Medicine

Chullin 105b ~ The Healing Effects of Alcohol

חולין קה, ב

לכרסם דחמרא שיכרא דשיכרא מיא דמיא לית ליה תקנתא והיינו דאמרי אינשי בתר עניא אזלא עניותא

The treatment for catarrh caused by the foam of wine is beer; the treatment for catarrh caused by the foam of beer is water; and for catarrh caused by the foam of water there is no remedy. And this is in accordance with the adage that people say: Poverty follows the poor. [Not only does a pauper have nothing to drink other than water, but there also is no treatment for the disease caused by his beverage.]

Beer and Health image.png

In today’s page of Talmud we read that the disease known as karsom (כרסם) was caused by the “foam” that floats above wine, beer or water. Karsom is translated by the Soncino, Koren and ArtScroll Talmuds as catarrh, that green phlegmy discharge from our noses and mouths when we come down with a heavy cold. In his dictionary, the great philologist of rabbinic literature Marcus Jastrow notes that there is another spelling of the word, barsom, (ברסם) “a dripping like balsam, whence catarrh of the head.” And Rashi describes it as “nasal mucus” (רירין הבאין מן החוטם). In any event, the cure for one type of this mucus was beer, which raises the question - can ingesting alcohol cure disease?

We are not going to examine the ongoing debate as to whether a regular glass of wine is good for you or not. At best the evidence is mixed, with any positive effects being highly dependent on not drinking “too much.” Alcohol may be cardioprotective, but only at a moderate dose and frequency of ingestion. On the other hand, even at a low dose, alcohol does some pretty terrible things to your immune system and ability to repair damaged tissue.

...even after a single acute or binge exposure, alcohol leads to tissue damage. In gastric mucosa and in bone, alcohol exposure alters basic signaling processes. In the repair of skin damage following injury or surgery, alcohol disrupts signaling in a broader context, in multiple tissue types. The derangement of the inflammatory response by alcohol leads to altered cytokine and chemokine production by multiple cell types and this, in turn, influences the responses of other cell types.
— Jung et al. Alcohol Exposure and Mechanisms of Tissue Injury and Repair. Alcohol Clin Exp Res. 2011 ; 35(3): 392–399.
Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk.
— O'Keefe et al. Alcohol and Cardiovascular Health: The Dose Makes the Poison...or the Remedy. Mayo Clin Proc.2014;89(3):382-393.

Alcohol has been used as a medicine for over 5,000 years and when thee alternative was drinking water contaminated with bacteria, alcohol provided a safer (and certainly more enjoyable) way to remain hydrated, since it is a natural antiseptic. Juniper essential oil for example, which is obtained from Juniper berries is both antimicrobial and antifungal. It is also an essential ingredient of gin. “Juniper is such an important aspect of gin” we learn on this useful website, “that quite literally, it is not only the primary botanical used in gin but by law, it needs to be the predominant flavour in anything seeking to be classified as gin.”

alcohol and the discovery of the cause of CHolera

In the 1850s, London (and much of Europe) suffered a series of cholera outbreaks, and no-one knew what caused them. But John Snow (1813-1858), anesthesiologist to Queen Victoria had a hunch. He drew a map of the deaths around the Broad Street pump, which, he suspected was somehow involved in transmitting whatever it was that was spreading the disease.

 
Snow map detail.png
 

There were a large cluster of deaths in the immediate vicinity of the Broad Street Pump; that made sense if the pump was supplying contaminated water. However, there were far fewer deaths than would be expected at the brewery, which lay at the corner of Broad Street and Hopkin Street. Snow dug deeper, and this is what he found:

 
John Snow.  On the Mode of Communication of Cholera . London, John Churchill 1855. p42.

John Snow. On the Mode of Communication of Cholera. London, John Churchill 1855. p42.

 

The men had been saved by their allotted drinks of beer, which came from a separate well and not from the one on Broad Street. This explanation did much to bolster Snow’s suspicions. On September 8, 1854 he famously removed the pump handle which prevented the pump from being used and, so the story goes, the cholera epidemic was averted.

Alcohol and Influenza

The Talmud had suggested wine would fight some infections. In the last century physicians had a similar idea. In 1913 in New York, a physician named John Hopkirk published a small book: Influenza. Its History, Nature, Cause and Treatment. To cure some of the many complications of influenza (including pneumonia and otitis media) Hopkirk wrote that “it will always be necessary…to administer port or champagne…there is no finer pick-me-up after an attack of influenza than good “fiz”.” During the Great Flu Epidemic of 1918 a few years later, physicians reverted to a similar strategy. Writing in the London Times on November 1, 1918, Britain’s chief medical officer had limited advice: wear small face masks, eat well, and drink a half bottle of light wine.

Purim in next week

When celebrating the festival of Purim, the Talmudic sage Rava recommends (Megillah 7b) that a person drink until they are so inebriated that they cannot distinguish between the phrases “cursed is Haman” (the enemy of the Jews), and “blessed be Mordechai” (one of the key figures in their salvation). Perhaps in doing so, we can remain sober enough to remember that from the time of the Talmud until today alcohol was thought to prevent and cure all manner of disease. But only in moderation.

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Chullin 22b ~ Yellow Pigeons, Folk Medicine and Hepatitis

Jaundiced man .jpeg

It was while working as a physician in Jerusalem in the 1990s that I first heard of a bizarre remedy to treat jaundice. A pigeon is placed on the belly of the yellow patient. After a few minutes, the jaundice is drawn out of the patient and enters the bird, which promptly dies. I never got to see the miracle in person, but people swore by it. I was reminded of this folk remedy by a passage in today’s page of Talmud, about which more below.

Pigeons for jaundice, Really?

At this point, a few of you are nodding and saying “sure, I’ve heard of that.” One or two of you might be saying “hey, I’ve seen that work/not work with my own eyes.” But most of you will be saying “what on earth is this all about?” So before we go on, let’s talk about the myth of using pigeons to cure jaundice.

We will never know how, where or when the myth began. It is mentioned in a book called Ta’ami Haminhagim טעמי המנהגים (Reasons for the Customs) by Abraham Isaac Sperling, first published in Poland in 1896. It is still in print today. At the back of the book is a small section called “Remedies” ( סגולות) where you will read this gem (based, apparently on this source):

אברהם יצחק שפרלינג  טעמי המנהגים , ירושלים הוצאת אשכול 1957

אברהם יצחק שפרלינג טעמי המנהגים, ירושלים הוצאת אשכול 1957

A remedy for yellowness:
Take a male pigeon for a man and a female pigeon for a woman. Place it on the umbilicus, and the pigeon will draw out all of the yellowness until there is none left, and the pigeon dies. This has been tested (בדוק).
— אברהם יצחק שפרלינג טעמי המנהגים, ירושלים הוצאת אשכול 1957

APPARENTLY It’s not just PIGEONS

The magus, or celestial intelligencer 1801..png

In 1801 Frances Barrett (“Professor of chemistry, natural and occult Philosophy, the Cabala, &c. &c.”) published The Magus, or Celestial Intelligencer; being a Complete System of Occult Philosophy. The illustrious professor had come across the pigeon-cures-jaundice myth in a slightly different form: it was the duck-cures-colic. “It is expedient for us to know” he helpfully informs us on page 37,“that there are some things which retain virtue only while they are living, others even after death. So in the colic, if a live duck is applied to the belly, it takes away pain, and the duck dies.”

Suffocation and a Ruptured Spleen

People still do this; you can find it discussed at sites like The Yeshiva World, (“A close relative of mine did this procedure for his father and it worked”) Ohr Somayach (“strong hearsay evidence”) and on the Hebrew site Ynet (אני מכיר רופא מכובד ומוכר …לאחר פרק זמן של חודשים הסכים לתת לביתו את הטיפול ביונים הוא עשה זאת ) And in case you want to see it in action, here is a video of the process. Watch through to the end and count how many pigeons were crushed to death by the charlatan performing the procedure. Warning: for anyone with a modicum of sensitivity, it’s hard to watch.

I know what you are thinking. The guy in the white coat simply crushed the pigeons to death. And you are correct. In fact a post mortem on the bodies of some of these poor birds revealed the cause of death as was a ruptured spleen.

A primer on Jaundice

Jaundice is a yellowing of the skin, though it is even more noticeable in the sclera. It is not a disease, but a symptom. Jaundice becomes apparent when when there is a buildup of bilirubin in the blood. Bilirubin is a breakdown product of heme, which is produced when red blood cells are broken down. It is then excreted via the liver.

There are several causes of jaundice, the most common of which is hepatitis (literally, an inflammation of the liver). Hepatitis itself has many different causes. Viral hepatitis is most often caused by hepatitis A - that’s the one you see when people in close contact don’t wash their hands enough. It is a self limiting disease lasting a few days or so. Hepatitis B, C and D are far more serious, and can lead to liver failure and chronic jaundice. Alcohol is another leading cause of hepatitis, and causes cirrhosis of the liver. But not all jaundice is caused by a liver problem. Newborn babies are very often jaundiced. This happens because they are busy breaking down their fetal hemoglobin, releasing heme in the process, which is then turned into bilirubin. Their livers are working just fine.

So now you understand why crushing a pigeon to death on a person with hepatitis A might appear to work. It is because hepatitis A is a self-limiting disease; it goes away after a few days, as does the jaundice. The pigeon had nothing to do with it. You could clap your hands three times and the hepatitis would also go away. The other causes of hepatitis are chronic, and sometimes fatal. In these cases, no amount of chicanery would be associated with a cure, because there wouldn’t be one (unless you have hepatitis C, in which case a new and very expensive drug will actually cure you, no pigeons needed).

Yellow Pigeons in today’s Daf

In today’s page of Talmud there is a discussion about sacrificing pigeons and doves. And the color yellow features prominently:

חולין כב, ב

ת"ר יכול יהו כל התורים וכל בני היונה כשרים תלמוד לומר מן התורים ולא כל התורים מן בני היונה ולא כל בני יונה פרט לתחילת הציהוב שבזה ושבזה שפסול מאימתי התורים כשרים משיזהיבו מאימתי בני יונה פסולין משיצהיבו

The Sages taught in a baraita: I might have thought all  old doves or all young pigeons would be fit for sacrifice; therefore, the verse states: “Of doves,” and not all doves; “of young pigeons,” and not all young pigeons.This serves to exclude birds at the beginning of the yellowing of their neck plumage, which is a marker of both doves and pigeons. They are unfit as doves because they are not sufficiently old and as pigeons because they are no longer young. The tanna elaborates: From when are the doves fit? It is from when the color of their feathers turns a glistening gold. From when are the pigeons unfit? It is from when their feathers turn yellow.

The Sages here describe how the color of both doves and pigeons changes from or to a yellow. (But I have not been able to find a description of this actually happening in any of the ornithology texts I consulted. )

Transference

So now we can understand why these birds were associated with jaundice - because they were once described as changing from being yellow or becoming yellow themselves. By the act of transference, the pigeons were able to draw out the jaundice. There are many examples of transference in Judaism, where an animal symbolically absorbs and removes sin. There was the Temple ritual in Jerusalem, in which the owner lay his hands on the head of the animal brought as a sacrifice to expiated for sin. There is the ritual of Tashlich on Rosh Hashanah, in which our sins are symbolically cast away as we throw bread into a stream. And there is the controversial ritual of Kaparrot, in which a chicken (or, more kindly, money) is swung over the head while reciting “this is my exchange, this is my substitute, this is my atonement. This rooster will go to its death, while I will enter and proceed to a good long life and to peace.” It doesn’t end well for the chicken, but at least it is slaughtered for food and given to the poor. If only those pigeons had it so lucky.

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