MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION.
Biblical and rabbinical traditions throw no light on the origin of the
details of the operation as now performed. That it was anciently
performed with a knife of stone is certain; an event common in its
general observance, and which seems to have pervaded all nations or
races, howsoever remote or scattered, that it has induced Tylor[60] to
ascribe the origin of the rite to the stone age. We are told that when
Moses was returning to the land of Egypt he had neglected circumcising
his son, and that because of that neglect he nearly lost his son's life;
his wife, Zipporah, the daughter of the Midian king and priest, Jethro,
seeing the danger and knowing its cause, took her little son Gershom and
circumcised him with a stone knife, and offered the foreskin to God as a
peace-offering. Just where the wine was first used we are not told.
Wine, however, was an emblem of thanksgiving, and, being one of the
fruits of the earth, was considered an acceptable offering to God. It
has since, in some form or other, either as wine or as the
representative of either divine or human blood, been used in both the
Catholic and Protestant Churches in their ceremonials or vicarious
sacrifices, or imitations of old customs. Circumcision was by many
connected with a blood sacrifice; it was so suggested by the words of
Zipporah at the circumcision of Gershom: "And Zipporah, his Midianitish
wife, took up a sharp stone and cut off the foreskin of her son, and
cast it at his feet and said, 'Surely a _Khathan_ of blood art thou to
me.'" Much speculation has followed the use of this word _Khathan_,
which, in the ordinary Arabian, may mean either husband or son-in-law;
it also means a newly-admitted member of a family; a similar word means
"to provide a wedding feast," and one other word from the same root and
branch means "to give or receive a daughter in marriage." In our own
day, the _mohel_, or ministerial circumciser, makes it a practice to
draw a little blood from the skin of such as are presented for the rite,
but whom nature has not furnished with sufficient foreskin for the
operation. The application, thrice repeated, of the blood and wine to
the lips of the child, is probably used as a sign of the sealing of the
compact. Wine is mentioned in connection with the High-Priest
Melchisedeck as the wine of thanksgiving at his meeting with Abraham;
wine was presented to Aaron by the angel, who, giving him a crystal
glassful of good wine, said to him: "Aaron, drink of this wine which the
Lord sends you as a pledge of good news." Originally, circumcision must
have consisted of the simple removal of the foreskin, and the
elaboration of the ceremonial details must have been a subsequent
occurrence; persons wounding their fingers will instinctively carry them
to their mouth, and it may be that the suction practiced by the Hebrews
had its origin in this natural haemostatic suggestion. Wine as a
haemostatic and as an emblem of thanksgiving and an acceptable offering
naturally came in as an accessory.
This practice--which, in the old, patriarchal days of the simple
shepherds, when men only lived on the flesh of their own flocks, their
diet, however, consisting mostly of cakes of flour, milk, honey, a few
herbs, or the flesh of the goat or sheep--could not have been as
objectionable as it is at the present day, with blood and secretions in
a continued ferment through diet and habits. Man, living in the open air
of Armenia, Palestine, or Arabia, sleeping in the open tents of our
Biblical forefathers, living on the simple diet of a shepherd's camp,
with the abstemiousness that those climates naturally induce in man,
could not help but be healthy. In those early days, when neither
passion, anxiety, nor worry disturbed either digestion or sleep, man had
no vitiated secretions, wine was then a rarity, and water was the drink.
One of the early patriarchs on such diet would have furnished a dainty
and savory dish to the most fastidious cannibal, who is now tormented by
the _komerborg kawan_, this being a term used by the Australian
cannibals to designate the peculiar nausea that is induced in them when
they recklessly eat of white man,[61]--something which they do not
experience from feasting on the savages who live on the simple diet of a
pastoral tribe. This primitive gastronomic science in regard to
cannibalism even reached such a pitch of refinement that, as has been
previously mentioned, some tribes even resorted to emasculation to
improve the flavor of the animal juices, which by this procedure became
less acrid. The Arabian and Oriental traditions bring us down tales of
how, on the same principles, human beings intended to grace the festive
platter were fed exclusively on rice. The salivary and buccal
secretions, under such a simple diet as that indulged in by our Biblical
forefathers, become bland and harmless; not only harmless, but even
antiseptic and positively beneficial, acting on the same principle as
local applications of pepsin. So that the practice, at the time of the
patriarchs and in their own family, of this part of the rite could not
have offered the same objection that it does at the present day. The
modern house-dweller, living on a mixed diet and in a climate that
induces him to eat grossly, both as to quality and quantity, partaking
more or less of vinous, spirituous, or fermented liquors, as well as
indulging in tobacco, is quite another being from the Arabian or
Armenian shepherd of former days. Business anxieties and worry also have
a very pronounced effect; so that, with the change in the conditions of
man and the inception and multiplication of diseased conditions, as well
as the creation of constitutional and transmissible diseases, this
practice of suction should have been stopped.
Intelligent rabbis, devoted to their religion, are necessarily prone to
defend any of the details in its ceremonials that age and practice have
sanctioned, and even some of the later writings of Israelism seem to
make the mezizah, or suction, a necessary and ceremonial detail. In the
"Guimara," composed in the fifth century, Rabbi Rav Pope uses these
words: "All operators who fail to use suction, and thereby cause the
infant to run any risk, should be destituted of the right to perform the
ceremony." In the "Mishna" it says, "It is permitted on the Sabbath to
do all that is necessary to perform circumcision, excision, denudation,
and suction." The "Mishna" was composed during the second century. The
celebrated Maimonides lent it his sanction, as in his work on
circumcision he advises suction, to avoid any subsequent danger. Our
modern Israelites are supposed, as a rule, to have taken their
authority, aside from previous usage and custom, from the "Beth Yosef,"
which was written by Joseph Karo, and subsequently annotated by the
Rabbi Israel Isserth. In all of these sanctions, however, there is no
reason expressed why it should be performed.[62] Maimonides undoubtedly
looked upon this act as having a decided tendency or action in depleting
the immediate vessels in the vicinity of the cut surface, and that the
consequent constriction in their calibre would prevent any future
haemorrhage. That this is the natural result of suction is a fact readily
understood by any modern physician. The depletion of the vessel for some
distance in its length, with the contraction in the coat that follows,
is certainly a better preventive to consequent haemorrhage than the
simple application of any styptic preparation that can only be placed at
the mouth of the vessel, but which leaves its calibre intact. Hot water,
or an extreme degree of cold, will answer to produce this contraction
and depletion, but there is here a local physical reaction that is more
liable to occur than when the contraction has taken place naturally, as
when induced by depletion, instead of by the stimulus of either heat or
cold. So that if, in the light of modern civilization and changed
conditions of mankind, and the existence of diseases which formerly did
not exist, we are now convinced that suction is dangerous, we should not
judge the ancients too hastily or rashly for having adopted the custom,
as it is certainly not without some scientific merit; although,
authorities are not wanting who hold that suction or depletion increases
the danger of haemorrhage.
It can be understood that the results of suction would be in some
measure analogous to those left by the application of an Esmarch bandage
on a limb. The ancients, performing the operation with rude implements
and having no haemostatic remedies or appliances, naturally followed the
best means at their command; they evidently feared haemorrhage, and their
rule in regard to exemption shows us that they recognized the existence
of haemorrhagic diathesis or other transmissible peculiarities of
constitution. This same fear of haemorrhage probably suggested the second
step of the operation being performed, as it is by laceration instead of
by cutting instruments, showing in this an evident desire to limit the
cutting part of the operation to as small a limit as possible. Against
an infant who has decided haemorrhagic tendency, we are about as helpless
as were the ancient Hebrews, and, while the Turkish or some of the
Arabian methods of performing the operation may be said in ordinary
cases--by the application of cord and the consequent constriction--to
limit the danger from subsequent haemorrhage, still, in the haemorrhagic
diathesis this would not be of any avail; so, as already observed, we
must not too rashly judge those old shepherds of the Armenian plains for
adopting a practice which to them was calculated to avert subsequent
dangers, or their descendants following in their footsteps, until having
learned better, even if that practice is to us disgusting, primitive,
and useless.
Cases occur,--happily not frequently,--of alarming and uncontrollable
haemorrhage. The following case is suggestive of the alarming extent and
persistence that may attend one of those haemorrhagic cases, even when
recovery eventually takes place. It is reported by Dr. Sannanel in the
_Gazetta Toscana delle science medicale e fisiche_ of 1844. The case was
that of a Jewish infant circumcised on the eighth day. Some hours after
the operation the child was observed to be bleeding; the haemmorrhage
would only cease for a few moments, and then come on with increased
force, and which proved rebellious to ordinary remedies. Dr. Sannanel
was called during the night of the third day after the operation. A
number of physicians had been in attendance, and neither ice,
astringents, pressure, nor any usual haemostatic means had had the least
effect; cautery with nitrate of silver, sulphuric acid, and the actual
cautery by means of heated iron were tried in succession, without any
good results. Ten days passed in this manner, the haemmorrhage only
ceasing for a few moments at a time, and the child was nearly
exsanguinated from the continued serous seepage and the paroxysmal
haemorrhages, when a lucky application of caustic potassa almost
immediately stopped the haemorrhage. This case was seen by nearly all the
leading medical men of Leghorn, who lent their aid and counsel to save
the little life. The case is interesting from the length of time it
persisted, and that even after all the loss of blood and suffering that
the little fellow endured he survived.[63]
Dr. Epstein, of Cincinnati, in a letter of March 29, 1872, to the
_Israelite_ of that city, mentions a nearly fatal case from haemorrage
after the rite of "_Milah_," and gives the result of his experience in
such cases. He argues that _Hitouch_ or _Hitooch_ alone, or the first
step or cutting off of the prepuce, performed with ordinary care, could
hardly be followed up with any more serious results than can be
controlled with the application of a little acidulated water. The second
act, or _Periah_, the act of laceration, he looks upon as one that calls
for coolness, judgment, and skill, as the membrane should only be torn
so far and no farther, the thin, inner fold of the prepuce being
vascular only in the sulcus back of the corona and at its lower
attachment, where it forms the frenum, or bridle; any carelessness or
over-anxiety on the part of the operator in tearing this membrane too
far back results in danger of haemorrhage; especially is this part of the
operation liable to be badly done if the inner preputial fold is thick
and resisting, as in that case undue force may carry the laceration back
into the vascular tissue. The means suggested by Dr. Epstein to arrest
haemorrhage are those ordinarily used in haemorrhagic cases, such as will
be given presently. The doctor regrets that the operators are not as
they should be, physicians, and that, when _mohels_ are employed,
persons are not sufficiently exacting as to their qualifications.[64]
In France the government has managed to secure more safety in the
operation. By a royal decree of date of May 25, 1845, in compliance with
a desire expressed by the Hebrew Consistory, it was ordered that no one
should exercise the functions of a _mohel_ or of _schohet_, without
being duly authorized to perform said functions by the Consistory of the
Circonscription; and that all _mohels_ and _schohets_ shall be governed
in the exercise of their functions by the Departmental Consistory and
the General Consistory. By virtue of this decree a regulation was passed
by the Consistories on the 12th of July, 1854, ordering that thereafter
circumcision should only be performed in a rational manner, and by a
properly qualified person. Suction was likewise abolished, and the wound
directed to be sponged with wine and water. This decree and the
resulting regulations have been of the greatest benefit to the French
Israelites, and some attention to the matter would not be amiss in the
United States.
This reformation has met with the approval of the leading French Jews,
whose General Consistory decided that suction was not necessarily a part
of the religious rite, and that, as it was undoubtedly introduced into
the rite on the days of primitive surgery, it was perfectly rational to
suppress this operative accessory, now that that same science, in its
enlightenment, pronounced it unsafe. The whole body of the Congregation
did not tamely submit to what they considered an innovation, and from
some of the mohels all possible resistance was opposed to prevent the
abolishment of this part of the operation from becoming a law. So
determined was this opposition in some instances that the Consistory of
Paris found it necessary to impose on all the mohels an obligation,
bound by an oath, that they would respect the law. Those who refused to
take the obligation gave up their vocation.
The Grand Rabbi of Paris, at the time of this reformation, M. Ennery,
was one of the most zealous supporters of the new departure. The
influence of the French pervaded northward, and the _mezizah_ was
abolished in Brunswick, Dr. Solomon, a learned Hebrew of that State,
being instrumental in having it done legally. The discussion of this
subject, in 1845, had one very happy effect,--the supporters of the
reformed idea of the rite issued a circular letter to all the leading
continental surgeons and medical men asking for their opinion on several
points in relation thereto, especially, however, on this part of the
rite. The opinions of many of these will be referred to in the medical
part of this work.
The after-treatment of the circumcised infant is governed more or less
by local habits and the individual intelligence of the mohel and his
experience. After turning back the inner fold of the prepuce, the parts
are covered with a small, square bandage, with an aperture to admit the
passage of the glans. This, and the subsequent small bandage of old
linen, which is calculated to hold it in place, are slightly coated with
a powder composed of lycopodium, with the slight addition, at times, of
Monsel's salts, alum-powder, or some vegetable astringent. Over these
another compress is placed, to prevent the friction of the clothes of
the infant or of the bedding. The infant then receives a final
benediction, and the godmother then receives the child in her arms and
carries it to its cot or crib. The operator generally visits the infant
in the afternoon of the operation, and carefully inspects the dressings,
to see that no haemorrhage has supervened.
It is customary to place the child in a bath, either the same evening or
on the following morning, the object of this being to remove and to
facilitate the removal of the dressings, which are more or less
saturated and clotted with blood. After the removal of these, the wound
is redressed, as previously, except that some cerate--ointment of roses
or some other mild ointment--is used. Some prefer the simple water
dressing from beginning to end. Since the introduction of creasote, acid
phenique, and carbolic acid, many mohels are in the practice of washing
the parts with water impregnated with one of these before performing the
operation, and using subsequently the same form of lotion at every
dressing. In case of haemorrhage there is an haemostatic water or lotion,
which has been long used by the German and Polish mohels with
considerable success, and which, in ordinary cases, has been found to be
all that was required. This water, called by the French "Mixture
d'arguesbusade," "Eau vulneraire spiriteuse de Theden," and by the
Germans as "Spritzwasser" and "Schusswasser," is composed as follows:--
Acetic acid, 10 grammes.
Rectified spirits of wine, 5 "
Diluted sulphuric acid, 21/2 "
Clarified honey, 8 "
This mixture is well mixed and filtered, and is then kept in a
tightly-stoppered vial.
Dr. Bergson uses a mixture composed of diluted sulphuric acid, 1 part;
alcohol, 3 parts; honey, 2 parts; and 6 parts of wine vinegar.
Haemostatic powders are also used by the Hebrews, being more conveniently
kept or carried than the haemostatic waters. In Russia and in Poland they
are composed of decomposed or decayed hawthorn-wood powder and
lycopodium. That of Berlin is composed of Armenian bole, red clay,
dragons' blood, powdered rose-leaves, powdered galls, and powdered
subcarbonate of lead. In France a haemostatic fluid, composed of dragons'
blood digested in turpentine, is in vogue. The Eau de Pagliari is also
used; it is composed of a mixture of tincture of benzoin, 8 ounces;
powdered alum, 1 pound; and 10 pounds of water, boiled together for six
hours, and is considered a powerful styptic. In addition to these, burnt
linen, spiders' webs, starch-powder, powdered alum, and plaster-of-Paris
powder are used by different mohels. Touching the bleeding points with a
pointed pencil of nitrate of silver is also a practice understood by the
Jewish circumcisers.