Shifra, Shfoferet and an Ancient Therapeutic Technique

Shifra and Puah were two midwives who briefly prevented genocide of children by the Egyptians, according to Exodus 1:15–21. According to the Exodus narrative, they were commanded by Pharaoh to kill all male Hebrew babies, but they refused to do so. When challenged by Pharaoh, they told him that Hebrew women’s labor was short-lived because they were “lively” or “vigorous,” and therefore the babies had been born (and protected) before the midwives arrived.

The names of the midwives have been found in other ancient Near Eastern contexts.¹ TB Sotah 11b gives midrashic interpretations of these names: “And why was she called Shifra? Because she would improve [mishapperet] the newborn.” This seems to refer to cleaning the baby, as found in Exodus Rabbah 1:17, “she beautified the baby when it would come out full of blood.” Regarding Puah, the Talmud continues, “And why was she called Puah? Because she would make a comforting sound [po’a] as she would take out the baby.” Abarbanel, in his commentary to Exodus, follows this approach: “There was a custom in Egypt that two midwives would come to stand with each woman giving birth, and one of them was engaged in bringing out the child and perfecting it, and that is why she is called Shifra . . . And the second was to support the woman giving birth and help her with words and sounds and prayers, therefore she is called Puah, as in Like a woman in labor I will call out (ef’eh) (Isaiah 42:14).”

Exodus Rabbah 1:17 explains that Puah was so called because “she would cause the newborn to cry out when it was thought to be stillborn” — again connecting Puah to sound, here specifically the sound made by a baby otherwise believed to have been stillborn. The theme of resuscitating newborns recurs in connection with Shifra as well. R. Meir of Rothenburg (c. 1215–1293), in his commentary to Exodus 1:15, explains that Shifra is connected to the word shfoferet, a tube, “because it was the custom of midwives that when a newborn was seen dying, the midwife would take a tube and insert it rectally and blow into it, and the dying infant would be revived.” This explanation was included in the commentary of Jacob ben Asher (Ba’al ha-Turim, c. 1270–1340) to this verse.

These comments appear to preserve an ancient medical tradition not noted in Julius Preuss’s encyclopedic work Biblical and Talmudic Medicine. It is only in the past twenty-five years that doctors have become aware of the cardiovascular effects of digital rectal manipulation for terminating atrial fibrillation and paroxysmal ventricular tachycardia.²