Newsday:

For thousands of years, rabbis performed a simple procedure to cleanse the wound left by a ritual circumcision. Like Boy Scouts treating a snake bite, they quickly sucked blood from the cut and spit it aside, ostensibly disposing of any harmful impurities. The procedure may seem pure 18th Century, but it is the subject of a clash between religion and science in modern-day New York. Prompted by a child’s death, the state health department is developing its first set of safety guidelines on the ritual of oral suction, which was abandoned by most Jews long ago but survived in a handful of Hasidic communities. Doctors have long been concerned that the act, called “metzitzah b’peh” in Hebrew, could spread disease, but their argument became urgent last year when New York City health officials said the procedure had given a baby a fatal infection. The illness was herpes simplex type 1, the common virus transmitted by saliva that causes cold sores. Usually harmless to adults, it can be deadly to newborns. The death was believed to be the first in the United States to be associated with metzitzah b’peh, but the city said it had linked four other herpes infections to two mohels, or circumcision performers, since 1988. Two more cases were reported in 2005, including one in which a child suffered brain damage. Efforts to curtail the practice, however, have met with resistance. Some Hasidic leaders, who say the act is commanded by Jewish law, threatened protests after city Health Commissioner Thomas Frieden recommended that infants not undergo the procedure. The new state guidelines would stop short of a ban, but include precautions that could reduce the chances of infection, said New York State Department of Health spokesman Robert Kenny. Rabbis will likely be asked to inform their congregations about the potential risks of the procedure and parents advised to seek prompt care from a pediatrician if their baby develops a fever or rash. Steps would also be taken to “ensure that mohels have full knowledge of their health status” before they perform the ritual, Kenny said. He declined to discuss details of the guidelines, saying they were still being developed. Several religious leaders who support metzitzah b’peh have suggested that mohels be asked to rinse their mouths with alcohol, undergo regular testing for disease and refrain from doing circumcisions if they have a cold sore. “Our priority is to protect the public health, and increase the awareness of the potential health risks associated with this practice,” Kenny said. The guidelines are likely to displease some doctors. Dr. Jonathan M. Zenilman, a professor at the Johns Hopkins School of Medicine in Baltimore, said that while infections have been rare, the potential for harm is substantial enough to justify a ban. “This is something that is pretty much counter to all of the infection-control measures that we have,” Zenilman said. Asking mohels to police themselves could be ineffective, he warned. As many as 70 percent of all adults have herpes simplex 1, and it is difficult to detect periods when the virus is contagious. It is unclear how the Hasidic community will react to the guidelines, which would be voluntary. Rabbi David Niederman, of the United Jewish Organizations of Williamsburg, has argued for no government action, saying there is too little medical evidence to justify a public warning on a ritual performed safely thousands of times a year. “Parents have been alarmed unnecessarily,” he said, adding that he has already begun receiving calls from worried mothers. He said religious law contained provisions that would allow oral suction to be abandoned, but only if there was proof it could cause permanent harm. “We are not fanatics,” Niederman said. “If there is evidence that this practice is not safe, we will not do it. We will be the first ones to act. That is embodied in the same Torah that tells us to make a bris for a child.” Rabbi J. David Bleich, a professor of both Jewish and secular law at Yeshiva University, said the debate over metzitzah b’peh began in Europe during the mid-19th Century, when suspicion arose that it was spreading tuberculosis. Ever since, there has been disagreement over whether the practice was recommended by the Talmud for medical reasons, or ordered as a requirement of a covenant with God. A majority of reform and modern orthodox mohels decided on the former, and now clean a circumcision wound with sterile gauze, a sponge or a glass tube. But a century and a half of debate hasn’t resolved the argument, and Bleich suggested that actions by health authorities wouldn’t settle the issue either. “Whatever changes are going to come are not going to come because of government pressure. If you want to change the way rabbis are doing things, the way to do it isn’t to threaten them.”