The Gastrointestinal Diagnostic Tests of the Talmudic Sage Shmuel
Daniel L. Cohen, MD
Department of Medicine
Jackson Memorial Medical Center
The Talmudic sage Shmuel used a turmita egg and a kulkha stalk in the third century CE to perform two of the earliest examples of diagnostic testing of the gastrointestinal tract. The objects were swallowed whole by the patient, passed through the digestive tract, and examined after expulsion. Similar practices are not recorded in other medical writings of the era. While there is no scientific evidence to support these practices, they are remarkably similar in design to the modern procedure of wireless capsule endoscopy. It is possible that the examination of ancient texts may provide concepts which can be successfully used in developing modern diagnostic and therapeutic tools.
history of medicine, Talmud, Judaism, gastroenterology, capsule endoscopy
The Gastrointestinal Diagnostic Tests of the Talmudic Sage Shmuel
The thousands of pages of the Talmud contain the oral traditions of the Jewish religion. Religious Jews spend their lives scrutinizing the text, which is composed of statements, arguments, and stories of rabbis living during the first six centuries of the Common Era. While the text forms the basis of Jewish law, practice, and morals, it also contains insights into other fields, including medicine.
One of the most prolifically quoted sages, both in general and in regards to medical matters, is Shmuel (Samuel). Shmuel was born in the Babylonian town of Nehardea around the year 180 CE and died around 254 CE . He was educated in the rabbinical academy in Netzivim, and it was probably in this town where he was instructed in medicine. He continued his studies upon returning to Nehardea, and later he moved to Israel where he was physician to Rabbi Yehuda the Prince in the town of Tzippori. Eventually he returned to Babylonia and served as the personal physician of King Shapur I .
A fascinating passage regarding Shmuel involves the field of gastroenterology:
What is a turmita egg? Shmuel said: The slave who can prepare one is worth a thousand denarii. For it must be placed a thousand times in hot water and a thousand times in cold water, until small enough to be swallowed whole. If there is a sore, it clings to it, and when it passes out, the doctor knows what medicine is required and how to treat him. Shmuel used to examine himself by swallowing a kulkha [a stalk], which weakened him so that his household tore their hair .
This passage is remarkable for several reasons. Firstly, it provides two of the earliest examples of diagnostic testing of the digestive tract—the turmita egg and the kulkha stalk. Amazingly, these objects were swallowed whole and passed through the digestive tract. Tests similar to these are not found in the writings of ancient Egyptians or Mesopotamians , or in Hippocrates  or Galen . While their texts often describe symptoms of illnesses and their treatments, cases of active investigation of internal organs are not found. This hints at an intense ambition to perform research and understand the mysteries of the human body .
Not only does Shmuel mention two different objects that could be used for this type of testing, it states that Shmuel himself underwent the procedure. The fact that he was willing to undergo self-examination suggests a dedication and profound belief in the benefits of this practice.
Unfortunately, this technique was extremely onerous, as illustrated by the poetic description of the suffering which Shmuel’s own household endured as he underwent the test. Given the discomfort of the examination, along with the rarity of finding someone capable of preparing a turmita egg, it was probably not a very practical test. Perhaps this is why its use ended.
While Shmuel could interpret the results of the turmita egg, he needed a slave to prepare one, and thus was not able to prepare one himself. This may explain why he used a kulkha stalk on himself instead. This also implies that he learned this test from someone else and did not invent it himself. Most likely he learned it in Babylonia where he studied medicine. The term turmita itself is not Hebrew or Aramaic in origin, and it likely comes from the Greek term trometa, an expression for soft eggs . Shmuel was able to use the kulkha stalk on himself, which may imply a more intimate knowledge of this object, possibly due to inventing its use as a diagnostic tool.
It is not clear from the text what gastrointestinal disease could be diagnosed by these tests, although a “sore” is mentioned. Whether this may be referring to peptic ulcer disease, a malignancy, inflammatory bowel disease, or another condition is not clear. Also it is not recorded how the test objects were interpreted after expulsion, or what therapy was given based on the results.
Given our modern understanding of gastroenterology, it is hard to imagine how these tests could be employed successfully, and it is thus easy to disregard the text as antiquated folk medicine. The basic concept, though, of swallowing an object, passively passing it through the bowels by means of peristalsis, and then examining the object for diagnostic purposes is remarkably similar to a modern diagnostic technique, namely wireless capsule endoscopy.
Wireless capsule endoscopy entails the swallowing of a camera contained within a pill-sized capsule, passage of the camera through the patient’s digestive tract, and examination of the images obtained from the camera. The concept of a swallowable electronic radio-telemetry capsule dates back to the 1950’s [8-10]. However it was never useful until video images could be transmitted with the introduction of wireless capsule endoscopy in 2000 (the Pill Cam, Given Imaging, Yoqneam, Israel) .
In a very short time, this technique became standard practice in the diagnostic work-up of obscure gastrointestinal bleeding and in the identification of small bowel lesions. It is now being studied for esophageal and large bowel disorders as well. While the images are transmitted to a data recorder via radio-telemetry and the actual capsule is not recovered and examined, this procedure maintains an eerily similarity to the ancient practices of Shmuel. Maybe this is because the Pill Cam was developed in Yoqneam, Israel, mere miles from the town of Tzippori where Shmuel lived eighteen-hundred years ago.
This case raises an important issue when discussing medical literature of the ancient world. Many passages contain clearly inaccurate and invalid statements based on a lack of understanding of the workings of the human body and disease states. Does this mean that these works are useless? Using the turmita egg and kulkha stalk of Shmuel as examples, there appears much that we can learn and use from these texts. It is not far-fetched that some of the concepts utilized in these writings can be applied to developing new diagnostic and therapeutic tools to better treat our patients in the modern scientific world.
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2. Babylonian Talmud, Nedarim 50b.
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© Copyright Priory Lodge Education 2007
First Published June 2007