New York City officials voted Wednesday to loosen regulations on a controversial circumcision ritual practiced in the ultra-Orthodox Jewish community. For some time, Mayor Bill de Blasio pledged to repeal the regulation that requires parents in the community to sign a consent form before the practice in which a mohel (the person who performs a circumcision on an infant) sucks blood away from the infant’s penis after cutting the foreskin.
The practice, known in Hebrew as metzitzah b’peh, has raised red flags for the city’s public health officials for some time, after they observed a notable rate of herpes simplex type 1 virus (HSV-1) infections in infant boys in the community. The virus can be passed from mohel to child during the practice. Since 2000, at least 18 babies in New York City have contracted the virus as a result of the ritual, according to the New York Daily News. One infant was infected in April. The incidence was reported to the city health department, but officials say the mohel who conducted the ritual hasn’t been identified.
The mayor believes working closely with the community may be more effective at preventing babies from becoming infected with the virus than the consent form. Many ultra-Orthodox religious figures claim that the restrictions placed by the consent form, required under former Mayor Michael Bloomberg’s administration, have led to feelings of isolation in the community and noncompliance to the rule.
Under the new regulations, hospitals working with patients from the ultra-Orthodox community are required to provide informational brochures that explain to parents the health risks associated with the ritual, which has also been described as oral suction circumcision. According to The New York Times, members of the city council are completing an agreement with leaders of the community strongly recommending herpes testing of a mohel if a baby becomes infected. However, the test would not be legally mandated.
The brochure from the city’s health department urges parents to forgo the ritual and reminds them they have the right to do so. It also explains that preventive measures attempted by mohels, such as taking medicine or using mouthwash before the ritual, won’t protect a child from exposure to the virus. Many adults carry HSV-1 but are unaware and do not have symptoms. But a newborn’s immune system is not yet equipped to fight off the infection, which can cause brain damage, disability and even death.
The tradition of metzitzah b’peh dates back to early Jewish scriptures, which say the practice is essential to the health of the baby. Even more, the Talmud says any mohel who fails to suction after circumcision should be fired.
According to Haaretz, the practice is an outgrowth of ancient Greek medical theory, specifically Hippocrates’s theory of the “four humors,” which explained the functions of the human body. Under this belief system, too much or too little of four specific bodily fluids (called humors)—blood, yellow bile, black bile and phlegm—impacts a person’s emotional and physical health. The theory has roots in the Indian Ayurvedic medicine system, later adopted by Greek, Persian and European physicians. Early physicians and religious figures believed clotting blood after circumcision would cause decay and therefore suctioning restored “equilibrium” between blood and the three other humors.