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Part-2




Rabbi Dr. Edward Reichman

HODS Rabbis & Physicians Seminar

Albert Einstein College of Medicine


[Part 2:ย  13 minutesย  38 seconds]

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This idea is also manifest in (the) in a number of other resuscitation episodes that we find in Tanach. Thereโ€™s two famous episodes of resuscitation. This is Eliyahuโ€™s resuscitation of the Ben hatzarfatit (ืฆืจืคืชื™ืชย ื‘ื™ืŸ), ื•ื™ื”ื™ ืื—ืจ ื”ื“ื‘ืจื™ื ื”ืืœื” ื—ืœื” ื‘ืŸ ื”ืืฉื” ื‘ืขืœืช ื”ื‘ื™ืช ื•ื™ื”ื™ ื—ืœื™ื• ื—ื–ืง ืžืื“ ืขื“ ืืฉืจ ืœื ื ื•ืชืจื” ื‘ื• ื ืฉืžื” (And it was after these happenings, that the son of the woman, the mistress of the house, became ill; and his illness was very serious until no soul was left within him) until he had no more breath left. And we recall (the) how Eliyahu at that time resuscitated him

ื•ื™ืชืžื“ื“ ืขืœ ื”ื™ืœื“ ืฉืœืฉ ืคืขืžื™ื ื•ื™ืงืจื ืืœ ื™ื”ื•ื” ื•ื™ืืžืจ ื™ื”ื•ื” ืืœื”ื™ the experts, the tanach experts, ย ย ย ย ย ืืœื”ื™ ืชืฉื‘ ื ื ื ืคืฉ ื”ื™ืœื“ ื”ื–ื” ืขืœ ืงืจื‘ื• (And he prostrated himself on the boy three times, and he called to the Lord and said, “O Lord, my God, restore please the soul of this child within him) So he performs some form of resuscitation, I donโ€™t want to get into the details, if your anybody interested there are at least 10 15 articles that have been written in medical literature, some in halachic literature analyzing in excruciating detail, the resuscitation that took place here in this case of Eliyahu. Youโ€™ll see in the ืžืคืจืฉื™ื in the middle ages, in the ืจื“’ืง and in the ืจืœื‘”ื’ ย how they explain this resuscitation, and theyโ€™re employing this principal of an achit as well. ืืคืฉืจ ืขื ื›ืŸ ื›ื™ ืขืฉื” ื›ืŸ ืœื”ืžืฉื™ืœื• ืœื• ื•ืœืžืžื• ื‘ื—ื•ื ื”ื˜ื‘ืขื™ perhaps the reason there had to be bodily contact between Eliyahu and the child is so that Eliyahu could transmit the innate heat from his body to the body of the child. ื”ื™ื•ืฆื ืžืคื ื™ื• ื•ืžื‘ืฉืจื• ื›ื™ ืจื•ื‘ ืงืžื™ื ื”ื ื™ืกื™ื ื ืขืฉื” ืขืœ ื™ื“ื™ ืžืขืฉ ืชื—ืœื• ืžื“ืจืš ื”ืขื•ืœื ย (he took out from himself and his flesh, because most miracles are done through natural ways of the world) ย now the ืจื“’ืง is assuming that this was indeed a miraculous event as most of the ืžืคืจืฉื™ื (commentators) explain. There is an interesting tangent by the way according to one line of halachic approach. (Pinchas) Eliyahu was a manifest, as a subsequent reincarnation if you will of Pinchas HaCohen (the Cohen) so if he was indeed a Cohen how is it possible to expose himself to ื˜ื•ืžืื” (impurity) in order to resuscitate the child? So itโ€™s an interesting tangent about the permissibility of him doing that.

The ืจืœื‘”ื’ likewise mentions this ื•ื›ืŸ ื‘ื–ื” ื”ื“ืจืš ื›ืžื• ืฉืขืฉื” ืืœื™ื”ื• ื‘ื‘ืŸ ื”ืฉื•ืžื™ืช ย (this is the same way Eliyahu did it with son of the Shunamite), Elisha ben hashunamit which weโ€™ll see in a moment ืฉืชื‘ื•ื ื”ืจื•ื— ืžืื‘ืจื™ ื”ื ื‘ื™ื ืืœ ืื‘ืจื™ ื”ื™ืœื“ ย (that the wind came from the organs of the prophet to the organs of the child)

The other episode, very similar to Eliyahuโ€™s resuscitation, and there have been a lot of comparisons between the two, this is the resuscitation episode of Elisha and (the son of Shunemmite ( ื‘ื™ืŸ ื”ืฉื•ื ืžื™ืช, ื•ึทืชึผึทื”ึทืจ ื”ึธืึดืฉึผืึธื” ื•ึทืชึผึตืœึถื“ ื‘ึผึตืŸ (And the woman conceived and bore a son) etcetera. And there was a traumatic event to the child ื•ึทื™ึผึนืืžึถืจ ืึถืœ ืึธื‘ึดื™ื• ืจึนืืฉืึดื™ย | ืจึนืืฉืึดื™ (And he said to his father, “My head! My head!โ€) My headย ื•ึทื™ึผึนืืžึถืจ ืึถืœ ื”ึทื ึผึทืขึทืจ ืฉื‚ึธืึตื”ื•ึผ ืึถืœ ืึดืžึผื•ึน (And he said to the servant, “Carry him to his mother.”). Any physicians here want to hazard a guess what the medical condition was which could have led to this childโ€™s death?

Man: AVNL

Rabbi: An AVNL formation is an excellent guess! Sudden onset, severe headache, and then passing out

Man: cerebral hemorrhage,

Rabbi: cerebral hemorrhage, sub arachnoids, some mediology sub arachnoids. So in the medical literature you will find these discussions. Another one which people have mentioned is the ื•ึทื™ึผึตืฆึตื ืึถืœ ืึธื‘ึดื™ื• ืึถืœ ื”ึทืงึผึนืฆึฐืจึดื™ื (he went out to his father, to the reapers) that he was out in the open heat, it was very hot, and he had heat stroke, he may have had heat stroke. So either way, and we have here a very direct resuscitation ย ื•ึทื™ึผึทืขึทืœ ื•ึทื™ึผึดืฉืึฐื›ึผึทื‘ ืขึทืœ ื”ึทื™ึผึถืœึถื“ he prostrates himself on top of the child, puts his mouth on his mouth, his eyes on his eyes etc. and performs an effective resuscitation obviously with the assistance of ื”ืงื“ื•ืฉ ื‘ืจื•ืš ื”ื•ื (G-D), so in this I must have missed or skipped the slide there, but here also the ืžืคืจืฉื™ื (commentators) in their discussion of this resuscitation episode, they mention this notion of choma tivโ€™i I think itโ€™s just important when youโ€™re reading through the ืžืคืจืฉื™ื (commentators) you have an idea of what these words mean. Absent this medical historical understanding, it would be difficult to interpret the Ramban difficult to interpret the ืจืœื‘”ื’ and how they understood these matters.

Yes?

Man asks a question: I just donโ€™t understand in the last case with Eliyahu breathing into the child, if the child is not breathing shouldnโ€™t the body be in overheat?

Rabbi: Right so youโ€™re asking a good question, youโ€™re asking a physiological question about what could have occurred. Now obviously we believe this was a miraculous event, this was not just an event which, although it may have roots in a physiological resuscitation, it was probably a miraculous resuscitation. There are debates; by the way, in both cases whether the child was completely dead or just appeared to be dead. But your question is a good question, merits further discussion and in these articles there is discussion about it.

Different man: we say itโ€™s a miraculous thing, so whatโ€™s the connection how do youโ€ฆ?

Rabbi: well even miraculous event have to be rooted in some natural phenomena. And there’s a ืžื—ืœื•ืงืช (argument) about whether all miracles, there’s a debate whether miracles have to be rooted in natural phenomena or not, but on the assumption that they do, so there was some potential physiological basis for these resuscitations. Any other questions on this before we go into the next chapter?

So this is the famous ืชืฉื•ื‘ื” (answer) of the ื—ื›ื ืฆื‘ื™, I believe Rabbi Flaum discussed the ื—ื›ื ืฆื‘ื™, and just very briefly the context. Weโ€™ll read the question and the relevance of this to the halachic discussions. This is the, and my objective here is just to enlighten some of the literally the handful of sources which are marshaled in the discussion of the contemporary issues of the definition of death, and to enlighten them from a historical perspective. The ื—ื›ื ืฆื‘ื™ writes ืžืขืฉื” ื‘ืจื™ื‘ื” ืื—ืช ืฉืคืชื—ื” ื‘ื˜ืŸ ืชืจื ื’ื•ืœืช ืœื”ื•ืฆื™ื ื‘ื ื™ ืžืขื™ื” ื‘ืฉืคืช ื”ืฉืœื—ืŸ

And Iโ€™ll just summarize actually, itโ€™s the case that was presented to him it was a ื›ืฉืจื•ืช (kosher) case, a case about whether a chicken was kosher or not. And the context of the case was somebody was preparing a chicken and, as was the practice in days of old, they would slaughter their own chickens at home; they didn’t go to a butcher and get the pre-packaged chickens. And when they shechted (slaughtered) when they slaughtered the chicken, they found that the chicken didn’t have a heart. After they were looking through it they said that the chicken didn’t have a heart. So they said if the chicken doesnโ€™t have a heart perhaps itโ€™s not a kosher chicken, because there are certain laws called the laws of treifa. So maybe since this chicken is missing a vital organ, perhaps this chicken is indeed not a kosher chicken. So this chicken, this case was brought as was many ื›ืฉืจื•ืช (kosher) cases of slaughtered chickens to the Rav at that time. And they brought it to the famous ื—ื›ื ืฆื‘ื™ in the 16th, 15/ 16th century, 16th 17th century. So how did he hold? He held the ืชืฉื•ื‘ื” (answer), ืชื•ืขื ืื•ืžืจื™ื ย ย ย ย ย ย ื›ื“ื‘ืจ ื‘ืจื•ืจ ื”ื•ื ืœื›ืœ ืืฉืจ ืœื™ื‘ื• ืœื‘ ื—ื›ื ื‘ืงื™ืจื‘ื• ย itโ€™s a nice pun over there. So itโ€™s very clear to everybody who has a heart beating within him, and a brain in his head, I wont mention the brain death reference over here, ืฉืื™ ืืคืฉืจ ืœืฉื•ื ื ื‘ืจื ื‘ืขื•ืœื ืœื—ื™ื•ืช ืืคื™ืœื• ืฉืขื” ืื—ืช ื‘ืœื ืœื‘ that it is absolutely categorically impossible for anybody to live one millisecond without a heart. So thatโ€™s, I mean it seems to be obvious, itโ€™s obvious, it was obvious to him at that time. And common knowledge, thereโ€™s no way you can live without a heart. So based on this question, he launched into a very extensive analysis about the importance of the heart in the life of the individual and in rabbinic literature, and hence the reference of this ืชืฉื•ื‘ื” (answer) in the contemporary discussions about the definitions of death, especially those who believe in cardiac death as the required death this is often mentioned to attest to the primacy of the heart in the definition of death. That is not the context of his ืชืฉื•ื‘ื” (answer) obviously, the ื—ื›ื ืฆื‘ื™ is not talking about whether a human being whose heart stops is dead or not, thatโ€™s not the context of the ืชืฉื•ื‘ื” (answer). But it nonetheless has extensive references to the importance of cardiac death. Now what I just want to mention to you in lieu of what we just mentioned briefly before about the innate heat, that many of the references that the ื—ื›ื ืฆื‘ื™ brings for his belief of the importance of the heart, many of them allude or explicitly reference this particular notion of the innate heat which we just talked about. ื•ื›”ื› [ื›ืŸ ื›ืชื‘] ื”ืจืื‘” ืข

[ื”ืจื‘ ืื‘ืจื”ื ืื‘ืŸ ืขื–ืจื] ืขืœ ืคืกื•ืง ื•ื™ืคื— ื‘ืืคื™ื• ื ืฉืžืช ื—ื™ื™ื] (as the Ibn Ezra wrote about the pasuk in torah (breishit) โ€œand he blew into his mouth the breath of lifeโ€) the heat will be emitted from the innate heat of the heart. ื•ื™ื‘ื™ืื• ืื—ืจ and it will be replaced with other air. ื”ืจื™ ื”ืจื™ ืžื‘ื•ืืจ ืฉื˜ืขื ื”ื™ื•ืช ืขื ื™ืŸ ื”ื—ื™ื™ื ืชืœื•ื™ ื‘ื ืฉื™ืžืช ื”ื—ื•ื˜ื ื”ื•ื

ืžืฉื•ื ืฉื“ืจืš ื”ื—ื•ื˜ื ื™ื•ืฆื ื”ืื•ื™ืจ ื”ื—ื ืžืŸ ื”ืœื‘ so heโ€™s inter inter, he’s discussing the inter- relationship between the breathing and the heart, which is obviously a very central relationship for the understanding of the passage in the Gemera in Yoma as well but his understanding of this inter relationship is based on the contemporaneous physiological understanding of innate heat, that there was a direct passage of air goingย  into the heart, feeding the flames of the heart, and air likewise being transmitted outside the body as well. And he brings down the Kuzari who also says ื› ื›ื™ ืื ื‘ืจื•ื— ื—ื ื˜ื‘ืขื™ ื”ื [ืื™ ืืคืฉืจ] ืœื• ื‘ืœืชื™ ืžืงื•ื ืฉื™ืงืฉืจ ื›ื”ืงืฉืจ ื”ืœื”ื‘ ื‘ืจืืฉ ื”ืคืชื™ืœื” so I mean these are important, the analogies that they mention, but the people that he brings all mention, not all but many of them mention this issue of the innate heat. ื•ื’ื ืจื‘ ืกืขื“ื™ื” ื’ืื•ืŸ ืืฉืจ ื”ื™ื” ื—ื›ื ื’ื“ื•ืœ ื•ืžื•ืคืœื’ ื‘ืชื•ืจื”ย  ย (also Rav Saadia Gaon who was a big smart rabbi) Rav Saadia Gaon in the times of the ื’ืื•ื ื™ื, ืขืœ ื”ื ืฉื™ืžื” ื‘ื“ื‘ืจื• ืขืœ ื”ื ืฉื™ืžื” when he’s speaking about breathing ื›ืชื‘ ื›ื™ ื”ื™ื ืœื”ืจื•ื™ื— ืœื—ื•ื ื”ื˜ื‘ืขื™ the purpose of breathing is to benefit the innate heat, to bring the air into the cardiac, into the heart in order to fan the flames of the innate heat. Now our issue today is not to discuss the details of the ืคื•ืกืงื™ ื”ืœื›ื” (deciders of Jewish law) of the ื—ื›ื ืฆื‘ื™ but suffice it to say that it generated a controversy, I donโ€™t know if itโ€™s a controversy as contentious as the brain death cardiac death controversy which has been, which has been around for a number of decades, but it did generate a controversy about this ืคืกืง (halachic decision) of the chicken which went back and forth for a number of decades with a number of ื’ื“ื•ืœื™ ื”ืคื•ืกืงื™ื (great declarers of halacha) weighing in as well, a progenitor to our discussions of the definitions of death today. So what is interesting, I just mentioned for your interest, is the crazy place of Rav Yonatan Eybeschutz responded to the ื—ื›ื ืฆื‘ื™ and in discussing with him he also discussed the physiology at that time, and this is apropos our conference, our two day conference. He says ื•ืœืžืขืŸ ื‘ื™ืื•ืจ ื”ื“ื‘ืจื™ื ื›ื™ ืชื•ืจื” ื”ื™ื ื•ืœื ื™ื’ื™ืข ืจืื•ืŸ ื‘ืžืœื›ืช ืฉืžื™ื ืงืžืชื™ ื•ื›ืชื‘ืชื™ ืขืœ ื™ื“ื™ ื”ืฉื™ืฉ ื”ืชื•ืจื” ื”ืžื•ืคืœื” ืจื‘ ื”ื ืš ื”ืœื™ ืœืขืฉื•ืช ื‘ืฉืžื™ ืœืืœื” ืฉืงื•ืจืื™ืŸ ย responzi ื•ื›ืœ ื”ืจื•ืคืื™ื ื•ื”ืœื™ what he did is he said in order to address this issue to solve this issue Rav Yonatan Eybeschutz wrote to the University of Halle, Germany which is a premier university in Germany, he said you know weโ€™re having these discussions about the heart and the primacy of the heart, well letโ€™s go to the medical source, which is what this conference has done, bring together physicians, bring together ืจื‘ื ื™ื (Rabbis) have the dialogue, clarify the science and the halacha ย will be clarified thereby as well. So thatโ€™s what he did, he sent a ืชืฉื•ื‘ื” (answer/ responsa) to the responzi as he calls it to the University of Halle to discuss whether itโ€™s possible for a chicken to live without a heart or not, thatโ€™s what he sent to the faculty at the University of Halle. ื•ื–ื”ื• ื”ืชืง ืชืฉื•ื‘ืชื• ื‘ืžืื•ื“ ืžืื•ื“ ย this is the ืชืฉื•ื‘ื” (answer), obviously he didnโ€™t write in Hebrew so it canโ€™t be letter by letter, but to be honest this is another interesting tangent, Hebrew was one of the languages of medicine in the middle ages, Latin, Greek, and Hebrew as well, was an integral part of medical training. Jews served as translators of many of the important medical treatises in the Middle Ages, and Hebrew were quite and important language. Says ื•ืื™ื ื›ืŸ ืื—ืจื™ ืืฉืจ ื™ื’ื™ืขื• ืœื™ื“ื™ื ื• ืฉืชื™ ืฉืืœื•ืชย  ย two questions came before us ืœื ื™ื“ืขื ื• ืกื™ื‘ืชื we have no idea why youโ€™re asking these questions ื•ื ืชื‘ืงืฉ ืžืื™ืชื ื• ื—ื›ื™ืจืช ื”ืจื•ืคืื™ื ืคื” ื‘ืžื“ืจืฉ ื”ื–ื” ืœืกื™ื ืขืœื™ื”ื ืขืœ ืคื™ ื™ืกื•ื“ื•ืช ื—ื›ืžื” ื”ืจืคื•ืื” ื•ื”ื ื˜ื•ืื— you want to answer these questions based on the modern, the then modern, medicine and surgery ื”ืชืืกืคื ื• ื™ื—ื“ ื‘ื™ืฉื™ื‘ื” we sat together in a meeting, we gathered the faculty ื•ืื—ืจื™ ื”ืขื™ื•ืŸ ื•ื”ืขืฆื” ื”ืกื›ืžื ื• ื‘ื“ื‘ืจ ื”ืชืฉื•ื‘ื” ื”ื–ืืช and we got together and we formed a consensus.

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