Avodah Zarah 10b ~ Gangrene and Ulcers

This post is for the page of Talmud to be studied tomorrow, Shabbat.

Print it up now and enjoy.

עבודה זרה י, ב 

דההוא קיסרא דהוה סני ליהודאי אמר להו לחשיבי דמלכותא מי שעלה לו נימא ברגלו יקטענה ויחיה או יניחנה ויצטער אמרו לו יקטענה ויחיה

There was a certain Roman emperor who hated the Jews. He said to the important members of the kingdom: If one had a nima rise on his foot, should he cut it off and live, or leave it and suffer? They said to him: He should cut it off and live. 

Just what is a Nima?

Rashi understands that nima means dead flesh: בשר מת ומצערו  Dead flesh that pains him.  The Schottenstein Talmud follows Rashi and translates it as dead flesh. 

The Koren English translation has this note on the word nima: 

From the Greek νομή, nomē, meaning an expanding wound or gangrene. Another version of the text has nomi, matching the version of the word in other places.

Liddel and Scott's Greek-English Lexicon gives some more details. Among its many meanings νομή, means spreading, as in spreading baldness or spreading ulcers. Goldschmidt's German translation (the first translation of the entire Babylonian Talmud, published 1897-1935) translates nima as Geschwür, meaning ulcer. The Soncino English translation, which often follows Goldschmidt, also translates nima as an ulcer. 

 But while nima is translated either as gangrene or an ulcer, the two are most certainly not the same.  

Ulcers

Four stages of a pressure ulcer

Ulcers describe a breakdown in the skin (or mucous membranes that line your mouth and gut) in which there is inflammation and in which dead tissues slough off.  You may have had a mouth sore, which is a kind of ulcer. Other commonly seen ulcers are pressure sores (typically at the base of the spine and buttocks in bed-ridden patients) and ulcers that form on the feet of those with diabetes.  The mainstay of treatment is to eliminate any pressure on the ulcer, to keep it meticulously clean, and to remove any dead tissue, a process known as debridement. Surgery is sometimes needed (for example, in cases of ulcerative colitis, in which ulcers form in the colon and rectum,) but in most cases can be avoided.

Gangrene

Gangrene is the death of tissue, caused by a loss of the blood flow.  It is far less common than ulcers, and far more serious.  (You can see all kinds of pictures of gangrene here.) It is mostly seen on the feet, but I've seen gangrene of the hands and fingers as well. When mountain climbers (and the homeless) loose fingers and toes, it's from gangrene.  

There are two kinds of gangrene. In wet gangrene, bacteria invade tissue which have little or no blood supply. They feed on the tissue and produce a great deal of pus; hence the description "wet".  Left untreated, the patient will likely become septic and die.  Amputation is often the only treatment option. Dry gangrene has a slower onset, and the tissue looks mummified or cracked; hence the term "dry". It does not usually cause infection or death. After several days, it becomes obvious where the black dead tissue ends and the pink health tissue begins. At that time, the tissue can be amputated; commonly, it just falls off (like here, but don't look if you are eating).

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From the context of our passage, it is not possible to be certain which of the two conditions is described in the word nima.The Jew-hating Roman Emperor was advised to amputate a foot with a nima on it. Since we don't treat ulcers with amputation, this lends support to those in the nima is gangrene camp: Rashi, Koren and Schottenstein. But perhaps, back in Talmudic days, foot ulcers were amputated. This would support those in the nima is an ulcer camp: Golschmidt and the Soncino. Either way, the description of the Jewish people as a nima really hurts.  Just like the nima did.

Avodah Zarah 8 ~ 2,000 Pages Done!

Tomorrow is an important milestone in the daf yomi cycle, the daily study of the Talmud. We will study page eight of Avodah Zarah, which is the 2,000th page of the Talmud.  There are only 711 pages left until the completion of this Daf Yomi cycle. We commemorated 1,000 pages learned back in September of 2022. Now let's do the same for this new milestone.

Pagination in Manuscripts of the Talmud

“The first complete edition of the Babylonian Talmud, the edito princeps, was printed from 1519/20-23. The Bomberg Talmud became a standard for the editions that followed, almost all subsequent editions adhered to his layout and foliation.”

— Marvin Heller. Earliest Printings of the Talmud. In Mintz and Goldstein. Printing the Talmud 2002. p 73

It should be noted that counting  Avodah Zarah 8 as the 2,000th page of the Talmud is a fairly recent development. By which we mean it has only been around since the saintly Daniel Bomberg and his 1519 edition.  Here, for example, is a page showing tomorrow's daf, from the handwritten manuscript found in the Bibliotheque Nationale in Paris.  It was completed in 1337. (Avodah Zarah 8 begins with the second word on the second line.) The pagination and layout is entirely different to the standard format of the Talmud we are used to seeing.

Avodah Zarah 7b-8a. Circa 14-15 century. From Paris, Bibliotheque Nationale. Suppl. Heb 1337.

Visualizing 2,000 pages

1 Back on Sunday Jan 5, 2020, we opened the new cycle of Daf Yomi with Berachot 2.

10 pages looks like this:

100 looks like this

1,000 pages looks like this. We reached the 1,000th page of Talmud on September 30th, 2022.

And here are 2,000 pages, represented as dots:

Fun Facts about 2,000

The last big deal we made out of two-thousand was Y2K, the year our secular calendar tiptoed into the twenty-first century.  But 2,000 is an interesting number in itself. Like all numbers, it can be written as the sum of two primes: 2 × 2 × 2 × 2 × 5 × 5 × 5=2,000. It is a Harshad number, which is to say, it is an integer that is divisible by the sum of its digits.  

2,000 seconds is equal to 33 minutes, 20 seconds. To count from 1 to 2,000 would take you about thirty-three minutes. And a cube with a volume of 2000 cubic inches would be around 1 feet tall.

Alpayim (אלפיים, lit. "2,000") was also the name of a literary magazine published in Israel between 1989 and 2009. You can see a picture of one of its covers above.

2,000 in the תנ׳ך

The number 2,000 in the Hebrew Bible, the תנ’ך, appears in a number of places.

1. In the Book of Joshua, the people are warned to stay at least 2,000 cubits away from the Ark which they are following.

יהושע 3:4

אַ֣ךְ ׀ רָח֣וֹק יִהְיֶ֗ה בֵּֽינֵיכֶם֙ ובינו [וּבֵינָ֔יו] כְּאַלְפַּ֥יִם אַמָּ֖ה בַּמִּדָּ֑ה אַֽל־תִּקְרְב֣וּ אֵלָ֗יו לְמַ֤עַן אֲשֶׁר־תֵּֽדְעוּ֙ אֶת־הַדֶּ֙רֶךְ֙ אֲשֶׁ֣ר תֵּֽלְכוּ־בָ֔הּ כִּ֣י לֹ֧א עֲבַרְתֶּ֛ם בַּדֶּ֖רֶךְ מִתְּמ֥וֹל שִׁלְשֽׁוֹם׃ 

but keep a distance of some 2,000 cubits from it, never coming any closer to it—so that you may know by what route to march, since it is a road you have not traveled before.

2. In the sad story of the פלגש בגבעה, there is a civil war. Thousands die and a note is made of 2,000 killed, in addition to the other deaths. 

שופטים 20:45

וַיִּפְנ֞וּ וַיָּנֻ֤סוּ הַמִּדְבָּ֙רָה֙ אֶל־סֶ֣לַע הָֽרִמּ֔וֹן וַיְעֹֽלְלֻ֙הוּ֙ בַּֽמְסִלּ֔וֹת חֲמֵ֥שֶׁת אֲלָפִ֖ים אִ֑ישׁ וַיַּדְבִּ֤יקוּ אַחֲרָיו֙ עַד־גִּדְעֹ֔ם וַיַּכּ֥וּ מִמֶּ֖נּוּ אַלְפַּ֥יִם אִֽישׁ׃

They turned and fled to the wilderness, to the Rock of Rimmon; but [the Israelites] picked off another 5,000 on the roads and, continuing in hot pursuit of them up to Gidom, they slew 2,000 more.

3. King Solomon took thirteen years to complete the building of the first Temple. Among its contents was a large circular metal tub that sat on twelve statues of oxen.  It held the volume of 2,000 baths.

מלאכים א, 7:26

וְעָבְי֣וֹ טֶ֔פַח וּשְׂפָת֛וֹ כְּמַעֲשֵׂ֥ה שְׂפַת־כּ֖וֹס פֶּ֣רַח שׁוֹשָׁ֑ן אַלְפַּ֥יִם בַּ֖ת יָכִֽיל׃

It was a handbreadth thick, and its brim was made like that of a cup, like the petals of a lily. Its capacity was 2,000 baths.

4. In the war between the Israelite King Hezekiah and the Assyrian King Shalmaneser of Assyria, Hezekiah is taunted by the Assyrian leader:

מלאכים ב, 18:23

וְעַתָּה֙ הִתְעָ֣רֶב נָ֔א אֶת־אֲדֹנִ֖י אֶת־מֶ֣לֶךְ אַשּׁ֑וּר וְאֶתְּנָ֤ה לְךָ֙ אַלְפַּ֣יִם סוּסִ֔ים אִם־תּוּכַ֕ל לָ֥תֶת לְךָ֖ רֹכְבִ֥ים עֲלֵיהֶֽם׃

Come now, make this wager with my master, the king of Assyria: I’ll give you 2,000 horses if you can produce riders to mount them.

5. Among the donations made to rebuild the Temple during Nechemia's rein was a collective donation of 2,000 pieces of silver.

נחמיה 7:71

וַאֲשֶׁ֣ר נָתְנוּ֮ שְׁאֵרִ֣ית הָעָם֒ זָהָ֗ב דַּרְכְּמוֹנִים֙ שְׁתֵּ֣י רִבּ֔וֹא וְכֶ֖סֶף מָנִ֣ים אַלְפָּ֑יִם וְכָתְנֹ֥ת כֹּֽהֲנִ֖ים שִׁשִּׁ֥ים וְשִׁבְעָֽה׃ 

The rest of the people donated: gold—20,000 drachmas, silver—2,000, and 67 priestly robes.

6. In the Book of Chronicles, we are reminded of a battle in which tribes of Reuven, Gad and (half of) Menashe prevailed against the Hagarites. Here is what they plundered:

דברי הימים א, 5:21

וַיִּשְׁבּ֣וּ מִקְנֵיהֶ֗ם גְּֽמַלֵּיהֶ֞ם חֲמִשִּׁ֥ים אֶ֙לֶף֙ וְצֹ֗אן מָאתַ֤יִם וַחֲמִשִּׁים֙ אֶ֔לֶף וַחֲמוֹרִ֖ים אַלְפָּ֑יִם וְנֶ֥פֶשׁ אָדָ֖ם מֵ֥אָה אָֽלֶף׃

They carried off their livestock: 50,000 of their camels, 250,000 sheep, 2,000 asses, and 100,000 people.

All of this suggests that the number 2,000 might not need be read literally. It seems to mean instead "a really big number."

2,000 in the Talmud – and in Avoda Zarah

Perhaps the most famous use of the number 2,000 in the Talmud is the distance beyond which a person may not travel on Shabbat.

עירובין נא, א

׳הני אלפים אמה היכן כתיבן דתניא ׳שבו איש תחתיו׳ אלו ארבע אמות ׳אל יצא איש ממקומו אלו אלפים אמה

These two thousand cubits, where are they written in the Torah? It was taught in a baraita: “Every man shall remain in his place” (Exodus 16:29); these are the four cubits, [which constitute the minimum Shabbat limit for one who ventured beyond his prescribed limit]. “Let no man go out of his place”(Exodus 16:29); these are the 2,000 cubits of the Shabbat limit for one who remains in his place.

On today's 2,000th page, the number 2,000 makes a cameo appearance where it can be found in Rashi explaining the word תחום:

תחום. אלפים אמה סביבות העיר

The boundary: this is 2,000 cubits around the city

Unfortunately, a really interesting appearance of the number 2,000 comes the day after reaching our important milestone.  On Avodah Zarah 9a we learn that that the number 2,000 is part of a critical eschatological calculation:

עבודה זרה ט, א

תנא דבי אליהו ששת אלפים שנה הוי העולם שני אלפים תוהו שני אלפים תורה שני אלפים ימות המשיח

The school of Eliyahu taught: The world is destined to exist for six thousand years. For 2,000 years the world was waste, as the Torah had not yet been given. The next set of 2,000 years are the time period of the Torah. The last set of 2,000 years are the period designated for the days of the Messiah.

Too bad that discussion didn't come a page earlier. That would have made for a wonderful coincidence.  Ah well. Congratulations to all those who have travelled this far.  And welcome aboard to all those whose journey is just starting. 

Avodah Zara 7a ~ Shopping for a Psak

Carl Schleicher, A Question About the Talmud, oil on canvas, c. 1860–71.Private collection

עבודה זרה ז, א

תָּנוּ רַבָּנַן: הַנִּשְׁאָל לְחָכָם וְטִימֵּא — לֹא יִשָּׁאֵל לְחָכָם וִיטַהֵר, לְחָכָם וְאָסַר — לֹא יִשָּׁאֵל לְחָכָם וְיַתִּיר

The sages taught: In the case of one who asks a question of a sage with regard to an issue of ritual impurity and the sage rules that the item is impure, he may not ask the same question of another sage and have him rule that it is pure. Similarly, in the case of one who asks a sage a halachic question and he deems it forbidden, he may not ask the question of another sage and have him deem it permitted.

There is a parallel ruling elsewhere in the Talmud:

נדה כ,ב

חכם שטימא אין חברו רשאי לטהר אסר אין חבירו רשאי להתיר

In the case of a halachic authority who deemed an item impure, another halachic authority is not allowed to deem it pure; if one halachic authority deemed a matter prohibited, another halachic authority is not allowed to deem it permitted

These ruling of the Talmud seem straightforward and easy to understand: don’t shop around for a rabbi who will give you the answer that you are looking for. But Rabbi Moshe Isserlis, the Rema, understood this passage with a slight twist. The prohibition of asking for a “second halakhic opinion” is only when the first ruling is kept secret. But if the second sage is aware that another has already ruled in the case, there is no prohibition in asking for a second (or a third, or a fourth) opinion, and the Rema ruled that this was normative practice for Ashkenazi Jews:

שולחן ערוך יורה דעה 242:31

כל תלמיד חכם שדעותיו מכוונות אינו מדבר בפני מי שגדול ממנו בחכמה אע"פ שלא למד ממנו כלום: הגה ואין לאדם להורות עד ארבעים שנה אם יש גדול ממנו בעיר אף על פי שאינו רבו (ב"י בשם הר"ן וסמ"ק ורש"י פרק הנחנקין) . חכם שאסר אין חבירו רשאי להתיר משקול הדעת אבל אם יש לו קבלה שטעה או שטעה בדבר משנה יוכל להתיר ואפילו אם טעה בשקול הדעת יכול לישא וליתן עם המורה עד שיחזור בו ולכן אין איסור לשואל [לשאול] לשני ובלבד שיודיע אותו שכבר הורה הראשון לאסור (רבינו ירוחם נתיב ב' ותוס' ורא"ש) ואפי' אם התיר הראשון וכבר חלה הוראתו אין לשני לאסור מכח שקול הדעת (כן משמע באשיר"י פרק קמא דעבודת כוכבים) וכל זה באותה הוראה עצמה אבל במעשה אחר פשיטא שיכול להורות מה שנראה אליו (מהרי"ק שורש קע"ב וחדושי רשב"א וע"פ)

…There is no prohibition in asking for a second halahkic opinion so long as the second sage is aware that another has already issued a ruling that forbade.

The Reasons for the Prohibition

Regardless of the later ruling of the Rema, early Rishonim were divided as to the reason that shopping for a psak was not permitted.

The earliest Rishon to rule on the issue appears to be the Ra’avad, Rabbi Avraham ben David (1125-1198):

חכם שטימא אין חבירו רשאי לטהר אסר אין חבירו רשאי להתיר ,ואם התירו אינו מותר

Two centuries later, in his own explanation on the Talmud, Rabbenu Nissim (1320-1376) cited the Ra’avad, and added what he thought to be the reason: The first prohibitive ruling turns the object into one that is now forbidden.

ר"ן על עבודה זרה א׳ ב

הנשאל לחכם וטימא לא ישאל לחכם ויטהר וכו'. כתב הראב"ד ז"ל בפירוש מס' ע"ז שלו דלא משום כבודו של ראשון נגעו בה אלא משום דכיון דאסרה ראשון שויה חתיכה דאיסורא ושוב אין לה היתר דאפילו התירה שני אינה מותרת

Somehow, the first ruling leaves a lasting and indelible impression on the object, such that a later permissive ruling is of no effect.

But according to Rabbenu Nissim, there is no such spell cast upon the object by the first ruling. Instead, he suggests two reasons that psak shopping is forbidden. First, it would be an affront to the honor of the first sage to have his ruling ignored, and second, the existence of two conflicting rulings would leave the impression that there exited two sets of rules, or as he put it, two Torot:

מפני כבודו של ראשון ועוד כדי שלא תראה תורה כשתי תורות הללו אוסרים והללו מתירים

How to justify going shopping for a psak

As Rabbi Yosie Levine notes in his excellent recent biography of Hakham Tsevi Ashkenazi, there were any number of reasons that would permit submitting a query to multiple authorities, or appealing a psak once it had been rendered. Here are a few:

1) The prohibition is on the respondent, not one the questioner.

This is the position of Tosafot in Niddah:

תוספית נדה כ, ב, ד׳ה אגמריה

הנשאל לחכם וטימא לא ישאל לחכם ויטהר וי"ל דקפידא לא הויא אשואל אלא אחכם אבל השואל ישאל כל מה שירצה דמתוך כך ידקדקו בדבר ופעמים שהראשון טועה ויצא הדבר לאורה

…this only applies to the sage, and not the petitioner. The petitioner may ask whomever he wishes, because the more he asks, the better is his understanding…

2) The Prohibition only applies if the first sage ruled stringently

This, as we have seen, is the position of the Ra’avad: “חכם שטימא אין חבירו רשאי לטהר אסר אין חבירו רשאי להתיר ,ואם התירו אינו מותר”. But if the first sage ruled leniently (and of course, strictness and lenience is often in the eye of the beholder), all bets are off and the petitioner may ask again, and again.

3) It only applies if the second sage was unaware of a prior ruling

This is the position of Tosafot in Chullin (44b). A story is told that Rav was about to declare that a piece of meat was not kosher, but later, the same case came before Rabbah bar bar Channah who permitted it. According to Tosafot, this case of shopping for a psak was permitted because Rabbah bar bar Channah was not aware of Rav’s (impending) decision: “לא ידע שאסר חבירו”.

4) It Does not apply if the second sage had a traditional ruling about the issue.

As we have seen, this is the position of the Rema, who ruled it into normative Ashkenazi practice (שולחן ערוך יורה דעה 242:31 ):

חכם שאסר אין חבירו רשאי להתיר משקול הדעת אבל אם יש לו קבלה שטעה …יוכל להתיר

If one sage prohibited, another may not permit through his own reasoning. But if the second has a received teaching that the first was in error, he may indeed permit.

5) It Does not apply if the second sage is somehow “greater” thaN the first

Rabbi Shabtei ben Meir Hakohen (1621-1662) wrote an important commentary to the Shulchan Aruch called the Siftei Kohen (שפתי כהן). To this day, it is printed right along side the text in all the standard editions, and in it, he opined that if the second sage was greater, (and who, exactly, is the arbiter of that?) he may overrule a prior psak:

שפתי כהן שולחן ערוך יורה דעה 242:53

אבל כל שהוא אינו חבירו שהוא גדול ממנו רשאי להתיר מה שאסר הראשון עכ"ל וכן דעת הר"ן שם וכ"כ ר' ירוחם נתיב ב' ח"ה דכל זה מיירי בששניהם שוים דאם הא' גדול מחבירו בחכמה יכול להתיר מה שאסר חבירו אפי' במידי דתליא בסברא ע"כ

6) It does not apply after the medieval period

Perhaps the most radical of rabbinic reinterpretations of this passage in today’s page of Talmud is found in the Aruch Hashulchan of the great Lithuanian Rabbi Yechiel Michael Epstein (1825-1908):

ערוך השולחן יורה דעה 242:63

ודע שלא נמצא דין זה, דחכם שאסר אין חבירו יכול להתיר, לא ברמב"ם ולא בטור. והרי גמרא מפורשת היא בכמה מקומות. ולא ראיתי מי שהעיר בזה. והנראה לעניות דעתי: דסבירא להו לרבותינו אלה דעכשיו אחר שנתפשטו ספרי הש"ס והפוסקים – לא שייך כלל דין זה. שהרי כבר נתבאר דדין זה אינו אלא כשנחלקו בסברא בעלמא. ועכשיו אין לך דבר הוראה שאין לה ראיה מאיזה גמרא או איזה פוסק, ורחוק הוא בכלל להורות בסברא בעלמא

We should note that this ruling - that a sage may not permit that which another had forbidden - is not found in either the Rambam nor the Tur, and yet it is a clear ruling of the Talmud in several different places. I think this is because the Rambam and the Tur believed that in their days, after the text of the Talmud and the rulings of the sages became widely known, this ruling was no longer applicable. As we have seen the injunction only applied when there was a difference of opinion; but today every opinion is supported by a passage in the Talmud or a legal ruling, and it is extremely unusual for a psak to be based on an unsupported opinion…

“...the law was intended only to limit authorities who were rendering halakhic decisions on the basis of logic alone; once the Talmud and codes had been promulgated, there was no issue for which an authority would not have recourse to textual proof, thus rendering moot the original injunction”

— Yosie Levine. Hakham Tsevi Ashkenazi and the Battlegrounds of the Early Modern Rabbinate. London: Littman Library of Jewish Civilization. 59.

Shopping for a Get - in early modern Europe

In his biography of the Hakham Tsevi, Yosie Levine has a deep dive into the 1706 divorce of Asher Anshul Cohen, which took place in London, under the eye of Rabbi Aaron Uri Hart, rabbi of the Great Synagogue there. Cohen was “an inveterate gambler who intended to escape from his creditors by fleeing to the West Indies.” But before doing so, he gave his wife a conditional get, which was not unusual. It allowed her to remarry if he was to be lost at sea - a real possibility back then. But “in actuality, it was more likely a clever strategy to protect the assets of the husband by transferring them to the wife. So as to not attract attention to his surreptitious plan, Cohen arranged for the divorce to be conducted privately.”

For reasons that are not entirely clear, the case came to the attention of Rabbi Mordechai Hamburger, (whose mechutenet was of Gluckl of Hameln). He objected to many aspects: the fact that the get was conditional, that it had been written by a Sephardi scribe with no experience, and that it had been written in English rather than Aramaic. For good measure, he also objected to the witnesses.

The best defense is a good offense, so Rabbi Hart convened a Bet Din to review Hamburger’s objections. It met in Hamburger’s absence, found his objections to the get unwarranted, and placed him and his wife into herem.

Hamburger then appealed to Rabbi David Nieto of London, who told him to seek the psak of the Hakham Tsevi, then in Altona. He also involved Rabbi Judah Loeb Harif of Amsterdam and Rabbi Judah Loeb of Rotterdam. (Yes I know, two Rabbis named Judah Loeb. There will be a third. Stay with me). Hakham Tsevi and the two Rabbis Judah all opined that the herem against Hamburger had no validity.

Rabbi Hart of London was now furious, and to defend his original herem against Hamburger he published an entire pamphlet which refuted all of the arguments of Hakham Tsevi, although he conceded that he was outnumbered and outgunned and accepted the decision of Hamburger’s defenders.

Despite Rabbi Hart conceding, Hamburger did what all good wealthy Jews do when they don’t like their rabbi: he opened a breakaway shul in his own home. This aroused yet more uninvited rabbinic intervention: Rabbi Loeb Kalish (there, that’s the third rabbi with the name Loeb) issued a new ban against Hamburger, and reported that no fewer than six other rabbis agreed with his position (including, are you ready for this, a Rabbi Judah Loeb of Grodzisk - that’s the third Rabbi Judah Loeb in the story). Meanwhile Rabbi Nathan Halperin, who later became the Av Bet Din of the important communities of Altona-Hamburg-Wandsbeck, couldn’t resist and joined in, issuing a ruling in defense of Hamburger (who was….a relative of his; you can’t make this up).

One big happy virtual bet Hamidrash

Let’s give the last word to Rabbi Yosie Levine, on whose analysis we have been leaning. He gave a rather upbeat assessment of this whole shopping for a psak thing, and described it as one big happy evolving Bet Hamidrash:

As long as the words of the first sage have not been actualized in practice, the second sage or any authority thereafter-maintains license to contribute his halakhic opinion. This was the position of Hakham Tsevi. It is a small leap to conclude that dispatching letters to multiple respondents created a kind of virtual beit midrash in which halakhic possibilities were not foreclosed simply by the issuance of the first response. Though separated by geographical distance, the parties involved tacitly understood that they were in conversation with one another, particularly when a questioner had written or insinuated that he had consulted other rabbis. If a given authority knew that his was not the only address to which a query had been dispatched, he could orient his response accordingly. He implicitly conceived of his responsum not as a formal ruling, but as an opinion intended to advance the greater halakhic conversation. In the early modern period, a respondent could safely assume that his word would not be the final one.

And if that was true of the early modern period, it is certainly an even better description of contemporary Orthodoxy.

Avodah Zarah 3b ~ Heliotherapy

The first few pages of the new tractate we are learning, Avodah Zarah addresses the punishment that awaits those wicked nations that persecuted the Jewish people.  Then comes this parable:

עבודה זרה  ג,ב–ד,א 

דאמר רבי שמעון בן לקיש אין גיהנם לעתיד לבא אלא הקדוש ברוך הוא מוציא חמה מנרתיקה  ומקדיר. רשעים נידונין בה וצדיקים מתרפאין בה. רשעים נידונין בה... צדיקים מתרפאין בה  דכתיב וזרחה לכם יראי שמי שמש צדקה ומרפא בכנפיה אלא שמתעדנין בה שנאמר ויצאתם ופשתם כעגלי מרבק

As Rabbi Shimon ben Lakish says: There is no Gehenna in the World-to-Come. Rather, the Holy One, Blessed be He, will remove the sun from its sheath [minnarteikah], and heats [umakdir]that world with it. The wicked will be punished by it and consumed by the heat, but the righteous will be healed by it....moreover, not only will they be healed by it, but they will even be rejuvenated by it, as it is stated in the continuation of that verse (Malachi 3:20) “And you shall go forth and leap as calves of the stall.”

Other mentions of the sun as medicine

We met the same homily in the name of Resh Lakish when we studied Nedarim 8b. Elsewhere (Bava Basra 16b) we read a teaching of Abaye that also addresses the healing power of the sun:

בבא בתרא טז, ב

רבי שמעון בן יוחי אומר אבן טובה היתה תלויה בצוארו של אברהם אבינו שכל חולה הרואה אותו מיד מתרפא ובשעה שנפטר אברהם אבינו מן העולם תלאה הקדוש ברוך הוא בגלגל חמה אמר אביי היינו דאמרי אינשי אידלי יומא אידלי קצירא

Rabbi Shimon ben Yochai said: there was a precious stone that hung from the neck of Abraham our forefather. Any sick person who looked at it was instantly cured.  When Abraham our forefather died, the Holy One, Blessed be He, hung this stone in the orb of the sun. Abaye said, this is what is meant by the popular saying "when the sun is lifted, sickness is lifted"

We know not to take homilies literally, but it turns out that Resh Lakish (c.200 CE) and Abaye (d~339 CE) were on to something when they taught that the sun heals.   

A History of Heliotherapy

In 1903, the Nobel prize for Medicine was awarded to a Dane named Niels Finsen. Finsen had invented a focusable carbon-arc torch to treat – and cure – patients with lupus vulgaris, a painful skin infection caused by tuberculosis.  While this was the start of the modern medical use of phototherapy, using the sun as a source of healing is much, much older. Older even than the Talmud, which mentions it in today’s daf. 

“The Nobel Prize in Physiology or Medicine 1903 was awarded to Niels Ryberg Finsen “in recognition of his contribution to the treatment of diseases...with concentrated light radiation, whereby he has opened a new avenue for medical science”.”

Perhaps the earliest reference to heliotherapy – that is, using sunlight to heal - is found in Egyptian papyrus records from over 3,500 years ago, which record using the sun, together with ingesting a local weed, to treat skin conditions. The active ingredients of that weed, Ammi majus, were isolated in 1947. These ingredients, together with heliotherapy, were used in the first clinical trials to treat vitiligo, which were conducted, rather fittingly, in Egypt.  Further work determined that it was only a narrow part of the sun’s spectrum that was needed to treat vitiligo, psoriasis, and other skin conditions, and so lamps were developed that produced only narrow band ultraviolet light (UVB). These UVB lamps are now a mainstay of treatment for psoriasis. 

Sunlight for Healthy Bones

“For most white people, a half-hour in the summer sun in a bathing suit can initiate the release of 50,000 IU (1.25 mg) vitamin D into the circulation within 24 hours of exposure”

— Environmental Health Perspectives 2008:116;4. A162

But ultraviolet light – UVB – can also be extremely dangerous. Too much exposure to sunlight will cause skin cancer, as the light produces molecules that directly damage DNA. Here is the great paradox of sunlight – too much of it will burn and can kill – but get the dose right and it is not only curative, but essential for healthy living. Sunlight is needed to produce vitamin D in the skin, and vitamin D is needed to produce healthy bones. Without it, you will develop rickets, a skeletal deformity that is characterized by bowed legs. 

Typical presentation of 2 children with rickets. The child in the middle is normal; the children on both sides have severe muscle weakness and bone deformities, including bowed legs (right) and knock knees (left). From Holick M. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80(suppl):1678S–88S.

Sunlight for a Healthy Immune System

The sun’s light effects the immune system, although many of these effects are only poorly understood. 

When some nerve fibres are exposed to sunlight, they release a chemical called neuropeptide substance P. This chemical seems to produce local immune suppression.  Exposure to the ultraviolet wavelengths in sunlight can change the regulation of T cells in the body which can also modulate autoimmune diseases.

Sunlight to Treat Melanoma?

While sunlight can cause skin cancer, it has been shown to release a hormone called alpha melanocyte-stimulating hormone. This hormone appears to limit the damage to DNA damage from sunlight and so may actually reduce the risk of melanoma (but don't try this as a treatment yet. It's certainly not ready for prime time.)

Sunlight for Your Mood

Then there’s sunlight for your mood. Seasonal affective disorder – SAD – is caused by a lack of exposure to sunlight, which most affects those living in the northern latitudes in the winter.  SAD was first described in 1984 by Norman Rosenthal working at the National Institute of Mental Health but why it happens is still something of a mystery.  Rosenthal went on to write several best-selling books on SAD and how to beat it. The answer appears to be something to do with sitting in front of a lamp that mimics sunlight (but the evidence that this works is still controversial).

 Sunlight for Babies with Jaundice

Sunlight is also a great treatment for babies with neonatal jaundice. This condition is very common and is caused when the baby breaks down the fetal hemoglobin with which it was born. A product of that breakdown is bilirubin, and if this is allowed to build up in the tissues it can cause lethargy, difficultly feeding, and in rare and extreme cases, brain damage. However, sunlight (or more precisely, the blue band of the spectrum at 459nm)  breaks down this dangerous bilirubin molecule into a harmless one called biliverdin.  So the best treatment for a newborn baby with mild jaundice is to put them out in the sun.  (Failing that, or if the degree of jaundice is not mild, you can consider phototherapy in the hospital.) 

The absorbance spectrum of bilirubin bound to human serum albumin (white line) is shown superimposed on the spectrum of visible light. Clearly, blue light is most effective for phototherapy, but because the transmittance of skin increases with increasing wavelength, the best wavelengths to use are probably in the range of 460 to 490 nm. Term and near-term infants should be treated in a bassinet, not an incubator, to allow the light source to be brought to within 10 to 15 cm of the infant (except when halogen or tungsten lights are used), increasing irradiance and efficacy. For intensive phototherapy, an auxiliary light source (fiber-optic pad, light-emitting diode [LED] mattress, or special blue fluorescent tubes) can be placed below the infant or bassinet. If the infant is in an incubator, the light rays should be perpendicular to the surface of the incubator in order to minimize loss of efficacy due to reflectance. From Maisels and McDonagh. Phototherapy for Neonatal Jaundice. New England Journal of Medicine 2008.358;920-928.

Sunlight for Infectious Diseases

 We don't treat infectious diseases with sunlight any more. But it wasn't always that way. Less than eighty years ago sunlight was recommended as a therapy for some patients with tuberculosis. The authors, writing in the journal Diseases of the Chest were cautious:

Even in those cases where the sun can be of great value, it is in no sense a specific cure for any manifestation of tuberculosis. Rest, good food, and fresh air, are still the fundamentals in treating all forms of the disease; and the sun, where it should be used, is only a valuable adjutant...Heliotherapy is not indicated in all cases of tuberculosis. The majority of patients with this disease should never use it...It is not a sure cure for any type of tuberculosis, but is often, especially in some of the extrapulmonary cases, a very valuable—or even necessary—aid.

In today's daf, Resh Lakish taught that the sun can both reward and punish. His insight was more correct than he could ever have imagined.  

“Bright light therapy and the broader realm of chronotherapy remain underappreciated and underutilized, despite their empirical support. Efficacy extends beyond seasonal affective disorder and includes nonseasonal depression and sleep disorders, with emerging evidence for a role in treating attention-deficit/hyperactivity disorder, delirium, and dementia.”

— Schwartz and Olds. The Psychiatry of Light. Harvard Review of Psychiatry 2015. 23 (3); 188.