[Avodah] Is Metzitzah Part of Milah?

[Micha Berger]

Back in 2006, when there was tragic news of an infant casualty of metzitzah
bepeh was in the news, we discussed MbP and whether it was required here.

In short, in the 19th century, three shitos emerged:

1- MbP is definitely required. I think this is the norm among Edot haMitzrach,
more sure about Chassidim and more Southern areas of the Pale of Settlement.

2- The Chasam Sofer allowed using gauze for metzitzah. (Although his talmid, the
Maharam Shick, never saw the teshuvah and couldn't believe the CS could
have given such a pesaq. More info at:
<http://onthemainline.blogspot.com/2010/04/rabbi-moshe-sofers-responsum-on.html>)

3- What became the dominant pesaq in Litta and Germany was that metzitzah
using a pipette is effectively MbP. The peh doesn't need to be directly
applied, as long as it's used.

I don't even have guesses about what Mughrabim (Morocco, Tunisia...) and
Spanish-and-Portugueses communities do.

Anyway, back to where I thought this post was going...

I had this theory that the underlying difference in assumption was whether
metzitzah is: part of the mitzvah, like milah and periah; proper medical
advice as per the science of the era; or medical advice that turned into
Minhag Yisrael.

1- The MbP is definitely required camp would hold that metzitzah is a third
step in milah. And therefore wouldn't change how it was done from the
way all Jews did it until now.

A good source for this position was posted on-list -- fixing a milah on
Shabbos. Shabbos 133a has a mishnah that says:
    All the needs of milah are done on Shabbos: mohalin, upor'in,
    umotzetzin, bandating and applying cumin [in a medication].

(Sidenote: cumin is known to slow clotting. Maybe I mistranslated
"khammon", or maybe it was some idea like metzitzah -- more bleeding
means more blood-letting.)

So far, we wouldn't know whether the mishnah is lumping metzitzah
with milah and peri'ah as a third step of the mitzvah, or with the
bandage and medicine as a medical care step.

And in fact the on amud beis R Papa says it is medically important:
    R Papa said: a craftsman [ie mohel] who doesn't do metzitzah, it is
    a sakahanh, and we sack him.
    Isn't that obvious? Since we violate Shabbos for it, [of course that
    means we hoold] it is a sakanah!
    Mahu deteima that you just let the blood pool [underneath], ka mashma
    lan that it is connected [and made to flow].
    *And it is similar to the bandage and cumin* [emph. mine -MB]. Just
    as the bandage and cumin if not done will pose a sakanah, here too
    if nothing is done, it posts a sakanah.

Notice this both groups metzitzah with the medical steps in the mishnah
and yet holds it somewhat separate. There is no discussion about whether
the bandage or cumin are there to post a risk.

And then there is what happens if there is still skin left behind after
the original milah on Shabbos, which is in the gemara between those two
quotes (top of 133b):
    Desanu Rabbanan: Someone does a milah, as long as he is stil]
    oseiq bemilah, he can return for the [remaning] strands [of skin],
    whether they are strands that are me'aqvin the milah or whether they
    are strands that are not me'aqvin the milah. [If he] separated [from
    the actual milah] -- for the strands that are me'aqvin the milah,
    he does go back, but for the strands that are not me'aqvin the milah,
    he may not go back.

And we hold (Tur YD 266, SA se'if 1, etc...) oseiq bemilah for this
halakhah is milah, peri'ah, AND metzizah. If the mohel realized he
needs to clean up his job but the milah is kosher any time before doing
metzitzah, he may. If he realizes while bandaging or medicating, he has
to clean up the milah after Shabbos.

So it does seem to say that metzitzah is both part of the beris milah 
even though it is also considered medically necessary.

2- Allowing gauze to be used would imply that metzizah is at most
minhag, and thus the willingness to change to anything that is medically
effective. Not making the diyuq I did in the gemara defending R Papa, it
does say that metzitzah is like bandaging and medicating.

I don't know what to do with the Tur and SA, though.

3- This could be considered ideologically similar to 2, but more cautious
about introducing change. It's not about bloodletting alone, but literally
since Avraham we used the mouth. So sucking on a tube keeps that minhag
going without medical risk to the child from a mohel with germs in
his mouth.

Why am I revisiting the question, other than a desire to write out the
machloqes and my sevaros for the sides in a hopefully evenhanded way?

AhSY gets to the topic later this week. (I am ahead a couple of days.)
YD 261:6 requires a father who can do the milah himself safely not to
delegate his mitzzvah to somoene else. And he continues:
    But metzizah he can delegate to another, because mtzitzah is not a
    mitzvah, but for health alone. siman 384], s"q 4.)

Which is what my theory would expect a Litvak (or a Yekke) to hold.

But it would raise a question... If those who require metzitzah bepeh
in the literal original way really do hold that metzitzah is an aspect
of the mitzvah, why don't more fathers from those communities do that
step themselves? How much expertese does it require? (I am not saying
all fathers, but far more can do metzitzah than actually pickingup
the knife...)

-Micha

-- 
Micha Berger                 "'When Adar enters, we increase our joy'
http://www.aishdas.org/asp    'Joy is nothing but Torah.'
Author: Widen Your Tent       'And whoever does more, he is praiseworthy.'"
- https://amzn.to/2JRxnDF                   - Rav Dovid Lifshitz zt"l