HMS 5765-2; Brit Milah II - The Surgery

Lessons in Memory of my brother Dale Alan Konigsburg

October 4, 2004 - Number 5765-2 Hag Sameach!

Brit Milah II - The Surgery

Maimonides gives us the best description of the surgery involved in a Brit Milah. Since Maimonides was a physician, this is how he describes the procedure: "the entire foreskin which covers the glans is cut so that the whole of the glans is exposed. Then a thin layer of skin beneath the foreskin is torn with the fingernail and turned back with the flesh of the glans completely exposed. Thereafter, one sucks the wound until the blood is drawn from the more remote places so that no danger to the child’s health may ensue... after this has been done, a plaster bandage or similar dressing is applied." (Mishna Torah: Hilchot Milah 2:2; Translation by Rabbi Isaac Klein in "A Guide to Religious Jewish Practice" p.421-2)
From this description we see that there are three stages to a ritual circumcision (Brit MIlah) The cutting of the foreskin. The tearing and folding of the mucous membrane. The suction of the blood.
While Maimonides gives us a description of what the surgery was like in his day, today there are some notable differences. The membrane and the foreskin are often cut at the same time. While any instrument can be used for the surgery, most use a surgical scalpel or a knife used exclusively for circumcision. A "magen" or a shield is used to protect the glans during the cutting. This shield has a slit in its surface so that the foreskin and the membrane can be placed in the slit and the glans itself is protected during the cutting.
It is the baby’s father who has the responsibility to do the circumcision, but usually the father delegates a professional to do the surgery. This expert is called a "mohel". Once the foreskin has been placed in the slit in the shield, sometimes the father will do the actual cut to fulfill this mitzvah.
Brit Milah must be done on the eighth day. Even if it is Yom Kippur. If there is any danger to the child or any illness in the child, the brit is postponed until the child is well. The first day when the child is born is counted as the first of the eight days. A child born by cesarian section is not circumcised on Shabbat or holidays.
The baby is brought into the room by a couple known as "kvatter" and "kvatterin" sometimes translated as "god parents" but not in the legal sense that we use the terms today. There is a custom of sending the mother of the baby out of the room for the Milah, but this is just an vestige of when all women were "hysterical" and could not watch the operation. Today, any mother who wants to be at the front for the Milah are welcome to stay. The person who holds the baby for the operation is called the "sandek" and this is a great honor usually reserved for the most religious member of the family. Before the baby is handed to the sandek, the baby is placed on a chair reserved for Elijah the prophet. Elijah is the guardian of circumcision and is said to be present at every Brit Milah.
A modern mohel will perform the surgery quickly so that there will not be much pain. After securing the baby in the hands of the Sandek, the mohel will remove the diaper and take a small "probe" and insert it under the foreskin to free the mucus membrane from the glans. Then a clamp is used to grab both the foreskin and the membrane and pull it away from the glans. A Magen clamp is then opened, with the foreskin/membrane placed in the slot and the glans secure under the shield. The clamp is closed and the Mohel (or the parent if they wish) then take the knife and cut across the top of the shield. There is a blessing recited before the cut is made, and another after the cut. Usually the father gives "permission" to the mohel to make the cut and the mohel says the blessing before cutting. The parents recite the blessing after. The clamp is then opened, the remaining foreskin is pulled back behind the glans. An antibiotic is applied to the bandage and the bandage is put into place. Often a special "steri-bandage" is used to promote faster healing. The diaper is replaced and the Milah is complete.

Next week: Brit Milah III - The Naming