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 15
Circumstances of the Injury
[i]
To
comprehend the details of an injury – its nature, mechanism, and pathogenesis –
as well as for diagnostic purposes, the circumstances of its occurrence are
routinely elucidated. This aspect of the "history of present illness"
was undoubtedly clarified by the physician who examined Jacob's prototype in
Egypt. From his contradictory account, it followed that the damage resulted
from an assault by a certain individual, presumably a man. The text of the
primary source states: "a man wrestled with him" (Gen. 32:25). It is
implied that Jacob did not initiate the fight, but rather an unknown individual,
for he asks: "what is your name?" (Gen. 32:28). From the very first
words, it is clear that this is not a chimera, a humanoid creature, or an
ephemeral entity. The speech is clear and grammatically correct, using a
language understandable to the victim. It should be noted that the attack
occurs suddenly, without warning. The cause of the assault remains unknown and
is explained neither by the combatants nor by the authors or editors of the
Book of Genesis. This circumstance has served as a springboard for the flight
of fancy among commentators and clergymen over the millennia.
The
absence of a motivation is of no significant importance from a physician's
perspective. While legal and theological speculations regarding the motive
abound in literature, they belong to the spiritual and political realms. We do
not touch upon this aspect of the event at the Jabbok River and therefore
neither enumerate nor discuss these well-known interpretations.
From
the Old Testament narrative, it follows that Jacob initially fights with a
"man" (Gen. 32:25). For some time, the struggle takes place in
complete silence from both opponents. In the dialogue following the infliction
of the injury, the rival refers to himself as an angel (Gen. 32:29). Prior to this,
the victim had guessed the unusual nature of his vis-à-vis, as he asked for a
blessing (Gen. 32:27). At the conclusion of the incident, Jacob confidently
asserts that the attacker was in reality a virtual entity: "I have seen an
angel face to face" (Gen. 32:31). Where and how the divine messenger
disappears remains unknown, as does his name (Gen. 32:30).
This
meeting and communication with such mythological beings was not Jacob's first.
He sees angels while fully awake upon entering a region he named
"Mahanaim" (Gen. 32:2–3). It remains unclear why at the Jabbok stream
the angel feared the sunrise and implored to be released (Gen. 32:26–27). In
"Mahanaim", the aforementioned entities appeared in broad daylight.
Jacob
had occasion to "converse" with one of these "angels" in a
dream seen in Haran (Gen. 31:11). At the same time, further in the text, this
non-physical entity declared: "I am God" (Gen. 31:13). This textual
contradiction is left unexplained. Later, Jacob compares the face of Esau to
the face of an "angel" (Gen. 33:10). We know that his brother was
born "red, all over like a hairy garment" (Gen. 25:25). Does this
mean that a similar persona materialized by the Jabbok River and appeared
"face to face" (Gen. 32:31)? Was it this "hairy" man who
delivered Jacob "from all evil" (Gen. 27:11, 48:16)? During his
journey to Northern Mesopotamia, Jacob dreams of the "angels of God"
ascending and descending a ladder (Gen. 28:12). These entities utter no words;
instead, the "Lord" speaks (Gen. 28:13–15).
For
an individual with such prior experience, the memory of battling an angel comes
as no surprise. At the same time, never in Jacob's life had it occurred that
angels inflicted bodily harm, let alone were overcome (Gen. 32:26, 29). An
angel is capable of guiding and delivering "from all evil" (Gen.
31:11, 48:16). Something benevolent was associated with this concept, as Jacob
uses it to appease Esau (Gen. 33:10). A violent attack does not align with our
understanding, nor even with the religious concepts of the authors. That is why
initially it is not a benevolent and almighty sublime figure who wrestles with
Jacob, but a man (Gen. 32:26). What became of him, where and why did he
disappear? Further on we read: Israel overcame him as well, as one of men (Gen.
32:29).
According
to the Book of Genesis, virtual entities generally appear before Jacob in
dreams. The sole instance of an actual (?) encounter with angels is
"registered" in Mahanaim (Gen. 32:2–3). Near the Jabbok River, the
interaction is contradictory, for it occurs both with an anonymous man and with
a nameless angel (Gen. 32:25, 29, 31). Both dissolve into space without a
trace; none of the companions saw them except Jacob. The workers guarding the
camp and the shepherds tending the flocks did not rush to separate the
fighters. The livestock did not panic or scatter. The relatives were not
alarmed by the family head's nocturnal fight with an anonymous assailant. His
approach to and departure from the bivouac went unnoticed…
According
to the text, the injury is inflicted by a "man" (Gen. 32:26, 33).
More precisely, it is a mental image of an unnamed individual. However, the
physical consequences of the hip joint trauma are real, as a third-party
observer subsequently describes the limping (Gen. 32:32). Such a dissonance in
Jacob's narrative could not have been ignored by the examining physician. This
ought to have compelled the diagnostician to further clarify the circumstances
of the incident.
According to the patient, the attack
was exceptionally unusual. A conceptual entity "touches" the hip
joint, after which it was "dislocated" (1978БроерМ_ЙосифонД,a, Gen.
32:26); "thigh was put out of joint" (1922LeeserI, Gen. 32:26).
Severe trauma to one of the strongest human joints occurs spontaneously.
There
were no witnesses to the incident. On this matter, the primary source states:
"Jacob was left alone" (Gen. 32:25). Could the patriarch clearly see
his rival? It is doubtful. Everything occurred during the dark hours of the
night. First we read: "he arose that night", and then: "a man
wrestled with him until the breaking of day" (Gen. 32:23, 25). In
darkness, visual acuity declines, objects are seen unclearly, and small details
are indistinguishable. There is no mention in the text that the struggle was
illuminated by the moon. At first glance, it is not surprising that Jacob
initially mistook the angel for a man (Gen. 32:25, 29). The writers lead us to
the idea of poor visibility at the time of the nocturnal battle. In November in
Jordan, it is usually cloudy and rain is not uncommon. Both of these factors
could indeed limit the effect of moonlight and cause the victim to fail to
identify the attacker. Therefore, the ancient Egyptian physician who compiled
Jacob's "case history", regarding the circumstances of the injury,
apparently recorded: "according to the patient, he was subjected to a
nocturnal assault by an unidentified individual, probably an angel."
Moreover, the question of how exactly and why the "hip joint was
dislocated" remained unresolved (Gen. 32:26).
[ii]
In
two instances from his past life, Jacob sees angels in a dream (Gen. 28:12,
31:11). In the latter instance, the patriarch speaks with one of these
"entities" (Gen. 31:11). Jacob meets angels in daylight at
"Mahanaim" (Gen. 32:2–3). The fourth case occurs on the night of the
crossing (Gen. 32:29, 31). That the battle took place with an angel is asserted
by the authoritative prophet Hosea (Hos. 12:4). Nevertheless, his literary gift
flourished approximately a millennium later.
From
the biblical books, it is known that angels dwell in heaven and speak from
there (Gen. 21:17, 22:11, 15). It is within their power to hover above the
earth (1 Chron. 21:16); to appear in a flame of fire (Exod. 3:2; Judg. 13:20);
to help people (Gen. 16:7, 19:15); they are able to walk (Exod. 14:19, 23:23,
33:34); to boldly enter a fiery furnace (Dan. 3:49); to bring forth fire from a
rock (Judg. 6:21); to be invisible (Judg. 13:21); sometimes merely to touch
people (1 Kings 19:5, 7); in a number of cases to strike the "people"
(2 Sam. 24:16–17; 2 Kings 19:35; 1 Chron. 21:15; 2 Chron. 32:21; Isa. 37:36),
doing so by the decision of "God" (Dan. 13:55); and to easily
transport a person from Judea to Babylon (Dan. 14:33, 36). From the above, it
follows that an angel is a creation endowed with supernatural abilities. It is
possible to "communicate" with an angel while awake, as well as in a
dream. From a linguistic point of view, an angel is a "servant of God, an
executor of His will, and His messenger to people" (2006ОжеговСИ_ШведоваНЮ).
According
to religious works, angels are capable of inflicting trauma upon a human (2
Sam. 24:16–17; 2 Kings 19:35; 1 Chron. 21:15; 2 Chron. 32:21; Isa. 37:36; Dan.
13:55). In scientific literature, no such evidence has been identified, nor are
there descriptions of encountering them in everyday life. Therefore, we have
put forward the hypothesis that Jacob's narrative of sustaining an injury
during a struggle with an angel – or perhaps a man – was inspired by a dream.
It seems to us that the Book of Genesis presents an account of a vivid dream or
hallucination of a laborer exhausted by hard physical work and emotional stress
over the course of two days.
It
is doubtful that in "Mahanaim" Jacob was met by "angels of
God" (Gen. 32:2–3). According to our version, these were birds and winged
insects fluttering over blossoming meadows. For the aforementioned reason,
these "angels" do not converse with anyone. The term is used in a
figurative sense. In Haran, Jacob speaks of a dream in which he sees and
perceives the speech of an angel (Gen. 31:11). The narrative is addressed to
credulous listeners: Rachel and Leah (Gen. 31:4). The spouses are uncritical,
as they are financially interested in implementing the recommendations of the
mythical angel (Gen. 31:14–16).
The
situation is only slightly more complex regarding the angels, the ladder
reaching into heaven, and God seen in a dream near the place of "Beth-el",
which was originally named the city of "Luz" (Gen. 28:12, 19). The specified
settlement is identified with the archaeological site of Beitin. Between 2000
and 1500 BCE, the aforementioned settlement possessed a wall and gates
(1992FreedmanDN). The interpretation of the vision of the ladder and angels is
difficult from the perspective of a religious person, yet quite simple from a
scientific standpoint.
The
motif of the ladder appears repeatedly in the ancient Egyptian Pyramid Texts.
In the burial chamber of Pharaoh Merenre (2255–2246 BCE), an utterance was
found stating: Atum shall gather "for you the gods belonging to the earth,
and they shall make a ladder for you so that you may ascend on it to
heaven"; and in another inscription we find: "A ladder to heaven
shall be set up for you so that you may ascend" (2007AllenJP).
In
another spell from the Pyramid Texts, dating back to 2350–2175 BCE, there are
the words: "Hail to you, ladder of the god; hail to you, ladder of Seth.
Stand up, ladder of the god; stand up, ladder of Seth; stand up, ladder of
Horus" (1952MercerSAB). The plot involving Jacob's mystical ladder appears
to have been penned by a scribe familiar with monumental ancient Egyptian
inscriptions. An Asiatic nomad could neither have seen nor read the hieroglyphs
inside the royal tombs.
It
follows from the primary source that Jacob approaches the enclosure of the
settlement after sunset (Gen. 28:11). Naturally, the entrance is closed. The
traveler has to spend the night under the open sky. Preparing for sleep, Jacob
hastily constructs a makeshift bed, placing stones at his headrest (Gen.
28:11). His mysterious dream resulted from a combination of fatigue, a rich
inner world, and an episode of hypoxia. During deep sleep, muscle tone
disappears. The sleeping Jacob's head rested on a large stone (Gen. 28:18). The
inelastic headrest of the bed caused excessive neck flexion, compression of the
larynx, and posterior displacement of the mandible. These factors, combined
with the relaxation of the lingual muscles, impaired upper airway patency.
Blood in the lungs ceased to be adequately saturated with oxygen.
In
turn, a low percentage of oxygen saturation in the blood flowing to the brain
triggers vivid dreams (2007ChokrovertyS). Acute hypoxia affects the
temporoparietal junction and the prefrontal cortex, the activities of which are
associated with an altered perception of one's own body as well as mystical
experiences (2005ArzyS_BlankeO). These are usually observed during the
"REM sleep" phase, also referred to as "rapid eye movement
sleep" (2011MallickBN_MorrisonAR). The aforementioned visions vary from
normal and mundane to bizarre and entirely surreal, and memories of them are
preserved when the sleeper is awakened closer to morning (2022LeviR).
Similarly, during an acute reduction of blood flow in the central nervous system,
particularly memorable dreams occur (1990WhinneryJE_WhinneryAM). Under
controlled clinical conditions during procedural sedation, hypoxic phenomena in
8% of individuals are accompanied by hallucinations
(2021ManirafashaA_CattermoleNG). They are also induced by an elevated level of
carbon dioxide in the blood, which acts upon the hippocampus or stimulates the
activity of the temporal lobes of the brain (1989MorseML_MilsteinJ). The cited
facts allow for a satisfactory explanation of the origin of Jacob's mystical
dream and permit it to be perceived as a mundane phenomenon. The Old Testament
supernaturalness and the search for the "essence" are the
speculations of commentators lacking medical education. The authors described a
dream induced by hypoxia.
It
appears to us that hypoxemia was the cause of the vivid dreams of the baker and
the chief cupbearer imprisoned by the pharaoh (Gen. 40:1–5, 9–11, 16–17). Both
were in a poorly ventilated dungeon cell in a hot climate, having surrogates
for bedding, including substitute pillows. A lack of oxygen in the ambient air,
an increased concentration of carbon dioxide, and laryngeal compression in the
event of an uncomfortable head position could very well have caused fantastical
dreams.
In
ancient Egyptian Houses of Life, manuals were compiled for dream interpretation
(1951GarnotJSF). Fragments of the Book of Dreams on Papyrus Chester Beatty III,
written during the 12th Dynasty, have survived to this day (1935GardinerAH).
This text partially enables us to understand the line of reasoning of Joseph
when commenting on the dreams of the chief cupbearer and the baker. The former
recounted: "in my dream, behold, a vine was before me; and in the vine
were three branches: and it was as though it budded, and her blossoms shot
forth; and the clusters thereof brought forth ripe grapes. And Pharaoh's cup
was in my hand: and I took the grapes, and pressed them into Pharaoh's cup, and
I gave the cup into Pharaoh's hand" (Gen. 40:9–11). To the dreamer wishing
to give wine to the pharaoh, a favorable prophecy is given. Apparently, it was
based on correspondences from the Book of Dreams: pressing wine is a bad sign
forecasting loss of property; drinking wine is a good sign signifying a life of
righteousness, as well as opening the mouth to speak (1935GardinerAH).
The
royal baker sees in his dream: "behold, I had three white baskets on my
head; and in the uppermost basket there was of all manner of bakemeats for Pharaoh;
and the birds did eat them out of the basket upon my head" (Gen.
40:16–17). It is assumed that the baker wishes to drive away and catch the
birds preying on the loaves intended for the pharaoh. According to the Book of
Dreams: seeing birds being caught portends misfortune, signifying loss of
property (1935GardinerAH). Could this be why the authors place an unfavorable
omen into Joseph's mouth?
We
believe that the pharaoh's dreams were likewise caused by hypoxia. The ruler
beholds two consecutive dreams regarding fat and emaciated cows, as well as
similar ears of grain devouring one another (Gen. 41:1–7). In the morning, the
king's "spirit was troubled" (Gen. 41:8). From our viewpoint, the
preferable explanation for a series of mystical dreams, accompanied by
nocturnal nightmares and morning anxiety, is a disorder associated with the
cessation of normal breathing during sleep. One such condition is obstructive
sleep apnea. In this pathology, the soft tissues of the oropharynx, larynx,
mandible, and tongue relax, obstructing the airways during sleep. Patients
awaken multiple times during the night due to snoring and reduced oxygen
saturation of the blood. It has been noted that obstructive sleep apnea is
characteristic of individuals with obesity and facial anomalies (2004VictorLD).
The pharaoh mentioned in the Book of Genesis was clearly well-nourished, which
could have caused obesity that impaired the nocturnal respiratory cycle,
especially given a hypersthenic physique.
Nocturnal
apnea is also observed in congenital central hypoventilation syndrome (syn.
Ondine's curse), which develops as a consequence of bulbar poliomyelitis,
trauma, encephalitis, brainstem infarction, hemorrhage, cavernous malformation,
osmotic demyelination syndrome, multiple sclerosis, Leigh syndrome, inferior
olivary heterotopia, mitochondrial and degenerative diseases, and brainstem tumors
(2020JuniorZD_GueriosEE). As a result of hypoventilation, individuals with
central hypoventilation syndrome develop hypoxia and hypercapnia, but there is
usually no ventilatory or arousal response during sleep to these endogenous
stimuli, nor is there a sensation of asphyxia in the awake state
(2010Weese-MayerDE_TrangH).
According
to the French National Registry, central hypoventilation syndrome is sometimes
associated with Hirschsprung's disease (2005TrangH_GaultierC). The
aforementioned pathology manifests in early childhood, accompanied by
intoxication, intestinal obstruction, emaciation, and infections. A subset of
patients is capable of surviving into adulthood, for instance to 20–46 years of
age, if constipation is periodic and transient (2012МосквитинИС_ТоваршиновАИ). From our primary source, we learn
that the pharaoh was wroth "against his chief cupbearer and against his
chief baker" (Gen. 40:1–2, 41:9–10). The cause could have been a
disruption of digestion and bowel evacuation, which is characteristic of
Hirschsprung's disease combined with central hypoventilation syndrome. Such a
combination is observed in 15–20% of patients with Ondine's curse syndrome and
is termed Haddad syndrome by some authors (2016TsoutsinosA_ChatzisAC).
According
to our hypothesis, Joseph was an actual vizier under Pharaoh Sheshi. If the
latter suffered from obstructive sleep apnea or Ondine's curse syndrome, his
death could have been sudden. Obstructive sleep apnea is associated with
substantial morbidity and even with some mortality (2004VictorLD). In
individuals with obstructive sleep apnea, the peak of sudden cardiovascular
death occurs during the hours between midnight and 6 a.m. During this period,
an increased incidence of sudden death is observed in patients with heart
failure, myocardial infarction, coagulation disorders, and fatal arrhythmias.
Recurrent episodes of acute apnea induce hypoxia, hypercapnia, blood pressure
spikes, and cardiac arrhythmias. Obstructive sleep apnea is also linked to
hypercoagulability, vascular oxidative stress, systemic inflammation, and
endothelial dysfunction. In obstructive sleep apnea syndrome, severe
disruptions of autonomic, hemodynamic, humoral, and vascular regulation occur
during sleep (2005GamiAS_SomersVK). The risk of sudden cardiac death increases
substantially in congenital central hypoventilation syndrome
(2008GronliJO_Weese‐MayerDE). Patients with Ondine's curse syndrome combined
with Hirschsprung's disease generally have a short life expectancy
(1990FodstadH_ShawisR).
It
appears more plausible to us that the king experienced an isolated episode of
digestive disorder resulting from a dietary flaw or a mild intestinal
infection. In that case, the execution of the biblical baker was retribution
for inadequate hygiene control in the kitchen, poor personal hygiene of the
cooks, and improper menu composition. Obviously, water ingested with wine is
predominantly excreted through the urinary tract rather than the intestines.
Therefore, the chief cupbearer was pardoned as having had no relation to
intestinal dysfunction or pathological defecation.
In
a pharaoh suffering from impaired pulmonary ventilation at night, sudden death
during sleep from hypoxia or cardiac pathology would be expected. In the
absence of heirs, Joseph would have had the opportunity to claim the throne. A
highly qualified physician could have warned the contender of such a turn of
events and thereby prompted him to compose a political allegory justifying the
upcoming change of power.
The
fantastical events of the final third of chapter 32 of the Book of Genesis
likewise allow for the assumption of a retelling of a dream induced by
hypoxemia. Jacob wades across the Jabbok stream at night (Gen. 32:23). Along
with him, the stream was crossed by at least two wives, two female servants,
and "eleven children" (Gen. 32:23–24). After the crossing, the head
of the family is left alone (Gen. 32:25). Consequently, Jacob stepped aside
from his relatives, presumably to rest in quiet. It seems to us that he sat
down, leaning against a tree trunk, or lay on a hastily made bed. In an extreme
scenario, rather than a proper pillow, a surrogate was placed under his head.
Thus, the development of nocturnal hypoxia due to head tilt with a relaxed body
was probable. A similar situation occurred when using a stone as a pillow at
"Beth-el" (Gen. 28:12, 18–19).
However,
near the Jabbok ford, there were more factors capable of affecting sleep. Over
the preceding two days, Jacob had worked intensely and experienced emotional
distress. He was frightened by the news of his brother's approach with an army
of "four hundred men" (Gen. 32:7–8, 12). Next, his actions in
dividing the caravan into two camps are narrated (Gen. 32:8–9). After a
poignant prayer, the father of the family goes to sleep (Gen. 32:14). Anxiety
was unlikely to allow him a good night's sleep. The following day was dedicated
to organizing and dispatching gifts to his brother (Gen. 32:14–21).
Furthermore, a brief overnight stay is mentioned, along with the implied
physically and emotionally demanding crossing of the river while relocating
belongings, children, and livestock (Gen. 32:22–24). As expected, a feeling of
fatigue arose, associated with a deficit of adenosine triphosphate (ATP) in the
cells. Lactic acid accumulated in the striated muscle tissue, causing pain.
Exhaustion, lack of proper night rest, and anxiety conditioned a state
bordering on neurosis, accompanied by a desire to rest.
It
is well known that hallucinations in mentally healthy subjects are induced by
sleep deprivation, mental exhaustion, and physical overwork (1906MossoA;
1983MullaneyDJ_JohnsonLC; 1996BeyersteinBL). Normally, hypnagogic
hallucinations (upon falling asleep) and hypnopompic hallucinations (upon
awakening) can occur, which are present in 33% of healthy individuals
(2005ManniR). They are associated with ordinary dreams, but with a higher level
of awareness, demonstrating broad phenomenological richness: from vague to
vivid imagery, from simple to complex concepts, and from mundane to bizarre
scenes. This is likely due to a relatively direct transition from wakefulness
to REM sleep imagery, and they are sometimes present in the final sleep cycles
closer to morning (2024FoffaniG).
Both
types of hallucinations are significantly more common in individuals with
symptoms of insomnia, excessive daytime sleepiness, or psychiatric disorders
(1996OhayonMM_GuilleminaultC). Hypnagogic and hypnopompic experiences,
including the sensation of a presence, fear, as well as auditory and visual
hallucinations, are presumed to arise in a state of heightened vigilance
initiated by the midbrain (1999CheyneJA_Newby-ClarkIR).
The
Book of Genesis narrates a phenomenon reminiscent of a hypnagogic
hallucination: at sunset, "a deep sleep fell upon Abram; and, lo, an
horror of great darkness fell upon him" (Gen. 15:12). The vision is
similar to a dream in the Epic of Gilgamesh, which the hero recounts to Enkidu:
"My friend, I have seen a dream – how heavy, how fearful, how dark!"
(1961ДьяконовИМ).
Gilgamesh's friend also sees dreams: "Enkidu slept and saw a dream, Enkidu
arose and interprets the dream, proclaiming to his friend: 'My friend, what did
the great gods counsel?'" (1961ДьяконовИМ). The standard version of the Epic of
Gilgamesh was first recorded in the Old Babylonian period, that is, in
1800–1600 BCE (1989KovacsMG). The earliest evidence of the practice of
collecting dreams in Mesopotamia dates back to the Old Babylonian period,
namely 2003–1595 BCE (2006NoegelSB).
In
a letter (ARM 26/1 225) from the Mari archive (18th century BCE), we read:
"The dream that I saw alarmed me ... I summoned the diviners with the
question: 'My Lord has sent me an urgent message; what do you advise?'"
(1956Munn-RankinJM; 1988DurandJ-M).
Literature
on dream interpretation existed both in Mesopotamia and in Egypt (2001BarS). In
Egypt, since the 12th Dynasty, members of the Houses of Life, where magic,
medicine, and divination were studied, compiled manuals in which they
systematically recorded correspondences between dreams and the events foretold
by them (1951GarnotJSF).
Diodorus
recounted the existence of dream interpretation specialists in Ancient Egypt
(1972El-AssalG). The Egyptians believed that the gods "communicated their
will to humans in sleep" (2021МюллерМ). The Instruction of King Amenemhat (12th
Dynasty) contains a reference to a prophetic dream: "He appeared in a
dream to his son, the ruler of all, and proclaimed: 'Appear as a god! Hearken
to my words'" (1978КоростовцевМА). The previously mentioned Papyrus Chester Beatty III contains the
so-called Book of Dreams, possibly also dating to the 12th Dynasty, where dream
episodes are interpreted in detail (1935GardinerAH). In The Eloquent Peasant
(Middle Kingdom), there are words implying the author's rational attitude toward
visions seen in sleep: "He who sleeps sees dreams" (1979ЛившицИГ_РубинштейнРИ).
In our opinion, ministers of the ancient Egyptian House of Life were involved in the creation of the Book of Genesis. In view of this, their inclusion of retellings of dreams in the work appears natural. In the Houses of Life, dreams were collected and analyzed. Such information was used to assist diviners. The authors of the primary source were aware of such specialists. The pharaoh repeatedly consulted with "magicians" regarding dreams (Gen. 41:8, 24). Joseph practiced divination using a cup and retold his dreams (Gen. 37:6–7, 9–10, 44:1, 5, 15). It seems natural that descriptions of the visions of sleeping and ill individuals could be included in the work under discussion.
[iii]
During
the crossing, Jacob transports across the river numerous herds of various
animal species, a large family, and possessions (Gen. 32:6, 15–16, 23–24). The
specified events occur under conditions of poor visibility, or more precisely,
at night (Gen. 32:23). It is not excluded that a drizzle was falling and a cool
wind was blowing as they crossed the stream. Jacob anticipated a sudden attack
and sought to conceal his actions. How far Esau's large detachment was located,
he did not know. In the morning, there was a pressing need to be prepared not
only to immediately begin moving, but also to be able to repel an attack
without being constrained by the procedure of crossing the river. In the
bustle, with insufficient visibility of the terrain, and in the presence of
obstacles such as rocks and the rushing water current, an accident could very
well have occurred with Jacob. Endeavoring to swiftly complete the initiated
crossing of the Jabbok, anxious for his family, the patriarch apparently paid
no attention to a "minor" injury sustained. Later, he was unable to
recall the incident, or it was forgotten due to the preceding days filled with
intense events.
Reading
closely into the text, it appears to us that after the restless night crossing,
Jacob's prototype indeed remains alone (Gen. 32:25). The patriarch needed to
regain his strength after completing an arduous and responsible task. For this
purpose, the head of the family separates from his companions and rests in solitude
on the southern bank of the Jabbok River. The animals driven across the river,
roused at night, are agitated and noisy. The laborers unload the camels and
donkeys, converse with one another, shout at the livestock, and unload the
baggage. The wives and children settle down for the night and converse. Jacob
needed to gather his thoughts, as a difficult conversation with his brother was
anticipated. The patriarch reasonably believes that a threat of violence and
ruin hangs over him and his family (Gen. 32:9, 12). Evidence of this is the
movement toward him of an army of four hundred mercenaries (Gen. 32:7). Prior
to crossing the Jabbok stream, Jacob divides the property and the
"people" into two camps, collects a large herd as a conciliatory gift
for Esau, and instructs the drovers (Gen. 32:8, 14–21). The last time, upon
completing the day's concerns, he had rested for merely a third of the usual
night time (Gen. 32:22–23).
Exhausted
after an intense twenty-four hours, sleep-deprived, and weighed down by heavy
thoughts, Jacob, being alone in the quiet, drifted off to sleep imperceptibly
to himself. The primary source does not state that the patriarch went to sleep
in a prepared bed, which means he did not carefully prepare a couch for
himself. Earlier in the text, overnight stays – and thus the arrangement of a
bed – are explicitly noted (Gen. 32:14, 22). We surmise that Jacob sat under a
tree or lay down, spreading a mat or a sheepskin on the ground, placing a stone
or a bundle with personal belongings at his headrest. It was in a similar
manner that he had to spend the night near the city of "Luz" (Gen.
28:11, 18–19). It was then that Jacob first envisioned angels and God (Gen.
28:12–13).
In
both instances, there was an unfavorable mutual alignment of the body and head,
as well as significant muscle relaxation. Consequently, the movement of air
through the respiratory tract was impaired, or an episode of "nocturnal
apnea" even occurred. From our point of view, near the Jabbok River,
Jacob's prototype developed a hypnopompic hallucination – an experience upon
awakening from sleep. Even normally during REM sleep, dreams vary from neutral
to entirely unrealistic, and clear memories of them are preserved when dreamers
are unexpectedly awakened. There is nothing unusual in paradoxical dreams.
Frequently, in a nocturnal vision, a person perceives movement, distinguishes
light and darkness, colors, small details of objects or surfaces, senses odors,
feels muscle tension, contact with water, and the temperature of objects, hears
sounds such as speech, and speaks himself, including with those long deceased.
In a dream, it is possible to walk, perform various actions, vividly drown,
swim underwater, fall into an abyss, fly, break out in sweat, become physically
fatigued, experience suffocation, and perceive the actions of other
individuals, objects, animals, chimeras, monsters, and benevolent entities. As
a familiar "experienced" dreamer recalled: "in a dream, anything
can happen..."
Due
to fatigue and prior sleep deprivation, Jacob's prototype rapidly
"sank" into deep sleep. The arising protective inhibition of neural
activity temporarily provided an analgesic effect for the overworked muscles
containing elevated levels of lactic acid, as well as the injured hip region. In
the state of "slow-wave" sleep, the victim sat or lay "until the
breaking of day" (Gen. 32:25). Dawn coincides with the transition to the
"REM" sleep phase. During this period of the gradual appearance of
the sun above the horizon, Jacob envisioned a dream featuring a battle and a
conversation with an angel (Gen. 32:25–30). The description of the vision is
close to the characteristics of hypnopompic hallucinations at the end of the
night. This was facilitated by the victim's religious worldview, which was
quite typical for people of the Bronze Age. One of the confirmations of our
position is that the dreamer realizes that the opponent "saw that he
prevailed not against him" (Gen. 32:26). It appears that the word
"saw" is used in the sense of "understood." Both the former
and the latter concepts indicate a higher level of awareness than in an
ordinary dream. The struggle ostensibly took place in the dark; therefore, the
error of Jacob's prototype in determining whether he faced a man or an angel is
forgivable. The described scene presented itself in the mind rather than being
registered by the visual analyzer. "Inferring" the thoughts of
another person and "revealing" their sensations through the creation
of visual images is a technique widely used in cinematography. A similar
phenomenon is observed in dreams.
During
a physical fight, combatants observe each other's dangerous movements. A
wrestler focused on victory does not look at his own body and is not distracted
by insignificant phenomena. The battle with an unknown individual proved
unexpected for Jacob. The struggle began in the dark under an ominous silence.
The mind of the awakening person perceives a threat to life. At that moment,
the patriarch certainly paid no attention to "minutiae" or
"mild" sensations. However, Jacob realizes that the opponent
"touched the hollow of his thigh" (Gen. 32:26). In a selfless duel,
noticing a light touch is impossible, as is clearly determining that someone
touched the area of a specific hip joint, let alone the joint itself. The named
organ of locomotion is situated deep within the body, is not visible from the
outside, and is difficult to subject to a specialized manual examination. On
this basis, we assert that in Jacob's "hip joint", significant pain
arose during the morning vision. Its level of intensity proved to be such that
nervous and physical tension "faded into the background." This is
what the authors attempted to convey to us.
In
the dream, the prototype of the literary Jacob felt pain in the hip joint region
for the first time. The foot or leg trauma sustained at the crossing, which had
slipped from memory, "emerged" from the gloom of the subconscious. He
was unable to recall the details of the incident during "REM" sleep,
having paid no attention to it earlier. In his thoughts, the injury became
"linked" to the image and actions first of a man – presumably his
brother – and subsequently an angel. The thought of an intercessor in a
critical situation contributed to the development of the plot, the formation of
a mystical image, and the theme of the conversation. The brain
"painted" the most comfortable scenario, much like modern artificial
intelligence agents generate content. Certain politicians and fraudsters behave
similarly, creating an alternative reality and convincing their counterparty of
it. It is easier for the majority to agree with a beneficial and simple
explanation if no loss or punishment is perceived in the immediate perspective.
The
victim's awakening at dawn was aided by the increasing illumination and sounds
emanating from the waking camp. Sleep became "shallow", and Jacob
realized that day was breaking and the sun would soon rise (Gen. 32:27). The
hallucination was interrupted at some point by the first rays of the sun or a
loud call, and therefore its content was well remembered. The dreamer had
already "encountered" "divine" beings; hence, what he
envisioned did not become something extraordinary. The patriarch perceived the
vision as part of real life, which continued in the light of the breaking day
with worldly concerns.
From
the description in the Book of Genesis, it is evident that the hypnopompic
hallucination was brief (Gen. 32:25–30). According to our calculations, the
morning twilight on the day of the injury lasted about half an hour. During
this time, Jacob becomes aware of the pain and the "dislocation" that
occurred in his hip joint (Gen. 32:26). Since he was unable to accurately
recall the episode of the injury, a certain man is "assigned" as the culprit
(Gen. 32:25). It should be noted that Jacob does not state that the
"dislocation" in the hip joint was executed by any of the men or a
messenger of God. The angel merely converses with him, whereas the leg is
injured after the touch of the "man" while Jacob "wrestled with
him" (Gen. 32:26). Moreover, it is apparent from the text that the joint
"was dislocated" as if "by itself", not even at the exact
moment of the "touch", but later (Gen. 32:26).
Jacob
"wrestled with an angel and with men" (Gen. 32:30). Where the angel and
the "men" disappear with the first rays of the sun remains a mystery.
It is clear that no one except the victim saw them, and consequently, no one
witnessed the moment the injury was inflicted. Neither the relatives nor the
shepherds noted any sounds of a fight. Sentries saw no strangers within the
encampment. No one rushed to help or raised an alarm. These
"discrepancies" point toward the description of a dream that
transitioned into a hypnopompic hallucination. However, common sense and our
own clinical experience testify to the impossibility of a hip joint
"dislocation" occurring during sleep in a healthy individual without
preceding trauma.
The wrestling scene was unequivocally "envisioned" during the night's rest, as was the notion that the damage was inflicted by an unknown individual. This convinced us that the accident had occurred earlier, during the wading across the Jabbok stream. On the preceding stages of the journey from Haran to Canaan, which we examined above, no traumatic events are observed. The incident during the river crossing was erased from memory due to its perceived insignificance at that moment, as well as the substantial physical and psycho-emotional stress at the immediate time of injury.
[iv]
It
is customary to distinguish two main types of injuries: "intentional"
and "unintentional" (2018AldridgeE_YonY). The hypothesis presented by
us reclassified Jacob's injury from "intentional" (resulting from
interpersonal unarmed violence) to "unintentional." The latter can be
the result of a deliberate action by an individual, as well as an accident,
such as a fall or loss of bodily balance. The mystical component of the injury
description in the Book of Genesis is dispelled by scientific facts and
reasoned judgements. One would like to believe that there is one fewer biblical
"miracle"; at least, its religious aura in our eyes has faded. Nor is
the ability to overcome an angel in a dream surprising – Jacob possessed a firm
moral core, strength of spirit, and a sincere desire for reconciliation.
In
reality, the matter discussed is the essence of a literary text. More
significant is that Old Testament Jacob had a prototype. The ancient Egyptian
doctor who participated in the writing of the Book of Genesis had an
understanding not only of normal anatomy, but also of traumatic pathology of
the hip joint. The physician understood and related that damage to the ligament
of the head of femur (ligamentum capitis femoris, ligamentum teres femoris) is
capable of disrupting gait. This is known to very few people 3,600 years after
the diagnosis was established for literary Jacob. Furthermore, the role and
function of the aforementioned anatomical element are still not fully
understood by us. Failing to account for the ligament of the head of femur as a
functional link, certain researchers posed the question "...how are the
enormous forces applied to the femoral head compensated for?" (1975ЯнсонХА).
In
1922, the authoritative anatomist L. P. Nikolaev noted that "the question
of the role of the ligamentum teres of the hip joint ... to this day cannot be
considered resolved" (1922НиколаевЛП). Another 76 years pass, and at the end of the
20th century, the pioneer of hip arthroscopy, T.J.W. Byrd (1998), writes that it
is difficult to describe the pathology of a structure with an essentially
unknown function. In the current 21st century, researchers have still made no
progress, noting the insufficient state of knowledge regarding this aspect of
the ligament of the head of femur (2013MartinRL_ClementeFR).
For
an unclear reason, even the term denoting this formation has numerous synonyms
(2004Архипов-БалтийскийСВa,b; 2006,2008,2012,2018АрхиповСВ; 2020ArkhipovSV_ProlyginaIV). The
anatomy, physiology, biomechanics, symptomatology, and diagnosis of alterations
in the ligament of the head of femur, its types, as well as the prevention of
pathology, have not yet been clarified. The consequences of dystrophic
transformations, injuries, and dysfunction of this structure – both for the hip
joint and for the entire musculoskeletal system – have not been realized. It is
interesting and unclear how information regarding this anatomical element
entered the text of a work that became religious and reached our days.
We
are genuinely amazed that the pathology of the ligament of the head of femur
does not respond to treatment, and the sad consequences for the hip joint are
predictable yet inevitable. This must be stated despite the undoubted progress
of medical science, the emergence of the newest technologies, and the colossal
investments of citizens and states in healthcare. We still do not know why
healing is impossible – that is what is truly incomprehensible. This is a real
tragedy for an individual. It is compounded by the fact that it entails not
only locomotor restrictions, but also psychological damage, impaired
development, and a decline in the quality of life. This can "touch"
anyone: an adult, a child, or an unborn person; someone engaged in sports,
leading a rational lifestyle, or passive regarding their health; residing in a
developed country or a state where the standard of living is low. Nowhere, no
one, for any amount of money, is capable today of curing damage to the ligament
of the head of femur and preventing its deleterious consequences.
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 15. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-15.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
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