Monday, May 27, 2019

Bechorot 37-38: Trephination

Once again, I find myself taking issue with a Talmudology post. Trephination might be mentioned in the Mishna / Talmud, but why did the ancients practice this art?

Let us start by establishing the meaning of the word מקדח. It literally means a drill or borer, rather than the hole made by a drill. To cite Jastrow:

Talmudology writes:

בכורות לז,ב
ובגולגולת ב"ש אומרים כמלא מקדח וב"ה אומרים כדי שינטל מן החי וימות
Concerning the deficiency in the skull: Beit Shammai say that it must be missing a piece like the size of a drilled hole, and Beit Hillel say: It must be missing an amount that if removed from a living person, he would die.
But just how big is Bet Shammai’s “size of a drilled hole?” In tomorrow’s daf (38a) we learn that it is the size of “the small drill hole, used by physicians” (בקטן של רופאים). So around the first century BCE there were physicians going around drilling holes (of various sizes) into the skulls of the living. Why on earth would they do such a thing, and just how common was this practice?

I believe that this is a mistaken translation. It is not that the physicians were drilling holes of various sizes, large and small. Rather, there were drills of various sizes. The Mishna in Ohalot, cited by our gemara, contrasts Rabbi Meir's position that it was a hole made by a small drill, that of doctors, to the chachamim who say it is the hole made by a larger drill, used in the Temple:

דתנן באיזה מקדח אמרו בקטן של רופאים דברי רבי מאיר וחכ"א בגדול של לשכה
As we learned in a mishna (Oholot 2:3): With regard to which drill did Beit Shammai state their opinion concerning an incomplete skull? It was with regard to a small drill of doctors, used for drilling bones. This is the statement of Rabbi Meir. And the Rabbis say: It was with regard to a largedrill, such as that used in the Temple chamber. According to the mishna concerning a window that imparts impurity, the size of this drill is like that of a sela coin, and the opinions of Beit Shammai and Beit Hillel would still be identical.

So it is not a small vs. large hole that doctors make, but rather a smaller hole, made by the smaller drill, which is the standard drill doctors use. Nothing in the Mishna or gemara itself states that doctors use this to drill a hole in a skull - trephination -  rather than in other bone, but Rashi does in fact make the leap and state that the doctor drilled a hole in the skull:

באיזה מקדח אמרו - ב"ש בגולגולת כמלא מקדח כקטן של רופאים שקודרין בו את הראש לתקן את המכה:
Along the way, Rashi also gives an explicit reason the doctors would drill such a hole - to fix a head injury.

This is also where I think Talmudology missed the boat. Why did the doctors drill into the skull? He should mention Rashi. Instead, the only scientific discussion is why it was practiced in rather ancient cultures, as a result of superstition:

“ opening in the head, trephination, could be “the activating element,” the act that could allow the demon to leave the body or the good spirit to enter it, for the necessary “undying” process to take place. If deities had to enter or leave the head, the opening had to be sufficiently large…The head was chosen for the procedure, not because of any particular intrinsic importance or because of magic or religious reasons, but because of the unique and universally accumulated experience observed by primitive man in the Stone Age with ubiquitous head injuries during altercations and hunting. Otherwise, the pelvic bone or femur could have served the same purpose. We must recall that even the much more advanced ancient Egyptian, Mesopotamian, Hindu, and even Hellenic civilizations believed the heart to be the center of thought and emotions, not the brain. In fact, the association of the heart with emotions lingered to the present age.
And so it was that the procedure came to be practiced across the world. This may also explain how it also ended up being used in ancient Israel, and trickled down into a teaching about ritual impurity cited by Bet Shammai.

If the purpose was to discuss the science of the Talmud, it seems that here would be a place to discuss trephination as contemporary science, as practiced by Galen, or by Hippocrates. For instance, here is Hippocrates:

That is just a taste. It is utterly confounding that he doesn't present this from a medical perspective.

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