Nedarim 50b ~ Shmuel, Colonoscopies, and the Pillcam

Shmuel: Astronomer and Doctor Extraoirdinaire

Shmuel (c. 165- 257 CE) was a fascinating talmudic rabbi, who lived in Nehardea in Babylon. (Nehardea is located in what is today Anbar province in Iraq, and is under the control of ISIS. Heritage visits are therefore not recommended.)  Shmuel's areas of special interest were medicine and astronomy. He taught that all illnesses could be traced to "the air"  (הכל ברוח)  - or as we might put it today, the environment - and although he was a modest man, he was certain of his medical and astronomical skills.   He claimed to know the cure for  all but three medical conditions, (...כל מילי ידענא אסותייהו לבר מהני תלת) and he declared that he knew astronomy so well that the stars of the sky were as familiar to him as were the streets of Nehardea where he lived.

Although I am as familiar with the paths of the stars as with the streets of Nehardea, I can not explain the nature or the movements of the comets..
— TB Berachot 58b

Abdominal Pains? Swallow This...

In today's page of talmud, Shmuel offers another of his medical teachings - a way to diagnose gastrointestinal disorders.  

 מאי ביצה טורמיטא? אמר שמואל עבדא דעביד לה שוי אלפא דינרי! ומעייל לה אלפא זימני במיא חמימי ואלפא זימני במיא קרירי עד דמתזוטרא כי היכי דבלעיתה. ואם אית כיבא סריך עלה וכד נפקא ואתיא ידע אסיא מאי סמא מתבעי ליה ובמאי מתסי

What is meant by a turmita egg? Shmuel said [that it is such an important diagnostic tool] that  a slave who knows how to prepare it properly is worth a thousand dinars.  He puts the egg into hot water a thousand times and into cold water a thousand times, until the egg has shrunk so that it may be swallowed whole.  If a person has a stomach illness, a residue forms over the egg, and when the patient excretes it, the egg can be examined and the doctor will know which medicine is needed and how to heal the patient....(Nedarim 50b)

All this may seem rather fanciful, but Shmuel was trying to solve a huge problem: when we want to understand how the gastrointestinal system is functioning, how do we look at, and get information from a place where the sun don't shine?  Shmuel devised a remote probe - in his case a hard-boiled egg -  to send in and retrieve the necessary information. Two thousand years later, an Israeli medical device company has updated this idea, and in doing so has revolutionized the way we can investigate intestinal disorders.

The Israeli Pillcam - Shmuel's Idea in Action 

Image of PillCam-Colon2.jpg

One way that your doctor can figure out what is wrong with your gastrointestinal system is to take a look. For a many years, that meant sedation and inserting a scope the width of your index finger down the mouth and into the stomach, or up the rectum and into the colon. But an Israel company has changed all that, using Shmuel's idea (sort of).  Given Imaging, based in Yokne'am, has developed a pill which contains a camera capable of sending high quality images from the depths of your guts straight to your doctor's computer. You just swallow the pill and let it send images from deep inside you.

Normal colon and findings visualized at colon capsule endoscopy. A: Normal colon; B: Diverticula; C, D: Polyps; E, F: Ulcerative colitis. From Spada et al. Colon capsule endoscopy: What we know and what we would like to know. World Journal of  Gastroenterology 2014: 7; 20(45): 16948-16955.

Normal colon and findings visualized at colon capsule endoscopy. A: Normal colon; B: Diverticula; C, D: Polyps; E, F: Ulcerative colitis. From Spada et al. Colon capsule endoscopy: What we know and what we would like to know. World Journal of  Gastroenterology 2014: 7; 20(45): 16948-16955.

There are of course limits to the pillcam technology - for one thing if a lesion is seen in the images, it will need to be biopsied, and that needs an old fashioned endoscopy exam.  But it is a wonderful option for GI doctors and their patients. Perhaps even Shmuel would have been willing to give up his very shriveled hard-boiled egg for the opportunity to swallow a new, shiny, white Israeli pillcam.