The Gemara challenges: This verse is necessary for teaching a different halakha, that which the school of Rabbi Yishmael taught. As the school of Rabbi Yishmael taught: When the verse states: “Verappo yerappe,” from here it is derived that permission is granted to a doctor to heal. The Gemara answers: If so, let the verse write: Verofeh yerappe, meaning: And a doctor shall heal. Learn from the phrase employed that the one who caused the injury is liable to give monetary compensation for medical costs in a case of damage.

When King David said: At midnight I rise, the assumption is that he rose precisely at midnight. The Gemara asks: Did David know exactly when it was midnight? Even Moses our teacher did not know exactly when it was midnight. How do we know this about Moses? As it is written that he said to Pharaoh: “Thus said the Lord: About midnight, I will go out into the midst of Egypt” (Exodus 11:4). The word about indicates that it was only an approximation. The Gemara clarifies: What is the meaning of the expression: About midnight? Did Moses say it or did God say it? If we say that the Holy One, Blessed be He, Himself, said: About midnight, toMoses, is there doubt before God in heaven? Rather, this must be understood as follows: God toldMoses: At midnight, but from the fact that whenMosescame to Pharaohhe said: About midnight; apparently, Moseswas uncertain about the exact moment of midnight. Moses, the greatest of all the prophets, was uncertain, and David knew?The Gemara offers several answers to this question:
David had a sign indicating when it was midnight. As Rav Aḥa bar Bizna said that Rabbi Shimon Ḥasida said: A lyre hung over David’s bed, and once midnight arrived, the northern midnight wind would come and cause the lyre to play on its own.Davidwould immediately rise from his bed and study Torah until the first rays of dawn.Once dawn arrived, the Sages of Israel entered to advise him with regard to the various concerns of the nation and the economy. They said to him: Our master, the king, your nation requires sustenance.He said: Go and sustain one another, provide each other with whatever is lacking.
The Sages of Israel responded to him with a parable: A single handful of food does not satisfy a lion, and a pit will not be filled merely from the rain that falls directly into its mouth, but other water must be piped in (ge’onim). So too, the nation cannot sustain itself using its own resources.
King Davidtold them: Go and take up arms with the troops in battle in order to expand our borders and provide our people with the opportunity to earn a livelihood.

The Gemara stated that fire was originally created at the conclusion of Shabbat. The Gemara asks: Was fire created at the conclusion of Shabbat? Wasn’t it taught in a baraita: Ten miraculous phenomena were created in heaven on Shabbat eve during twilight, and were revealed in the world only later? They were:Miriam’s well, and the manna that fell in the desert, and the rainbow, writing [ketav], and the writing instrument [mikhtav], and the tablets of the Ten Commandments, and the grave of Moses, and the cave in which Moses and Elijah stood, the opening of the mouth ofBalaam’s donkey, and the opening of the earth’s mouth to swallow the wicked in the incident involving Korah. Rabbi Neḥemya said in the name of his father: Even the fire and the mule, which is a product of crossbreeding, were created at that time. Rabbi Yoshiya said in the name of his father: Even the ram slaughtered by Abraham in place of Isaac, and the shamir worm used to shape the stones for the altar, were created at that time. Rabbi Yehuda says: Even the tongs were created at this time. He would say: Tongs can be fashioned only with other tongs, but who fashioned the first tongs? Indeed, the first pair of tongs was fashioned at the hand of Heaven. An anonymous questioner said to him: It is possible to fashion tongs with a mold and align it without the need for other tongs. Indeed, the first tongs were a creation of man. In any event, fire was originally created before Shabbat, not at the conclusion of Shabbat. The Gemara answers: This is not difficult. Thisbaraita is referring to our fire, and thatbaraita is referring to the fire of Gehenna. The Gemara explains: Our fire was created at the conclusion of Shabbat, but the fire of Gehenna was created on Shabbat eve. The Gemara proceeds to ask: Was the fire of Gehenna created on Shabbat eve? Wasn’t it taught in a baraita: Seven phenomena were created before the world was created, and they are: Torah, and repentance, and the Garden of Eden, and Gehenna, and the Throne of Glory, and the Temple, and the name of Messiah.The Gemara provides sources for the notion that each of these phenomena was created before the world was. Torah was created before the world was created, as it is written: “The Lord made me as the beginning of His way, the first of His works of old” (Proverbs 8:22), which, based on the subsequent verses, is referring to the Torah. Repentance was created before the world was created, as it is written: “Before the mountains were brought forth, or ever You had formed the earth and the world, even from everlasting to everlasting, You are God,” and it is written immediately afterward: “You return man to contrition; and You say: Repent, children of man” (Psalms 90:2–3). The Garden of Eden was created before the world was created, as it is written: “And God planted the Garden of Eden in the east [mikedem]” (Genesis 2:8). The term: In the east [mikedem] is interpreted in the sense of: Before [mikodem], i.e., before the world was created. Gehenna was created before the world was created, as it is written: “For its hearth is ordained of old” (Isaiah 30:33). The hearth, i.e., Gehenna, was created before the world was created. The Throne of Glory and the Temple were created before the world was created, as it is written: “Your Throne of Glory on high from the beginning, in the place of our Sanctuary” (Jeremiah 17:12). The name of Messiah was created before the world was created, as it is written in the chapter discussing the Messiah: “May his name endure forever; his name existed before the sun” (Psalms 72:17). The name of Messiah already existed before the creation of the sun and the rest of the world. This baraita states that Gehenna was created before the world was created and not during twilight before the first Shabbat. They say in answer: The void of Gehenna was created before the world, but its fire was created on Shabbat eve.The Gemara asks: And was its fire created on Shabbat eve? Wasn’t it taught in a baraita that Rabbi Yosei says: The fire that the Holy One, Blessed be He, created on the second day of the week will never be extinguished, as it is stated: “And they shall go forth, and look upon the carcasses of the men who have rebelled against Me; for their worm shall not die, nor will their fire be extinguished; and they shall be an abhorrence to all flesh” (Isaiah 66:24)? And Rabbi Bana’a, son of Rabbi Ulla, said: Why doesn’t the verse state: That it was good, at the end of the second day of the week of Creation, as it does on the other days? It is because on that day the fire of Gehenna was created. And Rabbi Elazar said that even though: That it was good, was not stated with regard to the creations of the second day, He later included it on the sixth day, as it is stated: “And God saw all that He had done and behold, it was very good” (Genesis 1:31). Rather, the void of Gehenna was created before the world was created, and its fire was created only on the second day of the week. And the thought arose in God’s mind to create our fire on Shabbat eve; however, it was not actually created until the conclusion of Shabbat, as it was taught in a baraita that Rabbi Yosei says: The thoughts of two phenomena arose in God’s mind on Shabbat eve, but were not actually created until the conclusion of Shabbat. At the conclusion of Shabbat, the Holy One, Blessed be He, granted Adam, the first man, creative knowledge similar to divine knowledge, and he brought two rocks and rubbed them against each other, and the first fire emerged from them. Adam also brought two animals, a female horse and a male donkey, and mated them with each other, and the resultant offspring that emerged from them was a mule. Rabban Shimon ben Gamliel disagrees and says that the first mule was in the days of Anah, as it is stated: “And these are the children of Zibeon: Aiah and Anah; this is Anah who found the mules in the wilderness, as he fed the donkeys of Zibeon his father” (Genesis 36:24). The interpreters of Torah symbolism [ḥamurot] would say: Anah was the product of an incestuous relationship, and as a result he was spiritually unfit to produce offspring. Therefore, he brought an example of unfitness, i.e., an animal physically unfit to produce offspring, into the world, as it is stated: “These are the sons of Seir the Horite, the inhabitants of the land: Lotan, and Shoval, and Zibeon, and Anah” (Genesis 36:20). And it is also stated: “And these are the sons of Zibeon: Aiah and Anah” (Genesis 36:24). One verse describes both Anah and Zibeon as sons of Seir, meaning that they are brothers, while the other verse describes Anah as Zibeon’s son. Rather, this teaches that Zibeon cohabited with his mother, the wife of Seir, and fathered Anah from her. He is called Seir’s son although in fact he was the offspring of Seir’s son and Seir’s wife. The Gemara asks: And perhaps there were two people named Anah, one the son of Zibeon and the other the son of Seir? Rava said: I will state a matter that even King Shapur did not state. And who is this King Shapur? This cannot be a reference to Shapur, king of Persia; rather, it must be an epithet for someone else. He is Shmuel, whose legal rulings were accepted by the public like the edicts of a king by his subjects. Some say a different version, that it was Rav Pappa who said: I will state a matter that even King Shapur did not state. And who is he that Rav Pappa is referring to by the epithet King Shapur? He is Rava. The verse said: “This is Anah who found the mules,” indicating that he is the same Anah mentioned initially in the earlier verse.

Hannah further said: “Neither is there any rock [tzur] like our God” (I Samuel 2:1). This can be understood as saying that there is no artist [tzayyar] like our God. How is He better than all other artists? Man fashions a form upon a wall, but is unable to endow it with breath and a soul, or fill it with innards and intestines, whereas the Holy One, Blessed be He, fashions a form of a fetus inside the form of its mother, rather than on a flat surface, and endows it with breath and a soul and fills it with innards and intestines.

The mishna taught that Rabbi Shimon ben Elazar says: Have you ever seen a beast or a bird that has a trade? It is taught in the Tosefta (5:13): Rabbi Shimon ben Elazar says: I never saw a deer work as one who dries figs, nor a lion work as a porter, nor a fox work as a storekeeper. And yet they earn their livelihood without anguish. But all these were created only to serve me, and I, a human being, was created to serve the One Who formed me. If these, who were created only to serve me, earn their livelihood without anguish, then is it not right that I, who was created to serve the One Who formed me, should earn my livelihood without anguish? But I, i.e., humanity, have committed evil actions and have lost my livelihood, as it is stated: “Your iniquities have turned away these things, and your sins have held back good from you” (Jeremiah 5:25).

(6) What do the words in our work and in the toil of our hands (ibid.) imply? Prior to Noah’s birth, men did not reap what they sowed. They would sow wheat and reap thorns and thistles, but when Noah was born, the world reverted to normal: Wheat was sown and wheat was reaped; barley was sown and barley was reaped. Furthermore, prior to Noah’s birth, men performed all their labor by hand, as it is written: And in the toil of our hands, but after Noah was born, plows, scythes, axes, and other implements were introduced.

(6) A certain philosopher once asked Rabbi Hoshaya, saying to him: ‘If circumcision is so dear to Him [God], why was it not given to Adam the first man?’ He said to him: ‘Why does this man [the philosopher] shave the corner of [the hair on] his head but leave the corner of his beard?’ He replied: ‘It is because this [the head hair] grew with him in his period of foolishness.’ He said to him: ‘If so, he should put out his eye, sever his hands, and break his legs, because they too grew with him in his period of foolishness.’ He said to him: ‘Have we come to such [frivolous] arguments?’ This was a rhetorical question. He said to him: ‘It is not possible for me to dismiss you with no response at all. The explanation is that everything that was created during the six days of Creation requires some action [to bring it to its perfected state], e.g., mustard requires sweetening, lupines require sweetening, wheat requires grinding. And even man needs to be perfected.’

(1)“See the work of God, for who can mend what He has warped?” (Ecclesiastes 7:13)
“See the work of God, for who can mend what He has warped?” When the Holy One blessed be He created Adam the first man, He took him and showed him all the trees in the Garden of Eden, and He said to him: ‘See My creations, how beautiful and exemplary they are. Everything I created, I created for you. Make certain that you do not ruin and destroy My world, as if you destroy it, there will be no one to mend it after you. Moreover, you will cause death to that righteous one.’ To what is the matter of [the death of] Moses our master analogous? [It is analogous] to a pregnant woman who was incarcerated in prison. She gave birth to a son, raised him, and she died there. Sometime later the king passed the entrance of the prison. As the king was passing, that son began screaming and he said: ‘My lord the king, I was born here, I grew up here; I do not know due to what sin am I placed here.’ [The king] said to him: ‘Due to your mother’s sin.’ So too regarding Moses, as it is written: “Behold, the man has become like one [of us]” (Genesis 3:22). And it is written: “Behold, your days are drawing near to die” (Deuteronomy 31:14).

(1) (Lev. 12:3:) “And on the eighth day the flesh of his foreskin shall be circumcised.” It is not written here that one lays out expenses over circumcision. See how much Israel loves the commandments, how many expenses they lay out in order to observe them! The Holy One, blessed be He, said, “You make the commandments joyful; I am increasing your joy, as stated (in Is. 29:19), ‘Then the humble shall increase their joy in the Lord.’” Beloved is circumcision, such that the Holy One, blessed be He, swore to Avraham that anyone who is circumcised will not descend to Geihinnom, as stated (Genesis 15:18), “On that day, the Lord made a covenant with Avram, saying.” And who does descend there? See what is written below (Gen. 15:19), “The Kenite, the Kenizzite ….” And so did Ezekiel see, as stated (Ezekiel 32:18-30), “Son of man, wail upon the masses of Egypt and make it descend, and the daughters of mighty nations, to the lowest lands and those that fall in the pit. Who do you surpass in pleasantness, go down and lay with the uncircumcised…. Assyria is there with all of her congregation, its graves are around it…. Meshech and Tubal and all their masses are there, its graves are surrounding it, they are all uncircumcised…. The princes of the North are there….” And so does Isaiah says (Isaiah 5:14), “And so does the pit widen itself and opened wide its mouth without measure (chok),” to he that doesn't have a statute [the words — "without measure" — can also be rendered "to he that doesn't have a statute"]. And where [do we see that] it (the commandment to circumcise) is called a statue? As it says (Ps. 105:10) "And He established it unto Jacob for a statute, to Israel for an everlasting covenant," because the Holy One, blessed be He, placed His name with Israel. And what is the name and the seal that He placed in them? It is Shaddai, the shin is placed on the nose, the dalet on the hand, and the yud on the circumcision. Therefore when he goes to his eternal home, there is an angel appointed in the Garden of Eden who takes him and brings him into the Garden of Eden. And regarding the heretics and sinners, The Holy One, “blessed be He, commands the angel to pull his foreskin (i.e. reverse his circumcision), as it says (Ps. 55:21) "He hath put forth his hands against them that were at peace with him; he has profaned his covenant." It happened that Tyrannus Rufus the wicked asked R. Aqiva, “Which works are the more beautiful? Those of the Holy One, blessed be He, or those of flesh and blood?” He said to him, “Those of flesh and blood are the more beautiful.” Tyrannus Rufus the wicked said to him, “Look at the heavens and the earth. Are you able to make anything like them?” R. Aqiva said to him, “Do not talk to me about something which is high above mortals, things over which they have no control, but about things which are usual among people.” He said to him, “Why do you circumcise?” He said to him, “I also knew that you were going to say this to me. I therefore anticipated [your question] when I said to you, ‘A work of flesh and blood is more beautiful than one of the Holy One, blessed be He.’ Bring me wheat spikes and white bread.” He said to him, “The former is the work of the Holy One, blessed be He, and the latter is the work of flesh and blood. Is not the latter more beautiful?” Tyrannus Rufus said to him, “Inasmuch as He finds pleasure in circumcision, why does no one emerge from his mother's belly circumcised?” R. Aqiva said to him, “And why does his umbilical cord come out on him? Does not his mother cut his umbilical cord? So why does he not come out circumcised? Because the Holy One, blessed be He, only gave Israel the commandments in order to purify them. Therefore, David said (in II Sam. 22:31 = Ps. 18:31), ‘the word of the Lord is pure.’”

(14) Since it is necessary for human beings to practice abstinence which will further their welfare in this world by taking from it only what is necessary, it follows that there should be in this world complete ascetics which separate and cut themselves off completely from secular occupations. So that all of mankind can learn from them on abstinence, each person according to his need, and according to what is fitting for his customs and tendencies.

(15) It would not, however, further the welfare of mankind if everyone would practice asceticism like them, because this would lead to the abandonment of civilization and to the end of the human race, and the verse already said: "He did not create it to be a deserted but formed it to be inhabited" (Yeshaya 45:18).

(16) Abstinence is one of the cornerstones of the world, and the need of human beings for it is just like their need for other sciences and trades in which some nations excel over others, for the benefit of all of mankind. Each class takes from the world according to its needs and what is suitable for it. It would not further the welfare of the world if everyone devoted themselves to only one field and no others, because the general welfare of the world is furthered by the cultivation of all fields, as the wise man said: "also He has set the world in their heart" (Koheles 3:11), and "everything has a time and place..." (ibid 3:1).

AND HE HID THE BOOK OF REMEDIES. As it is written (II Kings 20:3; Isa. 38:3), "I have done what is pleasing (and righteous) to You." And we said in B'rachot that he hid the Book of Remedies because their minds were not subdued by the illness; instead, they would be healed instantly.

(2) ספר רפואות – There was a book that had in it the order of remedies of what is not according to the law (i.e., talismans) to be treated with it, such as what those practitioners of talismans (i.e., charms and incantations) imagine, that if they make a talisman in a certain fashion, it is beneficial to a certain sick individual and things similar to this from those things that are forbidden, but from his friend he did not attach/fasten it other than through learning in the substance/nature of reality not in order to use something from what is included in it, and this is permitted like it will be explained to you, that things that God warned from doing them, it is permitted to learn/study them and to know them, for God stated you shall not learn to do them (Deuteronomy 18:9: “[When you enter the land that the LORD your God is giving you,] you shall not learn to imitate/לא תלמד לעשות [the abhorrent practices of these nations])” and through out accepted tradition it comes, but you may study to understand and to teach (see Tractate Sanhedrin 68a) and when people became corrupted and became cured through it, he (i.e., Hezekiah) hid it. And it is possible that there was a book that has in it the inoculation/vaccination of drugs that cause damage such as a certain drug that they inoculate him as such and have him drink as such and which causes this or that illness, and its healing is through this and that, that when the physician who sees these illnesses knew that they administer to him to drink a certain drink and give him contradictory/contrary things that it will save him, but when people became corrupted and they will kill with it, he (i.e., Hezekiah) hid it. But I have not prolonged to speak on this matter, but rather because I heard and also it was explained to me that [King] Solomon composed a book of healing (this is brought by Nachmanides in his Introduction to the Commentary on the Torah) – that if a person became ill with whichever illness that he turned to him and he (i.e., the infirm individual) did like he says he is healed, and Hezekiah saw that the people did not trust in God (see Rashi’s commentary to Tractate Sanhedrin 56a, s.v. "וגנז") in their illness but rather on this book of remedies, he stood up and hid it. And besides the futility/insignificance of this matter and what it has from the delusions/superstitions, here they attributed to Hezekiah and to his adherents that they agreed on the foolishness of this that one cannot attribute its example other than to the worst of the crowd. And according to their confused and stupid imagination, if a person is hungry and turns to the bread and eats it that it will cure him from that great pain without any doubt, shall we say that he has removed his trust from God, and he would say to them that they are fools, for just as I give thanks to God at the time that I eat that He (i.e., God) furnished/provided me to remove my hunger and to keep me alive and preserve me, so too, we should thank Him that He furnished a medicine that cures my illness, and I would not have to contradict this terrible explanation were it not for its popularity.

(12) Another belief which was very common in those days, and survived the Sabeans, is this: When a tree is grafted into another in the time of a certain conjunction of sun and moon, and is fumigated with certain substances whilst a formula is uttered, that tree will produce a thing that will be found exceedingly useful. More general than anything mentioned by the heathen writers was the ceremony of grafting an olive branch upon a citron tree, as described in the beginning of the Nabatean Agriculture. I am of opinion that the book of medicines which Hezekiah put away (B: T. Pes. 56a) was undoubtedly of this kind. They also said that when one species is grafted upon another, the branch which is to be grafted must be in the hand of a beautiful damsel, whilst a male person has disgraceful and unnatural sexual intercourse with her; during that intercourse the woman grafts the branch into the tree. There is no doubt that this ceremony was general, and that nobody refused to perform it, especially as the pleasure of love was added to the (supposed) future results of the grafting. The Law, therefore, prohibits us to mix different species together, i.e., to graft one tree into another, because we, must keep away from the opinions of idolaters and the abominations of their unnatural sexual intercourse. In order to guard against the grafting of trees, we are forbidden to sow any two kinds of seed together or near each other. When you study the traditional explanation of this precept, you will find that the prohibition of grafting, the principal element in this commandment, holds good for all countries, and is punishable by forty stripes: but the sowing of seeds one near the other is only prohibited in Palestine.

Why is there a need for double language? One might have thought that the verse speaks only of healing from human injury but illness that comes from heaven should not receive medical intervention lest it appear as though one is undermining the decree of the king. The Torah then comes and says it is fine.

(1) INTO THE GARDEN OF EDEN. Gan (garden) can be both masculine and feminine, hence the plurals gannim and gannot. We ask those who maintain that the words to till (dress) itand to keep it (le-ovdah u-le-shomrah) refer to the ground (adamah), how it is possible to till and keep a large area from a small one. Furthermore, after Adam sinned God expelled him from the garden and commanded him to till the soil. But according to their interpretation he was already tilling the soil while he was living in the Garden of Eden. (2)To till it (le-ovdah) therefore refers to the garden of whose fruit he ate. It was only after he sinned that he had to eat the grass of the ground, i.e., bread. To till it means to water it. To keep it means to guard the garden so that no animals enter therein and befoul it. Some say that le-ovdah means to serve God’s commandment. However, a commandment is not served.

(4) AND SHALL CAUSE HIM TO BE THOROUGHLY HEALED. This is a sign that permission has been granted to physicians to heal blows and wounds that are visible on the surface. However, it is in God’s hand to heal any illness which strikes inside of the body. It is thus written, For He maketh sore, and bindeth up (Job 5:18). Furthermore, Scripture tells us concerning King Asa, yet in his disease he sought not to the Lord, but to the physicians (II Chron. 16:12). Now Scripture distinguished between them. It does not state, verafo yirpe (and he shall surely heal), which is in the kal. It rather reads, ve-rappo yerappe (and shall cause him to be thoroughly healed). The latter is in the pi’el. I will explain this very well later on in this portion. The rabbis received a tradition concerning other payments in addition to the two mentioned in our verse. They similarly received a tradition to include spices which are not stated in the Torah among the incense spices.

(1) AND THE ETERNAL G-D PLANTED A GARDEN ‘MIKEDEM’ (EASTWARD) IN EDEN. Rashi explained that “in the east of Eden He planted the garden.” But Onkelos translated mikedem to mean “previously,” [that is, before man was created]. And so have the Rabbis said in Bereshith Rabbah, and this is the correct explanation.
The meaning of vayita (and He planted) is not that He brought the trees from another place and planted them here for it was from that place that He caused them to grow, just as it is said, And out of the ground the Eternal G-d caused to grow every tree. But the purport of the expression, and the Eternal G-d planted, is to state that it was the planting of the Eternal, for before He decreed upon the earth, Let the earth put forth grass, He had already decreed that in that place there be a garden, and He further said: “Here shall be this tree, and here that tree,” like the rows of planters. It was unlike the rest of the places on the earth concerning which He said, Let the earth put forth grass… and fruit-tree, and it then grew without order. Now concerning the trees of the garden of Eden He decreed that they grow branches and bear fruit forever, the root thereof was never to wax old in the earth, and the stock thereof was never to die in the ground. These trees were not to need any one to tend and prune them. For if they were in need of cultivation, who tended them after man was driven therefrom? This also is the meaning of the expression, And the Eternal G-d planted, that they were His plantings, the work of His hands, and existing forever, even as it is said, Its leaf shall not wither, neither shall the fruit thereof fail … because the waters thereof issue out of the sanctuary. If so, what then is the meaning of the verse: And He put him into the garden of Eden to cultivate it and to keep it? He put him [man] there so that he should sow for himself wheat and all kinds of produce, and every herb bearing seed, and rows of spices, reaping and plucking and eating at his will. This also is the meaning of to cultivate it and to keep it — to cultivate the ground of the garden by the rows he [man] would make there, for the part of the garden where the trees were was not to be cultivated.
It is possible that [in the words le’ovdah uleshomrah — literally, to cultivate her and to keep her,] He refers to the garden in the feminine gender, just as in the verses: And as the garden causeth the things that are sown in her to spring forth;And plant gardens. Our Rabbis noted this use of the feminine gender, saying in Bereshith Rabbah: “Le’ovdah uleshomrah (to cultivate her and to keep her) — these words refer to the sacrifices, as it is said, ‘Ta’avdun’ (Ye shall serve) G-d upon this mountain. It is this which Scripture says, ‘Tishm’ru’ (Ye shall keep) to offer unto Me in its appointed season.” The intent of the Rabbis in this interpretation is that plants and all living beings are in need of primary forces from which they derive the power of growth and that through the sacrifices there is an extension of the blessing to the higher powers. From them it flows to the plants of the garden of Eden, and from them it comes and exists in the world in the form of “rain of goodwill and blessing,” through which they will grow. This conforms to what the Rabbis have said: “The trees of the Eternal have their fill, the cedars of Lebanon, which He hath planted. Rabbi Chanina said: Their life shall have its fill; their waters shall have their fill; their plantings shall have their fill.” “Their life” refers to their higher foundations; “their waters” refer to His good treasure which brings down the rain; and “their plantings” refer to their force in heaven, just as the Rabbis have said: “There is not a single blade of grass below that does not have a constellation in heaven that smites it and says to it, ‘Grow.’ It is this which Scripture says, Knowest thou the ordinances of the heavens? Canst thou establish ‘mishtara’ (the dominion thereof) in the earth — [mishtara being derived from the root] shoter (executive officer).”

(1) We learn from Yoma:
R. Matia ben Heresh said that we give medicine to someone with a sore throat on Shabbat, because he may be in danger and any possible danger overrides the Shabbat. This principle also covers a risk [of danger] on the next Shabbat. How so? For example, when we prescribe an eight-day course of treatment starting on Shabbat, should we delay starting the treatment until after Shabbat so that it will not include two Shabbatot? The principle implies not. It was also taught here that we may warm water for a patient on Shabbat either to drink or for comfort; we do not say wait until he recovers, but rather we heat the water immediately. (BT Yoma 84b)

(2) This source has been interpreted to mean that if professional physicians say that hot water is necessary for drinking but extra is needed for the comfort of washing the patient after drinking, we do not say wait and see if he feels better after just drinking so that we would not need to desecrate Shabbat twice, but rather we do everything at once so as not to delay recovery. For it is good to be swift when there is danger, and the risk of danger overrides Shabbat – not only this Shabbat, but even next Shabbat.

(3)We do not give these things to gentiles or to children to do, but to Jewish adults.

(4) Another manuscript version has:We do not say, give these things to gentiles or to children to do, but even to Jewish adults.

(5) Similarly, in the Yerushalmi: - even to adults, even a Jew. (JT Shabbat 16:7)
The reason we say that these things should not be done by women or Samaritans is that they take on other opinions. (BT Yoma 84b)

(6) An alternative reading has:
but their opinions are only accepted as support for other opinions.

(7) The Tosefta reads:
We do not rule that these things should be done if they are recommended by women or Samaritans, but we add a Jewish opinion to theirs.(Tosefta Shabbat 15:15)

(8) This has been interpreted [by Rashi] to mean that if women or Samaritans say that desecrating Shabbat is necessary, we do nothing until we seek a Jewish professional opinion and if he says it is necessary, we follow all these opinions. This is consistent with what they said in Rosh Hashanah:
Their evidence is invalid but it may be used when combined with other witnesses. (BT Rosh Hashanah 24a)

(9) This interpretation is wrong as far as women are concerned. For a professional woman's opinion is definitely relied upon to permit desecrating Shabbat, as we have learned:
We call a midwife for a woman in labour, to come from afar. The rabbis taught us that if a woman in labour needs a lamp, her [female] attendant lights it up for her, and if she needs oil, her attendant fetches her oil. (BT Shabbat 128b)

(10) Furthermore, since we do not accept the textual version that says we do not desecrate Shabbat on the recommendation of women or Samaritans, but rather we accept the version: "these things should not be done [by women and Samaritans]", therefore it has nothing to do with their expertise. Here, then, is the explanation: We never have gentiles or children do these things lest bystanders say that we only permit desecration of Shabbat reluctantly where there is a risk to life and do not permit it a priori using those who are bound by Jewish law. This could lead to neglect of the patient. Even though in a case where there is no danger of life to the patient we do use a gentile to do what is necessary, in this case where there is danger we do not use them, but rather we ask adult Jews to do it. However, if women or Samaritans happen to be there, we do let them act, for they are obliged to observe Shabbat, and we assume they do so, but we do not specifically assign them by name to this work with the dangerously ill patient lest they hesitate, arguing to themselves that the Jewish men do not want to desecrate Shabbat themselves, but do not care if we [women and Samaritans] do. This is because the Samaritans do not recognise the principle of "do not put a stumbling block in the path of the blind", as it says in the [talmudic] chapter starting 'Slaughtering ordinary animals':
[The Jew should] cut off the head of one of the chickens [that the Samaritan slaughtered] and give it to him. (BT Hullin 4a)

(11) As for women, they may make mistakes because they are easily swayed, and that is what is meant by – "they take on other opinions", that is, unorthodox and erroneous opinions. Following the other textual versions that have – "we do not rule that gentiles and children should do it" lest the Jew may say since there is nobody around to do it we will not desecrate the Shabbat unnecessarily, but even adult Jews should do it - and if they wish they may do it together. The later section about women and Samaritans not doing it at all "but we add a Jew's opinion to theirs", means that we do not leave them alone to administer the help themselves lest they behave lazily or negligently, but we join a Jew with them and hand it [the responsibility] to the Jew. A Samaritan may share life-saving management with a Jew because while the Jew is active he too will be encouraged to act. This then is the best textual version.

(12) Our rabbis taught:
Desecrate Shabbat in order to save life, and it is good to be swift, and there is no need for a court permit. How so? If you see a baby falling into the sea you spread a fishermen's net and pull him out, and it is good to be swift. If the baby fell into a well, you remove the upper rim and haul him up, and it is good to be swift and there is no need for a court permit, even though it means forming a shelf in the soil. If a baby was locked in a room, you break down the door and let him out, and it is good to be swift and there is no need for a court permit, even though it means splitting the wood and making it useable as a tool. You put out a fire and douse the cinders and it is good to be swift and there is no need for a court permit, even though you are left with useable hot charcoal. (BT Yoma 83a)

(13) The Yerushalmi has:
It is good to be swift; he who is consulted is blameworthy; and he who consults is guilty of bloodshed. (JT Yoma 8,5)

(14)[On Yom Kippur] the patient is fed on experts' orders. Where there is no expert available, the patient is fed by his own request (Mishnah in BT Yoma 82a). And why? - "Each heart knows its own bitterness" (Proverbs 14:10). If the doctor says it is necessary but the patient says it is not, we feed him following the doctor's orders. Why so? We assume the illness has affected the patient's better judgment. In conclusion, Rav Ashi says that whenever the patient says he needs to eat, even if there are a hundred contrary opinions, we listen to the patient, for "each heart knows its own bitterness". (BT Yoma 83a)

(15) The analysis of the discussion is this: If one doctor says the patient needs to eat and the patient says he does not, and another doctor also says he does not need to eat, we do not feed him, because the single opinion does not outweigh the two others. If the patient and two or three or even a hundred doctors say he does not need feeding, but two say he does need, we take their opinion and feed him, for where there is a risk of danger we take the lenient path, and we do not use the majority principle. If the patient says he needs food, even if a hundred experts say he does not, we feed him, accepting his own judgment. This ruling is the conclusion of the discussion and the topic.

(16) We are aware that some authorities do use a majority principle and so does the She'iltot as well. Even though the position of the Bavli is clearly that the majority principle applies to assessing monetary cases, but here, in assessing danger to life, we use the leniency principle, it is apparent that these authorities who argue for the majority principle do not accept the way the text is generally read. Since [the Talmud] queries the need to interpret "experts" as meaning two expert opinions, this being obvious, the case in point should be read as a case where there are two opinions in favour of feeding and two against, and so we use the leniency principle. When Rav Ashi comes and says that where the patient says he needs to eat, we listen to him even against a hundred who say he does not need feeding, the Mishnah could still be construed as above – that alongside the patient there is another supporting opinion, [even if a hundred] say he does not need feeding, we feed him on the basis of the opinion of the "two experts". You might have thought that just as where the patient says he needs to eat we listen to him even against a hundred experts, so where he says he does not need to eat, we listen to him too, for in both cases "each heart knows its own bitterness". However, we apply the leniency principle [that dictates that the patient's opinion trumps a majority]. When it comes to being stringent [the patient saying he does not need to eat], the patient is considered as just one expert opinion, not as two.

(17) Therefore, where the patient and the one expert say that he does not need to eat, and two experts say he does need to, we take the latter opinion [on the leniency in danger principle]. But if there was only one expert opinion that he needs to eat, we ignore him [using the majority principle – and the patient is not fed]. On this reading we do not construe the patient as being incompetent because that would leave just one opinion against eating [the expert], not two [the patient and the expert].

(18) We do find (BT Bava Kama 90b) the use of the majority principle in order to establish presumption in capital cases, such as whether the means of murder were sufficient to kill – an injury to the chest is more commonly fatal than an injury to the leg. The majority principle applies routinely in legal proceedings, and this supports the position of those who said [that it applies here too]. However, since the talmudic text states that presumption concerning sick patients does not employ the majority principle, we will not prefer the merely theoretical argument over the expressly stated text. The standard legal situation could be seen as different [from the medical one] since there all opinions are of judges. But here, since where there are already two opinions that the patient needs to eat, we do not require any more opinions [who might think the patient does not need to eat] to arrive at a valid assessment of the patient's condition, and they are considered as non-existent. Furthermore, legal proceedings have special rules, such as that in order to convict you need a majority of two, not just a simple majority (BT Sanhedrin 32a) whereas in assessing medical danger there is no majority principle. The rabbinical and halakhic authorities rule this way.

(19) There is an opinion (RAMBAM, Yad, Shevitat Assor 2:8) that argues that where the Mishnah says that we listen to the experts, that means a reputable and knowledgeable expert, as opposed to doctors who are not so wise or expert. This seems an unlikely view, for we do not find that courts rule according to the wisest opinion but by the majority opinion. It is true that we find (BT Avodah Zarah 7a) that where rabbinical opinion is divided, one ruling pure and one ruling impure, or one permitting and one forbidding, if one rabbi is wiser than the other his opinion prevails, and therefore where medical opinion is equally divided we do take the more wise and expert opinion. In the situation of the law-court, although in principle we require consensus before ruling, all the judges present are required to express an opinion and the Torah stipulated that the majority decides. But here [in medical issues] we listen to the expert, and there is no reason to seek a second opinion from a lesser expert - his opinion would be void. However, where two doctors are opposed by one, since they are all equally competent professionals, the single opinion cannot prevail. Nonetheless, if one of them is exceptionally wise we do prefer his opinion even if he is a small minority. This is true in order to enable the patient to eat, but if he says the patient does not need to eat where other less expert doctors say he needs to eat, he is considered as a lone voice and is not heeded. There is a source for this (BT Yevamot 14a) in the dispute between the schools of Shammai and Hillel where the school of Shammai is the more convincing. We rule that the majority opinion applies where the opposing opinions are of equal authority, but nonetheless we take the wiser and more expert opinion in order to rule more strictly. In our context the "stricter" ruling means leniency [with the Yom Kippur fast] in cases of medical danger, allowing you to supply the patient with all he needs.

(20)Yerushalmi:
When the patient says I can fast, and the doctor says he does not know, R. Abahu, quoting R. Yohanan, says this is a situation of risk to life, and where life is at risk we rule leniently even overriding the Shabbat observance laws. (JT Yoma 8:4)
The assumption here is that the patient says he can fast only because his better judgment is affected by the illness, but where the doctor says the patient can fast and the patient says I do not know, we take the doctor's opinion. This is because the patient's lack of opinion is worthless - for on what basis can patients know, most of them having no expertise or knowledge of their illness? So we take the opinion of he [the doctor] who says he knows.

(21)We feed a "bolmos" patient even with ritually impure foods [if he is a priest] until his eyes clear. The tannaim say we feed a bolmos patient, but with the minimal possible infringement of the law. If we have untithed food or non-kosher nevelah meat, we use the latter; nevelah or sabbatical year produce, we use the latter; the priestly tithe portion or untithed food, we give the patient untithed food and not tithes. Ben Teima says that we give the patient tithes, not untithed food. Rabbah says there is no argument where there is tithed food available, but only where there is no option of using ordinary tithed food. One opinion is that un-tithed food is the more problematic [being forbidden to everybody], because tithes may be eaten by a priest. The other opinion is that tithes are the more problematic, because un-tithed food may be made permissible [by taking the tithe from it]. (BT Yoma 83a)

(22) Rabbi Abraham ibn Daud of blessed memory was asked about a case where the choice was between nevelah and food cooked on Shabbat.

(23) The chapter starting "Rabbi Yishmael" in Menahot:
Rava says that if [on Shabbat] a patient is estimated to need two figs, and ten people went simultaneously and brought him ten figs [from outside where they are forbidden to carry on Shabbat], they are all innocent, and even if they arrived one after another, and even if the patient recovered after eating the first one. Rava was asked for his ruling where there is a choice between picking two branches with one fig on each and picking one branch bearing three figs, where the patient is estimated to need two figs to recover. Do we bring the two branches which is just what he needs, or do we bring the single branch because there is less [forbidden] picking involved? Obviously we bring the single branch with the three figs, since less picking is involved. A pregnant woman [fasting on Yom Kippur] who smells a dish [and craves it] is fed until she calms down. The tannaim taught that if a pregnant woman smells sanctified meat or pig meat we [let her taste from] a skewer dipped in the sauces and if she settles that is fine, and if not, we give her the meat-fat itself – for nothing overrides danger to life except for idolatory, incest and murder. (BT Menahot 64a)

(24) Clearly the situation is that we cannot estimate medically what is needed to settle a pregnancy craving, sometimes it will be the taste of the sauce and sometimes the fat itself. A patient, on the other hand, is fed right from the start, following professional opinion as to what and how much he needs. We do what the doctor says and do not try and minimize the infractions of the law.

(25) The chapter in Keritut starting "They said to him" has:
We allow a pregnant woman to eat repeated small portions that are each below the minimum forbidden size, because she is in danger. This ruling is queried; if she is in danger, let her eat more. Rav Papa said the correct reading is: We allow a pregnant women to eat repeated small portions, and even more if she is danger. (BT Keritut 13a)
This means that even if she needs a full [forbidden] quantity, we feed her in repeated small portions so that it does not add up to the full amount within a short time. Thus rules the author of Halakhot (Sefer Halakhot Gedolot – at the end of the Yom Kippur Laws). It seems to me that this applies to a sick patient as well, sparing him from eating quantities that would normally be punishable by karet or flagellation. You may wonder then why the Talmud says you feed the patient with the minimum infringement of the law, choosing tithes where there is a choice between un-tithed food and tithe, both of them being simply forbidden. In cases where eating the full quantity of different foods would lead to punishments of different severities, where the patient eats less than the punishable quantity eating the one food is considered more serious than eating the other. Another approach is to say that the Talmud refers to the case of the sick patient who is estimated to need a full quantity within the specified [normally punishable] time.

(26) Also from Halakhot Gedolot:
It is right to feed a pregnant woman if we know that fasting would cause her to abort, even though we are not sure whether the foetus is viable. Furthermore, Rav Yitzhak ben Giat said that this depends on the woman's judgment of her condition, not on ours, so when she smells the food she becomes like a sick patient and we give her the food to eat.(loc. cit.)
It appears reasonable to rule with the author of the Halakhot Gedolot that if the pregnant woman says she needs to eat, obviously we give her something to eat, but even if we merely see her craving for that smell and her face changing colour, we give her something to eat for fear of an abortion. Since he also refers here to the danger to the foetus, we may infer that even where there is no danger to the mother we override the law.

(27) We have a text near the end of the first chapter of Arakhin:
Rav Nahman said in Shmuel's name: If a woman dies in childbirth on Shabbat we fetch a knife, open her belly and extract the foetus. Is that not obvious – all he is doing is cutting into flesh? Rava said that the point is that we fetch the knife through the public thoroughfare. We derive from here that we override the Shabbat laws in case of doubt. The Mishnah states: if we do not know whether the injured person is alive or dead, whether an idolator or a Jew, we continue with rescue operations. That is understandable, because the default position is that the injured person is alive, whereas in the case of death in childbirth, there is no such default assumption concerning the foetus. Nonetheless the doubt is sufficient to override the Shabbat.(BT Arakhin 7a)

(28) However, chapter 7 of Mishnah Ohalot has:
If a woman is in obstructed labour we fetch a knife and dismember the fetus, but if the head has already been delivered we do not touch the baby, for we do not sacrifice one life to save another. (Mishnah Ohalot 7:6)
from which we see that in principle we do not have to save the life [of the foetus]. We also have another tannaitic source that killing a baby on its first day of life is murder (BT Niddah 44a) - that is, specifically after birth but not as a foetus. The Torah says that killing a foetus [only] entails paying damages (Exodus 21:22). Nonetheless, when what is at stake is the law, we do desecrate Shabbat to try and save a foetus. As the Torah says "desecrate this one Shabbat to give him a chance of observing many [in the future]." Therefore, even where the foetus is less than 40 days gestational age and still non-viable, we desecrate Shabbat to save it, as the Halakhot Gedolot author holds. There are some opinions that we do not desecrate Yom Kippur in the case of the craving mother in order to prevent a stillbirth, but rather to save the life of the pregnant mother herself, for any aborting mother is in danger. The reasoning in the case of the mother who dies in childbirth is different, for as soon as she dies, the foetus is considered as already born, since it is no longer a constituent limb of its mother and it is no longer dependent on her, but it is a living being who is trapped behind a closed door. Albeit there is no default assumption of it being alive, but when in doubt we are lenient with the law in order to save life.

(29) Chapter "Even though":
Amemar, Mar Zutra and Rav Ashi were once sitting at the gate of King Yezdjird when the king's table-steward passed them by. Rav Ashi, observing that Mar Zutra turned pale in the face, took up [some food from the King's dish] with his finger and put it to his mouth. …'Why did you rely upon a miracle?' the Rabbis asked him. 'I saw', he replied, 'the demon of leprosy hovering over him'. (BT Ketubot 61a,b)
So we derive that turning pale is a sign of danger. In the same text, Rav Hamnuna says:
All food may be withheld from the waiter except meat and wine… Rav Ashi said: I was once standing with Rav Kahana when they brought him thin slices of turnips in vinegar, and had he not given me some I would have been put in danger. Rav Papa said that even [if you smell but do not eat] a fragrant date [you are in danger]. This is the rule: Any food that has a strong flavour or an acrid taste [will expose people to danger if they are not allowed a taste of it].
From this we derive that if a healthy person smells a food and becomes distressed, we give him that food to eat either on the basis of his reaction alone, or on the advice an expert who knows him. Thus writes RAMBAM of blessed memory (Yad,Maakhalot Assurot 14:15).

(30) Chapter "One may clear away":
One may deliver a pregnant woman on Shabbat and call for a midwife from a distant place, desecrating the Shabbat on her behalf. What does this last phrase add? — It adds the following taught by the Rabbis: If she needs a lamp, her friend may light a lamp for her. And if she needs oil, her friend brings her oil in the palm of her hand; but if that is not enough, she brings it in her hair; and if that in her hair is insufficient, she brings it to her in a vessel, through the public thoroughfare. Mar said: 'If she needs a lamp, her friend may light a lamp for her.' Is that not obvious? Rav Ashi says: It is necessary [to state this] only in the case of a blind [woman]. You might argue that since she cannot see it, it is forbidden, hence the text informs us that we calm her mind, for we desecrate Shabbat for an ordinary sick person over something that could cause them danger. 'If she needs oil, her friend brings her oil in the palm of her hand; but if that is not enough, she brings it in her hair.' [But why not] deduce [forbidding her to bring oil in her hair] on the grounds of wringing out? Rabba and Rav Joseph both answer: [The ban on] wringing out does not apply to hair. Rav Ashi said: Even if you say that wringing out does apply to hair, let her bring it to her in a vessel by means of her hair, [because] we vary the way we do things as much as we can. (BT Shabbat 128b)
From this we understand that even if there is danger we provide for the needs of the patient wherever possible in a way that is different from the normal way of doing things and avoids desecration of Shabbat – on condition that this does not delay the patient's needs at all.

(31) We also learn concerning circumcision:
We circumcise, expose [the corona], aspirate [the wound], and place a compress with cumin on it. If someone did not crush [the cumin] on the eve of Shabbat, he must chew it with his teeth and apply [it to the wound]; if he did not beat up wine and oil on the eve of Shabbat, each must be applied separately. We may not make a haluk for it in the first place, but should wrap a rag around it. If this was not prepared before Shabbat, he should wrap it round his finger even fetching it from another courtyard. (BT Shabbat 133a)
We derive from this that even though [the baby] is in danger we do not desecrate a law of Shabbat that is stated in the Torah but we do the actions in a different manner so that we desecrate [merely] a rabbinic injunction – on condition that all the patient's needs are fulfilled swiftly.

(32)Rav Yehudah quotes Shmuel as saying that all the time the womb is open we desecrate the Shabbat for a woman in labour, whether she says she says she needs it or whether she says she does not need it. When the womb closes, if she says she does not need help, we do not desecrate Shabbat for her, but if she does not say so, we do desecrate Shabbat for her. At what stage does the womb open? Abayye said, with the onset of labour. Rav Hunna the son of Rav Yehoshua said from the time blood starts draining out, and some say when she needs support in walking. (BT Shabbat 128a)
Our great rabbi [Alfasi] wrote in his Halakhot that the talmudic rabbis were careful to note that Rav Hunna did not say "when the bleeding starts" which implies that he meant before the onset of labour. We rule according to Abayye and do not desecrate Shabbat until blood starts draining out and labour begins. This ruling of the rabbis is problematic. First, the reason Rav Hunna the son of Rav Yehoshua did not use the phrasing "when the bleeding starts" was because he was responding to the question: at what stage does the womb open? - and the usual response to this is "from the time that", as we read in the Mishnah:
From what stage do we start reading the shema in the evening? From the time that we start Shabbat on a Friday evening – so says R. Eliezer. R. Yehoshua says from the time the priests go to the Temple to eat their tithes, which is indicated by the time the stars start to shine. (Mishnah Berakhot 2:2)
R. Eliezer's time is the earlier one and he uses the phrase "from the time that". Similarly in Pesahim:
From what stage is work forbidden on the fourteenth of Nissan? R. Eliezer ben Yaakov says from the time of daylight. Rabbi Yehuda says from the time of sunrise.(Mishnah Pesahim 2:2)
And the rabbis taught concerning the onset of mourning:
At what stage do we overturn the beds? When the corpse is brought out of the house, so says Rabbi Eliezer. Rabbi Yehoshua says when the grave is covered. (BT Moed Katan 27a)
Rabbi Eliezer's time is earlier, but Rabbi Yehoshua said "when". There are also many similar instances.

(33) And apart from this, why do we rule according to Abayye, when the principle is that we rule leniently in cases of danger to life? Indeed, in this very passage we read:
Ravina said to Maremar: where Mar Zutra rules leniently and Rav Ashi stringently, whom do we go by? He answered: we rule according to Mar Zutra, for we rule leniently when there is danger to life. (BT Shabbat 129a)
So it is clear that the timing does not depend on these definitions, and there are even some women who have no labour at all as the baby is born quickly. So we desecrate Shabbat for the mother either when she goes into labour, or when she starts to bleed, or when she can no longer walk unaided – in all these situations she is considered to be in danger. And when R. Moses [Maimonides] of blessed memory wrote that we desecrate Shabbat from the time that bleeding starts, in his opinion that is the earliest stage, and we rule leniently in situations of danger.

(34) Till when is the womb open? They conclude thus:
The Nehardaian rabbis said that after childbirth there are three phases – three days, seven days and thirty days. Till the third day whether she said she needs help or whether she said she does not need help, we desecrate Shabbat for her. Till the seventh day if she said she needs help we desecrate for her, and if she said she does not need help we do not desecrate Shabbat for her. That is just like anyone else in danger who when they say they need help we desecrate Shabbat for them. Till thirty days, even if she says she needs help we do not desecrate Shabbat for her, but ask a non-Jew to do what is needed. This ruling follows Rav Ulla son of Rav Ilai, who said that we provide for all the needs of a sick person on Shabbat by asking a non-Jew. (BT Shabbat 129a)
The ruling that we desecrate Shabbat for her in the first three days whether she says she needs it or not, is in the situation where there is no midwife or doctor around. However, it is common knowledge what a new mother needs on any weekday and so even if she says she does not need anyone to desecrate Shabbat for her and that she can wait till the evening, since these are things we do for any mother and they all need them, so she is defined as in danger in regard of this particular action and we desecrate Shabbat for her. We ignore her opinion and regard her as having impaired capacity to decide. After the first three days she is no longer considered as in a state of transient danger, and if she says she does not need it we listen to her. From the seventh to the thirtieth day we do not listen to her even if she says she needs us to desecrate Shabbat. This is if we know that she does not have any other illnesses, and she says so too. Any lay person is considered expert in this respect since there is no danger in waiting till the evening, after Shabbat, for hot water or anything else the mother may need.

(35) This is how Rav Aha explained it in his She'iltot:
For a woman who gave birth on Shabbat or even if Shabbat was the third day after delivery, even if she says she feels well and does not need a fire or hot water, and even if the doctors say she does not need them, [we make a fire]. For the rabbis have said that in the first three days after childbirth a mother's feeling well does not define her as healthy, and we make a fire, and heat water and cook, and do for her anything that a woman after childbirth needs. (She'iltot: Exodus 38)
However the gaon's [Rav Aha, above] opinion that we desecrate Shabbat even if both the mother and the doctors say there is no need, is implausible since many mothers after childbirth do not have hot water boiled for them every day, even on a weekday. We also read in She'iltot that a woman is not allowed to fast on Yom Kippur during the first thirty days after childbirth, but that is not accurate, because it only applies if she says that she needs to eat. We rule that she is automatically exempt only from not wearing shoes, but not from fasting, for eating and drinking are forbidden on pain of karet. Furthermore, when Shmuel (BT Shabbat 129a) speaks of the thirty day rule after childbirth and we asked concerning what, the answer was concerning ritual immersion and they did not add fasting to that, meaning that she is not exempt from fasting. However she is certainly exempt from fasting during the first three days. Up to seven days, if she says she does not need food she may carry on fasting and if not, we give her food. After this stage she is like all other women who have to fast on Yom Kippur.
Rav Yehuda, quoting Shmuel, said that we make up a fire on Shabbat for a woman after childbirth. Can he mean only for a woman after childbirth but not for a sick person, or only in the winter? Elsewhere Rav Yehuda, also quoting Shmuel, said we make up a fire for a person who caught cold after a blood-letting, even at the Tammuz solstice [mid-summer], all the more so for a sick patient. (BT Shabbat 129a)
However, R. Moses [Maimonides] of blessed memory, (Yad, Shabbat 2:14) wrote that we may make up a fire for a woman after childbirth but not for a sick patient - but we cannot understand that.

(36) In the chapter entitled "We do not put":
Shmuel said: an open wound is to be regarded as a danger for which Shabbat may be desecrated. Rav Hisda said: A berry-like blister is a harbinger of the Angel of Death. Rava said: An abscess leads to fever. Rav Shaman son of Abba said in the name of R. Yohanan: internal disease does not require a medical opinion [to justify desecrating Shabbat].(BT Avodah Zarah 28a)
We know that sores on the back of the hand or the foot do not require a medical opinion, as we find:
Rabina visited Rav Ashi. He saw that an ass had trodden on his foot, and he was sitting and reducing the swelling in vinegar. He said to him: do you not think that is forbidden? [A wound on] the back of the hand or on the foot is different, he replied...for Rav Adda said in Rav's name: [A wound on] the hand or on the foot is like an internal wound. (BT Shabbat 109a)Which lesions are internal? Rav Ammi explained: those on the lip and inward. Dental disease is also dangerous and we desecrate Shabbat for it, as we learn from a mishnah [in BT Shabbat 111a]. If someone has a toothache, we give him medication on Shabbat. R. Yohanan was troubled with tzafidna and he went to a certain [heathen] lady who attended to him on the Thursday and the Friday. He asked: What about tomorrow?
Concerning which the text says:
tzafidna is different, because though starting in the mouth it extends to the intestines. What are its symptoms? If he places anything between his teeth, the gums bleed. (BT Avodah Zarah 28a)
My interpretation is that internal disorders do not need an expert, that is, even if there is no doctor around and the patient says nothing, we do for him everything we would normally do for him on a weekday, including foods and medications a patient needs, desecrating Shabbat, without consulting anybody. However, if we recognize the condition as allowing of delay in treatment and not needing desecration of the Shabbat, it is definitely forbidden to do so. Even more so if the patient or the doctor says it is unnecessary, we would never desecrate Shabbat even for an internal disorder, whereas for an external wound we ask the expert or the patient and only desecrate Shabbat if one of them says it is necessary, or if one of them considers the condition to be dangerous.

(37) In the chapter headed "Before their festivals":
Rabbi Hanina said: For one who swallows a water leech… R. Nehemiah declared it permissible to get water heated for him on the Shabbat. Rav Huna son of Rav Joshua said: meanwhile [while the water is heating up] let him sip vinegar. (BT Avodah Zarah 12b)

(38) In the chapter headed "On Yom Kippur":
If there is a fall of debris, and it is doubtful whether or not anyone is buried there, or whether [anyone trapped] is alive or dead, one should excavate the heap of debris for the sake [of a possible survivor, even on Shabbat]. If one finds someone alive one should remove the debris, but if he is dead one should leave him there [until after Shabbat]. (BT Yoma 83a)If one finds him alive, one should evacuate the debris … even if he has only a short while to live. (BT Yoma 85b)
From the statement that we desecrate Shabbat for a short life expectancy, we learn that we transgress commandments to keep someone alive for a short while just as we would to keep him alive for many days – "you shall live by them" (Leviticus 18:8) interpreted as "you should not die because of them" - even for a short life expectancy.
How far does one examine [the trapped person]? Until [one reaches] his nose. Some say: to his umbilicus. If one searches and finds the upper organs to be dead, one must not assume those below are definitely dead. Once it happened that those above were dead and those below were found to be alive. … Rav Papa said: The dispute arises only as to from below upwards, but if from above downwards, since he has already checked above and found no sign of life, one need not search any further, as it is said: (Genesis 7:22)‘In whose nostrils was the breath of life’. (BT Yoma 85a)

(40) Coming back to the issue of idol-worship, incest and murder:
When Rabin arrived, he said in R. Yohanan's name: We may cure ourselves with everything except idolatry and incest (BT Pesahim 25a)
We are not concerned here to say that idolatrous rites, incest and murder are forbidden, but to say that we are forbidden to derive any benefit at all from them, including for healing.
R. Yohanan: we may cure ourselves with everything except the wood of the asherah. How so? If there is danger, even the wood of the asherah too [is permitted]; while if there is no danger, all [other] forbidden things of the Torah are also not [permitted]? — Indeed [he was referring to a situation of] danger, yet even so asherah wood [must] not be used (BT Pesahim 28a)
Now, even though chewing asherah wood or rubbing it does not constitute a pagan ritual, nonetheless we are forbidden to do so, for it would be a transgression of the biblical verse (Deuteronomy 13:18) "none of the unholy thing shall stick to your hand", so it too is forbidden. Similarly with incest and murder:
Rav Yehudah said in Rav's name: A man once lusted after a certain woman, and his heart was consumed with his desire. When the doctors were consulted, they said: his only cure is for her to submit [to his lust]. Whereupon the rabbis said: let him die rather than that she should yield. Then [the doctors said]: let her stand naked in front of him. [The rabbis answered] let him dies rather than she should stand in front of him naked.[The doctors said]: so let her converse with him from behind a fence. [Let him die, the rabbis replied, rather than she should converse with him from behind a fence.] (BT Sanhedrin 75a)
So we see that for these three sins we do not use them for healing purposes, neither the sin itself not its derivatives. Nor do we restrict this principle to the situation of duress where a non-Jew is trying to force the Jew to convert, but even where the non-Jew is simply reveling in the Jew's tribulation. A person does not use asherah wood for healing in order to transgress but for his own benefit and health, and nonetheless it is not allowed. Similarly, a man wants to fulfil his lust for his own benefit, and even though refraining puts him in danger, it is not allowed. In Kiddushin (BT Kiddushin 40a) we read of a woman who tempted Rav Kahana, who then went up to the roof and jumped off it to his death. The same thing happened with R. Zaddok, they both endangered their lives and went to their deaths. Lest you think that sinning is allowed when the non-Jew's self-indulgence is involved, here they endangered themselves [rather than sin in exactly this situation].

(41) You should not think that it is righteousness for a dangerously ill patient to refuse to desecrate Shabbat, against doctors' orders. It is bloodshed, as it says (JT Yoma 8:5) he who responds quickly is praiseworthy, he who is asked is reprehensible, and he who stops to ask is guilty of bloodshed. All the more so, he who refuses treatment is guilty. But we do come to the conclusion that these three serious sins are always forbidden even if only [pressed on the Jew] for the non-Jew's enjoyment. Thus Mordechai endangered his life, and put all the Jews in danger, because Haman himself had become an object of pagan worship, even though [from his own point of view] he actually only sought enjoyment and glorification – "Ahasuerus raised Haman to glory…and all the king's servants kneeled and bowed down to Haman" (Esther 3:1-2). Now you might wonder about Esther who did submit to a forbidden sexual relationship and the Talmud concludes that it was permissible because the King was acting for his own enjoyment. That is a different case because sexual relations out of wedlock with a non-Jew were not forbidden by the Torah but only by Shem's Court. The discussion (BT Yevamot 45a) rules that her offspring would also be legitimate. This was a promiscuous relationship for he gathered all the girls and slept with them one by one. You might think that in Esther's case there was a marriage, for he crowned her queen, but there is no such thing as a forced marriage. Furthermore marriage to a non-Jew is like any other prohibition and not in the category of incest, which only includes adultery with a Jewish married woman. In addition, a Jewish man who has sex with a non-Jewish woman is liable to the death penalty - for he may be summarily killed by a zealot - and is also liable to karet, as Rav remembered learning from the verse (Malachi 2:12) "May the Lord cut off anyone who does this" (BT Sanhedrin 82a) – but a non-Jewish man having sex with a Jewish woman is just an ordinary sin, derived from "do not intermarry with them" (Deuteronomy 7:3). This is made explicit in the chapter headed "A wayward son" (BT Sanhedrin 73b) – that ordinary sins are not derived from the paradigmatic case of the seduction of an engaged girl, only capital crimes or those incurring karet. You might wonder too why we are allowed to give an idol-worshipper shovels for hot coals for his own use, of the sort they also use for their pagan fire rituals (BT Sanhedrin 74b). In this case the question is not one of pagan rituals or their derivatives but one of setting a stumbling block in the path of the blind, which is an ordinary prohibition just like any other in the Torah, whereas the prohibitions of idol-worship and their derivatives are always forbidden even for simple enjoyment or for healing. Similarly for murder and incest. This is what the Sifra teaches us:
[In certain cases] we suspend the principles of Shabbat, but the principles of [the prohibition of] seduction of a betrothed girl cannot be suspended.(Sifra Leviticus Hatat 1:11)
and the Yerushalmi explains:
that means that we may not heal by means of forbidden sexual relations. [The Sifra states that in certain cases] we suspend the principles of Shabbat – does that not mean that Shabbat is suspended for healing? According to this, [the prohibition of] seduction is not suspended at all even for healing. Since we rule that it is not suspended at all we understand that means even if the motive is self-indulgence, and we cannot move from this position. (JT Avodah Zarah 2:2)

(42)Mar bar Rav Ashi found Ravina massaging his daughter with unripe olives of orlah. He said to him: Granted that the rabbis ruled [thus] in time of danger, was it [likewise] ruled when there is no danger? He answered: This inflammatory fever is also like a time of danger. Others say, he answered him: Am I then using it in the normal manner of its usage? (BT Pesahim 25b)
The explanation is that a forbidden action carried out in a different way from usual is classified as a rabbinical transgression - as it says in the same text:
[With regard to] all the prohibited actions in the Torah, we only punish with the whip when they are performed in their normal manner, excluding if someone rubbed on his wound the fat from an ox which was stoned, in which case he is exempt. (BT Pesahim 24b)
Since rabbinical transgressions are allowed for the treatment of sick patients, even if they are not in danger, we derive that we may use things as cures that we are otherwise denied benefit by rabbinical law, even where there is no danger, such as hametz which was not discarded for all of Passover, and mixed crops outside the Land of Israel. Nonetheless we have no source to allow eating these things for then they are considered as transgressions of the Torah and allowed only in situations of danger.

(43) Chapter "One should not place":
We may allow them [heathens] to heal us when the healing relates to money, but not personal healing (Mishnah). What is healing involving money and what is personal healing? Shall we say that healing involving money means where no danger is involved and personal healing where there is danger? But has not R. Yehudah said in the name of Rav: even a scar over the puncture wound caused by blood-letting should not be healed by them? Healing involving money therefore relates to one's cattle, and personal healing to one's own body, as Rav Yehudah said. Rav Hisda said quoting Mar Ukba: even though the ruling is that we may not be treated by heathens, if [a heathen physician on being consulted] says that such and such medicine is good, and such and such medicine is bad, it is permitted [to follow his advice] for he will think that he is merely asking him, and just as he is asking him so he will also ask others, so that [by giving wrong advice] he would have his reputation spoilt. Rabba bar Bar Hanna said in the name of R. Yohanan: In a case where it is doubtful whether [the patient] will live or die, we must not allow them to heal; but if he will certainly die, we may allow them to heal. Surely there is still the possibility of depriving him of a short time alive? A short time alive is not considered relevant, as it says (Kings II:7,4) "If we say: we will enter into the city, then the famine is in the city". They might have been forfeiting an extra short time alive. This implies that a short time alive is not considered relevant. (BT Avodah Zarah 27a)
This means that when faced with a possibly short life versus a possibility of a regular lifespan, we do not consider the former [as sacrosanct].
Rabba bar Bar Hanna said in the name of R. Yohanan: Any lesion for which the Shabbat may be desecrated should not be healed by a heathen. Others report that Rabba bar Bar Hanna said in the name of R. Yohanan: no internal condition should be healed by them. How do these versions differ? — They differ in the case of a swelling of the hand or a swelling of the foot. For Rav Hanna son of Mattana said in the name of Rav: a swelling of the hand or a swelling of the foot is to be regarded as [serious as] an internal lesion, and the Shabbat may be desecrated for them. (BT Avodah Zarah 27a-b)
It seems that R. Yohanan does not disagree with what Rav Yehudah said in the name of Rav, that even a scar over the puncture wound caused by blood-letting should not be treated by a heathen, for it is considered to be an internal injury, and so even though it is a small lesion, it is not to be treated by a heathen. Rabbi Yohanan holds that a heathen may not be asked to treat any lesion for which we would desecrate Shabbat, meaning that since life is dependent on it even though it is presently a very small lesion and both patient and doctor say that there is no danger from it and thus no need to desecrate Shabbat, nonetheless we do not let a heathen treat it.

(44) The second version of this discussion specifies internal lesions, and here too even if the lesion is small, since it is in a sensitive position a heathen is not allowed to treat it. The reason for this is that the heathen may give a drug that causes damage, as happened to R. Abahu in an episode which we will presently write about, or that he might give a drug which aggravates the condition, and since it is in a sensitive position, the patient's life may be endangered. Thus, if a bad drug is introduced into the scar above a blood-letting puncture wound, death can follow quickly, because this is a totally dangerous situation since the sinews of the heart and the head lead to the same site. Since Rav Yehudah specified that the scar above the puncture wound is small and in a sensitive position, we infer that if it were not in a sensitive position and so would not lead to danger, we could let a heathen treat it, agreeing with R. Yohanan's ruling. Coming back to the answer that "healing involving money" refers to non-dangerous conditions and "personal healing" refers to dangerous conditions, even R. Yohanan would reject this, for he agrees that treating blood-letting puncture wounds would not be called "personal healing" for they are not dangerous in themselves for their treatment to be called "personal". Therefore he would reject that solution and understand "healing involving money" to refer to treating animals and "personal healing" to refer to humans. Even though the Mishnah only allows [a heathen] to treat animals, wherever a lesion [of a human] is not internal it would also be allowed. The Mishnah permits [the heathen to treat] relating to money but forbids personal treatment and it is the talmudic rabbis' interpretation that any non-dangerous lesion is like healing involving money. Furthermore, even if we understand the Mishnah as does Rabbi Yohanan, that healing involving money refers to non-dangerous conditions and personal healing to dangerous conditions, even though at first we understood R. Yohanan as rejecting this solution, now we can definitely accept both ways of understanding the phrase, as they follow the same reasoning. So we see in the words of Rabenu Hananel of blessed memory:
The Mishnah follows R Yehudah in concluding that healing involving money refers to animals and personal healing to humans, and at the same time rules according to R Yohanan.
It seems that our great rabbi of sacred memory [Alfasi], in his Halakhot, thinks the same way, though there is an opinion that rejects Rav Yehudah's suggestion in the face of Rabbi Yohanan's.

(45) The ruling that follows from this discussion is that any lesion that warrants desecrating Shabbat, i.e. any dangerous lesion, is not to be treated by a heathen, and those for which we would not desecrate Shabbat may be treated by heathens. Where the patient is an eminent Jew and the non-Jew an expert physician, the Jew may be treated by the non-Jew, for when R. Yohanan had tzafidna he went on a Friday to the matronita who gave him a course of treatment. We wonder how Rabbi Yohanan could have done this since he himself says that any lesion for which we desecrate Shabbat should not be treated by a heathen. We conclude that since R. Yohanan was an eminent man, the expert physician would not risk her good name with the authorities in causing him harm.

(46)What is the ruling on heathens administering kohl? The Rabbis say – if you want to go blind, go blind. Levi says – if you want to die, die. The Rabbis were not used to using kohl on their eyes, but Levi was. Rava said: we have seen them [the heathens] tasting the paint. But, perhaps they taste it when it is unadulterated [in order to deceive us] and afterwards they add the poison and then it can blind. "Opion" is dangerous. R Simon forbids the use of "thariaki" [in the hands of a heathen], R Yohanan permits it. (JT Avodah Zarah 2:2)

(47)Opion means opium, a drug prepared from poppies and dangerous if used in the hands of a heathen other than under expert supervision. But their "thariaki" is allowed because it is expensive and they make it with special care.

(48)No man should have any dealings with magicians, nor are we allowed to be healed by them even [if it may save] an hour's life. Ben Dama the son of R. Ishmael's sister was once bitten by a serpent and a man from Kefar Sekhania came to heal him but R. Ishmael did not let him. [Ben Dama] said: my brother Ishmael, permit it for me. I will even cite a verse from the Torah that it is to be allowed. But he did not manage to finish his sentence before he died. Rabbi Akiva exclaimed: happy are you Ben Dama for you were pure in body and your soul likewise left you in purity. Nor have you transgressed the words of your colleagues, who said: (Ecclesiastes 10:8) "He who breaks through the fence, a serpent shall bite him". Even though we allow non-Jews to treat when only a short life expectancy is at stake, the case of magic is different, for it draws one in. (BT Avodah Zarah 27b)
Therefore it is forbidden to be treated by magicians even for a non-internal lesion which is not dangerous.

(49)Jacob the magician prepared for R. Abahu a medicine for his leg, and were it not for R. Ami and R. Assi who licked his leg, he would have lost his leg. The gemara asks: R. Abahu was an eminent man and he was an expert physician, [so he should not have been in danger from the magician]? The gemara answers: the case of R. Abahu is exceptional because the magicians took the attitude of (Judges 16:30) "let me die with the Philistines". (BT Avodah Zarah 28a).
Let us challenge this. It may be true that R. Abahu was unaware of the magician's hatred for him, and so he relied on his being an eminent person with the expertise of a doctor, but should he not have been concerned that the magic might draw him in to it, and even where there is no danger one may not use magicians? Was he not aware of the baraita where Rabbi Akiva said "happy are you Ben Dama for you were pure in body and your soul likewise left you in purity. Nor have you transgressed the words of your colleagues"? And why did Rabbi Ami and Rabbi Assi, who were present, not say anything? Even assuming neither of them had heard [Rabbi Akiva's] baraita, why did the gemara not ask how R. Abahu could have done such a thing – for already before the Ben Dama episode we have learned that we do not go to them for treatment even for a short life-expectancy? It seems that we only make a special rule against magic because it draws one into it when the healer uses magic with a pagan component, as in the Ben Dama case where he was bitten by a snake and the magician wanted to whisper an incantation which incorporated the names of pagan gods. The reason we say that magic is a special case for it draws one into it, is that were he to have recovered he may, Heaven forbid, have started to believe in it. In this way [magic] is similar to asherah wood and pagan rites which we may never use therapeutically. To begin with, the gemara thought that we never use [heathen rites] therapeutically because the heathens may try and endanger the patient, and so it makes a special case for magic which might draw one in, where the objection is due to their magic [leading the patient astray, and not due to any physical danger they might want to cause]. But if the [magicians] practice as a regular expert physician, and use medicines to heal, they are as acceptable as any other non-Jew.

(50) We find a similar episode discussed in the Yerushalmi:
Once Rabbi Joshua the son of Ben Dama was bitten by a snake and a man from Kfar Sekhania came to heal him with an incantation.
And further on:
[Rabbi Joshua ben Levi's] grandson swallowed something and someone came and whispered a single incantation over him, and it came out at once. He asked him: what did you say over me? He answered: such-and-such. He said: it were better for me, had I died and not heard that word (Ecclesiastes 10:5) "as an error committed by a ruler". (JT Avodah Zarah 2:2)
The explanation is this: he swallowed a water leech or a snake, and the person whispered an incantation over him using the names of pagan gods. When the creature [he had swallowed] came out, and he heard that pagan gods' names were included in the incantation, he said: rather had I died than come to this. From this we learn that the objection to the magician comes from the names he utters, and not because magic draws one in and leads the innocent astray. But if they use regular medical drugs, magicians are the same as any other non-Jew. This is the correct understanding of the R. Abahu incident.

(51) Chapter "He who injures" has:
R. Yishmael taught: we derive the doctor's license to heal from (Exodus 21:19) "you shall surely heal".(BT Bava Kama 85b)
This means, lest the doctor say, what do I need this trouble for, perhaps I will err and find myself guilty of manslaughter; so the Torah gives him permission to heal. I find this difficult in light of what was taught in the Tosefta:
If an expert doctor licensed by the authorities causes damage he is exiled. (Tosefta Bava Kama 9:3)
from which we see that accidental medical error is punishable. One could argue that a doctor, like a judge, is required to deliberate, and if he erred but did not declare it, there is no punishment at all, as we see:
lest the judge say what do I need this trouble for, the Bible says "[God] is with you in judgment" – the judge can only judge the case as it appears in his own eyes. Nonetheless, if he erred and the court found out, he has to pay reparation out of his own pocket, according to the set rules.(BT Sanhedrin 6b)
Even though the licensed judge is innocent, and the doctor who has inflicted damage or directly killed is also not legally liable for damages, nonetheless, if it becomes public knowledge he is not absolved in the eyes of God until he has made reparation for the damage, or gone into exile for the death of the patient.
On the issue of [someone who is] innocent in a human court but liable by heaven
If an expert and licensed doctor [inflicts damage] he is innocent at a human court and his punishment is left to Heaven. (ToseftaBava Kama 6:6)

(52) In any case, if he does not declare his error he not liable at all, just as the judge is completely absolved both in the human court and from heavenly punishment. The doctor, then, should take all precautions expected of him when there is danger to life so as not to cause damage through negligence.
It is reasonable to give an alternative explanation for the license given to doctors to heal, other than relieving them of worrying over accidental errors, and that is, lest the doctors say: God causes illness and He heals – for it is not natural for people to seek medical cures, though they have become accustomed to do so, as [when the rabbis criticized King Asa - Chronicles II 16] "when ill he did not seek God's help but the doctors'". However, this permission imposes a positive duty, for there is a duty to heal, which is in the category of saving life, as was taught:
We feed him [on Yom Kippur] according to experts' [advice]. (BT Yoma 82a).It was taught: a person seized with ravenous hunger is given honey and all kinds of sweet things, for honey and very sweet food enlighten the eyes of man. (BT Yoma 83b)
In all these cases the patient should be fed only under the guidance of an expert, because if the ravenous hunger was accompanied by a fever, eating honey could be fatal. Similarly, we learn that we give medicine for a sore throat on Shabbat (BT Yoma 84a), and that Rabina massaged his daughter with unripe olives of orlah because of her fever, and that we may use everything as medicine except asherah wood, in all cases following accepted medical practice which is only known to medical science. Similarly it is permitted to put kohl on an inflamed eye on Shabbat; kohl is a sort of medical eye-ointment. Seeing that we desecrate Shabbat for medicine, we understand that this is in the category of saving life. Saving life is a major mitzvah, he who is swift to use his medical knowledge is praiseworthy, he who is consulted is unworthy and he who consults is as bad as a murderer, all the more so he who gives up and does nothing. From this we conclude that a doctor who knows his science and craft is obliged to practice it, and if he refuses to do so he is as bad as a murderer.

(53) I find the following section in the chapter starting "These are strangled" difficult:
May a son let blood for his father? — Rav Matana ruled: "Love thy neighbour as thyself". Rav Dimi son of Hananiah said: (quoting Leviticus 24:21) "And he that kills an animal [has to restore it] and he that kills a man [is put to death]." Just as one who damages an animal while trying to heal it is not liable for damages, so if one wounds a man to heal him he is not liable. Mar the son of Rabina would not permit his son to lance a blister for him, lest he wound him and thus unintentionally transgress a prohibition. If so, even a stranger should be forbidden? In the case of a stranger, the unintentional transgression is in respect of a mere negative precept: but his son's transgression would incur the punishment by strangulation. (BT Yoma 84b)
The law follows this argument. That makes me wonder - if so, an expert should not practice medicine at all, in case he makes a mistake and become liable to be executed by the sword.
Where the text refers to a son letting his father's blood, or someone else letting another person's blood, in both cases there is danger involved inherently in the process of blood-letting. Not only the doctor should be worried about mishaps, the patient too should be concerned lest the drugs he consumes or the potions he is given to drink were prescribed wrongly or the diagnosis was wrong, and he is effectively committing suicide, for medical errors are fatal. So the patient too enters uncertain territory. A possible solution is that the doctor has nothing to worry about, since the Torah gave him permission to heal, and the All-merciful [God] even placed on him an obligation to do so. If he uses his judgment to practice well, he is only fulfilling his duty as the All-merciful commanded, even if he may make mistakes unwittingly. In contrast, in the case of the son treating his father, there are others who could remove the thorn or lance his abscess, so we do not allow the son to do it so as not to put him into a situation of possible capital punishment. Similarly, the challenge based on the mishnah (BT Shabbat 122a) that removing a thorn with a needle on Shabbat might be considered as incidentally wounding the patient, an action punishable by stoning if done intentionally, is met by the argument that since that is neither a situation of danger nor of illness, he should have waited until after Shabbat and avoided a possible desecration of Shabbat.
In the same way, in the process of blood-letting, the wounding itself is the medicine, so a son may let his father's blood, the son and anyone else being equal in this respect. If blood-letting is medicine, both are allowed to do it, and for both it is a mitzvah. If they made a mistake resulting in death, both would be liable to punishment for something punishable by death if done intentionally. So the ruling of Rav Papa and Mar son of Rabina [forbidding their sons to remove thorns or lance their abscesses] does not contradict the permission given by Rav Matana and Rav Dimi [for a son to let his father's blood].

(54) But our great teacher of blessed memory [Alfasi] wrote:
In answer to the question whether a son may let his father's blood, the Talmud responded that Rav Papa would not let his son remove a thorn from him, etc. (Alfasi on BT Sanhedrin, chapter 10)
One could say [in response to this] that even though generally wounding in the course of medical treatment is not culpable, and it is covered by the principle of 'love your neighbor as yourself', since somebody else could do the treatment we do not let a son do it, for he might accidentally cause a worse wound than is normal in the course of the medical procedure, and that is a situation which would be punishable by strangulation (were it done intentionally). But we do not worry that either the son or somebody else would actually kill the father, since the Torah imposed the duty of healing on them and all medicine involves a risk to life – what heals one patient kills another.

(55) The talmudic dictum "the best of doctors [end up in hell]" (BT Kiddushin 82a) criticizes doctors who cause damage intentionally, but does not imply any prohibition of the practice of medicine, as in the accompanying dictum that the best of butchers [are partners of Amalek], for a good butcher is especially commendable, for though his calling is that of gangsters, he did not follow their example.
There the Mishnah teaches:
If one is forbidden by his own vow to take any advantage from his neighbour, he may visit him [when he is sick]. He must stand, but not sit. He may offer him personal healing, but not healing related to money…(BT Nedarim 38b) What does this mean? Shall we say that personal healing means without payment, and healing involving money is for a fee? If so, the text should have read: He may heal him without payment, but not for a fee? But by personal healing his own person is meant, whilst healing involving money refers to his cattle. (BT Nedarim 41b)
The Yerushalmi also relates to this issue, saying that even if there is an attending physician, another physician may take over, for one is not destined to be healed by just anyone. So we see that the physician is doing a mitzvah, returning to the patient the health his body has lost.
This is true only of a skilled and knowledgeable expert, and where there is no greater physician present, but someone who does not understand the nature of the profession should not practice it. Similarly, if there is a greater physician present, he is forbidden to practice at all. This is derived from other legal situations, for how could someone rule on a capital case where a greater judge was available, and if he did so it would certainly be considered bloodshed. If a doctor was licensed by the authorities but caused damage, if he was an expert he has to pay damages, and all the more so if he was not licensed, for the authorities only license experts.

(56) As for doctors' fees, it seems to me that he may charge for his time and work but not for his knowledge, for he is returning lost health and the Torah has instructed us to return lost property, and when it comes to mitzvot we say:
just as I [God] act for free, so you [humans] should [do mitzvot] for free. (BT Bekhorot 29a)
Hence charging for knowledge and study is not allowed – it is comparable to charging for [the Temple rites of] sprinkling and sanctifying, whereas charging for work is allowed and is comparable to charging for fetching the ashes and the water, which is allowed. So too, charging for time is allowed as the Tanna says:
If the priest was an old man you mount him on an ass and pay him on the scale … of a workman idled from his particular occupation (BT Bekhorot 29b)
If someone has drugs that a patient needs he may not overcharge for them, even if under pressure they offer him a higher price, because only he has the drug he may only charge the real value. As it says in Bavli Yevamot:
A daughter of Rav Papa's father-in-law was required to marry her brother-in-law in a levirate marriage, but he was considered unworthy of her. When the case came before Abayye …. Rav Papa said to him… let her release you on condition that she gives you two hundred zuz. After the halitzah ceremony, Abayye said to her: give him [the stipulated sum]. Rav Papa replied: she was not serious [in her offer of paying him off]. Was it not in fact taught: If a man escaping from prison came across a ferry boat and said [to the ferryman]: take me across and I'll give you a dinar, [the ferryman] can only claim his ordinary fare. From this then it is evident that the one can say to the other: my offer was not serious. Here too [the woman may say]: I was merely fooling you. (BT Yevamot 106a)
The explanation of this passage is as follows: even though in general the court will not force a woman to pay the two hundred zuz for her divorce if her husband wants to make the divorce conditional on this payment, but if she did pay, the divorce holds and if she did not pay it does not. In the case of the levirate marriage there cannot be a financial condition, but Abayye required her to pay on the basis that it is as if the man was being hired to work for his employer on this condition. Rav Papa responded that the price was extortionate, taking advantage of her distress, and so she was not required to pay it, just as in the case of the ferryboat. Even though the price asked of the woman in this case was not too high, since the man can claim that by not marrying her he is losing a wife and her property, as we read at the end of the discussion:
if the [escaping prisoner] says [to the ferryman] take a dinar as your wage, he has to pay him [the full dinar]
nonetheless since the man was not worthy of her, the Torah provides them with a reasonable solution, halitzah – in the words of the Scripture (Deuteronomy 25:8) "and they speak to him" - so he is not really losing anything that he could reasonably have expected. Therefore he is considered to be claiming an excessive fee, and she is exempt from paying it. This is the explanation of this approach, and we derive from this that wherever someone takes advantage of a customer's immediate distress and duress to increase the charge for services, the customer can subsequently default on the payment and say he was not serious about agreeing to the price. This applies to someone who overcharges for drugs taking advantage of the patient's distress - the patient only has to pay the market value. Employers and customers are equal in this respect. However, if he promised the doctor a high fee he has to pay, because he is buying the doctor's knowledge, which has no fixed market value. There are those who see the ferry-boat owner as legally bound to save the fugitive, on the principle of restoring lost property, and therefore not deserving of payment at all, other than compensation for his working time. In their opinion the doctor may charge only for his working time – if his time was worth one sela, and the patient promised in advance to pay him [more], then he is only paid one sela. But this argument is unreasonable. Let us compare it to halitzah, where the financial condition of 200 zuz does not lead to a legal obligation on the woman, but using this clause punitively is also not forbidden, showing that there is no legal liability. However, it is simply logical not to countenance overcharging where the other party is under duress. So legally, the doctor can insist on any charge he fixes, his advice itself being priceless. Even though the doctor is obliged to heal, just as the ferry-boat owner is obliged to save the fugitive, as far as any obligation that applies to everybody is concerned, if any particular person makes his action conditional on payment the court will not exact payment on his behalf or collect his debt. This is unlike the situation of illegal interest where the court does intervene, following the exegesis on the biblical phrase (Leviticus 25:36) "your brother shall dwell with you": give his money back to him so that he may continue to live with you. (BT Bava Metzia 61b)

(1) AND I WILL SET MY TABERNACLE AMONG YOU. “This means the Sanctuary [at Jerusalem].” AND MY SOUL SHALL NOT ‘THIG’AL’ (ABHOR) YOU. “This means that My spirit shall not reject you. Every [form of the term] ge’ilah is an expression of spewing out something that has been absorbed in another substance, such as: for there ‘nig’al’ the shield of the mighty, meaning that the shield was not receptive to the oil with which it was anointed; for they used to anoint a leather shield with boiled [fat], in order to make the blows of arrows or spears glance off it, so that it should not pierce the leather.” This is Rashi’s language.
But I do not know what would be the meaning of this, that the Holy One, blessed be He, should say that if we keep all the commandments and do His will, He will not reject us and His soul will not abhor us! Similarly when [speaking of] our transgressing His covenant [with us], and committing great provocations, He said, I will not reject them, neither will I abhor them! And the prophet [Jeremiah] said at the time of cursing [i.e., the prediction of the destruction of the First Sanctuary], Hast Thou utterly rejected Judah? Hast Thy soul loathed Zion? But this subject is one of the secrets of the mysteries of the Torah. Scripture is thus stating that He will set His Tabernacle among us, and that “the soul” from which the Tabernacle comes, will not spew us forth as a pot which we scour in hot water [in order to cleanse it of substances it has absorbed], but instead our garments will always be white and new. For the term ge’ilah denotes, as Rashi said, “casting out,” related to the expression, his bull gendereth and doth not ‘yag’il’ (allow the cow to reject as loathsome), his cow calveth, and casteth not her calf. He states here My soul [and ‘My soul’ shall not abhor you] similar to the expression, the Eternal G-d hath sworn by His soul. And the prophet [Jeremiah] thus is saying by way of amazement: “Hast Thou loathed Zion, itself which is a city and a mother in Israel, and hast Thou cast her from before thee, so that all her sons are clothed with filthy garments, polluted [with sin]?”
Now according to their simple sense, these blessings, which are many and [stated in] general terms [affecting the people as a whole], — such as rain, plenitude, peace and the fruitfulness of people — are unlike the blessings with which He has already blessed [the people] in brief, saying, And He will bless thy bread, and thy water, and I will take sickness away from the midst of thee. For there He assured them that their food and drink would be [a source of] blessing, so that no sickness will occur to our bodies, and therefore the organs of procreation will be complete and healthy and we will give birth properly, and live full lives, as He said, None shall miscarry, nor be barren in thy Land, the number of thy days will I fulfill, and similarly He said at the beginning, for I am the Eternal that healeth thee. The reason for this [division of the blessings into two sections] is that [all] the blessings [mentioned in the Torah], although they are miraculous, are hidden miracles of which the whole Torah is full, as I have explained. They apply even to an individual who serves [Him], for when there is a pious man who keeps all the commandments of his G-d, the Eternal G-d will guard him from sickness, barrenness and bereavement, and he will live out his days in goodness. But these blessings which are stated in this section are general ones applying to the people [as a whole], and they [take effect] when the whole of our people shall all be righteous. Therefore He mentions here always the Land: and the Land shall yield;in your Land safely;peace in the Land;out of the Land;it shall not go through your Land.
Now we have already explained that all these blessings are miracles, for it is not natural that the rains should come [in their due season], and that we should have peace from our enemies, and that they should have faintness of heart so that a hundred of them flee before five, as a result of us observing the statutes and commandments of G-d, nor that everything should be the opposite [i.e., that none of these things should happen] because of us planting in the Seventh year [which we are forbidden to do]. But although they are hidden miracles, for they are [brought about] by means of the natural events of the world occurring according to their habit, yet [the Torah mentions them separately because] they come to be known [as miracles] because of their constant and continuous occurrence in the whole Land. For if one righteous man lives and G-d takes away sickness from him, and he lives out his days, this also happens to some wicked people [and is thus not acknowledged as miraculous]. But when an entire land and a whole people always have rains coming in their season, and plenitude, security, peace, health, strength and defeat of their enemies, in a manner unparalleled in the whole world, it becomes known to all that this is the Eternal’s doing. Therefore He said [in connection with these blessings], And all the peoples shall see that the Name of the Eternal is called upon thee, and they shall be afraid of thee. And the opposite of this will occur because of the curses, when punishments will come upon the [whole] Land, just as He said, and I will make your heaven as iron, and punishments of sickness, as He said, and sore sickness, and of long continuance, meaning that the food will be spoiled and bring about sickness, and thus the miracle will be made known to all because of its continued existence amongst the whole people. Therefore it is written, And the generation to come, your children that shall rise up after you, and the foreigner that shall come from a far land, shall say when they see the plagues of that Land, and its sicknesses. For they will not wonder at that [single] man upon whom all the curse that is written in this book shall lie for it happens many times in the natural order of the world, among all nations, that bad happenings come upon a certain individual. It is only with reference to that Land that they will wonder, and that all the nations will ask, Wherefore hath the Eternal done thus unto this Land?, for all will see and understand that the hand of the Eternal hath done this. And [by way of reply] they will say, Because they forsook the covenant of the Eternal, the G-d of their fathers.
In general then, when Israel is in perfect [accord with G-d], constituting a large number, their affairs are not conducted at all by the natural order of things, neither in connection with themselves, nor with reference to their Land, neither collectively nor individually, for G-d blesses their bread and their water, and removes sickness from their midst, so that they do not need a physician and do not have to observe any of the rules of medicine, just as He said, for I am the Eternal that healeth thee. And so did the righteous ones act at the time when prophecy [existed], so that even if a mishap of iniquity overtook them, causing them sickness, they did not turn to the physicians, but only to the prophets, as was the case with Hezekiah when he was sick. And Scripture states [of Asa, king of Judah, by way of rebuke], Yet in his disease he sought not to the Eternal, but to the physicians. Now had the practice of [consulting] physicians been customary among them, why should the verse mention [as a sinful act Asa’s consulting] the physicians, since his guilt was only because he did not [also] seek G-d? But the verse can be compared to someone saying: “That person did not eat unleavened bread on the Festival of Passover, but instead [ate] leavened bread.” For he who seeks the Eternal through a prophet, will not consult the physicians. And what part do the physicians have in the house of those who do the will of G-d, after He has assured us, and He will bless thy bread, and thy water, and I will take sickness away from the midst of thee, whereas the physicians are concerned [mostly] with food and drink, warning [the patient] against [eating] certain foods and commanding him [to eat] others. Thus also the Rabbis said: “During all the twenty-two years that Rabbah reigned [as head of the Academy at Pumbeditha], Rav Yoseph did not call even a blood letter to his house” [as he, being a righteous person, was protected directly by G-d and needed no physicians], and they also say by way of proverb: “A gate which is not open for the commandments [i.e., a house wherein the commandments are not observed] is open for the physician.” This is also the meaning of their saying: “People should not have to take medicaments, but they have become accustomed to do so.” [That is to say]: had they not accustomed themselves to [taking] medicines, people would become sick according to the degree of punishment corresponding to their sin, and would be healed by the will of G-d, but since they accustomed themselves to medicaments, G-d has left them to natural happenings. This is also the intent of the Rabbis’ interpretation: “And he shall cause him to be thoroughly healed. From here [you deduce the principle] that permission has been given to the physician to heal.” They did not say that “permission was given to the sick to be healed” [by the physician], but instead they stated [by implication] that since the person who became sick comes [to the physician] to be healed, because he has accustomed himself to seeking medical help and he was not of the congregation of the Eternal whose portion is in this life, the physician should not refrain from healing him; whether because of fear that he might die under his hand, since he is qualified in this profession, or because he says that it is G-d alone Who is the Healer of all flesh, since [after all] people have already accustomed themselves [to seeking such help]. Therefore when men contend and one smites the other with a stone or his fist the one who smote must pay for the healing, for the Torah does not base its laws upon miracles, just as it said, for the poor shall never cease out of the Land, knowing [beforehand] that such will be the case. But when a man’s ways please the Eternal, he need have no concern with physicians.

(1) YE SHALL KEEP ‘CHUKOTHAI’ (MY STATUTES). “And these are they: thou shalt not let thy cattle gender with a diverse kind, etc. Chukim (statutes) are the decrees of the King for which there is no reason [given].” This is Rashi’s language. But our Rabbis have not mentioned that the reasons for the commandments [mentioned in this verse] are hidden from us, and that the evil inclination and the idolaters raise objections against them, except in [the case of the prohibition against] wearing a garment made of wool and linen, but not in the case of mating of animals of diverse kinds [for which there is a reason, as will be explained later on]. And the intention of the Rabbis [in defining “statutes” as the laws of the King for which there is no reason] was not that these are decrees of the King of kings for which there are no reasons whatever, for every word of G-d is tried. [They meant] only that “statutes” are like the enactments which a king promulgates for his kingdom, without revealing their benefits to the people, and the people, not sensing these reasons, entertain questions about them in their hearts but they accept them nonetheless out of fear of the government. Similarly, “the statutes” of the Holy One, blessed be He, are His secrets in the Torah, which the people by means of their thinking do not grasp as they do in the case of mishpatim [“ordinances” — laws which conform to the human conception of justice], but yet they all have a proper reason and perfect benefit.
Now the reason for [the prohibitions against] kilayim [“mixed kinds,” as will be explained further on], is that G-d has created in the world various species among all living things, both plants and moving creatures, and He gave them a power of reproduction enabling them to exist forever as long, as He blessed be He, will desire the existence of the world, and He further endowed them with a power to bring forth [only] after their kind, and that they should never be changed, as it is said with reference to all of them [at the time of Creation], after its kind. This driving force in the normal mating of animals is for the sake of preserving the species, even as human beings engage in sexual activity for the sake of having children. Thus one who combines two different species, thereby changes and defies the work of Creation, as if he is thinking that the Holy One, blessed be He, has not completely perfected the world and he desires to help along in the creation of the world by adding to it new kinds of creatures. Moreover, the mating of diverse species of animals does not produce offspring, and even in the case of those that are by nature close to each other [such as the horse and the ass], from which offspring are born, such as mules, their seed is cut off, for they themselves [the mules] cannot produce offspring. Thus from the point of view of these two matters [i.e., the changing in the order of Creation and the sterility of the product, we see that] the act of combining different species is despicable and futile. Even when diverse species of vegetation are grafted together, their fruits do not reproduce afterwards, and they too are prohibited because of the two above-mentioned reasons [for the prohibition of mixing different species together]. This is the meaning of the prohibition [stated here in the verse], thou shalt not sow thy field with two kinds of seed, which in the opinion of our Rabbis constitutes a prohibition against grafting [diverse kinds of trees, or trees and vegetables, and is not a prohibition against merely sowing together diverse kinds of seed]. But He has prohibited also the mere sowing together of diverse kinds of seed, because their nature and form change when they derive nutrition from each other, and thus each kernel of it is as if it were grafted together from two kinds. Similarly, He has forbidden to plow with an ox and an ass together, because it is customary among tillers of the soil to bring their working animals into one cattle-shed, and there they might come to mate with a diverse kind. And one of our colleagues adds to the reason for the prohibition against mixing seeds, that it is in order not to throw into disorder the primary forces which bring about the growth of the plants, when they derive nutrition from each other, as is indicated in the saying of our Rabbis in Bereshith Rabbah: “Said Rabbi Simon: There is not a single kind of herb that does not have a constellation in heaven which smites it and says to it, ‘Grow.’ It is with reference to this that Scripture says, Knowest thou ‘chukoth shamayim’ (the statutes of heavens)? Canst thou establish ‘mishtaro’ (the dominion thereof) in the earth? — [mishtaro being derived from the root shoter (executive officer)].” Now he who grafts diverse kinds of plants or sows seeds of diverse kinds with the intention that they derive nutrition from each other, thereby destroys ‘chukoth shamayim’ (the statutes of heavens). This is why He has said, Ye shall keep ‘chukothai’ (My statutes), as they are the statutes of the heavens. And so did Rabbi Chanina in the name of Rabbi Pinchas say, that [the statutes mentioned here in the verse] are because of “the statutes with which I formed My world.” I have already written in the section of Bereshith that all plants have their foundations in higher [forces], and it is from there that the Eternal commanded them the blessing, even life forever. Thus he who mixes different kinds of seeds, denies and throws into disorder the work of Creation.

(4) In truth, it seems obvious in context that they permitted even medicine that is not derived from these sages’ study of nature. King Solomon, who composed a medical treatise, was not, God forbid, following the ways of the Emorites. The book was hidden away by Hezekiah, and the rabbis praised him for it, not because it went in the ways of the Emorites, but because the wisest of men, in his great wisdom, composed a book on substances that are very effective, from the realm of revealed nature as well as magical nature. Ultimately, the world relied upon them in their illness, and in their illnesses they did not seek out God. Therefore, he hid it, and the rabbis conceded to him. This is similar to the verse (2 Divrei Hayamim 16:12): “Even in his (=King Asa of Judah) illness he did not seek out God, but only physicians.” Therefore they hid [the book], but they did not burn it, because it does not constitute the ways of Emorites, although he pulverized the copper snake.

(2) From the roots of the commandment are that it is known that magic is a very bad thing and causes many mishaps to people. I do not have to write at length about it, as the things are well-known. And therefore we were commanded to put away from the world someone who makes efforts with this, as he is coming against the will of God, as He desires [the world’s] settlement and that everything should be administered in a natural way. As nature was at the beginning of creation and this one wants to change everything. And according to my opinion, the matter of magic is that at the beginning of creation, God, blessed be He, placed for each and every thing in the world a nature [through which] to accomplish its action well and straight, for the good of the creatures of the world that He created; and He commanded each one to act according to its species, as it is written about all the creatures, in Parashat Bereshit (Genesis 1:12), “according to its species.” And He also made a higher force govern each and every one from above, to compel it to perform its action; as they, may their memory be blessed, said (Bereshit Rabbah 1), “There is no [blade of] grass below that does not have a constellation above that tells it, ‘Grow!’” And besides the action that each and every one does according to its nature, there is another action that they have, by mixing one species with another. And in the craft of this mixing there are some angles that were not permitted for people to utilize, because God knows that the end result that will come out for people from these angles will be bad for them. And on account of this, He prevented them from them. And this is what they, may their memory be blessed, said more generally (Shabbat 67b), “Anything that has healing in it does not have the ‘ways of the Amorite’ in it”; meaning to say, it should not be forbidden from the perspective of magic — since there is a benefit to it that is found from true experience, it is not from the forbidden angles, as they are only forbidden because of the perspective of their damage. And there is another matter in these forbidden angles of mixture and machinations for which they were forbidden. [It is] because the power of this mixture is so strong that it negates the power of the constellations that are assigned upon the two species. And the illustration of this is that it is just like that which you see with the grafting of one species with a different one, that a new third species is created. It comes out that the grafting negates the power of both of them. And so we have been prevented from bringing up to our minds to switch the perfect acts of God, even if something that appears to be pleasing comes out in our hand.

(3) And it is possible that a hint will come up in our hands from the roots of the forbidden mixtures of seeds and animals and shaatnez (the mixture of linen and wool). And we will write at length about them in their places, with God’s help. And that which they, may their memory be blessed, said (Sanhedrin 67b, Chullin 7b), “Why is its name called kishufim (magic)? Because it contradicts the retinue (makchishin pamaliah) on high and on low,” is meaning to say that their power temporarily overrides the power of those forces appointed over them. And see the precision of their words, may their memory be blessed, as they said, “the retinue on high,” and they did not say, “the decree of High — since God, blessed be He, decreed it and wanted from the beginning of creation that this action would come out from the two of them when they are mixed. And there is an open rebuke from it towards those appointed over them [about their lack of absolute power]. Rather, they said that the power of the retinue on high is [that which is] contradicted regardless. And one whose intellect is close to the light of the face of the King and the power of his merit overrides the power of those appointed, will not fear from this phenomenon, as we found that the sage said to the witch in the Gemara (Shabbat 81, Sanhedrin 67b).

(4) And the knowledge of the difference [between] these things — which is the mixing He permitted to us that does not contain any angle of magic and which is the one that has an angle of magic and is forbidden as the science of magic — is well-known. And do not think that the craft of magic and [of] demons (shedim) is the same thing. As behold, they, may their memory be blessed, said (Sanhedrin 67b), “‘With their tricks,’ that is the work of demons; ‘with their spells,’ that is the work of magic.” It is implied from this that the matter of magic is possible to do without demons. However, sometimes it is also done with demons. And those demons that are used for the craft of magic are called angels of destruction. So did Rashi, may his memory be blessed, explain — since the matter of magic is always only done to destroy. And about the details of the laws of magic, we will write at greater length in the negative commandment of the witch, with God’s help, as its place is there. As here there is only the warning of the law, meaning to say that we will not forgive them, but [rather] kill them. (See Mishneh Torah, The Sanhedrin and the Penalties within Their Jurisdiction 15.)

(1) ורפא ירפא, “and he shall provide for healing.” Whenever the Bible mentions the word רפואה when applied to a human being the letter פ always appears with the dagesh. For instance Jeremiah 51,9 רפאנו את בבל ולא נרפתה, “we tried to cure Babylon but she was incurable;” when we find the word used as something being performed by G’d then there is no dagesh in the letter פ. Example: Jeremiah 17,14 רפאני יהוה וארפא, “Heal me O Lord and I shall be healed.” Another example is found in Psalms 147,3: הרופא לשבורי לב, “He heals the broken-hearted, etc.” There are many more examples. The reason for this distinction in the spelling of the description of the applied cure is that when man, i.e. a physician, administers a cure it is apt to be accompanied by pain and suffering, whereas a cure administered by the Lord is a painless procedure. This is part of the meaning of Proverbs 10,22: “the blessing of the Lord enriches, He does not add sorrow to it.”
When the sages in Baba Kama 85 stated that the words ורפא ירפא in our verse constitute permission for a physician to practice his art they said so only in connection with externally visible injuries or symptoms of diseases; internal diseases, especially mental diseases are not subject to treatment by physicians of flesh and blood. They are the sole domain of the One who provides the soul to all living creatures. [This interpretation seems to be based on Ibn Ezra, but is disputed by other authorities. Ed.].

(2) Some of the meals prepared in the world to come are bodily and intellectual – for both the body and soul. And there are some intellectual meals for souls who stand alone without the body, and they enjoy forever those very worlds where each and every one resides according to their level. The bodily meals have been reserved for them from the beginning, the refined and pure foods created from the supernal light through a chain of causes. And they are: Leviathan among the fishes, Bar-Yokhnai among the birds, which were created on the fifth day, and Leviathan is called what it is because it is ordered for the righteous, and likewise the Behemoth of the thousand mountains, which was created on the sixth day with the creation of the human being, but before him. And the quality of these foods is very profound; they can penetrate into the intellect and purify the heart, like the manna which the generation in the desert merited, which was “like wafers in honey”, and was an offspring of the upper light, about which it is written, “Sweet is the light, and good to the eyes, to see the sun.” And it is possible that their quality will be greater than those who ate the manna, for insofar as perception at the end of days will be greater and more elevated than all the times before, so will the hearts be wide enough to include knowledge of Ha-Shem (May He Blessed) in its completeness, like “waters covering to the sea,” and this will be in the time of the Messiah greater and greater than the generation of the desert who went out of Egypt, habituated to hard labor, raising their hands out of mud, and their “palms just passed from the kettle.” For this time will be the perfect and elevated time, following the will of the One Who dwells in the bush, what is not so in this world, because it does not follow what His will was. And that is why they fixed the wording of the Kaddish to say, ‘be-alma dibra khe-r’utay‘ [‘in the world He created according to His will’], so consequently we pray for the time of the King Messiah which in the future the Holy One Blessed be He will create according to His will. And the compelling proof of this is that this world which we stand in now, in its conduct indeed does not follow His will, because here – when Adam sinned because of the serpent, it was against His will, because it was indeed His will that Adam live forever, that he never die. And thus the intention of creation was originally that no creature ever cross the line of serving its Creator, and because the design of the Holy One Blessed Be He was not fulfilled, but instead, the design of the Adversary, nevertheless, this world itself necessarily will return to the end which was the desire of its Creator at its beginning. And because we pray for this very time, the formulation of the Kaddish was fixed in the Aramaic language, so that the ministering angels won’t recognize or understand it, for if they did understand, they would be jealous of our status at that time, and they would pray for the delay of the redemption. Therefore we seek mercy for the name YAH as it written regarding it, “By the hand on the throne of YAH,” that His name will be “made greater and sanctified”, that is, the “name Yah will be great and blessed” [yehay shmay (= shem yah) rabah mevorakh], namely, that both His name and His throne will be complete, in that world which He created according to His will, all of it will return to like it was at its beginning. And I have compelling proofs for this that there is no need for me to go into at length, for it is my intention in this Gate only to give an explanation of the bodily and intellectual meals prepared for the righteous in their body and soul, and for the intellectual meals which are for the soul alone without the body. And no one with understanding ought to be astonished if the righteous will have actual physical meals, that they will delight in both in body and soul. For see, in the Garden of Eden which had in its land a tree of life which could bring about eternal life for those who ate from it – whether good or bad, and there was water and grasses in it, which without a doubt, some of them were life-giving, others deadly, some of them healthful, others which would make you sick. And thus it is written in the Torah, “There He made for them a fixed rule, and there He put them to the test.”And the view of our rabbis z”l was that the wood was bitter, and the Holy One Blessed Be He sweetened the bitter with something bitter, a miracle within a miracle, and so our sages z”l taught in a midrash: “‘The Lord showed him [Moses] a piece of wood.’ Rabbi Elazar says it was hardofaney, R. Nathan says it was olive wood, and there are others who say it was the roots of a fig tree.” In any case, it was bitter. And so you find it written about Elisha, “The water is bad and the land causes bereavement,” and it is written, “Bring me a new dish, and put salt in it,” and that “healed” the water.Rabbi Simon ben Gamaliel says how much more wonderful are His ways than the ways of flesh and blood! He puts a harmful thing inside a harmful thing to make a miracle inside of a miracle. Moreover, we are able to teach even more midrash about this, for you know Torah has seventy faces, because when it said in the verse, “There He put them to the test,” that is to say, there Moses tested this plant, and it was out of the science the Holy One Blessed be He taught him that he knew the power of this plant, about its nature or its virtue, which was to sweeten the bitter. And so it uses the expression: va-yorehuHa-Shem (i.e., “the Lord instructed him”), instead of va-yar’ehu (“He showed him”),because he had to have Him teach him about this; the Holy One Blessed be He taught him the science of the plants He created – about their nature to revive and to kill, to heal and to sicken, to sweeten and to embitter. And this is the connotation of the expression hok u-mishpat (“statute and law”): hok is its virtue whose reason is not known, and about mishpat, our rabbis z”l said, “And the Lord instructed him [about] the tree” – that is, its nature, that it is by law to be so in its nature. And it is connected immediately to “If you will heed the Lord your God diligently, doing what is upright in His sight, giving ear to his commandments and keeping all His hukim [“statutes”], then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I the Lord am your healer.”Scripture has warned us not to entrust the core of our well-being to the power of plants, but rather to keeping the commandments, for they are the core. And with keeping the commandments He will keep them healthy, and prevent them from getting sick. And it was necessary to say this, because it is possible that mortals, erring and stumbling through their knowledge of the powers of these plants, will entrust the core of their well-being to them, and despair of seeking mercy from the Master of Mercy (may He be blessed) “in whose hand is every living soul.” And this is the reason why King Hezekiah hid the Book of Cures, so that human beings would not stumble over them, and the sages z”l thanked him for this.

(1) Says the commentator, "And since it has come to us, we will say something that it is a commandment (important) to publicize": From way back, I found this statement of the Sages, may their memory be blessed, in Yevamot 61a to be difficult. As we say over there, "You (the Jewish people) are called men (adam) but gentiles are not called men." It is difficult. As would it enter our minds that the Sages, may their memory be blessed, would say about a gentile that has God's image - as we have explained - that he is considered only like an animal? Moreover - if so, what is this that the Holy One, blessed be He, said (Exodus 19:5), "And you shall be a treasure for Me among all the nations?" And if all of the nations are only like animals of the field, this statement would only be as if He was saying, "And you shall be a treasure for Me from all the animals and from all the monkeys that are similar in their appearance to men." Furthermore - if so, all of their actions are like the actions of animals, that are not subject to reward and punishment. But behold, this thing contradicts what we have established [to be true] - gentiles have a share in the world to come (Sanhedrin 105, Mishneh Torah, Laws of Kings and Wars 8)! And see that even without the holy voice of the Rabbis, may their memory be blessed, who told us so - we would know this thing from the perspective of the intellect. For surely the Lord is just in all of His ways, and kind in all of His deeds. And we see how many of their pious ones - besides that they recognize the Author of creation, and believe that the holy Torah is divine - do kindnesses even to the Israelites. And some of them did great good to all of those that come to the world: Like the pious [Edward] Jenner, who invented the vaccine for smallpox, through which many myriads of people have been saved from disease, death and defects; and [Francis] Drake who brought the potato to Europe, which relieved famine several times; and [Johannes] Gutenberg who invented the printing press. And some of them were not rewarded at all in this world, like the pious [Johann] Reuchlin who exposed himself to death to save the Talmuds from burning, as had been commanded by [the Holy Roman] Emperor Maximilian in the year (5262) [5269] (1509) through the incitement of the apostate [Johannes] Pfefferkorn - may his bones be crushed - and the priests who joined together, in the way of the success of the wicked. And this Reuchlin that we mentioned threw himself against them and - through his arguments - convinced the emperor to take back his aforementioned commands. And because of that, he was mostly persecuted; and his enemies, the priests, embittered his life and pressed him - until he died from the pressure upon him, with a broken heart. And would it enter your mind that these great deeds would not be rewarded in the world to come behind the curtain, God forbid? For behold the Holy One, blessed be He, does not deprive any creature of its reward. And if you would find to say about even these pious men mentioned: That even though they kept the seven commandments of the Noahides (Sanhedrin 56b), their status is nevertheless not like that of resident aliens (gerei toshav) since they were not accepted in front of three Torah scholars (Avodah Zarah 64b) - and besides that, we only accept resident aliens at at time when we practice the jubilee (Arakhin 29a); since they have not done acts of Esau, they have a share in the world to come regardless (Avodah Zarah 10). In any event, it is difficult. As behold, it is simple [that the law is] that even the [dead body] of even their most pious one does not make a tent impure, because they are not called men (adam). And it is a good question - why not? Behold he has the image of God, and he was righteous and pious in his deeds, and he also has a share in the world to come. If so, why is he not called a man? If so, why are they not called adam? Indeed, something else that is difficult for me is about what was written by Tosafot mentioned above, that they are nevertheless called, the man. And this is a wonder - for if they are not included in men, how is it proper to call them, the man - with a definite object? And Amoraim (later scholars) in the Talmud likewise wrote (Gittin 47b) that gentiles are also included in, "and He gave the earth to the sons of man (Adam)" (Psalms 115:16). And this is a wonder! For if their ancestors were not included in, men, how could they be included in the sons of man? However God enlightened my eyes [to see] that the Sages, may their memory be blessed, said something great with this. For if we look at the condition of the Jews today and we look at the condition of the other nations today, we see that there are two big differences between them: For behold, when the Israelites were in Egypt, all who came to the world - both Israel and the other nations - were like orphans without a father; they all dwelt together in a thick darkness, and did not know God. And it was not only Pharaoh who said (Exodus 5:2), "I have not known the Lord." Rather even the Israelites did know their Father in heaven at all, to the point that our teacher, Moses, peace be upon him, needed to ask the Holy One, blessed be He (Exodus 3:13), "[when] they ask me, 'What is His name?' what shall I say to them?" And even when they crossed the Red Sea, their faith was still weak with them, such that there was an idol in their bosom at that time, as it is written (Sanhedrin 103b) on the verse (Zechariah 10:11), "And he shall pass through the sea with affliction" - that the idol of Micha went through the sea. It is shown from here that they were [still] immersed in all of the filth of the extreme abominations, like the Egyptians and like their practices. And they did not at all know about their obligations to God, to their fellows and to themselves. And all the more so was it like this with the other nations. As the worship of even the most understanding of them - such as the Greeks and the like - was made up of extreme abominations; to the ox and the donkey together and to the other animals of the forests and the beasts of the thousand mountains. And they would pray to plants and to trees - to sticks and stones - and to mountains and rivers, as if they were gods. They would also sacrifice their sons and daughters to demons; and all of their mountains would bring up the smoke of the blood of man. So God remembered the whole world and His covenant with His servant, Abraham; and he chose his descendants after him to be like priests and teachers to the rest of those that come to the world. And God, as it were, descended from the heavens to within Egypt - the land of wisdom at that time - among the people of the redeemer and the disgusting one, and opened their sealed eyes with pincers, by striking Pharaoh and his land with great and awesome plagues before their eyes. And when he was placed beneath the rod, they heard that they yelled out to him from the Heavens (Exodus 8:18), "in order that you shall know that I am the Lord in the midst of the earth" (providence); (Exodus 9:14) "so that you will know that there is none like Me in all of the earth" (omnipotence); (Exodus 9:29) "in order that you shall know that the earth is God's" (reward and punishment). Then the foolish children opened their eyes and saw who was the 'Ruler of the palace.' And what was still lacking in their knowledge of God, the more discerning were able to peek at with great power at the splitting of the Red Sea. Then they pointed with the finger upon Him, and said (Exodus 15:2), "This is my God, and I will embellish him." "And they trusted the Lord and Moses, His servant" (Exodus 14:31). But it was still not enough for them; until He revealed Himself with great fanfare and a wondrous and awesome display upon Mount Sinai. And among the flames of fire reaching to the heart of the skies, the darkness, the cloud and the mist, He broadcast His commandments, His statutes and His teachings - including all of the obligations of man. He also taught them afterwards the arrangements of proper conduct regarding the division of the camps, cleanliness, the groupings, the sounding of the horns, the holy vessels and that which is similar - in such a way that that the whole reason for their success in this world and in the world to come was not known to them from their own intellect, but only through the glorious Holy One, blessed be He, Himself. But it was not so with the other nations. That even though then throughout that whole time that the Holy One, blessed be He, drew Israel close, to perfect them, the vision of all [the others] that came into the world was one of laying down in a slumber of stupidity and in a chaos of awful abominations; nevertheless all that they grasped afterwards of the causes for success in this world and the next world, came to them by themselves - in such a way that we can say that they made themselves. For they have drawn and learned much from the Torah of God - the well of the Jews - in the long time from then until now; and they learned much about the obligations of man, and etiquette and ethics through the passage of time and from science. From the light of the intellect piercing through to them, little by little, a brightening light continues to grow brighter; to the point that if we look at the worst of the nations today, they are nevertheless superior to the most superior one of thousands of years ago, which does not reach the ankles of the former. And it was only in much time and with great effort that they made themselves. It comes out that the Israelites and the other nations each have one unique advantage. The advantage of the nations over Israel is that they made themselves from their own free choice and, literally, from their own efforts. And this is certainly an advantage over Israel, who were pulled up by the corners of their heads by the effort of God, in order to perfect them - so they cannot claim the credit for themselves. For in everything that God distinguished them, in order to perfect them - it was from the hand of God that was with them, and it was only in the merit of their forefathers. Yet there is nevertheless also a unique advantage to the Israelites: For everything that the nations grasped, they only grasped with their intellect. Hence there are many commandments of the Torah - which are much more elevated than the human intellect, such as the statutes of the Torah - that they still do not do, because they do not understand them [until the end of days, when God will pour forth His spirit upon all flesh]. Moreover because all that they have grasped has only been from the human intellect - therefore, whoever among them has been negligent from opening his eyes over the course of time, is still mired in the filth of the early abominations, like most of the residents of Africa. And in Asia and in America as well, there are many nations that still walk in darkness and worship mute idols and sacrifice their children to demons - like their ancestors from time immemorial. For they have not known the Lord and have not become familiar with His teachings. Not so Israel. They keep all of the statutes of the Torah, even those beyond human intellect. And also the whole people - from small to big - lives by its faith. Both the fool and the ignoramus will nurse from the breasts of the Torah of the Lord, and it will force him to open his eyes, to see the path of life. And this is [the meaning of] the verse (Isaiah 43:21), "I have created this nation for Me" - meaning, I made them, as it is written (Psalms 100:3), "He made us, and we are His." Therefore (Isaiah 43:21, cont.), "they will speak My praise" - it is fitting that they should praise Me - and not that they should boast about themselves from this. And it also states (Isaiah 60:21), "And all of your people are righteous" - that even the fools among them will "inherit the land" of the living; like an inheritance, without effort. And all of this is because they are "the shoot of My plantings" - that I created Myself, and I also made them - and "the work of My hands in which I glory." According to this - with regards to Israel's advantage and perfection, it is like the model of Adam (the first man). As when any person comes to the world, he is created with a lack of knowledge - until time, study and intellect open up the wrinkles [of his brain] to make him into a man. Not so the first man - he was created in his stature and his character (Rosh Hashanah 11a). And immediately when he had the breath of life breathed into him, he was a talking spirit with intellect and knowledge - knowing all of his obligations. And that is because he was also the same as the Israelites in his properties. As he was surely also the creation of the palms of the Holy One, blessed be He, Himself - like them. And behold that anytime the circumstances and actions of the son are similar to the circumstances and actions of his father, he is called by his father's name. As it is written (Leviticus 16:3), "Thus shall Aaron come to the holy" - which means to say any high priest from his descendants after him. And likewise is it written (Malakhi 2:4), "to have my covenant with Levi," which is meaning to say all of his descendants after him. And likewise is it written (Hosea 3:5), "and will seek the Lord, their God, and David, their king," which is meaning to say, the king that is from [David's] descendants. And likewise is it written (Ezekiel 37:24), "And My servant, David, shall be king over them," the intention of which is about the messianic king, who is from his descendants. And likewise is our holy nation called by the name, Israel, for the name of their forefather - not only because all of his offspring were intact, and no other nation came from him - but also because everything that happened to this old man, Israel, to suffer persecutions and bad events from his youth until the days of his old age; likewise, "Since my youth they have often assailed me, let Israel now declare" (indicating that the history of the Jews has been like the life experience of Israel). Therefore are they called by his name. And according to this, it is incorrect to call all those that come to the world by the name, men (adam) - for the first man was called like this because he was created from the dirt (adamah); but behold, all of his descendants were created from flesh and blood! But it is only fitting to call the Israelites this name - not for their [own] glory, but rather because their source and the perfection they reached was from the Holy One, blessed be He, Himself, and not from their own efforts, like Adam. And therefore every place in the Torah where it is stated, men (adam), the intention is only to the Israelites - such as (Leviticus 1:2). "When men sacrifice," which is only speaking about Israelites. As we say (Chullin 13b), "'From you' and not all of you, to exclude an apostate; 'from you' - among you I distinguished, but not among the nations. And the Talmud required another verse of (Leviticus 22:18) "any man (ish)" to also accept [sacrifices from] vows and gifts from the gentiles. But the name, men (adam) is not fitting for them. For they made themselves with much effort; so, regarding this, they are not similar to Adam at all. But any place where it is written, people (literally, the children of Adam), the nations of the world are also included - for all of them are the children and grandchildren of Adam, just like us. And likewise every time it is written, the man (ha'adam), with a definite article - it is certainly not Adam's name, in that Adam was actually his name. And surely no definite article ever comes before an actual name; such that we could not say, the Abraham, the Isaac or the Israel. Likewise can we not say that the man (ha'adam) is referring to Adam. But rather it is clear that in this way (with the definite article), its meaning is mentsch in the language of Ashkenaz (German). And [man] is called adam [only] as a borrowed [and not exact] term. And in this sense, the nations are certainly included - as they are all thinking creations with the image of God, like us. What comes out of our words is that that which only Israelites are called, men adam, is not such a great praise. It only testifies about them that it is not they, themselves, that removed the thick shell from [their] sealed heart; but rather it was only because they were like clay in the hand of the Craftsman, blessed be He.

(1) On the subject of wars between nations and needless bloodshed, the Rebbe said, “Many of the misguided follies which people in previous eras believed in, such as primitive cults like child-sacrifice to Molekh (Leviticus 20:2) and so on, have now disappeared. But so far, the pursuit of war—misguided error that it is—has not been abolished.” The Rebbe had contempt for the scientists who developed new weapons, saying, “What great sages they must be to figure out how to make a wonderful weapon that can kill thousands of people at once! Is there anything more foolish than to kill so many people for nothing!”

(7) But either way, [whether in the jubilee or shemittah year,] the human being in his technological character is obliged to elevate the labor of the soil from its low state. That is what the light of Hashem accomplishes via human technology: “In the future, all artisans will ‘stand upon’ [and work] the ground” (Yevamot 63a). The greater portion of the ground will emerge from its curse, because wisdom will redeem it.

(1) [When a person suffers from] a smallness of faith, it appears [to that person] that when people strive to strengthen their [this-worldly] situation, to fight against the problems that occur in the world, to acquire knowledge, might, beauty, organization – that all of this is external to the divine content in the world. Thus, a number of people who believe that they stand upon a divine basis are suspicious of all worldly progress. They hate culture, the sciences, political strategies – whether among Jews or non-Jews. But this is all a great error and a lack of faith. The pure outlook sees the divine appearance in every improvement of life: individual and general, spiritual and physical. It measures matters only according to the level of the usefulness that they have or the damage that they cause. Any movement that engaged in constructive creation, whether physical or spiritual, will never be an entirely negative movement. It may have imperfections, but everything in its totality is an element of the divine creation that is constantly acting. “Not chaos did He create it, but that it be inhabited did He make it” (Isaiah 45:18).

Since it is necessary for human beings to practice abstinence which will further their welfare in this world by taking from it only what is necessary, it follows that there should be in this world complete ascetics which separate and cut themselves off completely from secular occupations. So that all of mankind can learn from them on abstinence, each person according to his need, and according to what is fitting for his customs and tendencies.