Zevachim 62b ~ To the Right. Always to the Right

זבחים נד,ב

כל פינות שאתה פונה לא יהו אלא דרך ימין...

All turns that you make must be towards the right

Homer Simpson Lefty Store.jpeg

Today's page of Talmud teaches that when walking up the ramp to the top of the Altar in the Temple, the Cohen must make a right turn at the top. Following that, every turn he makes must be a right turn. But why a right turn?

The importance of the right side in Judaism

In the Talmud and in normative Jewish practice, the preference to favor the right over the left is everywhere. Here are just a few. (How many more can you think of?)

  • Rav Ashi rules that Tefillin must placed it on the left arm, because it is weaker than the right and the action of placing them should be performed with the stronger right hand (מנחות לז, א).

  • The Talmud teaches that a right-handed person who writes with her left hand on Shabbat has not violated the prohibition against writing. It doesn't count. Maimonides (הלכות שבת 11:14) agrees:

הַכּוֹתֵב בִּשְׂמֹאלוֹ אוֹ לְאַחַר יָדוֹ בְּרַגְלוֹ בְּפִיו וּבְמַרְפֵּקוֹ פָּטוּר

  • According to Rava, walking should start with the right leg, and not the left (יומא יא, ב)

  • As we know from studying Zevachim, the entire service in the Temple in Jerusalem must be performed with the right hand (ביאת המקדש 5:18 )

  • The rite of חליצה must be performed with the right leg and a right shoe (יבמות קד, א).

  • The mezuzah can only be placed on the right side of the door (רמבם הל׳ מזוזה 6:12).

  • The best student of a rabbi should walk on the rabbi's right side, relegating the second best to the left (יומא לז, א).

  • After observing his teacher Rabbi Yehoshua, Rabbi Akiva taught that the left hand should be used after using the bathroom, out of respect to the right hand (ברכות סב,ב). When challenged as to why Rabbi Akiva was impertinent enough to report on which hand his teacher wiped himself he replied תורה היא וללמוד אני צריך - "this too is Torah, and I must study it".

לֵ֤ב חָכָם֙ לִֽימִינ֔וֹ וְלֵ֥ב כְּסִ֖יל לִשְׂמֹאלֽוֹ׃

A wise man’s mind tends toward the right hand, a fool’s toward the left.

— Kohelet 10:2

It's not Just Judaism

In Islam

The importance of all things right handed is found in other religions. For example, when Muslims perform any of the following, it is mustahabb [مستحبّ‎, - "recommended"] to start on the right or use the right hand.

  • putting on one's garment and pants and shoes

  • entering the mosque, using the siwaak [ a kind of toothpick]

  • putting on kohl [an ancient blue eye cosmetic]

  • clipping the nails

  • trimming the mustache

  • combing the hair plucking the armpit hair

  • shaving the head

  • saying salaam at the end of prayer

  • washing the limbs when purifying oneself

  • exiting the toilet, eating and drinking

  • shaking hands

  • touching the Black Stone [ٱلْحَجَرُ ٱلْأَسْوَد‎, al-Ḥajaru al-Aswad, a rock set into the eastern corner of the Kaaba, the ancient building located in the center of the Grand Mosque in Mecca, Saudi Arabia. Legend has it that the rock dates back to Adam and Eve.]

  • Conversely, the Bukhari Sharif , one of the six major hadith collections of Sunni Islam rules along the lines of Rabbi Akiva:

"... when you urinate, do not touch your penis with your right hand. And when you cleanse yourself after defecation, do not use your right hand."

The right hand of the Messenger of Allah (peace and blessings of Allah be upon him) was for his purification and food, and his left hand was for using the toilet and anything that was dirty...
— Sunan Abi Dawood (33)

in christianity

in hinduism

  • Offerings, such as flowers or garlands, are carried with both hands on the right side of the body.

  • "Pointing with the forefinger of the right hand or shaking the forefinger in emphasis while talking is never done. This is because the right hand possesses a powerful, aggressive pranic force, and an energy that moves the forces of the world."

  • Vāmācāra ( वामाचार, meaning "left-handed attainment" in Sanskrit) describes the "Left-Hand Path" or "Left-path" It is used to describe a particular mode of worship that is heterodox to standard Vedic teachings.

  • In Benares, the holiest of the seven sacred cities and sitting on the Ganges, "pilgrims circumambulate with their right hands towards the center, as Krishna is alleged to have done at the sacred mountain."

Well, you get the point.  Judaism, along with all the major religions (and some you've never heard of) emphasize the dominance of the right hand in all things holy. Or mundane.

The Ngaga of southern Borneo believe everything in the after-world is reversed, “sweet” becoming “bitter”, “straight” becoming “crooked”, and “right” becoming “left”. Likewise the Toraja of Celebes (Sulawesi) believed the dead do everything backwards, even pronouncing words backwards... the dead therefore use their left hand...
— I. C. Mcmanus. Right Hand, Left Hand: The Origins of Asymmetry in Brains, Bodies, Atoms and Cultures. Phoenix 2003, p27.

 and It's not just religions

There are lots of things that have chirality - meaning they have a mirror image but cannot be mapped onto that mirror image by rotations and translations. They exist in left or right-handed versions. Let's start with in easy example. Um, your hands. Although your right hand mirrors your left, your right hand cannot (comfortably) fit into a handed-glove.

From here.

From here.

Here's another example. Bend your fingers and extend your thumb as below. You've made two mirror images that cannot be mapped onto each other. (Go on. Give it a try. See what I mean?) That's chirality.

If we extend this to molecules, they are left or right-handed, meaning they are mirror images but they cannot be superimposed on each other. These are isomers. Like this:

From here.

From here.

And here is where things start to get really weird. Nearly everything in the universe - from chemicals and medications to fundamental particles and even galaxies themselves have a right-handed or left-handed preference. No, really. 

Let's start with the essential building blocks of life: amino acids and sugars. Almost all amino acids (not you, glycine) used by life on earth (but not necessarily elsewhere in the universe) are left-handed.  Right-handed amino acids exist of course. They're just not utilized by any life form on earth. Any.  If you sit in a lab and cook up an amino acid from its ingredients, you will make an equal amount of the left and right handed variates. That's just good old chemistry at work. But life on earth can only use half the mixture: the L form. Some bacteria can actually convert right-handed amino acids into the left-handed version, but they can’t use the right-handed ones as is.

Like amino acids, sugars also come in two isomers, but those that are used by life forms on earth are the right-handed variety. All the enzymes that living things use to manipulate amino acids and sugars only work on left-handed amino acids and right-handed sugars. They simply can't use the opposites. Why did life turn out this way? Truth is, nobody knows.  

Medications also exhibit chirality. For example, propranolol is commonly used to help control high blood pressure. Some of you reading this may be taking it. The left form (L-propranolol) is the one that helps. The right form (known as D-propranolol) is inactive. (The Latin for left and right is laevus and dexter, respectively.)

Quinine is an antimalarial drug. It has an isomer called quinidine, and quinidine has no anti-malarial action. But it's a great drug to reduce arrhythmias of the heart. One compound, with two isomers, each with their own remarkable and very different healing properties.

Now consider muons, a fundamental particle in our universe. It is kind of like an electron, but about 200 times heavier. Muons have an average life-expectancy of 2.2 microseconds (so don't expect any kind of long-term relationship) after which time they decay into an electron, a neutrino, and an anitneutirno. The direction that the electron will come out depends on the direction in which the muon spins. Now you would expect there to be equal amounts of electrons that are ejected spinning one way or another. But there aren't.  What happens is that 99.9% of muons decay in a right-handed fashion.

And while we are on the subject of decaying muons, let's talk about those neutrinos, which are a weird fundamental particle with the smallest mass of any known thing. They too, have a preference for the right or left. All neutrinos are left handed, while all anti-neutrinos (whatever that means) are right handed.

Left and right handed galaxies. From here.

Left and right handed galaxies. From here.

Ready for more? Statistically speaking our universe should contain an equal amount of left and right handed galaxies (as noted in how they spin). But this should not occur. In an analysis of over 2,600 nearby spiral galaxies and a later analysis of 15,000 more, Michael Longo demonstrated that that left-handed spirals are more common in the northern hemisphere, above the northern galactic pole. And although the signal is less strong, right-handed spirals appear more frequently in the south.

It's good to be a leftie

About 10-13% of humans are left-handed. (Captive chimpanzees are more left-handed than us, with an approximate 2:1 ratio of righties to lefties. In us it's more like 8:1) But aside from the problem of not finding scissors that work for you, being a leftie gives you some pretty good advantages.

...not only left-handers are over-represented in confrontational sports, but the closer the physical interaction of the opponents such as in boxing, fencing, judo, or karate, the greater the prevalence of left-handers. In basketball, football, handball, table tennis, tennis, and volleyball, for instance, competitors stand some distance apart and do not confront directly. But even in these sports, there are more than the expected number of left-handers...
— Grouios G. et al. Do left-handed competitors have an innate superiority in sports? Perception and Motor Skills, 2000:90;1273-1282

At the undergraduate level they are more likely to take part in a whole range of events, from judo and fencing and soccer and volleyball. But when it comes to non-confrontational sports like cycle racing, running or swimming, the proportion of left handers fall back to that of the general population. Lefties make up about 10% of the population, but 23% of all Wimbledon tennis champions were lefties.

There is a lot more evidence that lefties have many advantages over (us) righties. In a complicated test of spatial skills which you can read about here, 47 lefties demonstrated faster and more accurate spatial skills than the 50 righties, along with strong executive control and mental flexibility. And in this study of 100 lefties and 100 righties, the left-handed demonstrated greater creativity than the right-handed on all 4 scales of the Torrance test which examines creative thinking.

Obama writes with his left hand.jpg

And lefties appear to be smarter that righties.  In a study of some 300 gifted children, left (-or mixed-handedness) occurred more frequently in those who were mathematically or verbally precocious (for our readers in the US, this meant an SAT-M score of more than 700 and an SAT-L score of more than 630). Of the last 15 US presidents, seven (about 47%) have been left-handed.  That's almost 1 in 2! Oh, and compared with righties, college-educated left-handers in the US earn 10-15% more.

Leonardo da Vinci was a lefty, as were Michelangelo, Isaac Newton, and Albert Einstein.

Despite these, and many other advantages, our cultures have stigmatized those who are left-handed. We all know that the word sinister (meaning something harmful or evil is going to happen) comes from the Latin sinister meaning left.  But there are more examples of anti-left associations in other languages too. Adroit, meaning clever or skillful comes from the French word for right droite, meaning dextrous. In German, linkisch means awkward, and it comes from the German links, meaning left. And so it goes on.

Back to the Jewish Bible

Left-handed people are mentioned only three times in Tanach, and all come from the tribe of Benjamin:

  • There were the 700 men from the tribe of Benjamin who could use a sling with deadly accuracy (שופתים 20:16):

מִכֹּ֣ל ׀ הָעָ֣ם הַזֶּ֗ה שְׁבַ֤ע מֵאוֹת֙ אִ֣ישׁ בָּח֔וּר אִטֵּ֖ר יַד־יְמִינ֑וֹ כָּל־זֶ֗ה קֹלֵ֧עַ בָּאֶ֛בֶן אֶל־הַֽשַּׂעֲרָ֖ה וְלֹ֥א יַחֲטִֽא׃

  • There were the ambidextrous men who came to fight for King David at Ziklag, who were from the tribe of Benjamin (דברי הימים א, 12:2)

נֹ֣שְׁקֵי קֶ֗שֶׁת מַיְמִינִ֤ים וּמַשְׂמִאלִים֙ בָּֽאֲבָנִ֔ים וּבַחִצִּ֖ים בַּקָּ֑שֶׁת מֵאֲחֵ֥י שָׁא֖וּל מִבִּנְיָמִֽן׃

  • And perhaps most famously there was the left-handed Ehud ( אֶת־אֵה֤וּד בֶּן־גֵּרָא֙ בֶּן־הַיְמִינִ֔י אִ֥ישׁ אִטֵּ֖ר יַד־יְמִינ֑וֹ) who assassinated the Moabite king Eglon (שופתים 3:12-30). Because Ehud was left-handed he hid his dagger on his right side. In this way he got past the body search outside the throne room, where the guards looked for a weapon on the left. As for the rest, well, read on:וַיִּשְׁלַ֤ח אֵהוּד֙ אֶת־יַ֣ד שְׂמֹאל֔וֹ וַיִּקַּח֙ אֶת־הַחֶ֔רֶב מֵעַ֖ל יֶ֣רֶךְ יְמִינ֑וֹ וַיִּתְקָעֶ֖הָ בְּבִטְנֽוֹ׃ וַיָּבֹ֨א גַֽם־הַנִּצָּ֜ב אַחַ֣ר הַלַּ֗הַב וַיִּסְגֹּ֤ר הַחֵ֙לֶב֙ בְּעַ֣ד הַלַּ֔הַב כִּ֣י לֹ֥א שָׁלַ֛ף הַחֶ֖רֶב מִבִּטְנ֑וֹ וַיֵּצֵ֖א הַֽפַּרְשְׁדֹֽנָה׃ Reaching with his left hand, Ehud drew the dagger from his right side and drove it into [Eglon’s] belly. The fat closed over the blade and the hilt went in after the blade—for he did not pull the dagger out of his belly—and the filth came out.

All of this is really strange because of course the name of this tribe  - Benjamin - literally means "the son of the right" בן ימין.  

Back to Zevachim

Today's daf yomi page of Talmud has a very short instruction:"All turns that you make must be towards the right." But this phrase reveals a profound truth about who we are as humans, and of the very stuff from which we are made.  In culture after culture, in religions after religion, and in the very structure of our universe, there are left or right-handed preferences and predilections, many of which we simply cannot currently explain. Our religious and cultural preferences for the right likely stems from the simple fact that left-handedness is eight times less common. Unfortunately, a suspicion of the other, of those who are not like the majority, is a common trait that in one way or another we all share. But it needn't be so. The other, those in the minority, teach us and enrich our lives. Heck, they are often even smarter and quicker than the majority.  We are all better off with them.

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Zevachim 54b ~ How High is Jerusalem?

זבחים נד, ב

דרש רבא מאי דכתיב (שמואל א יט, יח) "וילך דוד ושמואל וישבו בנויות ברמה" וכי מה ענין נויות אצל רמה? אלא שהיו יושבין ברמה ועוסקין בנויו של עולם אמרי כתיב (דברים יז, ח) וקמת ועלית אל המקום מלמד שבית המקדש גבוה מכל ארץ ישראל וארץ ישראל גבוהה מכל ארצות

Rava taught: What is the meaning of that which is written concerning David: “And he and Samuel went and dwelt in Naioth. And it was told Saul, saying: Behold, David is at Naioth in Ramah” (I Samuel 19:18–19)? But what does Naioth have to do with Ramah? They are in two distinct places. Rather, this means that they were sitting in Ramah and were involved in discussing the beauty [benoyo] of the world, i.e., the Temple. David and Samuel said: It is written: “Then you shall arise, and get you up unto the place which the Lord your God shall choose” (Deuteronomy 17:8). This teaches that the Temple is higher than all places in Eretz Yisrael. And Eretz Yisrael is higher than all countries. 

This passage is unequivocal in its meaning: Jerusalem - that is, the Temple Mount -  is the highest place in Israel, and Israel itself is the highest place on earth. Now you don't need me to tell you that this is not a true statement. But I will anyway. It's not true. When I lived in Efrat it would often snow there while in Jerusalem, a mere twenty minutes away, there would be no snow. Why? Because Efrat is at a higher elevation than is Jerusalem. And if you have looked out from the Bet Midrash of the Hebrew University's Mount Scopus campus you will look down on the Temple Mount some three hundred feet below.

There is another passage in the Talmud that teaches the same point but uses some additional verses from the Book of Jeremiah to prove (as it were) that the Land of Israel is higher than all other places on earth. Here it is:

Picture of a mountain.jpeg

סנהדרין פז, א 

ועלית מלמד שבית המקדש גבוה מא"י וא"י גבוה מכל הארצות אל המקום בשלמא בית המקדש גבוה מא"י דכתיב ועלית אלא א"י גבוה מכל הארצות מנא ליה דכתיב לכן הנה ימים באים נאם ה' (לא יאמר) חי ה' אשר העלה את בני ישראל מארץ מצרים כי אם חי ה' אשר העלה ואשר הביא את זרע בית ישראל מארץ צפונה ומכל הארצות אשר הדחתים שם וישבו על אדמתם

"And you shall go up" [Deut 17:8] This teaches that the Holy Temple is higher than all other places in Israel...And from where do we now that Israel is higher than all other lands? From the verses [Jeremiah 23: 7-8] "Therefore, behold the days come, saith the Lord, that they shall no more say, The Lord liveth, which brought up the children of Israel out of the land of Egypt,' But the Lord liveth, which brought up and which led the seed of the house of Israel out of the north country, and from all the countries whither I have driven them; and they shall dwell in their own land."

Rashi points to yet another verse from the Book of Jeremiah (16:23) that teaches that Israel is the highest place on earth.

רשי, זבחים נד, ב

וארץ ישראל גבוהה מכל הארצות - לא מיבעיא לן הכא ולאו מהכא נפקא לן אלא מקרא אחרינא דכתיב (ירמיהו טז כג) לא יאמר עוד חי וגו' כי אם חי ה' אשר העלה ואשר הביא את בני ישראל מארץ צפון ומכל המקומות אשר הדחתים שם וגו

So it's not just a one-off statement. The Talmud in at least two places, and Rashi in a third, claim that Israel is the highest place on earth. But after a quick check in your reference book or internet search engine of choice you will see this is not correct. It's not even close. (I'm talking to you, Denver).

it's true; Google said so

Here are some other places, randomly chosen that are physically higher than Jerusalem.

Location Elevation (feet)
Jerusalem 2,424
Mount of Olives 2,710
Hebron 3,051
Efrat 3,150
Ben Nevis (UK) 4,413
Denver, Colorado 5,280
Johannesburg, South Africa 5,751
Mount Everest 29,029

Maharsha to the Rescue?

The Maharsha, R. Shmuel Eidels (1555 – 1631) in his commentary to Kiddushin 69a  suggests that since the Earth is a sphere, Israel and Jerusalem can be seen as if they were its "center."

מהרש"א חידושי אגדות מסכת קידושין דף סט עמוד א

 שהעולם הוא כתפוח ומקום בהמ"ק הוא מרכז עולם וכן א"י ולכך אמרו בא"י כיון דהוא מקום הממוצע אוירו מזוג ומחכים ויותר מקום המקדש שע"כ היו שם בלשכת הגזית חכמי סנהדרין וק"ל

Perhaps the Maharsha means that the spherical earth spins on its axis and that is the highest point, just like you might see a model of the earth on a bookshelf that spins on an axis with the North Pole at the top. But that cannot be, because the axis of the rotation of the Earth does not pass through Israel. It passes through the North Pole.  

No No. It is all metaphorical

The Talmud's claim is measurably incorrect, and several commentators suggest a metaphorical explanation. For example, the mystically inclined Maharal of Prague, Rabbi Yeduah Loew, wrote that Jerusalem is, spiritually speaking, the highest point on Earth (באר הגולה, הבאר הששי). Elsewhere, the Maharal suggests that just as water flows from the peaks of mountains down into valleys, it is Torah teachings that flow down from the spiritual capital Jerusalem to water the rest of the world.  Perhaps it is this that gives Israel and its capital a shot at the claim of being the most spiritually elevated.  Perhaps. But it's a claim that is contingent on the behavior of all those who live there.

אמר ר' יוסי: מבקש אתה לראות פני השכינה בעולם הזה? עסוק בתורה בארץ ישראל"

(מדרש תהלים, תחילת פרק ק"ה).

Rav Yosi said: Do you desire to see the face of the Divine in this world? 

Then study Torah in the Land of Israel.

[Partial repost from Sanhedrin 87. Want more on this topic? Then try this nice essay from Dr Nissin Elikim in Hebrew.]

 

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Zevachim 25b ~ Teaching By Humiliation

זבחים כה, ב

 אמר ליה תרדא...

R. Chiya bar Abba said to R. Zeira: "Scatterbrain"

 

As a medical student in London, humiliation came with the territory. There I was, on rounds on General Surgery Firm. At its head, the consultant surgeon.  Followed (in their correct pecking order) by two senior registrars, three or four registrars, several senior house officers and house officers, nurses, physiotherapists, and a couple of medical students.  We gathered around the bed of some poor patient who had recently undergone surgery. The consultant surgeon turned to me: "Mr. Brown" he said, looking at me atop of his professorial reading glasses, "how long is the anal canal?" Everyone else smiled, relieved to know they had not been asked this, rather challenging question. I had no idea, despite having once known this useful fact to pass my anatomy exams. "Thirty centimeters, sir" I replied, hopefully.  "Correct," said the surgeon, as he surveyed the menagerie of staff trailing him.  "If you are an elephant." And so ended my surgical career.

Teaching By Humiliation in the Talmud

The insult hurled by R. Chiya bar Abba said to R. Zeira in today's Daf Yomi תרדא –  is variously translated as "lunatic" (Schottenstein) "imbecile" (Koren) and "fool"(Soncino). The rabbis of the Talmud were not shy to call out those they felt were slow-witted or annoying. After Rabbi Yehudah HaNasi was asked a relatively innocent question by Levi, the great editor of the Mishnah replied כמדומה לי שאין לו מוח בקדקדו - "it appears to me that Levi has no brains in his head," an insult he repeated on at least one other occasion. Rabbi Tarfon had enough of  Rabbi Elazar when he told him "How long will you pile up meaningless  words and bring them against us." He even used the same insult against Rabbi Akivah. Rabbi Akivah! (See ילקוט שמעוני תורה פרשת בהעלותך רמז תשכה.) Rabbi Yishmael was called "a date palm" (and not in a good way) by Rabbi Eliezer (see ספרא תזריע פרשה ה).  

The rabbis of the Talmud did not just insult individuals. The were not averse to humiliating swaths of Jewry.  Big swaths.  After hearing a teaching that came from Babylonia,  Rav Yirmiyah, who lived in Israel, couldn't control himself: "Stupid Babylonians; because they live in the dark, they state teachings that are dim." 

בבלאי טפשאי אמטול דיתבי בארעא חשוכא אמרי שמעתא דמחשכא
Stupid Babylonians; because they live in the dark, they state teachings that are dim.” 

— מאמר בשם ר׳ ירמיה, תלמוד בבלי זבחים נ, ב

 

One of my favorites though, came from Rabbi Dosa, who called his  younger brother "the first-born of Satan" which raised name calling among siblings to a whole new level.  I could go on, but you get the point. These guys could be really insulting.

Pimping in the Medical Literature

For the reader who is not medically trained, here's a new word: pimping. It's a real word that is OK to use in polite company (maybe).  According to the esteemed Journal of the American Medical Association, pimping is

a series of difficult and often intentionally unanswerable questions posed to a medical student or house staff in quick succession. The objective of pimping is to teach, motivate, and involve the learner in clinical rounds while maintaining a dominant hierarchy and cultivating humility by ridding the learner of egotism.

There is an art to pimping, according to Fredrick Brancati, the man generally thought to have invented the term in its medical content. Here is an excerpt from his classic 1989 paper, called, what else, The Art of Pimping:

Pimp questions should come in rapid succession and should be essentially unanswerable. They may be grouped into five categories:
1. Arcane points of history.These facts are not taught in medical school and are irrelevant to patient care—perfect for pimping. For example, who performed the first lumbar puncture? Or, how was syphilis named?
2. Teleology and metaphysics.These questions lie outside the realm of conventional scientific inquiry and have traditionally been addressed only by medieval philosophers and the  editors of the National Enquirer. For instance, why are some organs paired?
3. Exceedingly broad questions. For example, what role do prostaglandins play in homeostasis? Or, what is the differential diagnosis of a fever of unknown origin? Even if the intern begins making good points, after 4 or 5 minutes he can be cut off and criticized for missing points he was about to mention. These questions are ideally posed in the final minutes of rounds while the team is charging down a noisy stairwell.
4. Eponyms. These questions are favored by many old-timers who have assiduously avoided learning any new developments in medicine since the germ theory. For instance, where does one find the semilunar space of Traube? 
5. Technical points of laboratory research. Even when general medical practice has become a dim and distant memory, the attending physician-investigator still knows the details of his research inside and out. For instance, how active are leukocyte-activated killer cells with or without interleukin 2 against sarcoma in the mouse model? Or, what base sequence does the restriction endonuclease EcoRI recognize?
....pimping can create a hostile environment among the team members, suppress creativity or intellectual curiosity because of fear of embarrassment, and dehumanize students at the expense of maintaining medical hegemony.
— McCarthy, CP. McEvoy, JW. Pimping Medical Education. JAMA 2015; 314 (22). 2347-2348.

 Last year an Australian team published a paper titled "Teaching by humiliation” and mistreatment of medical students in clinical rotations. They found that 74% had experienced and 83% had witnessed teaching by humiliation during their adult clinical rotations; smaller proportions had experienced (29%) or witnessed (45%) it during their pediatric rotations, which just proves what everyone already knows.  Pediatricians are all nice. 

 

All this pimping comes with a down side. "Students’ responses to these practices" wrote the Australian researchers, "ranged from disgust and regret about entering the medical profession to endorsement of teachers’ public exposure of a student’s poor knowledge. Reported victims and perpetrators included junior medical staff, who were subjected to the practices as much as students and were equally likely to be the perpetrators, alongside senior medical and nursing staff."

As a deeply ingrained cultural, institutionalised practice, mistreatment requires focused action to replace the existing culture with one of compassion, tolerance and respect.
— Scott, KM. et al. “Teaching by humiliation” and mistreatment of medical students in clinical rotations: a pilot study. Medical Journal of Australia 2015; 203(4): 1-6

Talmudic Insults and Respect for the talmid

In today's page of Talmud, R. Chiya bar Abba called R. Zeira a "scatterbrain." Rabba called R. Amram the same thing back in Bava Kamma (105b.) In fact he called him a scatterbrain again in Bava Metziah, so he must really have meant it.  This epithet seems to have been the "moron" of its day. Even the great Abayye must have felt a little miffed when he was called a scatterbrain by Rava bar Hannan.  

It seems demeaning to use language like this, and out of place given the words of the Mishnah (Avot 2:10) יהי כבוד חבירך חביב עליך כשלך - "let your friend's honor be as important to you as your own." Rabbi Yair Chaim Bachrach (Germany, 1638-1732) addressed talmudic insults in his book of responsa called Chavvot Yair, first published in 1699. Apparently things were getting out of hand in Germany, where the talmudic art of humiliating had evolved. Yeshivah students now also yelled and gesticulated rather enthusiastically as they sparred with their learning partners:

 מש"כ קפיצה וסיפוק וריקוד תוך הפלפול איש נגד רעהו שזה גורם בלי ספק שחבירו ימהר לעשות כמעשהו וירקוד ג"כ כנגדו וירים קולו בצעקה גדולה ומרה יותר ולא ישמע איש שפת חבירו ואין זה רק מנהג יהוא וכל המרבה בה ה"ז משוגע 

Students jump and dance around each other in the middle of expounding a subject, and this will cause, without doubt, that other students will do the same and will leap and raise their voices in a louder and more bitter cry. No one will be able to listen to the voice of his partner. This is nothing other than a ridiculous custom, and anyone who does this often is a mesgugah...  

Rabbi Bachrach then rose to the defense of those who used talmudic insults, claiming that they did so with only good intentions. They did it, he said, in order to bring out the very best they could in those they insulted. (כלם י"ל שהיו חבריהם וגודלים מהם ולא קפדי כלל). Hmmm. I'm not convinced.

Insults don't work, not for medial students and not for any students.  Ad hominem attacks are now, alas, the currency of many public or political (especially political) debates, though they usually say more about the person uttering them than the person against whom they are directed. It seems that the rabbis of the Talmud were just as susceptible as the rest of us to this all-too-common failing. We can all do better. 

תנו רבנן: שלשה שונאין זה את זה, אלו הן: הכלבים, והתרנגולין, והחברין. ויש אומרים: אף הזונות. ויש אומרים: אף תלמידי חכמים שבבבל
The rabbis taught: three groups hate each other: Dogs, roosters, and sorcerers. Some say: so do prostitutes. And others say: so do the sages in Babylon...
— פסחים דף קיג עמוד ב

[Mostly a repost from here.]

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Zevachim 22b ~ On the Physical and Mental Dangers of Circumcision

Milah knife..jpg

An uncircumcised Cohen may not, we are told in a Mishnah, offer sacrifices at the Temple in Jerusalem.  Just how did the Mishnah know this? In tomorrow's daf, we learn the answer:

זבחים כב,ב

 אמר רב חסדא דבר זה מתורת משה רבינו לא למדנו מדברי יחזקאל בן בוזי למדנו: כל בן נכר ערל לב וערל בשר לא יבא אל מקדשי לשרתני

Rav Chisdah says: We did not learn this matter from the Torah of Moses, our teacher; rather, we learned it from the words of the prophet Ezekiel, son of Buzi: “No stranger, uncircumcised in heart or uncircumcised in flesh, shall enter into My Sanctuary to serve Me” 

From the words "uncircumcised in flesh" the Talmud learns that a Cohen for whom circumcision would be life-threatening is forbidden to take part in sacrificial rites.  Earlier, (on page 15b) Rashi explains how circumcision might be dangerous:

 ערל. כהן שמתו אחיו מחמת מילה

Not circumcised: This means a Cohen whose brothers have died due to circumcision.

To understand the today's daf, we need to remind ourselves of the genetics of hemophilia. So let's go.

X-LINKED HEMOPHILIA A

The classic teaching about bleeding deaths and circumcision is found in Yevamot 64a.

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.

NEJM report of hemophilia 1813.png

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:

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.

A Different explanation FROM Rabbenu Tam

In tomorrow's daf in Zevachim, we learn that there were indeed examples where what we call hemophilia A had been diagnosed, and as a result there were Cohanim who remained uncircumcised as adults. At least according to Rashi. But his grandson, Rabbenu Tam, has a different explanation. The Cohen did not have a clotting disorder. Rather, he was afraid of the pain of the procedure:

ערל. מפרש רבינו שלמה  בכל מקום שמתו אחיו מחמת מילה ור"ת מפרש דמומר לערלות וקרי ליה לבו לשמים לפי שאינו עושה אלא מדאגת צער המילה

According to Rabbenu Tam, this Cohen does not refuse circumcision as an act of religious rebellion. Rather, he refuses because of the pain involved in the procedure. Rabbenu Tam does not explain why the parents of the Cohen in question had not has him circumcised as a newborn - when he was in no position to object. But he makes a larger point: that a Jewish man who, out of fear, refuses to be circumcised - or to circumcise his newborn son - is not considered to be a religious rebel. Instead, he is called "one whose intentions are for the sake of heaven" - קרי ליה לבו לשמים.

Perhaps this expansive thinking of Rabbenu Tam might include today those who choose not to give their Jewish children a Brit Milah, because of concerns about informed consent.  Iceland recently introduced legislation to ban circumcision until a child reached the age of consent and could make an informed decision about his own genital future.  Rabbenu Tam would of course have wanted all Jewish newborn boys to have a Brit Milah and be welcomed into the Covenant of Abraham, but might he also understand those who felt differently?

[Partial repost from Repost from Yevamot 64a.]

Tagged: Hemophilia ACircumcision

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