Explanation: Even if he is not an expert in circumcision, he will not make himself have a bad name in any type of medical practice.

Observation: The Gemara here implies that according to Rebbi Yehudah, even though we require Milah to be done Lishmah, we conclude that it can be done by a Nochri.

Question: This is difficult. How is this different from Get where we require that a Get be written Lishmah, and yet we say in Gitin (23a) that if a Nochri writes a Get it is invalid because a Nochri writes a Get with his own intent?

Answer: These cases are incomparable. A Nochri does think with general intent. Regarding Bris Milah, regular intent is considered Lishmah. The Bris is valid as long as he does not do so with intent to serve Har Grizim (or any idolatry). Accordingly, any Bris performed by a Nochri is presumed valid. However, a Get for a woman is not assumed to be written Lishmah, as most women are not about to be divorced. Therefore, if a Nochri writes a Get, it is presumed invalid.

Opinion: Therefore, the one writing the Get must explicitly state in the beginning of his writing that he is writing the Get for a specific woman. Similarly, when someone is writing a Sefer Torah, he must explicitly state when he starts writing that he is writing for the purpose of writing the Torah of Bnei Yisrael, and the names of Hash-m that he is going to write will be written so that they should be holy. This is because general writing is not presumed to be Lishmah.

Proof#1: This is also implied in Gitin (54b), where the Gemara relates that a scribe confessed he had not written the names of Hash-m in a Sefer Torah Lishmah. This implies that he did not explicitly state that he is writing these names Lishmah.

Proof#2: This is also implied in Gitin (45b) regarding the incident where Rebbi Shimon bar Yochai permitted in Tzeidan to buy Sifrei Torah from Nochrim. The Gemara there asks, does Rebbi Shimon ben Gamliel require tanning Lishmah, but not writing Lishmah? The fact that the Gemara's question implies that the writing of Nochrim is invalid is an indication that the general writing of Nochrim is not Lishmah. If it was Lishmah, it should be valid just as their Milah is valid!

Question: Being that their presumed state of mind is not Lishmah, there is a difficulty from the Gemara in Gitin (45b). The Gemara there says that Sifrei Torah, Tefilin, and Mezuzos that were written by a heretic, Moser, idolater, slave, woman, minor, Kusi, and a Jewish Mumar (purposeful sinner) are invalid, as the Pasuk says, "u'Kishartem...u'Chisavtem" - "And you will tie...and you will write." This implies that only someone who ties (Tefilin onto his arm) is someone who can write. Why does the Gemara need to derive this from a Pasuk? It should merely state that a Nochri is not presumed to write Lishmah!

Answer: The Beraisa lists a Nochri due to its listing of a woman and minor.

Answer (cont.): We also find that the Beraisa stated a heretic in this list, even though with a special Pasuk it is clear that his writing is invalid, as he generally writes with intent for idolatry.

Observation: The Ri states that the one who holds "Dibrah Torah k'Lashon Bnei Adam" - "the Torah speaks as people do" will not contest all of the derivations made in Bava Metzia (31a), such as "Hashev Tashev" and "Hochei'ach Tochiach." This is indicated by the fact that we do not find any Tannaim who openly argue on these derivations.

Proof: Proof to this can be found in Rebbi Shimon's opinion in Kesuvos (67b), where he explains the double term "Ha'avet Ta'avitenu" as just being a double term. Yet Rebbi Shimon himself makes a derivation in Rosh Hashanah (8a) from the double term "Aser ti'Aser."

Question: One must study in depth to understand the reason why the Gemara will sometimes use these double terms for derivations, and why they will sometimes say they are not to be derived from due to "Dibrah Torah etc."

Explanation: We do not have the text (of "she'Aini") with a Yud. If so, this would mean he is making his Neder regarding intangible things, and the Neder therefore would be invalid as stated in Nedarim (15a) regarding a person who vows that he will not sleep. (See Tosfos in Yevamos 71a, DH "she'Ani" and in Kesuvos 59a, DH "Konam," and the Ran in Nedarim 14b DH "Konam.")

Question: This is difficult. What is the question from Nedarim according to the opinion that "Himol Yimol" teaches that a Nochri can perform a Bris? Perhaps Nedarim are different, as we define Nedarim based on how people use these words!

Question (cont.): Similarly, why do we derive from the Pasuk (that a Nochri with a Bris is still called an "Arel")? Don't we say that regarding Nedarim we look at the common usage of a word (not the word as defined by the Torah)?

Answer: The Gemara there derives the definition of an "Arel" from the Pasuk because we are unsure what the common usage of the word is, and we therefore bring a proof to its meaning from the Pasuk.

Answer (cont.): We similarly say in Pesachim (2a) that the Mishnah teaches us that the light of stars is considered light. The difference is regarding someone who makes a vow (not to have benefit from light that he cannot benefit from the light of the stars).

Answer (cont.): (Alternatively) [If so, see text of the Maharsha and Maharam], the Gemara understandably asks a contradiction between the two Pesukim, as the Gemara derives from a Pasuk that all idolaters are considered Areilim, and that their Bris Milah is not considered a Bris Milah.

Question: This is difficult according to the opinion that thought that an Arab and Gavnuni are considered to have a Milah.

Question: This is difficult. Why didn't the Gemara say that the difference between them is a person who purposely does not do Bris Milah? According to the opinion that the source that Nochrim cannot do a Bris is the Pasuk, "And you should guard My covenant" (implying not a Nochri) such a person cannot do a Bris, as he does not guard to ensure that the Mitzvah of Bris is kept.

Question (cont.): This is as we stated in Gitin (45a) that a Jew who purposely sins is not considered someone who ties Tefilin, as I quoted earlier (end of DH "v'Chi"), because he does not want to tie Tefilin. Here, too, we should say that he is not someone who can do Milah because he does not want to have a Bris Milah.

Question (cont.): According to the opinion that the source for a Nochri not to perform Bris Milah is the Pasuk, "Himol Yimol" (implying that one who is circumcised should perform a Bris), we can say as we did earlier (in our Gemara) that even though a Jew does not have a Bris, it is as if they have a Bris (regarding their ability to do Milah).

Answer: The Ri answers that a purposeful sinner regarding not having a Bris is still considered a person who guards the Bris. He just does not want to do so. However, he has the ability to be someone who guards the Bris if he so chooses.

Answer (cont.): In contrast, when we discuss tying Tefilin in Gitin, we say that "whoever is not one who ties" meaning that he does not fulfill the Mitzvah of tying, "he is not included in And you should write," and this person is nullifying the Mitzvah of tying Tefilin. (There are different ways to explain this answer of Tosfos. The Avodah Berurah quotes the Teshuvos Har Tzvi (Y.D. 107) as saying that when a person eventually performs a Bris, he rectifies the main aspect of the Mitzvah (although he transgressed during the entire time that he did not have a Bris). Tefilin, however, is a separate Mitzvah each day. Putting on one day does not rectify the lack of putting on Tefilin on a different day. Tosfos is therefore saying that even people without a Bris are considered to be guarding the Bris, as they very possibly will rectify the fact that they do not have a Bris at anytime. However, when someone does not put on Tefilin constantly, this means he has failed to be a person who ties Tefilin and will never rectify this through putting on Tefilin.)

Opinion#1: One should rule according to Rav that a woman cannot perform a Bris.

Implied Question: This is despite the fact that the rule is usually that if there is an argument between Rav and Rebbi Yochanan, we rule according to Rebbi Yochanan. (Why don't we follow the rule in this case?)

Answer: In this case the law follows Rav, because the Beraisa of Rebbi Yehudah ha'Nasi is according to Rav's opinion.

Opinion#2: However, the Bahag rules according to Rebbi Yochanan that a woman can perform a Bris.

Opinion#2 (cont.): According to Rav who says that she cannot, we must explain that the teaching in Kidushin (29a, regarding Milah), "Him" implying that she does not merely means that she does not have to ensure that he has a Bris (not that she cannot perform the Bris).

Implied Question: The Gemara in Yoma (85a) says that we turn over the stones from on top of a person on Shabbos, as we suspect that we will enable him to live a short while longer. This implies that we do care about enabling a person to live a short while longer. (Why do we not seem to care about a short amount of life in our Gemara?)

Answer: It is possible to answer that in both Gemaros we are trying to do what is best for the person. In the Gemara in Yoma (ibid.), if we do not care about a short amount of life, he will soon die. In our Gemara, if we do care about a short amount of life and do not allow him to be healed by the idolater, he will certainly die soon. In both cases, we leave the certainty (that he will soon die) and do the doubtful thing (possibly allowing him to live a much longer life).

Explanation: This means that he should not have long discussions with them, lest they persuade him to be a heretic.

Observation: This implies that although it is permitted to be healed from an expert Nochri doctor, it is forbidden to be healed from a heretical doctor.

Question: Later in our Gemara (28a), the Gemara implies that Rebbi Avahu accepted a medicine from Yakov the heretic. (How could he have been healed by a heretic?)

Answer: One is only forbidden to be healed by a heretic if he mentions the name of an idol during the healing, and says that the idol helps the healing process. We certainly suspect that a person will be drawn to such idolatry, and it is therefore forbidden to be healed in this manner.

Answer (cont.): This is like the version of our incident (quoted in the Bavli here) in the Yerushalmi here. There was an incident where Rebbi Eliezer ben Dama, who was the son of the sister of Rebbi Yishmael, was bitten by a snake. Yakov from the village of Sachanya came to heal him in the name of his "Rabbi" (i.e. idol), and Rebbi Yishmael did not allow him to do so.

Answer (cont.): Similarly, even if the doctor is not a heretic, if he said that the patient should take some water from a certain idol or from the wood that is in front of a certain idol, it is forbidden to do so. This is as we state in Pesachim (25a) that one can be healed from anything besides an Asheirah tree (i.e. idolatry).

Opinion: The Ri says that the case is when the doctor says that only this water or wood will work, not other water or wood. He can do this by using the powers of a demon which can trick a person, as we know that sometimes a demon has the ability to trick people in order to make them sin.

Opinion (cont.): This is as we find later (55a) that in a certain idolatrous temple during a time of drought, their idol appeared to them in a dream and instructed them to slaughter a person to him. They did so and it rained. (Hash-m allows this to happen in order to further punish those who worship and believe in idolatry, see 55a.)

Opinion (cont.): However, when he does not consider the materials from idols more helpful than any other such materials, and merely instructs to bring some water or wood, it is even permitted to bring water or wood that is by the idol.

Proof: The Yerushalmi states in Shabbos (14:4) that one can be healed from anything besides for idolatry if he says, "Give me leaves from this idol." However, if he says, "Give me leaves" we can even bring him leaves from an idol.

Implied Question: The Yerushalmi states that Rebbi Yonah had a certain sickness (see Avodah Berurah). They brought him water from the well of an idol (see Avodah Berurah in name of the Pnei Moshe) and he did not drink it. They brought the water to Rebbi Abba, who did drink it. Rebbi Mana says that if Rebbi Abba would have known where the water was from, he would not have drunk the water. Rav Huna says that the Mishnah also states that one cannot be healed from forbidden relations. (This implies that it does not matter if the doctor said that he should specifically drink this water or not, unlike what we have said.)

Answer: The Gemara there is also referring to a case where the doctor stated that only this water is going to help.

Explanation: Rashi explains that whoever transgresses the words of the sages is liable to be killed (from Heaven).

Question: Ben Dama also was not healed! (How is he better off than someone who transgresses the words of the Chachamim? The Teshuvos Divrei Rivos (#213) explains that the fact that he was bitten by a snake indicates that Ben Dama had in fact probably transgressed a Rabbinic prohibition. Accordingly, how could Rebbi Yishmael say that Ben Dama was unlike a person who would transgress a Rabbinic prohibition?)

Answer: [The Divrei Rivos understands that Tosfos is answering that the Gemara is no longer addressing Rebbi Yishmael's praise, but rather the ruling itself.] The Gemara originally asked that he also would have a snake bite him. In other words, why wouldn't Rebbi Yishmael allow him to be healed by the heretic? If he would be bitten again (because he transgressed the words of the Rabbanan), he could be healed by the heretic again! The Gemara concludes that there is no healing a snake bite that is due to transgressing a Rabbinic prohibition. Accordingly, it is better that he should die innocent from this snake bite than die guiltily from a snake bite due to transgression. (See Avodah Berurah for other explanations of this Tosfos.)

Observation: However, the Rabbanan argue on Rebbi Yishmael in Sanhedrin (74a). They say that in public, even for a small Mitzvah one should rather die than transgress. In private, there is a difference between idolatry and other Mitzvos. He should transgress if it is a matter of other Mitzvos, while he should allow himself to be killed if it is a matter of idolatry.

Observation (cont.): According to Rebbi Yishmael, there is no difference between types of commandments. In private, he should always transgress, and in public he should always allow himself to be killed and not transgress. The incident with Ben Dama was considered public, which is why Rebbi Yishmael did not allow him to transgress.

Observation (cont.): According to this, we can say that when Yakov the heretic healed Rebbi Avahu later (28a), it was in private (and according to the opinion of Rebbi Yishmael).

Opinion: Rav Achai Gaon in Sheiltos rules like the Rabbanan who argue on Rebbi Yishmael.

Proof: The Gemara generally seems to take this approach in Kesuvos (19a). Rava says there, is this true (Rav Chisda's ruling that witnesses should allow themselves to be killed instead of signing a document falsely)? In any case where witnesses would come before us and ask us what to do, we would advise them to sign their names falsely and not be killed. This is as we say that there is nothing that pushes aside a life threatening situation aside from idolatry, forbidden relations, and murder.

Proof (cont.): This is clearly according to the Rabbanan, as according to Rebbi Yishmael if it happened in private he would be allowed to transgress idolatry as well. If it was in public, he would have to allow himself to be killed no matter what sin he would otherwise transgress!

Question: This is difficult. Rava himself later (54a) says that every commandment would have been included in the prohibition not to serve idols. When the Torah stated, "And you should live with them" it made an exception that if a person is forced he could transgress. The Pasuk then says, "Do not desecrate" implying even when forced. We can reconcile these Pesukim by saying that in private one can transgress, but in public one must give up his life. This seems to be according to the opinion of Rebbi Yishmael, and it therefore requires further study.

Opinion: If a person wants to be stringent and sacrifice his life for other Mitzvos when he does not have to, he is permitted to do so. This is like the incident involving Rebbi Abba bar Zimra in the Yerushalmi. He was with an idolater, who threatened to kill him if he would not eat Neveilah. Rebbi Abba said that if you want to kill me, do so. He was stringent, and was probably in private at the time.

Opinion#1: Rashi explains that this argues on Rav Yehudah's statement earlier that we do not even allow a Nochri to heal the area where the blood letting instrument punctured the shoulder (a small wound).

Question: This is difficult. Earlier, when the Gemara (27a) asks a question from Rav Yehudah on its explanation that our Mishnah's statement regarding "monetary healing" refers to a wound or sickness that is not dangerous, the Gemara concludes that monetary healing refers to one's animal, whereas "soul healing" refers to a person. This is Rav Yehudah's opinion.

Question (cont.): The Gemara should have quoted the statement of Rebbi Yochanan, who differentiates between whether or not someone is in danger, in order to better understand our Mishnah. The Gemara then should have asked how Rav Yehudah understands the Mishnah. Rather, being that the Gemara did not do this, it is apparent that nobody argues on Rav Yehudah's statement.

Opinion#2: Rabeinu Tam therefore understands that Rebbi Yochanan and Rav Yehudah do not argue. Rebbi Yochanan is referring to a sick person whose life is in danger. He therefore says that if the wound is something for which we desecrate Shabbos, one should not be healed from a Nochri. This is because they will not give themselves a bad name if he dies, as they will excuse themselves by saying that he was in critical condition when they got to him. If the wound is not life threatening one can be treated by a Nochri, even if he is not an expert healer, as he certainly will not kill him. He has no excuse to do so! If he does, he will be giving himself a bad name.

Opinion (cont.): However, if someone is healthy and they want to treat the puncture from the bloodletting instrument in their shoulder, this is forbidden. This is because the Nochri will harm him and not worry about what people will say. This is because they will not give him a bad name if he kills him, but rather they will say that he clearly killed him on purpose because he was his enemy. (Rabeinu Tam is establishing three levels of wounds: Life threatening, not life threatening (but serious), and healthy with a small puncture wound.)

Question: Earlier, when the Gemara asked its question from Rav Yehudah, why didn't we establish the Mishnah as referring to a sick person. We can differentiate between someone who is not in danger and someone who is in danger. This is like the Gemara's original thought, that monetary healing does not involve life threatening danger while healing of souls does involve life threatening danger. We could have defended this understanding of the Gemara (from the question regarding Rav Yehudah's statement) by saying that Rav Yehudah is talking about a healthy person.

Answer#1: The implication is that the Mishnah is discussing all cases, whether someone is healthy or sick. If we say as the Gemara originally thought, the permitted case of monetary healing is only referring to a case where there is no life threatening danger. However, now that the Gemara says that monetary healing refers to his animal and healing of souls refers to any healing of people, the Mishnah applies to all forms of healing, whether with a healthy person or a person in life threatening danger.

Answer#2: Alternatively, the Gemara would rather explain our Mishnah like we explain the Mishnah in Nedarim (38b) that states that if someone swears not to benefit his friend, he can still heal his soul, but not his money. The Gemara there explains that monetary healing refers to healing his animal, while healing his soul refers to his body.

Answer#2 (cont.): We cannot answer there that monetary healing refers to when there is no life threatening danger, while healing the soul means there is life threatening danger, as we hold that a person is obligated to heal any problem with his friend's body.

Observation: Whatever we have said is forbidden (to be healed by a Nochri) for a healthy person and a person in a life threatening situation, is only regarding a doctor who is not an expert. However, if he is an expert it is permitted. This is as Rebbi Yochanan stated earlier that if he was a known expert, this is permitted. We rely on this in order to have Nochrim to blood letting for us. Regarding blood letting, anyone who does it is considered an expert.