Church vs. State

Circumcision’s Deadly Fault Line: Rationality vs. the Metzitzah B’Peh

A newborn’s death after a Jewish ritual reflects the gap between faith and the mind. By Kent Sepkowitz.

Noah Berger / AP Photo

Circumcision refuses to leave the front page. In the last decade, stories of all types have found their way above the fold. These include the horrifying—exposés on the routine practice of female circumcision in some countries; the thrilling—the startling news from the AIDS-research world that male circumcision provides a durable 30-50 percent reduction in acquisition of HIV among heterosexual men; and the middling—evidence that the American Academy of Pediatrics is starting to waffle on their 1999 statement of complete neutrality regarding the procedure. There also is the curious: the burgeoning foreskin-restoration movement (click here if you must, but beware if you are pregnant, have vascular disease, or are prone to motion sickness), complete with a national organization, NORM, and a startup company called Foregen, which promotes genital integrity and promises to grow you a new one. Someday.

This week, however, an even more controversial, and grim, circumcision-related issue surfaced. Writing in the Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention just reported a fatal transmission of herpes from an infected ritual circumciser, or mohel, to an eight-day-old baby apparently related to a practice performed in the ultra-Orthodox Jewish community called metzitzah b’peh. What, you ask, is metzitzah b’peh? According to the CDC, it refers to the ritual when a mohel “places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction).”

The transmission of herpes is thought to occur when the mohel, without or without a visible oral herpes sore (herpes is well-known to be transmissible even in the absence of a visible sore), touches his lips to the infant’s newly cut skin—a golden and tragic opportunity for herpes or any infection to enter the bloodstream. The immune system of the infant is far too immature to handle much of anything and some babies are quickly overwhelmed. In the CDC series, infants in two of 11 cases gathered over the last decade died and others were left with long-term neurologic disabilities.

This problem has flared previously. In 2005, a few cases (included in the new report) occurred in a different ultra-Orthodox Jewish community and resulted in substantial friction between the public-health authorities and the community. As with the recent series of issues related to possible under-reporting of child sexual abuse among the ultra-Orthodox, community leaders accused government officials of over-reaching in their pronouncements of what was safe and acceptable behavior for the community. Like many, from the Tea Party to every stomping-mad teenage boy, they claim that they are capable of governing themselves. So just leave us alone and get out of our room!

With the controversy surrounding metzitzah b’peh, we are tiptoeing on that ever-familiar fault line that separates church and state, or tries to. It’s the exact same impasse that has dogged mankind at least since Jesus advised someone to render unto Caesar that which was Caesar’s, yadda yadda. At the heart of it is a battle between the rational mind and the passionate heart, the visible and the spiritual, those who pride themselves in playing well with others and those who are even more proud to show how poorly they play. They will build their own goddammed sandbox and you’re not invited.

The discord seems to surface in some new and alarming form just about every week: prayer in public schools, use of taxpayer dollars for parochial schools via a “voucher” program, a marble monument of the Ten Commandments in front of a state supreme court. Politicians typically run the other way, knowing the riptide of the issue is dangerous for those who wade out too deep.

It is fitting that the precious real estate of the eternally derided foreskin should be the place where this problem finds its crescendo. Perhaps the only thing more intensely held than a person’s religious beliefs, be they strong or strongly disinterested, is a guy’s thoughts about his pecker. It is just about all we think about, though thankfully for one and all, the manifestations do vary. Given this, how completely and bizarrely ridiculous it is that men, millions and millions of men, that brutal tribe that spends all day thinking about it, worrying about it, protecting it, comparing it, agree to give up their foreskin and even that of their sons to the cold blade. That’s the point though—it is the ultimate leap of faith. The church-and-state issue remains unresolved because neither side can quit. The rational mind of course is correct, rationally—but we are not rational animals. The tradition of circumcision and, in its ultimate flowering, the ritual of metzitzah b’peh, show how puny is the strength of the human mind against the wild pumping of the human heart.