Achoo/Tzu gezunt

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July 03 2015
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From the time of Adom HaRishon until Yaakov Avinu, life threatening illnesses preceding death were unknown; when it came time to die, the healthy person sneezed and his soul left the body [Sanhedrin 107b]. Yaakov Avinu requested from HaShem that prior to death a person should initially become ill, thereby giving additional time to organize his affairs, bid farewell to his family, and correct any wrongs that he had done during his lifetime. Yaakov Avinu said, “Master of the Universe, do not take my soul from me until I can command my sons and the members of my household.”  Yaakov Avinu was answered positively, as noted, “And it came to pass after these things that someone said to Yosef, ‘Behold! - your father is ill.’ So he took his two sons, Manasseh and Ephraim, with him” [Bereishis 48:1]. All peoples of the world heard of this and were amazed, since nothing like this had happened since the heaven and the earth were created [Kaminker, n.d.; Mishnah Brurah (Orach Chaim, siman 230, seif katan 7); Pirkei deRabbi Eliezar, perek 52; Rosner, 1999]. 


This incident serves as the basis for the verbal exchange between a sneezer and those who hear a person sneeze. Mishnah Brurah (Orach Chaim, siman 230, seif katan 7) noted that if one sneezes, those near him should say “asusa” (Aramaic) meaning “to health,” the equivalent of tzu gezunt in Yiddish or labriyut in Hebrew. Thereafter, the one who sneezed responds “Baruch tihyeh” (‘Blessed are you”) to those who said asusa and then continues to thank Hashem, “Lishu’atcha kivisi Hashem” (“For Your salvation do I long, HaShem”) [Bereshis 49:18].  Me’Am Loez [Bereshis 48:1] cites a slightly varied version. Those who hear a person sneeze should say, “Chaim tovim” (“A good life”).  The sneezer, thanking HaShem for allowing him to avoid death, says, “Baruch ma’chayeh hamasim; Lishu’atcha kivisi Hashem” (Blessed is He who brings the dead to life; For Your salvation do I long).  The sneezer then responds to those who blessed him, “Yosefu lachayim sh’nos chaim” (“May you have many more years of life”).


The connection between sneezing and life is related to the creation of the Adom HaRishon. “And HaShem, God, formed the man of dust from the ground and He blew into his nostrils the soul of life and man became a living being” [Bereshis 2:7].  Apparently, life entered through the nostrils.  In describing the consequences of the flood, Noach noted, “All in whose nostrils was the breath of the spirit of life, of everything that was on dry land, died [Bereishis 7:22].  Just as life entered through the nostrils, a sneeze was the mode through which life exited from the body.


It is interesting to note that also in other cultures, an individual who hears a sneeze verbally responds to the sneezer. Upon hearing a sneeze, in German the response is gesundheit , in Spanish it is salud, and in Irish it is slainte [Wikipedia - God bless you, n. d.].  The format of a give-and-take verbal exchange between the sneezer and fellow Jews who hear the sneeze is duplicated in Islamic culture.  When one sneezes, the sneezer says “Praise be to God” and his fellow Muslims respond to him, “May God have mercy on you.” To which the sneezer counter-responds, “May God guide you and rectify your condition” [Wikipedia - Sneeze, n.d.].  


The American custom of responding to a sneeze by saying “God bless you” has its origins in the bubonic plague, caused by the bacterium, Yersinia pestis, and transmitted to humans through bites from infected fleas carried on mice and rats. Upon being bitten by an infected flea, the bacteria enter the skin and travel to the lymph nodes, primarily those in the armpits and groin, which become swollen and painful.  Localizing in inflamed lymph nodes, the bacteria colonize and reproduce. Symptoms appear suddenly, usually 2–5 days after exposure to the bacteria, and include chills, malaise, elevated fever (102 °F), muscle cramps, seizures, extreme pain, caused by the decay of the skin while the person is still alive, and gangrene (hence, the name “Black Death”) of the extremities such as toes, fingers, lips and tip of the nose. Without treatment, the bubonic plague kills about two thirds of infected humans within four days of plague manifestation [Wikipedia - Bubonic plague, n.d.]. Two major outbreaks of bubonic plaque occurred in Europe. The first epidemic (6th century) ravaged the Eastern Roman Empire (Byzantine Empire) and was named the Plague of Justinian after emperor Justinian I, who was infected but survived. The epidemic caused the death of an estimated 25 million people. Those afflicted with this disease died suddenly while sneezing.  In 590 A.C.E., Pope Pelagius II died of bubonic plague while sneezing. Thereafter, Pope Gregory I ordered that anyone sneezing be blessed immediately (“God bless you”), since sneezing was thought to be the initial sign that the person had bubonic plague.  Later, Pope Gregory VII commanded people to say “God bless you,” as an equivalent of “I hope you may rid yourself of the bacillus” [Askenasy, 1990; Wikipedia - God bless you, n.d.]. In Tosefta Shabbos [8th perek] it is stated that responding marpei  (“be healed”) or asusa to a sneeze is considered as darkei emori  (a pagan custom) and thus is forbidden. A second outbreak of bubonic plague occurred in the late Middle Ages, also killing millions of people.


What causes sneezing? A sneeze is triggered by the nervous system and generates a convulsive expulsion of air from the lungs through the nose and mouth. The causes of a sneeze are foreign particles, such as soot, pollen, or bacteria, or external stimulants that irritate the nasal mucous membranes and ignite the sneeze reflex center in the lower brain stem. Nervous impulses are transmitted to tightly close the throat and eyes, and to partially close the mouth. Next, chest muscles vigorously contract and throat muscles quickly relax, resulting in the expulsion of air, accompanied by saliva and mucus, out of the mouth and nose. During a sneeze, the back of the tongue is slightly elevated to partially close the mouth, so that the air ejected from the lungs is expelled primarily through the nose.  Hence, the purpose of a sneeze is to cleanse the nasal cavity and thereby to promote good health [Hatfield, n.d.; Wikipedia - Sneeze, n.d.].


Interesting facts concerning sneezing include: (a) sneezes travel at about 100 miles/hr and can transmit 100,000 germs into the air; (b) sneezing cannot occur during sleep; (c) sudden exposure to bright light can induce sneezing (known as the photic sneeze reflex); (d) hyperventilating during a rigorous workout may induce sneezing; and (e) plucking eyebrows can trigger a sneeze. Stomach fullness after a large meal may trigger sneezing, termed snatiation, an autosomal dominant genetic disorder. The longest continuous sneezing spree is 978 days and was set by Donna Griffiths, Worcestershire, England [Hatfield, n.d.; Wikipedia - Sneeze, n.d.].


There are a few pertinent halachos relevant to sneezing. (a) Rabbeinu Yonah [Berachos 6:30b, beginning with the word, “Ba”] cited a Yerushalmi Berachos [6:6; page 49b] stating that if one sneezed during a meal, his surrounding colleagues who are eating should not respond “asusa,” as talking during a meal might lead to choking [T’anis  5b].  (b) In a beit midrash where people intently learn Torah, mundane speech is distracting. Thus, if someone sneezed in the bet midrash, his surrounding fellows should not respond with gesundheit [Berachos 53a]. [For a more in-depth discussion of saying gesundheit in a beit midrash, see Halachipedia, n.d].


Miscellaneous aspects of sneezing mentioned in the Talmud:
(a) sneezing while praying shemoneh esrei is considered a good omen; just as the sneezer is relieved below (i.e., he feels better), so to he will be relieved above (i.e., he will be viewed favorably in heaven) [Berachos 24b].
(b) sneezing is one of the six bodily functions which is a beneficial sign for a sick person [Berachos 57b; Bereishis Rabbah 20:10], as noted with the son of the Shunamite woman, who although appeared to have died of sunstroke, he sneezed seven times and opened his eyes [II Melachim 4:35]. The connection between sneezing and healing is noted in Iyov [41:10], “His sneezing signifies the light of healing,” indicating that by means of a sneeze one comes to see the light of the world [Koren Talmud Berachos 57b].
(c) sneezing in a woman is a sign of impending menstruation [Niddah 63a] .
(d) after a suspected adulteress drank the “bitter testing waters,” if guilty, she sneezed until her body became unsettled (i.e., spasmodic sneezing) [Bamidbar Rabbah 9:21].
(e) incense was burned daily in the Temple; the emanating aroma was so powerful that, as reported by Rabbi Elazar ben Dilgai, his father’s goats sneezed from the smell of it wafting through the air [Tamid 3:8; Yerushalmi Sukkah 5:55]. And
(f) a concealed eavesdropper, sneezed and revealed his presence [Yerushalmi Yoma 3:7].


The topic of sneezing spans halacha, medicine, and history, all of which provide insight to the custom of responding tzu gezunt upon hearing a sneeze.


Appreciation is expressed to Mark (Moish) Speiser for reviewing this manuscript.


 


References


Askenasy, J.J.M., 1990, The history of sneezing, Postgrad. Med. J., 66:549-550.


Halachipedia, no date, Respecting the sanctity of the shul, http://halachipedia.com/index.php?title=Respecting_the_sanctity_of_the_Shul (retrieved 3/10/2015).


Hatfield, H., no date, 11 Surprising sneezing facts, http://www.webmd.com/allergies/features (retrieved 3/10/2015).


Kaminker, M. no date, What does Judaism say about sneezing? http://www.chabad.org/library/article_cdo/aid/22283283/ (retrieved 3/10/2015)


Rosner, F., 1999, Ominous sneezing, Amer. J. Med., 107:647.


Wikipedia,no date, God bless you, http://en.wikipedia.org/wiki/God_bless_you (retrieved 3/10/2015).


Wikipedia, no date, Sneeze, http://en.wikipedia.org/wiki/Sneeze (retrieved 3/10/2015).


Wikipedia, no date, Bubonic plague,  https://en.wikipedia.org/wiki/Bubonic_plague (retrieved 6/28/2015)

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