Bava Basra 142 ~ Maternal Deaths

Suetonius' Lives of the Twelve Caesars, 1506 woodcut.

Suetonius' Lives of the Twelve Caesars, 1506 woodcut.

Continuing the laws of inheritance, the Talmud rules that a fetus is not able to inherit from its mother until it is born. Then comes this technical question:  

למימרא דהוא מיית ברישא והא הוה עובדא ופרכס תלתא פרכוסי אמר מר בר רב אשי מידי דהוה אזנב הלטאה שמפרכסת

Does this mean that [when a pregnant womean dies,] the fetus always dies first [i.e. before its mother]? But there was a case where a pregnant woman died and after that the fetus thrashed around three times? Mar bar Rav Ashi said: That movement of the fetus does not indicate that it was alive. It was rather like the severed tail of a lizard, which thrashes about."

According to Mar bar Rav Ashi, the movement of a fetus inside its dead mother is not an indication of independent life. Instead it demonstrates reflex movements.  Here is one of those squirming detached lizard tails.

Mar bar Rav Ashi's explanation does not however, apply across all cases of the death of a pregnant woman. This is made clear by the Talmud in Arachin 7b:

Rabbi Nachman said in the name of Shmuel: A woman who sat on the birthstool and died on the Sabbath, we bring a knife and cut open her abdomen and remove the fetus.

This teaching clearly allows for the possibility that a fetus could survive the death of its mother. In fact the Talmud expands on the teaching of Mar bar Rav Ashi.  The observation that in cases of maternal death the fetus dies first seems to only be true in cases in which there is a "natural death." However, in cases in which a pregnant woman was executed, it is the mother who dies first, followed by the demise of the fetus:

ערכין ז, א

הני מילי לגבי מיתה איידי דוולד זוטרא חיותיה עיילא טיפה דמלאך המות ומחתך להו לסימנין אבל נהרגה היא מתה ברישא

This applies only to [her natural] death, because the child's life is very frail, the ‘drop’ [of poison] from the angel of death enters and destroys its vital organs, but in the case of death by execution she dies first.

Gruesome as this discussion is, the Talmud is likely correct. "Natural" maternal deaths that occur are likely from causes that will inevitably have led to the prior death of the fetus, like massive hemorrhage or sepsis.  In the case of execution, the sudden death of the mother would occur before that of the fetus. Thankfully, the execution of pregnant women no-longer occurs in our society, but a similar outcome can occur when the mother is a victim of severe traumatic injury.  We will return to this in June 2019, when we study Arachin in the Daf Yomi cycle.

Maternal Death Rates

Maternal deaths are defined as by the World Health Organization as the death of a woman whilst pregnant or within 42 days of delivery or termination of pregnancy, from any cause related to, or aggravated by pregnancy or its management, but excluding deaths from incidental or accidental causes. Worldwide, there are at least 287,000 such deaths each year. A recent study of maternal deaths in 115 countries noted that there are three main causes: Bleeding, high blood pressure (leading to complications like eclampsia) and infection.  Here in the US, maternal deaths are among the highest in the developed world, as an investigation from NPR last month detailed. Each year, 700-900 women die from pregnancy or childbirth-related causes, or about 14 per 100,000 live births. By comparison, the rate in Israel is 5 deaths per 100,000 live births.

Tragic as each of these deaths are, it was once a lot worse, and in the nineteenth century doctors played a major role in causing maternal deaths.  In Vienna, Dr. Ignaz Semmelweiss (d. 1865) noted that the death rates in one maternity ward were three or four times higher than in a second ward. He suggested, after much sleuthing, that the cause was the dirty hands of medical students. These students came straight from performing autopsies to examining their pregnant and post-partum patients, with no hand washing in between. In an era before the germ theory of disease, his suggestion that something was carried on the hands of the medical students was widely ignored, but he instituted compulsory hand-washing anyway. And within a year the death rate dropped to zero.

Over the past century the maternal death rate in the US has declined by over 99%, although there are still significant racial and economic disparities. Passages such as the one we read in today's Daf Yomi remind us that for centuries, giving birth was a dangerous experience.  

Bava Basra 126b ~ The Healing Power of Saliva

In a chapter that deals with the rules of inheritance, there is this interesting aside:

בבא בתרא קכו, ב

 ההוא דאתא לקמיה דרבי חנינא אמר ליה מוחזקני בזה שהוא בכור אמר ליה מנא ידעת אמר ליה דכי הוו אתו לגבי אבוה אמר להו זילו לגבי שכחת ברי דבוכרא הוא ומסי רוקיה ודלמא בוכרא דאמא הוא גמירי בוכרא דאבא מסי רוקיה בוכרא דאמא לא מסי רוקיה

A certain person once came before R. Hanina and said to him, 'I am sure that this man is firstborn'.  R. Hanina said to him, 'How do you know?' — The person replied to him: 'Because when people came to his father,  he used to say to them: "Go to my son Shikhath, who is firstborn and his saliva heals'. Might he not have been the firstborn of his mother only [but not of his father]? There is a tradition that the saliva of the firstborn of a father heals, but that of the firstborn of a mother does not heal.

Being declared a firstborn son was a big deal in talmudic times, for that lucky son would inherit twice the share of any other brothers.  (Daughters only inherit where there are no sons, or offspring of sons.) In the case brought before R. Hanina, there were two claims. One, that the Shikhath was a firstborn, based on the fact that his father called him "firstborn", and second that he was his father's firstborn by any woman. The evidence for that is the claim that his saliva heals. In talmudic society, only the saliva of a firstborn of a father heals. In his commentary on this passage, the Rashbam adds that the healing properties of saliva refer to its use as an eye medication. What are we to make of these claims that saliva heals, but only if it is the saliva of a firstborn son?

The many functions of human saliva

Saliva is an amazing material, and one we too often take for granted.  The many functions of saliva were reviewed in a paper published in The Archives of Oral Biology in 2015. We make a lot of it - about half a liter per day - and we need it to moisten and lubricate our mouths. It plays a critical role in taste, since it helps dissolve the foods into components that transmit taste on the tongue.  Saliva is also a key component of digestion. One of its main components is alpha-amylase, which appears to have a role in the breakdown of starch. It also protects the oral mucosa and esophagus not only by acting as a lubricant, but by buffering the acids in the stomach that sometimes make their way north into our mouths. The dentists among you will already know that saliva protects the teeth against abrasion, attrition, erosion, and dental caries, by removing uneaten food debris from the mouth. This debris, especially if sugary or acidic, can damage our teeth when bacteria feed off them. Saliva also has activity against bacteria, viruses and fungi.  For example, submandibular saliva inhibits the HIV-1 virus, even when diluted several-fold, and saliva inhibits the growth of candida, an opportunistic oral fungus.   

Saliva and wound healing

Last year, scientists from Lahore in Pakistan tested the ability of human saliva to heal wounds. They collected saliva from 24 willing human spitters, and applied the saliva to 2cm x 2cm wounds on the backs of  thirty "fully grown adult male rabbits weighing 2.0 to 3.4kg..." Three rabbits were controls and received no treatment. Another three had standard antibiotic ointment applied to their wounds, and the remaining lucky 24 rabbits had saliva applied every two hours for two weeks.  The Pakistani scientists noted "the healing speed of wounds on which saliva was applied was higher than the wounds on which wound healing medication (polyfax) was applied, and there was pus formation in the wound of negative control on which natural healing was observed." They concluded that "healthy human saliva possess significant (p<0.05) antimicrobial as well as wound healing properties. This innate ability of human saliva, mainly attributed to histatin protein, suggests that salivary proteins can be further used for medicinal purposes."

Wound healing properties of saliva, polyfax, and control on induced wounds on the backs of rabbits. From Haq et al.  Antimicrobial and Wound Healing Properties of Human Saliva. Int. J. of Pharm. Life Sci. 2016. 7 (2); 4911-4917.

Wound healing properties of saliva, polyfax, and control on induced wounds on the backs of rabbits. From Haq et al.  Antimicrobial and Wound Healing Properties of Human Saliva. Int. J. of Pharm. Life Sci. 2016. 7 (2); 4911-4917.

Healthy human saliva possess significant antimicrobial as well as wound healing properties. This innate ability of human saliva, ... suggests that salivary proteins can be further used for medicinal purposes.”
— ul-Haq, F et al. Antimicrobial and Wound Healing Properties of Human Saliva. International Journal of Pharmacy and Life Sciences. 2016:4911-4917

The histatins to which the Pakistani researchers referred are a group of proteins in the saliva which in 2008 were found to promote wound healing.  Cuts in the mouth heal much more quickly than do cuts elsewhere on the body: researchers have found that "wounds in the oral cavity heal much faster than skin lesions, with similar wounds healing in 7 days in the oral cavity compared with several weeks on the skin," and this is thought to be due to these histatins in the saliva.  

The mouth is a very dirty place

A nasty fight-bite injury, due to bacteria found in the mouth.

A nasty fight-bite injury, due to bacteria found in the mouth.

All this sounds rather interesting and would seem to support the use of saliva to heal, just as the saliva of Shikhath was said to do in today's page of Talmud. If however you find yourself with a wound and no local pharmacy, you might want to consider this before licking yourself.  The mouth is a terribly dirty place, microbiologically speaking.  It is full of nasty bacteria viruses and fungi, which the saliva only just manages to keep at bay.  I have seen dozens of  "fight-bites" in the ED. They are the outcome of a fist hitting a tooth (usually late on a Saturday night) and the hand often becomes badly infected as the bacteria in the victim's mouth, now safely hidden away deep in the crevice of the wound on the assailant's knuckle, go to work.  The result isn't pretty.

Vespasian, and others who healed with their saliva

The belief that saliva can heal the eyes is not limited to today's page of Talmud. You can find a detailed history in the 1891 paper by Frank Nicolson, The Saliva Superstition in Classical Literature. Perhaps one of the most striking examples of saliva as an ophthalmic medication is from the works of Tacitus, a Roman senator and historian, who died around 120 CE.  In his Histories, he recounts the story of Vespasian, - the same Vespasian who fought the Jewish insurrection in Judea and whose son Titus destroyed the Second Temple in 70 CE.  

In the months during which Vespasian was waiting at Alexandria for the periodical return of the summer gales and settled weather at sea, many wonders occurred which seemed to point him out as the object of the favor of heaven and of the partiality of the Gods. One of the common people of Alexandria, well known for his blindness, threw himself at the Emperor's knees, and implored him with groans to heal his infirmity...He begged Vespasian that he would deign to moisten his cheeks and eye-balls with his spittle... Vespasian, supposing that all things were possible to his good fortune, and that nothing was any longer past belief, with a joyful countenance, amid the intense expectation of the multitude of bystanders, accomplished what was required...the light of day again shone upon the blind. Persons actually present attest [this fact], even now when nothing is to be gained by falsehood.

(In case you were wondering, Vespasian was not a firstborn, but the third child born to his parents.)

Jesus is also said to have healed the blind with his saliva, as told in Mark 8:23-25:

They came to Bethsaida, and some people brought a blind man and begged Jesus to touch him. He took the blind man by the hand and led him outside the village. When he had spit on the man’s eyes and put his hands on him, Jesus asked, “Do you see anything?” He looked up and said, “I see people; they look like trees walking around.” Once more Jesus put his hands on the man’s eyes. Then his eyes were opened, his sight was restored, and he saw everything clearly.

In sum, the belief that saliva could heal the eyes and cure the blind was not only found in Jewish culture, but was part of Roman and early Christian legend. We now know that purified saliva does contain proteins and growth factors with anti-microbial and wound healing properties. However, the notion that saliva taken from the mouth might be helpful for failing eyesight is entirely without scientific foundation, because you are more likely to introduce an infection than you are to cure one. Even if you are a firstborn, an emperor, or a messiah.

Bava Basra 110a ~ Uncles and Nephews

בבא בתרא קי, א

אמר רבא הנושא אשה צריך שיבדוק באחיה ... תנא רוב בנים דומין לאחי האם

Ravah said: If a man wants to marry a women he should examine the character of her brothers...It was taught in a Baraita: Most sons resemble their maternal uncles.

In today's page of Talmud we continue a discussion of the rights of inheritance, which evolves into a discussion of the influence that ancestors have over their descendents.  The Baraita (a collection of teachings from the era of the Mishnah)  cited in support of Ravah's advice notes that not all sons resemble their maternal uncles, but most do.

Shared Genetic Material

The amount of material we share with our relatives varies by the relationship.  Only identical twins share all of their genetic material.  We share 50% of our genes with each of our parents, and 50% with each of our siblings.  But as you can see below, we share only 25% of our genetic material with our uncles or aunts - the same amount we share with our grandparents.

Image from here.

Image from here.

The amount of genetic material we share with our uncles or aunts does not vary with whether they are on our maternal or paternal side. A boy will no more genetically resemble his maternal uncle than they will his paternal uncle.  And for girls, the rule is the same regarding their aunts.

We find this statement repeated in the Jerusalem Talmud, where it appears as part of a lengthy list originally stated by Abba Shaul:

תלמוד ירושלמי קידושין פרק ד

אבא אוריין איש צדיין אומר משום אבא שאול כו'. רוב חמרים רשעים. רוב גמלין כשירין. רוב ספנים חסידים. רוב ממזירין פקחין. רוב עבדים נאים. רוב בני אבות בויישנים. רוב בנים דומין לאחי האם כשר שברופאים לגיהנם. הכשר שבטבחין שותף עמלק

Most donkey drivers are evildoers, most camel drivers are upright, most sailors are pious, most Mamzerim are cunning, most slaves are haughty, most people of fine genealogy are embarrassed [to take from the public charity fund], most sons are like their uncles [i.e. their mother's brothers], the best doctors go to hell; the best butcher is a partner of Amalek... 

When understood in this context, the connection between uncles and nephews is nothing more than a pithy generalization, and about as likely to be correct as the others on the list.  Like all talmudic aphorisms, it was uttered in a different time and place from our own. If you really want to know who your child will resemble, you should look no further than you and your spouse.  That will be the most likely predictor of your child's character, whether genetically encoded or socially constructed.