Niddah 24a ~ Halachic Reality and Anatomic Reality: Treif People and Treif Animals

In tomorrow’s page of Talmud we read of a dispute about survivability of an infant with a birth defect. According to Rav Zakkai, an infant lacking legs from the knees downward cannot live, and is classified as a treifah. Rav Yannai declared that such a child could live, but agreed that it is classified as a treifah. Rav Yannai believed that only a birth defect that included the urinary opening was severe enough to be incompatible with life. In both cases the child is declared a treifah, but what is in dispute is the prognosis of such a treifah.

נדה כד,א

בין רבי זכאי לרבי ינאי איכא בינייהו טרפה חיה מר סבר טרפה חיה ומר סבר טרפה אינה חיה

The difference between the opinion of Rabbi Zakkai and that of Rabbi Yannai is whether a tereifa [can survive beyond twelve months]. One sage, [Rabbi Yannai,] holds that a tereifah can survive [beyond twelve months. Therefore, although one whose legs were removed until above the knee has the status of a tereifa, if a woman discharges a fetus of this form she is impure. Only if the fetus lacks legs until his orifices is the woman pure, as such a person cannot survive.] And one sage, [Rabbi Zakkai], holds that a tereifah cannot survive [beyond twelve months]. …

Treifah Animals

We have previously met the concept of treifah when we studied Chullin and the laws of rural slaughter called shechitah. Here is a reminder, from the start of the third chapter of Chullin (42a) where we took a deep dive into animal anatomy.

אלו טרפות בבהמה נקובת הוושט ופסוקת הגרגרת ניקב קרום של מוח ניקב הלב לבית חללו נשברה השדרה ונפסק החוט שלה ניטל הכבד ולא נשתייר הימנו כלום הריאה שניקבה או שחסרה ר"ש אומר עד שתינקב לבית הסמפונות ניקבה הקבה ניקבה המרה ניקבו הדקין הכרס הפנימית שניקבה או שנקרע רוב החיצונה רבי יהודה אומר הגדולה טפח והקטנה ברובה המסס ובית הכוסות שניקבו לחוץ נפלה מן הגג נשתברו רוב צלעותיה ודרוסת הזאב רבי יהודה אומר דרוסת הזאב בדקה ודרוסת ארי בגסה דרוסת הנץ בעוף הדק ודרוסת הגס בעוף הגס זה הכלל כל שאין כמוה חיה טרפה

These wounds constitute tereifot in an animal,rendering them prohibited for consumption:

1. A perforated esophagus, where the perforation goes through the wall , 

2. or a cut trachea.

3. If the membrane of the brain was perforated, 

4. or if the heart was perforated to its chamber; 

5. if the spinal column was broken and its cord was cut; 

6. if the liver was removed and nothing remained of it…

7. a lung that was perforated

8. or a lung missing a piece….

9. If the abomasum was perforated

10. or the gallbladder was perforated, 

11. or the small intestines were perforated, it is a tereifa…

This is the principle: Any animal that was injured such that an animal in a similar condition could not live for an extended period is a treifa, the consumption of which is forbidden by Torah law. 

The original meaning of the term treif in the Torah is torn, and it describes a domestic animal that was attacked by a wild animal and suffered an injury that led to its death.

“וְאַנְשֵׁי־קֹ֖דֶשׁ תִּהְי֣וּן לִ֑י וּבָשָׂ֨ר בַּשָּׂדֶ֤ה טְרֵפָה֙ לֹ֣א תֹאכֵ֔לוּ לַכֶּ֖לֶב תַּשְׁלִכ֥וּן אֹתֽוֹ׃
You will be holy people to Me: you must not eat flesh torn by beasts in the field; you shall cast it to the dogs.”

— Exodus 22:30

But the rabbis of the Talmud greatly expanded this category - hence the list in this Mishnah in Chullin. Elsewhere in Chullin (57b) there is a dispute as to the prognosis of living animal that has been declared treif. According to Rav Hunna, if an animal is treif, by definition it cannot live for longer than a year (אמר רב הונא סימן לטרפה י"ב חדש). But there are other opinions. The great editor of the Mishnah, Rabbi Yehudah HaNassi held that a treifa is destined to die within 30 days, while a berasia states that a treif animal cannot give birth (leaving open the question about male animals).

““Jason Marcus, chef and owner of the new Traif restaurant on S. Fourth Street in Williamsburg, says the name is just cheeky, not a slap at his mostly Kosher eaters.”

“But [the name] really represents our philosophical view of how restaurants should be free of rules. We’re just people who live for good food.””

It is generally agreed upon that list in Chullin detailed the kinds of lesions that would be fatal within a year. And that’s when the problems begin. Some of them are certainly likely to be fatal. For example a perforated esophagus (נקובת הוושט) leads to mediastinitis, an inflammation of the chest cavity. And that is commonly fatal. If the animal swallows something sharp it can pierce not only the esophagus, but the membranes that surround the heart, called the pericardium. Way back in 1955 - at the start of the era of antibiotics - The Australian Veterinary Journal published a case series of twenty-one dairy cows that developed traumatic pericarditis. “Fifteen cases were treated with sulphonamide [an antibiotic] and six were not. ” The six animals untreated cows all died, and even among the cows treated with antibiotics, almost half died. So yes, some lesions recorded in the Mishanh (and later refined in the talmudic discussion which follows) are indeed fatal.

The Case of Serachot

But other lesions that render an animal treif are certainly not fatal. Take for example lung adhesions, called סרחות (serachot, or sircha in the singular), which are discussed elsewhere in the tractate Chullin (46b et. seq). These adhesions are fibrous tissues that may run between different lung lobes, or between the lungs and the rib cage. They are common and are caused by a number of conditions, including trauma or previous infections. Many kinds of serichot render an animal treif. But lung adhesions are certainly not lethal. Animals and humans live quite happily with them. In fact this doctor recently told me that the presence of lung adhesions does not prevent lungs from being donated and used for a lung transplant. Now, if they are used in that delicate situation, they most certainly do not have a fatal defect, or anything even close.

the case of the missing liver (and the missing heart)

Opening paragraph of the famous responsa on “the chicken that had no heart”. From שו׳ת חכם צבי, Amsterdam 1712.

Equally puzzling to the modern reader is the sixth category in the Mishna’s list: ניטל הכבד ולא נשתייר הימנו כלום - if the slaughtered animal was found to have no liver. Here’s the thing: an animal cannot live without a liver. If a healthy looking cow - or indeed any cow -was well enough to be slaughtered, it must have had a liver. So this is not an example of a treif animal - it’s an example of one that could not possibly have existed. But don’t take my word for it.

In 1709 the great rabbi of Hamburg, Zevi Ashkenazi, (better known as the Chacham Zevi, after the name of his responsa) was asked the following question. A young woman had opened a slaughtered chicken to remove the unwanted entrails, while her cat sat at her feet “waiting patiently for anything that may fall to the ground.” To her great surprise, the young woman found that the chicken did not have a heart, and so assumed the bird was treif. Not so, claimed her mother, who apparently owned the chicken. The cat must have eaten it, when it was thrown to the ground together with the entrails. The young women was however quite adamant, and insisted she had never fed anything that resembled a heart to the cat. The bird had been perfectly healthy before it was slaughtered, eating and drinking like any other healthy chicken, (וגם בעודנה בחיים חיותה היתה חזקה ובריאה ובכל כחה לאכול ולשתות). The question of the kashrut of the bird was brought to the local rabbis, who declared it to be treif, on the basis that while alive, it had no heart.

The Chacham Zevi was asked to weigh in on the matter. “It is absolutely clear to any person who has a wise heart” he wrote, apparently enjoying the play on words, “or who has a brain in his skull, that it is impossible for any creature to live for even a moment without a heart…Clearly, the heart fell out when the bird was opened, and that cat ate it…It is obvious that the chicken is permitted” Strike one for common sense. You would think. But not so fast. This answer of the Chacham Zevi engendered one of the great halachic disputes of the eighteenth century. In one corner, the Chacham, and in the other at least four leading rabbinic figures who vehemently opposed this ruling: Naphtali Katz of Frankfurt, Moses Rothenburg, David Oppenheim (who was the Chief Rabbi of Prague, no less) and Jonathan Eyebeschuetz (who spent much of his later life fighting halachic battles against Rabbi Yaakov Emden, who was the son of the Chacham Zevi). It got nasty, but that’s a story for another day.

Halachic Reality

No bird or animal can live without a heart, and none can do so without a liver. So there can be no case, like the one in the Mishnah, in which a healthy living animal was slaughtered and found to be without a liver.

Some of the categories of treifot overlap with conditions that are indeed incompatible with life. Others are perfectly innocuous and compatible with a long and healthy life. And a few make no sense given what we know about animal physiology. But none should be thought of as describing an anatomical reality. They describe instead a halachic reality, a reality that reflected a world some 1,500 years ago. And while our understanding of physiology has changed, these halachic classes remain a fixed part of Jewish tradition. Here is the great Maimonides, who was obviously troubled by the chasm that sometimes exists between halacha and facts.

רמב’ם משנה תורה הלכות שחיטה י, יג וְכֵן אֵלּוּ שֶׁמָּנוּ וְאָמְרוּ שֶׁהֵן טְרֵפָה אַף עַל פִּי שֶׁיֵּרָאֶה בְּדַרְכֵי הָרְפוּאָה שֶׁבְּיָדֵינוּ שֶׁמִּקְצָתָן אֵינָן מְמִיתִין וְאֶפְשָׁר שֶׁתִּחְיֶה מֵהֶן אֵין לְךָ אֶלָּא מַה שֶּׁמָּנוּ חֲכָמִים שֶׁנֶּאֱמַר (דברים יז יא)"עַל פִּי הַתּוֹרָה אֲשֶׁר יוֹרוּךָ

Each one of these lesions that were declared treif remain so even if modern medicine can demonstrate that some of them are not actually fatal, and that it is indeed possible to live despite them. Rather we must follow these rabbinic categories, as the Torah states“ You shall act in accordance with the instructions given you and the ruling handed down to you; [you must not deviate from the verdict that they announce to you either to the right or to the left.]

In more recent times, Rabbi Avrohom Yeshaya Karelitz, better known as the Chazon Ish, also addressed this question. “We see today” he wrote, “that very often surgeons operate on the abdomen of a person [with an injury like one found in a treif animal], and he is completely cured, and lives a long life.” But this does nothing to change the way we view the categories of treif. These depend solely on what was decided by the rabbis of the Talmud, and no modern findings can change them.

[Repost from here.]

Niddah 23b ~ Mourning for a Lost Fetus

The Talmud has spent much time discussing the various forms that the content of a miscarriage might assume, and how this determines the ritual purity of the mother (or indeed the the status of the deceased fetus). It all began a couple of pages ago with this Mishnah:

נדה כא,א

המפלת חתיכה אם יש עמה דם טמאה ואם לאו טהורה ר' יהודה אומר בין כך ובין כך טמאה המפלת כמין קליפה כמין שערה כמין עפר כמין יבחושין אדומים תטיל למים אם נמוחו טמאה ואם לאו טהורה המפלת כמין דגים חגבים שקצים ורמשים אם יש עמהם דם טמאה ואם לאו טהורה המפלת מין בהמה חיה ועוף בין טמאין בין טהורין אם זכר תשב לזכר ואם נקבה תשב לנקבה ואם אין ידוע תשב לזכר ולנקבה דברי רבי מאיר וחכמים אומרים כל שאין בו מצורת אדם אינו ולד

…In the case of a woman who discharges an item similar to a shell ,or similar to a hair ,or similar to soil,or similar to mosquitoes ,if such items are red, she should cast them into water to ascertain their nature: If they dissolved ,it is blood, and the woman is impure with the impurity of a menstruating woman; and if not, she is pure.

In the case of a woman who discharges an item similar to fish or to grasshoppers, repugnant creatures, or creeping animals, if there is blood that emerges with them, the woman is impure with the impurity of a menstruating woman. And if not, she is pure.

With regard to a woman who discharges tissue in the form of a type of domesticated animal, undomesticated animal, or bird, whether it had the form of a non-kosher species or a kosher species, if it was a male fetus, then she observes the periods of impurity, seven days, and purity, thirty-three days…And if the fetus was a female, the woman observes the periods of impurity, fourteen days, and purity, sixty-six days…

And if the sex of the fetus is unknown, she observes the strictures that apply to a woman who gave birth both to a male and to a female. This is the statement of Rabbi Meir. And the Rabbis say: Any fetus that is not of human form is not regarded as an offspring with regard to observance of these periods, and she is permitted to engage in intercourse provided that she does not experience a discharge of uterine blood.

It all makes for very technical and detached reading, and quite honestly I have no idea to what shapes these refer. Over the decades as an emergency physician I have probably treated a several hundred women who came to the ED with an active or completed miscarriage, and never once did I see a bird, fish, or snake in the products of conception. I did however, meet a lot of sad and frightened mothers.

On today’s page of Talmud we finally discuss another aspect of the loss of a pregnancy: the emotional. Here is Rava, who explains that a fetus shaped like an animal does not preclude a later son born from the same mother to be considered as a firstborn. This is because the father would not mourn over such a misformed fetus:

נדה כג,ב

דאמר קרא [דברים כח] ראשית אונו מי שלבו דוה עליו יצא זה שאין לבו דוה עליו

“By giving him a double portion of all that he has; for he is the first fruits of his strength [ono];the right of the firstborn is his” (Deuteronomy 21:17). It is derived from the verse that the status of a firstborn applies only to a son over whose death a father would mourn.The word “ono” is interpreted homiletically based on its similarity to the word “onen”, acute mourner. This offspring that has the form of an animal is therefore excluded, as its father’s heart would not mourn over its death.

It’s the only time that the Talmud considers any emotional aspect of the loss of a pregnancy, and it hardly a surprise that when it does, it is the father’s emotions that are of relevance, rather than the mother’s. The Talmud is, after all, a record of how men viewed things. Rashi understands Rava’s statement as primarily legal rather than emotional. The father mourns, not because of the loss of a growing fetus, but because “he considers the question of inheritance.”

מי שלבו דוה עליו - לב אביו מתאבל על מותו הוא דחשיב לענין נחלה:

His heart mourns: The father’s heart mourns over the death of the fetus because he considers the question of inheritance

The epidemiology of Miscarriage

A miscarriage is a pregnancy that ends spontaneously before the fetus has reached a viable gestational age. There is no hard cut off, but this usually equates both clinically and legally to a human pregnancy that ends before 24 weeks of gestation, and as a review article on the epidemiology and medical causes of miscarriage pointed out, “human reproduction is extraordinarily wasteful.” One estimate is that “78% of fertilized eggs fail to result in a live birth and that the vast majority of these losses occur before the clinical diagnosis of pregnancy.” In other words, most women loose a pregnancy and never know they were even pregnant. Others suggest the rate of miscarriage is about 15-20%, generally occurring before 12 weeks gestation. Whatever the actual number, chances are that either you have had a miscarriage, or you know someone who has. We are blessed with four children. Our first pregnancy ended in a miscarriage.

“Sporadic miscarriage is the most common complication of pregnancy, and one in four of all women who become pregnant will experience pregnancy loss. The vast majority are early, occurring well before 12 weeks of gestation... The incidence of clinically recognizable miscarriage in general population studies has been consistently reported as 12-15%- but this figure is just the tip of the iceberg of total reproductive loss.”

— Regan L. Rai R. Epidemiology and the medical causes of miscarriage. Bailliere's Clinical Obstetrics and Gynaecology 2000. 14 (5) .839-854.

The emotional cost of miscarriage

Since many women turn to the emergency department when they have a miscarriage, let’s start with an old paper looking at loss and grief in this population, a consecutive sample of 44 women. About three weeks later 82% felt a sense of loss, and two thirds “experienced some limitation with daily functioning.” Importantly, even the mothers who did not want the pregnancy experienced a feeling of loss.

A Swedish study published last year looked at a larger population of 103 women and 78 of their male partners. They used a few different tools, including the Revised Impact of Miscarriage Scale (RIMS), the Perinatal Grief Scale (PGS) and the Montgomery Asberg Depression Rating (MADRS-S). As measured by all of these tools, the emotional experience of the miscarriage was more pronounced in women. They were more likely to describe the miscarriage as resulting in “isolation or guilt,” and a “devastating event.” For the women, active grief and coping difficulties were reduced after four months, but the feeling of despair remained the same. For the men, all three factors, (active grief, difficult coping and despair) were reduced after four months compared to one week. Women without children, women who had experienced a previous miscarriage and women undergoing infertility treatment showed significantly more grief than women with previous children. The researchers also noted that the fact the women had more negative emotional consequences after a miscarriage than men can affect the relationship of the couple, “and therefore, the men should not be neglected during treatment of miscarriage.”

And things can quickly worsen. The overall risk for an episode of major depressive disorder following a miscarriage is about 2.5 times that of other women. Specifically, 11% of women who miscarry experienced an episode of major depressive disorder compared with about 4% of other women.

How about the fathers?

Since Rava specifically addressed the mourning process in a father, let’s look at a study of the psychological impact of stillbirth specifically on fathers, published in the British Journal of Psychiatry in 2006. It questioned 38 pregnant couples whose previous pregnancy had ended in stillbirth, and compared them with 38 pair-matched controls. The couples were assessed six weeks, six months and one year after the loss. It was a small study, so caution is needed in generalizing, but it found that

1. Fathers experienced higher levels of depression than controls across all assessments.

2. Mothers had higher levels of psychological symptoms than fathers at every assessment, although the difference did not reach the level of significance.

3. Symptoms largely remit after the birth of a live child, although mothers continue to be more vulnerable than fathers to ongoing psychological morbidity. 

4. Parents’ levels of symptoms to run in tandem rather than for one of the partners to ‘carry’ the burden of symptomatic distress for both parents, or for one of the partners (typically the father) to feel that they have to deny their grief in order to remain strong in the face of the other’s distress.

Finally, the researchers found that for fathers there was a trend for better outcomes associated with conceiving again within a year of the stillbirth. “It is possible that these are chance findings,” they wrote, “but it is also possible that fathers and mothers have different needs in relation to this decision. Whereas mothers need time to mourn and recover before becoming pregnant again, fathers’ levels of depression and anxiety may increase as more time elapses before there is a real prospect of becoming a parent again. If this is the case, then there are implications for the advice that parents should be given about the timing of a subsequent pregnancy in the best interests of both partners.”

Experiences of miscarriage after one week and four months. Three questionnaires, the revised impact of miscarriage scale (RIMS), the perinatal grief scale (PGS) and the Montgomery–Asberg scale (MADRS-S) was used for measurements after one week and four months for women (n = 64) with miscarriage and their male partner (n = 64). For comparisons between different time points, Wilcoxon’s Signed Ranks Test was applied. For comparisons between men and women, Mann U-Whitney’s test was applied, P < 0.005 was considered significant difference. From Volgsten, H. Jansson C. et al. Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage. Midwifery 2018. 64. 23–28.

Bonding with the unborn fetus

Although it may be hard to believe, there was a time when pregnant mothers did not carry around an ultrasound image of their growing fetus. However, studies of the perceived reality of the pregnancy and the nature and intensity of grief following a miscarriage are extremely limited. It seems intuitively obvious that the more an individual had perceived the pregnancy and baby as “real” prior to the miscarriage, the more intense would be their level of grief, and this is indeed what has been found. However there have been contradictory studies with regard to the effect of viewing an ultrasound. One study of men who had viewed an ultrasound found that they had significantly more vivid images of their unborn child and higher levels of grief than male partners who had not seen an ultrasound. Another study found no difference, leading to the conclusion that “the effect of ultrasound on maternal attachment and the possible influence of ultrasound on bereavement reactions after perinatal loss await further systematic investigation.”

The Rules of Mourning and the Emotions of Mourning

Based on several passage in the Talmud, Maimonides ruled that there are no mourning rites after a miscarriage or for an infant that dies within thirty days of its birth. And this is codified in the Shulchan Aruch, the Code of Jewish Law (Yoreh Deah 374:8).

הלכות אבל א, ו

הַנְּפָלִים אֵין מִתְאַבְּלִין עֲלֵיהֶן. וְכָל שֶׁלֹּא שָׁהָה שְׁלֹשִׁים יוֹם בָּאָדָם הֲרֵי זֶה נֵפֶל. אֲפִלּוּ מֵת בְּיוֹם שְׁלֹשִׁים אֵין מִתְאַבְּלִין עָלָיו

We do not mourn for a fetus. Anything which does not live for thirty days is considered as a fetus.

The scholar Meir Bar Ilan has suggested that the infant mortality rate in Israel during period of the Talmud was around 30%. Given this, perhaps it made psychological sense to limit mourning rites for this most vulnerable of populations. Perhaps. Mercifully, things are different today, and there are new and creative rituals that might fill the vacuum left in traditional Jewish law. In 1996 the Conservative movement published a responsa titled Jewish Ritual Practice Following a Stillbirth, which noted that “contemporary rabbis and halakhic bodies cannot continue to treat a still-birth as non-event.” The same, surely, is true of a miscarriage.

In a few weeks we will learn the following Mishnah (Niddah 5:3, 44a):

תִּינוֹק בֶּן יוֹם אֶחָד… וַהֲרֵי הוּא לְאָבִיו וּלְאִמּוֹ וּלְכָל קְרוֹבָיו כְּחָתָן שָׁלֵם

a day-old infant…in relation to his father and to his mother and to all his relatives, is like a fully-fledged groom [whose death is deeply mourned].

This Mishnah is the record of another tradition, one which, with great care and sensitivity, understood that a miscarriage or neonatal death has meaning for a father and mother far greater than may be reflected in any legal decision.

“I gave birth to seven children, but I had a lot of miscarriages, maybe twice as many as my children, ... My first miscarriage, which was before I had children, was very hard for me. I awoke with shuddering pain. everyone was outside, and I cried hysterically. . . .

Afterward I learned that if a woman undergoes a miscarriage, it is actually a fetus that comes to repair something, and blessed be God. He chose a woman who observes the commandments, to keep the holiness of the soul. . . . That really encouraged me.”

— Engelsman S.P Huss E. Cwikel J. How Ultra-Orthodox (Haredi) Israeli Women Cope with Normative and Difficult Pregnancy and Childbirth Experiences. Nashim 2018. 33; 136-157

Niddah 20a ~ Rabbis, Pheromones and the Scientific Method

Today the Talmud tells two stories of rabbis, Rav Elazar and Rava who each used their keen sense of smell to identify the origins of uterine blood.

נדה כ,ב

ואמאי קרו ליה מרא דארעא דישראל דההיא אתתא דאייתא דמא לקמיה דרבי אלעזר הוה יתיב רבי אמי קמיה ארחיה אמר לה האי דם חימוד הוא בתר דנפקה אטפל לה רבי אמי אמרה ליה בעלי היה בדרך וחמדתיו קרי עליה (תהלים כה, יד) סוד ה' ליראיו

There was an incident involving a certain woman who brought blood before Rabbi Elazar for examination, and Rabbi Ami was sitting before him.Rabbi Ami observed that Rabbi Elazar smelled the blood and said to the woman: This is blood of desire, i.e., your desire for your husband caused you to emit this blood, and it is not the blood of menstruation. After the woman left Rabbi Elazar’s presence, Rabbi Ami caught up with her and inquired into the circumstances of her case. She said to him: My husband was absent on a journey, and I desired him. Rabbi Ami read the following verse about Rabbi Elazar: “The counsel of the Lord is with those who fear Him; and His covenant, to make them know it” (Psalms 25:14), i.e., God reveals secret matters to those who fear Him. 

אפרא הורמיז אמיה דשבור מלכא שדרה דמא לקמיה דרבא הוה יתיב רב עובדיה קמיה ארחיה אמר לה האי דם חימוד הוא אמרה ליה לבריה תא חזי כמה חכימי יהודאי א"ל דלמא כסומא בארובה

The Gemara further relates that Ifera Hurmiz, the mother of King Shapur, sent blood before Rava for examination, [as she sought to convert and was practicing the halakhot of menstruation]. At that time Rav Ovadya was sitting before Rava. Rav Ovadya observed that Rava smelled the blood and later said to the woman: This is blood of desire. She said to her son: Come and see how wise the Jews are, as Rava is correct. Her son said to her: Perhaps Rava was like a blind man who escapes from a chimney, [i.e., it was a lucky guess…]

Available on Amazon. Results definitely not guaranteed.

Each rabbi had inhaled the odor of the sample of blood and and concluded that it was “the blood of desire.” Rashi explains that the women from whom the sample came had sexually desired her husband to the degree that it had prompted a uterine bleed (שנתאוית לבעלה וראתה הדם מחמת תאוה). Leaving aside the question of whether menstrual bleeding and sexual desire are somehow related, the question we will focus on is this: could these blood samples really have smelled different? And that brings us to the topic of the day: pheromones.

Pheremones and Menstrual synchrony

“Pheremones are chemical signals that have evolved for communication with other members of the same species.” That is how the Oxford University zoologist Tristram Wyatt, defines them, though he is an admitted sceptic when it comes to their existence in us. The earliest claim that they might exist in humans was made back in the 1970s in those famous studies of synchronized menstruation in women who lived together in the same college dormitory.

The landmark study was published by in 1971 the American physiologist Martha McClintock, who studied the menstrual cycles of young women living on the leafy campus of Wellesley College in Massachusetts. McClintock analyzed their mensrtual diaries, and noted “a significant increase in synchronization among roommates and among close friends.” She was quick to note that although this was a preliminary study, “the evidence for synchrony and suppression of the menstrual cycle is quite strong, indicating that in humans there is some interpersonal physiological process which effects the menstrual cycle.” Just as Rava and Rav Elazar had claimed.

Lots of hypotheses were proposed to account for this menstrual synchrony. Perhaps the young women were eating similar foods, or were influenced by the same weather, or were subject to the same daily stresses of exams. Perhaps the phases of the moon were responsible? Or perhaps they were influenced by the presence of men near the campus? There was another possibility too. Perhaps there was a pheromonal signal between the menstruating women. That might be the cause. Maybe a chemical signal between the women caused the synchrony, rather than it occurring as the result of an alignment of each woman’s cycle to some external environmental signal.

Only there was a big problem. Over the decades scientists tried to replicate McClintock’s findings, but they couldn’t. Twenty years passed and four studies couldn’t replicate the findings. Thirty years passed and new experiments failed to find evidence of menstrual synchrony. And now, almost fifty years since the original study the scientific consensus is that at best there is no evidence for it; at worst, it has been thoroughly discredited. Here is how a 2014 review in the Journal of Sex Research summarised the field:

An appreciation of the likely patterns of ovarian cycling throughout much of human evolutionary history (until the 20th century) coupled with data on the extraordinary variation within and among contemporary women in cycle length quickly leads to a nagging doubt regarding the likelihood of MS sensu stricto. Add a good dose of probability theory and the fact that reasonably well designed studies have failed to support the MSH, and one is left wondering why so much attention has been given to searching for elusive mechanisms and constructing convoluted evolutionary scenarios…

So much for menstrual synchrony. But now let’s get back to the question of pheremones. Since a pheromonal mechanism of synchronization is the only plausible mechanism to account for synchrony, and since synchrony doesn’t occur, then maybe it follows that there are no pheromones that modulate the length of the human menstrual cycle. To test this, Jeffrey Schank, a psychologist from the University of California at Davis painstakingly reviewed “all the studies directly or indirectly related to pheromone modulation of the menstrual cycle,”though he noted that “this is a very small literature of eight studies spanning 25 years.” All eight studies had serious methodological flaws that you can read about here, and Schanks concluded that when taken together, “these results cast doubt on the existence of pheromones that modulate the length of menstrual cycles.”

For example, consider a study by Kathleen Stern and (you guessed it…) Martha McClintock, published in the very prestigious journal Nature in 1998. They claimed that that odourless compounds “collected from the armpits of women in the late follicular phase of their menstrual cycles accelerated the preovulatory surge of luteinizing hormone of recipient women and shortened their menstrual cycles. Axillary (underarm) compounds from the same donors which were collected later in the menstrual cycle (at ovulation) had the opposite effect: they delayed the luteinizing-hormone surge of the recipients and lengthened their menstrual cycles.” Wouldn’t that support the suggestion that humans produce compounds that regulate a specific neuroendocrine mechanism in other people without being consciously detected as odours? That is, after all, the classic definition of a pheromone.

Well no. In the first place the study results were a trend but were not statistically significant. But more importantly, Schanks noted that it was was confounded by using the third cycle, which was a treatment cycle, as a baseline cycle for determining the change in cycle length resulting from ovarian cycle secretions. It was as flawed as the other seven studies.

The search continues

We have no evidence that human pheromones exist. But that is not the same as having evidence that they do not. The search continues, and some are hopeful that by returning to good scientific principles and by using more rigorous techniques we can avoid some of the mistakes of the past.

And what are we to make of the claim that Rava and Rav Elazar could detect pheromones? Well, we should make of it exactly what the Talmud itself makes of it. Either their conclusions were the result of God’s direct revelation to “those who fear Him” (סוד ה' ליראיו), or, and this is equally possible, they were just a lucky guess. Take your pick.

“Science is not subject to statutes of limitation or prohibitions against double jeopardy. Theories, methods, and data are forever open to critical review. Science only progresses when hypotheses and theories are given the most severe tests possible. Indeed, even when a theory passes a severe test, errors may be subsequently found in data and methods supporting that theory. This implies that neither theories, data, nor methods can be accepted with absolute certainty. Scientists are fallible, and even the peer review process is no guarantee against error. The fact that errors may occur at all levels of scientific inquiry appears to lead to the skeptical view that all of science is on an equally uncertain footing. However, by repeatedly scrutinizing theories, data, and methods to weed out errors, we can have growing confidence in those that survive. This is a never ending process, but the more we critically scrutinize previous results, the more confident we can be in those theories, data, and methods in which we fail to find errors. Perhaps future studies will find indisputable evidence of pheromones that modulate menstrual cycles, but the studies to date have not. ”

— Schank, J. Do Human Pheremones Exist? Human Nature 2006: 17 (4). 448-470.

Niddah 19a ~ The Many Colors and Properties of Blood

“It is an inherently human characteristic to assign meaning to blood.”

— Melissa Meyer. Thicker Than Water: The origins of blood as symbol and ritual. New York. Routledge 2005. p16

נדה יט, א

תניא נמי הכי שחור כחרת עמוק מכן טמא דיהה אפי' ככחול טהור ושחור זה לא מתחלתו הוא משחיר אלא כשנעקר הוא משחיר משל לדם מכה לכשנעקר הוא משחיר 

It was taught in a baraita: The black color of blood that is impure is blood as black as cheret. If the black is deeper than that, the blood is ritually impure; if the black is lighter than that, even if it is still as dark as blue, the blood is ritually pure. And this black blood does not blacken from its outset, when it is inside the body; rather, it blackens only when it is removed from the body. This is comparable to the blood of a wound, which is initially red, but when it is removed from the body it blackens.

In the discussion over the various kinds of uterine bleeding that render a woman ritually impure, the Talmud pauses to consider the color of the blood itself. Perhaps blood is only considered to be, well, blood, when it is red. Rabbi Abahu thought so, and brought a proof from the Second Book of Kings (3:22):

אמר רבי אבהו דאמר קרא (מלכים ב ג:כב) "ויראו מואב את המים אדומים כדם" למימרא דדם אדום הוא אימא אדום ותו לא

Rabbi Abbahu said that the verse states: “And the sun shone upon the water, and the Moabites saw the water some way off as red as blood” [which indicates that blood is red. The Talmud asks:] Is this to say that blood is red? If so, one can say that only blood that is red like the blood of a wound [is ritually impure], and no more colors of blood are impure.

On the left, bright red oxygenated (arterial) blood. On the right, darker deoxygenated (venomous) blood.

the many colors of blood

This is not the first time we have encountered talmudic hematology and a discussion of the color of blood. When we studied Chullin (87b) we read the following

חולין פז, ב
אמר רב יהודה אמר שמואל כל מראה אדמומית מכפרין ומכשירין וחייבין בכסוי… ר' אסי מנהרביל אומר בצללתא דדמאי

Rav Yehuda says in the name of Shmuel: All mixtures of blood and water that maintain a reddish and render food susceptible to contracting ritual impurity, and are included in the obligation of covering the bloodhue are considered blood and effect atonement by being presented on the altar…Rabbi Asi of Neharbil says: The statement of Rav Yehuda is referring to the clear part of the blood [ i.e., plasma. If the plasma has a reddish hue due to the blood, it has the status of blood and can render food susceptible to contracting ritual impurity].

That is one of the earliest references to a component of the blood known today as plasma. Here is how Rashi explains what Rav Yehuda was describing:

בצללתא דדמא - באותן מים שהם מן הדם עצמן כשהוא נקרש יש סביבותיו צלול כמים ואם יש

The clear part of the blood: The liquid that is part of the blood itself. When blood clots, it is surrounded by a clear liquid…

Left: Clotted blood separated into three layers. Right: unclotted blood.

It took another couple of thousand years for us to understand the nature of this “clear part of the blood.” Sure, blood looks uniformly red, but if you let it stand (and not clot) or better yet spin a sample in a centrifuge you will notice that to the naked eye it is made up of several components. At the bottom is a layer of dark red stuff, made up of red blood cells - you know, the ones that carry oxygen from the lungs around the body. On top of that is a thinner, lighter layer, made up of white blood cells that fight infection and platelets that are vital in forming blood clots. This layer is known as the buffy coat, from the word buff meaning yellowish (sort of like a manilla envelope). At the very top is a third layer with a yellowish tinge. We call that plasma, and it is what Rav Yehuda called “the clear part of the blood” - צללתא דדמא. So that is the plasma.

Today’s page of Talmud does not address the separate color of the plasma, but the combined color of blood that has been left to clot outside of the body.

THE COMPONENTS OF BLOOD

Absorption spectra for fully oxygenated and fully deoxygenated human hemoglobin. From here.

As anyone who has cut their knee will know, the blood that first oozes out is not bright red but a darker hew. This is blood from the venous side of the circulation; there is little oxygen in this blood since it has all been extracted by the muscles and organs that need it. The hemoglobin molecules in the red blood cells shine a different, darker color when they are not carrying a molecule of oxygen. Hence the darker blood.

Hopefully you’ve never done this, but cutting an artery is a whole different story. The blood does not trickle out. It gushes out like a little fountain. And it is bright, bright red. It comes out under force because the arteries are connected directly to the heart and carry the blood under pressure. It is bright red because the hemoglobin has just taken a trip through the lungs where they have happily bound to a molecule of oxygen. And oxyhemoglobin is bright red.

As the Talmud notes, once blood leaves the body it darkens (as oxyhemoglobin and other proteins break down) and turns black. The rabbis ruled that this denatured black blood is as ritually impure as its brighter red former self.

the Sacred as Red

“Red menstrual symbolism carried over into folk speech. Early modern Europeans frequently referred to menstruation as “monthly red flowers:’ “The blood-red soils of the Rouergue district” led the southwest French to say that a woman did not” ‘have her monthlies: she ‘went to Rodez,’” ...”

— Melissa Meyer. Thicker Than Water: The origins of blood as symbol and ritual. New York. Routledge 2005. p9

“Red has always connoted blood in all its ambiguous, multivocal meanings “ wrote Melissa Meyer in her 2005 book Thicker Than Water: The origins of blood as symbol and ritual. There are so many examples of this in the rich tradition of Judaism. At a brit, the Jewish circumcision ceremony, the community responds in unison and chants a verse from Ezekiel (16, 6):

“וָאֶעֱבֹר עָלַיִךְ וָאֶרְאֵךְ מִתְבּוֹסֶסֶת בְּדָמָיִךְ וָאֹמַר לָךְ בְּדָמַיִךְ חֲיִי וָאֹמַר לָךְ בְּדָמַיִךְ חֲיִי

– And when I passed by you, and you were weltering in your blood, and I said to you – In your blood you shall live, and I said to you – In your blood you shall live.” At the brit, blood is life affirming. But when expelled from the uterus, blood symbolizes the missed opportunity for life and transmits ritual impurity. As if to emphasise the multivocal meanings of the color, the most important ritual of purification described in the Torah (Numbers 19) required the ashes of a heifer. And not just any heifer. A red one, known as para adumma (פָרָה אֲדֻמָּה) the red cow.

זֹאת חֻקַּת הַתּוֹרָה אֲשֶׁר־צִוָּה יְה’ לֵאמֹר דַּבֵּר אֶל־בְּנֵי יִשְׂרָאֵל וְיִקְחוּ אֵלֶיךָ פָרָה אֲדֻמָּה תְּמִימָה אֲשֶׁר אֵין־בָּהּ מוּם אֲשֶׁר לֹא־עָלָה עָלֶיהָ עֹל׃ וּנְתַתֶּם אֹתָהּ אֶל־אֶלְעָזָר הַכֹּהֵן וְהוֹצִיא אֹתָהּ אֶל־מִחוּץ לַמַּחֲנֶה וְשָׁחַט אֹתָהּ לְפָנָיו׃ וְלָקַח אֶלְעָזָר הַכֹּהֵן מִדָּמָהּ בְּאֶצְבָּעוֹ וְהִזָּה אֶל־נֹכַח פְּנֵי אֹהֶל־מוֹעֵד מִדָּמָהּ שֶׁבַע פְּעָמִים׃

This is the ritual law that the LORD has commanded: Instruct the Israelite people to bring you a red cow without blemish, in which there is no defect and on which no yoke has been laid. You shall give it to Eleazar the priest. It shall be taken outside the camp and slaughtered in his presence. Eleazar the priest shall take some of its blood with his finger and sprinkle it seven times toward the front of the Tent of Meeting.

In many other cultures, both sacred and taboo objects are colored red. Here is Meyer (p9):

Indians bloodied or reddened sacred statuettes and stones. Sacred trees in Madagascar and Estonia were painted with blood. Greeks tinged Dionysian statues red. Romans touched up Jupiter's face with red colorants prior to festivals. In the Congo and West Africa, some native groups marked the new moon by applying fresh red pigment to sacred statues. The Chukchi daubed sacred tent poles and charms with blood.

Nothing evinced women's fertility more than the color red. Across cultures, many believed that menstrual blood retained in the womb formed a fetus. This most powerful substance was of particular concern when it had obviously not gone to create a child. The Zaramo of Tanzania extensively ritualized mkole tree sap, which turned from white to red, powerfully symbolizing female fertility cues. Fathers gave Nepalese girls red clothing at menarche. Unmarried girls wore red beaded necklaces. Pubescent Navajo girls wore red sashes during their puberty ritual, the kinaalda. Menstruating women often protected their communities by marking themselves red. Women of the Brazilian Tapuya, African Gold Coast, and Kaffir painted their bodies red. Among Victoria tribes, menstruating women were painted red from the waist up. Menstruating Australian Dieri women wore red pigment around their mouths. In India, menstruating women wore blood-stained scarves around their necks."

THe blood of the young and the Failed start-up AMbrosia

The Mishnah on today’s page identified the color of blood as "that which flows from a wound” (איזהו אדום? כדם המכה). On page 19b the Talmud returns to the color of blood:

אמי ורדינאה א"ר אבהו כדם אצבע קטנה של יד שנגפה וחייתה וחזרה ונגפה ולא של כל אדם אלא של בחור שלא נשא אשה ועד כמה עד בן עשרים

The Sage Ami of Vardina says that Rabbi Abbahu says: It is red as the blood that flows from the smallest finger of the hand, which was wounded and later healed and was subsequently wounded again. And this is not referring to the finger of any person, but specifically to the finger of a young man who has not yet married a woman. And furthermore, this does not mean any young man; rather, until what age must he be? Until twenty years old.

Rabbi Abahu who lived in Israel in the third century, declared that there was something special about the blood of a young person - or rather, that of a young unmarried man. It looked different. There is no truth to that declaration: the blood of the young and the blood of the old are identical in color. Even the blood of a person with obstructive pulmonary disease (and hence a slightly lower oxygen content) appears identical to that of a perfectly healthy person; only a machine might tell them apart. Rabbi Abahu wasn’t the only one who believed that certain sources of human blood had special properties. The Roman naturalist and author Pliney the Elder (23-79 CE) lived some two-hundred years before Rav Abahu. He thought it hard to find anything more marvellous than menstrual blood:

 On the approach of a woman in this state, must will become sour, seeds which are touched by her become sterile, grafts wither away, garden plants are parched up, and the fruit will fall from the tree beneath which she sits. Her very look, even, will dim the brightness of mirrors, blunt the edge of steel, and take away the polish from ivory. A swarm of bees, if looked upon by her, will die immediately;

For Pliney, menstrual blood could do all manner of things: It kills, animates, and blunts knives all at once. Today you can also find claims that a young person’s blood will heal you (though not that it blunts knives).

In 2016 a startup called Ambrosia offered to sell you a therapeutic blood transfusion from “donors age 16-25.” And the cost of a dose of this young person’s plasma? A mere $8,000. The company’s chief executive is Jesse Karmazin, who graduated medical school but never completed any other medical training. Ambrosia claimed it was running a clinical trial, though it was doing nothing of the sort, and by mid -2017 some 600 people had been gullible enough to part with their $8,000. All of this was a bit much, even for the fairly patient U.S. Food and Drug Administration. In February of this year the FDA issued a statement that shut down the company:

Simply put, we’re concerned that some patients are being preyed upon by unscrupulous actors touting treatments of plasma from young donors as cures and remedies. Such treatments have no proven clinical benefits for the uses for which these clinics are advertising them and are potentially harmful. There are reports of bad actors charging thousands of dollars for infusions that are unproven and not guided by evidence from adequate and well-controlled trials. The promotion of plasma for these unproven purposes could also discourage patients suffering from serious or intractable illnesses from receiving safe and effective treatments that may be available to them. We strongly urge individuals to consult their treating physicians prior to considering the use of such products for aging indications or for the treatment of conditions such as dementia, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, heart disease or post-traumatic stress disorder given the known and unknown risks associated with their use

(By the way, in 2016 Karmazin and the Massachusetts Board of Registration in Medicine had reached an agreement: Karmazin voluntarily agreed to cease practicing medicine in the state, and left, apparently for Florida. As others have noted, this tactic is typically used by doctors who are threatened with the loss of their medical license.)

It would of course be a wonderful thing if indeed a young person’s blood could transmit new life and vigor into the old. It does just that, when we transfuse it into those who have anemia, hemophilia or life-threatening blood loss from trauma. It doesn’t kill bees or reverse aging but its life sustaining properties are plentiful. Now go donate some.

[Partial repost from here.]