Gynecology

Yoma 29a ~ Psalm 22 and the Husband Stitch

Psalm 22 opens with the following phrase: לִמְנַצֵּחַ עַל אַיֶּלֶת הַשַּׁחַר - and it turns out to be rather difficult to translate. One translation is “To the chief Musician upon Aijeleth Shahar,” which is not really much of a translation. Another translation is “For the leader; according to “The deer of the dawn.””


The rabbis may have understood the words, but they found the meaning of this verse to be challenging. In today’s page of Talmud there are three explanations. The first comes from Rabbi Abahu:

יומא כט,א

דִּכְתִיב: ״לִמְנַצֵּחַ עַל אַיֶּלֶת הַשַּׁחַר״, מָה אַיָּלָה זוֹ קַרְנֶיהָ מַפְצִילוֹת לְכָאן וּלְכָאן, אַף שַׁחַר זֶה מַפְצִיעַ לְכָאן וּלְכָאן.

It is as it is written: “For the leader, about the morning hind” (Psalms 22:1); just as the antlers of a hind branch out from here to there, so too, the light of dawn diffuses from here to there.

This explanation is an atmospheric one. Just as the antlers of a deer grow in several different directions, so to the light of the dawn, known as אַיֶּלֶת הַשַּׁחַר “ayelet hashahar” - is diffused in many directions.(One of the many meanings of the phrase אַיֶּלֶת הַשַּׁחַר is “the morning star, “which is the name of the planet Venus.)

Another explanation comes from Rabbi Assi, who links Queen Esther to the appearance of the dawn:

אָמַר רַבִּי אַסִּי: לָמָּה נִמְשְׁלָה אֶסְתֵּר לְשַׁחַר — לוֹמַר לָךְ: מָה שַׁחַר סוֹף כל הַלַּיְלָה, אַף אֶסְתֵּר סוֹף כל הַנִּסִּים

Rabbi Assi said: Why was Esther likened to the dawn? It is to tell you: Just as the dawn is the conclusion of the entire night, so too, Esther was the conclusion of all miracles performed for the entire Jewish people.

That’s nice. But it is on the explanation of Rabbi Zeira that we will focus:

אָמַר רַבִּי זֵירָא: לָמָּה נִמְשְׁלָה אֶסְתֵּר לְאַיָּלָה — לוֹמַר לָךְ: מָה אַיָּלָה רַחְמָהּ צַר וַחֲבִיבָה עַל בַּעְלָהּ כל שָׁעָה וְשָׁעָה כְּשָׁעָה רִאשׁוֹנָה, אַף אֶסְתֵּר הָיְתָה חֲבִיבָה עַל אֲחַשְׁוֵרוֹשׁ כל שָׁעָה וְשָׁעָה כְּשָׁעָה רִאשׁוֹנָה

Rabbi Zeira said: Why is Esther likened to a doe? It is to tell you: Just as in the case of a doe its womb is narrow and it is desirable to its mate at each and every hour like it is at the first hour, so too, Esther was desirable to Ahasuerus at each and every hour like she was at the first hour.

Rabbi Zeira here articulates a very surprising explanation, whose purpose was to praise Esther's anatomy. He claims that the vagina of the female deer (and not the uterus, even though that is the usual translation of the word rechem,) is especially “narrow” and so the male deer finds intercourse especially pleasurable. (A female deer is called called a doe or a hind, from where we get the Yiddish word for a deer - hinda.) So too, the wicked Persian King Ahasuerus longed for intercourse with Esther and found each time as pleasurable as the first.

So a couple of things. First, the vagina of a deer is not especially narrow. It is the perfect size for what it needs to do. It is no more comparatively narrow than that of a dog, a monkey, or a whale, and there no evidence whatsoever that male deer have a greater urge to mate than does the male of any other species. Indeed, it is the very presence of those other species on the planet that indicates that the mating urge of the males of each of those species is perfect, thank you very much. Even that of the Black Widow spider, in whom the tiny male mates with the larger female, only to be eaten alive, in an example of what biologists call sexual cannibalism.

Second, Rabbi Zeira’s midrashic explanation in fact tells us about his mindset, rather than revealing any fact of the natural world. A man longs for intercourse with a woman who has a narrow, or tight vagina. That is what Rabbi Zeira is saying. But before you mutter something inappropriate under your breath, you should realize that this fantasy is still prevalent, and can be found in the medical literature.

The Husband Stitch

Here is a 2020 entry from Medical News Today about “the husband stitch.”

unsplash-image-C2QbMA_nHYE.jpg

The “husband stitch” refers to an extra stitch that some women may have received after vaginal delivery led to their perineum becoming cut or torn.

This stitch extends beyond what is necessary to repair a natural tear during childbirth or a cut from an episiotomy. The supposed purpose of the husband stitch is to tighten the vagina to its predelivery state.

It is important to note that the husband stitch is neither an accepted practice nor an approved medical procedure. Researchers have gathered most of the evidence about the husband stitch from the testimony of women who have had it and from healthcare workers who have witnessed it.

The origin of the husband stitch, or vaginal tightening surgery, traces back to the mid-1950s.

While repairing a vaginal delivery tear or episiotomy, a gynecologist would tighten the entrance of a woman’s vagina by adding an extra stitch.

Doctors stated that this procedure could improve a woman’s well-being by preserving the size and shape of the vagina, either to increase the frequency of her orgasms or to enhance a man’s pleasure in intercourse. At that time, it was also called the husband’s knot or a vaginal tuck.

Is the husband stitch an urban legend? No. Here is an excerpt from a peer-reviewed paper that appeared in Seminars in Plastic Surgery titled Aesthetic surgery of the female genitalia:

Vaginal laxity, as it is called, is a common complaint among parous women. Although women report that reduced sexual sensation is the most common specific symptom of vaginal laxity, it is not clear that this phenomenon is directly related to sexual dysfunction.

Vaginal tightening surgery has been around since the mid fifties, where gynecologists used to tighten the entrance of a woman's vagina with an extra stitch while repairing vaginal and perineum tears or episiotomies after giving birth. At that time it was notoriously known as the “husband's stitch,” the “husband's knot,” or the “vaginal tuck,” and doctors discreetly referred to this procedure as “improving a woman's well-being.”

The goal of these procedures is to reconstruct (or to narrow) the lower third of the vagina, which includes “the orgasmic platform, internal and external vaginal diameter (introitus) and the perineal body.” The procedure enhances vaginal muscle tone strength and control, and decreases internal and external vaginal diameters. Women choosing to have their vaginas tightened are generally healthy women without true functional disorders. 

In vaginal tightening procedures, portions of mucosa are excised from the vaginal fornices (via scalpel, needle electrode, or laser) to surgically “tighten” the lower third of the vagina. Presently there is no standardization of this procedure: It can be an anterior colporrhaphy, a high-posterior colporrhaphy, an excision of lateral vaginal mucosa, or a combination…known complications are localized infection and vaginal bleeding. Ninety five percent of patients treated with lateral colporrhaphy reported an improvement in sexual sensitivity, as well as greater vaginal tightness at the 6 months follow-up

Rabbi Ziera’s explanation of the first verse of Psalm 22 reflects this male fantasy, one which today, some women will accomodate by undergoing surgery. Rather than shy away from discussing these intimate and important areas of our life, the Talmud gives us an opportunity to explore them. It is up to us to do so with modesty, empathy and equity, while always giving the lead to women that for centuries, they were denied.

They take the baby so that they may fix me where they cut. They give me something that makes me sleepy, delivered through a mask pressed gently to my mouth and nose. My husband jokes around with the doctor as he holds my hand.

– How much to get that extra stitch? he asks. You offer that, right?
– Please, I say to him. But it comes out slurred and twisted and possibly no more than a small moan. Neither man turns his head toward me.

The doctor chuckles. You aren’t the first –

I slide down a long tunnel, and then surface again, but covered in something heavy and dark, like oil. I feel like I am going to vomit.

– the rumor is something like –
– like a vir–

And then I am awake, wide awake, and my husband is gone and the doctor is gone. And the baby, where is –

The nurse sticks her head in the door.

– Your husband just went to get a coffee, she says, and the baby is asleep in the bassinet.

The doctor walks in behind her, wiping his hands on a cloth.

– You’re all sewn up, don’t you worry, he said. Nice and tight, everyone’s happy. The nurse will speak with you about recovery. You’re going to need to rest for a while.
— Carmen Maria Machado, The Husband Stitch. Granta.
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Niddah 17b ~The Chatam Sofer, Rationalism, and Anatomy That Isn't There

This is the first of two posts for Niddah 17, which will studied on Shabbat. The second post will be published tomorrow, Friday.

Print them up and enjoy.

In August 2013 a paper published in the otherwise sleepy Journal of Anatomy caused quite a sensation. Although doctors have been dissecting the human body for centuries, it seems that they missed a bit. A team from Belgium announced that they had discovered a new knee ligament, which they called the anterolateral ligament. On today’s page of Talmud the rabbis describe the opposite phenomena. They identify an anatomical part that in reality does not exist at all.  This part is called the aliyah, which usually refers to an attic or the upper chamber of a house.

נדה יז, ב

משל משלו חכמים באשה החדר והפרוזדור והעלייה דם החדר טמא דם העלייה טהור נמצא בפרוזדור ספקו טמא לפי שחזקתו מן המקור

The Sages had a parable with regard to the structure of the sexual organs of a woman [based on the structure of a house]: The inner room represents the uterus, and the corridor [perozdor] leading to the inner room represents the vaginal canal, and the upper story represents the bladder. 

Blood from the inner room is ritually impure. Blood from the upper story is ritually pure. If blood was found in the corridor, there is uncertainty whether it came from the uterus and is impure, or from the bladder and is pure. Despite its state of uncertainty ,it is deemed definitely impure, due to the fact that its presumptive status is of blood that came from the source ,i.e., the uterus, and not from the bladder. 

What anatomy is being discussed here? In particular, what is the aliyah, the “attic” of female genital anatomy? It turns out to be complicated.

the Aliyah surrounds the ovaries

From the Mishanh in Niddah, it is clear that the aliyah sometimes bleeds, and that this blood becomes visible when it passes into the vagina. Maimonides identifies the aliyah with the space that contains the ovaries and the fallopian tubes. In modern medicine the ovaries and the Fallopian tubes and tissues that support them are called the adenxa. They are further from the vagina that the uterus, and so this identification does not fit in with Abaye's anatomy in which the aliyah is closer to the vagina than is the uterus.

רמב׳ם הל׳ איסורי ביאה ה, ד

ולמעלה מן החדר ומן הפרוזדוד, בין חדר לפרוזדוד, והוא המקום שיש בו שתי ביצים של אישה, והשבילים שבהן מתבשלת שכבת זרע שלה--מקום זה הוא הנקרא עלייה.  וכמו נקב פתוח מן העלייה לגג הפרוזדוד, ונקב זה קוראין אותו לול; והאבר נכנס לפנים מן הלול, בשעת גמר ביאה

Above the uterus and the vagina, between the uterus and the vagina, is the place in which the two ovaries are found, and the tubes along which the sperm from intercourse matures, this place is called the aliyah. (Maimonides, Mishneh Torah Issurie Bi'ah 5:4)

As we said, the problem is that the space which contains the ovaries is inside the abdomen, and this space does not connect with the vagina. It connects via the Fallopian tubes with the uterus.  Although Maimonides does not identify the aliyah as the ovaries themselves, some have done so. But the problem with this is that the ovaries don't bleed unless they develop a large cyst which then ruptures. But even in this case they bleed into the abdomen, or into the uterus, again via the Fallopian tubes, and not directly into the vagina.

Menachem ben Shalom (1249-1306) known as the Meiri, wrote an important commentary on the Talmud call Bet Habechirah - בית הבחירה and in it he too identifies the aliyah as the space between the uterus and the vagina in which the ovaries are found. He notes that in this space there are many blood vessels which may rupture and bleed directly into the vagina (עורקים שמתבקעים לפעמים), but as we have noted this is not biologically correct. Any bleeding from the adnexa is via the Fallopian tubes into the uterus itself, and certainly not directly into the vagina.

The Aliyah is the vagina

In his classic Biblisch-Talmudische Medezin published in 1911Jacob Preuss identified the aliyah as the vagina. "It can be assumed with reasonable certainty" he wrote "that the cheder refers to the uterus, that the prosdor is the vulva, and that the aliyah is the vagina." However certain he may have been, Preuss is the only one to make this identification, which does not fit in with the text of the Mishanh. So let's try another suggestion.

The Aliyah is the Bladder

Sefer Ha'Arukh, Venice 1552.

Sefer Ha'Arukh, Venice 1552.

Natan ben Yechiel of Rome, who died in 1106, wrote an influential lexicon of talmudic terms called the Sefer Ha'Arukh (ספר הערוך) which was first published around 1470. In that work the aliyah is identified as the urinary bladder. This identification also cannot be correct, because the bladder does not empty into the vagina, and because it does not lie between the uterus and the vagina but anterior to them. The commentary in the Schottenstein Talmud to Niddah 17b notes that a connection between the urethra and the vagina (known as a urethero-vaginal fistula) might account for bleeding from the bladder into the vagina. This is possible - though it is of course not normal anatomy.  

From here.

From here.

The AliyaH is a completely new structure

Meir ben Gedaliah of Lublin (d.1616) also considered the location of the aliyah in his modestly titled book Meir Einei Hakhamim - מאיר עיני חכמים - (Enlightening the Eyes of the Sages) first published in Venice in 1618.  He locates it between the uterus and the bladder, and provides two helpful schematics. The problem is that there is no such organ. You won't find it if you dissect a cadaver, and you won't find it in any textbook of anatomy (like this one). And as one astute radiologist and reader of Talmudology recently told me, you won't find it on an MRI either. Here is the text. 

Maharam Lublin. Meir Einei Hakhamim. Venice 1618. p255b.

Maharam Lublin. Meir Einei Hakhamim. Venice 1618. p255b.

This non-existent anatomy is also pictured in the Schottenstein Talmud (Niddah 17b), based on the difficult Mishanah.  

From Schottenstein Talmud Niddah 17b. Note that this does NOT correspond to the known female anatomy, but is a schematic based on Rashi's understanding.

From Schottenstein Talmud Niddah 17b. Note that this does NOT correspond to the known female anatomy, but is a schematic based on Rashi's understanding.

The CHatam Sofer on the Aliyah

Moses Schreiber known as Chatam Sofer, (d. 1839) was a leader of Hungarian Jewry and he too weighed in on the issue in his talmudic commentary to Niddah (18a).

What is the "corridor" or the "room" or the "roof" or the "ground" or the "aliyah" ? After some investigation using books and authors experts and books about autopsies it is impossible to deny the facts that do not accord with the statements of Rashi or Tosafot or the diagrams of the Maharam of Lublin...but you will find the correct diagram in the book called Ma'asei Tuviah and in book Shvilei Emunah...therefore I have made no effort to explain the words of Rashi or Tosafot for they are incompatible with the facts...

Tuviah HaCohen, the Doctor from Padua

I couldn't find the diagram in any edition of the Shvilei Emunah to which the Chatam Sofer refers, so let's look at the diagram from Ma'asei Tuviah, (“the best illustrated Hebrew medical work of the pre-modern era”) which I happen to have in my own library.

Detail from Tuviah HaCohen, Ma'aseh Tuviah, Venice 1708. p132b.

Detail from Tuviah HaCohen, Ma'aseh Tuviah, Venice 1708. p132b.

A careful reading of the annotation (זז) reveals that Tuviah HaCohen (1652-1729) identifies the aliyah as that area containing the ovaries and the Fallopian tubes. In doing so he followed the opinion of Maimonides that we cited earlier, even though that does not in any way fit in with the understanding of Abaye and his ruling that blood found in the vagina that comes from the aliyah is not impure because it does not come from the uterus. Any gynecologist (or first year medical student completing their anatomy dissections) will tell you that blood from the adnexa (the ovaries and Fallopian tubes) can only get into the vagina via the uterus. But the most interesting part of this diagram is the very first line of text, at the top of the image. 

פירוש המחבר כפי ידיעת הנתוח  

The author's explanation according to knowledge gained from an autopsy

Anatomical Theatre, Palazzo del Bo, at the University of Padua. It was built in 1594 by the anatomist who helped found modern embryology, Girolamo Fabricius. From here.

Anatomical Theatre, Palazzo del Bo, at the University of Padua. It was built in 1594 by the anatomist who helped found modern embryology, Girolamo Fabricius. From here.

Here, perhaps for the first time, anatomical knowledge from an autopsy is being shared in Hebrew. At the medical school in Padua, two bodies (one of each sex) had to be dissected each year, and all the students attended- Tuviah included.  As a medical student, Tuviah would have stood in the famous anatomical theater and watched the dissection, perhaps following along in one of the textbooks based on those dissections. 

Facts Matter

As the Chatam Sofer noted, facts matter. The illustration in the work of the Maharam of Lublin was an example of trying to get the facts to fit the text of the Mishnah (or more precisely, the explanations of Rashi and Tosafot) but in doing so the Maharam created a fictitious anatomical part.

It is very unlikely that the rabbis of the Talmud witnessed human dissections. In the ancient world two Greeks, Herophilus of Chalcedon and  Erasistratus of Ceos (who lived in the first half of the third century BCE) were "the first and last ancient scientists to perform dissections of human cadavers." Facts about human anatomy became clear once human dissection began in the fourteenth century, but as is demonstrated by the Maharam of Lublin, these lessons did not always diffuse into the Jewish community.  The Chatam Sofer is often - and rightly  - cited as a force for tradition against the challenges from the outside world. But the Hatam Sofer, at least in so far as gynecology was concerned, had no time for a theory when the facts show otherwise. In an age of "alternative facts" the Chatam Sofer is a model of rationalism.

[Mostly a repost from here.]

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Bava Basra 24a ~The Chatam Sofer, Rationalism, and Anatomy That Isn't There

In August 2013 a paper published in the otherwise sleepy Journal of Anatomy caused quite a sensation. Although doctors have been dissecting the human body for centuries, it seems that they missed a bit, and a team from Belgium announced that they had discovered a new knee ligament, which they called the anterolateral ligament. On today’s page of Talmud the rabbis describes the opposite phenomena. In it, the rabbis describe an anatomical part that is really hard to identify, and may not exist at all.  It is called the aliyah, which usually refers to an attic or the upper chamber of a house.

PROXIMITY or Majority?

The rabbis are trying to resolve the issue of who owns a dove found between two dove cots. How far could it hop, and what difference might that make with regards the decision?

בבא בתרא כג, ב

ניפול הנמצא בתוך חמשים אמה הרי הוא של בעל השובך חוץ מחמשים אמה הרי הוא של מוצאו נמצא בין שני שובכות קרוב לזה שלו קרוב לזה שלו מחצה על מחצה שניהם יחלוקו

With regard to a dove chick [nippul] that was found within fifty cubits of a dovecote, it belongs to the owner of the dovecote.If it was found beyond fifty cubits from a dovecote, it belongs to its finder.In a case where it was found between two dovecotes, if it was close to this one, it belongs to the owner of this dovecote; if it was close to that one, it belongs to the owner of that dovecote. If it was half and half, [i.e., equidistant from the two dovecotes,] the two owners divide the value of the chick.

Fair enough. But Abbaye, the great fourth century Babylonian sage had a different take. Perhaps we should not be concerned with proximity, but instead be concerned with who owns the majority of the doves in the area. And brings a proof that will surprise you.

אמר אביי אף אנן נמי תנינא דם שנמצא בפרוזדור ספיקו טמא שחזקתו מן המקור ואע"ג דאיכא עלייה דמקרבא

Abaye said: We learn in a Mishnah (Niddah 17b) as well that one follows the majority rather than proximity: With regard to blood that is found in the corridor [baperozdor],i.e., the cervical canal, and it is uncertain whether or not it is menstrual blood, it is ritually impure as menstrual blood, as there is a presumption that it came from the uterus, which is the source of menstrual blood. [And this is the halakha even though there is an upper chamber, which empties into the canal, which is closer.]

Here is that Mishnah in full:

נדה יז, ב

משל משלו חכמים באשה החדר והפרוזדור והעלייה דם החדר טמא דם העלייה טהור נמצא בפרוזדור ספקו טמא לפי שחזקתו מן המקור

The Sages had a parable with regard to the structure of the sexual organs of a woman [based on the structure of a house]: The inner room represents the uterus, and the corridor [perozdor] leading to the inner room represents the vaginal canal, and the upper story represents the bladder. 

Blood from the inner room is ritually impure. Blood from the upper story is ritually pure. If blood was found in the corridor, there is uncertainty whether it came from the uterus and is impure, or from the bladder and is pure. Despite its state of uncertainty ,it is deemed definitely impure, due to the fact that its presumptive status is of blood that came from the source ,i.e., the uterus, and not from the bladder. 

What anatomy is being discussed here? In particular, what is the aliyah, the “attic” of female genital anatomy? It turns out to be complicated.

the Aliyah surrounds the ovaries

From the Mishanh in Niddah, it is clear that the aliyah sometimes bleeds, and that this blood becomes visible when it passes into the vagina. Maimonides identifies the aliyah with the space that contains the ovaries and the fallopian tubes. In modern medicine the ovaries and the Fallopian tubes and tissues that support them are called the adenxa. They are further from the vagina that the uterus, and so this identification does not fit in with Abaye's anatomy in which the aliyah is closer to the vagina than is the uterus.

רמב׳ם הל׳ איסורי ביאה ה, ד

ולמעלה מן החדר ומן הפרוזדוד, בין חדר לפרוזדוד, והוא המקום שיש בו שתי ביצים של אישה, והשבילים שבהן מתבשלת שכבת זרע שלה--מקום זה הוא הנקרא עלייה.  וכמו נקב פתוח מן העלייה לגג הפרוזדוד, ונקב זה קוראין אותו לול; והאבר נכנס לפנים מן הלול, בשעת גמר ביאה

Above the uterus and the vagina, between the uterus and the vagina, is the place in which the two ovaries are found, and the tubes along which the sperm from intercourse matures, this place is called the aliyah. (Maimonides, Mishneh Torah Issurie Bi'ah 5:4)

As we said, the problem is that the space which contains the ovaries is inside the abdomen, and this space does not connect with the vagina. It connects via the Fallopian tubes with the uterus.  Although Maimonides does not identify the aliyah as the ovaries themselves, some have done so. But the problem with this is that the ovaries don't bleed unless they develop a large cyst which then ruptures. But even in this case they bleed into the abdomen, or into the uterus, again via the Fallopian tubes, and not directly into the vagina.

Menachem ben Shalom (1249-1306) known as the Meiri, wrote an important commentary on the Talmud call Bet Habechirah - בית הבחירה and in it he too identifies the aliyah as the space between the uterus and the vagina in which the ovaries are found. He notes that in this space there are many blood vessels which may rupture and bleed directly into the vagina (עורקים שמתבקעים לפעמים), but as we have noted this is not biologically correct. Any bleeding from the adnexa is via the Fallopian tubes into the uterus itself, and certainly not directly into the vagina.

The Aliyah is the vagina

In his classic Biblisch-Talmudische Medezin published in 1911Jacob Preuss identified the aliyah as the vagina. "It can be assumed with reasonable certainty" he wrote "that the cheder refers to the uterus, that the prosdor is the vulva, and that the aliyah is the vagina." However certain he may have been, Preuss is the only one to make this identification, which does not fit in with the text of the Mishanh. So let's try another suggestion.

The Aliyah is the Bladder

Sefer Ha'Arukh, Venice 1552.

Sefer Ha'Arukh, Venice 1552.

Natan ben Yechiel of Rome, who died in 1106, wrote an influential lexicon of talmudic terms called the Sefer Ha'Arukh (ספר הערוך) which was first published around 1470. In that work the aliyah is identified as the urinary bladder. This identification also cannot be correct, because the bladder does not empty into the vagina, and because it does not lie between the uterus and the vagina but anterior to them. The commentary in the Schottenstein Talmud to Niddah 17b notes that a connection between the urethra and the vagina (known as a urethero-vaginal fistula) might account for bleeding from the bladder into the vagina. This is possible - though it is of course not normal anatomy.  

From here.

From here.

The AliyaH is a completely new structure

Meir ben Gedaliah of Lublin (d.1616) also considered the location of the aliyah in his modestly titled book Meir Einei Hakhamim - מאיר עיני חכמים - (Enlightening the Eyes of the Sages) first published in Venice in 1618.  He locates it between the uterus and the bladder, and provides two helpful schematics. The problem is that there is no such organ. You won't find it if you dissect a cadaver, and you won't find it in any textbook of anatomy (like this one). And as one astute radiologist and reader of Talmudology recently told me, you won't find it on an MRI either. Here is the text. 

Maharam Lublin. Meir Einei Hakhamim. Venice 1618. p255b.

Maharam Lublin. Meir Einei Hakhamim. Venice 1618. p255b.

This non-existent anatomy is also pictured in the Schottenstein Talmud (Niddah 17b), based on the difficult Mishanah.  

From Schottenstein Talmud Niddah 17b. Note that this does NOT correspond to the known female anatomy, but is a schematic based on Rashi's understanding.

From Schottenstein Talmud Niddah 17b. Note that this does NOT correspond to the known female anatomy, but is a schematic based on Rashi's understanding.

The CHatam Sofer on the Aliyah

Moses Schreiber known as Chatam Sofer, (d. 1839) was a leader of Hungarian Jewry and he too weighed in on the issue in his talmudic commentary to Niddah (18a).

What is the "corridor" or the "room" or the "roof" or the "ground" or the "aliyah" ? After some investigation using books and authors experts and books about autopsies it is impossible to deny the facts that do not accord with the statements of Rashi or Tosafot or the diagrams of the Maharam of Lublin...but you will find the correct diagram in the book called Ma'asei Tuviah and in book Shvilei Emunah...therefore I have made no effort to explain the words of Rashi or Tosafot for they are incompatible with the facts...

Tuviah HaCohen, the Doctor from Padua

I couldn't find the diagram in any edition of the Shvilei Emunah to which the Chatam Sofer refers, so let's look at the diagram from Ma'asei Tuviah, which I happen to have in my own library.

Detail from Tuviah HaCohen, Ma'aseh Tuviah, Venice 1708. p132b.

Detail from Tuviah HaCohen, Ma'aseh Tuviah, Venice 1708. p132b.

A careful reading of the annotation (זז) reveals that Tuviah HaCohen (1652-1729) identifies the aliyah as that area containing the ovaries and the Fallopian tubes. In doing so he followed the opinion of Maimonides that we cited earlier, even though that does not in any way fit in with the understanding of Abaye and his ruling that blood found in the vagina that comes from the aliyah is not impure because it does not come from the uterus. Any gynecologist (or first year medical student completing their anatomy dissections) will tell you that blood from the adnexa (the ovaries and Fallopian tubes) can only get into the vagina via the uterus. But the most interesting part of this diagram is the very first line of text, at the top of the image. 

פירוש המחבר כפי ידיעת הנתוח  

The author's explanation according to knowledge gained from an autopsy

Anatomical Theatre, Palazzo del Bo, at the University of Padua. It was built in 1594 by the anatomist who helped found modern embryology, Girolamo Fabricius. From here.

Anatomical Theatre, Palazzo del Bo, at the University of Padua. It was built in 1594 by the anatomist who helped found modern embryology, Girolamo Fabricius. From here.

Here, perhaps for the first time, anatomical knowledge from an autopsy is being shared in Hebrew. At the medical school in Padua, two bodies (one of each sex) had to be dissected each year, and all the students attended- Tuviah included.  As a medical student, Tuviah would have stood in the famous anatomical theater and watched the dissection, perhaps following along in one of the textbooks based on those dissections. 

Facts Matter

As the Chatam Sofer noted, facts matter. The illustration in the work of the Maharam of Lublin was an example of trying to get the facts to fit the text of the Mishnah (or more precisely, the explanations of Rashi and Tosafot) but in doing so the Maharam created a fictitious anatomical part.

It is very unlikely that the rabbis of the Talmud witnessed human dissections. In the ancient world two Greeks, Herophilus of Chalcedon and  Erasistratus of Ceos (who lived in the first half of the third century BCE) were "the first and last ancient scientists to perform dissections of human cadavers." Facts about human anatomy became clear once human dissection began in the fourteenth century, but as is demonstrated by the Maharam of Lublin, these lessons did not always diffuse into the Jewish community.  The Chatam Sofer is often - and rightly  - cited as a force for tradition against the challenges from the outside world. But the Hatam Sofer, at least in so far as gynecology was concerned, had no time for a theory when the facts show otherwise. In an age of "alternative facts" the Chatam Sofer is a model of rationalism.

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