumcision, which has certified 90 mohels, says he doubts the oral suction method had anything to do with spreading herpes. Cohn believes the infants may have been infected by the mother or another source.
“They’re wild accusations without any basis,” Cohn said. “I’ve done 35,000 circumcisions and never had an infection, of any kind.”
The rabbi does warn parents that circumcision, in general, has its risks, just like any medical procedure. His association mandates herpes testing and rinsing with mouthwash before the ceremony, in addition to scrubbing and sterilizing hands.
The rabbi followed those precautions one morning at Brooklyn’s Congregation Shaare Zion, where he circumcised week-old Yosef Sananas.
Cohn first administered a topical anesthetic, wrapping gauze around the child’s legs to isolate the sterilized area. Then the baby, on a white pillow, was carried into the main worship space.
Invited guests watched as Cohn did what he’s done thousands of other times.
“He’s the best mohel in New York,” says the boy’s mother, Becky Sananas. “We chose him because we trust him.”
While New York City wrestles with the issue, suburban Rockland County — itself home to thousands of Orthodox Jews — seems to have found a solution.
For any suspected case after circumcision, county health officials use DNA testing to try to link a baby with the source of infection. Since the county introduced the protocol in 2013, three infant boys were diagnosed with herpes; the DNA of two mohels did not match the boys’ and the third test was inconclusive.
Members of the Jewish community participate voluntarily in the process, working with Dr. Oscar Alleyne, Rockland’s director of epidemiology.
“That proves that they trust us,” Alleyne said. “We have cooperation, along with a scientific approach.”
HIV (Aids), and Hepatitis C are messages from Hashem. Why can’t people see that these Herpes cases are also messages to change the method of Metzitza?
So much Yiddehse DENIAL in this article it’s mamash sickening. Any baby who is injured as a result of this outdated oral suctioning, is the fault of the parents who allowed their baby to be abused in such a way and should go to prison.
Great idea. Have the Mohalim test or some other screening every three months. But Im not sure. Im curious, any doctor here knows? If someone had in past herpes in mouth will it show later on a blood test? My 2 cents: if you have herpes coming soon or open herpes now and you continue to practice you are an achzar. Just some general info people dont know: Symptoms that people dont know: before herpes comes back to lips it iches quite bad. It can be prevented from popping out completelly by smearing zovirax then when only itching and not yet out. I couldnt tell you about inside the mouth. I dont know warning signs on that. These instructions came from a skin doctor in Israel to a patient. Zovirax can be prescribed in advanced to keep home for before the flare up. Even if you have an insurance that doesnt cover it, sorry my friend, pay because it’s the best. (I wonder if geting a PA – a doctors prior approval – makes the Insurance pay)
With all due respect to this mohl, 85 is too old to do this type of delicate operation.
I am as frum orthodox and Chasidic as a anybody and still and all I cant see why they should not be tested
I’m all for metzisa bepeh . But we need to make sure our mohalim use the proper protection. Is that mouthwash a good enough cleanser ? We need to have a proper and strict protocol that EVERY mohel must follow.
Shulchan Aruch does not accept statistical analysis in Hilchos Milah: Ee Efshar Le-hachazir Nefesh Achas Mi-Yisrael! This Rami Cohen lies when misquoting normative Poskim and has now settled in with supportive Hungarian Poskim. This fighting back and forth, all under the banner of protecting us from government encroachment on Shmiras Ha-Mitzvos (sic), has spoiled the good name of Mohalim. I suspect that never have so many less observant mothers opted out of Bris Milah as a direct result of the primitive and unsanitary image that Cohen and his ilk have created for Mohaalim. Real Poskim who have absolutely recognized the threat of disease transmission by Metzizah and allowed alternate methods to rplace oral contact include Ha-Rav Shimshon Refael Hirsch Zt’l, The Chasam SoferZt’l (and you can see the original T’shuvah in the British Museum and it does not say Ho-raas Sha-ah nor would the text support such Shtus),Reb Chaim (MiBrisk) Zt’l, The Chofetz Chaim (in Hilchos Shabbos in the Mishnah B’ruraH)Zt’l, etc, etc, etc. Time to STOP the Ka-naus and instill Yiras Shomayim.
What all the people who want to ban part of our Yiddeshe Mesorah (Including the commenters above) need to ask themselves is this;
If MbP causes HsV, why have there only been 17 cases in 14 years, when the practice, according to the board of health, takes place around 3,600 times a year? That means in 3/100ths of one percent (or one in every 2,900 cases of MbP) the child comes down with HsV.
In those cases, it’s never been proven to come from the Mohel. In fact, in Rockland, as the article states, in over 66% of cases of HsV that presented on the genitals of a baby that underwent MbP, the Mohel was explicitly ruled out! So the so-called “enlightened” jews who want to ban this part of our mesorah, have no scientific leg to stand on.
Patients pick up MRSA and other dangerous infections in hospital every day, where they supposedly sterilize and disinfect everything. Where is the outcry about that? People love to bash anything related to religion, especially Jewish traditions, which they decided are “outdated”.
An infant can pick up herpes, strep and a variety of other infections from the mother or in the hospital.