Siman 328

Pikuach nefesh overrides the Shabbat, as it is written: "and he shall live by them," and not that he should die by them (Yoma 85b). And even a doubt of pikuach nefesh overrides the Shabbat (Mishnah ibid. 83a), for there is nothing that stands before pikuach nefesh except for idol worship, forbidden sexual relations, and bloodshed (ibid. 82a). And it is forbidden to delay in the desecration of Shabbat for a person who is dangerously ill, for the laws of the Torah are mercy, kindness, and peace in the world, as it is written: "which a man shall do and live by them" (the Rambam at the beginning of chapter 2), and one who is zealous in pikuach nefesh, behold, he is praiseworthy. And it is stated in the Yerushalmi (ibid.): "One who asks—behold, this is disgraceful," for one should not ask a question regarding pikuach nefesh, because by the time he asks and they answer him, the sick person may come to danger; "and the one who is asked—behold, he is a shedder of blood," for he should have expounded in public that pikuach nefesh overrides the Shabbat.

And I learned from the responsum of the Ritzba brought in the Or Zarua HaGadol (siman 108), that this which was explained, that the one who asks is reprehensible and the one who is asked is a shedder of blood, this is regarding a patient whose time is urgent, for he is in great danger and every moment is significant for him; in this, certainly there is no asking and no answering, and one does everything in his power without being exacting, and Shabbat shall be exactly like a weekday. But regarding a patient whose time is not urgent—certainly there are questions, for they said in Menachot (64a): Rava inquired: A patient for whom they estimated two dried figs are needed, and there are two dried figs on two stems and three on one stem, which of them should he bring? And it concludes that he should bring the three; see there. Behold, there can be doubts regarding pikuach nefesh, and of necessity one must ask and the respondent must answer; rather, this is regarding a patient whose time is not urgent; see there. And according to this, regarding a patient who is in great danger and his time is urgent—it is forbidden to ask any question, and they shall do according to what is seen without any fear or hesitation, and the one who is zealous is praised. However, regarding a common patient—one may deliberate and ask questions, and such is the custom of the world (so it appears in my humble opinion), and see at the end of section 13.

Whether Shabbat is pushed aside regarding pikuach nefesh or is permitted: the opinion of the Rashba in the Responsa (siman 689) is that it is pushed aside, and so wrote the Ran in the second chapter of Beitzah. And it appears that this is the opinion of the Rambam at the beginning of the second chapter of Shabbat, and this is his wording: "Shabbat is pushed aside regarding danger to life like all other mitzvot, etc." see there. But from the words of the Rosh in the eighth chapter of Yoma (siman 14) it is implied that it is permitted, for he wrote and this is his wording: "And our teacher Meir brought a comparison from the preparation of food on Yom Tov... rather, since the Torah permitted the preparation of food on Yom Tov, it is like a weekday; and here too, since the Torah permitted pikuach nefesh, every melakhah is like a weekday" see there, and from this language it is clear that it is permitted and not pushed aside. Furthermore, since he compares it to the preparation of food on Yom Tov, and there it is not relevant to say "pushed aside" since it was never forbidden; and also in the Responsa of the Rashba there it is clear that according to the reasoning of our teacher Meir it is permitted and not pushed aside, see there. (And also the Ran in the second chapter of Beitzah wrote the distinction that Shabbat is pushed aside regarding danger to life, and the preparation of food on Yom Tov is permitted, see there; and since Rabbi Meir compares them to one another, learn from it that he holds that in both of them it is permitted. And ostensibly, the one who learns in Yoma there from milah that pikuach nefesh pushes aside Shabbat—certainly it is permitted, for regarding milah it is impossible to say that it is pushed aside, as I wrote in Yoreh Deah siman 266 section 25, see there. And there we explained that also regarding pikuach nefesh, that which the Rambam wrote "pushed aside," his intention is not literally pushed aside, see there; but since the Rashba and the Ran explicitly hold that it is pushed aside and not permitted, there is no necessity to remove the words of the Rambam from their plain meaning, and perhaps they hold that milah is also pushed aside. Or, that even though we learn from milah, nevertheless there is no proof that they are completely equal, and delve into this.)

And behold, in Yoma (6b) regarding the matter of whether tumah is pushed aside or permitted, it says that there is a practical difference regarding the matter of seeking out those who are pure; for if there are pure individuals prepared before him, even according to the one who holds it is permitted—we use the pure and not the impure, according to the first version there in the Gemara. Only if there are no pure individuals before us and it is necessary to obtain them, then according to the one who says "permitted"—the impure perform it, and according to the one who says "pushed aside"—we seek out the pure; see there. And if so, here too regarding a sick person, if the forbidden item and the permitted item are both prepared before us—certainly we feed him the permitted and not the forbidden. Only if the forbidden is prepared or easily obtainable and the permitted is not prepared or difficult to obtain, it depends on the dispute: if Shabbat and all prohibitions are permitted for pikuach nefesh, we take the forbidden, and if they are pushed aside, we seek out the permitted. So it would seemingly appear, but it is a new thing and we have not found this in the poskim; on the contrary, they warned to act with alacrity regarding everything the sick person needs. And even though according to what we explained it is possible that this is regarding a sick person whose time is urgent, as I wrote in section 2, nevertheless it is implied by all the poskim that it is not so.

And in truth, it appears in my humble opinion clear that even if it is "pushed aside," one does not need to wait for the permitted option, and it is not comparable to tumah. For since the Torah commanded to desecrate the Shabbat for him and to feed him all prohibited foods, if we were to say that we should wait—he could come to a state of danger. It follows that according to this, there is no difference between "pushed aside" and "permitted" regarding pikuach nefesh in this matter. There is only a difference according to the "some say" there, that according to the one who says "permitted," even if there are impure and pure people before us, the impure ones shall perform it; see there. If so, there is a great practical difference, such as if the permitted and the prohibited were before us: according to the one who holds it is "pushed aside," it is forbidden to give him the prohibited food, and according to the one who holds it is "permitted," it is allowed. However, for us even in this there is no practical difference, since according to the first version it is not so, as I have written. Nevertheless, there is a practical difference between nevelah and shechitah, which is that for a sick person who needs meat on Shabbat, one performs shechitah for him as will be explained, and one does not feed him nevelah for reasons that will be explained. However, if the nevelah is prepared before us, according to the one who holds it is "permitted," one performs shechitah for him on Shabbat and does not feed him the nevelah, and according to the one who holds it is "pushed aside," one feeds him the nevelah so as not to desecrate Shabbat with a primary category of labor; so explained the Rashba there (so it appears in my humble opinion).

And our sages, of blessed memory, said there, that when it is necessary to desecrate Shabbat for the sake of a person whose life is in danger—they should not do what is necessary to do for him through a non-Jew, nor through women, nor through minors, but rather through adult Israelites. And the reason: for perhaps those who see will say that only with difficulty did they permit desecrating Shabbat for the sake of saving a life, and they do not permit it through those obligated in the mitzvot, and from this a stumbling block will come, for perhaps at some time they will not find a non-Jew or minors or women, and the adults will not want to desecrate Shabbat, and it will lead to danger (Ran and so it is explicitly stated in the Rosh). And the Tosafot wrote further: that even where it is possible through a non-Jew—it is a mitzvah through an Israelite, for perhaps the non-Jew will be lazy and it will lead to danger, see there. And consequently, this is also the case regarding women and minors, for generally women are lazy, and all the more so minors. And according to their words, it may be that for this reason the sages forbade doing it through them.

One must wonder about our teacher, the Rema, in section 12, regarding what our teacher, the Beit Yosef, wrote of this law. This is his wording: "When one desecrates Shabbat for a person who is dangerously ill—one should strive not to do it through a non-Jew, minors, or women, but rather through adult men and people of understanding." Thus far his words. And our teacher, the Rema, wrote on this: "And some say that if it is possible to do it without delay and without postponement—one does it through a shinui; and if it is possible to do it through a non-Jew without any postponement at all—one does it through him, and such is the custom. But in a place where there is concern that the non-Jew will be lazy—one should not do it through him." Thus far his words. And how is it possible to say so? For according to the first reason we wrote, that the concern is because of a future time—it is simple that it is forbidden; and even according to the second reason, due to the concern of laziness, since the Talmud was concerned for this, how can we say that we are not concerned for this? And it is a matter of wonder. And according to the opinion of the Rambam, that which the Talmud said, that they should do it through the gedolei Yisrael—they are literally the gedolei Yisrael, those great in Torah and fear [of Heaven], to show everyone that so the Torah commanded us, and the Holy One, Blessed be He, who commanded us regarding Shabbat—He commanded us to desecrate Shabbat for a person who is dangerously ill. (The Taz, in subsection 5, also wondered about him, and it appears that the proponent of this opinion holds because of the reason of laziness, and that which the Talmud said: "And one does not do this through etc.", its explanation is that one is not obligated to do it through them. But this is against the majority of the poskim, and therefore in practice it is certainly correct to do it specifically through an adult Israelite.)

And anyone who is zealous to desecrate Shabbat for a matter involving danger—behold, this one is praiseworthy, even if he performs another melakhah along with it. How so? The Rambam wrote in chapter 2, law 16: "If one saw a child who fell into the sea—he spreads a net and brings him up, even if he traps fish with him. If he heard that a child was drowning in the sea and spread a net to bring him up and brought up only fish—he is exempt from everything. If he intended to bring up fish and brought up fish and a child—he is exempt even if he had not heard that he was drowning, since he brought up the child with the fish. If a child fell into a pit—he uproots a clod of earth and brings him up, even if he prepares a step with it at the time of its uprooting. If a door was locked before a child—he breaks the door and takes him out, even if he splits it into a kind of wood fit for melakhah, lest the child be frightened and die. If a fire broke out and it is feared that a person is there—they extinguish it in order to save him from the fire, even if he levels a path and prepares it at the time of extinguishing. And anyone who is first to save—behold, this one is praiseworthy, and there is no need to take permission from a beit din in any matter involving danger." Thus far his words. And one must be precise regarding the breaking of the door: who forces him to split it so that it becomes like a melakhah? Let him break it in a manner of breaking and it would be nothing more than a destroyer. And it seems to me that this is the explanation: that he fears the frightening of the child if he breaks it in a manner of breaking, for the sound of the breaking will frighten him; therefore, he breaks it in a manner of splitting, so that the child will not sense the breaking. And this is what he said, "lest the child be frightened," meaning if he breaks it with a simple breaking, and all the more so if he leaves him there, for he will certainly be frightened. (And this is what the Shas says in Yoma there: "Even though he intends to break it into splinters." And the Lechem Mishneh asked how it is permitted with intent, for in all of them intent is not mentioned, see there; and according to what I wrote it works well, for here he is forced to intend so that the child will not be frightened, and delve into this.)

A dangerously ill person for whom they assessed on Shabbat that he requires a known remedy involving a labor of Shabbat desecration for eight days, we do not say: let us wait until the night so that we find that we only desecrate one Shabbat for him. Rather, they shall act immediately, even though they will desecrate two Shabbats for him. And regarding extinguishing a lamp so that he may sleep, it was explained in siman 278 that it is permitted for a dangerously ill person when it is necessary for that. And even if it is clear to the doctors that he will die, but through medical remedies he can live some hours longer—it is permitted to desecrate the Shabbat for him, for we also desecrate for temporary life, and it will be further explained in siman 329.

If he required meat or broth of poultry meat—one is obligated to slaughter for him. The slaughterer is not permitted to say: Why should I desecrate the Shabbat with a primary category of labor? Let him eat nevela, meaning through the killing by a non-Jew or by a minor, for even for the sick person himself it is better to transgress the prohibition of nevela, which is a minor prohibition compared to slaughtering on Shabbat for which one is liable for stoning, excision, and a sin offering; nevertheless, this is not so. There are many reasons for this: First, because we fear that the sick person will find nevela loathsome (the Rosh ibid. and so wrote the Or Zarua HaGadol); and second: because the prohibition of Shabbat has already been set aside regarding kindling and cooking, while the prohibition of nevela has not yet been set aside (ibid. in the name of the Ra'avad); and third: because with nevela he will transgress for every single kezayit, while with slaughtering it is only one time (the Ran ibid.). And even though it is proven from there that we do not fear this, since they disagree there regarding tevel and terumah—as there is one who holds that terumah is more severe than tevel and we feed him tevel and not terumah, even though with tevel there is a prohibition for every kezayit, see there—that is because in order not to actively perform a new prohibition for him and feed it to him, we therefore feed him the lighter prohibition as it is, even though it contains a multitude of prohibitions. This is not the case here regarding slaughtering; we are creating for him a permitted state, meaning that at the time of eating it is completely permitted, therefore we certainly say this reasoning. And fourth: for behold, the Torah permitted this sick person prohibitions that obstruct his healing, and behold, the prohibition of nevela does not stand in his way, for his healing can also be through kosher meat, and therefore this prohibition was not permitted to him; this is not the case with the prohibition of Shabbat which stands against him, whether regarding slaughtering, whether regarding kindling, whether regarding cooking, and therefore the Torah permitted this prohibition to him (see the Ran in the name of the Ra'avad and the Rosh in the name of the Ran, and examine this carefully). And see what I wrote regarding this in Yoreh Deah siman 85 section 45 and section 46.

And it is simple that if the nevelah is prepared immediately and slaughtering requires delays, and the sick person needs it instantly—that we feed him the nevelah. And if he does not need it immediately, according to the one who holds that Shabbat is permitted for saving a life—we slaughter for him, and according to the one who holds it is pushed aside—we do not slaughter for him, and we feed him the prepared nevelah, for since he has meat, we will not permit for him the Shabbat that is pushed aside and not permitted (Rashba in the responsa there). And so too the matter is simple that if a shochet cannot be obtained—that we feed him nevelah, and so too if they slaughtered for him and he needs it immediately—one does not need to salt it. (See Magen Avraham subsection 9 who wrote regarding slaughtering that Shabbat is permitted, see there, and it is a wonder, for according to everyone we slaughter and only in the case that we wrote regarding this is there a difference between pushed aside and permitted, and there is no distinction whether the sick person is an adult or a minor.)

If it is necessary to heat wine for him—the Israelite shall fill it and the non-Jew shall heat it for him. And it is not comparable to slaughtering, for it is a light prohibition and he will not cut it off because of this. And according to the opinion of our teacher, the Rema, in the Responsa (siman 124 in the Hanau edition), even a person who is ill but not in danger is permitted to drink stam yeinam, see there (Magen Avraham ibid.), and some say that there is no permission except for a person who is ill and in danger. And also on Shabbat, the Israelite shall heat it and not the non-Jew, for the reason that has been explained, so that he does not transgress for every single drop (Bach and Taz subsection 6), and see Yoreh Deah siman 155. And when one slaughters a bird on Shabbat, he shall not cover its blood until nightfall if its mark is recognizable, as is written in Yoreh Deah siman 28, see there.

Our sages, of blessed memory, said in Menachot (64b): "If the doctors said to the patient that he requires one dried fig for his healing, and ten people ran and each one plucked a dried fig and each one brought his dried fig to the patient—all of them are exempt and they have a good reward from Hashem even if he was healed by the first one, for they all performed a mitzvah. Since one must be diligent in pikuach nefesh, they did not require that each one should ask his fellow if he is also going for this matter." And if the doctors estimated that he requires two dried figs, and there were three dried figs on one stem and on two other stems there was one dried fig each—it is better to minimize the plucking of stems, and he should pluck the one stem that has three on it; and even though he plucks three and the patient only required two, nevertheless, one plucking of three is better than two pluckings of two. And it is obvious that if there were two on one stem and three on one stem—that he should only pluck the stem of two. And all this is regarding a patient whose time is not urgent and there is time to be precise, but regarding a patient whose time is urgent—he should not be precise at all, and however it comes to his hand with diligence, so shall it be; and this is proof for what we wrote in section 2, see there.

Any illness that the doctors say is a danger, even though it is on the flesh externally—one desecrates the Shabbat for it. And even if one doctor says it is necessary and one doctor says it is not necessary—one desecrates, for this is a doubt regarding lives which overrides the Shabbat, and there is no distinction between a Jewish doctor or one who is not Jewish. And if one says it is necessary and two say it is not necessary—one does not desecrate, for one in the place of two is nothing. In what case are these words said: when they are all equal in wisdom, but if the one who says it is necessary is distinguished in wisdom—one listens to him to be lenient, such as when he says it is necessary, and not to be stringent when he says it is not necessary, even against another who says it is necessary and he is much smaller than him. And if two say it is necessary—even if one hundred say it is not necessary, one desecrates. And when the sick person himself says it is necessary—one desecrates even if all the doctors say it is not necessary, for "the heart knows its own soul's bitterness." But not the opposite, such as when the doctor says it is necessary and the sick person says it is not necessary—one coerces the sick person to receive the medicine and to desecrate the Shabbat for him. And all this we learned from the laws of a sick person on Yom Kippur, as will be explained in siman 618.

And behold, all this applies when there are differences of opinion between the physicians, but a person from the street against the physician, it appears that his words neither add nor subtract. For example, if the physician says it is not necessary to desecrate the Shabbat for him, and a person from the street says it is necessary - it is not considered a doubt at all, and one does not desecrate the Shabbat. And there is one who says that regarding a doubt of lives one should be lenient even in such a case, and one desecrates the Shabbat for him when it is known that this man is expert in illnesses, and he says that according to his understanding he is a dangerously ill person, and therefore this is considered a doubt.

And know that since we have written thus, it appears to me to explain what the Tur wrote: "And so too if one doctor says it is necessary and one says it is not necessary – we desecrate [the Shabbat], and RI wrote that an expert is not required, for all people are considered somewhat expert, and in a doubt regarding lives we are lenient," thus far his words, for the intention of RI is regarding the former, that every person is somewhat expert and is considered a doubt against the doctor who says it is not necessary. And this is also the intention of our teacher, the Beit Yosef, in section 10 who wrote like the wording of the Tur, and the words of RI he brought in the name of "there are those who say," and his intention is as I have written. However, I have seen one who wrote that against a doctor – it is obvious that his words are nothing, rather the intention of RI and the "there are those who say" is when there is no doctor at all, for then we rely on ordinary people to desecrate the Shabbat when they say it is necessary (Magen Avraham, subsection 7). And I am very much wondered, for if so, what did RI innovate and who would disagree with this? Is it that in a place where there are no doctors we would not desecrate Shabbat for the sick? And would we wait for the sick person himself until he says it is necessary, which is an uncommon matter? Therefore, it appears in my humble opinion as I have written. And it is obvious in a place where there are simple doctors called "felshers," and doctors called "doctors," that we consider the opinion of the [simple] doctor against the opinion of the [expert] doctor to be lenient and not to be stringent. Only our teacher, the Rema, wrote that regarding ordinary people we specifically require Israelites who know the gravity of the Shabbat and not non-Jews who are not doctors, for them we do not hold as proficient regarding the matter of desecrating the Shabbat. (And one whom they want to coerce to commit a great transgression, whether we desecrate the Shabbat for him, has been explained in siman 307, see there.)

There is a great principle regarding illnesses with respect to Shabbat: A person who is dangerously ill—one desecrates the Shabbat for him as has been explained, and a person who is not dangerously ill—one does not actually desecrate the Shabbat for him by the hand of an Israelite, but they permitted for him the shevut of an instruction to a non-Jew. And thus the Sages, of blessed memory, said (129b): "A person who is not dangerously ill—one instructs a non-Jew and he performs it." And their cooking was also permitted for him, and regarding their ordinary wine there is a dispute in this matter. And if it was permitted for the ill person or for another Israelite to perform a rabbinic prohibition for him with his own hands on Shabbat: the Rosh was uncertain about this, and according to the understanding of the Tur of the words of the Rambam—the Rambam permitted this, and according to the understanding of our teacher, the Beit Yosef, of his words—he did not permit it, as he wrote in his great work. And the Ramban, of blessed memory, decided that to perform it in the usual manner is forbidden, but to perform it by means of a shinui is permitted. And there are those who distinguish in such cases: that in a matter where there is a basis in a Torah labor, such as applying blue eye-salve which is like writing, or to perform a healing where there is concern for the grinding of herbs—it is forbidden, and anything that has no basis in a Torah labor—it is permitted, and our teacher, the Beit Yosef, in section 17 agreed with the opinion of the Ramban to perform it by means of a shinui, and so one should rule.

And if there is danger to a single organ in the sick person, but not danger to the entire body, nearly all the poskim agreed to one opinion: that one may perform a rabbinic prohibition for him with his own hands. Certainly, telling a non-Jew to perform a Torah prohibition is permitted for him, as it is much lighter than a rabbinic prohibition performed by an Israelite himself, as is proven from the previous law; and in the Shas it is called a "shevut that does not involve an action" (Eruvin 68a, according to the explanation of Tosafot Gittin 8b). However, for an Israelite to perform a Torah prohibition is forbidden for the sake of the danger to an organ when there is no danger to the entire body. But if through the organ the illness will spread to the entire body, this is called danger to the body, and one desecrates the Shabbat for him by an Israelite, even with a Torah prohibition.

And all these matters apply to a sick person who is cast in bed or sitting on his bed, who does not have the ability to go out from the door of his house, and there is a distinction regarding this between whether there is danger or no danger, as has been explained. But one who has a mere ache: an ache in the head or in his intestines or in the heart and the like, and he strengthens himself and walks like a healthy person—as there are those who are weak due to aches, who have a cough and the like, and they walk and travel and do all their business—they do not have the status of a sick person at all, and it is forbidden to perform a healing for them even by means of a non-Jew, as a decree on account of the grinding of medicinal herbs. However, one who has an ache through which his entire body is weakened, and even though he strengthens himself and walks, yet his walking is with heaviness and weakness—his status is like one who has taken to his bed, as a sick person in whom there is no danger.

A child who is not yet able to eat like all people—his law is like the law of a person who is ill but not in danger, for whom it is permitted to tell a non-Jew to cook on his behalf when there is a need for it, and it is permitted to feed him muktzeh with one's hands if there is a need for it (Magen Avraham, subsection 15). Therefore, when he does not want to eat except by means of his mother—it is permitted for the mother to feed him what they milked and cooked today, and she only needs to be careful that she herself does not put the food into the pot, but rather the non-Jew shall put it into the pot. And so too regarding a person who is ill but not in danger, one should be careful in this, and see in siman 318. And know, that in all the laws of a person who is ill, there is no difference between the ill person himself and another Israelite, for anything that is permitted to be done on his behalf—another Israelite is also permitted, and anything that is forbidden to be done on his behalf—even the ill person himself is forbidden, except for being like one who assists slightly at the time that the non-Jew performs the labor on his behalf—it is permitted, such as when he applies kohl to his eyes and he closes and opens them at the time of the application and everything similar to this, for such assistance has no substance. And even beforehand when he assists slightly—it is permitted, as our teacher, the Rema, wrote in section 3, that one who has pain in his teeth and it causes him distress to remove it—he tells a non-Jew to remove it. Thus far his words. And even though he must open his mouth wide before the non-Jew places his hand in his mouth to take the tooth, nevertheless it is permitted, because it is only assistance and has no substance. And there are some of the great authorities who indeed disagreed with this law for this reason, that assistance beforehand was not permitted at all but only at the time of the act (Turei Zahav, subsection 1), and his words were rejected by several great authorities (Eliyah Rabbah, subsection 4 and Tosefet Shabbat, subsection 5, and so wrote the Shach in Yoreh Deah in Nekudat HaKesef siman 198, and so he wrote in the name of the Ritva and the Ramah).

Our Sages, of blessed memory, said (Avodah Zarah 28a): Any wound that is within the body cavity, where one of the internal organs has become impaired due to a wound within it or due to a boil (at any rate), and it is from the lips and inward, whether in his mouth, his intestines, his liver, his spleen, or in other places within the body cavity—this is a person who is dangerously ill, and there is no need for an assessment that his illness is severe. Therefore, one profanes the Shabbat for him immediately without an assessment (the Rambam, chapter 2). And from where do we know that there is a wound there? For if there is a doctor who says so, then there is no need for signs, as it has already been explained that if only the doctor says he is dangerously ill, one profanes the Shabbat for him, and it is not upon the doctor to say if there is a wound there; rather, we are dealing even without a doctor, and regarding this we said that there is no need for an assessment. If so, from where do we know this? However, from the pain of the patient and the suffering that he feels from one of the internal organs, we estimate that there is a wound there (and according to what I have written there is no dispute among the poskim; see the Beit Yosef, the Bach, and the Magen Avraham, subsection 2, and it is not understood, see there and examine carefully).

And so too the teeth themselves, for with an ordinary ache it is merely a general discomfort, and it is forbidden to do anything as has been explained; but if the pain is very strong until his whole body becomes ill from it, even though he has not taken to his bed—this is a sick person whose life is in danger. And so too if the place where the teeth sit, which is called "yasles," becomes ill, and the pain is very strong until his whole body becomes ill as we have written—it is an internal wound and one desecrates the Shabbat. And all the more so a sickness called in the Gemara (ibid.) "tzafidna," which begins in the mouth and ends in the intestines, and the sign is when he puts something into his mouth blood comes out from between the teeth, and it is a dangerous sickness.

It has already been explained that a mere ache is nothing, and this is what our teacher, the Rema, wrote in section 3: "However, one who suffers in his teeth and it causes him pain to the point of needing to extract it—he may tell a non-Jew to extract it." Thus far his words. This is when the pain causes the entire body to become ill (Magen Avraham, subsection 3). Nevertheless, it is not in the category of danger, such as when the pain is not very strong, and its law is like that of a non-dangerous illness, which is permitted by means of a non-Jew but not by means of an Israelite, for extracting a tooth is a primary category of labor, as one uproots a thing from its place of growth. And there is one who forbids even by means of a non-Jew because he must open his mouth and thus becomes an assistant, but we have already written in section 20 that this is not so and it is permitted; see there.

And any internal wound does not require an assessment, as has been written; and even if there are no experts there, and even if the patient says nothing, and even if he is not constantly confined to bed, one performs for him everything that is done for such a person on a weekday. And even if by withholding the thing to be done for him he would not come to a state of danger through this, nevertheless one acts according to the routine of a weekday (Maggid Mishneh). However, from Rashi it is implied that specifically when the medicine saves him from danger and without it he would remain in danger is an Israelite permitted to desecrate Shabbat, but without this one should not desecrate Shabbat with a Torah prohibition, and so it is proper to be careful in this. However, if they know and recognize in that illness that he can wait, and it is not necessarily at this moment for this medicine that requires desecration of Shabbat and he can wait until the night - it is forbidden to desecrate for him, even though it is an internal wound. Therefore, one who groans from his heart, who is in danger and his medicine is to drink milk - one does not desecrate Shabbat for him with a Torah prohibition such as milking by himself on Shabbat, because it is known that for the lack of drinking one time he will not be in danger; so ruled the Rishonim (Ramban in Milchamot chapter 22 and Rashba in Ketubot 61).

And regarding a wound that is not internal—one consults an expert and the sick person, and one does not desecrate the Shabbat for him until one of them says that he requires the desecration of Shabbat, or until one of them says that in any event there is a doubt of danger to life, which also overrides the Shabbat. But without this—it is forbidden to desecrate the Shabbat for him, for ordinarily every wound on the exterior of the body does not involve a danger to life, unless they say that it involves a danger to life. And our sages, of blessed memory, said (Shabbat 109b) that a wound on the back of the hand and the back of the foot, which is the hand and the foot after the fingers on the side of the nails—this is like an internal wound and one desecrates the Shabbat for it, for a wound in this location is severe and dangerous to the entire body.

And similarly, one who was bitten by a rabid dog or one of the lethal creeping creatures of the earth, even if it is a doubt whether it is lethal or not, and similarly in the case of a rabid dog where there is a doubt—this is like an internal wound. And similarly, one profanes Shabbat for any wound caused by iron through the force of the blow on any part of the body. And there is one who is uncertain whether we require specifically with force or even without force (the Gara), and it seems to me specifically with force, for the language of the Gemara (Avodah Zarah 28a) is as follows: "This pedata is a danger, etc.", and Rashi explained: a wound from a sword stroke, see there. And the Targum on "wound for wound" translated: "pidea in place of pidea," and on the verse regarding a maul and a sword and a sharp arrow in Proverbs (25) it explained: "padi'a and a sword and a maul," which is a large hammer that strikes with force; and since the Sages, of blessed memory, called it "pedata," learn from this that it is with force. And similarly for an inflammation that occurs at the rectum—it is a danger and one profanes Shabbat for it; and for a simta, which is called plunkra in the foreign tongue, and I do not know what this is; and for one who has an extremely hot fever, or with shivering which they call schviedern where the cold and the heat come at once—one profanes Shabbat, to the exclusion of an ordinary fever where initially the cold comes and afterwards the heat—there is no danger in this, and its law is like a sick person who is not in danger. And similarly, one who is seized by blood—one lets his blood even by means of an Israelite, for it is a danger, even if he walks on his feet and even on the first day, because of the danger. And if he was seized by blood partially and it is evident that it is a mere ache—any medicine is forbidden to him until evening, unless the doctor says it is necessary. And know that a sick person lying in bed with heat—he is a sick person who is in danger, for it is known that until the sweat he stands in danger. And also afterwards until he rises from his bed he is a sick person, and if according to appearances his sweating is not yet complete—he is as one who is in danger.

Even though it has been explained that for the danger of a limb one does not desecrate the Shabbat with a Torah prohibition by means of an Israelite, nevertheless, an eye that rebelled—meaning that he is concerned for both his eyes or even for one eye and there is pain in the eye, or if tears were flowing from it due to the pain or if it was flowing blood, or if there was discharge in it, and it is at the beginning of the illness or in its middle—one desecrates the Shabbat for it, because the veins of the eye are dependent on the heart, and it is a danger to the heart; to the exclusion of if all these are at the end of the illness, there is no danger by means of these signs. And all the more so to apply a remedy that would increase the light of his eyes—which is certainly forbidden on Shabbat; however, when a doctor says that it is dangerous, it has already been explained that one desecrates.

If one underwent bloodletting and became chilled—it is a danger, and one makes a fire for him even during the Tammuz season; and so too any sick person who became chilled—it is a danger, and one makes a fire for him. However, if it is possible through a non-Jew—it is good to do it through him, for in this there is no panic and it is not needed this very moment, unless the doctor says that he needs warmth immediately, for then it is a mitzvah for the Israelite to light the fire for him, and not to wait until a non-Jew is found. And it has already been explained that a sick person who is not in danger is permitted to eat the cooked foods of a non-Jew, but in the evening it is forbidden even for himself. Regarding the vessel in which the non-Jew cooked, some say it requires koshering, and some say it does not require it. And one may rely on those who are lenient, for our teacher, the Rema, ruled in Yoreh Deah at the end of siman 113 that even the food itself is permitted after the Shabbat even to others, because cooking on Shabbat for a sick person has a distinguishing mark, and they did not decree against this. And even if they disagree on this, in any case, regarding the vessel, one certainly should not forbid it post facto for one who wishes to rely on those who are lenient (see Magen Avraham subsection 17, and they disagreed with him).

It is stated in the Gemara (108b): Wine inside the eye is forbidden, for the matter is evident that it is for healing, as he blinks (Rashi). On top of the eye is permitted, for they say he is doing it merely for washing (ibid.). And this is specifically when he does not open and close [the eye], but if he opens and closes—it is forbidden, for the matter is evident that it is for healing, and inside the eye it is impossible that there should not be blinking. And tasteless saliva—even on top of it is forbidden, as it is a loathsome thing, and the matter is evident that he is doing it for healing. And if it is difficult for him to open his eyes—he may moisten them with tasteless saliva, for it is evident that he intends to open them (Taz, subsection 15) and not for healing. And tasteless saliva is when he rises from his bed in the morning and has not yet tasted anything (see Magen Avraham, subsection 19). And regarding the matter of wine: Nowadays, when it is not the practice to wash with wine—it is forbidden (ibid.), for it is evident that this is for healing. And conversely, with water, when he washes his mouth and afterwards passes it over his eyes—it is permitted (ibid.), as such is the way of many people constantly.

A person may soak eye-salve on the eve of Shabbat and place it upon the eye, for it only appears as if he is washing, provided that he does not close and open it, so that it is not clearly apparent that it is for healing, for eye-salve alone does not appear as healing. And specifically when it is thin, but if the eye-salve is thick—it appears as healing. And even though a liquid also appears somewhat as healing, nevertheless they did not decree against this and we are not concerned in this case for the grinding of spices, for since they did not permit him to soak them except on the eve of Shabbat, there is a distinction (so it appears to me to explain). And the main reason is because in their days even healthy people would do so for pleasure, and in the Tosafot (18a, s.v. "u-mitrapet") they wrote that this deals specifically with a healthy person, but from Rashi (108b, s.v. "ve-noten") it does not imply so. And it appears that for us it is certainly forbidden, for healthy people are not accustomed to this, and they only do this for healing.

One may remove on Shabbat the scabs that have formed over a wound, and one may smear it with oil, but not with fat, because it melts and is considered "nolad." And even at the end of the healing of the wound where there is no pain, and the smearing of the oil is only for the sake of pleasure—it is also permitted, for smearing was never prohibited as I wrote in siman 327, and this does not appear like healing. Therefore, one may not place upon it oil and hot water mixed together, for it is evident that this is for healing. It is also forbidden to place the oil and the water upon a cloth because of squeezing, and even water alone is forbidden for this reason. However, oil alone, for which the prohibition of squeezing is because of "mefarek," is only prohibited when one needs the liquid that comes out, as I wrote in siman 320—it is permitted to place it on the cloth. And that which is forbidden to place hot water and oil is specifically upon the wound, but it is permitted to place it outside the wound so that it flows and descends to the wound. And it appears to me that according to our custom that we do not smear with oil on weekdays—it is forbidden to smear the scabs of a wound with oil, for it is evident that this is for healing, as I wrote in the previous siman, section 2; see there.

One may place a sponge and pieces of new, dry cloths upon a wound, because they are not for healing but rather so that the clothes do not chafe the wound; however, not from old cloths, as they heal the wound, but a sponge, even an old one, is permitted. And it appears that a sponge is permitted even with a sponge that is of any type that absorbs water within it, and likewise a sponge of wool, as they said regarding the death of Rabbi Chanina ben Teradyon: "They brought sponges of wool and placed them upon his heart." And it is possible that those of wool have the status of cloths, and it requires further study. And that which old cloths are forbidden, these words apply if they were never placed upon the wound, but if they were already upon the wound—even old ones are permitted, because they no longer heal.

And one may place a leaf upon a wound on Shabbat, because it does not heal but rather protects it so that it does not rub against his clothes, except for grape leaves which are for healing. And so too other leaves, if they are known for healing – it is forbidden, and all the more so it is forbidden to place salve upon the wound. And so too one may not place a reed upon the wound, because a reed heals. And all this is regarding an ordinary wound that has no danger, and is not categorized as an illness. But there are dangerous wounds according to the words of the physicians, and if the danger is to the entire body – it is like the law of a person who is dangerously ill, and if there is danger to a limb – one acts through a non-Jew, and a rabbinic prohibition through himself as has been explained, and all this depends according to the word of the physicians.

If there was a bandage placed upon his wound from the eve of Shabbat—and a bandage is a piece of cloth upon which salve was spread for healing—and it fell from its place on Shabbat, if it fell onto the ground, it is forbidden to return it. This is not due to the prohibition of healing, for it was already upon him from the eve of Shabbat, but rather the reason is that we decree lest he smear it when he sees that the smearing has become spoiled, and one who smears is liable because of scraping, as I have written in siman 321. However, if it fell onto a vessel, he may return it, for this is like it slipped from its place, which is certainly permitted to return to its place; for they only forbade lifting it from the ground, as it is like a different placement, for the first act has ceased and it is like placing it for the first time (Rashi, Eruvin 102b), but not when it fell onto a vessel, and he should only be careful when returning it not to tie it except with a loop. And this which we permitted when it fell onto a vessel is only when it fell on its own, but if he removed it intentionally, it is forbidden to return it. And there are those who disagree and permit it, and if he is in much pain, he may have it placed by a non-Jew even initially. And this is regarding a bandage made from the eve of Shabbat, but to command a non-Jew to make a bandage on Shabbat—meaning to smear it on a piece of cloth, which is a complete shevut—is forbidden even for one in pain, unless he became ill in his entire body from the wound; even though there is no danger in this, nevertheless it is permitted to tell a non-Jew to make a bandage for him and place it on his wound or his bruise, and likewise if there is a danger to a limb.

A bandage placed on one's wound from the eve of Shabbat — one may on Shabbat uncover part of the bandage and wipe the opening of the wound, and return that part to its place, and uncover the other part and wipe there as well and return it to its place. But the bandage itself — it is forbidden to wipe it, because he is performing memareiach, and he should only wipe the area of the wound. And a wound that has healed — they permitted him to place upon it a bandage prepared from the eve of Shabbat. And they were not concerned to forbid this, since he does not need it for its healing but only for general protection — we are not concerned that he might come to the prohibition of grinding herbs. And not only is it forbidden to place a bandage initially on a wound that has not healed, but even light ash, meaning ordinary ash — it is forbidden to place on his wound because it heals it, and only through a non-Jew did they permit it to him if he is in much pain and needs it. And know that in the Mikdash they permitted the placing of a bandage initially, because there is no shevut in the Mikdash. (Mishnah Eruvin 102b, and there it is stated: "They return a bandage in the Mikdash," but in the Rambam chapter 21 halacha 27 it is stated as I have written. And the Ra'avad disagreed with him, and the Maggid Mishneh wrote that it is an erroneous version, see there. And in my humble opinion it is a correct version, for "they return" in the Mishnah means placing it initially, according to the commentary of Rashi there, that he removes it at the time of the service and afterward places it, see there and examine carefully.)

One who pierces an abscess on Shabbat in order to widen the opening of the wound, in the manner that doctors do, for they intend in their healing to widen the opening of the wound—he is liable for the category of makeh b'patish, as this is the craft of the doctor. Rashi explained (107a): because of building an opening or repairing a vessel, but the Rambam wrote it is due to the reason of makeh b'patish. And if he pierced it only to extract the pus within it, and he is unconcerned if it returns and closes immediately—this is permitted ab initio, for it is not a completion of a craft at all, and all the more so according to the one who holds that a labor not needed for its own sake is exempt, and even though it is prohibited ab initio, nevertheless they permitted it because of the pain, and it is good to do it through a non-Jew if possible (Magen Avraham, subsection 32). And it is permitted to remove a thorn with a needle (Mishnah, chapter 17), provided that he is careful not to draw blood, so as not to make a wound on Shabbat (ibid.).

Men who have an "aperture" on their arms for healing—meaning they are always perforated, and when the hole is closed they place a legume inside it so that it will open—it requires investigation if it is permitted to place the legume on Shabbat into the hole so that it will open. For his intention is that it should be open always, and it is like "making an opening for it" and is forbidden; except that one could say since the hole existed from before, it is permitted (ibid.). In my humble opinion, it appears that this is like extracting pus, for the blockage is due to the pus, and the legume extracts the pus and does not allow the pus to increase, and despite all this, it occasionally becomes blocked again; and why is this not like opening an abscess to extract pus? And to place a bandage on the "aperture"—it is like all wounds, where for healing it is forbidden and for protection it is permitted (see Magen Avraham ibid. and examine it closely). And to extract pus—it is permitted, and even though a small amount of blood comes out with the pus, it is not from the blood absorbed in the body but rather blood of a wound which is "stored" (ibid. in the name of Sefer HaTerumah). And if a piece of cloth is placed on the wound—it is permitted to replace it with another, for the first one becomes foul (ibid.), provided that there is no healing bandage upon it. And it is forbidden to scratch a boil on Shabbat until he extracts blood, for this blood is from the body (ibid.) and is not "stored." (See Magen Avraham ibid. who wrote that from the wording of the Shulchan Aruch it implies that the liability for opening an abscess to make an opening for it is even if there was a hole and he widens it, see there. And certainly so it is according to the Rambam, for the liability is because of "striking with a hammer," but according to Rashi, for whom the liability is because of "building" or "an opening," the liability is only when it was closed; and so it is explained from the wording of Rashi 107a, see there and examine it closely).

One whose hand or foot was struck may bathe it in wine in order to stop the bleeding, but not in vinegar because it is strong and this constitutes an act of healing, and all the more so with spirits or other sharp substances it is forbidden. And if he is delicate and sensitive—even wine for him is like vinegar and is forbidden. And it is simple that this applies when there is no concern of danger in his injury but only mere pain, and healing for this was not permitted on Shabbat. But there are injuries in places where there is danger, such as an injury in the junction of the tendons—it is obvious that healing was permitted for him according to the specific laws that have been explained, and this depends on the statement of a doctor as I have written. And one whose hand or foot joint was dislocated from its place, meaning that the bone came out of the joint and there is no concern of danger in this—he may not rub it much with cold water, as this is its healing, but rather he washes in his usual manner and if it is healed, it is healed.

And know that this law was written by the Tur and the Shulchan Aruch in section 30, and in section 47 they wrote: A bone that came out of its place, one may return it. Thus far their words. And this is a contradiction between the two. And in truth, there is one who disagrees with this, for in the Gemara (148a) they only permitted a broken bone, and not when it came out of its place, for this is the wording of the Gemara: "The halacha is: one may return the break" (Magen Avraham, subsection 51). And in my humble opinion, the words of the Tur and the Shulchan Aruch are correct if we examine why they indeed changed from the wording of the Gemara; rather, it is certainly because regarding an actual break, the language of "returning" is not applicable, but rather "joining," as is common in the language of the poskim: "break to break shall be joined together," and the language of "returning" applies only to a bone that came out of its place. And in truth, they are two separate laws: for certainly to return it to its place is permitted, for how is it possible to leave it outside of its place? And that which is in section 30 is a different matter: that one should not rub the place with water after they have returned it to its place, and what does this matter have to do with that one? And I saw one who distinguishes between if it came out of its place entirely to the outside and if it came out slightly from its place (Mishnah Berurah in the name of Sha'arei Teshuvah), and this is nothing but words of prophecy, and it is clear as I have written with the help of Heaven. And it is a wonder regarding the Rambam that he omitted these two laws entirely, and both of them are explicit in the Mishnah and Gemara there.

It appears to me that the reasoning of the Rambam is as follows: behold, in the Mishnah (147a) it was taught: "We do not reset a fracture, and one whose hand or foot was dislocated should not scrub them with cold water, etc.", and in the Gemara, Rava said: "The halacha is: we reset a fracture." And regarding that which was taught about a dislocation, Rav Avya also thought to say the opposite of our Mishnah, and Rav Yosef said to him: where it was stated, it was stated, etc., see there. And it must be understood from where Rava knew to rule against the Mishnah, and Rashi, of blessed memory, explained that Rava holds that "we reset" was the version taught in the Mishnah, see there. And this is difficult, for if so, he should not have spoken using the language of "halacha," but rather "we reset was taught"; and it is also difficult why Rav Avya thought to also reverse the latter clause. Therefore, in my humble opinion, the matter is thus: behold, Rava was a physician, as is known, and he knew that according to the nature of the people of his generation, if they do not reset the fracture it would be a danger; because of this he says: the halacha is that we reset the fracture, meaning that now it is a danger. And therefore Rav Avya thought that the law of the latter clause also changed according to the natures of the generations, and Rav Yosef said to him that there is no proof, meaning that even though regarding resetting Rava says it has changed, nevertheless regarding scrubbing with cold water there is no necessity that it has changed, and it is possible that it changed and it is possible that it did not change, and there is no deciding factor in the matter. And since the Rambam saw that these laws depend on the natures of human beings, therefore it is impossible to rule a fixed halacha regarding them, and it depends on the statement of physicians. And perhaps the Rambam himself, who was a physician, knew that sometimes there is a danger in this and it is necessary to use medicines and one cannot give a fixed rule in this, and he omitted them and they are included in the general rule of what he wrote in chapter 2: "If a physician says it is necessary—we desecrate." And it seems to me that even now they consider this a danger, and therefore if such a thing should occur, Heaven forbid, they should inquire of physicians and act according to their words.

One who removes a fingernail with a tool, with a knife or with any other tool, is liable for a chatat, as it is a derivative of shearing. And with the hand, which is a deviation, he is exempt but it is forbidden, as is explained in the Gemara (94b) and in the Rambam chapter 9, and will be explained in siman 340. Therefore, a fingernail that has separated but not completely and causes him pain, and similarly tzitzin which are like thin strips that have separated from the skin of the finger around the fingernail and cause him pain: if the majority has not separated, this is not such great pain and it is completely forbidden. And so too even if the majority has separated: if they separated downward, this is not great pain; however, if they separated upward and he has great pain from this, they permitted him to remove it entirely with his hands. However, regarding the explanation of "upward," Rashi and Rabbeinu Tam disagreed, for Rashi explains toward the tips of his fingers, that it began to separate toward the side of the fingernail, and it is called "upward" because they are upward when he raises his hands. And Rabbeinu Tam explained the opposite, that they separated toward the body, and this is called "upward" when his fingers are lowered downward. Therefore, due to the concern of both explanations, it is impossible to do anything, and he should wrap the finger in a cloth and wait until night.

We learned in the Mishnah (111a): "One who feels pain in his teeth—he may not sip vinegar through them, but he may dip in his usual manner, and if he is healed, he is healed." And the Gemara established it: He may not sip and spit out, but he may sip and swallow, for in spitting out the matter is proven that it is for healing (and it requires further study, for if so, what is it coming to teach us by saying he may dip in his usual manner). And this is regarding a mere ache, but if he suffers greatly until the body is weakened from this, it has already been explained in section 22 that it is a danger, see there (and see Tosafot there, beginning with the words "One who," who wrote "and the same law applies etc.," and it requires further study what "and the same law applies" refers to regarding this, since one could err that specifically dipping is permitted and not swallowing without dipping, and examine this closely).

One who feels a mere ache in his throat—he may not gargle with oil, which is to say that he keeps the oil in his mouth, for it is evident that he does so for healing. And even by means of anigron, as explained in siman 202, see there, it is forbidden for this reason. However, he may swallow oil, and if he is healed, he is healed. And there are those who forbid this in this time, since it is not the way of healthy people to do so. And all the more so is it forbidden to tell a non-Jew to perform a healing for him, and likewise in the previous law regarding one who feels an ache in his teeth, for regarding a mere ache, it was not permitted to speak to a non-Jew.

The Tur wrote: One who groans from heart pain, whose remedy is to suck milk from an animal—it is permitted to suck from it on Shabbat; but if he suffers due to hunger—it is forbidden on Shabbat and permitted on Yom Tov. Thus far his words. And in Ketubot (60a) the reason is explained, because sucking is "mefarek" in an unusual manner, and in a case of suffering the Rabbis did not decree. And in Yevamot (114a) we say that because of suffering they only permitted on Yom Tov and not on Shabbat, and the Rif rejected that of Yevamot because of that of Ketubot. And the Tosafot distinguished that in Ketubot it deals with the suffering of illness, and this was permitted even on Shabbat, and in Yevamot it deals with the suffering of hunger, and this was not permitted except on Yom Tov, and this is the opinion of the Tur. And our teacher, the Beit Yosef, in section 33 wrote: "One who groans—it is permitted to suck milk from the animal, for in a case of suffering the Rabbis did not decree. And some say that if he only has suffering of hunger—it is forbidden to suck from the animal on Shabbat." Thus far his words. The explanation of his words: that the first opinion is the opinion of the Rif, and he holds that since the Rif does not distinguish between the suffering of illness and the suffering of hunger, we learn from this that they are equal, and even on Shabbat it is permitted even for the suffering of hunger. And the Gemara that mentions one who groans, it teaches the common case, for one who groans specifically requires milk, but for hunger one can eat or drink other foods and drinks and it is not common that he specifically requires milk, but if it so happened—it is permitted. And afterward he brought the "some say," and this is the opinion of the Tosafot and the Tur. (And the difficulty of the Magen Avraham in subsection 39 is answered; and what he wrote from the Ramban that for the sake of desire they do not permit, see there, I wonder what the connection is between hunger and desire, and the Ramban disagreed with the Maor who permitted for the sake of desire, see there and examine carefully.)

A woman may not drip milk from her breasts into a cup or into a pot and then nurse her son, for why should she perform a prohibition in a matter where there is no need for the infant, as he is able to nurse from her breasts in the manner of all infants. However, there are some infants who do not take the breast into their mouths until she drips a little milk onto the breast—it is permitted, since this is the need of the infant so that he will grasp the breast and nurse; and similarly, if the doctors commanded her to drip milk from her breasts onto a person who is dangerously ill—it is also permitted. But for a person who is not dangerously ill—it is forbidden, for this is a Torah prohibition of mefarek. And all the more so is she forbidden to drip from her milk onto one who was afflicted by an evil spirit, and there is no danger in this. And there is one who says that in a place of great pain—it is permitted, because this is a labor that is not needed for its own sake (Magen Avraham, subsection 41). And I am astonished, for according to the opinion of the Rambam one is liable for a labor that is not needed for its own sake, and in our days we have not heard this and one should not do so.

One may not chew mastich, which is a resin from which they make pitch, and no healthy person chews it and it is evident to all that it is for healing, and one may not rub it on the teeth for healing. But if one does this because of mouth odor—it is permitted, since it is not for healing. And even though it is possible that one who does not know that he has mouth odor will suspect him of doing it for healing, nevertheless, it is impossible to prevent him from this which is a necessity for him to be among people, because of a baseless suspicion.

All foods that healthy people eat and all drinks that healthy people drink—it is permitted for those with an ailment to eat them and drink them for healing. And it is not relevant to decree in this matter because of the grinding of herbs, since it is the food of healthy people. Furthermore, even if they are of the things that are beneficial for some things and harmful for other things, such as spleen which is beneficial for the teeth and harmful for the intestines, and leeks which are harmful for the teeth and beneficial for the intestines (Berakhot 44b), nevertheless it is permitted to eat them; even though the matter is proven that he is doing so for healing, nevertheless, in the end, healthy people eat this. And know that in Berakhot (38a) it implies explicitly that if he intends for healing—it is forbidden, as it says there regarding this matter that a person may eat all foods for healing: "The man intends for eating, and the healing occurs on its own," see there. And the Rambam in chapter 21, law 22, wrote: "A person may eat... and he eats them in order to be healed by them—it is permitted," see there, and it implies that even if his primary eating is for healing. And such is the wording of the Tur and Shulchan Arukh section 37 who wrote: "it is permitted to eat them and drink them for healing," which implies that his primary intention is for healing, and it requires great study.

Anything that is not the food or drink of healthy people—it is forbidden to eat or drink it for healing even if it is sweet to the palate; nevertheless, since healthy people do not eat this, it is evident that it is for healing. Our teacher, the Beit Yosef, wrote in section 37: "And specifically one who has a mere ache and he strengthens himself and goes about like a healthy person, but if he has no ache at all—it is permitted." Thus far his words. Meaning, that a completely healthy person, when he desires to eat them—it is permitted. And the reason must be said that it is impossible to forbid it to him because of those who see, since he is healthy, who can protest against him. But the wording of the Tur is as follows: "But if he eats and drinks it for his hunger and for his thirst and he has no illness—it is permitted." Thus far his words. This implies specifically for his hunger and for his thirst, but otherwise—it is forbidden. And our teacher, the Beit Yosef, holds that he took the common way of the matter. But one of the great Acharonim explained that it is specifically so, and he brought several proofs for this, that it is specifically for his hunger and for his thirst, but otherwise—even a healthy person is forbidden (Magen Avraham, subsection 43), and so it appears for the din. And it appears to me that there is no dispute here, and also the intention of our teacher, the Beit Yosef, is so, that a healthy person is permitted to eat them plainly, that he desires to eat them and does not eat them explicitly for healing, meaning that his strengths should be further strengthened, and one with an ache even in such a case is forbidden.

Our teacher, the Rema, wrote regarding this: "And so if he took to his bed—it is permitted," thus far his words. The explanation of his words: for a sick person who took to his bed and is not in danger—the shevut of telling a non-Jew was permitted to him, and whether an Israelite may perform a rabbinic prohibition with his own hands for his sake is a matter of dispute, as written in section 17; however, regarding the eating of things that healthy people do not eat and are good for eating—it is certainly permitted according to all opinions, for this is no worse than telling a non-Jew. And we do not decree in this case because of the grinding of medicaments, since we forbid him or another from performing any act involving a rabbinic prohibition, there is a distinction in the matter, and eating is not similar to labor and is more similar to telling a non-Jew. (And this is the intention of the Beit Yosef brought by the Taz in subsection 25, and the words of the Taz are not understood at all. And what the Magen Avraham wrote in subsection 44, that even another Israelite is permitted to do for him etc., see there, his intention is that since there are opinions in section 17 that even a physical act is permitted, all the more so eating is permitted. And granted that regarding an act there are those who disagree, nevertheless regarding eating everyone agrees. And the Machatzit HaShekel struggled with his intention, and the Pri Megadim remained with a difficulty, see there, and his intention is as I have written, and examine it closely.)

It is permitted to eat sweet resins and to swallow a raw egg in order to pleasant the voice, and even though people are not accustomed to eating them in this manner, nevertheless, since this is not for the healing of an illness but rather for the pleasantness of the voice—it is like the delight of Shabbat and is permitted. However, that which people are accustomed to making, beaten egg yolks with sugar—it is forbidden to beat them on Shabbat, just as it is forbidden to beat honey with mustard and wine with cress in siman 321, section 22, see there, and besides that there is in this a weekday activity. One who requires this should prepare it from the eve of Shabbat, and on Shabbat he may return to stir them with a spoon a little bit at a time, as is mentioned there, see there.

One may not induce vomiting on Shabbat, meaning taking some drug in order to vomit the food so that one can eat more, and even on a weekday it is forbidden in such a manner because of the waste of food. However, if one is in pain from an excess of food on a weekday—it is permitted even with a drug, but on Shabbat it is forbidden with a drug, for since he takes it for healing—it is forbidden. But by hand—it is permitted, meaning that he places his hand deep into the throat and vomits, for since he does not do it with a drug there is no reason to decree because of the grinding of drugs. And one who suffers in his bowels—it is permitted to place upon them a cup from which hot water was poured, even though it still contains heat. And even though he finds relief through this, nevertheless this is not in the category of healing for which we would decree because of the grinding of drugs. All this is when there is no concern of illness, but if there is a concern of illness—they should act according to the laws that were explained above. And similarly one who became intoxicated, whose cure is to smear the palms of his hands and his feet with oil—it is permitted to smear them on Shabbat, for that which clears his intoxication is not in the category of healing, and also it is not common to do this by means of drugs. (See Turei Zahav subsection 27 that it is forbidden to place for a drunkard ash from a crushed herb in his nose, for this goes towards healings, and one must decree because of the grinding of drugs, see there; but ground tobacco that everyone smells—it is permitted)

One may not engage in strenuous exercise, which is to say, pressing upon the body with force so that one becomes weary and sweats. According to the Rambam, if one does not intend to sweat—it is permitted, for the prohibition is because of the sweating, as this is the cure for most illnesses, and they bring about sweating through drugs. Therefore, they prohibited all sweating, even those that are not through drugs (Taz, subsection 28). It is prohibited to press the belly of an infant in order to bring out the excrement, for perhaps he will come to give him laxative drugs to drink. All this applies in a place where there is no illness, but regarding one who is ill, the details of the laws have already been explained above.

It is permitted to invert a cup of hot water that was upon the navel and to raise it, and this is what is called "heib mutter," and similarly it is permitted to raise the ears whether by hand or with a vessel, meaning the sinews of the ears, for sometimes they descend and the ears become dislocated (Rashi, Avodah Zarah 28b). And behold, Rashi explained there that there is danger in this, see there, but from the words of the Rambam, chapter 21, law 31, who wrote: "And similarly it is permitted to raise ears… for they do not do so with medicinal herbs such that one must be concerned for grinding," thus far his words, and if it involves danger, behold it is permitted to desecrate Shabbat as well. And in the Yerushalmi (chapter 14, halacha 4) it is considered among matters of danger, see there, and so it is explained in Midrash Ha'azinu, and this is its wording: "A person who suffers in his ear… and this is an ear wound, if it is a danger—one heals it on Shabbat," see there.

It appears to me that Rashi and the Rambam do not disagree regarding the law, but rather in the explanation of "raising the ears," for Rashi explains it as the tendons of the ears, that sometimes they descend downward and the jaws become disjointed and one must raise them, and there is a Torah prohibition in this due to "building," and the Yerushalmi calls them "daughters of the ears," meaning that the tendons are daughters to the ears, and there is danger in this and one desecrates the Shabbat. But the Rambam explains that the ears themselves became slightly weakened, and when one strengthens them there is no prohibition of "building," and this is what the Midrash says: "if it is a danger," meaning that if the tendons descended—it is a danger, and if it is the ears themselves—it is not a danger and one does not perform it with medications. And similarly, it is permitted to raise the "onkali," which is the lobe opposite the heart that obstructs breathing when it is bent inward, for each of these one does not perform with medications so that we should be concerned for the grinding of ingredients, and he has pain from them, and therefore they permitted it, for if not so, we should have prohibited it even though there is no labor in this, nevertheless it would be a weekday activity.

The Rambam wrote in chapter 21, law 21: "How so? One may not eat things that are not the food of healthy people, such as Greek hyssop and madder, nor things that are laxatives such as wormwood and the like. Similarly, one may not drink things that it is not the way of healthy people to drink, such as water in which drugs and herbs were cooked. But a person may eat foods and drinks that it is the way of healthy people to eat and drink, such as coriander, hops, and hyssop, etc., and one may drink Egyptian beer everywhere." And in law 29 he wrote: "One may not bathe in water that causes diarrhea, nor in mud in which one sinks, nor in foul-smelling steeping water, nor in the Sea of Sodom, nor in the bad waters of the Great Sea, because all of these are a source of pain, and it is written: 'And you shall call the Shabbat a delight.' Therefore, if he did not linger in them but emerged immediately, even if he has sores on his head—it is permitted." Thus far his words. And prior to this he wrote that it is forbidden to stand on the ground of Dimosit in the Land of Israel, because it causes exertion and heals. Thus far his words. And several things are not known to us, but from this one may learn regarding things known to us. And the reason it is not forbidden when one does not linger in the bad waters is because it appears as if he is cooling himself. And one may bathe in the waters of Gerar, the waters of Hamtan, the waters of Tiberias, and the good waters of the Great Sea, even though they are salty, for such is the way to bathe in them and there is no proof that he is doing so for healing. And one may whisper charms over snakes and scorpions so that they do not cause harm, and there is no concern of tzida in this, for it is merely a charm.

One may place a vessel over the eye to cool it, provided it is a vessel that may be handled on Shabbat, for this is a remedy for one who feels pain in his eye and there are no medicinal ingredients in this remedy; therefore, it is permitted to do it. And similarly, one may encircle the eye with a ring so that the swelling does not spread, and similarly, it is permitted to press a knife upon a wound so that it does not spread, because regarding these matters the grinding of medicinal ingredients is not applicable.

It is forbidden to place a garment upon a wound from which blood is issuing, because the blood will dye the garment; and even though he spoils the garment, nevertheless it is forbidden by rabbinic law, and all the more so if the garment is red, for then he does not spoil it. Therefore, one should first wash the wound with water or wine to clean the blood, and afterwards place the garment or the rag prepared from the eve of Shabbat upon it. And some say that one wraps spiderwebs, which are called "savetzina," over the wound, and covers all the blood and the entire lesion with them, and afterwards wraps a rag over it, for then it will not be dyed by the blood. And this is when the web is prepared, for if not so, it is muktzeh. And it is forbidden to press with his hands upon the wound, because through pressing blood will issue, and he is liable on account of mifarek; therefore, he should not fasten it tightly for this reason. And all the more so it is forbidden to apply leeches on Shabbat, except for a person who is dangerously ill, and all the more so to perform bloodletting.

It is forbidden to place a wick in the rectum, which is called a "klister," in the manner that is customary to do for one who is constipated, for this is included in the category of healing, unless he does it by means of a shinui, that he should hold it with two of his fingers and place it gently. And it is obvious that the wick must be prepared from before the day. And all the more so is it forbidden to perform a "klister" by means of a vessel called a "kanna," and it is close to coming thereby to a Torah prohibition, and therefore one should not perform them except for a patient who is in danger, and a simple "klister" may be performed by means of a shinui as I have written. And know that there is one who forbids placing spider webs on a cut because it heals, but in my humble opinion it does not heal but rather stops the blood, and I do not know if this is called healing, for regarding a cut, the flow of blood is not a danger but rather a repulsive thing, and the web holds back the blood, but the web is muktzeh. And by means of a non-Jew it seems to me that it is permitted, and that is that the non-Jew should take the web and place it on the location of the blood.