Bava Basra 142 ~ Maternal Deaths

Suetonius' Lives of the Twelve Caesars, 1506 woodcut.

Continuing the laws of inheritance, the Talmud rules that a fetus is not able to inherit from its mother until it is born. Then comes this technical question:  

למימרא דהוא מיית ברישא והא הוה עובדא ופרכס תלתא פרכוסי אמר מר בר רב אשי מידי דהוה אזנב הלטאה שמפרכסת

Does this mean that [when a pregnant womean dies,] the fetus always dies first [i.e. before its mother]? But there was a case where a pregnant woman died and after that the fetus thrashed around three times? Mar bar Rav Ashi said: That movement of the fetus does not indicate that it was alive. It was rather like the severed tail of a lizard, which thrashes about."

According to Mar bar Rav Ashi, the movement of a fetus inside its dead mother is not an indication of independent life. Instead it demonstrates reflex movements.  Here is one of those squirming detached lizard tails.

i saw this big lizard outside but it wasnt moving so my dad told me to poke it but it still wouldnt move so he threw mre a board i hit the lizard with it then it crawled at least a few inches then my dad told me to make its tail come off so i put the board on its tail then it crawled away and left it bloody tail beside and it started scwerming around enjoy!!

Mar bar Rav Ashi's explanation does not however, apply across all cases of the death of a pregnant woman. This is made clear by the Talmud in Arachin 7b:

Rabbi Nachman said in the name of Shmuel: A woman who sat on the birthstool and died on the Sabbath, we bring a knife and cut open her abdomen and remove the fetus.

This teaching clearly allows for the possibility that a fetus could survive the death of its mother. In fact the Talmud expands on the teaching of Mar bar Rav Ashi.  The observation that in cases of maternal death the fetus dies first seems to only be true in cases in which there is a "natural death." However, in cases in which a pregnant woman was executed, it is the mother who dies first, followed by the demise of the fetus:

ערכין ז, א

הני מילי לגבי מיתה איידי דוולד זוטרא חיותיה עיילא טיפה דמלאך המות ומחתך להו לסימנין אבל נהרגה היא מתה ברישא

This applies only to [her natural] death, because the child's life is very frail, the ‘drop’ [of poison] from the angel of death enters and destroys its vital organs, but in the case of death by execution she dies first.

Gruesome as this discussion is, the Talmud is likely correct. "Natural" maternal deaths that occur are likely from causes that will inevitably have led to the prior death of the fetus, like massive hemorrhage or sepsis.  In the case of execution, the sudden death of the mother would occur before that of the fetus. Thankfully, the execution of pregnant women no-longer occurs in our society, but a similar outcome can occur when the mother is a victim of severe traumatic injury.  We will return to this when we study Arachin in the Daf Yomi cycle.

Maternal Death Rates

“Between 2000 and 2020, eight countries recorded substantial increases in MMRs: Venezuela (182·8%), Cyprus (107%), Greece (101·1%), the USA (77·9%),
Mauritius (62·1%), Puerto Rico (55·9%), Belize (51·3%), and the Dominican Republic (36·0%;)”

— Khalil, Asma et al. A call to action: the global failure to effectively tackle maternal mortality rates. The Lancet Global Health 2023: 11(8), e1165 - e1167

The Commonwealth Fund. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries. November 2020.

Maternal deaths are defined as by the World Health Organization as the death of a woman whilst pregnant or within 42 days of delivery or termination of pregnancy, from any cause related to, or aggravated by pregnancy or its management, but excluding deaths from incidental or accidental causes. Worldwide, there are at least 287,000 such deaths each year. A recent study of maternal deaths in 115 countries noted that there are three main causes: Bleeding, high blood pressure (leading to complications like eclampsia) and infection.  Here in the US, maternal deaths are among the highest in the developed world. Each year, 700-900 women die from pregnancy or childbirth-related causes, or about 17 per 100,000 live births. By comparison, the rate in Israel is fewer than 3 deaths per 100,000 live births - the third lowest of all OECD countries.

Maternal mortality rate estimates for the period 2010–20 Figures created with data from the UNICEF Data Warehouse.2 (A) MMR estimates for Brazil and the eight countries and territories that recorded substantial increases in MMR between 2000 and 2020. (B) MMR estimates for the three countries (all in sub-Saharan Africa) where MMRs in 2020 surpassed 1000 maternal deaths per 100000 livebirths. (C) MMR estimates for the three countries that recorded over 10000 maternal deaths each in 2020. MMR=maternal mortality ratio. From Khalil, Asma et al. A call to action: the global failure to effectively tackle maternal mortality rates. The Lancet Global Health 2023: 11(8), e1165 - e1167

Tragic as each of these deaths are, it was once a lot worse, and in the nineteenth century doctors played a major role in causing maternal deaths.  In Vienna, Dr. Ignaz Semmelweiss (d. 1865) noted that the death rates in one maternity ward were three or four times higher than in a second ward. He suggested, after much sleuthing, that the cause was the dirty hands of medical students. These students came straight from performing autopsies to examining their pregnant and post-partum patients, with no hand washing in between. In an era before the germ theory of disease, his suggestion that something was carried on the hands of the medical students was widely ignored, but he instituted compulsory hand-washing anyway. And within a year the death rate dropped to zero.

Over the past century the maternal death rate in the US has declined by over 99%, although there are still significant racial and economic disparities. Passages such as the one we read in today's Daf Yomi remind us that for centuries, giving birth was a dangerous experience.  

Help Talmudology Climb Kilimanjaro!

The very first Talmudology post was published on November 14, 2014. That’s almost exactly a decade ago. It has been an absolute joy to undertake this project, and I want to thank each of you for being loyal readers.

Talmudology was never about making money. It was about thinking about Jewish texts together with you. But now, I am asking for something other than your time to read a post. I want your money.

Well, to be precise, I don’t want your money. Shalva does. Shalva, whose headquarters are in Jerusalem, provides an all-encompassing range of services for thousands of people with disabilities from infancy to adulthood, together with their families. Its comprehensive life-cycle programming provide leading-edge therapies, inclusive educational frameworks, social and recreational activities, employment training, and independent living, as well as respite and family support. The list goes on and on, and it does all this regardless of religion, ethnic background, or financial capability. Since the beginning of this terrible war, it has taken on additional responsibilities in providing respite care. Because that’s what they do.

As a fundraiser, Shalva has organized a kosher, shomer shabbat climb of Kilimanjaro. It was supposed to leave last January, but was postponed after the war broke out. Talmudology will take part, and there will be a special surprise at the peak.

KILIMANJARO FAQs

When is the trip?

It leaves on Sunday, January 19, 2025, and returns on Thursday January 30th. The full timetable is here.

How many people will be climbing for Shalva?

Currently there are about twenty-two registered climbers.

I like the idea of supporting Shalva, but I don’t want to spend my charity so that someone can mess around on a mountain for ten days.

I agree. That’s why every penny of your sponsorship will go to Shalva. I have already covered the airfare, permits, food, and the support team. So whatever amount you sponsor, none of it will be used to cover the costs of the trip itself. So go ahead, sponsor!

What is the success rate of reaching the summit?

Overall, the success rate is 60-80% across all tour operators. But it varies by route. The quicker the route, the lower the success rate. I will be climbing the slower eight-day Lemosho route, and it includes a Shabbat at rest. It has a success rate of 90-95%. (The route. Not Shabbat).

Um, asking for a friend: How many people die trying to climb Kilimanjaro?

Because the Kilimanjaro National Park authorities do not release these statistics, it is not possible to know just how many fatalities occur. Each year there are about 30,000-50,000 climbers, and about 10 fatalities, or about 0.02%. So, nothing to worry about.

What’s the surprise at the peak?

Summit day is Tuesday January 28th, and on that day, daf yomi will be learning Sanhedrin 42. Talmudology plans to give the World’s Highest Daf Yomi Shiur that day, at an incredible 19,341 feet (5,904 m). We will spend Shabbat at 12,795 feet (3,900m) so it won’t be the world’s highest Shabbat; that seems to have been celebrated at 15,540 feet (4,730m) on Mount Everest. But it will, to the best of our knowledge, be the highest daf yomi shiur ever given. And with your help, we can set that record.

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Bava Basra 126b ~ The Healing Power of Saliva

In a chapter that deals with the rules of inheritance, there is this interesting aside:

בבא בתרא קכו, ב

 ההוא דאתא לקמיה דרבי חנינא אמר ליה מוחזקני בזה שהוא בכור אמר ליה מנא ידעת אמר ליה דכי הוו אתו לגבי אבוה אמר להו זילו לגבי שכחת ברי דבוכרא הוא ומסי רוקיה ודלמא בוכרא דאמא הוא גמירי בוכרא דאבא מסי רוקיה בוכרא דאמא לא מסי רוקיה

A certain person once came before R. Hanina and said to him, 'I am sure that this man is firstborn'.  R. Hanina said to him, 'How do you know?' — The person replied to him: 'Because when people came to his father,  he used to say to them: "Go to my son Shikhath, who is firstborn and his saliva heals'. Might he not have been the firstborn of his mother only [but not of his father]? There is a tradition that the saliva of the firstborn of a father heals, but that of the firstborn of a mother does not heal.

Being declared a firstborn son was a big deal in talmudic times, for that lucky son would inherit twice the share of any other brothers.  (Daughters only inherit where there are no sons, or offspring of sons.) In the case brought before R. Hanina, there were two claims. One, that the Shikhath was a firstborn, based on the fact that his father called him "firstborn", and second that he was his father's firstborn by any woman. The evidence for that is the claim that his saliva heals. In talmudic society, only the saliva of a firstborn of a father heals. In his commentary on this passage, the Rashbam adds that the healing properties of saliva refer to its use as an eye medication. What are we to make of these claims that saliva heals, but only if it is the saliva of a firstborn son?

The many functions of human saliva

Saliva is an amazing material, and one we too often take for granted.  The many functions of saliva were reviewed in a paper published in The Archives of Oral Biology in 2015. We make a lot of it - about half a liter per day - and we need it to moisten and lubricate our mouths. It plays a critical role in taste, since it helps dissolve the foods into components that transmit taste on the tongue.  Saliva is also a key component of digestion. One of its main components is alpha-amylase, which appears to have a role in the breakdown of starch. It also protects the oral mucosa and esophagus not only by acting as a lubricant, but by buffering the acids in the stomach that sometimes make their way north into our mouths. The dentists among you will already know that saliva protects the teeth against abrasion, attrition, erosion, and dental caries, by removing uneaten food debris from the mouth. This debris, especially if sugary or acidic, can damage our teeth when bacteria feed off them. Saliva also has activity against bacteria, viruses and fungi.  For example, submandibular saliva inhibits the HIV-1 virus, even when diluted several-fold, and saliva inhibits the growth of candida, an opportunistic oral fungus.   

Saliva and wound healing

Last year, scientists from Lahore in Pakistan tested the ability of human saliva to heal wounds. They collected saliva from 24 willing human spitters, and applied the saliva to 2cm x 2cm wounds on the backs of  thirty "fully grown adult male rabbits weighing 2.0 to 3.4kg..." Three rabbits were controls and received no treatment. Another three had standard antibiotic ointment applied to their wounds, and the remaining lucky 24 rabbits had saliva applied every two hours for two weeks.  The Pakistani scientists noted "the healing speed of wounds on which saliva was applied was higher than the wounds on which wound healing medication (polyfax) was applied, and there was pus formation in the wound of negative control on which natural healing was observed." They concluded that "healthy human saliva possess significant (p<0.05) antimicrobial as well as wound healing properties. This innate ability of human saliva, mainly attributed to histatin protein, suggests that salivary proteins can be further used for medicinal purposes."

Wound healing properties of saliva, polyfax, and control on induced wounds on the backs of rabbits. From Haq et al.  Antimicrobial and Wound Healing Properties of Human Saliva. Int. J. of Pharm. Life Sci. 2016. 7 (2); 4911-4917.

“Healthy human saliva possess significant antimicrobial as well as wound healing properties. This innate ability of human saliva, ... suggests that salivary proteins can be further used for medicinal purposes.””

— ul-Haq, F et al. Antimicrobial and Wound Healing Properties of Human Saliva. International Journal of Pharmacy and Life Sciences. 2016:4911-4917

The histatins to which the Pakistani researchers referred are a group of proteins in the saliva which in 2008 were found to promote wound healing.  Cuts in the mouth heal much more quickly than do cuts elsewhere on the body: researchers have found that "wounds in the oral cavity heal much faster than skin lesions, with similar wounds healing in 7 days in the oral cavity compared with several weeks on the skin," and this is thought to be due to these histatins in the saliva.  

The mouth is a very dirty place

A nasty fight-bite injury, due to bacteria found in the mouth.

All this sounds rather interesting and would seem to support the use of saliva to heal, just as the saliva of Shikhath was said to do in today's page of Talmud. If however you find yourself with a wound and no local pharmacy, you might want to consider this before licking yourself.  The mouth is a terribly dirty place, microbiologically speaking.  It is full of nasty bacteria viruses and fungi, which the saliva only just manages to keep at bay.  I have seen dozens of  "fight-bites" in the ED. They are the outcome of a fist hitting a tooth (usually late on a Saturday night) and the hand often becomes badly infected as the bacteria in the victim's mouth, now safely hidden away deep in the crevice of the wound on the assailant's knuckle, go to work.  The result isn't pretty.

Vespasian, and others who healed with their saliva

The belief that saliva can heal the eyes is not limited to today's page of Talmud. You can find a detailed history in the 1891 paper by Frank Nicolson, The Saliva Superstition in Classical Literature. Perhaps one of the most striking examples of saliva as an ophthalmic medication is from the works of Tacitus, a Roman senator and historian, who died around 120 CE.  In his Histories, he recounts the story of Vespasian, - the same Vespasian who fought the Jewish insurrection in Judea and whose son Titus destroyed the Second Temple in 70 CE.  

In the months during which Vespasian was waiting at Alexandria for the periodical return of the summer gales and settled weather at sea, many wonders occurred which seemed to point him out as the object of the favor of heaven and of the partiality of the Gods. One of the common people of Alexandria, well known for his blindness, threw himself at the Emperor's knees, and implored him with groans to heal his infirmity...He begged Vespasian that he would deign to moisten his cheeks and eye-balls with his spittle... Vespasian, supposing that all things were possible to his good fortune, and that nothing was any longer past belief, with a joyful countenance, amid the intense expectation of the multitude of bystanders, accomplished what was required...the light of day again shone upon the blind. Persons actually present attest [this fact], even now when nothing is to be gained by falsehood.

(In case you were wondering, Vespasian was not a firstborn, but the third child born to his parents.)

Jesus is also said to have healed the blind with his saliva, as told in Mark 8:23-25:

They came to Bethsaida, and some people brought a blind man and begged Jesus to touch him. He took the blind man by the hand and led him outside the village. When he had spit on the man’s eyes and put his hands on him, Jesus asked, “Do you see anything?” He looked up and said, “I see people; they look like trees walking around.” Once more Jesus put his hands on the man’s eyes. Then his eyes were opened, his sight was restored, and he saw everything clearly.

This sort of thing carried on in a slightly different version through the Middle Ages. It involved not spittle, but touch. Here is Jack Hartnell, a lecturer in art history at the University of East Anglia in Norwich in the UK describing the healing power of kings in his 2018 book Medieval Bodies (p199).

[B]y the later Middle Ages. the touch of a monarch themselves, especially immediately after such coronation rites, had reciprocally been transformed into a much-prized thing. So charismatic was this touch that in certain cases it was even thought to have the ability to heal various illnesses through royal caress. Srofula, a form of tuberculosis of the lymph glands causing large sores and swellings around the neck, was a disease that became so associated with this type of monarchial healing that it took the Latin name morbus regius, the ‘regal disease’ or, sometimes, the ‘king’s evil.’ From the eleventh century onwards its French and English victims were granted special audiences with their respective monarchs to receive this miraculous cure. Records are hazy as to how precisely such healing touches were given: some royals may have employed a lingering stroke of the face and neck, while others may have had to do with a simple pat on the head. Either way, the hands of the king carried immense power.

In sum, the belief that saliva could heal the eyes and cure the blind was not only found in Jewish culture, but was part of Roman and early Christian legend. We now know that purified saliva does contain proteins and growth factors with anti-microbial and wound healing properties. However, the notion that saliva taken from the mouth might be helpful for failing eyesight is entirely without scientific foundation, because you are more likely to introduce an infection than you are to cure one. Even if you are a firstborn, an emperor, or a messiah.

Talmudology for Sukkot~ Take Two Etrogim, and Call Me in the Morning; The Citron as Medicine

The Midrash tells a story of a man who was so generous with his charitable donations that he had no money left to feed his own family. Out of ideas, he did what I suppose anyone in his position would have done. He went to gather up discarded etrogim [the citron taken as part of the four species on the Festival of Sukkot] and went to see a king.

ויקרא רבה לו:ה

, וְנִתְבַּיֵּישׁ לֵילֵךְ לְבֵיתוֹ הָלַךְ לוֹ לְבֵית הַכְּנֶסֶת, חָמָא תַּמָּן מִן אִלֵּין אֶתְרוֹגַיָא דְּמֵינוּקַיָא מְקַלְקְלֵי בְּיוֹם הוֹשַׁעְנָא, וּתְנִינַן תַּמָּן מִיָּד הַתִּינוֹקוֹת שׁוֹמְטִין לוּלָבֵיהֶן וְאוֹכְלִים אֶתְרוֹגֵיהֶם, נְסַב מִנְּהוֹן וּמְלָא יָת סַקָּא וְהָלַךְ לִפְרשׁ בַּיָּם הַגָּדוֹל, עַד שֶׁהִגִּיעַ לִמְדִינַת הַמֶּלֶךְ, כֵּיוָן שֶׁהִגִּיעַ שָׁם אַרָעַת שַׁעְתָּא וְאִשְׁתְּכַח מַלְכָּא חָשֵׁשׁ מֵעוֹי, אָמְרִין לֵיהּ בְּחֶלְמָא אַסְוָתָךְ אֱכֹל מִן אִלֵּין אֶתְרוֹגִין דִּיהוּדָאי מַצְלִין עִמְּהוֹן בְּיוֹם הוֹשַׁעְנָא וְאַתְּ מִתְּסֵי, פִּשְׁפְּשִׁין בְּהַהוּא שַׁעְתָּא לְכָל אִלְפַיָא וּלְכָל מְדִינְתָּא וְלָא אַשְׁכְּחוּן, אָזְלִין וְאַשְׁכְּחוּן לְהַהוּא גַבְרָא יָתֵיב עַל סַקָּא, אָמְרִין לֵיהּ אִית גַּבָּךְ כְּלוּם, אֲמַר לָהֶם גְּבַר מִסְכֵּן אֲנָא וְלֵית גַּבִּי כְּלוּם לִמְזַבְּנָא, פִּשְׁפְּשׁוּ בְּסַקָּא וְאַשְׁכְּחוּן מִן אִלֵּין אֶתְרוֹגִין, וַאֲמָרִין לֵיהּ אִלֵּין מָה הֵן, אֲמַר לוֹן מִן אִלֵּין דִּיהוּדָאי מַצְלֵי בְּיוֹם הוֹשַׁעְנָא, אַטְעָנוּן סַקָּא וְאַעֲלוּהָ קֳדָם מַלְכָּא, אָכַל מַלְכָּא אִלֵּין אֶתְרוֹגַיָיא וְאִתְּסֵי. פַּנּוּן שַׂקָּא וּמְלָאוּהָ דִינָרִין…

…He was ashamed to go to his home. He went to the synagogue and saw there some of the citrons that the children away... He took some of them and filled a sack, and embarked on a voyage in the Mediterranean Sea until he reached the province of the king. When he arrived there, it happened to be that the king had an intestinal illness. They said to him in a dream: ‘Your cure is to eat from those citrons with which the Jews pray on the day of the hoshana, and you will be cured.’ At that time, they searched all the ships and all the provinces, but could not find any. They went and found that man sitting on the sack. They said to him: ‘Do you have anything?’ He said to them: ‘I am a poor man and I have nothing to sell.’ They searched the sack and found those citrons. They said to him: ‘What are they?’ He said to them: ‘From those with which the Jews pray on the day of the hoshana.’ They loaded the sack and took it in before the king. The king ate those citrons and he was cured. They emptied the sack and filled it with dinars..

The etrog as medicine? Yes. People once believed, and many still believe today, that the etrog has medicinal uses. So in honor of Sukkot, let’s talk about some of them.

The Etrog in Ma’aseh Tuviah

The etrog as a medicine appears in one of the first Jewish encyclopedias, written by Tuviah Hacohen. He studied in a yeshivah in Cracow, and at the age of twenty-six, entered the University of Frankfurt, where he began to study medicine. Despite being taken under the wing of Fredrick William, the elector of Brandenburg, and receiving a stipend from him, anti-Jewish sentiment prevented Tuviah from graduating. As a result, he left for the University of Padua, where he graduated with a degree in medicine in 1683 and soon found employment as a physician in Turkey. He published his only work, Ma’aseh Tuviah (The Work of Tuviah), in Venice in 1708 and moved in 1715 to Jerusalem, where he died in 1729.

Tuviah Cohen has long been a favorite of historians of science and Judaism. Perhaps this is because he was a reformer of sorts, ready to sweep away old superstitions and replace them with scientific knowledge. Perhaps it is because his book, Ma’aseh Tuviah, was “ ... the best-illustrated Hebrew medical work of the pre-modern era,” full of wonderful drawings about astronomy and anatomy. Perhaps it is because his book is so clearly printed and a pleasure to read in the original. Or perhaps it is because Cohen was so adamantly opposed to Copernicus that he called him the “Firstborn of Satan”—which made his the first Hebrew work to attack Copernicus and his heliocentric system.

In any event, Tuviah wrote about the wonderful healing properties of the etrog.

Ma'aseh Tuviah, Venice 1708, 146a.

Because in homes that have abundant medicines they also have the five special fruits through with the Land of Israel was blessed, I will write in praise of the of etrog [פרי עץ הדר] which is more beautiful than any other fruit…. both the peel and the fruit itself are delicious to eat, and it also has many wonderful properties [סגולות נפלאות]. The peel alleviates all internal pain and strengthens the muscles. while the white of the fruit strengthens the internal organs. Its bitter taste is good for the liver, and cures thirst. The seeds are also good for internal pain as an an aid for digestion…it is as good as theriac for any person who is ill, and it is particularly beneficial for children with viral infections [ויראוליס] like smallpox. The wood of the tree itself does not have these qualities though without doubt it imparts them to the fruit, which is why the fruit never falls far from the tree [התפוח אינו נופל רחוק מן העץ]. And so if there is a scarcity of the fruit, cut some wood from the etrog tree and boil. It will strengthen the body and a serve to heal the soul.

The Etrog as a Cure for Cholera

We have had occasion in the past to talk about Hayyim Palagi (there are many different ways to spell his last name, 1788– 1868) who was a rabbi and leader of the Jewish community in Izmir (Smyrna), Turkey, though his influence was felt far beyond. Writing about the 1865 cholera outbreak in Turkey, Rabbi Palagi recalled how the Jews had fled Izmir.

In our town of Izmir in 5625 [= 1865] there was an outbreak of cholera, just like the outbreak of 5592 [= 1832] and many fled. The few who remained in the town were expelled by the mayor on the advice of physicians, and left for a nearby mountainside where men, women and children camped, and remained for about three weeks. There was not a single case of cholera the entire time,and the outbreak in the town eventually ended. During that time, I was particular with my prayers, and I prayed to God in the merit of Abraham who was called “a mountain” . . . that the merit of our ancestors would protect us and that we would not fall ill. And so it was. Praise be to God, for his loving kindness endures forever.

I am lucky to own a copy of one of his many works, called Refuah Vehayyim, published in Izmir in 1874. (It even contains three handwritten annotations in the margins written by Rabbi Palagi’s youngest son Yosef.) And here is what you can find on page 12b (though alas, there are no marginalia).

Sefer Refuah Vehayyim, Izmir 1874. 12b. (Chapter 4 #2).

It is written in the name of our teacher Rabbi Hayyim Vital, that to cure cholera take distilled water and the resin of the (?) mastic tree…and take half a cup of the size used for kiddush…and boil it with the resin and give it to the patient. And this is guaranteed.

And it is writtn in the Sefer Otzar Hayyim that this works with etrog peel…

Later in the book, Rabbi Palagi wrote that the etrog can be used for stomach aches in general, and not just those associated with cholera. However, it cannot be any old citron; it must be an etrog used for the mitzvah of lulav and etrog on Sukkot:

Sefer Refuah Vehayyim, Izmir 1874. 51b

For a stomach ache: the remedy is to eat etrogim with were used for the mitzvah of lulav and etrog during the holiday and through Hoshanah Rabbah. For they are used in prayer, and they heal…sometimes they are hard to digest, in which case they should be peeled and then boiled, and then that water should be drunk.

But wait - there’s more

In another of his many books Mo’ed Lekol Chai, Rabbi Palagi recommended the etrog as a means for easing the pains and dangers of childbirth. He cited another work in which this suggestion appeared, though in a slightly different and shorter form. (That work is Nazir Shimshon, published by Ya’akov Shimshon Shabtai Sinigaliah in Pisa in 1783. It is on page 38.)

When a women is pregnant, she should take the etrog on Hosha’ana Rabbah and afer removed the pittom [style] she should distribute charity to the poor each according to her means, and she should pray that God should should save her and that her child should be born healthy.

The reason for this is that there is an opinion that the Tree of Knowledge was an etrog, and when Eve ate from it, Death came into the world. We know that many women die during childbirth, and therefore they should undertake this ritual and say the following prayer:

Master of the Universe, you know that because Chava [Eve] ate from the Tree of Knowledge she sinned and brought Death to the world as well as the pains of childbirth. Had I been there at that time I would not have eaten from it and I would not have benefitted from it in any way, just as I did not want to blemish the etrog during the Festival [of Sukkot] But now I have blemished it, because now it is no longer a mitzvah to take it. I would never want to disobey your mitzvot. Please accept my prayer and my supplication that I should not die as a result of this child or as a result of childbirth. Save me, grant me an easy labor without pain or hardship and let no harm befall me or my child, for you are the God who saves…

And so any man whose woman whose wife is pregnant during Sukkot should arrange for her to take the etrog and give it to his wife and she should follow this procedure. She should say this prayer word for word and conclude by saying “let this infant bring contentment and not pain, and may it be born to a good and peaceful life. Amen.”

Hayyim Pilagi, Mo'ed Lekol Chai Jerusalem 1976 #25.

The Etrog increases Male potency

The etrog. It’s not just for women. In the anonymous collection of segulot called Sefer Refuot published in Vienna in 1926, we find the following recommendation:

Sefer Refuot, Vienna 1926

For increased virility, take four drahms of the tongue of an ox together with half a handful of etrog peel and half a drahm of girofilo

Good to know.

Not so Fast - Chaim Bachrach and his objection

Rabbi Yair Hayyim Bachrach (1638-1702) better known by his famous work the Chavot Yair, was a leading posek of his generation, and led the communities of Worms and Mainz. In his commentary on the Tur (הלכות לולב #664) he also noted the custom of pregnant women biting off the pitum of the etrog, and he was not happy about it. Not at all.

Jewish Etrogs, and Greek Etrogs

The belief in the medicinal properties of the etrog was not unique to our ancestors alone. The Greeks believed it too. In fact, it was they who gave the fruit we know as an etrog a name that reflects just this; they called it Citrus Medica, “the medical citrus" and that is the Latin name of the species to this day. Citrus Medica.

Gaius Plinius Secundus (AD 23/24–79) better known as Pliny the Elder held the cirton tree in very high esteem as demonstrated by this passage in his Natural History (Book XII chapter 7):

The citron tree, called the Assyrian, and by some the Median apple, is an antidote against poisons. The leaf is similar to that of the arbute, except that it has small prickles running across it. As to the fruit, it is never eaten, but it is remarkable for its extremely powerful smell, which is the case, also, with the leaves; indeed, the odour is so strong, that it will penetrate clothes, when they are once impregnated with it, and hence it is very useful in repelling the attacks of noxious insects. The tree bears fruit at all seasons of the year; while some is falling off, other fruit is ripening, and other, again, just bursting into birth. Various nations have attempted to naturalize this tree among them, for the sake of its medical properties, by planting it in pots of clay, with holes drilled in them, for the purpose of introducing the air to the roots;

The Chinese Etrog

To this day, the etrog is used as a medicine in China. They grow several different varieties including the world’s largest citrus, the “Ning’er Giant. And, as the photo below shows, it really is giant.

It is the custom of pregnant women to bite off the tip of the etrog and it is mentioned in the Tzenah Urenah.How fortunate we are that this custom has been utterly uprooted.

“Ning’er Giant” citron weighing about 17lb (8kg), held in the gentle hands of the farmer who grew it, Li Hua Zhong, near Ning’er Yunan. (Photo credit David Karp, 18 October 2011.)

Some varieties are grown for their antioxidant properties, while others release insulin, which may be of use in Type II diabetes. In fact, according to a 2012 Review on Phytochemical and Pharmacological Properties of Citrus medica Linn, the etrog will cure just about anything.

Result shows that Citrus medica Linn. possesses analgesic, hypoglycaemic, anticholinesterase, anticancer, antidiabetic, hypocholesterolemic, hypolipidemic, insulin Secretagogue, anthelmintic, antimicrobial antiulcer and estrogenic properties.

And presumably, all without any side effects! The Jinguu variety from southern Yunnan is used to treat respiratory disorders, whereas the Qingpi variety, grown in the Provinces of Zhejiang and Jianxi is used for its more general medicinal effects.

Citrus Fruits and the First Randomized controlled Medical Trial

The citrus (but not the etrog, sadly) made a surprising appearance in the first randomized controlled clinical trial that humanity conducted. In the 18th century, sailors in the British Navy, went without fresh fruit for long periods of time. Citrus fruits contain the essential Vitamin C also known as ascorbic acid. Without it you develop a very nasty disease called scurvy. There is lethargy, the hair and teeth fall out, the gums bleed spontaneously, and bruising appears. Without treatment, you die. So yes, it is very nasty.

Sailors were often at sea for months at a time, without access to fruit containing Vitamin C. In the 18th century, it is estimated that more British sailors died from scurvy than died in battle.

For reasons we won’t go into here, a Scottish naval Surgeon named James Lind (1716-1794) had a hunch that the disease was cured by a lack of whatever it was that citrus fruits contained. So he took 12 sailors with scurvy and fed them various experimental diets that included one enriched with oranges and lemons (but not etrogs), and compared them to a similar group of sailors who ate a regular Royal Navy diet. The results were startling.

On the 20th of May 1747, I selected twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of the knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz. water gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times light puddings, boiled biscuit with sugar, etc., and for supper, barley and raisins, rice and currants, sago and wine or the like. Two were ordered each a quart of cyder a day. Two others took twenty-five drops of elixir vitriol three times a day … Two others took two spoonfuls of vinegar three times a day … Two of the worst patients were put on a course of sea-water … Two others had each two oranges and one lemon given them every day … The two remaining patients, took … an electary recommended by a hospital surgeon … The consequence was, that the most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them, being at the end of six days fit for duty … The other was the best recovered of any in his condition; and … was appointed to attend the rest of the sick. Next to the oranges, I thought the cyder had the best effects…

The most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them being at the end of six days fit for duty … The other was the best recovered of any in his condition; and being now deemed pretty well, was appointed nurse to the rest of the sick.

Lind demonstrated that citrus fruits prevented and cured scurvy, and the first randomized controlled clinical trial, now the gold standard for evaluating new drugs, was born. Even Rabbi Bachrach would not have objected to that.

The etrog, whose Latin name means a medicine, has long been a symbol of healing, not only in our own tradition, but in others, often just as ancient. How fitting that we take it this year, a year of pain and sorrow for the Jewish People, and pray for the release of our bothers and sisters in captivity, the safety of our soldiers, and a speedy end to this most terrible and most just of wars. We all need some healing.

עד הניצחון

אַחֵינוּ כָּל בֵּית יִשְׂרָאֵל

הַנְּתוּנִים בַּצָּרָה וּבַשִּׁבְיָה

הָעוֹמְדִים בֵּין בַּיָּם וּבֵין בַּיַּבָּשָׁה

הַמָּקוֹם יְרַחֵם עֲלֵיהֶם

וְיוֹצִיאֵם מִצָּרָה לִרְוָחָה

וּמֵאֲפֵלָה לְאוֹרָה

וּמִשִּׁעְבּוּד לִגְאֻלָּה

הָשָׁתָא בַּעֲגָלָא וּבִזְמַן קָרִיב