Avodah Zarah 31b ~ Drinking Snake Venom

Don't Touch That Beer !

The Daf Yomi cycle is currently on a snake venom binge.  The widespread belief was that snakes will drink from liquids left out overnight, (especially when left under the bed) and in doing so would leave fatal venom behind.  In yesterday's page (Avodah Zarah 30b) a Rabbi Yehoshua even categorized three different kinds of liquid contaminated by a thirsty snake:

עבודה זרה ל,ב

שלשה מיני ארס הן של בחור שוקע של בינוני מפעפע ושל זקן צף

There are three kinds of snake venom: that from a juvenile snake sinks; from a middle-aged snake is found in the mid-section of a liquid, and that from an old snake floats on the top.

The Talmud also concluded that a snake would risk its own life to drink from undiluted wine, but is not willing to do so if the wine is diluted. On Avodah Zarah 35, which we will study in a few days, the Talmud delves into a series of questions about how thoroughly snake venom can infiltrate the lining a water pitcher, and how it will contaminate milk. For this reason (among others) cheese made by idol worshippers is forbidden. Apparently the milk from which the cheese was curdled could be contaminated by the venom in a way that Jewish cheeses were not.

In today's page of Talmud we discover that snakes even contaminate beer with their venom, which is the entree into a discussion of the permissibility of beer made by those who worship idols.

All of this raises the question: do snakes really contaminate a liquid from which they are drinking? The answer is no.  Absolutely not. Here is why.

A deep dive into snake venom

בבא קמא קטו, ב

והתניא מים שנתגלו הרי זה לא ישפכם ברשות הרבים ולא יגבל בהן את הטיט ולא ירבץ בהן את הבית ולא ישקה מהם את בהמתו ולא בהמת חבירו

It was taught in a Baraisa: water that was left uncovered should not be spilled out in a public area, nor should one knead clay with it, nor should one lay in the dust with it, nor should one give it to his animal, nor the animal of his friend, to drink. (Bava Kamma 115b)

The rabbis of the Talmud were very worried indeed about the health effects of water that had been left uncovered.  This concern was codified by Maimonides, and later by Ya'akov ben Asher (d. 1340) in his famous halakhic work called the Arba'ah Turim

טור יורה דעה הלכות מאכלי עובדי כוכבים סימן קטז 

דברים האסורים משום סכנה
  יש דברים שאסרום חכמים משום סכנה כגון משקין שנתגלו שיש לחוש שמא שתה מהן נחש והטיל בהן ארס אפי' אם שתו מהן אחרים ולא הוזקו אין לשתות מהן  שיש נחש שהארס צף למעלה ויש שארס שלו מפעפע עד אמצעית המשקה  ויש שהארס שלו שוקע לשולי הכלי לפיכך אפי' שתו ממנו אחרים ולא הוזקו אין לשתות מהן דשמא ארס של הנחש ששתה מהן שוקע ואלו המשקין שיש בהן משום גילוי מים יין חלב ודבש ושום כתוש 

Tur, Yoreh De'ah 116. Things that are Prohibited Because they are Dangerous

There are things that the rabbis of the Talmud prohibited because they are dangerous. For example, liquids that were left uncovered, because of the possibility that a snake drank from the water and expelled some of its poison into them. Even if others had drunk from the liquid, and not been injured, one should not drink from them.  For some snake venom floats on the surface, and some sinks to the middle and some moves to the edges of the vessel. Therefore, even if others had drunk and had suffered no harm, one should not drink from them, for perhaps the venom from the snake that had drunk the water had sunk to the bottom. The following liquids should not be drunk if they were left overnight in an uncovered vessel: water, wine, milk, honey, and crushed garlic...

The normative Code of Jewish Law, the שולחן ערוך agreed, but added an important caveat:

שולחן ערוך יורה דעה הלכות מאכלי עובדי כוכבים סימן קטז סעיף א 

משקים שנתגלו, אסרום חכמים דחיישינן שמא שתה נחש מהם והטיל בהם ארס. ועכשיו שאין נחשים מצויים בינינו, מותר

The rabbis forbade drinking from liquids that were left uncovered,. They were concerned that a snake may have drunk from them and expelled some of its poison into them. But now that snakes are not commonly encountered, this is permitted. (Shulchan Aruch Yoreh De'ah 116:1)

So today it is permitted for us to drink from an uncovered pot, but only in a place that does not have a problem with poisonous snakes.  Which is not helpful. There are poisonous snakes in nearly every state in the US, resulting in about 2,000 human envenomations each year, and we have noted before that Israel has its own problem with snakes, including the Palestinian Viper.  The World Health Organization estimates that snakes kill between 20,000 and 94,000 people per year. So exactly where this leniency of the Shulchan Aruch might apply is not clear.

But is drinking snake venom indeed dangerous? Nope. In 2012 India Today reported that police in New Delhi had seized about half a liter of snake venom to be used "in high-end raves planned for Valentine's Day in and around the national capital." Apparently the venom, when ingested, produces a euphoric state. Who knew?

Video evidence - Drinking Cobra Venom

It is really hard to find any peer-reviewed scientific studies about people drinking snake venom, because, um, it's a silly thing to do.  But that doesn't mean it hasn't been done. So where could we turn to find people doing silly things? YouTube of course. (Warning. This video involves spitting. Not by the snakes.)

Want more? Ok then. Here's another one. This time it involves drinking the venom directly from spitting snake. Apparently, these kind of human interest stories are popular in India. 

Why it is safe to drink snake venom

If you are a diabetic and take insulin, or know someone who does, you may have wondered why the drug has to be injected. It would, after all, be much less bothersome to swallow an insulin pill than to inject insulin several times a day.  The reason is that insulin is a protein, and like all proteins, it is easily broken down by heat and, more importantly, by the acid environment in the stomach.  Our gastrointestinal tracts evolved to break down proteins into their building blocks - and they perform a wonderful job doing precisely that.

Like insulin, snake venom is a complex protein. And so, like insulin, it too is easily broken down in the very acidic environment of your stomach.  Of course, if intact venom gets into your bloodstream, it could kill you. But if you drink venom, then the intact protein never does get into your bloodstream. You don't need to be an Indian snake charmer to safely drink snake venom. You just need a working digestive system.

HOW SNAKES DRINK

 In case you were wondering how we know how snakes drink, here is a diagrammatic view of the apparatus used to record the kinematics and water transport during drinking. The video camera was placed to the left. LED, light-emitting diode. From Cundall, D. Drinking in snakes: kinematic cycling and water transport. The Journal of Experimental Biology. 2000; 203, 2171–2185.

 In case you were wondering how we know how snakes drink, here is a diagrammatic view of the apparatus used to record the kinematics and water transport during drinking. The video camera was placed to the left. LED, light-emitting diode. From Cundall, D. Drinking in snakes: kinematic cycling and water transport. The Journal of Experimental Biology. 2000; 203, 2171–2185.

The Talmud was concerned that snakes leave venom in water from which they drank, and that a person drinking from that water would then suffer from envenomation. As we have seen, this concern has no biological basis, although theoretically, if there was an open cut or ulcer in the mouth, ingested venom could get into the bloodstream and then cause its havoc.  But there is another reason why the talmudic concern is overstated.  Snakes, you see, don't leave any venom when they drink water.  As you may have noted from watching the first video, it takes a lot to get a snake to expel its venom - like sticking a blue pen in its mouth.  Venom is a snake's most precious commodity, and it has evolved to protect that commodity. Snakes only release venom when they are in danger, or ready to strike their prey, and not otherwise. Want a great example? The venomous rattlesnake. That species has evolved a warning rattle to tell would-be predators that if they get any closer, they will be bitten. This only makes evolutionary sense if it was in the snake's best interest to do everything possible to conserve its venom.

In a fascinating article on how snakes drink published in The Journal of Experimental Biology, David Cundall notes that a snake's tongue does not carry or move water, and that "in many snakes, the tongue does not visibly move during drinking." That leads to the conclusion that snakes are suction drinkers. And that makes them even less likely to leave any venom behind in the water.

As far as is known, all snakes are suction drinkers, and the only critical structural variations that might be predicted to influence drinking performance are the relative dimensions and shapes of the mandibles and their suspensorial elements and the arrangements of intermandibular muscles and connective tissues.
— Cundall, D. Drinking in snakes: kinematic cycling and water transport. The Journal of Experimental Biology. 2000; 203, 2171–2185.

So let's put this all together:

  1. Snakes don't release their venom unless they are threatened or hunting. 
  2. Snakes use suction when they drink water. Their mouths are not open, which is needed when they are expelling venom.
  3. Snake venom is not dangerous when drunk.
  4. (If somehow venom did get into the water, it would be greatly diluted.)

So, there is no danger if you were to drink from water from which a venomous snake had drunk. None. What a relief.

[Partial repost from Bava Kamma 115.]

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Avodah Zarah 28b ~ Ear Candling

Do Not Try this at home

When Rav Abahu was suffering from ear pain, Rabbi Yochanan suggested several remedies. Here are two:

עבודה זרה כח, ב

ואי לא לייתי תרבא דחיפושתא גמלניתא וליפשר ולישדי ביה ואי לא למלייה לאודניה מישחא וליעבד שב פתילתא דאספסתא וליתי שופתא דתומא וליתוב ברקא בחד רישא וליתלי בהו נורא ואידך רישא מותבא באודנא וליתוב אודניה להדא נורא ויזדהר מזיקא ונישקול חדא וננח חדא

 He should bring the fat of a large beetle and melt it and apply it to the ear. And if not, he should fill his ear with oil and prepare seven wicks made of alfalfa and bring dried garlic ends, and tie the ends to the wicks with a strip of hair at one end, and set the wicks aflame. And he should place the other end of each wick in his ear one at a time, and place his ear opposite the flame. And he should be cautious of drafts [and avoid them, as they will harm his ear.] He should take one wick and remove one wick, [i.e., replace each wick as it is consumed until all seven have been used.]

The remedy for Rav Abahu's ear pain, then, was to fill his ear with oil, stick a wick into it, and set it on fire. The idea is that the burning wick draws out the wax, and other toxins, leaving the patient cured and rejuvinated.  Talmudology strongly recommends that you do not try this at home.

Ear Candling is still a thing

From here.

From here.

Although Rav Abahu (~279-320 CE) recommended  ear candling long ago, it is still in use today. On Amazon you can by candles to stick in your ear, and a guide to talk you through the steps. It's easier to use Amazon than to make your own candles with alfalfa and dried garlic ends, but, scientifically speaking, it's silly. Very silly. A case report from St. Mary's Hospital in London describes an elderly woman who had hearing loss in her left ear.  The woman denied ear candling, which is odd, since the ear was full of what appeared to be candle wax, and "histopathological examination confirmed the material as candle wax." (You can read another medical case report, this one on ear candling in a four-year old girl, here.) The authors noted that "ear candling is widely practiced as an alternative therapy. The procedure lacks scientific explanation, is known to produce complications and should be discouraged."

Eardrum of a patient with white candle wax causing inflammation and hearing loss.From Mohamed Zackaria & Antony Aymat (2009) Ear candling: A case report, The European Journal of General Practice, 15:3, 168-169,

Eardrum of a patient with white candle wax causing inflammation and hearing loss.From Mohamed Zackaria & Antony Aymat (2009) Ear candling: A case report, The European Journal of General Practice, 15:3, 168-169,

Is there any Science behind Candling?

Still, one case report doesn't mean all that much. We need a more scientific exploration of ear candling, which is precisely what we got in a 1996 research paper Ear Candles; Efficacy and SafetyThe authors, who were ear, nose and throat surgeons and audiologists (and supported by a grant from the William G. Reed Fund for Research in Otolargngology) tested the pressure that an ear candle would generate, and used a mass spectrometer to identify the contents of the candle stubs. After twenty trials using two different candle types, the authors reported that "no negative pressure was generated by any of the burning ear candles at any point during the trial." As for the contents of the burned candles "multiple analyses revealed the sample to be composed of multiple alkanes, which are found in wax candles...None of the contents of cerumen were identified."  

Physicians need to be aware of the dangers associated with ear candle use and counsel their patients accordingly.
— Seeley D. Quigley S. Langman A. Ear Candles; Efficacy and Safety. Laryngoscope 1996, 106; 1226-1229

The authors also reported their results of a survey 122 otolaryngologists. One-third were ‘aware’ of ear candle use amongst one or more of their patients. Fourteen had treated complications of ear candling, including 13 burns of the auricle and canal, 7 partial canal occlusions from candle wax and 1 eardrum perforation.

Ear candling seems to be popular and is heavily promoted (for example, via the Internet), with claims that could easily seem scientific to lay people. However, the truth is that its mechanism of action is first, implausible, and second, demonstrably wrong. Moreover, it has no positive clinical effects and seems to be associated with considerable risks. The few scientific articles available on this subject do not suggest that ear candles are an effective treatment for any condition.
— Ernst E. Ear candles: a triumph of ignorance over science. Journal of Laryngology and Otology 2004, 118:1-2

The Funny Side to Ear Candling

Dave Barry, the Pulitzer Prize winning columnist is one of the funniest writers in the business. He wrote perhaps the funniest newspaper column ever on today's topic. It's also probably the only humorous column on the topic. Dave gave Talmudology permission to reproduce it (I'm not making this up), and you can find it here. Dave also asked that readers do not circulate the piece by email or other electronic media. So read it and enjoy.  Given what we know now, perhaps even Rav Abahu would have found it amusing.

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Avodah Zarah 27a ~ Circumcision and Hemophilia A

עבודה זרה כז, א

 ישראל שמתו אחיו מחמת מילה ולא מלוהו 

A Jew whose brothers died following their circumcisions, and was not circumcised.... 

fig1.jpg

In today's Daf Yomi, the Talmud considers whether a Jew who was not himself circumcised may serve as a mohel. This situation could arise when the newborn baby had older brothers who died from bleeding following their circumcisions. The young brother is then exempt from the mitzvah to be circumcised.

We first encountered this situation while studying Yevamot (64a) where cases of post-circumcision deaths are described. To understand the today's daf, we need to remind ourselves of the genetics of hemophilia.

X-linked Hemophilia A

יבמות סד, א 

תניא מלה הראשון ומת שני ומת שלישי לא תמול דברי רבי רבן שמעון בן גמליאל אומר שלישי תמול רביעי לא תמול... א"ר יוחנן מעשה בארבע אחיות בצפורי שמלה ראשונה ומת שניה ומת שלישית ומת רביעית באת לפני רבן שמעון בן גמליאל אמר לה אל תמולי

It was taught: If she circumcised her first son and he died, and her second son and he too died, she should not circumcise her third son, so taught Rebbi.  Rabbi Shimon ben Gamliel stated that she should indeed circumcise her third child, but [if he died] she must not circumcise her forth...Rabbi Yochanan said that there was once a case in Zippori in which four sisters had sons:  The first sister circumcised her son and he died, the second sister circumcised her son and he died, the third sister circumcised her son and he died, and the forth sister came to Rabbi Shimon ben Gamliel and he told her "you must not circumcise your son" (Yevamot 64:)

The Talmud here is describing a disease that is affected through the maternal line (hence the four sisters - all of whom seem to pass this disease on to their male children). The disease is X-linked Hemophilia A; the term X-linked indicates that the faulty gene is carried on the X chromosome, which is men is always inherited from the mother. Hemophilia A is an X-linked recessive genetic disease, first described by the American physician John Conrad Otto, who in 1803 described a bleeding disorder that ran in families and mostly affected the men. John Hay from Massachusetts published an account of a "remarkable hemorrhagic disposition" in the New England Journal of Medicine in 1813.

Hay, John. Account of a Remarkable Haemorrhagic Disposition, Existing in Many Individuals of the Same Family. New England Journal of Medicine 1813:2;3;221-225.

Hay, John. Account of a Remarkable Haemorrhagic Disposition, Existing in Many Individuals of the Same Family. New England Journal of Medicine 1813:2;3;221-225.

 If the mother is a carrier  - as were each of the four sisters in Zippori - then she has a one in four chance of passing on the disease to a child, and that affected child will always be a son:

Courtesy NHLBI

Courtesy NHLBI

In Yevamot, the rabbis argued over a technical point - that is, how many cases of bleeding are needed to establish a pattern. According to Rebbi (that is  Rebbi Yehuda Ha-Nasi, c. 135-217 CE.) two cases were sufficient, while Rabbi Shimon ben Gamliel insisted on three cases before ruling that there was a life threatening pattern.  Indeed the disease in boys must have been very perplexing, because (as you can see in the diagram above) not every boy would be affected. In fact, if the mother is a carrier and the father is not, there is only a 50% chance of a boy having hemophilia.  It is this fact that perhaps explains the dispute between Rebbi and Rabbi Shimon ben Gamliel regarding how many children need to exhibit the disease before we can assume that any future male child will also have it.  If every boy born in the family would have been a hemophiliac, Rabbi Shimon's ruling would have seemed unnecessarily cruel.  But since by chance, half of the boys born might not have hemophilia, the need to demonstrate the prevalence of the disease (in a society in which its genetic foundations were not known) seems eminently sensible.

In  Hemophilia A there are various genetic mutations that result in low levels of clotting factors. These levels may be only mildly decreased, or so low that severe life threatening hemophilia results. It is treated with transfusions of clotting factors which restore the levels to normal. Although these transfusions must be given several times a week in those with severe disease, there is hope that recombinant clotting factors can lengthen the time between the needed transfusions.

Later in Yevamot, the Mishnah records the case of a priest who was not circumcised -  because of the deaths of his brothers when they underwent the procedure. So this law was certainly practiced, and the Talmud records not only the earliest known description of hemophilia, but the emphasis on the preservation of life as a normative Jewish practice. 

רמב׳ם משנה תורה הל׳ מילה ב, א

הַכּל כְּשֵׁרִין לָמוּל. וַאֲפִלּוּ עָרֵל וְעֶבֶד וְאִשָּׁה וְקָטָן מָלִין בְּמָקוֹם שֶׁאֵין שָׁם אִישׁ

Everyone is qualified to perform the operation of circumcision. Where there is no adult circumcised male, (Israelite), it is performed by an uncircumcised Israelite, a bondman, a woman or a minor. 

[Repost from Yevamot 64a.]

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