Brit milah

"Isaac's Circumcision", Regensburg Pentateuch, c1300

The origin of circumcision is not known with certainty; however, artistic and literary evidence from ancient Egypt suggests it was practiced in the ancient Near East from at least the Sixth Dynasty (ca. 2345–ca. 2181 BCE).[18] According to some scholars, it appears that it only appeared as a sign of the covenant during the Babylonian Exile.[1][2][3] Scholars who posit the existence of a hypothetical J source (likely composed during the seventh century BCE) of the Pentateuch in Genesis 15 hold that it would not have mentioned a covenant that involves the practice of circumcision. Only in the P source (likely composed during the sixth century BCE) of Genesis 17 does the notion of circumcision become linked to a covenant.[1][2][3][4]

Some scholars have argued that it originated as a replacement for child sacrifice.[2][4][19][20][21]

The 1st-century Jewish author Philo Judaeus defended Jewish circumcision on several grounds. He thought that circumcision should be done as early as possible as it would not be as likely to be done by someone's own free will. He claimed that the foreskin prevented semen from reaching the vagina and so should be done as a way to increase the nation's population. He also noted that circumcision should be performed as an effective means to reduce sexual pleasure.[16][22][23][24]

There was also division in Pharisaic Judaism between Hillel the Elder and Shammai on the issue of circumcision of proselytes.[25]

According to the Gospel of Luke, Jesus was circumcised on the 8th day.[26]

And when eight days were completed for the circumcision of the Child, His name was called Jesus, the name given by the angel before He was conceived in the womb.

According to saying 53 of the Gospel of Thomas, Jesus says:[27][28]

His disciples said to him, "is circumcision useful or not?" He said to them, "If it were useful, their father would produce children already circumcised from their mother. Rather, the true circumcision in spirit has become profitable in every respect."

Due to Jesus having undertaken this ceremony as a Jewish child, memory of this tradition has been preserved in traditional Christian churches according to the Gospel of Luke.[26][31] The Feast of the Circumcision of Christ is kept as a feast eight days after Nativity in a number of churches including the Eastern Orthodox Church, Catholic Church, Lutheran and some Anglican Communion churches.[32] In Orthodox Christian tradition, children are officially named on the eighth day after birth with special naming prayers.[33][34]

Significantly, the tradition of baptism universally replaced circumcision among Christians as the primary rite of passage as found in Paul's Epistle to the Colossians and in Acts of the Apostles.[35]

A mohel is a Jew trained in the practice of brit milah, the "covenant of circumcision." According to traditional Jewish law, in the absence of a grown free Jewish male expert, anyone who has the required skills is also authorized to perform the circumcision, if they are Jewish.[36] Yet, most streams of non-Orthodox Judaism allow female mohels, called mohalot (Hebrew: מוֹהֲלוֹת‎, plural of מוֹהֶלֶת mohelet, feminine of mohel), without restriction. In 1984, Deborah Cohen became the first certified Reform mohelet; she was certified by the Berit Mila program of Reform Judaism.[37]

Circumcision bench, 18th century. Jewish Museum of Switzerland.

Chair of Elijah used during the brit milah ceremony – Musée d'Art et d'Histoire du Judaïsme

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.[38]

Family circumcision set and trunk, ca. eighteenth century Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.

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,[39] and Maimonides says that this excluded paternal half-brothers. This may be due to a concern about hemophilia.[39]

An Israeli study found a high rate of urinary tract infections if the bandage is left on too long.[40]

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 for his foreskin to be surgically removed.

In recent years, the circumcision of adult Jews who were not circumcised as infants has become more common than previously thought.[41] In such cases, the brit milah will be done at the earliest date that can be arranged. The actual circumcision will be private, and other elements of the ceremony (e.g., the celebratory meal) may be modified to accommodate the desires of the one being circumcised.

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.[42] However, it is traditionally common to feed the infant a drop of wine or other sweet liquid to soothe him.[43][44]

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, per Psalms 44:23.[42]

Regarding an adult circumcision, pain is ideal, but not mandatory.

In a letter to the editor published in The New York Times on January 3, 1998, Rabbi Moshe David Tendler disagrees with the above and writes, "It is a biblical prohibition to cause anyone unnecessary pain". Rabbi Tendler recommends the use of an analgesic cream.[45] Lidocaine should not be used, however, because Lidocaine has been linked to several pediatric near-death episodes.[46][47]

The title of kvater 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 is Middle High German gevater/gevatere ("godfather").[48]

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:

1. the parents of the baby, to help them raise him wisely;
2. the sandek (companion of child);
3. the baby boy to have strength and grow up to trust in God and perceive Him three times a year;
4. the mohel for unhesitatingly performing the ritual;
5. to send the Messiah in Judaism speedily in the merit of this mitzvah;
6. to send Elijah the prophet, known as "The Righteous Kohen", so that God's covenant can be fulfilled with the re-establishment of the throne of King David.

Infant after brit

Circumcision cushion, Jewish Museum of Switzerland

At the neonatal stage, the inner preputial epithelium is still linked with the surface of the glans.[49] The mitzvah is executed only when this epithelium is either removed, or permanently peeled back to uncover the glans.[50] On medical circumcisions performed by surgeons, the epithelium is removed along with the foreskin,[51] to prevent post operative penile adhesion and its complications.[52] 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 of the inner layer of the foreskin as possible and prevent the movement of the shaft skin, what creates the look and function of what is known as a "low and tight" circumcision.[13]

According to Rabbinic interpretation of traditional Jewish sources,[53] the 'priah' has been performed as part of the Jewish circumcision since the Israelites first inhabited the Land of Israel.[54] However, the Oxford Dictionary of the Jewish Religion, states that many Hellenistic Jews attempted to restore their foreskins, and that similar action was taken during the Hadrianic persecution, a period in which a prohibition against circumcision was issued. Thus, the writers of the dictionary hypothesize that the more severe method practiced today was probably begun in order to prevent the possibility of restoring the foreskin after circumcision, and therefore the rabbis added the requirement of cutting the foreskin in periah.[55]

The frenulum may also be cut away at the same time, in a procedure called frenectomy.[56] 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.)[57] 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.’[8]

In the Metzitzah (Hebrew: מְצִיצָה‎), the guard 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. A scalpel is used to detach the foreskin. A tube is 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".[58][59] 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.[60] 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 a minority of Orthodox and Hassidic Jews.[61]

The ancient method of performing metzitzah b'peh (Hebrew: מְצִיצָה בְּפֶה‎), or oral suction[62][63]—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,[64] but some Haredi Jews continue to use it.[65][66][67] It has been documented that the practice poses a serious risk of spreading herpes to the infant.[68][69][70][71] Proponents maintain that there is no conclusive evidence that links herpes to Metzitza,[72] and that attempts to limit this practice infringe on religious freedom.[73][74][75]

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 leniency (Heter) that some consider to have been conditional 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.[76] along with letters from Dr. Wertheimer, the chief doctor of the Viennese General Hospital. It relates the story that a mohel (who was suspected of transmitting herpes via metzizah to infants) was checked several times and never found to have signs of the disease and that a ban was requested because of the "possibility of future infections".[77] 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. Other sources contradict this claim, with copies of Moses Sofer's responsa making no mention of the legal case or of his ruling applying in only one situation. Rather, that responsa makes quite clear that "metzizah" was a health measure and should never be employed where there is a health risk to the infant.[78]

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.[79] 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.[80] 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.[81] 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.[65] According to the Chief Rabbinate of Israel[82] and the Edah HaChareidis[83] 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.[68][84] 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.[67][85] The mohel's attorney argued that the New York Department of Health had not supplied conclusive medical evidence linking his client with the disease.[85][86] In September 2005, the city withdrew the restraining order and turned the matter over to a rabbinical court.[87] 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."[88] In May 2006, the Department of Health for New York State issued a protocol for the performance of metzitzah b'peh.[89] 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."[90] Later in New York City in 2012 a 2-week-old baby died of herpes because of metzitzah b'peh.[91]

In three medical papers done in Israel, Canada, and the US, oral suction following circumcision was suggested as a cause in 11 cases of neonatal herpes.[68][92][93] Researchers noted that prior to 1997, neonatal herpes reports in Israel were rare, and that the late incidences were correlated with the mothers carrying the virus themselves.[68] 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."[94]

Because of the risk of infection, some rabbinical authorities have ruled that the traditional practice of direct contact should be replaced by using a sterile 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.[95] 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[96] 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.[97] 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.[98]

In a motion for preliminary injunction with intent to sue, filed against New York City Department of Health & Mental Hygiene, affidavits by Awi Federgruen,[99][100] Brenda Breuer,[101][102] and Daniel S. Berman,[103][104] argued that the study on which the department passed its conclusions is flawed.[105][106][107][108]

The "informed consent" regulation was challenged in court. In January 2013 the U.S. District court ruled that the law did not specifically target religion and therefore must not pass strict scrutiny. The ruling was appealed to the Court of Appeals.[109]

On August 15, 2014 the Second Circuit Court of Appeals reversed the decision by the lower court, and ruled that the regulation does have to be reviewed under strict scrutiny to determine whether it infringes on Orthodox Jews' freedom of religion.[110]

On September 9, 2015 after coming to an agreement with the community The New York City Board of Health voted to repeal the informed consent regulation.[111]

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 are done with hemostasis, i.e., they stop the flow of blood. Moreover, 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.[112]

The desire to control male sexuality has been central to Milah throughout history. Jewish theologians, philosophers, and ethicists have often justified the practice by claiming that the ritual substantially reduces male sexual pleasure and desire.[15][16][22][23][24][117]

The political scientist Thomas Pangle concluded:[15]

As Maimonides — the greatest legal scholar, and also the preeminent medical authority, in traditional Judaism — teaches, the most obvious purpose of circumcision is the weakening of the male sexual capacity and pleasure... Closely related would appear to be the aim of setting before any potential adult male convert the trial of submitting to a mark that incurs shame among most if not all other peoples, as well as being frighteningly painful: "Now a man does not perform this act upon himself or upon a son of his unless it be in consequence of a genuine belief... Finally, this mark, and the gulf it establishes, not only distinguishes but unifies the chosen people. The peculiar nature of the pain, of the debility, and of the shame serves to underline the fact that dedication to God calls for a severe mastery over and ruthless subordination of sexual appetite and pleasure. It is surely no accident, Maimonides observes in the same passage just quoted, it was the chaste Abraham who was the first to be called upon to enact ritual circumcision. But of course we must add since the commandment applies to Ishmael as well as to Issac, circumcision is the mark uniting those singular peoples, descended from Abraham, who recall not only his chastity but above all his dread in the presence of God; who share in that dread, and who understand the dread and the circumcision to be in part their response as mortal, hence reproductive, hence sexual creatures — created in the image of God — to the presence of the holy or pure God Who as Creator utterly transcends His mortal, reproductive creatures, and especially their sexuality.

The Jewish philosopher Philo Judaeus argued that Milah is a way to "mutilate the organ" in order to eliminate "all superfluous and excessive pleasure."[16][22][118] Similarly, Maimonides proposed that two important purposes of circumcision are to temper sexual desire and to join in an affirmation of faith and the covenant of Abraham:[119][120]

As regards circumcision, I think that one of its objects is to limit sexual intercourse... and thus cause man to be moderate... Circumcision simply counteracts excessive lust... [Tempering lust] is, as I believe, the best reason for the commandment concerning circumcision. And who was the first to perform this commandment? Abraham, our father! of whom it is well known how he feared sin... There is, however, another important object in this commandment. It gives to all members of the same faith, i.e., to all believers in the Unity of God, a common bodily sign... It is also a fact that there is much mutual love and assistance among people that are united by the same sign when they consider it as [the symbol of] a covenant. Circumcision is likewise the [symbol of the] covenant which Abraham made in connexion with the belief in God's Unity. So also every one that is circumcised enters the covenant of Abraham to believe in the unity of God, in accordance with the words of the Law, "To be a God unto thee, and to thy seed after thee" (Gen. xvii. 7). This purpose of the circumcision is as important as the first, and perhaps more important.

— Maimonides, The Guide to the Perplexed (1190)

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.[121] The author of Sefer ha-Chinuch[122] provides three reasons for the practice of circumcision:

1. To complete the form of man, by removing what he claims to be a redundant organ;
2. To mark the chosen people, so that their bodies will be different as their souls are. The organ chosen for the mark is the one responsible for the sustenance of the species.
3. The completion effected by circumcision is not congenital, but left to the man. This implies that as he completes the form of his body, so can he complete the form of his soul.

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.[123]

In Of the Special Laws, Book 1, the Jewish philosopher Philo additionally gave other reasons for the practice of circumcision.[118]

He attributes four of the reasons to "men of divine spirit and wisdom." These include the idea that circumcision:

1. Protects against disease,
2. Secures cleanliness "in a way that is suited to the people consecrated to God,"
3. Causes the circumcised portion of the penis to resemble a heart, thereby representing a physical connection between the "breath contained within the heart [that] is generative of thoughts, and the generative organ itself [that] is productive of living beings," and
4. Promotes prolificness by removing impediments to the flow of semen.
5. "Is a symbol of a man's knowing himself."

A growing number of contemporary Jews have chosen not to circumcise their sons.[128][129][130][131]

Among the reasons for their choice are the claims that circumcision is a form of bodily and sexual harm forced on men and violence against helpless infants, a violation of children's rights, and their opinion that circumcision is a dangerous, unnecessary, painful, traumatic and stressful event for the child, which can cause even further psychophysical complications down the road, including serious disability and even death.[132][133][134][135] They are assisted by a number of Reform, Liberal, and Reconstructionist rabbis, and have developed a welcoming ceremony that they call the Brit shalom ("Covenant [of] Peace") for such children,[134][129][131] also accepted by Humanistic Judaism.[136][137] The 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[138][139] and circumcision of converts is not mandatory in either movement.[140]

Secular Israeli Jews (Hilonim) protest against ritual circumcision (brit milah) in Tel Aviv

The connection of the Reform movement to an anti-circumcision, pro-symbolic stance is a historical one.[17] From the early days of the movement in Germany and Eastern Europe,[17][141] some classical Reformers hoped to replace ritual circumcision "with a symbolic act, as has been done for other bloody practices, such as the sacrifices".[142] In the US, an official Reform resolution in 1893 announced converts are no longer mandated to undergo the ritual,[143] 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 an alternate covenant ceremony, brit atifah, for both boys and girls as a welcoming ritual into Judaism.[144] 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".[145]

Many European Jewish fathers during the nineteenth century chose not to circumcise their sons, including Theodor Herzl.[146][132] However, unlike many other forms of religious observance, it remained one of the last rituals Jewish communities could enforce. In most of Europe, both the government and the unlearned Jewish masses believed circumcision to be a rite akin to baptism, and the law allowed communities not to register uncircumcised children as Jewish. This legal maneuver spurred several debates addressing the advisibility of its use, since many parents later chose to convert to Christianity. In early 20th-century Russia, Chaim Soloveitchik advised his colleagues to reject this measure, stating that uncircumcised Jewish males are no less Jewish than Jews who violate other commandments.[124]