Avodah Zarah 28b ~ Ear Candling

Do Not Try this at home

When Rav Abahu was suffering from ear pain, Rabbi Yochanan suggested several remedies. Here are two:

עבודה זרה כח, ב

ואי לא לייתי תרבא דחיפושתא גמלניתא וליפשר ולישדי ביה ואי לא למלייה לאודניה מישחא וליעבד שב פתילתא דאספסתא וליתי שופתא דתומא וליתוב ברקא בחד רישא וליתלי בהו נורא ואידך רישא מותבא באודנא וליתוב אודניה להדא נורא ויזדהר מזיקא ונישקול חדא וננח חדא

 He should bring the fat of a large beetle and melt it and apply it to the ear. And if not, he should fill his ear with oil and prepare seven wicks made of alfalfa and bring dried garlic ends, and tie the ends to the wicks with a strip of hair at one end, and set the wicks aflame. And he should place the other end of each wick in his ear one at a time, and place his ear opposite the flame. And he should be cautious of drafts [and avoid them, as they will harm his ear.] He should take one wick and remove one wick, [i.e., replace each wick as it is consumed until all seven have been used.]

The remedy for Rav Abahu's ear pain, then, was to fill his ear with oil, stick a wick into it, and set it on fire. The idea is that the burning wick draws out the wax, and other toxins, leaving the patient cured and rejuvenated.  Talmudology strongly recommends that you do not try this at home.

Ear Candling is still a thing

From here.

Although Rav Abahu (~279-320 CE) recommended  ear candling long ago, it is still in use today. On Amazon you can by candles to stick in your ear, and a guide to talk you through the steps. It's easier to use Amazon than to make your own candles with alfalfa and dried garlic ends, but, scientifically speaking, it's silly. Very silly. A case report from St. Mary's Hospital in London describes an elderly woman who had hearing loss in her left ear.  The woman denied ear candling, which is odd, since the ear was full of what appeared to be candle wax, and "histopathological examination confirmed the material as candle wax." (You can read another medical case report, this one on ear candling in a four-year old girl, here.) The authors noted that "ear candling is widely practiced as an alternative therapy. The procedure lacks scientific explanation, is known to produce complications and should be discouraged."

Eardrum of a patient with white candle wax causing inflammation and hearing loss. From Mohamed Zackaria & Antony Aymat (2009) Ear candling: A case report, The European Journal of General Practice, 15:3, 168-169,

Is there any Science behind Candling?

Still, one case report doesn't mean all that much. We need a more scientific exploration of ear candling, which is precisely what we got in a 1996 research paper Ear Candles; Efficacy and Safety. The authors, who were ear, nose and throat surgeons and audiologists (and supported by a grant from the William G. Reed Fund for Research in Otolaryngology) tested the pressure that an ear candle would generate, and used a mass spectrometer to identify the contents of the candle stubs. After twenty trials using two different candle types, the authors reported that "no negative pressure was generated by any of the burning ear candles at any point during the trial." As for the contents of the burned candles "multiple analyses revealed the sample to be composed of multiple alkanes, which are found in wax candles...None of the contents of cerumen were identified."  

“Physicians need to be aware of the dangers associated with ear candle use and counsel their patients accordingly.”

— Seeley D. Quigley S. Langman A. Ear Candles; Efficacy and Safety. Laryngoscope 1996, 106; 1226-1229

The authors also reported their results of a survey 122 otolaryngologists. One-third were ‘aware’ of ear candle use amongst one or more of their patients. Fourteen had treated complications of ear candling, including 13 burns of the auricle and canal, 7 partial canal occlusions from candle wax and 1 eardrum perforation.

“Ear candling seems to be popular and is heavily promoted (for example, via the Internet), with claims that could easily seem scientific to lay people. However, the truth is that its mechanism of action is first, implausible, and second, demonstrably wrong. Moreover, it has no positive clinical effects and seems to be associated with considerable risks. The few scientific articles available on this subject do not suggest that ear candles are an effective treatment for any condition.”

— Ernst E. Ear candles: a triumph of ignorance over science. Journal of Laryngology and Otology 2004, 118:1-2

The Funny Side to Ear Candling

Dave Barry, the Pulitzer Prize winning columnist is one of the funniest writers in the business. He wrote perhaps the funniest newspaper column ever on today's topic. It's also probably the only humorous column on the topic. Dave gave Talmudology permission to reproduce it (I'm not making this up), and you can find it here. Dave also asked that readers do not circulate the piece by email or other electronic media. So read it and enjoy.  Given what we know now, perhaps even Rav Abahu would have found it amusing.

Avodah Zara 27a~ Circumcision, Death, and Hemophilia A

Can a(n uncircumcised) hemophiliac be a mohel?

On this page of Talmud there is a fascinating dispute about the biblical source of the rule that a gentile may not perform a ritual circumcision - brit mila. Daru bar Pappa (in the name of Rav) claimed it comes from the verse “And as for you, וְאַתָּה אֶת בְּרִיתִי תִשְׁמֹר you shall keep My covenant, you, and your descendants after you throughout their generations,” (Gen. 17:9) meaning that only your descendants may perform mila. Rabbi Yochanan had a different proof text, just three verses later (Gen. 17:13), when Abraham was told “ הִמּוֹל יִמּוֹל circumcise those who are born to you…” The use of the double emphasis הִמּוֹל יִמּוֹל teaches that a Jew must be circumcised by one who is already circumcised.

Although the law is clear, the use of the different proof-texts has ramifications for some specific cases that the Talmud now considers. One of them is the case of a man who could not be circumcised because his own brother had died from the procedure. According to Daru bar Pappa, such a man may himself act as a mohel and perform brit mila, since he is (at least) descended from those who are required to be circumcised. According to Rabbi Yochanan, however, this person is disqualified from being a mohel. He may indeed be a fully-fledged Jew, but הִמּוֹל יִמּוֹל teaches that he must himself have a brit mila in order to perform it on others.

עבודה זרה כז, א

אֶלָּא אִיכָּא בֵּינַיְיהוּ יִשְׂרָאֵל שֶׁמֵּתוּ אֶחָיו מֵחֲמַת מִילָה, וְלֹא מָלוּהוּ. לְמַאן דְּאָמַר ״וְאַתָּה אֶת בְּרִיתִי תִשְׁמֹר״ — אִיכָּא, לְמַאן דְּאָמַר ״הִמּוֹל יִמּוֹל״ — לֵיכָּא

Rather, there is a difference between them [Daru bar Pappa and Rabbi Yochanan] with regard to a Jew whose brothers died due to circumcision, and as a result, they did not circumcise him. According to the one [Daru bar Pappa] who says that the halakha is derived from the verse: “And as for you, you shall keep My covenant,” there is reason to permit such a person to perform circumcision, as he is a Jew. According to the one [Rabbi Yochanan] who says that the halakha is derived from the phrase: “He must be circumcised [הִמּוֹל יִמּוֹל],” there is no reason to permit this Jew to perform circumcision, as he is not circumcised himself.

So today we will discuss hematology, with a special focus on the disease that is the basis of the case on today’s daf, called hemophilia.

X-linked Hemophilia and the exemption from Brit Mila

A more detailed discussion of the disease is found on Yevamot 64b:

יבמות סו, ב

תניא מלה הראשון ומת שני ומת שלישי לא תמול דברי רבי רבן שמעון בן גמליאל אומר שלישי תמול רביעי לא תמול... א"ר יוחנן מעשה בארבע אחיות בצפורי שמלה ראשונה ומת שניה ומת שלישית ומת רביעית באת לפני רבן שמעון בן גמליאל אמר לה אל תמולי

It was taught: If she circumcised her first son and he died, and her second son and he too died, she should not circumcise her third son, so taught Rebbi.  Rabbi Shimon ben Gamliel stated that she should indeed circumcise her third child, but [if he died] she must not circumcise her forth...Rabbi Yochanan said that there was once a case in Zippori in which four sisters had sons:  The first sister circumcised her son and he died, the second sister circumcised her son and he died, the third sister circumcised her son and he died, and the fourth sister came to Rabbi Shimon ben Gamliel and he told her "you must not circumcise your son" (Yevamot 64:).

The Talmud here is describing a disease that is affected through the maternal line (hence the four sisters - all of whom seem to pass this disease on to their male children). The disease is X-linked Hemophilia A; the term X-linked indicates that the faulty gene is carried on the X chromosome, which in men is always inherited from the mother. Hemophilia A is an X-linked recessive genetic disease, first described by the American physician John Conrad Otto, who in 1803 described a bleeding disorder that ran in families and mostly affected the men. John Hay from Massachusetts published an account of a "remarkable hemorrhagic disposition" in the New England Journal of Medicine in 1813.

Hay, John. Account of a Remarkable Haemorrhagic Disposition, Existing in Many Individuals of the Same Family. New England Journal of Medicine 1813:2;3;221-225.

 If the mother is a carrier  - as were each of the four sisters in Zippori - and the father is not, then she has a one in four chance of passing on the disease to a child, and that affected child will always be a son:

Courtesy NHLBI

The rabbis argued over a technical point - that is, how many cases of bleeding are needed to establish a pattern. According to Rebbi (that is  Rebbi Yehuda Ha-Nasi, c. 135-217 CE.) two cases were sufficient, while Rabbi Shimon ben Gamliel insisted on three cases before ruling that there was a life threatening pattern.  Indeed the disease in boys must have been very perplexing, because (as you can see in the diagram above) not every boy would be affected. In fact, if the mother is a carrier and the father is not, there is only a 50% chance of a boy having hemophilia.  It is this fact that perhaps explains the dispute between Rebbi and Rabbi Shimon ben Gamliel regarding how many children need to exhibit the disease before we can assume that any future male child will also have it.  If every boy born in the family would have been a hemophiliac, Rabbi Shimon's ruling would have seemed unnecessarily cruel.  But since by chance, half of the boys born might not have hemophilia, the need to demonstrate the prevalence of the disease (in a society in which its genetic foundations were not known) seems eminently sensible.

In  Hemophilia A there are various genetic mutations that result in low levels of clotting factors. These levels may be only mildly decreased, or so low that severe life threatening hemophilia results. It is treated with transfusions of clotting factors which restore the levels to normal. Although these transfusions must be given several times a week in those with severe disease, there is hope that recombinant clotting factors can lengthen the time between the needed transfusions.

Later in Yevamot, the Mishnah records the case of a priest who was not circumcised -  because of the deaths of his brothers when they underwent the procedure. So this law was certainly practiced, and the Talmud records not only the earliest known description of hemophilia, but the emphasis on the preservation of life as a normative Jewish practice. 

Avodah Zarah 24a ~ Maternal Imprinting

From here.

The Parah Adumah, the red heifer, was used in several ceremonies in the Temple. It was, however, a rare animal. In today's page of Talmud there is a detailed discussion as to whether a red heifer born to an idol-worshipper could be used. The concern was that the heifer, or one of its ancestors, might have been used by the idol-worshipper for beastiality. Should this have happened, it was forbidden to use the red heifer as a sacrifice. The Talmud relates that in fact an idol-worshipper called Daba ben Natina had sold a red heifer to his Jewish neighbors. To insure that the heifer's mother had not been the object of beastiality, the pregnant cow had been watched "משעה שנוצרה" – from the moment it was impregnated. Then comes an obvious question: how could anyone be sure that the cow was indeed pregnant with a red calf which would warrant safeguarding her? Perhaps the calf  would be born another color? 

Here is the answer: "כוס אדום מעבירין לפניה בשעה שעולה עליה זכר" -"while the mother was copulating, the farmer would show her a red cup." That would insure that she would give birth to a little red calf that would grow into a bigger red heifer. The belief that what a mother sees during conception and gestation will affect her offspring is called maternal imprinting or psychic maternal impressions, or mental influence, or maternal imagination, or (my favorite) maternal fancy. 

“The history of the belief in maternal impressions is one of great antiquity...it is also one of practically world-wide distribution. [It can be found in] such far apart lands as India, China, South America, Western Asia and East Africa..the Esquimaux, the Loango negros, and the old Japanese.”

— John William Ballantyne. Teratogenesis: an Inquiry into the Causes of Monstrosities. Edinburgh, Oliver & Boyd 1897. 24

Maternal Imprinting in jewish sources

The earliest mention of maternal imprinting is the story of Yaakov and his division of the goats he watched for his uncle Lavan (Gen 30:25-43, 31:1-12).  As wages, Yaakov asked for all the speckled goats, while Lavan would get to keep the plain ones.  Yaakov then took several wooden rods from which he peeled the bark, and left these now speckled rods in front of a water trough.   The female goats stared at the rods while they are drinking and mating, and this in turn caused them to give birth to speckled kids, all of which Yaakov got to keep. That's how maternal imprinting works.  

The Midrash and Talmud are replete with the belief in maternal imprinting. Perhaps the most famous story is that of Rabbi Yochanan (~180-279 CE) who would regularly sit in front of the mikveh (ritual bath). He did this so that women leaving there would see him, and be blessed with sons as handsome as he was.

בבא מציעא פד, א

ר' יוחנן הוה אזיל ויתיב אשערי טבילה אמר כי סלקן בנות ישראל מטבילת מצוה לפגעו בי כי היכי דלהוו להו בני שפירי כוותי גמירי אורייתא כוותי

Rabbi Yochanan would go and sit by the entrance to the ritual bath. He said to himself: When Jewish women come up from their immersion [after their menstruation,] they should see me first so that they have beautiful children like me, and sons learned in Torah like me. 

Rabbi Akiva used maternal imprinting to save a king from a rather embarrassing situation:

מדרש תנחומא נשה, ז

מַעֲשֶׂה בְּמֶלֶךְ הָעַרְבִים שֶׁשָּׁאַל אֶת רַבִּי עֲקִיבָא, אֲנִי כּוּשִׁי וְאִשְׁתִּי כּוּשִׁית וְיָלְדָה לִי בֵּן לָבָן, הוֹרְגָהּ אֲנִי, שֶׁזָּנְתָה תַּחְתַּי. אָמַר לוֹ: צוּרוֹת בֵּיתְךָ שְׁחֹרוֹת אוֹ לְבָנוֹת. אָמַר לוֹ: לְבָנוֹת. אָמַר לוֹ: כְּשֶׁהָיִיתָ עוֹסֵק עִמָּהּ, עֵינֶיהָ נָתְנָה בְּצוּרוֹת לְבָנוֹת וְיָלְדָה כַּיּוֹצֵא בָּהֶם. וְאִם תָּמֵהַּ אַתָּה בַּדָּבָר, לְמַד מִן צֹאנוֹ שֶׁל יַעֲקֹב, שֶׁמִּן הַמַּקְלוֹת הָיוּ מִתְיַחֲמוֹת, שֶׁנֶּאֱמַר: וְיִחֲמוּ הַצֹּאן אֶל הַמַּקְלוֹת (בראשית ל, לט). וְהוֹדָה מֶלֶךְ הָעַרְבִים וְשִׁבַּח לְרַבִּי עֲקִיבָא

A king of Arabia once asked Rabbi Akiva, “I am black and my wife is black, yet she gave birth to a white child. Shall I have her executed for infidelity?” Rabbi Akiva responded by inquiring if the statues in his house where white or black. He said to Rabbi Akiva that they were white.  Rabbi Akiva explained to the king that during conception his wife's eyes were fixed on the white statues and so she bore a white child...the king agreed and praised Rabbi Akiva

Maternal Imprinting in Greek Thought, and Beyond

In 1998 Professors Wendy Doniger and Gregory Spinner published perhaps the most comprehensive review of imprinting, in a paper titled Misconceptions: Female Imaginations and Male Fantasies in Parental Imprinting. They noted Empedocles, who lived in the fifth century BCE, wrote that 

the fetuses are shaped by the imagination of the women around the time of conception. For often women have fallen in love with statues of men, and with images, and have produced offspring which resemble them.

Soranus of Ephesus, another Greek physician who lived in Rome and Alexandria (and who was a contemporary of Rabbi Yochanan) firmly believed in imprinting, both for animal husbandry and in humans:

Some women, seeing monkeys during intercourse, have borne children resembling monkeys. The tyrant of the Cyprians, who was misshapen, compelled his wife to look at beautiful statues during intercourse and became the father of well-shaped children; and horse-breeders, during covering, place noble horses in front of the mares.

Let's jump forward a millennium.   In 1282 it was reported that an infant was born with hair and claws like a bear. The Pope at the time "straightway ordered the destruction of all pictures of bears in Rome." This story is from John Ballantyne, a Scottish physician who in 1897 published Teratogenesis: an Inquiry into the Causes of Monstrosities. According to Ballantyne, in the seventeenth century, the belief in maternal impressions "reigned supreme."  Here is another example of the kind of thing it led to:

And then things get even weirder:

In 1726 the matter of maternal impressions was brought still more prominently before the profession and the public in England in connexion [sic] with the notorious case of an "Extraordinary Delivery of Rabbets" which was alleged to have occurred in the case of Maria Tofts of Godlyman in Surrey; she had a great longing for 'Rabbets"in early pregnancy.

Pregnancy and the fetus

Maternal imprinting is a rather extreme form of what we all know to be true; that what happens to a pregnant mother affects the fetus she is carrying. Here are two of the countless examples of this.  If a mother drinks enough alcohol while pregnant, the fetus will be born with Fetal Alcohol Syndrome. This syndrome includes facial abnormalities, growth delays, abnormal development of organs, and reduced immunity.  If a mother is infected with measles (rubella) early in pregnancy, the baby will likely be born with congenital rubella syndrome, which includes cataracts, congenital heart disease and brain damage.  But these examples do not imply that a woman who eats eggs will have children with large eyes or that a woman who eats an esrog will have fragrant children, as the Talmud (Ketuvot 60b) declares. Some things a pregnant mother does will have a huge effect on the fetus she carries. Some won't have any affect at all.  

John Ballantyne, the Scottish physician concluded his book noting, as we have, that of course there are some things a mother does that will affect fetal outcome. "To this extent" he wrote, "I believe in the old doctrine of maternal impressions; this is, I think, one grain of truth in an immense mass of fiction and accidental coincidence."

It's not the red cup after all

Back to today's page of Talmud.  It would seem that all you needed to produce a Parah Adumah was to place a red cup next to the mating cattle.  So why didn't every farmer use the red cup protocol to breed a red heifer? After all, these animals commanded fantastic prices because of their rarity. The answer offered by the Talmud is that the red cup protocol only worked with a herd of cattle that were known (במוחזקת) to produce red heifers.  Without that breeding history, the red cup protocol was useless. So this really wasn't about the red cup. It was about the genes, and that's the kind of parental imprinting that really does work.

“A surprising large number of people, in different cultures and over many centuries, have believed that a woman who imagines or sees someone other than her sexual partner at the moment of conception may imprint that image upon her child- thus predetermining its appearance, character or both.”

— Doniger W. Spinner G. Female Imaginations and Male Fantasies in Parental Imprinting. Daedalus 127 (1), No. 1, Science in Culture (Winter, 1998). 97-129

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[Special thanks to Rabbi Dr. Eddie Reichman, medical historian and Talmudology reader who has been researching maternal imprinting for years, and was kind enough to share his material.]

Avodah Zara 23b ~ Caesarean Section in Cows and Ewes

In this page of Talmud there is a discussion about the blemishes that might render the rare red heifer - parah aduma - unfit to be sacrificed. According to Rabbi Shimon, a parah aduma born via caesarian section may indeed be offered as a sacrifice, while his colleagues disagreed.

עבודה זרה כג, ב

הִקְדִּישָׁהּ בְּיוֹצֵא דּוֹפֶן — פְּסוּלָה, וְרַבִּי שִׁמְעוֹן מַכְשִׁיר

If one consecrated a red heifer despite the fact that it was born by caesarean section, it is disqualified for use as a red heifer, and Rabbi Shimon deems the heifer fit for use.

Elsewhere, the Talmud raises the question about cesarian sections in cows again, this time when it discusses sacrifices offered outside of the Temple. This act is usually prohibited, and is accompanied with a punishment, but there is one exception: an animal that was born by caesarean section:

זבחים קיב, א

ויוצא דופן שהקריבן בחוץ פטור

One who sacrifices an animal born by caesarian section, outside of the Temple, is exempt from punishment.

The term יוצא דופן literally means "brought out through the wall," the wall in question being the abdomen. Animals born by c-section may not be used as sacrifices in the Temple. There is something different, not quire right, perhaps not normal, about them. That's why these same c-sectioned animals may be offered outside of the Temple without penalty. 

The indications for a caesarean section in a cow

Before we go further, a clarification. The surgical procedure about which we are discussing can be spelled in various ways: caesarean, Caesarean, cesarean or just plain "c." Take your pick. Anyway, according to the American College of Veterinary Surgeons, there are several indications for performing a c-section in a cow:

• Inadequate cervical dilation (not enough relaxation of the cervix muscles)

• Abnormal pelvic bone conformation (shape) in the cow

• Rupture of the cow's abdominal musculature

• Problems with uterine position or uterine function

• Abnormalities of the cow's uterus or vagina

• Abnormal calf position that is not correctable through the vagina

• Fetal monsters (congenital defects)

• Presence of a dead fetus

Standing left oblique celiotomy approach. The placement of the incision is indicated by the dashed line. From Schultz L.G. et al. Surgical approaches for cesarean section in cattle. Can Vet J 2008;49:565–568

Having decided that your cow needs a c-section, there are no fewer that eight different ways you could operate on her to pull this off. Eight! Here they are: (The positions described are that of the cow, not that of the surgeon.)

1. standing left paralumbar celiotomy,

2. standing right paralumbar celiotomy,

3. recumbent left paralumbar celiotomy,

4. recumbent right paralumbar celiotomy,

5. recumbent ventral midline celiotomy,

6. recumbent ventral paramedian celiotomy,

7. ventrolateral celiotomy,

8. standing left oblique celiotomy

According to this helpful paper published in the Canadian Medical Journal, it is the left oblique approach that is preferable under most circumstances. This is because the uterus is readily removed from the abdominal cavity limiting contamination of the abdominal cavity.  

...and in sheep

In sheep, things are only slightly different. The most common cause for performing a c-section is a fetal lamb in the wrong position, one which cannot be safely corrected by manipulation. This is the cause of about 50% of all sheep c-sections.  The cause of about another third is incomplete or non-dilation of the cervix which has failed to respond to medical treatment.  Feto-pelvic disproportion, in which a single large lamb is too big to pass through the maternal pelvis account for another 5%.  There are generally three approaches to the c-section: through the flank, through the midline, and through an incision parallel to the midline, which is called the paramedian approach. Today the midline approach is not recommended, because it requires a general anesthetic, as opposed to a local injection. (You can read more about c-sections in the ewe in this helpful article.)

Exceptional animals with exceptional births

In modern Hebrew the phrase meaning a caesarean section, יוצא דופן, has another meaning: exceptional. Which certainly describes these animals born by c-section. In the pre-modern era, when there were neither local anesthetics nor antibiotics, there would have been only one survivor of a c-section if you were lucky, and it wasn't the mother. (We will have more to say about the c-section survival rate in women when we learn Bechorot 47 on November 4, 2026.)  For these animals who, but for the intervention of a skilled vet would otherwise have died in-utero, perhaps being spared from sacrifice was rather fitting.  If their birth was abrupt, bloody and at the hands of a human, perhaps their deaths could be different.  

“בהמה המקשה ללדת ויש סכנה לחייה, כי הוולד מת, והרפתנים קובעים שצריכים לחתוך את הוולד ולהוציאו דבלי זה הפרה תמות. אם מותר לעשות זה בשבת. אם צער בע”ח דוחה איסור מוקצה. הב”ח בסימן שח סעיף כג, מדבריו משמע דמשום צער בע”ח שרי טלטול מוקצה. וכנראה שהמחמירים לא ראו דברי הב”ח ולכן יש להתיר וכדאי הוא הב”ח לסמוך עליו 

The question of performing an emergency caesarean section on animal on Shabbat: 

...Does the prohibition of not causing pain to animals override the prohibition of מוקצה muktzeh [not touching certain items on Shabbat]?...Those who are strict in this matter [and prohibit the c-section] have not seen the words of the Bach [R. Yoel Sirkis 1561-1640]. It is permissible [to perform the surgery] and appropriate to rely on the opinion of the Bach”

— Rabbi Tzvi Pesach Frank [1874-1960]. Har Tzvi Tal Harim Shvut 3.