On the last few pages of this tractate, the Talmud discusses the end of life, or more precisely, the ends of lives. Having discussed how one mourns for a parent, on this daf, the focus is on the deaths that are most painful of all: the deaths of children.
מועד קטן כד, א-ב
כל שְׁלֹשִׁים יוֹם, תִּינוֹק יוֹצֵא בַּחֵיק, וְנִקְבָּר בְּאִשָּׁה אַחַת וּשְׁנֵי אֲנָשִׁים. אֲבָל לֹא בְּאִישׁ אֶחָד וּשְׁתֵּי נָשִׁים. אַבָּא שָׁאוּל אוֹמֵר: אַף בְּאִישׁ אֶחָד וּשְׁתֵּי נָשִׁים. וְאֵין עוֹמְדִין עָלָיו בְּשׁוּרָה. וְאֵין אוֹמְרִים עָלָיו בִּרְכַּת אֲבֵלִים וְתַנְחוּמֵי אֲבֵלִים
בֶּן שְׁלֹשִׁים יוֹצֵא בִּדְלוֹסְקָמָא. רַבִּי יְהוּדָה אוֹמֵר: לֹא דְּלוֹסְקָמָא הַנִּיטֶּלֶת בַּכָּתֵף, אֶלָּא הַנִּיטֶּלֶת בָּאֲגַפַּיִים. וְעוֹמְדִין עָלָיו בְּשׁוּרָה, וְאוֹמְרִים עָלָיו בִּרְכַּת אֲבֵלִים וְתַנְחוּמֵי אֲבֵלִים
בֶּן שְׁנֵים עָשָׂר חֹדֶשׁ יוֹצֵא בְּמִטָּה. רַבִּי עֲקִיבָא אוֹמֵר: הוּא בֶּן שָׁנָה וְאֵבָרָיו כְּבֶן שְׁתַּיִם, הוּא בֶּן שְׁתַּיִם וְאֵבָרָיו כְּבֶן שָׁנָה — יוֹצֵא בְּמִטָּה.בִּרְכַּת אֲבֵלִים וְתַנְחוּמֵי אֲבֵלִים
Within the first thirty days after birth, an infant that dies is taken out for burial in one’s bosom, that is to say, he is carried to his grave in one’s arms, not in a coffin….
And for such an infant, people do not stand in a line to offer their condolences to the mourners, as is ordinarily done after a burial; nor do others recite over him the mourners’ blessing, which is recited in the courtyard of the graveyard after the burial; nor is the usual formula for the consolation of mourners recited during the seven days of mourning.
A thirty-day-old infant that dies is taken out for burial in a coffin [deluskema]. Rabbi Yehuda says: Not in a small coffin that is carried on one’s shoulder, but rather in a coffin that is carried in the arms of two people. And for such an infant, people stand in a line to offer their condolences to the mourners. And others recite the mourners’ blessing at the cemetery. And people recite the consolation of mourners during the week of mourning.
A twelve-month-old infant is taken out for burial on a bier, just as an adult is.
There are, unfortunately, many examples of rabbis mentioned in the Talmud who mourned their children. One of the most well-known was Rabbi Yochanan, who buried ten children.
ברכות ה, ב
תָּנֵי תַּנָּא קַמֵּיהּ דְּרַבִּי יוֹחָנָן: כׇּל הָעוֹסֵק בְּתוֹרָה וּבִגְמִילוּת חֲסָדִים וְקוֹבֵר אֶת בָּנָיו — מוֹחֲלִין לוֹ עַל כׇּל עֲוֹנוֹתָיו
וְהָא אָמַר רַבִּי יוֹחָנָן, דֵּין גַּרְמָא דַּעֲשִׂירָאָה בִּיר
A tanna taught the following baraita before Rabbi Yochanan: If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven…
Rabbi Yochanan himself said, This is the bone of my tenth son…
Rabbi Yochanan bar Napcha (c.180–279 CE) is cited many hundreds of times in the Talmud. But it was his tragic family story that perhaps most defined who he was. He was a father who had lost ten children.
Childhood mortality in rabbinic sources
Rabbi Yochanan’s tragedy might have been extreme in its severity, but his was not a unique situation. In fact the Talmud and the Midrash are replete with stories that reflect the high rate of both infant and child mortality at the time. In this tractate we learn that Rabbi Yishmael lost at least two sons, (Moed Katan 28b) as did Rabbi Akiva (Moed Katan 21b). Rabban Gamiel cried in sympathy with a neighbor who lost her child (Sanhedrin 104b), whereas when Rav Yossi of Zippori lost a son, he chose not to cry, but to expound all day long in the Bet Midrash (Moed Katan 21a). The Midrash recounts that both sons of Rabbi Meir died on a Shabbat (Midrash Mishlei 31:10), and when the sons of Rabbi Yossi ben Chaninah died, he refused to wash with warm water (Ta’anit 13b). Children were eaten by wolves (Ta’anit 22b) murdered by brigands (Semahoth 12:13) and buried in earthquakes (Semachot 11:4). In some hemophiliac families, infants bled to death after being circumcised (Yevamot 64b), while other children committed suicide rather than face either physical abuse from their father (Semahoth 2:4-5), or an unwanted arranged marriage (Seder Eliyyahu Rabbah 19).
Professor Meir Bar Ilan (from the university that bears his family name) identified over two dozen other cases. Professor Bar Ilan adds that an additional factor should not be overlooked.
…almost all the cases indicate deaths of sons, not daughters. Apparently it reflects the nature of a patriarchal society, where one's importance depends merely on his sex (as in more than few societies even today). Furthermore, since there is no reason to believe that boys were prone to death more than girls (except in the case of circumcision), it reveals that, actually, the cases are all 'males' while ignoring the females. Because of this 'male' factor, one that wishes to know the exact number of deaths in the above sources, should multiply his data with (almost) 2.25 That is to say, that usually the deaths of girls were ignored, though they, apparently, happened at the same rate.
Calculating the infant mortality rate in THE TaLmudic era
Professor Bar Ilan counted about nine cases of infant or child death among the fifety or so tannaim mentioned by name in the Talmud. After taking into account the “ignored” factor of deaths of girls, he suggested that infant mortality rate among the families of the tannaim approached 30%.
To put this number into context, the infant mortality rate in Great Britain around 1880 was about 135 per thousand live births, or about 13%. Among the Jews of Italy, about 40% of children under the age of three died. It is harder to calculate the mortality rate in ancient Rome, but other scholars have estimated it to be 25-30%.
| Life Expectancy and Infant Mortality Rates in 16th Century Europe | ||||
|---|---|---|---|---|
| Village in Devon England, 1538-1599 |
Village in Essex England, 1550-1624 |
Bourgeoisie of Geneva, 1550-1599 |
English High Aristocracy, 1550-1599 |
|
| Average age of women at marriage | 26 | 24.5 | 21.4 | 22.8 |
| Infant mortality per 1000 (0-1 years) | 120-140 | 128 | - | 190 |
| Infant mortality per 1000 (1-14 years) | 124 | 149 | - | 94 |
| Infant mortality per 1000 (1-19 years) |
- | - | 519 | - |
| Average life expectancy | 40-46 | - | 28-29 | 37 |
| Data from Meir Bar Ilan, Infant Mortality in The Land of Israel in Late Antiquity | ||||
The Shameful infant Mortality Rate in the US
In 2017 the infant mortality rate in the US was 579 per 100,000 or just under 0.6%. That rate is fifty times lower than the rate during the centuries over which the Talmud was compiled. The leading cause of death is congenital malformations, but accidental injury remains a major cause of mortality in children. Just like it did in ancient Israel.
“The US ranks 30th of 193 countries in infant mortality rate, the ratio of babies that die before turning one year old. In the US, there are more than three times as many infant deaths for every 1,000 births as there are in the countries leading the list.”
But take a look at the chart below and you will see that the rate in the US is over two or three times higher than it is in other western countries. It is shameful that the country with the highest per capita rate of health care spending finds itself so low down on this list.
Infant mortality per 1,000 births, 2010-2015. Date from the United Nations. From here.
A very recent paper by Ezekiel Emanuel and colleagues from the University of Pennsylvania addressed the question of whether the medical care given in the US was “the best in the world.” (Spoiler alert: it is not). Among their findings were that even for the most privileged on US citizens, rich white people, on most measures of health outcomes they do worse than the average individual in other countries. Here is what they found for one of those measures, infant mortality:
The infant mortality rate among White US citizens in the 1% highest income counties is 3.54 per 1000 live births, while the 5% highest-income counties have an infant mortality rate of 4.01 per 1000 live births—higher than in all 12 comparison countries. Among all US citizens, the infant mortality rate is 5.90 deaths per 1000 live births. Among comparison countries, the infant mortality rate is lowest in Finland, at 1.70 per 1000 live births, and highest in Canada, with 4.70 per 1000 live births. Only 2 of the top 157 highest-income counties in the US have White infant mortality rates below that of Norway, and none have rates lower than Finland .
“Comparative studies show different data from various cultures and times, and together with the texts themselves, suggest that some 30% of all children born in the Land of Israel at the beginning of this era would not reach their maturity.”
“Neither the suffering nor the reward”
Because infant and childhood deaths were so common it is not surprising that the rabbis of the Talmud tried to inject a glimmer of metaphysical hope into this most tragic of tragedies. Rabbi Yochanan had lost no fewer than ten children, and his colleagues attempted to console him with the promise of a reward to come: “If one engages in Torah and acts of charity and buries his sons, all his transgressions are forgiven.” That might have consoled Yochanan the Rabbi, but it did not console Yochanan the grieving father. Rabbi Yochanan rejected the very notion that suffering -of any sort-was worth a reward. “I want neither this suffering nor its reward - לֹא הֵן וְלֹא שְׂכָרָן.”
[Mostly a repost from Berachot 5.]
