- My teacher, Rabbi Mordechai Sasson, would often grab the foreskin with his fingers and remove all of the membrane along with it, alleviating any need to tear the membrane or otherwise remove it.
- Others accomplish the same task with the help of an instrument called a "hemostat"
- Still others do what Rabbi Sasson did, except they only remove part of the membrane. The remaining membrane is then torn apart with the fingernails (which can be gloved, if the gloves are thin) and folded back beyond the corona of the glans. This third approach does not completely remove the membrane as do the first two methods described.
תשובות הגאונים שערי צדק חלק ג שער ה סימן ו
רב האיי ז"ל. (גם זו הועתקה) דע כי זה החוק יש בבבל מהיו' שנים רבות: שמושך המוהל את הערלה ומפסיק הקליפה התחתונה בידו כדרך שהם יודעין עד שהיא נפסקת, ומאבד אותה עם הערלה, וחותך אותה בבת אחת. ואם אינה נסדקת ונפסקת באצבע או בצפרנו, יהיה לו סרן הנקרא בלשון ערבי מדור ופוסק בו וחותך הכל בבת אחת ושפיר דאמי. ואין ראוי לחתוך בשני פעמים, אבל ראוי להיות מילה ופריעה בבת אחת וכשנעשות שתיהן יצא. +(שבת קל"ג קל"ז, י"ד רסד ג' ד')+ עד הנה.
Every person has the ability to educate oneself about the methods out there, and choose what works best for you. You can hire a mohel telling him exactly what you want him to do, and see if he will accommodate your wishes based on his comfort level. And if it doesn't work in either direction, don't hire the man. But by no means get upset because he has his way and you have yours. And both are fine, produce fine circumcisions, and leave baby no worse for wear with either method - it is merely a question of whether one believes one way is either better than the other, more halakhically advocated, or more vs. less painful to the baby.
On the topic of Milah and Priah at the same time, and using anesthesia on the baby (numbing) at the time of circumcision.
This response is the last big response that Rav Moshe wrote in his own handwriting. During this time, his vision was deteriorating (it should not happen to anyone), and after this response, the writing of which was very difficult for him, he only wrote short response.
15 Elul 5744,
To [many superlatives] Rabbi Shabsi/[tai?] Frankel, etc.
It's surprising about the letter the Rabbi wrote, which is dated 16 MarCheshvan 5743, because it has been more than 1 year and 8 months since it was written, and in all this time, I have seen the illustrious rabbi a number of times, and he never mentioned anything about the letter he had written. Nonetheless it has appeared. And now that the letter has been found, and it's a matter of Torah, I have the responsibility to respond. In particular because it is a matter that is halakha l'mayseh (quite relevant) and on the topic of the mitzvah of bris milah, which is very important, as the Talmud Nedarim (31b) explains.
1. Is there a concern when the foreskin and the priah membrane are removed at the same time with a knife of "changing the way the mitzvah is fulfilled"?
[Answer] What the rabbi has seen in
that the cutting of the foreskin, [along with] the membrane that is a thinner skin – the mohel did this in one cut with his knife. This is done through the insertion of a blunt thick needle [a probe], which he uses to separate the thin skin, which is the membrane, from the glans. America
The two skins [foreskin and membrane] were then attached, and he excised them together in one action. I was asked this question in 5714 (1954), and my answer was published in YD I:155, that according to the law there is no difference: not in the cutting of the foreskin or the cutting of the membrane with regard to what they use to do it.The mitzvah of milah is to remove the two skins that cover the glans (to the edge of the corona), which are the foreskin and the membrane. The definition of priah is "revealing," as Rashi explained at the end of Rabbi Eliezer D'Milah (Shabbat137b, s"v para). And there is no difference as to how this is accomplished.But, since the membrane is thin and attached to the glans, and it is impossible in practical terms, to cut it in a simple cutting of the foreskin, and it even can not [be cut] by itself [meaning, when the foreskin has already been removed and the membrane alone remains] unless one tears it with fingernails to fold it back from on the glans; and because it is so thin there is no need to cut it, rather they just fold it back beyond the corona, and it sticks to the skin of the shaft in that spot and becomes part of the shaft.
It is not part of the skin of the foreskin - which is thicker – for were one to do the same thing with the foreskin, to fold it back and have it stick below the corona, it would be quite clear that this is the original foreskin stuck back there. And maybe, when the circumcision is done this way [folding back extra foreskin] he did not fulfill the mitzvah of bris milah because it will look like it was never cut, because the skin is still there, except that it has changed its location on the organ.
The mitzvah is to circumcise yourselves (Genesis ), which means to completely cut off all that is recognized as that skin. And every word "Milah" at the end of parshat Lekh Lekha and Tazria refers to a cutting.
This implies that for the foreskin itself, a real cutting is required. But the membrane, which is a thin skin, which gets stuck and becomes part of the shaft itself and can no longer be recognized, it is good enough if it was not cut and was just folded back and set below//beyond the glans in the shaft – even though it gets stuck there and we are aware of it.
It's also possible that it's a "Halakah L'Moshe MiSinai," [namely] that the foreskin needs to have a complete excision, and none of it whatsoever should remain on the organ, not even on some other part of the organ (relocated), but this would not be the case with the membrane.
There is a difference between the membrane and the foreskin, and there is a difference to the law from the decree of the Torah, from the law from Sinai, since this is what was the practice "l'mayseh" [for] many generations.
Nonetheless, this is certainly not to suggest there is a mitzvah to specifically leave the membrane on the body, even in some other place [ie relocated to below the glans]. It is certain that if a mohel removed the membrane, leaving nothing behind, there is nothing lacking in the [fulfillment of] the mitzvah. If he's not adding pain to the baby.
And what it says in the Midrash Shochar Tov (and in Midrash Tehillim 35:2 it only mentions [a mitzvah done with] fingernails regarding using them to reflect the light at havdalah, but the text in Yalkut Shimoni Tehillim 723 it mentions fingernails for priah) it says fingernails are for priah, this is not meant to establish an obligation to do it this way.
It's only because it was the practice of mohels in all the generations with fingernails, because that way was easier to do, and it also healed better than when [priah was] done with a knife. That's why it was done with fingernails.
But if one sees that that the membrane is also excised with the knife, it is simple, in my humble opinion, that he is yotze [has fulfilled the mitzvah properly].And this is true even if it was done in two acts – cutting the foreskin and cutting the membrane.
And even on shabbos, two [separate] acts are permitted, even when there is a greater expert who can do them both [milah and priah, that is] in one act [of cutting]
And this expert I refer to is one who is an expert in the simple cutting of the foreskin – that he can excise all of the foreskin along with some of the membrane, because this makes it much easier for the person doing priah to grab the membrane.
But many mohelim are not able to do this: when they remove the foreskin they get nothing of the membrane. And then to go back with the knife and cut part of the membrane is extremely difficult, and they need to find a way to begin the cutting of the membrane, which is really a thin/delicate skin.
The second guy, the one standing by to cut the membrane, needs to do it with his fingernails and not a knife, because it is difficult to ascertain that he will only cut the thin membrane with the knife [and not, chas v'shalom, a part of the glans], unless he says he is an absolutely expert mohel. And even then we don't rely on him.
But in the first place, one should hire a mohel who can assure that when he removes the foreskin he also touches the end of the membrane, so that the priah will be relatively easy to do, with as little pain to the baby as possible.
But with regard to the fulfillment of the mitzvah of milah, there is no distinction in the cutting of both skins together, because if both [meaning neither] skins are not removed from the organ, it is nothing [IOW, not even considered a bris], whereas if both skins are removed from the organ it is a fulfillment of the mitzvah of milah.
The one distinction is that the foreskin needs to be removed completely from the organ, but with regard to priah, when it is moved off the glans and placed [still attached] below the corona there is that distinction because that can be done with the membrane but cannot be done with the foreskin.
[I included the rest of this - which does not translate the entire answer - simply because the point is a good tag to this posting about numbing.
2. The reason we don't use anesthesia on the baby before the circumcisionIt seems from here that Rav Shlomo Zalman was of the opinion that a tube for metzitzah was a better method than the mouth, and that doing metzitzah on shabbos is a melakha! He allows the old ways (no pipette and doing it on shabbos) as a nod to the days of old. But his personal view of the more ancient practices is that "they are not better."
With regard to what Rav Shlomo Zalman Auerbach wrote on 23 Cheshvan 5743 that in the act we are careful not to change a practice, even if [the old practice] is not a preferred way to do it.
He said [for example]:
We do not change how metzitzah is done, even though nowadays we have better mediums [tools] which are much easier and better than [classic] metzitzah, and we also do it on shabbos, even though it contains the issue of [it being] melakha.
And he also said that the reason we don't use anesthetic on the baby to prevent him from feeling discomfort, is because we don't want to do any changes in how this mitzvah is done, even though it would seem there is no real suspicion because there is no indication [that this is changing the mitzvah.]
But, you should know, that the real reason we don't use anesthetic is because anesthesia is not healthy for babies. It's also not good for older people. But the older people take the anesthesia because they specifically request it, because they'd much prefer to be numb [and deal with the risks that come with anesthesia] than to feel the pain of having skin removed without numbing. But the choice we make for children is most influenced by our concern for their wellbeing….