EUROSURGERY

VOLUME 63|NUMBER 1|JULY 2008|

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OOTS OF

EUROANATOMY

, N

EUROLOGY

AND

EUROSURGERY AS

OUNDINTHE

IBLE AND

ALMUD

HISTORICAL OBSERVATIONS AND interpretations regarding the treatment of com-ponents of the nervous system can be found in the writings of the Bible and Talmud.A review of topics germane to modern neuroanatomy, neurology, and neurosurgeryfrom these early, rich writings is presented herein. These historic writings provide aglimpse into the early understanding, description, and treatment of pathologies of thenervous system.

KEY WORDS:

Ancient, History, Neuroscience, Religion

Neurosurgery 63:156–163, 2008

DOI: 10.1227/01.NEU.0000319524.04958.0F

www.neurosurgery-online.com

LEGACIES

R. Shane Tubbs, M.S., PA-C.,Ph.D.

Section of Pediatric Neurosurgery,Children’s Hospital, andDepartment of Cell Biology,University of Alabama at Birmingham,Birmingham, Alabama

Marios Loukas, M.D., Ph.D.

Department of Anatomical Sciences,St. George’s University,Grenada, West Indies

Mohammadali M. Shoja, M.D.

Tuberculosis and Lung Disease Institute,Tabriz Medical University,Tabriz, Iran

Aaron A. Cohen-Gadol, M.D.

Clarian Neurological Institute andIndianapolis Neurosurgical Group,Indianapolis, Indiana

John C. Wellons III, M.D.

Section of Pediatric Neurosurgery,Children’s Hospital,Birmingham, Alabama

W. Jerry Oakes, M.D.

Section of Pediatric Neurosurgery,Children’s Hospital,Birmingham, Alabama

Reprint requests:

R. Shane Tubbs, M.S., PA-C., Ph.D.,Pediatric Neurosurgery,Children’s Hospital,1600 7th Avenue South ACC 400,Birmingham, AL 35233.Email: rstubbs@uab.edu

Received,

October 1, 2007.

Accepted,

April 18, 2008.

he writings referred to as the Bible, aterm derived from the Greek word for book,were written in antiquity in Heb-rew, Aramaic, and Greek, over a period exce-eding a millennium. The number of booksregarded as canonical and the order in whichthey are incorporated differs among the reli-gions and denominations that hold these writ-ings as sacred. The Jewish sacred writings arereferred to as the Tanakh.These writings weresubsequently referred to by Christian writersas the Old Testament. The Christian Bible (

Fig.1

) incorporates the Old and New Testaments.In addition to the Tanakh, Jews have lookedfor religious guidance from a collection ofwritings,the Mishnah and the Gemara, com-piled in the postbiblical period over the courseof 400 to 500 years. These writings are a com-pilation of the oral law and commentaries onthe Tanakh and are referred to as the Talmud(

Fig. 2

).Using various computerized search engines(e.g. PubMed, MEDLINE, Google) and search-ing for such terms as “neuroanatomy,” “neu-rology,” “neuropathology,” “neurosurgery,”“nervous system,” “nerves,” “brain,” “spinalcord,” “Bible,” “Biblical,” “Talmud,” “disease,”and “treatment,” we reviewed publicationsthat have reported ﬁndings and observationsfrom the Bible and Talmud regarding the nerv-ous system and its morphology, diseases, andtreatments. Such reports primarily includeinterpretations of these ancient writings because the original words and meanings oftenhave been lost to history. Most authors of suchworks have not provided details of theirmethodology of data collection for these tradi-tional teachings.

NEUROANATOMY

Moskopp (11) has reviewed the electronicBible,and although no words referring speciﬁ-cally to the brain or spinal cord were found, rel-evant anatomy such as the “head” and “neck”could occasionally be found. Interestingly,Moskoppfound reference to the “heart” and“eye” almost 800 times each. The following isa collection of the brief references to the spinalcord, peripheral nerves, brain, and cranium, asfound in the Bible and Talmud.

Spinal Cord

The spinal cord is mentioned only in theTalmud and is referred to in Talmudic poeticallegory as the “silver cord,” an expressionpreserved by anatomists of the Middle Agesas the

funis argenteus

. Interestingly, the com-mon Hebrew name for the spinal cord is

khutha-shedra

, meaning the string of the vertebralcolumn, with the lower part of the canal calledthe

parashoth,

or partings (cauda equina). Ofnote, the Talmud also reports the story of anewe owned by Rabbi Habiba (in early 15th-century Spain) that was dragging its hind legs.About this, the rabbi asked, “Perhaps its spinalcord is severed?” (13, 14). Such comments sug-gest an early understanding of the motor ﬁberscarried by this neuroanatomic structure.

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IBLE AND

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Peripheral Nerves

Scant mention of periph-eral nerves,and specificallyof the sciatic nerve, is foundin the Talmud and Old Testa-ment of the Bible. The He- brew term

gid ha-nashe

refersto the sciatic nerve, which is, by Biblical prohibition, not to be eaten.In fact, the Talmudgives precise instructions forthe removal of this nervefrom slaughtered animals(

Chullin

89b ff) (11). The basisof this law is deference for Jacob, who, as found inGenesis (32:25–32), is thoughtto have had an injured sciaticnerve. Interestingly, theHebrew

gid

refers not only tonerves, but also to ligamentsand tendons. Jacob, inGenesis (32:25–32), lost hiswrestling contestwith God(in the form of an angel) perhaps asa result of his injured sci-atic nerve(

Fig. 3

)(7):When the man saw that he could not overpower him,he touched the socket of Jacob’s hip so that his hip waswrenched as he wrestled with the man…. So Jacobcalled the place Peniel, saying, ‘It is because I saw Godface to face, and yet my life was spared’….The sunrose above him as he passed Peniel, and he was limp-ing because of his hip.The term

shigrona

from the Talmud is generally acceptedas referring to sciatica (14). For the treatment of sciatica, theTalmud recommends thatfresh brine be rubbed 60times over painful areas (13,14).I Kings (13:4–6) describeswhat some have viewed asthe healing of King Jerobam’s brachial plexopathy. Leon-S(9) has gone further in eluci-dating this ailment, whichoccurred between 937 and915 BC; he concludes that thecondition was caused byradial nerve injury.Budrys (1) suggests thatthe sudden loss of strength by the strongman Samson, asfound in Judges 13–16, mayindicate an acute inflamma-tory demyelinating polyneuropathy such as Guillain-Barré syn-drome or myasthenia gravis.Luke 5:18–25 describes the healing of a man “which wastaken with a palsy.” In Acts 9:33–34, Peter, Jesus’ disciple, healsparalysis in a man: “and he found there a certain man namedAeneas, who for eight years had been lying on a mat, for hewas paralyzed. And Peter said to him, Aeneas, Jesus Christheals you. Rise up and make up your own bed. And immedi-ately he rose up” (1, 8). In Luke 6:10, Jesus heals the paralyzedupper limb of a man: “and there was a man there, and his righthand was withered….He [Jesus] said to him, Stretch out yourhand. And he did, and his hand was restored.” Another heal-ing, thought to be of a man afﬂicted with cerebral palsy (1), isfound in Acts 3:1–10: “lame from his mother’s womb” whose“feet and ankles instantly were made strong.” Moskopp (11)has commented that the nails driven into Jesus’ hands duringhis cruciﬁxion may have injured his median nerves.

Brain and Meninges

References specifically to the brain are only found in theTalmud. Many rabbis believed that the spinal cord, bone mar-row, and brain were all essentially similar in their constitution,as evident in the Hebrew word

moach

, which refers to both the brain and bone marrow (14). Rabbi Abaye (c. 3rd century)thought sperm originated in the brain, as was also taught byAristotle. Interestingly, Plato thought sperm arose from thespinal cord (13).The area or hair overlying the anterior fontanelle is called the

kodkod

. An example of this term is found in the reference toAbsalom, the third son of King David, in II Samuel 14:25:“…Absalom was very handsome: from the sole of his foot tothe crown [

kodkod

] of his head there was no blemish on him.”The school of Rabbi Yannai indicated that

teﬁllin

(phylacteries)

FIGURE 3.

Jacob Wrestles the Angel

(detail), painted in 1861 by Eugène Delacroix (1798

–

1863

)

(Church of St. Sulpice, Paris)

FIGURE 1.

Title page from a1585 Latintranslation of theGreek New Testament (author’s private collection).

FIGURE 2.

The ﬁrst page of theBabylonian Talmud (TalmudBavli, Vilna edition).

[Jesus] healed them.” Rosner(13) stated that Matthew mayhave also had epilepsy.Interestingly, and without aclear origin, St. John (either John the Baptist or John theEvangelist) was a patron ofthose with epilepsy and, inFrance, epilepsy was referredto as

le mal Saint-Jean

(thesickness of St. John) (1).In the Jewish literature, theMidrash states that a skillfulphysician, and not an exor-cist, should be summonedfor an epileptic (2). In theTalmud, even a single seizureprohibited one from becom-ing a cohen (priest) (13).

Cranial Malformation

References to misshapen crania can be found in the Talmudand perhaps, the Bible

The Mishnah refers to several cranialabnormalities that would render priests unﬁt to serve in theTemple (14). The term

kilon

, used in the Gemara, described ahead that is in the shape of a “keg cover” or egg-shaped.

Liftan

head shapes resemble the head of a turnip that is wide at thetop and grows narrower as one moves downward.

Makban

refers to the shape of a hammer with a markedly protrudingforehead and occiput, which may represent scaphocephaly,attributable to sagittal synostosis. Although a round headwould not cause a person to be prohibited from serving as apriest, it was still thought of as unsightly; the round head wastypical of the Babylonians, who were thought to have unskilledmidwives (14).Some Biblical and Old Testament scholars, includingMoskopp (11), have hypothesized that Goliath, who was slain by David (I Samuel 17), had acromegaly with resultant macro-cephaly, whereas Feinsod (4) states that David may have beenable to approach the giant unnoticed because of a visual defectresulting from a pituitary adenoma. Of note, references togigantism are also found in II Samuel and I Chronicles (11).Although not related to cranial malformations, of note, theterm

sefikas

was used to disqualify potential priests; it wasdescribed as a “receding neck” and may have represented theKlippel-Feil syndrome.

Coma

Some scholars, including Budrys (1), believe that Jairus’daughter, as described in Luke, was in a coma: “He [Jesus]said, Do not weep, for she has not died but is sleeping. Andthey laughed scornfully at Him, knowing that she had died.But He took hold of her hand and called out saying, Child,arise! And the spirit returned and she rose up instantly; and Hedirected that something be given to her to eat” (Luke 8:41–55).should only be worn over this location, understanding that theanterior fontanelle was once the shortest route to the cerebrum.Talmudic sages called it “the place where the brain of a child issoft.” As a result, Aramaean translators interchanged

kodkod

with the word

mocha

, meaning brain (13). Rosner has recalleda story, set in Jerusalem, in which a rooster, thinking that thepulsatile anterior fontanelle of an infant was an insect, peckedout the brain of the child (14).Two coverings of the brain, one hard and one soft, were saidto resemble those that cover the testes. This text further men-tions that the “skin” (arachnoid, dura) of the brain is rich in blood vessels (14).

Cranium

Although the exact term “skull” is not found in these ancientwritings, it is interesting to note that some present-day termsare derived from Biblical events. Our modern term Calvary, aderivative of calvaria, is the purported site of Jesus’ cruciﬁxionin Jerusalem. Calvary, therefore, from the Latin term for cra-nium, is found only in the King James version of the Bible(5)

The Hebrew equivalent is Golgotha (Aramaic

Gûgaltâ

,Chaldean

Gulgalta

, Greek

κρανι′ου το′πος

) i.e., the “place of theskull,” referring to the plateau containing a pile of skulls or toa geographic feature resembling a skull. The traditional identi-fication of the site of Calvary was made by St. Helena, themother of Emperor Constantine, when she found (c. 326) whatwas believed to be a relic of the actual cross on which Jesus wascrucified. This spot, represented by a pile of rocks approxi-mately 5 m high, is inside the Church of the Holy Sepulcher built by the Roman emperor Constantine the Great (18).

NEUROLOGY

Pathology that affects the nervous system that is primarilynonsurgical (at least during the historical era during which theBible and Talmud were composed) can be identiﬁed in both theBible and Talmud. These entities include pathologies rangingfrom epilepsy to coma. The following is an overview of suchdisease processes, as found in these writings.

Epilepsy

Some have thought that descriptions of epilepsy are presentin the Gospels of Luke and Mark (1, 6, 8). For example, “…heteareth him: and he foameth, and gnasheth with his teeth, andpineth away…and he fell on the ground, and wallowed foam-ing” (Mark 9:18–20). Some have also posited that the “thorn inthe ﬂesh” of the Apostle Paul represented epilepsy (

Fig. 4

). Insupport of this notion, Paul rejoiced that the Galatians did notscornfully spit at him, as was often done to epileptics duringthis era (1). Some also believe that, while near Damascus, Saulexperienced a seizure (11). Among his 26 recorded healings, Jesus was known to have healed presumed epileptics (1, 4)(Matthew 4:24): “…News about him [Jesus] spread all overSyria, and people brought to him [Jesus] all who were ill withvarious diseases, those suffering severe pain, the demon-possessed, those having seizures, and the paralyzed, and he

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