Parshat Shoftim -
6 Elul 5765 / September 9-10, 2005
The Coming Week's Daf Yomi by Rabbi Adin Steinsaltz
Shabbat 129a – 135b
This essay is based upon the insights and chidushim (original ideas) of Talmudic scholar Rabbi Adin Steinsaltz, as published in the Hebrew version of the Steinsaltz Edition of the Talmud.
This week’s Daf Yomi covers the end of the eighteenth chapter (“Perek Mefanin”) and most of the nineteenth chapter (“Perek Rabbi Eliezer d’Milah”) of Masechet Shabbat. Among the topics discussed and analyzed in these two chapters are several issues that deal with medicine and the view of the Rabbinic sages regarding medicinal issues generally, and the practice of medicine on Shabbat specifically.
According to the Mishnah (128b), a woman in labor should be assisted on Shabbat, even if her care involves what would ordinarily be considered desecration of the Shabbat (Hillul Shabbat). The Gemara distinguishes between different levels of illness. For example, someone whose life is in danger can get any treatment at all on Shabbat, even if a Biblical prohibition is involved; if there is possibly a danger to life, we are somewhat more stringent. It is important to note that, according to the Gemara (129a), the subjective concerns of the patient are taken into account. This is true to the extent that, even if doctors testify that there is no danger to life, if the patient expresses concern, we may permit even Biblical prohibitions to ease the mental anguish that can potentially lead to real danger.
According to Rashi, the source for the rule “Safek Nefashot LeHakel” (whenever there is a concern for life, we must rule leniently) is a Biblical passage that appears in the context of the Torah’s rules about an Ir Miklat – a city of refuge. There the Torah instructs the community to save the individual, from whence we derive that in every case where there is a threat to life, the religious courts are obligated to find ways to save the person whose life is threatened.
As far as the woman who gave birth is concerned, the Gemara rules that, for the first few days after birth, both she and her newborn are considered to be in mortal danger, and everything can be done for them without concern for Hillul Shabbat. As an example, the Gemara (129a) permits lighting a fire for a woman who has just given birth. While the Gemara seems to indicate that this is done on behalf of the mother, it would appear that heat can be helpful to a newborn suffering from a condition known as “cold enjury”.
One popular medical treatment in the time of the Gemara – and, indeed, until fairly recently – was bloodletting, which allowed harmful elements to exit the body, and, in certain cases, also lowered blood pressure. Nevertheless, it was known that this treatment had to be used sparingly, particularly for older people. The Amora Shmuel, therefore, records a schedule for bloodletting, allowing it only once a month for younger people, and less frequently as people aged (129b). According to Rabbenu Hananel, after age 50, bloodletting was recommended only once every two or three months, and beyond that only once or twice a year.
The Gemara recognized the potential danger involved in bloodletting, as well as the importance of replacing the lost blood and strengthening the body. It therefore recounts various methods used by the Rabbis to strengthen themselves, including eating meat, drinking wine and keeping warm (129a). Eating meat – the Gemara specifically mentions eating spleen – could very well have helped raise the level of hemoglobin in the body; the wine and heat may have constricted the person’s blood vessels, thereby raising blood pressure.
In the context of discussing the performance of a brit milah (circumcision) on Shabbat in the nineteenth chapter, the Gemara further addresses health issues. The Amora Abayye quotes his adoptive mother as recommending a series of treatments for sick children (134a).
Abayye said: Mother told me, An infant whose anus is not visible should be rubbed with oil and stood in the sun, and where it shows transparent it should be torn crosswise with a barley grain, but not with a metal instrument, because that causes inflammation.
Abayye also said: Mother told me, If an infant cannot suck, his lips are cold. What is the remedy? A vessel of burning coals should be brought and held near his nostrils, so as to heat it; then he will suck.
Abayye also said: Mother told me, If an infant is too red, so that the blood is not yet absorbed in him, we must wait until his blood is absorbed and then circumcise him. If he is green, so that he is deficient in blood, we must wait until he is full-blooded and then circumcise him.
All of these describe known medical conditions. Some newborns suffer from a congenital condition known as atresia ani, where the rectum is not visible. It can be corrected with the appropriate surgical procedure.
The cold can create a condition where muscle movement – including movement of the jaw muscles – is limited. In such cases, warming the room may likely bring relief of the problem.
A number of suggestions have been made to explain the cases of the red and green newborn. The red child may have been suffering from a rare hereditary condition known as neonatorum purpura. The green child likely suffered from hemolytic jaundice of the newborn, which is also a hereditary condition.
According to the Gemara (134a), Rabbi Natan, in the course of his travels, recommended to mothers whose first children died after circumcision and appeared to suffer from these hereditary medical conditions that, with their subsequent children, they wait until the newborns are a little older and no longer show the symptoms of red or green. In both cases, Rabbi Natan relates that the children who survived were named “Natan HaBavli” in his honor.
It was well known to the Gemara that the full human gestation period is nine months long. One ruling of the Gemara that is difficult to understand is that one is Mehalel Shabbat (“desecrates” Shabbat) for a child born after seven months, but not for one who was born after eight months (135a). This is based on a well-accepted tradition in the ancient world – one which has no basis in medicine – that a baby born after seven months had a good chance of survival, while a baby born after eight months had no such chance. As far as the halakha is concerned, the point is moot, since we do not rely on the number of months of gestation in order to determine whether the baby may survive. Today, the decision is based primarily on the stage of the baby’s physical development.
In addition to his monumental translation and commentary on the Talmud, Rabbi Steinsaltz has authored dozens of books and hundreds of articles on a variety of topics, both Jewish and secular. For more information about Rabbi Steinsaltz’s groundbreaking work in Jewish education, visit www.steinsaltz.org or contact the Aleph Society at 212-840-1166.