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|Halakhic texts relating to this article:|
|Torah:||Genesis 17:1-14, Leviticus 12:3|
|* Not meant as a definitive ruling. Some observances may be rabbinical, custom or Torah-based.|
|Halakhic texts relating to this article:|
|Torah:||Genesis 17:1-14, Leviticus 12:3|
|* Not meant as a definitive ruling. Some observances may be rabbinical, custom or Torah-based.|
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The brit milah (Hebrew: בְּרִית מִילָה, pronounced [bʁit miˈla]; Ashkenazi pronunciation: [bʁis ˈmilə], "covenant of circumcision"; Yiddish pronunciation: bris [bʀɪs]) is a Jewish religious male circumcision ceremony performed by a mohel on the eighth day of a male infant's life. The brit milah is followed by a celebratory meal (seudat mitzvah).
10 This is My covenant, which ye shall keep, between Me and you and thy seed after thee: every male among you shall be circumcised. 11 And ye shall be circumcised in the flesh of your foreskin; and it shall be a token of a covenant betwixt Me and you. 12 And he that is eight days old shall be circumcised among you, every male throughout your generations, he that is born in the house, or bought with money of any foreigner, that is not of thy seed. 13 He that is born in thy house, and he that is bought with thy money, must needs be circumcised; and My covenant shall be in your flesh for an everlasting covenant. 14 And the uncircumcised male who is not circumcised in the flesh of his foreskin, that soul shall be cut off from his people; he hath broken My covenant.
Also, Leviticus 12:3 provides: "And in the eighth day the flesh of his foreskin shall be circumcised."
According to the Hebrew Bible, it was "a reproach" for an Israelite to be uncircumcised (Joshua 5:9.) The term arelim ("uncircumcised" [plural]) is used opprobriously, denoting the Philistines and other non-Israelites (I Samuel 14:6, 31:4; II Samuel 1:20) and used in conjunction with tameh (unpure) for heathen (Isaiah 52:1). The word arel ("uncircumcised" [singular]) is also employed for "impermeable" (Leviticus 26:41, "their uncircumcised hearts"; compare Jeremiah 9:25; Ezekiel 44:7,9); it is also applied to the first three years' fruit of a tree, which is forbidden (Leviticus 19:23).
However, the Israelites born in the wilderness after the Exodus from Egypt were not circumcised. Joshua 5:2-9, explains, "all the people that came out" of Egypt were circumcised, but those "born in the wilderness" were not. Therefore Joshua, before the celebration of the Passover, had them circumcised at Gilgal specifically before they entered Canaan. Abraham, too, was circumcised when he moved into Canaan.
The prophetic tradition emphasizes that God expects people to be good as well as pious, and that non-Jews will be judged based on their ethical behavior, see Noahide Law. Thus, Jeremiah 9:25-26 says that circumcised and uncircumcised will be punished alike by the Lord; for "all the nations are uncircumcised, and all the house of Israel are uncircumcised in heart."
The penalty of non-observance is kareth (spiritual excision from the Jewish nation), as noted in Genesis 17:1-14. Conversion to Judaism for non-Israelites in Biblical times necessitated circumcision, otherwise one could not partake in the Passover offering (Exodus 12:48). Today, as in the time of Abraham, it is required of converts in Orthodox, Conservative and Reform Judaism. (Genesis 34:14-16).
As found in Genesis 17:1-14, brit milah is considered to be so important that should the eighth day fall on the Sabbath, actions that would normally be forbidden because of the sanctity of the day are permitted in order to fulfill the requirement to circumcise. The Talmud, when discussing the importance of Milah, compares it to being equal to all other mitzvot (commandments) based on the gematria for brit of 612 (Tractate Nedarim 32a).
Covenants in ancient times were sometimes sealed by severing an animal, with the implication that the party who breaks the covenant will suffer a similar fate. In Hebrew, the verb meaning "to seal a covenant" translates literally as "to cut". It is presumed by Jewish scholars that the removal of the foreskin symbolically represents such a sealing of the covenant.
It is customary for the brit to be held in a synagogue, but it can also be held at home or any other suitable location. The brit is performed on the eighth day from the baby's birth, taking into consideration that according to the Jewish calendar, the day begins at the sunset of the day before. If the baby is born on Sunday before sunset, the Brit will be held the following Sunday. However, if the baby is born on Sunday night after sunset, the Brit is on the following Monday. The brit takes place on the eighth day following birth even if that day is Shabbat or a holiday. A brit is traditionally performed in the morning, but it may be performed any time during daylight hours. 
The Talmud explicitly instructs that a boy must not be circumcised if he had two brothers who died due to complications arising from their circumcisions; this may be due to a concern about haemophilia. An Israeli study found a high rate of urinary tract infections if the bandage is left on too long.
If the child is born prematurely or has other serious medical problems, the brit milah will be postponed until the doctors and mohel deem the child strong enough.
Most prominent acharonim rule that the mitzvah of brit milah lies in the pain it causes, and anesthetic, sedation, or ointment should generally not be used. Eliezer Waldenberg, Yechiel Yaakov Weinberg, Shmuel Wosner, Moshe Feinstein and others agree that the child should not be sedated, although pain relieving ointment may be used under certain conditions; Shmuel Wosner particularly asserts that the act ought to be painful, as per Psalms 44:23. Regarding an adult circumcision, pain is ideal, but not mandatory. In a letter-to-the-editor published in the January 3, 1998, NY Times, Moshe David Tendler disagrees with the above and writes "It is a biblical prohibition to cause anyone unnecessary pain". He recommends the use of an analgesic cream such as Lidocaine, even though it has been implicated in several pediatric near-death episodes. 
The title of kvater (male) or kvaterin (female) among Ashkenazi Jews is for the person who carries the baby from the mother to the father, who in turn carries him to the mohel. This honor is usually given to a couple without children, as a merit or segula (efficacious remedy) that they should have children of their own. The origin of the term may simply be "Gevatter", an archaic German word for godfather, but it is also said to be a Yiddish erroneous combination of the words kavod ("honor" in Hebrew) and tor ("door" in Yiddish), meaning "The person honored by bringing the baby". Another source is a mix of Hebrew and Yiddish meaning 'like the father'.
After the ceremony, a celebratory meal takes place. At the birkat hamazon, additional introductory lines, known as Nodeh Leshimcha, are added. These lines praise God and request the permission of God, the Torah, Kohanim and distinguished people present to proceed with the grace. When the four main blessings are concluded, special ha-Rachaman prayers are recited. They request various blessings by God that include:
At the neonatal stage, the inner preputial epithelium is still linked with the surface of the glans. The mitzvah is executed only when this epithelium is either removed, or permanently peeled back to uncover the glans. On medical circumcisions performed by surgeons, the epithelium is removed along with the foreskin, to prevent post operative penile adhesion and its complications. However, on ritual circumcisions performed by a mohel, the epithelium is most commonly peeled off only after the foreskin has been amputated. This procedure is called priah (Hebrew: פריעה), which means: 'uncovering'. The main goal of "priah" (also known as "bris periah"), is to remove as much inner layer of the foreskin as possible and prevent the movement of the shaft skin, what creates a final look of what is known as "low and tight" circumcision style.
According to Rabbinic interpretation of traditional Jewish sources, the 'priah' has been performed as part of the Jewish circumcision since the Israelites first inhabited the Land of Israel. However, the Oxford Dictionary of the Jewish Religion, argues that many Hellenistic Jews had an operation performed to conceal the fact of their circumcision, and that similar action was taken during the Hadrianic persecution, in which period a prohibition against circumcision was issued. Thus, hypothesize the editors, it was probably in order to prevent the possibility of obliterating the traces of circumcision that the rabbis added to the requirement of cutting the foreskin that of priah. The frenulum may also be cut away at the same time, in a procedure called frenectomy. According to Shaye J. D. Cohen, in Why Aren't Jewish Women Circumcised?: Gender and Covenant in Judaism, pg 25, the Torah only commands circumcision (milah.) David Gollaher has written that the rabbis added the procedure of priah to discourage men from trying to restore their foreskins: ‘Once established, priah was deemed essential to circumcision; if the mohel failed to cut away enough tissue, the operation was deemed insufficient to comply with God's covenant’ and ‘Depending on the strictness of individual rabbis, boys (or men thought to have been inadequately cut) were subjected to additional operations.’
The guard (top center) is slid over the foreskin as close to the glans as possible to allow for maximum removal of the former without any injury to the latter. The scalpel is used to detach the foreskin, and the underlying blue bag is a sterilization pouch for the metal tools. The tube (center left) was used for metzitzah In addition to milah (the actual circumcision) and p'riah, mentioned above, the Talmud (Mishnah Shabbat 19:2) mentions a third step, metzitzah, translated as suction, as one of the steps involved in the circumcision rite. The Talmud writes that a "Mohel (Circumciser) who does not suck, creates a danger and should be dismissed from practice". Rashi on that Talmudic passage explains that this step is in order to draw some blood from deep inside the wound to prevent danger to the baby, and current medical knowledge confirms the benefits of the practice. There are other modern antiseptic and antibiotic techniques—all used as part of the brit milah today—which many say accomplish the intended purpose of metzitzah, however, since metzitzah is one of the four steps to fulfill Mitzvah, it continues to be practiced by many Orthodox and Hassidic Jews.
The ancient method of performing metzitzah—metzitzah b'peh, or oral suction—has become controversial. The process has the mohel place his mouth directly on the circumcision wound to draw blood away from the cut. The vast majority of Jewish circumcision ceremonies do not use metzitzah b'peh, but some Hasidic Jews use it. It has been documented that the practice poses a serious risk of spreading herpes to the infant. Proponents maintain that there is no conclusive evidence that links herpes to Metzitza, and that attempts to limit this practice infringe on religious freedom.
The practice has become a controversy in both secular and Jewish medical ethics. The ritual of metzitzah is found in Mishnah Shabbat 19:2, which lists it as one of the four steps involved in the circumcision rite. Rabbi Moses Sofer (1762–1839) observed that the Talmud states that the rationale for this part of the ritual was hygienic — i.e., to protect the health of the child. The Chasam Sofer issued a conditional leniency (Heter) to perform metzitzah with a sponge to be used instead of oral suction in a letter to his student, Rabbi Lazar Horowitz of Vienna. This letter was never published among Rabbi Sofer's responsa but rather in the secular journal Kochvei Yitzchok. along with letters from Dr. Wertheimer, the Chief Dr of the Viennese General Hospital, attesting to the fact the mohel was checked several times and never found to have signs of the disease and the ban was requested because of the "possibility of future infections". Moshe Schick (1807–1879), a student of Moses Sofer, states in his book of Responsa, She’eilos u’teshuvos Maharam Schick (Orach Chaim 152,) that Moses Sofer gave the ruling in that specific instance only because the mohel refused to step down and had secular Government connections that prevented his removal in favor of another mohel and the Heter may not be applied elsewhere. He also states (Yoreh Deah 244) that the practice is possibly a Sinaitic tradition, i.e., Halacha l'Moshe m'Sinai.
Chaim Hezekiah Medini, after corresponding with the greatest Jewish sages of the generation, concluded the practice to be Halacha l'Moshe m'Sinai and elaborates on what prompted Moses Sofer to give the above ruling. He tells the story that a student of Moses Sofer, Lazar Horowitz, Chief Rabbi of Vienna at the time and author of the responsa Yad Elazer, needed the ruling because of a governmental attempt to ban circumcision completely if it included metztitzah b'peh. He therefore asked Sofer to give him permission to do brit milah without metzitzah b’peh. When he presented the defense in secular court, his testimony was erroneously recorded to mean that Sofer stated it as a general ruling. The Rabbinical Council of America, (RCA) which claims to be the largest American organization of Orthodox rabbis, published an article by mohel Dr Yehudi Pesach Shields in its summer 1972 issue of Tradition magazine, calling for the abandonment of Metzitzah b'peh. Since then the RCA has issued an opinion that advocates methods that do not involve contact between the mohel's mouth and the open wound, such as the use of a sterile syringe, thereby eliminating the risk of infection. According to the Chief Rabbinate of Israel and the Edah HaChareidis metzitzah b'peh should still be performed.
The practice of metzitzah b'peh was alleged to pose a serious risk in the transfer of herpes from mohelim to eight Israeli infants, one of whom suffered brain damage. When three New York City infants contracted herpes after metzizah b'peh by one mohel and one of them died, New York authorities took out a restraining order against the mohel requiring use of a sterile glass tube, or pipette. The mohel's attorney argued that the New York Department of Health had not supplied conclusive medical evidence linking his client with the disease. In September 2005, the city withdrew the restraining order and turned the matter over to a rabbinical court. Dr. Thomas Frieden, the Health Commissioner of New York City, wrote, "There exists no reasonable doubt that ‘metzitzah b'peh’ can and has caused neonatal herpes infection....The Health Department recommends that infants being circumcised not undergo metzitzah b'peh." In May 2006, the Department of Health for New York State issued a protocol for the performance of metzitzah b'peh. Dr. Antonia C. Novello, Commissioner of Health for New York State, together with a board of rabbis and doctors, worked, she said, to "allow the practice of metzizah b'peh to continue while still meeting the Department of Health's responsibility to protect the public health."
In three medical papers done in Israel, Canada, and the USA, oral suction following circumcision was suggested as a cause in 11 cases of neonatal herpes. Researchers noted that prior to 1997, neonatal herpes reports in Israel were rare, and that the late incidences were correlated with the mothers not carrying the virus themselves. Rabbi Doctor Mordechai Halperin implicates the "better hygiene and living conditions that prevail among the younger generation", which lowered to 60% the rate of young Israeli Chareidi mothers who carry the virus. He explains that an "absence of antibodies in the mothers’ blood means that their newborn sons received no such antibodies through the placenta, and therefore are vulnerable to infection by HSV-1."
Because of the risk of infection, some rabbinical authorities have ruled that the traditional practice of direct contact should be replaced by using a glass tube between the wound and the mohel's mouth, so there is no direct oral contact. The Rabbinical Council of America, the largest group of Modern Orthodox rabbis, endorses this method. The RCA paper states: "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,...". The sefer Mitzvas Hametzitzah by Rabbi Sinai Schiffer of Baden, Germany, states that he is in possession of letters from 36 major Russian (Lithuanian) rabbis that categorically prohibit Metzitzah with a sponge and require it to be done orally. Among them is Rabbi Chaim Halevi Soloveitchik of Brisk.
In September 2012, the New York Department of Health unanimously ruled that the practice of metztizah b'peh should require informed consent from the parent or guardian of the child undergoing the ritual. Prior to the ruling, several hundred rabbis, including Rabbi David Neiderman, the executive director of the United Jewish Organization of Williamsburg, signed a declaration stating that they would not inform parents of the potential dangers that came with metzitzah b'peh, even if informed consent became law.
In a Motion for preliminary injunction with intend to sue, filed against New York City Department of Health & Mental Hygiene, affidavits by Doctors Awi Federgruen Professor at the Columbia University Graduate School of Business. Brenda Breuer, Director of Epidemiologic Research at the Department of Pain Medicine and Palliative Care at the Beth Israel Medical Center, and an Associate Professor of Clinical Neurology at the Albert Einstein College of Medicine. Daniel S. Berman, Chief of Infectious-Disease at New York Westchester Square Hospital, argues that the study on which the department passed its conclusions is flawed.
A brit milah is more than circumcision, it is a sacred ritual in Judaism, as distinguished from its non-ritual requirement in Islam. One ramification is that the brit is not considered complete unless a drop of blood is actually drawn. The standard medical methods of circumcision through constriction do not meet the requirements of the halakhah for brit milah, because they cause hemostasis, i.e., they stop the flow of blood. Morever, circumcision alone, in the absence of the brit milah ceremony, does not fulfill the requirements of the mitzvah. Therefore, in cases where a Jew who was circumcised outside of a brit milah, an already-circumcised convert, or an aposthetic (born without a foreskin) individual, the mohel draws a symbolic drop of blood (Hebrew: הטפת דם, hatafat-dam)from the penis at the point where the foreskin would have been or was attached.
A Milah L'shem giur is a "Circumcision for the purpose of conversion". In Orthodox Judaism, this procedure is usually done by adoptive parents for adopted boys who are being converted as part of the adoption or by families with young children converting together. The conversion of a minor is valid in both Orthodox and Conservative Judaism until a child reaches the age of majority (13 for a boy, 12 for a girl); at that time the child has the option of renouncing his conversion and Judaism, and the conversion will then be considered retroactively invalid. He must be informed of his right to renounce his conversion if he wishes. If he does not make such a statement, it is accepted that the boy is halakhically Jewish. Orthodox rabbis will generally not convert a non-Jewish child raised by a mother who has not converted to Judaism.
The laws of conversion and conversion-related circumcision in Orthodox Judaism have numerous complications, and authorities recommend that a rabbi be consulted well in advance.
In Conservative Judaism, the Milah l'Shem giur procedure is also performed for a boy whose mother has not converted, but with the intention that the child be raised Jewish. This conversion of a child to Judaism without the conversion of the mother is allowed by Conservative interpretations of halakha. Conservative Rabbis will authorize it only under the condition that the child be raised as a Jew in a single-faith household. Should the mother convert, and if the boy has not yet reached his third birthday, the child may be immersed in the mikveh with the mother, after the mother has already immersed, to become Jewish. If the mother does not convert, the child may be immersed in a mikveh, or body of natural waters, to complete the child's conversion to Judaism. This can be done before the child is even one year old. If the child did not immerse in the mikveh, or the boy was too old, then the child may choose of their own accord to become Jewish at age 13 as a Bar Mitzvah, and complete the conversion then.
Where the procedure was performed but not followed by immersion or other requirements of the conversion procedure (e.g., in Conservative Judaism, where the mother has not converted), if the boy chooses to complete the conversion at Bar Mitzvah, a Milah l'shem giur performed when the boy was an infant removes the obligation to undergo either a full brit milah or hatafat dam brit.
In Of the Special Laws, Book 1, the Jewish philosopher Philo (20 BCE - CE 50) gives six reasons for the practice of circumcision. He attributes four of the reasons to "men of divine spirit and wisdom". These include the idea that circumcision:
Rabbi Saadia Gaon considers something to be 'complete', if it lacks nothing, but also has nothing that is unneeded. He regards the foreskin an unneeded organ that God created in man, and so by amputating it, the man is completed.
Maimonides (Moses ben Maimon "Rambam", CE 1135-1204), who apart from being a great Torah scholar was also a physician and philosopher, argued that circumcision serves as a common bodily sign to members of the same faith. He also asserted that the main purpose of the act is to repress sexual pleasure, with the strongest reason being that it is difficult for a woman to separate from an uncircumcised man with whom she has had sex.
Talmud professor Daniel Boyarin offered two explanations for circumcision. One is that it is a literal inscription on the Jewish body of the name of God in the form of the letter "yud" (from "yesod"). The second is that the act of bleeding represents a feminization of Jewish men, significant in the sense that the covenant represents a marriage between Jews and (a symbolically male) God.
The leaders of Reform Judaism in early nineteenth century Germany at first rejected circumcision, claiming it to be 'barbaric'. Theodor Herzl, the founder of Zionism and associated with the Reform movement, notably refused to allow his son to be circumcised. By 1871, rabbinic leadership in the German Reform Movement reasserted "the supreme importance of circumcision in Judaism", though those who had not been circumcised would continue to be considered as Jews. Although the issue of circumcision of converts continues to be debated, the necessity of Brit Milah for Jewish infant boys has been stressed in every subsequent Reform rabbis manual or guide. Since 1984 Reform Judaism has trained and certified over 300 of their own practicing mohalim in this ritual.
Some contemporary Jews choose not to circumcise their sons. They are assisted by a small number of Reform and Reconstructionist rabbis, and have developed a welcoming ceremony that they call the brit shalom ("Covenant [of] Peace") for such children, also accepted by Humanistic Judaism.
This ceremony of brit shalom is not officially approved of by the Reform or Reconstructionist rabbinical organizations, who make the recommendation that male infants should be circumcised, though the issue of converts remains controversial and circumcision of converts is not mandatory in either movement.
However, the connection of the Reform movement to an anti-circumcision, pro-symbolic stance is a historical one. From the early days of the movement in Germany, some classical Reformers hoped to replace ritual circumcision "with a symbolic act, as has been done for other bloody practices, such as the sacrifices." As a result, many European Jewish fathers during the nineteenth century chose not to circumcise their sons, including Theodore Herzl. In the US, an official Reform resolution in 1893 abolished circumcision for converts, and this ambivalence towards the practice has carried over to classical-minded Reform Jews today. In Elyse Wechterman's essay A Plea for Inclusion, she argues that, even in the absence of circumcision, committed Jews should never be turned away, especially by a movement "where no other ritual observance is mandated". She goes on to advocate for an alternate covenant ceremony, brit atifah, for both boys and girls as a welcoming ritual into Judaism. With a continuing negativity towards circumcision still present within a minority of modern-day Reform, Judaic scholar Jon Levenson has warned that if they "continue to judge brit milah to be not only medically unnecessary but also brutalizing and mutilating...the abhorrence of it expressed by some early Reform leaders will return with a vengeance", proclaiming that circumcision will be "the latest front in the battle over the Jewish future in America."
In Israel, a small number of families who have chosen not to have their sons circumcised formed a support group in the year 2000. Over two and a half years, 200 couples have enlisted. According to the Leadership Conference of Secular and Humanistic Jews, "circumcision is not required for Jewish identity."
circumcised but did not perform priah, it is as if he did not circumcise.The Jerusalem Talmud there adds: "and is punished kareth!"
The mohel brings the baby’s organ into his mouth immediately after the excision of the foreskin and sucks blood from it vigorously. This action lowers the internal pressure in the tissues of the organ, in the blood vessels of the head of the organ and in the exposed ends of the arterioles that have just been cut. Thus, the difference between the pressure in the blood vessels in the base of the organ and the pressure in the blood vessels at its tip is increased. This requirement has deep religious significance as well as medical benefits....Immediately after incising or injuring an artery, the arterial walls contract and obstruct, or at least reduce, the flow of blood. Since the arterioles of the orlah, or the foreskin, branch off from the dorsal arteries (the arteries of the upper side of the organ), cutting away the foreskin can result in a temporary obstruction in these dorsal arteries. This temporary obstruction, caused by arterial muscle contraction, continues to develop into a more enduring blockage as the stationary blood begins to clot. The tragic result can be severe hypoxia (deprivation of the supply of blood and oxygen) of the glans penis.28 If the arterial obstruction becomes more permanent, gangrene follows; the baby may lose his glans, and it may even become a life-threatening situation. Such cases have been known to occur. Only by immediately clearing the blockage can one prevent such clotting from happening. Performing metzitzah immediately after circumcision lowers the internal pressure within the tissues and blood vessels of the glans, thus raising the pressure gradient between the blood vessels at the base of the organ and the blood vessels at its distal end—the glans as well as the excised arterioles of the foreskin, which branch off of the dorsal arteries. This increase in pressure gradient (by a factor of four to six!) can resolve an acute temporary blockage and restore blood flow to the glans, thus significantly reducing both the danger of immediate, acute hypoxia and the danger of developing a permanent obstruction by means of coagulation. How do we know when a temporary blockage has successfully been averted? When the “blood in the further reaches [i.e., the proximal dorsal artery] is extracted,” as Rambam has stated.
The poskim consulted by the RCA agree that the normative halacha permits using a glass tube, and that it is proper for mohalim to do so given the health issues involved.
Metzizah b’peh — loosely translated as oral suction — is the part of the circumcision ceremony where the mohel removes the blood from the baby’s member; these days the removal of the blood is usually done using a sterilized glass tube, instead of with the mouth, as the Talmud suggests.
The meetings have been extremely helpful to me in understanding the importance of metzizah b'peh to the continuity of Jewish ritual practice, how the procedure is performed, and how we might allow the practice of metzizah b'peh to continue while still meeting the Department of Health's responsibility to protect the public health. I want to reiterate that the welfare of the children of your community is our common goal and that it is not our intent to prohibit metzizah b'peh after circumcision, rather our intent is to suggest measures that would reduce the risk of harm, if there is any, for future circumcisions where metzizah b'peh is the customary procedure and the possibility of an infected mohel may not be ruled out. I know that successful solutions can and will be based on our mutual trust and cooperation.[dead link]
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