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NEWS:
Janice Hopkins Tanne
Ultra-Orthodox Jews criticised over circumcision practice
BMJ 2006; 332: 137 [Full text]
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[Read Rapid Response] The glass tube
Jacob F. de Wolff   (21 January 2006)
[Read Rapid Response] Circumcision and Methicillin-Resistant Staphylococcus Aureus: A Recipe for Disaster
George Hill   (22 January 2006)

The glass tube 21 January 2006
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Jacob F. de Wolff,
SHO
Chase Farm Hospital, Enfield, Middx

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Re: The glass tube

I would like to correct a factual inconsistency. The glass tubes (filled with an absorbant material, usually cotton) were introduced in 19th century Germany, not specifically because of herpes. Hygienic concerns were indeed the main motivation for this move, which was accepted by a significant number of the rabbinical authorities of the time (e.g. Rabbi S.R. Hirsch, responsum in his posthumous collection Shemesh Marpeh, Mesorah Publications 1992). However, there are dissenting opinions, and is a matter of religious law.

Mohalim in the Western world practice scrupulous antisepsis during the circumcision, and the rate of infection is generally very low. Many (if not most) of those performing metzitzah be-peh pre-rinse with chlorhexidine.

The relevance of this incident to Mayor Bloomberg's reelection is not explained, nor is the fact that he is Jewish. Did it actually swing the Jewish vote?

Competing interests: The author is an Orthodox Jew.
Circumcision and Methicillin-Resistant Staphylococcus Aureus: A Recipe for Disaster 22 January 2006
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George Hill,
Vice-President for Bioethics and Medical Science
Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seatle, Washington 98107-4137, USA

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Re: Circumcision and Methicillin-Resistant Staphylococcus Aureus: A Recipe for Disaster

Dear Editor:

The risks of infant circumcision go far beyond infection with herpes as happened in New York.1 In the late 19th early 20th centuries, fatal infections of the circumcision wound with tuberculosis, diphtheria, and Staphylococcus aureus were reported.2-5

The introduction of antibiotic therapy in the late 1940s greatly reduced the risks associated with bacterial infection through the portal-of-entry created by the open circumcision wound. However, the epidemic of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), which is resistant to most antibiotics, threatens to return newly-circumcised baby boys to the perilous situation of the pre-antibiotic era.6

The risk of infection extends beyond the operating theatre because caregivers, who may be carriers of CA-MRSA, may infect the infant.7 Circumcised newborn males have a high risk of staphylococcus infection.8 For example, Annunciato & Goldblum reported post-circumcision staphylococcal scalded syndrome.9 Infection with more virulent CA-MRSA, however, increases the risk of a long-term hospital stay and even death.10

Doctors Opposing Circumcision has prepared a literature review regarding the increased risk posed by CA-MRSA to newborn circumcised boys.11 We urge hospital administrators and public health authorities in those nations that still perform non-therapeutic social circumcision of male infants to suspend the performance of that medically-unnecessary operation until such time as an effective treatment for CA-MRSA infection is developed. Action should be taken before disaster occurs.

George Hill
Vice-President for Bioethics and Medical Science
Doctors Opposing Circumcision
Suite 42
2442 NW Market Street
Seattle, Washington 98107-4137
Web: http://www.doctorsopposingcircumcision.org

References

  1. Tanne JH. Ultra-Orthodox Jews criticised over circumcision practice BMJ 2006;332: 137. [Extract]
  2. Holt LE. Tuberculosis acquired through ritual circumcision. JAMA 1913;LXI(2):99-102. [Full Text]
  3. Reuben MS. Tuberculosis following ritual circumcision. Arch Pediatr 1917; XXXIV:186-90. [Full Text]
  4. Rosenstein JL. Wound diphtheria in the newborn infant following circumcision. J Pediatr 1941;18:657-8. [Full Text]
  5. Sauer LW. Fatal staphylococcus bronchopneumonia following ritual circumcision. Am J Obstetr Gynecol 1943; 46: 583. [Full Text]
  6. Chase M. Defying treatment, a new virulent bug sparks health fears. The Wall Street Journal, New York, Friday, Januany 20, 2006:A1
  7. Payne MC, Wood HF, Karakawa W, Gluck L. A prospective study of staphylococcal colonization and infections in newborns and their families. Am J Epidemiol 1966:82:305-16.
  8. Thompson DJ, Gezon HM, Rogers KD, et al. Excess risk of staphylococcus infection and disease in newborn males. Am J Epidemiol 1965;84(2):314-28. [Abstract]
  9. Annunziato D, Goldblum LM. Staphylococcal scalded skin syndrome. A complication of circumcision. Am J Dis Child 1978;132(12):1187-8. [Full Text]
  10. Noskin GA, Rubin RJ, Schentag JJ, et al. The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 Nationwide Inpatient Sample Database. Arch Intern Med 2005;165:1756-61. [Abstract]
  11. Epidemic Methicillin-Resistant Staphylococcus Aureus: Dramatically Increased Risk for Circumcised Newborn Boys. Seattle: Doctors Opposing Circumcision, 2005, 2006. [Full Text]

Competing interests: None declared