During the nineteenth and twentieth centuries many Jewish reformers, doctors, and physicians in Central and Eastern Europe proposed to replace circumcision with a symbolic ceremony, while others sought to ban or abolish circumcision entirely, as it was perceived as a dangerous, barbaric and pagan ritual of genital mutilation that could transmit infectious diseases to newborns. The first formal objection to circumcision within Judaism occurred in 1843 in Frankfurt. The Society for the Friends of Reform, a group that criticized traditional Jewish practices, said that brit milah was not a mitzvah but an outworn legacy from Israel's earlier phases, an obsolete throwback to primitive religion. With the expanding role of medicine came further opposition; certain aspects of Jewish circumcision such as "periah" and "metzitzah" (drawing the blood from the circumcision wound through sucking or a cloth) were deemed unhygienic and dangerous for the newborns. Later evidence that syphilis and tuberculosis – two of the most feared infectious diseases in the 19th century – were spread by mohels, caused various rabbis to advocate "metzitzah" to be done using a sponge or a tube. Among the secular, non-observant Jews that chose to not circumcise their sons and keep them intact there was also Theodor Herzl.