Medicine

Talmudology for Sukkot~ Take Two Etrogim, and Call Me in the Morning: The Citron as Medicine.

In honor of Sukkot, which begins on Friday night, here is a treat from the Talmudology archives.

שבת שלום וחג שמח

The Midrash tells a story of a man who was so generous with his charitable donations that he had no money left to feed his own family. Out of ideas, he did what I suppose anyone in his position would have done. He went to gather up discarded etrogim [the citron taken as part of the four species on the Festival of Sukkot] and went to see a king.

ויקרא רבה לו:ה

, וְנִתְבַּיֵּישׁ לֵילֵךְ לְבֵיתוֹ הָלַךְ לוֹ לְבֵית הַכְּנֶסֶת, חָמָא תַּמָּן מִן אִלֵּין אֶתְרוֹגַיָא דְּמֵינוּקַיָא מְקַלְקְלֵי בְּיוֹם הוֹשַׁעְנָא, וּתְנִינַן תַּמָּן מִיָּד הַתִּינוֹקוֹת שׁוֹמְטִין לוּלָבֵיהֶן וְאוֹכְלִים אֶתְרוֹגֵיהֶם, נְסַב מִנְּהוֹן וּמְלָא יָת סַקָּא וְהָלַךְ לִפְרשׁ בַּיָּם הַגָּדוֹל, עַד שֶׁהִגִּיעַ לִמְדִינַת הַמֶּלֶךְ, כֵּיוָן שֶׁהִגִּיעַ שָׁם אַרָעַת שַׁעְתָּא וְאִשְׁתְּכַח מַלְכָּא חָשֵׁשׁ מֵעוֹי, אָמְרִין לֵיהּ בְּחֶלְמָא אַסְוָתָךְ אֱכֹל מִן אִלֵּין אֶתְרוֹגִין דִּיהוּדָאי מַצְלִין עִמְּהוֹן בְּיוֹם הוֹשַׁעְנָא וְאַתְּ מִתְּסֵי, פִּשְׁפְּשִׁין בְּהַהוּא שַׁעְתָּא לְכָל אִלְפַיָא וּלְכָל מְדִינְתָּא וְלָא אַשְׁכְּחוּן, אָזְלִין וְאַשְׁכְּחוּן לְהַהוּא גַבְרָא יָתֵיב עַל סַקָּא, אָמְרִין לֵיהּ אִית גַּבָּךְ כְּלוּם, אֲמַר לָהֶם גְּבַר מִסְכֵּן אֲנָא וְלֵית גַּבִּי כְּלוּם לִמְזַבְּנָא, פִּשְׁפְּשׁוּ בְּסַקָּא וְאַשְׁכְּחוּן מִן אִלֵּין אֶתְרוֹגִין, וַאֲמָרִין לֵיהּ אִלֵּין מָה הֵן, אֲמַר לוֹן מִן אִלֵּין דִּיהוּדָאי מַצְלֵי בְּיוֹם הוֹשַׁעְנָא, אַטְעָנוּן סַקָּא וְאַעֲלוּהָ קֳדָם מַלְכָּא, אָכַל מַלְכָּא אִלֵּין אֶתְרוֹגַיָיא וְאִתְּסֵי. פַּנּוּן שַׂקָּא וּמְלָאוּהָ דִינָרִין…

…He was ashamed to go to his home. He went to the synagogue and saw there some of the citrons that the children away... He took some of them and filled a sack, and embarked on a voyage in the Mediterranean Sea until he reached the province of the king. When he arrived there, it happened to be that the king had an intestinal illness. They said to him in a dream: ‘Your cure is to eat from those citrons with which the Jews pray on the day of the hoshana, and you will be cured.’ At that time, they searched all the ships and all the provinces, but could not find any. They went and found that man sitting on the sack. They said to him: ‘Do you have anything?’ He said to them: ‘I am a poor man and I have nothing to sell.’ They searched the sack and found those citrons. They said to him: ‘What are they?’ He said to them: ‘From those with which the Jews pray on the day of the hoshana.’ They loaded the sack and took it in before the king. The king ate those citrons and he was cured. They emptied the sack and filled it with dinars..

The etrog as medicine? Yes. People once believed, and many still believe today, that the etrog has medicinal uses. So in honor of Sukkot, let’s talk about some of them.

The Etrog in Ma’aseh Tuviah

The etrog as a medicine appears in one of the first Jewish encyclopedias, written by Tuviah Hacohen. He studied in a yeshivah in Cracow, and at the age of twenty-six, entered the University of Frankfurt, where he began to study medicine. Despite being taken under the wing of Fredrick William, the elector of Brandenburg, and receiving a stipend from him, anti-Jewish sentiment prevented Tuviah from graduating. As a result, he left for the University of Padua, where he graduated with a degree in medicine in 1683 and soon found employment as a physician in Turkey. He published his only work, Ma’aseh Tuviah (The Work of Tuviah), in Venice in 1708 and moved in 1715 to Jerusalem, where he died in 1729.

Tuviah Cohen has long been a favorite of historians of science and Judaism. Perhaps this is because he was a reformer of sorts, ready to sweep away old superstitions and replace them with scientific knowledge. Perhaps it is because his book, Ma’aseh Tuviah, was “... the best-illustrated Hebrew medical work of the pre-modern era,” full of wonderful drawings about astronomy and anatomy. Perhaps it is because his book is so clearly printed and a pleasure to read in the original. Or perhaps it is because Cohen was so adamantly opposed to Copernicus that he called him the “Firstborn of Satan”– which made his the first Hebrew work to attack Copernicus and his heliocentric system.

In any event, Tuviah wrote about the wonderful healing properties of the etrog.

Ma'aseh Tuviah, Venice 1708, 146a.

Because in homes that have abundant medicines they also have the five special fruits through with the Land of Israel was blessed, I will write in praise of the of etrog [פרי עץ הדר] which is more beautiful than any other fruit…. both the peel and the fruit itself are delicious to eat, and it also has many wonderful properties [סגולות נפלאות]. The peel alleviates all internal pain and strengthens the muscles. while the white of the fruit strengthens the internal organs. Its bitter taste is good for the liver, and cures thirst. The seeds are also good for internal pain as an an aid for digestion…it is as good as theriac for any person who is ill, and it is particularly beneficial for children with viral infections [ויראוליס] like smallpox. The wood of the tree itself does not have these qualities though without doubt it imparts them to the fruit, which is why the fruit never falls far from the tree [התפוח אינו נופל רחוק מן העץ]. And so if there is a scarcity of the fruit, cut some wood from the etrog tree and boil. It will strengthen the body and a serve to heal the soul.

The Etrog as a Cure for Cholera

We have had occasion in the past to talk about Hayyim Palagi (there are many different ways to spell his last name, 1788– 1868) who was a rabbi and leader of the Jewish community in Izmir (Smyrna), Turkey, though his influence was felt far beyond. Writing about the 1865 cholera outbreak in Turkey, Rabbi Palagi recalled how the Jews had fled Izmir.

In our town of Izmir in 5625 [= 1865] there was an outbreak of cholera, just like the outbreak of 5592 [= 1832] and many fled. The few who remained in the town were expelled by the mayor on the advice of physicians, and left for a nearby mountainside where men, women and children camped, and remained for about three weeks. There was not a single case of cholera the entire time,and the outbreak in the town eventually ended. During that time, I was particular with my prayers, and I prayed to God in the merit of Abraham who was called “a mountain” . . . that the merit of our ancestors would protect us and that we would not fall ill. And so it was. Praise be to God, for his loving kindness endures forever.

I am lucky to own a copy of one of his many works, called Refuah Vehayyim, published in Izmir in 1874. (It even contains three handwritten annotations in the margins written by Rabbi Palagi’s youngest son Yosef.) And here is what you can find on page 12b (though alas, there are no marginalia).

Sefer Refuah Vehayyim, Izmir 1874. 12b. (Chapter 4 #2).

It is written in the name of our teacher Rabbi Hayyim Vital, that to cure cholera take distilled water and the resin of the (?) mastic tree…and take half a cup of the size used for kiddush…and boil it with the resin and give it to the patient. And this is guaranteed.

And it is writtn in the Sefer Otzar Hayyim that this works with etrog peel…

Later in the book, Rabbi Palagi wrote that the etrog can be used for stomach aches in general, and not just those associated with cholera. However, it cannot be any old citron; it must be an etrog used for the mitzvah of lulav and etrog on Sukkot:

Sefer Refuah Vehayyim, Izmir 1874. 51b

For a stomach ache: the remedy is to eat etrogim with were used for the mitzvah of lulav and etrog during the holiday and through Hoshanah Rabbah. For they are used in prayer, and they heal…sometimes they are hard to digest, in which case they should be peeled and then boiled, and then that water should be drunk.

But wait - there’s more

In another of his many books Mo’ed Lekol Chai, Rabbi Palagi recommended the etrog as a means for easing the pains and dangers of childbirth. He cited another work in which this suggestion appeared, though in a slightly different and shorter form. (That work is Nazir Shimshon, published by Ya’akov Shimshon Shabtai Sinigaliah in Pisa in 1783. It is on page 38.)

When a women is pregnant, she should take the etrog on Hosha’ana Rabbah and after removing the pittom [style] she should distribute charity to the poor each according to her means, and she should pray that God should should save her and that her child should be born healthy.

The reason for this is that there is an opinion that the Tree of Knowledge was an etrog, and when Eve ate from it, Death came into the world. We know that many women die during childbirth, and therefore they should undertake this ritual and say the following prayer:

Master of the Universe, you know that because Chava [Eve] ate from the Tree of Knowledge she sinned and brought Death to the world as well as the pains of childbirth. Had I been there at that time I would not have eaten from it and I would not have benefitted from it in any way, just as I did not want to blemish the etrog during the Festival [of Sukkot] But now I have blemished it, because now it is no longer a mitzvah to take it. I would never want to disobey your mitzvot. Please accept my prayer and my supplication that I should not die as a result of this child or as a result of childbirth. Save me, grant me an easy labor without pain or hardship and let no harm befall me or my child, for you are the God who saves…

And so any man whose wife is pregnant during Sukkot should arrange for her to take the etrog and give it to his wife and she should follow this procedure. She should say this prayer word for word and conclude by saying “let this infant bring contentment and not pain, and may it be born to a good and peaceful life. Amen.”

Hayyim Pilagi, Mo'ed Lekol Chai Jerusalem 1976 #25.

The Etrog increases Male potency

The etrog. It’s not just for women. In the anonymous collection of segulot called Sefer Refuot published in Vienna in 1926, we find the following recommendation:

Sefer Refuot, Vienna 1926

For increased virility, take four drahms of the tongue of an ox together with half a handful of etrog peel and half a drahm of girofilo

Good to know.

Not so Fast - Chaim Bachrach and his objection

Rabbi Yair Hayyim Bachrach (1638-1702) better known by his famous work the Chavot Yair, was a leading posek of his generation, and led the communities of Worms and Mainz. In his commentary on the Tur (הלכות לולב #664) he also noted the custom of pregnant women biting off the pittom of the etrog, and he was not happy about it. Not at all.

It is the custom of pregnant women to bite off the tip of the etrog and it is mentioned in the Tzenah Urenah.How fortunate we are that this custom has been utterly uprooted.

Jewish Etrogs, and Greek Etrogs

The belief in the medicinal properties of the etrog was not unique to our ancestors alone. The Greeks believed it too. In fact, it was they who gave the fruit we know as an etrog a name that reflects just this; they called it Citrus Medica, “the medical citrus" and that is the Latin name of the species to this day. Citrus Medica.

Gaius Plinius Secundus (AD 23/24–79) better known as Pliny the Elder held the cirton tree in very high esteem as demonstrated by this passage in his Natural History (Book XII chapter 7):

The citron tree, called the Assyrian, and by some the Median apple, is an antidote against poisons. The leaf is similar to that of the arbute, except that it has small prickles running across it. As to the fruit, it is never eaten, but it is remarkable for its extremely powerful smell, which is the case, also, with the leaves; indeed, the odour is so strong, that it will penetrate clothes, when they are once impregnated with it, and hence it is very useful in repelling the attacks of noxious insects. The tree bears fruit at all seasons of the year; while some is falling off, other fruit is ripening, and other, again, just bursting into birth. Various nations have attempted to naturalize this tree among them, for the sake of its medical properties, by planting it in pots of clay, with holes drilled in them, for the purpose of introducing the air to the roots;

The Chinese Etrog

To this day, the etrog is used as a medicine in China. They grow several different varieties including the world’s largest citrus, the “Ning’er Giant. And, as the photo below shows, it really is giant.

 

“Ning’er Giant” citron weighing about 17lb (8kg), held in the gentle hands of the farmer who grew it, Li Hua Zhong, near Ning’er Yunan. (Photo credit David Karp, 18 October 2011.)

 

Some varieties are grown for their antioxidant properties, while others supposedly release insulin, which may be of use in Type II diabetes. In fact, according to a 2012 Review on Phytochemical and Pharmacological Properties of Citrus medica Linn, the etrog will cure just about anything.

Result shows that Citrus medica Linn. possesses analgesic, hypoglycaemic, anticholinesterase, anticancer, antidiabetic, hypocholesterolemic, hypolipidemic, insulin Secretagogue, anthelmintic, antimicrobial antiulcer and estrogenic properties.

And presumably, all without any side effects! The Jinguu variety from southern Yunnan is used to treat respiratory disorders, whereas the Qingpi variety, grown in the Provinces of Zhejiang and Jianxi is used for its more general medicinal effects.

Citrus Fruits and the First Randomized controlled Medical Trial

The citrus (but not the etrog, sadly) made a surprising appearance in the first randomized controlled clinical trial that humanity conducted. In the 18th century, sailors in the British Navy, went without fresh fruit for long periods of time. Citrus fruits contain the essential Vitamin C also known as ascorbic acid. Without it you develop a very nasty disease called scurvy. There is lethargy, the hair and teeth fall out, the gums bleed spontaneously, and bruising appears. Without treatment, you die. So yes, it is very nasty.

Sailors were often at sea for months at a time, without access to fruit containing Vitamin C. In the 18th century, it is estimated that more British sailors died from scurvy than died in battle.

For reasons we won’t go into here, a Scottish naval Surgeon named James Lind (1716-1794) had a hunch that the disease was cured by a lack of whatever it was that citrus fruits contained. So he took 12 sailors with scurvy and fed them various experimental diets that included one enriched with oranges and lemons (but not etrogs), and compared them to a similar group of sailors who ate a regular Royal Navy diet. The results were startling.

On the 20th of May 1747, I selected twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of the knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz. water gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times light puddings, boiled biscuit with sugar, etc., and for supper, barley and raisins, rice and currants, sago and wine or the like. Two were ordered each a quart of cyder a day. Two others took twenty-five drops of elixir vitriol three times a day … Two others took two spoonfuls of vinegar three times a day … Two of the worst patients were put on a course of sea-water … Two others had each two oranges and one lemon given them every day … The two remaining patients, took … an electary recommended by a hospital surgeon … The consequence was, that the most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them, being at the end of six days fit for duty … The other was the best recovered of any in his condition; and … was appointed to attend the rest of the sick. Next to the oranges, I thought the cider had the best effects…

The most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them being at the end of six days fit for duty … The other was the best recovered of any in his condition; and being now deemed pretty well, was appointed nurse to the rest of the sick.

Lind demonstrated that citrus fruits prevented and cured scurvy, and the first randomized controlled clinical trial, now the gold standard for evaluating new drugs, was born. Even Rabbi Bachrach would not have objected to that.

The etrog, whose Latin name means medicine, has long been a symbol of healing, not only in our own tradition, but in others, some just as ancient. After all, everyone needs a little healing.

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Chullin 105b ~ The Healing Effects of Alcohol

חולין קה, ב

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

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

Beer and Health image.png

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

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

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

Alcohol has been used as a medicine for over 5,000 years and when 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.

 
Snow map detail.png
 

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

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

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

 

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

Alcohol and Influenza

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

Purim

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

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Chullin 22b ~ Yellow Pigeons, Folk Medicine and Hepatitis

Jaundiced man .jpeg

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

Pigeons for jaundice, Really?

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

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

אברהם יצחק שפרלינג טעמי המנהגים, ירושלים הוצאת אשכול 1957

אברהם יצחק שפרלינג טעמי המנהגים, ירושלים הוצאת אשכול 1957

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

APPARENTLY It’s not just PIGEONS

The magus, or celestial intelligencer 1801..png

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

Suffocation and a Ruptured Spleen

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

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

A primer on Jaundice

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

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

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

Yellow Pigeons in today’s Daf

In 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.

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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.

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.

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.

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