Kiddushin 25

Bechorot 45b ~ Syndactyly, and Talmudology Keeps a Promise

Remember Polydactyly?

In April 2016, which is to say over three years ago, Talmudology wrote about polydactyly, when the Daf Yomi cycle studied Kiddushin 25. There we wrote: “We will discuss syndactyly when we study tractate Bechorot, (daf 45a), on June 1st, 2019,  הבעל"ט” And here we are. Tomorrow, June 1st 2019 (which is Shabbat) we will learn Bechorot 45, and we are therefore delighted to keep our promise and explain syndactyly, which is the condition in which one or more adjacent digits are fused together. But first, have a quick re-read of that earlier post; it will help put this medical condition into perspective…….Done? OK then, here we go.

The Cohen with fused digits

Tomorrow we continue the discussion of physical abnormalities which would prohibit a Cohen from serving in the Temple. The Mishnah reads as follow:

בכורות לה,ב

אצבעותיו מורכבות זו על זו או קלוטות למעלה עד הפרק כשר למטה מן הפרק וחתכה כשר

A priest whose fingers or toes are configured one upon the other, or one whose fingers or toes are attached, is likewise disqualified. But if they were attached from above the palm of the hand or the bottom of the foot only until the middle joint, he is fit. If they were attached below the joint, higher up on the finger or toe, and he cut to separate them, he is fit. 

The case here is a Cohen with, say two fingers or two toes that are fused together, so that it appears that there is a digit missing. The hand may look like this:

Palm view of classic simple syndactyly of left long and ring fingers. Over 50% of all webbed fingers occur like this.From  here .

Palm view of classic simple syndactyly of left long and ring fingers. Over 50% of all webbed fingers occur like this.From here.

maydeletesmaller.jpg

Or in extreme cases like this:

The hand of the patient with syndactyly of several digits. From Biesecker L.G. The Greig cephalopolysyndactyly syndrome.  Orphanet Journal of Rare Diseases 2008, 3:10

The hand of the patient with syndactyly of several digits. From Biesecker L.G.The Greig cephalopolysyndactyly syndrome. Orphanet Journal of Rare Diseases 2008, 3:10

These photos are all obviously from young children, which is good news. Surgeons are able to separate the fused fingers or toes, generally when the infant is 1-2 years old, and so there are now few adults around in whom the condition went uncorrected.

The Classification of Syndactyly

Syndactyly (from the Greek syn = together; dactylos=digit) occurs in about 2-3 per 10,000 live births In 10-40% there is a family history of the condition and is twice as common among males (remember these facts for later). In about half of all cases there are bilateral and symmetrical fusions, and while it may be an isolated finding, in many cases it is part of a genetic disorder like Apert’s or Poland’s syndrome.

There are several different types and subtypes, depending on whether the condition is classified based on an anatomical approach, a genetic or molecular approach, a descriptive approach or an embryological classification. One classification, from a 2012 review of the topic published in The European Journal of Human Genetics, is shown below.

Schematic diagrams of syndactyly types (I-a–III). Shaded digits depict cutaneous fusion only, while bony synostosis is represented by black digital elements within the shaded area. The grey digital elements show hypoplastic phalanges or clinodactyly/brachydactyly. The digital elements with amorphous borders symbolize dysplastic bones. From Malik S. Syndactyly: phenotypes, genetics and current classification.  European Journal of Human Genetics  (2012) 20, 817–824;

Schematic diagrams of syndactyly types (I-a–III). Shaded digits depict cutaneous fusion only, while bony synostosis is represented by black digital elements within the shaded area. The grey digital elements show hypoplastic phalanges or clinodactyly/brachydactyly. The digital elements with amorphous borders symbolize dysplastic bones. From Malik S. Syndactyly: phenotypes, genetics and current classification. European Journal of Human Genetics (2012) 20, 817–824;

What Causes Syndactyly? It’s often the genes

Syndactyly sometimes runs in families, so in these cases a genetic cause was long suspected. For example, fusion of the fourth and fifth metacarpals (an uncommon type of syndactyly) was first described 1928 and was initially thought to have an X-linked recessive trait. It was later classified as an autosomal dominant inheritance, found in some families with male-male transmission as well as females affected. But we are now able to exactly pinpoint some of the genetic causes. Type I, Apert syndrome, is associated with the FGFR2 gene (to be exact the the loci 10q26). Type II, (Carpenter syndrome) is linked to RAB23 gene, and Type V, also known as Pfeiffer syndrome is been linked to the FGFR 1 and 2 genes.

A family with three generations of ring and small finger involvement, none of which was ever surgically corrected. From Flatt A. Webbed Fingers. In The Care of Congenital Hand Anomalies, 2nd ed. St. Louis: Quality Medical Publishing, Inc., 1994:228–275.

A family with three generations of ring and small finger involvement, none of which was ever surgically corrected. From Flatt A. Webbed Fingers. In The Care of Congenital Hand Anomalies, 2nd ed. St. Louis: Quality Medical Publishing, Inc., 1994:228–275.

Why did the Mishnah Discuss Syndactyly in Cohanim?

At first, the discussion of syndactyly as a disqualification for a Cohen seems rather odd. I mean really, how many cases could there have been? But the reason that the Mishnah spent time on this is now obvious. In many cases it is a genetic disorder, mostly affecting men. To be a Cohen you must be the child of a father who is a Cohen. As we have already learned, there are several “Cohen related genes,” and now we can add to the list the possibility that one of the many genetic causes of syndactyly was linked to those who were Cohanim, and who might pass the gene to their male children.

As we saw in an earlier post, the rabbis of the Mishnah and Talmud described different medical observations without realising that they originated from a single cause (like alcoholic liver disease) or had a genetic component. How lucky we are to have this knowledge at our fingertips (sorry). The rabbis would have wanted no less.

[Extra credit: The Wiki page on Syndactyly notes that “The earliest appreciation of syndactyly as a birth anomaly…can be traced back to the Andalusian Muslim surgeon Al-Zahrawi (d. 1013 CE).” This should obviously be corrected, since it was mentioned as a birth defect in the Mishnah, edited c. 200 CE, some eight hundred years earlier. Can someone please edit the page so that it is accurate? Thanks.]

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Kiddushin 25b ~ Can Elephants Jump?

In a discussion of how one acquires ownership of an animal, Rabbi Shimon rules that they must be lifted - literally, lifted.  And then the Talmud jumps right in with the kind of question you and I would ask:

קידושין כה, ב 

אלא מעתה פיל לרבי שמעון במה יקנה אמר ליה אביי בחליפין אי נמי בשוכר את מקומו רבי זירא אמר מביא ארבעה כלים ומניחן תחת רגליו

If so, how would one acquire an elephant according to Rabbi Shimon?  Abaye said to him - by means of chalifin [a token exchange of a utensil or piece of clothing to finalize the transaction]. Rebbi Zeira says, the buyer brings in four vessels and places them under the elephant's feet [demonstrating that the elephant has now entered the buyer's domain]. (Kiddushin 25b)

A.H Atwell, National Geographic.

A.H Atwell, National Geographic.

Now leaving aside why the Talmud jumped to ask a question about elephants when one could ask the same thing about say, a cow or a horse, and leaving aside the question of just how Rebbi Zeira would go about getting his elephant to stand with each leg on a pot, the reader surely wants to know if there is um, an easier way to acquire an elephant. And yes, there is. The Talmud offers another helpful way to gain possession of your very own Dumbo. אי נמי בחבילי זמורות - "An alternative is to use bundles of vines." Rashi offers an explanation: the vines are three tefachim [about 30 cm.] heigh, and the elephant is led to stand on them, "and any lifting that is above three tefachim is called lifting [for the purposes of the transfer of ownership]."

Elephants at the circus in Washington DC. two days ago. They demonstrated - just in time  - that Rebbi Zeira's suggestion was indeed workable. So long as you have a full time elephant trainer...

Elephants at the circus in Washington DC. two days ago. They demonstrated - just in time  - that Rebbi Zeira's suggestion was indeed workable. So long as you have a full time elephant trainer...

Tosafot's Solution - jumping elephants

Tosafot, a collection of medieval commentaries on the Talmud, is dissatisfied with Rashi for a number of reasons. First, if the Talmud had meant to suggest that a platform three tefachim in height be built, it would have said so, and not concocted some contraption using grape vines. Second, the grape vines, being grape vines, are legally considered to be part of the ground itself, so the elephant standing on them would not be separate from the ground, which is precisely what is needed to effect a legal transfer of ownership.    

In light of these objections, Rav Meshulam offers his own explanation of what the Talmud meant when it suggested using vines.  (Fun fact: Meshulam may be the same as Meshulam ben Natan who was Rashi's son-in-law, having married Miriam, Rashi's second daughter.) 

אי נמי בחבילי זמורות. פי' בקונטרס משכחת לה להגבהת פיל בחבילי זמורות הגבוהים מן הארץ שלשה ומעלהו עליהן דהגבהת ג' הגבהה היא דנפיק לה מתורת לבוד ולפירושו בכלים לא מצי למימר דליקני מדין הגבהה שיניח כלים תחת רגליו דסתמייהו אין בעוביין שלשה טפחים ולפי' ר"ת דמפרש דהגבהה בטפח קני צ"ל סתם כלים אין בעוביין טפח וקשה אמאי נקט חבילי זמורות לנקוט אבנים או עצים ומפרש הרב משולם דלהכי נקט חבילי זמורות לפי שהן מאכל פיל כדאמרינן פרק מפנין (שבת דף קכח.) מטלטלין חבילי זמורות בשבת מפני שהן מאכל לפילין ומגביהין לפיל חבילי זמורות למעלה והוא קופץ ומגביה את עצמו מן הארץ ואוכלן ואין לתמוה אי חשיבא הגבהה בהכי דכה"ג אשכחן בפרק שילוח הקן (חולין דף קמב.) כי היכי דליגבינהו ולקנינהו

...Rav Meshulam therefore explained that the Talmud offered the explanation of vines because elephants eat them...and we lift up the vines in front of the elephant , which will jump up to eat them, thereby lifting itself off of the ground... 
Elephants stand on tip toe. From  here .

Elephants stand on tip toe. From here.

There is one small problem with Rav Meshulam's explanation: elephants can't jump. Here is Tony Barthel, curator of Elephant Trails at the National Zoo in Washington DC.  "If you were to look at an elephant’s skeleton, you’ll see that they’re standing on their tippy toes...All the bones are pointed straight down.” This means that they cannot jump, even if they wanted to.  Elephants cannot jump, and they cannot technically even run, since that requires all four legs to be off the ground at once. Why then did Rav Meshulam suggest this explanation, one which is not biologically possible?  Here is Rabbi Dr. Natan Slifkin's answer, from his recently published Torah Encyclopedia of the Animal Kingdom:

 The answer is that he had no reason to believe otherwise. There were no zoos in medieval Europe, and very few elephants.The emperor Charlemagne, king of the Franks,received an elephant as a gift in 797.Frederick II used an elephant in his capture of Cremona in 1214. King Henry III of England received an elephant from Israel in 1254. Alfonso V of Portugal gave an elephant to Renew d'Anjou in 1477. The Vatican was given an elephant in 1514. But the average person in those times never saw an elephant. Illustrations from that era show that artists, basing themselves on stories,were very unsure about how to depict elephants.They were often portrayed as possessing a body like those of horses or deer, sometimes even with split hooves. Of particular relevance to us is that they are sometimes drawn with the hindlimb structure of lions or dogs, poised with elastic energy. Rav Meshullam ben Nathan, who was born in Provence in 1120 and passed away in Melun in 1180, never saw either a live elephant or an accurate drawing of one. He thus had every reason to believe that, like other animals elephants can jump.

So there you have it.  Don't suggest biological explanations if you've not studied biology. Even if you are Rashi's son-in-law.

From  here , the thirteenth century   Book of the Marvels of the World   ( Livre des Merveilles du Mond  e ).    Note the bent hind legs of the elephant, which suggest the ability to jump.

From here, the thirteenth century Book of the Marvels of the World (Livre des Merveilles du Monde).  Note the bent hind legs of the elephant, which suggest the ability to jump.

[An expanded version of Rabbi Dr. Slifkin's essay can be found here.]

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Kiddushin 25a ~ Polydactyly

קידושין כה, א–ב

 א"ר חייא בר אשי אמר רב היתה לו יתרת וחתכה עבד יוצא בהן לחירות, אמר רב הונא והוא שנספרת על גב היד

Rav Hiyyah bar Ashi said in the name of Rav: if a slave had an extra finger and his master cut it off, the slave is freed on account of this act. Rav Huna said this only applies if the extra finger is in line with the others [lit. counted alongside the hand].  

Polydactyly (from the Greek daktylos, meaning finger), is a developmental abnormality in which there are more than the customary five fingers or toes at the end of the arms and legs. It has long been recorded in ancient civilizations - and is even mentioned in our own Hebrew Bible. Do you know who is described there as having a total of twenty four fingers and toes? (Click here to find out.)

Polydactyly is classified by the location of the extra digit: If it is found on the thumb or big toe, it is called preaxial polydactyly. If it is found on the the little (fifth) finger or toe it is called postaxial polydactyly.  Accessory digits in-between are classified according to their location and where they join the hand or finger. Syndactyly, on the other hand (!) occurs when there are fewer than five fingers or toes on each limb. (We will discuss syndactyly when we study tractate Bechorot, (daf 45a), on June 1st, 2019,  הבעל"ט.)

Rav Huna's Classification, and Swanson's classification

There are many different ways to classify polydactyly - although the most commonly used is the 1964 Swanson classification system, a modified version of which was adopted by the American Society for Surgery of the Hand and the International Federation of Societies for Surgery of the Hand in 1976. 

But Rav Huna, who died in Babylon around the year 296 CE, developed his own classification system long before Swanson, and it is based on simple observation: does the extra digit seem to begin in line with the other fingers, or does its origin seem to lie above them?  For Rav Huna, an extra digit that originated beyond the metacarpal-phalyngeal joint (the knuckle for our non-medical reader) in the hand, or beyond the metatarsal-phalageal joint in the foot did not have the legal status of a normal digit.  So an act of assault by the owner of a slave in which this kind of digit was amputated would not legally count as sufficient cause to allow the slave to gain his freedom.  With this information, look at the drawings below and decide in which case the loss of the extra digit would be sufficient cause for the slave to be freed.

Various forms of postaxial (ie. not on the big toe) Type A polydactyly of the foot, ranging from a partially duplicated fifth intermediate phalanx (top left) to a fully developed sixth digit, including the metatarsal (bottom right). From Case DT. Hill RJ. Merbs CF. Fong M. Polydactyly in the Prehistoric American Southwest.    Journal of Osteoarchaeology   2006: 6: 221–235.

Various forms of postaxial (ie. not on the big toe) Type A polydactyly of the foot, ranging from a partially duplicated fifth intermediate phalanx (top left) to a fully developed sixth digit, including the metatarsal (bottom right). From Case DT. Hill RJ. Merbs CF. Fong M. Polydactyly in the Prehistoric American Southwest.  Journal of Osteoarchaeology 2006: 6: 221–235.

If the slave had an extra fifth toe outlined in Figures 2-6, its loss would result in the slave going free. In all these cases, the extra digit arises in line with the base the the other toes (and in Figure 6, the extra toe is joined to an extra metatarsal). But in Figure 1, the extra fifth digit arises from the distal end of the fifth distal phalange (or, for our non-medical reader, the tip of the pinky); in this case its traumatic amputation by the slave's owner would not result in the slave gaining his freedom. 

This categorization appears to be another previously unrecognized medical first in the Talmud: Rav Huna's classification of polydactyly.   

היתה לו אצבע יתירה וחתכה, אם עומדת בסדר האצבעות יוצא לחירות
— שולחן ערוך יורה דעה הלכות עבדים סימן רסז סעיף כט
Polydactylous feet from Newspaper Rock in Indian Creek State Park, Utah. These carvings in rock are called petroglyphs, and were made by native Americans as long as  1,500  years ago .

Polydactylous feet from Newspaper Rock in Indian Creek State Park, Utah. These carvings in rock are called petroglyphs, and were made by native Americans as long as 1,500  years ago.

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