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thyroid cartilage ("koba'," "pikah sliel-gargeret"),
and the epiglottis ("shippuy koba'"; Hul. 18b).
The trachea is composed of incomplete cartilaginous
rings ("hulyot"), and membranous ones ("bene
hulyah").

The alimentary canal of ruminating animals is
thus described :

"Tlie food passes from the mouth into the phar-
ynx, thence into the esophagus ["istomka"], thence
into the reticulum ["bet ha-kosot"], tlKjnce into the
psalterium [" lia-masas " or " hemses "J, thence into
tlie abomasum ["karsa"], thence into the duode-
num [" resh mayah "], thence into the small intestines
["kerukiih kattinah"], thence into the blind gut
["sanya debe"], thence into the large intestines
["kerukit 'ubya"], thence into the rectum [" peta-
roka"], whence it makes its exit through the
sphincter aid ["iskutha "] " (Lev. R. iii.).

According to R. Samuel, there are no hair-like
projections (" milot ") below the pylorus (" mezar ").
The gastrointestinal tract throughout its length



I



411



THE JEWISH ENCYCLOPEDIA



Medicine



is covered exterually witli the peritoneum ("kerum
niklaf ") except the posterior surface of the lower
portiou of the rectum (" hilholet " ; Hul. 49b). The
peritoneum forms the greater omentum (" peder "),
wliich is attached to the greater curvature or "bow "
("Kashta ") of the stoniucli (ih. 50a) and the begin-
ning of the small intestines {ib. i)3a).

The liver is attached to the diaphragm (" tarpesha")
by a fold of the peritoneum i^ib. 46a). It is united
also with tiie gall-bladder (■■marah")by means of
a narrow tube ("simpona " ; ib. 48b). The pancreas
is considei-ed an accessory organ of the livei', and is
called the "finger of the liver" ("ezba' ha-kabed '").
Its relations to the abdominal organs are described
correctly (Taniid 31a). The anterior abdominal wall
is divided into an inner, peritoneal layer ("keres
penimit") and an outer, muscular one ("keres hizo-
nah "). The spleen and kidneys are frequent!}-
mentioned in Talnuid and Midrash, but no descrip-
tion is given (see below).

The lungs are composed of two "rows" ("'aru-
got"), right and left, divided vertically by a sep-
tum ("tarpesh ha-leb ") which rises from the pericar-
dium (" kis ha-leb ") and is attached to
The Lungs the spinal column. The large bronchi
and Heart. (•' bet ha-siniponot ") enter respectively
the inner side of each row (ib. 50a).
Alongside of the bronchi enter also the large blood-
vessels (" mizrakim " ; ib.^'ih). The number of lobes
in each lung is given correctly {ib. 47a). The pleura
is composed of two layers, an outer, rough one
("kerama 'illaya") and an inner, rose-colored one
("kerama tatta'a," "kittuna de-warda"; ib. 46a).
The heart is composed of two ventricles ("halal"),
the right being larger than the left {ib. 45b). It is
situated to the left of the median line (Men. 37b).
Rab expressed a radical view for his time, namely,
that the aorta ("kaneh shelleb ") contains blood, not
air (Hul. 45b). The large veins are called "weri-
dim"; the small ones, "hute dam."

The brain is not mentioned in the Bible. Accord-
ing to the Talmudists, it has two coats, an outer
(the dura mater) and an inner coat (the pia mater),
the one being hard (" kashshish "), the other thin
("dakkik "). The spinal cord begins outside of the
condyloid ])rocesses (Hul. 45a). The Zohar gives a
somewhat more detailed description: "The skull
contains three cavities in which the brain is lodged.
From the brain issue thirty-two paths. These ])aths
spread over the body connecting it with the brain "
(Zohar on Lev. xxvi.).

From the laws relating to circiuucision, flux, men-
struation, etc., which are discussed at length in the
Bible and especially in the Talmud, may be gath-
ered some idea of the knowledge which tiie ancient
Jews possessed concerning tlie anatomy of the gen-
erative organs. Of the male genitals the anatom-
ical parts are mentioned as follows: The scrotum
("kis") is divided by a septum into
The two sacculi (Bek. 40a): the testes

Generative ("bezim," "ashakim") have twocoats

Organs. (Hul. 45a): each testicle has an appen-
dix, the epididymis ("hute bezah " ;
Yeb. 75a); it is supplied with blood-vessels ("gide
pahad"; Hul. 93a) and nerves {ib. 45b), and it con-
tains a viscid fluid (Yeb. 75a). It was held that the



spermatic fluid and the urine had each a separate
canal for their exit (Bek. 44b).

Besides the uterus only the visible parts of the
female generative organs ("rehem"), there being
many synonyms, are mentioned in the Bible. The
Talmud mentions the following: Monsvenerii({Yl(i\)r.
"kaf tappuah"; Yer. Yeb. 1-2); TO^t-rt (" 'erwah ");
rima puikndoruni ("bet ha-setarim " ; Niddah 66b);
vestibulum vaginae. {'■' hat hizon"; ib. 41b); orificivm
urethrm ("lul"; ib. 17b); hymen ("betulim"); osti-
um vagina ("bet shinnayim"; ib. 46b); vagina
("bet toref," "bet ha-rehem"; Shab. 64a) ; septum
vesica -vaginalis {'' g&g prosdor"; Niddah 18a); sep-
tum vagina-rectalis ("karka prosdor"; ib.)\ uterus
("rehem"; ib.); canalis cervicis uteri ("makor; ib.
41a); C(7Jv/m«ten ("heder " [ib. 17b]; "betherayon"
['Ar. 7a]).

According to the Mosaic law (Lev. xii. 2-5), a
woman after giving birth to a male child remained
imclean for seven days thereafter ; in the case of a
female child, fourteen d: "i. Then followed a period
of purification — for a male thirty days, and for a
female sixty-six days. According to

Etnbry- the Mishnah, miscarriages fell under
ology. the same law, provided, however, the
fetus (" shefir") was completely formed
(" merukkam ") and its features were well differen-
tiated ("mi-zorat adam "). Monstrosities and all fe-
tuses not viable were exempt from the above-named
law (Niddah iii. ). This interpretation of the Biblical
law served as an impetus to the Talmudists for the
diligent study of embryology.

The esteem in which were held those who occu-
pied themselves with this study is shown in the leg-
end that King David devoted a great deal of his time
to these investigations (Ber. 4a). R. Samuel, it is
said, was able to tell the exact age of a fetus (Niddah
25b). The fetus, it was held, is completely formed at
the end of the sixth week. Aba Saul, a grave-digger
by occupation, but also an embryologist, describes
an embryo at the end of tiie sixth week as follows:
"Size, that of the locust; eyes are like two specks
at some distance from each other, so are the nostrils ;
feet like two silken cords; mouth like a hair. . . .
The soles are not well defined." He adds that the
embryo should not be examined in water, but in oil,
and only by sunlight (Niddah 25b). R. Samuel
(^.c.) contended that it wasinipo.ssibleto differentiate
the sex before the end of the fourth month, which,
by the vvay, is the opinion of modern embryologists.
At certain autopsies it was found that the male em-
bryos were completely formed at the end of the
forty-first day, and the female embryos at the end
of the eighty-first day. Tiie Kabbis contended that
the autopsies had not been free from error (Niddah
30b). Tlie soft partsare formed first, ihen the bones
(Gen. R. xiv.). Monstrosities like cyclopia, monop-
sia, double back with double spinal column, and
artresia a'sophagi ("weshet atum "), etc., are men-
tioned (Niddah '23b, 24a, b).

The Bible identifies the blood with the soul (Gen.
ix. 4). The Talmudists regard blood as the es.sen-
tial i)rinciple of life (Hul. 125a). The relation be-
tween strength and the development of muscles is
mentioned in the Bible (Job xl. 16). The Talmud-
ists noted the fact that the muscles change their form



Uedicine



THE JEWISH ENCYCLOPEDIA



412



•when in motion (Hul. 93a). Respiration is compared
to burning. Expired air can not sustain life (Sanh.

77a). The life of all the organs of
Physi- the body depends upon the heart
ology. (Yer. Ter. viii. 4). Each gland secretes

a fluid peculiar to itself, although all
the glands derive their material from the same
source (Num. R. XV.). The difference in the struc-
ture of the teeth in herbivorous and carnivorous
animals is noted (Hul. 59). Saliva, besides moisten-
ing the tongue, adds to the palatability of food
(Num. R. XV.). The stomach performs a purely
mechanical function, that of churning the food; it
is compared to a mill. Digestion proper ("ikkul ")
is carried on in the intestines. The time occupied
in digestion is not the same in all individuals. The
end of the digestive period is made manifest by the
return of a desire for food (Bek. 52b). Eating when
the bowels are full is likened to the making of a fire
in a stove from which the ashes have not been re-
moved {ib. 55a). Normal defecation hastens diges-
tion. Birds digest their food rapidly (Shab. 82a);
dogs, slowly (Oil. xi. 7). The reasoning faculties
are lodged in the brain (Yeb. 9a). The movements
of the body depend upon the integrity of the spinal
cord (Hul. 58). Rabbi Isaac holds that the liver
elaborates blood (Shab. 82a).

There are numerous refeiences to the influence of
climate, customs, trade, etc., upon tlie development
of the organism as a whole, and upon certain groups
of muscles (Ab. R. N. xxxi. ; Yeb. 103a; M. K. 25b).
The phenomena preceding tlie period of menstru-
ation are described in detail (Niddah xi. 8). The
menstrual fluid is considered by Rabbi Mei'r as an
extra nutritive material which is discharged periodic-
ally when of no use, but which is converted into
milk during the period of lactation (ih.). Absence
of menstruation indicates sterility. Fear and cold
may arrest the flow {ib. 66).

Tliat medicine was an integral part of the religion
of Israel is made more evident from the pathological
studies of the Rabbis than from any other branch of

medical science. It is indeed rcjiiark-
Pathology. able that the Rabbis seem to have been

the first to recognize practically what
is at present the prevailing theory, namely, that the
symptoms of all diseases are merely outward mani-
festations of internal changes in the tissues — a theory
never advanced by their contemporaries, e.f/., Hip-
pocrates and his (liscii)les, and only vaguely hinted
at by Galen (" De Locis Affectis," i., ch. ii). Their
pathological studies were a direct outgrowth of
the law concerning the "flesh that is torn of beasts
in the field," which becomes unfit ("terefah") for
food (Ex. xxii. 30 [A. V. 31]). Certain rules con-
cerning tiiis infection are enjoined upon those who
come in contact with the flesh of an animal that
"dietli of itself or is torn with beasts" (Lev. xxii.
8). Tlie Talmudists went a step further, and de-
clared that tlie word " unlit " included the flesh of
animals aftlicted with any disease which would have
sooner or later caused the death of the aniniai (Hul.
ii). 1).

In order, therefore, to determine the condition of
the internal organs, each slaughtered animal was
subjecTed to an autopsy ; tliis is tlie ]iraclise even



to-day. The pathological changes of the lungs
have been most diligently studied as to color, con-
sistency, cavities, and vegetable growths. Redness
of the lungs indicates hyperemia (Hul. 47b), a
condition which is not fatal (ib. 46b) ; blue and
light-green discoloration is not considered danger-
ous {ib. 47b); black indicates that the object has
begun to disintegrate ("lakah"); and the part of
the lungs thus affected can not return to its nor-
mal state. Bright yellow ("yarok") is considered
the color indicative of the most fatal condition. If,
on inflating the lungs, it is found that air does
not enter into a certain part of them ("otem be-
re'ah "), it is then important to find out whether the
obstruction is caused by pus or mucus ("mugla") in
the bronchi, which might have been expelled by
coughing, or is due to thickening of the tissues. In
the latter case the animal is unfit for food. Caseous
degeneration ("re'ah she-yabeshah "), "in which
there is no blood and it crumbles under the nail,"
makes the flesh of the animal unfit for food. Sof-
tening of the lung (" re'ah she-nitmasmesah ") is fatal.
In the case of an animal with collapsed lungs (" re'ah
she-zamekah ") the following rule is given by the
Talmud: if after they have been immersed in water
they can be inflated with air, the flesh of the animal
isfit for food ; if they can not be so inflated it is unfit.
A pitcher-shaped cavity in the lung (" re'ah she-nish-
pekah k«-kiton"), filled with fluid, renders the ani-
mal unfit for food. An empty cavity ("re'ah she-
nimmokah ") is not dangerous to life {ib.). The
Rabbis speak of vegetable growths ("zemahim") on
the lungs in connection with adhesions of the lung
to the thorax ("dofen"); and they describe several
forms, all of which are not considered dangerous.

Perforation of the outer coat of the brain is not
fatal; but the slightest perforation of the inner coat
is. Rabbi Jacob held tliat an injury of the spinal
cord is fatal ; the editor of the Mishnah said that it
is fatal only when the injury extends to more than
one-half of its transverse diameter (Hul. iii. 1). A
sheep that dragged its hind legs was diagnosed by
Rabbi Yemar as suffering from ischiagra ("shig-
rona ") ; but Rabina contended that it was a jtaral ysis
due to the solution of continuity of the spinal cord.
The sheep was killed, and the diagnosis of Rabina
was corroborated (Hul. 51a). This is the only case
on record in ancient literature where a diagnosis
was made during life and was verified at a post-
mortem examination. Rabbi Levi saw one who suf-
fered from tremor of the head, and he remarked that
the man was suffering from softening of the spinal
cord. Abaya said that such cases were not fatal, but
the patients lost their reproductive functions (ib.).

Perforation of the heart is considered fatal. No
other pathological changes of the heart are men-
tioned. A transverse division of the trachea is not
considered fatal, provided it is less than one-half of
its circumference. Lonuitudinul woiuids in the
trachea heal quickly {ib. 45a, 54a, and 57b). Loss
of substance is not considered fatal (ib. 18b). Per-
foration of the esophagus is fatal, since the food
may escape into the mediastinum (ib. 45b). Vol-
vulus is considered fatal (ib. .50b). Perforation of the
stomach or of the intestines is fatal. Extirpation of
the spleen in animals and in man is not considered



413



THE JEWISH ENCYCLOPEDIA



Medicine



fatal (Hul. 2). Kupture or wounding of the spleen
is considered fatal. Ablation of tlic uterus is men-
tioned and is not considered fatal (Bek. vi. 4). Atro-
phy and abscess of the kidney are fatal (Hul.
r)5a, b). Accumulation of transparent fluid in tlie
kidney is not fatal (ib. 53b).

Tlie pathological changes in the liver mentioned in
the Talmud are: that in which the organ becomes
dry and bloodless and "crumbles under the nails";
abscess; and stone-like hardening. Extirpation of
the liver is not considered fatal if there is left intact
the part whicli surrounds the biliary duct and " that
])lace from which the liver receives its vitality."
Absence of one testicle is mentioned, and the sub-
ject is considered sterile (Bek. vi. 6). Hypertro-
l)hy and atrophy of the testicles (ib. 40b), scrotal
liernia ("ruah ba-ashakim "), and elephantinsis scroti
(the sulTerer being called "me'ushkan " ; ib.) are also
mentioned. Various forms of hypospadias and epi-
spadias are described (Niddah 13a ; Yeb. 76a). The
Mishnah enumerates 140 pathological conditions
which in the eyes of the Law make a man a "crip-
jile" ("mum") and therefore unfit to perform any
religious service in the Temple. Fifteen of these
describe various osteologic deformities of the head,
spine, and extremities (Bek. vii.). The rare cases of
individuals having a tendency to hemorrhage arc
i-clated, and the fact that this affection is hereditary
is noted (Yeb. 64b).

Woiuids in different parts of the body, caused by
different weapons— sword, arrow, hammer, etc. —
i.re mentioned in the Bible (II Sam. ii. 23, iii. 27, iv. 6,
xviii. 14, XX. 10; Num. xxv. 8; Judges iii. 21, v.
24; I Kings xxii. 34; II Chron. xxxv. 23; and often
elsewhere). Inflammation and abscesses (Deut.
xxviii. 27, 35), gangrene and putrid discharges (Ps.
xxxviii. 6; Prov. xii. 4, xiv. 30; II Mace. ix. 9) are
also referred to. Wounds were treated by the ap-
plication of wine or oil, bandages or
Surgery, sutures (Isa. i. 5; Jer. viii. 22, xlvi.
11, li. 8; Deut. xxviii. 27). The sur-
gical operations mentioned in the Bil)le are those of
CiiscuMCisiON and castration, the latter being pro-
hibited (Deut. xxiii. 1).

During the Talmudical period surgery attained
a high degree of development. INIan}^ physicians
devoted themselves exclusively to it. Surgeons
("ummanim"; Sanh. 91b), when operating, used to
wear a tunic over their dress (Kelim xxvi. 5).
They used various surgical instruments {ib. xiii. 2).
In major operations the patients were given an an-
esthetic or a sleeping-potion ("sanmie de-shinta";
B. M. 83b). Venesection was extensively used upon
'.he healthy and the sick alike. ]\Iar Samuel Yar-
hinai went so far as to recommend its use once in
tiiirty days (Shal). 129b). After the age of fifty
venesection should be em])loyed less frequently ((Jit.
7()a). It is not to be performed during inclement
weather; and a careful dietetic regime should be
followed for some time after the operation (Shab.
129a). Bleeding by means of leeches ("'alukah,"
" nime shel mayim" ; 'Ab. Zarah 12b) and by means of
cupping (the c\ip l)eing called "karna de-ummana";
Shab. cliv. 2) is frequently mentioned. Dislocation
of various joints ('Ab. Zaraii 29), fractures, amputa-
tions (Ker. 66a; Sem. 28; Shab. 66a), and trephining



(Ket. 77b) are discussed in the Talmud. Artificial
teeth, made of hard wood, gold, or silver, were used
(Shab. 65a; Ned. 66b). Extirpation of the spleen
was successfully performed upon man ('Ab. Zarah
44a). The following forms of castra-

Opera- tion are mentioned; Amputatio mem-
tions. bri; extirpatio testiculovum (Deut.
xxiii. 2 [A. V. 1]); subcutaneous
stretching or cutting of the cord (Lev. xxii. 24;
Bek. 39b) ; and obliteration of the testicle by means
of gradual pressure. Intubation of the larynx was
practised upon animals (the tube was called "keru-
mit shel kaneh"); and a plate ("hidduk.shel karwe-
yah ") was used in a case of loss of sub.stance of
the cranium. A uterine speculum was used (Nid-
dah 66).

The practise was adopted of freshening up the
borders of old Avounds in order that union might be
effected (Hul. 77). The operation for imperforate
anus in the new-born is described (Shab. 134b).
Wounds exposed to air do not h^al as readily as
protected ones (Hul. 46). In an accident in which
the abdominal viscera were protruding through a
wound the reposition of the organs was effected
automatically by frightening the patient, which
caused the abdominal muscles to relax ; after this
the external wound was closed by sutures (Shab.
82a). Nasal polyps are said to cause fetor ex oi-e
(Ket. 77). Crutches and various other orthopedic
appliances are mentioned (Shab. 65a). Intestinal
parasites and hydatids are frequently mentioned
(Hul. 48a). Extraction of the fetus through an
incision made in the abdomen was an operation
known to the Talmudists(Niddaii 40b). See B.\ths,
Bathing; CntciTMCisioN; Midwife; Mihacles;
Heai-th Laws.

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