Today is June 28, 2017 / /
The Lindenbaum Center for Halakhic Studies at Yeshivat Chovevei Torah
I am about to give birth in the next few weeks. My doula has told me that she recommends the mother chew the placenta and spit it out afterwards as she has seen amazing recuperative benefits from this. (She does warn that Rh negative mothers should not do this unless the father is Rh negative as well.) The primary benefit, according to her experience, is that it causes the uterus to contract quickly after childbirth and prevents postpartum hemorrhaging. The placenta contains oxytocin which causes the uterus to contract; obstetricians often give mothers the synthetic form of this hormone, Pitocin, for the same purpose. I have spoken to a number of my friends who have ingested the placenta and most of them report positive results (some have ingested it in other forms: putting pieces of it in a smoothie or into gel-caps). So – my question to you is – is it permissible according to halakhah to eat the placenta, by chewing it and spitting it out or even swallowing it? I find the idea repulsive; but if I decide that I am willing to do it, may I do so according to halakhah?
I am about to give birth in the next few weeks. My doula has told me that she recommends the mother chew the placenta and spit it out afterwards as she has seen amazing recuperative benefits from this. (She does warn that Rh negative mothers should not do this unless the father is Rh negative as well.) The primary benefit, according to her experience, is that it causes the uterus to contract quickly after childbirth and prevents postpartum hemorrhaging. The placenta contains oxytocin which causes the uterus to contract; obstetricians often give mothers the synthetic form of this hormone, Pitocin, for the same purpose. I have spoken to a number of my friends who have ingested the placenta and most of them report positive results (some have ingested it in other forms: putting pieces of it in a smoothie or into gel-caps).
So – my question to you is – is it permissible according to halakhah to eat the placenta, by chewing it and spitting it out or even swallowing it? I find the idea repulsive; but if I decide that I am willing to do it, may I do so according to halakhah?
Thank you for your question; may the birth be free of complications.
This case raises a number of important questions:
One important note before we begin our analysis. For the purpose of this teshuvahwe consider the chewing or ingesting of a placenta to constitute a “practice done for health purposes.” We take no opinion as to whether this practice does, in fact, have any health value. The point is to determine whether halakhah permits this act when it is being done with a health purpose in mind, and we leave it to others to decide if doing so is a wise health practice. 
Let us now address these three issues in order:
The placenta is the organ attached to the lining of the uterus during pregnancy which provides oxygen and nutrients to the growing fetus. The Hebrew term for the placenta is שליא, shilya. Halakhah deals extensively with both human and animal placenta. Eating the placenta of an animal is dealt with explicitly in the Mishnah: “One who slaughters an animal and finds a placenta [in the uterus] – a person who is not fastidious may eat it.” (Hullin 4:7). Consumption of a human placenta is not discussed; presumably such a practice was unknown or rare in the Jewish community during Talmudic times.
In general, the Talmud only briefly addresses the issue of eating human flesh or its byproducts, probably because such cases were uncommon and were likely viewed as morally or aesthetically repulsive. It may be for this reason that the Talmudic and Tannaitic sources which address the kashrut status of human flesh, blood, or fat, refer to humans as “bipeds” and not as “humans”, allowing a distancing from this phenomenon.
Over the centuries, halakhic questions regarding the use of human flesh or human byproducts concerned its use for medical remedies, folk remedies, or segulot (protective charms or rituals). Examples include: ingesting embalmed and mummified flesh used as a standard medicinal ingredient (mumia); wearing belts from human skin or burning human teeth as a type of medical segulah; swallowing the foreskin removed at the brit milah as a segulah to treat infertility or to have male children; ingesting breast milk to cure a wide range of ailments; drinking urine to cure various illnesses; burying the placenta as a charm for keeping the newborn warm; and eating the placenta as a cure for infertility.
Is human flesh kosher? Halakhah does not classify human beings as animals (if it did, they would be non-kosher, as they do not have split hooves or chew their cud). As humans are not included in the Torah’s prohibitions against eating non-kosher animals, it would follow that there should be no prohibition against eating flesh taken from a living human being. This is the position taken by most Rishonim, including Raavad (on Rambam, Ma’akhalot Asurot 3:4), Tosafot (Ketuvot 60a, s.v. yakhol), Ramban, Rashba and Ran (on Ketuvot 60a), and Rosh (Ketuvot 5:19). Rosh and Rashba qualify this and state that there would be a mitzvat prosh, a rabbinic requirement to separate oneself from this, either because it is repulsive (this seems to be the point of Rashba, Responsa 1:364), or because of concerns of marit ayin, when it would look like one is eating non-kosher meat (Rosh 5:19, quoted in Taz, YD 79:3).
In contrast to these more lenient positions, Rambam rules that while human beings are not “non-kosher,” they are also not “kosher;” one who eats human flesh transgresses the positive Biblical mitzvah “These are the animals that you shall eat,” which is understood to mean “the only meat you may eat is meat which is categorized as kosher” (Rambam, Ma’akhalot Asurot 2:3). Shulkhan Arukh does not rule on this matter but Rema rules like Rambam that, “It is Biblically forbidden to eat human flesh” (YD 79:1). Although many poskim adopt Rema’s strict ruling, other poskim continue to treat the matter as unresolved or even rule like the Rishonim who are lenient (see Taz YD 79:3, Pri Hadash 79:6, and Darkhei Teshuvah 79:15).
The placenta is a piece of flesh; nonetheless, it is in a different halakhic category. It is not a part of the human body but something that is produced by and comes from the human body; halakhically this is referred to as yotzei min (ha’tamei), coming from (a non-kosher animal). The general principle is yotzei min ha’tamei tamei, yotzei min ha’tahor tahor; that which comes from or is produced by a non-kosher animal is not kosher, that which comes from or is produced by a kosher animal is kosher (Mishnah Bekhorot 1:2). This is why pig’s milk is not kosher while cow’s milk is kosher.
In regards to humans, the Talmud is clear – what is produced by the human body is kosher for consumption. In addition to breast milk, this also includes blood, which is why it is permitted for a person to suck the blood from bleeding gums (Ketuvot 60a) or from a bleeding finger. The Talmud does forbid one to eat human blood that has separated from the body, for example, if some dripped on a person’s food, because of marit ayin – it would look as if he were eating animal blood (Shulkhan Arukh YD 66:10).
Even Rambam who states that human flesh is Biblically prohibited would permit the consumption of the byproducts of the human body (Ma’akhalot Asurot 3:2). Byproducts of the human body are permitted, either because the Rabbis have determined that they are an exception to the yotzei min ha’tamei, tamei rule or because they do not fall under this rule at all as the human flesh itself is prohibited only based on a positive mitzvah and not a negative prohibition. Said in another way, although a human is not in the “kosher” category, he or she is also not in the “non-kosher/tamei” category and the principle of yotzei min ha’tamei does not apply.
Consequently, the placenta, a byproduct of the body, would not be considered a forbidden food even for Rambam who states that flesh from a human is Biblically forbidden. In fact, a number of Talmudic sources state that the shilya is generally not consumed and a “mere secretion.” Some Rishonim took this to indicate that even the placenta of a non-kosher animal would not be forbidden. Thus, no prohibition applies to eating a human placenta.
All of this is to address the case where one is actually swallowing some of the placenta. In a case where a person will be chewing it and spitting it out, the question of the kashrut of the placenta is mostly moot as one will not actually be ingesting the placenta itself. The only real question would be the permissibility of ingesting the blood of the placenta. As mentioned earlier, although human blood is not forbidden per se, it may present problems of marit ayin. We address this below in our discussion of marit ayin.
Even if the placenta is kosher, should one avoid eating it because of marit ayin, the appearance of doing something forbidden? If one were to chew the placenta, it may look like she is eating non-kosher meat or animal blood as the placenta is very bloody. Although this would most likely be done in private – in a hospital or birthing room – marit ayin remains a problem even when the act is done in private. Marit ayin is not a concern for three reasons:
While standard concerns for marit ayin do not apply in this case, the ingesting of blood on the surface of the placenta (if any exists), may present a separate problem. We have already mentioned that human blood that has separated from the body is forbidden based on the concern of marit ayin (Shulkhan Arukh YD 66:10). According to some poskim this restriction is like any other marit ayin concern and would not apply when the context is clear, as it is in this case. However, other poskim understand that there is a categorical Rabbinic restriction against eating human blood that has separated from the body. According to this latter approach, it would be forbidden to eat the blood on the surface of the placenta even in cases where it was clear that the blood was from the placenta and not from an animal. One should therefore be careful to wash off any surface blood from the placenta to avoid this problem.
We have thus seen that eating or chewing the placenta once it has been washed of surface blood presents neither a problem of kashrut nor a general one of marit ayin. The one remaining concern that must be addressed is that of bal tishaktzu.
After prohibiting us from eating various rodents, insects and reptiles, the Torah states: אַל תְּשַׁקְּצוּ אֶת נַפְשֹׁתֵיכֶם בְּכָל הַשֶּׁרֶץ הַשֹּׁרֵץ וְלֹא תִטַּמְּאוּ בָּהֶם וְנִטְמֵתֶם בָּם, “You shall not make yourselves abominable (אל תשקצו) with any creeping thing that creeps, neither shall you make yourselves unclean with them, that you should be defiled thereby” (Vayikra 11:43). The straightforward halakhic application of this verse is to prohibit the eating any type of creeping thing (see Rambam, Book of Mitzvot, Negative Mitzvah 179, and Ma’akhalot Asurot 2:12). The Rabbis, however, used the verse to prohibit the eating of anything that is repulsive, a prohibition known as bal tishaktzu. Rishonim and poskim debate whether this is to be understood as a Biblical or Rabbinic prohibition, with the general consensus that it is a Rabbinic one.
This prohibition of bal tishaktzu is applied primarily to the eating of repulsive things reflecting the original context of the verse which prohibited certain things from being eaten. Thus, the Talmud prohibits the eating of live kosher grasshoppers and drinking water from a vessel used for blood-letting; and Rishonim prohibit the eating of foods that have fecal matter in them, the drinking of urine, and even eating with dirty hands.
Let’s take a moment to explore the scope of this prohibition more fully. This prohibition is also extended by the Gemara to prohibit holding oneself back from urinating when the need is urgent. Although this is not the ingesting of something repugnant into one’s body, it is keeping something “repugnant” in one’s body accompanied by physical discomfort. While this extends the prohibition beyond the act of eating, the prohibition would still be limited to mistreatment of one’s body by bringing the body directly in contact with something that causes repulsion. So, for example, it is possible that bal tishaktzu would prohibit one spreading feces on his body but would not prohibit one to be a tanner who makes regular use of feces even if one were to find such activities repulsive.
Our ability to extend the prohibition of bal tishaktzu beyond the act of eating might hinge on how we define the word nafshoteikhem, “yourselves” in the verse, “you shall not abominate yourselves.” Does this word connote (a) the appetitive dimension of the person and is limited to the act of eating; (b) the life-force of the person including all functions that sustain life, such as the excretory functions; or (c) the person’s body, extending to cases of external contact.  This range can be seen in the different meanings of the phrase ti’anu et nafshoteikhem, “afflict yourselves” (Vayikra 16:29), regarding Yom Kippur. The narrow meaning of this phrase prohibits eating and drinking (meaning ‘a’), but the extended meaning includes all forms of bodily pleasure, including bathing, anointing, and sex (meaning ‘c’). It seems that the Rabbis applied the primary scope of the prohibition of bal tishaktzu to the act of eating (meaning ‘a’), but also extended it to the excretory functions (meaning ‘b’). Whether or not it would apply to how one treats one’s body in general (meaning ‘c’) is open for debate.
Let us now return to the matter at hand. Would this prohibition apply to consuming a placenta? There are two reasons why it would not: (i) whether or not the eating is repulsive is determined subjectively, based on the person who is doing the eating; (ii) the prohibition does not apply when the eating is being done for health purposes. Let’s look at these two reasons a little more closely:
The source for the ruling that bal tishaktzu is defined subjectively is a mishnah that deals with none other than a case of eating a placenta (of an animal). The mishnah (Hullin 4:7) states,” One who slaughters an animal and finds a placenta inside (the uterus) – a person who is not fastidious may eat it.”  The mishnah recognizes that most people would be repulsed by eating the placenta, a point made explicitly by Rashi (Hullin 77a): נפש היפה – שאין דעתו קצה בה מחמת מיאוס, “a person who is not fastidious – who is not repulsed out of disgust.” While the mishnah does not directly address the prohibition of bal tishaktzu, it makes clear that there is no problem for someone to eat something that she does not find repulsive even if most other people would find it to be so.
This position is stated emphatically by Pri Hadash (YD 84:3), who first demonstrates that if a person is unaware that something disgusting is in her food, there is no problem of bal tishaktzu. He then goes on to state that this is evidence of the subjective definition of this prohibition: ומהכא שמעינן דלא אזלינן בענין מאיסותא בתר רובא דעלמא אלא בתר כל חד וחד, “from here we see that we do not follow what most of the world considers repulsive, but rather the subjective experience for each individual.” He later qualifies this by stating that something that everyone would find repulsive would be a problem even for the rare individual who did not share this reaction.
In our case, as there are a growing number of people who eat the placenta, this would certainly not be considered something that everyone finds repulsive. Thus, if the person were not disgusted, there would not be a problem of bal tishaktzu.
What about a case where the mother does find eating the placenta to be repulsive, but is nevertheless willing to do it for the sake of a health need? Here too, there is no halakhic problem. Mordekhai (Shabbat, no. 383), based on the Talmud’s assumption (Shabbat 110a) that people would drink urine for medicinal reasons, states that there is no problem of bal tishaktzu when something is consumed for health purposes. Mordekhai’s ruling is quoted in Beit Yosef (SA YD 84) and Shakh (YD 84:3), and repeated and endorsed by the poskim.
What constitutes a legitimate health need for this matter? Mordekhai speaks specifically about a holeh she’ein bo sakanah, a sick person who is not in any mortal danger. As we have already mentioned, a woman immediately after childbirth is considered to be a holah she’yeish bah sakanah, and is in the category of holah she’ein bah sakanah for up to 30 days after childbirth (SA OH 330:4). There would then be no concern of bal tishaktzu for a woman to eat the placenta after childbirth even if she found the eating to be repulsive.
It is not immediately obvious why bal tishaktzu would not apply in a case of a health need. Some poskim explain that since it is only a Rabbinic prohibition, the Rabbis could choose to waive the restriction when a health concern was present: “they said [it was forbidden] and they said [that in this case it was permitted].” This explanation would not suffice for those who believe this prohibition to be Biblical in nature, a point already made by Pri Megadim (Siftei Da’at YD 81:3). It seems that something more definitional is being said – that it is fundamentally not defined as bal tishaktzu in a health context, as Pri Megadim states: ואולי כל שעושה לרפואה ל”ש בל תשקצו, “perhaps whenever it is being done for health purposes, bal tishaktzu does not apply.”
Why would bal tishaktzu not be relevant in a health context? It is possible that it is a question of one’s experiential reality. People are psychologically prepared to undergo certain difficult procedures or to take foul-tasting medicine for health purposes, and thus, in this context, we can assume that one is not repulsed by the experience. This explanation falls short in cases where the person is genuinely disgusted by the experience.
It is also possible to explain this from a definitional, rather than an experiential perspective. We have seen that bal tishaktzu applies almost exclusively to cases of eating. However, when something is being taken for health reasons, we would define the act as one of ingesting medicine and not one of eating, and hence bal tishaktzu would be irrelevant. Alternatively, it can be argued that only when the act serves no legitimate purpose can it be considered an act of debasing one’s self or one’s body. The “repulsion” (מאוס, נפשו קצה) would still be present, as that is a reality of one’s experience. However, it would not be considered an “abomination” (תשקצו), a word that expresses a value judgment (this is clear from the verse (Devarim 7:26) שַׁקֵּץ תְּשַׁקְּצֶנּוּ וְתַעֵב תְּתַעֲבֶנּוּ כִּי חֵרֶם הוּא and from the use of the word throughout the section of kosher and non-kosher animals in Parashat Shmini (Vayikra 11:9-44)). This is consistent with those poskim who say that there is no bal tishaktzu when the item is being eaten for any purpose, even not a medicinal one (see Pri Hadash YD 81:3 and Ben Ish Hai, Second Year, Parashat Emor).
However we explain it, the consensus of the Ahronim is that bal tishaktzu does not apply when something is being taken for health purposes, and thus there would be no problem here to eat or chew the placenta in whatever form your doula advises.
It is permissible to eat or to chew and spit out the placenta after birth, especially when done for health purposes. The placenta of a human is kosher as are all byproducts of the human body. There is no problem of marit ayin as this is being done for health purposes and the context is clear. However, blood on the surface of the placenta may present an independent problem and would need to be washed off. Finally, the prohibition of bal tishaktzu is not applicable if you do not find it repulsive; even if you do find it to be so, this prohibition does not apply since this eating is being done for health purposes.
A possible objection to the position that a human placenta is permissible to be eaten can be raised based on Rambam’s ruling regarding the shilya (placenta) of a kosher animal. Rambam (Ma’akhalot Asurot 4:5, and see also 4:18) states that while the shilya is not considered flesh, nevertheless the shilya that was discharged from a cow after a live birth is forbidden. One way to understand this is that the shilya is enough like the flesh of the animal itself to require ritual slaughter, though not enough to be an actual transgression of eating the flesh on a living animal. Following this, one could argue that just as Rambam maintains that it is forbidden to eat human flesh, he would likewise forbid (although to a lesser degree) eating the placenta that was discharged from a human body.
This is a faulty conclusion. The broad consensus of the poskim is that, for Rambam, the placenta is not “quasi-flesh” which requires shehitah, but rather a by-product of the animal in the standard category of yotzei min ha’tamei. A live cow is a kosher animal; however, since it may not be eaten alive, anything that it produces or discharges is in the category of yotzei min ha’hai and likewise forbidden. Thus, the Talmud Bekhorot 6b states that were it not that a verse explicitly permitted milk from cows, it would be forbidden because they come from living animals: הואיל וליכא מידי דאתי מחי ושרייה רחמנא, “since there is nothing that comes from a living animal that the Torah permitted,” and a similar point is made regarding eggs (Tosafot Hullin 64a, s.v. she’im, Rosh Bekhorot 1:5). In fact, there may be situations where certain forms of milk and eggs are forbidden because they were not included in this special exception (see SA YD 81:5 and Shakh YD 87:9, but see also Shakh 81:12). Thus, the placenta of a cow is something that comes from a live animal which has not been explicitly permitted and hence is forbidden. This understanding of Rambam’s ruling is given by:
The consensus of the poskim, then, is that the entire problem with a shilya of a kosher animal is that it is יוצא מן החי. Following this, it is clear that when it comes to the placenta from a human body, there would be no prohibition even according to Rambam who forbids the eating of human flesh. As we have seen, this prohibition extends only to the flesh of humans and not to milk or blood from a human. There is no yotzei min ha’tamei category for humans because they are not a davar tamei, a non-kosher animal (Rambam, Ma’akhalot Asurot 3:1). Similarly, there is no yotzei min ha’hai category because, for Rambam, there is no prohibition of אבר מן החי for human flesh and certainly no prohibition of something that just derives from a living human being.
Thus, even if we were to go so far as to say that the placenta of a cow is forbidden as a type of actual אבר מן החי, and not just as a יוצא מן החי, there would still be no basis to prohibit it in the human context, since for Rambam there is no prohibition of אבר מן החי in the case of humans. This is stated explicitly by Kreiti U’pleiti (YD 81:4): וסייע להו משלית אדם דטהורה, דלא שייך באדם וה”ה בטמאה נמי איסור אבר מן החי, that is, the shilya of a human is permissible, since אבר מן החי does not apply to humans. For Rambam, the only prohibition that applies to the human body is a prohibition against eating human flesh. Given that Rambam rules (4:5) that the placenta is not flesh, a point underscored by all the poskim quoted above, a human placenta would be permissible to be eaten.
In the above quote, Kreiti U’pleiti is referencing Bekhorot 7b, which attempts to demonstrate that the shilya of a donkey is permissible to be eaten by analogy to the halakhah that the shilya of a human is not a source of tumah. The Gemara seems to assume, in this sugya, that it is permissible to eat the shilya of a human. This is stated explicitly by Or Zarua (1:443): אמר לי’ רב חסדא לרב הונא תניא דמסייע’ לך עור הבא כנגד פניו של אדם בין חי בין מת טהור. פי’ והוא הדין לאכילה. This gemara, then, provides a clear basis to permit the eating of a human placenta.
I have developed this point at length, because I have seen a responsum by Rabbi Yoni Rosensweig who argues, based on Rambam’s ruling regarding the placenta of a cow, that the placenta of a human would be forbidden. The author also assumes, without any evidence, that Rambam’s position regarding the placenta of a cow is held by other Rishonim as well and thus argues that these Rishonim would also forbid the eating of a human placenta. While he makes a reasonable argument why the placenta should be considered more a part of the body than urine which is deemed as “mere refuse,” the author fails to argue why it should be forbidden in the case of humans where there is no prohibition of אבר מן החי and certainly no prohibition of יוצא מן החי. [The major hiddush of the author is that if we assume that some of the relevant sugyot refer only to the embryonic sac and others refer to both the embryonic sac and the placenta, then a number of difficulties in these sugyot and in certain rulings of Rambam can be resolved. This approach can also be found in the work Sefer Imrei Hamudot on Bekhorot, by Rabbi Daniel Nasi, siman 22, pp. 100-101. While the author might be correct in this matter, this is unrelated to his assertion that the halakhic problems with the placenta of a cow should be relevant to the case of a human placenta.]
 For a discussion on homeopathic remedies and alternative medicine in halakhah in general, and what criteria are needed for a particular remedy or treatment to override halakhic restrictions, see Encyclopedia Hilkhatit Refuit, s.v. refuah, section 7; Rav Shlomo Aviner, “Alternative Medicine,” (Hebrew), Assia, vol. 9, p.90ff; Rav Gedalyah Aharon Rabbinovitch, “Unproven Medical Treatments” (Hebrew), Halakhah U’refuah, vol. 3; and Yalkut Yosef, Sova Smahot, vol. 2, ch. 8, footnote on no. 15.
 A close look at the Talmudic sources reveals that the term shilya refers to both the placenta and the attached embryonic sac. Absent any clear evidence to the contrary, any halakhic ruling regarding shilya applies equally to the placenta and the embryonic sac.
Sources indicating that the term refers to the embryonic sac include: Mishnah Niddah 3:4: שאין שליא שאין עמה ולד (and see Rashi there, 26a, s.v. ha’bayit tamei); Bava Kama 11a: דאין מקצת שליא בלא ולד; and Tosefta Brakhot 2:14: שכשברא הקדוש ברוך הוא אדם לא בראו ערום שנ’ בשומי ענן לבושו וערפל חתלתו בשומי ענן לבושו זה השפיר וערפל חתלתו זה שליא. The identification with the embryonic sac is stated explicitly by Rambam, Peirush Ha’mishnayot, Mishnah Zevahim 3:5 (and similarly on Mishnah Hullin 4:7): ושליה הנרתיק המתהווה על העובר בתוך הגוף and Rashi, Berakhot 4a, s.v. u’vishilya.
Sources indicating that the term refers to the placenta, and not just the embryonic sac, include Tosefta Niddah 4:9 (quoted on Niddah 26a):שליא שאמרו תחלתה כחוט הערב וראשה כתורמס וחלולה כחצוצרות אין שליה פחותה מטפח רבן שמעון בן גמליאל אמר דומה , לקרקבן של תרנגול ולמה אמרו שליא והלא שליא שאין עמה ולד. Similarly, Mishnah Zevahim 3:5 and Hullin 4:7 indicate that what is being spoken about is something substantial that could theoretically be eaten or nailed to a tree. Additionally, Niddah 27a, deals with a case in which the shilya is expelled days after a live birth, a phenomenon that occurs with a placenta (referred to as “retained placenta”) but not with the embryonic sac.
 Consuming the placenta is mentioned in the Torah (Devarim 28:57) as part of the long litany of curses. The verse, however, refers to eating the placenta as a form of sustenance not for medical purposes.
 See Sifra Shemini, chapter 4, no. 4; Mishnah Bikkurim 2:7; Tosefta Kritot 2:18; Kritot 20b, 21b; Ketuvot 60a.
 It is noteworthy that there does not seem to be any record in the responsa literature of the use of human blood for medicinal purposes despite the fact that its use for such purposes was widespread in the medieval period. See Bill Schutt, Cannibalism: A Perfectly Natural History (Chapel Hill, NC: Algonquin Books of Chapel Hill), 2017, pp. 211-212: “Perhaps the most commonly consumed human tissue is blood – a substance that has, until fairly recently, been misunderstood… Some of this blood… was consumed to treat epilepsy. So popular was this practice that public executions routinely found epileptics standing close by, cup in hand, ready to quaff their share of the red stuff. .. It was also dried and made into powder or mixed into an elixir with other ingredients. Most interesting to me was that consuming blood turned out to be far more than a medieval folk remedy, as evidenced by the fact that English physicians were still prescribing it as late as the mid-18th century.” It is possible that Jews avoided using human blood for medicinal purposes out of a deeply ingrained sense that all blood is forbidden one that would have emerged from the regular home-based practice of kashering meat to remove blood and the discarding of eggs with blood spots.
 See Responsa Radvaz 3:548; Responsa Ginat Veradim YD, 1:4-5; Ben Ish Hai, Emor, halakhah 6; Mishneh Li’melekh to Avel 3:1; and Darkhei Teshuvah 79:15. See Schutt, Cannibalism, pp. 216-217, “Apparently, Arabs often used the petroleum-based substance we call tar or bitumen as an adhesive and to staunch wounds. Their word for this material was mumia but it also became their word for the mummified human remains they discovered after taking over Egypt in the 6th century CE. The Arabs mistakenly believed the mummies to have been prepared with bitumen during the preservation process. Centuries later, Europeans heard about the medical benefits of mumia…. As a consequence, mummy powder was available at the Merck Pharmacy in Darmstadt, Germany until 1908. Listed as mumia vera aegyptica, it sold for 17.50 marks/kg.” See also H. J. Zimmels, Magicians, Theologians and Doctors (London: Jason Aronson, Inc), 1952, pp. 126-128.
 Birkei Yosef, Shiyurei Brakhah, YD 349:1.
 This was widespread during the Middle Ages and persists until today. See Responsa Rashbash, 518; Mahzik Brakhah YD 79:2; Kaf Ha’hayim YD 2, p. 31a, Ben Ish Chai, Emor, halakhah 6, and Darkhei Teshuvah 79:15. The practice is addressed in contemporary works as well; see Yalkut Yosef, Sova Smahot, Milah, no. 15. For historical background and parallels in other cultures, see Daniel Sperber, Minhagei Yisrael, (Mossad Ha’rav Kook: Jerusalem, 1990), vol. 1, pp. 292-4.
 This remedy was used in Talmudic times, see Shabbat 77b, and appears frequently in halakhic and responsa literature, see Shulkhan Arukh YD 81:7 and 87:4 and Shakh no. 7; Shulkhan Arukh OH 328:34; Responsa Radvaz 6:2202; Responsa Yakhin U’boaz 1:25; Responsa Zera Avraham YD 4; Ben Ish Hai, Emor, halakhah 9.
 See Yerushalmi Moed Katan 3:2; Kritot 6a; Shabbat 110a. There is extensive discussion of this in rishonim, Shulkhan Arukh and responsa literature, see Mordehai Shabbat 383; Shulkhan Arukh YD 81:1 and Shakh no.3; Mahazik Brakhah YD 81:4; Ben Ish Hai, Emor, halakhah 7; Responsa Yosef Ometz, 40;
 Shabbat 129b, Shulkhan Arukh OH 330:7. See also Mishnah Hullin 4:7: ואין קוברין אותה בפרשת דרכים ואין תולין אותה באילן מפני דרכי האמורי, and Yerushalmi Shabbat 18:3: תני השיליא הזאת בשבת עשירין טומנין אותן בשמן. והעניים טומנין אותן בתבן וחול. אלו ואלו טומנין אותן בארץ כדי ליתן ערבון לארץ.
 See Raphael Patai, “Childbirth in Popular Custom” (Hebrew), Talpiot 6, pp. 246-7. Patai states that this was widespread in Jewish communities in Russia and spread to America as well.
 Another related question is whether there is an obligation to bury parts of the human body that have fallen off or been removed during a person’s lifetime. This could include amputated limbs and organs that have been surgically removed, as well as an embryo after a miscarriage or the placenta after a live birth (in these last two cases there is a question of whether we view these as part of the woman’s body or not; in the case of miscarriage, whether the fetus or embryo requires burial for its own sake). In the case of a limb (ever min ha’hai), Rav Moshe Feinstein (Iggrot Moshe YD 3:141) is of the opinion that there is a mitzvah of burial while other poskim (Noda Bi’Yehudah Tinyana, no. 209 and Tzitz Eliezer 10:25, chapter 8) state that there is no mitzvah of burial per se, but that care must be taken to prevent kohanim from coming in contact with it. All poskim agree that in the case of an internal organ or a placenta after live birth, which is not considered a limb and not a source of tumah, there is no mitzvah of burial or a need to dispose of it in any particular way (see Iggrot Moshe, ibid., final paragraph, and Tzitz Eliezer, ibid., par. 9).
 The law would be different regarding flesh taken from a dead body as deriving benefit from a corpse is prohibited. See Avodah Zarah (29b), Ramban Ketuvot (60a, s.v. hakhi garsinan), Rambam, Avel 14:21, Shulkhan Arukh YD 349:1, Shakh YD 79:3).
 Vayikra 11:2
 Ra’ah (Ketuvot 60a, s.v. katav ha’rav) and Ritva (Ketuvot 60a, s.v. uli’inyan basar) also state that it is forbidden to eat flesh taken from a human. They argue that it is Biblically forbidden, derived from the prohibition of eating the meat of non-kosher animals. Ritva adds that it should also be forbidden on the basis of eiver min ha’hai, since other than fish and locusts no meat is permitted without shehitah. Responding to this argument, Rashba states that there is no prohibition of eiver min ha’hai or basar min ha’hai in a case where no shehitah has been mandated (in other words, it is no different than fish and locust). See Teshuvot Ha’rashba (1:364) and Ramban, Commentary on Torah, Vayikra 11:3, and also Arukh Ha’shulkhan YD 79:11-12.
 Bee honey is kosher due to the manner in which the honey is made and to what degree it is seen as produced from the body of the bee. See Bekhorot 7b and Shulkhan Arukh YD 81:8.
 See Rambam, Ma’khalot Asurot 3:1-2; Magid Mishneh on Rambam, Ma’akhalot Asurot 2:3; Ramban, Ketuvot 60a; and Gra and Pri Hadash on YD 81:1.
 In conceptual terms, this is an issur gavra, a prohibition on the subject – dictating what he or she may or may not eat – and not an issur heftzah – the prohibited status of the human being as a non-kosher animal.
 Mishnah Hullin 4:7
 Hullin 113b. There is some debate as to whether this applies to all placentas or only to those from a donkey, see Raavad on Rambam, Ma’akhalot Asurot 5:13, and Rambam, ibid., 4:5, and Shakh and Pri Hadash on YD 81:4.
 Or Zarua 1:443
 This conclusion may possibly be challenged based on Ramban’s rulings regarding the shilya (Ma’akhalot Asurot 4:5) although I believe that this is in error. For an extended discussion of this, see Addendum.
 The question of the kashrut status of the placenta itself might still be relevant in the case of chewing, according to those poskim who rule that it is forbidden to taste non-kosher food even if one spits it out afterwards (see Shakh YD 108:24, based on Responsa Rivash 288, and Pithei Teshuvah YD 98:1). [I thank Rabbi Ysoscher Katz for raising this question.] I am inclined to believe that this would not be a concern in our case. Given that human flesh is only prohibited based on a positive mitzvah, it is most likely not considered to be a non-kosher food per se, as discussed above. If the food itself is forbidden – as is the case with standard, non-kosher foods – it is reasonable to assume that it may not only not be eaten but also not be tasted. However, if – as is the case with human flesh – the “food” has a neutral status, and what is forbidden is for a person to do the act of eating, then this prohibition would likely be limited to the act of eating itself and not extend to a different act, one of chewing or tasting.
 Shulkhan Arukh OH 301:45. Rambam, Shabbat 22:20 and Yom Tov 5:4. See Shabbat 64b, 146b, Beitzah 9a, and Avodah Zarah 9a. Tosafot Shabbat 65a, s.v. amar Rav cites a debate as to whether we rule in accordance with the opinion that forbids marit ayin in private. Tosafot Ketuvot 60a, s.v. mimahan rules that if it were a marit ayin issue of a rabbinic prohibition violation, it would not be prohibited in private. A number of poskim rule according to this view, see Taz OH 301:28, 336:9 and 243:3, and Mishneh Brurah 301:65. [And see Rema, YD 87:3, Taz 4, Shakh 6 and Pithei Teshuvah 10, regarding whether marit ayin is a concern at all in cases of rabbinic prohibitions.] In our case, however, the concern is that it will look like a Biblical violation of eating non-kosher meat and animal blood.
 See Tosafot Shabbat 62a, s.v. vi’hatanya; Eruvin 77b s.v. ee hakhi; and Hullin 41a, s.v. u’vishuk; Shulkhan Arukh YD 298:1, Iggrot Moshe OH 2:40, Yabia Omer YD 6:8
 See Magen Avraham 463:5, Pri Hadash OH 461:2, Pri Hadash YD 87:7, and Pri Toar YD 87:9. The simple sense of Responsa Rashba 3:257, Rema 87:3, Taz 4 and Shakh 6, however, is that marit ayin is a general concern to be applied in all relevant cases.
 See Pri Hadash 66:15 and Yalkut Yosef, YD, 66:19.
 See Kanfei Yonah 66:10. Arukh HaShulkhan YD 66:35 understands this to be a debate between Rambam and Shulkhan Arukh; he rules like Rambam that human blood that has separated from the body is always forbidden. According to this approach, the concern of marit ayin motivated the Rabbinic ruling, but the ruling itself was a categorical prohibition. See also Darkhei Teshuvah 66:68.
 Rambam in Sefer Ha’mitzvot (Negative, 179) strongly implies that it is a Biblical prohibition, but that lashes are not given because it is not the simple meaning of the verse. However, in Ma’akhalot Asurot 17:29-30 he implies that the prohibition is only Rabbinic. Rishonim who explicitly state that it is Rabbinic include: Meiri and Ritvah on Makkot (16b), and Trumot Ha’deshen, no. 116. Those who hold that it is Biblical include Rabbeinu Yonah, Sha’arei Teshuvah 3:93, Yereiyim 151, and Rashbash 274.
 See Taz YD 116:6 who states that it is a Biblical prohibition. Pri Megadim, Mishbitzot Zahav YD 13:1 and Sha’arei Teshuvah OH 3:16 cite Ahronim on both sides of the debate. Pri Megadim in Mishbitzot Zahav OH 3:14 and Eshel Avraham OH 154:19 seems to come down on the side that it is Rabbinic, while in Siftei Da’at, YD 81:3 he assumes that it is Biblical. Magen Avraham 92:2 and 103:2, Mishnah Brurah 3:31, Arukh Ha’shulhan YD 116:20 and OH 103:2, and Shulkhan Arukh ha’Rav 92:2 all rule that it is a Rabbinic prohibition.
 Shabbat 90b and Makkot 16b.
 See Rambam, Ma’akhalot Asurot, 17:29-30, Responsa Radvaz 2:739, Shulhan Arukh YD 116:6 and Shakh YD 81:3. See also Shulhan Arukh OH 240:4, based on Ra’avad, Ba’alei HaNefesh, Sha’ar Kedushah, s.v. od yeish. This case seems to be seen as a type of “eating” and hence included, according to this opinion, in the prohibition.
 Makkot 16b.
 See Ketuvot 77a: מתני’. ואלו שכופין אותו להוציא: מוכה שחין, ובעל פוליפוס, והמקמץ, והמצרף נחושת, והבורסי… גמ’… מאי מקמץ? אמר רב יהודה: זה המקבץ צואת כלבים.. While there is no evidence that the man involved in this profession – in contrast to his wife – finds these activities repulsive, there is also no indication that bal tishaktzu would ever be a problem here even were he to find them so (one can imagine such a case under circumstances where the man felt compelled to take on this profession to provide for his family, although he finds it to be disgusting).
 The word nefesh in the Torah could have the very specific meaning of “throat” or one’s appetitive soul, see Tehillim 107:9, Mishlei 16:24, 25:25, Yishayahu 5:14. It likewise can mean the “life-force” (e.g., Breishit 2:7, 35:18 and Devarim 12:23); the “person” himself (e.g., Vayirka 21:11, Bamidbar 6:6, 23:10), and the seat of emotions (e.g., Devarim 21:14, 23:25).
Rambam, Shmoneh Perakim, ch. 1, identifies 5 dimension of the nefesh: the nourishing (which includes the excretory functions), the sensory, the imaginative, the source of desire and repulsion, and the intellect. Eating repulsive foods and holding oneself back from urinating impact on three of these: the nourishing, the sensory, and the desire/repulsion. See also Rambam, Moreh Nevukhim 1:41, who defines nefesh as “life-force,” “intellect,” and “will”.
 This ambiguity of the scope of the word nefesh is likewise present in Rambam, who ends his laws of Ma’akhalot Asurot, and his discussion of bal tishaktzu, by stating (17:32): וכל הנזהר בדברים אלו מביא קדושה וטהרה יתירה לנפשו, וממרק נפשו לשם הקדוש ברוך הוא שנאמר והתקדשתם והייתם קדושים כי קדוש אני. What ‘nefesh’ is cleansed and purified through our caring for our bodies and the keeping of these laws, is it our bodies or our metaphysical souls? While context would seem to point to the meaning of “soul,” the use of the verse והתקדישתם והייתם קדושים might allude to the passage in Berakhot (53b) which applies this verse to washing one’s hands before and after the meal, that is, to concerns for bodily cleanliness. Another passage in Rambam, using the same verse in Vayikra, sheds light on this. In his conclusion of Laws of Impure Foods (16:12), Rambam writes: שהפרישות מביאה לידי טהרת הגוף ממעשים הרעים, וטהרת הגוף מביאה לידי קדושת הנפש מן הדעות הרעות, וקדושת הנפש גורמת להדמות בשכינה, שנאמר והתקדשתם והייתם קדושים כי קדוש אני י”י מקדשכם. For Rambam, purity of the body – from evil deeds and from eating forbidden or disgusting foods – leads to purity of the soul, a variation of the adage “cleanliness is next to godliness.” Following this, I would argue that for Rambam, the meaning of the word nefesh in the prohibition of bal tishaktzu, refers to both the body and the soul. By abominating the body, we abominate the soul that resides within.
 A similar case is found in Mishnah Avodah Zarah 2:5 – אמר לו והלא קיבת עולה חמורה מקיבת נבלה ואמרו כהן שדעתו יפה שורפה חיה.
 See also Sha’arei Teshuvah OH 202:1, who emphasizes the subjective definition, and see Pri Megadim, Eshel Avraham OH 154:19, who states explicitly that this prohibition follows the subjective definition of what is disgusting to the one who is doing the eating. However, see Pri Megadim, Siftei Da’at YD 84:3, who quotes the Knesset Ha’gedolah to say that bal tishaktzu applies to things that most people find disgusting, even if the one eating it does not find it to be so. It is not clear how he would explain the mishnah Hullin (4:7).
 See, for example, Pri Megadim, Siftei Da’at YD 84:3 and Pri Hadash YD 81:3.
 Shulkhan Arukh Ha’Rav OH 92:2 in the case of not interrupting one’s Shmoneh Esrei to relieve oneself, and Arukh Ha’shulkhan OH 103:2, in the case of not passing gas during Shmoneh Esrei.
 This is echoed by Arukh Ha’shulkhan, YD 81:10 and Ben Ish Hai, Second Year, Parashat Emor.
 From a halakhic perspective these acts were never considered eating in the first place, based on the principle that אכילה שאינה ראויה. If, nevertheless, the prohibition of bal tishaktzu applies only to acts of eating, then halakhah here must be following the experiential definition of the act not its standard halakhic definition. Given that from the experiential perspective one does not experience taking medicine as an act of eating or drinking, it could be considered outside the parameters of bal tishaktzu. This approach must find a way to account for the one non-eating case of bal tishaktzu: holding oneself back from urinating.
 This is somewhat similar to the ruling that there is no prohibition of bal tashchit when the object is being destroyed for a legitimate purpose (see Tosafot Avodah Zarah 11a, s.v. okrin). Although there is an objective destruction of an object of value, once it is being done for a purpose, it is no longer defined as hashhatah, wanton destruction.
 This would only be an issue for someone who wants to actually swallow the placenta. If a person is only chewing it and spitting it out, the only issue is eating blood of a human which is permissible when there is no surface blood and no concern for marit ayin.
 A number of these poskim use both the phrase יוצא מן החי and אבר מן החי. However, they make it clear by the analogies that they draw to the cases of milk and eggs, that they are using the term אבר מן החי imprecisely and are in fact referring only to the problem of יוצא מן החי (a point made explicitly by Mateh Levi, ibid., who even coins the phrase יוצא דאבר מן החי). In fact, even Shut Dvar Yehoshua, who states that the shilya is unique in this prohibition of יוצא because it was, prior to being expelled, a part of the animal itself, nevertheless states that the problem remains one of יוצא מן החי not אבר מן החי : דאע”ג דחלב שריא משום דאינו מחובר להגוף מ”מ שליא הוי כמחובר להגוף.. לפיכך שפיר נאסר משום יוצא מן החי. This is also reinforced by the fact that Rambam rules that one who eats אבר מן החי receives lashes, which is not the case here, and that אבר מן החי applies only to parts of the body that the body does not replace (see Arukh Ha’shulkhan 62:2, and compare to 81:11). And see also Teshuvot Hatam Sofer (YD 70) regarding the distinction between these two concepts.
 This is unlike Ritva (Ketuvot 60a, s.v. u’Li’inyan basar) who asserts that the prohibition of ever min ha’hhai, or the possible related one of eating meat that is lacking shehitah (see Beitza 25 and Tosafot, Rashba and Meiri ad. loc.), applies to humans as well.