The Chasam Sofer's ruling on Metzitzah Be-peh

Metzitzah be-feh has been in the news lately, as it will be every few years. I thought it might be nice to translate two important documents relating to this controversy since, to my surprise, I discovered that neither seems to have ever been translated and published in its entirety. I mean the question which R. Elazar Horowitz of Vienna sent to his teacher the Chasam Sofer in 1837, and the response he received. I once posted the letters as they were printed in the first volume of Kochve Yitzchak (1845) (link). Here are the letters and the translation:

I have of course taken some liberties. Obviously Rabbi Horowitz's letter did not begin "Dear Rabbi Sofer," but I didn't want all the titles, which aren't meant to be translated, to be distracting. On the other hand I also didn't want to completely remove the flavor of rabbinic writing, so I kept some of it in. But the main purpose is simply to make these documents accessible.

Sheviti, etc. Sunday 16 Shevat 5597 (1837) Vienna

Dear Rabbi Sofer,

Teach me, Rabbi, what is the rule regarding a question which my local friend Dr. Wertheim asked of me. According to the law of our religion is a mohel required to make that suction which is performed after the circumcision specifically with his mouth? Or perhaps it is proper to peform the suction through some other means, such as to soak a sponge in wine or water and squeeze the place of the wound with it a number of times, and through this achieve the healing effect for the infant no differently than through oral suctioning? The circumstances behind this question is that some months ago in our city many children who were circumcized by a certain expert mohel developed festering sores all over the genitals and from there it spread to the entire body. Many infants died because of this, and were unresponsive to any medical attention. Some of them lived, but were in great pain. The doctors judged that this condition was caused by the mohel's orally suctioning the wound (ha-metzitzah she-be-feh). The mohel was examined and proved to have a clean bill of health, and they could not diagnose anything like this illness in him. However, we need to know what to do in a situation like this in general. Now, I answered that in my opinion I see nothing in this suggestion which is opposed by our holy Torah. Even though Rav Pappa said (Shabbat 133b) "a circumcizer who does not suction is dangerous, and we dismiss him" nevertheless it is not explicit that the suction must be specifically with the mouth and lips, and so certainly it is alright to also do it in some other manner, so as to draw blood from the 'far places.' See what is the reason why Hazal required suction: for the healing of the circumcision. Qualified physicians attest that a sponge or something like it also does this. If so, these accomplish the purpose of healing. So why shouldn't we believe the physicians in this in the same way that we accept the many medical accomplishments and advances in recent generations, which were unknown in earlier times?

Do not reply that the expression מייץ mentioned by Rav Pappa refers only to oral suction, since we find in Shabbat 88a that the word has an expansive definition, for we find the very term in the case where "There was a certain Sadducee who saw Raba engrossed in his studies while the finger[s] of his hand were under his feet, and he ground them down, so that his fingers spurted blood." (See here.) Rashi there explains that he was pressing his fingers with his foot, and this is what drew blood from the fingers. Thus we see that מייץ refers to pressure and not only suction (he gives some similar examples in German). Also Rashi explains (Lev. 1:15) the words "its blood shall be drained out" that it is like the term mitz apayim "wringing of the nose" (Prov. 30) and "afes ha-metz" "the wringing out is at an end" (Is. 16) and "He presses the place of slaughtering against the side of the altar" ve-hadam mitmatzeh ve-yored, "the blood is wrung out and goes down" (Zevachim 65). Also Rashi explains the same verse in Prov. 33:3 mitz chalav "churning of milk" mitz skhitah "squeezing" (and he uses the Old French term empreindre, which means to press or stamp). From all this it seems to me clear and simple to permit it. However, with all this, I don't want to authorize something new like this until you my master concurs with me. So please pardon me, respecting your honor's Torah, to let me know your exalted opinion on these things. I have not been feeling well lately, so please send me your words.

Your student and beloved friend, I bow toward your honor and glory.

Ha-kattan Elazar Ha-levi Ish Horovitz

The Chasam Sofer replied as follows:

Sheviti, etc. Pressburg, Monday, 20 Shevat 5597 (1837)

Greetings and long life to my student and friend Rabbi Elazar Halevi Segal Horowitz, Chief Rabbi of Vienna.

Your nice letter reached me, and it is correct what you wrote, that we do not find the metzitzah (suction) is specifically with the mouth, save for the position of the Kabbalists who say that [the process] enacts a neutralization of strict judgment through the lips and the mouth. We are not engaged in mysteries when there is some concern for physical danger. Now, the roots mitz and matzat are the same, c.f., Proverbs 30[:31] mitz apayim and Judges 6:38 "and wrung dew out of the fleece." In all these places Rashi explains them in terms of squeezing, compressing, and suctioning something with force. Radak and Ibn Ezra similarly explain them. If so, we only need to draw the blood from the 'far places' though whichever method we are able, and we can rely on experts who assure us that some method accomplishes it. I further say that even if it was explicit in the Talmud that the suction is meant to be oral, nevertheless since this is not an integral part of the circumcision, but only adjoined because of a health measure, so if one circumcised and did not suction the blood, he has already performed the commandment, and the baby is permitted to eat terumah, and the father may make a Passover sacrifice. However he is in physical danger so long as the blood was not suctioned from the far places. In Chapter Rabbi Eliezer De-mila we find that Rav Pappa understood that suction is similar to the dressing and cumin, which are health measures. Now, we do not presently use the [particular] dressing [specified in the Talmud] and cumin, nor the particular type of dressing mentioned in the Talmud by Abbaye and Rava. Therefore we know that since these are for healing, we are not particular about which remedy we use in its place, and the same thing applies to suction - even if oral suction had been mentioned in the Mishnah, we would be able to change it to another method which accomplishes the same thing, so long as we heed qualifies physicians who will attest that in truth a sponge accomplishes the same thing as oral suction. More than this we needn't be concerned with, in my opinion. God should heal you and make you feel good!

Moshe ha-kattan Sofer mi-Frankfurt di-Main

For a listing of some people and places were doubts about the authenticity of this exchange see Shlomo Sprecher's article Mezizah be-Peh - Therapeutic Touch or Hippocratic Vestige? in Hakirah 3. He, like me, does not find such charges convincing, although whether anyone likes it or not they have to be grappled with - as Sprecher did - in contemporary debate. Maybe in the future I will translate some of the documents relating to that charge.

I want to conclude with a quote from Buxtorf's Synagoga Judaica (The Jewish Synagogue). This 17th century book was and is considered hostile to Judaism, and properly so, but it is also highly interesting. It is believed that R. Yehuda Aryeh Modena's book describing Judaism, his Historia de' riti hebraici, was written partially as a response to Buxtorf's book. So I will quote what Buxtorf writes (from an English translation of 1657) :

. . . he cuts away so much of the fore-skin that the top of the yard may be seen bare and naked, which he throws in haste into the Bason filled with sand, restoring the knife to him from which he took it, and takes on the Cips full of red Wine, out of which he sucks so much as he can hold in his mouth, which he presently spnes out again upon the Infant to wash away the blood, and also some in his face, if he perceive him to faint: instantly upon this he takes the childs yard in his mouth, and sucks as much bloud out of if as he can possible, to the end that it may sooner leave bleeding, which bloud he casts out again, either into one of the bowls of red Wine, or into the bason of Sand. this he doth three times at the least, which the Hebrews call mezizah, which Moses Commanded not, but was instituted by the Rabbines and wise men amont the Jews, as it seemed good unto them.

Similarly, Modena writes (this is from an English translation of 1650) nothing more than

the Circumciser going on in his businesse, with his mouth sucketh the Blood, which abundantly floweth from the wound, doing thus two or three times, and so spitteth it forth in a Bowl of wine.

I believe it is important to not forget the therapeutic intention behind MBP, no matter where one falls on the spectrum of opposition. This was still clear in the 17th century, when a hostile writer could think of nothing worse to say about it than that "Moses Commanded [it] not" and the apologist who wanted to portray Judaism in its most positive light left out of his book the belief in gigulgim, but not a description of MBP - in fact, he did not even see the need to explain that this was meant for the health of the baby.

Finally, it is also interesting to note that the Chasam Sofer's permission to use a sponge relies on the attestations of physicians that it accomplishes the same healing as oral suction. I wonder if this leaves a conundrum since according to modern medicine suctioning blood from a sterile wound accomplishes nothing at all.