The new tractate of Eruvin, which we started to learn last Tuesday (named in Latin dies Martis, and see Shabbat 156 for an explanation) is concerned with the various legal definitions of public and private thoroughfares, and the prohibition against carrying on Shabbat. But in today’s page of Talmud we take a brief detour, (for reasons that need not detain us here) into questions of ritual impurity.
Although human remains transmit ritual impurity, if they are missing a bit they may not transmit a certain kind of ritual impurity called tumat ohel. Which brings us to the case of a skull with a hole in it. How much needs to be missing for the skull to be incapable of causing others to become impure?
ערובין ז,א
דִּתְנַן: הַשִּׁדְרָה וְהַגּוּלְגּוֹלֶת שֶׁחָסְרוּ — וְכַמָּה חֶסְרוֹן? … וּבַגּוּלְגּוֹלֶת, בֵּית שַׁמַּאי אוֹמְרִים: כִּמְלֹא מַקְדֵּחַ, וּבֵית הִלֵּל אוֹמְרִים: כְּדֵי שֶׁיִּנָּטֵל מִן הַחַי וְיָמוּת.
We learned in a Mishnah: The skull…that is incomplete do not impart ritual impurity… How much is considered a deficiency in the skull for this purpose?…Beit Shammai say: It must be missing a piece the size of a drill hole, and Beit Hillel say: It must be missing an amount that, when removed from a living person, would cause him to die, [which is a larger amount].
What is this Drill hole all about?
But just how big is Bet Shammai’s “size of a drilled hole?” The commentators are silent on the matter here. The late and very great R. Adin Steinzaltz, (who died just nine days ago at the age of 83 and those intellectual output and infectious smile will be sorely missed) translated the passage without explanation. The medieval commentator Rashi, however, directs us elsewhere, telling us to “see Bechorot chapter three where this is explained.” If we take Rashi’s advice and revisit Bechorot (38a), we read a passage cited from a Mishnah in the tractate Oholot (2:2), where the dimensions of this drill are outlined by Rebbi Meir:
בְּאֵיזֶה מַקְדֵּחַ אָמְרוּ, בַּקָּטָן שֶׁל רוֹפְאִים, דִּבְרֵי רַבִּי מֵאִיר
It it is the size of “the small drill hole, used by physicians” (בקטן של רופאים). Good, we are making progress.
Maimonides in his explanation of this Mishnah explained that implement was a small mallet used to open up “wounds and abscesses.” However that type of surgery is carried out on the skin and so is performed using a sharp knife, and not a drill (or a mallet). The implement was more likely to have been a drill in the modern sense of the word. Indeed this is the explanation given by Samson ben Abraham of Sens (1150-1230), better known as the Rash Mishantz, who also describes how it was used to drill into the skulls of both living animals and living people.
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?
Trephinated skull of a 50 year-old woman found in Corseaux-En Seyton, Switzerland. Growth of the bone around the burr-hole indicate that the the patient survived the procedure. From the collection of the Cantonal Museum of Archeology and History, Lausanne Switzerland.
Trephination - a hole drilled into the skull
Let’s start by introducing you to a word you may not have heard of. Trephination. It is the art of boring holes into people’s heads, and is also known as trepanning. The word is ultimately derived from the Greek trypanon, which was the instrument used to bore these head-holes. That is what the Talmud refers to as “the small drill hole, used by physicians” (בקטן של רופאים).
Trephination, the removal of a piece of the skull of a living individual without penetration of the underlying soft tissues goes back a long, long way. In fact it is the oldest surgical procedure known to humanity, and it predated Bet Shammai by at least 4,000 years. Oh, and by the way, many victims survived the procedure, as we can tell by noting the smooth edges around the hole. This indicates that there was some boney growth, and hence a living person, after the procedure.
Trephinated skulls from ancient Israel
Left: Round trephination found in Jericho. Right: Angular trephination, found in Timna. Angular trephination was associated with a very low rate of survival, indicated by lack of healing of the wound in the skull. It may have been practiced for ritual rather than for therapeutic reasons. From Arensburg B., Hershkovitz I. Cranial deformation and trephination in the Middle East. Bulletins et Mémoires de la Société d'anthropologie de Paris, XIV° Série. Tome 5 fascicule 3, 1988. pp. 139-150.
Trephinations in Israel and South Sinai by type, healing status and period. From Arensburg B., Hershkovitz I. Cranial deformation and trephination in the Middle East. Bulletins et Mémoires de la Société d'anthropologie de Paris, XIV° Série. Tome 5 fascicule 3, 1988. pp. 139-150.
Archeologists in Israel have discovered many trephinated skulls. According to Prof I. Hershkovitz from the Department of Anatomy at Tel-Aviv University these include trephined skulls from the 7th century BCE at Tel Duweir, a trephinated skull found in a tomb near Timna, roughly dated between the 6th century B.C.E. and the 3rd century C.E, and a skull from the Hellenistic-Roman period in Acco. Two trephinated skulls from the Middle Bronze Age I (~2,200-2,000 BCE) were found in Jericho, one from the Early Bronze age was found in Azor, and a trephinated Iron Age skull was found in Yavneh. But the very earliest skull found around the Land of Ancient Israel was uncovered in a a large cemetery at Wadi Hebran in the Southern Sinai. It belonged to a man aged between 35 and 40, who was buried around 4,000 BCE; that’s over 6,000 years ago. So yeah, trephination is a really old procedure.
“According to anthropologists who have studied trephined skulls, patient survival rate varied greatly. One scientist found advanced healing in 250 of 400 skulls, for a survival rate of 62.5%. Other scientists have found the survival rate to be between 23.4% and 55.3%.”
Around the world with trephination
Evidence of trephination is by no means unique to ancient Israel. Trephinated skulls have been found in Peru, India, and Africa (where it is still practiced). The procedure was practiced in several different and geographically remote populations, which demonstrates that it independently evolved in each. Why would that happen?
In 2015 the neurosurgeon Miguel Faria suggested the following as an explanation. Neolithic man would have noticed that while massive blunt head injuries were invariably lethal, milder head injuries were not. There might be an extended period of unconsciousness to be sure, but some victims would, having been left for dead in the back of a cave, “miraculously” recover and become “undead.” Today we would call this period a “coma”, and, so the claim goes, it would have been supposed that “something in the head had to do with undying.” Then this:
“..an 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.
