New Essay: The Plague Wedding

In the months following the worldwide COVID-19 pandemic there has been renewed attention given to what had previously been an obscure and long-forgotten Jewish ceremony. On March 18, 2020, a wedding took place at the Ponevezh cemetery in the city of Bnei Brak in Israel. It was reported in the Israeli press, and drone footage documented a huppa erected next to the wall of the cemetery, with a few dozen onlookers carefully weaving their way among the fresh graves.

Such a wedding acquired an unforgettable moniker: It was known in Yiddish as a shvartse khasene, a “black wedding,” and is sometimes referred to as a “cholera wedding” or a “plague wedding.”

The story travelled widely, and the ceremony has since been reported in The New York Times, The Los Angeles Review of Books, and on various blogs and websites. This unexpected attention to a little-known and often controversial Jewish response to pandemics raises many questions. What were its origins, how widespread was it, and what might be the halakhic and philosophical implications of this striking, and admittedly, bizarre ceremony? This paper, long in preparation before the COVID pandemic, is an attempt at some answers.

To read the full essay go to the Tradition Online site by clicking here.

Yoma 55a ~ Yom Kippur, Counting, and Why the Chinese Are Good at Math

A Mishnah that we studied a couple of days ago on page 53a described how the Cohen Gadol (High Priest) would sprinkle the blood of his sacrifice in Temple on Yom Kippur.

נִכְנַס לַמָּקוֹם שֶׁנִּכְנַס, וְעָמַד בַּמָּקוֹם שֶׁעָמַד, וְהִזָּה מִמֶּנּוּ אַחַת לְמַעְלָה וְשֶׁבַע לְמַטָּה

He entered into the place that he had previously entered, the Holy of Holies, and stood at the place where he had previously stood to offer the incense, between the staves. And he sprinkled from the blood, one time upward and seven times downward.

And then he would count to avoid any error:

וְכָךְ הָיָה מוֹנֶה: אַחַת, אַחַת וְאַחַת, אַחַת וּשְׁתַּיִם, אַחַת וְשָׁלֹשׁ, אַחַת וְאַרְבַּע, אַחַת וְחָמֵשׁ, אַחַת וְשֵׁשׁ, אַחַת וָשֶׁבַע. יָצָא וְהִנִּיחוֹ עַל כַּן הַזָּהָב שֶׁבַּהֵיכָל.

And this is how he would count as he sprinkled, to avoid error: One; one and one; one and two; one and three; one and four; one and five; one and six; one and seven. The High Priest then emerged from there and placed the bowl with the remaining blood on the golden pedestal in the Sanctuary.

Today’s page of Talmud comments on this interesting way of keeping track of the sprinklings:

יומא נה, א

תָּנוּ רַבָּנַן: אַחַת, אַחַת וְאַחַת, אַחַת וּשְׁתַּיִם, אַחַת וְשָׁלֹשׁ, אַחַת וְאַרְבַּע, אַחַת וְחָמֵשׁ, אַחַת וָשֵׁשׁ, אַחַת וָשֶׁבַע, דִּבְרֵי רַבִּי מֵאִיר. רַבִּי יְהוּדָה אוֹמֵר: אַחַת, אַחַת וְאַחַת, שְׁתַּיִם וְאַחַת, שָׁלֹשׁ וְאַחַת, אַרְבַּע וְאַחַת, חָמֵשׁ וְאַחַת, שֵׁשׁ וְאַחַת, שֶׁבַע וְאַחַת.

וְלָא פְּלִיגִי: מָר כִּי אַתְרֵיהּ וּמָר כִּי אַתְרֵיהּ

The Sages taught in a baraita that when sprinkling, the High Priest counted: One; one and one; one and two; one and three; one and four; one and five; one and six; one and seven. This is the statement of Rabbi Meir. Rabbi Yehuda says that he counted: One; one and one; two and one; three and one; four and one; five and one; six and one; seven and one.

The Gemara comments: They do not disagree about the matter itself that the High Priest sprinkles once upward and seven times downward. Rather, this Sage rules in accordance with the norm in his place, and this Sage rules in accordance with the norm in his place. In one place they counted the smaller number first, while in the other place they would count the larger number first.

WHo excels at math?

In a 1994 study of forty second-generation Chinese-American and 40 Caucasian-American preschoolers and kindergartners, the Chinese-American children outperformed Caucasian-American children on measures of mathematics, spatial relations, visual discrimination, numeral formation, and name writing. A 2011 study that explored cultural differences in young children’s early math competency prior to their school showed that Taiwanese children performed better than U.S., Peruvian, and Dutch children. More Taiwanese four-year-olds were able to count up to at least 21 when compared with children from the other three countries. There are more studies like these, but you get the idea. But why should some cultures be especially good at math? The answer, it appears, is in the language.

The Best language to learn math…is not english

From here.

It turns out that the way numbers are counted in different languages may make arithmetic easier - or harder. In a fascinating article in The Wall Street Journal, Sue Shellenbarger noted that Chinese, Japanese, Korean and Turkish use simpler number words and express math concepts more clearly than English. And this makes it easier for small children to learn counting and arithmetic. “The trouble starts at "11” she wrote:

English has a unique word for the number, while Chinese (as well as Japanese and Korean, among other languages) have words that can be translated as "ten-one"—spoken with the "ten" first. That makes it easier to understand the place value—the value of the position of each digit in a number—as well as making it clear that the number system is based on units of 10.

English number names over 10 don't as clearly label place value, and number words for the teens, such as 17, reverse the order of the ones and "teens," making it easy for children to confuse, say, 17 with 71, the research shows. When doing multi-digit addition and subtraction, children working with English number names have a harder time understanding that two-digit numbers are made up of tens and ones, making it more difficult to avoid errors.

These may seem like small issues, but the additional mental steps needed to solve problems cause more errors and drain working memory capacity…

This suggestion was supported by a more recent study that showed that among Chinese children language abilities were able to significantly predict both informal and formal math skills.

Language	17	27
English	'seventeen'	'twenty-seven'
Chinese	'ten-seven'	'two-ten-seven'
Japanese	'ten-seven'	'two-ten-seven'
Turkish	'ten-seven'	'two-ten-seven'
Hebrew	'seven-ten'	'twenty-seven'

Today’s discussion in the Talmud notes that there were different ways of counting the one “upward sprinkling” and the seven “downward” ones. Of course neither effected the way that numbers higher than eleven are counted in Hebrew, but it is a reminder that the order in which we count things plays a very significant role in how we might see the world. And how good we are at getting our sums right.

Yoma 44b ~ Gold

יומא מד, ב

אָמַר רַב חִסְדָּא: שִׁבְעָה זְהָבִים הֵן: זָהָב, וְזָהָב טוֹב, וּזְהַב אוֹפִיר, וְזָהָב מוּפָז, וְזָהָב שָׁחוּט, וְזָהָב סָגוּר, וּזְהַב פַּרְוַיִם. שֶׁדּוֹמֶה לְפָז. זָהָב שָׁחוּט — שֶׁנִּטְוֶה כְּחוּט. זָהָב סָגוּר — בְּשָׁעָה שֶׁנִּפְתָּח כָּל הַחֲנוּיוֹת נִסְגָּרוֹת. זְהַב פַּרְוַיִם — שֶׁדּוֹמֶה לְדַם הַפָּרִים. זָהָב וְזָהָב טוֹב, דִּכְתִיב: ״וּזְהַב הָאָרֶץ הַהִוא טוֹב״. זְהַב אוֹפִיר — דְּאָתֵי מֵאוֹפִיר. זָהָב מוּפָז —

Rav Chisda said: There are seven types of gold mentioned in the Bible: Gold, and good gold, and gold of Ophir (I Kings 10:11), and glistering gold (I Kings 10:18), and shaḥut gold (I Kings 10:17), and closed gold (I Kings 10:21), and parvayim gold (II Chronicles 3:6). The Gemara explains the reason for these names: There is a distinction between gold and good gold, as it is written in the verse: “And the gold of that land is good” (Genesis 2:12), which indicates the existence of gold of a higher quality. Gold of Ophir is gold that comes from Ophir. Glistering [mufaz] gold is so named because it resembles the luster of pearls [paz] in the way it glistens. Shaḥut gold is named as such because it is very malleable and is spun like thread [shenitve keḥut]. Shaḥut is a contraction of the words shenitve keḥut. Closed gold is so called because when a shop opens to sell it, all the other shops close, as no one is interested in purchasing any other type of gold. Parvayim gold is so called because its redness resembles the blood of bulls [parim].

רַב אָשֵׁי אָמַר: חֲמִשָּׁה הֵן, וְכל חַד וְחַד אִית בֵּיהּ זָהָב וְזָהָב טוֹב. תַּנְיָא נָמֵי הָכִי: בְּכל יוֹם הָיָה זְהָבָהּ יָרוֹק, וְהַיּוֹם אָדוֹם — וְהַיְינוּ זְהַב פַּרְוַיִם שֶׁדּוֹמֶה לְדַם הַפָּרִים

Rav Ashi said: There are in fact only five types of gold, the last five in Rav Chisda’s list. Gold and good gold are not independent categories; rather, each and every one of the types of gold has two varieties: Regular gold and a superior variety called good gold. That was also taught in a baraita with regard to parvayim gold: On every other day the coal pan was made of greenish gold, but on this day it was made of a red gold, and this is the parvayim gold which resembles the blood of bulls.

Illustration drawn for Talmudology by Yosef Itzkowitz (www.yosefpaper.com)

Not all Gold is “gold”

We usually think of gold as being the color of, well, gold. But that’s not its only color. While pure gold is a sort of reddish yellow, gold alloys vary in color depending on the proportion of the other metals that are found in it. (An alloy is a mixture of two or more different metal elements.) So an alloy of gold and copper will be more red, while an alloy of gold and silver (or gold and other metals like nickel or palladium) will give a white looking gold. You can see how this works in the figure below:

In addition, the purity of gold is measured in karats (also spelled carats, but certainly not carrots), where each karat is 1/24 (or 4.1667%) part of pure gold. Sixteen karat gold means that it is an alloy in which 16 parts are gold and 8 parts are another. Pure gold is, by definition, free of other metals and is therefore 24-karat (ie 24 parts out of 24) gold.

Where does “Parvayim Gold” come from?

Recent evidence suggests that gold is formed by the massive collision of neutron stars. “Every element on the periodic table heavier than bismuth…is forged by the rapid-process in these most extreme stellar surfaces” wrote the cosmochemist Tim Gregory in his recent book Meteorite (p.168). “This includes some of your most highly prized substances like …silver, platinum and gold.” This gold was incorporated into the earth’s mantle when the planet was being formed, and was incorporated with other metals, which is why different kinds of gold alloys may be extracted from different mines.

It is this feature that Rav Chisda and Rav Ashi were highlighting in today’s page of Talmud. Shauhut gold (זָהָב שָׁחוּט) which Rav Chisda noted to be so malleable that it could be “spun like a thread” (נִּטְוֶה כְּחוּט) was likely almost pure gold (i.e. 24 carat). Today, gold can be made into a thin sheet known as gold leaf that is an astonishing four to five millionths of an inch in thickness (0.1 to 0.125 millionths of a meter or micrometers, µm). And the “spinning into a thread” that Rav Chisda mentioned? Today it is possible to spin gold into a thread that is just one atom thick. One atom. Think about that.

Another kind of gold mentioned by Rav Chisda is Parvayim gold which was a red color that “resembled the blood of bulls” (שֶׁדּוֹמֶה לְדַם הַפָּרִים). This gold was likely an alloy with a high content of copper, (found towards the bottom right of the triangle above).

The Medicinal Qualities of Gold

The Jewish physician Abraham Portaleone was born in Mantua in 1541, and is best known for his work Shilte Hagibborim [Shields of the Mighty], in which he sought to identify the precise ingredients of the Temple incense mentioned in the famous talmudic passage called Pittum Haketoret (Grinding of the Spices). Portaleone was also very interested in pharmacology, and authored a Latin text De Auro Dialogi Tres (Three Dialogues on the Application of Gold in Medicine) about the possibilities of a medical use of gold “a topic halfway between alchemy and medical studies that still created heated scientific debate.” Here is the assessment of historian Alessandro Guetta in his 2014 work on the history of Italian Jewry:

Contemporary medical authorities were divided into two camps on this: those who denied gold’s powers and those convinced of them. Portaleone’s position lay midway between the two. In his view, the hypothesis that gold had powerful medicinal properties was true; nevertheless, it remained a mere hypothesis, since such properties do not reside within gold as we know it …but in its quintessence, a substance perfectly pure and balanced in composition. In truth, nobody had yet succeeded in extracting this essence…consequently, the long list of healings that ancient and modern doctors had attributed to attributed to the ingestion of “common gold” mixed with water or wine was the fruit of ignorance and charlatanism. As for gold’s capacity to cauterize wounds, it has this in common with many other metals with the same characteristics.

We are now some four centuries after Abraham Portaleone wrote his book about gold. And it is indeed now true that gold can be used as a medicine. Aurotherapy is used to treat some kinds of inflammatory diseases like rheumatoid arthritis, and may have a role to play in the treatment of some cancers and as an agent to improve wound healing. So to add to the Talmudic categorization of gold based on its color and malleability, we can now thankfully add another: how useful it is in treating disease.

Yoma 43a ~ Androgyny and the Fluidity of Gender

The Torah proscribes a series of steps required to render a person spiritually pure. One of those steps (Numbers 19:17) is to pour spring water on the ashes of a sacrificed animal. But who is qualified to do the pouring? The Talmud cites a Mishnah (Parah 5:4) that tells us:

יומא מג, א

מֵיתִיבִי: הַכֹּל כְּשֵׁרִין לְהַזּוֹת, חוּץ מִטּוּמְטוּם וְאַנְדְּרוֹגִינוֹס וְאִשָּׁה. וְקָטָן (שֶׁיֵּשׁ) בּוֹ דַּעַת, אִשָּׁה מְסַיַּעְתּוֹ וּמַזֶּה.

Everyone is qualified to sprinkle the purification waters, except for a person whose sexual organs are concealed [tumtum], and a hermaphrodite [androginus], and a woman. And concerning a minor who has a basic level of intelligence, a woman may assist him and he sprinkles the purification waters.

Today we will explore the nature of these two mysterious categories known as the tumtum and the androginus. We also posted this about a year ago while studying Shabbat, but hey, lots of people have subscribed to Talmudology since then, and be honest, can you recall that post in detail? No? Then read on…

The tumtum is a person whose genitalia are somehow hidden or covered, so that it is not known if they are male or female. In contrast, the genitalia of the androgyne (an ancient Greek word formed from ἀνδρός  andros - “man” and γυνή gune, - “woman”) are in plain sight. It just isn’t clear whether they are male or female organs. The two are mentioned on at least twenty-three pages of the Babylonian Talmud, and in no fewer than nine halachot in the Jerusalem Talmud, so let’s figure out what, from a medical perspective, they are.

The Tumtum

There is no ambiguity about the gender of a tumtum. We just need to get a glimpse of the genitals. (The eleventh century dictionary known as the Aruch connects the word tumtum with the word atum (אטום), meaning sealed.) The problem is that the genitals are covered by what is usually described as skin. Once this cover is surgically opened, the gender will be revealed. In fact according to Rav Ammi (Yevamot 64a), both Abraham and Sarah were each a tumtum. Yes, you read that correctly. Each had genitalia that were hidden. Rav Ammi suggests this as an explanation as to why the couple were infertile for so many years. Once the covering had been removed the couple could then procreate as normal, and along came Isaac.

אמר רבי אמי אברהם ושרה טומטמין היו שנאמר (ישעיהו נא, א) הביטו אל צור חוצבתם ואל מקבת בור נוקרתם וכתיב (ישעיהו נא, ב) הביטו אל אברהם אביכם ואל שרה תחוללכם

Rabbi Ami said: Abraham and Sarah were originally tumtumin, as it is stated: “Look to the rock from where you were hewn, and to the hole of the pit from where you were dug” (Isaiah 51:1), and it is written in the next verse: “Look to Abraham your father and to Sarah who bore you” (Isaiah 51:2),

רשי:

חוצבתם - נעשה לו זכרות: “Hewn”: He was made into a male

נוקרתם - נעשה לה נקבות : “From where you were dug” which made here a female

Urologists have yet to identify this syndrome.

The Androgyne

In 1797 the physician James Parsons, published a book which he dedicated to the Royal Society of London, of which he was a Fellow: “ A Mechanical and Critical Inquiry into the Nature of Hermaphrodites.” Parsons noted that the Romans “had laws made against their Androgyni [which were] remarkably severe; for whensoever a child was reputed one of these, his sentence was to be shut up in a chest alive, and thrown into the sea…

Parsons was not only well-read in Roman law; he cited the fourth chapter of the Mishnah in Bikkurim, which contains a list of the ways in which the androgne sometimes resembles a man, and sometimes a woman:

ביכורים פרק ד

כֵּיצַד שָׁוֶה לַאֲנָשִׁים: מְטַמֵּא בְּלֹבֶן כַּאֲנָשִׁים, וְזוֹקֵק לְיִבּוּם כַּאֲנָשִׁים, וּמִתְעַטֵּף וּמִסְתַּפֵּר כַּאֲנָשִׁים, וְנוֹשֵׂא אֲבָל לֹא נִשָּׂא כַּאֲנָשִׁים, וְחַיָּב בְּכָל מִצְוֹת הָאֲמוּרוֹת בַּתּוֹרָה כַּאֲנָשִׁים:

In what ways is the andogyne like men?…He dresses like men; He can take a wife but not be taken as a wife, like men. [When he is born] his mother counts the blood of purification, like men; He may not be secluded with women, like men. He is not maintained with the daughters, like men…And he must perform all the commandments of the Torah, like men.

כֵּיצַד שָׁוֶה לַנָּשִׁים: מְטַמֵּא בְּאֹדֶם כַּנָּשִׁים, וְאֵינוֹ מִתְיַחֵד עִם הָאֲנָשִׁים כַּנָּשִׁים, וְאֵינוֹ עוֹבֵר עַל "בַּל תַּקִּיף" וְלֹא עַל "בַּל תַּשְׁחִית" וְלֹא עַל "בַּל תְּטַמֵּא לַמֵּתִים" כַּנָּשִׁים, וּפָסוּל מִן הָעֵדוּת כַּנָּשִׁים, וְאֵינוֹ נִבְעַל בַּעֲבֵירָה כַּנָּשִׁים, וְנִפְסַל מִן הַכְּהֻנָּה כַּנָּשִׁים:

And in what ways is he like women?… he must not be secluded with men, like women; And he doesn’t make his brother’s wife liable for yibbum (levirate marriage); And he does not share [in the inheritance] with the sons, like women; And he cannot eat most holy sacrifices, like women…. he is disqualified from being a witness, like women…

The Androgyne & Congenital Adrenal Hyperplasia

Ambiguous genitalia in neonates. From here.

One of the most common causes of androgyny is congenital adrenal hyperplasia (CAH), caused by a mutation in the CYP21 gene. The adrenal glands, which sits atop the kidneys, are where the action takes place. They produce androgens, which are then converted into the potent sex hormone testosterone. In most (95%) cases of CAH, there is a deficiency of the enzyme 21-hydroxylase. As a result, the adrenal glands produce excessive amounts of the virilizing hormone androgen. (It also causes severe salt wasting, which can be very dangerous, but we are not getting into that now. And there are different severities of the syndrome, but you’ve got a limited attention span, so we will keep it simple.) This excessive androgen production does very little in (XY) males; their genitalia look normal. But in genetic (XX) baby girls the androgens affect the external genitalia and they may become ambiguous: the clitoris becomes enlarged, sometimes to the degree that it resembles a penis. In very severe cases the baby girl has what appears to be an empty scrotum, and may be raised as a boy, all the while being an XX girl with CAH.

Today all newborns are screened for 21-hydroxylase. The deficiency can be treated with hormone replacement, and the genital ambiguity may be corrected, although this latter intervention has, over the last decades, become very controversial.

“Anecdotally, in the Western world most [intersex] babies were raised as female because the genitalia were easier to reconstruct... clinical experience suggests that cultural factors are very influential. This may be no bad thing as there is no ‘right’ medical answer and the child will have to grow up in the community into which it is born.”

— Woodhouse, C.R.J. Intersex Surgery in the Adult. BJU International 2004. 93 (3): 57-65

The androgyne and the hermaphrodite

James Parsons, A Mechanical and Critical Inquiry into the Nature of Hermaphrodites. London 1797. p85.

The Soncino Talmud identifies the androgyne as a hermaphrodite, that is, a person with both male and female genitalia. So does Goldschmidt’s German translation (“der zwitter”). Cases of true hermaphroditism are extremely rare, and there are only a few scattered case reports in the medical literature. (You can read one reported from Sheba Hospital in Tel Aviv here.) Rather than there being two sets, in these cases the genitalia are ambiguous, and although they have both ovarian and testicular tissue the scrotum does not always contain testes.

Alice Dreger, formerly a Professor of Medical Humanities and Bioethics at Northwestern University, (it’s complicated) wrote a terrific (and controversial) book that tackles some of the issues facing intersex people - those who were once called hermaphrodites. In the past, when faced these difficult cases of intersex or ambiguous genders, clinicians focused on what she calls a “gonadal division.” (Since biopsies and genetic sequencing were not available to the rabbis of the Talmud, they, like clinicians, focused on this gonadal division, for what else could they do?) But, she notes,

a system that emphasizes gonadal anatomy above all else suffers from two major deficits. First, it is scientifically questionable, because it relies on the anatomy of the gonads (functioning or not) more than any other considerations. Second, it provides little clinical help, often confusing and harming the patient, and sometimes also the physician.

Instead, she advocates for a description based on etiology and the patient’s needs. “Such an approach would have the salutary effects of improving patient and physician understanding and reducing the biases that are inherent in the use of the current language of 'hermaphroditism'.”

“True hermaphrodites: defined as presenting at least one ovary and at least one testis, or at least one ovotestis...The scientific understanding of sexual development has progressed tremendously in the last 125 years, but the existing taxonomy does not reflect that progress. Scientists and clinicians now recognize that the structure of the gonads does not correlate simply with genotype, phenotype, physiology, diagnosis, or gender identity. The anatomy of testicular tissue in women with androgen insensitivity syndrome (AIS) is quite similar to the anatomy of testicular tissue in non- intersex males, yet their physiologies, phenotypes and gender identities differ markedly.”

— Dreger, A, et al. Changing the Nomenclature/Taxonomy for Intersex. Journal of Pediatric Endocrinology & Metabolism 2005. 18, 729-733

The many Shades of Gender

We are used to think that when an egg carrying an X chromosome meets a sperm carrying an X or Y chromosome, one of two things will happen: a genetic female (46XX) or a genetic male (46XY) with genitalia to match. But in fact it is way more complicated than that. We know that there are at least 14 genes involved in the process of sexual differentiation, and many more will likely be discovered. A mutation or malfunction of any of these has a dramatic effect on the process of gender differentiation. For example if there is a defect in the enzymes involved in producing testosterone, there may be ambiguous external genitalia; deficiency of the enzyme 5α-reductase results in variable degrees of under-masculinized external genitalia and genital ambiguity; individuals with partial androgen insensitivity syndrome may also have ambiguous genitalia, and there is no consensus regarding an optimal sex of rearing them; and newborns with congenital adrenal hyperplasia, may have male appearing genitalia while all the time being 46XX.

We have previously noted the strange effects of yet gene discovered in the 1980s. This sex-determining gene on a tiny bit of the male Y chromosome is called the sry gene. That gene tells the body to develop into a male or female appearing body. Sometimes the sry gene sneaks off of the Y gene and makes its way into the DNA of an XX female. As a result, she will develop male anatomy while genetically remaining an XX female. (Please read that sentence again, just to be sure you have understood it.) And sometimes the sry gene on an XY genetic male can mutate and not work. In that case, the genetic male appears to have the organs of a female, which is what occurs in Swyer syndrome. (You can hear more about the amazing sex-changing effects of sry in this fascinating podcast.)

And then there is the small community in the Dominican Republic where there have been a number of cases in which little girls grow a penis and turn into little boys. These observations were first reported to the scientific community in 1974, and are caused by a deficiency of the steroid 5α-reductase. Here is how the BBC explained what is going on when they reported about it in 2015.

When you are conceived you normally have a pair of X chromosomes if you are to become a girl and a set of XY chromosomes if you are destined to be male. For the first weeks of life in womb you are neither…Then, around eight weeks after conception, the sex hormones kick in. If you're genetically male the Y chromosome instructs your gonads to become testicles and sends testosterone to a structure called the tubercle, where it is converted into a more potent hormone called dihydro-testosterone. This in turn transforms the tubercle into a penis. If you're female and you don't make dihydro-testosterone then your tubercle becomes a clitoris…the reason [some genetic males] don't have male genitalia when they are born is because they are deficient in an enzyme called 5-alpha-reductase, which normally converts testosterone into dihydro-testosterone.

So the boys, despite having an XY chromosome, appear female when they are born. At puberty, like other boys, they get a second surge of testosterone. This time the body does respond and they sprout muscles, testes and a penis.

So gender identity is very complicated. James Parsons, that physician who wrote the book on hermaphrodites in 1797 tackled some of the difficult questions that were addressed in Mishnah Bikkurim: can a hermaphrodite get married? (yes, but to which gender varies by case); can they be a witness? (only if the “predominating sex” is male); can they be ordained as a minister? (no); The rabbis were puzzled as to the “true” gender of the androgyne, and so classified them as sometimes male, and sometimes female. It was the best they could do at the time, and Parsons, writing 1,500 years later did the same. Thanks to modern medicine we have learned why these intersex cases occur, but as a society we have still a long way to go to help make their lives easier.