Gittin 67b~ Might Talmudic Medicines Really Work?

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For the next three days, those who study the Talmud following the one-page-a-day Daf Yomi cycle will spend some time reading about cutting edge medical practices.  In Babylon. About 1,500 years ago. Here's a smattering of some of those practices:

For  sun-stroke

  • the remedy is on the first day to take a jug of water, [if it lasts] two days to let blood, [if] three days to take red meat broiled on the coals and highly diluted wine. For a chronic heat stroke, he should bring a black hen and tear it lengthwise and crosswise and shave the middle of his head and put the bird on it and leave it there till it sticks fast, and then he should go down [to the river] and stand in water up to his neck till he is quite faint, and then he should swim out and sit down. If he cannot do this, he should eat leeks and go down and stand in water up to his neck till he is faint and then swim out and sit down. (Gittin 67b).

For blood rushing to the head

  • take shurbina [a kind of cedar] and willow and moist myrtle and olive leaves and poplar and rosemary and yabla [a herb]  and boil them all together. The sufferer should then place three hundred cups on one side of his head and three hundred on the other. Otherwise he should take white roses with all the leaves on one side and boil them and pour sixty cups over each side of his head. (Gittin 68b.)

For migraine

  • take a woodcock and cut its throat with a white zuz over the side of his head on which he has pain, taking care that the blood does not blind him, and he should hang the bird on his doorpost so that he should rub against it when he goes in and out. (Gittin 68b.)

For a cataract

  • take a scorpion with stripes of seven colors and dry it out of the sun and mix it with stibium in the proportion of one to two and drop three paint-brushfuls into each eye — not more, lest he should put out his eye. (Gittin 69a.)

For night blindness

  • take a string made of white hair and with it tie one of his own legs to the leg of a dog, and children should rattle potsherds behind him saying 'Old dog, stupid cock'. He should also take seven pieces of raw meat from seven houses and put them on the doorpost and [let the dog] eat them on the ashpit of the town. After that he should untie the string and they should say, 'Blindness of A, son of the woman B, leave A, son of the woman B,' and they should blow into the dog's eye. (Gittin 69a.)

For catarrh [or a lung infection?] 

  • take about the size of a pistachio of gum-ammoniac and about the size of a nut of sweet galbanum and a spoonful of white honey and a Mahuzan natla  of clear wine and boil them up together...He can also take the excrement of a white dog and knead it with balsam, but if he can possibly avoid it he should not eat the dog's excrement as it loosens the limbs. (Gittin 69a-b.)

For swelling of the spleen

  • take the spleen of a she-goat which has not yet had young, and stick it inside the oven and stand by it and say, 'As this spleen dries, so let the spleen of So-and-so son of So-and-so' dry up'. (Gittin 69b.)

For a stone in the bladder

  • take three drops of tar and three drops of leek juice and three drops of clear wine and pour it on the penis of a man or on the corresponding place [i.e. the urethra] in a woman. Alternatively he can take the ear of a bottle and hang it on the penis of a man or on the breasts of a woman. Or he can take a purple thread which has been spun by a woman of ill repute or the daughter of a woman of ill repute and hang it on the penis of a man or the breasts of a woman. Or again he can take a louse from a man and a woman and hang it on... (Gittin 69b.)

We could go on but no doubt you've got the idea.  I doubt there are many of us eager to eat balsam mixed with dog excrement to ease our winter coughs (For those who are, remember: the Talmud tells us to go easy on the excrement.) But I will share with you the remarkable healing properties of two ancient remedies. To be sure, neither is a talmudic concoction, but their stories have implications for those too. 

A rich source of new antimicrobials potentially resides in medieval and early modern medical texts
— Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129- 15.

A 1,000-Year-Old Antimicrobial Remedy

Bald’seyesalve.A facsimile of the recipe, taken from the manuscript known as Bald’s Leechbook (London, British Library, Royal 12, D xvii). 

Bald’seyesalve.A facsimile of the recipe, taken from the manuscript known as Bald’s Leechbook (London, British Library, Royal 12, D xvii). 

I am not aware of any published descriptions of attempts to test these talmudic remedies. But a recent paper described something close. It was an attempt to reproduce a remedy described in Bald's Leechbook, an English medical text written in the tenth century. This text, which exists as a single copy in the British Library in London, contains a number of remedies, including those for what appear to be microbial infections.  Here's one of them:  

Make an eyesalve against a wen [a lump in the eye]: take equal amounts of cropleac [an Allium species] and garlic, pound well together, take equal amounts of wine and oxgall, mix with the alliums, put this in a brass vessel, let [the mixture] stand for nine nights in the brass vessel, wring through a cloth and clarify well, put in a horn and at night apply to the eye with a feather; the best medicine.
Image of a hordeolum.jpeg

The most likely clinical condition that correlates with a wen is a hordeolum, or, in non-medical language, a sty. It's a bacterial infection of an eyelash follicle, caused by a common bacterium called Staph. Aureus. They are easily treated with antibiotic cream and warm compresses. A group of medical researchers (with the help of a historian from the School of English and Centre for the Study of the Viking Age at the University of Nottingham) tested the effect of Bald’s eyesalve on Staph. aureus. They wanted to to determine if it worked at all.  If it did, they wanted to see if its efficacy could be attributed to a single ingredient, or whether it only worked when all the ingredients were combined according to the instructions laid down by Bald.  

Of course the first thing the scientists needed to do was to figure out what some of ingredients were. For example, copleac might be an onion, or a leek. (Actually, they couldn't figure out which of the two it was, so they made two variants of the recipe.) Next, they took both the recipe, and controls, which were the individual ingredients alone, and after leaving them to stand for "nine nights" as the Leechbook requires (læt standan ni􏰍on niht) they applied them to colonies of Staph Aureus. Then they counted the number of colonies of the bacteria that remained.

Two hundred microliters of ES-Onion or ES-Leek (batch A, filled circles, and batch B, open circles) or of each individual ingredient preparation was added to five 1-day-old cultures of S. aureus growing at 37°C in a synthetic wound. After 24 h of further incubation, the collagen was dissolved to recover cells for agar plate counts. The control treatment was sterile distilled water left to stand for 9 days in the presence of brass, which was also present in all other preparations, to simulate the presence of a copper alloy vessel  Asterisks denote treatments whose results were significantly different from those of the control. From Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129-15. 

Two hundred microliters of ES-Onion or ES-Leek (batch A, filled circles, and batch B, open circles) or of each individual ingredient preparation was added to five 1-day-old cultures of S. aureus growing at 37°C in a synthetic wound. After 24 h of further incubation, the collagen was dissolved to recover cells for agar plate counts. The control treatment was sterile distilled water left to stand for 9 days in the presence of brass, which was also present in all other preparations, to simulate the presence of a copper alloy vessel  Asterisks denote treatments whose results were significantly different from those of the control. From Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129-15. 

To their great delight they found the recipe was only effective when all the ingredients were present. They even tested whether it was necessary to wait for nine days and reported that "the number of viable cells left after treatment with either version...was [significantly] lower when the eyesalve had been left to stand for 9 days prior to use." In other words, the potion concocted only worked when the recipe was followed in its entirety; skipping any part decreased the efficacy.    

What is the remedy for a boil? — Abaye said: [A mixture of] ginger and silver dross and sulphur and vinegar of wine and olive oil and white naphtha laid on with a goose’s quill.
— Gittin 86a

But the next experiments were no less remarkable. The researchers tested the potion on methicillin-resistant Staph. Aureus (MRSA) which is an entirely modern "superbug". Through the indiscriminate and widespread use of antiobiotics, this strain of Staph. Aureus has grown resistant to the usual antibiotics, and is very real health problem.  The researchers tested the onion (ES-O) and leek (ES-L) versions against a standard antibiotic used to treat MRSA, called vancomycin, using mice that had been infected with the superbug. Vancomycin, the standard modern therapy, did not cause significant reductions in viable bacteria, but "ES-O and ES-L caused statistically significant drops in the numbers of viable cells recovered from wounds." In fact when compared to our modern vancomycis, the Leechbook potions caused a ten-fold reduction in the number of viable MRSA cells recovered. Of course there's a long way between a single small study done on cell cultures and mice, and a drug that is safe and effective in humans. But this story reveals how come very old medical texts may contain treatments that work. 

For more on the the story of the discovery of Bald'eye remedy, listen to this wonderful podcast:

If medieval physicians really did use observation and experience to design effective antimicrobial
medicines, then this predates the generally accepted date for the adoption of a rational scientific method (the formation of the Royal Society in the mid-17th century) and the modern age of antibacterial medicine (Lister’s use of carbolic acid in the late 19th century) by several hundred years.
— Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129-15

The 2015 Nobel Prize for an Ancient Remedy

...take one bunch of Qinghao, soak in two sheng of water, wring it out to obtain the juice and ingest it in its entirety
— Extract from The Handbook of Prescriptions for Emergency Treatments by Ge Hong (283–343 CE).

Another example of the medical wisdom of some ancient texts was acknowledged by the Nobel Prize Committee, no less. Last year, the Nobel Prize in Medicine was shared by the Chinese physician Youyou Tu "for her discoveries concerning a novel therapy against Malaria." Professor Tu led a team that screened more than 2,000 traditional Chinese medical herbs for antimalarial activity. Extracts from a herb known locally as Qinghao, (Artemisia annua) inhibited the malarial parasite and was successfully tested on mice in 1971. Clinical studies in the 1980s established the efficacy of artemicinin (as it came to be called). This drug is now part of the standard treatment for malaria worldwide.  Yet it was first identified in a Chinese medical text from the third century CE. - the era of the Mishnah and early Talmud.

Ancient texts certainly may contain efficacious treatment, though the odds are stacked against them. Today only a very tiny number of compounds that are screened for possible medical benefit ever make it to early trials, and of those most fail. It would take a lot of convincing to get Pfizer to test a "woodcock with its throat cut with a coin" for headache.  Until then, it is best to follow the words of another very old source of wisdom, Rav Sherira Gaon, who died around the year 1000 CE. (and so lived around the time of the composition of Bald's Leechbook). 

אוצר הגאונים, חלק התשובות, גיטין דף ס"ח ע"ב, סימן שע

צריכין אנן למימר לכון, דרבנן לאו אסותא אינון, ומילין בעלמא דחזונין בזמניהון...אמרונין, ולאו דברי מצוה אינון. הלכך לא תסמכון על אלין אסותא, וליכא דעביד מינהון מידעם, אלא בתר דמיבדיק וידע בודאי מחמת רופאים בקיאים, דההיא מילתא לא מעיקא לה וליכא דליתיה נפשיה לידי סכנה. והכין אגמרו יתנא ואמרו לנא אבות וסבי דילנא, דלא למעבד מן אילין אסותא אלא מאי דאיתיה

We must tell you that the rabbis were not physicians.  Whatever they saw in their day, they addressed, but these matters are not mitzvot.  Therefore, do not rely on these remedies. They must not be applied until they have been tested by expert physicians, who can be sure that the remedy will not cause harm or danger. This is what our ancestors have taught us.  We should not apply these remedies unless they have been tested...
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