Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com
Chapter 10
DISEASES OF THE PATIENT AND HIS RELATIVES
[ii] Introductory Remarks
[xii] Father
[xiv] Twin Brother
[xvi] Younger Female First Cousin
[xvii] Navigation
The
protograph of the Book of Genesis was not intended to be studied for millennia.
The work was addressed to the authors’ contemporaries, recounting well-known
events from their recent past. Based on the narrative context, a thoughtful
reader understood what the writers were hinting at. Therefore, no specific
dating of the text was undertaken. Realism is achieved through the presentation
of actual circumstances from a familiar history, with only minor manipulation
of facts and embellishment characteristic of fictional prose. To impart even greater
verisimilitude, the authors naturally describe the illnesses of the
protagonists. As a result, their images appear authentic, evoking trust and
empathy. The reader involuntarily searched for similar illnesses and symptoms
in themselves and their close relatives.
Our review of Jacob's illnesses and injuries does not claim to provide a definitive diagnosis. Rather, it represents a modern physician's hypothesis based on a retrospective assessment of an ancient narrative. Even taking into account our specialization, the opinions presented will be more precise than those of a religious commentator relying on translations and speculations of later eras.
[iii]
Information
regarding Jacob's health in the neonatal period is extremely sparse. Assessing
the mother's obstetric history and her delivery of twins, we suggest that Jacob
suffered a birth trauma. This assumption is made on the basis of the
description of the "arm presentation" symptom at birth (Gen. 25:26).
Following arm presentation, we may anticipate fractures of the humerus,
clavicle, or radius, as well as damage to the brachial plexus (1986ТрубниковВФ; 1989СеровВН_МаркинСА; 1994КоржАА_БондаренкоНС; 2005КорниловНВ_ГрязнухинЭГ; 2021CarterE_WrightR). Consolidation of a
humeral fracture sustained during delivery occurs spontaneously within three
weeks, and residual deformities are resolved during the first two to three
years of life (1972Уотсон-ДжонсР). In the case of a birth with an
arm extended forward, one should suspect: abrasions, subcutaneous haemorrhages
on the head, fractures of the cranial vault, subarachnoid haemorrhages, and
brain injuries with concussion or contusion, as well as the formation of an
intracranial haematoma.
The most frequent complications of arm presentation – fractures of the upper limb bones and neonatal cephalohaematomas – are treated conservatively. If Jacob's prototype suffered such birth injuries, general care and swaddling would have been sufficient for fracture consolidation and the resolution of the consequences of head injuries. However, the aforementioned injuries serve as a prerequisite for a complex of neurological pathologies known as cerebral palsy. Explicit signs of this disease are not described in the epic, but we are alerted by the fact that the victim in his adolescence is characterized as "mild", not becoming a hunter like his twin (Gen. 25:27). Apparently, in connection with the complicated birth, Jacob exhibited differences in the dynamics of maturation compared to his brother. The consequences of neonatal traumatic brain injury could manifest in delayed mental and physical development, while neuropathy of the upper limb hindered labor activity. A quiet disposition, birth injury, and residual disability aroused the mother's sympathy, provoking overprotection (Gen. 25:28, 27:8, 43).
[iv] Period: Youth – Early Adulthood
In
his youth, Jacob engaged in manageable labor in the nomadic camp, in
particular, preparing food (Gen. 26:29, 34). In young adulthood, he was
demonstrably involved in slaughtering livestock (Gen. 27:9, 14). He proceeded
on foot for his multi-day journey to Haran (Gen. 28:5, 10, 29:1). Later we
learn that the traveler used a staff while marching (Gen. 32:11). Despite
covering hundreds of kilometers, he managed to reach his destination safely
(Gen. 29:4). On the basis of the above, it is permissible to state that the
function of the lower limb girdle was not grossly impaired. The use of
additional support during walking could have been due to mild spastic manifestations
in the leg muscles. It is known that shepherds use a staff when moving over
rough terrain. However, it cannot be ruled out that Jacob's use of a staff is
explained by a prior trauma, possibly birth-related, with consequences in the
form of cerebral palsy.
During the journey, Jacob moved heavy objects with his hands: "the stone that he put under his head" and "the stone from the mouth of the well" (Gen. 28:18, 29:10). Thus, the traveler possessed satisfactory physical strength. From our point of view, movements of the upper limb girdle, including the hands, were unrestricted. If Jacob's prototype indeed suffered a birth injury, its manifestations were satisfactorily compensated for in young adulthood.
[v]
Jacob
in his prime worked successfully as a shepherd in Northern Mesopotamia (Gen.
30:43). He pastured small livestock and worked with his hands (Gen. 30:36–38).
At the same time, climatic factors – "heat" and "frost" – had
a negative impact on him, and a lack of sleep was observed (Gen. 31:40). There
was a potential danger of attack by predators and robbers (Gen. 31:39).
Information about injuries is not revealed in the accounts of his activities as
a livestock breeder. From what has been read, it can be concluded that disorders
of the musculoskeletal system and significant somatic diseases were absent.
From
Haran, Jacob headed toward his homeland, "to the land of Canaan"
(Gen. 31:17). The head of the family transported his children and wives on
camels and led numerous livestock (Gen. 31:17–18). Managing the movement of the
caravan, he had to travel on foot. This idea is confirmed by the words:
"he fled with all that he had", as well as "he arose and crossed
the river" (Gen. 31:21). After meeting his father-in-law on "Mount
Gilead", Jacob "went on his way" (Gen. 32:2). That is, at least
during the first stage of the exodus from Northern Mesopotamia, no problems
with the lower limb girdle are described. There is no reason to assume impaired
hand or arm function either. During a stop at "Mount Gilead", Jacob
"pitched his tent" (Gen. 31:25). There he also single-handedly lifted
a large stone into a vertical position and slaughtered livestock for a meal
(Gen. 31:45, 54). It appears that he personally had to divide the caravan into
two parts and select animals as a gift for his brother (Gen. 32:8, 14–16).
In the narrative of the migration
from Haran to Canaan, there is an episode concerning the night crossing of the Jabbok
River (Gen. 32:23). Jacob fords the stream and leads his companions to the
other bank (Gen. 32:24). Next, a struggle with a man is described, as a result
of which "the socket of his hip was dislocated"
(1978БроерМ_ЙосифонД,a, Gen. 32:25–26); "thigh was
put out of joint" (1922LeeserI, Gen. 32:26). In the morning, the victim
continues his journey, but limps on "his hip" (1978БроерМ_ЙосифонД,a, Gen. 32:32); "his thigh"
(1922LeeserI, Gen. 32:32). In the following verse, it is explained to us that
during a dislocation, damage occurs to the "sinew of the thigh, which is
on the socket of the hip" (1978БроерМ_ЙосифонД,a, Gen. 32:33): "sinew
which shrank, which is upon the hollow of the thigh … he struck against the
hollow of Jacob's thigh on the sinew that shrank." (1922LeeserI, Gen.
32:33). Nothing else was injured in the bout – neither the head, nor the torso,
nor the upper limb girdle, as at the end of the day Jacob "built himself a
house and made booths for his livestock" (Gen. 33:17).
After some time, the family crosses the Jordan and settles near the city of Shechem (Gen. 33:18). In the description of their subsequent life, it is known that Jacob himself does not pasture the livestock – this task is entrusted to his sons (Gen. 34:5). It appears that his labor activity was constrained by the consequences of the injury sustained at the Jabbok River (Gen. 32:26). Following the confrontation with the townsmen of Shechem, "Ya'akov came to Luz, which is in the land of Canaan" (Gen. 35:6). Here, after communicating with God, he constructs a "stone pillar" (Gen. 35:14). Further, "on the way to Ephrath", Jacob sets up a "pillar" over the grave of his deceased wife and pitches "his tent beyond Migdal-Eder" (Gen. 35:20–21). A brief summary of the patient's deeds in mature age demonstrates the preservation of walking function and the absence of upper limb pathology. The primary source reports no diseases of the internal organs or sensory organs.
[vi] Period: Late Adulthood – Old Age
We
calculate Jacob's elderly period from the moment of his return to Mamre city of
Kiryath-arba, that is Hebron, where Abraham and Isaac had sojourned" (Gen.
35:27, 37:1). In describing the sufferer's life, Joseph is mentioned as the son
of "his old age" (Gen. 37:3). Jacob no longer works in the field
himself. The livestock is pastured by his sons, who also engage in harvesting
grain crops (Gen. 37:2, 7, 12). The head of the family stays at home and
manages household activities (Gen. 37:13–14). In connection with the above, a
deterioration in his state of health is assumed. This could have been the
progression of a dystrophic pathology of the injured hip joint (Gen. 32:26).
There is no clarity on this matter.
After
almost 20 years, Joseph asks his brothers about their father: "is your
aged father well" (Gen. 43:27). Judah replies concerning him: "we
have an aged father" (Gen. 44:20). This statement is made immediately
prior to Jacob's relocation to Egypt (Gen. 46:6). Into the Nile Valley, the
children carry their father in a wagon (Gen. 45:19, 27, 46:5). The family sets
out from Be'er-Sheba (Gen. 46:5). In a straight line from this settlement to
the nearest branch of the Nile, it is approximately 340 km. For an elderly
person, it is undoubtedly difficult to cover such a distance on foot.
According
to the authors' chronology, 17 years after arriving in Egypt, Jacob fell ill
(Gen. 47:28, 48:1). Noticing a significant deterioration in health, he pondered
death (Gen. 47:29–30). This could have been, for instance, the terminal stage
of a severe chronic illness, a prolonged episode of ventricular arrhythmia, or
a hypertensive crisis. Joseph visits his father and sees that he is in bed
(Gen. 48:2). The writers omit the details of the ailment. Their silence is
understandable, but ancient Egyptian literary monuments can help elucidate it.
In the Story of Sinuhe (Middle Kingdom) we find: "For old age has come;
feebleness has overtaken me. My eyes are heavy, my arms weak; my legs fail to
follow. The heart is weary; death is near. May I be conducted to the city of
eternity!" (2006LichtheimM). In another translation of the Story of Sinuhe
we read: "old age has approached: weakness has overcome me, my eyes are
heavy, my arms have grown weak, and my legs no longer obey my weary heart. I am
approaching departure, and they will lead me to the city of Eternity"
(1978КоростовцевМА). In
the Instruction of Ptahhotep (Old Kingdom) we find: "O Prince, my Lord,
the end of life is at hand; old age descendeth [upon me]; feebleness cometh,
and childishness is renewed. He [that is old] lieth down in misery every day.
The eyes are small; the ears are deaf. Energy is diminished, the heart hath no
rest. … Command me, thy servant, therefore, to make over my princely authority
[to my son]. Let me speak unto him the words of them that hearken to the
counsel of the men of old time; those that hearkened unto the gods."
(1908BattiscombeG). In another rendition of the Instruction of Ptahhotep it is
stated: "Age is here, old age arrived, Feebleness came, weakness grows,
Childlike one sleeps all day. Eyes are dim, ears deaf, Strength is waning
through weariness. The mouth, silenced, speaks not. The heart, void, recalls
not the past, The bones ache throughout. Good has become evil, all taste is
gone. What age does to people is evil in everything. The nose, clogged,
breathes not, Painful are standing and sitting." (2006LichtheimM).
From
the dialogue between Joseph and Jacob, we learn that the patriarch meets his
grandsons for the first time during their blessing (Gen. 48:8, 10–11). Here a
doubt arises for us as to whether Jacob had actually lived in Egypt for 17
years by this point (Gen. 47:28). This figure appears to us to be an
intervention in the text by later editors. Joseph's sons were born "before
the year of famine came" (Gen. 41:50). The specified fact is confirmed by
Jacob himself, uttering the words: "your two sons, who were born to you in
the land of Egypt before my coming to you in Egypt" (Gen. 48:5).
The
bountiful period of high agricultural yield lasted 7 years (Gen. 41:47–48). It
seems natural that the firstborn Menasheh was born approximately one year after
Joseph's marriage, and Ephraim another 12 months later (Gen. 41:45, 51–52).
Then "the seven years of famine began" (Gen. 41:54). In the second
year of the socio-climatic disaster, Jacob is invited to Egypt, for we read:
there were "still five years of famine (ahead)" (Gen. 45:11, 19).
Thus, Menasheh was 8 years old, and Ephraim was 7 years old. Further, mention
is made of Jacob's migration to the banks of the Nile and his 17-year residence
there (Gen. 46:28, 47:1, 27–28). "And the time drew near for Isra'el to
die" (Gen. 47:29). At that specified moment, Menasheh had turned 25 years
old, and Ephraim 24 years old. As scions of a noble family, the young men
should have completed their education by age 20, worked, and provided for their
own families (2016ДжарманОА_МикиртичанГЛ).
Joseph
comes with his sons to visit his sick father (Gen. 48:1–2, 8–9). At the same
time, he takes his offspring by the hand like young children, brings them to
his blind father, and leads them away when required (Gen. 48:12–13). The
unnaturalness of the situation is complemented by the process of blessing. The
blinded man crosses his arms and places them precisely on the heads of his
grandsons (Gen. 48:14, 17–19). In conclusion, Jacob "remembers"
capturing land from the "Emorite" with his sword and bow (Gen. 48:22).
Meanwhile, according to the text, the patriarch never encroached on foreign
territory and never fought as a warrior. Moreover, he managed to settle
conflicts peacefully and purchase land (Gen. 31:53, 33:10, 19, 34:30). The
briefly reviewed fragment of the chapter resembles an ideological insertion
with gross manipulation of dates. If one reads the book in fragments with
intervals and unintentionally erases part of what was read from memory, the
contradictions will be imperceptible. We have encountered similar
recommendations.
Apparently,
the exacerbation of Jacob's chronic illnesses occurs shortly after moving from
Canaan. In that case, the consequences of the Minoan eruption could have
worsened his state of health. The Book of Genesis reports that "the eyes
of Israel were dim with age, so that he could not see" (Gen. 48:10).
Blindness was widespread among the inhabitants of the Nile Valley during the
dynastic period. "Various eye diseases from which the Egyptians suffered
in antiquity, evidently no less than modern inhabitants, occur as a result of
dirt, dust, and mass quantities of fine sand raised by dry and hot winds"
(1926МатьеМЭ).
Ophthalmic complaints caused by environmental conditions were constant problems
for the ancient Egyptians (2016LordC). According to surgeon D.-J. Larrey's
observations of Napoleon's French soldiers in Egypt, blindness was caused by
eye infections, bright sunlight, sand dust, nighttime hypothermia, and high
humidity in marshy areas. As the Napoleonic physician noted, eye diseases
developed over a short period of time and required treatment (1803LarreyDJ).
It
is considered that exposure to dust, ultraviolet radiation, dryness, and high
temperature play a role in the formation of pterygium, which manifests with
redness, a sensation of "sand in the eyes", astigmatism, and
decreased visual acuity (2003NolanTM_WakefieldD; 2015YuX-Y_LuXH). Exposure to
dust can cause lacrimation, blurred vision, foreign body sensation, dry eyes,
subconjunctival haemorrhage, and conjunctival hyperemia
(2021KatipoğluZ_ZenginN). Daily exposure to dust is associated with an
increased risk of corneal damage (2018XiangP_MaLQ). It has been noted that
long-term contact with volcanic dust causes eye redness, pathological discharge
from the palpebral fissures, foreign body sensation, and itching
(2005KimuraK_IsashikiM). Following a volcanic eruption in South America in
1991, volcanic dust was deposited for several months and led to the death of
sheep and blindness in part of the bird population (1995InbarM_SalaniFM).
During flights in search of food, it was impossible for them to close their
eyes, which clogged the latter with ash microparticles. In view of unfavorable
conditions for the organs of vision, ophthalmology in Egypt arose no later than
the Old Kingdom. Among the Pharaoh's court servants of that time, the eye
physician of the Great House Irenekhet Niankhpepi is known to us
(1974PorterB_MossRLB).
Meanwhile,
blindness in Jacob's prototype could have been caused by trachoma – a chronic
bacterial infection. The development of mature "age-related"
cataracts in both eyes or terminal-stage chronic angle-closure glaucoma cannot
be ruled out. Blindness struck Jacob in Egypt, whereas prior to moving to the
Nile Delta he distinguished objects, as we read: "he saw the wagons that Joseph
had sent" (Gen. 45:27). After arriving in Egypt, "Israel said to Joseph:
Now let me die, since I have seen your face" (Gen. 46:30). It must be
assumed that upon meeting Pharaoh, Jacob distinguished contours or even saw his
interlocutor (Gen. 47:7–10). After describing several scenes, mention follows
of the patriarch's blindness (Gen. 48:10). This implies a rapid reduction in
visual acuity, which fits the hypothesis regarding the influence of adverse
factors characteristic of Egypt and dust from the Santorini volcanic explosion.
The
narrative of the blind, aged Jacob fitted well into the ancient Egyptian
literary tradition. Blindness is mentioned in the utterances of the Pyramid
Texts (1952MercerSAB). Linguists have noted: "eye diseases seem as common
among Egyptian gods as among the ancient Egyptians" (2008МеексД_Фавар-МеексК). In the Story of Sinuhe we find:
"weakness has overcome me, and my eyes are heavy" (1978КоростовцевМА). In the Instruction of Ptahhotep
it is stated: "Eyes are dim, ears deaf, strength is waning through
weariness" (2006LichtheimM). Excerpts from fictional works illustrate
Jacob's condition in the final period of life. He meets Joseph sitting on his
couch, and having made a prophecy to his sons, "he drew up his feet into
the bed and expired" (Gen. 48:2, 49:33).
At
the end of his life, Jacob suffered from a certain somatic disease (Gen. 48:1).
This did not prevent him from making several dispositions and announcing a
testament (Gen. 47:29–30, 48:21–22, 49:3–32). On the basis of the above, we
conclude that Jacob died not as a result of trauma or suddenly, for instance
from a coronary event. Immediately before death, the patient was conscious and
faded gradually. He lived a long, vivid life and, according to the Book of Genesis,
was a long-liver, reaching the age of "one hundred and forty-seven
years" (Gen. 47:28).
Thus, the reliably differentiated pathologies of Jacob are blindness and an injury to the hip joint. Complete absence of vision implies bilateral ocular involvement. The exact nature of the disease cannot be established. The preferred diagnosis is "ophthalmopathy" due to exposure to dust and ultraviolet radiation. Significantly more clarity exists regarding the damage to the hip articulation. Of course, it is unknown which specific joint was affected: the right or the left. However, the medical writer described the symptomatology, pathological anatomy, and even the differential diagnosis of the injury in exceptional detail for a non-scientific work. Presumably, he saw this as his main mission when working on the Book of Genesis.
[viii]
Terach, son of Nachor, son of Serug (Gen. 11:22–24). He was a "long-liver", dying at the age of "two hundred and five years" (Gen. 11:32). The cause of death has not been established. It is known that he died after migrating from "Ur-Kasdim" to Haran (Gen. 11:31). It is thought that the departure from his homeland was prompted by the plundering of Ur by the army of King Samsu-iluna around 1740 BCE. In a straight line from Ur to Haran, the distance is approximately 930 km. Decompensation of cardiovascular system activity as a consequence of the arduous multi-month journey, stress, and possibly injury cannot be ruled out.
[ix]
The name of Terach's wife, her lifespan, and her past medical conditions are unknown. Naturally, she was the mother of Abraham's prototype, Jacob's grandfather. At the same time, the primary source states: "Terach begot Abram, Nachor, and Haran" (Gen. 11:27). The initial absence of the female principle figures in ancient Egyptian theology, according to which all creation is brought forth by a male deity. Evidence that the god Atum self-fertilized is present in an utterance of the Pyramid Texts, dating to 2350–2175 BCE (1952MercerSAB). According to the Shabaka Stone, the god Atum created the Great Ennead [of gods] (2007РакИ). In the Book of Knowing the Creations of Ra and of Overthrowing Apophis, we read the words of the supreme god Ra-Atum: "That which I spat out was Shu, that which I spouted out was Tefnut" (2021МюллерМ). By analogy with the ancient Egyptian Atum and Terach, it will be stated below in the Book of Genesis: "Abraham begot Isaac" (Gen. 25:19).
Abraham,
son of Terach, son of Nachor, was a long-liver who lived 175 years (Gen. 25:7).
There is no information regarding his somatic diseases and injuries. At the
same time, the text contains signs of a psychotic disorder. Our preliminary
conclusion is based on the fact that he was frequently unable to distinguish
between what was absent and what was actually occurring. Such a pathology is
commonly termed psychosis. According to the World Health Organization's
interpretation, this condition is characterized by disorders of thinking,
perception, and emotions, which "may be acute, transient, chronic, or
episodic, arising as a primary disorder, such as schizophrenia, or as part of a
mood disorder, such as depression or bipolar disorder, or secondarily due to
conditions such as alcohol or drug abuse, somatic diseases (e.g., HIV/AIDS, cerebral
malaria), or neurological disorders (e.g., dementia and stroke)" (emro.who.int). In the modern understanding of
psychosis, the American Psychological Association and the World Health
Organization hold that a diagnosis of psychosis requires the presence of
hallucinations (without insight into their pathological nature), delusions, or
both hallucinations without insight and delusions (2015ArciniegasDB).
Given
the retrospective nature of the diagnosis and the insufficient amount of
verified information, Abraham's illness may be classified as "Psychosis of
unspecified etiology" with code F29 according to the International
Classification of Diseases, Tenth Revision (1992WHO). Analysis of our primary
source allows us to clarify the nature of Jacob's grandfather's ailment only to
a certain extent.
Abraham
arrives with his father and settles in Haran (Gen. 11:31). In our opinion, he
was over 25 years old at that time. Here Abraham first "hears" a
voice in the form of a monologue that does not originate from an external
source. In the Book of Genesis, we find: "And the Lord said to Abram: Go
forth from your land, from your kin, and from your father's house" (Gen.
12:1). He perceives an auditory imperative hallucination as objective reality.
Due to a loss of insight into his condition, he genuinely believes in the
necessity of executing the instructions and considers it impossible to disobey
them. "So Abram went, as the Lord had told him" from Haran (Gen.
12:4). Having reached Canaan, namely "to the place of Shechem, unto the
terebinth of Moreh", again "the Lord appeared to Abram and said: to
your offspring I will give this land" (Gen. 12:6–7). We evaluate the
narrative as a verbal hallucination that "transmits" a neutral message,
yet engenders the desire to construct an altar. The first was erected near
Shechem, and the second east of Beth-el (Gen. 12:7–8). The actions appear to be
driven by delusions accompanied by obsessive desires to perform rituals
intended to "propitiate" the repeatedly heard voices. Today, this may
appropriately be viewed as an attempt at psychotherapeutic self-treatment – unconscious,
but sometimes, by coincidence, "effective".
After
leaving Egypt, Abraham "settled in the land of Canaan" (Gen. 13:1, 12).
Notably, according to the writers, the surroundings of the Jordan are described
"like the garden of the Lord, like the land of Egypt" (Gen. 13:10).
The impression arises that the epithets were intended for Egyptian and Asian
readers. The latter knew from the poem "Enki and Ninhursag" about the
location of paradise "in the land of Dilmun", according to
Sumerian-Babylonian beliefs – the "land of immortality"
(1981KramerS).
Abraham
establishes himself in the southern Levant at approximately 38–39 years of age.
Here, an auditory imperative hallucination recurs: "The Lord said to Abram
after Lot had separated from him: Raise your eyes and look from the place where
you are now … arise, walk through the land" (Gen. 13:14–17). Once again,
he acts in accordance with an imaginary command and prepares a ritual site:
"And Abram moved his tent, and came and settled in the terebinths of
Mamre, which are in Hebron; and he built an altar there" (Gen. 13:18).
Here hallucinations reemerge for him, but in a more complex form. Abraham
imagines extended dialogues and bargaining with a supernatural entity:
"the word of the Lord came to Abram in a vision, saying: Fear not, Abram,
I am your shield; your reward shall be very great. And Abram said: Lord God,
what will You give me?" (Gen. 15:1–2). He becomes entrenched in the false
belief that God has "given" the land "from the river of Egypt to
the great river, the River Perat" and the
right to dominate a dozen ethnic groups (Gen. 15:18–21). The delusion recurs
later, though in a more modest form: "I will give to you and to your
offspring after you the land of your sojourning, all the land of Canaan"
(Gen. 17:8).
After
some time, Abraham hallucinates again. By this moment, his son Ishmael is born
(Gen. 17:15). According to our calculations, the father was over 44–45 years
old. The internal voice proclaims: "I will establish My covenant between
Me and you, and will multiply you exceedingly" (Gen. 17:2). A delusional
idea of changing his own name and his wife's name arises (Gen. 17:5,15). God
"demands" the mandatory performance of penile foreskin circumcision
within the tribe (Gen. 17:11–14). This is followed by the "promise"
of offspring from a woman of advanced age (Gen. 17:16–17). The thought
synthesized in the delusion prompts action, resulting in the circumcision of
all males in the tribe (Gen. 17:23). The specified events presumably take place
in the southern Levant near the desert (Gen. 16:7). Here Abraham wanders and
pastures his livestock. Moving further north, the patriarch again experiences a
vivid hallucination: "The Lord appeared to him in the terebinth of Mamre …
in the heat of the day" (Gen. 18:1). Abraham looks up and "sees"
that "three men are standing near him" (Gen. 18:2). Extended
dialogues follow below. Abraham "hears" how "Sarah laughed
within herself, saying: After I have grown old, shall I have pleasure?",
as well as the thoughts of God: "Shall I hide from Abraham what I am about
to do?" (Gen. 18:12, 17). Sitting by his tent in Hebron, he
"observes" how the men "went toward Sodom", and then he
"stands before the Lord" (Gen. 18:1, 22). Their discussion begins,
culminating in the deity's departure and Abraham's return "to his
place" (Gen. 18:23–33).
Mention
of the "heat of the day" in the Old Testament narrative indirectly
points to a high probability of overheating in an elderly person's organism. A
patient with classic heat stroke has been documented who presented with
impaired consciousness and reversible downbeat nystagmus as part of a
cerebellar syndrome. Downbeat nystagmus is a central type of nystagmus, defined
as nystagmus in the primary position with a fast downward phase and a slow
upward movement. The nystagmus is maximal in downward gaze, and its intensity
can be enhanced by a lateral oblique downward eye position
(2005DeleuD_ZalabanyHA).
According
to J.R. Keane (2006), triplopia was observed in 85% of patients with eye
movement disorders. Triple vision is a rare complaint, so unlikely from an
anatomical perspective that it is frequently considered a diagnostic symptom of
hysteria. Oculomotor dysfunction was identified in 11 out of 13 patients,
including third cranial nerve palsy in five patients, internuclear
ophthalmoplegia in four, and sixth cranial nerve palsy in two. The underlying
causes were: brainstem infarction in four patients; ischemic mononeuropathy,
trauma, surgical intervention, and hysteria in two patients in each category,
as well as a tumor in one patient. In the cited study, the majority of patients
with triplopia exhibited eye movement disorders (11/13 [85%]). In eight (62%)
of the 13 patients, triplopia appeared to be a novel interpretation of
oscillopsia or binocular diplopia, whereas the remaining five patients (38%)
presented with monocular diplopia or triplopia as a functional complaint, with
or without oculomotor movement disorders (2006KeaneJR).
In
Case 8 of the Edwin Smith Papyrus, strabismus associated with brain trauma is
described (1930BreastedJH). In such a pathology of the visual organs, a person
sees a duplicated image. Without interruption, a new colorful visual-auditory
hallucination arises in the biblical narrative. It features not three, as
before, but "those two angels" (Gen. 19:1). The violent intentions of
the inhabitants of Sodom, the demand for the handover of Lot's nephew's guests,
and the mob attack are described (Gen. 19:1–10). With his inner eye, Abraham
sees how the perpetrators are blinded by angels, and for some reason "from
the small to the great" (Gen. 19:11). It remains unclear why children are
deprived of sight. It is difficult to comprehend why in Abraham's thoughts not
only the settlement of Sodom is destroyed, but also Amora, as well as what
"their sin" appeared to be in his painful fantasy (Gen. 18:20, 19:23–28).
The hallucination continues, and Abraham, like in a motion picture, observes
the details of Lot's cohabitation with his daughters, hears their
conversations, sees the newborn children, and learns that they will become the
founders of the tribes of the "Moabites" and "Ammonites"
(Gen. 19:30–38). Reading these lines, one comes to understand that the medical
writer describes in detail the images and sounds generated by the brain of a
sick person in psychosis.
Apparently,
to indicate chaotic behavior, the character's location changes. For an unexplained
reason, Abraham leaves the bountiful terebinth grove of "Mamre" and
settles further south, "between Qadesh and Shur", in "Gerar" (Gen. 18:1, 20:1). Shur was located before
"Egypt, as you go toward Asshur", in a desert area with scarce wells
(Gen. 16:7, 20:14, 25:18). In this unfavorable territory with a hot, dry
climate and a lack of water, perseverations arise in Abraham. A scene appears
in his mind in which he calls his wife his sister, as he once did in Egypt
(Gen. 12:13, 19, 20:2). He imagines King Abimelech's dream: apologies and the
payment of heavy compensation, the development of female infertility, and
immediately thereafter their miraculous healing (Gen. 20:3–18). Abimelech
returns the wife to Abraham, almost repeating the deeds of Pharaoh (Gen. 12:19,
20:14).
Perseveration
is the inappropriate continuation or repetition of a response or action. This
distortion is associated with various neurological disorders and, when
pronounced, is considered a pathognomonic sign of brain damage
(1995HotzG_Helm-EstabrooksN). Perseveration is a "very common behavior
associated with neurological brain disorders. … Speech-language pathologists
and other specialists working with individuals who have suffered neurological
events such as strokes and traumatic brain injuries, as well as progressive
neurological disorders such as Parkinson's disease and certain forms of
dementia, are well aware of the prevalence of perseveration in these
populations" (2004Helm-EstabrooksN).
After
the birth of Isaac, another auditory hallucination of Abraham is narrated:
"God said to Abraham: Be not distressed on account of the lad and your
bondwoman" (Gen. 21:2, 12–13). At present, it appears to us that he was
58–59 years old. Below, the author presents us with a typical delusion of
control. Abraham develops an unshakable conviction that his actions are being
directed by an external force. He "hears" the instruction: "Take
your son, your only son Isaac, whom you love; and go to the land of Moriah, and
offer him there as a burnt offering upon one of the mountains of which I shall
tell you" (Gen. 22:2). Abraham submissively obeys and, in a psychotic
state, attempts to kill his own offspring (Gen. 22:6–12). Sarah's attitude
toward what is happening is omitted in the text, as are the experienced
sensations of the lad lying on the altar (Gen. 22:9). The insane reaction to a
perceptual deception culminates in another auditory hallucination in which the
inner voice blesses Abraham (Gen. 22:15–18). By coincidence or as a result of
psychological trauma experienced, Sarah dies shortly thereafter (Gen. 23:2).
The
tale of Abraham's attempt to sacrifice his son is not condemned by the
narrator. Apparently, human slaughter is perceived by him as legitimate and as
a means of interacting with the deity. During the First Dynasty (ca. 3078–2900
BCE), the sacrifice of servants was practiced in Abydos (2024CampbellRA).
Ancient Egyptian depictions of ritual murders, strangulation, and burning of
people have survived (2021МюллерМ). At the fortress of Mirgissa near the Second Cataract of the Nile, a
ritual burial was discovered containing the skull of a tortured person from the
Middle Kingdom era (1963VilaA). In the palace area of Avaris, an early 18th
Dynasty burial was excavated, yielding animal skeletons and dismembered human
remains associated with a religious context (2010FuscaldoP). Human sacrifice
among the Egyptians "existed in an earlier period, since later the gods
were given cakes in the shape of humans and animals as a universally recognized
substitute for human victims" (2021МюллерМ).
Artifacts
associated with human sacrifice have been identified during excavations in the
Sumerian cities of Ur and Kish; at Syrian sites such as Tell Umm el-Marra,
dating to 2500–2200 BCE; at Shiyukh Tahtani from the mid-third millennium BCE;
at Ebla from 2000–1900 BCE; and in the Levant at Jericho, dating to 1750–1650
BCE, with emphasis typically placed on young people and animals (2015RechtL).
In the Atrahasis Epic, it is stated that the assembly of the gods decided to
kill the god "We-ila", and from his flesh and blood mixed with clay,
"seven males were made and [seven] females were made"
(1999LambertWG_CivilM). In Sumerian Ur, the royal burial ritual was accompanied
by human sacrifices. "The number of victims ranged from five or six to
seventy or eighty individuals" (1961ВуллиЛ).
Surveying
the psychotic symptomatology and context, one must note the absence in Abraham
of signs of cognitive impairment, amnesia, or motor/speech deficits of the
limbs. He works extensively, travels, and communicates. He exhibits prolonged
periods without manifestations of psychosis. At least, the writers present for
our consideration a limited number of episodes of inappropriate behavior and
hallucinations. Over time, the frequency of psychotic disorders increases
markedly. Their manifestations become more pronounced and destructive. In
individual cases, the exacerbation of the condition can be linked to an
increase in environmental temperature. Hallucinations occur upon falling asleep
and during waking hours, and a hallucinatory change of his own name is also
noted. With the disorder of the mental sphere, the family microclimate
deteriorates and anxiety grows, especially after the demise of his wife.
Abraham did not escape brain disease and suffered severely. Creating a cult on
the basis of pathological phenomena is sacrilegious.
The
sage Amenemope, who composed during the reign of Amenhotep III (1391–1354 BCE),
advocated respect for individuals with intellectual and physical disabilities:
"Do not laugh at a blind man nor mock a dwarf, nor disrupt the condition
of the lame. Do not tease a man who is in the hand of God, nor frown at him if
he errs" (2011KozmaC_LachmanR). The moral instructions of the ancient
Egyptians appear to have been reflected in the attitude of the Book of Genesis's
authors toward Abraham's character. The reader does not perceive the mockery of
an ancient Egyptian physician, but merely finds symptoms of a mental disorder.
The medical writer fully adheres to the essence of Immanuel Kant's (1724–1804)
aphorism: "The starry heavens above me and the moral law within me"
(2015КантИ).
The
authors unleash a stream of clouded consciousness upon the reader. Plots and
locations change constantly, like views in a kaleidoscope. The alogism of the
scenes, the survey of the future followed immediately by a look into the past
from the future, does not in the least disturb the narrator. The text resembles
intricate weaving. Outright fiction stands alongside realistic material. Facts
are shuffled like a deck of cards, reflecting a "jumping" thought
process. In places, the reader fails to understand where the character is
located, what is true, and what is false. Apparently, the task of the authors
was to convey the state of the mental sphere of a mentally ill individual. To
this end, the hero is attributed numerous symptoms of brain damage, but they
are not systemized as in a medical monograph. The composite image of the
patient appears natural. The signs of the disorder in a general form are
recognizable and clearly distinguishable from the norm. Delusions and
hallucinations are interspersed with confabulations – the automatic invention
of information of an autobiographical and episodic nature. In the presented
turbulence of thoughts, it is irrational to seek any meaning. This is a
psychiatrist's experiment captured in a work of fiction.
Today,
during a consultation, doctors present "Rorschach inkblots" – symmetrical
inkblots – and ask patients to explain what they see, thereby revealing
emotional conflicts and hidden motives. An Egyptian physician offers his own
speculative test in which, instead of images on papyrus, there is a selection
of verbal pictures. Depending on the answers to subsequent questions, he
established a diagnosis for the patient, identifying defects in thinking,
attention, and memory, both short-term and long-term. The multitude of diverse
commentaries on the Book of Genesis is akin to a compilation of questionnaires
from individuals tested by a psychiatrist. Their analysis in both age and
temporal aspects provides excellent material for a medical dissertation.
Primary
psychoses develop in a subgroup of the population with genetic and epigenetic
risk factors under sufficient exposure to triggering stimuli. Secondary
psychotic disorders occur in individuals with Alzheimer's, Parkinson's, and
Huntington's diseases, diffuse Lewy body disease, frontotemporal degeneration,
prion and cerebrovascular diseases, traumatic brain injury, neoplasms, HIV
infection, and substance use (2015ArciniegasDB). Physicians of ancient Egypt
could observe psychoses with delusions and hallucinations without the patient's
insight into their condition. This conclusion is made based on the analysis of
the Edwin Smith Papyrus, which describes victims with acute traumatic brain
injury and its consequences, manifested by: facial expression distortions with
changes in the width of palpebral fissures, stupor, disorientation, aphasia,
deafness, tearfulness, lameness, impaired coordination, and loss of ability to
perform specific movements (1930BreastedJH).
Indirect
evidence of brain damage in ancient Egyptians also exists from archaeological
sources. In particular, the skull of a 30–35-year-old male who lived during the
Old Kingdom (2687–2345 BCE) was discovered, exhibiting signs of multiple bone
metastases of cancer (presumably carcinoma or myeloma) with traces of
intravital incisions (2024TondiniT_CamarósE). Other skeletal signs of tumor
formation in the head region have been identified in Egyptians from various
eras. On a skull dated to the First Dynasty, traces of cavernous hemangioma or
osteoangioma were found; from the New Kingdom, there are specimens indicating
meningioma and carcinoma metastasis; from the Late Period, a case of possible
hemangioma or osteoangioma has been recorded (1987PahlWM_El-MeligyM). In the
Kasr al-Ainy Medical Museum in Egypt, three trepanned skulls from the pharaonic
period are preserved, proving that patients survived this procedure
(2014Collado-VázquezS_CarrilloJM). The presence of trepanation skills of the
cranial vault among Egyptian surgeons is indirectly confirmed by a case of
successful opening of the frontal sinus of a patient with sinusitis in
2181–2160 BCE (2025FujitaH_ShinDH). Fourteen trepanations from the dynastic
period are known, which could have been performed to obtain fetishistic
objects, as therapeutic procedures for skull fractures, in the treatment of
mental disorders, or to "release demons" (1998SullivanR). Thus,
malignant tumors and injuries are documented among the ancient Egyptians,
meaning that physicians encountered psychotic phenomena.
In
Abraham, "spiritistic" communication was initially recorded at a
young age. Having lived to an advanced age, the patriarch continues to
periodically perceive the voices of super-beings and converse with them. A
history of cranial trauma is absent, which could otherwise account for the
formation of a chronic haematoma with subsequent inappropriate behavior. A
rational explanation is brain damage caused by a slowly expanding, relatively
benign space-occupying lesion. It appears that the occult phenomena in
Abraham's prototype were caused by a parasitic cyst that sometimes forms inside
the cranium in specific diseases of livestock herders: cysticercosis and
echinococcosis (1980XuZ_ZhongH; 2007AsriF_GhannaneH; 2017DaSilvaVBR_DeLimaMDCA;
2020LakhdarF_ChaouiM). As we recall, the patriarch "was very rich in
livestock", possessing "flocks and herds", camels, and donkeys
(Gen. 12:16, 13:2). Apparently, this was the cause of the parasitic disease.
Domestication of animals, pasturage, and livestock breeding created the
potential opportunity for human infection with zoonotic diseases transmitted
from animals, aggravated by poor sanitation and personal hygiene in the 2nd
millennium BCE (2026ArnottR).
Wild
and domestic ungulates and canids participate in transmitting the pathogenic
agent causing echinococcosis to humans (2009MoroP_SchantzPM). Systematic
autopsy revealed echinococcosis in sheep, goats, camels, and cattle, and
cysticercosis in cattle, goats, and sheep (1978DadaBJ_BelinoED). Cysticercosis
is predominantly acquired from pigs and cattle (2005EliasFM_AraújoNSD;
2013ZammarchiL_COHEMI PSG; 2014ToddECD). In the soft tissues of a mummy from
the period of Pharaoh Sethnakhte, who ruled in 1196–1194 BCE, traces of four
parasite species were discovered, including a Trichinella spiralis cyst,
indicating the consumption of undercooked pork (2014ClarkeEM_ThomasGS;
2015MichalikDE_ThomasGS). In the Book of Genesis, a dietary prescription
reducing the risk of developing anthropozoonotic pathologies appears to be the
prohibition against eating raw and insufficiently heat-treated animal flesh
containing blood, as well as consuming blood itself (Gen. 9:4).
Tapeworms
whose larval stages cause echinococcosis and cysticercosis have been known
since the beginning of written human history (2005MillerNR_NewmanNJ). According
to retrospective analysis, the physical condition of the inhabitants of Avaris
was poor, and a significant portion of the men were immigrants from other
regions. Anemic diseases, most likely caused by parasites, affected no less
than a third of the population (1996BietakM). In the Ebers Papyrus, written at
the decline of the Hyksos rule, helminths are mentioned, among which one can
unequivocally identify: roundworms (A. lumbricoides), pinworms (Enterobius
vermicularis), Guinea worms (Dracunculus medinensis), and tapeworms
(2004CoxFEG).
Currently,
the earliest archaeological finds associated with echinococcosis in Egypt date
to the 8th century BCE (2022LedgerML_MitchellPD). A case of gastric
cysticercosis is known in a mummified Egyptian woman who lived in the 2nd–1st
centuries BCE (2006BruschiF_FornaciariG). There is no reason to assert that
Egyptians in the Old and Middle Kingdoms did not suffer from cysticercosis and
echinococcosis lesions. Given the ancient practice of animal husbandry in
Mesopotamia, the aforementioned parasites spread across its territory. Their
larvae could have been transported to the banks of the Nile by livestock and
migrants. It has been established that mental disorders involving
disorientation, stereotyped movements, screaming, and hallucinations are
described in ancient Mesopotamian texts (2006ScurlockJ). A portion of these
psychoses may appropriately be explained by helminthic infection.
Clinical
manifestations of intracranial echinococcosis usually arise in late stages,
several years after initial infection, partly due to the slow growth of the
cyst. Impairment of visual function is the primary complaint, and cranial nerve
palsies may also develop. Ocular cysticercosis affecting the eye, orbit, and
optic nerve has also been described. Neurocysticercosis is the most common
parasitic process (2005MillerNR_NewmanNJ). The localization of parasitic cysts
in the brain of certain patients engenders auditory and visual hallucinations
(1973BekenyG_PéterÁ; 2007AsriF_GhannaneH; 2009PowerB_GoossensC).
Neurological
symptoms in head injuries feature in the Edwin Smith Papyrus. In Case 7, a
skull base fracture presenting with bleeding from the external auditory canals
and nose is discussed. Such an injury is obligatorily accompanied by brain
contusion. Naturally, the medical writer recorded aphasia, tremors, difficulty
raising the head, and opening the mouth in the victim. Case 8 describes a
patient who had previously suffered a comminuted fracture of the cranial vault
with emerging neurological symptoms: strabismus, lameness due to monoplegia,
and apparently impaired coordination of movements, as he cannot touch the
middle of his palm with a finger (1930BreastedJH). The compiler of this manual
undoubtedly observed the consequences of skull fracture and brain contusion:
motor, speech, and sensory disorders, hallucinations, fears and anxiety,
emotional lability, irritability and aggression, disorientation, as well as
cognitive impairments. Compression of brain matter by a chronic haematoma
resembles the effect of a parasitic cyst, but develops more rapidly and is
associated with prior trauma. Based on the primary source and medical facts, we
believe that according to the authors' design, Abraham suffered from a disease
characteristic of livestock herders. Such could have been echinococcosis or
cysticercosis.
In
the Book of Genesis, it is stated that Abraham "was ninety-nine years old
when he was circumcised in the flesh of his foreskin" (Gen. 17:24). Below
we find: "On that very same day Abraham and his son Ishmael were
circumcised" (Gen. 17:26). Moreover, at the time of the surgical
intervention, Ishmael had reached the age of "thirteen years" (Gen.
17:25). Scenes depicting the excision of boys' foreskins are portrayed on the
walls of temples and tombs of the Old Kingdom, as well as the 18th–20th
Dynasties (2011MegahedM_VymazalováH).
In
accordance with our proposed chronology, Abraham was over 57–58 years old at
the time of circumcision. It is clear from the text that medical indications
for the operation were absent. At the same time, the year following the
circumcision, Abraham's son Isaac is born (Gen. 21:2). From the above, one
might suggest the presence of phimosis, that is, an organic cause hindering
conception. A neutral explanation for the circumcision of the foreskin is
imitation of ancient Egyptian practice. This was a justified preventive measure
that radically eliminated moist skin pathologies under hot climate conditions
with undeveloped personal hygiene. A reduction in the number of
mechanoreceptors was the "lesser evil", chosen due to the absence of
qualified medical care.
According
to our primary source, besides Abraham and Ishmael, "all the men of his
household" underwent circumcision on the same day (Gen. 17:27). At the
start of the victorious expedition to rescue Lot, there were 318 combatants in
Abraham's tribe (Gen. 14:14). Counting Abraham, Ishmael, and adult males, a
minimum of 320 circumcisions had to be performed within twenty-four hours.
Including male children from eight days of age, the potential
"patients" numbered up to 350 souls. Furthermore, Abraham himself
"circumcised the flesh of their foreskin" (Gen. 17:23). With a
daylight duration of 16 hours and continuous operation, Abraham would have
excised each foreskin in less than three minutes. Drawing on personal
experience, we rule out the performance of approximately 350 operations by a
single surgeon in one day. It is unknown whether Abraham had any experience in
surgical treatment of humans at all, though perhaps he did with animals. Since
oxen were present in the herd, it is appropriate to assume the skill of
castrating bulls (Gen. 24:35). On the day of mass circumcision, Abraham was
located in the southern Levant in the area of the "Be'er-Lahai-Roi"
well, which is "between Qadesh and Bered" (Gen. 16:14). It is
difficult to imagine that several practicing surgeons capable of executing the
order conveyed by Abraham's internal voice – "every male among you shall
be circumcised" (Gen. 17:10) – existed in a desert area. How could such an
idea occur to a nomad? We believe the authors hint at Abraham's familiarity
with the technique of circumcision in the Nile Valley or an imitation of
Egyptian tradition (Gen. 12:14, 16). The earliest written document testifying
to the excision of the foreskin in Egypt dates to the First Intermediate
Period. On the stela of Naga ed-Deir, one of the chieftains proclaims: "I
was circumcised together with one hundred and twenty men..."
(1966SassonJM). As can be observed, a rite of collective foreskin excision is
described in this instance. The writers of our primary source needed to
gradually prepare the reader for the idea that Abraham's descendants – and thus
Jacob and Joseph – practice circumcision, just as the inhabitants of the Nile
Valley do.
It
should be noted that circumcision was known to the inhabitants of Northern
Syria, specifically the Balikh and Khabur plains. Bronze figurines of warriors
dating approximately to 2800 BCE from this region depict the visual
consequences of circumcision with striking accuracy (1966SassonJM). According
to the Book of Genesis, Jacob and Joseph head to Canaan from
"Paddan-Aram" (Gen. 31:18). The latter toponym is unequivocally
identified as Mesopotamia (1999ГерцЙ). In Northern Mesopotamia, along the middle course of the Balikh River,
lay the starting point of Jacob's caravan – Haran. It cannot be ruled out that
the authors of the primary source knew that circumcision had been practiced in
"Paddan-Aram" since at least the beginning of the third millennium.
According
to our timeline of events in the Book of Genesis, after eight years of
residence in Shechem, a conflict arises between Jacob's family and the son of
the city's ruler (Gen. 34:4–6). In Shechem (Sychem, Nablus), signs of
urbanization are observed between 1900–1750 BCE, and in 1650–1550 BCE it was a
prosperous city (1992FreedmanDN). In accordance with archaeological research,
between 1650–1550 BCE the settlement structures and wall were destroyed three
times, with human activity interrupted until 1450 BCE (1974DeverWG). According
to biblical legend, a second mass circumcision is performed in the specified
settlement: "all the males were circumcised, all who went out of the gate
of his city" (Gen. 34:24). Here, the writer with medical training
demonstrates knowledge of the peculiarities of the postoperative period. The
doctor recorded the deterioration of the operated individuals' condition "on
the third day, when they were sore" (Gen. 34:25). The question arises:
could the specified phenomenon interest a writer lacking medical knowledge?
From
the text, it is difficult to conclude who performs the surgical interventions:
the men of Shechem themselves or Jacob's sons, who engaged in livestock
breeding. In the Middle Bronze Age, the population of Shechem is estimated at
approximately 2,000 people, "that is, about 400 adult males"
(1992FinkelsteinI). The presence of a sufficient number of surgeons in this settlement
capable of performing numerous operations within a short period is unlikely.
This work would have required several days. In connection with the above, the
story of the "Shechem massacre" is a literary fiction.
The
discussed plot resonates with an original theme in ancient Egyptian visual
arts. In particular, the slaying of enemies, apparently after circumcision, is
captured on the ancient Egyptian Battlefield Palette of the late Gerzean
Predynastic period, preserved in the British Museum (Abydos, ca. 3100 BCE, britishmuseum.org). The bas-relief of the artifact
depicts bearded, circumcised foreign captives being devoured by vultures and a
lion – presumably symbols of Nile authority (1966SassonJM). The palette proves
that, in accordance with ancient Egyptian beliefs, the absence of a foreskin
was no guarantee of preserving enemies' lives. That is why, according to the
authors' design, Jacob's two sons, Shimon and Levi, hesitated not to slay all
the circumcised men of the city of Shechem with their swords (Gen. 34:25).
After circumcision, they did not become closer to Jacob's kinsmen.
Jacob's
first sons were born a year apart. According to our calculations, the eldest – Reuven
– was 21 years old by the specified event, Shimon was 20, Levi was 19, and Judah
was 18. It is incredible that two young men could carry out a successful attack
on a city surrounded in the Middle Bronze Age by ramparts and massive stone
walls (1990FinkelsteinI). During this period, the expansion of settlements and
urbanization were occurring in the country (1990MazarA). It is impossible to
defeat several hundred men of a fortified city potentially prepared for
defense, as well as professional soldiers and bodyguards of "Hamor the
Hivite, prince of that country" (Gen. 34:2). In our narrative, the
fairytale quality is emphasized by the plundering of the city and the capture
of women and children (Gen. 34:27–29). What happened later to the captives is
not stated below.
In
reality, the legend under consideration was invented, perhaps, as an attempt at
self-reassurance following a real, unpunished crime against Jacob's daughter.
The writers urgently needed to apply the legal norm in force at that time.
According to the Hittite Laws, a man was to be put to death if he attacked a
woman in the mountains and raped her (1997HoffnerJrHA). According to the Code
of Hammurabi, if "a man forces intimate contact upon the wife of another
man, who has not known a man and lives in her father's house", the
perpetrator was to be put to death (1920HandcockPSP). In the eyes of
contemporaries, the act of Jacob's sons turned out to be justified, while also
demonstrating their victorious martial spirit. The writers compel one to doubt
the truth of the account of mass murder. Having captured the city and exacted
just retribution, Jacob's family flees for some reason (Gen. 35:1, 3, 5). The
settlement was depopulated, while all infrastructure remained intact – why
leave it? Somehow, the mother's nurse ends up in the caravan (Gen. 35:8). Jacob
himself states that "I am few in number; they will gather themselves
together against me and strike me" (Gen. 34:30). Yet we learned earlier
that his sons had destroyed all male enemies (Gen. 34:25).
The
indiscriminate slaughter perpetrated by Shimon and Levi in Shechem was
vengeance for the dishonoring of their sister (Gen. 34:25). The unprovoked
murder of individual men of Shechem would today be classified as hooliganism
reflecting explicit disrespect for society and disregard for accepted norms.
Even under Bronze Age legislation, this was considered a crime. The described
transgression of Jacob's children is not followed today as a sacred precedent.
However, a portion of the Earth's population has no intention of abandoning the
ancient practice of foreskin excision. In this, one sees a selective attitude
toward the "directives" of a work of fiction. What is useful is
preserved, while what is unneeded is rejected, regardless of the fact that the
example to follow was imparted "from above". Commentators here
unanimously demonstrate common sense.
The
description of tragic events gradually reveals the authors' complex and
purposeful design. They keep an abundance of details in mind, remember the age
of the heroes, know legislation, military affairs, and customs, understand
psychology, and also possess a concept of surgery. The epic turns out to be
colorful, dramatic, and triumphant. Occasionally, the storytellers overreach,
assuming the reader is not fully informed about the historical context and has
not visited the cities of Samaria. The Stela of Sebek-khu tells of the Asian
campaign of King Senusret III's army (1872–1853 BCE) into Canaan, the fall of
the city of "Sekem" (possibly Shechem) and the land of "Retenu",
which "indicates that Sekem was the chief city" (2011Saad-AllahTMA).
The conquest success of the Pharaoh's army could not be repeated by two brave
men armed with swords (Gen. 34:25).
Circumcision
was performed by the Egyptians as a rite from early times
(1924SmithGE_DawsonWR). At Predynastic Cemetery No. 7000 in Naga ed-Deir,
mummified bodies with excised foreskins were identified
(1965LythgoeAM_DunhamD). At the prehistoric cemetery of Naga ed-Deir (5th
millennium BCE), one hundred miles north of Luxor, Elliot Smith discovered that
all male corpses were circumcised (1947CastiglioniA). The oldest depiction of
the circumcision operation was found on a wall relief dating from the period of
the 5th Dynasty Pharaoh Djedkare, who flourished in 2388–2356 BCE (2002BunsonMR;
2011MegahedM_VymazalováH). Egyptologists believe that the excision of the
foreskin was not religious in nature, but represented a "preparation for
marriage" (2021МюллерМ). Herodotus in the 5th century BCE wrote: "Only three nations on
earth have circumcised themselves from time immemorial: the Colchians, the
Egyptians, and the Ethiopians. The Phoenicians and the Syrians of Palestine
themselves admit that they borrowed this custom from the Egyptians" (1972Геродот).
It
is difficult to imagine the emergence and development of surgery in the Middle
Bronze Age within a small nomadic ethnic group. Meanwhile, this medical
specialty in Egypt flourished during the Old Kingdom, or in 2613–2181 BCE,
while New Kingdom papyri dating to 1567–1085 BCE testify to its degradation
(1989RowlingJT). Numerous invasive and non-invasive procedures are depicted in
tombs: reductions of broken bones, circumcisions, interventions on the neck and
limbs (1963WellsC). By 2400 BCE, operations were performed regularly in the
Nile Valley (2012GabrielRA). The use of a flint knife for excising a
superficial tumor is recommended in a prescription of the Ebers Papyrus,
written in the 16th century BCE (1889EbersG). Thus, at the end of the Second
Intermediate Period, methods developed during the Old and Middle Kingdoms were
still employed.
In
Mesopotamia, surgery as a specialty emerged in the first half of the 18th
century BCE (2010GellerMJ). Rules governing surgical practice and penalties for
practitioners' errors were first set forth in the Code of Hammurabi, compiled
around 1760 BCE (1959KevorkianJ; 2016PearnJ). Harshness toward Mesopotamian
physicians did not promote the development of surgery for most of the 2nd
millennium BCE. Having "tasted the fruits" of Hammurabi's pernicious
innovation, physicians preferred phantasmagoria over expediency for
self-preservation, as a result of which mysticism began to dominate medicine
(2010GellerMJ).
The
civilizations of Mesopotamia and Ancient Egypt, having abandoned the
development of general and specialized surgery, disappeared. It appears that a
negative attitude toward medicine due to unfulfilled, inflated expectations,
along with religious populism and demagoguery, contributed to this. Idle talk
and promises are simpler than study and action.
The creators of the Book of Genesis demonstrate a familiarity with surgery, underscoring their erudition. This specialty has not yet been "cast aside" by the writers as a relic of the past, which allows dating the work to the first half of the 2nd millennium. The authors introduce us to thoracic surgery in the second chapter, where a rib resection procedure under general anesthesia is described (Gen. 2:21). The operation of foreskin excision is known to at least three generations of Joseph's ancestors: Abraham, Isaac, and Jacob (Gen. 17:23–27, 21:4, 34:14–15). From the text, it is clear that the storytellers know the details of the postoperative period following circumcision (Gen. 34:24–25). A non-medical author would not pay attention to the intricacies of an unfamiliar craft.
Abraham's
wife was Sarah, who was ten years younger than her husband (Gen. 17:17).
According to the epic, the matriarch lived 127 years (Gen. 23:1–2). The age
reached is perceived by us with skepticism. Rather, it is an exaggeration
required, among other things, to demonstrate her good health. The spouses
shared a father, but had different mothers (Gen. 20:12). Thus, a similarity in
genotype and a predisposition to the same diseases are to be expected. From the
description of Sarah's life, no pathology of the central nervous system is
observed. This speaks in favor of Abraham having an acquired brain condition
rather than a congenital one.
Sarah's
sole health problem was primary infertility. The narrative of her marriage to
Abraham echoes the ancient Egyptian myth of full siblings who became husband
and wife – Osiris and Isis (2006МюллерМ). Infertility is also assumed in Isis during
her life with Osiris, which "remains unexplained in Egyptian
mythology" (1995RegulaT). According to our calculations, Sarah married at
age 13–14 and gave birth to her only child at age 48–49. "Gathering"
the obstetric history of Jacob's mother, we suggested that three generations of
women in his clan suffered from "polycystic ovary syndrome". Late
pregnancies of Sarah, Rebekah, and Rachel, culminating in the birth of healthy
children, speak to this pathology (Gen. 21:2, 25:25–26, 30:23, 35:16–18).
Isaac,
son of Abraham, son of Terach, lived 180 years and died of natural causes (Gen.
11:26, 25:1, 35:28–29). No injuries to the body or limbs are reported for Isaac.
There is an episode of psychological trauma in adolescence during his father's
attempt to sacrifice him (Gen. 22:9–10). Among past illnesses, only blindness
is indicated (Gen. 27:1). Taking into account the authors' dating, Isaac went
blind at the age of one hundred (Gen. 25:26, 26:34). According to our timeline
of events, visual acuity decreased at approximately 47–46 years of age. His vision
was so poor that he had to identify objects by touch, unable to distinguish
them up close (Gen. 27:12, 21–22, 26–27). It is unclear whether he perceived
light. At the birth of his sons, no signs of decreased visual acuity in Isaac
are observed in the text. In our view, he was over 28–29 years old at that
time. The leader of the clan wanders with flocks, manages the construction of
wells, and carries out the planting and harvesting of grain crops (Gen. 26:1, 12,17–23).
This presupposes that vision was not lost during his children's adolescence
(Gen. 25:29–34). Apparently, significant deterioration develops at the end of
the 3rd or beginning of the 4th decade of life.
Isaac
inherited Abraham's entire estate, who "was very rich in livestock"
(Gen. 13:2, 25:5). The heir manages the household prudently, so "he had
possessions of flocks and possessions of herds" (Gen. 26:14). Isaac lived
in semi-desert conditions: "by Be'er-Lahai-Roi", in "Gerar",
in the "valley of Gerar", and in "Be'er-Sheva" (Gen. 25:11,
26:1, 17, 23). In ocular pathology, it is impossible to travel, manage
effectively, and supervise.
In
the narrative of the blessing of his sons, we find that Isaac maintains bed
rest. His son says to him: "arise, sit and eat" (Gen. 27:25). This
circumstance can be explained by helplessness not due to a somatic cause, but
owing to complete loss of vision. Sand dust and intense ultraviolet radiation
could have caused corneal opacification. A preferred explanation for the
shepherd's blindness appears to us to be a chronic bacterial eye infection,
which over time impaired the transparency of the cornea.
The
primary causes of corneal opacification include: trachoma, infectious
keratitis, xerophthalmia, onchocerciasis, "traditional" eye
medications, and eye injuries. According to literature data, approximately 5.5
million people on the planet currently suffer from bilateral blindness or
visual impairment due to trachoma, and another 6.2 million from unilateral
blindness (2023WangEY_WestS). According to World Health Organization
statistics, trachoma today remains the leading cause of visual impairment and
blindness in poor agricultural areas of Africa, Central and South America,
Asia, Australia, and the Middle East (who.int). Trachoma (bacterial eye infection) and
onchocerciasis (helminthic "river blindness") were likely
characteristic of the inhabitants of the Nile Valley and the land between the
Tigris and Euphrates. Linguists who studied the literature of Egypt note:
"eye diseases seem as common among Egyptian gods as among the ancient
Egyptians" (2008МеексД_Фавар-МеексК). In the Ebers Papyrus, there is a
section devoted to eye pathology containing a description of "Egyptian
trachoma", which the physician Larrey observed in the 18th century
(1929GarrisonFH). The disease nehat also features there, resembling an
infectious ocular lesion in a number of characteristics (2002NunnJF). The
compiler of the mentioned manuscript recommends: to cure dim eyes: rub down
myrrh, onion, verdigris, and northern must with antelope dung, clear oil, and
the entrails of a qadyt-animal (1974BryanCP_SmithG). In the quoted ancient
Egyptian prescription handbook, other remedies for corneal opacification are
found: granite powder, as well as turtle bile mixed with honey (1930MajorRH).
The London Medical Papyrus asserts that in the case of "eye dimness",
an incantation helps (1992SteinerRC).
Evidence
has survived from Sumerian-Akkadian therapeutic procedures regarding an
operation using a barber's razor for corneal opacification (2014ScurlockJ). The
Code of Hammurabi, compiled around 1760 BCE, prescribes a payment of 5–10
shekels of silver in Babylonia for the successful surgical treatment of a
leukoma (1920HandcockPSP; 2016PearnJ). In the Old Kingdom of Egypt, at the end
of the 3rd millennium BCE, Irenekhet Niankhpepi flourished as "the eye
physician of the Great House" (1974PorterB_MossRLB). On a wall relief from
the Ramesside period, there is a depiction of a person having a specialist
possibly remove a foreign body from their eye (2014BlomstedP). Therefore, we
are not puzzled by the mention of eye diseases in the protagonists of the Book
of Genesis. Such pathology was known in both Ancient Egypt and Mesopotamia.
However, conferring the status of a blind person upon Isaac is rather a
literary device of the Egyptian writers. This is hinted at by his poetic
blessings and the appeasement of his sons (Gen. 27:28–29,39–40). The
patriarch's words resemble ancient Egyptian Songs of the Blind Harper, which
were carved in tombs to serve the purpose of comforting the deceased
(2006LichtheimM).
Isaac
is described as a religious man (Gen. 25:21). Like his father, he occasionally
"hears" the voice of God giving advice on where best to settle (Gen.
26:2–5). Subsequent events recounted by the writers recall Abraham's
interactions with Pharaoh and King Abimelech, with the markers being a conflict
concerning wives and the phrase "she is my sister" (Gen. 12:18–20,
20:1–7, 26:6–16). Isaac "conversations" with Abimelech occur,
according to our calculations, almost 40 years after Abraham spoke with him,
before his son was born (Gen. 20:1–7, 21:2–3). By the time of Isaac's anomalous
vision, his father had passed away, and the same is expected regarding the fate
of Abimelech. Thus, their meeting is speculative – a memory of Abraham
recounting his hallucination. Following the episode involving Abimelech's
ascertainment of Rebekah's marital status, Isaac again interacts with God. It
must be assumed that this occurs in a dream: "The Lord appeared to him
that night, and said..." (Gen. 26:24). Abraham is mentioned in the vision,
followed below by an account of Isaac concluding a covenant with King Abimelech
in the presence of witnesses Achuzzath and Phichol, "the commander of his
army" (Gen. 26:26–31). The literary scene turns out to be virtually a copy
of the narrative describing how "Abimelech and Phichol, the commander of
his army" come to Abraham to negotiate peaceful coexistence (Gen. 21:22–32).
Here, as in the case of Isaac, a well in "Be'er-Sheva" features.
Abraham claims that he dug this spring himself: "Therefore he called that
place Be'er-Sheva" (Gen. 21:30–31). Under Isaac, "servants" dig
the well, and upon learning this, "he called it Shibah. Therefore, the
name of the city is Be'er-Sheva to this day" (Gen. 26:32–33). If the
subject were the same individual, we would suspect perseveration – that is, an
inappropriate repetition of an action, or more precisely, a production of a
sleeping brain or a hallucination reproducing familiar events. Neither earlier
nor later are anomalous visions described for Isaac. Visual distortions
immediately precede the statement of blindness (Gen. 27:1).
According
to our hypothesis, in the Book of Genesis, the medical author documented
hallucinations in a mentally healthy person with severe visual system
impairment. In the International Classification of Diseases, 10th Revision,
this pathology is coded as "Visual hallucinations" (R44.1) or
"Psychophysiological visual disturbances" (H53.16) (icd10data.com).
In the updated International Classification of Diseases (ICD-11), a refined
code 9D56 "Disease of the visual system" appeared, also termed
Charles Bonnet syndrome. Under this code, it is defined as the experience of
complex visual hallucinations in an individual who has suffered partial or
complete loss of vision. The hallucinations are exclusively visual in nature,
usually temporary, and are not associated with mental or behavioral disorders (icd.who.int).
The
nosology was named after the naturalist and philosopher Charles Bonnet
(1720–1793), who described the visual hallucinations of his intelligent,
eloquent, mentally healthy, but visually impaired grandfather Charles Lullin
(2005MenonGJ). Visual hallucinations are recognized as the most common
psychotic symptom in visual impairment, and elderly age contributes to the
exacerbation of psychotic phenomena (2026FlorosGD_MylonaI). Visual
hallucinations in Charles Bonnet syndrome are associated with lesions of the
visual pathways, visual cortex, retina, and light transmission within the eye,
for example in cataracts and corneal opacification (2020O'BrienJ_FfytcheD).
Visual hallucinations occur only in the context of acquired vision loss and
never in individuals with congenital blindness (2005MenonGJ).
In our primary source, the storytellers shared an observation of a patient with "Charles Bonnet syndrome". Perhaps the prototype of Isaac did not suffer from this pathology, but its description speaks in favor of the participation of a perceptive and retentive medical specialist in the composition of the Book of Genesis.
Rebekah,
daughter of Bethuel, son of Nachor, brother of Abraham (Gen. 11:26, 22:20–23,
25:20). She was a grandniece of Isaac, Jacob's father. According to our
version, Rebekah suffered from primary infertility caused by polycystic ovary
syndrome. According to the text, she was fortunate enough to give birth to two
sons after 20 years of marriage (Gen. 25:20,26). The writers deliberately place
information allowing one to determine how long the period of childlessness
lasted in close proximity. Thereby, the absence of organic pathology is
emphasized, showing only the delayed nature of the impairment in the capacity
to conceive. Without understanding the true cause of infertility, the physician
meticulously presented information regarding members of a single family
possessing a similar ailment, demonstrating the likelihood of childbearing in
mature age.
No overt somatic or psychiatric abnormalities are observed in Rebekah. There is no information regarding injuries either. As stated in the primary source, 40 years after the birth of her children, she was alive and well (Gen. 26:34–35). According to our calculations, her age was over 30 years around 1660 BCE. In the account of the exodus from Mesopotamia, it is stated that Jacob gathered "to go to Isaac his father in the land of Canaan" (Gen. 31:18). Here and below, Rebekah is not mentioned, except for the fact that she was buried "in the cave that is in the field of Machpelah, which is before Mamre, in the land of Canaan" (Gen. 49:30–31). It appears to us that the woman died of natural causes prior to 1640 BCE, that is, at fifty years of age.
Esau,
son of Isaac, son of Abraham, was Jacob's full brother (Gen. 25:19,25–26). Esau's
overall lifespan is unknown. He was alive at the time of Jacob's caravan
arriving in "Hebron" (Gen. 35:27). Somewhat later, the twins buried
their father together (Gen. 35:29). Following the mournful event, Esau departs
to the east and settles "in Mount Seir" (Gen. 36:8). In another place
in the text, it is reported that his exodus "into the land of Seir, into
the field of Edom" took place significantly earlier (Gen. 32:4). Either
the storytellers or the editors mislead us. In our judgment, the authors
assumed Esau's relocation to have occurred before 1629 BCE, thereby implying
survival up to 48 years of age.
When
analyzing the text from the standpoint of modern medicine, it is clear that
Jacob and Esau were dizygotic twins. This is indicated by significant physical
differences between the brothers at birth and differences in temperament that
manifested later. In particular, Jacob is described as a "mild man"
(Gen. 25:27). It must be assumed that Esau, at the very least on the contrary,
was hot-tempered and apparently physically strong, as he later threatened to
kill his brother (Gen. 27:41–42).
From
the description of Esau's appearance, it follows that he exhibited
manifestations of congenital hypertrichosis (Gen. 25:25, 27:11,23; 1996КозловаСИ_БлинниковаОЕ). Formerly, excessively pronounced
growth of hair in atypical locations was termed "congenital universal
hypertrichosis" (1986ДемиковаНС_УдлерЕЕ).
Later, it was established that such symptoms are the consequences of several
rare hereditary syndromes causing impaired hair follicle development
(2018PooniaK_BhallaM). Based on the text, it is appropriate to assume
congenital hypertrichosis lanuginosa or congenital generalized hypertrichosis
(2003WendelinDS_MallorySB). At birth, Esau possessed areas of skin devoid of
hair, as evidenced by the epithet "ruddy" (Gen. 25:25). Until mature
age, excessive hairiness persisted in him (Gen. 27:11, 23). Therefore, it is
most probable that the Book of Genesis provides one of the early descriptions
of congenital generalized hypertrichosis.
The
oldest written record of hypertrichosis is contained in the Epic of Gilgamesh,
recorded between 2000–1800 BCE (2004SommerBD). Such a feature was inherent to
Enkidu, as is clear from the words: "Shaggy with hair is his whole body,
he wears hair like a woman, locks of hair grow thick like grain" (1961ДьяконовИМ). In the ancient Egyptian pantheon,
there existed a protective deity Bes, depicted as a shaggy dwarf. No depictions
of Bes prior to 2000 BCE have been found (2021МюллерМ). From the time of the 12th Dynasty (1991–1783
BCE), the cult of Bes spread throughout Egypt. "Shaggy dwarf freaks,
Beses, and their wives – the goddesses Beset" were part of the retinue of
the goddess Meskhenet, patroness of women in childbirth and assistant to
midwives. A belief circulated that "the shaggy dwarfs Beses and Beset beat
tambourines and, making terrifying grimaces", drive away snakes and
scorpions that appear in the home (2004РакИВ). There is an opinion that Bes was a foreign
god, described as "coming from the east, the Lord of the East" (2021МюллерМ). We consider it possible to
propose a hypothesis regarding the ancient Egyptian Bes as an embodiment of the
Mesopotamian Enkidu image. Both exhibited signs of hypertrichosis, both were
distinguished by considerable physical strength and primitive wildness, and
according to legends, both captured wild animals. Regarding Esau, it is stated
that he became a "man skilled in hunting" (Gen. 25:27). Furthermore,
he was Jacob's elder brother. In the Epic of Gilgamesh, the main hero speaks of
Enkidu as: "younger brother", "pursuer of mountain wild asses,
panthers of the desert!" (1961ДьяконовИМ).
In
the Mesopotamian creation epic Enūma Eliš, presumably composed in the last
quarter of the 12th century BCE, the goddess Tiamat "employed serpents,
dragons, and hairy human heroes" (2021HeinrichAC). Among early classical
works, creatures with excessive hairiness are narrated in the Iliad (8th
century BCE). In the first and second chants, the poet portrays the
"shaggy monsters", half-human and half-horse centaurs, as
"savage children of the mountains" (1960Гомер). Diodorus Siculus (1st century BCE) recounted
hairy satyrs meeting Bacchus (that is, Osiris) in Ethiopia (2021МюллерМ). Another ancient mention of
atypical hair growth is included in Pliny the Elder's (22/24–79 CE) Natural
History. The encyclopedist, citing a certain Tauron, writes of such a
distinguishing feature in two mythical peoples of India: the
"Chromandae" and the "Astomi" (1855Pliny).
Priority
in the scientific description of a case of generalized hypertrichosis belongs
to the pen of Felix Platter (1536–1614) in his work Observationum (1614,1680PlatterF). Today, it has been established that the signs of congenital
generalized hypertrichosis are a manifestation of an anomaly in an
X-chromosome-linked gene (2003WendelinDS_MallorySB).
Jacob's
twin brother is described as a laborer, "skilled in hunting" (Gen.
25:27). He caught game and hunted it using special "implements",
including a bow and sword (Gen. 27:3,5,40). This occupation, vital for
sustaining the family, was fraught with danger to life. An understanding of the
specified fact is heard in his words: "for I am going to die" (Gen.
25:32). Esau was also versed in livestock breeding, as he possessed
"herds" of domestic animals (Gen. 36:6). At the moment of leaving his
native land for a new place of residence, his possessions turned out to be
"too great" (Gen. 36:7). Apparently on account of excessive
hairiness, he avoided people, dwelling at a distance – becoming a "man of
the field" (Gen. 25:27). Esau traveled extensively on foot, worked, and
grew weary (Gen. 25:30). Residing mainly outside settlements, he managed to
master the culinary art to perfection (Gen. 25:28, 27:4,31). His state of
health is indirectly indicated by the size of his family (Gen. 36:4–6, 9–19).
Moreover, Esau founded a family seven years earlier than Jacob, taking "as
wives Judith daughter of Beeri the Hittite, and Bahsemath daughter of Elon the
Hittite" (Gen. 26:34). According to a different list, he chooses wives
from the daughters "of Canaan: Adah daughter of Elon the Hittite, and Abolibamach
daughter of Anah, granddaughter of Zibeon the Hivite; and Machalath daughter of
Ishmael", "Abraham's son, sister
of Nebayoth" (Gen. 28:9, 36:1–3). According to our calculations, five sons
were born to Esau in "Canaan": Eliphaz, Reuel, Yeush, Yalam, and
Korah, as well as an unknown number of daughters (Gen. 36:4–6). Maintaining a
large head of livestock and caring for numerous children require significant
effort and good physical fitness.
It
appears to us that he was a courageous and strong-willed man, accustomed to
risk in the life of a hunter and trapper (Gen. 25:32). He possessed pronounced
leadership qualities. To meet his brother, he rapidly gathers a host numbering
"four hundred men" (Gen. 32:7, 33:1). He was revered as a chieftain
of tribes, the father of the "Edomites" (Gen. 36:40, 43). The Book of
Genesis describes no attacks by Esau upon anyone, nor murders, deceptions,
hostility, or unrighteous deeds. His march to meet his brother testifies to
care and consideration. He did not compel Jacob to undertake a multi-kilometer
march with young children and drive numerous herds to distant "Seir",
but rode out to the meeting place himself. Attractive character traits, in
particular non-covetousness, are illustrated by the episode involving the
transfer of the birthright (Gen. 25:31). Jacob's request to "sell"
the right to inherit their father's property is met positively (Gen. 25:33).
The decisive factor was a kind attitude toward his mild brother (Gen. 25:27).
Among other things, weariness, a desire to eat, and stress resulting from
experienced dangers during the hunt and famine "in the land" took
their toll (Gen. 25:30, 32, 26:1). Esau apparently believed he could provide
for himself, whereas his brother could not, and therefore had no need for
excess wealth.
He
was bypassed by the attention of his mother, who loved the other son (Gen. 25:28).
This was vividly manifested in the episode where Rebekah demands the
interception of the paternal blessing from Esau (Gen. 27:6–10). Jacob does not
wish to become a "deceiver" and bring "a curse upon himself",
yet he complies (Gen. 27:12, 14). Upon learning of his mother's conspiracy with
his brother behind his back, an adult man, we think seventeen years old,
"cried out with an exceeding great and bitter cry" "and
wept" (Gen. 26:34, 27:34, 38). Esau revered his father, never reproached
his mother, lived according to his conscience, worked, demonstrated generosity,
and ended up defrauded. One can understand why he grew angry and said "in
his heart": "I will kill Ya'akov my brother" (Gen. 27:41). We
ought not to judge this thought-crime harshly, especially given that even his
father wished him to break his brother's yoke "from off his neck"
(Gen. 27:40). Despite the negative past, Esau genuinely rejoices at his
brother's return from his wanderings and even weeps (Gen. 33:4).
Non-covetousness, kindheartedness, and tactfulness are manifested in his
reluctance to accept gifts, his reconciliation with his brother, his invitation
to live together, and his offer of an escort (Gen. 33:9, 11–12). He does not
insist on dependency so as not to offend or display harboured malice, does not
pester with questions, does not annoy with his presence, does not interfere,
and departs without troubling his brother on the day of their meeting (Gen.
33:16). Feeling respect for his father despite being deprived of his inheritance,
he participates in his funeral and does not remain living in the ancestral home
(Gen. 35:29). Realizing that their native land could not sustain the herds of
both brothers, as the elder he decides to leave first (Gen. 36:6–8). After
living in the prosperous field of Mamre city of Kiryath-arba, that is Hebron, Esau
settles in the arid and meager mountains of "Seir" (Gen. 32:4, 36:8–9,
30). The listed details speak to good cognitive abilities and developed
empathy. The migration from Canaan eastward to the area of the Al-Sharat
mountain range resonates with the return to his ancestral home of the shaggy
god Bes, who came "from the east, the Lord of the East" (2021МюллерМ).
In
the family, Esau was given the nickname "Edom", that is, red (Gen.
25:30, 36:1,8). One of the reasons for the nickname's emergence was the red
color of his skin at birth (Gen. 25:25). Redness of the skin in newborn infants
during the first week of life is well known. Such a reaction is normal and is
due to skin thinness, expansion of superficial vessels, and elevated hemoglobin
levels in the blood. The second explanation for Esau's nickname is his request
for a dish of red color cooked from lentils (Gen. 25:30, 34). Therefore, there
is no basis for attempting to retrospectively identify dermatological or
vascular disorders. Indeed, a red skin tint in Esau is not mentioned later.
From
our point of view, the epithet "red" in relation to Esau was used not
in connection with pathology, but out of a desire to emphasize an analogy with
the god Seth. In turn, Jacob, by the authors' design, demonstrates traits of
the god Osiris. Just as Osiris and Seth conflicted in ancient Egyptian myths,
so in the Book of Genesis a confrontation between Esau and Jacob is observed.
Osiris
was perceived by the Egyptians as the "good king of the deceased"
bearing the name "Good Being", which characterized him as "very
mild and the most benevolent of all the gods" (2021МюллерМ). Initially, the Egyptians
perceived Osiris as a man who lived, like them, on earth, suffered a violent
death, but with the help of the gods overcame it and attained eternal life
(2000БаджЭАУ). The
widest development of the cult of Osiris occurred from the time of the Middle
Kingdom (1940МатьеМВ).
However, tales of Osiris circulated in the Nile Valley from deep antiquity and
found reflection in the Pyramid Texts of the 5th–6th Dynasties
(1980GriffithsJG).
According
to myth, the god Seth was born with red eyes and an equally red mane (2007РакИ). In our primary source we read:
"And the first came forth red, all over like a hairy garment; and they
called his name Esau" (Gen. 25:25). Plutarch (1st–2nd centuries CE) wrote:
"during festivals, the Egyptians, mocking, humiliate and insult red-haired
people, and the inhabitants of Coptos, for instance, knock a donkey down
because Typhon [Seth] was red-haired" (1996Плутарх). The "Metternich Stela" narrates:
"Know not the Black, speak not to the Red, make no distinction between the
son of a noble and a poor man" (1983ЛипинскаяЯ_МарцинякМ). Here, "Black" is Osiris, the color
of fertile soil, while "Red" is Seth, the color of the dead sands of
the desert with which this god was associated. By the end of the Middle
Kingdom, Seth had come to be regarded as the "opposite" of Osiris – the
god of the desert, the personification of evil, war, drought, and other
calamities (2007РакИ).
Red soil in Africa is "a common phenomenon almost everywhere, with the
exception of the chernozem deposits of the Nile Valley" (2000ТантлевскийИР). In choosing the color red for Esau,
the writers sought to demonize the character. At the same time, the episodes of
the epic featuring him speak of a completely different type. The prototype was
rather a sensitive, strong, brave, good-natured, and industrious shepherd.
Erythema or hyperemia, as well as hypertrichosis, were invented by a writer
with medical training for the vividness of scenes in a work of fiction.
At the decline of the Hyksos rule, a shift in religious priorities among the inhabitants of the Nile Delta was observed. At least in the fictional text, the veneration of Seth instead of Osiris is reflected. This is stated in the tale The Hyksos King Apopi and Pharaoh Seqenenre – the patron of the shepherd-king was the god Seth (1958КацнельсонИС_МендельсонФЛ). Apepi I occupied the throne of the Great Hyksos approximately in 1585–1553 BCE (2002BunsonMR). Based on the foregoing, it can be thought that the legend of Esau was composed earlier, as was the Book of Genesis as a whole.
[xv]
Leah,
the elder daughter of Laban, son of Bethuel the Aramean, brother of Rebekah
(Gen. 27:43, 28:5, 29:16). She was Jacob's first cousin and became his wife
(Gen. 29:23–24, 26). Regarding her health, it is indicated that she had
"weak eyes" (Gen. 29:17). It is assumed that the phrase denotes low
visual acuity. Therefore, the preferred retrospective diagnoses are the most
common pathologies of this kind: "high myopia" and "open-angle
glaucoma". These are among the most frequent conditions impairing visual
ability.
In
2000, high myopia affected approximately 163 million people worldwide, or 2.7%
of Earth's inhabitants (2016HoldenBA_ResnikoffS). The number of people on the
planet suffering from blindness due to glaucoma in 2015 was nearly 3 million,
while the number of individuals with visual impairment due to glaucoma stood at
approximately 4 million (2017FlaxmanSR_ZhengY). Furthermore, epidemiological
studies consistently report an association between myopia and open-angle
glaucoma (2026AkadaM_TsujikawaA).
The
text notes no issues with Leah's somatic, psychiatric, or reproductive health. She
became the mother of a daughter and six sons (Gen. 35:23). In Ancient Egypt, a
woman who had children was considered "successful" and commanded
admiration (2016ДжарманОА_МикиртичанГЛ). The storytellers
"compensated" for her visual defect by presenting Leah as a heroic
mother. Giving birth to, nursing, and raising seven children is arduous labor.
At
first glance, Leah married Jacob owing to the cunning scheme of Laban, who
substituted the bride (Gen. 29:23–25). This story echoes an episode from
ancient Egyptian mythology: "the goddess Nephthys fell in love with
Osiris. One dark, moonless night she assumed the form of Isis and came to
Osiris's bed. From their love, the great god of Duat, Anubis, was born"
(2007РакИ). According
to Plutarch (1st–2nd centuries CE), "Isis learned that loving Osiris had
mistakenly united with her sister as with herself, and saw proof of this in a
garland of lotus that he had left with Nephthys" (1996Плутарх).
We believe the authors ingeniously modified the well-known plot. In the Book of Genesis, Laban deceptively provided for the future of his visually impaired daughter. The father understood that by founding her own family and having children, the daughter would receive support in the event of complete blindness and in old age. In Laban's action, the kindest intentions of a loving parent are observed, albeit at the price of deceit.
[xvi]
Rachel,
the younger daughter of Laban, son of Bethuel the Aramean, brother of Rebekah
(Gen. 27:43, 28:5, 29:16). She, like Leah, was Jacob's first cousin and wife
(Gen. 29:26, 28). As with Jacob's mother, Rachel exhibited signs of primary
infertility (Gen. 29:31, 30:1–2). The childless period lasted fourteen years
(Gen. 29:30, 30:22–23, 25, 31:38, 41). From our perspective, Rachel, like Sarah
and Rebekah, suffered from primary infertility caused by polycystic ovary
syndrome. She was fortunate to give birth to two sons: Joseph and Binyamin
(Gen. 30:23–24, 35:16). The woman experienced her inability to bear children
painfully and pondered her own death (Gen. 30:1). In the Nile Valley,
childlessness was dreaded, as it implied the interruption of the funerary cult
(2016ДжарманОА_МикиртичанГЛ).
Intuitively,
Rachel sought to obtain offspring not merely to secure help in advanced age. A
wife who had not borne a child could legitimately be set aside by Jacob under §
138 of the Babylonian Code of Hammurabi, provided he paid her bride-price in
silver and returned her dowry (1920HandcockPSP). The Code of Hammurabi fixed
norms for bride-wealth and the father-in-law's liability in §§ 159–161
(1920HandcockPSP). Under § 261, "If a man hires a shepherd to pasture oxen
or sheep, he shall pay him 8 gur of grain per year" (1920HandcockPSP).
Accordingly, one wife of Jacob was worth approximately 56 gur of grain. He and
his father-in-law were not wealthy livestock breeders, and furthermore, Jacob
had worked off the aforementioned price. In view of the above, Laban, assuming
infertility, gave "Rachel his daughter Bilhah his maidservant to be her
maidservant" (Gen. 29:28–29). Bilhah served as a kind of insurance that
could compensate for her mistress's infertility under § 144 of the Code of
Hammurabi (1920HandcockPSP). Presumably, the nurse who accompanied Rebekah to
Canaan for her wedding to Isaac held a similar status (Gen. 24:59). She appears
to have been a young woman who died "below Beth-el" after Jacob's
exodus from Shechem (Gen. 35:8). To us, Dvorah outlived Rebekah by at least 6–7
years, who passed away in the period between 1660–1640 BCE. Apparently,
according to the authors' design, the nurse elevated the bride's status. This
is clear from the letter ARM 26/2 298 (the Royal Archives of Mari) sent by the
vassal Usur-awassu to his lord Yasmah-Addu, in which mention is made of a nurse
who raised the queen from childhood and traveled with her to the capital from
Qatna (1988CharpinD_LafontB).
There are no indications in the text of any pathology in Rachel, and it is stated that she "was beautiful of form and beautiful of appearance" (Gen. 29:17). This presupposes good somatic health. Rachel dies suddenly in a complicated labor (Gen. 35:16–19). Apparently, death was caused by massive postpartum haemorrhage. Rachel was approximately 10 years younger than her husband, married at around 14 years of age, gave birth to her firstborn at 21, and died, according to our calculations, around 1631 BCE. At the time of her death and the birth of her second son, her age was approximately 36 years. The reader will undoubtedly be puzzled by Jacob's words commenting on Joseph's dream: "Shall I and your mother and your brothers indeed come to bow ourselves to the ground to you?" (Gen. 37:10). The speech was uttered approximately two years after Rachel's death. We have no pragmatic explanation for the quoted statement.
Title & Contents / Chapter 1 / Chapter 2 / Chapter 3 / Chapter 4 / Chapter 5 / Chapter 6 / Chapter 7 / Chapter 8 / Chapter 9 / Chapter 10 / Chapter 11 / Chapter 12 / Chapter 13 / Chapter 14 / Chapter 15 / Chapter 16 / Chapter 17 / Chapter 18 / Chapter 19 / Chapter 20 / Chapter 21 / Chapter 22 / Chapter 23 / Chapter 24 / Chapter 25 / References / Notes
Russian-language version:
Титул и оглавление / Глава 1 / Глава 2 / Глава 3 / Глава 4 / Глава 5 / Глава 6 / Глава 7 / Глава 8 / Глава 9 / Глава 10 / Глава 11 / Глава 12 / Глава 13 / Глава 14 / Глава 15 / Глава 16 / Глава 17 / Глава 18 / Глава 19 / Глава 20 / Глава 21 / Глава 22 / Глава 23 / Глава 24 / Глава 25 / Список литературы
Author of the publication
Arkhipov S.V. – Independent Researcher, MD, PhD, Orthopedic Surgeon, Medical Writer, Finland.
Correspondence: Sergey Arkhipov, e-mail: archipovsv @ gmail.com
Publication history
October 23, 2026 - online version of the book is published.
Suggested citation
Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Chapter 10. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-10.html
Note
Keywords
hip joint, hip dislocation, osteoarthritis, ligament of the head of femur, ligamentum teres, ligamentum capitis femoris, Minoan Eruption, Bronze Age, Ancient Medicine, Ancient Egypt, Edwin Smith Papyrus, Biblical Chronology, Genesis, Genesis Protograph, Bereshit
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
Comments
Post a Comment