Ketuvot 103 ~ The Death of the Editor

כתובות קג, א

ת"ר בשעת פטירתו של רבי אמר לבני אני צריך נכנסו בניו אצלו אמר להם הזהרו בכבוד אמכם נר יהא דלוק במקומו שולחן יהא ערוך במקומו מטה תהא מוצעת במקומה

The rabbis taught in a Baraisa: At the time of Rebbi's death he said "I need my sons." They came to him and he said to them: "[After I die] be careful of you mother's honor. Leave a lamp to burn [for me] in its usual place. Let [my usual place at] the table be set, let [my] bed be ready in its usual place...

The Talmud has been discussing the obligations of a man’s heir’s to their father’s widow. As an example, it records the instructions that Rabbi Yehudah HaNassi – known to all simply as Rebbi – gave to his sons to honor his widow. This is how he began:"הזהרו בכבוד אמכם -be careful of your mother's honor." 

As the story spills onto daf 104, the Talmud hints at the cause of Rebbi’s demise. He seems to have been suffering from an intestinal disorder, since Rebbi’s maid noted that he needed to use the latrine very often. This was causing him great distress –although apparently the distress was not because he needed to move his bowels so often, but rather that as a result of his condition, he could not wear tefillin. 

Rabbi Yehudah HaNassi, Editor Extraordinaire

According to the great scholar of the Talmud David Halivni, the Mishnah came into being 

...as a result of the exigencies of the post-Temple era...towards the second half the of century with the termination of the oppressive Roman regimens, the Mishnah continued to flourish through the activities of the enormously prestigious R. Judah Hanassi...only to collapse of its own weight soon after R. Judah Hanassi's death.  
As a result, relatively few additions entered the Mishnah; it basically remained much the same as it was when compiled by the editor-anthologist.  This is why the Mishnah is the only classical rabbinic book about whose editor we are relatively certain.  We have no idea who the editors were of any of the other classic rabbinic texts (including the Talmud) but the evidence clearly indicates that R. Judah Hanassi was the editor-anthologist of the Mishnah.  This evidence is based on two sources: the occasional cross reference by R. Yochanan to R. Judah as editor-anthologizer and, above all, the fact that no one who lived after R. Judah Hanassi is mentioned in the Mishnah. 

The Medical History of Rabbi Yehudah HaNassi

Recent scholars have been tempted to diagnose the many illnesses from which Rebbi suffered. In her Hebrew paper The Illnesses of Rabbi Yehudah HaNassi in Light of Modern Medicine, the historian Esther Divorshki  from the University of Haifa noted that more is known about the ailments of Rebbi than about any other talmudic sage. Some think that Rebbi suffered from painful hemorrhoids, to such a degree that his cries could be heard when he used the latrine ( and as described in Bava Metziah 85a). Rebbi was so distressed by this illness that he ascribed to it a religious meaning, and proclaimed: “The righteous die though intestinal diseases.” But as Divorshki correctly notes, hemorrhoids are not painful to the degree described in the Talmud (– unless complicated by anal fissures). She therefore suggests that Rebbi’s illness - the one from which he died - was an inflammatory bowel disease.

Rebbi suffered from a number of other diseases throughout his life. In Nedarim  we learn that he had episodes of temporary memory loss. He was also afflicted with צמירתא and צפרנא (Bava Metziah 85a). Divorshki the historian notes that some have suggested that צמירתא is kidney stones, perhaps complicated with urinary tract infections. As for צפרנא, (or, in variant forms, צפדנא) Avraham Steinberg from Sha'arei Tzedek Hospital suggests that since this disease was characterized by bleeding from the gums, “it seems reasonable to identify this illness with scurvy.” Julius Preuss had a similar suggestion, one he offered with great certainty: “There can be no doubt that tzafdina refers to stomatitis, perhaps scorbutic stomatitis which also occurs sporadically.” And if these were not enough, Rebbi also had an eye ailment, which his personal physician Shmuel was able to cure, as well as inflammation of his joints, (Yerushalmi Shabbat 16:1) that suggests the illness we call gout. 

A Unifying Diagnosis?

Can a wise clinician put all this together and come up with a single unifying diagnosis that can explain all of Rebbi’s terrible symptoms? In 1978, Ari Shoshan suggested in Korot, The Israel Journal of the History of Medicine and Science, that Rebbi suffered from a psychosomatic disease.  However, Divorshki suggests that the rapidly advancing field of genetics can provide a more satisfying solution. She posits that Rebbi had a seronegative spondyloarthritis associated with a specific tissue type called HLA (Human Leukocyte Antigen) B-27. (Don't be afraid. Seronegative means that the condition is not associated with rheumatoid factor, and spondyloarthritis is a group of conditions that causes inflammation of the joints - and other tissues.)  This tissue disorder –a kind of autoimmune disease - is associated with gout (Rebbi had that) and inflammation of the mouth (check) and uveitis – a painful inflammatory eye condition (also that). Perhaps, Divorshki notes, צמירתא was not in fact kidney stones or a urinary infection, but an inflammation of the bladder wall or referred pain from an inflammation of the intestines, caused by the same nasty tissue disorder. For reasons that are still not known, this autoimmune disease can flare up and then, just as mysteriously, become dormant for months or years, which could explain how Rebbi appeared to have been cured.

Schematic ribbon diagram of the HLA-B27 molecule’s peptide-binding cleft with a bound peptide (light blue); the letters N and C indicate, respectively, the amino and carboxy termini of the bound peptide. HLA-B*27:06, one of the two subtypes that seem to have no association with ankylosing spondylitis, and the disease-associated subtype HLA-B*27:04 (from which Rebbi may have been suffering) differ from each other by two residues at positions 114 and 116. From Khan, MA.  Polymorphism of HLA-B27: 105 Subtypes Currently Known.  Current Rheumatology Reports. (2013) 15:362 

Schematic ribbon diagram of the HLA-B27 molecule’s peptide-binding cleft with a bound peptide (light blue); the letters N and C indicate, respectively, the amino and carboxy termini of the bound peptide. HLA-B*27:06, one of the two subtypes that seem to have no association with ankylosing spondylitis, and the disease-associated subtype HLA-B*27:04 (from which Rebbi may have been suffering) differ from each other by two residues at positions 114 and 116. From Khan, MA.  Polymorphism of HLA-B27: 105 Subtypes Currently Known.  Current Rheumatology Reports. (2013) 15:362 

We now have identified at least 105 subtypes of HLA-B27, and the list continues to grow.  Today, seronegative spondyloarthitis, of the sort that may have afflicted Rebbi, can often be managed with medications that suppress the immune response. But without these, damage to the host tissues slowly builds until the organ systems start to fail, offering no respite from the painful symptoms of this disease. Perhaps now we are in a position to better understand Rebbi’s dying words, which appear on daf  104a.

“May it be Your will that there will be peace when I rest in eternity.”

Rebbi wanted nothing more than respite from his pain, and his wish was granted: ‘A voice from heaven emerged and said: “He will come with peace, they will rest on their resting places.”