Burns

Pesachim 75b ~ Burns and Ritual Impurity

The Torah details lots of rules about skin blemishes known as tzaraat. One of these blemishes is the result of a burn:

ויקרא 13:24

אוֹ בָשָׂר כִּי־יִהְיֶה בְעֹרוֹ מִכְוַת־אֵשׁ וְהָיְתָה מִחְיַת הַמִּכְוָה בַּהֶרֶת לְבָנָה אֲדַמְדֶּמֶת אוֹ לְבָנָה׃ וְרָאָה אֹתָהּ הַכֹּהֵן וְהִנֵּה נֶהְפַּךְ שֵׂעָר לָבָן בַּבַּהֶרֶת וּמַרְאֶהָ עָמֹק מִן־הָעוֹר צָרַעַת הִוא בַּמִּכְוָה פָּרָחָה וְטִמֵּא אֹתוֹ הַכֹּהֵן נֶגַע צָרַעַת הִוא׃ 

When the skin of one’s body sustains a burn by fire, and the patch from the burn is a discoloration, either white streaked with red, or white, the priest shall examine it. If some hair has turned white in the discoloration, which itself appears to go deeper than the skin, it is leprosy that has broken out in the burn. The priest shall pronounce him unclean; it is a leprous affection.

In today’s page of Talmud we read more about this case of tzaraat caused by a skin burn.

פסחים עה, ב

״מִכְוַת אֵשׁ״ — אֵין לִי אֶלָּא שֶׁנִּכְוָה בְּאֵשׁ וּבְגַחֶלֶת. נִכְוָה בְּרֶמֶץ, בְּסִיד רוֹתֵחַ, וּבְגִפְסִיס רוֹתֵחַ, וּבְכׇל דָּבָר הַבָּא מֵחֲמַת הָאוּר, לְאֵיתוֹיֵי חַמֵּי הָאוּר, מִנַּיִין? תַּלְמוּד לוֹמַר: ״מִכְוָה״ ״מִכְוָה״ רִיבָּה

From the phrase “a burn from fire,” I only know that if someone was burned by a fire or by a coal he is subject to the laws of tzaraat of a fire. With regard to one who is burned by hot ash, by burning lime, or by burning plaster, or by anything else that is burning and whose source of heat comes from fire, to include water heated by fire, from where is it derived that these cases are also considered a burn from fire? The verse states: A burn, a burn, twice. By repeating the term, it includes all these types of burns.

The Classification of Burns

The modern classification of burn severity is based on two features: the depth of the burn, and the amount of skin (the surface area) that is burned.

Three kinds of burn.jpg

First degree or superficial burns involve only the very superficial layer of skin called the epidermis. There is pain and redness, but there are no blisters and the wound is dry. This is commonly the burn you get with sunburn. Second degree or partial thickness burns involve two layers of skin, the epidermis and the dermis. These are painful, red and moist, and will form blisters over the first 24 hours. Third degree of full thickness burns go deeper into the subcutaneous tissues. They are red and white, and do not produce blisters. Fourth degree burns are deeper still; they involve the fascia and bone. The tissues are white and charred and again, no blisters are formed.

In addition to the depth of the burn they are classified by the area of skin involved. Burns that cover more than about 50% of the total surface area of the body are often fatal.

The Mishnaic Classification of Burns

The Mishnah in Nega’im discusses burns in the context of ritual impurity

נגעים 9:1

.. אֵיזֶה הוּא הַשְּׁחִין? לָקָה בְעֵץ אוֹ בְאֶבֶן אוֹ בְגֶפֶת אוֹ בְמֵי טְבֶרְיָא, כֹּל שֶׁאֵינוֹ מֵחֲמַת הָאֵשׁ, זֶה הוּא שְׁחִין. אֵיזוֹ הִיא מִכְוָה? נִכְוָה בְגַחֶלֶת אוֹ בְרֶמֶץ, כֹּל שֶׁהוּא מֵחֲמַת הָאֵשׁ, זוֹ הִיא מִכְוָה 

What is a "boil"? An injury received from wood, stone, peat, or the waters of Tiberius, or from any other object whose heat is not due to fire is a boil. What exactly is a "burn"? A burn caused by a live coal, hot embers, or any object whose heat is due to fire is a burning.

Burns, Fluid Loss and Skin Discharges

If it is not immediately clear why a burn should be associated with ritual impurity, remember that burns of a second degree or worse produce a yellow-green discharge (or more properly, an exudate. In fact in severe burns (second degree burns that involve more than about 15% of the body surface area) the fluid loss is so massive that if left untreated the patient will die of dehydration. To prevent this physicians use a general formula that guides the volume of fluids that should be provided to the burn patient in the first 4 hours:

Total amount of fluid to be given in the first four hours (cc) = weight (kg) x %body surface area involved/2.

Types of exudate (discharge) seen in burns. From Vowden P, Bond E. Meuleneire F. Managing high viscosity exudate. Wounds International 2015: 6 (1):

Types of exudate (discharge) seen in burns. From Vowden P, Bond E. Meuleneire F. Managing high viscosity exudate. Wounds International 2015: 6 (1):

And here is what the discharge from a burn can look like:

From Vowden P, Bond E. Meuleneire F. Managing high viscosity exudate. Wounds International 2015: 6 (1):

From Vowden P, Bond E. Meuleneire F. Managing high viscosity exudate. Wounds International 2015: 6 (1):

Yes, I agree. Nasty. But now let’s briefly turn to another kind of discharge, found in the person described in the Torah as a zov. In Leviticus chapter 15 we find the laws of the זב – zov - a man who experiences a discharge from his penis.

ויקרא טו, ב–ג

אִישׁ אִישׁ כִּי יִהְיֶה זָב מִבְּשָׂרוֹ זוֹבוֹ טָמֵא הוּא. וזֹאת תִּהְיֶה טֻמְאָתוֹ בְּזוֹבוֹ רָר בְּשָׂרוֹ אֶת־זוֹבוֹ אוֹ־הֶחְתִּים בְּשָׂרוֹ מִזּוֹבוֹ טֻמְאָתוֹ הִוא

When any man has a discharge issuing from his member, he is unclean. The uncleanness from his discharge shall mean the following—whether his member runs with the discharge or is stopped up so that there is no discharge, his uncleanness means this…

As we have noted previously, the condition that is described is gonorrhea. The word gonorrhea is from the Greek roots gone meaning seed and rhein, meaning flow, and so the description of this sexually transmitted disease is found in its very name. That flow is a a thick yellow-green discharge from the penis or vagina, and yes, it looks very similar to the discharge that can be seen with severe burns.

Note how similar it is to exudate from a burn. (And next time, please wear a glove.)

Note how similar it is to exudate from a burn. (And next time, please wear a glove.)

Genital discharges from gonorrhea are thick and yellow-green. So too are the discharges from a deep burn. Both are not only physically uncomfortable, but once, long ago, rendered a person ritually impure. Be careful to avoid both.

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