Sanhedrin 69b ~ The Youngest Mother in the World

In the daily cycle of Talmud study, we are currently learning Sanhedrin, a tractate that discusses all things judicial including capital punishment. In three days from now - Shabbat Shuvah (the Shabbat of Repentance) - we will read a bizarre and disquieting passage. In it, the Talmud discusses a tangential issue (as it so often does) and considers the earliest age at which a boy or a girl could conceive a child. After establishing that a boy as young as eight could father a child, the Talmud entertains the possibility that a girl as young as six years of age could give birth to a child.

סנהדרין סט, ב

Batsheva gave birth when aged six - ובת שבע אולידא בשית

Don't try this at home

Today we are going to do something that goes against a fundamental belief I have about Aggadah - (rabbinic stories and legends): that they should never be taken literally.   Instead, we are going to take this Aggadah literally. It suggests that perhaps (and it is only raised as a possibility) Batsheva, the woman who married King David and was the mother of King Solomon, was only six years old when she gave birth to her first child. Is this suggestion in any way scientifically possible? You might be surprised.

The Youngest Mother in the World

 In May 1939 the French medical journal La Presse Medicale published a report from Lima about a little girl who had given birth to a baby at the age of only five years and seven months. Let me say that again. She had given birth to a baby when she was five years and seven months old.  Putting aside the monstrous child abuse that is at the heart of this story (if that is even possible to do), let's focus on the pregnancy itself.

Report from La Presse Medicale, May 31, 1939. The complete original is here.

The little girl in the picture is Lina Medina, then five months pregnant. She lived in Peru, and her parents had brought her to a hospital fearing she had a tumor in her abdomen.  Instead she was found to be pregnant, and six weeks later she gave birth by cesarian section to a healthy baby boy. She named her son Gerardo, after the chief physician Dr. Gerardo Lozada at the hospital where she was diagnosed. Her father was briefly arrested for child abuse but was later released. No charges were ever brought against her abuser, who Lina did not identify.  Lina later married and had a second son in 1972.

The New York Times, November 15, 1939.p9.

How do we know the story is true?

On November 15, 1939, The New York Times reported that the story had been authenticated by Dr S.L. Christian, the assistant surgeon general of the US Public Health Service. Christian had travelled to Peru, and while there he examined Lina.  There is also a case report from Dr Edmundo Escomel on the pathology of one of Lina's ovaries that had been removed at the time of her cesarian section. (For those of you who are French speaking pathologists, you can read it here.) The report notes that Lina had the ovaries of a fully mature woman, and that she likely had a pituitary disorder that caused her precocious fertility.   The story of Lina Medina has been authenticated by the fact-checking website Snopes, and there is a Wiki page about her (though having a Wiki page is not really proof of anything.)

Finally, there is a paper from a team at Hadassah Medical School in Jerusalem, published in Fertility and Sterility in 2009. The paper (titled At what age can human oocytes be obtained?) addresses the methods to remove and preserve eggs and sperm from young patients undergoing chemotherapy. "Increasing numbers of young cancer survivors" they wrote, "are experiencing infertility related to their past cancer treatment. Having children thus becomes an important issue for young cancer patients." One option to preserve fertility is to retrieve and preserve oocytes, which are the precursors to the ovum, the mature egg. The authors (who cite the pathology report on Lina Medina's ovary) report the successful removal of oocytes in girls ages 5, 8 and 10.  This report from Hadassah is of the youngest age for ovarian oocyte retrieval, and demonstrates that even in girls who show no signs of menarche (the onset of menstruation), it is possible to find oocytes that can mature into eggs.

From Revel A. et al. At what age can human oocytes be obtained? Fertility and Sterility 2009; 92 (2):458-463.

Back to Batsheva

It would appear that it is indeed possible for Batsheva, barely be out of kindergarten, to have given birth to her first child when she was only six years old.  Today, her abuser would be arrested and locked up for a very long time. How fortunate are we not to have to take this talmudic story literally, even if it is, regrettably, entirely plausible.

“The first group…accept the teachings of the sages in their simple literal sense and do not think that these teachings contain any hidden meaning at all. They believe that all sorts of impossible things must be... They understand the teachings of the sages only in their literal sense, in spite of the fact that some of their teachings when taken literally, seem so fantastic and irrational that if one were to repeat them literally, even to the uneducated, let alone sophisticated scholars, their amazement would prompt them to ask how anyone in the world could believe such things true, much less edifying. The members of this group are poor in knowledge. One can only regret their folly. Their very effort to honor and to exalt the sages in accordance with their own meager understanding actually humiliates them. As God lives, this group destroys the glory of the Torah of God and say the opposite of what it intended.
”

— Maimonides, Introduction to Perek Chelek, Chapter Ten of Mishnah Sanhedrin.

next time on Talmudology: Where does a snake keep its venom?

Sanhedrin 63b ~ The Fireproof Salamander

A salamander unharmed in the fire. From Koninklijke Bibliotheek, KB, KA 16, Folio 126r, c 1350.  From here.

סנהדרין סג, ב 

אף חזקיה מלך יהודה ביקש אביו לעשות לו כן אלא שסכתו אמו סלמנדרא 

During a discussion of idol worship, today's page of Talmud notes that some cult practices demanded that parents sacrifice their children by burning them alive. “Even the father of Hezekiah the king of Judea wanted to sacrifice him in this way, but his mother saved him by covering him with the blood of the salamander.” Rashi gives this explanation:

The salamander is a small creature that emerges from a furnace which has been burning for seven consecutive years.  Fire cannot burn someone who has smeared himself with the blood of the salamander.  

From where did Rashi get the idea that the salamander emerges from a fire that has been burning for seven years?  Perhaps from the Midrash Tanchumah, where it burns not seven years but seven days.

מדרש תנחומא (ורשא) פרשת וישב סימן ג

 בריות הגדלות באור ואין גדלות באויר ואיזו זו סלמנדרא כיצד הזגגין העושין את הזכוכית כשהן מסיקין את הכבשן שבעה ימים ושבעה לילות רצופין מכובד האור יוצא משם בריה הדומה לעכביש (ס"א לעכבר) והבריות קורין אותה סלמנדרא אדם סך ידו מדמה או אחד

  למה? על שתחילת בריאתה מן האור מאיבריו אין האור שולטת באותו מקום 

There are creatures that thrive in fire and not in air, like the salamander. How is it created? When glassmakers leave a furnace continuously alight for seven days and seven nights, out of the fire there emerges a creature that resembles a spider (or a mouse). That creature is called the salamander. If you cover your arm or any limb with its blood, it  that place will become impervious to fire. Why is does the salamander have this ability? Because it was created from fire. 

Elsewhere in the Talmud the fire-proof properties of the salamander are used as a homiletic device:

 חגיגה  כז , א

תלמידי חכמים אין אור של גיהנם שולטת בהן, קל וחומר מסלמנדרא; ומה סלמנדרא שתולדת אש היא - הסך מדמה אין אור שולטת בו, תלמידי חכמים, שכל גופן אש, דכתיב הלוא כה דברי כאש נאם ה' - על אחת כמה וכמה 

The fires of hell do not burn Torah scholars, and this is learned a fortiori. Consider the salamander which is created from fire and its blood protects from fire. How much more so is a Torah scholar protected, for his entire body is fire, as it is written "for my words are not as fire, says God" (Jeremiah 23:29). 

This is all rather strange. Where does this legend come from, and does science have anything to say about fireproof salamander? Read on.

“[The salamander] has no digestive organs, and gets no food but from the fire, in which it constantly renews its scaly skin. ”

— Leonardo da Vinci, Book XX: Humorous Writings, The Notebooks of Leonardo da Vinci, edited by Jean Paul Richter, 1880

Identifying the Talmudic Salamander

There is in fact a European species of salamander called the Fire Salamander (Salamandra salamandra) which has bright markings that serve to warn predators that it is poisonous (and that they should therefore leave it alone).  But this cannot be the salamander referred to in the Talmud, because it is found in central and southern Europe, and not in the Middle East where the Talmud was written. The talmudic salamander is the Near Eastern Fire Salamander, found in Israel, Iran, Iraq, Syria and Lebanon. Here is a picture of one, taken on Mt. Carmel near Haifa. 

The Near Eastern Fire Salamander, (Salamandra infraimmaculata)

The salamander is an amphibian that can grow up to thirteen inches in length and feeds on insects and larva. According to Dr Michael Warburg from the Technion, they can live for up to twenty years. He knows this because he visited the same pond on the top of Mt. Carmel for twenty-five years (!) and published a paper titled "Longevity in Salamandra infraimmaculata from Israel with a partial review of life expectancy in urodeles." And what was the name of the journal in which it was published I hear you ask. Good question.  It was Salamandra. Of course it was.

Salamanders live near ponds and streams, though they spend most of their adult lives out of the water.  They can exude a toxin when threatened, which can cause skin irritation but not much more. Since they do not have lungs they breath through their skin, which must be kept moist. And Dr. Warburg, the Technion salamander specialist, informs us that they lay their eggs in water. Not in furnaces. So from where did the rabbis of the Talmud get the ideas that they were fireproof creatures, born from the within flames? They got it from the surrounding cultures which had similar stories about the origins of the salamander.

The FIREPROOF Salamander in other cultures

According to the explorer Marco Polo (d.1324) the name of the creature comes from the Persian words Sam meaning "fire," and Andar and meaning "within."  The Roman historian Pliny the Elder (23-79 CE)  wrote that the salamander was "so intensely cold as to extinguish fire by its contact, in the same way as ice does" which demonstrates that the fireproof salamander story goes back to long before the talmudic period. The legend is also found in the writings of Saint Isidore of Seville (560-636 AD) who lived around the time that the Talmud was redacted.

“The Salamander is so called because it is strong against fire....It fights against fires and alone among living things, extinguishes them. For it lives in the midst of flames without pain and without being consumed and not only is not burned, but it puts the fire out.”

— An Encyclopedist of the Dark Ages; Isidore of Seville, by Ernest Brehaut, Columbia University 1912, p228

The legend is also found some unusual contemporary places. In Ray Bradbury's dystopian novel Fahrenheit 451, books are banned and firemen don't have the job of putting out fires. Instead, they are tasked with burning any books that are found. Do you recall the name of their firetrucks? That's right - they were called Salamanders. The firemen also had an official symbol, which was a salamander.

We know an idea has deeply embedded itself in popular culture when it appears in The Simpsons. And in an episode called See Homer Run, Homer takes a job as The Safety Salamander, teaching schoolchildren about fire safety. And what does Homer need to wear for the job?  A salamander suit. Of course.  

From See Homer Run, in The Simpsons Season 17 Episode 6.

But that's fiction. Take a look at the logo of the International Association of Heat and Frost Workers below. It is a salamander over a fire, and insulating some pipes. And that is a fact.

Logo of the International Association of Heat and Frost Insulators and Allied Workers. It's a salamander over a fire, and insulating some pipes.  

Evidence to the contrary

So the talmudic legend of the fire-proof salamander is a Jewish version of a legend found in contemporary Roman and Christian lore - a legend that still reverberates today. But although the Roman Pliny recounted the myth, he was also skeptical of it. There are numerous references on the internet which tell of Pliny throwing a salamander onto a fire, to see what would happen.  The salamander died.  But I cannot find a primary source for this story (please let me know if you find one), so let's go with Pliny's observations from his work Natural History:

As to what the magicians say, that it is proof against fire, being, as they tell us, the only animal that has the property of extinguishing fire, if it had been true, it would have been made trial of at Rome long before this. Sextius says that the salamander, preserved in honey and taken with the food, after removing the intestines, head, and feet, acts as an aphrodisiac: he denies also that it has the property of extinguishing fire.

We will leave the aphrodisiac properties of the salamander for another time, and focus instead on Pliny's observation that a simple test will confirm or falsify the legend. All you need are a couple of salamanders and a fire...which is also not an experiment too many of us would have the heart to do. But the Christian scholar, Pierius (d ~309) did.  In his work, cited by the British polymath Sir Thomas Browne Pierius wrote 

Whereas it is commonly said that a Salamander extinguisheth the fire, we have found by experience, that it is so far from quenching hot coals, that it dieth immediately therein.

And that should settle the matter. Rabbi Dr. Natan Slifkin did not throw a salamander into a fire, but he did accidentally leave one rather too close to a heat lamp, which is, I suppose, the next best thing. "I myself once found a fire salamander which I kept in a vivarium" he wrote in his fascinating book Sacred Monsters, "and when I accidentally left a heater too close to its cage, the salamander did not so much escape unscathed, as shrivel up into a withered corpse!"

A Fireproof Newt? SORTA

Rabbi Dr. Slifkin also references a report from a 1997 edition of Herpetological Review (All Amphibians, all of the time!) from a Mark Stromberg at the Hastings Natural History Reservation in California (part of UC Berkeley). He reported seeing the California Newt (Taricha Torosa) moving over the unburned litter in front of a controlled fire that had been burning for at least three hours. Then comes this:

Each newt walked directly into the flame front and did not pause while walking through the burning leaves. The slime covering their bodies foamed up, resembling an egg meringue. Within 20-30 s they were through the flames and on the cool, black ashes of the litter. Upon close examination, the now crusty white coating easily wiped off their wet bodies. I did not observe any skin blisters and the skin color looked normal. The newts were returned to the forest litter and they continued to walk downhill. They did not stop or curl up but walked normally, proceeding at near-record newt speed. As they walked through patches of un- burned grass, the leaves and litter removed almost all of the thin, white crust. They walked under a rotting log in dense litter and I did not follow them further. Fires are frequent in central, coastal California where T. torosa is common. Foaming of the skin secretions would dissipate heat and may be a mechanism used by this species to escape wildland fires.

(I tracked down the original. You can read it here, p82-84.)

This report is fascinating, but hardly proves that salamanders are fireproof.  At best, newts may have the ability to delay the brief harmful effects of a forest fire (which would certainly make evolutionary sense).  

An Explanation

Dr Warburg, the salamander guy from the Technion, noted in his paper that the salamander only spends about 1.25% of its adult life-time in ponds. The rest of the time it lives in rotting logs and leaf litters. This might explain the origin of the legend. When our ancestors, be they Jewish, Roman, or Christian would gather logs and kindling to light a fire, they might inadvertently sweep up a salamander or two with them. When these leaves and logs were set alight, the salamanders would scuttle out of the fire as quickly as they could, and ta-da, it looks like they were born from the flames. Perhaps that is how this whole salamander fire thing started.

The legend of the fireproof salamander is almost 2,000 years old, and certainly predates the Mishnah and Talmud.  It's a great story to tell around a campfire at night. Just don't be surprised if you see a salamander emerging, unscathed, from the ashes.

שנה טובה

Next time on Talmudology: The Youngest Mother in the World

Sanhedrin 45 ~ Stoning and the Height of a Lethal Fall

In today's page of Talmud we continue with the rather gruesome details of judicial execution. Here the Mishnah details the procedure for execution by stoning:

סנהדרין מה, א

 בית הסקילה היה גובה שתי קומות אחד מן העדים דוחפו על מתניו נהפך על לבו הופכו על מתניו ואם מת בה יצא ואם לאו השני נוטל את האבן ונותנו על לבו אם מת בה יצא ואם לאו רגימתו בכל ישראל 

The elevation of the stoning grounds was twice the height of a man. One of the witnesses to the crime pushes him by his hips [so that he falls on his side]. If he falls onto his chest he is turned onto his hips. If he dies [from the fall] the court has fulfilled its obligation. If he is still alive the second witness takes a stone and places it on his chest. If the condemned man dies, the court has fulfilled its obligation.  If he is not dead, he is stoned by all of Israel...

The Talmud states that condemned is standing when he is pushed.  But why push him from twice the height of a person?  According to the Mishnah in Bava Kamma (50b), a fall into a pit that is only ten handbreadths deep is lethal. If this is case, why not push the condemned from that smaller height? Rav Nahman in the name of Rabbah bar Avuha explained that pushing from the greater height insures a quicker and less painful death, thereby fulfilling the biblical requirement of loving your neighbor by choosing a more swift execution. Still, it seems rather improbable that the condemned would be killed merely by falling from a twelve foot platform.  

“ואהבת לרעך כמוך ברור לו מיתה יפה
Love your fellow as yourself, by choosing for him a better way to die”

— Sanhedrin 45a

Let's take another look at what science says about the height of lethal falls, starting with that Mishnah cited from Bava Kamma:

החופר בור ברה"ר ונפל לתוכו שור או חמור חייב אחד החופר בור שיח ומערה חריצין ונעיצין חייב א"כ למה נאמר בור מה בור שיש בו כדי להמית עשרה טפחים אף כל שיש בו כדי להמית עשרה טפחים היו פחותין מעשרה טפחים ונפל לתוכו שור או חמור ומת פטור ואם הוזק בו חייב

If a man digs a pit on public ground and a bull or a donkey falls into it, he is liable for damages. Whether he dug a pit, or a ditch, or a cave, trenches, or wedge-like ditches, he is liable for damages that his digging caused. If so why is pit mentioned in the Torah? It is to teach the following: just as a standard pit can cause death because it is ten tefachim [handbreadths] deep, so too for any other excavation to have sufficient depth to cause death, it must be ten tefachim deep. Where, however, they were less than ten tefachim deep, and a bull or a donkey fell into them and died, the digger would be exempt.  But if then animal was only injured by falling into them, the digger would be liable. (Mishnah, Bava Kamma 50b.)

THE HIGHEST FALL SURVIVED (WITHOUT A PARACHUTE)

According to The Guinness Book of Records, Vesna Vulovic  holds the world record for the highest fall survived without parachute. And how high was that? Really, really high:

Vesna Vulovic (Yugoslavia) was 23 working as a Jugoslavenski Aerotransport hostess when she survived a fall from 10,160 m (33,333 ft) over Srbsk, Kamenice, Czechoslovakia (now Czech Republic), on 26 January 1972 after the DC-9 she was working aboard, blew up. She fell inside a section of tail unit. She was in hospital for 16 months after emerging from a 27 day coma and having many bones broken...She never suffered any psychological trauma as a result of the incident, and never experienced any fear of flying. She is still alive today, and flies with some regularity. However, Vulovic does not consider herself lucky. Thirty years after the crash, in an interview she said:  ''I'm not lucky. Everybody thinks I am lucky, but they are mistaken. If I were lucky I would never have had this accident and my mother and father would be alive. The accident ruined their lives too."

In my years as an emergency physician I saw countless patients with injuries from falls. Most injuries were relatively minor, but several of my patients died. Is there really a minimum height below which a fall would result in a trivial, or at least a non-fatal injury? Based on my experience, the answer is an unequivocal no.  A fall from any height, however low, can result in a serious or fatal injury, and that includes a fall from standing. But that's just my experience. What does the medical literature say? Does it agree with the assertion of the Mishnah that a fall below 10 tefachim (about 76 cm or 30 inches) cannot result in a fatal injury? Let's take a look...

““At autopsy, classic findings in falls from height include aortic lacerations and vertebral compression fractures, as well as ring fractures of the skull base...Severe head injuries most frequently occurred in falls from heights below 10m and above 25m, whereas in the group that fell from 10 to 25m, few head injuries were seen and they rarely were the cause of death.”

— Turk, EM. Tsokos, M. American Journal of Forensic Medical Pathology 2004;25: 194–199

THE EPIDEMIOLOGY OF FALLS

Falls are very common. In the US they make up about a third of the injuries that lead to an ED visit in the each year - that's close to eight million visits.  In keeping with my experience, national data shows that only about 1% of all fall injuries that come to the ED are serious.  And here's another interesting finding that is in keeping with my own clinical experience: it's close to impossible to predict what kind of injury a person will have based on the height of the from which the victim falls. In a paper that examined over six-hundred fatal falls that occurred in Singapore, the authors noted that  

...there was much variability in the injury severity scores, in relation to the height of fall... Thus, a subject who had fallen through a height of 10 m, with primary feet impact, could have sustained complete traumatic transection of the thoracic aorta, with haemorrhage into the pleural cavities but little else by way of serious injury; while another, similar, subject could have fallen through 20 m and had sustained multiple head, thoracic and abdominal injuries...

In fact these authors had a very hard time coming up with a model that describes the height of fall and indicators of injury severity other than to give this rather useless nugget: "Our findings suggested that the height of the fall was significantly associated with ... the extent of injury." Well thanks. But it's one thing to fall 10m or more (that's over 30 feet for those if you not on the metric system). What about falls from less lofty heights?

FALLS DOWN THE STAIRS, AND FALLS FROM STANDING

Let's start with falls down the stairs. German forensic pathologists published a paper in Forensic Science International that addressed this aspect of falls in 116 fatal cases.  The most frequent victim was a man between 50 and 60 years old, and brain and skull injuries were the most common cause of death. About 8% broke their spines as they fell and (shocker) many were intoxicated. So stairs can kill.  

What about falls from standing? Well back to the German forensic pathologists, who this time published a retrospective analysis of 291 fatal falls. Of these, 122 -that's 42% - were falls from standing. About 80% of these ground-level falls were not immediately fatal, and the victim survived anywhere from three hours to almost a year post injury. Almost 60% of the men and 11% of the women who sustained a fatal ground-level fall were (shocker again) intoxicated.  So there we have it. The medical literature demonstrates that falls from standing can certainly be lethal.  Especially after kiddush.

From Thierauf A. et al. Retrospective analysis of fatal falls. Forensic Science International 2010. 198. 92–96. Forgive the English. It wasn't their first language

The US federal government has also weighed in on the matter. OSHA, the Occupational, Safety and Health Administration has a ruled that a duty to erect fall barriers to protect employees only applies when the fall will be more than 6 feet (1.8m).  

“Each employee who is constructing a leading edge 6 feet (1.8 m) or more above lower levels shall be protected from falling by guardrail systems, safety net systems, or personal fall arrest systems.”

— 29 CFR 1926.501

Back to Stoning

How likely then, is it that executing a person by pushing him from a height of about 12 feet will result in his instant death? Not likely at all. We know (and the those German pathologists have shown) that a fall from standing can be lethal, but it doesn't happen very often, and is certainly not likely to be immediate. Remember, the pathologists found that of all lethal falls, about 42% were from a standing position. Which is not the same as saying that 42% of falls from a standing position are lethal.

There is another interesting data source that may help us, and it comes from a 1995 paper titled Fatal Work Related Falls from Roofs, published in the Journal of Safety Research.  It examined 288 falls from roofs and showed that falls from as low as 6-15 feet may be fatal. Again, this is an analysis of fatal falls, not of all falls. 

From Suruda A. Fosbroke D. Braddee R. Fatal work related falls from roofs. Journal of Safety Research 1995;26: 1-8

The LD50 for falls

The LD50 is used to describe toxins or medications, and is the dose which would kill 50% of those who ingested it.  The LD50 can also be used to describe falls, and is the height from which at least 50% of those who fell would die.  According to this medical text, the median lethal distance (LD50) for falls is four stories, which is about 48 feet, or 15 meters. Mortality increases to 90% when the fall is greater than seven stories.  

The Role of Alcohol

In considering the first step of the judicial process of stoning, there is one more factor to consider: the role of alcohol. The Talmud (Sanhedrin 43a) relates that when the convict was taken out to be executed, he would be given a drink of wine and frankincense, כדי שתטרף דעתו – in order to dull his senses. Perhaps this would make the twelve foot fall more likely to be lethal? It turns out not to be so.

While you may be more at risk from a fall if you are drunk, drunk people who fall are not more likely to sustain a lethal injury when compared with those who are sober. Pushing a drunk person off a platform is not more likely to result in their death compared to pushing a sober person, though neither is recommended.

In conclusion, the first part of the penalty of stoning - that push of a twelve foot platform - would only very rarely result in the instant death of the criminal.  This meant that the execution would proceed to the second step - in which a heavy stone was placed on the chest to cause suffocation. The details are horrific, and thankfully have not been practiced in our legal system for nearly two thousand years.