In light of recent media highlights questioning the time honored custom of metzitzah b’peh, Matzav.com would like to present to its readers a complete overview on the halachic, historical, and medical issues as they relate to metzitzah b’peh. This article first appeared part of the monthly halachic publication “Halacha Berurah” disseminated to hundreds of shuls across the country. It was authored by Rabbi Elli Bohm, a rosh chabura in Bais Medrash Govoah in Lakewood NJ. The halachic aspects were reviewed by Harav Yisroel Belsky shlit”a Rosh Yeshiva Torah Voda’as. The medical facts contained within this article were reviewed by Dr. Daniel S. Berman, MD, F.A.C.P., Chief of Infectious-Disease at New York Westchester Square Hospital.
The Bris Milah Procedure
There are several steps in the bris milah process.
The tip of the aiver on which the bris is performed has two coverings. The outer covering is a thick layer of skin called the foreskin or orlah. The mohel, using a sharp surgical knife called the izmal, completely removes that entire layer. This step is called chituch – excision. Beneath the foreskin lies a thin membrane. The mohel tears the membrane and pulls it back, thereby exposing the corona completely. This step is called priah – uncovering. It is beyond the scope of this article to discuss whether these two procedures can be performed simultaneously or must be performed consecutively. After the chituch and priah have been completed, the mohel performs metzitzah – the act of drawing out blood from the wound. Once these steps are performed, the mohel dresses the wound.
The main theme of this chapter is to discuss in detail, the purpose of metzitzah, the manner in which it is performed, and the medical issues involved.
Bris Milah and Medical Healthiness
Bris milah is a delicate surgical procedure and is normally the first surgical treatment performed on such a young infant. A mohel is very cautious and is in close contact with the physicians to determine whether the infant has physically matured and achieved stability or if a postponement of the bris is necessary. Although the Torah requires that the bris be performed on the eighth day – and even if the eighth day occurs on Shabbos one is obligated to desecrate the Shabbos to perform it – nonetheless, even the slightest ailment or the smallest amount of unnecessary pain could be a reason to postpone the bris. Quite often, a mohel is even more cautious in performing the bris than the physician, and after consultation with rabbonim may choose to postpone the bris until there isn’t even the slightest risk of injury. Maintaining the infant’s health is first priority.
As an aside, many medical professionals throughout the ages have acknowledged that the circumcision process itself is medically advantageous for the patient. Circumcision has been reported to reduce the incidence of urinary tract infections in children, genital cancer, infection of the glands, among other diseases. Additionally, a study has been performed that showed the transmission of HIV to be more common amongst uncircumcised gentiles than circumcised ones.
There are two types of illnesses that may cause a bris to be delayed. A systemic illness that affects the entire body, such as a fever, causes the bris to be delayed until the infant has been completely cured for seven full days. A baby who required a blood transfusion or was placed in an incubator must wait seven full days from the time he is released, even if medical opinion maintains that the bris can be performed sooner. A bris is also delayed if the infant has a localized ailment which could place its health in jeopardy if a bris would be performed on the eighth day. However, once an infant is cured, a bris may be performed immediately and no seven-day waiting period is needed. The bris of an underweight baby is delayed until the desired weight has been gained, at which point a bris should be performed immediately.
The most common cause for delay is a condition called jaundice. This manifests itself by the skin of the infant possessing a shade of yellow. Every human body contains millions of red blood cells. These cells have an approximate life span of one-hundred-and-twenty days. After this period, the cells break down and form a substance called bilirubin. The bilirubin gets processed by the liver and is excreted as part of the urine. Until birth, the mother’s liver processes the bilirubin. Occasionally, the infant’s liver has not matured to function properly. Consequently, the excess bilirubin is deposited in the skin and the skin takes on a yellowish shade. In such an instance, a bilirubin test would result in a high count and the bris is delayed until the count drops and the normal color appears. A liver that is not fully functional can cause the infant to be prone to infection, and a wound may not heal as quickly and the blood may not clot properly. Once the bilirubin level declines, a bris may be performed immediately and no seven-day waiting period is necessary, as this occurrence is not due to any illness but lack of maturity. In certain rare instances where the infant is severely jaundiced and requires hospitalization, the bris would be delayed for an additional seven days after the normal color appears.
The Metzitzah Controversy
We mentioned above that one of the integral steps in the bris milah procedure is metzitzah – drawing out blood from the wound. Traditionally, this practice has been performed by the mohel orally suctioning the blood. This practice is still performed at an overwhelming percentage of religious brisos.
The Gemara in Maseches Shabbos states that metzitzah must be performed following circumcision and refraining from doing so endangers the life of the infant. It states further that any mohel who refrains from doing so (or having someone else do so) should be demoted from his position as a mohel.
Recently, this practice has been denigrated and ridiculed by some in the media and by certain individuals who wish to modernize ancient traditional practices.
Opposition by certain individuals towards metzitzah is not new at all. The tumult regarding metzitzah began in the early nineteenth century and was addressed by virtually all gedolei Yisroel from that time on. There are more responsa, proclamation letters, and journal articles written about this subject than most areas of halacha.
It is the intention of this chapter to present an overview of the historical dialogues that took place, expound on a halachic analysis of the procedure, discuss the scientific and medical issues involved, deliberate on the recent claim of new statistical medical evidence, and present the views of contemporary gedolei Yisroel.
In 1831, Professor Wolfers, a German professor, published a mohel‘s guidebook. In it, he attempted to demonstrate that the sole purpose of the metzitzah procedure is to serve as a therapeutic measure for the medical safety of the infant and that it is not an integral part of the mitzvah of bris milah. Consequently, he asserted that since, to his knowledge, modern science does not recognize any health advantages in such a procedure, and on the contrary, it invites the transmission of diseases between the mohel and the infant, it should not be performed.
In his book, Dr. Wolfers alludes to a venereal infection, which plagued that generation. He speculates that a number of children contracted the bacteria from the mohel at their brisos. He further elaborates that such an act is utterly uncivilized and repugnant.
In 1837, Rav Eleizer Horowitz, rov of Viena, author of the sefer Yad Eliezer, and a close disciple of the Chasam Sofer, was approached by an individual named Dr. Wertheim who was the chief doctor of the Jewish Vienna Hospital and a university professor. Dr. Wertheim related to him his uneasiness with the metzitzah practice, since there were a number of local infants who experienced a skin eruption on the milah area after their brisos were performed by a particular mohel. The lesions were first localized at the milah location, but then spread to the rest of the body. This resulted in a number of fatalities. The mohel was examined and no sign of the disease was noticed on him. Still and all, the doctor speculated that it originated from the mohel. The Yad Eliezer asked the Chasam Sofer in a letter, whether, in light of the tragedies allegedly resulting from this mohel, one is permitted to alter the metzitzah procedure, and instead of performing an oral suction, use a gauze to squeeze out the blood.
The Chasam Sofer responded that the Gemara does not specifically mention that metzitzah be done orally. Moreover, even if the Gemara had specifically mentioned that it is to be performed orally, one would not be limited to performing it in the traditional manner, since metzitzah is not an inherent part of the mitzvah and is only performed as a therapeutic measure. Consequently, it is not the ‘act’ that matters, but the ‘result’ of having the blood drawn out. The Chasam Sofer, however, strongly emphasized that there must be reliable attestation that the squeezing of the gauze performs the identical suctioning as when performed orally.
The Yad Eliezer writes that the doctors assured him that the result of the gauze is identical to oral suction.
Dr. Wertheim, overjoyed with this ruling, started campaigning amongst doctors and rabbonim to outlaw metzitzah b’peh. It was at that time that many leading personalities in the reform movement began broadcasting the opinion of several medical professionals that the metzitzah process is dangerous. They sought to abolish the practice, with the ultimate goal of putting an end to bris milah altogether, as well as other religious practices. There were many doctors who joined this movement, attempting to portray such ancient practices as barbaric. In their eyes, such an act defied all precepts of cleanliness, hygiene and health precautions. This revved them up and helped them galvanize others to join their campaign.
The dialogue with the Chasam Sofer was first published in a journal in 1845. This ruling of the Chasam Sofer created somewhat of an alarm in religious circles throughout Europe, as it weakened the discrediting of the reform movement. The teshuva was never printed amongst the rest of the Chasam Sofer’s responsa, and there were those who therefore questioned the authenticity of the letter.
The Chasam Sofer was niftar six years earlier and they had no way to authenticate it. Later, it became known that there were a number of talmidim who were familiar with the writing of the letter. They maintained that the Chasam Sofer did not wish to publicize this responsum, since he did not issue it as a general ruling, but as a response to a specific incident where there was a concern that the mohel was contagiously spreading the disease. He never intended that metzitzah b’peh be curtailed under general circumstances. Indeed, the original manuscript of the teshuva is now in the possession of a descendent of the Chasam Sofer living in London, and on the margin appears the writing of one of the disciples of the Kesav Sofer (the Chasam Sofer‘s son) which states that it is forbidden to publicize this letter since it was intended only for the specific situation in Vienna.
To counter the distorted views of the reform movement and those of the secular doctors, many responsa and proclamation letters were published.
In 1844, the Tiferes Yisroel published his perush on Mishnayos. In his commentary to the Mishnah in Maseches Shabbos that deals with bris milah, he strongly upholds the practice of metzitzah b’peh and counters the arguments of the opposition.
The Aruch L’ner, Maharam Schick, Avnei Neizer, Rav Yehuda Assad, Rav Shamshon Rafael Hirsch, Rav Yitzchok Elchonon Spector, and many other European rabbonim also published extensive teshuvos on the matter.
In 1900, a proclamation letter was released bearing the signatures of 42 prominent Hungarian rabbonim. In the letter, these rabbonim forbade and condemned any slight alteration of the traditional procedure of metzitzah b’peh. In 1901, a similar letter was released by the gedolei Eretz Yisroel of that time bearing the signatures of Rav Shmuel Salant, Rav Yaakov Alishar, and Rav Shneur Zalmen Ladier.
A Halachic Analysis
The Mishnah in Maseches Shabbos states that one may perform all the necessities of bris milah on Shabbos. We may circumcise (milah), uncover the corona (priah), draw blood (metzitzah), and place a bandage and cumin upon the makom hamilah.
The Gemara quotes Rav Papa who maintains that one who does not draw blood from the wound is responsible for creating a danger to the person being circumcised, and we should dismiss him from his duties. The Gemara questions the novelty of this statement, for since we desecrate the Shabbos to draw the blood, it is obvious that not doing so is dangerous and is reason enough to dismiss the mohel.
The Gemara explains that without Rav Papa’s statement one might have thought that we are dealing with blood that is not absorbed in the body; a case where drawing it out would not involve making a wound, which would not be a violation of Shabbos. Thus, there would be no proof that failure to do so poses a danger. Rav Papa therefore teaches us that we are dealing with blood that is absorbed in the body, where drawing it out indeed constitutes Shabbos desecration and failure to do so constitutes a danger. The Gemara concludes that the reason for the Mishnah‘s law of drawing blood is the same as that for the application of a bandage and cumin – they are all to prevent a potentially fatal condition from developing.
The Rambam, in codifying the Gemara, mentions that one must draw blood from the distant locations (i.e., an excessive suction is required). Apparently, he derives this from the Gemara’s answer that we are not dealing with surface blood, but blood that is deeply contained in the body. The Rambam writes that failure to draw such blood poses a danger.
Medical Advantage of Metzitzah
There are several explanations by the poskim as to what danger Chazal refer to.
Drawing out blood prevents the blood from clotting and coagulating under the skin, which may result in inflammation and swelling. This is analogous to various situations in which modern surgeons utilize leeches to draw off excess blood that has accumulated under the skin. This occurs predominantly in limb reattachment surgery where arterial flow can be reestablished, but venous channels are too small to be reattached and must develop naturally. Leeches are used as a temporary measure to remove accumulated blood.
Additionally, drawing blood flushes out any infection present which commonly occurs during surgical procedures. Prior to the invention of post-operative antiseptics, sepsis infection accounted for the death of almost half of all patients undergoing major surgery.
It is not mentioned in the Gemara nor in the Rambam that metzitzah is to be performed orally. Nonetheless, it is mentioned in countless Rishonim, and such has been the minhag for centuries. It is mentioned in the Itur, Machzor Vitri, Avudraham, Shibolei Haleket and other Rishonim.
The Rama himself alludes to this minhag when he writes that prior to making the brachos following the milah, one should wash his hands and mouth so that they are clean. Additionally, the Rama maintains that one should spit out the blood on the earth prepared to place the foreskin in. The Taz quotes the custom of Rav Feivish of Krakow who would perform the bris milah on Rosh Hashana prior to tekias shofar and not rinse out his mouth; thus, the blood of the bris combined with the shofar, unifying the two mitzvos. Clearly, the universal tradition at that time was to perform metzitzah b’peh.
In Kabbalah, the concept of metzitzah b’peh plays a very important and significant role. In the Tikunei Zohar it states that the strong correspondence between the actual bris milah and the metzitzah b’peh which follows is rooted in the very gematriya of the word milah, which is 85 or פה-peh-the mouth. Rav Chaim Vital writes that the gematriya of Hashem‘s name, אלו-הים, is 86, and he expounds deeply on the correlation and the significance of that number. The mekubalim write that it sweetens all bad judgments that may be coming to a person.
The question that much of the controversy revolved around is whether, despite the fact that it has been the custom and possesses much hidden significance in Kabbalah, metzitzah has to be performed orally or it can be substituted with a different method or perhaps discontinued altogether.
The issue really hinges on the following question: What role does metzitzah have in performing a bris milah? Is it a therapeutic measure to prevent any fatal condition from occurring or an integral part of the mitzvah?
This question dates itself back to the Ran, who lived in the fourteenth century. A straightforward, simple reading of the Gemara mentioned above would definitely indicate that the sole purpose of metzitzah is as a therapeutic measure. This, indeed, is the opinion of many poskim, including the Chasam Sofer mentioned above, the Aruch L’ner, Maharam Schick and others. The Avnei Neizer, Rav Yehuda Assad, Levush Mordechai and others maintained that it is an integral part of the mitzvah.
The entire discussion of whether one can substitute a different form of metzitzah or perhaps do away with it completely is only applicable if it is deemed a therapeutic measure, in which case it is the result that matters, not the act itself. It is obvious, however, that if metzitzah is an integral part of the mitzvah, it must be performed orally and cannot be changed.
The Chasam Sofer mentioned above maintained that since, in his opinion, metzitzah is a therapeutic measure, it can be performed with a gauze. He emphasized, however, that the gauze must be proven to perform the identical suction.
The Aruch L’ner strongly criticized those who use a gauze, since he maintained that, according to the Rambam’s opinion, one must suction the blood from the distant parts and such an extreme suction is only achieved orally. Additionally, he writes that who knows if Chazal had other reasons in mind for metzitzah and only listed one of them. He therefore forbids anyone from changing the tradition. However, the Aruch L’ner maintains that if a mohel is infected with a contagious disease, he should not perform the metzitzah, but should have someone else perform either the metzitzah or the whole bris milah.
The Maharam Shick also writes that perhaps Chazal had other reasons in mind besides the therapeutic measure. Therefore, he writes, we cannot change the minhag. He adds that he himself was a mohel for over forty years and never encountered a case where a child contracted a disease.
In 1886, Rav Shamshon Rafael Hirsch vehemently criticized those who wanted to change the traditional form of doing an oral metzitzah and stated that he agrees with the Aruch L’ner that gauze cannot sufficiently squeeze out the blood. In 1888, the government intervened and outlawed the performance of direct oral suction due to the health risks they claimed were involved. At that time, someone introduced a glass pipette with which one can still perform an oral suction, but without direct contact. The blood gets suctioned up through the tube into a gauze separating the blood from the mouth. Rav Hirsch sent a question to the Kovna Rov, Rav Yitzchok Elchonon Spector. Rav Yitzchok Elchonon responded that being that the government does not allow any other method, the glass pipette is the best available option and may be used, but under general circumstances, he would not permit it.
Experts claim that the pipette, although better than the gauze which the Aruch L’ner prohibited, also cannot perform a suction that is as effective as direct oral contact. Often, air enters the tube while performing the metzitzah which prevents sufficient blood from being drawn. Only in a vacuum sealed suction, such as suction with one’s mouth, can this be accomplished.
Additionally, there are medical advantages for the wound to come into direct contact with the saliva in the mohel‘s mouth. Saliva is known to have certain wondrous chemical properties and is widely reported as a natural antiseptic. Additionally, the proteins contained in saliva are said to aid in the healing of wounds. Indeed, it is the instinctive reaction of a person who cuts his finger to put it into his mouth which alleviates the pain.
We would be remiss if we were to imply that the opinion of all gedolei Yisroel was that metzitzah b’peh is required, and only in pressing situations of imminent danger or under coercion from tyrant dictatorships were they lenient. There were definitely rabbonim, albeit few, who maintained that since metzitzah is a therapeutic measure, it may be performed in another manner, even under general circumstances. Nonetheless, the vast majority of rabbonim, which included the leading poskim of the generation, all maintained that metzitzah should be performed orally and forbade changing the procedure under normal circumstances.
Recent Medical Developments
Recently, an article was published in a secular medical journal, authored by eleven physicians and one individual with a PhD, attempting to insinuate a connection between metzitzah b’peh and neonatal (infant) herpes.
There are two types of herpes, referred to as HSV-1 and HSV-2. The two forms of herpes are very similar, although HSV-1 generally results in oral infections while HSV-2 generally occurs on the milah area. Herpes is not a new virus; cold sores on the lips were referred to by the herpes name for close to a thousand years.
Once the body is infected by the virus, it produces antibodies that control the virus. After fighting the disease, these antibodies circulate in the bloodstream and can easily be the source for a lab technician to detect whether an individual once carried herpes.
Approximately 90 percent of adults over the age of 50 possess antibodies for herpes, indicating that they were infected by the virus at some time.
In addition to the primary phase of the virus, it is quite common for people to suffer from a reactivation phase at different intervals, often stimulated by illness or sun exposure. Some individuals never experience any reactivation phase. The reactivation phase generally produces a cold sore on the lip which can shed the virus. However, at times, it is possible to shed without the occurrence of a reactivation phase and without displaying any obvious signs. This is called asymptomatic shedding. The virus is too weak to produce any obvious signs, but is still capable of shedding. The overall incidence of asymptomatic shedding is between 5% to 10% of the time.
Herpes that is contracted by an infant under the age of six weeks can be fatal 65% of the time. Generally, treating it appropriately in a timely manner can help. Most neonatal HSV infections result from infectious maternal secretions at delivery. Infants can also contract the virus from contact with a caregiver, including a parent or nursery personnel who are experiencing, at the time of contact, an active form of the virus, manifesting as oral lesions or shedding asymptomatically. Hospital environments are documented to be a substantial source for the contraction of many infectious diseases including the herpes virus.
The aforementioned medical journal article attempts to establish a connection between eight infants who experienced an outbreak of herpes on the milah area shortly after their brisos which was done by a mohel who performed metzitzah b’peh. This pretense was surmised without any corroborating evidence, and was based on mere speculations as the article itself inconspicuously admits.
The eight infants were collected from personal communication with the doctors involved. It spanned a time period of six years from 1997-2003. The study did not seem to look at all cases of neonatal herpes in these institutions over this time period to see if other cases were discovered which did not involve metzitzah b’peh and must have originated from elsewhere. Rather, it seems that only the few isolated incidents involving metzitzah b’peh were sought after and collected to impress upon the reader the danger involved.
There was not any conclusive evidence linking the mohalim in those cases to the virus transmissions. Generally, DNA analysis is used to establish such a definitive connection. The entire article, however, is replete with biased speculations. The speculations are based on the following indications: exclusive distribution of the herpes virus on the milah area, timing of appearance (4-11 days after the bris), absence of HSV exposure in mothers and absence of clinical signs consistent with HSV infections among family members.
Firstly, the article itself admits that only four of the infants’ mohalim were tested and that one of the mothers tested positive. Consequently, this narrows down the analysis to three out of the eight infants.
Furthermore, documentation has been released from the ministry of health that two of the mothers were not tested. This information is contrary to the claim in the article that all of the mothers, besides for one, tested negative.
Moreover, the article makes no mention whether investigation was performed on any relatives of the infants or people who cared for these infants, when it is well described in the article that postnatal infections are commonly contracted from such individuals. Other than observation for clinical signs, no serology testing was performed on any of the fathers who generally can also be a viable source for the disease.
The article makes no mention of any investigation and testing performed in the hospital where the infants were born, even though, as we mentioned, this is commonly a source for contagious diseases.
The article focuses only on the fact that antibody tests resulted positive for these mohalim – for something which 90% of middle-aged people test positive for and does not indicate the ability to shed the virus. As mentioned earlier, no DNA testing was performed linking the transmission of the virus to the babies, nor was there any positive mouth culture demonstrating whether the mohel had a reactivation phase of herpes at that time. The timing of appearance and the fact that there was an exclusive distribution of herpes in an area where there is an open wound which has to be treated by caregivers are certainly no attestation. Any caregiver could have treated the wound without cleaning their hands properly after touching their oral cavity. This journal article is a typical example of when a prejudiced result supersedes any investigation.
Rabbonim and mohalim are extremely scrupulous regarding the health and well-being of infants, sometimes to an even greater extent than the physicians. There is no question that they would be the first ones to take action were there any substantial threat. Coupled with the understanding of the importance of metzitzah b’peh, the rabbonim and mohalim are well informed of all relevant medical information.
Rav Yosef Shalom Elyashiv and other leading rabbonim are constantly updated with all the medical facts and have been in continued contact with leading physicians.
Instead of promoting biased views based on prejudice speculations, would it not be more logical-especially if one is resorting to speculations-to conjecture and say that no threat exists after observing thousands of infants undergo brisos with metzitzah b’peh each year? It is an extreme rarity that herpes is discovered, and even in those insolated cases, no proof has been supplied linking the contraction to the mohel.
Is it that far-fetched to accept the theory of many reputable doctors that saliva is not an efficient way of transmitting viruses? Saliva is known to be a natural antiseptic with components which weaken viruses. In fact, HIV, a highly contagious virus, has never been shown to be transmitted through contact with saliva. Additionally, the placement of wine in one’s mouth (which is customarily done at a bris) prior to performing metzitzah b’peh further dilutes the virus. The time of contact is also very brief. This is all in addition to the small percentage of the mohel shedding the virus when no obvious blisters exist in his mouth.
People have surgical operations performed where the potential danger is extensively greater. Shouldn’t the sakana mentioned in Chazal when no metzitzah is performed be enough of a reason to perform a proper metzitzah despite the very insignificant chance of an inconclusive viral transmission?
The Views of Our Generation’s Gedolei Yisroel
Rav Moshe Feinstein and many gedolei Yisroel concurred that metzitzah b’peh is not an inherent part of the mitzvah of bris milah and is only performed to prevent sakana to the infant. Nonetheless, performing metzitzah in another fashion may not effectively achieve this goal. Additionally, the minhag in most segments of Klal Yisroel has been to perform metzitzah orally.
The Chazon Ish was once at a bris when he overheard Rav Shmuel Wosner, ybl”c, commending the mohel for performing a proper metzitzah. He encouraged Rav Wosner to do all he can to see to it that in the circles where metzitzah b’peh is still performed, the practice should be upheld and not weakened. In some communities where metzitzah b’peh is not diligently performed, it is a result of the bans placed by the tyrant governments from where these communities originated from.
In our times, Rav Yosef Shalom Elyashiv has been at the forefront of the movement to protect this age-old practice and has signed the recent letters of proclamation advocating metzitzah b’peh. The gedolim maintain that only if a particular situation calls for concern, such as if the mohel has a blister in his mouth or when performing brisos in a degenerated society, should metzitzah b’peh not be performed.
In the mid-1980’s, when the Aids epidemic started spreading like wildfire with no cure, the world was frightened. Ten days before Rav Moshe Feinstein’s passing, a family member approached him for a heter to discontinue the practice of metzitzah b’peh. Rav Moshe Feinstein said, “Chas v’shalom to stop metzitzah b’peh. We have a rule that ‘Shomer mitzvah lo yeida dovor ra – if one does a mitzvah properly, nothing bad will befall him.’ Therefore, if a mohel is doing the bris, he is assured that nothing bad will happen to him or the baby.”
Rav Reuven Feinstein was present and asked, “Doesn’t our father hold that metzitzah b’peh is only a minhag? Why put ourselves into a possible danger for a minhag?” Rav Moshe answered, “A minhag that Klal Yisroel keeps cannot be changed. This, too, is included in the rule that the mitzvah will protect a person and no evil will come from it.”
This rule applies especially nowadays after no conclusive proof has been established and the potential for risk is extremely minute.
The medical facts contained within this article were reviewed by Dr. Daniel S. Berman, MD, F.A.C.P., Chief of Infectious-Disease at New York Westchester Square Hospital.
עי’ ספר זכרון ברית לראשונים (ר”י הגוזר) עמוד 20 שמכניס אבר בפיו ומוצץ בכל כוחו, ועי’ ספר העיטור הל’ מילה ח”ד, מחזור ויטרי הל’ מילה סי’ תק”ה, אבודרהם הל’ ברכות ריש שער ט’, שבולי הלקט הל’ מילה סי’ ח’, ועי’ מש”כ לקמן בציון 18 ו19.
עי’ שד”ח במילואים לקונטרס המציצה שהביא מס’ קובץ דם ברית שזו אחד מהטעמים, ועי’ יד פשוטה על הרמב”ם מילה ב’ ג’, עי’ תתתע”ד שהביא שבספרי הרמב”ם בעניני רפואה איתא לענין פציעה מכלי מתכות וז”ל שם: “כדי למנוע התפשטות הסם ימצוץ בפה בכח חזק מאד.”
עי’ תשו’ חת”ס ליד אליעזר שהעתיק בספר הברית, עי’ חידושי חת”ס מס’ שבת דף קו ד”ה ועוד, עי’ קצוה”ח בחו”מ ס’ שפ”ב סק”ב ד”ה ובזה, עי’ תפא”י שם, עי’ ישועת יעקב או”ח של”א:א, חכמ”א קמ”ט:יד, שו”ת שו”מ מהדו”ת ח”ד סי’ ז’, מהר”ץ חיות סי’ ס’, חוות דעת סי’ ס’, בנין ציון סי’ כג’ וכד’, מהר”ם שיק יו”ד סי’ רמ”ח, שו”ת אג”מ יו”ד סי’ רכ”ג.
עי’ ספר הברית דף רכב, ועי’ ספר הזכרון להגר”י הוטנר זצ”ל דף תקנ”א שהעתיק תשו’ שם מהגרי”א ספקטר זצ”ל שההיתר הוא רק אם אין מניחים מן הממשלה, ועי’ ספר ברית כרותה לשפתיים דף קא דהגר’ יוסף ברוער זצ”ל, אב”ד וואשינגטאן הייטס, והגר”ש שוואב זצ”ל אמרו שההיתר היה רק במקום שהמשלה אסרו.
עי’ מהר”ץ חיות סי’ ס’, ועי’ שו”ת הר צבי יו”ד ס’ רי”ד, ועי’ ספר הברית דף רכ”ג שהביא תשו’ מהגר”ש הכהן מו”ץ ווילנא, ועי”ש מה שהביא מבעל ערוך השולחן, ועי’ בה”ל סי’ של”א שנראה שמכריע כיד אליעזר, ועי’ שו”ת שבט הלוי יו”ד סי’ ק”ל וקל”א שמתמיה עליו, ועי’ שו”ת ציץ אליעזר חי”ח סי’ כ”ד דנראה ברור דבעל המשנ”ב זצ”ל לא עיין בגופן של דברים בהספרים הנזכרים, והעתיק רק כפי שמובא מהם בספר פ”ת על או”ח שמציין אליו, עי”ש. ולכאו’ יש למידק שאפילו הפוסקים שהתירו לשנות כ”ז דוקא אם פעולותיהם שוה למציצה בפה, ויש לפקפק בזה. ועי’ ספר הברית דף רכ”ד שהגר”ח מבריסק זצ”ל צוה את מוהלי קהילתו שלא ימצצו עוד בפה, ושמעתי בשם הגה”ר מאיר סאלאווייציק שליט”א שבבריסק היה מוהל זקן חשוב שהיה לו מחלה בפיו והגר”ח אמר שלזמן קצר לא יעשו המוהלים מציצה בפה (אולי משום כבוד הבריות) ובאיזה חדשים חזרו ועשו מציצה בפה. ועי’ ספר הברית שם שהביא תשו’ מהגר”ח ברלין שהיתר מציצה בכלי אלא כתב שם שאעפ”כ אין לשנות מנהג אבותינו מעולם שהיו מוצצין בפה אבל היכא דאיכא שום שמץ חשש ספק ספיקה לסכנה ח”ו ודאי אין לדקדק על קיום מנהג אבותינו ורשאין לשנותו מחשש סכנה, וראיתי תשו’ מהגר”ח עוזר זצ”ל לבעל שו”ת שאירת יעקב (שנת תרס”ו) וז”ל: והנה אמת ונכון הדבר אשר המוהלים רובם ככולם פה (וילנא) מוצצים ע”י ספוג והרב ר’ שלמה מוילנא לא מיחה על ידם, סבת הדבר מתחלה לפי הנראה היתה בגלל מוהלים חולים אשר חששו למצוץ בפה, ודבר הזכוכית לא הובא בעירינו וע”כ בהכרח סמכו על הספוג מצמר גפן ע”פ עידות הרופאים, והתחילו לנהוג כן כמה מוהלים ואין ביד המורים לשנות עוד מנהגם שכבר נהגו רבות בשנים, והנה אין ספק אשר במקום שאין שום חשש מצד מחלות המוהל או הילד שראוי למצוץ בפה, וכל הפחות ע”י זכוכית, עכ”ל.
עי’ שו”ת אג”מ יו”ד סי’ רכ”ג, ועי’ לקמן מה שציינו בשמו, עי’ בשו”ת ציץ אליעזר כמה תשובות בענין זה, ועי’ שו”ת מנחת יצחק ח”ט סי’ צ”ז וצ”ח שהחמיר מאד, ועי’ שו”ת שבט הלוי שיש כמה תשובות ע”ז, ועי’ הכרוז שיצא מגדולי א”י וחו”ל.