Volume 47 Number 21
                    Produced: Thu Mar 10  6:04:09 EST 2005

Subjects Discussed In This Issue: 

Measuring time vs. keeping track of time
         [Mike Gerver]
Metzitzah B'peh (3)
         [Nachum Klafter, Frank Silbermann, Eitan Fiorino]
News from Israel
         [Shmuel Himelstein]


From: <MJGerver@...> (Mike Gerver)
Date: Mon, 7 Mar 2005 04:05:55 EST
Subject: Measuring time vs. keeping track of time

In Berachot 3b (last Thursday's daf yomi), Rabbi (Yehuda ha-Nasi) and R.
Natan argue about how many mishmarot (night watches) the night is
divided into. Rabbi, arguing for four mishmarot of 3 hours each, cites
two psukim from Tehillim, Ps. 119:62 and Ps. 119:148, to argue that when
David ha-Melekh woke up at midnight, there were still a plurality of
"mishmarot" ahead of him, i.e. at least two mishmarot, before dawn (6
a.m.), and hence each mishmarah was 3 hours. R. Natan counters this
argument by saying that David was not talking about the number of
mishmarot before dawn, but the number of mishmarot before the time that
other kings would wake up, at the beginning of the third hour of the
day, i.e. at 8 am, hence there were two mishmarot of four hours each
ahead of him.

R. Natan's argument does not seem unusual to us today, but in fact, it
was highly innovative and way ahead of its time. This is because of the
distinction between measuring time and keeping track of time, a
distinction that I first read about in Geza Szamosi's book "The Twin
Dimensions: Inventing Time & Space" (McGraw-Hill, 1986), on p. 95.
Keeping track of time means knowing what hour of the day it is, or what
day of the week or month, or what time of the year. People have been
doing that for thousands of years, using the sun and stars initially,
and later hour glasses and clocks of various kinds. But it is only in
the last several hundred years that most people have thought of time as
a quantity, like distance or weight, that could be measured in terms of
some unit. Nowadays, we think of an hour primarily as a unit of
time. But originally the word "hour" in English, and "sha'ah" in Hebrew,
were only used to designate times of day, e.g. the first hour, the
second hour. The Rambam, in Kiddush HaChodesh 7:4, describes the molad
as being at "nine hours and 204 chalakim from the tenth hour." We would
say "nine hours and 204 chalakim" and would not feel the need to say
"from the tenth hour," because we think of an hour as primarily a unit
of time, rather than primarily as a way of designating a time of
day. But even as late as the Rambam's time, an hour was only a way of
designating a time of day, and not a unit of time. The period from 7:30
to 8:30 would not have been considered to be one hour, but to be the
last half of the seventh hour and the first half of the second
hour. Calling this period "one hour" would have been considered a
far-fetched metaphor at best.

Szamosi argues that the idea of measuring time, and hence using time as
an independent variable, evolved from the need to develop notation to
represent the lengths of notes in polyphonic music, so that different
singers or groups of singers could keep together properly. This notation
was developed over a period of a few hundred years starting in the late
1100s CE, primarily by Christians, but also by Jews such as the Ralbag
(Levi ben Gershon) in Provencal the 1300s. He also argues that the
inability to treat time as an independent variable was the primary thing
that prevented Galileo's law of the motion of falling bodies, and hence
Newton's laws, from being discovered long before they were.

R. Natan's referring to the period from 12:00 midnight until 8:00 am as
"two mishmarot" was highly unusual in his time (late 2nd century CE),
since it uses "mishmar" as a unit of measurement, rather than as a
designation of a time of day. The actual mishmarot, according to R.
Natan, would run from 6 pm to 10 pm, from 10 pm to 2 am, and from 2 am
to 6 am, so 12 midnight to 8 am would not normally have been thought of
as "two mishmarot." Determined to answer Rabbi's argument, and quite
willing to use creative and far-fetched metaphors to do so, R. Natan
stumbled across a concept that was more than a thousand years ahead of
his time.

Interestingly, R. Natan was not the only person to do so, although as
far as I know he was the first. The Christian philosopher Augustine of
Hippo, according to Szamosi, in the 5th century CE, advocated the notion
of time as a quantity which could be measured independently of motion,
for example by reciting poetry of a given meter at a constant rate (the
equivalent, I guess, of saying "one one thousand, two one
thousand,...").  But Augustine's ideas about time did not catch on or
have any influence on philosophy for hundreds of years, and neither,
apparently, did R.  Natan's innovative argument in Berachot 3a.

Mike Gerver
Raanana, Israel


From: Nachum Klafter <doctorklafter@...>
Date: Mon, 7 Mar 2005 01:04:13 -0500
Subject: RE: Metzitzah B'peh

> From: David Mescheloff <david_mescheloff@...>

> I would like to share with mail-Jewish friends what may be a new
> thought on this issue.
> [snip]
> The VAC uses a specialized foam, which is slathered on the wound, then
> covers the area in an airtight seal. A pump that produces subatmospheric
> pressure draws out fluids, enabling the body to heal faster by returning
> blood flow to the damaged area.
> [snip]
> I imagine that no
> mechanical "pump that produces subatmospheric pressure" can be as
> sensitive and as finely tuned so as to draw blood in just the right
> amount to the area of the infant's fresh incision - not too much so as
> to do harm to the wound, but not so little as to be ineffective - as the
> experienced, trained human mouth of the mohel.

I think that Rabbi/Dr. Mescheloff is greatly misinformed.  This surgical
device has no application for circumcisions, nor do the strategies it
employs to promote wound healing.  The surgical device about which he
has read applies constant low pressure to the tissue through the area
which is sealed with the special foam.  It is not a one time sucking
action; it goes on for weeks at a time.  Also, it is used on wounds
where healing is a major challenge, such as burns where large amounts of
skin are lost.  These wounds can take weeks or even months to heal.
Many of them require skin grafts, and the grafted tissue is very
vulnerable.  Visit a surgical intensive care unit of any metropolitan
hospital and you will find burn patients there for many weeks at a time.

Sucking on the circumcision wound does not create an airtight seal.
There is not "special foam" that is put on after the metzitzah is done.
Once the metzitzah is done, a bandage is immediately applied.  No low
pressure situation is achieved.  The skin of infants heals extremely
well, in general.  A neonate's penis does not require extra effort to
get blood there.  There is plenty of blood.  In fact, bleeding is one of
the frequent complications of brissin.  Many mohalim make use of special
preparations which stop the bleeding.

There are three things which speed up wound healing for circumcision:
1) Avoiding infections
2) Keeping the size of the gap between the inner and outer layers of the
foreskin remnant as small as possible.  Preferably, these edges should
be touching, and expert mohalim achieve this when they apply the
3) Minimizing bleeding

The best way to do this is to use the Bronstein Mogen Clamp.  Some
poskim forbid this instrument, however, and it is therefore not an
option for the mohalim who do not want to rely upon this heter.

Even if one day we were to discover that metzitzah is beneficial for
healing (which I very highly doubt will ever happen) this would not be
relevant to our present situation where there is a total consensus among
ALL pediatric urologists that sucking out blood does NOT help healing.
I challenge anyone to find a pediatric urologist or obstetrician who
recommends sucking on circumcision wounds for the millions of non-Jewish
baby boys circumcised each year worldwide.

Metzitzah was an ancient medical practice which was thought to be
helpful for wounds in the times of Hazal and throughout the middle ages.
Doctors believed that saliva was beneifical to wounds as recently as the
early 20th century.  There is a peculiar book called Bris Kerusa Bein
Ha-Sefasayim which makes the case for direct oral metzitzah, and cites
medical scientific papers from the 2nd and 3rd decade of the 20th
century which state that salive helps wounds heal.  This is no longer an
accepted medical notion.

The fact that Chazal accepted medical or scientific teachings of their
era which, in modern times, have been revised or disproved should NOT
lessen our respect for Chazal.  Chazal were experts in Torah.  The
greatest scientific minds of their times believed many things about the
universe which we no longer accept.  Chazal tentatively accepted the
findings of the greatest scientists and doctors of their era because
they realized that physics, chemistry, and medicine were not part of the
revelation at Har Sinai, and that they therefore had no special or
secret knowledge put them on any better footing in science or medicine
than anyone else in their generation.  I think it is hard for people who
have not studied science to realize how much our conception of the world
around is determined by our generation.  If we lived in times when
everyone thought the earth was flat, or that the moon and stars were not
made of the same type of matter as the earth, etc., 99.99999% of us
would never question these notions.  It is easy, retrospectively, to
look back at the ancient or medieval world and feel like we are of
superior intelligence because so many of their notions seem preposterous
to us.  That would be a poor understanding, however, of how knowledge
progresses, and how dependent each of us is on what information we are
privy to in forming our views of the world around us.

Nachum Klafter, MD
Assistant Prof. of Clinical Psychiatry  
University of Cincinnati College of Medicine.

From: Frank Silbermann <fs@...>
Date: Mon, 7 Mar 2005 10:10:21 -0600 (CST)
Subject: Metzitzah B'peh

Is this practiced with adult converts?  When I became observant (in my
30s), I was told that I would need a drop of blood drawn because my
circumcision was performed by an M.D. in a hospital on the third day.
I'm pretty sure Metzitzah B'peh wasn't done the first time, and I
remember distinctly that it wasn't done the second time.

(Since circumcision is a bigger ordeal when performed on adults, I would
presume that any medical benefit of metzitzah b'peh would be extra
relevant in that case.)

Frank Silbermann	New Orleans, Louisiana		<fs@...>

From: Eitan Fiorino <Fiorino@...>
Date: Mon, 7 Mar 2005 12:36:47 -0500
Subject: RE: Metzitzah B'peh

Rabbi Dr. David Mescheloff suggested that the purpose of metzitza b'peh
may not have been simply to disinfect the wound, but as a method of
vacuum-assisted wound closure (VAWC, a technique of applying gentle
pressure to wounds to promote healing) and that in fact "the
experienced, trained human mouth of the mohel" might be the ideal system
for promoting wound healing of the wound of a brit mila.  In other
words, before we toss about the idea of discarding metzitza b'peh me
must consider that the true medical rationale of chazal may not be known
to us, and that maybe it has nothing to do with preventing infection but
rather has to do with promoting would healing (these are really two
connected processes but that is another story).

He quoted extensively form a news story describing a patent dispute
between 2 companies selling 2 forms of VAWC devices.  Indeed,
superficially one might think that the suction applied by the mohel's
mouth might resemble vacuum-assisted wound closure.

First I think the entire argument is moot because any purported wound
healing benefits from the suction of metzitza b'peh would happen as a
result of metzitza performed with a glass tube.

Second, VAWC works by providing negative pressure to a wide wound
surface (such as a pressure ulcer or diabetic ulcer) over a period of
time - days to weeks - which is quite different than the several seconds
of negative pressure applied to the wound by metzitza.  In fact, the
concept of VAWC is very likely not even applicable to the healing of
small, shallow linear incisions (such as the wound of a brit milah), in
which the wound quickly re-epithelializes - chronic or intermittent
application of negative pressure to such an incision might in fact
actually delay the healing process.



From: Shmuel Himelstein <himels@...>
Date: Wed, 09 Mar 2005 06:01:35 +0200
Subject: News from Israel

Yediot Acharonot of 8 March carried two items of interest in the Jewish

a) R' Vozner, one of the leading Poskim in Bnei Brak, ruled that if
anyone sells caps or fireworks, one is permitted to report him to the
police because of the dangers of these products.

b) A seminar was held on Charedim in Israel, and the findings are very
interesting, including the following:

a.  There are no fewer than 40 Charedi papers in the country

b.  At least 12 health clubs for Charedi women were opened in the last

c.  36% of Charedi families went on vacation in the last year

d.  82% of the families have at least one cellular phone, but unlike the
other groups, these phones are not given to young people.

e.  Between 20-25% of all food sold now has a Mehadrin Hechsher. One of
the reasons for this is that non-religious people often buy at Charedi
supermarkets, which are cheaper. Further, of the National Religious
stream, 45% can be classified as "Chardal," or "Chareidi Dati Leumi,"
whose food buying patterns are like those of the Charedim.

f.  The percentage of men in the "Litvak" stream learning full time has
gone down from 60% a few years ago to 30% today.

g.  In the next ten years they expect a massive entry of Charedim into
the job market, including jobs which require academic degrees.

h.  55% of families have a home computer

Shmuel Himelstein


End of Volume 47 Issue 21