Today’s page of Talmud discusses the etiology of epilepsy.
פסחים קיב,ב
שְׁלֹשָׁה דְּבָרִים צִוָּה רַבִּי יוֹסֵי בְּרַבִּי יְהוּדָה אֶת רַבִּי: אַל תֵּצֵא יְחִידִי בַּלַּיְלָה, וְאַל תַּעֲמוֹד בִּפְנֵי הַנֵּר עָרוֹם, וְאַל תִּכָּנֵס לְמֶרְחָץ חָדָשׁ, שֶׁמָּא תִּפָּחֵת. עַד כַּמָּה? אָמַר רַבִּי יְהוֹשֻׁעַ בֶּן לֵוִי: עַד שְׁנֵים עָשָׂר חֹדֶשׁ. וְאַל תַּעֲמוֹד בִּפְנֵי הַנֵּר עָרוֹם, דְּתַנְיָא: הָעוֹמֵד בִּפְנֵי הַנֵּר עָרוֹם — הָוֵי נִכְפֶּה. וְהַמְשַׁמֵּשׁ מִטָּתוֹ לְאוֹר הַנֵּר — הָוַיִין לוֹ בָּנִים נִכְפִּין
Rabbi Yosei, son of Rabbi Yehuda, commanded Rabbi Yehuda HaNasi with regard to three matters: Do not go out alone at night; do not stand naked before a candle; and do not enter a new bathhouse, lest it collapse when they light the fire beneath it…
With regard to not standing naked before a candle, the Talmud comments that this is as it was taught in a baraita: One who stands naked before a candle will become epileptic, and one who engages in intimacy by candlelight will have epileptic children.
Having established one cause of epilepsy, the Talmud then add to it, and includes some nuanced qualifications.
תָּנוּ רַבָּנַן: הַמְשַׁמֵּשׁ מִטָּתוֹ עַל מִטָּה שֶׁתִּינוֹק יָשֵׁן עָלֶיהָ — אוֹתוֹ תִּינוֹק נִכְפֶּה. וְלָא אֲמַרַן אֶלָּא דְּלָא הָוֵי בַּר שַׁתָּא, אֲבָל הָוֵי בַּר שַׁתָּא — לֵית לַן בַּהּ. וְלָא אֲמַרַן אֶלָּא דְּגָנֵי לַהֲדֵי כַּרְעֵיהּ, אֲבָל גָּנֵי לַהֲדֵי רֵישֵׁיהּ — לֵית לַן בַּהּ. וְלָא אֲמַרַן אֶלָּא דְּלָא מַנַּח יְדֵיהּ עִילָּוֵיהּ, אֲבָל מַנַּח יְדֵיהּ עִילָּוֵיהּ — לֵית לַן בַּהּ.
Likewise, the Sages taught: One who engages in intimacy in a bed upon which a baby is sleeping, that child becomes epileptic. And we said that this will occur only if the child is not yet one year old; however, if he is one year old we have no problem with it, as he is old enough not to be affected. And furthermore, we said this only concerning a baby that is sleeping near the father’s feet; but if the baby is sleeping near his head he is sufficiently far away so that we have no problem with it. And we said this only if he does not place his hand on the baby at the time, but if he places his hands on the baby to serve as a barrier between them, we have no problem with it.
What is Epilepsy?
Epilepsy is caused by inappropriate and disorderly firing of neurons in the brain. The word comes from the French épilepsie, or from the earlier Greek epilambanein ‘seize, attack’, (from epi ‘upon’ and lambanein ‘take hold of’). It describes a condition which can manifest in a number of different ways. The person can look out blankly into the distance and not respond. These are called absence seizures. Sometimes it begins with an odd sensation of smell or sounds. This is called an aura, and it may herald a more generalized seizure. Generalized seizures may begin with a shaking in one limb, and then the person falls to the ground with a generalized seizure. These are very scary to watch, but usually resolve by themselves within a couple of minutes. Following this, during the postictal period, the person typically falls into a deep sleep for some time, perhaps half an hour or so, and often has no recollection of the events. Sometimes the generalized seizures do not end; this is called status epileptics, and it is a life-threatening condition.
The Causes of Seizures
The two most commonly identified causes of seizures are a neurologic birth injury (8%) and cerebrovascular disease (11%). But lots of other things can cause seizures, like head trauma (6%), brain tumor (4%), and infections of the central nervous system (3%). In the elderly, the cause of a new seizure is more likely to be vascular (from say a stroke), or a tumor.
In addition, some toxins can cause seizures. Of these alcohol is the one most commonly associated with seizures. And some stressors like fatigue or sleep deprivation may exacerbate an underlying seizure disorder.
Scientific vs Talmudic Causes of Seizures and Epilepsy
From Harwood-Nuss’ Clinical Practice of Emergency Medicine. Kluwer 2021. Chap 159.
Standing naked in front of a candle (Pesachim 110)
Engaging in intimacy in a bed upon which a baby is sleeping (that child becomes epileptic) (Pesachim 110)
Copulating in a mill (will lead to epileptic children) (Ketuvot 60b)
After going to the bathroom, not waiting the time to walk half a mil before having sexual intercourse (Gittin 70a). This is because the demon of the bathroom accompanies the person and then attacks.
Epilepsy in the Jewish Bible
In the Bible (Numbers 24:4) the prophet Bilaam introduces himself with the following enigmatic words:
במדבר 24:3
נְאֻ֕ם שֹׁמֵ֖עַ אִמְרֵי־אֵ֑ל אֲשֶׁ֨ר מַחֲזֵ֤ה שַׁדַּי֙ יֶֽחֱזֶ֔ה נֹפֵ֖ל וּגְל֥וּי עֵינָֽיִם׃
The speech of he who hears God’s speech, Who beholds visions from the Almighty, who falls, but with eyes open.
In his classic work Biblical and Talmudic Medicine, Julius Preuss wrote that the expression “with open eyes” refers “to a clairvoyant soothsayer.”
I am equally certain that the term “fallen down,” is the designation for epileptics; for in Hebrew and Arabic, the verb naphal, whose present participle is nophel, always means fallen down…Who first offered this explanation (of the term nophel meaning “fallen down”)? I can certainly not be the first, for this explanation seems to be very obvious. However I have looked in vain in numerous translations and commentaries of ancient and modern times and in exegetic handbooks and dictionaries…
Preuss noted that the same word is found in the story of Saul (I Sam 19:24). “Scripture uses the expression (vayipol) in relation to Saul after he became “manitic:” and he fell down the entire day and the entire night, that is, he had frequent epileptic seizures.”
שמואל א, 19:24
וַיִּפְשַׁ֨ט גַּם־ה֜וּא בְּגָדָ֗יו וַיִּתְנַבֵּ֤א גַם־הוּא֙ לִפְנֵ֣י שְׁמוּאֵ֔ל וַיִּפֹּ֣ל עָרֹ֔ם כָּל־הַיּ֥וֹם הַה֖וּא וְכָל־הַלָּ֑יְלָה עַל־כֵּן֙ יֹֽאמְר֔וּ הֲגַ֥ם שָׁא֖וּל בַּנְּבִיאִֽם׃
Then he too stripped off his clothes and he too spoke in ecstasy before Samuel; and he fell down naked all that day and all night. That is why people say, “Is Saul too among the prophets?”
“The Egyptians and Babylonians recognized seizures as being associated with physical ills, particularly head trauma, but, like the Greeks and Romans, sometimes ascribed their occurrence to causes that seem rather more occult than physical. Epileptics were thus often considered unclean or evil, and Pliny advised persons to spit upon seeing an epileptic, “to throw back the contagion.” Such magical thinking about seizures persists, in altered forms, and is part of the stigma of epilepsy. The treatment of epilepsy may thus have great social importance for the patient, who may still have to contend with this view of epilepsy. ”
And epilepsy in the Christian Bible
In Matthew (14:15) we read the story of a boy brought to Jesus because he was having seizures:
…a man came to him, knelt before him, and said, “Lord, have mercy on my son, because he has seizures and suffers terribly, for he often falls into the fire and into the water. I brought him to your disciples, but they were not able to heal him.” Jesus answered, “You unbelieving and perverse generation! How much longer must I be with you? How much longer must I endure you? Bring him here to me.” Then Jesus rebuked the demon and it came out of him, and the boy was healed from that moment.
In the original Greek the text reads “he is moonstruck,” a phrase related to our modern term “lunatic.” However, as the New English Translation notes, “now the term is generally regarded as referring to some sort of seizure disorder such as epilepsy.”
A Sacred Disease then and now
The earliest treatise to discuss epilepsy is called On the Sacred Disease. It was written around 400BCE. and attributed to Hippocrates. Here is how the book opens:
It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause from the originates like other affections. Men regard its nature and cause as divine from ignorance and wonder, because it is not at all like to other diseases. And this notion of its divinity is kept up by their inability to comprehend it, and the simplicity of the mode by which it is cured, for men are freed from it by purifications and incantations. But if it is reckoned divine because it is wonderful, instead of one there are many diseases which would be sacred; for, as I will show, there are others no less wonderful and prodigious, which nobody imagines to be sacred.
So the Greek author rejects the notion that the gods cause the disease. But despite the passage of time, some cultures retain a special respect for those who are epileptic. In her 1997 award winning book When the Sprit Catches You and You Fall Down, the reporter Ann Fadiman described the clash of cultures between Hmong immigrants from southeast Asia and western medicine. It is told through the story of a young Hmong girl Lia Lee who had a severe form of epilepsy.
Dan [a medical resident] had no way of knowing that Foua and Nao Kao had already diagnosed their daughter's problem as the illness where the spirit catches you and you fall down. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy, the most common of all neurological disorders. Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia's parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter's head that had been stirred up by the misfiring of aberrant brain cells. (p28)
The book painfully records what happens when an ancient system of belief is confronted with modern medicine. It is a reminder that different cultures interpret diseases and their origins in very different ways. The rabbis of the Talmud had no idea what caused the frightening condition we call epilepsy, but assumed that it was a punishment of some kind, and associated it with the sin of immodest behavior. We now know that it is nothing of the sort, and have medications that can usually bring the symptoms under control. Modern medicine, even with all its shortcomings, has given us that, for which we must be grateful.
