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A medical dilemma

I do not expect to gather workable medical remedies from the Talmud, which offers many. Still less do I expect to find modern clinical dilemmas addressed in the Talmud. In fact, even experts in the Talmud do not claim to understand its medical remedies, nor do they advocate for them (save for one, a remedy for choking).

How surprising, then, to find a modern clinical dilemma set forth in Shabbat 110a. The medicines have changed in the last 2,000 years; the clinical dilemma has not. It is painful to see that a source of pain persists over the millennia.

The dilemma begins with jaundice. The Talmud lays down a series of medical remedies for jaundice. One of them is particularly surprising: a sterility potion.

Its ingredients consist of any two of these three items: Alexandrian sap, alum and saffron. We shall not dwell on the ingredients because, again, we do not fully understand them, nor, even if we did, would we use them to treat jaundice.

However, we will pay close attention to a question the Talmud raises that leads to a clinical dilemma: Who said it is permitted to take a sterility potion?

The question flows naturally into the sources in Jewish law that forbid castration, of both human and animal (Leviticus 22:24 and other sources cited and analyzed in Shabbat 110a).

Among the issues addressed in the sources:

Are there gradations in the prohibition of castration? For example, does the ingestion of a sterility potion rise to the level of physical castration, or is the culpability equal in both cases?

Does the ingestion of a sterility portion apply to one who is already castrated?

The thrust of the questions is to narrow the possible permit to ingest such a potion. For example, if it is forbidden for one who is already castrated to ingest a sterility potion, all the more so should it be forbidden for a healthy person to ingest it.

So the Talmud suggests: Perhaps the permit is limited to an old man.

But no, this cannot be, because perhaps his potency can be restored, in which case it would be forbidden for him to take the sterility potion.

So perhaps the permit is limited to women. But no, this cannot be, because some sages hold that the commandment to procreate applies equally to male and female. (The majority opinion is that the commandment to procreate applies only to males.)

So perhaps the permit is limited to a woman who can no longer bear children, or to a barren woman.

Why should the Talmud go to great lengths to limit the use of this particular cure for jaundice? Clearly, the Talmud was distressed by the prospect of prescribing the use of a dangerous medicine. It may be a treatment that cures jaundice, but also damages one’s health elsewhere in the body.

Is this not a frequent, current dilemma? Medicines can conflict. Take your pick: You cannot be healed of two medical dilemmas because the treatment for one entails the exacerbation of the other. So which treatment takes precedence?

Expertise is brought to bear in order to eliminate or mitigate such dilemmas. But not necessarily completely.

The Talmud itself attempts to eliminate the dilemma at hand by suggesting a slew of treatments for jaundice other than the sterility potion. But the suggestions are not definitive, as each person responds differently to different treatments. So the suggested treatments for jaundice are articulated in the Talmud this way: “Try treatment #1; if it doesn’t work, try treatment #2; if it doesn’t work, try #3, etc.” The admission is there: Perhaps in an individual case no treatment for jaundice is available other than a sterility potion! What a painful dilemma.

This kind of dilemma was not limited to the practice of medicine 2,000 years ago. It plays out in doctors’ offices every day.

I have in front of me a learned Hebrew article penned a few years ago based on Shabbat 110a. The author is bothered by the way Maimonides rules on the use of the sterility potion. It does not quite jibe with the language in the Talmud. The author locates a slightly different formulation of the law in the Tosefta (a parallel source) and suggests that it is the basis of Maimonides’ formulation.

As I was reading through this learned article, it was all about the sterility potion, nothing else. A Maimonidean formulation is a legitimate focus, but the Talmudic context is a clinical dilemma. The Talmud gets into the sterility potion only because of the need to treat jaundice. The article, however, does not mention jaundice once. The author has castrated the Talmud, so to speak, which reads, “For healing jaundice, the sterility potion should consist of . . . and is it permitted to drink this?”

I say to myself: It would certainly not detract from the author’s analysis of Maimonides one whit to mention the broader context, at least in a single sentence. The original source, the Talmud, worked in a context. It hurt — a different kind of pain — to see it ignored.

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