Talmudology on the Parsha, Shemot: A History of Jewish Midwives

שמות 1:15–22

וַיֹּ֙אמֶר֙ מֶ֣לֶךְ מִצְרַ֔יִם לַֽמְיַלְּדֹ֖ת הָֽעִבְרִיֹּ֑ת אֲשֶׁ֨ר שֵׁ֤ם הָֽאַחַת֙ שִׁפְרָ֔ה וְשֵׁ֥ם הַשֵּׁנִ֖ית פּוּעָֽה׃

וַיֹּ֗אמֶר בְּיַלֶּדְכֶן֙ אֶת־הָֽעִבְרִיּ֔וֹת וּרְאִיתֶ֖ן עַל־הָאבְנָ֑יִם אִם־בֵּ֥ן הוּא֙ וַהֲמִתֶּ֣ן אֹת֔וֹ וְאִם־בַּ֥ת הִ֖וא וָחָֽיָה׃

וַתִּירֶ֤אןָ הַֽמְיַלְּדֹת֙ אֶת־הָ֣אֱלֹהִ֔ים וְלֹ֣א עָשׂ֔וּ כַּאֲשֶׁ֛ר דִּבֶּ֥ר אֲלֵיהֶ֖ן מֶ֣לֶךְ מִצְרָ֑יִם וַתְּחַיֶּ֖יןָ אֶת־הַיְלָדִֽים׃

וַיִּקְרָ֤א מֶֽלֶךְ־מִצְרַ֙יִם֙ לַֽמְיַלְּדֹ֔ת וַיֹּ֣אמֶר לָהֶ֔ן מַדּ֥וּעַ עֲשִׂיתֶ֖ן הַדָּבָ֣ר הַזֶּ֑ה וַתְּחַיֶּ֖יןָ אֶת־הַיְלָדִֽים׃

וַתֹּאמַ֤רְןָ הַֽמְיַלְּדֹת֙ אֶל־פַּרְעֹ֔ה כִּ֣י לֹ֧א כַנָּשִׁ֛ים הַמִּצְרִיֹּ֖ת הָֽעִבְרִיֹּ֑ת כִּֽי־חָי֣וֹת הֵ֔נָּה בְּטֶ֨רֶם תָּב֧וֹא אֲלֵהֶ֛ן הַמְיַלֶּ֖דֶת וְיָלָֽדוּ׃

וַיֵּ֥יטֶב אֱלֹהִ֖ים לַֽמְיַלְּדֹ֑ת וַיִּ֧רֶב הָעָ֛ם וַיַּֽעַצְמ֖וּ מְאֹֽד׃

וַיְהִ֕י כִּֽי־יָרְא֥וּ הַֽמְיַלְּדֹ֖ת אֶת־הָאֱלֹהִ֑ים וַיַּ֥עַשׂ לָהֶ֖ם בָּתִּֽים׃

וַיְצַ֣ו פַּרְעֹ֔ה לְכל־עַמּ֖וֹ לֵאמֹ֑ר כל־הַבֵּ֣ן הַיִּלּ֗וֹד הַיְאֹ֙רָה֙ תַּשְׁלִיכֻ֔הוּ וְכל־הַבַּ֖ת תְּחַיּֽוּן׃

And the king of Egypt spoke to the Hebrew midwives, of whom the name of the one was Shifra, and the name of the other Pu῾ah: and he said, When you do the office of midwife to the Hebrew women, you shall look upon the birth stones; if it be a son, then you shall kill him: but if it be a daughter, then she shall live. But the midwives feared God, and did not as the king of Miżrayim commanded them, but saved the men children alive. And the king of Miżrayim called for the midwives, and said to them, Why have you done this thing, and saved the men children alive? And the midwives said to Par῾o, Because the Hebrew women are not as the Egyptian women; for they are lively, and are delivered before the midwives come to them. Therefore God dealt well with the midwives: and the people multiplied, and grew very mighty.

In a remarkable act of defiance, the Hebrew midwives Shifra and Pu’ah refused to murder the baby boys that they delivered. For this, they have ever since been evoked in discussions of Jewish midwifery, which is the topic of this week’s Talmudology on the Parsha.

Abaye’s Midwife-Surgeon

In Masechet Shabbat, the great Babylonian amora Abaye (d.337) described the skill of his nurse, (whom he called אם, mother, for she raised him). She was both a midwife and a surgeon, as this passage makes clear:

שבת קלד,א

אָמַר אַבָּיֵי, אֲמַרָה לִי אֵם: הַאי יָנוֹקָא דְּלָא יְדִיעַ מַפַּקְתֵּיהּ, לְשַׁיְיפֵיהּ מִישְׁחָא וְלוֹקְמֵיהּ לַהֲדֵי יוֹמָא, וְהֵיכָא דְּזִיג — לִיקְרְעֵיהּ בִּשְׂעָרְתָּא שְׁתִי וָעֵרֶב. אֲבָל בִּכְלִי מַתָּכוֹת — לָא, מִשּׁוּם דְּזָרֵיף

Abaye said: my nurse told me: In the case of a baby whose anus cannot be seen, [as it is obscured by skin,] let one rub it with oil and stand it before the light of the day. And where it appears transparent, let one tear it with a barley grain widthwise and lengthwise. However, one may not tear it with a metal implement because it causes infection and swelling.

This midwife was also skilled in a number of other post-natal interventions:

וְאָמַר אַבָּיֵי, אֲמַרָה לִי אֵם: הַאי יָנוֹקָא דְּלָא מָיֵיץ, מֵיקַר [הוּא] דְּקָר פּוּמֵּיהּ. מַאי תַּקַּנְתֵּיהּ? לַיְתוֹ כָּסָא גּוּמְרֵי, וְלַינְקְטֵיהּ לֵיהּ לַהֲדֵי פּוּמֵּיהּ, דְּחָיֵים פּוּמֵּיהּ וּמָיֵיץ. וְאָמַר אַבָּיֵי, אֲמַרָה לִי אֵם: הַאי . יָנוֹקָא דְּלָא מִנַּשְׁתֵּים — לִינְפְּפֵיהּ בְּנָפְווֹתָא וּמִנַּשְׁתֵּים

וְאָמַר אַבָּיֵי, אֲמַרָה לִי אֵם: הַאי יָנוֹקָא דְּלָא יְדִיעַ מַפַּקְתֵּיהּ, לְשַׁיְיפֵיהּ מִישְׁחָא וְלוֹקְמֵיהּ לַהֲדֵי יוֹמָא, וְהֵיכָא דְּזִיג — לִיקְרְעֵיהּ בִּשְׂעָרְתָּא שְׁתִי וָעֵרֶב. אֲבָל בִּכְלִי מַתָּכוֹת — לָא, מִשּׁוּם דְּזָרֵיף. וְאָמַר אַבָּיֵי, אֲמַרָה לִי אֵם: הַאי יָנוֹקָא דְּלָא מָיֵיץ, מֵיקַר [הוּא] דְּקָר פּוּמֵּיהּ. מַאי תַּקַּנְתֵּיהּ? לַיְתוֹ כָּסָא גּוּמְרֵי, וְלַינְקְטֵיהּ לֵיהּ לַהֲדֵי פּוּמֵּיהּ, דְּחָיֵים פּוּמֵּיהּ וּמָיֵיץ. וְאָמַר אַבָּיֵי, אֲמַרָה לִי אֵם: הַאי יָנוֹקָא דְּלָא מִנַּשְׁתֵּים — לִינְפְּפֵיהּ בְּנָפְווֹתָא וּמִנַּשְׁתֵּים.

Abaye said: My nurse told me: If a baby refuses to nurse, that is because its mouth is cold and it is unable to nurse. What is his remedy? They should bring a cup of coals and place it near his mouth, so that his mouth will warm and he will nurse. And Abaye said that my mother told me: A baby that does not urinate, let one place him in a sieve and shake him, and he will urinate.

And Abaye said: My nurse told me: If a baby is not breathing, let them bring his mother’s placenta and place the placenta on him, and the baby will breathe. And Abaye said that my mother told me: If a baby is too small, let them bring his mother’s placenta and rub the baby with it from the narrow end to the wide end of the placenta. And if the baby is strong, i.e., too large, let them rub the baby from the wide end of the placenta to the narrow end. And Abaye said that my mother told me: If a baby is red, that is because the blood has not yet been absorbed in him. In that case, let them wait until his blood is absorbed and then circumcise him. Likewise, if a baby is pale and his blood has not yet entered him, let them wait until his blood enters him and then circumcise him.

As we will shortly see, this ability to both deliver babies and operate on a number of neonatal conditions was common among Jewish midwives.

Ancient Roman midwife attending a woman giving birth. From TheWellcome Trust Corporate Archive.

A thirteenth century Hebrew Midwifery Manual

Klalei haMilah (The Rules of Circumcision), is a work attributed to Jacob haGozer and Gershom haGozer, a father and son team who were both known by their profession (haGozer, lit. ‘the cutter’). They practised in Worms during the first half of the thirteenth century, and one chapter of their guidebook addresses midwifery, based on (of all things) the first chapter of the biblical book of Ezekiel. Here is a flavor, from a 2019 paper on the topic by Elisheva Baumgarten.

‘As for your birth, when you were born’ (Ezekiel 16: 4) – Thus we learn from this that a woman may be delivered on the Sabbath. ‘Your navel cord was not cut’ – Thus the umbilical cord is severed for the newborn (lit. child) on the Sabbath and it is tied on the Sabbath because its life depends on it. “You were not bathed in water to smooth you” – Thus the infant is washed in order to smooth its skin. “You were not rubbed with salt,” – Thus the infant is salted on the Sabbath.

And R. Gershom the Circumciser, of blessed memory, explained that when he questioned the midwives (about this practice), they said that they do not salt the child at all; God forbid, for how could he tolerate any salt? However, they salt the placenta, and they also pour wine on it, and [moreover], she [one of the midwives] says that it (wine) is good for the mother of the child for it will season her food. ‘Nor were you swaddled’—Thus, the infant is swaddled on the Sabbath. ‘Swaddled’: meaning they bind the child in cloth rags that fix him and straighten his limbs. As we have said here (lit. now), Everything that is enumerated in the Chapter of Rebuke may be done for women in labour on the Sabbath. Thus, the infant would be endangered if we did not carry out all that is mentioned in this chapter; therefore, these (actions) are permitted on the Sabbath without sin (lit. even when premeditated).

Jewish Midwives in Eighteenth Century Germany

In a fascinating paper published in 2022, the Israeli academic Nimrod Zinger noted that the names and actions of several midwives appear in the memorial books of German Jewish communities, known as memorbikher. “The criterion for entering the memorbukh was a donation to one of the community’s institutions, made by family members of the deceased or by the deceased themselves,” and their names were read by the cantor each Shabbat. Here is an example, from the Pinkas hazkharat neshamot be-kehilat Wermaiza (Jerusalem, National Library of Israel, MS Heb. 656–4), 45:

May God remember the soul of old Mrs. Hech’le daughter of Rabi Toviya z”l with the souls of S.R.R.A. [Sarah, Rebecca, Rachel, and Leah], for she rose early in the mornings and went in the evenings to the synagogue. For her lovingkindness [gemilut ḥasadim] toward the poor and the rich, and for delivering babies for several years for free, in our community and in other places. Her heirs gave, on her behalf, some golden coins for charity. our community and in other places. Her heirs gave, on her behalf, some golden coins for charity. our community and in other places.

We should note that Hech’le did not receive payment for her services, but instead practiced midwifery as part of her charitable activity. And here is another mention, this time from the community of Vienna:

May God remember the soul of the pious Mrs. Mara’le daughter of R. Natan Segal z”l…for she was charitable for every person near and far, and did charity for poor and far [rich], and was modest in all her actions, and for the women in labor among our people she did as Shifra and Puah and was a woman of valor.

Zinger noted that these descriptions demonstrated that “patients often chose not to call on physicians or professional healers, such as doctors or surgeons, but rather on non professional healers, who usually did not receive payment for their aid.” In addition to acting as midwives, many women mentioned in these German memorial books provided other charitable services, including treating wounds and fractures, and burying the dead. Consider, for example, Fromet Shnabir of Frankfurt, who died in 1724:

[She was like] Shifra and Puah and sat nights and days by women in labor and the sick, poor and rich, and dealt with medications and bandages by herself …with the living and the dead…with any person in issues of medications, bruises and wounds for the rich and the poor, and any person who turned to her, and she lent [money] to the poor in times of need.

Sometimes, the midwife was part of a healing duet, in which her husband was a physician. Here is a description of Rachel the midwife and her husband of Zelcely the physician, who lived in Mainz.

the important, decent, and pleasant woman… Mrs. Rachel Frumrechi, daughter of the deceased Rabbi Meir Katz, wife of the deceased Rabbi Zelcely the rofeh [physician]…who went all her days in the path of the righteous, who did charity with her body and with her money for the poor and for the rich. She did good deeds, visited the sick, and always went to the women giving birth to save them.

Still, even pious midwives needed an income, which is why a contract was sometimes drawn up in which there was a guarantee of payment for the services of a midwife. Here is one that was signed in July 1759 in Offenbach, between the Jewish community and a midwife named Haya’le:

Her annual salary of twenty-five gold coins will be paid by the community, may God protect it, in four payments [i.e., every three months]. It was also promised that she will be provided free accommodation according to her need. There is also a need to settle her status before His Majesty. Anyone who calls for her to perform a delivery will have to pay her at least one gold coin, and every householder whose wife is about to deliver must call for her, and if he does not, he will have to pay the mentioned gold coin before his wife leaves her bed. The community, may God protect it, will be pledged for that gold coin, with the agreement of the householders. She has to notify the officer on duty [parnas ha-hodesh] if she does not receive her fee before the wife leaves her bed. Then the community may prevent the husband from conducting smechim bezetam [the ritual surrounding a woman’s arrival at the synagogue after her son’s birth] if he does not pay before the Sabbath.

(According to Zinger, this turned out not to be enough, and in 1761 Haya’le asked for an increase. The community agreed to raise to sixty gold coins, and to provide her with firewood for winter.)

“Elka Godel, born in Mea Shearim (a Jerusalem neighbourhood), went to Vienna for her training and returned home with her diploma in 1901. However, her young age was to her disadvantage. She was sent by the Jewish Colonisation Association to Zichron Ya’akov (a settlement near Haifa) as a replacement for the local midwife. Since she was only 22 years old, not yet married and had not given birth herself, she was greeted by the local population with a lack of trust, until she finally managed to attend a number of successful births”

— Galbloom R. 1961, ‘The Nostalgic Story of Elka Godel’, La-Ishah, 15 August, 22–3.

Polish midwife certificate awarded to Sara Malia Goldfarb (nee Arzt). Sara was born in Jaroslaw (then part of the Austrian Empire, and graduated from the Royal Imperial School for Midwives in Lwow (now Lviv in Ukraine) on 15 July 1882. She practised as a midwife in Port Said, Egypt. Sara Malia and some of her siblings had gone to Egypt for the opening of the Suez Canal several years earlier, in 1869. Image courtesy of Albert Braunstein, Sara’s great-grandson and Talmudology reader.

Jewish Midwives in Late Ottoman Palestine

In her 2010 paper, Zipora Shehory-Rubin noted that the first midwives in Eretz Israel had no formal professional education and were therefore generally ignorant of hygienic necessities. In late Ottoman Palestine, poor living conditions, overcrowding and lack of minimal sanitary and hygienic conditions led to high rates of both maternal and infant mortality.

The great majority of the country’s inhabitants lacked any kind of medical help or treatment, making do with all sorts of herbal remedies, whispered prayers, supposed healing powers and amulets, and even asking help of what one might call witch-doctors… the causes of the high incidence of illness and death among infants… included unhygienic living conditions with crowding, lack of lighting and fresh air, the flow of raw sewage, accompanied by filth and foul odours. There was a lack of public services for the removal of sewage and garbage. Water was collected in cisterns, and was insufficient in quantity and quality. There was also malnutrition, insufficient clothing and heating during the winter, widespread disease and epidemics, as well as the frequency of drought and famine years. Moreover, premature marriages impaired the health and longevity of young mothers and their offspring.

To address this, the Ezrat Nashim (Women’s Help) Society was founded in 1895, to care for pregnant women, and to provide a midwife for those too poor to pay for one. In 1898, there were 22 midwives in Jerusalem, of whom 13 were Ashkenazi and 9 were Sepharadi. Few had any theoretical training and some could neither read nor write. Many of the midwives were older widows, who went out to work to provide income for their families. But there was little in the way of modern medicine to be practiced. Commonly, to induce labor or prevent a difficult birth, many women resorted to placing the key of the synagogue under their pillow, or taking a thread from the cover of the Ark and tying it to the bed.

If the birth ended in success, the midwife would receive her fee from the head of the family and in due course leave the house, in order to be ready for her next case. Sometimes the midwife would receive items of food (sugar, oil, bagels, raisins or dates) and small gifts (such as a kilo of soap) in addition to her fee. If a son was born, the midwife won a higher fee, and visitors and relatives used to leave her small gratuities or gifts. Before she left the house, the father would ask her to attend the next birth.

It is little wonder, therefore, that in 1925 the Annual Report of the Jerusalem Branch of the Hebrew Women’s Federation, observed that “there wasn’t a woman in the old city [in Jerusalem] or outside, who had not experienced the death of two or three babies at birth, or shortly thereafter, from among the eight to twelve children they had brought into the world.”

The Fertility Institute Named after a Biblical Midwife

In Israel today, The Institute of Fertility and Medicine According to Halacha (מכון פועה - פוריות ורפואה ע"פ ההלכה) is named Machon Pu’ah, after, of course, our very own midwife from this week’s parsha. Here is their mission statement:

Whether individuals are struggling with fertility, women's health, men's health, genetics or intimacy, PUAH is here to help. PUAH advisors embody a unique synthesis of rabbinical knowledge and specialized training in modern reproductive medicine to provide the best guidance possible. Our counseling and guidance is free-of-charge, helping to ease the difficult journey. All that we do is carried out in accordance to Jewish law, with deep sensitivity and compassion.

So this week, if you are looking for a charity to support, think of Machon Pu’ah, and send them a donation in honor of Shifra and Pu’ah and Abaye’s Mother, and Hech’le and Haya’le and Fromet and Rachel and all the unnamed and and unrecognized Jewish midwives who, over many thousands of years, were the unsung heroes of Jewish continuity.

Childbirth and care of the neonate has long been the provenance of women, starting with the Hebrew midwives Shifrah and Pu’ah. The knowledge that midwives passed down to each other saved countless babies from the complications of childbirth or the rigors immediately following it. While some of their advice was certainly in error from our modern perspective (Abaye’s nurse recommended placing a baby in a sieve and shaking her in order to get her to urinate,) their knowledge and skills often worked. Otherwise we would not be here to tell about it.

“[Frumit’le] was involved in charity work for the living and for the dead. She delivered young babies at the hekdesh [Jewish hospital] like Puah and Shiphrah...She did not neglect any mitzvah, big or small, and prepared medications with no charge for the rich and the poor alike.”

— Description of Frumit’le of Frankfurt, who died in 1753:Mimorbukh shel kehilat Frankfurt de-Main (Jerusalem, National Library of Israel, MS Heb. 1092 = 4), 329.

Bava Kamma 60b ~ Quarantine and Social Isolation

By now, we are all experts in the pros and cons of quarantine and social distancing. COVID taught us that (before we became experts in containing Russia, and, more recently, in dealing with the intractable problem of peace in the Middle East). The COVID pandemic might seem like a long time ago, but we can still recall with ease the days of isolation that we had to observe, and how often the rules changed.

All of this makes today’s page of Talmud all the more interesting, since it contains the locus classicus that addresses quarantine and social distancing during a pandemic.

בבא קמא ס, ב

ת"ר דבר בעיר כנס רגליך

Our Rabbis taught: When there is an epidemic in the town keep your feet inside your house (Bava Kamma 60b.)

Social Isolation

There is a long history of isolating those with disease, beginning with our own Hebrew Bible:

 (כל ימי אשר הנגע בו יטמא טמא הוא בדד ישב מחוץ למחנה  מושבו.  (ויקרא פרק יג, מו

As long as they have the disease they remain unclean. They must live alone; they must live outside the camp (Lev. 13:46).

(צו את בני ישראל וישלחו מן המחנה כל צרוע וכל זב וכל טמא לנפש. (במדבר ה, ב

Command the people of Israel to remove from the camp anyone who has a skin disease or a discharge, or who has become ceremonially unclean by touching a dead person (Num. 5:2).

These are examples of social isolation, that is, individual and community measures that reduce the frequency of human contact during an epidemic. Here, for example, are some of the ways that social distancing was enforced during the Spanish flu epidemic of 1918-1918, an outbreak that killed about 40 million people worldwide:

... isolation of the ill; quarantine of suspect cases and families of the ill; closing schools; protective sequestration measures; closing worship services; closing entertainment venues and other public areas; staggered work schedules; face-mask recommendations or laws; reducing or shutting down public transportation services; restrictions on funerals, parties, and weddings; restrictions on door-to-door sales; curfews and business closures; social-distancing strategies for those encountering others during the crisis; public-health education measures; and declarations of public health emergencies. The motive, of course, was to help mitigate community transmission of influenza.

And you certainly don’t need to be reminded of the social isolation that we all went through during the COVID pandemic. The teaching in this page of Talmud emphasizes not the isolation or removal of those who are sick, but rather the reverse - the isolation of those who are well.  Of course the effect is the same: there is no contact between those who are ill and those who are well, but since there are usually many more well than there are sick, the effort and social disruption of isolation of the healthy will be much greater.  

“Implementation of social distancing strategies is challenging. They likely must be imposed for the duration of the local epidemic and possibly until a strain-specific vaccine is developed and distributed. If compliance with the strategy is high over this period, an epidemic within a community can be averted. However, if neighboring communities do not also use these interventions, infected neighbors will continue to introduce influenza and prolong the local epidemic, albeit at a depressed level more easily accommodated by healthcare systems.”

— Glass, RJ. et al. Targeted Social Distancing Design for Pandemic Influenza. Emerging Infectious Diseases 2006. 12: (11); 1671-1681.

It is not hard to see a relationship between expelling those who are ill and denying entry to those whose health is in doubt.  In the 14th century, when Europe was ravaged by several waves of bubonic plague that killed one-third of the population, many towns enacted measures to control the disease. Around 1347 the physician Jacob of Padua advised the city to establish a treatment area outside of the city walls for those who were sick.  "The impetus for these recommendations" wrote Paul Sehdev  from the University of Maryland School of Medicine, "was an early contagion theory, which promoted separation of healthy persons from those who were sick. Unfortunately, these measures proved to be only modestly effective and prompted the Great Council of the City to pursue more radical steps to prevent spread of the epidemic." And so the notion of quarantine was born. Here is Sehdev's version of the story:

In 1377, the Great Council passed a law establishing a trentino, or thirty-day isolation period . The 4 tenets of this law were as follows: (1) that citizens or visitors from plague-endemic areas would not be admitted into Ragusa until they had first remained in isolation for 1 month; (2) that no person from Ragusa was permitted go to the isolation area, under penalty of remaining there for 30 days; (3) that persons not assigned by the Great Council to care for those being quarantined were not permitted to bring food to isolated persons, under penalty of remaining with them for 1 month; and (4) that whoever did not observe these regulations would be fined and subjected to isolation for 1 month. During the next 80 years, similar laws were introduced in Marseilles, Venice, Pisa, and Genoa. Moreover, during this time the isolation period was extended from 30 days to 40 days, thus changing the name trentino to quarantino, a term derived from the Italian word quaranta, which means “forty."

The precise rationale for changing the isolation period from 30 days to 40 days is not known. Some authors suggest that it was changed because the shorter period was insufficient to pre- vent disease spread . Others believe that the change was related to the Christian observance of Lent, a 40-day period of spiritual purification. Still others believe that the 40-day period was adopted to reflect the duration of other biblical events, such as the great flood, Moses’ stay on Mt. Sinai, or Jesus’ stay in the wilderness. Perhaps the imposition of 40 days of isolation was derived from the ancient Greek doctrine of “critical days,” which held that contagious disease will develop within 40 days after exposure. Although the underlying rationale for changing the duration of isolation may never be known, the fundamental concept embodied in the quarantino has survived and is the basis for the modern practice of quarantine.

More talmudic health measures during an epidemic

In addition to staying indoors, on today’s page the Talmud recommends two other interventions during a plague:

ת"ר דבר בעיר אל יהלך אדם באמצע הדרך מפני שמלאך המות מהלך באמצע הדרכים

Our Rabbis taught: When there is an epidemic in the town, a person should not walk in the middle of the road, for the Angel of Death walks in the middle of the road...

 ת"ר דבר בעיר אל יכנס אדם יחיד לבית הכנסת שמלאך המות מפקיד שם כליו

Our Rabbis taught: When there is an epidemic in the town, a person should not enter the synagogue alone, because the Angel of Death deposits his tools there...

It probably won't surprise you to learn that neither of these two measures is discussed in the medical literature, and in fact if there's an epidemic in town, you probably shouldn't go to shul at all. 

How this page of Talmud was ignored by…

The early Codes of Jewish Law

There is nothing about this topic in the literature of the Ga’onim, the rabbis who continued to shape Jewish law after the redaction of the Babylonian Talmud, from about 600–1040. Neither is it mentioned in any of the three earliest codes of Jewish law, the Halakhot of Rabbi Yitzhaq Alfasi (11th century), the Mishnah Torah of Maimonides (late 12th century), and the Halakhot of Rabbi Asher ben Yehiel, better known by his acronym Rosh (late 13th to early 14th century). Asher ben Yehiel had a son by the name of Ya’akov, who organized the material from these three codes into an important new work known as the Tur, and which itself became the basis for the later authoritative Shulhan Aruch, which became the accepted Code of Jewish Law. But Ya’akov also ignored the entire topic of behavior during a pandemic.

The Maharsha

Later commentators on the Talmud added their own rulings about social isolation during a pandemic. The Polish exegete Rabbi Shmuel Eidels known by his acronym as Maharsha (1555–1631) wrote that the rabbis of the Talmud could not have been suggesting that one should not flee from the locus of a pandemic. “This is certainly not the case, because if there is an outbreak of plague in a town it is best to leave and flee for one’s life. Rather, the intent of the Talmud is that if one cannot flee, then do not go outside into the streets.” In true talmudic fashion, this comment of the Maharsha was itself commented on by a later rabbi, Yosef Hayyim from Baghdad (1835–1909) who is better known by the title of his major work on Jewish law, Ben Ish Hai. In his commentary on the Talmud, he wrote that “the words of the Maharsha are only applicable to [bubonic] plague. But in the case of cholera, even when arrangements could be made to care for a sick person at home, it is best to flee the city. Because cholera also frightens a person, and he can be consumed by the illness on account of this fear . . . Therefore it is best to flee far away so that his ears cannot hear and his eyes cannot see the sickness that rules over everyone, lest he be overtaken with fear, and he himself be taken, God forbid.

Sefer Hasidim

Although the practice of relocating because of a pandemic outbreak was not addressed in the early Jewish codes, it is mentioned in an important work called Sefer Hasidim (The Book of the Pious), a collection of folk stories, customs, and ethical adjurations that originated in the German Jewish community around Regensberg in the thirteenth century and was first published in 1487.

If there is plague in the city, and one heard that things are well in another city, they should not go there, for the Angel of Death has power over those who originate in that land, even aliens, so when caravans travel from a plagued city to a different land, it is smitten. However, if individuals go, and their intention is not commercial, it will not cause harm, and they are acting wisely. Anyone who wishes to escape should go to another land until the plague is arrested, and “May He destroy death forever” (Isaiah 25:8).

Clearly the Sefer Hasidim ignored the talmudic dictum to stay in one’s own house and ride out the pandemic. Sefer Hasidim encouraged individuals to flee, while disapproving of any large-scale organized temporary migration. It is not clear whether the Angel of Death alluded to here is identical with the Angel mentioned in the Talmud as “walking in the middle of the road” or is instead a moniker for the miasma, the tainted air that was thought to be the direct cause of pandemic illness from the time of the Talmud until the nineteenth century. Either way, the advice offered by Sefer Hasidim demonstrates that the Jewish practice at the time did not follow the advice of the Talmud.

The Maharil

The Sefer Hasidim was cited by a later authority, Rabbi Ya’akov ben Moshe Moellin (c. 1365–1427) who is better known by his acronym Maharil. He was born in Mainz but spent his later years in Worms where he was buried. In his most important work, he addressed the same vexing question: is it permitted to flee in the face of an impending epidemic? He offered a quasi-religious observation. The Talmud in tractate Sanhedrin observed that for “seven years there was a pestilence, yet no one died before his time.” Since death is predestined, fleeing from an epidemic or remaining in place is of no consequence; those who were fated by God to live will survive, while those ordained by God to die will do so, regardless of where they are. But Maharil downplayed this uncomfortable observation.

Instead, he cited the talmudic stories about the free reign of the Angel of Death. He also mentioned a ruling from his own teacher Rabbi Shalom Neusdadt (died c. 1413) who gave permission to flee during the early stages of an epidemic (though what constituted an “early stage” was not defined). This gave Maharil the freedom to find a rabbinic way to permit what it was that Jews were doing anyway. Faced with the conflicting talmudic sources but basing himself in part on the earlier Sefer Hasidim, Maharil wrote simply “for these reasons we do in fact flee” and concluded that “there appears to be no prohibition” in doing so.

The Maharshal

A century after Maharil, another rabbi codified the rulings about when and where to flee from an epidemic into law. The Polish Rabbi Shlomo Luria (1510– 1573), better known as Maharshal, descended from a family line that it was claimed could be traced back to Rashi, and his mother was herself a Talmudist of some repute. The Maharshal, like Maharil before him, ignored the talmudic advice that required to shelter-in-place: Here is his ruling:

“Section 26. The law about when a plague breaks out in a city: if the plague is not widespread you are required to flee. If it has become widespread, you should stay at home [lit. gather your feet].”

Luria considered the same talmudic sources cited by Maharil that suggested death can be indiscriminate during a plague, and referenced Maharil’s work, though without naming Maharil as the author. He concluded:

If a person has the ability to save himself and his property, then God forbid that he should not do so. He must separate himself from the sorrows of the community—even if as a result he will be punished by not being among those comforted by Zion.

Here is how the Maharshal concludes his legal opinion: “Therefore it is clear that if a plague comes to the city, a person must flee if he can do so, unless he has already contracted the plague and been cured, for then everyone says that he has nothing to fear.” He analyzed and reinterpreted today’s passage in the Talmud to be in harmony with what it was that everyone, Jew and Gentile alike, were doing when faced with an outbreak of plague, or indeed any infectious disease.

and by the Aruch Hashulchan

A few centuries later, another rabbi wrestled with the Talmud’s applicability, this time in a world in which vaccination was a reality. Rabbi Yehiel Michel Halevi Epstein (1829– 1908) served as the rabbi of Novogrudok (Navahrudak), in what is now Belarus for over 30 years, and while there he wrote the halakhic work by which he is best known, Aruch Hashulchan, first published in 1884.

The great rabbis have ruled that when there is an outbreak of smallpox in children and there are many deaths, a public fast should be declared. Every person, together with their young children should distance themselves from the city [where there is an outbreak], and should he not do so will pay for this with his life. And in the Talmud it is written “If there is plague in the city, gather your feet.” But smallpox is an infectious disease, and so there is an obligation to stay far from the city. Today the disease is not common, because about one hundred and fifty years ago the doctors started to give the cowpox [vaccine] to every young child aged about a year. In doing so they prevented this disease, as is well known.

But today the childhood disease called diphtheria is widespread, and it is a form of [the disease described in the Talmud as] askara which constricts the throat. I believe that if, God forbid, there is an outbreak of this disease, one should impose a public fast day.

Here, perhaps for the first time, is a new reason to ignore the Talmud’s advice: the infectious nature of smallpox. It had been well understood for centuries that many diseases are contagious, and that a person may become infected merely by having contact with the sick. But Rabbi Yehiel Michel Halevi Epstein was among the first to use the phrase mahala midabeket, which in modern Hebrew means “infectious disease.” Once the mechanisms of transmission began to be understood, it made sense to re-evaluate the talmudic advice to shelter-in-place. Such counsel was not sensible if the disease was likely to be spread easily from person to person, and the discovery of the role of bacteria and viruses would further support the importance of putting as much distance as possible between oneself and the outbreak of an epidemic. Epidemic outbreaks had once been understood as an unavoidable consequence of divine anger, planetary misalignment, or polluted air. But now they were acknowledged to be the entirely avoidable consequence of poor hand hygiene and an inattention to antisepsis.

[There is much, much more on the topic of fleeing, and on the larger Jewish encounter with pandemics in my book, The Eleventh Plague, from where much of the above is taken.]

 שולחן ערוך יורה דעה הלכות מאכלי עובדי כוכבים סימן קטז סעיף ה 

עוד כתבו שיש לברוח מן העיר כשדבר בעיר, ויש לצאת מן העיר בתחלת הדבר, ולא בסופו. וכל אלו הדברים הם משום סכנה, ושומר נפשו ירחק מהם ואסור לסמוך אנס או לסכן נפשו בכל כיוצא בזה

Initial growth of an infectious contact network. Colored rectangles denote persons of designated age class, and colored arrows denote groups within which the infectious transmission takes place. In this example, from the adult initial seed (large purple rectangle), 2 household contacts (light purple arrows) bring influenza to the middle or high school (blue arrows) where it spreads to other teenagers. Teenagers then spread influenza to children in households who spread it to other children in the elementary schools. Children and teenagers form the backbone of the infectious contact network and are critical to its spread; infectious transmissions occur mostly in the household, neighborhood, and schools. From Glass, RJ. et al. Targeted Social Distancing Design for Pandemic Influenza. Emerging Infectious Diseases 2006. 12: (11); 1671-1681.

Talmudology on the Parsha, Vayechi: Binyamin the Werewolf

בראשית 49:27

בִּנְיָמִין֙ זְאֵ֣ב יִטְרָ֔ף בַּבֹּ֖קֶר יֹ֣אכַל עַ֑ד וְלָעֶ֖רֶב יְחַלֵּ֥ק שָׁלָֽל׃

Binyamin is a ravenous wolf: in the morning he shall devour the prey, and at night he shall divide the spoil.

“Binyamin is a ravenous wolf.” What an intriguing description of a person. Was he always hungry? Did he like to hunt? Was he mostly grey? Ibn Ezra explained that, like a wolf, Binyamin was a strong fighter (דמהו לזאב כי גבור היה). Sforno explained that wolves hunt at dusk and dawn, when there is not much light. In the same way, the descendents of the tribe of Binyamin (King Shaul and Mordechai of the Purim Story) ruled at a period of Jewish history immediately before dawn - at the start of the Jewish monarchy (Shaul) and at dusk, the end of Jewish self rule (Mordechai).

binyamin the werewolf

But there is another explanation of this verse, given by the twelfth century French scholar Rabbeinu Ephraim ben Shimshon in his commentary on the Torah. You see, Rabbenu Ephraim explained that this verse means Binyamin was a werewolf.

Image from here.

Another explanation: Binyamin was a “predatory wolf,” sometimes preying upon people. When it was time for him to change into a wolf, as it says, “Binyamin is a predatory wolf,” as long as he was with his father, he could rely upon a physician, and in that merit he did not change into a wolf. For thus it says, “And he shall leave his father and die” (Gen. 44:22)—namely, that when he separates from his father, and turns into a wolf with travelers, whoever finds him will kill him.

Rabbeinu Ephraim has more to say about werewolves in general, and how they relate to Binyamin. This can be found in his commentary to Genesis 35:27. It turns out that Binyamin the werewolf ate his mother, the matriarch Rachel:

Image from here.

There is a type of wolf that is called loup-garou (werewolf), which is a person that changes into a wolf. When it changes into a wolf, his feet emerge from between his shoulders. So too with Binyamin - “he dwells between the shoulders” (Deuteronomy 33:12). The solution for [dealing with] this wolf is that when it enters a house, and a person is frightened by it, he should take a firebrand and thrust it around, and he will not be harmed. So they would do in the Temple; each day, they would throw the ashes by the altar, as it is written, “and you shall place it by the altar” (Leviticus 6:3); and so is the norm with this person whose offspring turn into wolves, for a werewolf is born with teeth, which indicates that it is out to consume the world. Another explanation: a werewolf is born with teeth, to show that just as this is unusual, so too he will be different from other people. And likewise, Binyamin ate his mother, who died on his accord, as it is written, “And it was as her soul left her, for she was dying, and she called his name ‘the son of my affliction’ ” (Genesis 35:18).

Rashi also believed in Werewolves

It may surprise you to learn that Rashi also believed in werewolves. Here is his commentary on Job 5:23:

איוב 5:23

כִּ֤י עִם־אַבְנֵ֣י הַשָּׂדֶ֣ה בְרִיתֶ֑ךָ וְחַיַּ֥ת הַ֝שָּׂדֶ֗ה השְׁלְמָה־לָּֽךְ׃

For you will have a pact with the rocks in the field, And the beasts of the field will be your allies.

וחית השדה. הוא שנקרא גרוש"ה בלע"ז וזו היא חית השדה ממש ובלשון משנה תורת כהנים נקראים אדני השדה

and the beasts of the field That is what is known as grouse(?) in Old French, and this is actually a beast of the field. In the language of the Mishnah in Torath Kohanim, they are called “adnei hasadeh.”

In order to translate the old French word גרוש"ה (which should be read as garove), we turn to Otzar halo’azim, a dictionary of Rashi’s old French. Under entry #4208 we read the following:

Moshe Catano, the author of this dictionary, tells us that the Rashi was using the old French word for a “man-wolf, which is refers to the legends of a man that turns into a wolf.” So yes, Rashi seems to have believed in werewolves.

On this week’s Talmudology on the Parsha, we will take a dive into the world of Werewolves. Here is the plan of what we will be discussing:

The Three Signs of Mental Illness

What is Gandrifus? Koren vs Artscroll (and Jastrow)

The Parallel Discussion in the Yerushalmi: “Man-dog”

Lycanthropy in the Ancient World

Lycanthropy and Mental Illness

Lycanthropy and Porphyria. Or Not

Lycanthropy and Melancholy

Summary

---

The three Signs of Mental Illness

In Chagigah, there is a fascinating discussion of what features a person must demonstrate to be declared a shoteh, or what today we might call mentally ill or insane. First, the rabbis give a description of three behaviors that might lead to this diagnosis:

חגיגה ג, ב

תָּנוּ רַבָּנַן אֵיזֶהוּ שׁוֹטֶה הַיּוֹצֵא יְחִידִי בַּלַּיְלָה וְהַלָּן בְּבֵית הַקְּבָרוֹת וְהַמְקָרֵעַ אֶת כְּסוּתוֹ אִיתְּמַר רַב הוּנָא אָמַר עַד שֶׁיְּהוּ כּוּלָּן בְּבַת אַחַת רַבִּי יוֹחָנָן אָמַר אֲפִילּוּ בְּאַחַת מֵהֶן

The Sages taught: Who is considered an insane? (1) One who goes out alone at night, (2) and one who sleeps in a cemetery, (3) and one who rends his garment. It was stated that Rav Huna said: A person does not have the halakhic status insanity until all of these signs are present at the same time. Rabbi Yochanan said: He is considered insane even due to the appearance of only one of these signs.

So far so good. This is an argument whether you need just one behavior (Rabbi Yochanan) or all three (Rav Huna). Next, there is a discussion as to whether, if there is a rational explanation for these behaviors, they could still contribute to a diagnosis of insanity. Well, says the Talmud, it depends:

יכִי דָמֵי אִי דְּעָבֵיד לְהוּ דֶּרֶךְ שְׁטוּת אֲפִילּוּ בַּחֲדָא נָמֵי אִי דְּלָא עָבֵיד לְהוּ דֶּרֶךְ שְׁטוּת אֲפִילּוּ כּוּלְּהוּ נָמֵי לָא 

לְעוֹלָם דְּקָא עָבֵיד לְהוּ דֶּרֶךְ שְׁטוּת וְהַלָּן בְּבֵית הַקְּבָרוֹת אֵימוֹר כְּדֵי שֶׁתִּשְׁרֶה עָלָיו רוּחַ טוּמְאָה הוּא דְּקָא עָבֵיד וְהַיּוֹצֵא יְחִידִי בַּלַּיְלָה אֵימוֹר גַּנְדְּרִיפַס אַחְדֵּיהּ וְהַמְקָרֵעַ אֶת כְּסוּתוֹ אֵימוֹר בַּעַל מַחְשָׁבוֹת הוּא כֵּיוָן דְּעַבְדִינְהוּ לְכוּלְּהוּ הָוֵה לְהוּ

The case is about a person who performs these actions in a deranged manner, but each action on its own could be explained rationally. With regard to one who sleeps in the cemetery, one could say that he is doing so in order that an impure spirit should settle upon him. [Although it is inappropriate to do this, as there is a reason for this behavior it is not a sign of madness.] And with regard to one who goes out alone at night, one could say that gandrifus took hold of him and he is trying to cool himself down. And as for one who tears his garments, one could say that he is a man engaged in thought, and out of anxiety he tears his clothing unintentionally.

What is Gandrifus? Koren vs Artscroll (and jastrow)

What might be this thing called gandrifus - (גַּנְדְּרִיפַס)? The Koren Talmud, whose online translation at Sefaria is the one that we usually cite, translates this word as a “fever that took hold of a person,” following the second explanation of Rashi:

דהיוצא יחידי בלילה אימור גנדריפס אחדיה אני שמעתי חולי האוחז מתוך דאגה ולי נראה שנתחמם גופו ויוצא למקום האויר…

“I have heard” Rashi says, “that gandrifus is a fever, and the person, goes outside to cool down.” But Rashi’s first explanation is more in keeping with a mental illness: “I have heard this is when a person is gripped by depression [da’agah, also worry].” But the Artscroll (Schottenstein) English Talmud has a completely different translation. Here it is:

אֵימוֹר גַּנְדְּרִיפַס אַחְדֵּיהּ- one could say that a fit of lycanthropy seized him.

In a footnote, the translators explain that “Lycanthropy is a type of melancholy, which comes from worry.” The Soncino English Talmud also translates the gandrifus as lycanthropy, though it leaves out the melancholy part. (Goldschmidt’s 1929 German translation makes no mention of wolves: “nachts allein ausgegangen sein, weil er von der Melancholie befallen wurde.” But the Hebrew ArtScroll skips this explanation entirely, and translates gandrifus according to Rashi’s second explanation, though it expands on it in a footnote.)

But hang on, surely something is amiss here. Lycanthropy, according to the Merriam-Webster Dictionary, means either “a delusion that one has become a wolf” or “the assumption of the form and characteristics of a wolf held to be possible by witchcraft or magic.” What does that have to do with depression?

But in fact, and as we shall see in some detail, the Artscroll translation appears to be the one that is most appropriate. Let’s begin with Marcus Jastrow and his famous dictionary, which has an entry for this strange word gandrifus. Here it is in the original:

So according to Jastrow, a person with gandrofus (there are variant spellings of the word in Hebrew) believes himself to be a wolf. But not just any wolf. A sad wolf. The word is a corrupt version of the Greek word λυκαθρωπία, lykthropia, meaning “wolf-like.” And you can even hear the similarity between the two words gan-dro-fus and (ly)kan-tro-py.

The Parallel Discussion in the Yerushalmi: “MAn-dog”

There is a similar passage in the Talmud Yerushalmi that lists the signs of insanity, and it uses a slightly different word, kunitrofus (קֻנִיטְרוֹפּוֹס), which is why Jastrow lists the two versions under the same entry. The English translation of this passage, also from Sefaria, is by Heinrich Guggenheimer, “a renowned mathematician who also published works on Judaism,” and who in 2015 at the age of 97.

ירושלמי תרומות א, א

סֵימָנֵי שׁוֹטֶה הַיּוֹצֵא בַלָּיְלָה וְהַלָּן בְּבֵית הַקְּבָרוֹת וְהַמְּקַרֵעַ אֶת כְּסוּתוֹ וְהַמְּאַבֵּד מַה שֶׁנּוֹתְנִין לוֹ. אָמַר רִבִּי הוּנָא וְהוּא שֶׁיְּהֵא כוּלְּהֶן בּוֹ דִּלָא כֵן אֲנִי אוֹמֵר הַיּוֹצֵא בַלָּיְלָה קֻנִיטְרוֹפּוֹס

 . הַלָּן בְּבֵית הַקְּבָרוֹת מַקְטִיר לַשֵּׁדִים. הַמְּקַרֵעַ אֶת כְּסוּתוֹ כוֹלִיקוֹס. וְהַמְּאַבֵּד מַה שֶׁנּוֹתְנִין לוֹ קִינִיקוֹס. רִבִּי יוֹחָנָן אָמַר אֲפִילוּ אַחַת מֵהֶן. אָמַר רִבִּי בּוּן מִסְתַּבְּרָה מַה דְּאָמַר רִבִּי יוֹחָנָן אֲפִילוּ אַחַת מֵהֶן בִּלְבַד בִּמְאַבֵּד מַה שֶׁנּוֹתְנִין לֹו אֲפִילוּ שׁוֹטֶה שֶׁבְּשׁוֹטִים אֵין מְאַבֵּד כָּל־מַה שֶׁנּוֹתֵן לוֹ

The signs of an insane: One who goes out in the night, stays overnight in a graveyard, tears his clothing, and destroys what one gives to him. Rebbi Huna said, only if all of that is in him since otherwise I say that one who goes out in the night is a man-dog;

One who stays overnight in a graveyard burns incense to spirits, he who tears up his clothing is a choleric person; Rebbi Jochanan said, even only one of these is proof. Rebbi Abun said, what Rebbi Jochanan said, even only one of these is reasonable only for him who destroys what one gives to him; even the greatest idiot does not destroy all one gives to him.

So according to the late Heinrich Guggenheimer, a kunitrofus is a “man-dog.” He certainly did his homework, because this is how it is translated in Henry Lidell’s classic Greek-English lexicon, first published in 1843, (and, fun bonus fact, Lewis Carroll wrote Alice's Adventures in Wonderland for Henry Liddell's daughter Alice).

Now would also be a good time to explain the etymology of the word werewolf, which according to Daniel Ogden’s very recent book The Werewolf in the Ancient World, probably comes from the Anglo-Saxon w(e)arg meaning outsider, “in which case werewulf is to have signified ‘outsider-wolf’ in origin” (p8).

Lycanthropy in the Ancient World

Perhaps the earliest legend of a human turning into a wolf comes from the Greek myth of Lycaon, which dates back to the sixth century BCE. Lycaon gave Zeus a human sacrifice, which made Zeus very angry. So angry, that he turned Lycaon into a wolf.

Another legend is the story of Petronius and the werewolf, which Ogden attested to around 66CE, in which a traveller is turned into a werewolf and secures the safety of the clothes he will need to transform himself back into a human by urinating on them as they lay in a graveyard. He is later identified as a werewolf when a wound on his neck is identified as the one inflicted on him while in lupine form. (There is a terrific animated video of the simplified story in Latin (!) with subtitles, and very much worth the four minute watch, available here.) There are many more versions, including the tale of Damarchus from around the same time, in which Damarchus is tricked into eating human flesh, and is transformed into a wolf. All of which is enough to show that the rabbis of the Talmud may have heard of these legends too.

Lycanthropy and Mental Illness

Lycanthropy, as the term is used today, does not mean the ability to transform oneself into a wolf (because, well, there is no such ability). Instead, it is the belief that one has been transformed into an animal, or the display of animal-like behavior suggesting such a belief. And there are case reports of this mental illness. Here is one, from a paper published in 1999 in the British journal Psychopathology: 

Mrs T. is a 53-year-old Caucasian lady.  She is divorced and lives in a residential home for recovered mentally ill. She has been diagnosed as epileptic since the age of 11. She is prone to suffer complex partial seizures in the form of epigastric aura, followed by turning the head to the left side, with loss of consciousness... She has been treated with several antiepileptics…At the age of 27 she went to Singapore with her husband who was working in the navy. She started to develop severe depression and suicidal ideas. So she came back to the UK and was admitted to a psychiatric hospital. Since then she has had 4 admissions mainly due to depression and suicidal attempts. She had one admission due to a manic attack. During this attack she had accelerated thoughts, disinhibited behaviour and speech, talking to strangers about having had oral sex.

At all her admissions she manifested delusions in the form of beliefs that her heart was not working or that she was dead or part of her body had died. After each discharge she returned to her normal level of functioning.

During her last admission, in 1996, she took an overdose of temazepam. She said that she did not intend to kill herself at that time. However, she was escaping from the belief that claws were growing in her feet. She found a support for her belief when the chiropodist could not cut her nails. When she was asked about the meaning of having claws she said that she was going to be ‘lunatic’. She could not give an explanation of the word lunatic more than changing into a helpless person. ... Her psychotic symptoms were treated with anti-psychotic medication. However, the frequency of fits was high during this time. Although she was stabilised in her mood after the last discharge, her husband found the whole situation very difficult.

In the last follow-up in the out-patient clinic she still had the belief that claws grew in her feet mainly at night when she was not wearing shoes and socks.

But lycanthropy is not limited to the British. The American Journal of Psychiatry also reported a case of lycanthropy, in which the patient, a forty-nine-year-old married woman, “presented on an urgent basis for psychiatric evaluation because of delusions of being a wolf” and “feeling like an animal with claws.” She suffered from extreme apprehension and felt that she was no longer in control of her own fate; she said, “A voice was coming out of me.”  The report continues:

The patient chronically ruminated and dreamed about wolves. One week before her admission, she acted on these ruminations for the first time. At a family gathering, she disrobed, assumed the female sexual posture of a wolf, and offered herself to her mother.

This episode lasted for approximately 20 minutes. The following night, after coitus with her husband she growled, scratched, and gnawed at the bed. She stated that the devil came into her body and she became an animal. Simultaneously, she experienced auditory hallucinations. There was no drug involvement or alcoholic intoxication. 

The patient was treated in a structured inpatient program…and placed on neuroleptic medication. During the first 3 weeks, she suffered relapses when she said such things as “I am a wolf of the night; I am a wolf of the day…I have claws, teeth, fangs, hair…and anguish is my prey at night…the gnashing and snarling of teeth…powerless is my cause, I am what I am and will always roam the earth long after death….”

She exhibited strong homosexual urges almost irresistible zoophilic drives, and masturbatory compulsions – culminating in the delusion of a wolflike metamorphosis...

By the fourth week she had stabilized considerably, reporting, “I went and looked into a mirror and the wolf eye was gone.” There was only one other short-lived relapse, which responded to reassurance by experienced personnel. With the termination of that episode, which occurred on the night of a full moon, she wrote what she experienced: “I don’t intend to give up my search for [what] I lack…in my present marriage…my search for such a hairy creature. I will haunt the graveyards…” She was discharged during the night week of hospitalization on neuroleptic medication.

This very ill woman was diagnosed with “pseudoneurotic schizophrenia.” Her symptoms, wrote the psychiatrists who authored this case report, “were organized about a lycanthropic matrix,” and included the following classic symptoms: 

1. Delusions of werewolf transformation under extreme stress.

2. Preoccupation with religious phenomenology, including feeling victimized by the evil eye.

3. Reference to obsessive need to frequent graveyards and woods.

 The causes of this terrible mental affliction include schizophrenia, manic-depressive psychosis, and psychomotor epilepsy. But there is also porphyria.

“Common to all the ‘scientific’ attempts at explanation mentioned here is the desire to make the actions of historical protagonists comprehensible in terms of modern categories. Even in the twentieth century, the sinister figure of the werewolf seems to spark the need for rationalization.”

— Nadine Metzger. Battling demons with medical authority: werewolves, physicians and rationalization. Hist Psychiatry 2013; 24(3): 341–355.

 Lycanthropy and Porphyria. Or not

Another possible cause of lycanthropy is the rare metabolic disease called porphyria, made famous as the cause of the madness of King George III. As a result missing enzymes (and there are several varieties of the illness) there is a build up of porphyrins in the body, which eventually become toxic. The condition is characterized by:

1.  Severe photosensitivity in which a vesicular erythema is produced by the action of light. This may be especially noticeable in the summer months or in a mountainous region.

2. The urine is often reddish-brown as a result of the presence of large quantities of porphyrins.

3. Over the years the skin lesions ulcerate, and attack the cartilage and bone. Over a period of years structures such as the nose, ears, eyelids and fingers undergo progressive mutilation.

4. The teeth may turn red or reddish brown due to the deposition of porphyrins.

There are a few suggestions in the medical literature that lycanthropy might be explained by porphyria (like this paper, and this one). In his frequently cited 1964 paper, the British physician Leon Illis wrote that “the red teeth, the passage of red urine, the nocturnal wanderings, the mutilation of face and hands,the deranged behaviour: what could these suggest to a primitive, fear-ridden,and relatively isolated community? Fig 2 gives an obvious answer.” And the figure is shown below.

Image of a victim of porphyria. Could this be a case mistaken for a werewolf? From L. Illis. On porphyria and the aetiology of werewolves. Proceedings of the Royal Society of Medicine 1964: 57; 23-26.

But others are not so sure. In his excellent review paper “Werewolves and the Abuse of History,” the Dutch anthropologist Willem de Blécourt wrote that we need to be careful of a special group of amateur werewolf authors. The doctors.

Not having been trained in either history of folklore (or cultural studies), they have used selective texts to diagnose “the werewolf.” One of the results is that werewolf publications are now saddled with what is confusingly called “the werewolf syndrome,” namely hypertrichosis, a rare somatic condition that leaves its sufferers with hair either all over their body or in places where it usually does not grow….they are also connected to another very rare condition,“congenital erythropoietic porphyria” (or CEP). Further, within psychiatry there is now a recognized affliction called “lycanthropy,” denoting humans who are under the delusion that they have changed into a number of animals, among them, a wolf.

The problem, according to Blecourt, begins with the belief that the werewolf legend must have something tangible behind it. As Illis wrote in 1964, “a belief as widespread both in time and place as that of the werwolf [Illis’s spelling] must have some basis in fact. Either werwolves exist or some phenomenon must exist or have existed on which, by the play of fear, superstition and chance, a legend was built and grew.” But Illis based himself on only one late nineteenth century Dutch report, which was “was not even a wolf, but only a translation of a local term, denoting someone who can change into a cat, boar, monkey, deer, water buffalo, crocodile, or ant heap.” This author, according to Blecourt, “appears not to have been too concerned with European werewolves, but to have specifically drawn his werewolf picture to fit porphyria symptoms.” The problem is that many of the modern explanations are based on film depictions of werewolves, which themselves reinvented the legend, rather than being based on archival sources. “What stands out in the flood of recent popular werewolf publications” Blecourt lamented, “is that their authors, apart from occasionally branching out to people who are shifting into other animals, pay abundant attention to fiction, especially as expressed on television and in the cinema, and to “scientific” theories about the beast’s origin.”

 Lycanthropy and melancholy

Is there a connection between lycanthropy and depression? In his very helpful paper Medical and Neuropsychiatric Aspects of Lycanthropy, Miles Drake explained thar melancholy, one of the four humors that were thought to control our health and character, “came also to represent the pathological state of mood aberration. Lycanthropy was widely held to represent an excess of melancholy.” While we read this connection in the ArtScroll translation of the passasge in Chagigah, it can also be found in other texts. In 1586, the Italian Tomaso Garzoni published L’Hospedale de’ pazzi incurabilim, which was translated into English in 1600 as “The hospital for incurable fooles." In it, the author reported that

Among the humours of melancholy, the physicians place a kind of madness by the Greeks called Lycanthropia, termed by the latins insania lupina, or wolves furie: which bringeth a man to this point . . . that in Februarie he will goe out of the house in the night like a wolf, hunting about the graves of the dead with great howling, and pluck the dead mens bones out of the sepulchers, carrying them about the streets to the great fear and astonishment of all them that meet him ... melancholike persons of this kinde, have pale faces, soaked and hollow eyes, with a weak sight, never shedding one tear to the view of the world, a dry tongue, extreme thirst, and they want spittle and moisture exceedingly.

The connection between lycanthropy and melancholy (or what today we would call depression) was explicitly made by the English writer Robert Burton (1577-1640) in his massive work, The Anatomy of Melancholy, first published in 1621. Burton, who himself seems to have suffered from melancholy, wrote that the affliction can cause terrible physical suffering.

Melancholie abounding in their head, and occupieing their brane, hath deprived or rather depraved their judgements, and all their senses.., the force which melancholic hath, and the effects that it worketh in the bodie are almost incredible. For as some of these melancholike persons imagine, they are . . brute beasts .... Through melancholie they were alienated from themselves . . they may imagine, that they can transforme their owne bodies, which nevertheless remaineth in the former shape.

Burton noted that madness and melancholy are often conflated, and that the two can combine to produce religious visions and revelations, as well as lycanthropy:

There are other case reports about werewolves in the early modern period. Here is one from the French writer Simon Goulart’s Admirable and Memorable Histories, which was translated into English in 1607.

in the yeare 1541 who thought himselfe to bee a Wolfe, setting vpon diuers men in the fields, and slew some. In the end being with great difficultie taken, hee did constantlye affirme that hee was a Wolfe, and that there was no other difference, but that Wolues were commonlie hayrie without, and hee was betwixt the skinne and the flesh. Some (too barbarous and cruell Wolues in effect) desiring to trie the truth thereof, gaue him manie wounds vpon the armes and legges: but knowing their owne error, and the innocencie of the poore melancholic man, they committed him to the Surgions to cure, in whose hands hee dyed within fewe days after. ( page 387.)

“Lycanthropy is a rare phenomenon, but it does exist. It should be regarded as a complex and not a diagnostic entity. Furthermore, although it may generally be an expression of an underlying schizophrenic condition, at least five other differential diagnostic entities must be considered. ”

— Rosenstock H.A, Vincent K.R. A Case of Lycanthropy. Am J Psychiatry. 1977; 134:10; 1147-1149.

Summary

We have covered a lot of material, all of which was needed to explain not only the meaning of the talmudic word gandrofus, but also its use in the context of ancient nosology. Here is a summary:

1. The Talmud lists gandrofus as a kind of illness which while serious, is not enough to provide an exemption from the mitzvah to appear in the Temple.

2. ArtScroll, Soncino and Jastrow (but not Rashi) explain it to mean lycanthropy and (per ArtScroll,) melancholy.

3. Lycanthropy, the belief that a person could turn into a wolf, was a widespread belief in the ancient world, the medieval world, and the early modern world too. Rashi cites the legend.

4. Lycanthropy was associated with melancholy, an early term for depression.

5. And so gandrofus is the affliction of lycanthropy and depression.

6. Despite this, a person suffering from gandrofus is not exempt from the mitzvah of appearing in the Temple.

7. ArtScroll’s translation is the preferred one to Rashi’s.

8. QED.

9. Oh, and also, Binyamin was a werewolf.

Bava Kamma 55a ~ Does a Goose have a Scrotum?

בבא קמא נה,א

אמר שמואל אווז ואווז הבר כלאים זה בזה ... מאי טעמא ? אמר אביי זה ביציו מבחוץ וזה ביציו מבפנים

Shmuel said "a domestic goose and a wild goose are kilayim with one another"...what is the reason [to classify them as two distinct species]? Abbaye explained, the male wild goose has testicles that are external, but the male domestic goose has testicles that are internal...(Bava Kama 55a)

The Emden goose, a species of domestic goose.

The Koren Talmud on Wild and Domestic Geese

In today's Daf Yomi page of Talmud, we enter a brief discussion of the biblical prohibition of כלאים - kilayim - which is the prohibition of cross breeding two different species, be they plant or animal.  According to the great talmudic sage  Abbaye (died c. 339 CE), cross breeding a domestic goose and a wild goose is forbidden as well, because they seem to be two different species as evidenced by their anatomy: "the male wild goose has testicles that are external, but the male domestic goose has testicles that are internal."  Here is the background note found in The Koren Talmud. 

Today, these two types of birds are treated as one species. The wild goose is classified as the Anser anser, also known as the greylag goose, and the domestic goose is classifeid as the Anser anser domestica. Although the differences between them are not always apparent, they do differ in several ways, such as in their appearance, voice, and behavior. In terms of their appearance, they differ in color, as the wild goose is usually gray and the domestic goose white, and the neck of the domestic goose is shorter than that of the wild goose.
Another difference is that the male organ of the wild goose is more recognizable than that of the domestic goose. As for laying eggs, the wild goose lays fewer eggs than the domestic goose, which can lay more than ten eggs at a time.

All of this is very helpful indeed, but it does not address the claim that was made by Abbaye and which Rashi clarifies: "ביצי הזכרות ניכרין באווז הבר מבחוץ"  - that the testes of wild geese may be seen outside of the body.  Is that the case? Let's see what the geese experts have to say.

The Handbook of Bird Biology

The avian urogenital system. From  Lovette IJ. and Fitzpatrick JW. The Handbook of Bird Biology, Wiley-Blackwell 2016, 198.

Here are the ornithologists at the Cornell Lab of Ornithology on the location of bird testes:

Oval or elliptical in shape, avian testes are paired and lie within the body cavity at anterior end of each kidney.

In most birds the the intestinal, urinary, and generative canals open into a cavity called the cloaca.  However the Cornell Handbook notes that a few species including ostriches, ducks and geese, have a more advanced copulatory organ, the cloacal phallus. "Although often called a 'penis', this structure differs from the mammalian equivalent: since it lacks an internal urethra, sperm must travel along the external surface of the phallus." Good to know.

The Manual of Ornithology: Avian Structure and Function

The authors of the 1993  Manual of Ornithology are an interesting duo: on is a professor of biology, and the other, a radiologist. Here is their description of  where bird testes are located:

Male birds have paired testes within the abdominal cavity just anterior and ventral to the lobes of the kidneys. During much of the year the testes may be difficult or impossible to find because of their small size, but during the breeding season the testes may grow to several hundred times their non-breeding size, resembling two bean-shaped organs lying next to the kidneys on the dorsal abdominal wall...Some birds experience a nightly drop in body temperature that allows sperm development in males.  In other species the male develops a cloacal protuberance, a swelling of the terminal end of the vas deferens.  This functions like a mammalian scrotum, holding the developing sperm away from the high temperatures within the abdomen. 

To be clear: there are no testes on the outside of the body, as Abbaye claims; the closest we get to this is a small swelling during the mating season. 

Goose Production

The last reference book we will look at is Goose Production, published in 2002 by Food and Agriculture  Organization of the United Nations. Chapter Five addresses the male (and female) reproductive system found in geese:

There are two bean-shaped testicles inside the body cavity which produce both spermatozoa and male hormones. They are highly vascularized and change in size and position according to whether the gander is sexually active or not...the copulatory organ of the gander is very well developed. It is invaginated, spiral-like, and is about 15cm in length.

To recap: Geese testes are only located within the body cavity. No birds - geese included - have a scrotum, though sometimes the cloaca may swell to hold the maturing sperm.  And of course there is no difference between the natural and wild goose in any of these anatomical facts.

So what Did Abbaye mean?

What then, are we to make of Abbaye's testicular error? A couple of options spring to mind:

1. The translation of  אווז - avaz - as a goose is wrong, and he was referring to another species. The problem with this is (1) there is no dispute as to the translation and identification of this word and (2) even if Abbaye was referring to another species of bird, in no species do the testes reside in any place other than snugly inside the abdomen.

2. The geese in Abbaye's time were different.  There is no way to determine if this claim is true, though based on what we know about evolution it would be a pretty remarkable evolutionary change in the space of less than  two millennia.  Wait a minute, you say: what about the article in The New York Times with the title 'Evolution Is Happening Faster Than We
   Thought'? Perhaps two millennia is enough time for a change like this to occur?  Well, it is true that certain evolutionary changes may happen more quickly than scientists had previously expected, but this only happens "as long as natural selection — the relative benefit that a particular characteristic bestows on its bearer - is strong." One place where this happens is within our cities, where, for example, the temperature can be much higher or the ambient light much brighter, than in the surrounding countryside. However no such selective pressure is known to have occurred for geese living betwen Abbaye's time and our own.  Absent this evolutionary pressure, the suggestion that the internal anatomy of geese has changed is without any merit. 

3. Abbaye was wrong.  Abbaye was descended from a family of priests, and after the death of his parents was raised by an uncle and a kindly foster mother.  As a young man Abbaye spent some time in poverty: he worked at night irrigating agricultural canals so that he could be free during the day for study. Eventually his fortune changed and he became a wine trader and a farmer with tenants of his own. But there is no record of his having worked closely with animals, and animal husbandry would be an unlikely occupation for the head of the rabbinic academy in Pumbedita, a position that he occupied for the last five years of his life. It is very likely then, that wise as he was, Abbaye simply had no factual experience on which to base his claim that wild and domesticated geese have different male sexual organs. It is always best to speak with authority only about that which you are certain is correct.  Abbaye was certainly in authority as a great leader of a great rabbinic academy. But being in authority, and being an authority are by no means the same. That's a great lesson to remember.

Testes of pheasant during the reproductive season.  From here.