Bava Metzia 52b ~ The Not So Dead Sea

This post is for the page of Talmud to be studied tomorrow, Shabbat. Print it up now and enjoy

בבא מציעא נב, ב

לא יעשנה משקל בין משקלותיו ולא יזרקנה בין גרוטותיו ולא יקבנה ויתלנה בצואר בנו ובצואר בתו אלא או ישחוק או יתוך או יקוץ או יוליך לים המלח 

It was taught in a Baraisa: A person should not make [an eroded coin that does not contain enough metal] into a wight among his weights, not should he throw it among his pile of silver utensils, nor should he hang it as a necklace on the neck of his son or daughter. Instead, he should either grind it up, or melt it down, or cut it into pieces or bring it to the Dead Sea [and throw it in]. 

We have encountered the use of the Dead Sea as a dumping ground before, back when we were studying Nazir. There, the Talmud discussed the fate of various offerings (or money set aside to buy these offerings) that were designated to be brought to the Temple in Jerusalem but, that, for one reason or another, could not in the end be donated.  For example, the Talmud discussed the case of a father who declared that his son would be a nazarite, and set aside money to bring the associated Temple offerings. However, the son decided he did not want the ascetic life thank you very much, and declined to become a nazarite. What then should become of the money set aside? If the father had set aside the money and specifically for the purchase of a chatas - חטאת - a sin offering - he is rather out of luck.  The Mishnah states that the money must be cast into the Dead Sea - that is, it cannot be used for any purpose. (This is because the הטאת can never be offered as a voluntary sacrifice, and since the son will not become a nazir, the money cannot be used for a voluntary sacrifice- or any other purpose.) Here is the mishnah:

משנה נזיר כח, ב

היו לו מעות סתומין יפלו לנדבה מעות מפורשים דמי חטאת ילכו לים המלח

If he had set aside unspecified funds [for his son to bring as a nazir, and the son declined to follow through], they may be used for voluntary offerings. If he had set aside specified money [for a chatas sacrifice], he should bring it to the the Dead Sea [and throw it in]...  

THE FORMATION OF THE DEAD SEA

The Dead Sea lies on a boundary between the Arabian tectonic plate and the Sinai sub-plate, which is part of the larger African tectonic plate. In 1996 Garfunkel and Ben-Avraham published a paper on The Structure of the Dead Sea basin. They note that the Dead Sea rift was formed when the two tectonic plates moved apart from each other, creating a hole in the middle.  The Dead Sea is one of the most saline lakes in the world, containing more than 30% of dissolved salts, mostly sodium, calcium and magnesium, potassium and bromine; it is almost ten times more saline than the oceans. The lake lies about 400m below sea level, and in  some places the lake is as deep as 300m (for those of you in the US, that is almost 1,000 feet). It is these salts that make the lake so seemingly inhospitable to life, and explain why the rabbis chose the Dead Sea as an example  (perhaps the example) of the place to throw the money set aside for a sacrifice that could not be brought. Once the coins were thrown into the murky depths of the lake, they would sink into the silt, rust, and never be found. The Dead Sea is a metaphor for a place without life, which is probably why the Mishnah also rules that into it should be thrown any vessel on which is an idolatrous images. They will simply never be found again. 

 עבודה זרה מב, ב 

המוצא כלים ועליהם צורת חמה, צורת לבנה, צורת דרקון - יוליכם לים המלח

If one finds vessels on which is the likeness of the sun, the moon or a dragon [all of which were used for idolatry], the vessels should be thrown into the Dead Sea...

The name “Dead Sea” is of relatively recent vintage. It was first introduced by Greek and Latin writers such as Pausanias (160-180 AD.) Galen (2nd century AD) and Trogus Pompeius 2nd century AD.)
— — Arie Nissenbaum. Life in a Dead Sea: Fables, Allegories, and Scientific Search. BioScience 1979: 29 (3). p153.

LIFE IN THE DEAD SEA

It is fascinating to note that while we refer to the lake as the Dead Sea, it is not called this in the Hebrew Bible or the Talmud. Rather, it is the Salt Sea - ים המלח - with no reference to anything about it being dead.  This choice turns out to have been a good one, for although the lake seems to be devoid of any life, there is life within it.  

The increased salinity and the elevated concentration of divalent ions make the Dead Sea an extreme environment that is not tolerated by most organisms. This is reflected in a generally low diversity and very low abundance of microorganisms.
— — Ionescu D, Siebert C, Polerecky L, Munwes YY, Lott C, et al. (2012) Microbial and Chemical Characterization of Underwater Fresh Water Springs in the Dead Sea. PLoS ONE 7(6): e38319.

— Ionescu D, Siebert C, Polerecky L, Munwes YY, Lott C, et al. (2012) Microbial and Chemical Characterization of Underwater Fresh Water Springs in the Dead Sea. PLoS ONE 7(6): e38319.

Microorganisms were first discovered in the Dead Sea in the 1930s, and since then bacteria have been isolated in both the sediment and the water, albeit at low concentrations.  However a series of dives in June 2010 revealed a complex system of freshwater springs that feed the lake, and surrounding these springs are bacterial communities with much higher densities, and much greater cell diversity, than was previously known. (You can watch a two-minute video of divers at the bottom of the Dead Sea here. It is amazing to realize that they are the first humans to see the depths of the Dead Sea).  An international team of researchers described the findings from these dives in a paper titled Microbial and Chemical Characterization of Underwater Fresh Water Springs in the Dead Sea,that was published in 2012.  The colonies of cells that surround the freshwater springs are up to 100 times more dense than the found in the ambient water of the Dead Sea, and include bacteria that consume sulfides, and those that metabolize iron and nitrates. The authors conclude that the underwater system of springs that feed the Dead Sea are an "unknown source of diversity and metabolic potential."  

Graphical representation of the sequence frequency in the studied Dead Sea samples, showing major detected phyla and families of different functional groups of Bacteria. From Ionescu D, Siebert C, Polerecky L, Munwes YY, Lott C, et al. (2012) M…

Graphical representation of the sequence frequency in the studied Dead Sea samples, showing major detected phyla and families of different functional groups of Bacteria. From Ionescu D, Siebert C, Polerecky L, Munwes YY, Lott C, et al. (2012) Microbial and Chemical Characterization of Underwater Fresh Water Springs in the Dead Sea. PLoS ONE 7(6): e38319.

Despite these findings of life, the Dead Sea is still in trouble. Its level is dropping at the rate of about three feet per year, and its surface area is now only 600 Km2, down from over 1,000 Km2 in the 1930s.  The prophecy of Ezekiel (47:8-9) that the water of the Dead Sea would be replaced with fresh water in which great numbers of fish will live is still a long, long way off.  

יחזקאל פרק מז, ח-ט 

ויאמר אלי המים האלה יוצאים אל הגלילה הקדמונה וירדו על הערבה ובאו הימה אל הימה המוצאים ונרפאו ונרפו המים:  והיה כל נפש חיה אשר ישרץ אל כל אשר יבוא שם נחלים יחיה והיה הדגה רבה מאד כי באו שמה המים האלה וירפאו וחי כל אשר יבוא שמה הנחל

He said to me, "This water flows toward the eastern region and goes down into the Arabah, where it enters the [Dead] Sea. When it empties into the sea, the salty water there becomes fresh.Swarms of living creatures will live wherever the river flows. There will be large numbers of fish, because this water flows there and makes the salt water fresh; so where the river flows everything will live...(Ez. 47:8-9)

[Repost from Nazir 28.]

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Talmudology on the Parsha, Metzora ~ The Zov, and Gonorrhea

ויקרא 15:2-3

וַיְדַבֵּ֣ר יְהֹוָ֔ה אֶל־מֹשֶׁ֥ה וְאֶֽל־אַהֲרֹ֖ן לֵאמֹֽר׃

דַּבְּרוּ֙ אֶל־בְּנֵ֣י יִשְׂרָאֵ֔ל וַאֲמַרְתֶּ֖ם אֲלֵהֶ֑ם אִ֣ישׁ אִ֗ישׁ כִּ֤י יִהְיֶה֙ זָ֣ב מִבְּשָׂר֔וֹ זוֹב֖וֹ טָמֵ֥א הֽוּא׃

וְזֹ֛את תִּהְיֶ֥ה טֻמְאָת֖וֹ בְּזוֹב֑וֹ רָ֣ר בְּשָׂר֞וֹ אֶת־זוֹב֗וֹ אֽוֹ־הֶחְתִּ֤ים בְּשָׂרוֹ֙ מִזּוֹב֔וֹ טֻמְאָת֖וֹ הִֽוא׃

And the Lord spoke to Moshe and to Aharon, saying, Speak to the children of Israel, and say to them, When any man has a running issue out of his flesh, because of his issue he is unclean.

In this week’s parsha, the laws of the זב – Zov - a man who experiences a discharge from his penis - are outlined. If a man experiences this discharge on two days he becomes impure (טמאי), and must undergo a process of spiritual recovery that includes isolation from others and immersion in running water. If he has a third day of penile discharge he is required to bring an offering to the Temple. (The laws differ in their application to a woman who is infected, but the basic idea is the same. To keep it simple, we'll just focus on the male Zov.)

The Zov in the Talmud

Rav Huna (c. 216-297 CE) left us with a careful description of the nature of this penile discharge:

נדה לה, ב

אמר רב הונא זוב דומה למי בצק של שעורים זוב בא מבשר המת שכבת זרע בא מבשר החי זוב דיהה ודומה ללובן ביצה המוזרת שכבת זרע קשורה ודומה ללובן ביצה שאינה מוזרת

Rav Huna says: The discharge of ziva is similar to water of barley dough. Whereas the discharge of ziva comes from dead flesh, i.e., when one’s penis is flaccid, semen comes from living flesh, when one’s penis is erect. Moreover, the discharge of ziva is runny, and is similar in appearance to the white of a unfertilized egg. By contrast, semen is viscous, and it is similar in appearance to the white of an egg that is not unfertilized, i.e., a fertilized egg.

אין כל צורך להביא ראיות ומופתים להוכיח, כי במחלה מתדבקת ידועה
Gonorrhoe הכתוב מדבר, במחלה הנקראת אצלינו היום

There is no need to bring any proofs to prove that the verse in the Bible is referring to a well known infection, which today we call Gonorrhoe [sic]...
— י.ל קצנלסון. התלמוד והכמת הרפואה. הוצאת חיים ברלין תרפ׳ח. 378

what causes the discharge?

The rabbis of the Mishnah thought that if the discharge was due to an external factor, then the person so afflicted did not become a Zov. Here is the list of those external causes of genital discharge, as outlined in Nazir 65b:

נזיר סה, ב

בשבעה דרכים בודקין את הזב עד שלא נזקק לזיבה במאכל ובמשתה במשא ובקפיצה ובחולי ובמראה ובהירהור

A Zov is examined in seven ways…about food and drink [certain foods such as cheese and wine could have caused the discharge], about carrying a load, jumping and illness [strenuous physical activity could also do so], sight and thought [he is asked whether he has been thinking about or looking at women, which could have caused his discharge]…

In modern Hebrew, zivah (זיבה) is the term for gonorrhea, a sexually transmitted disease caused by the bacterial species Neisseria gonorrhoeae.  Preuss, in his famous Biblical and Talmudic Medicine has this to say about the Zov:

“It is clear forthwith that the only illness we know that can be referred to here is gonorrhea” (354).

Abraham Steinberg, in his more recent three volume Encyclopedia of Jewish Medical Ethics, also identifies the disease described in Leviticus as gonorrhea, (though he notes that some rabbis identified the discharge as being sperm, rather than pus. More on that below).  If a Zov is indeed a man suffering from gonorrhea, that would explain “the laws of isolation and impurity in regard to people with flux [=discharge] as being hygienic rules to prevent the spread of the disease” (Vol  II, p452).

More than you wanted to know about gonorrhea

According to the Centers for Disease Control and Prevention, there are about 330,000 new cases of gonorrhea in the US. That makes it the second most common sexually transmitted disease, with first place going to chlamydia- and the two are frequently found together. The World Health Organization estimated a global total of  106 million cases in 2008 (and that’s an increase of 21% compared to 2005).  Gonorrhea is most common in women age 15-19, and infections in women are usually asymptomatic. In contrast, gonorrheal infection in men is nearly always symptomatic, with the most common symptoms being pain on urination (dysuria) and purulent penile discharge. (Think of what comes out of your nose when you get a bad cold. Now think of that coming out of another orifice.)   But gonorrhea is not just a disease of the genital tract. It may involve the eyes, pharynx and anus, and if it is not treated it may (rarely) progress to disseminated disease that includes endocarditis and meningitis. In women, untreated gonorrhea can cause pelvic inflammatory disease and sterility.

While the Zov in Temple times had to remove himself society and hope for an end to the symptoms, in the era of antibiotics things are different. Gonorrhea is generally easy to treat – a single shot of ceftriaxone in the muscle and a swig of oral azithromycin and you are on the mend. The problem is that drug resistant gonorrhea is now emerging worldwide, and consequently some infections are difficult to treat. 

Don't Touch That Chair...

As outlined in our parsha, the Zov imparts ritual impurity to the bed on which he lies and the chair on which he sits. Preuss wrote that “the hygienic value of these regulations… is obvious.” If the disease that is described in the Torah is indeed gonorrhea, well, then we now understand enough to say that the hygienic value of these regulations is, contra Preuss, really not that obvious at all. We now know that you cannot catch gonorrhea from sitting on a chair or lying on a bed that an infected person had touched.  But in fairness, such beliefs were not uncommon even a century age. We’ve had occasion to review the theories prevalent in early twentieth century America about the transmission of gonorrhea. Back then, doctors claimed girls were susceptible to infection from gonorrhea “from everyday nonsexual objects, including their mothers’ hands, bed linens…and toilet seats.” It is hardly surprising, therefore, to read in the Torah, that the Zov contaminates all he touches. But it is not so. You need sexual or oral contact to transmit the disease, (which can also be caught by the innocent newborn baby passing through its mother's infected genital tract).  

Maimonides on the Nature of the Zov

In his Mishneh Torah, Maimonides identified the Zov as suffering from a physical disease – and not a spiritual one [הלכות מחוסרי כפרה 2:1]:

The Zov that is described in the Torah, is a form of semen that results from an infection in the tubes [of the genital tract]. When the discharge of the Zov flows, it does not do forcefully like ejaculate, and there is no pleasure associated with it. Rather it flows passively like dough…

(Maimonides was following the best medicine of his time when he described the discharge as a form of semen. The word gonorrhea is from the Greek roots gone meaning seed and rhein, meaning flow.)

In an era that did not have antibiotics, removing the infected person and isolating him was really all that could be done. Today, we have alternatives: antibiotics to treat the infection, and condoms to prevent its spread.   But we lack the self-reckoning that the infection might encourage. As an ER physician, I’ve treated many, many cases of gonorrhea, and every patient encounter was centered on diagnosing and treating the infection. I do not recall any discussions about changing the behavior that allowed infection to take place in the first place. Perhaps I bear responsibility for not having had that conversation, and perhaps I should have followed the example of the biblical text. That text was mistaken in some of the details of how the disease is spread, but accurate in requiring the Zov to leave his social network, and perhaps reflect on the kind of behaviors that led to his infection in the first place.

Talmudology on the Parsha will be back after Pesach.

חג כשר ושמח

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Talmudology on the Parsha, Tazriah: The Baby Born After Seven (or Nine) Months

ויקרא 12:1

וַיְדַבֵּ֥ר יְהֹוָ֖ה אֶל־מֹשֶׁ֥ה לֵּאמֹֽר׃

דַּבֵּ֞ר אֶל־בְּנֵ֤י יִשְׂרָאֵל֙ לֵאמֹ֔ר אִשָּׁה֙ כִּ֣י תַזְרִ֔יעַ וְיָלְדָ֖ה זָכָ֑ר וְטָֽמְאָה֙ שִׁבְעַ֣ת יָמִ֔ים כִּימֵ֛י נִדַּ֥ת דְּותָ֖הּ תִּטְמָֽא׃

And the Lord spoke to Moses saying: Speak to the children of Israel, saying, If a woman have conceived seed, and born a man child: then she shall be unclean seven days; as in the days of her menstrual sickness shall she be unclean…

This week’s parsha focusses on various elements of ritual purity and impurity, and opens with the rules as they apply to a mother who has just given birth. And so this week we will turn to the fascinating topic of a baby born after only seven or eight months’ gestation. Let’s begin with a discussion from the Talmud in tractate Niddah.

נדה ח, ב

דאיכא דילדה לט' ואיכא דילדה לשבעה

Some women give birth after nine months, and some after seven months…

Hang on. What about women who give birth after eight months? Why aren’t they on this brief list? The answer is that in talmudic times, a baby born after eight months of gestation was thought to be unable to survive.

In talmudic times, a baby born after eight months of gestation was thought to be unable to survive.

A Baby at the Window

Here is an example. In a passage from the tractate Bava Basra we read a list of objects which, if placed in an opening between rooms, blocks the tumah (ritual impurity) from passing from one room into the next. Among that list is a baby born after only eight months of gestation:

בבא בתרא כ, א

 עשבין שתלשן והניחן בחלון או שעלו מאליהן בחלונות ומטלוניות שאין בהן שלש על שלש והאבר והבשר המדולדלין בבהמה ובחיה ועוף ששכן בחלון ועובד כוכבים שישב בחלון ובן שמנה המונח בחלון והמלח וכלי חרס וספר תורה כולם ממעטין בחלון 

Grass that was plucked and placed in an opening, or grass that grew by itself in an opening; scraps of fabric that are smaller than three by three fingerbreadths; a partially severed limb or a piece of flesh hanging from a domestic or a wild animal; a bird resting in an opening; an idol worshipper sitting in an opening; a baby born after only eight months of gestation lying in an opening; salt, earthenware vessels and a Torah scroll -all of these reduce the size of the opening and so prevent the tumah from passing through it.

The Talmud then questions this ruling about the premature child lying on a window between two rooms, one if which contains a source of tumah. Won't the mother of the baby carry the child away? How then can we suggest it will be a barrier to the tumah? The Talmud, as always, has a solution: the case is regarding a child born prematurely on Shabbat. Such a child is mukzteh, that is, it is in a category of objects that must not be moved on Shabbat: 

דתניא בן שמנה הרי הוא כאבן ואסור לטלטלו בשבת

For it was taught in a Braisa. A baby born at eight months of gestation is treated like a stone [on Shabbat, because it is muktzeh.]

The premature baby is given the status of a stone because it was not considered to be viable, and as a non-viable human being it does not contract ritual impurity. So that's why the premature baby is listed along with grass, idol worshippers, and the severed limbs of cattle as preventing the transmission of tumah. Got it?

When we studied Yevamot we came across another case which pivoted on the viability of babies born at seven vs. eight months of gestation. The question there was about proving the paternity of a child, and the discussion hinges on the belief that while a child born after seven months of gestation would be viable, a child born at eight months gestation would not be so.  Rashi noted the following: בר תמניא לא חיי -  "an eight month fetus cannot survive." And so now we can ask, where on earth does this notion come from? 

it is the women who make the judgments and ... insist that the eighth-month babies do not survive, but the others do.
— Hippocrates, On the Seventh-Month Child

Seven vs Eight Months of gestation in antiquity

Homer's Iliad, written around the 8th century BCE,  records that a seven month fetus could survive. But it is not until Hippocrates (c. 460-370 BCE, or some 500 years before Shmuel), that we find a record of the belief that a fetus of eight months' gestation cannot survive, while a seventh month fetus (and certainly one of nine months gestation) can.  His Peri Eptamenou (On the Seventh Month Embryo) and Peri Oktamenou (On the Eight-Month Embryo) date from the end of the fifth century BCE, but this belief is viewed with skepticism by Aristotle.

In Egypt, and in some other places where the women are fruitful and are wont to bear and bring forth many children without difficulty, and where the children when born are capable of living even if they be born subject to deformity, in these places the eight-months' children live and are brought up, but in Greece it is only a few of them that survive while most perish. And this being the general experience, when such a child does happen to survive the mother is apt to think that it was not an eight months' child after all, but that she had conceived at an earlier period without being aware of it.

The belief that an eight month fetus cannot survive has a halakhic ramification: Maimonides ruled that if a boy was born prematurely in the eighth month of his gestation and the day of his circumcision (eight days after his birth) fell out on Shabbat, the circumcision - which otherwise would indeed occur on Shabbat, is postponed until Sunday, the ninth day after his birth. 

רמב׳ם הל' מילה יד, א

מי שנולד בחדש השמיני לעבורו קודם שתגמר ברייתו שהוא כנפל מפני שאינו חי... אין דוחין השבת אלא נימולין באחד בשבת שהוא יום תשיעי שלהן

A child born after eight months of gestation before being fully formed is treated as a stillbirth because it will not live...and we do not set aside the laws of Shabbat [to circumcise him] but he is circumcised on Sunday, which is the ninth day of his life.

This belief persisted well into the early modern era. Here is a state–of–the–art medical text published in 1636 by John Sadler.  Read what he has to say on the reasons that an eight month fetus cannot survive (and note the name of the publisher at the bottom of the title page-surely somewhat of a rarity then): 

Front page of 17 cent textbook.jpeg

Saturn predominates in the eighth month of pregnancy, and since that planet is "cold and dry"," it destroys the nature of the childe". That, or some odd yearning of the child to be born in the seventh but not the eight month (according to Hippocrates) is the reason that a child born at seven and nine months' gestation may survive, but not one born at after only eight months. 

Evidence from Modern Medicine

Today we know that gestational length is of course critical, and that, all things being equal, the closer the gestational length is to full term, the greater the likelihood of survival. We can state with great certainty, that an infant born at 32 weeks or later (that's about eight months) is in fact more likely to survive than one born at 28 weeks (a seven month gestation.) In fact, a seven month fetus has a survival rate of 38-90% (depending on its birthweight), while an eight month fetus has a survival rate of 50-98%. Here is the data, taken from a British study.

Draper, ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births by weight and gestational age: retrospective population based study British Medical Journal 1999; 319:1093.

Draper, ES, Manktelow B, Field DJ, James D. Prediction of survival for preterm births by weight and gestational age: retrospective population based study British Medical Journal 1999; 319:1093.

Back in 2013, a study from the Technion in Haifa showed that even the last six weeks of pregnancy play a critical role in the development of the fetus. This study found a threefold increase in the infant death rate in those born between 34 and 37 weeks when compared full term babies.  

You can read more on the history of the eight month fetus in a 1988 paper by Rosemary Reiss and Avner Ash.  From what we have reviewed, the talmudic belief that a seven month fetus can survive but an eight month fetus cannot is one that was widely shared in the ancient world, and even in the early modern era.  But all the evidence we have today firmly demonstrates that it is simply not true.

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The (Second) Great American Eclipse

Once again, it is coming. Tomorrow, on Monday April 8th there will be a solar eclipse visible to millions of people across north America.  It will be the first total eclipse to cross the continental United States since 2017, which I was lucky enough to witness with my family from Charleston, South Carolina. This time, some 31 million people in the US will be in the path of the witness the spectacle of the totality, when the day turns to night.

I will be traveling to Indianapolis to witness the totality. Some time ago I considered a Talmudology Eclipse weekend, but happily, I could not pull that off since I must be in Chicago for a family event. It will the second total eclipse for me, and I am ready with my viewing glasses.

What does the Talmud have to say about the cause of a solar eclipse? (You would be very surprised.) You can find my essay on the topic here, which was published in the journal Hakirah. Since there are no new Jewish aspects to this eclipse as opposed to the one I witnessed in 2017, the essay remains current, other than for the descriptions and timing on that event.

Do go and see the total solar eclipse. It will (once again) be incredible.

Happy viewing.

The Forward, Sunday Jan 25, 1929

The Forward, Sunday Jan 25, 1929

 

 

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