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

Tu B'Shavt ~ A New Year for Health

The opening Mishnah of Masechet Rosh Hashanah includes this:

ראש השנה ב ,א

באחד בשבט ראש השנה לאילן כדברי בית שמאי בית הלל אומרים בחמשה עשר בו

On the first of Shevat is the New Year for the tree; [the fruit of a tree that was formed prior to that date belong to the previous tithe year and cannot be tithed together with fruit that was formed after that date;] this ruling is in accordance with the statement of Beit Shammai. But Beit Hillel say: The New Year for trees is on the fifteenth of Shevat.

 Declaring different kinds of New Years goes back to the Talmud. But this practice was updated in a remarkable way by a Russian Jewish immigrant to the US in the early twentieth century. Tonight, we mark the fifteenth of Shvat, the date that, according to Bet Hillel, is the new year for the tithing of trees, and we will tell his remarkable - and overlooked - story, of it has everything to do with Tu B’Shvat.

“Twice a year on the fifteenth day of Shevat and on the eighteenth day of Iyar all the Jewish children from 3 to 13 years of age should undergo a thorough physical examination by the local Jewish physicians free of charge. ”

— Charles Spivak

Charles Spivak and the fight against tuberculosis

Hayyim Haykhl Spivakovski (1861-1927) immigrated to the US from Russia, where he became Charles Spivak. He graduated from Jefferson Medical College in Philadelphia in 1890 (and his thesis, on talmudic theories of menstruation won a prize), and after his wife contracted tuberculosis in 1896 he moved with her to Denver. There she could take advantage of the high altitude which had been shown to help fight the disease. This began his life-long mission to fight the tuberculosis and improve the care of the many Jewish refugees from eastern Europe who contracted it. 

From here.

Spivak founded the Jewish Consumptives’ Relief Society (JCRS), which provided kosher food and a Sabbath atmosphere, but was open to anyone. “We have in our institution chasidim and agnostics,” he wrote in 1914, “Jews and Christians, republicans and progressives, socialists and anarchists, men of all kinds of religious, political and economic options.” Spivak’s personal philosophy was informed by “a unique blend of Yiddishkeit [Jewish values], secularism and socialism” and his approach to the distribution of funds was sometimes at odds with bureaucratic and impersonal ways that some Jewish charities functioned. “We may not be able to return him [the patient] to his family as a useful working unit,” he reminded his benefactors, “we may actually waste money without any hope for any return, nevertheless, we feel that he or she must receive our care and attention, that whole-souled and whole-hearted charity is, after all, the only true, pure and unalloyed charity.” He estimated that of among the 3.3 million Jews then living in the US about 4,600 died each year from the disease, and ten times that number were chronically infected, or as he put it, were “living tuberculous Jews.” It was therefore the duty of the Jewish community to support the fight for to prevent the spread of tuberculosis and search for a cure. 

Dr. Chales Spivak. From here.

In that opening Mishnah of Rosh Hashanah, we read that are several different dates that mark the beginning of different new years. The first day of the Spring month of Nissan is the new year for kings, which is used to date legal documents. The new year for trees is marked in the late winter month Shevat, which is used to count tithes, and first day of the late summer month of Tishrei is used to count the number of years since creation. In December 1918, Spivak updated this list and gave it a thoroughly modern twist. Writing in the Journal Jewish Charities, he suggested that the rhythm of the Jewish calendar could be used to improve public health and reduce the toll from tuberculosis.

Twice a year on the fifteenth day of Shvat (New Years for Trees) and on the eighteenth day of Iyar (Lag B'Omar) all the Jewish children from 3 to 13 years of age should undergo a thorough physical examination by the local Jewish physicians free of charge.  

In the evening of the respective days all organized societies in the community should hold Health meetings at which the subject of how to maintain good health and prevent disease should be discussed by health officers and physicians.

 A custom should also be inaugurated that all adults should visit their family physicians during the months of Tishre and Nisson [sic] for the purpose of undergoing a physical examination.

 Spivak’s suggestion was of course dependent on a working knowledge of the Jewish calendar, but the dates he suggested would help. The fifteenth of Shevat was often celebrated in schools, and Lag B’Omer, the thirty-third day of the period leading up to the festival of Shavuot was celebrated as a minor holiday; it marked the end of the pandemic deaths of the students of the talmudic giant Rabbi Akiva. Most Jewish adults, even those who had jettisoned traditional Jewish practice when they arrived in America, would be aware of the timing of the other two months.  The festival of Pesach (Passover) is celebrated in Nissan, and Rosh Hashanah, the start of the Jewish New Year that leads into Yom Kippur (the Day of Atonement) is commemorated in Tishrei.

Helping others, even after his death

Spivak, a member of the Denver Hebrew Speaking Society, developed liver cancer and died in 1927 at the age of 68. His generous spirit is evident in his last will and testament, where he asked that

…my body be embalmed and shipped to the nearest medical college for an equal number of non-Jewish and Jewish students to carefully dissect. After my body has been dissected, the bones should be articulated by an expert and the skeleton shipped to the University of Jerusalem, with the request that the same be used for demonstration purposes in the department of anatomy.

Apparently his request was fulfilled, and somewhere on the campus of the Hebrew University of Jerusalem is his skeleton.

Denver’s National Jewish Hospital

Spivak was not the only Jew who helped Denver’s many “consumptives.” He had traveled to Denver because of its high altitude, and in there in the 1880s a woman by the name of Frances Wisebart Jacobs raised funds to open a new hospital to treat the many “consumptives” who had traveled to the mile high city. She found support from the Jewish community, which agreed to plan, fund and build a nonsectarian hospital for the treatment of respiratory diseases, primarily tuberculosis. That hospital opened in 1899 as The National Jewish Hospital for Consumptives, and after several name changes it is now known as National Jewish Health. Today, it remains a major center for the care of patients with lung and respiratory illnesses.

““…[Pain] knows no creed, so is this building the prototype of the grand idea of Judaism, which casts aside no stranger no matter of what race or blood. We consecrate this structure to humanity, to our suffering fellowman, regardless of creed.” ”

— Rabbi William Friedman at the laying of the cornerstone of the new hospital. From Tom Sherlock. Colorado's Healthcare Heritage: A Chronology of the Nineteenth and Twentieth Century Healthcare, volume 1, p374.

While the Talmud declared four kinds of new year, Spivak declared a fifth. His new year for health was to be commemorated together with Tu B’Shavt, the new year for trees. In this way, he tied it to the Jewish calendar, and his memory is a reminder of the importance of getting a routine physical exam from your doctor. It might save your life.

Gittin 67b~ Might Talmudic Medicines Really Work?

For the next three days, those who study the Talmud following the one-page-a-day Daf Yomi cycle will spend some time reading about cutting edge medical practices.  In Babylon. About 1,500 years ago. Here's a smattering of some of those practices:

For  sun-stroke

• the remedy is on the first day to take a jug of water, [if it lasts] two days to let blood, [if] three days to take red meat broiled on the coals and highly diluted wine. For a chronic heat stroke, he should bring a black hen and tear it lengthwise and crosswise and shave the middle of his head and put the bird on it and leave it there till it sticks fast, and then he should go down [to the river] and stand in water up to his neck till he is quite faint, and then he should swim out and sit down. If he cannot do this, he should eat leeks and go down and stand in water up to his neck till he is faint and then swim out and sit down. (Gittin 67b).

For blood rushing to the head

• take shurbina [a kind of cedar] and willow and moist myrtle and olive leaves and poplar and rosemary and yabla [a herb] and boil them all together. The sufferer should then place three hundred cups on one side of his head and three hundred on the other. Otherwise he should take white roses with all the leaves on one side and boil them and pour sixty cups over each side of his head. (Gittin 68b.)

For migraine

• take a woodcock and cut its throat with a white zuz over the side of his head on which he has pain, taking care that the blood does not blind him, and he should hang the bird on his doorpost so that he should rub against it when he goes in and out. (Gittin 68b.)

For a cataract

• take a scorpion with stripes of seven colors and dry it out of the sun and mix it with stibium in the proportion of one to two and drop three paint-brushfuls into each eye — not more, lest he should put out his eye. (Gittin 69a.)

For night blindness

• take a string made of white hair and with it tie one of his own legs to the leg of a dog, and children should rattle potsherds behind him saying 'Old dog, stupid cock'. He should also take seven pieces of raw meat from seven houses and put them on the doorpost and [let the dog] eat them on the ashpit of the town. After that he should untie the string and they should say, 'Blindness of A, son of the woman B, leave A, son of the woman B,' and they should blow into the dog's eye. (Gittin 69a.)

For catarrh [or a lung infection?] 

• take about the size of a pistachio of gum-ammoniac and about the size of a nut of sweet galbanum and a spoonful of white honey and a Mahuzan natla of clear wine and boil them up together...He can also take the excrement of a white dog and knead it with balsam, but if he can possibly avoid it he should not eat the dog's excrement as it loosens the limbs. (Gittin 69a-b.)

For swelling of the spleen

• take the spleen of a she-goat which has not yet had young, and stick it inside the oven and stand by it and say, 'As this spleen dries, so let the spleen of So-and-so son of So-and-so' dry up'. (Gittin 69b.)

For a stone in the bladder

• take three drops of tar and three drops of leek juice and three drops of clear wine and pour it on the penis of a man or on the corresponding place [i.e. the urethra] in a woman. Alternatively he can take the ear of a bottle and hang it on the penis of a man or on the breasts of a woman. Or he can take a purple thread which has been spun by a woman of ill repute or the daughter of a woman of ill repute and hang it on the penis of a man or the breasts of a woman. Or again he can take a louse from a man and a woman and hang it on... (Gittin 69b.)

We could go on but no doubt you've got the idea.  I doubt there are many of us eager to eat balsam mixed with dog excrement to ease our winter coughs (For those who are, remember: the Talmud tells us to go easy on the excrement.) But I will share with you the remarkable healing properties of two ancient remedies. To be sure, neither is a talmudic concoction, but their stories have implications for those too. 

“ A rich source of new antimicrobials potentially resides in medieval and early modern medical texts”

— Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129- 15.

A 1,000-Year-Old Antimicrobial Remedy

Bald’seyesalve.A facsimile of the recipe, taken from the manuscript known as Bald’s Leechbook (London, British Library, Royal 12, D xvii).

I am not aware of any published descriptions of attempts to test these talmudic remedies. But a 2015 paper described something close. It was an attempt to reproduce a remedy described in Bald's Leechbook, an English medical text written in the tenth century. This text, which exists as a single copy in the British Library in London, contains a number of remedies, including those for what appear to be microbial infections.  Here's one of them:  

Make an eyesalve against a wen [a lump in the eye]: take equal amounts of cropleac [an Allium species] and garlic, pound well together, take equal amounts of wine and oxgall, mix with the alliums, put this in a brass vessel, let [the mixture] stand for nine nights in the brass vessel, wring through a cloth and clarify well, put in a horn and at night apply to the eye with a feather; the best medicine.

The most likely clinical condition that correlates with a wen is a hordeolum, or, in non-medical language, a sty. It's a bacterial infection of an eyelash follicle, caused by a common bacterium called Staph. Aureus. They are easily treated with antibiotic cream and warm compresses. A group of medical researchers (with the help of a historian from the School of English and Centre for the Study of the Viking Age at the University of Nottingham) tested the effect of Bald’s eyesalve on Staph. aureus. They wanted to to determine if it worked at all.  If it did, they wanted to see if its efficacy could be attributed to a single ingredient, or whether it only worked when all the ingredients were combined according to the instructions laid down by Bald.  

Of course the first thing the scientists needed to do was to figure out what some of ingredients were. For example, copleac might be an onion, or a leek. (Actually, they couldn't figure out which of the two it was, so they made two variants of the recipe.) Next, they took both the recipe, and controls, which were the individual ingredients alone, and after leaving them to stand for "nine nights" as the Leechbook requires (læt standan nion niht) they applied them to colonies of Staph Aureus. Then they counted the number of colonies of the bacteria that remained.

Two hundred microliters of ES-Onion or ES-Leek (batch A, filled circles, and batch B, open circles) or of each individual ingredient preparation was added to five 1-day-old cultures of S. aureus growing at 37°C in a synthetic wound. After 24 h of further incubation, the collagen was dissolved to recover cells for agar plate counts. The control treatment was sterile distilled water left to stand for 9 days in the presence of brass, which was also present in all other preparations, to simulate the presence of a copper alloy vessel Asterisks denote treatments whose results were significantly different from those of the control. From Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129-15.

To their great delight they found the recipe was only effective when all the ingredients were present. They even tested whether it was necessary to wait for nine days and reported that "the number of viable cells left after treatment with either version...was [significantly] lower when the eyesalve had been left to stand for 9 days prior to use." In other words, the potion concocted only worked when the recipe was followed in its entirety; skipping any part decreased the efficacy.    

“What is the remedy for a boil? — Abaye said: [A mixture of] ginger and silver dross and sulphur and vinegar of wine and olive oil and white naphtha laid on with a goose’s quill.”

— Gittin 86a

But the next experiments were no less remarkable. The researchers tested the potion on methicillin-resistant Staph. Aureus (MRSA) which is an entirely modern "superbug". Through the indiscriminate and widespread use of antiobiotics, this strain of Staph. Aureus has grown resistant to the usual antibiotics, and is very real health problem.  The researchers tested the onion (ES-O) and leek (ES-L) versions against a standard antibiotic used to treat MRSA, called vancomycin, using mice that had been infected with the superbug. Vancomycin, the standard modern therapy, did not cause significant reductions in viable bacteria, but "ES-O and ES-L caused statistically significant drops in the numbers of viable cells recovered from wounds." In fact when compared to our modern vancomycis, the Leechbook potions caused a ten-fold reduction in the number of viable MRSA cells recovered. Of course there's a long way between a single small study done on cell cultures and mice, and a drug that is safe and effective in humans. But this story reveals how come very old medical texts may contain treatments that work. 

For more on the the story of the discovery of Bald'eye remedy, listen to this wonderful podcast:

“If medieval physicians really did use observation and experience to design effective antimicrobial
medicines, then this predates the generally accepted date for the adoption of a rational scientific method (the formation of the Royal Society in the mid-17th century) and the modern age of antibacterial medicine (Lister’s use of carbolic acid in the late 19th century) by several hundred years.”

— Harrison F, Roberts AEL, Gabrilska R, Rumbaugh KP, Lee C, Diggle SP. 2015. A 1,000-year-old antimicrobial remedy with antistaphylococcal activity. mBio 6(4):e01129-15

The 2015 Nobel Prize for an Ancient Remedy

“ ...take one bunch of Qinghao, soak in two sheng of water, wring it out to obtain the juice and ingest it in its entirety”

— Extract from The Handbook of Prescriptions for Emergency Treatments by Ge Hong (283–343 CE).

Another example of the medical wisdom of some ancient texts was acknowledged by the Nobel Prize Committee, no less. Last year, the Nobel Prize in Medicine was shared by the Chinese physician Youyou Tu "for her discoveries concerning a novel therapy against Malaria." Professor Tu led a team that screened more than 2,000 traditional Chinese medical herbs for antimalarial activity. Extracts from a herb known locally as Qinghao, (Artemisia annua) inhibited the malarial parasite and was successfully tested on mice in 1971. Clinical studies in the 1980s established the efficacy of artemicinin (as it came to be called). This drug is now part of the standard treatment for malaria worldwide.  Yet it was first identified in a Chinese medical text from the third century CE. - the era of the Mishnah and early Talmud.

Ancient texts certainly may contain efficacious treatment, though the odds are stacked against them. Today only a very tiny number of compounds that are screened for possible medical benefit ever make it to early trials, and of those most fail. It would take a lot of convincing to get Pfizer to test a "woodcock with its throat cut with a coin" for headache.  Until then, it is best to follow the words of another very old source of wisdom, Rav Sherira Gaon, who died around the year 1000 CE. (and so lived around the time of the composition of Bald's Leechbook). 

אוצר הגאונים, חלק התשובות, גיטין דף ס"ח ע"ב, סימן שע

צריכין אנן למימר לכון, דרבנן לאו אסותא אינון, ומילין בעלמא דחזונין בזמניהון...אמרונין, ולאו דברי מצוה אינון. הלכך לא תסמכון על אלין אסותא, וליכא דעביד מינהון מידעם, אלא בתר דמיבדיק וידע בודאי מחמת רופאים בקיאים, דההיא מילתא לא מעיקא לה וליכא דליתיה נפשיה לידי סכנה. והכין אגמרו יתנא ואמרו לנא אבות וסבי דילנא, דלא למעבד מן אילין אסותא אלא מאי דאיתיה

We must tell you that the rabbis were not physicians. Whatever they saw in their day, they addressed, but these matters are not mitzvot. Therefore, do not rely on these remedies. They must not be applied until they have been tested by expert physicians, who can be sure that the remedy will not cause harm or danger. This is what our ancestors have taught us. We should not apply these remedies unless they have been tested...

2023 UPDATE:

This post was originally published in 2015. Here is what has happened since.

In 2020, Harrison and her colleagues tested the ability of Bald’s eyesalve against a particularly nasty bacterial infection of the eye. (The salve “was “prepared using a standard method as previously reported with garlic, onions, bovine bile and white wine”.) They found it was active against Neisseria Gonorhoeae, a sexually transmitted disease that can cause conjunctivitis in infants and adults alike:

Here, we show that Bald’s eyesalve is also effective against a multidrug-resistant N. gonorrhoeae strain. N. gonorrhoeae is a common cause of ophthalmia neonatorum or neonatal conjunctivitis acquired during delivery from an infected mother. If left untreated, it can lead to corneal perforation and blindness, with neonatal conjunctivitis being a major cause of childhood corneal blindness in developing countries. With the increasing occurrence of multidrug-resistant strains of bacteria, an alternative treatment for N. gonorrhoeae is very valuable and these experiments show that Bald’s eyesalve has the potential to be developed into a viable alternative.

In 2022 the salve was the topic of a PhD dissertation (supervised by Dr. Harrison), and was the subject of an early safety study in 109 healthy volunteers. “The reconstructed medieval ancientbiotic” wrote the authors, coining a clever new word while doing so “was well tolerated and had a good safety profile when applied to healthy human skin over a 48-h exposure period. There were no serious adverse events amongst our sample of healthy volunteers. Our findings suggest that further molecular investigation and testing of Bald’s eyesalve is worthwhile….We believe this is the first time that a medieval “ancientbiotic” comprising multiple ingredients has been assessed in a Phase I trial with healthy volunteers.” Harrison and Connelly have also published a 22-page review of the topic, which you can find here, in a terrifically titled compendium Making the Medieval Relevant.