Wednesday, July 26, 2023


Tov ShebiRofim LeGehennem: the best doctors go to hell


Many commentators emphasize “the best” part.  It is only the best doctors that go to hell, ordinary doctors are ordinary people, they go wherever they deserve.

 

My old favorite interpretation was that the best doctors (perhaps as a consequence of the praise heaped upon them) are so (over)confident that they do not ask advice from others, and therefore make avoidable mistakes.  This interpretation has colored my practice, it had become a motto for me. I try to look everything up and ask for advice.

 

Recently, I heard Shmuelly Bornstein report (commenting on Gittin 73)  that people believe that the best doctors are those that do not do the harmful things necessary to cure the patient. Homeopaths, spirit healers. These charlatans obviously have a special place in hell for all the people they keep from getting optimal treatment.

 

Today, I thought of a new interpretation.  The best doctors are those who write guidelines and set standards. They believe in their models and theories. They certainly believe in their laboratory results. They end up trying to keep their models prominent, even when they are superseded by new discoveries. IN our times, they are the consultants for pharma, giant drug companies that market their money making drugs.  The drug companies delay the launch of better medicines to maximize  their profits, take advantage of patent laws. They design studies (studies only they can sponsor because of the expense)  to maximize sales, even if people who do not benefit from their product  receive it.  These best doctors certainly belong in hell.

 

 

 

 


Friday, June 02, 2023

 

Naso: Passion

Embedded between burdens of the Levites and the twelve individual and identical offerings of the tribal princes are laws relating, implicitly, to passions. The wayward wife acts on her infatuation.  The jealous husband's imagination kindles his fury. They feel that these emotions spring from the unique parts of their being. The establishment of a ritual to deal with these seemingly private matters attests to their banality.  These suspicions and desires come from the river of species preservation that brought us into life and flows toward the preservation of our families, tribes and nations past individual mortality.

The evolutionary forces that made passion the driver toward procreation, like all Darwinian explanations, are post-hoc justifications. There are elements of intragroup re-selection. An element of competition is intrinsic to ardor. The most passionate, and those with the skills and strength to act on their desires, prevail. Thus, passion has an element of self-selection. QED

 

The sotah ritual deals with passions gone awry. The system of monandry assumed in the Torah is imagined violated. Should I apologize for this demeaning rite? It is a little more benign that expected.  The male imagination is not sufficient cause to condemn the wife. In the hands of the Talmud (we recently completed the tractate Sota) the accusations and fantasies are  subject to rules of evidence, including the standard two (valid) witnesses required to establish the facts. The penalty, the trial by ordeal, the drinking of the embittering waters is very unlikely to have true, physical, ill effects ( unless adulterated). The Mishna (written when the second temple stood) says that the ritual was abandoned when adultery became too commonplace. There was also a realization that the potion was ineffective. It was the end of an era.

I recently read D.H. Lawrence’s  Lady Chatterley’s Lover (not a recommendation). The book, on its surface, is a celebration of adultery and the passion that drives it. It comes at the beginning of an era that glorifies passion as a supreme value. That ethos is strong, I find it difficult to speak against it; that ethos is a stick in the eye of Gd.

The Talmud relates that the community of sages wanted to release the populace from the temptation of lust. This resulted in unacceptable consequences.  Hens would no longer lay eggs. The sages compromised and blinded the demiurge Lust in one eye; they reduced the passion, they did not kill her.

There is a sotah story embedded in the haftorah: the annunciation of the birth of (lusty) Samson. The (nameless) wife of Manoah is frustrated by her childlessness (like Lady Chatterley). She is approached by a man who is later (conveniently) revealed to be an angel. The text says that he appeared to her. But when she relates the event to her husband , the woman says   בָּ֣א אֵלַ֔י Ba. The word could also mean that they did something that might result in a child! When she reports this episode of seclusion to her husband, he celebrates the news of a child.  He wants to know more about the conditions that have been dictated: strict sobriety for mother and son and Nazerite status for the son. Manoah does not invoke the sotah ritual… and he could have. Is this his merit? Does his desire for a child cancel his possessiveness and jealousy? Is Manoah a modern?

The nazir is the outsider, the alienated one, zar. The restrictions: wine and grape products, contact with the dead, cutting (or combing) the hair – do not remove the nazir from life, they remove the nazir from the loss of reason. The prohibited matters are those that release a person from careful thought. Intoxication releases desire from the constraints of (imagined) consequences. Death, and the finitude it implies, asks the question “why not”. Our vestigial hair is in the service of passion. The nazir is distanced from the river of passion, at least partially. The rules allow life on another plane.

The parade of identical gifts is a redirection of passion. The gifts could have been demonstrative of the grandiosity of the tribes and their princes. The huge tribe of Judah could have brought far more than the small tribe of Benjamin. The rich tribes of Reuben and Gad (too wealthy to cross the Jordan) could have brought more ostentations gifts. Perhaps that would have been more just: from each according to the ability to give. No showing off here. Every gift identical – and not. At the level of description, they are all the same, but the worker who made the bowel and the herder who bred the sheep and cattle could tell them apart. But that escapes the description.

Gd gives history a direction. We can glorify our victories, enjoy the fleeting moments of our pleasures, agonize in the consequences of indulgence. All predictable small eddies in the giant river of time.  I prefer to believe that it is going somewhere, at least to the sea.

 

 

Friday, May 19, 2023

 Siyum on Sotah


This week, daf yomi concluded messecheth Sotah. Every Messechta has a personality.  Sotah is very distinctive. 

In some ways it is a continuation of Nazir, the preceding messechet.,Together, they deal with issues that are presented, juxtaposed, in the parsha for the coming week, introduced at mincha today: Naso: Nazir, the person who separates  from the community as an ascetic, and sotah the woman who is alienated from her husband by jealousy. There is also a mention of Birchat Cohanim, the priestly blessing,  that is described in the parsha. 

Incidentally, Sotah has 49 blat, one for every day of the sefirat ha'omer. Also, they are divided, the first 32 , lamed beth, blatt are about the details of sotah, a somewhat negative subject, like the 32 days of the omer that are more severe in their mournful aspect.  The last 17 blatt include the section on birchat Cohanim and are generally more agaddic. 


There is some ambiguiy about how the mesechta ends.  The Rom edition  has an addendum after the HAdran. That addendum is the famous breitha of rabbi Pinchas ben YAir, which becomes the skeleton of the Mesilath Yeshorim, the classic Musar text  by Rabbi  Moshe Chaim Luzzato.  It dscirbes a stepwise ascent of positive qualities  

רַבִּי פִנְחָס בֶּן יָאִיר אוֹמֵר, זְרִיזוּת מְבִיאָה לִידֵי נְקִיּוּת, וּנְקִיּוּת מְבִיאָה לִידֵי טָהֳרָה, וְטָהֳרָה מְבִיאָה לִידֵי פְרִישׁוּת, וּפְרִישׁוּת מְבִיאָה לִידֵי קְדֻשָּׁה, וּקְדֻשָּׁה מְבִיאָה לִידֵי עֲנָוָה, וַעֲנָוָה מְבִיאָה לִידֵי יִרְאַת חֵטְא, וְיִרְאַת חֵטְא מְבִיאָה לִידֵי חֲסִידוּת, וַחֲסִידוּת מְבִיאָה לִידֵי רוּחַ הַקֹּדֶשׁ, וְרוּחַ הַקֹּדֶשׁ מְבִיאָה לִידֵי תְחִיַּת הַמֵּתִים, וּתְחִיַּת הַמֵּתִים בָּא עַל יְדֵי אֵלִיָּהוּ זָכוּר לַטּוֹב, אָמֵן:


 Rabbi Pineḥas ben Ya’ir says: Torah study leads to care in the performance of mitzvot. Care in the performance of mitzvot leads to diligence in their observance. Diligence leads to cleanliness of the soul. Cleanliness of the soul leads to abstention from all evil. Abstention from evil leads to purity and the elimination of all base desires. Purity leads to piety. Piety leads to humility. Humility leads to fear of sin. Fear of sin leads to holiness. Holiness leads to the Divine Spirit. The Divine Spirit leads to the resurrection of the dead.



The more standard last passage:


 מִשֶּׁמֵּת רַבִּי בָּטְלָה עֲנָוָה וְיִרְאַת חֵטְא. אֲמַר לֵיהּ רַב יוֹסֵף לְתַנָּא: לָא תִּיתְנֵי עֲנָוָה, דְּאִיכָּא אֲנָא. אֲמַר לֵיהּ רַב נַחְמָן לְתַנָּא: לָא תִּיתְנֵי יִרְאַת חֵטְא, דְּאִיכָּא אֲנָא.

Friday, September 08, 2017

Gout: Sanhedrin 48b

The gemarrah discusses the transfer of the curse that David conferred upon Yoav to the descendents of Shlomo.  The last was a foot disease.  The gemarrah suggests that it was podagara
ואמר רב יהודה אמר רב שאחזו פודגרא א"ל מר זוטרא בריה דרב נחמן לרב נחמן היכי דמי א"ל כמחט בבשר החי מנא ידע אי בעית אימא מיחש הוה חייש ביה ואיבעית אימא מרביה הוה גמיר לה ואיבעית אימא (תהלים כה, יד) סוד ה' ליראיו ובריתו להודיעם
The curse of those who “hold onto a staff” was fulfilled among Solomon’s descendants in Asa, as it is written concerning him: “But in the time of his old age, he was diseased in his feet” (I Kings 15:23). And Rav Yehuda saysthat Rav says: This means that he was seized with gout [podagra]. Mar Zutra, son of Rav Naḥman, said to Rav Naḥman: What are the circumstances and symptoms of this disease? Rav Naḥman said to him: The pain is similar to the pain of a needle piercing live flesh. The Gemara asks: How did Rav Naḥman know what gout is like? The Gemara answers: If you wish, say that he himself suffered from the disease. And if you wish, say that he learned it as a tradition from his teacher. And if you wish, say that he knew this through divine inspiration, as the verse states: “The secret of the Lord is with them that fear Him; and He will show to them His covenant”(Psalms 25:14).
Rashi:
פודגרא - כן שם החולי אף בלשוננו:

We, in medicine,continue to  use the word podagra for gout. It is interesting to see how lasting this curse has been. 

The 1908 Nobel Prize in medicine was awarded to  two men of Jewish ancestry: Paul Ehlich and Elie Metchnikoff.  Metchnikoff had discovered cellular immunity, especially phagocytosis.  Phagocytosis is the process whereby cells, especially cells of the immune system, white blood cells, engulf ( eat) objects. 

Classic gout is caused by sodium urate crystals.   These are needle like crystals  that are ingested by immune cells.  These needle crystals start the immune response that causes the pain of gout. 

In  medical school, I was taught that the needle crystals puncture the bags of enzymes in the cell, releasing them into the joint and causing the pain.  This would conform to the the model of "needles through living flesh."  I also recall that Metchnikoff had discovered this process. 

I  dreamed that Metchnikoff had seen this gemarrah and that led him to look for this phenomenon  with the microscope. The knowledge of the puncturing secret of podagra allowed him to see this happening, despite the primitive microscope that he used.

   Now,  that seems unlikely.  Although his maternal grandfather  was a Jewish writer in Russia, he was an early maskil and was eventually baptized a Lutheran.  Still, it is possible that he studied talmud with his grandson ( probably on Shabbath, while smoking a cigarette). 



Looking into the matter further, the current understanding of gout inflammation and pain is not so simple.  The uric acid crystals are ingested by the immune cells, but the significance of their piercing nature is less than clear.  I could not easily find a mention of Elie Metchnikoff making the observation of uric acid crystal ingestion  by immune cells. 

In Kings, there is a story about Elisha and bears in a forest.  The gemarrah tells us, there were no bears, there  was no forrest.  But the story is still good. The gemarrah hints  a secret that was revealed over time. The secret is fractal.  The story is still good. 

Friday, May 25, 2012

Nidah 5
 Unexpected blood 

 Presumably, the blood of Nidah comes according to the (cyclical) Veseth
Nidah is a tumah onto itself.  It declared a tuma in the Torah ( Metzorah). 
There are associated tumoth.  The issue of blood  does not necessarily mean nidah. 
There could be an early miscarriage and that would carry the tumath meith.
There is often ( always) a confusion between Nidah and Zivah. 
Thus, the status of unexpected blood ( Nidah 5) includes these ambiguities.

Sunday, April 10, 2011

Mishna Yomi: Challa 2: 7 The minimum requirement for challah falls from 1:24 to 1:48 for commercial ventures. The man making a party for his son bakes as much as the town baker for the occasion, but it is private party so the challa is 1:24. The woman who sells the bread she bakes at home may not be making much more than any other private person, but the commercial nature of her baking lowers the cahlla to 1:48.

Thursday, June 28, 2007

The Genesis of Yevamoth

Yehuda and Tamar, of course. Dealt with Yevomoth 34B

But how about Lot and his daughters?

Was this a kind of early attempt to preserve the name of one cut off from offspring? And doesn't the act of his daughters accomplish that? Amom and Moav are names that live to this day!

The story of Lot and his daughters also has relevence to the question of the yibim act while asleep! ( Yevomoth 54) I wonder why the gemmarah ignores it?

Then there is the curse of ariri for marrying a sister. Yevomoth 55)

Who calls himself ariri? Avram. Who married his sister?