Bava Basra 12b ~ Prophecy and Mental Illness

בבא בתרא יב, ב 

א"ר יוחנן מיום שחרב בית המקדש ניטלה נבואה מן הנביאים וניתנה לשוטים ולתינוקות

Rabbi Yochanan said: "After the destruction of the Holy Temple the power of prophecy was taken from the prophets and given to the mentally ill and to children. 

A long time ago I saw a patient in the emergency department who was brought in by ambulance after a worried relative called about his odd behavior. The patient had long been hearing voices. In his apartment the medics had found a little clay model of Jerusalem which the voices had told him to besiege. He told the medics that the voices had told him to lay on his right side for exactly three hundred and ninety days, which he had done.  He survived by eating through a store of barley, beans and lentils which those same voices had told him to prepare. The voices also told him to bake bread over a fire that burned human excrement, but the patient had protested, and the voices agreed to let him burn animal dung instead.  

In The Madhouse — Plate 8. From A Rake's Progress, William Hogarth, 1734.

Actually I made that up. Although I've treated hundreds of acutely schizophrenic, delusional or manic patients as an ER doctor, I have never treated a person like the one I just described.  But there was a person who did follow the voice in his head that told him to do all these things -the clay models, the laying on one side for over a year, the animal dung to bake bread.  All of it. His name was Ezekiel, and he was a prophet in our Bible.

“You also, son of man, take a brick and lay it before you and inscribe a city on it, even Jerusalem. Then lay siege against it, and build a fort against it, and build a mound against it; set camps and place battering rams against it all around. Moreover take for yourself an iron plate and set it up for a wall of iron between you and the city. And set your face against it so that it is besieged, and lay siege against it. This shall be a sign to the house of Israel. As for you, lie down on your left side and lay the iniquity of the house of Israel upon it. According to the number of the days that you lie on it, you shall bear their iniquity. For I have laid upon you the years of their iniquity according to the number of the days, three hundred and ninety days. So you shall bear the iniquity of the house of Israel. When you have accomplished them, lie again on your right side, and you shall bear the iniquity of the house of Judah forty days. I have appointed you each day for a year. Therefore you shall set your face toward the siege of Jerusalem, and your arm shall be uncovered, and you shall prophesy against it. I will lay bands upon you, and you shall not turn yourself from one side to another until you have ended the days of your siege. Also take for yourself wheat, and barley, and beans, and lentils, and millet, and spelt, and put them in one vessel and make bread. According to the number of the days that you lie on your side, three hundred and ninety days, you shall eat it. ...You shall eat it as barley cake, having baked it in their sight with dung that comes out of man.... Then I said, “Ah, Lord God! My soul has not been defiled. For from my youth up even until now I have not eaten of that which dies of itself, or is torn in pieces, nor has abominable meat come into my mouth. Then He said to me, “I have given you cow dung instead of man’s dung over which you shall prepare your bread.””

— Ezekiel 4:1-15

In today's page of Talmud, Rabbi Yochanan declares not that prophecy is dead, but that the kind of things once said by the prophets of the Bible will henceforth be said by those with mental illness (שוטים) and children.  Rabbi Yochanan may have been the first to see the overlap of mental illness and the kinds of things once said by prophets of the Bible, but today psychiatrists and others involved in the care of the mentally ill have noted this overlap too.

Abraham and Moses on the Psychiatrist's Couch

In 2012, three psychiatrists from the Harvard  Medical School asked a simple question: How does a psychiatrist today help a patient to understand that their psychotic symptoms are not caused by supernatural visitations, "when our civilization recognizes similar phenomena in revered religious figures?" So the psychiatrists set off to examine the way in which revelation of the divine was described in the Bible, "with the intent of promoting scholarly dialogue about the rational limits of human experience." All this was to "educate persons living with mental illness, healthcare providers, and the general public that persons with psychotic symptoms may have had a considerable influence on the development of Western civilization."

They analyzed four religious figures, including two from our tradition, from a behavioral, neurologic, and neuropsychiatric perspective. They found that, based on the text of the Bible, Abraham had no affective, neurological or medical conditions, and since he showed no evidence of disorganization, they doubted that Abraham had classic schizophrenia too.  But they raised the possibility of his having paranoid schizophrenia. This is a subtype of schizophrenia "that tends to manifest little or no disorganization, has preserved functional affect, and is associated with better occupational and social functioning." The psychiatrists based this diagnosis on the voices Abraham kept hearing, and "a very Abraham-centered worldview of dispensing universal blessings and curses based on one’s interactions with Abraham." Moses had "auditory and visual hallucinations of a grandiose nature with delusional thought content." He also exhibited "hyperreligiosity, grandiosity, delusions, paranoia, referential thinking, and phobia (about people viewing his face)." They were not certain though, if Moses displayed symptoms of paranoid schizophrenia, or if instead, he may have had a bipolar disorder.  Jesus also displayed auditory and visual hallucinations, "delusions, referential thinking, paranoid-type thought content, and hyperreligiosity"(!) The Harvard psychiatrists also note that the lifetime risk of suicide in schizophrenia is 5-10%, and that Jesus "appears to have deliberately placed himself in circumstances wherein he anticipated his execution." Finally Paul is analyzed. He seems to have had a large number of  auditory and visual perceptual experiences "that resemble grandiose hallucinations with delusional thought content." They reject the suggestion that he suffered from temporal lobe epilepsy, and they note that Paul wrote a great deal. This kind of productive writing, they claim, "tends to be more strongly associated with mood disorders than psychosis or epilepsy. This is persuasive toward Paul having a mood disorder, rather than schizophrenia or epilepsy."

Murray, E. Cunningham M. Price B . The Role of Psychotic Disorders in Religious History Considered. Journal of Neuropsychiatry and Clinical Neurosciences 2012; 24:410–426

The point of all this analysis was not to test the the faith of those who believe in the prophetic abilities of Abraham, Moses, Jesus or Paul. Rather, it was to emphasize how those with what we today would describe as the florid symptoms of mental illness are revered as religious teachers. And one more thing.  They claimed not to have any disrespect for those with religious beliefs towards any of these four figures.

Discussion about a potential role for the supernatural is outside the scope of our article and is reserved for the communities of faithful, religious scholars, and theologians, with one exception. It is our opinion that a neuropsychiatric accounting of behavior need not be viewed as excluding a role for the supernatural. Herein, neuropsychiatric mechanisms have been proposed through which behaviors and actions might be understood. For those who believe in omnipotent and omniscient supernatural forces, this should pose no obstacle, but might rather serve as a mechanistic explanation of how events may have happened. No disrespect is intended toward anyone’s beliefs or these venerable figures.

Nocturnal Hallucinations in Israeli Ultra-Orthodox Jews

Since Rabbi Yochanan described prophecy as being given to those with mental illness, it might be worth looking at the content of some hallucinations in the Jewish mentally ill.  Is there anything in their hallucinations that we could perhaps interpret as prophecy? Let's turn to a helpful paper published in 2001, which described the nocturnal hallucinations in 122 ultra-orthodox Jewish Israeli men. The authors were two psychiatrists who noted that this symptom of nocturnal hallucinations only seemed to affect male members of the ultra-orthodox population.  The group who experienced these nocturnal hallucinations were younger than other patients with symptoms of mental illness, "and their visit was more often associated with a request for a psychiatric evaluation before receiving an exemption from compulsory army service." But let's put that rather disquieting fact aside, and move on. The majority of the hallucinations were frightening, and included figures of the sort that "may appear among the fears of ultra-orthodox men," including (and I'm not making this up) "policemen, soldiers [and] Sephardi men." 

From Greenberg D. Brome, D.  Nocturnal Hallucinations in Ultra-orthodox Jewish Israeli Men. Psychiatry 2001. 64 (1); 81-90.

Now you might be thinking that this group included a fair number of malingerers who were keen to avoid military service. The psychiatrists considered that possibility too, but noted that about 45% of the men came for more than one visit, and about 11% did not not request a recommendation letter for the army.  So they concluded that "the night hallucinations are a real clinical and culturally determined phenomenon, which in a minority of cases may have been misused and presented for purposes of gaining exemption from army service."  In any event, most ended up with a diagnosis of "subnormality and/or psychosis," with a generally good prognosis. But there is nothing that appears to be particularly prophetic in the thoughts of this group of mentally ill Jewish men.

“We suggest that some of civilization’s most significant religious figures may have had psychotic symptoms that contributed inspiration for their revelations. It is hoped that this analysis will engender scholarly dialogue about the rational limits of human experience and serve to educate the general public, persons living with mental illness, and healthcare providers about the possibility that persons with primary and mood disorder-associated psychotic-spectrum disorders have had a monumental influence on civilization.”

— Murray, E. Cunningham M. Price B . The Role of Psychotic Disorders in Religious History Considered.Journal of Neuropsychiatry and Clinical Neurosciences 2012; 24:410–426

On the origin of prophecy today

In his seventeenth century commentary on the Talmud, R. Samuel Eliezer ben R. Judah HaLevi Edels, better known as the Maharsha, suggests that there are different kinds of prophecy.

"Not all prophecy is the same. For the prophecy of the prophets was endowed by God, Blessed be He, or one of His angels, whereas the prophecy of the mentally ill and children is endowed by a demon..."

Which may only serve to scare the mentally ill even more. R. Yochanan's statement reminds us that the line between mental disease and religiously inspired hallucinations (or delusions) is very blurred, and that, whatever the source of their visions and hallucinations, the mentally ill deserve more than our pity or support. They deserve our respect.

מהרש"א חידושי אגדות מסכת בבא בתרא דף יב עמוד ב 

וענין שנטלה מן הנביאים ונתנה לשוטים אין הנבואות שוות דנבואת נביאים ע"י הש"י או ע"י מלאכיו אבל נבואת השוטים ותינוקות אינו אלא ע"י שד דהכי מחלק בפרק הרואה בין החלומות שיש מהן ע"י המלאך ויש מהן ע"י שד

“If you hear a car backfire and you believe that it may be a pistol shot, that is an illusion. If you hear a pistol shot when there has been no sound (either of a pistol or a car backfiring), that is a hallucination. If you hear a pistol shot and believe that it is God firing a pistol at you because you [as a physician] have ordered inappropriate lab tests, that is a delusion. If [a physician] decides he is ordering too many laboratory tests in the absence of an external sensory stimulus, that is called enlightenment.”

— Joseph Sapira. The Art and Science of Bedside Diagnosis. Williams & Wilkins 1990. p518.

Bava Basra 3b ~ How to Mellify a Corpse

Herod the Weird

Today's page of Talmud contains a bizarre account of the sexual proclivities of Herod the Great, the Jewish Roman King who died in 4 BCE. Herod took a fancy to one of the women in the House of the Hasmoneans, where he was a slave. He led a rebellion, killing all members of the Hasmonean house but the one woman of his desires. Then comes this:  

בבא בתרא ג, ב

 כי חזת ההיא ינוקתא דקא בעי למינסבה סליקא לאיגרא ורמא קלא אמרה כל מאן דאתי ואמר מבית חשמונאי קאתינא עבדא הוא דלא אישתיירא מינייהו אלא ההיא ינוקתא וההיא ינוקתא נפלה מאיגרא לארעא טמנה שבע שנין בדובשא איכא דאמרי בא עליה איכא דאמרי לא בא עליה

When she saw that he [Herod] wanted to marry her, she went up on to a roof and cried out "...I am throwing myself down from this roof." He preserved her body in honey for seven years. Some say that he practiced necrophilia with her, others that he did not...

While studying Bava Kamma we discussed the medicinal properties of honey. We noted that although the Talmud described honey as being harmful to your health, it is in fact very good for you. It has antibiotic and antiviral properties, helps with a cough, and has been claimed as a therapy for dozens of medical conditions.  In today's page of Talmud we can add another use for honey: to preserve body parts. Or even whole bodies.

Honey as a MEDICAL Preservative

Dr. Shankargouda Patil is a senior lecturer at the Ramaiah Dental College in Bangalore, India, and has published two papers on honey as a preservative. In one experiment Dr. Patil took "commercially available fresh goat meat" and placed each bit into containers containing either formalin, water, honey or jaggery syrup. (Jaggery syrup being a coarse brown Indian sugar made by evaporating the sap of palm trees.) After waiting all of twenty-four hours he then processed the tissues and stained them as you would any medical specimen.  He noted that although formalin is routinely used to preserve medical specimens, it is highly toxic. And as I recall from my days in the lab, highly smelly. So it makes sense to see if there are alternative preservatives.  Like honey. 

Photomicrograph of the tissues fixed in: A. Formalin, B. Honey, C. Sugar syrup, D. Molasses syrup, E. Distilled water (H & E, 40X). From Patil S, Premalatha B R, Rao R S, Ganavi B S. Revelation in the Field of Tissue Preservation – A Preliminary Study on Natural Formalin Substitutes. J Int Oral Health 2013; 5(1):31-38.

Patil notes that honey's high osmolarity, low pH and the presence of components such as hydrogen peroxide and phenol inhibine in it all contribute to its anti-oxidative and antibacterial effect. Here is how he thinks honey works as a fixative:

From Patil S, Premalatha B R, Rao R S, Ganavi B S. Revelation in the Field of Tissue Preservation – A Preliminary Study on Natural Formalin Substitutes. J Int Oral Health 2013; 5(1):31-38.

Ever keen to push the boundaries of honey as a medical preservative, Dr Patil published a second paper titled Natural sweeteners as fixatives in histopathology: A longitudinal study. This time he studied the fixative property of jaggery and honey over a six-month period and compared them with formalin as a control.

From Patil S, et al. Natural sweeteners as fixatives in histopathology: A longitudinal study. Journal of Natural Science, Biology and Medicine 2015, 6 (1); 67-70  

Macroscopic appearance of tissues after 6 months of fixation with: (a) Formalin, (b) jaggery, and (c) honey. From Patil S, et al. 2015. 

The conclusion from all this was that at the end of six months, honey was as good a fixative as formalin. In addition, the tissues preserved in honey had no significant odor, while the formalin preserved tissues were "pungent."  On the down side though, honey left the tissues a light-brown color, while formalin caused no color change.  But all this is small potatoes compared to Herod's efforts to preserve an entire human corpse. And it turns out that Herod wasn't the only one who carried out this rather peculiar exercise. 

“הדבש נראה שיש לו שתי סגולות האחת למהר למחות ולכלות הדברים הנחתכים הנופלים לתוכו. והשניה להעמיד ולקיים הדברים הנחתכים הנטמנים בתוכו”

— שו"ת הרשב"א חלק א סימן פ

IT JUST GOT WEIRDER

Human female fetus (a) 20 weeks gestational age before and, (b) after embalming for one month in honey. From Sharquie K.E. Najim R.A. Embalming with honey. Saudi Med J 2004; 25 (11). 1755-1756.

In a paper published in 2004 in the Saudi Medical Journal, researchers from the medical college of Baghdad took these experiments to a whole new level. They preserved mice, rabbits and then ... two human fetuses in honey, to evaluate the embalming qualities of honey.

After embalming the 2 human fetuses in honey for one month and leaving them to dry at room temperature, they were mummified and shrunken. The weight of the first fetus changed from 500gm to 115gm while the second fetus weight changed from 400g to 95g. Both fetuses were darker in color. Both fetuses were observed for a period of one year without any change in their shape despite being kept at room temperature.

In case you were wondering, the authors note that "the protocol for the research project was approved by the ethical committee at the College of Medicine, University of Baghdad, Iraq. For human fetuses embalming, the nature of the experiment was explained to the parents and their approval was taken, to use the fetus for the experiments." Well that makes me feel a whole lot better.

Preserving Human Corpses in Honey

In her entertaining book Stiff: The Curious Lives of Human Cadavers, Mary Roach wrote that "in twelfth-century Arabia, it was possible to procure an item known as a mellified man. The verb to mellify" she continues, "comes from the Latin for honey, mel. Mellified man was dead human remains steeped in honey." Vicki Leon picks up the story in her equally entertaining book How to Mellify a Corpse: And Other Human Stories of Ancient Science and Superstition.

It had long been common knowledge that the Babylonians embalmed with wax and honey. But the big news began when Alexander the Great died at age thirty-three. Always organized, Alex had left pre-need instructions to mellify his remains. The high sugar content of honey draws water from cells and gradually dehydrates tissues. Thus, if honey happens to surround a corpse, under the right conditions it produces a drying action while also preserving.  It seemed to work for Alex. His body survived a 1,000-mile road trip, a corpse-napping and decades-long display u a glass coffin in Memphis, Egypt - and he was still being called 'lifelike' when last seen centuries later by Roman Emperor Carcalla.

The story of Herod's sexual proclivities with a dead body recounted in today's page of Talmud are, I hope, wildly exaggerated.  But the ability of honey to preserve a dead body are, it turns out, quite likely to be true.  Just try to forget all this by next Rosh Hashanah. 

Bava Metzia 106b - Kimah, the Pleiades, and the Planting Season in Iraq

בבא מציעא קו, ב

ועד אימת אמר רב פפא עד דאתו אריסי מדברא וקיימא כימה ארישייהו 

Until when is it considered to be the planting season? Rav Pappa said until the season when sharecroppers come in from the field and Kimah is overhead. [Bava Metzia 106b]

In today's page of Talmud, Rav Pappa, who lived near the Iraqi town of Sura, used the presence of Kimah overhead as a marker of the planting season.  Which of course raises the question of what, precisely, he meant by the term Kimah.

A color-composite image of the Pleiades from the Digitized Sky Survey ...

...and now in Hebrew.

Just what, and where, is Kimah?

The term Kimah (כימה) appears three times in the Bible. Here they are, along with the JPS translation.

עמוס ה', ח

עֹשֵׂה כִימָה וּכְסִיל, וְהֹפֵךְ לַבֹּקֶר צַלְמָוֶת, וְיוֹם, לַיְלָה הֶחְשִׁיךְ

Him that maketh the Pleiades and Orion, And bringeth on the shadow of death in the morning, And darkeneth the day into night.

איוב ט', ט

עֹשֶׂה-עָשׁ, כְּסִיל וְכִימָה; וְחַדְרֵי תֵמָן

Who maketh the Bear, Orion, and the Pleiades, And the chambers of the south.
 

איוב ל"ח, ל"א-ל"ב

הַתְקַשֵּׁר, מַעֲדַנּוֹת כִּימָה; אוֹ-מֹשְׁכוֹת כְּסִיל תְּפַתֵּחַ 

Canst thou bind the chains of the Pleiades, Or loose the bands of Orion?
 

But none of these verses in their original help us understand where in the sky Kimah can be found. Back in 1982, Chaim Milikowski, now a professor of Talmud at Bar-Ilan University, published  a paper with the catchy title of Kima and the Flood in Seder 'Olam and B.T. Rosh Ha-Shana. Stellar Time-Reckoning and Uranography in Rabbinic Literature. Here's what he says about the word Kimah:

... there is no doubt that it refers to a star or configuration of stars. It is generally taken to be the Pleiades, but various scholars have also suggested Sirius, Scorpio and Draco. Unfortunately, in none of its occurrences can kima be identified on the basis of
its context, nor does it appear in any contemporaneous cognate language. The identification of kima as Pleiades is based upon two considerations,neither conclusive.The Septuagint to Job 38:31 translates kima as Pleiades, as does also Symmachus and the Vulgate. However, at Amos 5:8, while Symmachus and Theodotion have Pleiades, Aquila and the Vulgate have no material contemporaneous ...but it does occasionally appear in the Babylonian Talmud and in the midrashim. A number of these passages support the identification of kima as the Pleiades.

And here is what Prof. Melikowski says about the passage from today's daf yomi:

From the statement of R. Papa (fourth-century Babylonian Amora)in B.T. Baba Mesi'a' 106b it follows that the position of kima at nightfall around February or March is the middle of the sky: this is roughly true of all astral bodies from the Pleiades to Sirius.

Melikowski ultimately concludes that Kimah is indeed the Pleiades, (at least it was for the authors of Seder Olam Rabbah). Identifying Kimah with the Pleiades is fairly common. The JPS translation of the Bible did it.  The Artscroll Complete Tisha B'Av Service (page 63) does so, as does Rabbi Avraham Rosenfeld in his Tisha B'Av Compendium (page 38) and Feldman in his 1931 Rabbinic Mathematics and Astronomy  (page 77). Lazarus Goldschmidt (d. 1950) who translated the Talmud into German, uses the word Siebengestirn, or the Seven-Star, which is Pleaides. The Soncino English Talmud translates Kimah as...Kimah, which is not very helpful, but in a footnote point out that Jastrow does not identify Kimah with the Pleiades.  Marcus Jastrow (d.1903) was a lone voice who did not agree with the general consensus. In his famous dictionary he wrote that Kimah was probably Draco and not Pleiades - though he did not elaborate.  So let's follow the majority and move on.

The Pleiades

The Pleiades are a cluster of hundreds of stars all about 400 light years from earth. They are often called the Seven Sisters, after their six brightest stars (go figure).  With the naked eye on a clear night you can see about six of them; with a really good pair of eyes you might get to see eleven. In In 1769, Charles Messier included the Pleiades as number 45 in his first list of comet-like objects, published in 1771, which is why the group is also referred to a M45.  You may not have noticed them in the sky, but I'm fairly sure you've noticed them on the front of a Subaru.

Rashi places this group in the tail of the constellation of Aires, based on his understanding of the Talmud in Berachot 58b. Most modern astronomy books place them in the shoulder of the constellation Taurus, but as you can see from the diagram below, there's nothing to drive this decision one way or the other.

The Pleidas (M45) sits right in between Taurus and Aires...

“Samuel (third-centuryBabylonian Amora) gives an etymology of the name kima: like a hundred (keme’ah) stars. Though only six or seven stars are easily visible to the naked eye, the Pleiades consist of several hundred stars bunched closely together. Consequently, Samuel’s description is very applicable though it remains a question how he can have known this.”

— Chaim Milikowsky. "Kima" and the Flood in "Seder 'Olam" and B.T. Rosh Ha-Shana Stellar Time-Reckoning and Uranography in Rabbinic Literature. Proceedings of the American Academy for Jewish Research, Vol. 50 (1983), pp. 105-132

Rashi vs Tosafot on the Pleiades

Rav Pappa (c. 300-375 CE.) lived in Neharda which is very close to the modern Iraqi town of Sura.  So let's take a look at the sky around Sura on say, the 15th of Adar in the year 350 CE. According to Rashi, the workers would end at the end of the ninth hour of the day. On that day there would be about eleven hours of between sunrise and sunset. So around hour nine the sky in the southwest would look like this:

Of course you cannot see any stars in the sky, and the area where Kimah would be (shown in the crosshairs labelled M45) is also empty.  But if there was a total solar eclipse at that very moment, and the sun's light was extinguished, here's what you would see:

Without the light of the sun, Kimah is visible high in the sky, just like Rav Pappa said. Here is Rashi's explanantion:

עד זמן דכי אתא אריסא מדברא. ונכנס לבית בזמן שהן רגילין ליכנס דהיינו לאחר תשע שעות ביום קרוב לסוף העשירית קיימא כימה שהוא זנב טלה להדי רישייהו בראש כל אדם דהיינו באמצע הרקיע שנראה לכל אדם כאילו הוא על ראשו והן הן ימי אדר

Until the season when sharecroppers come in from the field, and go home. At the time they usually finish, namely after nine hours near to the end of the tenth hour. Then Kimah, which is located in the tail of Aires, is directly above the heads of the people, that is, it is in the zenith of the sky. It appears to all as if it is directly above, and this is during Adar...

There is of course one problem with Rashi's explanation. Barring a solar eclipse, no-one could ever see Kimah at the ninth hour of the day, because no stars are visible during the day. On the basis of this, Tosafot challenges the explanation of Rashi:

 ומה שפי' בקונטרס דביום ראשון של אדר בסוף שעה עשירית קיימא כימה באמצע הרקיע קשה דפועלים לא אתו מדברא עד צאת הכוכבים כדפי' בריש הפועלים (לעיל דף פג:) ותו דבסוף י' שעות הן עוד היום גדול ואין נראין הכוכבים ומשמע שבא ליתן סימן לאריסין להכיר שעה שיבאו מן השדה וזה דוחק לומר דה"ק כשיחשיך לילה אז רואין למפרע שבשעת הליכתן היתה כימה להדי רישייהו ונראה לפרש דאתו אריסי מדברא בתחילת הלילה וקיימא כימה להדי רישייהו היינו בתחילת שבט ואז כלה זמן הזרע והא דאמר בפ' כל הקרבנות (מנחות דף פה. ושם ד"ה וזורע) שהיו זורעים קודם הפסח ע' יום וזהו חמשה יומי בתוך שבט התם שקרקע חשובה היא שזורעין בה לצורך העומר נמשך שם ימי הזרע יותר א"נ דבתחילת שבט של חמה הוא דקיימא כימה להדי רישייהו ואין תחילת של שבט של חמה מתחיל ברוב שנים יותר מע' יום לפני הפסח

Rashi's explanation...is hard to accept. First, workers do not come in from the fields until nightfall...and furthermore, at the tenth hour it is clearly still daytime, and no stars can be seen. But the Talmud is giving a sign whereby the workers would know when to stop work. And it is far fetched to say that what is meant is that at nightfall it will become retroactively apparent that Kimah was at overhead when they stopped working...

Instead, Tosafot understands (1) workers finish at nightfall and (2) at this time Kimah must be overhead.  This turns out not to be in Adar, as posited by Rashi, but a month earlier, in Shevat, which coincides with December. If we go back to Sura in Shevat of 349, the Pleiades would indeed be seen after sunset, but rising in the east.

Pleiades (M45) rising one hour after sunset as seen from Sura, Iraq in 349 CE.

The upshot of all this is that according to Rashi the planting season in Iraq ends some time in March (Adar), whereas for Tosafot the season ends earlier, in early January (Shevat). Who is correct? If only we could find an Iraqi farmer willing to decide the matter for us.

Satellite Imagery from Iraq supports...Tosafot

I couldn't find a farmer, so I used a "Commodity Intelligence Report" from the US Department of Agriculture Foreign Agricultural Service (an agency that I fear may not be long for this world). In a report from last January, they wrote that "wheat, the major winter grain, and barley are planted at the beginning of October until the end of November" which is close to Tosafot's opinion that the planting ends in Tevet.  Here are some satellite images to prove the point:

Image courtesy of the USDA from here.

Satellite imagery from December 2014 indicated fields of winter grain starting to emerge near Arbil in northern Iraq

Finally, a report published by Reuters last January notes that the Iraqi planting season ended the previous month - that is, in December. And so, assuming that the planting seasons have not changed much since the time of Rav Pappa, the explanation that is most likely to be correct is that of Tosafot, written by French and German medieval talmudists who were unlikely to ever have travelled to Iraq, or spent time plantiing there.  

“Many a night I saw the Pleiads, rising through the mellow shade,
Glitter like a swarm of fire-flies tangled in a silver braid.”

— Locksley Hall by Alfred Tennyson, 1835

Bava Metzia 85b ~ Rebbi's Ailments

בבא מציעא פה, ב 

שמואל ירחינאה אסייה דרבי הוה חלש רבי בעיניה א"ל אימלי לך סמא א"ל לא יכילנא אשטר לך משטר [א"ל] לא יכילנא הוה מותיב ליה בגובתא דסמני תותי בי סדיה ואיתסי

Shmuel Harchina'ah was Rebbi's physician. One day Rebbi was suffering from an eye ailment. Shmuel said to him, "I will insert this medication into your eyes." Rebbi told him "I cannot endure that treatment." Shmuel said to him "I will gently put a salve on the surface of your eyes." Rebbi replied "I cannot endure that either." So Shmuel put a tube of medicine under Rebbi's pillow, and he was cured." [Bava Metzia 85b]

RABBI YEHUDAH HANASSI, EDITOR EXTRAORDINAIRE

Rebbi, (Teacher) was the moniker of  Rebbi Yehudah Hanassi, Judah the Prince (~135-217 CE). Rebbe edited the Mishnah, and so had a pivotal role in the formation of Jewish practice and indeed the evolution of Judaism itself.  According to the great scholar of the Talmud David Halivni, the Mishnah came into being 

...as a result of the exigencies of the post-Temple era...towards the second half the of century with the termination of the oppressive Roman regimens, the Mishnah continued to flourish through the activities of the enormously prestigious R. Judah Hanassi...only to collapse of its own weight soon after R. Judah Hanassi's death.  

As a result, relatively few additions entered the Mishnah; it basically remained much the same as it was when compiled by the editor-anthologist.  This is why the Mishnah is the only classical rabbinic book about whose editor we are relatively certain.  We have no idea who the editors were of any of the other classic rabbinic texts (including the Talmud) but the evidence clearly indicates that R. Judah Hanassi was the editor-anthologist of the Mishnah.  This evidence is based on two sources: the occasional cross reference by R. Yochanan to R. Judah as editor-anthologizer and, above all, the fact that no one who lived after R. Judah Hanassi is mentioned in the Mishnah. 

Even though Rebbi was on very good terms with the leader of the Roman occupiers of Israel, the Emperor Macrus Aurelius Antoninus, he was not a healthy man, and suffered from a great many ailments. You may recall some of them when we studied Ketuvot. There we read that he suffered with an intestinal disorder, and Rebbi’s maid noted that he needed to use the latrine very often. This was causing him great distress –although apparently the distress was not because he needed to move his bowels so often, but rather that as a result of his condition, he could not wear tefillin. 

THE MEDICAL HISTORY OF RABBI YEHUDAH HANASSI

Recent scholars have been tempted to diagnose the many illnesses from which Rebbi suffered. In her Hebrew paper The Illnesses of Rabbi Yehudah HaNassi in Light of Modern Medicine, the historian Esther Divorshki  from the University of Haifa noted that more is known about the ailments of Rebbi than about any other talmudic sage. Some think that Rebbi suffered from painful hemorrhoids, to such a degree that his cries could be heard when he used the latrine (and as described in today's page of Talmud). Rebbi was so distressed by this illness that he ascribed to it a religious meaning, and proclaimed: “The righteous die though intestinal diseases.” But as Divorshki correctly notes, hemorrhoids are not painful to the degree described in the Talmud (– unless complicated by anal fissures). She therefore suggests that Rebbi’s illness - the one from which he died - was an inflammatory bowel disease.

Rebbi suffered from a number of other diseases throughout his life. In Nedarim  we learn that he had episodes of temporary memory loss. He was also afflicted with צמירתא and צפרנא (that's in taday's daf, Bava Metziah 85a). Divorshki the historian notes that some have suggested that צמירתא is kidney stones, perhaps complicated with urinary tract infections. As for צפרנא, (or, in variant forms, צפדנא) Avraham Steinberg from Sha'arei Tzedek Hospital suggests that since this disease was characterized by bleeding from the gums, “it seems reasonable to identify this illness with scurvy.” Julius Preuss had a similar suggestion, one he offered with great certainty: “There can be no doubt that tzafdina refers to stomatitis, perhaps scorbutic stomatitis which also occurs sporadically.” And if these were not enough, today we leaned that Rebbi also had an eye ailment, which his personal physician Shmuel was able to cure, as well as inflammation of his joints, (Yerushalmi Shabbat 16:1) that suggests the illness we call gout. 

A UNIFYING DIAGNOSIS?

Can a wise clinician put all this together and come up with a single unifying diagnosis that can explain all of Rebbi’s terrible symptoms? In 1978, Ari Shoshan suggested in Korot, The Israel Journal of the History of Medicine and Science, that Rebbi suffered from a psychosomatic disease. However, Divorshki suggests that the rapidly advancing field of genetics can provide a more satisfying solution. She posits that Rebbi had a seronegative spondyloarthritis associated with a specific tissue type called HLA (Human Leukocyte Antigen) B-27. (Don't be afraid. Seronegative means that the condition is not associated with rheumatoid factor, and spondyloarthritis is a group of conditions that causes inflammation of the joints - and other tissues.)  This tissue disorder –a kind of autoimmune disease - is associated with gout (Rebbi had that) and inflammation of the mouth (check) and uveitis – a painful inflammatory eye condition (that's the passage in today's daf with which we opened.). Perhaps, Divorshki notes, צמירתא was not in fact kidney stones or a urinary infection, but an inflammation of the bladder wall or referred pain from an inflammation of the intestines, caused by the same nasty tissue disorder. For reasons that are still not known, this autoimmune disease can flare up and then, just as mysteriously, become dormant for months or years, which could explain how Rebbi appeared to have been cured.

Schematic ribbon diagram of the HLA-B27 molecule’s peptide-binding cleft with a bound peptide (light blue); the letters N and C indicate, respectively, the amino and carboxy termini of the bound peptide. HLA-B*27:06, one of the two subtypes that seem to have no association with ankylosing spondylitis, and the disease-associated subtype HLA-B*27:04 (from which Rebbi may have been suffering) differ from each other by two residues at positions 114 and 116. From Khan, MA.  Polymorphism of HLA-B27: 105 Subtypes Currently Known.  Current Rheumatology Reports. (2013) 15:362

We now have identified at least 105 subtypes of HLA-B27, and the list continues to grow.  Today, seronegative spondyloarthitis, of the sort that may have afflicted Rebbi, can often be managed with medications that suppress the immune response. But without these, damage to the host tissues slowly builds until the organ systems start to fail, offering no respite from the painful symptoms of this disease. Perhaps now we are in a position to better understand Rebbi’s dying words, which appear on Ketuvot 104a.

“May it be Your will that there will be peace when I rest in eternity.”

Rebbi wanted nothing more than respite from his pain, and his wish was granted: ‘A voice from heaven emerged and said: “He will come with peace, they will rest on their resting places.”

[Repost from here.]