More Discussions for this daf
1. Buying a Korban from Nochri in Temple times 2. Yotzei Dofen
DAF DISCUSSIONS - AVODAH ZARAH 23

Kosofsky, Samuel (ACS) asks:

Rebbe,

(Your website "ask a question," section wouldn't take my math answer)

Today's daf raises the question of whether a yotzei dofen, a child born by caesarian section, is a vlad maalya, a regular child or not. Rashi quotes masechte nida that the discussion entails whether there is tumat leyda and days of dmei tahara or not. Is this an academic discussion or halacha l'maase? Could a C section have been performed in Chazal's days and the woman have lived? Did they actually perform operations and suture up the wounds? It seems to me that this procedure wasn't developed until sometime in the 19th Century and wouldn't have been performed on a live woman in those days. Perhaps it was doable and simply wasn't recorded.

B'kavod,

Sam Kosofsky

The Kollel replies:

It would seem from the halachic discussions in the Talmud that this was not just an academic question, as the Gemara (Bechoros 19a) discusses also whether the calf born after a Yotzei Dofen is considered a Bechor, and if an animal could survive such an operation, possibly people also did.

We do not have a historical record of mothers surviving such a birth until the 16th century, and the mortality rate remained at 100% until the end of the 19th century. It is still possible, however, that a few women survived in ancient times but the matter was not recorded in the medical books of Hippocrates or Galen.

The term c-section is often erroneously attributed to Julius Caesar. (The 10th-century Byzantine-Greek historical encyclopedia "The Suda" reads, "For when his mother died in the ninth month, they cut her open, took him out..."), but historians question this as there is no ancient record of mothers having survived such an operation and Caesar's mother lived a long time after his birth.

Actually, the Latin term "caedo" means "to cut," so "Caesar" -- both as the name for the man and for the procedure -- might derive from some form of the word. However, the Roman historian Pliny the Elder says that the word refers to one of Caesar's antecedents who "was so named from his having been removed by an incision in his mother's womb," and not to Julius Caesar.

Yoel Domb

Martin Schejtman asks:

Dear Rav,

I can't understand your remarks about c-section survival rates. Why would the Gemara here, and the Mishnah in Bechorot 8:2 (also see an incredulous Ramba"m therein, quoted below) discuss a procedure where the mother would die almost for sure? Would it even be halachically acceptable to perform a c-section knowing the mother would die?

Ramba'm quote:

יוצא דופן והבא אחריו שניהם אינן בכור לא כו': מה שאפשר להיות בזה שתהא האשה מעוברת משני וולדות ונקרע דופנה ויצא א' מהן ואח"כ יצא השני כדרך העולם ומתה אחר שיצא השני אבל מה שאומרים המגידים שהאשה חיה אחר שקורעים דופנה ומתעברת ויולדת איני יודע לו טעם והוא ענין זר מאד ואין הלכה כרבן שמעון:

To answer one of the questions below, it seems that surgical suture has existed for millennia (see wikipedia quote below).

Wikipedia quote starts here:

Through many millennia, various suture materials were used, debated, and remained largely unchanged. Needles were made of bone or metals such as silver, copper, and aluminium bronze wire. Sutures were made of plant materials (flax, hemp and cotton) or animal material (hair, tendons, arteries, muscle strips and nerves, silk, and catgut).

The earliest reports of surgical suture date to 3000 BC in ancient Egypt, and the oldest known suture is in a mummy from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician Sushruta, written in 500 BC.[23] The Greek father of medicine, Hippocrates, described suture techniques, as did the later Roman Aulus Cornelius Celsus. The 2nd-century Roman physician Galen described gut sutures.[24] In the 10th century the manufacturing process involved harvesting sheep intestines, the so-called catgut suture, and was similar to that of strings for violins, guitar, and tennis racquets.

End of wikipedia quote

Lastly, I can't understand precisely what Ramba"m does not believe: he doesn't believe c-sections are survivable at all or he doesn't believe a woman can give birth through a c-section and then have another child (presumably because the uterus would rupture in the 2nd pregnancy and kill the mother, as often happened in the not so distant past to women with a previous c-section)?

Brachah,

martin

The Kollel replies:

We can presume with some certainty that maternal mortality was very high in ancient times, and that in many cases the mother was clearly dying from the birth itself (e.g. when the birth process had complications). In these cases only an emergency c-section could have saved the baby and it was probably performed quite frequently, as just as we say אין דוחין נפש מפני נפש to save the mother, the same would apply to saving her child. It is possible as you wrote that sutures might have been performed on the uterus in an attempt to save the mother as well and this might have succeeded in rare cases.

Rashi in Nidah 40a writes that there was a special herb given to a woman which would enable her stomach to open in order to remove the fetus and also enable her to be cured. Preuss in his monumental "Biblical and Talmudic Medicine" (p. 424) attempts to explain which herb was used for this purpose. (I don't have the book at present so I can't quote the source.) The Chazon Ish (Emunah u'Bitachon 5:3) also concludes that ancient medicine may have had solutions for this operation.

Regarding the Rambam you quoted, he would seem to be denying even the possibility of a woman surviving a c-section and therefore he sought to explain the Mishnah as referring to a multiple birth. Other Rishonim also explain that this operation was performed only after the death of the mother and they believe that in some cases the child may survive its mothers death (Rashi, Chulin 38b; Tosfos, Chulin 38a, DH Ela).

Yoel Domb