What is "Asuvei Yenuka," and how is it comparable to Apiktevizin and
removing a splinter?
(a) RASHI explains that Asuvei Yenuka refers to manipulating the bones and
joints of a baby in order to straighten them into their proper positions.
It is comparable to Apiktevizin because it is a corrective procedure which
involves manipulating the body. In this respect it is also similar to
removing a splinter. (Rashi later (147b), however, says that Apiktevizin
has medicinal properties, and is not merely a corrective procedure, see
Gilyon Hashas of Rebbi Akiva Eiger.)
According to Rashi, it is not clear why the Gemara states, at the end of
the Sugya, that a splinter is not comparable to Asuvei Yenuka because it is
"Lo Pakid." It should have said that a splinter is not part of the person's
body, while Asuvei Yenuka involves adjusting parts of the body!
(b) RABEINU CHANANEL, the BA'AL HA'ME'OR, and the ARUCH explain that Asuvei
Yenuka refers to a disorder in which a certain cartilage or bone in the
upper throat of the child descends into the lower part of the throat
(either the esophagus or trachea). A nurse puts her finger down his throat
to bring the bone back into its proper position. Since the treatment can
cause vomiting, the Gemara compares it to Apiktevizin.
This, too, is difficult to understand. How is this treatment comparable to
removing a splinter? Furthermore, the comparison to Apiktevizin is not
clear, because the nurse had no intention to cause the child to vomit,
making it a Davar sh'Eino Miskaven as far as vomiting is concerned.
The RITVA answers that usually, the nurse causes the child to vomit and
*spit up blood* while vomiting (which is forbidden because of Netilas
Neshamah). Therefore, such an act falls into the category of "Pesik Reshei"
(unavoidably causing a Melachah to be done on Shabbos). The Gemara's
question, then, is whether the Rabanan permitted an act of Eino Miskaven
which *nearly always* causes a Melachah to be done, for the sake of healing
on Shabbos. In this respect it is comparable to taking out a splinter,
which also usually causes blood to flow and is therefore a Pesik Reshei.
(Rav Sheshes, who permits the act to be done, apparently does not consider
it to be a full Pesik Reishei, since it *is* possible that there will be no
bleeding. Nevertheless, he does not permit such an act for non-therapeutic
purposes, since it is *close* to a Pesik Reishei. -M. Kornfeld)
(c) The Rishonim, citing RABEINU TAM, say that the question is whether one
may open a closed duct in order to take something out of it; is such an act
considered healing or not? Thus, the question of the bone that falls into
the throat, the act of causing one to vomit, and removing a splinter are
all questions of opening a closed duct for the sake of healing. The Gemara
answers that the splinter is "Lo Pakid" -- it is not the same as Asuvei
Yenuka because it is merely deposited underneath the skin. It is not
blocking any natural path that will be used as a duct of some sort. The
throat, though, is a duct that needs to be opened.