Pt2 Medical Diseases and Their Remedies (Avodah Zarah 28a-29a)

This is the second part of a three-part series. Part 1 is here; the outline of the series can be found at Part 1.

Hemorrhoids (פיקעא)

Anecdote - R’ Ya’akov suffers from hemorrhoids, and R’ Ami or R’ Asi instructs him in a treatment - Burn the specified bundle of 7 red ice-plant seeds and spread the ashes on the sores; in the meantime place a bramble kernel “crevice against crevice”

רבי יעקב חש בפיקעא,

אורי ליה רבי אמי,

ואמרי לה רבי אסי אורי ליה:

ליתי שב ביני אהלא תולנא,

וצייר ליה בחללא דבי צוארא,

וליכריך עילויה נירא ברקא,

וטמיש ליה בנטפא חיורא,

וליקליה

ובדר ליה עילויה.

אדהכי והכי,

ליתי קשיתא דאסנא,

לינח פיקעא להדי פיקעא.

R’ Ya’akov suffered from hemorrhoids¹

R’ Ami instructed him,

and some say that R’ Asi instructed him that

he should bring 7 seeds of ice plant that are red like a worm

and bind them in the collar of a shirt,

and then he should wrap a strip of hair around it,

and dip the bundle in white naphtha

and he should burn it

and spread the ashes upon the sores.

In the meantime,

he should bring the kernel (קשיתא) of a bramble [asna] fruit

and place its crevice against his own crevice, i.e., the anus.

The treatment for hemorrhoids is distinguished between the “upper” and “lower” crevice; For the lower crevice - Melted fat of a goat that has not given birth

והני מילי פיקעא עילאה,

פיקעא תתאה מאי?

לייתי תרבא דצפירתא דלא אפתח,

וליפשר ולישדי ביה.

The Talmud remarks: And this matter applies only to the upper crevice, which is located at the outer edge of the anus and can be treated with bramble fruit.

What should one do if he is experiencing pain in the lower crevice, located deeper within the rectum?

He should bring the fat of a goat that has not yet opened, i.e., given birth,

and he should melt it and then he should apply it to the irritated area.

Alternatively - ashes of shade-dried pumpkin leaves

ואי לא,

לייתי תלת טרפא קרא דמייבשי בטולא,

וליקלי

וליבדר עילויה.

And if this is not possible,

he should bring 3 pumpkin leaves that were dried in the shade

and he should burn them,

and then he should spread the ashes upon the irritated area.

Alternatively - snail shells

ואי לא,

לייתי משקדי חלזוני.

And if this is not possible,

he should bring snail shells² instead.

Alternatively - oil-and-wax spread on worn cloth and applied to the area

ואי לא,

מייתי משח קירא,

ולינקוט בשחקי דכיתנא בקייטא,

ודעמר גופנא בסיתווא.

And if this is also not possible,

he should bring oil mixed with wax [kira]

and he should smear it upon worn flax clothing in summer,

or worn cotton clothing in winter,

and place it upon the irritated area.

Ear pain

Anecdote - R’ Abbahu has ear pain; R’ Yoḥanan, or the study hall, instructs him in a remedy

רבי אבהו חש באודניה,

אורי ליה רבי יוחנן,

ואמרי ליה בי מדרשא.

R’ Abbahu suffered from pain in his ear.

R’ Yoḥanan instructed him,

and some say that other rabbis from the study hall instructed him, how to heal it.

Abaye citing his mother - kidney fluid is especially beneficial for the ear

מאי אורי ליה?

כי הא דאמר אביי:

אמרה לי אם —

לא איברי כולייתא אלא לאודנא.

The Talmud asks: What did they instruct him?

They told him to act in a fashion similar to that which Abaye said:

My mother told me that³

the kidney was created only for the ear,

i.e., it can be extremely beneficial to the ear.

Rava citing Minyumi the physician - most liquids are bad for the ear, except kidney fluid

ואמר רבא:

אמר לי מניומי אסיא —

כולהו (שקיינו) [שקייני] קשו לאודנא,

לבר ממיא דכולייתא.

And Rava said:

Minyumi the physician said to me:

All liquids⁴ are harmful to the ear

except for the fluid of the kidneys.

Remedy - Tepid fluid extracted from a heated goat kidney and placed in the ear

לייתי כולייתא דברחא קרחא,

וליקרעיה שתי וערב,

ולינח אמללא דנורא,

והנהו מיא דנפקי מיניה --

לישדינהו באודניה

לא קרירי ולא חמימי, אלא פשורי.

Therefore, R’ Abbahu should bring the kidney of a bald goat [barḥa]

and tear it vertically and horizontally (שתי וערב - “crosswise”)

and then place it upon dimming coals (מללא דנורא).

And as for those fluids that issue from it --

he should apply them to his ear

while they are neither cold nor hot, but tepid.

Alternatively - melted beetle fat

ואי לא,

לייתי תרבא דחיפושתא גמלניתא,

וליפשר

ולישדי ביה.

The Talmud adds:

And if this is not possible,

he should bring the fat of a large⁵ beetle

and melt it

and apply it to the ear.

Alternatively - oils, wicks, flame-based treatment

ואי לא,

למלייה לאודניה מישחא,

וליעבד שב פתילתא דאספסתא,

וליתי שופתא דתומא,

וליתוב ברקא בחד רישא,

וליתלי בהו נורא,

ואידך רישא מותבא באודנא,

וליתוב אודניה להדא נורא,

ויזדהר מזיקא,

ונישקול חדא וננח חדא.

And if not,

he should fill his ear with oil

and prepare 7 wicks made of alfalfa [aspasta]

and bring dried garlic ends,

and tie the ends to the wicks with a strip of hair at one end,

and set the wicks aflame.

And he should place the other end of each wick in his ear one at a time,

and place his ear opposite the flame.

Parenthetically, the Talmud notes: And he should be cautious of drafts and avoid them, as they will harm his ear.

The Talmud continues: And he should take one wick and remove one wick, i.e., replace each wick as it is consumed until all 7 have been used.

Alternatively - threads

לישנא אחרינא:

ואי לא,

לייתי שב פתילתא ביקרא,

ושייף ליה מישחא דאספסתא,

ונייתי חד רישא בנורא וחד רישא באודניה,

ונשקול חדא וננח חדא,

ויזדהר מזיקא.

The Talmud presents another version of this remedy:

And if not,

he should bring 7 wicks of wax tapers⁶

and smear them with alfalfa oil,

and place one end of each wick in the flame and one end in his ear,

and take one wick and remove one wick.

And again he should be cautious of drafts.

Alternatively - fibers

ואי לא,

לייתי אודרא דנדא דלא משקף

וננח בה,

ולתלייה לאודניה להדי נורא,

ומזדהר מזיקא.

And if this is not possible,

he should bring fiber that was dried⁷ but not combed⁸

and place it in his ear,

and then bring his ear opposite the flame.

And he should be cautious of drafts.

Alternatively - a salted, burned reed tube placed in the ear

ואי לא,

לייתי גובתא דקניא עתיקא בר מאה שנין,

ולימלחיה מילחא גללניתא,

ולקלי ולידבק.

And if not,

he should bring the tube of an aged reed that is 100 years old, i.e., that has been detached from the ground for a century,

and salt it with rock (גללניתא) salt

and then burn it and stick it in his ear.

A mnemonic is given for ear treatment: moist remedies for dry conditions, dry remedies for moist conditions

וסימנך:

• רטיבא ליבשתא

• ויבשתא לרטיבא.

The Talmud adds:

And your mnemonic to remember these remedies is this:

• Moist cures are prescribed for dry afflictions,

• and dry cures are prescribed for moist afflictions.

Dislocated jaw (אזנים - “ears”)

Rabba bar Zutra citing R’ Ḥanina - Permits setting the dislocated jaw/“ears” on Shabbat

אמר רבה בר זוטרא, אמר רבי חנינא:

מעלין אזנים בשבת.

§ The Talmud returns to the issue of medical treatment on Shabbat.

Rabba bar Zutra says that R’ Ḥanina says:

One may raise his ears to their appropriate position, i.e., set his dislocated jaw, on Shabbat.

Rav Shmuel bar Yehuda - one version allows doing so by hand and not medicine, another says the reverse

תני רב שמואל בר יהודה:

ביד

אבל לא בסם.

Rav Shmuel bar Yehuda teaches:

This applies only if one raises it by hand,

but not by means of medicine (סם).

איכא דאמרי:

בסם

אבל לא ביד.

There are those who say the opposite:

One may raise his ears by means of medicine,

but not by hand.

The reason given for forbidding manual setting is the concern that one might injure the area

מאי טעמא?

מזריף זריף.

What is the reason that one may not manually raise the ear?

It is because doing so might injure⁹ the ear,

which would constitute a violation of Torah law, whereas applying medicine is a violation of rabbinic law.

Dangerous eye disease (עין שמרדה - “eye that rebelled”)

Rav Zutra bar Toviyya citing Rav - one may apply kohl on Shabbat on an “eye that rebelled”

אמר רב זוטרא בר טוביה, אמר רב:

עין שמרדה --

מותר לכוחלה בשבת.

Rav Zutra bar Toviyya says that Rav says:

With regard to an eye that rebelled, i.e., which is apt to pop out of its socket --

it is permitted to apply kohl to it on Shabbat.

סבור מיניה:

הני מילי הוא דשחקי סמנין מאתמול,

אבל משחק בשבת

ואתויי דרך רשות הרבים —

לא.

The rabbis initially concluded from this that

this statement applies only where one had already ground the ingredients yesterday, i.e., on Friday,

but if he planned to grind them on Shabbat,

or to bring them through a public domain,

it would not be permitted,

as this would constitute a desecration of Shabbat by Torah law.

R’ Ya’akov citing Rav Yehuda - Qualifies that for this eye danger, even grinding the medicine on Shabbat and carrying it through the public domain is permitted

אמר ליה ההוא מרבנן ורבי יעקב שמיה:

לדידי מיפרשא מיניה דרב יהודה,

אפילו מישחק בשבת

ואתויי דרך רשות הרבים —

מותר.

To dispel this notion, one of the rabbis, named R’ Ya’akov, said to them:

This matter was explained to me by Rav Yehuda,

who said that even if he plans to grind the ingredients on Shabbat

and bring it through a public domain,

it is permitted.

Anecdote - Rav Yehuda permits eye treatment on Shabbat; Rav Shmuel bar Yehuda criticizes him

רב יהודה שרא למיכחל עינא בשבת.

אמר להו רב שמואל בר יהודה:

מאן ציית ליהודה מחיל שבי?!

The Talmud relates that Rav Yehuda permitted someone to apply kohl to the eye on Shabbat.

Rav Shmuel bar Yehuda said to the rabbis:

One who adheres to the ruling of Yehuda desecrates Shabbat.

... but later when Rav Shmuel bar Yehuda himself gets eye pain and asks, Rav Yehuda pointedly refuses leniency to him personally, while maintaining the general leniency

לסוף חש בעיניה,

שלח ליה: שרי או אסיר?

שלח ליה:

לכולי עלמא שרי,

לדידך אסיר.

Ultimately, Rav Shmuel bar Yehuda himself suffered pain in his eye.

He sent a message to Rav Yehuda, asking: Is it permitted or prohibited for me to treat my eye on Shabbat?

Rav Yehuda sent back to him:

For everyone else, it is permitted;

for you, it is prohibited,

as you treated my lenient ruling with disdain.

וכי מדידי הוא?

דמר שמואל היא!

Rav Yehuda continues:

But was it of my own accord that I issued this ruling?!

It is the ruling of Mar Shmuel!

Anecdote - Shmuel’s female slave’s eye became infected on Shabbat

ההיא אמתא דהואי בי מר שמואל,

דקדחא לה עינא בשבתא,

as demonstrated in the following incident:

There was a certain female slave who was in the house of Mar Shmuel¹⁰

whose eye became infected (קדחא) on Shabbat.

... no one treated her, and her eye was ruined

צווחא,

וליכא דאשגח בה.

פקעא עינא.

She screamed in pain,

but there was no one who attended to her.

Eventually, her eye popped (פקעא) out of its socket.

The next day Shmuel publicly taught that such an eye may be treated on Shabbat

למחר

נפק מר שמואל ודרש:

עין שמרדה —

מותר לכוחלה בשבת.

The next day,

Mar Shmuel went out and taught:

With regard to an eye that rebelled --

it is permitted to apply kohl to it on Shabbat.

The reason for permitting treatment of a dangerously diseased eye on Shabbat is that the eye’s tendons are linked to the heart (making it life-threatening)

מאי טעמא?

דשורייני דעינא באובנתא דליבא תלו.

What is the reason for this leniency, seeing as one may desecrate Shabbat only to treat life-threatening afflictions?

The reason is that the tendons [shuraynei] of the eye are dependent upon the valves of the heart.

Rav Yehuda - which eye conditions count as dangerous enough to justify Shabbat desecration, and which do not - A list of 6 eye conditions

כגון מאי?

אמר רב יהודה:

כגון:

1. רירא,

2. דיצא,

3. דמא,

4. דימעתא,

5. וקידחא,

6. ותחלת אוכלא,

The Talmud asks: What ailment of the eye, for example, is considered life-threatening?

Rav Yehuda said:

For example, any of the following:

1. Abnormal discharge (רירא);

2. the sensation of pricking (דיצא);

3. blood flow from the eye;

4. excessive tearing;

5. and inflammation;

6. and the onset of infection (אוכלא).

It excludes from the category of danger: the final stage of a fading infection and treatments meant only to improve eyesight

לאפוקי

1. סוף אוכלא

2. ופצוחי עינא,

דלא.

This list serves to exclude

1. the final stages of a waning infection that is mostly healed,

2. and the opening (פצוחי) of the eye, i.e., treatment administered to improve one’s eyesight,

which are not life-threatening and therefore one is not permitted to treat them on Shabbat.

1. פיקעא.

On this word, see Jastrow (modernized), entry “פִּיקְעָא”:

(פְּקַע) split, especially slits in the rectum.

• Avodah Zarah 28a sq. - חש בפיקעא - “suffered from slits”

• Avodah Zarah 28a - ליתי … ולינח פ׳ להדי פיקעא - “let him get the kernel of a bramble fruit and place its split (wedge-shaped) side against the slit”

• Avodah Zarah 28a - פיקעא עילאה - “slits in the upper part of the rectum”, פיקעא תיתאה - “in the lower participle”

Steinsaltz here translates the ailment being referred to here, as “hemorrhoids”. For other places where Steinsaltz translates ailments in the Talmud as “hemorrhoids”, see these pieces of mine:

• “Pt3 The Talmudic Sugya of Remedies (Gittin 69a-b)“, section “Remedies for Hemorrhoids (#14)“, where the Aramaic word used is רושחתא.

• “Pt2 The Greatness of Residing in Eretz Yisrael, and the Future Messianic Resurrection (Ketubot 111a-b)“, section “Health Advice: Don’t excessively sit, stand, or walk“, where the Aramaic word used is תחתוניות. The same word is found, and translated as such, in “Lives, Loves, and Hatreds: Psychological and Social Commentary on Human Behaviors, Group Dynamics, and Animal Traits (Pesachim 113b)“, section “10 to 11 Things That Cause Hemorrhoids (Berakhot 55a)“.

2. משקדי.

On this word, see Jastrow (modernized), entry “*מִשְׁקְדֵי”:

(שקד) guards;

משקדי חלזוני - snail-shells.

• Avodah Zarah 28b:3 ed. (Manuscript Munich: a. Arukh משקרי).

3. Compare the extended sugya of Abaye citing his mother in medical matters related to a newborn, in my “Neonatal Care and Conditional Circumcision: Medical Observation, Harm Prevention, and Maternal Expertise (Shabbat 134a)“, and see my intro and initial note there.

4. שקייני - “potions”.

On this word, see Jastrow (modernized), entry “שַׁקְיָינָא”:

(שקי) drink, liquid, infusion.

Plural: שַׁקְיָינֵי, שִׁיקְ׳.

• Targum Jonathan on Numbers 6:3.

• Shabbat 78a:6 - כל שקייני וכ׳ (Manuscript Munich: שתייתא) - “all liquids (infusions of collyrium) heal etc.”, see טְלַל I.

• Shabbat 147b:9 - כולהו שקייני מדיבחא וכ׳ - “all infusions (medicines) taken between Passover and Pentecost are efficacious”

• Avodah Zarah 28b:4 - כולהו שקייני קשו וכ׳ (not שקיינו, Rashi שַׁקְיָינִין) - “all liquids are bad for the ear, except etc”

5. גמלניתא.

On this word, see Jastrow (modernized), entry “גַּמְלָנָא”:

Aramaic, equivalent to Hebrew: גַּמְלוֹן

large-sized.

• Shabbat 66b:22 - שומשמנא גמלניתא Arukh (ed. גמלא) - “a large ant”

• Avodah Zarah 28b:5, see חִיפּוּשִׁיתָא.

6. ביקרא.

On this word, see Jastrow (modernized), entry “בַּרְקָא II”:

(ברק)

1) (adj.) shining, white.

• Sanhedrin 98a:14 - סוסיא ברקא - “a white horse”, see בָּארַג.

Plural: בַּרְקֵי. Jerusalem Talmud Bava Batra 8:4:4; Jerusalem Talmud Kiddushin 1:5:8 - “he let him ride אתרי ריכשי ברקי on two white steeds (i.e. the donator gave him a doubly fortified document; another opin.: he made him ride on two …, which run in different directions”, i.e. the document is invalid; see explanation ibid., compare

• Bava Batra 152a, Ketubot 55a.

• Gittin 69a:2 - שודרא ברקא - “a string of white hair”

• Shabbat 67a:1; Avodah Zarah 28b:5 - נירא ברקא - “a white thread (of hair)”

2) (as a noun) something white, white thread.

• Ibid. וליתוב ב׳ וכ׳ - “and let him put a white thread around one end”

• Ibid. פתילי ב׳ Manuscript Munich: (ed. פתילתא ביקרא, correct accordingly) - “strings of white stuff”

7. נדא

On this word, see Jastrow (modernized), entry “נָרָא”:

(see the preceding word) violet (color), violet (flower).

• Gittin 19b:15 - בדקינן ליה במיא דנרא - “we examine the sheet with a violet-colored liquid (to bring out any faded writing)”

• Avodah Zarah 28b:1 - אודדא דנרא Arukh (editions: אודרא דנדא; Manuscript Munich: דנורא) - “violet-dyed wool” [Rabbi Ḥananel: מיא דנרא - “decoction of the bark of the pomegranate-tree”, Pers. nâr, Perles, ‘Etymologische Studien’, p. 37, sq.]

8. משקף.

On this word, see Jastrow (modernized), entry “שְׁקַף”, Aramaic , section Pa’el: - שַׁקֵּיף, 1

Part. pass. מְשַׁקַּף or מַשְׁקַף.

• Avodah Zarah 28b:7 - דלא משקף Manuscript Munich: (ed. מִשְּׁקִיף, Itpe’el:) - “(wool) that has not been beaten (hatchelled)”

9. מזריף זריף - “cause swelling, inflame”.

On this word, see my note in “Neonatal Care and Conditional Circumcision“ (cited earlier), on section “... Where the area appears translucent, Tear gently with a barley-grain widthwise and lengthwise; avoid metal tools so as to avoid infection and swelling“.

10. For other anecdotes about Shmuel in regards to his female slaves, see my “Appendix 2 - Amoraic Practices in Regards to their Female Slaves (Niddah 47a:15-16)“.