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}}</ref> In more recent times, boys have been infected with ''herpes'' and some have died.

}}</ref>—has become controversial. The process has the ''[[mohel]]'' place his mouth directly on the circumcision wound to draw blood away from the cut. The majority of Jewish circumcision ceremonies do not use ''metzitzah b'peh'',<ref>{{REFnews

}}</ref> along with letters from Dr. Wertheimer, the chief doctor of the Viennese General Hospital. It relates the story that a ''mohel '' (who was suspected of transmitting [[herpes]] via metzizah to infants) was checked several times and never found to have signs of the disease and that a ban was requested because of the "possibility of future infections".<ref>{{REFbook

}}</ref> [[Moshe Schick]] (1807–1879), a student of Moses Sofer, states in his book of Responsa, ''She’eilos u’teshuvos Maharam Schick'' (Orach Chaim 152,) that Moses Sofer gave the ruling in that specific instance only because the ''mohel '' refused to step down and had secular Government connections that prevented his removal in favor of another ''mohel '' and the Heter may not be applied elsewhere. He also states (''Yoreh Deah'' 244) that the practice is possibly a Sinaitic tradition, i.e., [[Halacha l'Moshe m'Sinai]]. Other sources contradict this claim, with copies of Moses Sofer's responsa making no mention of the legal case or of his ruling applying in only one situation. Rather, that responsa makes quite clear that "metzizah" was a health measure and should never be employed where there is a health risk to the infant.<ref>{{REFweb

The practice of ''metzitzah b'peh'' was alleged to pose a serious risk in the transfer of ''[[herpes]] '' from [[mohel]]im to eight Israeli infants, one of whom suffered brain damage.<ref name="Gesundheit"/><ref>{{REFweb

}}</ref> When three New York City infants contracted ''[[herpes]] '' after ''metzizah b'peh'' by one ''mohel'' and one of them died, New York authorities took out a restraining order against the ''mohel'' requiring use of a sterile glass tube, or pipette.<ref name="Hartog"/><ref name="NewmanNYT">{{REFnews

}}</ref> Dr. Thomas Frieden, the Health Commissioner of New York City, wrote, "There exists no reasonable doubt that ‘metzitzah ‘''metzitzah b'peh’ peh''’ can and has caused neonatal ''[[herpes]] '' infection....The Health Department recommends that infants being circumcised not undergo ''metzitzah b'peh''."<ref>{{REFnews

|quote=The person performing ''metzizah b'peh '' must do the following: Wipe around the outside of the mouth thoroughly, including the labial folds at the corners, with a sterile alcohol wipe, and then discard in a safe place. Wash hands with soap and hot water for 2-6 minutes. Within 5 minutes before ''metzizah b'peh'', rinse mouth thoroughly with a mouthwash containing greater than 25% alcohol (for example, Listerine) and hold the rinse in mouth for 30 seconds or more before discarding it.}}</ref> Dr. [[Antonia Novello|Antonia C. Novello]], Commissioner of Health for New York State, together with a board of rabbis and doctors, worked, she said, to "allow the practice of ''metzizah b'peh pe'' to continue while still meeting the Department of Health's responsibility to protect the public health."<ref>{{REFweb

|quote=The meetings have been extremely helpful to me in understanding the importance of ''metzizah b'peh '' to the continuity of Jewish ritual practice, how the procedure is performed, and how we might allow the practice of ''metzizah b'peh '' to continue while still meeting the Department of Health's responsibility to protect the public health. I want to reiterate that the welfare of the children of your community is our common goal and that it is not our intent to prohibit ''metzizah b'peh '' after circumcision, rather our intent is to suggest measures that would reduce the risk of harm, if there is any, for future circumcisions where ''metzizah b'peh '' is the customary procedure and the possibility of an infected mohel may not be ruled out. I know that successful solutions can and will be based on our mutual trust and cooperation.

}}</ref> Later in New York City in 2012 a 2-week-old baby died of ''[[herpes]] '' because of ''metzitzah b'peh''.<ref>{{REFweb

In three medical papers done in Israel, Canada, and the US, oral suction following [[circumcision ]] was suggested as a cause in 11 cases of neonatal ''[[herpes]]''.<ref name="Gesundheit"/><ref>{{REFjournal

}}</ref> Researchers noted that prior to 1997, neonatal ''[[herpes]] '' reports in Israel were rare, and that the late incidences were correlated with the mothers carrying the virus themselves.<ref name="Gesundheit"/> Rabbi Doctor [[Mordechai Halperin]] implicates the "better hygiene and living conditions that prevail among the younger generation", which lowered to 60% the rate of young Israeli Chareidi mothers who carry the virus. He explains that an "absence of antibodies in the mothers’ blood means that their newborn sons received no such antibodies through the placenta, and therefore are vulnerable to infection by HSV-1."<ref name="Halperin">{{REFjournal

|quote = The mohel brings the baby’s organ into his mouth immediately after the excision of the foreskin and sucks blood from it vigorously. This action lowers the internal pressure in the tissues of the organ, in the blood vessels of the head of the organ and in the exposed ends of the arterioles that have just been cut. Thus, the difference between the pressure in the blood vessels in the base of the organ and the pressure in the blood vessels at its tip is increased. This requirement has deep religious significance as well as medical benefits....Immediately after incising or injuring an artery, the arterial walls contract and obstruct, or at least reduce, the flow of blood. Since the arterioles of the ''orlah'', or the foreskin, branch off from the dorsal arteries (the arteries of the upper side of the organ), cutting away the foreskin can result in a temporary obstruction in these dorsal arteries. This temporary obstruction, caused by arterial muscle contraction, continues to develop into a more enduring blockage as the stationary blood begins to clot. The tragic result can be severe hypoxia (deprivation of the supply of blood and oxygen) of the glans penis.28 If the arterial obstruction becomes more permanent, gangrene follows; the baby may lose his glans, and it may even become a life-threatening situation. Such cases have been known to occur. Only by immediately clearing the blockage can one prevent such clotting from happening. Performing ''metzitzah '' immediately after circumcision lowers the internal pressure within the tissues and blood vessels of the glans, thus raising the pressure gradient between the blood vessels at the base of the organ and the blood vessels at its distal end—the glans as well as the excised arterioles of the foreskin, which branch off of the dorsal arteries. This increase in pressure gradient (by a factor of four to six!) can resolve an acute temporary blockage and restore blood flow to the glans, thus significantly reducing both the danger of immediate, acute hypoxia and the danger of developing a permanent obstruction by means of coagulation. How do we know when a temporary blockage has successfully been averted? When the “blood in the further reaches [i.e., the proximal dorsal artery] is extracted,” as Rambam has stated.