Pt2 Bodily Afflictions and Illnesses as Signs of Sin: Wounds, Edema (Hidrokan), and Diphtheria (Askara) (Shabbat 33a-b)

Appendices - Organ Functions: A List of Thirteen Organs and Their Functions (Berakhot 61a-b); Extreme Poverty, Intestinal Illness, and Other Causes of Distress and Their Implications (Eruvin 41b)

This is the second and final part of a two-part series. Part 1 is here; the outline of the series can be found there.

Diphtheria (Askara) is divine punishment for neglecting to separate tithes (ma’aser) or due to speaking Lashon Hara (Psalms 63:12)

A baraita cites a debate regarding the divine cause of askara:¹

One opinion attributes it to neglecting tithes (מעשר), while R' Elazar ben Yosei links it to lashon hara.²

Rava (or R' Yehoshua ben Levi) supports the latter view by citing Psalms 63:12, which states that liars' mouths will be “stopped”.³

תנו רבנן:

אסכרה באה לעולם על המעשר.

רבי אלעזר ברבי יוסי אומר: על לשון הרע.

אמר רבא, ואיתימא רבי יהושע בן לוי:

מאי קראה —

״והמלך ישמח באלהים

יתהלל כל הנשבע בו

כי יסכר פי דוברי שקר״.

[...]

The Sages taught:

Askara comes to the world as punishment for neglecting to separate tithes.

R' Elazar, son of R' Yosei, says: Askara comes as punishment for slander.

Rava said, and some say that it was R' Yehoshua ben Levi who said it:

What is the verse that alludes to this?

“But the king shall rejoice in God;

every one that swears by Him shall glory;

for the mouth of them that speak lies shall be stopped” (Psalms 63:12).

The punishment for lying is that the mouth will be stopped. Askara affects the mouth along with other parts of the body.

[...]

Why does askara start in the intestines and end in the mouth?

A discussion among R' Yehuda, R' Elazar ben Yosei, and R' Shimon in Yavne⁴ examined why “this plague”⁵ starts in the intestines (בני מעיים) and ends in the mouth.

כשנכנסו רבותינו לכרם ביבנה

היה שם

1. רבי יהודה

2. ורבי אלעזר ברבי יוסי

3. ורבי שמעון

נשאלה שאלה זו בפניהם:

מכה זו --

מפני מה מתחלת בבני מעיים, וגומרת בפה?

taught in a baraita:

When our Sages entered the vineyard in Yavne,

1. R' Yehuda,

2. and R' Elazar son of R' Yosei,

3. and R' Shimon were there,

and a question was asked before them

with regard to this plague of askara:

Why does it begin in the intestines and end in the mouth?

R' Yehuda: The disease follows the path of speech formation, from internal organs to the mouth, as a punishment for slander (Lashon Hara)

R' Yehuda ben Ila’i explains that while different organs contribute to speech—the kidneys advise (יועצות), the heart understands (מבין), and the tongue “shapes”⁶—the mouth ultimately completes it.⁷

נענה רבי יהודה ברבי אלעאי

״ראש המדברים בכל מקום״

ואמר:

אף על פי ש

1. כליות יועצות,

2. ולב מבין,

3. ולשון מחתך —

פה גומר.

R' Yehuda, son of R' Ila’i,

who was the head of the speakers in every place,

responded and said:

Even though

1. the kidneys advise,

2. and the heart understands,

3. and the tongue shapes the voice that emerges from the mouth,

still, the mouth completes the formation of the voice. Therefore, the disease begins in the same place that slander begins and it ends in the mouth.

R' Elazar ben Yosei: Askara ends in the mouth because one eats non-kosher food

R' Elazar ben Yosei: Askara ends in the mouth because one eats prohibited food.⁸

נענה רבי אלעזר ברבי יוסי ואמר:

מפני שאוכלין בה דברים טמאין.

[...]

R' Elazar, son of R' Yosei, responded and said:

This disease ends in the mouth because one eats with it non-kosher things.

[...]

R' Shimon: The disease is a punishment for neglecting Torah study (Bitul Torah)

R' Shimon: The disease is a punishment for neglecting Torah study (ביטול תורה).

Challenges to R' Shimon's View:

1. Women: They don’t study Torah⁹ but still contract askara.

   1. Response: they cause their husbands to neglect Torah study.

2. Non-Jews: They are not obligated in Torah study¹⁰ but also suffer from it.

   1. Response: they cause Jews to neglect Torah study.

3. Toddlers (תינוקות): They are not obligated in Torah study but still die from askara.

   1. Response: they cause their fathers to neglect Torah study.

4. Schoolchildren (תינוקות של בית רבן): They study Torah yet still suffer from askara.

נענה רבי שמעון ואמר:

בעון ביטול תורה.

1. אמרו לו: נשים יוכיחו!

   1. שמבטלות את בעליהן.

2. גוים יוכיחו!

   1. שמבטלין את ישראל.

3. תינוקות יוכיחו!

   1. שמבטלין את אביהן.

4. תינוקות של בית רבן יוכיחו!

[...]

R' Shimon responded and said:

This disease comes as a punishment for the sin of dereliction in the study of Torah.

1. They said to him: Women will prove that dereliction in the study of Torah is not the cause, as they are not obligated to study Torah and, nevertheless, they contract askara.

   1. He answered them: They are punished because they cause their husbands to be idle from the study of Torah.

2. They said to him: Gentiles will prove that this is not the cause, as they also contract askara even though they are not obligated to study Torah.

   1. He answered them: They are also punished because they cause Israel to be idle from the study of Torah.

3. They said to him: Children will prove that this is not the cause, for they are not at all obligated to study Torah and they also suffer from askara.

   1. He answered them: They are punished because they cause their fathers to be idle from the study of Torah.

4. They said to him: School children will prove that this is not the cause, as they study Torah and, nevertheless, they suffer from askara.

[...]

Appendix 1 - Organ Functions: A List of Thirteen Organs and Their Functions (Berakhot 61a-b)

Berakhot.61a.29-61b.1

A List of Thirteen Organs and Their Functions

A baraita describes the roles of various organs in the body, attributing specific functions and emotions to each.

It explains how the organs work in harmony to maintain health, each organ with its role:¹¹

1. Kidneys: Advise (יועצות)

2. Heart: Understands (מבין)

3. Tongue (לשון): Shapes [sounds] (מחתך - literally: “cuts”)

4. Mouth: Completes (גומר; i.e. shapes the voice)

5. Esophagus (ושט): [Handles] food intake and output

6. Trachea (קנה): Produces the voice

7. Lungs: Draw liquids

8. Liver: Becomes angry

9. Gallbladder (מרה): Calms with “a drop”¹²

10. Spleen (טחול): Laughs (שוחק)

11. Maw (קרקבן): Grinds food¹³

12. Stomach (קיבה): sleeps (ישנה; i.e. induces sleep)

13. Nose (אף): Awakens (נעור)

תנו רבנן:

1. כליות -- יועצות,

2. לב -- מבין,

3. לשון -- מחתך,

4. פה -- גומר,

5. ושט -- מכניס ומוציא כל מיני מאכל,

6. קנה -- מוציא קול,

7. ריאה -- שואבת כל מיני משקין,

8. כבד -- כועס,

9. מרה -- זורקת בו טפה ומניחתו,

10. טחול -- שוחק,

11. קרקבן -- טוחן,

12. קיבה -- ישנה,

13. אף -- נעור.

Tangential to the subject of kidneys, the Gemara cites that which the Sages taught in a baraita with regard to the roles of various organs:

1. The kidneys advise,

2. the heart understands,

3. the tongue shapes the sounds that emerges from the mouth,

4. the mouth completes the shaping of the voice,

5. the esophagus takes in and lets out all kinds of food,

6. the trachea produces the voice,

7. and the lungs draw all kinds of liquids,

8. the liver becomes angry,

9. the gall bladder injects a drop of gall into the liver and allays anger,

10. the spleen laughs,

11. the maw grinds the food,

12. and the stomach brings sleep,

13. the nose awakens.

The Principle of Bodily Harmony: When Sleep- and Wake-Regulating Organs Misfunction, the Body Declines and Perishes

Regarding the final two organs in the list (#12-13: stomach and nose, which induce sleep and awaken, respectively) disruption in their natural roles--an organ reversing its function--leads to deterioration (נמוק).

Immediate death occurs if both bring on sleep or both awaken the person.¹⁴

נעור הישן,

ישן הנעור —

נמוק והולך לו.

תנא:

אם שניהם ישנים

או שניהם נעורים —

מיד מת.

If they reversed roles such that the organ which brings on sleep were to awaken,

or the organ which awakens were to bring on sleep,

the individual would gradually deteriorate.

It was taught:

If both bring on sleep

or both awaken,

the person immediately dies.

Appendix 2 - Extreme Poverty, Intestinal Illness, and Other Causes of Distress and Their Implications: Perspectives on Overwhelming Forces, Exemption from Gehenna, and Sudden Death (Eruvin 41b)

Eruvin.41b.12-18

Three Forces That Overwhelm a Person: Non-Jews, Evil Spirit, and Extreme Poverty

A baraita lists three factors that force people to act against their will and God's will: non-Jews, evil spirit (רוח רעה), and extreme poverty (דקדוקי עניות).

תנו רבנן:

שלשה דברים מעבירין את האדם על דעתו ועל דעת קונו,

אלו הן:

1. נכרים,

2. ורוח רעה,

3. ודקדוקי עניות.

[...]

Since the Gemara discussed one who stepped beyond the Shabbat limit due to an evil spirit, the Gemara cites a related baraita, in which the Sages taught:

Three matters cause a person to act against his own will and the will of his Maker,

and they are:

1. Gentiles,

2. and an evil spirit,

3. and the depths of extreme poverty.

[...]

Exemption from Gehenna Due to Intense Earthly Hardships: Extreme Poverty, Intestinal Illness, Government Persecution, and a Bad Wife

Categories of people are considered exempt from Gehenna due to their earthly suffering: extreme poverty, intestinal disease, government oppression (רשות), and a person with a bad wife (אשה רעה).

שלשה אין רואין פני גיהנם,

אלו הן:

1. דקדוקי עניות,

2. וחולי מעיין,

3. והרשות.

4. ויש אומרים: אף מי שיש לו אשה רעה.

[...]

The Gemara cites a related teaching: Three classes of people do not see the face of Gehenna, because the suffering that they bear in this world atones for their sins,

and they are:

1. Those suffering the depths of extreme poverty,

2. those afflicted with intestinal disease,

3. and those oppressed by creditors.

4. And some say: Even one who has an evil wife who constantly harasses him.

[...]

Three Conditions That Lead to Sudden Death: Intestinal Disease, Childbirth Complications, and Severe Edema

The Talmud lists three conditions that may lead to sudden death even while a person is speaking normally: intestinal disease, childbirth complications (חיה), and severe edema.

שלשה מתין כשהן מספרין,

ואלו הן:

1. חולי מעיין,

2. וחיה,

3. והדרוקן.

It was similarly taught: Three classes of people are liable to die while conversing with others, i.e., to die suddenly, although they appear to be in good health and are capable of engaging in conversation,

and they are:

1. Those afflicted with intestinal sickness,

2. and a woman in childbirth,

3. and one who is sick with edema [hidrokan].

1. אסכרה - a throat disease.

See Jastrow:

“choking, croup (E.B. =diphtheria)”

And see Hebrew Wiktionary, my translation:

Throat inflammation, diphtheria, a throat disease caused by bacteria that can lead to suffocation [...]

Etymology:

From Greek: ἐσχάρα (eskhára); the word ἑσχάρα in Ancient Greek, in its medical context (as found in Hippocrates), means scab, a crust of skin that forms over a burn, wound, or similar injury (in English: eschar). The word diphtheria is a transcription of diphtherie in French, a medical term coined in 1857, which did not exist in Ancient Greek.

Possibly derived from the root סכר (E.B. the Talmud already makes this linguistic connection later), meaning “to close, seal”.

And see Hebrew Wikipedia, “דיפתריה”, section “בספרות חז"ל”:

The disease of askara was already known to the Talmudic rabbis, and it is mentioned in several places in rabbinic literature:

• It is described (=in our sugya) as a punishment for the prohibition of lashon hara (evil speech), for eating untithed produce (טבל), and for eating before havdalah.

• The biblical Twelve Spies and the students of R' Akiva were punished with it (the death of R' Akiva’s students is one of the reasons for the mourning customs during the counting of the Omer).

• One who eats without salt and drinks without water should fear it at night, whereas one who regularly eats lentils once a month prevents it.

• The members of the ma'amad (מעמד) would fast on Wednesday for the sake of the children, so that the disease would not enter their mouths.

• Death from this disease was considered the most severe form of death among the 903 types of death created in the world.

On the last item, see Berakhot.8a.13, where a baraita states that there are 903 types (מיני) of death, derived from the numerical value (גימטריא - gematria) of the Hebrew word totzaot (תוצאות - “issues”) in the biblical phrase “issues of death” (Psalms 68:21). The most painful is askara (אסכרא), compared to “a thorn (חיזרא) [entangled] in wool (גבבא דעמרא)” or “ropes (פיטורי) at the entrance of the esophagus (פי ושט)”, while the easiest is the “kiss (נשיקה) of death,” likened to drawing (משחל) a hair (בניתא) from milk:

תניא נמי הכי:

תשע מאות ושלשה מיני מיתה נבראו בעולם,

שנאמר: ״למות תוצאות״,

״תוצאות״ בגימטריא הכי הוו.

קשה שבכלן — אסכרא,

ניחא שבכלן — נשיקה.

אסכרא דמיא --

1. כחיזרא בגבבא דעמרא דלאחורי נשרא,

2. ואיכא דאמרי: כפיטורי בפי ושט,

נשיקה דמיא כמשחל בניתא מחלבא.

It was also taught in a baraita:

Nine hundred and three types of death were created in the world,

as it is stated: “Issues [totzaot] of death,”

and that, 903, is the numerical value [gimatriya] of totzaot.

The Gemara explains that the most difficult of all these types of death is croup [askara],

while the easiest is the kiss of death.

Croup is like

1. a thorn entangled in a wool fleece, which, when pulled out backwards, tears the wool.

2. Some say that croup is like ropes at the entrance to the esophagus, which would be nearly impossible to insert and excruciating to remove.

The kiss of death is like drawing a hair from milk.

2. See Wikipedia, Lashon hara:

Lashon hara (or loshon horo, or loshon hora) (Hebrew: לשון הרע‎; "evil tongue") is the halakhic term for speech about a person or persons that is negative or harmful to them, even though it is true.

It is speech that damages the person(s) who is talked about either emotionally or financially, or lowers them in the estimation of others.

Lashon hara differs from the more severe prohibition of hotzaat shem ra, "making a bad name," in that hotzaat shem ra consists of untrue statements.

Lashon hara is considered to be a very serious sin in the Jewish tradition. The communicator of lashon hara (which is included in rechilut - רכילות) violates the Torah prohibition of “lo telech rachil b'ameicha” (לא תלך רכיל בעמיך), translating to "thou shalt not go up and down as a talebearer among thy people" (Leviticus 19:16).

3. יסכר - i.e. wordplay on “askara”. See my note about regarding the etymology of “askara”, that the word may indeed be related or influenced to this Hebrew root meaning “stopped, blocked”.

4. On these rabbis in Yavne, see my previous piece.

Unusually and notably, each of the three responses here starts with

R' [X] responded and said:

נענה רבי [פלוני] ואמר

which is a common formulation in midrashic literature, and less common in the Talmud.

5. מכה - makkah - i.e. askara; compare the Hebrew word makkah in the phrase “Ten Plagues” - עשרה מכות.

6. מחתך - literally: “cuts”, i.e. it shapes the voice.

On these three organ functions, see my appendix to this piece, items #1-4.

7. I.e. since slander originates from the mouth, the disease that punishes slander likewise manifests there.

8. דברים טמאין - literally: “impure things”.

9. See Hebrew Wikipedia, תלמוד תורה לנשים, my translation:

According to Jewish law, women are not included in the obligation of Torah study (מצוות תלמוד תורה), although a woman who studies Torah receives reward for it.

The Talmudic sages instructed fathers not to teach their daughters Torah, and some even considered it forbidden […]

The commandment of Torah study consists of two components: one is learning the details of halakhot, customs, and fundamental beliefs for the purpose of observance in daily life; the other is an analytical study of the Torah in all its layers. The Talmudic sages expounded on the verse "And you shall teach them to your sons to speak in them" (Deuteronomy 11:19) to infer that women are not obligated in Torah study […]

Already in the Tannaitic period a dispute arose regarding whether it is appropriate for a man to teach his daughter Torah. In the Mishnah (Sotah 3:4), Ben Azzai states that a person is obligated to teach his daughter Torah. In contrast, R’ Eliezer said: “Anyone who teaches his daughter Torah is as if he teaches her frivolity (tiflut).”

According to Maimonides (Rambam), tiflut refers to “vanity and nonsense.” In his Laws of Torah Study, he elaborates further: “For most women’s minds are not directed toward learning, but they divert words of Torah to idle matters according to their limited understanding” […]

In the Jerusalem Talmud, a harsh statement is recorded against women's Torah study:

A matrona (a noblewoman) asked R’ Elazar: "Why is it that only one sin was committed in the incident of the Golden Calf, yet they [the sinners] are punished with three types of death?" He replied: "A woman’s wisdom is only in her spindle."

His son, Hyrcanus, said to him: "Because you did not answer her with a single word of Torah, you have caused me to lose 300 kor of tithe produce each year!"

R’ Elazar responded: "Let the words of Torah be burned rather than be transmitted to women!"

10. See Hebrew Wikipedia, “איסור לימוד תורה לנוכרי“, my translation:

In Talmudic literature, the study of Torah by a non-Jew is a halakhic matter, which dictates that it is forbidden to teach Torah—except for the laws of the Seven Noahide Commandments—to a person who is not Jewish. According to the Talmud, a non-Jew who studies Torah laws that he is not permitted to learn is liable to death by divine decree (מיתה בידי שמיים).

Source of the Prohibition

The source of this prohibition appears in the Talmud:

R’ Ami said: "One does not transmit words of Torah to a non-Jew, as it is stated: 'He did not do so for any other nation, and they do not know His ordinances'" (Psalms 147:20).
— Babylonian Talmud, Tractate Chagigah 13a

And in Tractate Sanhedrin:

R’ Yoḥanan said: "A non-Jew who engages in Torah study is liable to death, as it is stated: 'Moses commanded us a Torah, an inheritance of the congregation of Jacob' (Deuteronomy 33:4) — it is an inheritance for us (the Jewish people) and not for them (the non-Jews)."
— Babylonian Talmud, Tractate Sanhedrin 59a

[…]

11. Broader analysis of this list:

This Talmudic passage presents an interesting physiological model, embedded in the interpretive traditions of rabbinic literature. Several key themes emerge:

The Talmudic Systemization of the Body

The passage organizes human physiology into a structured list, assigning cognitive, emotional, and functional properties to various organs.

This is characteristic of early medical thought, which sought to explain bodily functions through analogical reasoning rather than empirical observation.

The division of organs into specific roles mirrors broader efforts in antiquity to categorize knowledge within a hierarchical framework.

Comparison with Greco-Roman Medicine

The idea that specific organs govern emotions and mental faculties parallels Hellenistic medical theories, particularly those found in the works of Hippocrates and Galen, where bodily fluids (“humors”) were believed to control temperament.

For example, the attribution of anger to the liver recalls Galenic humoral theory, in which the liver played a role in bile production, associated with choleric (hot-tempered) dispositions.

Similarly, the spleen’s role in inducing laughter aligns with Greek notions of melancholia, which connected the spleen to black bile and mood regulation.

Biblical Influence

The text also builds upon biblical idioms, such as the heart as the seat of understanding (לב מבין), a concept appearing frequently in the Bible (e.g., 1 Kings 3:9, where Solomon asks for a lev mevin – an understanding heart).

The idea that “the kidneys advise” (כליות יועצות) suggests a view of the kidneys as sources of wisdom, a belief already present in biblical literature (Psalms 16:7, “my kidneys instruct me at night”).

See Wikipedia, “Kidney”, section “Society and culture“:

In ancient Egypt, the kidneys, like the heart, were left inside the mummified bodies, unlike other organs which were removed.

Comparing this to the biblical statements, and to drawings of human body with the heart and two kidneys portraying a set of scales for weighing justice, it seems that the Egyptian beliefs had also connected the kidneys with judgement and perhaps with moral decisions.

According to studies, in […] ancient Hebrew [literature] various body organs in humans and animals served also an emotional or logical role, today mostly attributed to the brain and the endocrine system.

The kidney is mentioned in several biblical verses in conjunction with the heart, much as the bowels were understood to be the "seat" of emotion – grief, joy and pain.

Similarly, the Talmud (Berakhoth 61a) states that one of the two kidneys counsels what is good, and the other evil.

Kidneys were once popularly regarded as the seat of the conscience and reflection, and a number of verses in the Bible (e.g. Ps[alms] 7:9 […]) state that God searches out and inspects the kidneys, or "reins", of humans, together with the heart.

The Talmudic passage referred to appears immediate before the one in the main piece, in Berakhot.61a.28:

תנו רבנן:

שתי כליות יש בו באדם:

1. אחת — יועצתו לטובה

2. ואחת — יועצתו לרעה.

ומסתברא ד

1. טובה — לימינו

2. ורעה — לשמאלו,

דכתיב:

1. ״לב חכם — לימינו

2. ולב כסיל — לשמאלו״.

The Sages taught in a baraita:

A person has two kidneys;

1. one advises him to do good

2. and one advises him to do evil.

And it stands to reason that

1. the one advising him to do good is to his right

2. and the one that advises him to do evil is to his left,

as it is written:

1. “A wise man’s understanding is at his right hand,

2. but a fool’s understanding is at his left” (Ecclesiastes 10:2).

12. טפה; i.e. of gall.

Meaning, it calms the anger of the liver mentioned in previous item.

13. טוחן.

Compare my piece here, section “Physical Decline in Old Age: Interpreting Ecclesiastes 12:4 as Referring to Constipation, Digestion Issues, Light Sleep, and Loss of Musical Enjoyment”:

בשביל קורקבן שאינו טוחן

because the stomach is not grinding [and digesting one’s food].

14. The discussion about the “stomach bringing sleep” and the “nose awakening” serves as an implicit theory of bodily balance: If these functions are disrupted (i.e., an organ takes on the wrong role), the body deteriorates and dies.

This concept resembles the balance-of-forces idea present in Hippocratic medicine.