April, 1951

Medicine in the TalmudABRAHAM BERNSTEIN, M.D.. and HENRY C. BERNSTEIN, M.D., San Francisco

THE TALMUD1 2 is a commentary on the Bibleand also an encyclopedia. It includes portions

on jurisprudence, history, ethics, mythology, astron-omy, mathematics, philosophy, theology, medicine,anatomy and botany. It was compiled by a numberof Jewish scholars. The Talmudic teachings, forcenturies transmitted orally, were finally placed indefinite literary form at the end of the fifth centuryas a collective labor of many generations.Much attention was given in-the Talmud to medi-

cine, to study of principles and theories which werelater discussed by modern scientists and clinicians.Rabbis of considerable erudition and sagacityevolved a system of treatment and hygiene which inscope and quality stood far above the period ofcivilization in which they lived.The Talmud contains no medical treatises as

such; medical subjects are discussed in connectionwith religious rites and ceremonies. As guides toan understanding of stages in the development ofmedical lore, the. Talmudic statements have greathistorical value. Many old methods applied by theTalmudists were strikingly like those with whichmedical science is occupied at present. The medicalinstructions and directions of the Talmud are sopositive and so concrete that it is quite evident thatthe Talmudic physicians were versed in etiology andpathology; their medical knowledge was based notonly on hypotheses and traditions, but also on obser-vation, dissection, and experimentation.The wealth of Talmudic medicine is best revealed

when it is compared with the methods of modernmedicine, for many of the views, hygienic rulesand methods of treatment of the ancient Talmudicphysicians stand inspection in the light of today'sscientific knowledge.The diagnosis of diseases was made on the basis

of palpation, observation and, sometimes, the appli-cation of physical and chemical reagents. Bloodtests were made with a number of reagents com-posed of seven chemicals. The diagnosis of stom-atitis was made on the basis of the redness, swellingand tenderness of the inflamed area. In cases inwhich the diagnosis was doubtful, the patient wasisolated for observation. The diagnosis of skin dis-eases was made on the size, shape, exudation andcolor of the lesion. Clinical observation took fromone to three weeks. The Talmud suggested that athorough examination was necessary for correctdiagnosis. "A physician who treated without exami-nation brought harm.", "A physician who heals fornothing is worth nothing."The Talmud considered that the prognosis of an

illness depended upon the cause and the site affected.Internal diseases were more serious than external.The most dangerous were angina pectoris, menin-gitis, inflammation of the spinal cord, and gall-bladder disease. Heart disease was recognized as agrave malady because the function of all organs

depended upon the heart. Open wounds were treatedas a serious disease; cancer was considered danger-ous. Diseases of the eye were also regarded as grave.Perforations of the heart, esophagus, stomach orvolvulus were believed to be fatal, as was injury ofthe spinal cord. Atrophy or abscess of the kidneycaused death, but extirpation of the spleen, removalof the uterus and accumulation of transparent fluidin the kidney were not considered fatal.The Talmud considered hygiene to be of the ut-

most importance. Cleanliness, bathing, proper food,regular living, isolation of infected patients andprevention of contagious diseases were urgently ad-vised. "Be careful of the flies near the contagiouspatient." "The amputated organs of the contagiousshould be buried." Patients with leprosy wereisolated. Persons who had been in contact with aleper were isolated during the incubation period.To drink water which flowed through a filthy

place was forbidden because of the danger of con-tamination. The drinking of dish water was notpermissible. Wine or milks left uncovered shouldnot be drunk because of the danger of a hiddensnake entering and drinking the liquid and pollut-ing it with venom. It was advised that hands bewashed before each meal and lips and mouth washedafter meals to prevent diseases of gums and mouth."Water suspected of containing germs should beboiled befpre using." "Do not drink from uncleanglasses." "If you taste soup, do not return remainsto the pot."To prevent an offensive odor from the mouth,

plenty of fresh water to drink and frequent mouthwashes were recommended. The food for eatingmust be prepared fresh and clean. It was recom-mended one should not live in a town where therewere no vegetable gardens. The Talmud also warnedagainst living in a town where there were neitherphysicians nor bathing facilities.

It was suggested that the food to be eaten shouldbe varied. Carbohydrates and vegetables were re-garded as unsatisfactory, but together with fats theywere recognized as a source of energy, producingpower. "Do not eat immoderately," was an admoni-tion then as now. Other statements seem even todayto have been born of studious observation: "Winein small amounts is a remedy; in large amounts itis poisonous"; and, "The following seven objectsare beneficial if used moderately and harmful ifused excessively: travel, luxury, work, wine, sleep,warm water, and venesection for medical purposes."The Babylonian Talmudl states that the causes of

diseases are uncleanliness, cold wind, improperfood, worry, fear, trauma, hereditary weakness, andinfections. Unhygienic conditions are consideredimportant factors contributing to sickness. Theancient rabbis found that diseases were prevalentin unclean places; cold and heat were factors inmany maladies. Living in damp places and dwelling

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where there was insufficient sunshine was observedto be injurious to health; and ingestion of un-ripened fruits and contaminated water was notedto be dangerous and the cause of many severe dis-eases. Tapeworms entered the body when beef thathad not been boiled thoroughly was eaten. Otherobservations of etiologic import: More diseasescome from overeating than from hunger; lack ofexercise results in weakness and nervousness; frightcauses palpitation of the heart; trauma of the spinalcord produces limping, while softening of the cordcauses tremor of the head; a fall may cause injuryto the internal organs with fatal results; hemophiliaand epilepsy are hereditary and prevalent only incertain families; the food, utensils and clothing ofpersons afflicted with contagious diseases are thesources of the spreading of those diseases.The Talmud speaks of minute organisms and in-

sects as the cause of certain diseases and states that"there are many germs and insects that are danger-ous to health; minute organisms existing everywherein abundance; if man could see them all, he couldnot exist."

It is remarkable that the Talmudists were the firstto state that symptoms of all diseases are merelyexternal manifestations of internal changes in thetissues or organs and that they observed that thenature of the change varied with the disease. Atabout the same time, the contemporaries of thewriters of the Talmud, Hippocrates and his dis-ciples, created a theory that the body contains fourhumors: blood, phlegm, yellow bile, and black bile.The improper proportion or irregular distributionof these humors caused disease. Later, Galen statedthat the normal condition of the body dependedupon a proper mixture of the four elements, heat,cold, moisture, and dryness; all symptoms and alldiseases were explained on this theory. The ancientmedical schools knew very little about pathologicchanges. They did not suspect that structuralchanges appear in the body during disease.The Talmud established a religious rule forbid-

ding the eating of meat of an animal afflicted witha disease. Therefore, all animals slaughtered werethoroughly examined as to the condition of theirinternal organs. Thus, much valuable scientificknowledge about diseased structures and morbidprocesses was made available. The pathologicalchanges of organs with regard to color, position.consistency and cavities were noted. Bones, muscles,glands, and internal organs were carefully describedas to histologic and topographic features. The exactnumber of bones in the human body was determinedwhen Rabbi Ishmael dissected the body of a womanwho had been executed as a criminal.

In 1855, Wilcker suggested a method of determin-ing the total quantity of blood in the body. Thisconsisted in washing the blood from the vesselswith water and estimating the amount of hemo-globin in the washings. A similar method, by whichthe color of all the blood in the body mixed with ameasured amount of water was compared withsamples of blood and water in known rates, was

used by the Talmudists some 1,500 years earlier.And they obtained more accurate results thanWilcker. Rabbi Ashi discovered the presence of'*elastic threads" in a case of pulmonary disease.The rabbis were able to determine whether bleedingwas from the lungs or from other organs by observ-ing the color of the blood.

Hemophilia was first reported by Fordyce inAmerica, in 1784. Hippocrates and Galen made nomention of this disease, and in the medical literatureof the Middle Ages there is no reference to it. TheTalmnudists, however, described the disease 2,000years ago. In connection with the rite of circum-cision there were instances of death traceable toexcessive loss of blood. The rabbis characterizedsuch victims as descendants of a bleeder's family.In such instances parents who had lost two sons dueto loss of blood were enjoined not to observe thisrite for any of their sons born thereafter. Therabbis knew that this disease was transmitted frommother to son, and that women, although not them-selves bleeders, transmitted the disease to their sons.The cause of death was explained to be a lack ofviscosity of the blood which interfered with theprotective property of clotting.The Talmudists considered that in illness the

prognosis depended upon the cause and the site oflesion. They predicted the course and end of certaindiseases in accordance with the varying pathologicalconditions. Blue and light green discolorations ofthe lung were not considered dangerous; black in-dicated that the lungs had begun to disintegrate;a bright yellow color was an indication of almostcertain death. Softening of the lungs was mortal; anempty cavity was not dangerous to life. In the caseof collapsed lungs in an animal, the Talmud gavethe following rule: If after the lungs have been im-mersed in water they can be inflated with air, theflesh of the animal is fit for food; if they cannot beinflated, it is unfit.The ancient Greek physicians claimed that in-

ury to the trachea or removal of the spleen wasfatal. The rabbis stated that a wound in the tracheaheals quickly and that removal of the spleen willnot cause death. This is in accordance with medicalknowledge of today.

Galen supposed that the thoracic cavity was filledwith air; he believed that from a physiological pointof view such a condition was necessary for the nor-mal process of respiration. The Talmudists, how-ever, stated that such a condition was evidence ofa pathological process.

In light of the variety of medical lore and theconflict of theories among the ancients of separatecivilizations and cultures, one cannot but conjecturehow much fuller and more exact medical knowledgemight have become in that day if there had beenthen the wholesome forums which today stimulateadvances in medicine.

350 Post Street.REFERENCES

1. Babylonian Talmud (completed at the end of the fifthcentury).

2. Palestinian Talmud (completed in 390 A.D.).