Chullin 105b ~ The Healing Effects of Alcohol

חולין קה, ב

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

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

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

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

“...even after a single acute or binge exposure, alcohol leads to tissue damage. In gastric mucosa and in bone, alcohol exposure alters basic signaling processes. In the repair of skin damage following injury or surgery, alcohol disrupts signaling in a broader context, in multiple tissue types. The derangement of the inflammatory response by alcohol leads to altered cytokine and chemokine production by multiple cell types and this, in turn, influences the responses of other cell types. ”

— Jung et al. Alcohol Exposure and Mechanisms of Tissue Injury and Repair. Alcohol Clin Exp Res. 2011 ; 35(3): 392–399.

“Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk.”

— O'Keefe et al. Alcohol and Cardiovascular Health: The Dose Makes the Poison...or the Remedy. Mayo Clin Proc.2014;89(3):382-393.

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

alcohol and the discovery of the cause of CHolera

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

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

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

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

Alcohol and Influenza

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

Purim

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

Chullin 22b ~ Yellow Pigeons, Folk Medicine and Hepatitis

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

Pigeons for jaundice, Really?

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

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

אברהם יצחק שפרלינג טעמי המנהגים, ירושלים הוצאת אשכול 1957

“A remedy for yellowness:
Take a male pigeon for a man and a female pigeon for a woman. Place it on the umbilicus, and the pigeon will draw out all of the yellowness until there is none left, and the pigeon dies. This has been tested (בדוק).”

— אברהם יצחק שפרלינג טעמי המנהגים, ירושלים הוצאת אשכול 1957

APPARENTLY It’s not just PIGEONS

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

Suffocation and a Ruptured Spleen

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

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

A primer on Jaundice

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

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

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

Yellow Pigeons in today’s Daf

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

חולין כב, ב

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

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

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

Transference

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

Tu B'Shvat ~ A New Year for Health

The opening Mishnah of Masechet Rosh Hashanah includes this:

ראש השנה ב ,א

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

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

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

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

— Charles Spivak

Charles Spivak and the fight against tuberculosis

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

From here.

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

Dr. Chales Spivak. From here.

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

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

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

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

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

Helping others, even after his death

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

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

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

Denver’s National Jewish Hospital

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

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

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

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

Avodah Zarah 12b ~ Vinegar, Leeches and Rav Huna

עבודה זרה יב ,ב

ת"ר לא ישתה אדם מים לא מן הנהרות ולא מן האגמים לא בפיו ולא בידו אחת ואם שתה דמו בראשו מפני הסכנה מאי סכנה סכנת עלוקה

The Sages taught: A person should not drink water from rivers or from ponds either by drinking from the water directly with his mouth, or by collecting the water with one hand alone. And if he drank in this manner, his blood is upon his own head, due to the danger. What is this danger? It is the danger of swallowing a leech.

There are about 680 identified species of leeches (so far). Most are found in freshwater, and are found on every continent except Antarctica. You should stay away from them.

In western developed countries, our drinking supplies are safe to drink (mostly). But around the world leeches are still found in water that is used for human (and animal) consumption.  Today's page of Talmud reminds us of the danger that leeches once imposed. That danger is still very much present.

The Nile Leech. And others

The Koren Talmud notes that one species of leech, the Nile leech (Limnatis nilotica) can still be found in bodies of water in Israel.  Indeed, leeches are found across the Middle East. Ten years ago, a case report was published in the Turkish Journal of Parasitology which described what happened when Limnatis nilotica  got into the nose of a poor five year-old girl in Turkey.

“ The doctor who was trying to aspirate the blood in the patient’s mouth noticed the bloody formation moving slightly. This formation was removed by an otolaryngologist under local anesthesia and was brought to the parasitology laboratory and identified as a leech.”

— Agin, H. et al. Türkiye Parazitoloji Dergisi, 32 (3): 247 - 248, 2008

The girl had nose bleeds and had vomited blood over three days.  She required an urgent blood transfusion, and while trying to remove blood from the girl's nose the doctor "noticed the bloody formation moving slightly." The bloody moving formation was carefully removed and sent to the pathology laboratory where it was identified. It was a leech. Here is a picture of the villain:

Leech obtained from the case. From Agin, H. et al. Severe Anemia Due to the Pharyngeal Leech Limnatis nilotica in a Child. Türkiye Parazitoloji Dergisi, 32 (3): 247 - 248, 2008

This is certainly not an isolated incident.  In fact, there are so many reports of leeches in the medical literature, that an Iranian group published a meta-analysis of leeches "as a live foreign body." 

Selection of published literature on leech infestations. From Saki, N. et al. Meta Analysis of the Leech as a Live Foreign Body: Detection, Precaution and Treatment. Pakistan Journal of Biological Sciences 2009: 12 (24); 1556-1563

The more you read, the more the meta-analysis gets scary. Here is another table, detailing the 28 patients the Iranians had seen at their hospital in Ahwaz, Iran. (Fun fact about Ahwaz: in 2011 the World Health Organization declared it to be the most air-polluted city in the world. Ahwaz: If our leeches don't kill you, our air will.)

Detail of 28 leech infested patients seen over a ten year period at Ahwaz Jondishapour University of Medical Science, Ahwaz, Iran. From Saki, N. et al. Meta Analysis of the Leech as a Live Foreign Body: Detection, Precaution and Treatment. Pakistan Journal of Biological Sciences 2009: 12 (24); 1556-1563

The longest leech they found was a whopping 10 cm (over 4 inches) that had taken up residence in the back of the mouth. Why didn't the patient feel that massive creature? Well, leeches are crafty; they secrete an analgesic so the victim doesn't feel the bite. At most, you might feel a little wiggling.  

Vinegar. Really?

Today's page of Talmud not only cautions us to be careful when drinking from a spring or river. It also suggests a treatment for leech attachment: 

אמר רבי חנינא הבולע נימא של מים מותר להחם לו חמין בשבת ומעשה באחד שבלע נימא של מים והתיר רבי נחמיה להחם לו חמין בשבת אדהכי והכי אמר רב הונא בריה דרב יהושע ליגמע חלא

 Rabbi Hanina says: In the case of one who swallows a water leech [nima], it is permitted to perform labor on Shabbat and heat water for him to drink on Shabbat, as his life is in danger. And in fact there was an incident involving one who swallowed a water leech, and Rabbi Neḥemya permitted them to heat water for him on Shabbat. In the meantime, until the water is ready, what should he do? Rav Huna, son of Rav Yehoshua, said: He should swallow vinegar.

As it turns out, Rav Huna's advice to drink vinegar can be found in today's medical literature. The Ahwaz team offers this suggestion:

If the leech is in the nares or upper pharynx, it be detached by applying 30% cocaine, 1:10,000 adrenalin or dimethyl phthalate to it. Another method is irrigation with strong saline, vinegar, turpentine or alcohol.

Rav Huna's treatment with vinegar seems to be supported in the medical literature. So next time you travel to Ahwaz, take some along with you.