Healing

Yevamot 116b~ Of Snake Bites, Palestinian and Israeli

The Palestinian Viper צפע ארצישראלי. Vipera palaestinae

יבמות קטז, ב

דאמר רב יהודה אמר שמואל שילפי קציר חטין היו והלכו עשרה בני אדם לקצור חטין נשכו נחש לאחד מהן ומת

Rav Yehudah said in the name of Shmuel: It was the end of the harvest when ten men went to reap their wheat; a snake bit one of them and he died

Snake bites were a widespread fear in ancient Israel. The Talmud warns that snakes can be found in houses and records a snake attack that occurred in the toilet, so going to the bathroom was a risk to one’s life. (Snakes still appear  to make relieving oneself in the Holy Land a dangerous enterprise, if this report is to be believed.)  And because of the possibility that a snake had discharged its venom into a standing bucket of liquids, the Talmud ruled that it is forbidden to drink from a liquid that had been left uncovered [Terumot 8:4] – a ruling codified, (with some changes) into normative Jewish law.

שולחן ערוך יורה דעה קטז

  משקים שנתגלו, אסרום חכמים דחיישינן שמא שתה נחש מהם והטיל בהם ארס. ועכשיו   שאין נחשים מצויים בינינו, מותר

Liquids that have been left uncovered [overnight] were forbidden by the rabbis, because of the concern that a snake may have drank from them and left its venom in them. Today, when snakes are less prevalent in society, it is permitted [to drink]

Actually, there is no danger in drinking at all, even in places where snakes are found. Snakes only discharge their venom when they intend to bite, not when stopping for a drink. And even if there was venom in the liquid, snake venom is not absorbed by the human gastrointestinal tract, so it would have absolutely no effect. Still, this shows how dangerous snakes were thought to be, and so when they did not bite, it was considered to be miraculous. Hence the Mishnah (Avot 5:5) records that one of the ten miracles that occurred during the time of the Second Temple was that no person was ever injured by a snake.

snake bites in Israel and around the world

Snake bites remain a threat in Israel and beyond (though in my six years of working in Jerusalem as an emergency physician I recall treating only one victim; he was a handler at a private snake collection- who should have known better.) In the US, venomous snakes are found in every state except Maine, Alaska and Hawaii, and each year in the US there are about 2,000 recorded venomous snake bites that result in about 6 deaths. The World Health Organization estimates that snakes kill between 20,000 and 94,000 people per year.

Kastururante A. et al. The Global Burden of Snakebite. PLOS Medicine 2008. 5:1591-1604

Snakes are such a problem for Israel and its neighbors that in 1998 the Israel Defense Forces (IDF) and the Jordanian Armed Forces held a joint conference on the topic. Since snakes are cold blooded, they are virtually inactive in the winter months, and summer time can be too hot for them; hence they are most active in the spring and fall. Like the report in today’s page of Talmud, the IDF found that the peak incidence for snakebites is May (that is, harvest time). 

Snakebites in the IDF. Average incidence per month, 1993-1997. From Haviv, J, et al. Field treatment of snakebites in the Israel Defense Forces. Public Health Rev 1988; 26:24-256.

There are at least eight species of poisonous snake found in Israel, of which the most common is the Palestine Viper, (shown in the photo above,) which is found in all regions north of Be’er Sheva. It is this snake that is responsible for all the fatal snake bites in Israel, though the IDF reported not one fatality during its five year study period.

sidebar: palestinian or israel viper?

Let's re-read that last paragraph:

There are at least eight other species of poisonous snake found in Israel, of which the most common is the Palestine Viper

Is that its real name? Well, it depends who you ask, or perhaps, in what language you ask. The snake's Latin name is Vipera palaestinaeand its Hebrew name is...צפע ארצישראלי! The snake could have been given a Hebrew name that was transliterated from the Latin, i.e. צפע פלסטיני – but that's not what whoever chose the name decided on.  Outside the case of the viper in the Jerusalem Zoo, this multiple naming is evident:

(It's not only snakes that have may have a crisis of identity. The chamomile flower, common in Israel, is called by its scientific name Anthemis palaestina, and in Hebrew it is קחוון ארצישראלי. Similarly the Terebinth; it is known to the scientific community as Pistacia palaestina, and in Hebrew as אלה ארץ-ישראלית. I could go on, but the point is made.)

One snake living happily, called two names by two peoples. There's a lesson there somewhere. But I digress.

the treatment of snake bites in the Talmud - and today

The Talmud offers a remedy for the unfortunate person bitten by a snake (of either the Palestinian or Israeli variety. Not the person. The snake.)

If one is bitten by a snake, he should take an embryo of a white donkey, tear it open, and sit on it (Shabbat 109b)

How does this advice compare with the IDF field manual? Not very well, as you can see from this list of the field treatment do's and dont's from the Medical Corps of the IDF.  Embryos of white donkeys do not make it. (Donkey embryos as a therapy also fail to make a fascinating 1953 report of 65 cases of viper bite in Israel.)

Haviv, J, et al. Field treatment of snakebites in the Israel Defense Forces. Public Health Rev 1988; 26:24-256.

Snake venom produces its deadly effects by causing a coagulopathy, which is the general name for a breakdown in the normal way the blood clots.  When things get really bad, snake venom causes a consumption coagulopathy, in which (as its name implies), all the vital bits that are needed for blood to clot are consumed, leaving the poor victim susceptible to life-threatening uncontrollable bleeding. Here's a chart of the clotting pathways that medical students have to learn (a process only slightly less painful than a snake bite itself,) with the bits that venom attacks shown in green.

Diagram of the clotting pathway showing the major clotting factors (blue) and their role in the activation of the pathway and clot formation. The four major groups of snake toxins that activated the clotting pathway are in green and the intermediate or incomplete products they form are indicated in dark red. There are four major types of prothrombin activators, which either convert thrombin to form the catalytically active meizothrombin (Group A and B) or to thrombin (Group C and D). From Maduwage K, Isbister GK. Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite. PLoS Negl Trop Dis 2014. 8(10): 1-13.

The standard treatment for snake envenomation is antivenom. (This is a technical term for something that is anti the venom.) In the 1950s  antivenom was already part of the standard  treatment of viper bites in Israel, though apparently it was then called by the far fancier name of "serum antivenimeux."  (If chemistry or immunology is your thing, you can read more about how viper antivenom was made in Israel here.) These antivenoms work in a number of ways, one of which is by blocking the toxin and preventing it from binding to its target (i.e. those green diamonds in the diagram above).

It was these ten vials of antivenom that saved the life of the brave Jewish lady preparing for her son's Bar Mitzvah back in 2011. You can read all about that episode here. (Spoiler alert - the mom won.)

snakes that heal

Snakes aren't only associated with coma, convulsions and death.  They are - paradoxically -  often associated with those who heal.  Here is the cover of Fred Rosner's book; notice what looks like two snakes wrapped around a winged pole.  Compare that image with the insignia of the US Army Medical Corps below.

The image you see is the caduceus, the rod carried by the Greek god Hermes (known as Mercury when in Rome). But in fact this double-snake flying-rod has nothing to do with healing, and is erroneously -though very widely- used as a medical emblem.  But as an article in the Journal of the American Medical Association points out, the adoption of the double-snaked caduceus of Hermes - at least in the US - is likely due to its having been used as a watermark by the prolific medical publisher John Churchill.   

The correct mythological association is with the Staff  of Asklepios, the ancient Greco-Roman god of medicine. In one legend, a snake placed some herbs into the mouth of another serpent that Asklepios had killed, and the dead snake was restored to life.  As a mark of respect, Asklepios adopted as his emblem  a snake coiled around his staff.  While the US Army Medical Corps uses the caducues as its badge, on its regimental flag the US Army Medical Command uses the more appropriate single snaked staff. Oh, and a rooster.  

 

U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

 

Fortunately, the Israel Defense Forces clearly know a caduceus from an Asklepios. They adopted the correct Greco-Roman mythological symbol for the medical unit of the first Jewish army in 2,000 years.

 
 

 

The Greeks may have had their tradition, but we have ours. And in ours, it is never the snake that heals.

עשה לך שרף ושים אותו על נס, והיה כל הנשוך וראה אותו וחי. וכי נחש ממית או נחש מחיה? אלא בזמן שישראל מסתכלין כלפי מעלה ומשעבדין את לבם לאביהן שבשמים היו מתרפאים, ואם לאו היו נימוקים...

”Make a fiery snake and place it on a pole, and it will be that anyone who is bitten will look at it and live” [Numbers 21:8] But is a snake the source of life and death? Rather, the verse means that when Israel looked up and submitted their heart to their Father in Heaven, they were healed, but if they did not do so, they perished.
— Mishnah Rosh Hashanah 3:8
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Pesachim 56a~ The Snake as a Symbol of Healing

In much of the Talmud snakes are associated with coma, convulsions and death.  But occasionally - and paradoxically -  they are sometimes associated with those healing, and those who heal. Let’s begin with this page of Talmud.

פסחים נו, א

תָּנוּ רַבָּנַן: שִׁשָּׁה דְבָרִים עָשָׂה חִזְקִיָּהוּ הַמֶּלֶךְ, עַל שְׁלֹשָׁה הוֹדוּ לוֹ, וְעַל שְׁלֹשָׁה לֹא הוֹדוּ לוֹ. 

עַל שְׁלֹשָׁה הוֹדוּ לוֹ: גָּנַז סֵפֶר רְפוּאוֹת — וְהוֹדוּ לוֹ. כִּתֵּת נְחַשׁ הַנְּחשֶׁת — וְהוֹדוּ לוֹ. גֵּירַר עַצְמוֹת אָבִיו עַל מִטָּה שֶׁל חֲבָלִים — וְהוֹדוּ לוֹ

The Sages taught: King Hezekiah performed six innovative actions. With regard to three the Sages agreed with him, and with regard to three they did not agree with him.

With regard to three actions the Sages agreed with him:  He suppressed the Book of Remedies, and they agreed with him.  He ground the copper snake through which miracles were performed for Israel (Numbers 21:9), destroying it because it had been used in idol worship (II Kings 18:4), and they agreed with him…

You might have heard that the symbol for healing, that snake (or is it two snakes?) wrapped around a central pole, came from the episode to which today’s page of Talmud is referring. In Numbers 21 the Children of Israel complain that “there is no bread and no water, and we have come to loathe this miserable food.” So God sends fiery snakes “that bit the people and many of the Israelites died.” Let’s let the Good Book tell the rest:

7-10 :במדבר כא

וַיָּבֹא הָעָם אֶל־מֹשֶׁה וַיֹּאמְרוּ חָטָאנוּ כִּי־דִבַּרְנוּ בַיהוָה וָבָךְ הִתְפַּלֵּל אֶל־יְהוָה וְיָסֵר מֵעָלֵינוּ אֶת־הַנָּחָשׁ וַיִּתְפַּלֵּל מֹשֶׁה בְּעַד הָעָם׃

וַיֹּאמֶר יְהוָה אֶל־מֹשֶׁה עֲשֵׂה לְךָ שָׂרָף וְשִׂים אֹתוֹ עַל־נֵס וְהָיָה כָּל־הַנָּשׁוּךְ וְרָאָה אֹתוֹ וָחָי׃

וַיַּעַשׂ מֹשֶׁה נְחַשׁ נְחֹשֶׁת וַיְשִׂמֵהוּ עַל־הַנֵּס וְהָיָה אִם־נָשַׁךְ הַנָּחָשׁ אֶת־אִישׁ וְהִבִּיט אֶל־נְחַשׁ הַנְּחֹשֶׁת וָחָי׃

וַיִּסְעוּ בְּנֵי יִשְׂרָאֵל וַיַּחֲנוּ בְּאֹבֹת׃ 

The people came to Moses and said, “We sinned by speaking against the LORD and against you. Intercede with the LORD to take away the serpents from us!” And Moses interceded for the people.

Then the LORD said to Moses, “Make a seraph figure and mount it on a standard. And if anyone who is bitten looks at it, he shall recover.” 

Moses made a copper serpent and mounted it on a standard; and when anyone was bitten by a serpent, he would look at the copper serpent and recover.

The Israelites marched on and encamped at Oboth.

But you’d be wrong. In fact the episode in the Bible and the fiery snakes that cured has nothing to do with this medical symbol of healing.

From the beginning of the 17th century, the figure of Asklepios began appearing on medical medals and calling cards. The same pattern seen in antiquity emerged: The symbol was used only in a medical context, whereas the caduceus, although used by some medical organizations, was associated with other fields, especially commerce, communications, chemistry, and pharmacy
— Robert A. Wilcox. Emma M. Whitham. The Symbol of Modern Medicine: Why One Snake Is More Than Two. Ann Intern Med. 2003;138:673-677.


snakes that heal

Here is the cover of Fred Rosner's book; notice what looks like two snakes wrapped around a winged pole.  Compare that image with the insignia of the US Army Medical Corps below.

Rosner Book.jpg

The image you see is the caduceus, the rod carried by the Greek god Hermes (known as Mercury when he was in Rome). But in fact this double-snake flying-rod has nothing to do with healing, and is erroneously -though very widely- used as a medical emblem.  As an article in the Annals of Internal Medicine points out, the adoption of the double-snaked caduceus of Hermes - at least in the US - is likely due to its having been used as a watermark by the prolific medical publisher John Churchill.   

The correct mythological association is with the Staff  of Asklepios, the ancient Greco-Roman god of medicine. The opening lines of the Hippocratic Oath clearly reveal the central role occupied by Asklepios (and his mythologic daughters, Hygieia and Panakeia,) in the hearts and minds of the ancients: “I swear by Apollo Physician and Asklepios and Hygieia and Panakeia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgement this oath and this covenant . . .”

In one legend, a snake placed some herbs into the mouth of another serpent that Asklepios had killed, and the dead snake was restored to life.  As a mark of respect, Asklepios adopted as his emblem a snake coiled around his staff.  While the US Army Medical Corps uses the caducues as its badge, on its regimental flag the US Army Medical Command uses the more appropriate single snaked staff. Oh, and a rooster.  

 
U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

 

Fortunately, the Israel Defense Forces clearly know a caduceus from an Asklepios. They adopted the correct Greco-Roman mythological symbol for the medical unit of the first Jewish army in 2,000 years.

 
Insignia of the IDF Medical Corps.
 

 

The Greeks may have had their tradition, but we have ours. And as the Midrash notes, in ours, it is never the snake that heals.

עשה לך שרף ושים אותו על נס, והיה כל הנשוך וראה אותו וחי. וכי נחש ממית או נחש מחיה? אלא בזמן שישראל מסתכלין כלפי מעלה ומשעבדין את לבם לאביהן שבשמים היו מתרפאים, ואם לאו היו נימוקים...

”Make a fiery snake and place it on a pole, and it will be that anyone who is bitten will look at it and live” [Numbers 21:8] But is a snake the source of life and death? Rather, the verse means that when Israel looked up and submitted their heart to their Father in Heaven, they were healed, but if they did not do so, they perished.
— Mishnah Rosh Hashanah 3:8

[An encore post from here.]

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Shabbat 109b ~ Curing Snakebites

The Palestinian Viper צפע ארצישראלי. Vipera palaestinae

The Palestinian Viper צפע ארצישראלי. Vipera palaestinae

Snake Bites Everywhere

Snake bites were a widespread fear in ancient Israel. The Talmud warns that snakes can be found in houses and records a snake attack that occurred in the toilet, so going to the bathroom was a risk to one’s life. (Snakes still appear to make relieving oneself in the Holy Land a dangerous enterprise, if this report is to be believed.)  There was also a great fear of drinking water into which a snake may have expelled some venom, and loyal Talmudology readers may recall that we previously examined this concern (and included a clip of a man safely drinking freshly expelled snake venom. Actually, if you remember, there is no danger, even in places where snakes are found. Snakes only discharge their venom when they intend to bite, not when stopping for a drink. And even if there was venom in the liquid, snake venom is not absorbed by the human gastrointestinal tract, so it would have absolutely no effect. But I digress.)

In tomorrow’s page of Talmud, the fear of snakes is taken to a whole new level, at least for women. What should a woman do if she thinks she is being being pursued by a particularly amorous snake? How can she get that snake to give up the chase? And finally, what can she do if the snake has already entered her is an act of carnal intimacy?

All this shows how dangerous snakes were, and so when they did not bite, it was considered to be miraculous. Hence the Mishnah (Avot 5:5) records that one of the ten miracles that occurred during the time of the Second Temple was that no person was ever injured by a snake.

In today’s page of Talmud, we focus on a cure for a snakebite:

שבת קט,ב

 האי מאן דטרקיה חיויא ליתי עוברא דחמרא חיורתא וליקרעיה ולותביה עילויה והני מילי דלא אישתכח טרפה ההוא

One who was bitten by a snake should have the fetus of a white donkey brought to him, and it should be torn open and placed on the snakebite.

At first the suggestion sounds ridiculous. Why on earth should a donkey’s fetus cure a snakebite, and what difference does the color of the mother donkey make? But we can begin to make sense of the suggestion by noting the Aramaic words for snake (chivyah) and white (chivrah). Say them out loud. There was a belief that “like cures like” and while we are still at a loss to describe why a donkey’s fetus might be used, we can at least make sense of the white aspect of the whole thing.

snake bites in Israel and around the world

The Talmudic concern for snakebites clearly reflected a reality: they are prevalent in the middle east, and were often deadly. Indeed snakebites remain a threat in Israel and beyond (though in my six years of working in Jerusalem as an emergency physician I recall treating only one victim; he was a handler at a private snake collection- who should have known better.)

In the US, venomous snakes are found in every state except Maine, Alaska and Hawaii, and each year in the US there are about 2,000 recorded venomous snakebites that result in about 6 deaths. The World Health Organization estimates that snakes kill between 20,000 and 94,000 people per year.

Kastururante A. et al. The Global Burden of Snakebite. PLOS Medicine 2008. 5:1591-1604

Kastururante A. et al. The Global Burden of Snakebite. PLOS Medicine 2008. 5:1591-1604

Snakes are such a problem for Israel and its neighbors that in 1998 the Israel Defense Forces (IDF) and the Jordanian Armed Forces held a joint conference on the topic. Since snakes are cold blooded, they are virtually inactive in the winter months, and summer time can be too hot for them; hence they are most active in the spring and fall. Just as the Talmud described in Yevamot 116b, the IDF found that the peak incidence for snakebites is May (that is, harvest time). 

Snakebites in the IDF. Average incidence per month, 1993-1997. From Haviv, J, et al. Field treatment of snakebites in the Israel Defense Forces. Public Health Rev 1988; 26:24-256.

Snakebites in the IDF. Average incidence per month, 1993-1997. From Haviv, J, et al. Field treatment of snakebites in the Israel Defense Forces. Public Health Rev 1988; 26:24-256.

There are at least eight species of poisonous snake found in Israel, of which the most common is the Palestine Viper, (shown in the photo at the top of the page) which is found in all regions north of Be’er Sheva. It is this snake that is responsible for all the fatal snake bites in Israel, though the IDF reported not one fatality during its five year study period. 

sidebar: palestinian or israel viper?

Let's re-read that last paragraph:

There are at least eight other species of poisonous snake found in Israel, of which the most common is the Palestine Viper

Is that its real name? Well, it depends who you ask, or perhaps, in what language you ask. The snake's Latin name is Vipera palaestinaeand its Hebrew name is...צפע ארצישראלי! The snake could have been given a Hebrew name that was transliterated from the Latin, i.e. צפע פלסטיני – but that's not what whoever chose the name decided to do.  Outside the case of the viper in the Jerusalem Zoo, this multiple naming is evident:

(It's not only snakes that have may have a crisis of identity. The chamomile flower, common in Israel, is called by its scientific name Anthemis palaestina, and in Hebrew it is קחוון ארצישראלי. Similarly the Terebinth; it is known to the scientific community as Pistacia palaestina, and in Hebrew as אלה ארץ-ישראלית. I could go on, but the point is made.)

One snake living happily, called two names by two peoples. There's a lesson there somewhere. But I digress.

the treatment of snake bites in the Talmud - and today

As we noted, today’s page of Talmud offers a remedy for the unfortunate person bitten by a snake (of either the Palestinian or Israeli variety. Not the person. The snake.)

If one is bitten by a snake, he should take an embryo of a white donkey, tear it open, and place it on the bite

How does this advice compare with the IDF field manual? Not very well, as you can see from this list of the field treatment do's and dont's from the Medical Corps of the IDF.  Embryos of white donkeys do not make it. (Donkey embryos as a therapy also fail to make a fascinating 1953 report of 65 cases of viper bite in Israel.)

Haviv, J, et al. Field treatment of snakebites in the Israel Defense Forces. Public Health Rev 1988; 26:24-256.

Haviv, J, et al. Field treatment of snakebites in the Israel Defense Forces. Public Health Rev 1988; 26:24-256.

Snake venom produces its deadly effects by causing a coagulopathy, which is the general name for a breakdown in the normal way the blood clots.  When things get really bad, snake venom causes a consumption coagulopathy, in which (as its name implies),  all the vital bits that are needed for blood to clot are consumed, leaving the poor victim susceptible to life-threatening uncontrollable bleeding. Here's a chart of the clotting pathways that medical students have to learn (a process only slightly less painful than a snake bite itself,) with the bits that venom attacks shown in green.

Diagram of the clotting pathway showing the major clotting factors (blue) and their role in the activation of the pathway and clot formation. The four major groups of snake toxins that activated the clotting pathway are in green and the intermediate…

Diagram of the clotting pathway showing the major clotting factors (blue) and their role in the activation of the pathway and clot formation. The four major groups of snake toxins that activated the clotting pathway are in green and the intermediate or incomplete products they form are indicated in dark red. There are four major types of prothrombin activators, which either convert thrombin to form the catalytically active meizothrombin (Group A and B) or to thrombin (Group C and D). From Maduwage K, Isbister GK. Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite. PLoS Negl Trop Dis 2014. 8(10): 1-13.

The standard treatment for snake envenomation is antivenom. (This is a technical term for something that is anti the venom.) In the 1950s  antivenom was already part of the standard  treatment of viper bites in Israel, though apparently it was then called by the far fancier name of "serum antivenimeux."  (If chemistry or immunology is your thing, you can read more about how viper antivenom was made in Israel here.) These antivenoms work in a number of ways, one of which is by blocking the toxin and preventing it from binding to its target (i.e. those green diamonds in the diagram above).

snakes that heal

Snakes aren't only associated with coma, convulsions and death.  They are - paradoxically -  often associated with those who heal.  Here is the cover of Fred Rosner's book; notice what looks like two snakes wrapped around a winged pole.  Compare that image with the insignia of the US Army Medical Corps below.

 
Rosner Book.jpg
 

The lower image is the caduceus, the rod carried by the Greek god Hermes (known as Mercury when in Rome). But in fact this double-snake flying-rod has nothing to do with healing, and is erroneously -though very widely- used as a medical emblem.  But as an article in the Journal of the American Medical Association points out, the adoption of the double-snaked caduceus of Hermes - at least in the US - is likely due to its having been used as a watermark by the prolific medical publisher John Churchill.   

The correct mythological association is with the Staff  of Asklepios, the ancient Greco-Roman god of medicine. In one legend, a snake placed some herbs into the mouth of another serpent that Asklepios had killed, and the dead snake was restored to life.  As a mark of respect, Asklepios adopted as his emblem  a snake coiled around his staff.  While the US Army Medical Corps uses the caducues as its badge, on its regimental flag the US Army Medical Command uses the more appropriate single snaked staff. Oh, and a rooster.  

 
U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

 

Fortunately, the Israel Defense Forces clearly know a caduceus from an Asklepios. They adopted the correct Greco-Roman mythological symbol for the medical unit of the first Jewish army in 2,000 years.

 
Insignia of the IDF Medical Corps.
 

 

The Greeks may have had their tradition, but we have ours. And in ours, it is never the snake that heals.

עשה לך שרף ושים אותו על נס, והיה כל הנשוך וראה אותו וחי. וכי נחש ממית או נחש מחיה? אלא בזמן שישראל מסתכלין כלפי מעלה ומשעבדין את לבם לאביהן שבשמים היו מתרפאים, ואם לאו היו נימוקים...

”Make a fiery snake and place it on a pole, and it will be that anyone who is bitten will look at it and live” [Numbers 21:8] But is a snake the source of life and death? Rather, the verse means that when Israel looked up and submitted their heart to their Father in Heaven, they were healed, but if they did not do so, they perished.
— Mishnah Rosh Hashanah 3:8
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Berachot 10b ~ The Snake as a Symbol of Healing

In much of the Talmud snakes are associated with coma, convulsions and death.  But occasionally - and paradoxically -  they are sometimes associated with those healing, and those who heal. Let’s begin with today’s page of Talmud.

ברכות י, א

תָּנוּ רַבָּנַן: שִׁשָּׁה דְבָרִים עָשָׂה חִזְקִיָּהוּ הַמֶּלֶךְ, עַל שְׁלֹשָׁה הוֹדוּ לוֹ, וְעַל שְׁלֹשָׁה לֹא הוֹדוּ לוֹ 

עַל שְׁלֹשָׁה הוֹדוּ לוֹ: גָּנַז סֵפֶר רְפוּאוֹת — וְהוֹדוּ לוֹ. כִּתֵּת נְחַשׁ הַנְּחשֶׁת — וְהוֹדוּ לוֹ. גֵּירַר עַצְמוֹת אָבִיו עַל מִטָּה שֶׁל חֲבָלִים — וְהוֹדוּ לוֹ

The Sages taught: King Hezekiah performed six innovative actions. With regard to three the Sages agreed with him, and with regard to three they did not agree with him.

With regard to three actions the Sages agreed with him:  He suppressed the Book of Remedies, and they agreed with him.  He ground the copper snake through which miracles were performed for Israel (Numbers 21:9), destroying it because it had been used in idol worship (II Kings 18:4), and they agreed with him…

You might have heard that the symbol for healing, that snake (or is it two snakes?) wrapped around a central pole, came from the episode to which today’s page of Talmud is referring. In Numbers 21 the Children of Israel complain that “there is no bread and no water, and we have come to loathe this miserable food.” So God sends fiery snakes “that bit the people and many of the Israelites died.” Let’s let the Good Book tell the rest:

7-10 :במדבר כא

וַיָּבֹא הָעָם אֶל־מֹשֶׁה וַיֹּאמְרוּ חָטָאנוּ כִּי־דִבַּרְנוּ בַיהוָה וָבָךְ הִתְפַּלֵּל אֶל־יְהוָה וְיָסֵר מֵעָלֵינוּ אֶת־הַנָּחָשׁ וַיִּתְפַּלֵּל מֹשֶׁה בְּעַד הָעָם׃

וַיֹּאמֶר יְהוָה אֶל־מֹשֶׁה עֲשֵׂה לְךָ שָׂרָף וְשִׂים אֹתוֹ עַל־נֵס וְהָיָה כָּל־הַנָּשׁוּךְ וְרָאָה אֹתוֹ וָחָי׃

וַיַּעַשׂ מֹשֶׁה נְחַשׁ נְחֹשֶׁת וַיְשִׂמֵהוּ עַל־הַנֵּס וְהָיָה אִם־נָשַׁךְ הַנָּחָשׁ אֶת־אִישׁ וְהִבִּיט אֶל־נְחַשׁ הַנְּחֹשֶׁת וָחָי׃

וַיִּסְעוּ בְּנֵי יִשְׂרָאֵל וַיַּחֲנוּ בְּאֹבֹת׃ 

The people came to Moses and said, “We sinned by speaking against the LORD and against you. Intercede with the LORD to take away the serpents from us!” And Moses interceded for the people.

Then the LORD said to Moses, “Make a seraph figure and mount it on a standard. And if anyone who is bitten looks at it, he shall recover.” 

Moses made a copper serpent and mounted it on a standard; and when anyone was bitten by a serpent, he would look at the copper serpent and recover.

The Israelites marched on and encamped at Oboth.

But you’d be wrong. In fact the episode in the Bible and the fiery snakes that cured has nothing to do with this medical symbol of healing.

From the beginning of the 17th century, the figure of Asklepios began appearing on medical medals and calling cards. The same pattern seen in antiquity emerged: The symbol was used only in a medical context, whereas the caduceus, although used by some medical organizations, was associated with other fields, especially commerce, communications, chemistry, and pharmacy
— Robert A. Wilcox. Emma M. Whitham. The Symbol of Modern Medicine: Why One Snake Is More Than Two. Ann Intern Med. 2003;138:673-677.
Rosner Book.jpg

SNAKES THAT HEAL

Here is the cover of Fred Rosner's book; notice what looks like two snakes wrapped around a winged pole.  Compare that image with the insignia of the US Army Medical Corps below.

The image you see is the caduceus, the rod carried by the Greek god Hermes (known as Mercury when he was in Rome). But in fact this double-snake flying-rod has nothing to do with healing, and is erroneously -though very widely- used as a medical emblem.  As an article in the Annals of Internal Medicine points out, the adoption of the double-snaked caduceus of Hermes - at least in the US - is likely due to its having been used as a watermark by the prolific medical publisher John Churchill.   

The correct mythological association is with the Staff  of Asklepios, the ancient Greco-Roman god of medicine. The opening lines of the Hippocratic Oath clearly reveal the central role occupied by Asklepios (and his mythologic daughters, Hygieia and Panakeia,) in the hearts and minds of the ancients: “I swear by Apollo Physician and Asklepios and Hygieia and Panakeia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgement this oath and this covenant . . .”

In one legend, a snake placed some herbs into the mouth of another serpent that Asklepios had killed, and the dead snake was restored to life.  As a mark of respect, Asklepios adopted as his emblem a snake coiled around his staff.  While the US Army Medical Corps uses the caducues as its badge, on its regimental flag the US Army Medical Command uses the more appropriate single snaked staff. Oh, and a rooster.  

 
U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

U.S. Army Medical Command Regimental Flag. Don't ask about the rooster...

 

Fortunately, the Israel Defense Forces clearly know a caduceus from an Asklepios. They adopted the correct Greco-Roman mythological symbol for the medical unit of the first Jewish army in 2,000 years.

 
Insignia of the IDF Medical Corps.
 

 

The Greeks may have had their tradition, but we have ours. And as the Midrash notes, in ours, it is never the snake that heals.

עשה לך שרף ושים אותו על נס, והיה כל הנשוך וראה אותו וחי. וכי נחש ממית או נחש מחיה? אלא בזמן שישראל מסתכלין כלפי מעלה ומשעבדין את לבם לאביהן שבשמים היו מתרפאים, ואם לאו היו נימוקים...

”Make a fiery snake and place it on a pole, and it will be that anyone who is bitten will look at it and live” [Numbers 21:8] But is a snake the source of life and death? Rather, the verse means that when Israel looked up and submitted their heart to their Father in Heaven, they were healed, but if they did not do so, they perished.
— Mishnah Rosh Hashanah 3:8

[A repost from here.]

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