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danger? Even if the danger will be after several years, we permit it
now. As the Gemara states in Yoma (84b): “…not only a possibility [of
danger] on this Shabbos but also a possibility [of danger] on another
Shabbos.” Obviously, this is not limited to Shabbos, but applies even to
WRITING
105 endangered immediately is not proof of anything.
a number of years later. Therefore, the fact that the children were not
PRESCRIPTIONS AND
USING INSTRUMENTS
We can add to this the words of the Gemara in Shabbos (145b):
ON SHABBOS IN AN
Rav Chiya bar Abba said to Rav Assi: Why are the birds in Baby-
OPHTHALMOLOGY lonia fatter than those in the land of Israel? …because they were not
DEPARTMENT exiled, as it says: “Moav has been at ease since his youth and he has
settled on his lees, he has never gone into captivity” (Yirmiyahu 48:11).
By contrast, birds in the land of Israel were exiled, as it is written:
“From the birds of the sky to the beasts, they have fled and gone”
(Yirmiyahu 9:9).
1 Questions Shabbos in an OphthalMology DepaRtMent Although Rav Chiya lived about six hundred years after the Bab-
ylonian exile, the influence of the exile still expressed itself in the
I wish to ask a number of questions relating to my work in the oph- offspring of the birds. Likewise, the after-effect of pain in the eyes
thalmology department in the hospital on Shabbos: augmented by the pain of the circumcision is liable to express itself
1. It is an international law that a physician is obligated to record after many years. In a similar vein, there are Rabbanim who have in-
his instructions regarding medication and treatment in the pa- structed people to write the words “may Hashem revenge his blood”
tient’s chart. The nurses carry out the instructions according to on the tombstones of Holocaust survivors, since the suffering they
what is written in the charts. It is forbidden for a nurse to give endured certainly left its mark and hastened their death.
medication without a physician’s order and signature. Therefore, the answer to the question – why do we not circumcise
the baby immediately considering that medicine has proven that
What should a physician do on Shabbos when he gives orders to there is no harm to performing the circumcision – is that our Sages,
administer medications to patients with eye ailments in order with their holy eyes, were able to see that there is a remote possibility
to save them from danger to their lives? For example, patients that the baby will be harmed, and perhaps it will only be expressed
hospitalized after surgery for cataracts, retina, or for glaucoma, years later. Therefore, we are obligated to give the baby seven days of
receive drops and compresses and capsules according to their rehabilitation.
needs, to prevent infection, to balance the pressure, and to min- These are the words of the greatest of Torah scholars, the Ram-
imize the level of reaction in the eye. Is it permissible for the bam (Mishnah Commentary, Shabbos 19:19): “And they said “until he
physician to write? recovers,” meaning, until he is completely healed from his illness, and
It is well known that there is an oculo-cardiac reflex: when stress the healing process is complete, and after the fever has subsided, he
or pressure is put on the eye or the extra-ocular muscles of the must wait another seven full days, and these are the days of ritual
eye are pulled, this can slow down the heartbeat (bradycardia). purity. Then he can be circumcised.” The Rambam adds that just as

296 1 Medical-HalacHic Responsa of Rav ZilbeRstein Circumcision with an Eye Infection 2 285