From Cholera to Coronavirus: Recurring Pandemics, Recurring Rabbinic Responses

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From Cholera to Coronavirus: Recurring Pandemics, Recurring Rabbinic Responses
Edward Reichman

This article is dedicated to the refuah shelema of my dear friend, the tzaddik, Yisachar Chaim ben Esther Malka (who is suffering from coronavirus) and to the memory of Romi Cohen z”l a mentor and life-long inspiration, one of the greatest people of our generation, who died 28 Adar 5780 from coronavirus at the age of 92, yehi zikhro barukh.

Having recently written an article on the salvific practice of reciting Pittum ha-Ketoret in times of epidemic, I find it ironic that I find myself in need of prayer in home-quarantine after being exposed to a patient with documented coronavirus (I have, thank God, tested negative). This current pandemic has generated a plethora of novel halakhic issues that were formerly unfamiliar to modern poskim. As with all halakhic challenges, especially in the field of medicine, we seek historical precedent in rabbinic literature. With modern medical developments, such as organ transplantation, brain death, surrogate motherhood, or ovarian transplants, rabbinic precedent is sparse at best. Disease and its impact on society and religious practice, however, is as old as humanity itself. Many turn to the Spanish influenza pandemic of 1918 for possible halakhic guidance, primarily because it is incessantly referenced in the media as a benchmark for the worst pandemic in recent history.1 Unfortunately there were many more pandemics of great magnitude throughout history, such as Black Death, polio, and smallpox. 

The present essay focuses primarily on the impact of one disease on Jewish religious practices. The disease cholera, aptly called חולי רע (“evil disease”) in Hebrew,2 caused seven prolonged pandemics in the eighteenth and nineteenth centuries. As opposed to the Spanish flu, which lasted less than two years, the cholera pandemics each spanned from seven to twenty-four years. We thus have halakhic responses to cholera over a considerable period of time. While a comprehensive review of all the halakhic literature on cholera remains a desideratum,3 we review here some of the issues our predecessors faced in times of pandemic in the hope of providing perspective, inspiration, and guidance on how to cope with our present predicament. Some of the parallels are striking, and it is humbling that despite our remarkable, divinely guided advances in both the understanding and treatment of disease, in many ways, little has changed.

A Word About Contagion and Disease Transmission in the Pre-Modern Era

Prior to the development of germ theory and the field of bacteriology in the late nineteenth century, the mechanism of disease transmission was poorly understood. While the history of theories of contagion is not the substance of our essay, suffice it to say that in the pre-modern era there was only a rudimentary understanding that diseases could be passed from person to person, or through the air. In addition, different times of day, poor hygiene or dietary practices were thought to be associated with disease acquisition. Conversely, specific foods or practices were thought to be preventive. Though the science behind the theories was lacking, their general appreciation of the transmissibility of disease informed their preventive measures.

Prayer in the Times of Cholera

R Akiva Eiger

R. Akiva Eiger

Rabbi Akiva Eiger (1761-1837) was the rabbi of Posen during the second cholera pandemic (1829-1837). He penned a number of letters from 1830 to 1831 regarding multiple aspects of the disease and its impact.4 The first of these letters, which has been widely cited during the present coronavirus pandemic, addresses, in part, the impact of contagion concerns on the daily prayer services, which by nature congregated large groups of people in relatively small spaces. The letter is written to Rabbi Eliyahu Guttmacher, the rabbi of the nearby community of Pleschen:

His honor’s letter has reached me, regarding prayer in the synagogue. In my view, it is true that gathering in a small space is inappropriate, but it is possible to pray in groups, each one very small, about fifteen people. Prayer should begin at first light, with the next group following after. Furthermore, each one should have a designated time to come pray there. The same for minha.… And they should be careful that people beyond the aforementioned quota not push their way into the synagogue. Perhaps a guard from the police should oversee this. Once they have reached the number (15), they should not allow others to enter until that group is finished. Set this request before the magistrate, and that I have written this instruction for you. And if they refuse, it would be good to arrange it with the local authorities. You will certainly succeed if you mention my name, that I have instructed you not to have large gatherings in the synagogue in a small space, and that I have advised you of these arrangements, and have cautioned you to recite Tehillim and pray for the king as well, may God protect him.

This letter is remarkable for its sensitivity to the notion of contagion and crowding as well as the consideration of involvement of the secular authorities to enforce compliance. 

Consistent with his earlier letter about crowd limitation in the synagogue, in 1831 R. Eiger and the members of the rabbinic court of Posen issued a decree, paraphrased below, providing guidance in advance of the high holidays in the midst of the cholera pandemic.5

We provide the following guidelines given the recommendation of the physicians that gathering of large crowds for prolonged periods of time, leaving early on an empty stomach, and breathing the sharp [toxic] morning air is likely to cause cholera. Furthermore, the fumes of oil lamps… in the synagogues are harmful to one’s health.… All synagogues, including both the men’s and women’s section, should fill to only half of their seating capacity such that every other seat is empty. To allow for equal access during the high holidays, half the congregants will attend for the two days of Rosh Hashana while the other half will attend for Yom Kippur, with the specific holiday being determined by lottery. A military guard should be posted at the synagogue entrance to maintain orderly seating .The length of the service for Rosh Hashana should not exceed five hours, each oleh to the Torah will be limited to one mi sheberakh, piyyutim should be omitted, and the cantor should not prolong the prayers with melodies or musical flourishes. 

Similar guidelines were provided for Yom Kippur, though the issue of eating on the fast day received separate treatment (see below). The assumption, addressed in the decree, was that the people designated by lottery to not attend synagogue would pray in private house minyanim. Provisions for contagion precautions were set forth for these situations as well. 

RabbiYaakov Tzvi Meklenberg (1785-1865), the rabbi of Königsburg and author of the work HaKtav vehaKabbala, also issued restrictions for synagogue attendance in 1857 due to concerns of disease spread during the third cholera pandemic (1846-1860). His recommendations were more limited, instructing just the women of the community to refrain from attending synagogue and to pray at home.

In the present coronavirus pandemic, the initial recommendations for many communities, in the spirit of the letter of R. Akiva Eiger above, was to limit synagogue attendance and increase the distance between congregants in order to minimize contagion. With the rapid progression of disease and increasing fatalities, limited synagogue attendance gave way to complete closure of synagogues across the globe, a measure unprecedented in halakhic history.

 

Limitation of Public Gatherings

Akiva Eiger’s son-in-law, Rabbi Moshe Sofer (Hatam Sofer) also faced concerns in Pressburg regarding contagion in the community. In the year 1831, the same year of the letter of R. Akiva Eiger, in the midst of the cholera pandemic, physicians banned public gatherings to limit the spread of disease. The secretary of the Hevra Kadisha planned to cancel the annual dinner of the burial society scheduled, according to tradition, for seventh of Adar. Hatam Sofer instructed that under no circumstances should the seuda (festive meal) be cancelled.6

While in the initial stages of the coronavirus, there was debate about the canceling of weddings, community dinners and other simchas, widespread consensus evolved that such measures are necessary to control disease, though minority dissent still persists. While it is of course purely speculative as to what Hatam Sofer would have done in today’s climate, the strength of the science and unanimity of the recommendations would surely be a factor.

Fasting During a Pandemic

  • Rabbi Akiva Eiger

The issue of fasting for individuals afflicted with disease has been addressed in halakhic literature throughout the centuries. A subset of these discussions focusses on community recommendations in times of widespread disease. Here I briefly discuss a few such cases that arose during cholera pandemics.

The community decree authored by R. Akiva Eiger and the members of the rabbinic court in 1831 included a discussion about the upcoming fast of Yom Kippur.7 The decree stipulates that as fasting on Yom Kippur is a biblical obligation, they could not be lenient on a general basis to permit breaking the fast. However, in order to facilitate rapid access to medical consultation, they arranged for two physicians to be positioned in a centrally located facility close to all the synagogues throughout the entire day of Yom Kippur. They hastened to add that one should consult the physician for even the slightest symptoms, as there is risk not only to oneself, but to others as well. “You will be called to judgment,” they wrote, “both for yourself and for the souls of the others [you affected], not to mention that on this holy and awesome day one should refrain from violating the prohibition of shedding blood.”

  • Hatam Sofer

    R. Moshe Sofer

    Rabbi Moshe Sofer

Hatam Sofer also addressed the issue of fasting on Yom Kippur in times of cholera,8 when the recommendation was that leaving one’s house without eating was considered dangerous (even life-threatening). In principle, he permits a healthy person to eat on Yom Kippur in order to prevent possible danger, though he did not permit it in this particular case. According to the question, the danger arose only when leaving the house. If one stayed at home, there would be no danger. Therefore, he suggested fasting at home and refraining from going to shul.

  • Rabbi Yisrael Salanter
R. Salanter

R. Yisrael Salanter

Perhaps the most famous rabbinic decision regarding fasting during a pandemic is that of Rabbi Yisrael Salanter in 1848 during the third cholera pandemic.9 The most dramatic retelling of the story is found in the literary work of Hebrew author David Frischmann, “The Three Who Ate”:

Three people who ate […] did not eat on any regular day of the week, but on Yom Kippur. And not just on any Yom Kippur, but on Yom Kippur that fell on Shabbat. They didn’t eat in secret, but in front of everyone gathered in the Great Synagogue. They weren’t simple people or boors. These three were not frivolous. Rather they were the princes of the community and their most important leaders, none other than the rabbi of the city and the two Dayanim [rabbinic judges] who stood with him… It was the afternoon of Yom Kippur. The rabbi stood bent over on the Bima… Even now my eyes can picture that incredible sight, as I stood there in the congregation of the synagogue. The rabbi stood on the Bima, his dark eyes shining out from his pale face and white beard. The Mussaf service was almost over and the congregation stood silently waiting to hear something from this man of God…  Suddenly my ears heard a sound, but I could not understand exactly what it was. I heard the sounds, but my heart could not comprehend. “With the permission of God and with the permission of the community, we hereby permit people to eat and to drink today.” The beadle came forward and the Rabbi whispered a few things into his ear. Then he spoke with the two Dayanim who were next to him. They nodded as if to approve of what he had said. As this was happening the beadle brought a cup of wine and some cake from the rabbi’s home. If I am lucky to live for many more years I will never forget that incredible day and that awesome sight. If I close my eyes for a moment I can still see them: the three who ate! The three shepherds of Israel standing on the Bima in the synagogue, eating in front of everyone, on Yom Kippur.10

The version of events varies from R. Salanter’s granting permission to break the fast if warranted and providing food in the synagogue for those in need, to his personally reciting Kiddush, eating cake, and completely abrogating the fast for the entire community with no limitations.

Among the victims of this pandemic was the father of the Hafetz Haim, who lived in Vilna at that time, succumbed from cholera just two weeks after this famous incident, on Simhat Torah.11

The veracity and details of what R. Salanter did that Yom Kippur remain in dispute and is not our focus here. Rather, we highlight the halakhic implications of the general contours of the story. To be clear, violation of halakhic precepts in the care of a critically ill patient is not a matter of dispute. The issue here is the permissibility to violate Torah or rabbinic law on a broad basis for the entire community, including presently healthy people, to preclude, or in anticipation of, possible life-threatening illness (pikuah nefesh).12 It is this particular issue that evoked the opposition of the local Vilna rabbinic court.13

Fasting was not the only case where blanket permission to violate prohibitions prophylactically was considered for the healthy on a communal basis in times of pandemic. Rabbi Eliezer Fleckeles (1754-1826) was asked about the permissibility of receiving a smallpox inoculation on Shabbat during times of outbreak if this were the only day it was offered.14 The needle injection constituted a Sabbath violation, the exact nature of which was debated. The questioner, Rabbi Isaac Spitz, his son-in-law, offered a cogent argument that given the widespread disease, if one neglected protection today, he could be stricken with fatal disease tomorrow. Violation of Shabbat, albeit limited to rabbinic prohibitions, should surely be warranted, even for the healthy, in anticipation of life-threating circumstances. Rabbi Fleckeles concurred completely with the questioner’s logic and permitted the inoculation, though he recommended minimizing the Shabbat violation if at all possible.15 

Rabbi Yechezkel Landau’s classic responsum on autopsy provides another example. Rabbi Landau was willing to waive the prohibitions of desecrating and deriving benefit from the corpse, as well as the obligation to bury the body, for the potential life-saving information that could be garnered from an autopsy. He limits this permission only to cases of direct and immediate benefit, explicitly stating that violating prohibitions in anticipation of future benefit is not halakhically justified and would lead to wholesale abrogation of Torah laws.16 He therefore allowed autopsy only if there was direct and immediate benefit. Hazon Ish however, writing some two centuries later, considered times of plague equivalent to immediate danger even for the presently healthy and relaxed the prohibitions of autopsy in times of epidemic.17 

In the present coronavirus pandemic, the issue of fasting has surfaced as yet only peripherally regarding the fast of the firstborn on erev Pesach.18 However, this fast is neither biblical nor major, and is anyway preempted by the performance of a siyum. The focus of halakhic discussion has shifted to the nature of the siyum, and the possibility of participating by video conference, etc. 

The general approach to fasting today during times of disease is more nuanced than during the cholera pandemics and informed by our modern understanding of disease transmission, as well as the specifics of the particular disease in question. To be sure, halakhic questions should still be asked on a case by case basis.

As to the broader issue of allowing Torah violation or abrogation on a community basis for the presently healthy, we are seeing, for example, discussions about using rare halakhic loopholes to delay tevilat kelim due to concerns for contagion.

Meta-Halakhic Community Initiatives

The very same rabbinic authorities who grappled with the purely halakhic ramifications of the cholera pandemic also demonstrated tremendous sensitivity and effort towards the meta-halakhic aspects of the pandemic, including both the financial and medical wellbeing of the community. In addition to his better-known suggestions to limit the number of people in shul, R. Eiger also added the following recommendations:

His honor should collect, for each person, from small to great and even infants in their mother’s womb, six large coins, and from that his honor should fund saving of lives. And if his honor wishes to send me from this sum to save lives, I will do it wholeheartedly, and the money will be distributed to the needy. And they should be very careful not to become cold. It would be good for each person here to wear flannel, belted over his belly. Not to eat bad foods, especially gherkins, and to reduce eating fruit and fish and drinking alcohol, not to eat past satiation, and better to eat a lot over many times, but each time not to eat a lot. Be clean; don’t leave any filth or dirt in the home. This includes changing to clean clothing multiple times during the week. Do not worry, distance yourself from any kind of sadness. Don’t walk about the city at night; during the middle of the day, when the sun shines, it is good to stroll in the fields for air, and to open the windows in the morning so that air will enter the rooms. Don’t go outside on an empty stomach, eat some grains of mustard and take bark from an oak tree. Take water and wash your face and hands with it every morning. Wash the floors of the rooms several times with good strong vinegar, mixed with rose water.19

An emphasis on financial support pervades the other letters R. Eiger wrote about the cholera pandemic as well. In addressing the leaders of the local Adat Yeshurun Congregation R. Eiger details his aid to the poor, including the non-Jewish population, for which he received a commendation from Frederick William III. He further notes how the severe travel restrictions had destroyed the economy and beleaguered the poor and he appeals to the congregation to provide a comprehensive financial plan to support those who suffered monetary losses as a result.

In a later letter on the topic in 1831, R. Eiger laments the continued spread of the epidemic, “practically in every province and in every city.”20 He lays out a more detailed financial plan which is to include money for medications and medical services, sharply emphasizing the need to seek medical care immediately upon the development of even the slightest symptoms of disease, lest the rapid disease progression lead to one’s demise. Coffee, tea, and spirits are to be provided for the poor while still healthy. Specific locations and dedicated staff are to be designated to care for the ill. His deference to the recommendations of the medical community is unequivocal: “He who violates the words of the physicians regarding health behavior has sinned greatly against God, for danger supersedes prohibitions (גדול סכנתא מאיסורא), especially in a case of danger to both oneself and others, which will lead to the spread of disease. His sin will be great to bear.”

R. Salanter likewise initiated community measures to address the cholera pandemic, such as renting a separate hospital dedicated to caring for the victims, and providing for medical staff who, under his influence, worked without remuneration. He also required them to perform their duties on Shabbat and specifically directed them not to have them performed by gentiles.21

Visiting the Ill and Risk to the Caregiver22

R. Chaim brisker

R. Chaim Soloveitchik

Bikur Holim societies of old provided more than food and emotional support, they often provided needed medical and physical comfort care as well. Concern for contagion was reflected in the society manuals providing guidelines to its members. In one such manual from mid-eighteenth-century Berlin, we read: “We have accepted upon ourselves to visit all those afflicted with illness, except if they are afflicted with certain [contagious] illnesses, God forbid, from which one must distance oneself.”23 Examples of such illnesses included diarrheal maladies (such as cholera), smallpox, and measles.

Rabbi Chaim Soloveitchik (1853-1918) personally attended to those afflicted with cholera despite the potential risk of contracting the contagious disease. He did however differentiate between levels of risk, stipulating that if the risk of contagion were close to certain, one would not be permitted to incur such risk. One is not required to expose oneself to certain danger, he argued, even if he is aiding one who is in certain danger.24

Halakhic Leniency for Psychological Impact of Disease 

Rabbi Shaul Landau, the Av Beit Din (Chief Rabbinic Judge) of Cracow asked Hatam Sofer about the following incident in his community.25 During a cholera outbreak, the people greatly desired to recite kiddush levana (the blessing over the new moon). However, the moon was not visible during the halakhically allowed time for recitation. The community was greatly distressed and fearful that this was a bad omen. In light of the medically accepted fact that emotional distress and worry can have negative implications for one’s health, R. Landau declared that there would still be an opportunity to bless the new moon on the 16th of the month (past the usual time for the blessing) if the skies were clear. As it happened the skies were cloudless and hundreds gathered to recite the prayer.

Burial and Tahara

Burial practices were changed during times of epidemics due to the possible contagion of the body even after death. In the times of the Hazon Ish there was a cholera pandemic and the physicians cautioned against touching the bodies of those who had died due to fear of contagion. The Hevra Kadisha initially heeded the medical recommendations, and as a result, many Jewish bodies remained unburied in a state of disgrace (bizayon). So it remained until Hazon Ish personally picked up one of the bodies and attended to his burial. The Hevra Kadisha was profoundly impacted by this act and returned to performing their customary burials (presumably with modifications to prevent contagion).26 

The location and timing of burial were also affected during times of cholera and other pandemics, necessitating deviation from standard practices.27 

During the present coronavirus outbreak the Ministry of Health is Israel initially suggested no tahara was required for patients with coronavirus, and that they would not require takhrikhim (shrouds). They quickly reversed this decision and are allowing a limited tahara performed by specially trained individuals. The American based National Association of Chevra Kadisha, under the guidance of Rabbi Elchanan Zohn, issued guidelines for the tahara of one infected with coronavirus or other contagious diseases.28 Rabbi Herschel Schachter has also issued a ruling regarding the performance of a tahara and burial procedures in light of the current pandemic.

Shiva and Aveilut

Mourning practices were suspended during cholera pandemics, and the question arose as to whether the shiva should be observed if the restrictions were lifted prior to the completion of the shloshim period.29 

During a late nineteenth-century cholera pandemic Rabbi Malkiel Tannenbaum (1847-1910) provided two possible reasons for the cancellation of shiva, each with different halakhic ramifications:30

At this time, we have seen, in our sins, many cities affected with cholera. In our city there have also been some instances, albeit few, where three people have died in a six-week period, with one of them above seventy years old. However, in a nearby village, within tehum shabbat [approximately one kilometer], many have fallen sick and about eight have died. In some nearby cities the sickness is raging, may God save us. So, I was asked if there is an obligation to observe mourning rites, for in Shulhan Arukh [Yoreh Deah] 374 an opinion is brought that during a plague no mourning rituals are conducted due to fright. I have set out to explain this law…  It seems the intention [of the law] is that at a time of wrath there are many who die, may God save us. Thus, if all of the relatives of all those who have died will observe mourning rituals, that will greatly scare the living, because it will be clear that many people have died. But, if there will be no mourning rituals, the [death] won’t be as apparent. One could also suggest another explanation: the mourners themselves may have fear and anxiety when they remain closed in their homes, and this may damage their health… But it is clear that the first explanation is correct. A practical difference between these two explanations is where a plague is discovered in a city, may God save us, and many people fall sick from this illness, may God save us. However, only a few have died, such that it is impossible for people to fear for a great number of casualties. According to the second explanation, [the avoidance of rituals] is still relevant in such a case, so as to not cause fear for the mourners themselves. According to the first explanation, however, fear is not relevant, and one is required to observe mourning rituals. Another practical difference is if one wishes to observe mourning rituals [despite the rabbinic recommendation to the contrary]. According to the first explanation, this is allowed if he knows that those grieving the other casualties will not observe mourning rituals – for one mourner will not cause fright. But according to the second explanation, he is not allowed to put himself into danger… According to this we need to clarify: what is the number of deaths from which it is permissible not to observe mourning rituals? …It is where according to the judge’s [understanding] the word about the plague is already [circulating] in the whole city, and there will be fright when the large number of deaths will become known. … May the Almighty rebuild the breached walls of His people Israel, and death will be swallowed forever speedily in our days, Amen. 

During the present coronavirus outbreak shiva observance has also been curtailed, though the cancellation or limitation of mourning practices is motivated exclusively by medical concerns for contagion. 

Fleeing During a Pandemic versus Sheltering in Place

Ramo Synagogue, Cracow

Rama Synagogue, Cracow

During pandemics in pre-modern times a common response was to flee the area of infestation. This was partially based on notions of contagion and the belief that diseases, including cholera, were caused by miasma, a noxious form of “bad air,” referred to as ipush ha-avir in rabbinic literature, which pervaded the environment. A number of rabbinic authorities throughout the centuries advocated such responses, such as Rabbi Moshe Isserles, something he himself did in 1555 when he fled his home in Cracow due to an epidemic.31 Fleeing itself created a number of halakhic challenges. During the sixth cholera pandemic (1899-1923),  one partner of a shared business wanted to flee the city, dissolve the partnership and cash out his share, while the other wished to continue business as usual and refused to pay.32 The state of the pandemic, and whether fleeing was the commonly accepted practice at this time for this specific outbreak factored into the decision.

To stem the spread of coronavirus the present recommendations are the opposite: stay at home if possible, limit travel, with the extreme measure being a “shelter in place” order tantamount to home quarantine for all. 

Kaddish Recitation 

The magnitude of one cholera pandemic is reflected in the psak of R. Eiger regarding the recitation of the mourner’s kaddish. The custom of the community was that only one person would recite kaddish at a time and the mourners would rotate. The death toll was so vast that each person could not even recite kaddish once a month. Rabbi Eiger therefore ruled that for the kaddish after the Aleinu prayer, all the mourners could recite the kaddish together.33 

Specific Cholera Prayers 

A number of prayers were composed for recitation during times of cholera pandemics.34 While they are labeled as cholera prayers, which was the disease of the time, the content is not disease specific. The National Library of Israel lists some thirty prayers for cholera, including among them celebratory prayers for survival from a cholera pandemic. They were all written during the eighteenth and early nineteenth centuries for different cholera pandemics. A comprehensive analysis of these prayers, and comparison to other prayers for plague/epidemics, has yet to be done.35

Plague (a.k.a. Black) Weddings

"Black Wedding"

“Black Wedding”

There were also extra-halakhic Jewish responses in the times of cholera.36 One curious practice was to perform a marriage of two orphans, who would be supported by the community, on the grounds of the Jewish cemetery. It was the hope that this collective act of hessed (kindness) would help avert the onslaught of the disease.37 These types of weddings were performed during the cholera pandemics; one such wedding being convened between the graves of Rabbi Yosef Karo and Rabbi Isaac Luria in 1865.38 

Contemporary authors are resurrecting the discussions about plague weddings in the coronavirus climate, especially in light of one such recent wedding held in Bnei Brak

Response of Society to the Jews During Pandemics

While the focus of this article is on the Jewish response to cholera, it bears mention that there was also a unique response of the non-Jewish world to the relationship of Jews and cholera. The perception, sometimes based on fact, that Jews suffered less than their neighbors during times of epidemics is ubiquitous throughout history. This was sometimes attributed to idiosyncratic religious practices, such as hand washing or dietary restrictions. Irrespective of the reality, the perception of asymmetric mortality led to theories that the Jews intentionally initiated plagues, such as by poisoning wells.39 Yet, there was also a diametrically opposite current of thought that Jews, either due to their presumed unhygienic habits and living conditions, or to their biological predisposition, should, at least theoretically, suffer more during times of plague.40 Both of these ideas surfaced during the cholera pandemics.41 

A Jewish Medical Response to the Cholera Pandemic

Dr. Waldemar Haffkine

Dr. Waldemar Haffkine

I conclude with a different Jewish response to a cholera pandemic, that of Dr. Waldemar Haffkine (1860-1930), who focused on the medical cause, and developed a vaccination to prevent the disease.42 Born in Odessa to a Jewish family of limited means, Haffkine was a brilliant young student. As a young bacteriologist in Russia, he was offered professional advancement, but only on condition of renouncing his Judaism. Persistently refusing, he was continually held back. He took a position at the Pasteur Institute in Paris as a librarian and performed experiments in his off-hours. Inspired by Pasteur’s path-breaking discoveries, Haffkine developed a vaccine for cholera, which he tested on himself. He was sent to India where his vaccine saved an untold number of lives.43 

He was knighted in Queen Victoria’s Diamond Jubilee Year Honors in 1897. The Jewish Chronicle of that time noted “a Ukraine Jew, trained in the schools of European science, saves the lives of helpless Hindus and Mohammedans and is decorated by the descendant of William the Conqueror and Alfred the Great.”44 The Times of London wrote on October 28, 1930, that with Haffkine’s death bacteriology had lost one of its pioneers, “for he was distinguished in the small company of men and women — the number includes Koch, von Behring Ebert and Kitasato – whose work serves today as one of the foundations of modern medicine.”

In 1916 he authored an essay “A Plea for Orthodoxy,” extolling the virtues of Orthodox Judaism. During the last years of his life, upon return from India to Europe, Haffkine spent his days learning Talmud, while he financially supported European Torah institutions. In his last will he stipulated that the income from his estate be used to subsidize yeshivot in Eastern Europe.45 Rabbi Yechezkel Abramsky later lauded Haffkine for his appreciation of the value of yeshiva education.46

Conclusion

Mankind has faced the ravages of disease for millennia, and rabbis over the centuries have addressed the attendant halakhic ramifications. In every age, the rabbis both integrated and heeded the contemporaneous medical knowledge and recommendations. We have focused on the halakhic responses to cholera pandemics as an example of this process. Even this limited overview reflects and highlights the commonality of our experiences with those of our ancestors. 

As I write this conclusion, the coronavirus pandemic has not yet reached its peak in the area I live. Tragically, we have lost precious souls to this disease. Many new radical rabbinic decisions have been rendered and more are sure to follow. With the help of Hashem, and with continued prayer and enhanced religious observance, Klal Yisrael has survived all previous pandemics. God willing, we will share the religious and halakhic lessons learned from our current reality with our own descendants.

Rabbi Edward Reichman, M.D., is a Professor of Emergency Medicine at the Albert Einstein College of Medicine. 

 

  1. On the history of the Spanish flu, see, Jeremy Brown, Influenza: The Hundred Year Hunt to Cure the Deadliest Disease in History (Atria Books, 2018).
  2. This is not the origin of the term cholera, which likely derives from the Hippocratic term for bile, but rather a Hebrew folk etymology.
  3. For a brief discussion of the halakhic responsa relating to cholera, see H.J. Zimmels, Magicians, Theologians and Doctors (Edward Goldston and Son, 1952), 106-107.
  4. Igrot Rabbi Akiva Eiger (Makhon Da’at Sofer, 5754), letters 71-73.
  5. See Natan Gestetner, Pesakim ve-Takanot Rabbi Akiva Eiger (Jerusalem, 5731), letter 20, 70ff.
  6. As per the testimony of Rabbi Shmuel Reinitz, heard from the students of the Hatam Sofer; see B. Schwartz, “Customs of the Seventh of Adar” [Hebrew] BeNetivei Hesed veEmet (5761), 125-129, esp. 128.
  7. Gestetner, op. cit.
  8. Responsa Hatam Sofer, 6:23.
  9. For more on this story, see Eliezer Mermelstein, “Eating on Yom Kippur in Times of Plague” [Hebrew], Etz Haim, Year 3, 1:7 (Tishrei, 5769), 173-194; Alexander Lvov, “Rabbi Isroel Salanter, the Haskalah and the ‘Theory of Secularization’: An Analysis from a Folklorist Point of View,” Central and East European Jews at the Crossroads of Tradition and Modernity, (ed.) L. Lampertiene (Center for Studies of the Culture and History of East European Jews, 2006), 106-128. Lvov views R. Salanter’s specific suggestions, including his recommendations for eating on Yom Kippur, in light of the preventive measure guidelines published in the Russian newspapers shortly before the holiday; N. Kamenetsky, The Making of a Gadol I (2004), 1104ff; I. Taub, “The Rabbi Who Ate on Yom Kippur: Rabbi Israel Salanter and the Cholera Epidemic of 1848,” Verapo Yerapei 1(2009), 295-313. For a recent halakhic analysis of R. Salanter’s actions, see Rabbi Osher Weiss, “Regarding the Decision of Rav Yisrael Salanter During the Time of Plague” [Hebrew].
  10. Translation excerpted from Jeremy Brown, Talmudology Blog, “Berachot 50a – ‘The Three Who Ate’ on Yom Kippur” (February 21, 2020).
  11. Kamenetsky, op. cit., 1106.
  12. In the current coronavirus pandemic there have been major halakhic exemptions made to religious practice, including canceling of minyanim and public Torah reading, closing yeshivot (which entails a decrease in Torah learning), refraining from attending Megilla reading, prohibiting Shiva visits, etc. In all of these cases, the target audience is likewise the presently healthy person. However, in all these cases, the halakhic accommodations constitute a passive approach and the omission of the performance of positive commandments. To advocate active violation of halakha (whether biblical or rabbinic) for the entire community, as opposed to case-by-case rulings for individuals, in order to prevent the healthy from becoming ill, is a matter of greater significance. It was this dimension of R. Yisrael Salanter’s Yom Kippur ruling that was considered radical by his colleagues and which evoked strong responses.
  13. See Mermelstein, op. cit., and Kamenetsky, op. cit., for expansive discussions on this point.
  14. Teshuva Me-Ahava, 1:135.
  15. This responsum is the precursor to modern halakhic discussions about different types of injections (intravenous, intramuscular, or subcutaneous) for medical reasons on Shabbat.
  16. Noda biYehuda II, Y.D., 210.
  17. Hazon Ish, Ohalot 22:32.
  18. Declaring a new fast in times of plague, as in times of drought, is a different halakhic discussion (see Orah Haim, 576), and indeed, a half-day fast was declared in the early days of the pandemic, on erev Rosh Hodesh Nissan.
  19. Adapted from the translation by Rabbi Mordechai Torczyner, whom I thank for his permission.
  20. Cf. Esther 8:17.
  21. Dov Katz, Tenu’at HaMusar, 149-150.
  22. Not discussed here is whether a physician is expected to tolerate a higher threshold of risk than others in the care of patients with contagious disease. On this topic, see, for example, Tzitz Eliezer 9:17, Chapter 5.
  23. Aaron ben Moses Rofeh, Takanot shel Benei ha-Havurah de-Bikkur Holim (Berlin, 1750).
  24. Rabbi Yosef Dov Soloveitchik, Reshimot Shiurim, Bava Metzia 30b. Rabbi Eliyahu Chaim Meisels (1821-1912), rabbi of Lodz, likewise assisted those in need during an epidemic despite the possible danger. See Rabbi Moshe Sternbuch, Teshuvot ve-Hanhagot 5:390.
  25. Hatam Sofer, O.H., 102.
  26. See Moshe Yosef Raziel, “Endangering Oneself to Save Others,” [Hebrew] Va-hai Bahem 1 (5752), 37-45.
  27. On the topic of burial on Shabbat during an epidemic, see Igrot Moshe Y.D., 4:55; Hatam Sofer II, Y.D., 334. Rabbi Haim Palaggi discussed the permissibility of asking a non-Jew to dig graves on Shabbat during a cholera pandemic in 1865, see Ruach Haim O.H., 325:4 (he was hesitant to permit). Rabbi Yaakov Reischer (1661-1733) addressed the issue of alternate burial and the use of quicklime to hasten decomposition of the body after death from plague to prevent contagion. See Shevut Yaakov 2:97.
  28. For further halakhic discussion see Yehoshua Veisinger, “Tahara in Cases of Contagious Disease” [Hebrew] Tehumin 36 (5776), 234-247.
  29. Rav Pe’alim III, Y.D., 28. For further discussion, see Yalkut Yosef Y.D., 374:1 notes.
  30. Divrei Malkiel 2:90. I thank R. Mordechai Torczyner for this reference and his translation of the passage in conjunction with Rabbi Baruch Weintraub.
  31. Rama, Y.D., 116:5; and see the introduction to his Mekhir Yayin on Megillat Esther. See also Teshuvot Maharil 41; Magen Avraham, O.H. 576:3.
  32. Moshe Ezra Mizrachi, Divrei Moshe Hoshen Mishpat, 81 (R. Mizrachi found in favor of the non-fleeing brother).
  33. Piskei Teshuvot, He’arot 132, n. 106.
  34. On saying special prayers for the community during a cholera epidemic, see Hatam Sofer, Likkutim be-Kovetz Teshuvot 1.
  35. Some of these prayers are for the disease called cholera morbus. See, for example, British Library Or. 10225 (NLI System number: 000124353-1). The prayer is titled as a prayer for cholera, but the text refers to the disease as קולירה מורבוץ, likely cholera morbus. This term historically was used to refer to acute diarrheal illnesses, what we today would call gastroenteritis, rather than the specific disease cholera.
  36. Kabbalistic responses to cholera and other epidemics also merits further study and is not addressed here. One such example is from 1848, the same year R. Salanter reportedly made kiddush on Yom Kippur, when representatives of a town visited the great Rav Meir of Premishlan asking for assistance with salvation during the current plague. It is reported that the deceased sage gave them a loaf of bread and some water which was to be placed outside the house of a particular individual. This was a reference to phrase in Exodus 23:25, associating the blessing of bread and water with the removal of sickness; see Avraham Maimon, “The Hanging of Bread in the Air” [Hebrew] Or Torah (Tevet 5762), 232.
  37. For more on black weddings, see Sara Barnea, “Orphan Weddings” [Hebrew] Segulah 77 (July 2016), 44-53. I thank Dr. Ari Zivotofsky for this reference, and see here.
  38. See Zimmels, op. cit., 233, n. 141.
  39. For a recent thorough analysis of this topic, see Tzafrir Barzilay, Well-Poisoning Accusations in Medieval Europe: 1250-1500, Ph.D. Dissertation (Columbia University, 2017).
  40. See, for example, John Efron, “The Jewish Body Degenerate?” in his Medicine and the German Jews: A History (Yale University Press, 2001), 105-150. Regarding cholera specifically, see, for example, Katharina Kreuder-Sonnen, “Jewish Bodies and Jewish Doctors: The Cholera Years in the Polish Kingdom,” in Marcin Moskalowcz, ed., Jewish Medicine and Healthcare in Central Eastern Europe: Shared Identities, Entangled Histories (Springer, 2019), 79-95.
  41. See letters in The Lancet, December 30, 1854, p. 552, and January 13, 1855, p. 50; L. Angelini, et. al., “Religious Precepts and Cholera: The Case of the Jewish Community of Ferrara During the Epidemic of 1855,” Journal of Preventive Medicine and Hygiene 46:4 (November 2005), 163-168; Harmen Snel and Jits van Staten, “Jews and the Cholera Epidemics in Amsterdam in 1832 and 1849,” Aschkenas 28:1 (2018), 71-84; Myrna Gene Martin, “Outsiders on the Inside: Italian Jewish Ghettos and Cholera in the 1830s,” European History Quarterly 49:1 (2019), 28-49. One intriguing theory attributes decreased prevalence of plague among Jews due to the cleaning of granaries for Pesach and the elimination of rats, considered to be the vector for plague transmission. See Martin Blaser, “Passover and Plague,” Perspectives in Biology and Medicine 41:2 (Winter, 1998), 243-256.
  42. The most comprehensive biography of Haffkine in English is Selman Waksman, The Brilliant and Tragic Life of W.M.W. Haffkine (Rutgers University Press, 1964). For discussions of his scientific work, see Ilana Lowy, “From Guinea Pigs to Man: The Development of Haffkine’s Anticholera Vaccine,” Journal of the History of Medicine and Allied Sciences 47 (1992), 270-309; Barbara Hawgwood, “Waldemar Mordechai Haffkine, CIE (1860-1930), Prophylactic Vaccination Against Cholera and Bubonic Plague in British India,” Journal of Medical Biography 15(2007), 9-19.
  43. He later developed a vaccine for Bubonic Plague as well.
  44. London Jewish Chronicle (June 1, 2012), 8.
  45. Tuvia Preschel, “Waldemar Haffkine (Mordecai Zeev) on the 70th Anniversary of His Death,” The Jewish Press (October 13, 2000), 43.
  46. See R. Yechezkel Abramsky, “Collection of Hiddushei Torah, Piskei Halakha and Mahshava” [Hebrew] Kol HaTorah 44 (5758), 9-28, esp. 22. Haffkine’s name is misspelled as חסקינד. R. Abramsky mentions Haffkine in the context of a discussion about the importance of the “yeshiva,” contrasting it to the university. He quotes Haffkine as saying that anyone can create a university, but only the Jews can create a “yeshiva,” which is an essential ingredient for the survival of the Jewish people.

1 Comment

  1. Betzalel Sochaczewski says:

    For a comprehensive analysis of the narrative of R. Yisroel Salanter and Yom Kippur, hear Prof. Shneyer Leiman’s lecture at http://www.torahinmotion.org/store/products/freedom-expression-within-judaism-making-gadol.

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