Nazir 65b ~ The Zov, and Gonorrhea

The Zov in The Torah...

In Leviticus chapter 15 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.)

...And in the Talmud

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 today’s daf, (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).

 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 the Torah, 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 today we 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 new-born 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. 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 possibly 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.

Nazir 39a ~ Lice

איבעיא להו האי מזיא מלתחת רבי או מלעיל למאי?... ת"ש מהא אינבא חיה דקאים בעיקבא דבינתא ואי סלקא דעתך מלתחת רבי ברישא דבינתא בעי למיקם. לעולם מלתחת רבי ואגב חיותא נחית ואזיל אינבא

ת"ש אינבא מתה ברישא דבינתא ואי סלקא דעתך מלעיל רבי בעיקבא דבינתא בעי למיקם התם נמי משום דלית בה חילא שרוגי שריגא ואזיל...

A question was asked: Does hair grow from the roots or the tips?...Let us suggest an answer from the live nit [or louse - meaning is not certain] which is found at the root of a strand [of hair]. Now if the hair grew from the root, shouldn't the nit be found at the tip? [The Talmud rejects this suggestion:] The growth may well be from the tip, but the nit, being alive, continually moves down [towards the root].

Let us suggest an answer from the case of a dead nit [or louse, that is found] at the end of a strand [of hair].  If the hair grows from the end, shouldn't the dead nit be found near the root? [The Talmud rejects this suggestion too:]  Perhaps the dead nit has no power [to grasp the hair] and so as the hair grows from the root, the nit slides.

The louse nit (egg) with its adherent cylindrical sheath cemented to the hair shaft.  The free distal end (arrow) would be directed towards the hair tip.  The egg has a domed operculum (arrow) that contains air holes, allowing the maturing larvae to breath.From Burkhat el al.  The adherent cylindrical nit structure and its chemical denaturation in vitro. Arch. Pediatric Adolescent Medicine 1988. 152; 711.

Pediculosis Humanus Capitas

Pediculosis Humanus capitas is the long scientific name of the tiny head louse.  The female, less than 3mm long, lives for about a month, and in that time lays over three hundred eggs.  The eggs are laid on a shaft of hair close to the scalp, where, warmed by the skin of their itchy host, they incubate for two weeks before hatching.  The new lice emerge, grow for about 12 days, mate, and lay their eggs, and the cycle continues. Humans are the only known host of these lice, and somewhere in this cycle you as a parent may get a call to come and take your child out of school because they have been found to have head lice, or nits, the name given to their eggs.  About 15% of school age children in the UK have head lice, while in the US estimates range from 6-12 million infestations per year. In the US, the cost to treat those millions of infestations is more than $350 million.

True story: Many years ago while working in an emergency department in Boston, I received a call from the (warm and loving Jewish) preschool my children then attended.  My daughter had nits, and could not attend class. Despite my explaining that I could not leave my shift in the ED to come and get her for as trivial a reason as head lice, the school was adamant. She remained outside the classroom until arrangements to pick here up were made.  I do hope the psychological damage was minimal.

“No healthy child should be excluded from or allowed to miss school time because of head lice. “No nit” policies for return to school should be discouraged.”

— Barbara L. Frankowski, Leonard B. Weiner, Committee on School Health and Committee on Infectious Diseases. Head Lice. Pediatrics 2002: 110 (3); 642.

Fortunately, the American Academy of Pediatrics issued a report on head lice in 2002, and though it came too late for me, their advice supported my decision. Here's what they suggested:

Because a child with an active head lice infestation has likely had the infestation for a month or more by the time it is discovered, poses little risk to others, and does not have a resulting health problem, he or she should remain in class but be discouraged from close direct head contact with others. If a child is assessed as having head lice, confidentiality must be maintained so the child is not embarrassed. The child’s parent or guardian should be notified that day by telephone or a note sent home with the child at the end of the school day stating that prompt, proper treatment of this condition is in the best interest of the child and his or her classmates. 

Head Lice in Antiquity

Head lice have been with us for a long, long time, as evidenced by the Talmud's clear acquaintance with them.  Amazingly though, remains of a head louse have been identified on a louse comb from the Roman period that was discovered near the Dead Sea. (Even older remains have been found on the hair from Egyptian mummies, and nine-thousand year old lice eggs were found on human remains in Nahal Hemar near the Dead Sea.) "The comb was most probably used by inhabitants of the village of En Gedi, who were preparing a place of refuge in the cave, which would have been well equipped with food in baskets, storage jars and a large water pool before the end of the Bar Kokba Revolt in 135 CE." 

Wooden comb found in the Cave of the Pool, near Nahal David in the Dead Sea region. It was discovered in 1961.  From Mumcouglu and Hadas. Head Louse (Pediculus humanus capitis) Remains in a Louse Comb from the Roman Period Excavated in the Dead Sea Region. Israel Exploration Journal, Vol. 61, No. 2 (2011), pp. 223-229 

Head Lice More Recently

The House of Twenty Thousand Books, by Sasha Abramsky, was just published by the New York Review of Books (and was reviewed in The Wall Street Journal last week.)  It is wonderful read about the life, and library, of Chimen Abramsky (1916-2010) who was the son of the great Dayan Yechezkiel Abramsky, (1886-1976) head of the London Bet Din. Chimen (pronounced Shimon) who eventually became a professor of Jewish Studies at University College London, was an expert on Jewish books and built a significant collection of his own, which is detailed in the book. He also served as an advisor to Sotheby's and to Jack Lunzer, who built the greatest privately owned Jewish library in the world. Anyway, I came across this passage in the book, reminding us that presence of head lice was not just an annoyance - it was a way of life: 

Infant and childhood mortality soared in these years [of the First World War] in part because of the prevalence of diseases such as typhus - which  presumably explains why, in early photographs, the heads of Chimen and his brothers are shorn, to county the typhus-carrying lice.  Isaac Bashevis Singer, who was a few years older than Chimen, and like Chimen was brought up in a devout household...recalled having his sidelocks and head hair shaved off for this reason during the First World War...he wrote in his essay "The Book"..."I saw my red sidelocks fall and I knew this was the end of them. I wanted to get rid of them for a long time." (Sasha Abramsky. The House of Twenty Thousand Books. NYRB 2015. 57-58.)

For the Nazir, hair is a central part of his religious identity, and once that identity is no-longer needed, the hair is shaved off.  Which is exactly what Isaac Bashevis Singer felt too. 

The Lunar Eclipse You Can See From Your Sukkah

As we've noted before, a solar eclipse can only occur at the start of  a Hebrew month, as the moon gets between the sun and the earth.  A lunar eclipse is also linked to the Jewish month, and can only occur around the 15th day of the month, when the moon is full.  As the earth passes between the sun and the moon, its shadow is cast onto the moon, resulting in an eclipse.

 So why don't we see a lunar eclipse every month? The answer is simple. The moon's orbit is inclined at 5 degrees from the sun-earth plane, so that each month the moon may be slightly above, or slightly below that plane. And a lunar eclipse will occur only when the three bodies line up on the same plane.  

Tonight - The Great Sukkot Lunar Eclipse

Tonight, Sunday night September 27th, is the 15th of Tishrei, and of course the first night of Sukkot. It will also be the night of a lunar eclipse, and will be visible to many of us. (Not you Australia. Or Japan.) Just when you'll be able to see the lunar eclipse, and how much of an eclipse you will see, is shown on this NASA chart:

Chart Courtesy of NASA.  P1=00:11:47UT.  U1= 01:07:11UT.    U2= 02:11:10UT.  U3=03:23:05UT. U4=04:27:03UT. P4=05:22:27UT.

The lunar eclipse will be more spectacular than usual, because the moon will be at its closest point as it orbits the earth. This makes it appear about 7% larger than usual, when it takes on the unjustified title of a supermoon. The moon will appear to turn red, as it enters the shadow of the earth, and for this reason it is sometimes called a blood moon.

The Talmud on Eclipses

תלמוד בבלי סוכה דף כט עמוד א 

תנו רבנן: בזמן שהחמה לוקה - סימן רע לעובדי כוכבים, לבנה לוקה - סימן רע לשונאיהם של ישראל, מפני שישראל מונין ללבנה ועובדי כוכבים לחמה...

תנו רבנן: בשביל ארבעה דברים חמה לוקה: על אב בית דין שמת ואינו נספד כהלכה, ועל נערה המאורסה שצעקה בעיר ואין מושיע לה, ועל משכב זכור, ועל שני אחין שנשפך דמן כאחד

Our Rabbis taught, A solar eclipse is a bad omen for idolaters; a lunar eclipse is a bad omen for Israel, because Israel reckons [its calendar] by the moon, and idolaters by the sun...

Our Rabbis taught, A solar eclipse happens because of four things:
1. When an Av Bet Din [head of the Rabbinic Court] died and was not properly eulogized;
2. If a betrothed girl cried out aloud in the city and there was no-one to save her [from being raped];
3. Because of homosexuality; and
4 If two brothers were killed at the same time.

That's what we have - four causes of a solar eclipse, and none for a lunar eclipse - we are just told that it is a "bad omen for Israel." And how does Rashi explain this passage?  לא שמעתי טעם בדבר  - "I have not heard any explanation for this." 

LATER JEWISH EXPLANATIONS OF A SOLAR ECLIPSE

If we know that eclipses are regular celestial events whose timing is predictable and precise, how are we to understand Talmud in Sukkah, which suggests that an eclipse is a divine response to human conduct? We have already seen that Rashi was unable to explain the passage, but that didn't stop others from trying.  The Maharal of Prague (d. 1609) has a lengthy explanation which you can read here.  It goes something like this: "Yes, an eclipse is a mechanical and predictable event. But in truth, if there was no sin, there would be no eclipses, because God would have designed the universe differently, and in such a sin-free universe...there would be no need to design an eclipse." So the Maharal suggests that in a sin-free universe, the moon would not orbit as it does now, at a 5 degree angle to the sun-earth plane.  But where would the moon be? It couldn't be in the same plane as the sun and the earth, since then there would be an solar eclipse every month. If it were at say 20 degrees above the plane, then there would still be both solar and lunar eclipses, though they would be more rare. The only way for there to be no solar eclipses (in the Maharal's sin-free imaginary universe) would be for the moon to orbit the earth at 90 degrees to the sun-earth axis.  Then it would never come between the sun and the earth, and there could never be a solar eclipse. Perfect, except then there would never be a Rosh Chodesh, and the moon would always be visible. Oy.

יערות דבש דרוש י׳ב

Another attempt to explain the Talmud was offered by Jonatan Eybeschutz (d. 1764). In 1751 Eybeschutz was elected as chief rabbi of the Three Communities (Altona, Hamburg, and Wandsbek), and was later accused of being a secret follower of the false messiah Shabtai Zevi. In January 1751, Eybeschutz gave a drasha in Hamburg in which he addressed the very same problem that Maharal had noted: if a solar eclipse is a predictable event, how can it be related to human conduct? His answer was quite different: The Talmud in Sukkah is not actually addressing the phenomenon that we call a solar eclipse. According to Eybeschutz, the phrase in Sukkah "בזמן שהחמה לוקה" actually means - "when there are sunspots."

Inventive though this is, it is as implausible as the suggestion of the Maharal. In the first place, sunspots could not have been seen prior to the invention of the telescope. They were first described in March 1611 by a contemporary of Galileo named Christopher Scheiner (though Galileo lost no-time in claiming that he, not Scheiner was the first to correctly interpret what they were.)  Because sunspots could not have been seen, this cannot be what the rabbis in Gemara Sukkah were describing.

Christopher Scheine, Rosa Ursina sive Sol (Bracciai 1626-1630)

Second, according to Eybeschutz, sunspots "have no known cause, and have no fixed period to their appearance".  We can't fault Eybeschutz  for his first claim, but - even by the science of his day - his second was not correct. In fact both Scheiner and Galileo knew  - and wrote - that sunspots were permanent (at least for a while) and moved slowly across the face of the sun.

It's interesting to note that Galileo got very excited about the discovery that the spots moved across the face of the sun. This suggested (though it did not prove) that the sun itself was spinning. Galileo had also discovered that Jupiter was orbited by moons. Both of these discoveries now added further support to the Copernican model in which the Earth was spinning on its ownaxis, and was not the center of all the movement of objects in the sky. But Eybeschutz did not believe Copernicus was correct: "Copernicus and his supporters have made fools of themselves when they declare that the Earth orbits [the Sun]. They have left us with a lie, and the truth will bear itself witness that the Earth stands still for ever."  Eybeschutz wanted to have sunspots explain away a talmudic mystery, but he dismissed the evidence that they provided in other matters - namely, that the earth moves.

Looking at the Eclipse while Sitting in the Sukkah

This coming Sunday, the first night of Sukkot, those of us on the east coast of the United States will be able to peak the lunar eclipse (weather permitting) as we begin our first meal (weather permitting) in the Sukkah. In Europe and Israel you will need to stay up later, perhaps glancing at the red moon through a now darkened Sukkah. On the west coast of the United States, the moon will be eclipsed as it rises.  A lunar eclipse coinciding with Sukkot is not a rare event; the last time it happened was...last year.  However, last year's eclipse was not visible to the vast majority of those sitting in their Sukkot, unless you were on the west coast of the US, in Sydney Australia, or crossing the Pacific.  But consider this: the next time you'll be able to witness a total lunar eclipse while sitting in your Sukkah will not be until 2033 (for those in Australia, the Pacific, and the western US).  For those in western Europe and the eastern US, you will have to wait until 2080. So I plan to enjoy this total eclipse of the the sukkot supermoon, because I won't see another.   

Nazir 28b ~ The Not So Dead Sea

Over the last several pages the Talmud has ruled on 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.  Consider, for example 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.)

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], the money is thrown into the Dead Sea...   

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.

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) 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)