[The city estimates that metzitzah b’peh is used in some 3,600 local circumcisions each year. The city’s health department says that, between 2000 and 2011, 11 babies contracted herpes as a result, and 2 of them died. This spring, the Centers for Disease Control and Prevention declared that the procedure created a risk for transmission of herpes and other pathogens and was “not safe.” ]
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A. Romi Cohn washed his mouth with antiseptic before a circumcision
last week. Mr. Cohn has written a textbook on the subject.
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The grandmother carried the sleeping infant boy on a white pillow toward the synagogue’s altar, and passed him to her son. Her son carried the infant toward the mohel, or Jewish ritual circumciser, who stood amid a cluster of chanting men.
The mohel lifted the infant’s clothing to expose his tiny penis. With a rapid flick of a sharp two-sided scalpel, the mohel sliced off the foreskin and held it between his fingers. Then he took a sip of red wine from a cup and bent his head. He placed his lips below the cut, around the base of the baby’s penis, for a split second, creating suction, then let the wine spill from his mouth out over the wound.
“You’re O.K.,” he said to the infant, Benjamin Asher Mortob, who stopped crying after several more seconds. The sanctuary filled with elated prayer.
The mohel, A. Romi Cohn, said he had performed more than 25,000 circumcisions, on babies and adults, in New York City and elsewhere over the last 40 years. When he circumcises an infant, he said, he almost always put his mouth on the baby’s penis to pull blood away from the wound in an ancient part of the circumcision ritual, known in Hebrew as metzitzah b’peh, that is still commonplace in parts of the ultra-Orthodox Jewish community but is rare in other branches of Judaism.
The city estimates that metzitzah b’peh is used in some 3,600 local circumcisions each year. The city’s health department says that, between 2000 and 2011, 11 babies contracted herpes as a result, and 2 of them died. This spring, the Centers for Disease Control and Prevention declared that the procedure created a risk for transmission of herpes and other pathogens and was “not safe.”
So on Thursday, the city’s Board of Health is scheduled to vote on a proposal that would require parents to sign a consent form indicating that they are aware of the risk of herpes transmission when a circumcision procedure, or bris, includes direct oral contact.
The measure, which Mayor Michael R. Bloomberg strongly supports, would probably be the first governmental regulation of the ritual in the United States, rabbis say. It would not affect the way most Jewish ritual circumcisions are performed — gauze or a sterile pipette is used to pull blood from the wound — nor would it ban the practice. But the issue being raised in New York coincides with moves in Denmark, Germany and other countries toward restricting or banning infant circumcision.
Mr. Cohn, 83, said that he would rather go to jail then comply with the consent requirement. While he acknowledged that there were unqualified circumcisers who work without proper health testing and training, he said he believed that the ritual was completely safe when performed by him or another practitioner certified by an association of circumcisers; he is the chairman of the group.
“If you follow strictly the ritual, there will be no harm to the baby,” he said. A circumcision, he added, “is a joyous occasion — nothing traumatic about it.”
And Benjamin Asher’s father, Isaac Mortob, 27, said his family had sought out Mr. Cohn in part because he did the procedure in the traditional way, including the oral suction. “I don’t want a 99 percent job, I want a 100 percent job,” he said. “I want him” — his firstborn son — “to be fully Jewish.”
But city health officials say the mohel’s safeguards, which include rinsing with Listerine before the procedure, sterilizing tools, scrubbing hands with surgical soap and being tested annually for pathogens, are insufficient.
The main virus that worries the city is oral herpes, which is present in some 70 percent of the city’s adult population and can cause fatal infections in babies. Highly contagious, it is spread through contact with infected saliva, even by sharing drinks or towels.
“There is no safe way to perform oral suction on an open wound in a newborn,” said Dr. Jay K. Varma, the city’s deputy commissioner for disease control. If the measure passes, he said, circumcisers who do not comply could face warning letters or fines.
Ultra-Orthodox leaders plan to sue the city if the regulation is passed, arguing that the measure would constitute an unconstitutional infringement on their religious freedom. Some 200 ultra-Orthodox rabbis published a decree in late August warning adherents that it was forbidden “to participate in the evil plans of the New York City health department,” according to a translation by Yeshiva World News. And a Jewish religious court in Crown Heights, Brooklyn, went further, stating that oral suction was a mandatory part of the procedure that should be promoted.
“There is nothing to worry from metzitzah b’peh,” the judges wrote, according to a translation by the Chabad Lubavitch movement. “To the contrary, it is very beneficial, even according to the doctors.”
But other Jewish leaders disagree.
Rabbi Gerald C. Skolnik, the president of the Rabbinical Assembly, the international association of conservative rabbis, said he supported the Board of Health’s move to require parental consent. He said that direct suction was not required by Jewish law and that the serious risks of the practice were “inconsistent with the Jewish tradition’s pre-eminent concern with human life and health.”
In 2005, the Rabbinical Council of America, the main union of modern Orthodox rabbis, urged that a sterile glass tube be used for suction, rather than the mohel’s mouth. But the group opposes the city’s effort to regulate the practice; instead it has asked the city to work with Orthodox groups “to voluntarily develop procedures to effectively prevent the unintended spread of infection.”
Mr. Cohn, a Holocaust survivor and retired real estate developer who lives on Staten Island, has written a textbook on circumcision. He said he had trained some 80 mohels over the years. After each circumcision, he places the thimble-size foreskin in a small jar of sand and ground cloves that he carries. He wants one day to be buried with the jars at the Mount of Olives in Israel, where Jewish tradition says the Messiah will arrive.
When he stands with a prayer shawl over his head awaiting the babies — he sometimes does three or four a day — he looks out into congregations filled with men he has circumcised; sometimes grandfathers, fathers and sons in the same family. Because he is performing a religious obligation, his services are free. Never, he said, had there been an infection.
But not everyone involved always knows there is oral suction included in the bris — or that herpes can be transmitted by contact with infected saliva.
Benjamin Asher’s grandmother, Sara Mor, who had carried him carefully up to the altar last week at the Sephardic Synagogue on Avenue S in Brooklyn, said she had not heard of it, though she has four sons.
“I never watch it, I’m scared to watch it,” she said of the circumcisions. “I don’t know what they are doing there.”
And in Brooklyn last week, at a bris so fancy with glittering dresses and Louboutin heels that it looked like a wedding, Danielle Alfaks, 22, said she had found out two days earlier that the mohel would put his mouth over the wound of her 8-day-old son, Eli. “That’s freaky, for me,” she said at a brunch reception after the circumcision at Congregation Shaare Zion on Ocean Avenue. But she added she would sign a consent form if asked.
Eli’s uncle, Mourdi Alfaks, 32, held him as Mr. Cohn performed the procedure. “He’s the greatest mohel who ever lived in history,” he said. He would not sign a consent form, he said, because “it makes no sense.”
Earlier that morning, Eli’s father, Albert Alfaks, 29, wiped a tear from his eye as he handed Mr. Cohn the scalpel, echoing Abraham’s circumcision of his son, Isaac, in the Bible.
Of the mohel, he said, “I guess I feel like if that’s what he has to do, God bless him.”
