Tu B'Shavt ~ A New Year for Health

The opening Mishnah of Masechet Rosh Hashanah includes this:

ראש השנה ב ,א

באחד בשבט ראש השנה לאילן כדברי בית שמאי בית הלל אומרים בחמשה עשר בו

On the first of Shevat is the New Year for the tree; [the fruit of a tree that was formed prior to that date belong to the previous tithe year and cannot be tithed together with fruit that was formed after that date;] this ruling is in accordance with the statement of Beit Shammai. But Beit Hillel say: The New Year for trees is on the fifteenth of Shevat.

 Declaring different kinds of New Years goes back to the Talmud. But this practice was updated in a remarkable way by a Russian Jewish immigrant to the US in the early twentieth century. Tonight, we mark the fifteenth of Shvat, the date that, according to Bet Hillel, is the new year for the tithing of trees, and we will tell his remarkable - and overlooked - story, of it has everything to do with Tu B’Shvat.

“Twice a year on the fifteenth day of Shevat and on the eighteenth day of Iyar all the Jewish children from 3 to 13 years of age should undergo a thorough physical examination by the local Jewish physicians free of charge. ”

— Charles Spivak

Charles Spivak and the fight against tuberculosis

Hayyim Haykhl Spivakovski (1861-1927) immigrated to the US from Russia, where he became Charles Spivak. He graduated from Jefferson Medical College in Philadelphia in 1890 (and his thesis, on talmudic theories of menstruation won a prize), and after his wife contracted tuberculosis in 1896 he moved with her to Denver. There she could take advantage of the high altitude which had been shown to help fight the disease. This began his life-long mission to fight the tuberculosis and improve the care of the many Jewish refugees from eastern Europe who contracted it. 

From here.

Spivak founded the Jewish Consumptives’ Relief Society (JCRS), which provided kosher food and a Sabbath atmosphere, but was open to anyone. “We have in our institution chasidim and agnostics,” he wrote in 1914, “Jews and Christians, republicans and progressives, socialists and anarchists, men of all kinds of religious, political and economic options.” Spivak’s personal philosophy was informed by “a unique blend of Yiddishkeit [Jewish values], secularism and socialism” and his approach to the distribution of funds was sometimes at odds with bureaucratic and impersonal ways that some Jewish charities functioned. “We may not be able to return him [the patient] to his family as a useful working unit,” he reminded his benefactors, “we may actually waste money without any hope for any return, nevertheless, we feel that he or she must receive our care and attention, that whole-souled and whole-hearted charity is, after all, the only true, pure and unalloyed charity.” He estimated that of among the 3.3 million Jews then living in the US about 4,600 died each year from the disease, and ten times that number were chronically infected, or as he put it, were “living tuberculous Jews.” It was therefore the duty of the Jewish community to support the fight for to prevent the spread of tuberculosis and search for a cure. 

Dr. Chales Spivak. From here.

In that opening Mishnah of Rosh Hashanah, we read that are several different dates that mark the beginning of different new years. The first day of the Spring month of Nissan is the new year for kings, which is used to date legal documents. The new year for trees is marked in the late winter month Shevat, which is used to count tithes, and first day of the late summer month of Tishrei is used to count the number of years since creation. In December 1918, Spivak updated this list and gave it a thoroughly modern twist. Writing in the Journal Jewish Charities, he suggested that the rhythm of the Jewish calendar could be used to improve public health and reduce the toll from tuberculosis.

Twice a year on the fifteenth day of Shvat (New Years for Trees) and on the eighteenth day of Iyar (Lag B'Omar) all the Jewish children from 3 to 13 years of age should undergo a thorough physical examination by the local Jewish physicians free of charge.  

In the evening of the respective days all organized societies in the community should hold Health meetings at which the subject of how to maintain good health and prevent disease should be discussed by health officers and physicians.

 A custom should also be inaugurated that all adults should visit their family physicians during the months of Tishre and Nisson [sic] for the purpose of undergoing a physical examination.

 Spivak’s suggestion was of course dependent on a working knowledge of the Jewish calendar, but the dates he suggested would help. The fifteenth of Shevat was often celebrated in schools, and Lag B’Omer, the thirty-third day of the period leading up to the festival of Shavuot was celebrated as a minor holiday; it marked the end of the pandemic deaths of the students of the talmudic giant Rabbi Akiva. Most Jewish adults, even those who had jettisoned traditional Jewish practice when they arrived in America, would be aware of the timing of the other two months.  The festival of Pesach (Passover) is celebrated in Nissan, and Rosh Hashanah, the start of the Jewish New Year that leads into Yom Kippur (the Day of Atonement) is commemorated in Tishrei.

Helping others, even after his death

Spivak, a member of the Denver Hebrew Speaking Society, developed liver cancer and died in 1927 at the age of 68. His generous spirit is evident in his last will and testament, where he asked that

…my body be embalmed and shipped to the nearest medical college for an equal number of non-Jewish and Jewish students to carefully dissect. After my body has been dissected, the bones should be articulated by an expert and the skeleton shipped to the University of Jerusalem, with the request that the same be used for demonstration purposes in the department of anatomy.

Apparently his request was fulfilled, and somewhere on the campus of the Hebrew University of Jerusalem is his skeleton.

Denver’s National Jewish Hospital

Spivak was not the only Jew who helped Denver’s many “consumptives.” He had traveled to Denver because of its high altitude, and in there in the 1880s a woman by the name of Frances Wisebart Jacobs raised funds to open a new hospital to treat the many “consumptives” who had traveled to the mile high city. She found support from the Jewish community, which agreed to plan, fund and build a nonsectarian hospital for the treatment of respiratory diseases, primarily tuberculosis. That hospital opened in 1899 as The National Jewish Hospital for Consumptives, and after several name changes it is now known as National Jewish Health. Today, it remains a major center for the care of patients with lung and respiratory illnesses.

““…[Pain] knows no creed, so is this building the prototype of the grand idea of Judaism, which casts aside no stranger no matter of what race or blood. We consecrate this structure to humanity, to our suffering fellowman, regardless of creed.” ”

— Rabbi William Friedman at the laying of the cornerstone of the new hospital. From Tom Sherlock. Colorado's Healthcare Heritage: A Chronology of the Nineteenth and Twentieth Century Healthcare, volume 1, p374.

While the Talmud declared four kinds of new year, Spivak declared a fifth. His new year for health was to be commemorated together with Tu B’Shavt, the new year for trees. In this way, he tied it to the Jewish calendar, and his memory is a reminder of the importance of getting a routine physical exam from your doctor. It might save your life.

Gittin 67b~ Might Talmudic Medicines Really Work?

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).

I am not aware of any published descriptions of attempts to test these talmudic remedies. But a 2015 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.

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 nion 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.

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...

2023 UPDATE:

This post was originally published in 2015. Here is what has happened since.

In 2020, Harrison and her colleagues tested the ability of Bald’s eyesalve against a particularly nasty bacterial infection of the eye. (The salve “was “prepared using a standard method as previously reported with garlic, onions, bovine bile and white wine”.) They found it was active against Neisseria Gonorhoeae, a sexually transmitted disease that can cause conjunctivitis in infants and adults alike:

Here, we show that Bald’s eyesalve is also effective against a multidrug-resistant N. gonorrhoeae strain. N. gonorrhoeae is a common cause of ophthalmia neonatorum or neonatal conjunctivitis acquired during delivery from an infected mother. If left untreated, it can lead to corneal perforation and blindness, with neonatal conjunctivitis being a major cause of childhood corneal blindness in developing countries. With the increasing occurrence of multidrug-resistant strains of bacteria, an alternative treatment for N. gonorrhoeae is very valuable and these experiments show that Bald’s eyesalve has the potential to be developed into a viable alternative.

In 2022 the salve was the topic of a PhD dissertation (supervised by Dr. Harrison), and was the subject of an early safety study in 109 healthy volunteers. “The reconstructed medieval ancientbiotic” wrote the authors, coining a clever new word while doing so “was well tolerated and had a good safety profile when applied to healthy human skin over a 48-h exposure period. There were no serious adverse events amongst our sample of healthy volunteers. Our findings suggest that further molecular investigation and testing of Bald’s eyesalve is worthwhile….We believe this is the first time that a medieval “ancientbiotic” comprising multiple ingredients has been assessed in a Phase I trial with healthy volunteers.” Harrison and Connelly have also published a 22-page review of the topic, which you can find here, in a terrifically titled compendium Making the Medieval Relevant.

Nedarim 41~ The Strange Story of Theriac

Theriac pot, 1782, from here.

In today’s page of Talmud, there is a discussion of the benefits of a fever, which we reviewed in our previous post. It is during this that Rava chimes in:

נדרים מא, ב

אָמַר רָבָא: הַאי אִישָּׁתָא, אִי לָאו דְּפַרְווֹנְקָא דְּמַלְאֲכָא דְמוֹתָא, מְעַלֵּי כְּחִיזְרָא לְדִיקְלֵי, חַד לִתְלָתִין יוֹמִין, וְכִי תִּירְיָיקִי לְגוּפָאי

Rava said: With regard to fever [ishta]…it is advantageous if its incidence is once in thirty days, and it is like an antidote [tiraiki] for poison in the body…

What might this “antidote” be? In his famous dictionary, Marcus Jastrow, explains תִּירְיָיקִי in this way:

So today, we will delve into the strange history of this antidote tiraiki, better known as theriac.

Theriac is mentioned by the Rambam, (הל׳ חמץ ומצה 4:10) and in the Shulchan Aruch, the Code of Jewish Law. There we learn that should any chametz (unleavened bread) fall into your theriac on Passover, the mixture may be kept and used, despite the usual prohibition of mixtures of this sort. Good to know.

שולחן ערוך אורך חיים, 441

והתריאק"ה שנתן לתוכן חמץ מותר לקיימן בפסח שהרי נפסד צורת החמץ

In his commentary on our passage of Talmud, Rabbi Asher ben Jehiel (1250–1328), known as the Rosh, noted that theriac is made from all manner of spices. He would surely know this, because during the time in which he lived, theriac flourished. But theriac predated the Rosh by more than one thousand years…

The second century Greek physician Galen is thought to have authored an entire work De Theriaca ad Pisonem on the healing properties of theriac, and its use as an antidote to poison.

Where did theriac come from?

The word theriac comes from the Greek term θηριακή (thēriakē), meaning "pertaining to animals,” from another word θηρίον (thērion), meaning a wild animal. It is from this word that word “treacle” is derived. Theriac may have originated in the second century BCE., where legend has it that it was developed as an antidote against poisoning by Mithridates VI, King of Pontus. Actually, the king seems to have had an unusual interest in this antidote; he is thought to have tested it on prisoners condemned to death, and hence theriac was once known as mithridatium. The original recipe (and there are many) contained as many as forty ingredients, and over the centuries theriac was variously concocted using all manner of things, although the most frequently listed were viper flesh, opium, wine, honey and cinnamon. Theriac was used for perhaps some two millenia (!) until it declined in popularity in the 18th century. Here, for example, is the Latin theriac recipe of Paul Guldenius, printed in Thorn in 1630. (It is one of only two surviving copies, held by the Gdansk Library of the Polish Academy of Sciences.)

The printed Paul Guldenius Theriac recipe (Gdansk Library of the Polish Academy of Sciences). From Raj. et al. The real Theriac – panacea, poisonous drug or quackery? Journal of Ethnopharmacology 2021: 11

And here is the translated list of the Guldenius recipe:

Also from Raj. et al.

Jews, Theriac and the Black Death

During the terrible outbreak of bubonic plague in the middle of the fourteenth century, and the many that followed, theriac was recommended for its preventive and curative properties. For example, it was discussed by the Italian Jew Abraham ben Hananiah Yagel (1553– c.1624). He was by any definition a polymath. His works include not one but two lengthy encyclopedias, a manual of belief “audaciously adapted from a Catholic manual” and a work in praise of women. But Yagel was first and foremost a physician, and it was in this role that in 1587 he published his first work, a short tract on plagues called Moshia Hosim [The Savior of Those Who Seek Refuge]. “Do not fear the warmth brought on by theriac,” he wrote, “for in small diluted doses it cannot harm anyone.” Those who were sick should dress in clean, comfortable clothes “for they stimulate the sense of touch” and should be surrounded with sheets soaked in a mixture of vinegar and theriac, as well as fresh flowers and sweet-smelling roses “for they uplift the sprits of the sick.”

What should you take if theriac was not available? Good question. Yagel recommended urine:

…those who are learned about nature have taught that it is useful and good to take the urine of a young, handsome, and healthy boy, and to drink it each morning. It will filter out the bad air [that causes the plague].

Hold off your criticism. Yagel here was indeed reflecting the best of contemporary medical thinking. The German medical historian Karl Sudhoff (1853– 1938), who made a career studying almost 300 plague texts from the early Middle Ages, noted that in one Latin treatise on health written in 1405, “older patients who were sometimes counseled to drink a boy’s fresh urine might (understandably enough) feel some nausea.” And the Italian physician named Dionysus Secundus Colle who recovered from the plague around 1348 had this to say: 

I have seen women gathering snails and capturing lizards and newts, which they asserted that, once they had all been burnt down to a powder . . . they administered two drachmas of it in a boy’s urine, and they cured and persevered many, and afterward I was compelled to investigate [this cure myself] and afterwards I cured many.

Theriac was also thought to prevent infection. Jacob Zahalon (1630– 1693), the author of Otzar Hahayyim [A Treasury of Life] described his work as both a physician and a rabbi during an outbreak of bubonic plague in Rome in 1656. The plague arrived from Spain and swept over southern Italy, killing over one million people; in the Jewish Ghetto in Rome, according to Zahalon, it lasted some nine months.

When the physician visited the sick, he would hold in his hand a large tar torch, burning it night and day to purify the air for his protection, and in his mouth he had theriac . . .

“Poison antidotes figured prominently as wonder drugs, owing to their powers to cure poison alongside a wider variety of ailments. The ubiquitous theriac and its forerunner mithridatium were prime examples.”

— Alisha Rankin, The Poison Trials: Wonder Drugs, Experiment and the Battle for Authenticity in Renaissance Science. The University of Chicago Press 2021. p150.

In a recent paper on the healing properties of theriac from a group of Polish researchers, the authors explain the theory behind the use of theriac:

The humoral doctrine, based on the views attributed as far back as to Hippocrates (5th/4th c. BC), assumed the existence in body of four basic substances called the humors. Disturbance of their balance or having them spoiled would cause disease. 

The[se] humoral physicians supposed that both for epidemic and intoxication the real cause was a “venom”, entering into body and corrupting its liquids. Hence, drugs believed to neutralize poisons, such as Theriac, were used when a “venom” was diagnosed. Therefore early modern medics recommended the treacle to be used in case of epidemics (when the toxin was considered e.g. airborne) as well as after poisoning, a snake or a rabid dog bite etc.

Contemporaries actually believed that Theriac is a potent anti-epidemic drug. After all, it was used not only during the outbreaks of bubonic plague, the early modern epidemic disease par excellence. For instance, in 1551, during the sudor anglicus outbreak, numerous English physicians regarded the treacle as a staple in prophylaxis, cure and treatment of that mysterious and contagious disease. In the 17th c., London physicians assumed that Theriac might resist measles outbreaks among children and young adolescents. Whereas in German-speaking territories in the 18th c. the treacle was used as a medicine against numerous types of “typhoid fevers” and typhus, smallpox, and other contagious diseases, including the cattle plague. In Muslim world, in turn, it was widely recommended during the outbreaks of cholera.

“כי הטריאקה איננה סם אחד, אבל היא מרקחת רבת ההרכבה, יכנס בה שאור ודבש ובשר שקצים ורמשים, כי יכנסו בה אבק העקרבים ובשר האפעה, כי לכך נקראת כן, כי הארס בלשון יון תריאק. וכן בלשון תלמוד טרקיה חויא (שבת קט:), וכן הוזכרה המרקחת בלשונם כי טוריאקה לכוליה גופא (נדרים מא:), וחלילה שיכנס בקטורת בשר שקצים ורמשים ושאור

Theriac [called “triga” by Rashi] is not one ingredient but is a compound of many ingredients, containing leaven and honey, the flesh of forbidden animals and reptiles, for the powder of dried scorpions and the flesh of the viper go into it, this being the reason why it is so called [theriac], for “poison” in Greek is called theriac.

So also in the language of the Talmud:“Torkai (stung by) a serpent.” Similarly this compound is mentioned in the language [of the Rabbis]: “as theriac is good for the whole body.”’”

— Ramban, Commentary to Ex. 30:34

Fake Snake oil and Genuine Snake Oil

Over the centuries, theriac was concocted with all manner of different exotic ingredients. But how could the consumer be sure they were getting the real-deal theriac, and not some useless knock-off? Through a poison trial, obviously.

In her fascinating recent book The Poison Trials: Wonder Drugs, Experiment and the Battle for Authenticity in Renaissance Science, Alisha Rankin, a professor of history at Tufts University in Boston describes how theriac and other wonder drugs were tested. Often, a pair of criminals condemned to death would be used. They were given a poison like aconite (which comes from a genus of flowering plants which includes monkshood) and then one of them received the theriac. One such Poison Trial took place in 1524 and was overseen by the physician to Pope Clement VII. Here is Rankin:

Led by the pope’s personal physician Paolo Giovio, the doctors gave both prisoners a good quantity of a deadly aconite called napellus, enough to kill “not merely two men, but one hundred.” As the poison took effect, the prisoners started to gesticulate wildly and cry out from the pain in their hearts. Immediately, Caravitia [a surgeon who had created the antidote and offered it to the pope] anointed one of them with some of the oil, and the man’s heart and pulse quickly returned to normal. The other prisoner, who was given no antidote, died in great agony…

Less than two weeks later, a four-page pamphlet appeared in print, described as a “Testimony of the most true and admirable virtues of a composite oil against plague and all poison, with which an experiment was conducted by distinguished men, at the command of the Supreme Pontiff Pope Clement VII, in the Roman Capitoline edifice.”

Still, these trials did not convince everyone. Galen had written that “there is much trickery practiced about the drug by tricksters.” During the Renaissance period, there was concern that the theriac was inferior or outright fraudulent. The same concerns were raised about another cure-all: unicorn horn, and apothecaries had to go to great lengths to prove to the satisfaction of their customers that the horn came from a genuine unicorn.

But did it work?

It probably goes without saying, but I will say it anyway. There is nothing that we today would count as scientific evidence to suggest that theriac, in any of its recipes, actually worked. The same group of Polish researchers we cited above carefully reconstructed theriac from that the recipe of Paul Guldenius (and you can read their fascinating paper here). They concluded that “only two species included in Theriac can be harmful in humans: poppy and sea squill, but in both cases the calculated quantity of morphine and cardiac glycosides, respectively, were below toxic level.” Well at least that. And here are some more of their observations:

Summing up the results, due to the extreme complexity of the Theriac recipe after theoretical analysis it is easier to say what pharmacological effect the medicine did not have than what it actually had. Historical and phytochemical investigations have consistently shown that – at least in the Early Modern period – the assumptions regarding narcotic or toxic effects of Theriac are not supported by the results. On the other hand, taking into account the compounds one can expect positive results in antioxidant tests or antimicrobial and anti-inflammatory activity. Still, at the moment there is no indication that the famous panacea’s efficacy in the main indications was based on anything more than just a placebo effect.

This too, seems to have been understood by at least one talmudic rabbi. In reply to Rava’s statement that having a fever once every month was “as good as theriac,” his contemporary Rav Nahman bar Yitzchak had this brief retort:

לָא הִיא וְלָא תִּירְיָיקָה

- Give me neither a fever nor theriac!

Rosh Hashanah 2 ~ A New Year for Health

The new tractate of Talmud that we begin to study today opens with these famous words:

ראש השנה ב ,א

ארבעה ראשי שנים הם באחד בניסן ר"ה למלכים ולרגלים באחד באלול ראש השנה למעשר בהמה ר' אלעזר ור"ש אומרים באחד בתשרי באחד בתשרי ראש השנה לשנים ולשמיטין וליובלות לנטיעה ולירקות באחד בשבט ראש השנה לאילן כדברי בית שמאי בית הלל אומרים בחמשה עשר בו

There are four days in the year that serve as the New Year, each for a different purpose: On the first of Nisan is the New Year for kings; it is from this date that the years of a king’s rule are counted. And the first of Nisan is also the New Year for the order of the Festivals, as it determines which is considered the first Festival of the year and which the last.

On the first of Elul is the New Year for animal tithes; all the animals born prior to that date belong to the previous tithe year and are tithed as a single unit, whereas those born after that date belong to the next tithe year. Rabbi Elazar and Rabbi Shimon say: The New Year for animal tithes is on the first of Tishrei.

On the first of Tishrei is the New Year for counting years, as will be explained in the Gemara; for calculating Sabbatical Years and Jubilee Years, i.e., from the first of Tishrei there is a biblical prohibition to work the land during these years; for planting, for determining the years of orla, the three-year period from when a tree has been planted during which time its fruit is forbidden; and for tithing vegetables, as vegetables picked prior to that date cannot be tithed together with vegetables picked after that date.

On the first of Shevat is the New Year for the tree; the fruit of a tree that was formed prior to that date belong to the previous tithe year and cannot be tithed together with fruit that was formed after that date; this ruling is in accordance with the statement of Beit Shammai. But Beit Hillel say: The New Year for trees is on the fifteenth of Shevat.

 Declaring different kinds of New Years goes back to the Talmud. But this practice was updated in a remarkable way by a Russian Jewish immigrant to the US in the early twentieth century. Today, Talmudology is proud to tell his remarkable - and overlooked - story.

“Twice a year on the fifteenth day of Shevat and on the eighteenth day of Iyar all the Jewish children from 3 to 13 years of age should undergo a thorough physical examination by the local Jewish physicians free of charge. ”

— Charles Spivak

Charles Spivak and the fight against tuberculosis

Hayyim Haykhl Spivakovski (1861-1927) immigrated to the US from Russia, where he became Charles Spivak. He graduated from Jefferson Medical College in Philadelphia in 1890 (and his thesis, on talmudic theories of menstruation won a prize), and after his wife contracted tuberculosis in 1896 he moved with her to Denver. There she could take advantage of the high altitude which had been shown to help fight the disease. This began his life-long mission to fight the tuberculosis and improve the care of the many Jewish refugees from eastern Europe who contracted it. 

From here.

Spivak founded the Jewish Consumptives’ Relief Society (JCRS), which provided kosher food and a Sabbath atmosphere, but was open to anyone. “We have in our institution chasidim and agnostics,” he wrote in 1914, “Jews and Christians, republicans and progressives, socialists and anarchists, men of all kinds of religious, political and economic options.” Spivak’s personal philosophy was informed by “a unique blend of Yiddishkeit [Jewish values], secularism and socialism” and his approach to the distribution of funds was sometimes at odds with bureaucratic and impersonal ways that some Jewish charities functioned. “We may not be able to return him [the patient] to his family as a useful working unit,” he reminded his benefactors, “we may actually waste money without any hope for any return, nevertheless, we feel that he or she must receive our care and attention, that whole-souled and whole-hearted charity is, after all, the only true, pure and unalloyed charity.” He estimated that of among the 3.3 million Jews then living in the US about 4,600 died each year from the disease, and ten times that number were chronically infected, or as he put it, were “living tuberculous Jews.” It was therefore the duty of the Jewish community to support the fight for to prevent the spread of tuberculosis and search for a cure. 

Dr. Chales Spivak. From here.

As we learn in today’s page of Talmud, we learn that are several different dates that mark the beginning of different new years. The first day of the Spring month of Nissan is the new year for kings, which is used to date legal documents. The new year for trees is marked in the late winter month Shevat, which is used to count tithes, and first day of the late summer month of Tishrei is used to count the number of years since creation. In December 1918, Spivak updated this list and gave it a thoroughly modern twist. Writing in the Journal Jewish Charities, he suggested that the rhythm of the Jewish calendar could be used to improve public health and reduce the toll from tuberculosis.

Twice a year on the fifteenth day of Shvat (New Years for Trees) and on the eighteenth day of Iyar (Lag B'Omar) all the Jewish children from 3 to 13 years of age should undergo a thorough physical examination by the local Jewish physicians free of charge.  

In the evening of the respective days all organized societies in the community should hold Health meetings at which the subject of how to maintain good health and prevent disease should be discussed by health officers and physicians.

 A custom should also be inaugurated that all adults should visit their family physicians during the months of Tishre and Nisson [sic] for the purpose of undergoing a physical examination.

 Spivak’s suggestion was of course dependent on a working knowledge of the Jewish calendar, but the dates he suggested would help. The fifteenth of Shevat was often celebrated in schools, and Lag B’Omer, the thirty-third day of the period leading up to the festival of Shavuot was celebrated as a minor holiday; it marked the end of the pandemic deaths of the students of the talmudic giant Rabbi Akiva. Most Jewish adults, even those who had jettisoned traditional Jewish practice when they arrived in America, would be aware of the timing of the other two months.  The festival of Pesach (Passover) is celebrated in Nissan, and Rosh Hashanah, the start of the Jewish New Year that leads into Yom Kippur (the Day of Atonement) is commemorated in Tishrei.

Helping others, even after his death

Spivak, a member of the Denver Hebrew Speaking Society, developed liver cancer and died in 1927 at the age of 68. His generous spirit is evident in his last will and testament, where he asked that

…my body be embalmed and shipped to the nearest medical college for an equal number of non-Jewish and Jewish students to carefully dissect. After my body has been dissected, the bones should be articulated by an expert and the skeleton shipped to the University of Jerusalem, with the request that the same be used for demonstration purposes in the department of anatomy.

Apparently his request was fulfilled, and somewhere on the campus of the Hebrew University of Jerusalem is his skeleton.

Denver’s National Jewish Hospital

Spivak was not the only Jew who helped Denver’s many “consumptives.” He had traveled to Denver because of its high altitude, and in there in the 1880s a woman by the name of Frances Wisebart Jacobs raised funds to open a new hospital to treat the many “consumptives” who had traveled to the mile high city. She found support from the Jewish community, which agreed to plan, fund and build a nonsectarian hospital for the treatment of respiratory diseases, primarily tuberculosis. That hospital opened in 1899 as The National Jewish Hospital for Consumptives, and after several name changes it is now known as National Jewish Health. Today, it remains a major center for the care of patients with lung and respiratory illnesses.

““…[Pain] knows no creed, so is this building the prototype of the grand idea of Judaism, which casts aside no stranger no matter of what race or blood. We consecrate this structure to humanity, to our suffering fellowman, regardless of creed.” ”

— Rabbi William Friedman at the laying of the cornerstone of the new hospital. From Tom Sherlock. Colorado's Healthcare Heritage: A Chronology of the Nineteenth and Twentieth Century Healthcare, volume 1, p374.

While the Talmud declared four kinds of new year, Spivak declared a fifth. His new year for health was tied to the Jewish calendar, and his memory is a reminder of the importance of getting a routine physical exam from your doctor. It might save your life.