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The Shulchan Aruch in Orach Chaim 173:2 writes:

בין בשר לדגים חובה ליטול משום דקשה לדבר אחר וחמירא סכנתא מאיסורא

There is an obligation to wash one's hands between fish and meat because it causes "דבר אחר" and we are more strict about things that are life threatening than things that are forbidden.

The source of this is a Gemara in Pesachim 76b which states:

תני רב כהנא בריה דרב חיננא סבא פת שאפאה עם צלי בתנור אסור לאכלה בכותחא ההיא ביניתא דאיטווא בהדי בישרא אסרה רבא מפרזיקיא למיכליה בכותחא מר בר רב אשי אמר אפילו במילחא נמי אסורה משום דקשיא לריחא ולדבר אחר:

Rav Kahana, son of Rav Ḥinnana the Elder, teaches: In the case of bread that one baked together with roasting meat in the oven, it is prohibited to eat the bread with kutaḥ, which contains milk, because the bread absorbs some of the meat’s aroma. The Gemara relates: There was a certain fish that was roasted together with meat, Rava of Parzikiyya prohibited it from being eaten with kutaḥ, due to the meat flavor absorbed in the fish. Mar bar Rav Ashi said: Even to merely eat it with salt is also prohibited because meat that is roasted or cooked with fish is bad for odor, meaning it causes bad breath, and for something else. Therefore, one should avoid eating it due to the danger involved.

Rashi ad loc. explains that the "דבר אחר" is Tzara'as, a spiritual skin-malady that hasn't existed in hundreds, if not thousands, of years. The Shulchan Aruch writes this as well in Yoreh De'ah 116:2.

We have no source that I'm aware of that this Tzara'as was dangerous. If so, why does the Shulchan Aruch as well as many other Poskim, call it life threatening?

(Note that Tzara'as is not leprosy even though it is commonly mistranslated as that. See here, here, here, and here for several of the hundreds of sources that say this. Also see שו"ת תורת חסד אבן העזר סימן ה סוף אות ה' that is explicit that the Tzara'as caused by eating fish and meat together is not a physical malady. Also, note that I am not looking for opinions that argue on the Shulchan Aruch and say it's not a Sakana. I've seen the Magen Avraham, Chassam Sofer, etc. I'm merely looking to understand the Shulchan Aruch and those that agree with him. I'm aware that the Divrei Malkiel says he doesn't mean it. That's a Dochek and certainly doesn't fit with all of the Poskim who actually treat it as more Machmir than Issur.)

Another side question that bothers me is being that Tzara'as is a spiritual malady that comes from behaving inappropriately (such as by speaking Lashon Harah or being miserly), not a physical one, how can eating fish and meat together cause it?

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    I've long suspected, perhaps baselessly, that the word "tzraas" (& "m'tzora" etc) has changed meaning over the course of Hebrew's development. If so then, while in Chumash it may refer only to the spiritual malady, it refers later also to a different malady, presumably leprosy -- perhaps even as soon as sefer M'lachim (Naaman). I haven't checked your "here, here, here, and here" links for the evidence that "tzaraas" is only the spiritual malady, but if they're referring only earlier Hebrew then they don't necessarily disprove my suspicion. If I'm right, that could answer your questions. – msh210 May 31 '20 at 9:34
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    @msh210 None of those sources say that the Tzara'as by fish and meat is not the physical malady. The שו"ת תורת חסד אבן העזר סימן ה סוף אות ה' says that though. There is room to argue with him and if anyone has a reliable source that does say that the Tzara'as here is the actual leprosy that would be a valid answer. – Eliyahu May 31 '20 at 12:39
  • Not everyone agrees tzaraas doesn't exist anymore – Double AA May 31 '20 at 12:47
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    Where does anyone say the fish thing is life threatening? It just says dangerous. That doesn't have to me life threatening. – Double AA May 31 '20 at 12:48
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    Eliyahu Sakana in the Chanuka sugya (the reason we light indoors) meant the goyims would steal the candles. At least according to Rashi and Tosafos. So sakana does not even need to mean physical harm. – user6591 May 31 '20 at 23:24
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B”H. I don’t know if you’ve gotten your answer to this question yet, but I’d like to provide my standpoint on it, and we could discuss it. From what I can gather, you’re wondering why there is a greater stringency placed upon washing one’s hands between eating fish and meat due to the inherent danger of Tza’aras, and more specifically, why this particular type of Tzaaras is life threatening.

Firstly, I’d like to direct your focus to a particular point, just because there aren’t any sources that say it was dangerous, doesn’t make it inherently safe. Far from it. Just because a malady is spiritual doesn’t mean that it cannot be deadly, and threaten the body as well. Secondly, the particular Tza’aras you’re referencing is the one mentioned by Rashi. Given that the illness and particular malady hadn’t been present for thousands of years meant that it must have been extremely rare, for whatever reason; possibly because it was well-understood that this malady was particularly lethal, enough to be mentioned explicitly, as a footnote to the otherwise broad assortment of Tza’aras. If not lethal, it was definitely rare, given the extremely low frequency of cases of it as mentioned by Rashi. Thirdly, you mentioned that we have no sources saying it’s dangerous, even though poskim and the Shulchan Aruch themselves label it as such. We know it was life-threatening, because it was treated as such. Obviously, the specifics cannot be completely discerned, as this disease has not been identified in anyone today as far as I am aware, and what exactly it was is anyone’s guess at this point.

Given what we are aware of, we can deduce that this skin condition had to have some degree of lethality or danger, coupled with its low frequency. That’s my explanation for why it was listed as such, so we should both agree that despite a lack of additional sources, it was generally understood to be life-threateningly dangerous for one reason or another.

I’d also like to point out that type of Tza’aras is regarded equally as dangerous for the spirit, as it is for the body. If anything, this only serves to reinforce my point. It would definitely have an impact on someone’s Tahara to be afflicted with this condition.

I am deeply sorry that I couldn’t produce any sources for my argument, but I decided to apply some logic to it, in order to try and establish a general understanding of the Tza’aras before either of us can elaborate further.

To give an answer to your other question, though, I think that the general understanding of Tza’aras can be any skin malady, though most often leprosy. And given that it has both a spiritual aspect to it, and a physical one inherent in the fact that it presents itself on the skin in one form or another, we can infer that it had some physical aspect to it. I’m certain that other Tza’aras (such as leprosy) could come about naturally within someone. But in the exact same way, HaShem could afflict someone with it as punishment for Lashon Hara or miserliness.

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When asked about the danger of eating fish and meat together, I heard in the name of Rav Tzvi Berkowitz that it may be similar to a smoking one cigarette where each one is technically dangerous in the sense that it damages one's health. Is one going to be deadly? For the vast majority of people - no. As you increase the number of cigarettes smokes, each one builds onto the next and causes further danger to that individual's life. Similarly, eating fish and meat together may not be an immediate danger for the vast majority of people.

As for the second question, perhaps transgressing the words of the Rabanan in Pesachim (76b) warrant tzara'as. Similar to Rav Dovid Zvi Hoffman's words in Vayikra (p. 220)

"Tzara'at does not generate tum'a because it results from the sin [for this is not always the case; other illnesses also result from various sins but do not generate tum'a]. Rather, tzara'at generates tum'a because the outward appearance of the disease is the symbolic image of the sinner."

Someone who doesn't care about a concern the Rabanan decreed on the nation would seem to be lacking something from within which warrants the projected image of tzara'as. (Not getting into whether nature has changed nowadays since you are only asking the questions according to the opinions who say this danger is still going strong.) Alternatively, if we understand the issue is one of danger, then perhaps the tzara'as would also be warranted for those who transgress the command to protect their life - וְנִשְׁמַרְתֶּם מְאֹד לְנַפְשֹׁתֵיכֶם (Devarim 4:15). Along the lines of, 'If you don't care about your health with meat/fish, then I'll give you dangerous tzara'as to see if you wake up to protect your health or continue not caring.

An additional point to consider is the scientific findings that

stearic acid found in beef and docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) found in fish have been found to exacerbate psoriasis. We also see that omega-3 fatty acids from fish enhance TNFalpha which is also implicated in psoriasis.

Some point to parallels between tzara'as and psoriasis, a skin disorder which can be dangerous in rare circumstances. (I don't know how those opinions explain that it spreads to clothing and the house...)

The Midrash Tanchuma (Metzora 4) brings a list of aveiros which can bring about tzara'as, including chillul Hashem, stealing, instigating arguments between brothers, etc. Since causing harm to our body is 'stealing' in a sense from the One Who lent us our body, it may warrant tzara'as as well.

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    If the combination is only dangerous to cause tzaraas because eating it is a negation of the sages prohibition, why did they prohibit it it start with? – Double AA Jun 11 '20 at 2:21
  • I don't understand the relevance of the cigarette analogy. The question wasn't how dangerous each bite is, but from where [else] do we see that it is indeed dangerous on whatever level. – Double AA Jun 11 '20 at 2:22
  • @njm I don't particularly understand either answer. The Mechaber says its dangerous because it causes Tzaraas. All Rav Berkowitz seems to be addressing is why eating it one time doesn't cause Tzaraas as far as we can see, not why Tzaraas is dangerous. Furthermore, the second answer is circular. It causes Tzaraas because it's bad and its bad because it causes Tzaraas. – Eliyahu Jun 11 '20 at 2:54
  • Fair points - If we understand the issue is one of danger, then perhaps the tzara'as wouldn't come just for the Rabanan making their decree but for those who transgress the command to protect their life. 'If you don't care about your health with meat/fish, then I'll give you dangerous tzara'as to see if you wake up or continue not caring. Regarding cigarettes, I thought it was a source showing it's dangerous to some degree, albeit not perceptible to medical science. (?) – NJM Jun 11 '20 at 12:01
  • "it was a source showing it's dangerous to some degree, albeit not perceptible to medical science" Why are you presenting that source here? – Double AA Jun 11 '20 at 14:10

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