The Mishnah (28:6) discusses the case of a matlit (patch) that was tameh midras and then added to side of a basket or garment. The Mishnah discusses the status of the main kli and the patch when it is added and then subsequently removed. We shall focus on the second case.
The Mishnah explains that while it is attached to a garment, the garment is metameh shtayim ufoselet echad. Put simply the garment acts as an av hatumah in that, by way of transmitting tumah, it can make two items tameh (a rishon and sheni) and make a third, terumah, pasul (a shlishi). If it is then removed, the patch retains its status as an av ha'tumah, but the garment can only metameh echad ufolel echad. In other words the garment is treated as a kli that was in contact with an av hatumah and is now a rishon le'tumah.
The Bartenura explains that, unlike the case where the matlit was added to the basket, in this case, the matlit never loses it susceptibility and retains the tumat midras. When it is attached the garments, the garment is metameh shtahim ufoselet echad because it is like any other kli that is in contact with a midras.
The Mishnah Achrona, reflects on the Bartenura's comment that the garment is considered like a kli that is in contact with a midras. He explains that this relates to law in the beginning of the fifth perek of zavim that if a person is in contact with a midras, and they touch food, drink or klei shetef then it makes them tameh. The Rash comments there that if a kli was in contact with the midras then it would make food and drink tameh (a rishon). Consequently in our Mishnah the garment would also only make food and drink a rishon le'tumah. However, the entire beged itself is not considered an av ha'tumah, like the matlit, such that it could also make people and keilim tameh.
Recall however that we have learnt (27:7) that if one wove a beged that was three by three tephachim, it become tameh midras, and then the beged was completed, the entire beged is tameh midras. The Mishnah Achrona however explains that this case is different since the matlit in our case is smaller than the beged. We have learnt (24:7) that if two keilim are attached to one another, then the larger of the two define the status of the combined kli. Consequently, in our case the small patch that is added to the beged cannot defined the beged as tameh midras. In the earlier Mishnah, where the small beged was added to until the beged was finished, despite, the original part being smaller than the completed beged, while the original patch was being added to, it was always larger than the addition.
The Rambam however rules that, in our case, the beged is considered an av ha'tumah -- it is considered a midras like the matlit. Considering the Rambam's position, how do we understand the earlier Misnah (24:7) that the larger of the two combined keilim determines the status? The Mishnah Achrona suggest that in our case, since the matlit, is serving to repair the kli, (e.g. plug a hole or mend a tear) its status of tumah can dictate the status of the beged. This explanation would be consistent with the earlier Mishnah (18:7) that discussed the bed leg that was tameh midras and was attached to bed (to repair). In that case the entire bed became tameh midras.
The Mishnah Achrona finally suggests that perhaps the Rash and Rambam are not substantially different. The Rambam simply understands that a matlit is usually added for repairs. The result, as we have explained is the beged itself become an av ha'tumah as in Mishnah (18:17). The Rash and Bartenura however preferred to understand that the Mishnah is referring to all cases where the matlit may be added, not just for repairs. As such, the larger of the two dictates the status of the beged and the beged would only cause food and drink to become tameh since the beged is considered only in contact with the midras.
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