From Parshat Chayei Sarah
Date of issue: 6 Nissan 5761 -- March 31, 2001

Modern Issues in Brit Milah - Part Two
by Rabbi Howard Jachter

This week we shall continue our discussion of some of the questions that modernity has generated in regards to the Mitzva of Milah. We will discuss the use of shields and clamps in the context of Brit Milah. We seek to shed light on an area of moderate controversy and some misinformation.

The Plain Mogen, the Gomco Clamp, and the Bronstein Mogen
A few hundred years ago, a plain Mogen shield was introduced to enhance the safety of Brit Milah. The Pri Megadim (Orach Chaim, Eishel Avraham 75:8) endorses the use of this shield. Most Mohelim use at least this basic shield for Brit Milah.

Approximately sixty years ago, the Gomco clamp was introduced and became a standard tool for physicians who perform circumcision. Halachic authorities strongly opposed the use of the Gomco clamp. Rav Yosef Dov Soloveitchik (personal communication in 1984), Rav Moshe Feinstein (Teshuvot Igrot Moshe Yoreh Deah 2:119), Rav Yosef Eliyahu Henkin (Eidut Leyisrael p.144), Rav Yaakov Kaminetzsky (Emet Leyaakov p.361), Rav Zvi Pesach Frank (cited in Teshuvot Tzitz Eliezer 8:29) and Rav Eliezer Waldenberg (Teshuvot Tzitz Eliezer 8:29) strongly oppose the use of the Gomco clamp. Virtually no Orthodox Mohel uses a Gomco clamp for a Brit Milah.

One major criticism of Gomco clamp is that no blood is drawn. The Gomco clamp causes the blood to stop flowing to the foreskin, thus
producing a bloodless circumcision. Rav Soloveitchik, Rav Moshe, and Rav Waldenberg mention that the drawing of blood is an indispensable component of the Brit Milah procedure. Rav Chaim Soloveitchik of Brisk emphasizes this point vigorously (Chidushei Hagrach Al Hashas, Shabbat 135a). Rav Moshe seeks to demonstrate this assertion from Chazal's mentioning the act of drawing of blood in the Bracha recited at a Brit performed on a convert (Shabbat 137b). Another proof is that Hatafat Dam Brit (drawing of blood) is performed on a baby whose Brit was conducted improperly, such as a Brit performed before the eighth day or at night (Shach Y.D.262:2).

Another major criticism expressed by Poskim is that Halacha views the dead foreskin as detached from the body. Thus, the Mohel has not performed any cutting, which is certainly an indispensable component of the Milah procedure. Rav Frank and Rav Waldenberg express considerable concern for what they perceive as the excessive amount of pain inflicted on the baby when using the Gomco clamp.

Bronstein Mogen
The famous Mohel, Rabbi Harry Bronstein zt"l, introduced in the late 1950's an upgraded version of the traditional Mogen. Rabbi Bronstein writes (in a pamphlet introducing his Mogen) that he seeks satisfy the standards of both the secular medical establishment and Halachic authorities. At that time, doctors advised against performing a Brit without a clamp and many parents heeded their advice. Mohelim were caught in a terrible dilemma because the Brit implements that the Rabbis permitted were forbidden by the doctors and what the doctors permitted the Rabbis forbade. Rabbi Bronstein developed his Mogen to satisfy both Rabbis and doctors and thereby facilitate proper fulfillment of the Mitzva of Milah by millions of Jews. Rabbi Bronstein notes that Rav Eliezer Silver (one of the outstanding Torah luminaries of North America in the middle of the twentieth century) gave his written approval to this procedure (printed in the Torah journal Hapardes, volume 30 number 1). In addition, I have been informed that many Mohelim prefer to use the Bronstein Mogen because of its considerable safety benefits (it leaves much less to chance).

There has been a somewhat mixed reaction among the Poskim to the Bronstein Mogen. Rav Yosef Dov Soloveitchik told me (in 1984) that the use of this implement is acceptable if blood is drawn. Blood is drawn at every Brit where the Bronstein Mogen is used properly (as noted by Rav Moshe Pirutinsky's Sefer Habrit p.179). When used properly, the Bronstein Mogen does not eliminate the blood supply to the foreskin.
Accordingly, Rav Moshe Feinstein (Teshuvot Igrot Moshe 3:98) rules that a Milah performed with the Bronstein Mogen is acceptable. Rav Shlomo Zalman Auerbach (cited in Nishmat Avraham 5:86-87) also rules that a Mogen clamp is acceptable if blood is drawn. Rav Shaul Yisraeli (Teshuvot Bemareh Habazak 2:96) recommends the use of the Bronstein Mogen at least in certain circumstances.

There have been two points raised to argue that it is less than ideal to perform Milah with a Bronstein Mogen. One argument is that the Rambam (Hilchot Milah 2:2) and Shulchan Aruch (Y.D. 264:3) describe the Mohel performing the Periah process (removal of the second level of skin beneath the foreskin) with his fingernail. Moreover, the Shulchan Aruch describes Milah (removing the foreskin) and Periah as two discrete processes that are occasionally done by two different people on one child. A Mohel who uses the Bronstein Mogen accomplishes the Milah and Priah with one simultaneous cut. The Bronstein Mogen sets in place all of the skin that the Mohel will cut and the Mohel subsequently performs the Milah and Periah with one cut.

However, a responsum of Rav Hai Gaon (printed in Teshuvot Hageonim Shaarei Tzedek 3:5:6) endorses the practice of Mohelim in his country (Babylon) to simultaneously perform both Milah and Periah, even though the Mohel does not perform the Periah with his fingernail. Moreover, Rav Moshe Feinstein (Teshuvot Igrot Moshe Y.D. 1:155 and 3:98) permits simultaneous performance of Milah and Periah and endorses the authenticity of the Teshuva attributed to Rav Hai Gaon. Shulchan Gavoah 264:27 (an important Sefardic authority) records the practice of Mohelim in Solonika (described by Rav Ovadia Yosef as a community filled with pious and learned Jews) to simultaneously perform Milah and Periah.

Many more Halachic authorities rule Periah is acceptable even if the Mohel does not use his fingernail. Rav Chaim Ozer Grodzinsky (Teshuvot Achiezer 3:65:12) notes that since Periah is impossible to perform with a fingernail when performing a Brit on an adult, Periah performed on adult converts is accomplished with an instrument. Rav Chaim Ozer concludes that it is definitely acceptable to perform Periah with an instrument. Rav Ovadia Yosef (Teshuvot Yabia Omer 7 Y.D. 22), after citing numerous authorities to support his opinion, rules that Periah with an instrument is acceptable. The aforementioned Poskim, however, write that it is preferable to perform Periah with a fingernail as described in the Shulchan Aruch. Mohelim who use the Bronstein Mogen argue that the safety and societal benefits of the implement justify the performance of Periah in a halachically acceptable, albeit less than ideal manner. Moreover, the practice of the Mohelim of Babylon and Solonika constitutes ample precedent to perform Milah and Periah simultaneously, without using a fingernail .

The second reservation that Poskim express is the reluctance to endorse a change in the traditional procedure for Brit Milah. Even though Rav Moshe Feinstein rules that a Milah performed with a Bronstein Mogen is acceptable, he declines to endorse its use. Rav Moshe explains that "one should Lechatchilah (initially) avoid anything new." Rabbi Donny Frank (Journal of Halacha and Contemporary Society number 36, Fall 1998, p.50) notes that "the application of Chadash Assur Min Hatorah (any new procedure is forbidden) to methods of Brit Milah is a curious one for innovations have been made over the centuries including the plain shield which is commonplace today." Indeed, Rav Shlomo Zalman Auerbach and Rav Yosef Shalom Eliashiv are cited (Nishmat Avraham 5:84) as ruling that a Mohel is "obligated" to use anesthetics if it medically sound to use them, even though it represents a departure from the traditional procedure. Similarly, one may argue that the safety afforded by the use of the Bronstein Mogen justifies the departure from the traditional procedure for Brit Milah.

Rav Yechezkel Landau (Teshuvot Nodah Beyehudah O.C. 2:18) presents guidelines for legitimate Halachic innovation. The Nodah Beyehuda was asked whether a synagogue may be constructed in a shape other than the traditional rectangular form. Rav Landau responded that although Halacha has no specific requirements regarding the shape of a shul "it is best not to deviate from the venerated practices [of the Jewish People]." However, he writes, "If the reason [a departure from the traditional practice is desired] is that the proposed plan will allow for more available seating area, there is no reason why this plan should not be implemented." Rav Laudau asserts, though, that the change is inappropriate if the motivation to change the shape is to imitate the architectural style of the nobility.

Similarly, Rabbi Harry Bronstein's motivation for introducing his Mogen was pure and noble. He risked his life for decades to perform tens of thousands of Halachic circumcisions in the Soviet Union, despite government decrees, in accordance with Jewish tradition (see Shabbat 130a). Rabbi Bronstein established more than sufficient credibility to believe his written assertion that his motivation to develop his Mogen was to facilitate Milah for millions of Jews who would otherwise refuse a Halachic circumcision for their children. Moreover, the enhancement of the safety of Brit Milah is a legitimate reason for change, just as the introduction of the plain shield was accepted as a legitimate change. Furthermore, Rabbi Bronstein wrote that he has not introduced anything new. Rather, he has merely modified the plain shield that Mohelim used in Europe for many generations.

Finally, Mohelim report that the Bronstein Mogen does not cause any more pain to the boy than the traditional shield. Moreover, Rabbi Donny Frank (op. cit. p.40 note 14) cites a scientific study whose results were cited in a report by the Associated Press, which compared the reactions of babies to the Bronstein Mogen and the Gomco clamp. The report states:
"The boys circumcised with a Mogen… had less than half the heart rate increase and total crying time of infants circumcised with a Gomco… Oxygen levels were also higher in the Mogen infants, a sign they suffered less stress… With the Mogen, half of them did not cry at all. They were comfortable… With the Gomco clamp they cried longer… over 60% of the time."


Conclusion
Almost all Mohelim use at least a plain shield and virtually all Orthodox Mohelim do not use a Gomco clamp. Regarding the Bronstein Mogen, there is no universally accepted practice. Some Mohelim use it for every Brit they perform, some use it only upon request, and others never use it. Rav Yosef Dov Soloveitchik and Rav Eliezer Silver permitted its proper use without any reservations (as long as blood is drawn). Rav Moshe Feinstein and Rav Shlomo Zalman Auerbach are among the many Poskim who rule that a Brit performed with a Bronstein Mogen is acceptable (as long as Brit is drawn). The objections articulated by Rav Waldenberg (Teshuvot Tzitz Eliezer 8:29 and 10:38) seem to apply only when the Mohel fails to use the Bronstein Mogen properly.

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