If you were to ask a person to end the sentence - Hakol B'yidei Shamayim Chutz M'... the answer that would normally be given is Yiras Shamayim (translated into English this means - all is in the hands of Heaven with the exception of choosing to fear Him). Today's daf offers an alternate end to the classic phrase.
On Bava Basra 144b, the gemara discusses the plight of one who became ill and needs to expend funds in order to recuperate (obviously they did not have ObamaCare in the time of the gemara). The Mishna on 144b states that if a person who was one of the heirs of an estate became ill in performing duties related to the estate, he must pay his own doctor bills.
In interpreting the mishna, Ravin states that it is only when one becomes ill due to his negligence that he alone must bear the costs of the doctor care. However, if he is injured due to an accident, the cost of the medical care is borne by the estate. The gemara then asks what is an accident? The gemara answers in the name of R' Channina that everything is in the hands of Hashem except for tzinim pachim - cold drafts (no not from the tap).
The Rashbam explains that a person has the ability to guard himself against becoming ill from the cold and if he does not take care of himself, he is to blame.
Tosafos (d'h Hakol) explains that whether a person will be attacked by a lion or a thief is in the hands of Hashem, but Hashem does not declare whether the person will become ill from exposure to cold as this is something that he can protect himself from. Tosafos further explains that a person has the ability to kill himself through fire or drowning as even though Hashem has not declared that the person will die, Hashem does not prevent him from taking these steps.
Tosafos then finishes the thought by making reference to (and distinguishing) the "Chutz M' Yiras Shamayim" concept. Tosafos explains that this refers to Hashem's determination as to whether a person will be strong or weak, wealthy or poor, short or tall or smart or stupid. These are things that Hashem determines. However in our gemara we discuss things which are in a person's hand - the ability to avoid illness through common sense.
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