HODS Rabbis & Physicians Seminar
Albert Einstein College of Medicine
[Part 2: 13 minutes 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. There’s two famous episodes of resuscitation. This is Eliyahu’s resuscitation of the Ben hatzarfatit (צרפתית בין), ויהי אחר הדברים האלה חלה בן האשה בעלת הבית ויהי חליו חזק מאד עד אשר לא נותרה בו נשמה (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
ויתמדד על הילד שלש פעמים ויקרא אל יהוה ויאמר יהוה אלהי the experts, the tanach experts, אלהי תשב נא נפש הילד הזה על קרבו (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 don’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. You’ll see in the מפרשים in the middle ages, in the רד’ק and in the רלב”ג how they explain this resuscitation, and they’re employing this principal of an achit as well. אפשר עם כן כי עשה כן להמשילו לו ולממו בחום הטבעי 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. היוצא מפניו ומבשרו כי רוב קמים הניסים נעשה על ידי מעש תחלו מדרך העולם (he took out from himself and his flesh, because most miracles are done through natural ways of the world) now the רד’ק is assuming that this was indeed a miraculous event as most of the מפרשים (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 טומאה (impurity) in order to resuscitate the child? So it’s an interesting tangent about the permissibility of him doing that.
The רלב”ג likewise mentions this וכן בזה הדרך כמו שעשה אליהו בבן השומית (this is the same way Eliyahu did it with son of the Shunamite), Elisha ben hashunamit which we’ll see in a moment שתבוא הרוח מאברי הנביא אל אברי הילד (that the wind came from the organs of the prophet to the organs of the child)
The other episode, very similar to Eliyahu’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 ( בין השונמית, וַתַּהַר הָאִשָּׁה וַתֵּלֶד בֵּן (And the woman conceived and bore a son) etcetera. And there was a traumatic event to the child וַיֹּאמֶר אֶל אָבִיו רֹאשִׁי | רֹאשִׁי (And he said to his father, “My head! My head!”) My head וַיֹּאמֶר אֶל הַנַּעַר שָׂאֵהוּ אֶל אִמּוֹ (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 child’s death?
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 וַיֵּצֵא אֶל אָבִיו אֶל הַקֹּצְרִים (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 וַיַּעַל וַיִּשְׁכַּב עַל הַיֶּלֶד 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 הקדוש ברוך הוא (G-D), so in this I must have missed or skipped the slide there, but here also the מפרשים (commentators) in their discussion of this resuscitation episode, they mention this notion of choma tiv’i I think it’s just important when you’re reading through the מפרשים (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 רלב”ג and how they understood these matters.
Man asks a question: I just don’t understand in the last case with Eliyahu breathing into the child, if the child is not breathing shouldn’t the body be in overheat?
Rabbi: Right so you’re asking a good question, you’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 it’s a miraculous thing, so what’s the connection how do you…?
Rabbi: well even miraculous event have to be rooted in some natural phenomena. And there’s a מחלוקת (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 תשובה (answer) of the חכם צבי, I believe Rabbi Flaum discussed the חכם צבי, and just very briefly the context. We’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 חכם צבי writes מעשה בריבה אחת שפתחה בטן תרנגולת להוציא בני מעיה בשפת השלחן
And I’ll just summarize actually, it’s the case that was presented to him it was a כשרות (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 doesn’t have a heart perhaps it’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 כשרות (kosher) cases of slaughtered chickens to the Rav at that time. And they brought it to the famous חכם צבי in the 16th, 15/ 16th century, 16th 17th century. So how did he hold? He held the תשובה (answer), תועם אומרים כדבר ברור הוא לכל אשר ליבו לב חכם בקירבו it’s a nice pun over there. So it’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, שאי אפשר לשום נברא בעולם לחיות אפילו שעה אחת בלא לב that it is absolutely categorically impossible for anybody to live one millisecond without a heart. So that’s, I mean it seems to be obvious, it’s obvious, it was obvious to him at that time. And common knowledge, there’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 תשובה (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 תשובה (answer) obviously, the חכם צבי is not talking about whether a human being whose heart stops is dead or not, that’s not the context of the תשובה (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 חכם צבי 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. וכ”כ [כן כתב] הראב” ע
[הרב אברהם אבן עזרא] על פסוק ויפח באפיו נשמת חיים] (as the Ibn Ezra wrote about the pasuk in torah (breishit) “and he blew into his mouth the breath of life”) the heat will be emitted from the innate heat of the heart. ויביאו אחר and it will be replaced with other air. הרי הרי מבואר שטעם היות ענין החיים תלוי בנשימת החוטם הוא
משום שדרך החוטם יוצא האויר החם מן הלב so he’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 going 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 כ כי אם ברוח חם טבעי א”א [אי אפשר] לו בלתי מקום שיקשר כהקשר הלהב בראש הפתילה 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. וגם רב סעדיה גאון אשר היה חכם גדול ומופלג בתורה (also Rav Saadia Gaon who was a big smart rabbi) Rav Saadia Gaon in the times of the גאונים, על הנשימה בדברו על הנשימה when he’s speaking about breathing כתב כי היא להרויח לחום הטבעי 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 פוסקי הלכה (deciders of Jewish law) of the חכם צבי but suffice it to say that it generated a controversy, I don’t know if it’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 פסק (halachic decision) of the chicken which went back and forth for a number of decades with a number of גדולי הפוסקים (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 חכם צבי 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 ולמען ביאור הדברים כי תורה היא ולא יגיע ראון במלכת שמים קמתי וכתבתי על ידי השיש התורה המופלה רב הנך הלי לעשות בשמי לאלה שקוראין responzi וכל הרופאים והלי 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 we’re having these discussions about the heart and the primacy of the heart, well let’s go to the medical source, which is what this conference has done, bring together physicians, bring together רבנים (Rabbis) have the dialogue, clarify the science and the halacha will be clarified thereby as well. So that’s what he did, he sent a תשובה (answer/ responsa) to the responzi as he calls it to the University of Halle to discuss whether it’s possible for a chicken to live without a heart or not, that’s what he sent to the faculty at the University of Halle. וזהו התק תשובתו במאוד מאוד this is the תשובה (answer), obviously he didn’t write in Hebrew so it can’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 ואים כן אחרי אשר יגיעו לידינו שתי שאלות two questions came before us לא ידענו סיבתם we have no idea why you’re asking these questions ונתבקש מאיתנו חכירת הרופאים פה במדרש הזה לסים עליהם על פי יסודות חכמה הרפואה והנטואח you want to answer these questions based on the modern, the then modern, medicine and surgery התאספנו יחד בישיבה we sat together in a meeting, we gathered the faculty ואחרי העיון והעצה הסכמנו בדבר התשובה הזאת and we got together and we formed a consensus.