Talmudic medicine

In preparing a shiur on Alternative Medicine, I had the opportunity to review the Rambam's position on medicines and therapies recorded in the gemara, as well as the responses from sages across the generations. Here are a few sources, as food for thought; feel free to suggest corrections for my translations, which I did a little hastily:

Rambam, Moreh haNevuchim 3:37

ואמרו בפירוש כל שיש בו משום רפואה אין בו משום דרכי האמורי, רוצים בזה שכל מה שיגזרהו העיון הטבעי הוא מותר וזולתו אסור... ואל יקשה עליך מה שהתירו מהם במסמר הצלוב ושן השועל, כי הדברים ההם בזמן ההוא היו חושבים בהן שהוציא אותם הנסיון והיו משום רפואה

They said explicitly that medicinal treatments are not subject to "Emorite ways", meaning that anything mandated by natural studies is permitted, and anything else is prohibited… Do not be troubled by the Sages' permission of a tzaluv's nail or a fox's tooth, for in their day they thought these were medical products of testing...


Meiri Shabbat 67a

וזה שכתבו רבותינו ע"ה הרבה מהם בסוגיא זו ובמקומות אחרים הם נעזרו בדבר זה בצירוף בשני דברים הא' שלא היה שם דבר כדאי להטעות אלא הבלים המוניים וכזבי הנשים כמו שתראה ברובם שהיו מיחסים אותם על שם הנשים המיניקות והמגדלות את הילדים ומגדלות אותם בלימוד הבליהם והוא אמרם אמרה לי אם וכו':
והשני שמצד שהיו ההמון באותו זמן בטוח באותם הענינים היה טבעם מתחזק ונמצא מצד ההרגל עזר טבעי בהם

The fact that our Sages of blessed memory recorded many of these practices in this passage and other passages was a result of two factors:
First: These practices did not include anything which could mis-lead someone [into idolatry – MT]; these were only the empty practices of the masses and the follies of women, as you can see that the majority of them were ascribed to nursemaids and nannies of children, who raised them and inculcated in them these empty practices. Thus the sages said, "My mother [or nursemaid – MT] told me."
Second: Because the masses believed in these practices in those days, they were strengthened, and as a result of habituation they found natural help in them.


Vilna Gaon to Yoreh Deah 179:13

כל הבאים אחריו חלקו עליו שהרי הרבה לחשים נאמרו בגמרא והוא נמשך אחר הפלוסופיא ולכן כ' שכשפים ושמות ולחשים ושדים וקמיעות הכל הוא שקר אבל כבר הכו אותן על קדקדו שהרי מצינו הרבה מעשיות בגמ' ע"פ שמות וכשפים אמרה איהי מלתא ואסרתה לארבא אמרו כו' (שבת פ"א ב' חולין ק"ה ב') ובספ"ד מיתות ובירושלמי שם עובדא דר"א ור"י ובן בתירה וכן ר"ח ור"א דאיברו עיגלא תילתא ור' יהושע דאמר שם ואוקמיה בין שמיא לארעא (בכורות ח' ב') וכן אבישי בן צרויה (סנהדרין צ"ה א') והרבה כיוצא ואמרו (בספ"ד מיתות חולין ז' ב') למה נקרא שמן כשפים כו' והתורה העידה ויהיו תנינים וע' זוהר שם וכן קמיעין בהרבה מקומות ולחשים רבו מלספר. והפלסופיא הטתו ברוב לקחה לפרש הגמרא הכל בדרך הלציי ולעקור אותם מפשטן וח"ו איני מאמין בהם ולא מהם ולא מהמונם אלא כל הדברים הם כפשטן אלא שיש בהם פנימיות לא פנימיות של בעלי הפלוסופיא שהם חצוניות אלא של בעלי האמת:

All who came after him [Rambam - MT] disagreed with him, for many incantations were mentioned in the gemara. He was drawn after philosophy, and so he wrote that sorcery, Names, incantations, demons and amulets are lies, but they have already struck him upon his skull for we have found many anecdotes in the Talmud with Names and sorcery. Examples are in Shabbat 81b, Chullin 105b, the end of the seventh chapter in Sanhedrin…
Philosophy, with its many lessons, tricked him into explaining all of these talmudic passages in the manner of mockery, uprooting them from their simple explanation… All of these are in accord with their simple meanings, but they have inner meanings. Not the inner meanings of the philosophers, which are actually external, but of the people of truth.


R' Neriah Gutel, Hishtanut haTevaim baHalachah, pg. 179 citing R' Avraham ben haRambam (and see his footnote 427 there)

לא נתחייב מפני גודל מעלת חכמי התלמוד ותבונתם לשלימות תכונתם בפירוש התורה ובדקדוקיה ויושר אמריה בביאור כלליה ופרטיה שנטען להם ונעמיד דעתם בכל אמריהם ברפואות ובחכמת הטבע והתכונה ולהאמין אותם כאשר נאמין אותם בפירוש התורה שתכלית חכמתה בידם ולהם נמסרה להורותם לבני אדם

We are not obligated, due to the great stature of the Sages of the Talmud, and their understanding and complete comprehension of the explanation of Torah and its fine points and its righteous sayings in explaining its principles and specifics, to therefore argue on their behalf and support their views in all of their statements about medicines and the study of nature and mathematics, and to believe them in this as we believe them in explaining the Torah, in which the entirety of its wisdom is in their hands, and was given to them to teach to humanity.

Science and Halachah

Today's battles of Science and Torah are often taken as occurring in a vacuum - as though someone woke up yesterday and realized that there may be some issues regarding the age of the universe, or some other cause celebre.

One result of this perspective is that authorities who take positions on either side of the issue - (1) Hold the line against the influence of modern research, or (2) Amend our understanding of the way the world works - are often accused of holding insidious or subversive agendas, trying to maintain their political power, etc.

In reality, though, the lines on this were staked out at least 700 years ago, in early debates about halachic rulings which seemed to depend on incorrect science. Of course, the question of accepting secular research goes back long before that, and is negotiated in the gemara itself, but the specific question of: "The sages believed X and based their halachic rulings on X, and now the world thinks/believes/proves that X is wrong - what do we do?" is first clearly hashed out in the responsa of the 12th to 14th centuries.

I intend to use the next session or two of my "Responsa that changed Jewish History" series to look at the positions outlined in those responsa, and the support brought for those positions. For a taste, here's a classic example of the responsa of that era: Rashba, Volume 1, Responsum 98. The translation, which is only partial, is my own.

Question: An animal was found to have an extra eiver [yeteret], from one of those eivarim which renders the animal a tereifah, in a place which should render it a tereifah. It was clarified that twelve months had passed. Would we say that since twelve months passed it is not a tereifah, and it is kosher, for Chullin 58 says that a tereifah cannot live twelve months? Although I have seen and heard that some permit this and are lenient, I wish to know your view.

Response: If you saw or heard one who is lenient and permits a yeteret, or any other situation the sages listed as a tereifah, do not listen to him, do not agree with him, there should not be such in Israel. It appears to me that one who permits this is slandering the words of the sages. I will speak with you about this at length, so that a fence will be built for you and for all who tremble at the word of Gd, and the words of the holy sages of Israel will not be made like a fence that has been pushed aside, such that a fox could ascend and break through.

In Chullin 42, the sages listed, “There are eighteen tereifot… This is the rule: If an animal that suffers such a wound cannot live, it is a tereifah.” And the gemara comments that the author of the mishnah believed that a tereifah cannot live, and that which he had learned he listed, and that which he had not learned he did not list. The list is brought with “Zeh haKlal,” and we depend on “Zeh haKlal” formulations in the gemara. Some sages added other tereifot, situations in which the animal could not live, according to their views, and they depended upon this rule… There is a view there in the gemara that when the mishnah says it “cannot live,” this does not refer to living twelve months alone, but rather that it will eventually die from that wound… In any case, all those listed there, and included by the sages, cannot ever be permitted.

Ulla included all of the tereifot in eight categories, saying (Chullin 43), “These eight categories were told to Moshe at Sinai: Pierced, split, removed, lacking, torn, trampled, fallen and broken.” We say that these were told to Moshe at Sinai, and yeteret is among those that were removed, according to Rav Huna, or those that are pierced or split… And Rav Huna’s position is definitive, and none have ever argued it… For all of these, they never said that living twelve months or giving birth would be a sign [of health], for there is no sign in the survival of known tereifot, and they are prohibited unconditionally. We don’t say that we leave them [to see if they survive], for according to the view that a tereifah cannot live, they cannot live. One who said that they survived two or three years was describing something that never happened, and who testifies to this is mistaken; such never happened.

It is as we say in the gemara: “R’ Yosi ben Nehorai asked R’ Yehoshua ben Levi: How big a hole in the windpipe?” And he replied, “It is as we learned…” R’ Yosi ben Nehorai replied: But we had a lamb like that in our area, and it lived! To which R’ Yehoshua ben Levi replied, “You depend on this? The law has spread in Israel that a bird with a fallen thigh is a tereifah, and R’ Shimon ben Chalafta had such a chicken and he prepared a tube for it, and it lived, and that was only within twelve months, and the same must be true for your case.” Therefore, even if many people go about saying they saw this, we contradict them. The words of the sages will stand, and we will not slander the words of the sages and uphold the words of these others.

In cases like these I say: Please do not slander the words of the sages regarding that which they considered a definite tereifah, and they did not leave as a doubt.

And if there is one whose heart disturbs him, saying that perhaps the sages only spoke of the majority of cases and most animals experiencing one of the listed tereifot will not survive, but some of them might survive due to their physical and constitutional strength, then you will have cancelled our mishnah’s rule of “None like this live.” All of those listed by those sages, within the view of the mishnah’s author, cannot live… And if this were true that we had seen it live, this would be testimony that the animal is not among the tereifot. Further, it would be testimony not only about itself, but it would be ‘purifying’ itself and its peers. You cannot escape one of two possibilities: Either a tereifah cannot live and the fact that this animal lived testifies that it is not a tereifah, or this case resolves the debates [regarding whether a tereifah can live] and testifies that the law is against the author of the mishnah, and like the author of the baraita who stated that a tereifah can live…

And if you will reply: What can we do – we have seen a yeteret of the foot survive twelve months, with our own eyes! This is what R’ Yehoshua ben Levi told R’ Yosi ben Nehorai, “You depend on this?” Meaning: This is not possible. It is as though you testify that you have seen the impossible. Or, there is another cause. So, too, here we ask the witness how he knows that this animal had, in fact, survived that period. Perhaps you forgot or erred, or perhaps you were confused regarding the time, or perhaps you confused this animal for another, for it is not possible to testify that this animal was in his sights for the entire twelve months. And if he will strengthen himself in his error and say, “No, for I love these strange words, this is what I saw and this is what I will follow,” then we will tell him that it is impossible to slander the words of the sages. The witness, and one thousand like him, should be cancelled, rather than cancel one point of the positions agreed upon by the holy Jewish sages, the prophets and students of prophets, and statements given to Moshe at Sinai…

Much more in the class itself, of course...

Science and Religion and Explaining the Holocaust

From time to time I attend a funeral at which the officiant begins by quoting these lines from Ben Sira: “Seek not to understand what is too difficult for you, search not for what is hidden from you, be not over-occupied with what is beyond you, for you have been shown more than you can understand.”

I always wonder how secular people take that sentiment, which strikes me as so offensive to the modern ear. “That which is too difficult for me?” “More than you can understand?” What happened to modern science, to exploration, to the idea that mystery is only that which I have yet to comprehend?*

But it’s certainly a Jewish perspective. See the mishnah in Chagigah (2:1), that one should not investigate certain matters related to Gd. See the innumerable Jewish sources delineating the ways in which a human being cannot comprehend the infinite.

I believe that this issue of a defined limit to human comprehension is one of the major points that separate Science and Religion within Judaism. Much about them is reconcilable, but this point, I think, is simply one of disagreement.

The scientific approach takes as axiomatic that given enough data, I will be able to reach an accurate conclusion. New tools/formulae may be required for data acquisition as well as analysis, but those, too, are within my grasp.

The religious approach of Jewish tradition, on the other hand, takes as a given that intellect is not the sole actor on the stage of exploration; other forces define/shape/limit my comprehension. These may include my spiritual character, the alienness of the subject matter, or some deus ex machina intervening to put a halt to my understanding, but there are non-neural factors which affect my ability to absorb and analyze.

This is on my mind because last night, while packing up some old tapes, I found a recording of a parshah class Rav Aharon Soloveitchik taught at Yeshiva University in the late ‘80s. I think it was Fall of 1989, because I was in my Junior year in high school, and the parshah under discussion was Ki Tavo.

One day I’ll have to blog about those classes, and the impact they had on me. I was looking for direction, and even though I only attended a handful of those shiurim, and I can’t say I grasped everything being said, they were still a key experience. But enough about that for now.

Rav Ahron discussed the problem of reward and punishment, and Divine oversight and theodicy. In the course of addressing various questions, he came to the Holocaust, and he said:

Because if one tries to explain the Holocaust, he will be nichshal [stumble] in one of two things. If he will try to explain the Holocaust under the secular perspective he will be nichshal in blasphemy. And if he will try to explain from a religious perspective, and point a finger at certain people, why the Holocaust took place, then he will speak stupidity and gasus haruach [arrogance].

[Speak might actually have been spout – it’s hard to tell on the recording, and my mental recollection is spout.]

From a scientific perspective, this answer is entirely unacceptable. I have data about Gd, I should be able to determine how Gd could permit the Holocaust. But from the religious perspective of Jewish tradition, Rav Aharon’s answer makes perfect sense – there is, indeed, a non-intellectual limit on what I will ever comprehend, so that none of my answers, from any approach, will ever be accurate.

One could, of course, try to harmonize the Science and Religion approaches. One could claim that what Religion calls the limit on comprehension, Science calls a lack of data – we cannot understand Gd because we lack the tools to collect the relevant data.

But I don’t believe that this is what Religion is saying; Religion, in Jewish tradition, states definitively that human beings will never possess the tools to collect the data. We will simply live in philosophical limbo, trying to contend with our world while avoiding blasphemy, stupidity and arrogance.

[*The use of Ben Sira is all the more remarkable to me because non-Orthodox officiants are the ones who cite this passage. Ben Sira is not generally considered to be in the Orthodox liturgical canon, his presence in the Talmud notwithstanding.]

Evolution and the Moving Eye of the Flatfish

I am not a fan of the evolution/Creation debate. Aside from the frustrating fact that it never evolves beyond the same arguments, vitriol and narrow stereotyping, I am fundamentally embarrassed by some of the views espoused by the Creation side - and no argument is more embarrassing to me than the challenge, “That could not have evolved!”

This approach is as old as Darwin, and, indeed, he was stymied by a few cases from its class, such as, “The eye is so complex, it could not have evolved in successively functional steps.” It demands either a logical explanation for an evolutionary step, or, in the absence of such an explanation, it demands physical evidence that such an evolutionary step occurred.

But I don’t like or trust this approach.

One reason I don’t like this argument is that it rarely considers new evidence or arguments, relying instead on outdated literature. Every few years scientists discover another missing link, or develop another explanation for an unlikely evolutionary process, but the creationists never update their data to include, or refute, these findings. In response, evolutionists reject the creationist view as outdated – which, in this respect, it is.

A second reason I don’t like this argument is that it sets up an unfair logical playing field, demanding Reason from the evolutionist side but not from the creationist side. The evolutionist does not have a good theory and does not have all of the evidence to support his theory, and so the creationists are going to call him on his lack of evidence. But when the evolutionist calls the creationists on their own lack of evidence – ie where is Noah’s Ark? – then he is told to accept it on faith. If we can accept Creation on faith, the scientist must be able to accept a theory even in the absence of a complete constellation of evidence.

But the third and strongest reason I don’t like this approach is this: Evidence which is missing now may well be discovered later. Theories which are gapped today might be made whole with the passage of time. People who pin their hopes on today’s inadequate science are due for a surprise tomorrow.

Witness this ScienceDaily report from July (I meant to blog it ages ago, but never had the chance):
Flatfish Fossils Fill In Evolutionary Missing Link
Opponents of evolution have insisted that adult flatfishes, which have both eyes on one side of the head, could not have evolved gradually. A slightly asymmetrical skull offers no advantage. No such fish -- fossil or living -- had ever been discovered, until now.
All adult flatfishes--including the gastronomically familiar flounder, plaice, sole, turbot, and halibut--have asymmetrical skulls, with both eyes located on one side of the head. Because these fish lay on their sides at the ocean bottom, this arrangement enhances their vision, with both eyes constantly in play, peering up into the water…
But in the 10 July 2008 issue of Nature, Matt Friedman, graduate student in the Committee on Evolutionary Biology at the University of Chicago and a member of the Department of Geology at the Field Museum, draws attention to several examples of such transitional forms that he uncovered in museum collections of underwater fossilized creatures from the Eocene epoch--about 50 million years ago...
Friedman examined multiple adult fossil remains of two primitive flatfishes, Amphistium and a new genus that he named Heteronectes.
"Amphistium has been known for quite some time," he said. "The first specimen was described more than 200 years ago, but its placement in the fish evolutionary tree has been uncertain ever since. Close examination of these fossils yield clues that they are indeed early flatfishes."
The most primitive flatfishes known, both Amphistium and Heteronectes have many characteristics that are no longer found in modern flatfish. But the one that caught Friedman's attention was the partial displacement of one eye, evident even in the first Amphistium fossil discovered over two centuries ago.
"Most remarkably," he said, "orbital migration, the movement of one eye from one side of the skull to the other during the larval stage, was present but incomplete in both of these primitive flatfishes." For both sets of fossils, the eye had begun the journey but had not crossed the midline from one side of the fish to the other.
"What we found was an intermediate stage between living flatfishes and the arrangement found in other fishes," he said. These two fossil fishes "indicate that the evolution of the profound cranial asymmetry of extant flatfishes was gradual in nature."

I certainly believe that Gd created the universe, and I am no wiser than anyone else regarding the mechanism Gd used. But this I do know: Arguments predicated on " I found a gap in your theory" and "Where is your proof?" are doomed by the march of theoretical development and investigation.