Bava Kamma 105b ~ Teaching By Humiliation

בבא קמא קה, ב

אמר ליה תדורא...

Rabbah said to Rav Amram : "Scatterbrain" 

As a medical student in London, humiliation came with the territory. There I was, on rounds on General Surgery Firm. At its head, the consultant surgeon.  Followed (in their correct pecking order) by two senior registrars, three or four registrars, several senior house officers and house officers, nurses, physiotherapists, and a couple of medical students.  We gathered around the bed of some poor patient who had recently undergone surgery. The consultant surgeon turned to me: "Mr. Brown" he said, looking at me atop of his professorial reading glasses, "how long is the anal canal?" Everyone else smiled, relieved to know they had not been asked this, rather challenging question. I had no idea, despite having once known this useful fact to pass my anatomy exams. "Thirty centimeters, sir" I replied, hopefully.  "Correct," said the surgeon, as he surveyed the menagerie of staff trailing him.  "If you are an elephant." And so ended my surgical career.

Teaching By Humiliation in the Talmud

The rabbis of the Talmud were not shy to call out those they felt were slow-witted or annoying. After Rabbi Yehudah HaNasi was asked a relatively innocent question by Levi, the great editor of the Mishnah replied כמדומה לי שאין לו מוח בקדקדו - "it appears to me that Levi has no brains in his head," an insult he repeated on at least one other occasion. Rabbi Tarfon had enough of  Rabbi Elazar when he told him "How long will you pile up meaningless  words and bring them against us." He even used the same insult against Rabbi Akivah. Rabbi Akivah! (See ילקוט שמעוני תורה פרשת בהעלותך רמז תשכה.) Rabbi Yishmael was called "a date palm" (and not in a good way) by Rabbi Eliezer (see ספרא תזריע פרשה ה).  One of my favorites, though, came from Rabbi Dosa who called his  younger brother "the first-born of Satan" (and you thought your kids had issues).  I could go on, but you get the point. These guys could be really insulting.

Pimping in the Medical Literature

For the reader who is not medically trained, here's a new word: pimping. It's a real word that is OK to use in polite company (maybe).  According to the esteemed Journal of the American Medical Association, pimping is

a series of difficult and often intentionally unanswerable questions posed to a medical student or house staff in quick succession. The objective of pimping is to teach, motivate, and involve the learner in clinical rounds while maintaining a dominant hierarchy and cultivating humility by ridding the learner of egotism.

There is an art to pimping, according to Fredrick Brancati, the man generally thought to have invented the term in its medical content. Here is an excerpt from his classic 1989 paper, called, what else, The Art of Pimping:

Pimp questions should come in rapid succession and should be essentially unanswerable. They may be grouped into five categories:

1. Arcane points of history.These facts are not taught in medical school and are irrelevant to patient care—perfect for pimping. For example, who performed the first lumbar puncture? Or, how was syphilis named?

2. Teleology and metaphysics.These questions lie outside the realm of conventional scientific inquiry and have traditionally been addressed only by medieval philosophers and the  editors of the National Enquirer. For instance, why are some organs paired?

3. Exceedingly broad questions. For example, what role do prostaglandins play in homeostasis? Or, what is the differential diagnosis of a fever of unknown origin? Even if the intern begins making good points, after 4 or 5 minutes he can be cut off and criticized for missing points he was about to mention. These questions are ideally posed in the final minutes of rounds while the team is charging down a noisy stairwell.

4. Eponyms. These questions are favored by many old-timers who have assiduously avoided learning any new developments in medicine since the germ theory. For instance, where does one find the semilunar space of Traube? 

5. Technical points of laboratory research. Even when general medical practice has become a dim and distant memory, the attending physician-investigator still knows the details of his research inside and out. For instance, how active are leukocyte-activated killer cells with or without interleukin 2 against sarcoma in the mouse model? Or, what base sequence does the restriction endonuclease EcoRI recognize?

“....pimping can create a hostile environment among the team members, suppress creativity or intellectual curiosity because of fear of embarrassment, and dehumanize students at the expense of maintaining medical hegemony.”

— McCarthy, CP. McEvoy, JW. Pimping Medical Education. JAMA 2015; 314 (22). 2347-2348.

 Last year an Australian team published a paper titled "Teaching by humiliation” and mistreatment of medical students in clinical rotations. They found that 74% had experienced and 83% had witnessed teaching by humiliation during their adult clinical rotations; smaller proportions had experienced (29%) or witnessed (45%) it during their pediatric rotations, which just proves what everyone already knows.  Pediatricians are all nice. All this pimping comes with a down side. "Students’ responses to these practices" wrote the Australian researchers, "ranged from disgust and regret about entering the medical profession to endorsement of teachers’ public exposure of a student’s poor knowledge. Reported victims and perpetrators included junior medical staff, who were subjected to the practices as much as students and were equally likely to be the perpetrators, alongside senior medical and nursing staff."

“As a deeply ingrained cultural, institutionalised practice, mistreatment requires focused action to replace the existing culture with one of compassion, tolerance and respect.”

— Scott, KM. et al. “Teaching by humiliation” and mistreatment of medical students in clinical rotations: a pilot study. Medical Journal of Australia 2015; 203(4): 1-6

Talmudic Insults and Respect for the talmid

In today's page of Talmud, Rabbah called Rav Amram תדורא, a scatterbrain. In fact he called him a scatterbrain again (in the next tractate we will learn), so I guess he really meant it.  This epithet seems to have been the "moron' of its day. Rabbi Hiyya bar Abba called Rebbi Zeira a scatterbrain, and  even the great Abayye must have felt a little miffed when he was called a scatterbrain by Rava bar Hannan.  

It seems demeaning to use language like this, and out of place given the words of the Mishnah (Avot 2:10) יהי כבוד חבירך חביב עליך כשלך - "let your friend's honor be as important to you as your own." Rabbi Yair Chaim Bachrach (Germany, 1638-1732) addressed talmudic insults in his book of responsa called Chavvot Yair, first published in 1699. Apparently things were getting out of hand in Germany, where the talmudic art of humiliating had evolved. Yeshivah students now also yelled and gesticulated rather enthusiastically as they sparred with their learning partners:

 מש"כ קפיצה וסיפוק וריקוד תוך הפלפול איש נגד רעהו שזה גורם בלי ספק שחבירו ימהר לעשות כמעשהו וירקוד ג"כ כנגדו וירים קולו בצעקה גדולה ומרה יותר ולא ישמע איש שפת חבירו ואין זה רק מנהג יהוא וכל המרבה בה ה"ז משוגע 

Students jump and dance around each other in the middle of expounding a subject, and this will cause, without doubt, that other students will do the same and will leap and raise their voices in a louder and more bitter cry. No one will be able to listen to the voice of his partner. This is nothing other than a ridiculous custom, and anyone who does this often is a mesgugah...  

Rabbi Bachrach then rose to the defense of those who used talmudic insults, claiming that they did so with only good intentions. They did it, he said, in order to bring out the very best they could in those they insulted. Hmmm. I'm not convinced.

Insults don't work, not for medial students and not for any students.  Ad hominem attacks are also unlikely to elevate the quality of an argument. In this final run up to the US presidential elections we are likely to see more of both forms of  disrespect, though they usually say more about the person uttering them than the person against whom they are directed.  

“ תנו רבנן: שלשה שונאין זה את זה, אלו הן: הכלבים, והתרנגולין, והחברין. ויש אומרים: אף הזונות. ויש אומרים: אף תלמידי חכמים שבבבל
The rabbis taught: three groups hate each other: Dogs, roosters, and sorcerers. Some say: so do prostitutes. And others say: so do the sages in Babylon...”

— פסחים דף קיג עמוד ב

Bava Kamma 90a ~ The Prosecution & Punishment of Animals

בבא קמא צ, א 
תנו רבנן שור תם שהמית והזיק דנין אותו דיני נפשות ואין דנין אותו דיני ממונות מועד שהמית והזיק דנין אותו דיני ממונות וחוזרין ודנין אותו דיני נפשות קדמו ודנוהו דיני נפשות אין חוזרין ודנין אותו דיני ממונות 

The rabbis taught: a tam ox that killed a person and inflicted damages, is tried first for the capital case and is not tried for the damages. A muad ox that killed a person and inflicted damages is tried first for the damages and is then tried for the capital case.

The notion that an animal should be tried for a crime is a completely foreign one to our modern sensibilities. Animals do not commit crimes; they act on instinct. When those instincts lead to a conflict with human society animals might be removed, or killed. But tried for a crime? Isn’t that an odd notion? Not so much, it turns out.

On the prosecution of animlas

In her review article The historical and contemporary prosecution of animals, Professor Jen Girgen noted that the formal prosecution of animals existed for centuries. Aristotle (d.322 BCE) mentioned animal trials in Athens, although there is no direct evidence of them having taken place in ancient Greece. The earliest known records of animal trials are from the mid-13th century. For example, in France in 1386, a pig was put on trial for the death of a child:

The defendant was brought before the local tribunal, and after a formal trial she was declared guilty of the crime. True to lex talionis, or "eye-for-an- eye" justice, the court sentenced the infanticidal malefactor first to be maimed in her head and upper limbs and then to be hanged. A professional hangman carried out the punishment in the public square near the city hall. The executioner, officially decreed to be a "master of high works," was issued a new pair of gloves for the occasion in order that he might come from the discharge of his duty, metaphorically at least, with clean hands, thus indicating that, as a minister of justice, he incurred no guilt in shedding blood.

In medieval times, animals were tried in two different court systems. The Church handled cases in which animals were a public nuisance (usually because they ate a farmer’s crops) while secular courts judged cases involving the physical injury or death of person.  Apparently these trials were taken seriously: “The community, at its own expense, provided the accused animals with defense counsel, and these lawyers raised complex legal arguments on behalf of the animal defendants. In criminal trials, animal defendants were sometimes detained in jail alongside human prisoners. Evidence was weighed and judgment decreed as though the defendant were human.”  Animals that faced these trials included swans, rodents, dolphins (dolphins!) grasshoppers, and, in 1713, a nest of termites, which was I suppose fair enough. The termites were munching their way through a monastery, devouring the friars' food, destroying their furniture, and even threatening to topple the walls of the monastery. 

“The ox is to be executed, not because it had committed a crime, but rather because the very act of killing a human being- voluntarily or involuntarily-had rendered it an object of public horror.
”

— JJ Finkelstein. The ox that gored. Transactions of the American Philosophical Society, Vol. 71, No. 2 (1981), pp. 1-89

The animals that faced prosecution would rarely appear in court on their trial day (because, I suppose, they had other things on their mind) so they usually lost the case by default.  Here’s a fairly typical example. In 1575 weevils were helping themselves to the vineyards in a picturesque hamlet in France, and were brought to trial:

The plaintiff and the two lawyers appointed as counsel for the beetle defendants presented their respective sides of the case…Pierre Rembaud, the beetles' newly appointed defense counsel, made a motion to dismiss the case. Rembaud argued that, according to the Book of Genesis, God had created animals before human beings and had blessed all the animals upon the earth, giving to them every green herb for food. Therefore, the weevils had a prior right to the vineyards, a right conferred upon them at the time of Creation… While the legal wrangling continued, the townspeople organized a public meeting in the town square to consider setting aside a section of land outside of the Saint Julien vineyards where the insects could obtain their needed sustenance without devouring and destroying the town's precious vineyards. They selected a site named "La Grand Feisse" and described the plot "with the exactness of a topographical survey."…However, the weevils' attorney declared that he could not accept, on behalf of his clients, the offer made by the plaintiffs. The land…was sterile and not suitable to support the needs of the weevils. The plaintiff’s attorney insisted that the land was, in fact, suitable and insisted upon adjudication in favor of the complainants. The judge decided to reserve his decision and appointed experts to examine the site and submit a written report upon the suitability of the proposed asylum.

How did this case end? We have no idea.  The last pages of the court records were (I kid you not) eaten by insects.  

The Source- our Hebrew Bible

The impetus for all this, according to historians, was our own Hebrew Bible, or more precisely, the passage from Exodus 21:28.

וְכִי-יִגַּח שׁוֹר אֶת-אִישׁ אוֹ אֶת-אִשָּׁה, וָמֵת סָקוֹל יִסָּקֵל הַשּׁוֹר, וְלֹא יֵאָכֵל אֶת-בְּשָׂרוֹ, וּבַעַל הַשּׁוֹר, נָקִי

"If a bull gores a man or woman to death, the bull is to be stoned to death, and its meat must not be eaten. But the owner of the bull will not be held responsible.

The Jewish scholar Bernard Jackson, (who seems to have spent his entire career studying the legal history of the goring ox,) noted this connection.  “The stoning of the goring ox”, he wrote, 

… may well have been the parent, rather than the child, of the idea of divine punishment of animals .... [O]nce the concept of divine punishment of animals became established, it could then be transferred back to the legal sphere as a primarily penal notion.

What sense can we make of these medieval trials – and what sense can be made of the earlier Talmudic law that also placed animals on trial for their actions? Girgen suggests a number of possible ways to explain these trials, which seem to have become increasingly popular in the middle ages. 

1. Rehabilitation of the offending animal. This is not a satisfying explanation, since “these proceedings usually ended with the execution of the animal.” That left little opportunity for rehabilitation.

2. Retribution, which is another word for revenge. Indeed, this is precisely the notion reflected in the biblical law of “an eye for an eye”- although of course that was not the way the rabbis of the Talmud interpreted the verse. Under Roman law, the Torah law of עין תחת עין was called lex talionis – the law of retaliation. This need to retaliate was, according to Justice Oliver Wendell Holmes, a key feature of early legal systems, which were “…grounded in vengeance.”

3. Revenue for the king. This would only explain cases in which the animal was impounded or confiscated from the owner and given over to the king or local lord. But this did not happen when the animal was executed – which apparently was a frequent outcome of these trials.

4. The elimination of a social danger. Now, this begins to sound familiar. In the US and other western countries, vicious dogs are, after all, put down, and when this happens we breathe a collective sigh of relief. So by sentencing a dangerous animal to death, the courts were making life safer for everyone else.

5. Deterrence – that is, “to dissuade would-be criminals - both animal and human-from engaging in similar offensive acts”. As the legal scholar Nicholas Humphrey noted, "if word got around about what happened to the last pig that ate a human child, might not other pigs have been persuaded to think twice?” That implies endowing animals with an agency that we would consider today to be quite fanciful. So perhaps the deterrent effect was not aimed at other animals, but rather at other humans – deterring them from committing these kinds of horrible crimes.

6. Establishing control in a disorderly world. Perhaps these trials were a search for order in a world of chaos. “Just as today,” wrote Professor Humphries “when things are unexplained, we expect the institutions of science to put the facts on trial ... the whole purpose of the legal actions was to establish cognitive control.". The good professor continues:

What the Greeks and mediaeval Europeans had in common was a deep fear of lawlessness: not so much fear of laws being contravened, as the much worse fear that the world they lived in might not be a lawful place at all. A statue fell on a man out of the blue; a pig killed a baby while its mother was at Mass; swarms of locusts appeared from nowhere and devastated the crops .... To an extent that we today cannot find easy to conceive, these people of the pre-scientific era lived every day at the edge of explanatory darkness.

By defining events as crimes rather than as natural occurrences, they could be placed within a legal context – and controlled. The late JJ Finkelstein of Yale University (d. 1974) wrote one of the most detailed studies of the ox that gored (called, rather unimaginatively, The Ox that Gored). On page 24 of his 86-page essay he addressed this aspect:

[T]he "crime" of the ox that gored a person to death is not just to be found in the fact that it had "committed homicide.". . .The real crime of the ox is that by killing a human being-whether out of viciousness or by an involuntary motion, it has objectively committed a de facto insurrection against the hierarchic order established by Creation.

Trials of animals in more recent Times

Animal trials continued well into the twentieth century. In 1906 in Switzerland a dog was sentenced to death for killing a man, while his masters – who had used the dog to help them rob the man - were sentenced to life in prison. In 1924, Pep, a Labrador retriever, was accused of killing Pennsylvania Governor Gifford Pinchot's cat. 

The dog was tried (without the assistance of counsel) in a proceeding led by the Governor himself. Governor Pinchot found Pep responsible for the cat's death and sentenced the dog to life imprisonment in the Philadelphia State Penitentiary. Pep died of old age, still incarcerated, six years later… And in 1927, a dog was reportedly tried and incarcerated by a Connecticut justice of the peace for "worrying the cat of a neighbor lady.”

In fact, “trials” of dangerous animals continue to this day. Depending on where you live, a judge may rule an animal to be dangerous if it has attacked others, and may order it destroyed.  This is what happened in New Jersey in 1991, when Taro, a 110 lb Japanese Akita dog was sentenced to death by a judge in Bergen County, after it had apparently attacked its owner’s niece. Taro’s owner appealed the verdict and the dog remained on death row for three years, until the order to execute the dog was upheld.  That’s when newly elected Governor Christin Todd Whitman issued an executive order and reprieved the dog, which by now had been imprisoned for more than one thousand days at a cost to the state of more than $100,000. Taro was exiled from New Jersey, and died in her sleep five years later. 

What do we talk about when we talk about punishment?

What is it that we want to see happen when we call for a criminal to be “punished”?  This simple question has been answered by legal scholars and judges who have written about theories of punishment, but we knew little about what the average citizen wants to see happen when a punishment is imposed. 

In a series of experiments published in 2002, psychologists from Princeton and Northwestern University studied the motivation underlying use of punishment in a group of students; that is to say, in people with no special legal training or background. What are the motives of ordinary people when they wish to punish a criminal? (Ok, they weren’t exactly “ordinary people, since they were Princeton University students, but still…)The two specific motives they contrasted were just deserts and deterrence. The “just desserts” theory is the belief that when punishing a criminal, our concerns should not be about future outcomes like rehabilitation, but rather about providing a punishment appropriate for the given crime. “Although it is certainly preferable that the punishment serve a secondary function of inhibiting future harmdoing, its justification lies in righting a wrong, not in achieving some future benefit. The central precept of just deserts theory is that the punishment be proportionate to the harm.”  So what motivates the theory of punishment in ordinary people? Does it come from a deservingness perspective, in which the focus is on atoning for the harm committed, or from a utilitarian, deterrence perspective, in which the focus is on preventing future harms against society? 

The psychologists found that in sentencing hypothetical criminal perpetrators, their student subjects responded to factors associated with the “just deserts theory” and ignored those associated with deterrence. This desire to see a criminal get his just desserts is also found when animals are put on trial.  More recent work by the psychologists Geoffrey Goodwin and Adam Benforado also addressed the way in which we view punishment as retribution.  They asked volunteers (found on-line using something called Amazon's Mechanical Turk interface) about a number of different scenarios in which animals had killed or injured people. In five different studies the results demonstrated "...clear evidence for the existence of retributive motives and for a broader conception of the viable targets of retribution."

Back to the goring ox

In the view of J.J. Finkelstein, the Yale scholar, “the system of categorization reflected in the biblical statement of the laws of the goring ox is essentially the same as our own… the cosmic apprehension of the biblical authors, the way in which the Bible perceives and classifies the world of experience, is in every fundamental respect identical with ours, that is, with that of the civilization we usually describe as "Western.” Once we understand that animal trials were not just an interesting quirk mentioned in today’s page of Talmud, but were – and still are - a common part of the judicial process, Finkelstein’s claim view is entirely plausible.  This, together with the insights from the field of psychology about what motivates people to punish others, leads us to a remarkable conclusion.  Moderns, like those before us, seek to punish, not to rehabilitate the criminal or deter others from committing a crime, but because the criminal “deserves to be punished”. It matters not one bit if that criminal is a human, a dog, or an insect.  

Bava Kamma 85a ~ Is Honey Bad For You?

בבא קמא פה,א 

כדתניא הרי שעבר על דברי רופא ואכל דבש או כל מיני מתיקה מפני שדבש וכל מיני מתיקה קשין למכה והעלה מכתו גרגותני יכול יהא חייב לרפאותו ת"ל רק

It was taught in a Braisa: If the victim of an assault disobeyed the advice of his doctor and ate honey or all types of sweets - and this violated his doctor's instructions because honey and all types of sweets are harmful for a wound - it could be thought that the assailant is still obligated to heal the victim. Therefore the Torah uses the word רק (only) to teach otherwise...(Bava Kamma 85a)

Secretions of the honey bee. From Israili, Z. Antimicrobial Properties of Honey. American Journal of Therapeutics 2014. 21; 304–323.

Three days ago we studied the medical effects of garlic, and noted that although the Talmud praises it for its health effects, there is conflicting evidence as to its efficacy. Today, we turn to honey, which has been used as a medicine for at least the last 3,000 years.  It is therefore very surprising that in the culture that gave birth to the Talmud, honey was thought to be bad for your health.  As we will see, honey has some quite amazing therapeutic uses.

FROM WHERE DOES HONEY COME?

The honeybee is the only insect that produces food eaten by humans. Here is what happens: The female honeybees use their proboscis (a tube-like tongue) to up suck flower nectar and mix it with their saliva and enzymes. Then they store it in a honey sack. Back at the hive, the mixture is regurgitated into cells, dried to about 16% moisture, and stored as a primary food source. As you might expect, the content of the honey depends on a number of factors including the species of bee, the kind of flowers on which they fed, and the conditions in which the honey was stored.

Honey as an Antibiotic

In a recent review article that focuses on the antimicrobial properties of honey, Zafar Israili from the Emory School of Medicine noted that a large number of laboratory and clinical studies have confirmed the broad-spectrum antimicrobial properties of honey.  These include antibacterial, antifungal, antiviral, and antimycobacterial.  “Honey,” wrote Israili, “was found to be an effective topical treatment for ringworms, athlete’s foot, jock itch, nail fungus, and yeast infections and reported to be comparable to many over-the-counter antifungal preparations.” These properties are likely due to the honey’s acidity, osmotic effect, high sugar concentration, and the presence of chemicals like hydrogen peroxide, antioxidants, and lysozymes.  

Honey contains more than 600 compounds (you can see a list of them here), and the wound healing properties of honey are probably its oldest and best studied medicinal property.  It has been shown to aid wound healing in conditions such as chronic pressure sores, traumatic and diabetic wounds, diabetic foot ulcers, boils, burns, fistulas, necrotizing fasciitis, and a very nasty condition called Fournier’s gangrene. (That's necrosis of the scrotum. Yes, quite gross.) So in contrast to the advice of the talmudic doctors that "honey is bad for an injury", honey turns out to be rather good for wounds, especially when applied directly to them.  But honey isn't just good for wounds...

“There is a large body of evidence to support the use of honey as a wound dressing for a wide range of types of wounds. Its antibacterial activity rapidly clears infection and protects wounds from becoming infected, and thus it provides a moist healing environment without the risk of bacterial growth occurring. It also rapidly debrides wounds and removes malodor.”

— Molan, PC. The Evidence supporting the use of honey as a wound dressing. Lower Extremity Wounds 2006. 5 (1); 52.

Your Mother was correct

A 2012 study from physicians at the Sackler School of Medicine in Tel Aviv tested the effects of honey on nocturnal cough and sleep quality.  They enrolled 150 children age 1-5 years (and presumably, their tired and exasperated parents) and half an hour before bedtime, gave half of them “a single dose of 10g of eucalyptus honey, citrus honey, or labiatae honey,” and the other half a placebo. (In case you were wondering, as was I, as to what the placebo was, here’s the answer: date extract, “because its structure, brown color, and taste are similar to that of honey.” True enough.) What they found might change the way you treat your own cough this winter. Each of the three honey groups had a better response compared with the date extract, and no significant differences were found among the different types of honey. The authors concluded that honey may be preferable to cough and cold medications for childhood respiratory infections. 

The effect of different types of honey and date extract on cough frequency (I), cough severity (II), cough bothersome to child (III), the child’s sleep (IV), parent’s sleep (V), and combined symptoms score (VI). P <0.05 for the comparisons between group D and the other groups. A, eucalyptus honey; B, citrus honey; C, labiatae honey; D, silan date extract. From Cohen, AH. et al. Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-blind, Randomized, Placebo-Controlled Study. Pediatrics 2012. 130 (3); 465-471.

Honey as a Medicine for Pretty much everything

There are dozens of other medical conditions for which honey may be used. Here is what the review from Israili has to say:

Honey has been reported to be of benefit in a large number of human pathologies including allergy, asthma, bronchitis, common cold, flu, hay fever, nasal congestion, rhinitis, sinusitis, upper respiratory infections, sore throat, cough, fatigue, anxiety, migraine (stress related), cuts, lacerations, burns, wounds (venous, arterial, diabetic, malignant), pressure ulcers, malignant ulcers, perianal and gluteofemoral fistulas, bed sores, adult and neonatal postoperative infections, necrotizing fasciitis, pilonidal sinus, insect bites, infections (bacterial including antibiotic-resistant strains and fungal), septicemia, conjunctivitis and other eye diseases, endophthalmitis, acne, chronic seborrheic dermatitis, dandruff, eczema, psoriasis, inflammation, gingivitis, stomach ache, stomach ulcers, digestive disorders, constipation, vomiting, diarrhea, colitis, dehydration, diabetes, osteoporosis, insomnia, chronic fatigue syndrome, anemia, hypertension, immune disorders, multiple sclerosis, cardiovascular disease, hepatitis, tumors, cancer, and radiation/chemotherapy-induced oral mucositis.

You'd have to check the references and decide if the evidence supports claims like this. But in any event, this list is in startling contrast to the advice of physicians living during talmudic times, that those who were ill or injured should avoid honey.

The Koren Talmud on Honey - woops

In its otherwise excellent translation and commentary on the Talmud, the Koren Talmud has this to say in a footnote on today's daf:

Ingesting large quantities of sweet foods can cause a rise in blood sugar, which in turn can delay the healing of injuries. In addition, poor circulation caused by the fatty deposits in the arteries can limit the amount of oxygen and healing nutrients that reach a wound. Nerve damage, or neuropathy, causes numbness in the feet that prevents open wounds from healing. Moreover, when blood sugar levels are high, the immune system cannot effectively do its job of clearing away dead and damaged tissue and building new skin cells.

Oy.  This is a mess.  In the first place, in persons who are not diabetic, ingesting sweet foods will only cause a mild and very temporary rise in blood sugar. Second, fatty deposits are caused by cholesterol plaque build-up, and not by carbohydrates (which are sugars). Third, neuropathy has absolutely nothing to do with preventing wound healing.  That's caused mostly by a deficient microcirculation, which is often associated with a neuropathy, (for example in diabetics) but is not caused by it.  Finally, elevated blood sugars might effect the immune system, but again, this is only an issue for those whose diabetes is poorly controlled.

The Koren edition seems to be following a long tradition of getting it wrong when it comes to honey. In today's page of Talmud, honey is recorded as being harmful to your health, and the Koren Talmud tries, but fails, to give this belief a patina of scientific credibility.  But both are wrong.  In fact, you might want to put down that garlic so praised by the Talmud, and pick up some honey. That would be very good for you.

Bava Kamma 82a ~ Is Garlic Good for You?

     בבא קמא פב, א

...עשרה תקנות תיקן עזרא...אוכלין שום בערב שבת... משום עונה דכתיב אשר פריו יתן בעתו וא"ר יהודה... זה המשמש מטתו מערב שבת  לערב שבת. ת"ר חמשה דברים נאמרו בשום משביע ומשחין ומצהיל פנים ומרבה הזרע והורג כנים שבבני מעיים וי"א מכניס אהבה ומוציא את הקנאה

Ezra made ten regultions...That they eat garlic on the eve of Shabbat, on account of the mitzvah to have sexual relations. As it is written [Psalms 1:3]: “He shall be like a tree…that yields its fruit in its proper time,” and Rav Yehuda taught….this verse refers to a person who has sexual intercourse on every eve of Shabbat. The rabbis taught that garlic has five qualities: It satiates and warms the body and brightens the face, it increases semen, and it kills parasites in the intestines. Others add that it instills love and so eliminates jealousy (Bava Kamma 82a)

Many, many years ago I watched a rabbi liberally rubbing garlic into matzah at his home as part of Friday night Shabbat dinner. I thought it was because he liked the taste.  I may have been wrong.

Today, the Talmud (Bava Kamma 82a) lists ten regulations enacted by Ezra when he led the return of the Jewish people from Babylonia to Israel. Some, like reading from the Torah on Mondays and Thursdays, you may have heard of. Others, never became quite so popular. Which brings us to enactment #5: to eat garlic on the eve of Shabbat. The Talmud explains why Ezra decreed (presumably to the men only) that garlic should be eaten on Friday night – because it increases male fertility and Friday night is the prescribed time to have intercourse.  So is the Talmud correct? Does garlic increase fertility? You’d be surprised…

The Medicinal Properties of Garlic

In a 2005 review article from Yeshiva University and the Albert Einstein College of Medicine, Ellen Tattleman noted that garlic has been used for medicinal purposes for thousands of years. Sanskrit records show that it has been in use as a medicine for at least 5,000 years, making the Chinese relative newcomers to the garlic industry, since they’ve only been using it for some 3,000 years. The Egyptians, Babylonians, Greeks, and Romans used garlic for healing purposes, and even the great Louis Pasteur noted garlic’s antibacterial activity, in 1858. In case you want to prepare this at home, it is the root bulb of the garlic plant (fresh, dehydrated, or as a steam-distilled oil) that you need to go for.  This bulb contains allicin which is formed when alliin, a sulfur-containing amino acid, comes into contact with the enzyme alliinase. This reaction happens whenever you chop, crush or chew raw garlic. The antimicrobial, lipid lowering, antioxidant, and anti-clotting effects that have been attributed to garlic are thought to be related to this allicin and other breakdown products. We will return to these medicinal properties later, but for now let’s focus on the effect of garlic on male fertility; after all, that’s what today’s page of Talmud discusses.

Garlic and Sperm Production - in Mice

There is conflicting evidence about the role of garlic on sperm production.  Some studies have shown that it impairs the Leydig and Sertoli cells that are part of the machinery of sperm production – if you are a rat. Other studies have shown that garlic, or rather the allicin that garlic produces, can protect the testes against toxins.  If you are a rat, being exposed to these testicular shriveling toxins. When it comes to the sperm themselves, again, the evidence is conflicting.  In mice, garlic has been shown both to increase and to decrease the production of sperm, and scientists have also noted conflicting results about the effect of garlic on testosterone levels.

In 2001 a group of Japanese researchers investigated the pharmacological activities of four garlic preparations, raw garlic juice, garlic powder, heated garlic juice and aged garlic extract, on testicular hypogonadism (hypospermatogenesis and impotence) induced by warm water treatment. The results showed that aged garlic extract at a 4 ml/kg  dose for a couple of weeks significantly enhanced spermatogenesis and improved impotence after warm water treatment of mice. In contrast, the other preparations were only slightly effective.  So perhaps infertile male mice should try garlic on Friday nights.

Overall, the effects of garlic on sperm production - on rodents -  are not clear.  A 2013 review in Andrologia of the impact of garlic on male fertility of concludes with these remarks:

In traditional oriental medicine, garlic has been used to improve male sexual dysfunction and to recover testicular functions. But in the literature, there are very few studies about the potential effects of garlic on spermatogenesis (about ten studies), and their results are contradictory. These discrepancies could be related to three main factors (i) the type of preparations, (ii) the way of administration [sic] and (iii) the dose.

Garlic and the Quality of Human Sperm

So much for mice and rats; what about the effect of garlic on human sperm production? It turns out that you can buy a combination antioxidant widely touted to improve male fertility. It is called Menevit, and among other substances, each capsule apparently contains 333 micrograms of garlic oil.   But a 2009 study from Australia found that after three-months of therapy with Menevit® there was no significant change in sperm concentration, motility or morphology, although it did produce a significant reduction in sperm DNA fragmentation. Which is confusing because the same team reported that infertile men treated with Menevit® for the same period of time had an improvement in the levels of sperm global DNA methylation, though whether that is a marker of anything important is not clear.  If you are confused, so are the experts. Here is what one expert review concluded, in the excitingly titled Male Infertility: Contemporary Clinical Approaches:

The present body of evidence surrounding the treatment of male factor infertility with antioxidants is difficult to critically interpret because of less than ideal study design (not screening for oxidative stress at enrollment, sperm quality as a primary endpoint instead of pregnancy and a lack of concurrent placebo controls). Furthermore, the use of a large number of different types and dosages of antioxidant and the lack of adequately powered studies to analyse pregnancy outcomes precludes definitive conclusions being made… Firm conclusions relating to antioxidant therapies ability to improve sperm concentration, motility and morphology is presently impossible due to the abundance of contradictory results and inadequately controlled studies.
 

are there Other Benefits of Garlic?

So the evidence that garlic does anything useful to sperm production is, um, not great. But what about the other widely touted health benefits of garlic? For example, some claim that garlic lowers your lipids and in a study published in the prestigious Journal of the American Medical Association, garlic appeared to be have a real, but modest effect on lowering cholesterol, when compared to placebo.  There is also a claim that garlic lowers your blood pressure. In a meta-analysis (which is an analysis of many trials lumped together) of 23 trials only three showed a statistically significant reduction in diastolic blood pressure and one showed a statistically significant reduction in systolic blood pressure (approximately 3 percent) in patients treated with garlic compared with placebo. There are claims that garlic can prevent cancer, and slow the onset of atherosclerosis. Here is a summary from my colleagues at the National Center for Complementary in Integrative Medicine, part of the National Institutes of Health:

• Some evidence indicates that taking garlic can slightly lower blood cholesterol levels; studies have shown positive effects for short-term (1 to 3 months) use. However, an NCCIH-funded study on the safety and effectiveness of three garlic preparations (fresh garlic, dried powdered garlic tablets, and aged garlic extract tablets) for lowering blood cholesterol levels found no effect.

• Preliminary research suggests that taking garlic may slow the development of atherosclerosis (hardening of the arteries), a condition that can lead to heart disease or stroke

• Evidence suggests that taking garlic may slightly lower blood pressure, particularly in people with high blood pressure. 

• Some studies suggest consuming garlic as a regular part of the diet may lower the risk of certain cancers. However, no clinical trials have examined this. A clinical trial on the long-term use of garlic supplements to prevent stomach cancer found no effect.

And if you are tempted to take a garlic containing pill, because "why not, it can't do any harm" please bear in mind that although it appears to be safe for most adults:

• Side effects include breath and body odor, heartburn, upset stomach, and allergic reactions. These side effects are more common with raw garlic.

• Garlic can thin the blood (reduce the ability of blood to clot) in a manner similar to aspirin. This effect may be a problem during or after surgery. So use garlic with caution if you are planning to have surgery or dental work, or if you have a bleeding disorder.

• Garlic has been found to interfere with the effectiveness of  a drug used to treat HIV infection. Garlic may also interfere with other drugs, though this has not been well studied.

The more things change, the more they stay the same.

In today's page of Talmud it was claimed that garlic does many different things: "It satiates and warms the body and brightens the face, it increases semen, and it kills parasites in the intestines, and it instills love and so eliminates jealousy." How strange then to note that today the supposed health effects of garlic are widely touted.  Plus ça change, plus c'est la même chose.