Avodah Zarah 12b ~ Vinegar, Leeches and Rav Huna

עבודה זרה יב ,ב

ת"ר לא ישתה אדם מים לא מן הנהרות ולא מן האגמים לא בפיו ולא בידו אחת ואם שתה דמו בראשו מפני הסכנה מאי סכנה סכנת עלוקה

The Sages taught: A person should not drink water from rivers or from ponds either by drinking from the water directly with his mouth, or by collecting the water with one hand alone. And if he drank in this manner, his blood is upon his own head, due to the danger. What is this danger? It is the danger of swallowing a leech.

There are about 680 identified species of leeches (so far). Most are found in freshwater, and are found on every continent except Antarctica. You should stay away from them.

In western developed countries, our drinking supplies are safe to drink (mostly). But around the world leeches are still found in water that is used for human (and animal) consumption.  Today's page of Talmud reminds us of the danger that leeches once imposed. That danger is still very much present.

The Nile Leech. And others

The Koren Talmud notes that one species of leech, the Nile leech (Limnatis nilotica) can still be found in bodies of water in Israel.  Indeed leeches are found across the Middle East. Ten years ago, a case report was published in the Turkish Journal of Parasitology which described what happened when Limnatis nilotica  got into the nose of a poor five year-old girl in Turkey.

“ The doctor who was trying to aspirate the blood in the patient’s mouth noticed the bloody formation moving slightly. This formation was removed by an otolaryngologist under local anesthesia and was brought to the parasitology laboratory and identified as a leech.”

— Agin, H. et al. Türkiye Parazitoloji Dergisi, 32 (3): 247 - 248, 2008

The girl had nose bleeds and had vomited blood over three days.  She required an urgent blood transfusion, and while trying to remove blood from the girl's nose the doctor "noticed the bloody formation moving slightly." The bloody moving formation was carefully removed and sent to the pathology laboratory where it was identified. It was a leech. Here is a picture of the villain:

Leech obtained from the case. From Agin, H. et al. Severe Anemia Due to the Pharyngeal Leech Limnatis nilotica in a Child. Türkiye Parazitoloji Dergisi, 32 (3): 247 - 248, 2008

This is certainly not an isolated incident.  In fact, there are so many reports of leeches in the medical literature, that an Iranian group published a meta-analysis of leeches "as a live foreign body." 

Selection of published literature on leech infestations. From Saki, N. et al. Meta Analysis of the Leech as a Live Foreign Body: Detection, Precaution and Treatment. Pakistan Journal of Biological Sciences 2009: 12 (24); 1556-1563

The more you read, the more the meta-analysis gets scary. Here is another table, detailing the 28 patients the Iranians had seen at their hospital in Ahwaz, Iran. (Fun fact about Ahwaz: in 2011 the World Health Organization declared it to be the most air-polluted city in the world. Ahwaz: If our leeches don't kill you, our air will.)

Detail of 28 leech infested patients seen over a ten year period at Ahwaz Jondishapour Universtiy of Medical Science, Ahwaz, Iran. From Saki, N. et al. Meta Analysis of the Leech as a Live Foreign Body: Detection, Precaution and Treatment. Pakistan Journal of Biological Sciences 2009: 12 (24); 1556-1563

The longest leech they found was a whopping 10 cm (over 4 inches) that had taken up residence in the back of the mouth. Why didn't the patient feel that massive creature? Well, leeches are crafty; they secrete an analgesic so the victim doesn't feel the bite. At most, you might feel a little wiggling.  

Vinegar. Really?

Today's page of Talmud not only cautions us to be careful when drinking from a spring or river. It also suggests a treatment for leech attachment: 

אמר רבי חנינא הבולע נימא של מים מותר להחם לו חמין בשבת ומעשה באחד שבלע נימא של מים והתיר רבי נחמיה להחם לו חמין בשבת אדהכי והכי אמר רב הונא בריה דרב יהושע ליגמע חלא

 Rabbi Hanina says: In the case of one who swallows a water leech [nima], it is permitted to perform labor on Shabbat and heat water for him to drink on Shabbat, as his life is in danger. And in fact there was an incident involving one who swallowed a water leech, and Rabbi Neḥemya permitted them to heat water for him on Shabbat. In the meantime, until the water is ready, what should he do? Rav Huna, son of Rav Yehoshua, said: He should swallow vinegar.

As it turns out, Rav Huna's advice to drink vinegar can be found in today's medical literature. The Ahwaz team offers this suggestion:

If the leech is in the nares or upper pharynx, it be detached by applying 30% cocaine, 1:10,000 adrenalin or dimethyl phthalate to it. Another method is irrigation with strong saline, vinegar, turpentine or alcohol.

Rav Huna's treatment with vinegar seems to be supported in the medical literature. So next time you travel to Ahwaz, take some along with you.    

Avodah Zarah 10b ~ Gangrene and Ulcers

עבודה זרה י, ב 

דההוא קיסרא דהוה סני ליהודאי אמר להו לחשיבי דמלכותא מי שעלה לו נימא ברגלו יקטענה ויחיה או יניחנה ויצטער אמרו לו יקטענה ויחיה

There was a certain Roman emperor who hated the Jews. He said to the important members of the kingdom: If one had a nima rise on his foot, should he cut it off and live, or leave it and suffer? They said to him: He should cut it off and live. 

Just what is a Nima?

Rashi understands that nima means dead flesh: בשר מת ומצערו  Dead flesh that pains him.  The Schottenstein Talmud follows Rashi and translates it as dead flesh. 

The Koren English translation has this note on the word nima: 

From the Greek νομή, nomē, meaning an expanding wound or gangrene. Another version of the text has nomi, matching the version of the word in other places.

Liddel and Scott's Greek-English Lexicon gives some more details. Among its many meanings νομή, means spreading, as in spreading baldness or spreading ulcers. Goldschmidt's German translation (the first translation of the entire Babylonian Talmud, published 1897-1935) translates nima as Geschwür, meaning ulcer. The Soncino English translation, which often follows Goldschmidt, also translates nima as an ulcer. 

 But while nima is translated either as gangrene or an ulcer, the two are most certainly not the same.  

Ulcers

Four stages of a pressure ulcer

Ulcers describe a breakdown in the skin (or mucous membranes that line your mouth and gut) in which there is inflammation and in which dead tissues slough off.  You may have had a mouth sore, which is a kind of ulcer. Other commonly seen ulcers are pressure sores (typically at the base of the spine and buttocks in bed-ridden patients) and ulcers that form on the feet of those with diabetes.  The mainstay of treatment is to eliminate any pressure on the ulcer, to keep it meticulously clean, and to remove any dead tissue, a process known as debridement. Surgery is sometimes needed (for example, in cases of ulcerative colitis, in which ulcers form in the colon and rectum,) but in most cases can be avoided.

Gangrene

Gangrene is the death of tissue, caused by a loss of the blood flow.  It is far less common than ulcers, and far more serious.  (You can see all kinds of pictures of gangrene here.) It is mostly seen on the feet, but I've seen gangrene of the hands and fingers as well. When mountain climbers (and the homeless) loose fingers and toes, it's from gangrene.  

There are two kinds of gangrene. In wet gangrene, bacteria invade tissue which have little or no blood supply. They feed on the tissue and produce a great deal of pus; hence the description "wet".  Left untreated, the patient will likely become septic and die.  Amputation is often the only treatment option. Dry gangrene has a slower onset, and the tissue looks mummified or cracked; hence the term "dry". It does not usually cause infection or death. After several days, it becomes obvious where the black dead tissue ends and the pink health tissue begins. At that time, the tissue can be amputated; commonly, it just falls off (like here, but don't look if you are eating).

---

From the context of our passage, it is not possible to be certain which of the two conditions is described in the word nima.The Jew-hating Roman Emperor was advised to amputate a foot with a nima on it. Since we don't treat ulcers with amputation, this lends support to those in the nima is gangrene camp: Rashi, Koren and Schottenstein. But perhaps, back in Talmudic days, foot ulcers were amputated. This would support those in the nima is an ulcer camp: Golschmidt and the Soncino. Either way, the description of the Jewish people as a nima really hurts.  Just like the nima did.

Avodah Zarah 8 ~ 2,000 Pages Done!

Page eight of Avodah Zarah, is the 2,000th page of the Talmud.  There are only 711 pages left until the completion of this Daf Yomi cycle. We commemorated 1,000 pages learned back in April 2015. Now let's do the same for this new milestone.

Pagination in Manuscripts of the Talmud

“The first complete edition of the Babylonian Talmud, the edito princeps, was printed from 1519/20-23. The Bomberg Talmud became a standard for the editions that followed, almost all subsequent editions adhered to his layout and foliation.”

— Marvin Heller. Earliest Printings of the Talmud. In Mintz and Goldstein. Printing the Talmud 2002. p 73

It should be noted that counting  Avodah Zarah 8 as the 2,000th page of the Talmud is a fairly recent development. By which we mean it has only been around since the saintly Daniel Bomberg and his 1519 edition.  Here, for example, is a page showing tomorrow's daf, from the handwritten manuscript found in the Bibliotheque Nationale in Paris.  It was completed in 1337. (Avodah Zarah 8 begins with the second word on the second line.) The pagination and layout is entirely different to the standard format of the Talmud we are used to seeing.

Avodah Zarah 7b-8a. Circa 14-15 century. From Paris, Bibliotheque Nationale. Suppl. Heb 1337.

Visualizing 2,000 pages

1 Back on August 3, 2012 we opened the new cycle of Daf Yomi with Berachot 2. That day just happened to be ט׳ו באב.

10 pages looks like this:

100 looks like this

1,000 pages looks like this. We reached the 1,000th page of Talmud on April 29th, 2015.

And here are 2,000 pages, represented as dots:

Fun Facts about 2,000

The last big deal we made out of two-thousand was Y2K, the year our secular calendar tiptoed into the twenty-first century.  But 2,000 is an interesting number in itself. Like all numbers, it can be written as the sum of two primes: 2 × 2 × 2 × 2 × 5 × 5 × 5=2,000. It is a Harshad number, which is to say, it is an integer that is divisible by the sum of its digits.  

2,000 seconds is equal to 33 minutes, 20 seconds. To count from 1 to 2,000 would take you about thirty-three minutes. And a cube with a volume of 2000 cubic inches would be around 1 feet tall.

Alpayim (אלפיים, lit. "2,000") was also the name of a literary magazine published in Israel between 1989 and 2009. You can see a picture of one of its covers above.

2,000 in the תנ׳ך

The number 2,000 in the Hebrew Bible, the תנ’ך, appears in a number of places.

1. In the Book of Joshua, the people are warned to stay at least 2,000 cubits away from the Ark which they are following.

יהושע 3:4

אַ֣ךְ ׀ רָח֣וֹק יִהְיֶ֗ה בֵּֽינֵיכֶם֙ ובינו [וּבֵינָ֔יו] כְּאַלְפַּ֥יִם אַמָּ֖ה בַּמִּדָּ֑ה אַֽל־תִּקְרְב֣וּ אֵלָ֗יו לְמַ֤עַן אֲשֶׁר־תֵּֽדְעוּ֙ אֶת־הַדֶּ֙רֶךְ֙ אֲשֶׁ֣ר תֵּֽלְכוּ־בָ֔הּ כִּ֣י לֹ֧א עֲבַרְתֶּ֛ם בַּדֶּ֖רֶךְ מִתְּמ֥וֹל שִׁלְשֽׁוֹם׃ 

but keep a distance of some 2,000 cubits from it, never coming any closer to it—so that you may know by what route to march, since it is a road you have not traveled before.

2. In the sad story of the פלגש בגבעה, there is a civil war. Thousands die and a note is made of 2,000 killed, in addition to the other deaths. 

שופטים 20:45

וַיִּפְנ֞וּ וַיָּנֻ֤סוּ הַמִּדְבָּ֙רָה֙ אֶל־סֶ֣לַע הָֽרִמּ֔וֹן וַיְעֹֽלְלֻ֙הוּ֙ בַּֽמְסִלּ֔וֹת חֲמֵ֥שֶׁת אֲלָפִ֖ים אִ֑ישׁ וַיַּדְבִּ֤יקוּ אַחֲרָיו֙ עַד־גִּדְעֹ֔ם וַיַּכּ֥וּ מִמֶּ֖נּוּ אַלְפַּ֥יִם אִֽישׁ׃

They turned and fled to the wilderness, to the Rock of Rimmon; but [the Israelites] picked off another 5,000 on the roads and, continuing in hot pursuit of them up to Gidom, they slew 2,000 more.

3. King Solomon took thirteen years to complete the building of the first Temple. Among its contents was a large circular metal tub that sat on twelve statues of oxen.  It held the volume of 2,000 baths.

מלאכים א, 7:26

וְעָבְי֣וֹ טֶ֔פַח וּשְׂפָת֛וֹ כְּמַעֲשֵׂ֥ה שְׂפַת־כּ֖וֹס פֶּ֣רַח שׁוֹשָׁ֑ן אַלְפַּ֥יִם בַּ֖ת יָכִֽיל׃

It was a handbreadth thick, and its brim was made like that of a cup, like the petals of a lily. Its capacity was 2,000 baths.

4. In the war between the Israelite King Hezekiah and the Assyrian King Shalmaneser of Assyria, Hezekiah is taunted by the Assyrian leader:

מלאכים ב, 18:23

וְעַתָּה֙ הִתְעָ֣רֶב נָ֔א אֶת־אֲדֹנִ֖י אֶת־מֶ֣לֶךְ אַשּׁ֑וּר וְאֶתְּנָ֤ה לְךָ֙ אַלְפַּ֣יִם סוּסִ֔ים אִם־תּוּכַ֕ל לָ֥תֶת לְךָ֖ רֹכְבִ֥ים עֲלֵיהֶֽם׃

Come now, make this wager with my master, the king of Assyria: I’ll give you 2,000 horses if you can produce riders to mount them.

5. Among the donations made to rebuild the Temple during Nechemia's rein was a collective donation of 2,000 pieces of silver.

נחמיה 7:71

וַאֲשֶׁ֣ר נָתְנוּ֮ שְׁאֵרִ֣ית הָעָם֒ זָהָ֗ב דַּרְכְּמוֹנִים֙ שְׁתֵּ֣י רִבּ֔וֹא וְכֶ֖סֶף מָנִ֣ים אַלְפָּ֑יִם וְכָתְנֹ֥ת כֹּֽהֲנִ֖ים שִׁשִּׁ֥ים וְשִׁבְעָֽה׃ 

The rest of the people donated: gold—20,000 drachmas, silver—2,000, and 67 priestly robes.

6. In the Book of Chronicles, we are reminded of a battle in which tribes of Reuven, Gad and (half of) Menashe prevailed against the Hagarites. Here is what they plundered:

דברי הימים א, 5:21

וַיִּשְׁבּ֣וּ מִקְנֵיהֶ֗ם גְּֽמַלֵּיהֶ֞ם חֲמִשִּׁ֥ים אֶ֙לֶף֙ וְצֹ֗אן מָאתַ֤יִם וַחֲמִשִּׁים֙ אֶ֔לֶף וַחֲמוֹרִ֖ים אַלְפָּ֑יִם וְנֶ֥פֶשׁ אָדָ֖ם מֵ֥אָה אָֽלֶף׃

They carried off their livestock: 50,000 of their camels, 250,000 sheep, 2,000 asses, and 100,000 people.

All of this suggests that the number 2,000 might not need be read literally. It seems to mean instead "a really big number."

2,000 in the Talmud – and in Avoda Zarah

Perhaps the most famous use of the number 2,000 in the Talmud is the distance beyond which a person may not travel on Shabbat.

עירובין נא, א

׳הני אלפים אמה היכן כתיבן דתניא ׳שבו איש תחתיו׳ אלו ארבע אמות ׳אל יצא איש ממקומו אלו אלפים אמה

These two thousand cubits, where are they written in the Torah? It was taught in a baraita: “Every man shall remain in his place” (Exodus 16:29); these are the four cubits, [which constitute the minimum Shabbat limit for one who ventured beyond his prescribed limit]. “Let no man go out of his place”(Exodus 16:29); these are the 2,000 cubits of the Shabbat limit for one who remains in his place.

On today's 2,000th page, the number 2,000 makes a cameo appearance where it can be found in Rashi explaining the word תחום:

תחום. אלפים אמה סביבות העיר

The boundary: this is 2,000 cubits around the city

Unfortunately, a really interesting appearance of the number 2,000 comes the day after reaching our important milestone.  On Avodah Zarah 9a we learn that that the number 2,000 is part of a critical eschatological calculation:

עבודה זרה ט, א

תנא דבי אליהו ששת אלפים שנה הוי העולם שני אלפים תוהו שני אלפים תורה שני אלפים ימות המשיח

The school of Eliyahu taught: The world is destined to exist for six thousand years. For 2,000 years the world was waste, as the Torah had not yet been given. The next set of 2,000 years are the time period of the Torah. The last set of 2,000 years are the period designated for the days of the Messiah.

Too bad that discussion didn't come a page earlier. That would have made for a wonderful coincidence.  Ah well. Congratulations to all those who have travelled this far.  And welcome aboard to all those whose journey is just starting. 

Avodah Zarah 3b ~ Heliotherapy

The first few pages of the new tractate we are learning, Avodah Zarah addresses the punishment that awaits those wicked nations that persecuted the Jewish people.  Then comes this parable:

עבודה זרה  ג,ב–ד,א 

דאמר רבי שמעון בן לקיש אין גיהנם לעתיד לבא אלא הקדוש ברוך הוא מוציא חמה מנרתיקה  ומקדיר. רשעים נידונין בה וצדיקים מתרפאין בה. רשעים נידונין בה... צדיקים מתרפאין בה  דכתיב וזרחה לכם יראי שמי שמש צדקה ומרפא בכנפיה אלא שמתעדנין בה שנאמר ויצאתם ופשתם כעגלי מרבק

As Rabbi Shimon ben Lakish says: There is no Gehenna in the World-to-Come. Rather, the Holy One, Blessed be He, will remove the sun from its sheath [minnarteikah], and heats [umakdir]that world with it. The wicked will be punished by it and consumed by the heat, but the righteous will be healed by it....moreover, not only will they be healed by it, but they will even be rejuvenated by it, as it is stated in the continuation of that verse (Malachi 3:20) “And you shall go forth and leap as calves of the stall.”

Other mentions of the sun as medicine

We met the same homily in the name of Resh Lakish when we studied Nedarim 8b. Elsewhere (Bava Basra 16b) we read a teaching of Abaye that also addresses the healing power of the sun:

בבא בתרא טז, ב

רבי שמעון בן יוחי אומר אבן טובה היתה תלויה בצוארו של אברהם אבינו שכל חולה הרואה אותו מיד מתרפא ובשעה שנפטר אברהם אבינו מן העולם תלאה הקדוש ברוך הוא בגלגל חמה אמר אביי היינו דאמרי אינשי אידלי יומא אידלי קצירא

Rabbi Shimon ben Yochai said: there was a precious stone that hung from the neck of Abraham our forefather. Any sick person who looked at it was instantly cured.  When Abraham our forefather died, the Holy One, Blessed be He, hung this stone in the orb of the sun. Abaye said, this is what is meant by the popular saying "when the sun is lifted, sickness is lifted"

We know not to take homilies literally, but it turns out that Resh Lakish (c.200 CE) and Abaye (d~339 CE) were on to something when they taught that the sun heals.   

A History of Heliotherapy

In 1903, the Nobel prize for Medicine was awarded to a Dane named Niels Finsen. Finsen had invented a focusable carbon-arc torch to treat – and cure – patients with lupus vulgaris, a painful skin infection caused by tuberculosis.  While this was the start of the modern medical use of phototherapy, using the sun as a source of healing is much, much older. Older even than the Talmud, which mentions it in today’s daf. 

“The Nobel Prize in Physiology or Medicine 1903 was awarded to Niels Ryberg Finsen “in recognition of his contribution to the treatment of diseases...with concentrated light radiation, whereby he has opened a new avenue for medical science”.”

Perhaps the earliest reference to heliotherapy – that is, using sunlight to heal - is found in Egyptian papyrus records from over 3,500 years ago, which record using the sun, together with ingesting a local weed, to treat skin conditions. The active ingredients of that weed, Ammi majus, were isolated in 1947. These ingredients, together with heliotherapy, were used in the first clinical trials to treat vitiligo, which were conducted, rather fittingly, in Egypt.  Further work determined that it was only a narrow part of the sun’s spectrum that was needed to treat vitiligo, psoriasis, and other skin conditions, and so lamps were developed that produced only narrow band ultraviolet light (UVB). These UVB lamps are now a mainstay of treatment for psoriasis. 

Sunlight for Healthy Bones

“For most white people, a half-hour in the summer sun in a bathing suit can initiate the release of 50,000 IU (1.25 mg) vitamin D into the circulation within 24 hours of exposure”

— Environmental Health Perspectives 2008:116;4. A162

But ultraviolet light – UVB – can also be extremely dangerous. Too much exposure to sunlight will cause skin cancer, as the light produces molecules that directly damage DNA. Here is the great paradox of sunlight – too much of it will burn and can kill – but get the dose right and it is not only curative, but essential for healthy living. Sunlight is needed to produce vitamin D in the skin, and vitamin D is needed to produce healthy bones. Without it, you will develop rickets, a skeletal deformity that is characterized by bowed legs. 

Typical presentation of 2 children with rickets. The child in the middle is normal; the children on both sides have severe muscle weakness and bone deformities, including bowed legs (right) and knock knees (left). From Holick M. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 2004;80(suppl):1678S–88S.

Sunlight for a Healthy Immune System

The sun’s light has been shown to have effect the immune system, although many of these effects are only poorly understood. 

When some nerve fibres are exposed to sunlight, they release a chemical called neuropeptide substance P. This chemical seems to produce local immune suppression.  Exposure to the ultraviolet wavelengths in sunlight can change the regulation of T cells in the body which can also modulate autoimmune diseases.

Sunlight to Treat Melanoma?

While sunlight can cause skin cancer, it has been shown to release a hormone called alpha melanocyte-stimulating hormone. This hormone appears to limit the damage to DNA damage from sunlight and so may actually reduce the risk of melanoma (but don't try this as a treatment yet. It's certainly not ready for prime time.)

Sunlight for Your Mood

Then there’s sunlight for your mood. Seasonal affective disorder – SAD – is caused by a lack of exposure to sunlight, which most affects those living in the northern latitudes in the winter.  SAD was first described in 1984 by Norman Rosenthal working at the National Institute of Mental Health but why it happens is still something of a mystery.  Rosenthal went on to write several best selling books on SAD and how to beat it. The answer appears to be something to do with sitting in front of a lamp that mimics sunlight (but the evidence that this works is still controversial).

 Sunlight for Babies with Jaundice

Sunlight is also a great treatment for babies with neonatal jaundice. This condition is very common and is caused when the baby breaks down the fetal hemoglobin with which it was born. A product of that breakdown is bilirubin, and if this is allowed to build up in the tissues it can cause lethargy, difficultly feeding, and in rare and extreme cases, brain damage. However, sunlight (or more precisely, the blue band of the spectrum at 459nm)  breaks down this dangerous bilirubin molecule into a harmless one called biliverdin.  So the best treatment for a newborn baby with mild jaundice is to put them out in the sun.  (Failing that, or if the degree of jaundice is not mild, you can consider phototherapy in the hospital.) 

The absorbance spectrum of bilirubin bound to human serum albumin (white line) is shown superimposed on the spectrum of visible light. Clearly, blue light is most effective for phototherapy, but because the transmittance of skin increases with increasing wavelength, the best wavelengths to use are probably in the range of 460 to 490 nm. Term and near-term infants should be treated in a bassinet, not an incubator, to allow the light source to be brought to within 10 to 15 cm of the infant (except when halogen or tungsten lights are used), increasing irradiance and efficacy. For intensive phototherapy, an auxiliary light source (fiber-optic pad, light-emitting diode [LED] mattress, or special blue fluorescent tubes) can be placed below the infant or bassinet. If the infant is in an incubator, the light rays should be perpendicular to the surface of the incubator in order to minimize loss of efficacy due to reflectance. From Maisels and McDonagh. Phototherapy for Neonatal Jaundice. New England Journal of Medicine 2008.358;920-928.

Sunlight for Infectious Diseases

 We don't treat infectious diseases with sunlight any more. But it wasn't always that way. Less than eighty years ago sunlight was recommended as a therapy for some patients with tuberculosis. The authors, writing in the journal Diseases of the Chest were cautious:

Even in those cases where the sun can be of great value, it is in no sense a specific cure for any manifestation of tuberculosis. Rest, good food, and fresh air, are still the fundamentals in treating all forms of the disease; and the sun, where it should be used, is only a valuable adjutant...Heliotherapy is not indicated in all cases of tuberculosis. The majority of patients with this disease should never use it...It is not a sure cure for any type of tuberculosis, but is often, especially in some of the extrapulmonary cases, a very valuable—or even necessary—aid.

In today's daf, Resh Lakish taught that sun can both reward and punish. His insight was more correct than he could ever have imagined.  

“Bright light therapy and the broader realm of chronotherapy remain underappreciated and underutilized, despite their empirical support. Efficacy extends beyond seasonal affective disorder and includes nonseasonal depression and sleep disorders, with emerging evidence for a role in treating attention-deficit/hyperactivity disorder, delirium, and dementia.”

— Schwartz and Olds. The Psychiatry of Light. Harvard Review of Psychiatry 2015. 23 (3); 188.

[Mostly a repost from Bava Basra 16 and Nedarim 8.]