Therapeutic
Bathing in Rabbinic Literature: Halachic Issues and their Background in History
and Realia
Avraham Ofir Shemesh
Therapeutic
bathing has been in vogue since antiquity. In the course of the generations,
the therapeutic characteristics of various springs, lakes, and other mineral
waters have been established, leading to their use in a variety of diseases.
General historical sources, just like Jewish sources from the Talmudic and
post-Talmudic periods, mention the use of therapeutic springs and baths in
various locations.[1]
This
article discusses the halachic aspects of therapeutic bathing and is based on
Jewish, halachic literary sources. The purpose of this study is to present the
therapies which were used in terms of the halachic problems which they
engendered. In this article, we will not endeavor to reach and definitive
halachic conclusions in controversial areas. Rather, we will focus on the
medical and halachic issues which arose in connection with these therapies.
1.
The Therapeutic Characteristics of Baths: Medical and Historical Background
Therapeutic
springs are a geo-hydrological phenomenon arising from the leaching of minerals
from the earth as hot water rises under pressure from the water table. Various
expressions are used for such waters: hot springs, mineral water, and thermal
water. In Hebrew, they are called hammot; in
Arabic: ma’ sukhna.
Thermal
water rises from deep in the earth and contains foul smelling sulfuric gasses
as well as other minerals, such as potassium, calcium, sodium, chlorine, and
magnesium cations and chlorine anions, silicon dioxide, sulfates, and more.[2]
Thermal
waters are to be found primarily around geological faults.. Each spring has its
own characteristic minerals, derived from the surrounding conditions and the
specific rock formations in the area. It follows that each spring has distinct
therapeutic properties for various diseases.
Thermal
springs are located in various places. We shall briefly survey the situation in
the area surrounding the Dead Sea. Along the geographic fault running through
Israel, from the Jordan Valley to the Dead Sea, there are a number of
well-known therapeutic springs[3].
Among them are the hot springs of Tiberias and a series of springs on the south
shore of the Dead Sea (Hammei Zohar, Ein Boqeq, and Hammei Mazor). The
water in these springs is quite hot and the mineral level is rather high. The
water is also relatively radioactive.
This
phenomenon is usually explained by the fact that water with high salt content
is trapped underground. As the water rises to the surface, it passes through
stone-age strata containing phosphates and bituminous shale. By leaching out
the radioactive substances which accompany the phosphates and the sulfuric
compounds in the bituminous shale, the water acquires a certain level of
radioactivity and hydrogen sulfide (H2S)[4].
In
Talmudic literature, the usual expression for therapeutic springs is hammei teverya or mei teverya. It
should be noted that these expressions are not limited to springs in the vicinity
of Tiberias. Rather, the “Tiberian Springs” became the generic expression for
all hot springs everywhere in the world[5].
Use of
such springs included bathing, drinking, and mud baths[6] A
number of sources scattered through Talmudic and contemporary non-Jewish
sources indicate that the spring waters were used to cleanse the stomach, deal
with general weakness, nervous diseases, and a variety of skin problems such as
leprosy and boils[7].
Each
spring in Israel was known for its ability to cure certain diseases For
example, the springs of Kalliroë were thought to
be effective for skin diseases, irregularities in digestion, and rheumatism.
The Ba’ara Springs were good for every condition, but
especially nervous diseases The Pahal Springs were used for skin disorders; the
Emaus Springs for nervous conditions, sexual problems and lesions caused by
wild animals[8].
Hot
springs remained popular for therapeutic purposes through the Middle Ages into
modern times[9].
Post-Talmudic halachic literature of Eastern European origin documents the
popularity of European spas, frequented by Jews from East to West for therapy,
health, and convalescence[10].
Among the
springs mentioned in responsa are: Tiplitz[11],
Ovin[12],
Carlsbad[13],
Barcelona[14].
To this very day these sites are used therapeutically. Recent studies in Israel
and abroad lend scientific support to the contention that bathing in such hot
springs is medically effective for skin conditions, routine lesions, nervous
disorders, and other problems. Even drinking the water has been found to be
effective.
New
theories, such as hydrotherapy, balneotherapy, and radiotherapy, have been
developed to explain the therapeutic effect of hot springs[15].
2.
Therapeutic Bathing in Talmudic and post-Talmudic Literature
In
Talmudic, medieval, and modern rabbinic literature there is a series of
questions which arise in connection with the use of hot springs. For example,
heating water or food on Shabbat; koshering of utensils; ritual immersion,
ritual washing of the hands; etc.
In this
article, we shall focus exclusively on medical issues[16]. It
is interesting to note that there are relatively many references to hot springs
in the halachic discussions of the Mishna and Talmud. It seems reasonable to
conclude that there are two elements in the historical and halachic background
for this: (a) the increased size of Jewish settlements in the vicinity of the
hot springs in the mishnaic and Talmudic periods; and
(b) the arrival of local Jewish sages to undergo therapy at the spas. Not only
the sages went to the spas; Jewish residents from various areas in Israel and
the surrounding areas also went.[17]
The
differences and unique characteristics of each spring gave rise to questions
and practical halachic problems for those who went there. In addition, the
therapeutic springs also provided intellectual-halachic stimulation for
discussions in the academies in the context of discussions of more unusual
situations[18].
In such discussions, medical issues were particularly prominent.
I.
Drinking Mineral Water for Therapeutic Purposes (Mei Teverya,
Mei Deqalim, Mei Deqarim)
Therapeutic
spring water was used for internal problems, such as cleansing the stomach and
treating digestive problems. Both the Palestinian and Babylonian Talmuds explained that such purgative water was called mei deqalim or mei deqarim after
its point of geographic origin or after its therapeutic effect[19].
The
Palestinian Talmud describes such water as follows: Mei deqarim
pierces the gall bladder… Mei deqalim goes out
from between two date palms.
The Babylonian
Talmud has a more precise tradition (Shabbat 110a):
Those who
say “mei deqarim”
refer to the piercing of the gall bladder; those who say “mei
deqalim” refer to the water which goes out from
between two date palms. What is “mei deqalim”? Rabba bar Barona said: There are two kinds of
palms in the west [of Israel] and a spring of water goes out from between them.
The first cup loosens; the second causes diarrhea; and the third passes out
just as it enters.
According
to the Palestinian Talmud, the phrase mei deqalim refers to a spring which goes out from between
to date palms. Prof. Zev Vilnai suggested that this
refers to springs in the area of the Dead Sea where there were many date palms
in the Roman period. It is probable that they were referring to water derived
from the springs of Kalliroë (Kalliroë in Greek means “beautiful flow”). These
springs are on the eastern shore of the Dead Sea.
It is
interesting to note that these springs, surrounded by therapeutic baths, were
marked on the Midba map (from the sixth century)
between two date palms, just as the Talmudic sages described them.[20]
Suessmann Munter, a historian of Jewish
medicine, suggested that mei deqalim is tamarhindi,
derived from the tamarindus indica
plant. Support for his suggestion can be found in the fact that the sages
mentioned dates as causing diarrhea just like me deqalim
(Ketubbot 10b).[21]
The
suggestion is nonetheless dubious because the date palm usually mentioned in
Talmudic literature is the common date palm (phoenix dactylifera).[22]
The
Babylonian Talmud refers to two additional medical facts in connection with
mineral water: (a) it pierces the gall bladder. It seems that because of its
high concentration of minerals, it was called mei
deqarim (i.e., “water which pierces);
and (b) that
it was used to cleanse the stomach and prevent constipation.[23] One
cup loosens the stomach and softens it; a second cup causes diarrhea; and a
third cup comes out directly from the anus. This implies that such water lead
to very acute diarrhea[24] In
other words, mei deqalim
is a strong purgative which must be used cautiously and in relatively small
doses.[25]
Drinking
Mineral Water: Halachic Aspects
In
ancient as well as in modern halachic literature, there are a number of
contexts in which drinking spring water is discussed:
A.
Laws of Ritual Purity
The
Mishna (Makhshirin 6:7) discusses the halachic
ramifications of drinking mineral water on the preparation of the liquids in
becoming liable to become ritually impure:
The
following neither render impure nor prepare fruits for becoming impure:
…Drinking the waters of Tiberias although they be clean when excreted.
The point
of the Mishna is that even after drinking the waters of Tiberias, they are
still clean and resemble regular water when excreted from the body. Nonethless, their halachic status is not that of regular
water which does indeed prepare fruits for becoming impure.
This
source indicates that they drank foul water containing various minerals
believing that those minerals were healthful.
B.
Drinking Spring Water on Shabbat
The
Mishna (Shabbat 14:3) discusses various prohibited therapeutic activities on
Shabbat. Among them is the drinking of mineral water:
Any food
that a person eats for therapeutic purposes and any drink aside from mei deqalim and a cup
of roots [are prohibited on Shabbat] because they cure jaundice. But it is
permitted to drink mei deqalim
for thirst and it is permitted to anoint oneself with the oil of roots for
non-therapeutic purposes.
The
Mishna clearly considers mineral water to be therapeutic. Therefore, it is
prohibited on Shabbat. If, however, a person drinks it for thirst and his
purpose is only to quench his thirst, it is permitted. It must be assumed that
such mineral water was in general not drunk. They would drink it only in the
absence of any other beverage or for therapeutic purposes.
There is
a parallel discussion of drinking mineral water in the Tosefta
(Shabbat, ed. Lieberman, 12:13):
One may
drink ichor, mei deqalim,
or a cup of roots. One rinses the face, hands, and feet with them. But one may
not rinse a sandal with them. Rabbi Yohanan the Sandal Maker permitted this.
This
passage in the Tosefta deals with three kinds of
therapy: ichor[26],
a cup of roots[27],
and mei deqalim.
Unlike the Mishna quoted above which prohibits mei
deqalim on Shabbat, the Tosefta
permits it. Perhaps the Tosefta is only referring to
quenching the thirst.
In any
event, we assume that the rinsing of the sandal in the context of the Tosefta is some kind of treatment for external lesions
caused by rubbing the skin. The liquids referred to are therapeutic for skin
conditions.[28]
C.
Drinking Mineral Water on Hol ha-Mo’ed
The Tosefta (Mo’ed Qatan, ed. Lieberman, 2:10) reports that the Talmudic
sages were in doubt about drinking mei deqalim on Hol ha-Mo’ed
until Rabbi Akiva, one of the greatest of the Tanna’im,
declared it to be permitted:[29]
One may
drink ichor, mei deqalim,
and a cup of roots on Hol ha-Mo’ed. At first
they said: One may not drink ichor, mei deqalim, or a cup of roots on Hol ha-Mo’ed. Then Rabbi Akiva came and taught that one may
drink ichor, mei deqalim,
and a cup of roots on Hol ha-Mo’ed.
According
to Rabbi Abraham Bornstein of Sochaczew (1839-1910),
the prohibition to drink mineral water is based on the fear that because of its
bitter taste it would interfere with rejoicing during the festival. Further,
its therapeutic effect does not take effect immediately. Therefore, its
therapeutic effect does not enhance the festival[30].
D.
The Blessing on Therapeutic Spring Water
Drinking
spring water gave rise to the fundamental question of whether to pronounce a
blessing. And if so, how to formulate the blessing. Blessings on beverages were
first discussed in the Palestinian Talmud (Brachot
6:8; folio 10d):
The blessing
on drinking water when thirsty is she-ha-kol nihye bi-dvaro.
Rabbi Yona
said: Aside from mei deqarim.
Rabbi Yosi
said: Any water drunk for thirst.
Rabbi Abbun
said: Drinking mei deqarim
requires the blessing barukh she-bara mei refu’ot.
According
to Rabbi Yona, one does not recite the blessing she-ha-kol
nihye bi-dvaro when
drinking spring water for therapeutic purposes. Perhaps this is because of its
taste or because of the harm it does to the body, viz. the piercing of
the gall bladder, as explained in the Babylonian Talmud above[31].
According
to Rabbi Yosi, one does recite the blessing she-ha-kol
nihye bi-dvaro when
quenching the thirst with spring water.
Rabbi
Abbun, on the other hand, holds that such water has its own special blessing
connected with its therapeutic use: barukh
she-bara mei refu’ot
(“blessed be He who hath created therapeutic waters).
The
blessing on spring water is not mentioned in the Babylonian Talmud. Nor is it
mentioned in the works of Rambam, the Tur, or R. Yosef Karo.
Rabbi
Yaakov Etlinger (Germany, 1798-1871) discusses the blessing on mineral water in
response to a question he received in the year 1847 from Rabbi Bamberger of
Wuerzburg. In summary, the question was as follows:
The question
revolves around drinking spring water, called mineral water, for therapeutic
purposes. Is a blessing required?
In
response, Rabbi Etlinger surveyed the kinds of mineral water known to him,
their medical uses, and the corresponding halacha in each case:
There are
three categories of therapeutic water. Some drink tasteless water from the
wells for therapeutic purposes in order to cool the blood. Some well-known
drink spring water that tastes good. And some drink bitter or salty water that
tastes bad.
It therefore
seems to me that we must make the following distinction: drinking bitter water
or tasteless well water for therapeutic purposes requires no blessing. But
drinking good tasting water requires a blessing even if drunk for therapeutic
purposes. This is similar to any other good tasting beverage that requires a
blessing even if drunk for therapeutic purposes.
Rabbi
Etlinger emphasizes that the principal point in deciding whether to pronounce a
blessing on beverages or foods is their taste. This is because the blessings
were instituted whenever there is enjoyment in eating or drinking[32].
It
follows that medicines in principle require blessings when they taste good.
Therefore, Rabbi Etlinger concludes that (a) tasteless spring water drunk only
to “cool the blood” requires no blessing because it does not taste good; (b)
good tasting water requires a blessing; and (c) bitter or salty water tastes
bad and therefore requires no blessing.[33]
A similar
question touching on the taste of spring water was directed to Rabbi Hayyim ben
Mordechai Sofer (1821-1886), the author of Kol Sofer:
A certain
rabbinic scholar asked me at Carlsbad about sugar. His illness prevents him
pronouncing a blessing over sugar. Is he required to pronounce a blessing
before drinking hot water?
I answered
that he should not pronounce a blessing because his sole purpose in drinking
hot water is therapeutic and no one drinks it to quench thirst.
He asked: if
so, why is it permitted to drink hot water on Shabbat? Is it not clear that the
hot water is therapeutic and therefore prohibited on Shabbat?
I said:
Perhaps therapy is only prohibited on Shabbat if the therapeutic effect is
immediate, as in the case of mei deqalim, vinegar, etc. But the waters of Carslbad do not provide instant results. Rather, the
beneficial result comes only after around a month of drinking several cups per
day. Therefore, such therapy is not prohibited on Shabbat even though the water
drunk on Shabbat is part of the ongoing therapy.[34]
In the
Middle Ages, as sugar was disseminated through the Near East and Europe, it was
used in the preparation of medicines. This was due both to its nutritional
value and its sweetness, which improves the bitter taste of many medicines.
The
questioner did not know whether to recite a blessing on the sugared water
because his health condition made it unhealthy to drink it.[35]
Therefore, he was forced to drink the water as it is.
Rabbi
Sofer said not to recite any blessing on the waters because it was intended to
be therapeutic and tasted bitter In the course of the responsum, the rabbi
mentioned another aspect of hydrotherapy that reveals something about the way
the water was used and the relationship between therapy and the laws of Shabbat
In
response to the question “why is it permitted to drink the water on Shabbat?”
since it is therapeutic, the rabbi answered that the water is not immediately
effective. Instead of taking effect on Shabbat itself, the effect is apparent
only after some time. This means that the water treatment produces long-range
results.
In some
cases, therapeutic considerations required the patient to drink the mineral
water slowly, with interruptions. Rabbi Yosef Shaul Nathansohn (Poland,
1810-1875) discussed the question of physicians prescribing such water
semiannually. In such a case must the patient pronounce a new blessing each
half year?
Regarding
someone who drinks spring water for therapeutic purposes with the advice of a
physician and must wait half a year between doses.
Rabbi
Nathansohn decided that he must recite a blessing on every individual cup
because the half-year waiting period between doses is considered an
interruption.[36]
Other
authorities, however, disagree and hold that a single blessing covers all the
cups.[37]
II.
Bathing in Spring Water and Sea Water
Bathing on Shabbat and the Prohibition of Medical
Treatment
Talmudic
and mishnaic passages deal with therapeutic bathing
in several contexts: thermal baths, salty mikva’ot of
various standards, and foul steeping pools.
The Tosefta (Shabbat, ed. Lieberman, 12:13) distinguishes
between different sources of water when discussing the permissibility of
bathing on Shabbat:
It is
permitted to bath in the waters of Tiberias and in the Great Sea [i.e.,
the Mediterranean], but not in steeping pools [used for soaking flax][38] and
not in the Sea of Sodom [i.e., the Dead Sea].
When?
Whenever the purpose is therapeutic. If the purpose is ritual purity, bathing
is permitted.
The Tosefta permits bathing in therapeutic springs and in the
Mediterranean on Shabbat because their waters are suitable for healthy people
as well. Therefore anyone bathing there does not create the impression of
engaging in therapy.
On the
other hand, bathing in the Dead Sea or in a foul steeping pool is prohibited
because it is clear that the only purpose of the bathing is therapeutic, unless
one’s purpose is ritual purity.
This halacha
is quoted in the Palestinian Talmud (Shabbat 14:3, folio 14c) in a slightly
different version:
We bath in
the Great Sea and in the Waters of Tiberias even though the purpose is
therapeutic, but not in steeping pools and not in the Waters of Sodom.
When?
Whenever the purpose is therapeutic. But whenever the purpose is ritual purity,
bathing is permitted.
The
Palestinian Talmud emphasizes that bathing in the Mediteranean
and the Hot Springs of Tiberias is permitted even if it is intended to be
therapeutic because other, healthy people are bathing there solely for
pleasure.
On the
other hand, bathing in steeping pools or in the Dead Sea is not common for
healthy people. Therefore bathing there is prohibited if the purpose is solely
therapeutic.
In the
Babylonian Talmud (Shabbat 109a-b) there are several more points of
understanding regarding therapeutic bathing:
a.
Health Spas visited only by the Ill and those visited by Healthy Patrons
It is
permitted to bath in the Gader Hot Springs, which are salty, because healthy
people also bath there. Therefore, it is not apparent that any specific person
is bathing for therapeutic purposes. The Springs of Hamatan[39] and
Assia[40] were
frequented by healthy people. Therefore, it was permitted to bath there on
Shabbat.
b. Clear
Water and Foul Water
Bathing
is permitted in the Mediteranean in “nice water,”
viz. in areas where the water is clear and clean. This is because healthy
people bath there for pleasure or for hygiene.
On the
other hand, bathing in foul sea water, such as areas around reefs, where there
is less flow and more sea weeds, is prohibited because it is clear that the
purpose of bathing is therapeutic as such water contained substances vital for
health
c.
Duration of Bathing
Remaining
in the Dead Sea or in a steeping pool for a long time clearly indicates
therapeutic intention, as in cases of skin disease. However, if the bather
remains in the water only briefly, he creates the impression of non-therapeutic
bathing.
The
Talmudic sources deal with the duration of bathing in the Dead Sea and in
steeping pools. The medieval halachic authorities disagree regarding hot
springs. Some hold that the prohibition in hot springs applies only to people
who remain in the water for a relatively long time. Others prohibit even brief
bathing in hot springs. Still others hold that even long immersion is
permitted.[41]
On the
other hand, some modern authorities claim that a patient suffering from a
“rash” (i.e., lesion) on his head is permitted to bath there only
briefly because otherwise it would be clear that his intention is therapeutic.[42]
According
to the stricter opinion, any spring which is clearly used for therapeutic
bathing is prohibited on Shabbat even for brief immersion because even brief
immersion is clearly intended to be therapeutic.[43]
Rabbi
Raphael Meldola, the rabbi of Pisa, Italy, in the beginning of the eighteenth
century, severely criticized the Jews who visited therapeutic baths on Shabbat:
There are
now many ignorant Jews who go every year to health spas with natural and
artificial baths all over this country. They have convinced themselves that it
is permitted to bath there and even to remain in the water for a long time on
Shabbat…
I do not
know where they found such a leniency to bath on Shabbat in hot water for
therapeutic purposes…. for these baths are used all year round only because of
their therapeutic properties. That is why they are so expensive.
I hereby
testify that I have strongly protested against this, but without any success.[44]
Rabbi Raphael Meldona claimed
that the baths were in the possession of wealthy local residents who opened
them to the general public at certain times of the year when the water
contained therapeutic substances. At such times, the patrons streamed to the
baths and paid dearly for their therapy.
Rabbi
Raphael objected. But his words fell on deaf ears.
Rabbi
Raphael was not alone in the battle. Other Italian rabbis stood by his side in
denouncing therapeutic bathing on Shabbat. One of them was Rabbi Raphael
Baruch, the rabbi of Livorno. Rabbi Raphael Meldona
added Rabbi Raphael Baruch’s letter to his own responsa.
Rabbi
Raphael Baruch also claimed that the bathing in those baths was clearly
motivated by therapeutic intentions, not pleasure. That is why people visit the
baths during a limited time:
Those baths
are different because they are closed all year and no one goes there aside from
a few days every year when they are therapeutically effective. Then they go and
spend a lot of money for the cure.[45]
In Rabbi
Yaakov Sofer’s encyclopedic work Kaf ha-Hayyim (Bagdad and Israel, 19th-20th
cent.), we find a summary of the various aspects of therapeutic bathing in hot
springs on Shabbat. According to Rabbi Sofer, the prohibition of bathing in
therapeutic springs on Shabbat applies to relatively healthy people who suffer
from simple aches and pains. Those who are indeed ill, however, are permitted
to bath there even if their condition is not life threatening.[46]
Further,
bathing in the spring is permitted if the patient requires treatment specifically
even on Shabbat and refraining from treatment would exasperate his condition.
If, on
the other hand, refraining from treatment on Shabbat would merely delay his
cure, but not exasperate his condition, bathing in the hot springs is
prohibited.
Therapeutic
Bathing on Fast Days
Bathing
on the Ninth of Av and Yom Kippur is prohibited (Yoma 8:1). However, only
pleasurable bathing is prohibited; washing or rinsing the body for purposes of
cleanliness is permitted.
The Palestinian Talmud discusses therapeutic bathing in the
Hot Springs of Tiberias on Fast Days:
Shmuel bar
Abba had a rash He went as asked Rabbi Yassa whether he might wash.
He asked: If
he does not wash, might he die?
They
responded: Yes.
He said:
Indeed he may wash even on the Ninth of Av and on Yom Kippur[47].
Shmuel
had a rash and asked Rabbi Yassa whether he was permitted to bath. Rabbi Assa claimed that in light of the threat to Shmuel’s life,
bathing was permitted both on the Ninth of Av and on Yom Kippur, both of which
are severe fast days[48].
Although
the Talmudic story creates the impression that it is referring to ordinary
bathing, it might actually be referring to therapeutic bathing in health
springs.
According
to Talmudic sources, the treatment for “rashes” (Acne)[49]
included anointing the skin with oil[50] and
immersion in therapeutic springs. This is clear in a passage in the Babylonian
Talmud (Shabbat 109b):
One bathes in the Waters of Tiberias and in steeping pools and in the
Dead Sea even when suffering from a rash on the head.
III.
Applying Therapeutic Mud and Bathing in Mud
In
addition to the use of mineral water, the mud from springs also had medical
properties. In technical language, such mud is called “piloma.”[51]
The
Mishna (Shabbat 22:6) stated:
It is
prohibited to go down into the keroma
(wrestling ground) on Shabbat.
In the
Talmudic explanation of this Misha (Shabbat folio 147b) we learn that the
Mishna is referring to immersing the body in mud for therapeutic purposes:
Rabbi Hiyya bar Abba said in the name of Rabbi Yohanan: It is
prohibited to stand on the mud [of the hot springs] at Diosmsith
because it is therapeutic.
This
implies that mud baths are prohibited at hot springs because such bathing is
therapeutic.
Medieval
rabbis explained the medical benefits of mud bathing in different ways. Rabbeinu Hannanel (North Africa,
980-1050) explained that mud affects the bowels:
Under the
water there is mud. Some say that bathing there is cooling and that the water
loosens the bowels[52].
He means
that immersion in the mud cools the body, increases the activity of the bowels,
and loosens them.[53]
According
to Maimonides, mud is therapeutic because it caused increased sweating. But it
is not clear if this is because of the heat of the mud from thermal springs or
because of bodily movements that accompany immersion in mud[54].
Medical
use of mud is common in Israel to this very day. Zev Vilnay
related that in the area around Sheikh Abraq there is
a certain spring surrounded by mud. The Arabs call it al-matba’a,
meaning “place of immersion.” Many Arabs go there and immerse themselves,
occasionally up to their necks. It is their belief that such immersion is a
panacea and even cures infertility[55].
Summary
and Conclusions
Medical
treatments in health springs have given rise to a number of halachic issues
since the days of the Talmudic sages through contemporary times. Three
principle therapeutic practices come under discussion: (a) therapeutic bathing;
(b) mud baths; (c) drinking mineral water.
Medical
treatments connected with bathing in spring water are discussed in the context
of the prohibition of healing on Shabbat and the prohibition of bathing on fast
days.
As far as
Shabbat is concerned, the governing principle prohibits any source of water
that is clearly used for therapeutic purposes (Dead Sea, foul steeping pools,
etc.) unless healthy people also go there for enjoyment or for hygiene.
As far as
fast days are concerned, there were rabbis who permitted therapeutic bathing as
long as the purpose of bathing is not enjoyment. Mud baths are discussed in
connection with Shabbat.
The
medical science that underlay these therapies posited that mud causes diarrhea
and sweating, both of which were thought to be healthy physiological processes.
Drinking mineral water as therapy for internal problems
is discussed in the following contexts: the laws of ritual impurity which were
relevant in the days of the Second Temple; drinking therapeutic beverages on
Shabbat; drinking unpalatable beverages during Hol ha-Mo’ed;
the laws of blessings.
The
question of blessings reflects the differences between the various types of
mineral water. Some mineral water tastes good, and therefore requires a
blessing. Other mineral water tastes bad. The quality of the water and the
method of treatment influenced the decision regarding the appropriateness of
the blessing.
Foul or
bitter mineral water would be drunk with interruptions between the doses.
Therefore, some held that due to the interruptions each cup requires a new
blessing.
In this
article we have dealt with the halachic problems directly touching upon medical
treatment at hot springs. But it important to note that we have not discussed
other problematic areas that arise indirectly.
Among the
problems we have not dealt with are: squeezing water from towels on Shabbat;
carrying towels to a spring on Shabbat;[56]
swimming; frequently springs dedicated to idol worship;[57]
straying from a religious life style;[58]
influence of non-Jewish cultural values; desecration of Shabbat;[59]
lessening of Torah Study; and the availability of kosher food.[60]
There are also halachic problems which, as far as I
know, are not discussed in medieval rabbinic literature even though they in
fact existed in those days. For example, men and women bathing together, which
was quite common in the Middle Ages, especially in Germany. Such mixed bathing
involved much revelry and immodesty and was accompanied by music and the
consumption of wine.[61]
Major changes in the fabric of modern society have
exacerbated the problems of immodesty in mixed bathing. Further, technological
developments have led to new problems of desecrating Shabbat through the use of
electrical devices, such as pumps, lighting, etc.
[1] Medical
use of health springs in Israel has been discussed in various scholarly forums.
For example, see A.S. Hirschberg, “Mekomot ha-Marpe be-Erets Yisrael,” in Ha-Tekufa 6 (5680), pp 242-244; M. Buchmann,
“Mi-Toldot Hammei Teverya,” in Erets Kineret (publ.: WZO, Jerusalem, 5711), pp 157-166; S.
Twig, “Merhatsot marpe
be-Yisrael,” in Kardom 1, 6 (1979), pp. 27-28;
Y. Hirschfeld, “ha-Merhatsot
ha-Romiyyim,” in Derech
Erets (Tel Aviv, 5743), pp. 209-213; Y. Hirschfeld, “Mekom Mayim Yafim,” in Sekira Historit Archiologit, Ariel 55-56 (1988), pp. 9-30; E. Yekutieli-Cohen, Perakim
mi-Toldot Hammei Teverya, Mi-Tuv Teverya 6 (5748), pp. 22-27. On health spas in other
parts of the world, see references infra.
[2] See
A. Dworzecki, Hammei Marpe be-Erets Yisrael, Doc.
Diss., Hebrew University, 5752, pp. 14-19; M. Buchmann,
Tverya u-Maayanoteiha ha-hammim, (Tverya, 5716), pp. 2-5.
[3] Heath
spas in Israel have been described by geographers and pilgrims through the
generations. The impressions of medieval visitors are surveyed by A. Lev, Samemei ha-Marpe (Tel Aviv,
5762), p. 53.
[4] See
Y. Kolton, “Maayanot
le-Hofei Yam ha-Melah,” in Midbar
Yehuda (ed. S. Ilan;
publ.: ha-Hevra le-Hagganat
ha-Teva; n.d.), pp. 66-67.
[5] See.
R. Yankelovits, “Hammei Teverya,” Mi-Tuv Teverya 6 (5748), p. 16.
[6] See.
A. Dworzecki, supra n.2, pp. 136-142; Buchmann, supra n. 2, p 29.
[7] A.
Dworzecki, “Seggulat Hammei ha-Marpe,” in 11th
World Conference for Jewish Studies (Sect. 2, vol. 1; Jerusalem, 5754), pp.
40-42. See further E. Dvorjetski, “Medical Hot
Springs in Eretz-Israel,” in ARAM Periodical 4
(1992), pp. 425-449.
[8] Health
spas around the Dead Sea have been described by Greek and Roman writers. They
mentioned the characteristics of the spas and even recommended bathing there.
For example, Pliny the Elder mentions the medical value of the springs of Kalliroë in Transjordan (Naturalis
Historia, 74,5). See further Dworzecki,
supra n. 7, p. 43.
[9] See
Lev, supra n. 3, p. 53
[10] For
example, Rabbi Sh. Swadron (1835-1911) discussed
divorcing a weak wife suffering from a severe cough who had been referred to
therapeutic baths (Resp. Maharsham 3:327).
[11] See,
for example, Rabbi Ts. Flekeles, Resp. Teshuva mi-Ahava 1:26 and
1:57.
[12] Rabbi
Yaakov Moelin, Resp. Maharil
ha-Hadashot, 204:2.
[13] Resp.
Maharsham 4:142 and 6:83; Rabbi A. Bornstein, Resp.
Avnei Nezer Even ha-Ezer 67 and O.H. 395.
[14] Rabbi
Eshtori ha-Parhi, Sefer Kaftor va-Ferah, ch. 7.
[15] See
L. Kourland, “Maayanot Refu’iyyim,” in Enc. Ivr.
24, p 47.
[16] Summarized
in Sh.Y. Zevin (ed.), Enc.
Talm. 16, pp. 44-52.
[17] In
various Talmudic sources there are reports of Sages going for cures at health
spas. See, for example, Pal. Talm. Shvi’it 9:1 (=folio 38d) and Kohelet
Rabba 5:14.
[18] This
discussion involves the Passover sacrifice which must be roasted or, perhaps,
cooked in a hot spring. There are no such hot springs in the Jerusalem area.
See Enc. Talm., supra n. 16, s.v. hammei teverya, p. 45.
[19] Some
hold that this liquid derives from date palms. Regarding the expression mei deqalim, see I.
Loew, Die Flora der Juden 2:346.
[20] Z
Vilnay, Aggadot Erets Yisrael, pp. 304-305.
[21] Tamar
Hindi was used as purgative in the Middle Ages as well. See, for example, Rabbi
Menahem ibn Zerah, Tseida la-Derech, 1:3, ch. 10, folio
31a.
[22] R.
Moshe ben Maimon, Hanhagat ha-Bri’ut
(ed. S. Munter), p. 47, n. 67.
[23] Cf.
Mishna Torah, Hilchot
Shabbat 21:29, where only bathing, not drinking, is considered purgative.
Rabbi Moshe ben Nachman
ascribes other curative powers to water: “The water of the hot springs of Tiberias is fit to drink. It is not bitter but only the
sick drink it (Milhemet ha-Shem,
Shabbat 18a in the pagination of the Rif). Therapeutic drinking of the water
from the hot springs of Tiberias was known in the 12th
century as evidenced by the pottery used for the purpose. Such pottery has been
found in the building used by patients being treated there. An inscription
found on the pottery attests to the waters effects on the stomach. See A. Dworzecki, “Terumat ha-geniza ha-kahirit le-heker hammei ha-mirpa,” in 12th World Conference for Jewish
Studies, Pt. 2, p 87
[24] Some
surmise that these cups were the kasayya tiveriyya mentioned in the Talmud (Nidda
21a). See Y. Schwarz, “Hayyei yom
yom be-Tverya,” in Idan 11 (1988), p. 1-4.
[25] According
to the Babylonian Talmud (Shabbat 147b), the beverages were effective only
between Passover and Shavuot. It must be assumed that during this period of
time the springs produced a greater flow with a higher mineral concentration.
[26] The
word translated here as “ichor” seems to refer to a
liquid derived from organic manure or a product of its fermentation; cf. German
Jauche. As we shall see later, foul liquids
were often considered therapeutically effective.
[27] “Cup
of roots”is a medical beverage used to treat jaundice
and to prevent pregnancy (Shabbat 110a).
[28] According
to the Tosefta (Terumot,
ed. Lieberman, 10:11, rinsing the sandal was intended to soften it.
[29] This
is the halachic decision of the Beit
Yosef (O.H. 432).
[30] See,
for example, Resp. Avnei Nezer
(O.H. 395).
[31] This
is the idea of Rabbi Eliezer Valdinberg:
“Perhaps this is why no blessing is pronounced on them because drinking them
pierces the gall bladder.” See Rabbi Eliezer Yehuda Valdinberg, Resp. Tsits Eliezer 12:1.
[32] Regarding
the blessing to be said over mineral water see, for example, M. Benyahu, Ma’amarim be-refu’a le-Rabbi Raphael Mordechai
Malki, p. 156.
[33] And
see Resp. Tsits Eliezer
8:15, ch. 15.
[34] Sefer Kol Sofer (Muncacz, 5641) ad
Shabbat 14:68.
[35] Regarding
the use of sugar in sweetening medicines, see A.O. Shemesh,
“Kitvei ha-Rishonim ve-ha-Aharonim,” in Korot
16, pp. 84-85.
[36] Divrei Sha’ul (i.e.,
Sefer Yosef Da’at; Lvov, 5638-5639), no. 23.
[37] Rabbi
Sh. Schwadron, Resp. Maharsham
6:38.
[38] There
were a number of steps in preparing flax fibers: the stalks were dried in the
sun. Then they severed the seeds from the stalk. The stalks were then soaked in
water to soften them. They were removed from the water, squeezed and dried. The
next step was nipputs, grinding the stalks to
remove the fibers. Finally, the fibers were combed in order to clean them. See
A.S Hirschberg, Hayye ha-Tarbut be-Tefufat ha-Mishna ve-ha-Talmud (Warsaw,
6684), pp. 71-78.
[39] In
the Tosefta (ed. Zuckermandel;
Tohorot 6:78) we find mention of the hot springs at Hamatan. See Sh. Lieberman, Tosefet
Rishonim 4.
[40] Regarding
Assia, see Hullin 48a
[41] Tur (O.H. 326).
[42] Bayit Hadash O.H.
326. Cf. Eliyahu Rabba,
ibid., who wrote that only therapeutic bathing is customary there.
[43] Rabbi
Sh. Z. of Liadi, Shulchan
Aruch 326:48.
[44] Rabbi
Raphael Meldola, Resp. Mayim
Rabbim, O.H. 1:25.
[45] Resp.
Mayim Rabbim 26.
[46] Rabbi
Yaakov Sofer, Kaf
ha-Hayyim, O.H. 328:253.
[47] Pal.
Talm. Mo’ed Katan 3:5 (folio 82d).
[48] In
accord with this principle many authorities through the generations have
permitted bathing on the Ninth of Av for those suffering from any illness. See,
for example, Rabbi Yosef ben
Moshe (15th century) who permitted bathing for those suffering from
the disease called zand (Leket
Yosher, p. 109, sect. b).
[49] S.
Munter identified this disease as acne. See his “Munahei Mahalot ha-Or” in HaRefu’ah 16 (5698). p. 3.
[50] See,
for example, Tosefta Trumot
(ed. Lieberman; 9:14). Cf. ibid. Shvi’it 6:4.
[51] Regarding
piloma, see Sh. Lieberman, Yevanim
ve-Yevanut be-Erets Yisrael,
p. 71, and M. Buchmann, “The Nature of Piloma,” in Acta Medica Orientalia 14 (1955),
pp.287-292.
[52] This
explanation is found in Rabbi Nathan of Rome’s Aruch
(ed. Kohut), s.v.
plm.
[53] Purging
the stomach was considered a physically therapeutic act. Cf. Berachot 57b.
[54] Regarding
the healthfulness of sweating, see J. Preuss, Biblisch- Talmudische Medizin, pp. 536-537.
[55] Z.
Vilnay, Aggadot Erets Yisrael: ha-Shefeila,
ha-Hof, ha-Negev, ha-Galil, p 135.
[56] See
Shabbat 22:5; Rabbi Yaakov Reischer, Resp. Shevut Yaakov 2:7
[57] Regarding
the concern of gentile practices at spas, see Hirschberg, Mekomot
ha-Mirpa be-Erets Yisrael,
pp. 242-244.
[58] Shabbat
147b.
[59] Resp.
Mayim Rabbim 25-27.
[60] See
Rabbi Hayyim Elazar Shapira of Muncacz, Sefer Darchei Hayyim ve-Shalom 564. See
also his Minhat Elazar
5:31 and Rabbi Y. Weiss, Minhat Yitshaq 10:92.
[61] For
example, the spa at Leukerbad in Switzerland
(depicted in the woodcut by Hans Bosch the Elder) and the therapeutic baths of Plombières (woodcut by de Valna,
Jutna, Venice, 1553). On the other hand, a woodcut
from the year 1556 showing therapeutic baths at Piermonte
indicated separation of the sexes. See R. Margutta, Toledot ha-Refu’ah
(Jersualem, 5761), pp. 66-67.