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A Case of Cranial Surgery in the Talmud
Adam Weinberg
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Washington University, St. Louis, MO, USA
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NJHN 0964-704X 1744-5213 Journal of the History of the Neurosciences, Vol. 25, No. 02, February 2006: pp. 00 Journal of the History of the Neurosciences
A Case of Cranial Surgery in the Talmud
A Case of Cranial Surgery in the Talmud Adam Weinberg
ADAM WEINBERG
Washington University, St. Louis, MO, USA
The history of Jewish discourse on law and philosophy was transformed from an oral
teaching to a written teaching around the beginning of the Common Era. The result of
these written laws and commentaries is known today as the Talmud. Many pages of the
Talmud discuss illnesses and diseases and their potential treatments, however very few
of these potential treatments involve invasive surgery. In one instance, involving a
painful skin ailment called raaton, the authors of the Talmud suggest cranial surgery
as the cure and describe the preparation of a potential anesthetic, the surgery environ-
ment, and the removal of a growth. Although this account raises several questions
about the ailment itself, it provides us with a rare look at invasive cranial surgery
dating back nearly 2,000 years.
Keywords Talmud, Gemara, cranial surgery, brain surgery, history
Introduction
The study of Jewish law and philosophy, historically and until today, uses three main
sources for textual references. The first source is the Hebrew Bible, or Old Testament.
Traditionally, Judaism contends that the Bible cannot be understood without the Oral
Law, which has existed in practice for as long as the Bible. The Oral Law is relied on to
explain and derive philosophy and law from the Bible; the Bible itself is viewed as an out-
line that requires additional commentary and interpretation to be understood. The codifi-
cation of Oral Law is called the Mishna. The Mishna was written in shorthand and also
requires additional interpretation and commentary to be fully understood. The source used
for expounding upon the Mishna is called the Gemara (Telushkin, 1991).
The Hebrew Bible accounts several incidents of head injury, including Jael and Sisera
(Judges 4:2122; 5:26), where a nail is driven through Siseras temple, damaging the brain,
and causing a quick death, the story of Thebez and Abimelech (Judges 9:5054), where
Abimelechs skull is broken, as well as several other cases (Feinsod, 1997; Shapiro, 1990). The
Mishna goes further discussing physicians who performed trephination and expounds on the
instruments used in such cases (Ohelot 2:34). The Gemara expounds even further, discussing
specific remedies to be applied to a multitude of injuries and diseases, including head trauma
and the like (Rosner, 1986). One such case will be investigated, where the Gemara prescribes a
type of cranial surgery, explaining not only the surgery itself, but the preparation of a potential
anesthetic and the surgical environment. Further, this paper will trace the thinking of the
Gemaras authors, in order to understand its relevance to Jewish law and practice. It will also
investigate the surgery itself and discuss what implications it has for modern neurosurgery.
I would like to thank Dr. Stanley Finger for encouraging me to pursue this project, as well as
for his continued assistance in preparing my work for publication.
Address correspondence to Adam Weinberg, 6337 Southwood Ave., Apt. 1 East, St. Louis,
MO 63105, USA. Tel.: 314-721-8202. E-mail: ajweinbe@artsci.wustl.edu
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A Case of Cranial Surgery in the Talmud 103
Historical Background
The Mishna, or Oral Law, compiles all law and philosophy derived from the Hebrew
Bible and organizes them topically. For example, if someone wanted to know all of the
laws that apply to establishing and maintaining a justice system, it would be necessary to
investigate many chapters in many areas of the Hebrew Bible. The Mishna organizes all of
these laws together. Historically, the laws expounded upon in the Mishna were transmitted
orally, from parents to children, and from teachers to students. This process was modified
in the late second century CE (Telushkin, 1991).
The eventual writing down of Oral Law was in large part prompted by the cata-
strophic loss of Jewish life during the Great Revolt against Rome. At the start of the Com-
mon Era (CE), Jews lived under direct Roman rule. By the year 66 CE, persecution of
Jews had reached unbearable circumstances, and many Jews attempted to revolt against
Roman rule. After suffering horrendous losses including the destruction of the second
Temple, the holiest site in Judaism, many Jewish leaders ordered surrender, but other fac-
tions refused, and a civil war among Jews ensued. Sixty years later another revolt against
Rome was attempted, known as the Bar-Kochba rebellion. Again, the results were cata-
strophic (Telushkin, 1991).
Well over a million Jews were killed in the two ill-fated uprisings, and the leading
centers of Jewish learning, along with thousands of rabbinical scholars and students, were
killed or left devastated. This decline in the number of knowledgeable Jews is commonly
accepted to have been the decisive factor in Rabbi Judah the Princes decision to record in
writing the Oral Law around the year 170 C.E. Many of the teachers quoted in the Mishna
date back many generations to as early as 300 BCE. Judaisms leading rabbis had resisted
writing down the Oral Law, teaching that law and philosophy taught orally compelled stu-
dents to maintain close relationships with teachers, and they considered teachers, not
books, to be the best conveyors of the Jewish tradition. But with the deaths of so many
teachers in the failed revolts, Rabbi Judah apparently feared that the Oral Law would soon
be forgotten. The finished product of written law and philosophy was organized into sixty-
three tractates; referred to today as the Mishna (Telushkin, 1991).
Around 170 CE, when the Mishna was being complied, Oral Law and the accompa-
nying interpretations were studied intensely by most Jews. As a result the derivation of
law and philosophy recorded in the Mishna were concise and direct. They lacked the gen-
erations of intricate interpretations and discussions that always accompanied them when
taught orally. Since much of the accompanying commentary discussed the application of
these laws and philosophies in different settings, and under different intents, it was
decided to write down the prevailing commentaries and interpretations as well. This pro-
cess started shortly after the finishing of the Mishna, but it was not completed until the
fifth century CE. These writings are called the Gemara. The Gemara also quotes sources
that date back to before the Common Era (Telushkin, 1991). The combination of Mishna
and Gemara is referred to as the Talmud. Each Gemara starts explicitly with the Mishna it
refers to, which in turn refers explicitly to a verse or concept in the Hebrew Bible.
Gemara Kesubos 77b
Many pages of Gemara deal with remedies for a great number of injuries and illnesses,
nonetheless, in all of its pages there are only a small handful of prescriptions for which
invasive medical surgery is required and explained. The surgery to be discussed in this
paper is cranial surgery, performed in order to remove a type of growth or organism
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104 Adam Weinberg
resting on the meninges. The Gemara calls this affliction raatan, and explains its symp-
toms, as well as how to prepare the operation room, the recipe and application for an anes-
thetic, the process by which to remove the growth, and how to dispose of it.
What are its symptoms? His eyes tear, his nostrils run, he brings spittle from
his mouth, and flies swarm around him. And what is its cure? Abaye said: take
the following ingredients: Pennyroyal and wormwood, the bark of a nut tree
and the shavings of a hide, a lily, the calyxes that cover red dates, and boil
them together. Then take the patient into a house made of marble (where there
is no draft). And if there is no marble house available, take him instead into a
house whose walls are seven bricks and a half-brick thick. Then pour 300 cups
of this potion of his head until the surface (top) of his skull softens. Then tear
open his skull to expose the organism on the membrane. Bring four myrtle
leaves, lift up each (end) and insert one leaf underneath. Remove it entirely,
with tongs, and burn it. For if not, it returns to the victim (Kesubos 77b).
In order to understand why invasive cranial surgery was being prescribed, it is neces-
sary to know what law(s) it is related to. The Mishna that follows comes from the tractate
called Kesubos (Hebrew for marriage contract).
In the case of a man in whom certain defects arose after he was married, and
whose wife wanted a divorce, we do not compel him to divorce. Rabban
Shimmon ben Gamliel said: In what cases were these things said? In the case
of minor defects, which his wife is expected to tolerate? But with major
defects, we do indeed compel him to divorce.
The Gemara follows the Mishna with several questions concerning what defects are
considered major defects. It lists three: 1) A man smitten with boils, 2) A man who has
polypus, defined as a polyp of the nose or mouth that emits a strong odor, and 3) A man
who gathers excrement. The Gemara elaborates on boils, calling them by a specific
disease known as raatan, for which cranial surgery is named as the cure.
Several questions emerge from this Mishna and Gemara. 1) If raatan is grounds for
divorce because it is a physical defect, then why arent countless other defects listed as
grounds for divorce as well? After all, in Gemara Gittin (tractate dealing with divorce and
remarriage) dozens of physical injuries and illness are explained, each with a potential
remedy, and none of which are grounds for divorce. 2) Are the authors of the Gemara tell-
ing readers that physical defects that arise after marriage justify an end to that marriage? If
so, then why is a man who handles excrement, either compulsively or as part of his profes-
sion, listed among the reasons?
In order to answer these questions it is necessary to understand what the laws of mar-
riage are intended for. Most of the marriage laws are derived from the Bible (Mishpatim
21:10) in order to maintain dedication and obligation between husband and wife. Logic
dictates that it is essential to know what obligations a husband has towards his wife before
we can understand what justifications there may be for divorce. The Mishna earlier in the
tractate of Kesubos states:
concerning the verse that details a husbands duties toward his wife, which
states, he may not reduce food, clothing/shelter, and must provide sexual/
emotional satisfaction. (Kesubos 47b, Micha 3:3, Psalms 78:27)
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A Case of Cranial Surgery in the Talmud 105
The question now becomes, does raatan prevent a husband from fulfilling any of the
biblically required duties? The Gemara explains that for both polyps and for a man who
handles excrement, the wife should first make a stipulation to attempt to tolerate these
conditions before coming to the courts for a divorce. In the case of raatan however, the
Gemara makes no such statement because, Raatan is painful to the touch, and intimate
relations with him cause the skin to break (Kesubos 77b). The Gemara then elaborates
noting that raatan makes the husbands duty of sexually satisfying his wife nearly impos-
sible. By following the logic of the Gemara it can now be interpreted that the major
defect in question has little to do with the physical appearance of boils, and more to due
with a husbands inability to fulfill a biblical commandment.
Nonetheless, divorce is not easy in Jewish law. As noted already, an entire tractate of
the Mishna is dedicated to divorce and ways to overcome it (Gittin Vol. III). Perhaps that
is why the Gemara asks, What is its cure. In other words, let us make this ailment a
nonissue if possible. But if that is the case, why does the Gemara not provide a cure or
treatment for polyps?
Although many of the sages quoted in the Mishna and Gemara date back to the year
10 CE, it is believed that a lot of the medical advice written down was influenced by
Greek, Babylonian, and Persian medicine, and perhaps by Roman medicine later into the
first century. All of these communities were involved in medical treatment, and the cure or
removal for a polyp may have been common knowledge, especially in Rome (Geller,
2002). On the other hand, while it is known that Galen in the first century learned a
tremendous amount about the anatomy of the brain through animal dissection and through
the autopsies of deceased gladiators, invasive cranial surgery with the intent of survival
was not common (Geller, 2002).
Methods
The steps for surgery enumerated in the Gemara are: 1) create a mixture/potion, 2) choose
the appropriate operating room, 3) apply the mixture/potion, 4) open the skull, 5) identify
the growth, and 6) remove and dispose of the growth.
The first step is the preparation of an anesthesia, which requires the mixing and boil-
ing of pennyroyal and wormwood with a few additional herbs. The Gemara states later
that this mixture will be used to soften the skull, which raises the question whether or not
the mixture was primarily used as a pain reducer or simply as a surgical agent. Between
625690 CE, Paul of Aegineta developed many tools for cranial surgery and is also
credited as being perhaps the first ancient surgeon to have taken advantage of antisepsis, a
process that today refers to chemical treatments that kill or inhibit microorganisms.
Specifically, he promoted the use of wine to dress the wound after surgery. Commentary
on the Gemara alludes to a similar procedure, stating that the same potion used before
surgery should be used on the skull after surgery (Steinberg, 2003). In 1170 CE Roger
Salerno is noted for encouraging the use of wormwood soaked in rose water and feathers
to control blood clotting during trephination (Lui & Apuzzo, 2003). Here we see, nearly
1,000 years prior, the same prescription being used for cranial surgery.
Further insight into the true intention of the mixture can be gained from an analysis of
the verse in Hebrew. The verse, which is often translated as the surface of his skull
softens, can be alternatively read as the part that was soft (when he was a baby). This
reading comes from a translation by Rashi, one of the most prominent commentators men-
tioned in the Gemara. Rashi explains that this verse is not one step, pour 300 cups on
his head until the surface of his skull softens, but is two steps, pour 300 cups, then
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106 Adam Weinberg
locate the soft spot in preparation for opening the skull (Kesubos 77b, Rosner, 1978). This
implies that the mixture was being used as a type of primitive anesthesia.
This alternative reading may also imply that the mixture was being used to expose the
sutures in the skull. In other words, the combination of ingredients helped make the
sutures, or soft spots of the skull, more visible to the surgeon.
Another interesting aspect of the prescribed mixture concerns the symptoms of
raatan, and flies swarm around him. The word in Hebrew, remu, translated as flies,
can mean simply insect. This is noteworthy, because even to this day a very popular topi-
cal medicine used for animals with fleas combines pennyroyal and wormwood as active
ingredients (www.callicoma.com, 2005). It is uncertain whether the development of this
mixture originated with the authors of the Gemara or was adapted from the medicine
being used in Babylonia (Geller, 2002).
The second step in the description lays out the operating room. Then take the patient
into a house of marble where there is no draft, and if there is no marble house a house
whose walls are seven and one-half bricks thick. There are two possibilities for the sug-
gestion of marble, the first being the ease with which it can be washed down of blood after
the surgery. The second reason is implied by the commentaries in emphasizing where
there is no draft. The same reason is given by the commentaries for the second choice,
a house whose walls are seven and one-half bricks thick. This instruction implies an
early understanding of the need for a clean surgical environment (Feldman, 1986).
Dating back to ancient times, internal medicine and surgery were distinguished from
one another. Surgery was not considered to be a part of medicine but was thought of as
hand-skill, performed by itinerants and the like. Surgery was mainly considered lowly
work not appropriate for a physician, and as a result many surgeries were performed in
less than ideal environments. Further, it was not until the end of the Middle Ages and the
Renaissance that surgery would be taught in the universities (Steinberg, 2003). In contrast,
the Gemara seems to make the work of surgery in this case paramount, requiring a proper
working environment.
The third step provides an amount of mixture to be applied to the head, 300 cups.
The number 300 is often used in the Gemara to simply mean a lot or to emphasize the
importance of the amount that needs to be used (Shabbos 13b). The emphasis on the
amount is most likely directly connected to the fact that the anesthetic mixture, as we
know today, probably did not reduce the pain all that much. Before the discovery of mod-
ern anesthesia, surgeons worked very rapidly to minimize the patients suffering. This
seemingly exaggerated amount is potentially an attempt to use the best they had with max-
imum effect.
The fourth step, and potentially the most interesting, involves opening the skull,
Then tear open his skull. The Gemara simply instructs the surgeon to tear it open, with-
out instructing as to how. One obvious question comes to mind; is knowing how many
cups of mixture to use a more crucial detail then knowing how to actually perform the
opening? It is possible that trephination was common knowledge at the time (Geller,
2002), however another biblical source provides a more detailed answer.
Mishna Ohelot 2:3 describes a tool in Hebrew called a gimlet that is used to make
holes in bone. The Mishna then names two different types used for making openings in the
skull: a workers gimlet and a physicians gimlet. Further, it provides a working definition
of the physicians tool, stating that it makes a hole the size of a sela coin. The commen-
taries explain that the coin has a diameter 1/3 the width of a handbreadth. Using this infor-
mation it is now possible to read the Gemara to say tear back the skull once the surgeon
has made the opening.
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A Case of Cranial Surgery in the Talmud 107
The fifth step involves identifying the problem, expose the organism on the mem-
brane. This step raises a variety of questions such as the physical characteristics of the
growth that are not mentioned. The authors of the Gemara note, It is not clear on which
membrane the problem rests, the outer one or the inner one (Bechoros 45a). Using
todays terminology, they might have been referring to the dura matter (outer layer) and
the pia matter (inner layer).
The last step detailed in the Gemara explains removing and disposing of the problem.
Bring four myrtle leaves, lift up each end and insert one leaf underneath. Remove it
entirely, with tongs, and burn it. For if not, it returns to the victim. The leaves mentioned
directly in the Hebrew are again not specified but simply leaves. It is often implied that
they were myrtle leaves because they are small and tough, or perhaps because the oil from
the myrtle leaf was believed to have medical use (Feldman, 1986). More specifically
immature myrtle leaves have thin sharp edges but still bend with pressure.
The authors of the Gemara understood from their own history, as well as from the
neurological advances made by Galen, that physical injury to the brain often resulted in
death. As mentioned earlier, there are several accounts of head injury resulting in a
quick death in the Bible itself (Feinsod, 1997; Shapiro, 1990). Furthermore, the impe-
tus for writing the Mishna and Gemara down came after the Great Revolt and Bar
Kochba Rebellion, which resulted in the death of countless Jews. The authors were
therefore astutely aware of the terminal cost of head injury. As a result, the Gemara
instructs the use of something that can separate the growth without permanently dam-
aging the brain (Steinberg, 2003).
More evidence of this knowledge appears in another Mishna that deals with the laws
of kashrut. Kashrut, or kosher, refers to the laws that outline which foods can and cannot
be eaten by Jews. Further, the laws detail how an animal is to be raised, slaughtered, and
prepared. One of the main laws prescribed, postslaughter, is an autopsy of the animal. The
Mishna states that no mortal blemish can be found on the animal. After a lengthy discus-
sion debating various blemishes that deem an animal not kosher, the Mishna describes the
process of inspecting the nervous system regarding a sheep. It differentiates between a
spinal injury, which the Mishna recognizes as mortal, and a type of sciatica caused by a
prolapse in the vertebral disc, which is not considered mortal (Levinger & Blickstein,
2000). The Mishna describes a second case where it differentiates between cranial deficits
that are considered nonmortal problems and meningeal tears that are considered extremely
dangerous and potentially mortal.
It is clear that the authors were aware of the potential dangers in tearing any aspect of
the meninges. The next line in the Gemara qualifies this, Remove with tongs. Since
the problem has already been separated from the brain with the leaves, the Gemara now
instructs the use of an instrument, i.e. tongs, for the final removal.
The Gemara ends with the statement, For if not, it returns to the victim. The impli-
cations for this last verse seem extremely direct to modern sensibility. Today one of the
biggest considerations concerning surgery for the removal of a tumor is the amount of the
tumor that can safely be removed; knowing that whatever cannot be removed has the
potential to spread (Steinberg, 2003).
After this point the Gemara discusses various rabbis who dealt with individuals suf-
fering from raatan. Most avoided direct contact for fear that the disease was contagious.
The rabbis who dealt with the afflicted, and were known as the surgeons, were protected
from the disease as a result of their high level of spirituality or closeness to God (Kesubos
77b). The Gemara does not return to the issue of surgery and therefore never discusses the
details of the recovery period.
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108 Adam Weinberg
Nonetheless, Mishna Ohelot 2:4 describes a case that is applicable. The commentaries
describe the case of a physician who performs trepanation on a person for a skull defect.
The skull defect is then covered with the dried shell of a pumpkin. Interestingly enough, a
similar practice was done through the early 1900s, and it may still be performed today by
native island communities with coconut shells (Rosner, 1978). A different Mishna,
Shabbos 5:34, describes the process for bandaging a wound. To treat a wound one
applies cotton or lint, often with onion, wine, or garlic peels. The Mishna also makes a
statement that retains its importance to this day. It warns against touching a wound
because The hand causes inflammation (Avodah Zarah 28b).
With this analysis and interpretation we might now state these instructions in modern
vernacular. The cure is surgery. Prepare the anesthesia. Check that the operating room is
clean and sterile. Sedate the patient and anesthetize the site for surgery. Cut a small hole in
the skull over the site of the growth. Remove the growth, as much as possible. Fuse the
opening back together, and treat with bandaging.
The Illness
What was the disease they were hoping to cure by modern day standards? It is important
to note that the earliest commentaries on the Gemara, including Rashi, imply that the
growth on the membrane was a type of parasite. The verse in Hebrew literally reads, Lift
up each, and insert one leaf underneath. The commentaries on the Gemara often add the
word each leg, implying some kind of living organism (Kesubos 77b). Most likely this
assumption of the later commentaries is derived from another story in the Mishna that
records the final illness of Titus. When Titus landed on dry land after the destruction of
the Temple in Jerusalem, a gnat flew into his nose, ascended into his head and knocked
against his brain for seven years After Titus died, they opened his skull and found there
something like an insect (or bird), two selas (coin) in weight.
We can extract this storys medical essence. The gnat knocking against his brain can
easily be understood to be severe headaches, and the insect found upon autopsy may have
been a growth or tumor (Rosner, 1978).
It is also important to know what other invasive surgeries were prescribed in the
Mishna. This will help in understanding the role of the brain as seen by the authors. In
Mishna Sanhedrin 21b, there is an account of a splenectomy. Several trepanations for sei-
zure disorders are mentioned in Hullin 57a. Amputations for severe wounds or gangrene
appear in Gittin 56a, and one description of Caesarean section is mentioned with little
additional detail (Rosner, 1977).
All of these surgeries were viewed as life saving by the authors, which gives the brain
crucial importance in the eyes of the Mishna. More direct evidence of the brains role
comes from Rabbi Judah the Prince, who encouraged the writing of the Mishna in the first
place. Rabbi Judah knew that the brain was the seat of thought and logic, as he is quoted in
tractate Yebemot 60a, in saying, the brain for understanding and reason. Further, the
prayers that were composed during the same time period enforce this concept. After the
destruction of the second Temple in Jerusalem, prayers were composed to take the place
of the Temple service. In one of the very first daily prayers composed it is written, King
of the universe, who gave the brain understanding to distinguish between day and night
(Scherman & Zlotowitz, 1984). Although it is possible to pick up a prayer book even
today and read the phrase who gave the heart, this is simply a bad translation. The
word used in the prayer is sechvi, which refers to the brain (Scherman & Zlotowitz, 1984).
The word for heart in Hebrew is lev, and it does not appear in the prayer.
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A Case of Cranial Surgery in the Talmud 109
So what is the disease the Gemara is instructing its readers to cure? As already pos-
ited, it may have been a tumor. However this would not explain the signs and symptoms:
watery eyes, running nose, etc. Furthermore, if the surgery were really being performed as
a response to such signs, what was found upon opening the skull? It is hard to imagine any
growth would be present in connection with a skin defect.
Another possibility is that the disease was meningitis, which appears as a fungus on
the brain. The Gemara warns that the disease is contagious, which meningitis is. However,
the signs enumerated in the Gemara are not related to meningitis. The most common men-
ingitis signs and symptoms are high fever, headache, stiff neck, nausea, vomiting, as well
as discomfort looking into bright lights, confusion, and sleepiness. None of which are
related to a skin disorder (Freedman, 1999).
Yet another possibility is leprosy. Leprosy appears as a skin defect, and it was
believed to be contagious for thousands of years. Leprosy, however, is not associated with
growths on the brain. Leprosy results in skin lesions that are accompanied by sensory loss.
This is inconsistent with the Gemaras claim that the skin defect was painful. Further,
the Bible speaks of leprosy specifically, as do documents in every other major world
culture dating back as far as written records allow. The Mishna deals with leprosy as a
separate issue and is clearly not speaking of it here.
It is also possible that not all of the symptoms were a result of a single disorder.
Hence, a person could have been suffering from meningitis or a brain tumor and simulta-
neously contract a severe cold or skin infection. Nonetheless, the like in hood that two
separate disorders overlapped with such frequency as to be interpreted as symptoms of a
single disorder is unlikely.
Thus, the disease remains uncertain. Nonetheless, that could be expected considering
the advances that have been made in neurology since the time of the Gemara. Interestingly
enough, Tosafos, one of the commentaries recorded with the Gemara, warns against fol-
lowing all of the prescribed remedies and medical procedure listed in the Mishna and
Gemara saying, Nowadays, it is generally accepted that some are unhealthy. Perhaps this
is due to a change in nature, just as we see that certain remedies stated in the Talmud are
no longer effective (Gittin 56a).
Discussion and Conclusion
The Gemara is an ancient source of Jewish law and philosophy. It seeks to explain and
debate aspects of the Hebrew Bible, and in doing so it captures many medical issues that
are still relevant today. The cranial surgery analyzed in the Gemara sheds some light on
the role pathology and potential cures played in the history of Jewish life. After the failed
revolts against Rome, and the destruction of the second Temple in 66 CE, millions of Jews
were dispersed throughout Asia, Africa, and Europe. From that time on the Mishna, and
eventually the Gemara, became the portable houses of study for the Jewish people.
During the first few centuries of the Common Era, medical problems, particularly
those relating to anatomy and pathology, became the focus of Jewish study because of
their role in the observance of kashrut (dietary restrictions). Animals were subjected to
anatomical and pathological examinations after ritual slaughter. Many Jews dating back to
300 BCE, and potentially earlier, became experts at investigating animals for worms,
infectious disease, and for poisons found in decaying animal matter (Rosner, 1986). Fur-
ther, physiological studies were often conducted with sick animals before slaughter to help
establish signs for disease. There are also reports of the sages performing postmortem
examinations on human cadavers. Based on the discussions in the Mishna, it is understood
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110 Adam Weinberg
that the sages of this period (300 BCE 170 CE), while most likely influenced by the
dominance of humoral pathology, also ascribed to a sort of anatomical pathology.
This background helps explain the brain, as the authors of the Mishna and Gemara
understood it, and helps justify why such an account of cranial surgery was recorded. Ulti-
mately, the logic of the Gemara leads to the conclusion that the surgery was performed to
prevent a divorce. But more importantly, it provides modern readers with a glimpse into
invasive surgery dating back nearly 2,000 years. Neurosurgery has come a long way since
then, but the rabbis who are recorded in the Mishna and Gemara made some important
steps in dealing with brain. Anesthesia was not popularized until the 1800s; however, the
Gemara might have been referring to an anesthetic nearly 1,500 years earlier. Sterilization
is of paramount importance in todays neurological environment, yet here we see refer-
ence to the importance of a clean and dust-free operating room. Finally, the Gemara
expresses knowledge of the brains delicacy, the importance in prescribing a means for
removing the growth, and the foresight to say, Remove it entirely for if not it returns to
the victim.
References
Artscroll (2001): Schottenstein Edition. Talmud Bavli. Tractate Avodah Zarah Vol. II:28b, Tractate
Brechos Vol. III:45a, Tractate Gittin Vol. III:56a, Tractate Kesubos Vol. IV:77b, Tractate Ohelot
Vol. I, 2:34, Tractate Shabbos Vol. I:13b. Brooklyn, NY: Mesorah Publications.
Callicoma website. Retrieved, April 4, 2005. http://www.callicoma.com.au/shampoos.htm.
Feinsod M (1997): Three head injuries: The Biblical account of the deaths of Sisera, Abimelech and
Goliath. Journal of the History of the Neurosciences 6(3): 320324.
Feldman D (1986): Health and medicine in Jewish tradition. New York: Crossroads Publishing.
Freedman B (1999): Duty and healing: Foundation of a Jewish bioethics. New York: Routledge
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operative environment. Neurosurgery 52: 319.
Rosner F (1977): Medicine in the Bible and the Talmud. New York: Yeshiva University Press.
Rosner F (1978): Biblical and Talmudic medicine. New York: Sanhedrin Press.
Rosner F (1986): Modern medicine and Jewish ethics. New York: Yeshiva University Press.
Scherman N, Zlotowitz M (1984): The Complete Artscroll Siddur. Brooklyn: Mesorah Publications.
Shapiro RM (1990): Head injuries in the Old Testament. Radiology 74: 84.
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