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 .

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.

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.

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?

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Bava Kamma 35a ~ Analgesia for Animals

בבא קמא לה, א

ההוא תורא דהוה בי רב פפא דהוה כיבין ליה חינכיה עייל ופתקיה לנזייתא ושתי שיכרא ואיתסי

There was an ox in the house of Rav Pappa that had a toothache. It went inside, pushed the cover off a beer barrel, drank the beer, and was healed.

Descartes on Animal Pain

The silly notion that animals do not feel pain is widely thought to have originated with the French philosopher Rene Descartes (1596-1650). "They eat without pleasure, cry without pain, grow without knowing it; they desire nothing, fear nothing, know nothing". While these words were those a student of Descartes, the contemporary philosopher Peter Harrison notes that they are generally thought to capture the essence of Descartes' view of animals. "The father of modern philosophy" continues Harrison, "is credited with the opinion that animals are non-sentient automata, an opinion for which over the centuries he has been ridiculed and vilified."

To be able to believe that a dog with a broken paw is not really in pain when it whimpers is a quite extraordinary achievement, even for a philosopher.
— John Cottingham. "A Brute to the Brutes?' Descartes's Treatment of Animals. Philosophy 1978; 53; 551-559.

Scientists Ignoring Animal Pain

Vivisection of a dog. From J. Walaeus.  Epistola Prima de Motu Chyli et Sanguinis  (1647) .

Vivisection of a dog. From J. Walaeus. Epistola Prima de Motu Chyli et Sanguinis (1647).

The debate as to Descartes' true view is fascinating, but need not detain us. What is certain is that the pain that animals undoubtedly feel was either denied as existing, or overlooked for centuries by scientists.  Animals were used for experiments of the most horrendous kind in the names of science, even when the pain was evident to those who were causing it. Here, for example, is the French physiologist Claude Bernard (d. 1878), who felt that without vivisection, 'neither physiology not scientific medicine is possible': 

A physiologist is not a man of fashion, he is a man of science, absorbed by the scientific idea where he pursues: he no-longer hears the cry of animals, he no-longer sees the blood that flows, he sees only his anatomist feels himself in a horrible slaughter house; under the influence of a scientific idea, he delightfully follows a nervous filament through stinking livid flesh, which to any other man would be an object of disgust and slaughter.
It is sometimes said that people in the seventeenth century had no motion of cruelty to animals and Descartes even argued that animals are mere machines, incapable of feeling pain. It is also said there was so much cruel treatment of one human being by another in the seventeenth century that what was done by the vivisectionists to animals would scarcely have seemed horrendous.
— David Wootton. Bad Medicine. Oxford University Press 2006. 108-109.

Do Fish Feel Pain? - Yes!

The tropical Zebrafish grow to about 2.5 inches in length.  And they don't like pain.

The tropical Zebrafish grow to about 2.5 inches in length.  And they don't like pain.

Rav Pappa's ox sought out pain relief from beer, but recent evidence has shown that it's not just oxen who like to have their pain relieved.  So do fish.  In a paper in the The Journal of Consciousness Studies, Lynn Sneddon demonstrated that not only can fish feel pain, but that they are willing to pay a cost to get pain relief. Zebrafish, like humans, prefer an interesting environment to a boring one. When given a choice, these fish swim in an enriched tank with vegetation and objects to explore, rather than in one that is bare. With me so far? OK. Next, Sneddon, from the University of Liverpool in the UK, injected the tails of the zebrafish with acetic acid, which no doubt annoyed them, but did not cause any change in their preference for the interesting tank over the one that was bare.  Finally, she injected the fish with acetic acid, but added a painkiller into the water of the bare tank. This time, the fish chose to swim into the bare but drug filled tank. Fish who were injected with saline as a control remained in the enriched tank and did not swim into the drug enhanced bare tank.  The conclusion: zebrafish are willing to pay a cost in return for getting relief from their pain. Similar observations have been made in rodents too; when in pain, they will self administer analgesics, preferring to drink analgesic dosed water or eat dosed food when presented with a choice. 

Defining Animal Pain

In the scientific world there was  - and perhaps still is -  a debate about the nature of pain that animals may feel.  Sneddon, the fish physiologist, wrote that if we are to conclude that animals experience pain in a way similar to humans, then (1) "animals should have the apparatus to detect and process pain; (2) pain should result in adverse changes in behavior and physiology; and (3) analgesics (painkillers) should reduce these responses..." Thanks to advances in microscopy and physiology, today we know that animals have many of the anatomical features (like nerves that transmit the pain stimulus) needed to process pain.  

The Ox of the House of Rav Pappa

Rav Pappa's ox demonstrated the second and third of Sneddon's features: pain changed the behavior of the ox (off it trotted to find pain relief ), and analgesia, (in this case beer) indeed reduced the pain response.  Of course we are left wondering how it was known that the ox of the house of Rav Pappa specifically had a toothache, (and not say sinusitis or a bad migraine), but based on what we know about the ways in which fish and rodents will seek out an environment in which painkillers are available, the story is no where near as fanciful as we might suspect.  

קיצור שולחן ערוך - קצא

אָסוּר מִן הַתּוֹרָה לְצַעֵר כָּל בַּעַל חָי. וְאַדְּרַבָּא, חַיָב לְהַצִּיל כָּל בַּעַל-חַי מִצַּעַר 

It is forbidden to cause pain to any living creature. In fact a person is required to save any living creature from pain...(Abbreviated Code of Jewish Law by Shlomo Ganzfreid, 1864).


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Sotah 31a ~ What Can a Fetus See?

Happy anniversary to Talmudology. We are now a year old, and our very first post was about the viability of an eight month fetus.  The first post of our second year is also about the fetus.  This one concerns an aggadic statement, that is to say, a homiletic teaching, that is not to be taken literally - or so one would think.  In today's daf yomi the Talmud discusses the miracles which occurred as the Children of Israel crossed through the parted waters of the Red Sea. Rabbi Meir taught that even a fetus in its mother's womb praised God, saying "This is my God and I will glorify him." Now we might have considered this a homiletic teaching that is meant to simply express a degree of amazement and thanks.  But the Talmud then asks a question that suggests Rabbi Meir meant what he said more literally:

סוטה לא, א

והא לא חזו! אמר רבי תנחום כרס נעשה להן כאספקלריא המאירה וראו

These fetuses in the womb could not see the Divine presence, so how could they sing praise? Rabbi Tanchum said: Their mother's abdomen became as clear as glass for them and they were able to see.

While Rabbi Tanchum suggested that it takes physical sight rather than emotional insight to see the divine, it turns out that the fetus can see - and hear, while still in the womb.

Increased Fetal Heart Rate in Response to Light

In 1980, two Israelis published a preliminary report on the response to light of ten fetuses between 38 and 43 weeks' gestation. They inserted an amnioscope through the cervix and shone a light into the womb for thirty seconds while monitoring the heart rate of the little fetus. They found that eight of the ten fetuses had an acceleration of their heartbeat in response to the light. That's interesting you say, but hardly what Rabbi Tanchum was describing. And you'd be correct.  So let's turn to some other studies.

Increased Fetal Brain Activity in Response to Light

A review in the European Journal of Obstetrics and Gynecology and Reproductive Biology published in 1996 was sceptical that the fetus could see much of anything while inside the womb: 

In utero visual stimulation appears to be very a dark room the amniotic cavity may be candled with a torch light, especially in the case of a polyhydramnios [an excess of amniotic fluid]. Measurements performed during rat and guinea-pig gestation have demonstrated that if only 2% of incoming light was transmitted in utero below 550 nm, this value increases with wavelength of the signal to reach 10% around 650 nm. Thus, a limited portion of external light may reach the human fetal retina when eyelids are open (this behavior starts at 20 weeks) or through the eyelids. 

But in 2003 a group of researchers from the United Kingdom (with apparently nothing else to do for amusement) built a light source from a "cardboard tube lined with non-conducting aluminised plastic, resulting in a light intensity of 1,100–1,200 Lux at the maternal abdomen as measured with a hand-held light meter." After an ultra-sound confirmed that the fetus was looking forward (really, they did this too) they turned the light on and off. And all this took place while the mother and her in-utero child were lying in a functional MRI scanner, which was used to look for activation of the little fetal brain in response to the light. Of the nine subjects they tortured in this way, one could not be analyzed due to motion, three did not show any significant activation, and five showed significant activation. Oddly, none of the fetal brains that responded showed any activation of the occipital lobe, that part of the brain in which the primary visual cortex is located and which responds to light.  Instead, it was the fetal frontal cortex showed a response to the light being shone.  Hmmm.

The Fetal Response to Sound

So much for vision. Researchers have also studied what - if anything - a fetus may be able to hear.  A group from Rambam Hospital and the Technion in Haifa studied the effect of music on fetal activity. Back in 1982 they took twenty pregnant women and played them either 25 minutes of nothing, or 25 minutes of classical or pop music through headphones. If you are wondering, the music was either a canon and songs composed by Pachelbel or "the pop-hits of the [sic] Boney-M." (Give yourself an extra point if you can recall any of the pop hits of the Boney M.) Anyway, they played the music in random sequence and monitored the fetus for breathing and body movements.  They found that compared to no music, when music was piped into the mothers' ears there was a significant increase in the breathing movements of the fetus, but there was no difference between classical and pop music. seems that the fetus moves into a more active state when music is played to the mother.
— Zimmer, EZ. et al. Maternal Exposure to music and fetal activity. Europ. J. Obstet. Gyec. Reprod. Biol. 1982 (13) 210.

And remember the experiments with cardboard tubes shining light into the womb of forward facing fetuses? Well that same group also performed functional MRI scanning of the brains of a group of fetuses but this time they strapped "an MRI compatible headphone" to the maternal abdomen (or the maternal ears, as a control) and played 15 seconds of music. (The paper does not specify the kind of music that was chosen. I do hope it wasn't the Boney-M.) Five of the twelve fetuses that had music piped into their mother's abdomen showed activation of the temporal lobes, but despite this low number the authors enthusiastically concluded that their study showed "...that brain activity can be detected in response to stimulation prenatally..." 

A ray of hope flitters in the sky
A tiny star lights up way up high
All across the land dawns a brand new morn
This comes to pass when a child is born
— Boney M. When a Child is Born, 1981.

Giving Thanks - Thanksgiving

The Talmud describes how the Crossing of the Red Sea was a miracle of such extraordinary nature that even in-utero fetuses joined in singing a prayer of thanks with the Children of Israel. In his famous introduction to the tenth chapter of Sanhedrin, Maimonides describes how aggadah should not be taken literally. Instead, a deeper message should be sought. And so for our American readers, who celebrate Thanksgiving today, Talmudology leaves you with this question: what are you thankful for? For what blessings in your life might a fetus open its eyes and see, or say thanks while still in its mother's  womb? Now that I think of it, that's a question that everyone should answer.

Happy Thanksgiving.

Human fetuses are, to a certain extent, able to memorize certain sensory properties...Despite the fact that they have only very short periods of wakefulness and that their brain is not mature enough to integrate sensory experiences, several experiments suggest that this does not prevent pre- and perinatal learning.
— Lecanuet, J, Schaal B. Fetal Sensory Competencies. European Jopurnal of Obstetrics and Gynecology and Reproductive Biology 1996. 68: 1-23
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