Pesachim 116a~ Roasting the Paschal Lamb and the Maillard Reaction

From here

פסחים קטז, א

שֶׁבְּכָל הַלֵּילוֹת אָנוּ אוֹכְלִין בָּשָׂר צָלִי שָׁלוּק וּמְבוּשָּׁל, הַלַּיְלָה הַזֶּה — כּוּלּוֹ צָלִי…

On all other nights we may eat meat that has been roasted or stewed or cooked. But on this night, we may only eat the meat [of the Passover offering] that has been roasted

Spring is just around the corner (unless you are reading this in the southern hemisphere, in which case, please ignore) and barbecue grills are soon going to be fired up. The kobran Pesach, the Pashal lamb that was offered in the Spring festival of Passover needed a barbecue of its own. It had to be cooked over an open fire, as the Mishnah on this page of Talmud reminds us. Earlier in this tractate the Mishnah went into other meticulous details about the permitted cooking process:

פסחים עד, א

מַתְנִי׳ כֵּיצַד צוֹלִין אֶת הַפֶּסַח? מְבִיאִין שַׁפּוּד שֶׁל רִמּוֹן, וְתוֹחֲבוֹ לְתוֹךְ פִּיו עַד בֵּית נְקוּבָתוֹ, וְנוֹתֵן אֶת כְּרָעָיו וְאֶת בְּנֵי מֵעָיו לְתוֹכוֹ, דִּבְרֵי רַבִּי יוֹסֵי הַגְּלִילִי. רַבִּי עֲקִיבָא אוֹמֵר: כְּמִין בִּישּׁוּל הוּא זֶה, אֶלָּא תּוֹלִין חוּצָה לוֹ. אֵין צוֹלִין אֶת הַפֶּסַח לֹא עַל הַשַּׁפּוּד וְלֹא עַל הָאַסְכָּלָא. אָמַר רַבִּי צָדוֹק: מַעֲשֶׂה בְּרַבָּן גַּמְלִיאֵל שֶׁאָמַר לְטָבִי עַבְדּוֹ: צֵא וּצְלֵה לָנוּ אֶת הַפֶּסַח עַל הָאַסְכָּלָא 

MISHNA: How does one roast the Paschal lamb? One brings a spit [shappud] of pomegranate wood and thrusts it into the mouth of the lamb until it reaches its anus, and one then puts its legs and entrails inside it and roasts it all together; this is the statement of Rabbi Yosei HaGelili…

One may not roast the Paschal lamb on the metal spit nor on a metal grill [askela]…

The reason that a wooden spit had to be used is that a metal spit would conduct heat to the inside of the carcass and cook it, “and in the Torah it states that the Paschal lamb must be roasted in fire and not roasted through something else [like the heat conducted along a metal spit] (וְרַחֲמָנָא אָמַר ״צְלִי אֵשׁ״, וְלֹא צָלִי מֵחֲמַת דָּבָר אַחֵר). So today on Talmudology we ask: “what is so special about the roasting process?”

Roasting and the Maillard Reaction

In 1912 the French biochemist Louis Camille Maillard described a special reaction that occurs only when food has reached a temperature of 280-330F, (140-165C) and if your French is good enough you can read his original description here. What occurs in this special temperature range is that amino acids found in proteins (like meat and fish) react with reducing sugars giving the food its characteristic brown color and special flavor. Maillard uncovered a complex family of reactions, and as noted in Stuart Farrimond’s excellent book The Science of Cooking, these reactions “help us make sense of the many ways in which food browns and takes on flavor as it cooks.” He continues (p 16):

Seared steak, crispy fish skin, the aromatic crust of bread, and even the aroma of toasted nuts and spices are all thanks to this reaction…Understanding the Maillard reaction helps the cook in many ways: adding fructose-fish honey to a marinade fuels the reaction; pouring cream into simmering sugar provides milk proteins and sugars for the butterscotch and caramel flavors; and brushing pastry with egg provides extra protein for the crust to brown.

As Farrimond the food scientist explains, the temperature needs to reach at least 284F (140C) to give the amino acids and sugars enough energy to react together. At this temperature the proteins and sugars fuse, releasing “hundreds of new flavors and aromatic substances” and the food starts to turn brown. At around 320F (160C) “molecular changes continue and more enticing new flavors and aromas are created…there are now cascades of malty, nutty, meaty and caramel-like flavors.” Now is the time to be careful and pay attention to the temperature, for above about 356F ( 180C) the food begins to char. This destroys the aromas and leaves acrid, bitter flavors. So “watch the food closely and remove it from the heat before it begins to blacken.”

None of this happens when you boil food, because the boiling point of water (at sea level) is 212F (100C) so the all these glorious mouth watering reactions cannot occur.

Let’s pause to think about how some of the other biblical sacrifices were offered, and whether they too underwent the Maillard reaction.

The Burnt Offering (קרבן עולה)

During the Temple period there were other animal sacrifices that were roasted over a flame. One of these was called the Korban Oleh (lit. the sacrifice that goes up), but things didn’t stop with the Maillard process. This sacrifice had to be entirely burned on the altar, (although the skin was saved and given to the Priestly family on rotation that day). Nothing was left of it but charcoal and ashes, which were then shoveled out and disposed of in a ritual of its own. This was a popular sacrifice, which was offered for all sorts of reasons: like recovery from a skin disease, the new appointment of a priest, the completion of a Nazirite's vow, after recovery from skin disease, by a woman after childbirth, after recovery from a state of abnormal bodily discharges, conversion into Judaism or as a voluntary sacrifice, when the sacrificial animal could be a young bull, ram, year-old goat, turtle doves, or pigeons.

The Sin offering (קרבן חטאת) and the Guilt offering (קרבן אשם)

Much of the sin offering (the kidneys, their fat, the entrails and part of the liver) was burned on the altar. Sometimes the entire carcass was burned to a crisp, and sometimes it was left for the priests - the Cohanim - who could eat it under certain conditions (Lev. 6:25-30). Most of these rules also applied to the guilt offering.

The Tamid Offering (קרבן תמיד)

This was offered twice a day, every day including Shabbat. It was also brought on the New Moon (Rosh Chodesh) and on Pesach and Sukkot. Most of it was burned on the altar.

The “Peace’ Offering (קרבן שלם)

This was a large category of offerings, some for festivals, some by the Nazarite completing his or her term, and some for just saying thanks. Many had to be brought with bread, and much of the animal was burned, though male Cohanim were entitled to eat some parts that remained.

רמבם הל׳ מעשה קרבנות 9:6

וְכֵיצַד מַעֲשֵׂה שְׁלָשְׁתָּן. שׁוֹחֵט וְזוֹרֵק הַדָּם כְּמוֹ שֶׁבֵּאַרְנוּ. וּמַפְשִׁיט וּמוֹצִיא הָאֵימוּרִין. וְאַחַר כָּךְ מְנַתֵּחַ אֶת הַבָּשָׂר וּמַפְרִישׁ הֶחָזֶה וְשׁוֹק הַיָּמִין וְנוֹתֵן הָאֵימוּרִין עִם הֶחָזֶה וְהַשּׁוֹק עַל יְדֵי הַבְּעָלִים וְכֹהֵן מַנִּיחַ יָדוֹ תַּחַת יְדֵי הַבְּעָלִים וּמֵנִיף הַכּל לִפְנֵי ה' בַּמִּזְרָח. וְכֵן כָּל הַטָּעוּן תְּנוּפָה בַּמִּזְרָח מְנִיפִין אוֹתוֹ

What is procedure for bringing these three [types of peace offerings]? [The sacrificial animals] should be slaughtered and their blood should be sprinkled on the altar, as we explained.They are skinned and the portions offered on the altar are removed. Afterwards, the meat is cut up and the breast and the right thigh are set aside. The portions to be offered together with the breast and the thigh are placed on the hands of the owners…

How the Korban Pesach differed

Compared with nearly every other animal scarified in the Temple in Jerusalem, the Passover offering was the only one to be eaten in full by the participants (though the usual bits were offered up on the altar). In fact one of it requirements was that it be eaten entirely. Noting was left over. It was eaten in small family units and everyone had to have at least a little bit. These small groups ensured that everyone would smell and taste the barbecued lamb. Its aroma and taste were very special, for they were the result of the Maillard reaction. No doubt the memory of it all lingered for a long time afterwards, and just as the memory began to fade, it was time to do it all over again.

Pesachim 113a ~ The Problem of Polypharmacy

On today’s page of Talmud there is lots of advice. Lots and lots. Live in a city which has horses that neigh and dogs that bark, because they will provide security. Don’t live in a city where the mayor is a doctor, for he will be too busy with his job to govern properly. Then comes this

פסחים קיג, א

אֲמַר לֵיהּ רַב לְחִיָּיא בְּרֵיהּ: לָא תִּשְׁתֵּי סַמָּא, וְלָא תְּשַׁוַּור נִיגְרָא, וְלָא תִּעְקַר כַּכָּא, וְלָא תְּקַנֵּא בְּחִיוְיָא

Rav said to Chiyya, his son: Do not get into the habit of drinking medications, lest you develop an addiction. And do not leap over a ditch, as you might hurt yourself in the process. And do not pull out a tooth, but try to heal it if possible. And do not provoke a snake in your house to try to kill it or chase it away…

Today we will focus on the first bit of advice on this list - the problem of taking too many medications.

The problem of polypharmacy

There is a medical word that describes taking too many medications - it is called polypharmacy. And it is a real problem, especially in the elderly, who are often prescribed one drug after another as they see different specialists and sub-specialists. There is some debate about how many drugs are considered to be polypharmacy, but most physicians have a cut off at five or more in one person.

The Rashbam and the NIH on addiction

The Rashbam (1085-1158), grandson of the famous French commentator Rashi, gave this explanation on today’s passage of Talmud:

לא תשתי סמא - אל תשתה סמים מפני שנקבע להם ווסת ויהא לבך שואלך ותפסיד מעות ואפילו לרפואה לא תישתי אם אפשר לרפואה אחרת

Do not take drugs - Don’t take drugs because you will become addicted to them, and you will constantly be looking for them and spend lots of money. Even when they are needed to cure you, do not take them if there is an alternative.

The Rashbam’s words here could not be of more relevance to us moderns. The problem of drug addiction and the abuse of some prescribed medications is one of the leading health challenges facing the US and other industrialized nations. In fact, before the COVID pandemic, it occupied much of the attention of the US National Institutes of Health, which set up a multi-million dollar investment program to address the crisis called HEAL - Helping to End Addiction Long-Term. I played a small but I hope useful role in the effort, helping to establish a program to develop effective, non-addictive treatments to reduce the burden of illness due to pain and to reduce risk of addiction. Only a few drugs we use today have the potential to become addictive, and the Rashbam’s words do not feature in the current advice we give our patients. But when we do use these useful but potentially addictive and dangerous drugs, we must do so with the utmost care.

The Dangers of Polypharmacy

The Artscroll English translation of the passage above reads “do not ingest any unnecessary drugs.” Of course what makes a drug unnecessary is often a matter of legitimate medical dispute, but there is no doubt that taking a lot of medications - polypharmacy - can lead to some serious complications. In a recent expert review of the dangers of taking too many drugs researchers noted that “in general, polypharmacy has been linked to a range of negative outcomes, including falls, frailty, and mortality.” It is hard to tease out any causation (as opposed to any association) though, and the research is complicated. Is a person taking lots of drugs more likely to be weak and fall and get infections because of the several drugs she is taken, or has she been prescribed several drugs precisely because she is frail and at risk of these and other problems?

The outcomes associated with polypharmacy can be broadly put into four categories as you can see in the figure below. “In the inner circle, closest to polypharmacy, are drug-related outcomes, such as drug-drug interactions. As we move to the outer circles, the outcomes could potentially be related to the more proximal outcomes (e.g. drug-drug interactions can contribute to hospital admissions) and are also more likely to be affected by other health-related factors.” Here are some of the problems of polypharmacy.

A framework for polypharmacy and conceptual classification of outcomes. From Jonas W. Wastesson, Lucas Morina, Edwin C.K. Tan, Kristina Johnell. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert Opinion of Drug Safety 2018: 17 (12); 1185-1196.

1. Adverse drug reactions. All drugs have side effects, and the more drugs you take, the more likely you are to experience some of those effects. In addition, drugs interact with each other, often in bad ways. In fact up to 10% of hospitalizations in the elderly are due to adverse drug reactions.

2. A Swedish study based on nationwide registers found that the risk of falls increased with the number of drugs used in a dose-response fashion, meaning the more drugs you take, the more likely you are to fall.

3. Physical function like getting out of a chair or gripping something is reduced in those with polypharmacy, though it is difficult to establish a causal relationship.

4. Polypharmacy has been shown to cause frailty and sarcopenia, which is a loss of muscle mass.

5. Polypharmacy has been linked to lowered cognitive functions and dementia. In a study of community-living Japanese older adults, polypharmacy was associated with lower cognitive status, and a longitudinal register-based (nested case-control) study matching incident dementia cases with dementia-free cases found that polypharmacy was associated with receiving a dementia diagnosis. 

6. Polypharmacy has been linked with hospital admission in studies including general older adults, nursing home residents, and in people diagnosed with dementia. One researcher found that the risk of unplanned hospital admissions increased with the number of medications used, though this effect was less evident for people with a high number of chronic conditions.

7. Finally, polypharmacy has been linked with increased mortality. A 2017 systematic review (with meta-analysis) estimated that the risk of death goes up by around 8% for each additional drug taken. So not good.

The authors of this review leave us with these sobering conclusions:

The prevalence of polypharmacy in older adults is increasing in most countries. This is a cause for concern given the observed association between polypharmacy and a wide spectra of negative health outcomes, including drug-related problems, adverse drug events, physical and cognitive function, hospitalization, and mortality… scalable interventions to reduce polypharmacy (by deprescribing or other interventions) is needed to revert the trend of increasing levels of polypharmacy in the older population.

Prevention is better than cure

Commenting on today’s passage of Talmud, Rabbi Yosef Chaim of Baghdad, known as the Ben Ish Chai (1860-1930), gave this advice:

לָא תִּשְׁתֵּי סַמָּא. פירוש אם ראית בעצמך התחלת מיחוש באיזה חולי לא תמהר לשתות סם דהסם עושה מלחמה עם החולי וראוי תחלת הכל וְקָרָאתָ אֵלֶיהָ לְשָׁלוֹם (דברים כ, י) שתעשה הכנות טבעיות לשמירת עצמך מן החולי הן מצד האכילה שקורין בערבי פהרי"ז הן מצד הישיבה והמנוחה והמקום וכיוצא בזה ואולי יהיה לך זה עזר לרפואה טבעית ולא תצטרך לשתות סם לגמרי

If you begin to feel unwell from some disease, do not rush to make a drug, because the drug will wage war against the illness. But it is best…if you use a natural preparation to keep yourself healthy and prevent illness, with a proper diet, and also by sitting comfortably, getting enough rest, and paying attention to where you live, and so on. In doing so, perhaps this will provide natural healing and you will not need any drugs at all.

Just like the advice of the Rashbam, the Ben Ish Chai is also spot on. Preventing disease with exercise, a proper diet, getting enough rest and living in a healthy environment are far better for you than trying to treat a disease once it has begun. This does not mean that diseases that we can and should treat with medications are best tackled with “natural interventions.” Cinnamon does not help control your blood sugar if you have diabetes. But insulin does. Still, the advice of the Rashbam and Ben Ish Chai should be played on a loop in the waiting room of doctor’s offices and clinics. And we should listen.

Pesachim 112b ~ The Causes of Epilepsy

Today’s page of Talmud discusses the etiology of epilepsy.

פסחים קיב,ב

שְׁלֹשָׁה דְּבָרִים צִוָּה רַבִּי יוֹסֵי בְּרַבִּי יְהוּדָה אֶת רַבִּי: אַל תֵּצֵא יְחִידִי בַּלַּיְלָה, וְאַל תַּעֲמוֹד בִּפְנֵי הַנֵּר עָרוֹם, וְאַל תִּכָּנֵס לְמֶרְחָץ חָדָשׁ, שֶׁמָּא תִּפָּחֵת. עַד כַּמָּה? אָמַר רַבִּי יְהוֹשֻׁעַ בֶּן לֵוִי: עַד שְׁנֵים עָשָׂר חֹדֶשׁ. וְאַל תַּעֲמוֹד בִּפְנֵי הַנֵּר עָרוֹם, דְּתַנְיָא: הָעוֹמֵד בִּפְנֵי הַנֵּר עָרוֹם — הָוֵי נִכְפֶּה. וְהַמְשַׁמֵּשׁ מִטָּתוֹ לְאוֹר הַנֵּר — הָוַיִין לוֹ בָּנִים נִכְפִּין 

Rabbi Yosei, son of Rabbi Yehuda, commanded Rabbi Yehuda HaNasi with regard to three matters: Do not go out alone at night; do not stand naked before a candle; and do not enter a new bathhouse, lest it collapse when they light the fire beneath it…

With regard to not standing naked before a candle, the Talmud comments that this is as it was taught in a baraita: One who stands naked before a candle will become epileptic, and one who engages in intimacy by candlelight will have epileptic children.

Having established one cause of epilepsy, the Talmud then add to it, and includes some nuanced qualifications.

תָּנוּ רַבָּנַן: הַמְשַׁמֵּשׁ מִטָּתוֹ עַל מִטָּה שֶׁתִּינוֹק יָשֵׁן עָלֶיהָ — אוֹתוֹ תִּינוֹק נִכְפֶּה. וְלָא אֲמַרַן אֶלָּא דְּלָא הָוֵי בַּר שַׁתָּא, אֲבָל הָוֵי בַּר שַׁתָּא — לֵית לַן בַּהּ. וְלָא אֲמַרַן אֶלָּא דְּגָנֵי לַהֲדֵי כַּרְעֵיהּ, אֲבָל גָּנֵי לַהֲדֵי רֵישֵׁיהּ — לֵית לַן בַּהּ. וְלָא אֲמַרַן אֶלָּא דְּלָא מַנַּח יְדֵיהּ עִילָּוֵיהּ, אֲבָל מַנַּח יְדֵיהּ עִילָּוֵיהּ — לֵית לַן בַּהּ. 

Likewise, the Sages taught: One who engages in intimacy in a bed upon which a baby is sleeping, that child becomes epileptic. And we said that this will occur only if the child is not yet one year old; however, if he is one year old we have no problem with it, as he is old enough not to be affected. And furthermore, we said this only concerning a baby that is sleeping near the father’s feet; but if the baby is sleeping near his head he is sufficiently far away so that we have no problem with it. And we said this only if he does not place his hand on the baby at the time, but if he places his hands on the baby to serve as a barrier between them, we have no problem with it.

What is Epilepsy?

Epilepsy is caused by inappropriate and disorderly firing of neurons in the brain. The word comes from the French épilepsie, or from the earlier Greek epilambanein ‘seize, attack’, (from epi ‘upon’ and lambanein ‘take hold of’). It describes a condition which can manifest in a number of different ways. The person can look out blankly into the distance and not respond. These are called absence seizures. Sometimes it begins with an odd sensation of smell or sounds. This is called an aura, and it may herald a more generalized seizure. Generalized seizures may begin with a shaking in one limb, and then the person falls to the ground with a generalized seizure. These are very scary to watch, but usually resolve by themselves within a couple of minutes. Following this, during the postictal period, the person typically falls into a deep sleep for some time, perhaps half an hour or so, and often has no recollection of the events. Sometimes the generalized seizures do not end; this is called status epileptics, and it is a life-threatening condition.

The Causes of Seizures

The two most commonly identified causes of seizures are a neurologic birth injury (8%) and cerebrovascular disease (11%). But lots of other things can cause seizures, like head trauma (6%), brain tumor (4%), and infections of the central nervous system (3%). In the elderly, the cause of a new seizure is more likely to be vascular (from say a stroke), or a tumor.

In addition, some toxins can cause seizures. Of these alcohol is the one most commonly associated with seizures. And some stressors like fatigue or sleep deprivation may exacerbate an underlying seizure disorder.

Scientific vs Talmudic Causes of Seizures and Epilepsy

From Harwood-Nuss’ Clinical Practice of Emergency Medicine. Kluwer 2021. Chap 159.

• Standing naked in front of a candle (Pesachim 110)

• Engaging in intimacy in a bed upon which a baby is sleeping (that child becomes epileptic) (Pesachim 110)

• Copulating in a mill (will lead to epileptic children) (Ketuvot 60b)

• After going to the bathroom, not waiting the time to walk half a mil before having sexual intercourse (Gittin 70a). This is because the demon of the bathroom accompanies the person and then attacks.

Epilepsy in the Jewish Bible

In the Bible (Numbers 24:4) the prophet Bilaam introduces himself with the following enigmatic words:

במדבר 24:3

נְאֻ֕ם שֹׁמֵ֖עַ אִמְרֵי־אֵ֑ל אֲשֶׁ֨ר מַחֲזֵ֤ה שַׁדַּי֙ יֶֽחֱזֶ֔ה נֹפֵ֖ל וּגְל֥וּי עֵינָֽיִם׃ 

The speech of he who hears God’s speech, Who beholds visions from the Almighty, who falls, but with eyes open.

In his classic work Biblical and Talmudic Medicine, Julius Preuss wrote that the expression “with open eyes” refers “to a clairvoyant soothsayer.”

I am equally certain that the term “fallen down,” is the designation for epileptics; for in Hebrew and Arabic, the verb naphal, whose present participle is nophel, always means fallen down…Who first offered this explanation (of the term nophel meaning “fallen down”)? I can certainly not be the first, for this explanation seems to be very obvious. However I have looked in vain in numerous translations and commentaries of ancient and modern times and in exegetic handbooks and dictionaries…

Preuss noted that the same word is found in the story of Saul (I Sam 19:24). “Scripture uses the expression (vayipol) in relation to Saul after he became “manitic:” and he fell down the entire day and the entire night, that is, he had frequent epileptic seizures.”

שמואל א, 19:24

וַיִּפְשַׁ֨ט גַּם־ה֜וּא בְּגָדָ֗יו וַיִּתְנַבֵּ֤א גַם־הוּא֙ לִפְנֵ֣י שְׁמוּאֵ֔ל וַיִּפֹּ֣ל עָרֹ֔ם כָּל־הַיּ֥וֹם הַה֖וּא וְכָל־הַלָּ֑יְלָה עַל־כֵּן֙ יֹֽאמְר֔וּ הֲגַ֥ם שָׁא֖וּל בַּנְּבִיאִֽם׃

Then he too stripped off his clothes and he too spoke in ecstasy before Samuel; and he fell down naked all that day and all night. That is why people say, “Is Saul too among the prophets?”

“The Egyptians and Babylonians recognized seizures as being associated with physical ills, particularly head trauma, but, like the Greeks and Romans, sometimes ascribed their occurrence to causes that seem rather more occult than physical. Epileptics were thus often considered unclean or evil, and Pliny advised persons to spit upon seeing an epileptic, “to throw back the contagion.” Such magical thinking about seizures persists, in altered forms, and is part of the stigma of epilepsy. The treatment of epilepsy may thus have great social importance for the patient, who may still have to contend with this view of epilepsy. ”

— Robert Gross. A brief history of epilepsy and its therapy in the western hemisphere. Epilepsy Research 1992: 12; 65-74.

And epilepsy in the Christian Bible

In Matthew (14:15) we read the story of a boy brought to Jesus because he was having seizures:

…a man came to him, knelt before him, and said, “Lord, have mercy on my son, because he has seizures and suffers terribly, for he often falls into the fire and into the water. I brought him to your disciples, but they were not able to heal him.” Jesus answered, “You unbelieving and perverse generation! How much longer must I be with you? How much longer must I endure you? Bring him here to me.” Then Jesus rebuked the demon and it came out of him, and the boy was healed from that moment.

In the original Greek the text reads “he is moonstruck,” a phrase related to our modern term “lunatic.” However, as the New English Translation notes, “now the term is generally regarded as referring to some sort of seizure disorder such as epilepsy.”

A Sacred Disease then and now

The earliest treatise to discuss epilepsy is called On the Sacred Disease. It was written around 400BCE. and attributed to Hippocrates. Here is how the book opens:

It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause from the originates like other affections. Men regard its nature and cause as divine from ignorance and wonder, because it is not at all like to other diseases. And this notion of its divinity is kept up by their inability to comprehend it, and the simplicity of the mode by which it is cured, for men are freed from it by purifications and incantations. But if it is reckoned divine because it is wonderful, instead of one there are many diseases which would be sacred; for, as I will show, there are others no less wonderful and prodigious, which nobody imagines to be sacred.

So the Greek author rejects the notion that the gods cause the disease. But despite the passage of time, some cultures retain a special respect for those who are epileptic. In her 1997 award winning book When the Sprit Catches You and You Fall Down, the reporter Ann Fadiman described the clash of cultures between Hmong immigrants from southeast Asia and western medicine. It is told through the story of a young Hmong girl Lia Lee who had a severe form of epilepsy.

Dan [a medical resident] had no way of knowing that Foua and Nao Kao had already diagnosed their daughter's problem as the illness where the spirit catches you and you fall down. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy, the most common of all neurological disorders. Each had accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia's parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter's head that had been stirred up by the misfiring of aberrant brain cells. (p28)

The book painfully records what happens when an ancient system of belief is confronted with modern medicine. It is a reminder that different cultures interpret diseases and their origins in very different ways. The rabbis of the Talmud had no idea what caused the frightening condition we call epilepsy, but assumed that it was a punishment of some kind, and associated it with the sin of immodest behavior. We now know that it is nothing of the sort, and have medications that can usually bring the symptoms under control. Modern medicine, even with all its shortcomings, has given us that, for which we must be grateful.

Pesachim 109b ~ The Square Root of Two and the Danger of Pairs

The Mishnah established that a person must drink four cups of wine on the night of the Passover Seder. But this may pose a problem:

פסחים קט, ב

לֹא יִפְחֲתוּ לוֹ מֵאַרְבָּעָה. הֵיכִי מְתַקְּנִי רַבָּנַן מִידֵּי דְּאָתֵי בֵּהּ לִידֵי סַכָּנָה, וְהָתַנְיָא: לֹא יֹאכַל אָדָם תְּרֵי, וְלֹא יִשְׁתֶּה תְּרֵי, וְלֹא יְקַנַּח תְּרֵי, וְלֹא יַעֲשֶׂה צְרָכָיו תְּרֵי

But wasn’t it taught in a baraita: A person should not eat pairs, i.e., an even number of food items; and he should not drink pairs of cups; and he should not wipe himself with pairs; and he should not attend to his sexual needs in pairs.

The rabbis were concerned that doing things in pairs exposes a person to sorcery or demons. Why then would the Mishnah require that an even number of cups be drunk? That would place a person in great danger! Rabbi Nachman provides some reassurance. No harm will come because the night of the Passover Seder is a special night.

פסחים קט, ב

אָמַר רַב נַחְמָן, אָמַר קְרָא: ״לֵיל שִׁמּוּרִים״ — לַיִל הַמְשׁוּמָּר וּבָא מִן הַמַּזִּיקִין

Rav Nachman said that the verse said: “It was a night of watching to the Lord” (Exodus 12:42), which indicates that Passover night is a night that remains guarded from demons and harmful spirits of all kinds. [Therefore, there is no cause for concern about this form of danger on this particular night.]

Additional, or perhaps alternative reasons for reassurance are provided by the great Babylonian sage Rava (c.280-352), and Ravina, who lived several generations later:

רָבָא אָמַר: כּוֹס שֶׁל בְּרָכָה מִצְטָרֵף לְטוֹבָה, וְאֵינוֹ מִצְטָרֵף לְרָעָה. רָבִינָא אָמַר: אַרְבָּעָה כָּסֵי תַּקִּינוּ רַבָּנַן דֶּרֶךְ חֵירוּת, כׇּל חַד וְחַד מִצְוָה בְּאַפֵּי נַפְשַׁהּ הוּא

Rava said: The cup of blessing for Grace after Meals on Passover night is used in the performance of an additional mitzva and is not simply an expression of freedom. Therefore, it combines with the other cups for the good, i.e., to fulfill the mitzva to drink four cups, and it does not combine for the bad. [With regard to the danger of drinking pairs of cups, it is as though one drinks only three cups.]

Ravina said: The Sages instituted four separate cups, each of which is consumed in a manner that demonstrates freedom. Therefore, each and every one is a distinct mitzva in its own right.[In other words, each cup is treated separately and one is not considered to be drinking in pairs.]

The Danger of Pairs

Over the next few pages of Talmud (Pesachim 109-111) the rabbis explain some of the issues around pairs.

פסחים קי, א

תָּנוּ רַבָּנַן: שׁוֹתֶה כִּפְלַיִם — דָּמוֹ בְּרֹאשׁוֹ. אָמַר רַב יְהוּדָה: אֵימָתַי — בִּזְמַן שֶׁלֹּא רָאָה פְּנֵי הַשּׁוּק, אֲבָל רָאָה פְּנֵי הַשּׁוּק — הָרְשׁוּת בְּיָדוֹ. אָמַר רַב אָשֵׁי: חֲזֵינָא לֵיהּ לְרַב חֲנַנְיָא בַּר בִּיבִי, דְּאַכֹּל כָּסָא הֲוָה נָפֵיק וְחָזֵי אַפֵּי שׁוּקָא. 

The Sages taught in another baraita: If one drinks in pairs his blood is upon his head [i.e., he bears responsibility for his own demise]. Rav Yehuda said: When is that the case? When one did not leave the house and view the market place between cups. However, if he saw the marketplace after the first cup, he has permission to drink another cup without concern. Likewise, Rav Ashi said: I saw Rav Chananya bar Beivai follow this policy: Upon drinking each cup, he would leave the house and view the marketplace.

The great Babylonian sage Abaye (d~337 CE.) was raised never to drink precisely two cups.

פסחים קי, א

וְאַבָּיֵי, כִּי שָׁתֵי חַד כָּסָא, מְנַקֵּיט לֵיהּ אִימֵּיהּ תְּרֵי כָסֵי בִּתְרֵי יְדֵיהּ

When Abaye would drink one cup, his mother would immediately place two cups in his two hands so that he would not inadvertently drink only one more cup and thereby expose himself to the danger of drinking in pairs.

Rav Nachman, who was a contemporary of Abaye, apparently had a personal butler, and followed a similar practice:

 וְרַב נַחְמָן בַּר יִצְחָק, כִּי הֲוָה שָׁתֵי תְּרֵי כָסֵי, מְנַקֵּיט לֵיהּ שַׁמָּעֵיהּ חַד כָּסָא, חַד כָּסָא — מְנַקֵּיט לֵיהּ תְּרֵי כָסֵי בִּתְרֵי יְדֵיהּ

 And similarly, when Rav Nachman bar Yitzchak would drink two cups, his attendant would immediately place one more cup in his hand, and if he would drink one cup, the attendant would place two cups in his two hands. These reports indicate that one should be concerned for his safety after drinking an even number of cups, even when he remains at home.

Isaac Baer Levinsohn On the origins of the Suspicion

Isaac Baer Levinsohn (1788-1860) was a Ukrainian Hebrew scholar and leader of the Haskalah. In a collection of his essays and letters called Yalkut Rival published in Warsaw in 1878 he addressed the origin of the Talmudic concern about pairs of things. Here it is:

Yalkut Riva’l, Warsaw 1878, p59-60.

The Babylonian Talmud, Chapter Arve Pesachim, (109–110), expounds at length on the matter of concern about zugot, even numbered events…

In early general literature, I found that both the Greek philosopher Pythagoras and his student Plato were most particular about the number two. They believed that it indicates very bad omen. During the era of Pythagoras, this belief was prevalent over the entire Italian region. The Romans also believed in the terrible powers of the number two. Since they customarily consecrated all evil things to the god Pluto, we find in mythological books of the early Romans that the second month of the year and the second day of that month were consecrated to this god…

Our Sages (who generally sought scriptural hints at established customs) noted [in Gen. Rab. 4:7] that the second of the six days of creation is the only one in which ki tov, “that it is good” [Gen 1:6–8], is not written. We also treat the fourth day of the week like the second day, and do not begin projects on it…

However, it is distinctly possible that the number four is considered to not be good because of zugot, as it is a double pair. Tractate Pesachim of the Babylonian Talmud [112b] also states that on the eve of the fourth day [= Tuesday night] Agrat bat Machlat ventures out (see my Bet Yehudah for speculation as to the original identity of Agrat, the qelipah “shell”). Finally, to defuse these primitive beliefs from the hearts of the masses, our sages maintained elsewhere that Monday and Wednesday are, in fact, excellent days to begin projects, with a mnemonic: Ba”D qodesh, “holy Monday and Wednesday,” literally “holy fabric.”

The fear of √2

It is not clear to which writings attributed to Pythagorus Levinsohn was referring, but it may be connected to the Pythagorean discovery (if it was indeed discovered by him) that the square root of two is an irrational number. In his sweeping history of mathematics The Universal History of Numbers: From Prehistory to the Invention of the Computer Georges Ifrah wrote (p.596) that the discovery that √2 is irrational (meaning it goes on and on forever without a repeating pattern, like π) “greatly perturbed the Pythagoreans, who believed that number ruled the Universe…”

The new numbers were called “unmentionable” and the existence of these monsters was not to be divulged to the profane. According to the Pythagorean conception of the world, this inexplicable error on the part of the Supreme Architect must be kept secret, lest one incur divine wrath.

Could this explain the origin of the fear of the number two, and from that the fear of doubles in general?

The Code of Jewish Law on auspicious days

In general, Jews are forbidden to pay any attention to superstitions, although as those of you who have spent time studying the Talmud will know, Jews are a superstitious lot. Here is the Shulchan Aruch, the Code of Jewish Law, on the topic:

שולחן ערוך יורה דעה 179

שלא לכשף לעונן ולנחש. ובו י"ט סעיפים
אאין שואלין בחוזים בכוכבים ולא בגורלות: הגה משום שנאמר תמים תהיה עם ה' אלהיך (ב"י בשם תוספות דע"פ ובשם ספרי) וכ"ש דאסור לשאול בקוסמים ומנחשים ובמכשפים (פסקי מהרא"י סי' צ"ו):

It is forbidden to turn to astrologers or those who forecast using lotteries. For it is written “You shall be perfect with the Lord your God”

So far so good. But then comes this:

נהגו בשאין מתחילין בב' ובד' גואין נושאין נשים אלא במילוי הלבנה: הגה ולכן נהגו ג"כ להתחיל ללמוד בר"ח כי אע"פ שאין ניח

We have the custom not to begin a project on the second day of the week, or the fourth day of the week

Superstition in our Modern World

Our modern, rational world is still filled with superstitions. In the US, at lest 85% of buildings using an Otis elevator do not have a thirteenth floor. Actors still say to one another “break a leg” right before a show, reflecting a superstition that wishing an actor “good luck” was…bad luck. And there are any number of superstitions around boats and boating. Pairs and irrational numbers may no longer frighten us but just like our ancestors, we remain, sadly, a superstition-wary people.

“אָמַר רַב פָּפָּא, אָמַר לִי יוֹסֵף שֵׁידָא: בִּתְרֵי קָטְלִינַן, בְּאַרְבְּעָה לָא קָטְלִינַן, בְּאַרְבְּעָה מַזְּקִינַן. בִּתְרֵי, בֵּין בְּשׁוֹגֵג בֵּין בְּמֵזִיד. בְּאַרְבְּעָה, בְּמֵזִיד — אִין, בְּשׁוֹגֵג — לָא

Rav Pappa said: Yosef the Demon said to me: “If one drinks two cups, we demons kill him; if he drinks four, we do not kill him. But this person who drank four, we harm him. There is another difference between two and four: With regard to one who drinks two, whether he did so unwittingly or intentionally, we harm him. With regard to one who drinks four, if he does so intentionally, yes, he is harmed; if he does so unwittingly, no, he will not be harmed.””

— פסחים קי, א -Pesachim 110a

For more on the fifth cup and magical pairs, see the excellent paper by Leor Jacobi from where the translation of Levinsohn’s paragraph on the origin of the suspicion was taken.