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 16
Textual and Conceptual Borrowings
[i]
According
to modern legal practice, borrowing ideas, concepts, or facts is not considered
plagiarism. Today, legislation protects only a specific form of expression
rather than thoughts themselves. However, paraphrasing someone else's ideas in
one's own words without attributing the author is recognized as an ethical
violation in the academic or scientific community. The Book of Genesis falls
into the category of literary works of the epic genre. This is how its writers
intended it to be. Its reclassification into a religious work was carried out
centuries later, when "copyright had expired". In connection with the
above, nothing prevents us from quoting large passages, as well as searching
for borrowings in the Russian translation of the Hebrew version.
In
this case, we have focused on the events directly related to the injury of the
literary Jacob. They are described in the final third of Chapter 32:
"22
The present went thus on before him and he lodged himself that night in the
camp 23 And he rose up that night, and he took his two wives, and his two women
– servants, and his eleven sons, and passed over the ford of the Yabbok. 24 And
he took them, and sent them over the stream, and sent over what he had. 25 And
Jacob was left alone; and there wrestled a man with him until the breaking of
the day. 26 And when he saw that he could not prevail against him, he struck
against the hollow of his thigh ; and the hollow of Jacob's thigh was put out
of joint, as he was wrestling with him. 27 And he said, Let me go, for the day
hath dawned. And he said, I will not let thee go until thou hast blessed me. 28
And he said unto him. What is thy name? and he said, Jacob. 29 And he said, Not
Jacob shall any more be called thy name, but Israel; for as a prince hast thou
power with God and with men, and hast prevailed. 30 And Jacob asked him, and
said. Tell me, I pray thee, thy name. And he said, Wherefore is it that thou
dost ask after my name? And he blessed him there. 31 And Jacob called the name
of the place Peniel : for I have seen an angel of God face to face, and my life
hath been preserved. 32 And the sun rose unto him as he passed by Penuel, and
he halted upon his thigh. 33 Therefore do the children of Israel not eat the
sinew which shrank, which is upon the hollow of the thigh, unto this day;
because he struck against the hollow of Jacob's thigh on the sinew that shrank."
(1922LeeserI).
There
is nothing to add to what has been said. This is a complete episode of an
artistic creation. The authors set the punctuation marks and placed a period at
the end. One can only attempt to understand what was written by assuming that a
pair of co – writers worked on the text: an Egyptian physician and a scribe
with Asiatic roots who was familiar with magica. We have noticed that the co – authors
creatively used literary works, monumental inscriptions, images, and the
realities of the epistolary genre known to them.
Jacob
sends sheep, goats, cows, camels, and donkeys as a present to his brother (Gen.
32:15–16, 22). This method of winning favor was widely practiced in Middle
Bronze Age Mesopotamia. In a letter (ARM 26/2 335) from the Mari archives to
Shunukhra – Khalu, the vassal Yamsuma writes that a bull was sent to him as a
gift, adding: "May you be the one who protects my position at the palace
gate!" (1988CharpinD_LafontB). In a letter (ARM 35 230), also from the
Mari archives, Khali – Khadun mentions bringing sheep and gifts to the
commander Shawalis (1988DurandJ–M). In the Tale of the Shipwrecked Sailor /
Story of Sinuhe, we read: "his majesty sent me royal gifts, to gladden the
heart of a humble servant" (1979ЛившицИГ_РубинштейнРИ). On a fresco in the BH 3 tomb of Khnumhotep
II at Beni Hasan (12th Dynasty, 20th–18th centuries BCE) on the southern wall
in the lower register, a procession of drovers and accountants with herds of
rams, goats, cows (bulls), and donkeys is depicted (1893GriffithFL,a). This
appeared to us as an illustration to the story of sending gifts to Esau.
It
seems prudent and practical in a hot climate to set off on a journey at night
(Gen. 32:23). According to the Story of Sinuhe, the hero fleeing from Egypt
"went further at nighttime" (1979ЛившицИГ_РубинштейнРИ). In the Old Testament narrative, the
departure of Jacob's caravan in the dark hours also pursued secrecy. The same
reason dictated Sinuhe's movement from his overnight resting place toward the
border. It is known that "it is better to send a caravan on its way before
dawn at 3 a.m." (1964ЛакозаИИ_ЩегинВА).
Jacob
brings across the stream "his two wives, his two female servants, and his
eleven children" (Gen. 32:23). At the time of crossing the Jabbok River,
Jacob had 12 children: 11 sons and a daughter. The numeral 11 indicated in the
text refers to the number of sons, simultaneously hinting at Egyptian deities.
In Ancient Egypt, there existed the concept of the "Great Ennead",
that is, the gods before whom the deceased recited the "Negative
Confession". It usually consisted of eleven gods: Ra (Horakhty), Shu,
Tefnut, Geb, Nut, Nephthys, Isis, Seth, Horus (son of Isis and Osiris), Hathor,
Hu, and Sia, while Osiris was not included in the Great Ennead (2004РакИВ). In the Old Testament plot, 11
male children are specified, and Jacob is implied as Osiris.
In
the text we find: "crossed the ford of the Jabbok. He took them and sent
them over the stream" (Gen. 32:23–24). It seems that the phrase refers
without any ambiguity to crossing the river with small children in arms and
leading older children across to the other bank by the hand. However, an utterance
carved in the tomb of Pepi II (6th Dynasty, ca. 2246–2152 BCE) contains the
words: "Shake, sky! Tremble, earth! – before the great one as he stands
up. The sky's door [has been opened] to him, and he shall pull open the Cool
Waters' door" (2007AllenJP). In the Pyramid of Pepi I (6th Dynasty, ca.
2289–2255 BCE) states: "The sky's door has been opened to you, the Cool
Waters' door has been made to pull open to you, and you will find the Sun
standing, waiting for you. He will take hold of your arm, lead you into the sky's
dual shrines, and put you on Osiris's throne." (2007AllenJP). In a text on
the wall of the tomb of Unas (5th Dynasty, ca. 2353–2323 BCE), it is recalled
how "Osiris when he went forth to the sky and crossed to the Cool Waters
with his son Horus at his fingers that he might foster him and have him appear
as the great god in the Cool Waters." (2007AllenJP). Knowing the Pyramid
Text spell, the reader is meant to imagine the incarnation of Osiris in Jacob,
carrying his son Joseph – the counterpart of Horus – across the water. In an
extreme case, one can perceive a hint by the authors at the future ascension to
the throne of Joseph under the name of Yaqub – Hor, the successor to King
Sheshi (1997RyholtKS_Bülow–JacobsenA). The listing of Jacob's herds, his
success in animal husbandry, and his status as a wealthy livestock owner
correlate with the Near Eastern and Egyptian archetype of the ideal shepherd – king
and the gods Osiris and Dumuzi.
A
solid amount of clear mutual borrowings connects Osiris and the Asiatic dying
god, Tammuz – Adonis (Babylonian Dumuzi – Duzi), creating difficulties in
resolving the issue of priority between Asia or Egypt (2021МюллерМ). Dumuzi (Tammuz) was an ancient
Mesopotamian god of shepherds, fertility, water, and vegetation. Like Dumuzi,
Osiris was revered as a skilled shepherd. In a Pyramid Text utterance dated to
2350–2175 BCE, it is implied that Osiris was a shepherd: "Thou dost not
know them; thou art astonished at them; thou hast laid them in thine arms like
herdsmen of thy calves" (1952MercerSAB). In a
Coffin Text spell (ca. 2134–2040 BCE), the receipt of a staff by Osiris is
mentioned, and further down he is called the Great Shepherd (1977FaulknerRO).
In
the Admonitions of Ipuwer (12th Dynasty), we find words about the god: "He
is the herdsman of all; there is no evil in his heart. His herds are few, but
he spends the day herding them" (2006LichtheimM).
This concept also applies to the solar deity. In another rendition of the
Admonitions of Ipuwer (dated by V. V. Struve to the Second Intermediate
Period), Ra is described as the shepherd of men: "It is said: he is the
shepherd of all, and there is no evil in his heart. When his flock is
scattered, he spends his days gathering it, even if the hearts of his creatures
be fevered" (1978КоростовцевМА). "The borrowing of Asiatic motifs by
Egyptian mythology never seriously altered Egyptian thought, and this could not
be done by the few Asiatic deities who were worshipped in Egypt at one
time" (2021МюллерМ).
In
the description of the crossing of the Jabbok stream, a phrase stands out:
"and sent over what he had" (Gen. 32:24). The stockbreeder Jacob, as
the earthly hypostasis of the god Osiris, solicitously leads his herds across
the river – read: his subjects, that is, his "flock". Wading cows and
calves across a canal, possibly as a symbol, is depicted on a fresco in the
Mastaba of Ti, built during the 5th Dynasty (2014AuenmüllerJ).
Our
primary source states: "Then Jacob was left alone; and a man wrestled with
him until the breaking of day" (Gen. 32:25). Here we discern a borrowing
from the seventh tablet of the Epic of Gilgamesh: "Into Enkidu's womb pain
penetrated, upon the bed of night where he lay alone. At night he recounted his
sorrows to his friend: 'My friend, a dream I saw this night: the heavens cried
out, the earth answered, in the dark night I stand alone, I see a man – his
face is grim, to a storm – bird his face is like. His wings are bird's wings,
his talons are eagle's talons. I began to wrestle with him – he overcame me, I
began to defend myself – he sprang upon my shoulders, he rent the earth, he
plunged me down…'" (1961ДьяконовИМ). The writers of the Book of Genesis do not
mention a dream vision. However, it is likely that the physician involved in
creating the text implied a hypnopompic hallucination, which occurs upon
awakening with a higher level of consciousness than during sleep (2024FoffaniG).
Such experiences are sometimes accompanied by a feeling of presence, fear,
virtual sounds, and visual images, arising, among other things, in a state of
heightened vigilance (1999CheyneJA_Newby-ClarkIR).
At
the conclusion of the discussed verse, we find: "And a man wrestled with
him until the breaking of day" (Gen. 32:25). As is evident from the
mythological Book of Gates and the Book of Day and Night, right before dawn
comes "the hour of the fierce battle of Ra with his eternal enemy, the
serpent Apep", the image of which had formed by the beginning of the Old
Kingdom (2007РакИ). Ra's
journey in the underworld is examined in more detail in the Amduat, reliably
known from the beginning of the 18th Dynasty (2008RichterBA). According to this
text, also called the Book of What is in the Duat, "the main action
unfolds an hour before sunrise, for by the dawn hour all evil must be
destroyed" (2007РакИ).
Jacob, acting as the god Ra, intended to crush the mystical stranger. By
placing the struggle at the end of the night, the authors make the parallels
with ancient Egyptian myths even more noticeable. At the same time, we see more
similarity between the biblical battle and the account of the sick Enkidu's
dream from the Epic of Gilgamesh: "in the dark night I stand alone, I see
a man – his face is grim, to a storm – bird his face is like. His wings are
bird's wings, his talons are eagle's talons. I began to wrestle with him – he
overcame me, I began to defend myself – he sprang upon my shoulders, he rent
the earth, he plunged me down…" (1961ДьяконовИМ).
The
Book of Genesis recounts that the angel fighting against Jacob "saw that
he did not prevail against him, and he touched the socket of his hip"
(Gen. 32:26). The Coffin Texts (ca. 2134–2040 BCE) praised the mystical
victories of the deceased. In one spell we read: "I have entered! in
company with Magic by means of my power in order to overcome for myself that
foe of mine, so that I may go forth into the day. He has been granted to me and
he will not be rescued from me, even as He whose shape is invisible has
commanded."; while in another we find: "I am one who overcomes with
strength, the heir of everything; I myself have guarded my body, I have felled
my foes, and I have created it, this new state(?) in which I am." (1973FaulknerRO).
On the eastern wall of the tomb of nomarch Ameni (Amenemhat) at Beni Hasan (12th Dynasty), scenes of wrestling sports are depicted (2004РакВИ). Among them are various wrestling holds involving grabbing the opponent's leg and hinting at dislocation in the hip joint. One scene appears to depict an attempt to pull away an excessively abducted leg at the hip joint of a lying athlete (tomb BH 2, second miniature from the left in the central part of the eastern wall) (1893GriffithFL,a). A similar hold involving the abduction and wrenching of a leg out of the hip joint was discerned by us on the fresco of the eastern wall (upper register, seventh composition from the right) in the tomb of Baqet III (BH 15), nomarch of Upper Egypt from the beginning of the Middle Kingdom (1893GriffithFL,b). These techniques undoubtedly led to injuries of the hip joint ligaments. In our text, the indication of a dislocation in the hip joint is also perceived as a severe injury.
Apparently, the earliest depiction of ancient Egyptian wrestlers is present in the tomb BH29 of the nomarch Baqet I in the Beni Hasan necropolis (1893GriffithFL,b). This high-ranking official flourished at the beginning of the 11th Dynasty, that is, in the late 22nd to early 21st centuries BCE (2002BunsonMR). On the fresco of the south wall, next to Baqet I, there are sketches of individuals with orthopaedic pathology: thoracic kyphosis (a hunchback), bilateral clubfoot, and genu recurvatum. Similar depictions of wrestlers, individuals with bilateral talipes equinovarus and hyperextension of the knee joint, are captured in the tomb BH17 of the nomarch Khety, who ruled at the beginning of the 20th century BCE (1893GriffithFL,b). The patient with clubfoot undoubtedly limped 'on his feet', and the second 'on his knee' (in biblical terminology). On the walls of the aforementioned tombs, we did not observe clear episodes associated with medical activity. At the same time, everyday life in the domains of the nomarchs buried in the Beni Hasan cemetery is represented in exceptional detail. Frescoes featuring scenes of fortress sieges, archery, and sword attacks imply the presence of the wounded. For some reason, the work of military physicians did not attract the attention of the artists."
Realizing Jacob's might, the angel pleaded: "Let me go, for the day breaks. But he said, 'I will not let you go...'" (Gen. 32:27). The motif of detaining gods is repeatedly encountered in the Pyramid Texts. In an utterance from the tomb of Pepi I (6th Dynasty, ca. 2289–2255 BCE), it is stated: "Since you are the one who prevents them from turning around from within your arms, you should go forth toward them, ba as one fully born, sharp as one fully born, in your identity of Sopdu, your flail in your (one) arm, your scepter behind your (other) arm, and those of the nighttime shall fall on their face to you, and the Imperishable Stars shall kneel to you". In the burial chambers of Pepi II (6th Dynasty, ca. 2246–2152 BCE), there is an exhortation: "do not revert; take hold of Nut, and she will be with you." (2007AllenJP). Another utterance of a Pyramid Text says: "Thou strikest with the ‘bȝ – sceptre, thou directest with the 'iȝȝ.t – sceptre; thou commandest the gods; thou layest hold for thyself of the arm of the imperishable stars". Second statement goes as follows: "N. has passed by the messengers of Osiris. No god can hold N.; no opponent stands in the way of N.". In another instance it says: "Lay hold of the arm of N. for life before the sweet – smelling ones, unite the bones of N., assemble his limbs, that N. may sit upon his throne." (1952MercerSAB).
The
phrase spoken by Jacob in dialogue with the angel sounds truly defiant: "I
will not let you go unless you bless me!" (Gen. 32:27). A. H. Gardiner
(1935) noted that one of the peculiarities of the Egyptians was the habit of
threatening their gods. We have found no exact correspondence between the
primary source excerpt quoted above and ancient Egyptian writings. At the same
time, a similar plot with many identical elements and their general order is
present in a Hittite ritual text recorded on tablet KBo 21 from the archives of
Hattusa (1983TsevatM). This tablet describes the struggle of the goddess Hebat
with a king "who detains her until they begin to dispute over who has
overcome whom; the dispute ends with the king's request for a blessing"
(2003УолтонДХ_ЧавалесМУ).
After
the blessing, we learn of the injury to Jacob's sinew of the "hip
socket" (Gen. 32:33). Communication with supernatural entities and their
retribution in the form of the striking of tendons figures in the Hittite text
(KBo 6, 34, duplicate KUB 8, 59) Soldier's Oath, where, apparently, a priest:
lays the tendons (and) salt in their hands. He throws them into the fire and
pronounces the following: "Just as these tendons are torn to pieces in the
hearth, and just as salt is scattered in the hearth, – whoever breaks these
oaths, shows disrespect to the king of the land of Hatti, and turns his gaze
hostilely toward the land of Hatti, may these oaths overtake him! May he be
torn to pieces like tendons, may he be scattered like salt! Just as salt has no
seed, so may the name of this man, his offspring, his house, his cattle, and
his sheep perish!" (1969PritchardJB). In the Old Testament narrative and
on Hittite tablets, a connection can be traced between the struggle and the
mystical destruction of a human body, like the tearing of animal tendons.
To
the question "What is your name?" Jacob answers guilelessly (Gen.
32:28). The angel conceals his moniker, but bestows a new name upon his
opponent: "Israel; for you have struggled with an angel and with men, and
have prevailed" (Gen. 32:29). By inventing a new name for the hero,
hitherto unknown to anyone, the authors "made him invulnerable". In
Ancient Egypt, it was implied that one who knows the true name of a person has
power over him (2004РакИВ).
A second name with the theophoric element "El" is concocted for
Jacob, which confirms that the biblical text belongs to the Mesopotamian naming
tradition adopted at the beginning of the 2nd millennium BCE. In documents from
the Mari archive, a letter (ARM 2 23) of Ibal – pi – El has been revealed, and
another dispatch mentions "Yakhsib–El, a Canaanite" (1988DurandJ–M).
Yeskit – El writes to the king in a letter (ARM 26/2 386), and Yasim–El sends
a tablet (ARM 26/2 403 – bis) to his brother (1988CharpinD_LafontB). Individual
monikers were used without concealing the addressee. For example, Osiris is
sometimes referred to as Orion, associating with the constellation. In the
pyramid of Pepi I (6th Dynasty, ca. 2289–2255 BCE), the following utterance is
inscribed: "Look, he is come as Orion,” (they say). “Look, Osiris is come
as Orion: the lord wine – colored with supplies, the perfect one of whom his
mother has spoken, the heir of whom his father has spoken, the one whom the sky
has conceived and the morning – star has given birth". (2007AllenJP). The
god Ra says in a myth: "I am Khepri in the morning, Ra at noon, and Atum
in the evening" (1940МатьеМВ).
In
turn, "Jacob asked, saying, 'Tell me your name, I pray.' And he said, 'Why
is it that you ask about my name?'" (Gen. 32:30). According to the beliefs
of the ancient Egyptians, concealing a name radically increased protection from
external forces. In the myth of "Ra and the Serpent", there is Isis's
appeal to the supreme deity: "Tell me your name, O my divine father! For
the man who pronounces his name lives" (1940МатьеМВ). Ra, caring for his own safety,
"reported his Ren [secret name] to Isis alone, and not aloud, but from
heart to heart, so that no one else would ever know this name or gain power
over the great god" (2004РакИВ). The assignment of a new moniker is also carried out with respect to
Sarah and Abraham (Gen. 15:5, 15).
At
the conclusion of the angel's conversation with Jacob, "he blessed him
there" (Gen. 32:30). In the Epic of Gilgamesh, Utnapishtim recalls:
"Enlil went up, ascended the ship, took me by the hand, led me outside,
placed my wife on her knees next to me, touched our foreheads, stood between
us, blessed us: 'Hitherto Utnapishtim has been a human being, but henceforth
Utnapishtim shall be like us, the gods'" (1961ДьяконовИМ). According to the authors' design,
as a result of the blessing, Jacob is likewise likened to a deity. On this
basis, he blesses Pharaoh, his sons – with preference given to Joseph – and his
grandsons as well (Gen. 47:7, 10, 48:15, 20, 49:25–28).
In
the morning, Jacob rejoices at the presence of higher powers and, after the
shock he has experienced, exclaims: "for I have seen an angel of God face
to face, and my life hath been preserved." (Gen. 32:31). A similar
sentiment is drawn by the writers from the Pyramid Texts. An utterance from the
tomb of Unas (5th Dynasty, ca. 2353–2323 BCE) states: "Face has fallen on
face, face has seen face: the knife all dappled black has emerged and swallowed
for itself and acquired for itself." (2007AllenJP).
In
the morning, the blessed Jacob boldly steps forward to meet his brother:
"Just as he crossed over Penuel the sun rose on him" (Gen. 32:32).
Here, the ancient Egyptian mythological canon regarding the triumphant
completion of the nocturnal battle can be observed. In accordance with the Book
of Gates and the Book of Day and Night, in the pre – dawn hour, "Having
gained victory over Apep, the gods rejoice: ... Rise up, O Ra, in your
sanctuary!". Then the nocturnal Mesqet Boat floats out into the sky:
"The Doors of the Horizon fly open, Ra bathes his body in the waters of
the sacred lake and, amidst the jubilation of the gods, passes into the diurnal
Mandjet Boat" (2007РакИ).
In
the morning, Jacob passes a settlement mentioned for the first time:
"Penuel" (Gen. 32:32). In the Story of Sinuhe, the fugitive recalls:
"when dawn broke, I reached Peten" (1979ЛившицИГ_РубинштейнРИ). In both stories, the fleeing
heroes bypass a settlement – the first heading toward Egypt and the second in
the opposite direction, toward Asia, yet both dreaming of returning to their
homeland.
As one can observe, the account of the events at the Jabbok River represents a high – level compilation of fragments and meanings. The Egyptian, Hittite, and Mesopotamian texts underwent modifications, yet they remain recognizable. We had access only to a limited number of fragmentary records. Undoubtedly, other parallels between the oldest writings and Old Testament history, not yet found by us, will be uncovered. The material we have gathered has demonstrated that the legend of the crossing of the biblical stream truly possesses a spiritual subtext. It has nothing to do with Abrahamic religions, but is instead connected with Bronze Age Egyptian and Mesopotamian beliefs. Commentary within the framework of modern confessions turns out to be mere wordplay. What we see is not only detachment from reality, but also the adaptation of outdated views to serve a comfortable doctrine.
[ii]
At
the end of Chapter 32, we noted an "artifact" which speaks of the "sinew
which shrank" (1922LeeserI, Gen. 32:33); "sinew that shrank"
[dry/withering] of an animal intended for food preparation (1978БроерМ_ЙосифонД,a, Gen. 32:33). It feels as though the 33rd
verse is composed of two parts: the editor's words and Jacob's memories.
Between them, one can discern an omission of the phrase: "and he
said:". With this, the excerpt would look smoother, yet the inconsistency
remains. We see the initial part of the 33rd verse as an anomaly:
"Therefore to this day the children of Yisrael do not eat the sinew that
shrank, which is on the hip socket, unto this day" (1978БроерМ_ЙосифонД,a, Gen. 32:33a); "Therefore do the
children of Israel not eat the sinew which shrank, which is upon the hollow of
the thigh, unto this day" (1922LeeserI, Gen. 32:33a).
In
the absence of the specified fragment, the text appears logical and precise,
requiring no additions. From the remaining phrases of verses 32 and 33,
information about the consequences of human "sinew" injury is
compiled: "And the sun rose on him as he crossed Penuel; and he limped on
his hip, [artifact]: because he touched the socket of Ya'akov's hip in the sinew
that shrank" (1978БроерМ_ЙосифонД,a, Gen.
32:32–33b); "And the sun rose unto him as he passed by Penuel, and he
halted upon his thigh. [artifact]: because he struck against the hollow of
Jacob's thigh on the sinew that shrank." (1922LeeserI, Gen. 32:32–33b).
Having read the verses, we unambiguously understand that the cause of the gait disturbance was an injury to the "sinew" of the hip joint. Here, the victim is named "Jacob", while in the inserted words he is called "Yisrael" (Gen. 32:33a). The insertion focuses attention on the "sinew that shrank" of the hip joint, although it will be discussed further below. Besides this, this is the sole instance throughout the Pentateuch where a prohibition on consuming a specific anatomical element – the "shrunken sinew" – is mentioned. The concept designates the ligament of the head of femur, which is confirmed by authoritative commentators with medical training, anatomists, physicians, philologists, and translators (1851MaimonidesM; 1923,2004PreussJ; 2010СафроновД; 2020ArkhipovSV_ProlyginaIV; 2026SrinivasanS_SakthivelS).
The
first half of the 33rd verse narrates a body part of animals used for food
preparation. From what has been said, it is clear that this rule applies only
to the "sons" of "Israel". A literal reading implies male
children of Jacob. According to an expanded interpretation, the commandment is
addressed to all descendants exclusively through the male line.
Among other things, we noted the use of the indefinite expression: "to this day". The phrase is also encountered in the Book of Devarim, that is, Deuteronomy (Deut. 2:22). It is hypothesized that similar words – "to this day" – appeared in the Bible with the participation of the editor of the "proto – Deuteronomistic" history, who lived during the reign of King Josiah (1973CrossFM; 2011ФридманР). He ruled the Kingdom of Judah from 640 to 609 BCE (1996Cohn–SherbokD). This named statesman initiated significant political and religious reforms. In the "eighteenth year of King Josiah", the high priest Hilkiah found the "Book of the Law" of Moses "in the House of the Lord" (2 Kings 22:3, 8; 2 Chron. 34:8, 14). The writing was presented publicly by being read before the gathered people (2 Kings 23:2; 2 Chron. 34:30). According to R. Friedman (2011), this event took place in 622 BCE. W. M. L. de Wette (1805) believed that Deuteronomy was written shortly before it was "found" by the priest Hilkiah. This judgment, based on an analysis of King Josiah's reform, provides a "reliable basis" for dating (2006SkaJL).
There
is also a well – founded view that Hilkiah handed King Josiah not Deuteronomy,
but a version of the Pentateuch (2000ТантлевскийИР). Perhaps it is in this designated version
that the injunction not to eat "the sinew that shrank, which is on the hip
socket" appears for the first time. In that case, the gloss "to this
day" would imply 622 BCE, or – according to Old Testament chronology – "the
eighteenth year of King Josiah". We are aware that this is a weakly
provable assumption.
Other
biblical characters have been proposed for the role of the editors of the Book
of Genesis. Acceptable candidates are Jeremiah, the son of the priest Hilkiah,
and the scribe Baruch, son of Neriah, who worked with him (Jer. 1:1, 36:4).
Jeremiah was a priest who never offered sacrifices (2011ФридманР). Accordingly, he did not have to
independently dissect animal carcasses for ceremonial purposes. Baruch recorded
Jeremiah's prophecies and read them before the nobility (Jer. 36:4, 13, 15,
18). This implies special trust in Jeremiah's utterances, which influenced
existing religious ideas and thoughts. According to legend, one of the scrolls
of Jeremiah's prophecies was destroyed by King Jehoiakim, who ruled in Judea
from 609 to 598 BCE (Jer. 36:21–23; 1996Cohn–SherbokD; 2006LipschitsO).
Following this, Baruch writes another scroll "from the mouth of Jeremiah
all the words" of the first one and adds "to them many similar words
besides" (Jer. 36:32). That is, the tandem creatively develops the writing
despite obstacles placed in their way. In accordance with R. Friedman's opinion
(2011), Baruch could have been the "author – editor of the Deuteronomistic
history", who "inserted his own commentaries" and
"constructed the histories extending from Moses to the destruction of the
Judean kingdom by the Babylonians". Hence, the explanation "Therefore
to this day the children of Israel do not eat the sinew that shrank, which is
on the hip socket" can legitimately be attributed to Baruch, who worked
jointly with Jeremiah. These reformers recorded the observance of the dietary
commandment and also documented that their fellow tribesmen possessed knowledge
of the ligament of the head of femur in animals.
The
above suggests that the gloss mentioning the ligament of the animal's femoral
head was inscribed into our primary source between 609 and 598 BCE. The
explanation hints that the prohibition on consuming the "sinew" as
food had its roots in the once – existing Kingdom of Israel and was practiced
by the "sons of Israel". Consequently, the commandment applied
primarily to them, but not to the subjects of the Kingdom of Judah. The
Northern Kingdom of Israel is referred to in the records as Samaria. Around 720
BCE, it was occupied by the Neo – Assyrian army of Sargon II
(2019HasegawaS_RadnerK). Certain authors date the conquest to 722 BCE (2011ФридманР). Other researchers believe that
the last king of Samaria disappears from the historical arena in 723–722 BCE
(1990Na'amanN). In turn, Jerusalem, the capital of the Southern Kingdom of
Judah, was destroyed by the Babylonians in 586 BCE, which marked the end of the
Judean monarchy (2024RegevJ_BoarettoE). We tentatively determine the period for
introducing information about the ligament of the head of femur into the Book
of Genesis as the end of the 7th to the beginning of the 6th century BCE.
The
presence of a connection between the "sinew that shrank" and
religious regulations rather than an injury indicates that it was written by an
individual with a weak grasp of vertebrate anatomy, rather than a physician.
During religious services, priests slaughtered livestock and cut them into
pieces (Exod. 29:16–17). This suggests that the author of the
"artifact" in the 33rd verse of Chapter 32 is not the High Priest
Hilkiah. He personally had occasion to detach the pelvic limb of a sacrificial
animal and observe the ligamentous apparatus of the hip joint. Jeremiah also
did not have a sufficient grasp of livestock morphology, and it is likewise
unlikely that the scribe Baruch knew it.
Judging
by its language, the earliest surviving text of the Book of Genesis is found in
the Samaritan Pentateuch, composed in a variety of ancient Hebrew. The letters
of the Samaritan script are close to the characters found on ancient Hebrew
coins and in inscriptions (1913HerbermannC). Over a century ago, P. Kahle
(1915, 1947) noted that the Samaritan Pentateuch represents a popular reworking
of an ancient form of the text and preserves many old readings
(2005VanderKamJ_FlintP; 2014RavascoA). This work is recognized as the oldest
version of the Torah (2009DufourSS). At the same time, philologists have noted
that the difference between Samaritan and biblical Hebrew is merely phonetic
(2015SchorchS).
At
the beginning of the 21st century, a thorough comparative analysis of the
translation of the Samaritan Pentateuch and the Masoretic text was conducted
(2013TsedakaB_SullivanS). In both, the meaning and spirit of the verses of
Chapter 32 narrating the injury of the femoral head ligament are fundamentally
indistinguishable. The gloss we identified – "Therefore to this day the
children of Israel do not eat the sinew that shrank, which is on the hip
socket" – is present in both documents. In connection with the above, it
is thought that this excerpt existed in the "pre – Samaritan" text
identified by P. Kahle (1915) (2005VanderKamJ_FlintP). This
"addition" was apparently inscribed in Paleo – Hebrew. It
"migrated" without transformations into the Torah written in the
"Aramaic" script after the Babylonian captivity. The
"updated" text was proclaimed – read: "fixed" – during the
public presentation of the Holy Scripture by the priest Ezra, presumably in 445
BCE (Neh. 6:15, 8:2–3; 1958WrightJS). The necessity for this became urgent, as
a diverse tradition of transmitting sacred texts existed during the Second
Temple period (2012AndersonRT_GilesT).
The
mentions in the Bible of the editing of books by the biblical Moses and Joshua,
as well as our discovery of the "artifact" in the 33rd verse of
Chapter 32 of the primary source, point to a long, multi – stage history of the
epic's formation. This is also confirmed by modern studies drawing attention to
the significant internal diversity of ancient texts that existed prior to the
Samaritan Pentateuch (2015ZahnMM). Regarding the Book of Genesis, it is
hypothesized that these were still uncodified translations from Ancient Egyptian
into Akkadian, Hebrew, and Aramaica.
The considered explanation of the Old Testament verse was made later than the compilation of the protograph, as confirmed by the phrase "to this day". The addition was made by a scribe working in the mid – 1st millennium BCE in the territory of the Southern Levant. Glosses are not an "invention" of Judean scribes. Such insertions appear at least a millennium earlier in native Ancient Egyptian manuscripts. In particular, the Edwin Smith Papyrus contains numerous commentaries by a physician or scribe dating to the Hyksos era, that is, later than the fixation of the treatise's core material (1930BreastedJH).
[iii]
The
literary and theological component of the description of Jacob's injury
examined by us was masterfully linked by the authors with the scientific and
medical part. Here we are referring to the verses concerning exclusively the
injury of the human hip joint. In accordance with the current division of
Chapter 32 of the Book of Genesis, this is discussed in verse 26 and verses
32–33. Between them lies fabricated text presented as a retelling of a
hypnopompic hallucination – or, in ancient terminology, a "prophetic
dream". The insertion is based on motifs familiar to the scribes of the
Egyptian House of Life. It was conceived as material for diviners to
"justify" events and "predict" Joseph's ascension to the
throne.
After
removing the epistolary fragment – sort of a travel sketch about a prophetic
dream – as well as the later – written editor's note, we recover the medical
component: "And he saw that he did not prevail against him, and he touched
the socket of his hip; and the socket of Ya'akov's hip was dislocated as he
wrestled with him. ... And the sun rose on him as he crossed Penuel; and he
limped on his hip, ... because he touched the socket of Ya'akov's hip in the sinew
that shrank" (1978БроерМ_ЙосифонД,a, Gen.
32:26, 32–33b); "And when he saw that he could not prevail against him, he
struck against the hollow of his thigh ; and the hollow of Jacob's thigh was
put out of joint, as he was wrestling with him. … And the sun rose unto him as
he passed by Penuel, and he halted upon his thigh.
… because he struck against the hollow of Jacob's thigh
on the sinew that shrank." (1922LeeserI, Gen. 32:26, 32–33b).
In
our judgment, an ancient Egyptian physician was involved in composing the
quoted excerpts. What was inscribed by an unknown doctor 3,600 years ago
remains relevant today. A modern medical specialist will perceive naturalness
in the explanation of the cause of the abnormal gait. The logical construction
of the Ancient Egyptian medic is worthy of an advanced orthopedic surgeon of
the current century. First, a severe hip joint injury is indicated. Then, the
natural limp caused by the maiming of the upper leg segment is stated. Next, as
if for a colleague, the pathology is specified: damage to the intra – articular
ligament of the hip joint had occurred. For a patient unfamiliar with the
anatomy of this joint, the rupture or tearing of an unknown "shrunken sinew"
carries no useful semantic load and only complicates the understanding of the
essence. A close analogy is the explanation of chest pain and shortness of
breath: "left bundle branch block".
Could
the healer of Egypt's Second Intermediate Period have known the pathogenesis
and symptomatology of incipient hip osteoarthritis? Perhaps we are seeing
references to medical knowledge where there are none or where everyday
experience is sufficient? To clarify these questions, it is necessary to turn
to the history of medicine. Such an approach can shed light on a more complex
puzzle: whether there was a prototype of the traumatic event of which the
ancient Egyptian physician had knowledge?
It
has been suggested that trauma surgeons were in high demand in Ancient Egypt,
as wars and accidents in this seemingly agrarian society meant that fractures
and dislocations were common occurrences (1996SullivanR). Our text speaks of an
injury to the musculoskeletal system: Jacob's unknown adversary "touched
the socket of his hip, and the hip socket was dislocated" (Gen. 32:26).
The
Book of Genesis also contains indirect evidence of a dislocation of a different
localization. Thus, in accordance with Joseph's prediction, the "chief
baker" was executed by hanging by the head (Gen. 40:22). The diviner
states: Pharaoh "will take off your head from you and hang you on a
tree" (Gen. 40:19). The separation of the head from the body occurs during
execution by hanging (1948PoldervaartA). Fracture or dislocation of the
cervical vertebrae, as well as fracture – dislocation of the vertebrae,
frequently occur in judicial hanging (2011VijK).
The
author of the Edwin Smith Papyrus was familiar with injuries specific to those
executed by hanging. Such damage is reflected in cases 31 and 32, which present
a typical clinical picture of a cervical vertebra dislocation or fracture – dislocation
(1930BreastedJH). The mention in the primary source of hanging with the
separation of the head implies that the writer had encountered pathological
phenomena associated with an open dislocation in the cervical spine.
Movable
joints of human lower limbs reliably became known to the Egyptians from the
time of the Old Kingdom. An exclamation from the tomb of Pepi I (6th Dynasty, ca.
2289–2255 BCE) mentions the joints of the legs: "Arise, Merire – 'He Whom
the Sun Desired'! You have received your water, your joints are gathered for
you. So stand up on your feet, an akh [spirit] before the akhs [spirits]"
(2007AllenJP). The region of the hip joint, but not the articulation itself, is
mentioned in a statement from the collection of Coffin Texts (ca. 2134–2040
BCE): "your back is the Extender of the Sunshine, your legs [thighs] are
Anubis, your buttocks are Isis and Nephthys, your feet are Duamutef"
(1973FaulknerRO). To denote "thighs", the translator used the English
word "legs", yet based on the context, this refers to the region of
the hip joints (1993WalkerJH). The Ramesseum V and Ramesseum III papyri feature
the knee joint (Science in Ancient Egypt, 1.sae.saw – leipzig.de, 2.sae.saw – leipzig.de).
The
first document is presumed to be contemporary with the Kahun Gynecological
Papyrus, dating to 2100–1900 BCE (2002NunnJF). Be that as it may, the
aforementioned medico – magical Ramesseum papyri were discovered in a late 13th
Dynasty burial belonging to a person who, judging by the combination of texts
and artifacts, could have been a magician, physician, or priest (2006LeachB).
In the tomb of Pepi I (6th Dynasty, ca. 2289–2255 BCE) there are the words:
"the imperishable stars shall bend their knees before you", while in
an utterance from the tomb of Unas (5th Dynasty, ca. 2353–2323 BCE) it is
stated: "The husk appeared, the cup appeared, issuing from the knee of
Horus" (2007AllenJP). An anatomist will see in these words the articular
capsule (joint capsule) and the patella ("kneecap"). In the Coffin
Texts (ca. 2134–2040 BCE), there are statements mentioning knee joints: "O
knees of Orion I which are on the shoulders of him who flew up and destroyed a
full half of Punt"; "I have entered into the finger and toe of Osiris
and the body of Osiris, into the strong arm, into the knee and into the
head" (1973FaulknerRO).
In
case 48 of the Edwin Smith Papyrus (1650–1550 BCE), the physician asks a
patient lying on his back to draw up – that is, bend – his legs at the joints
(1930BreastedJH; Science in Ancient Egypt, sae.saw – leipzig.de). To designate the leg joints that
should first be bent and then straightened, the hieroglyph wꜥrt is used. This hieroglyph means
the hip joint itself or the anatomical region surrounding the joint
(1993WalkerJH). In the upper part, the leg can be bent and straightened only at
the hip joint. For example, this is intuitively understood when the
diagnostician makes requests such as: "please bend / abduct / straighten
the hip". Based on the foregoing, it is thought that the author could
examine patients with hip joint pathology.
The
Edwin Smith Papyrus describes the clinical picture of joint dislocations, but
not of the lower extremity. Case 25 discusses dislocation of the lower jaw.
Case 31 implies a subluxation or dislocation of a cervical vertebra. Case 34
describes a dislocation of the acromial end of both clavicles (1930BreastedJH).
Researchers
focused on paleopathology believe that in Ancient Egypt, "it would be
surprising if dislocations were not treated, even though they left no traces in
surviving sources" (2006BlomstedtP). Meanwhile, one of the best examples
of dislocation treatment is contained in the Edwin Smith Papyrus, which
discusses the technique of reducing a lower jaw dislocation that is still used
today (1996SullivanR).
The
ancient Egyptians understood the concept of dislocations and fractures. In
particular, excavations at cemeteries near the pyramids at Giza (mid – 3rd
millennium BCE) revealed skeletons with injuries characteristic of construction
work during the implementation of a large – scale architectural project. There
is evidence of successful fracture treatment with examples of quality bone
reposition (2013ForshawR).
Iconographic
evidence of dislocations and reductions exists only from after Egypt's Second
Intermediate Period. A fresco in the mortuary temple of Queen Hatshepsut (15th
century BCE) depicts Queen Ati of Punt with a significant forward curvature of
the lumbar spine (hyperlordosis). It is suggested that a patient with bilateral
congenital hip dislocation is depicted here (2014SaidGZ). Lumbar spine
hyperlordosis in such pathology is well known to orthopedists (1957ЧаклинВД). The opinion has been expressed
that in the tomb of the architect Ipuy (ca. 1300 BCE), who served during the
era of Ramesses II, the artist depicted a physician reducing a shoulder
dislocation using a technique analogous to Kocher's method (2013ColtonC). Other
authors note that this is more likely a reduction of a dislocation in the elbow
joint (1927DaviesN). From our perspective, the fresco captures the reduction of
a humeral head dislocation. The patient is semi – recumbent and is not going to
stand up. With one hand, the bonesetter is clearly performing traction along
the long axis of the arm, utilizing the extension effort in his own knee joint.
With the opposite hand, the bonesetter, having grasped the area of the victim's
wrist, appears intent on performing rotation in the shoulder joint. Here, the
forearm lever of maximum length is used. Moreover, the lying person is in such
a position that when severe pain occurs, he will involuntarily lean in the
direction opposite to the physician and facilitate reposition with his own
weight. The competent methodology we observed regarding humeral dislocation
suggests that in Old and Middle Kingdom Egypt, attempts at reducing a traumatic
hip dislocation could have been undertaken.
Significantly
less information about hip joint pathology has come down from the past of
Mesopotamia. The Code of Hammurabi contains the rule: "§ 221. If a
physician has healed a broken bone of a man or has cured a diseased joint, the
patient shall pay the physician 5 shekels of silver" (1980КоростовцевМА_КузищинаВИ). Considering that the first part of the
paragraph speaks of a bone fracture, in the second part "diseased
joint" may imply joint damage, including dislocation. Despite the laws
being written between 1792 and 1750 BCE, there is an almost complete absence of
sacred – religious motivation and a realistic approach to reality (1952ДьяконовИМ). In the Hittite tradition, complex
diseases, especially severe and chronic ones, were in many cases attributed to
evil forces and demons, whose influence could be neutralized by rituals
involving spells and incantations, and sometimes direct appeals to gods
(2002BryceT).
In
the catalogue of cuneiform tablets, seemingly compiled by Esagil – kin – apli,
chief scholar of the Babylonian king Adad – apla – iddina, who ruled from 1067
to 1046 BCE, there are medical texts entitled: "If a man's hips are
continually aching" and "(If) a man's hips ache" (2018FinkelIL).
It is appropriate to assume that they deal with dystrophic pathology of the hip
joint. A series of tablets from the same period, termed the Diagnostic and
Prognostic Handbook, includes texts mentioning injuries and diseases of the hip
joint. Constant pain in the hips at normal and elevated body temperatures is
discussed in cuneiform tablet DPS 11. Pain specifically in the hip joint is
mentioned in the text on tablet DPS 13. Tablet DPS 14 lists external signs of
hip joint pathology: changes in skin color in its area to red, dark red,
yellow, black, as well as subcutaneous hemorrhages, tissue edema, the presence
of a wound penetrating into the joint, and muscle weakness (2014ScurlockJoA).
Perhaps
a diagnostician – diviner in Nineveh encountered pain in the hip joint area, or
more precisely, in the upper thigh. He recounted this in the text of the
divinatory cuneiform tablet K 3743, compiled between 911 and 612 BCE
(1951LabatR). Dating to the same period is the clay tablet AMT 56,1, found in
Nineveh, which bears an inscribed prescription "for stiffness in the hips
and groin" (2010GellerMJ). We have found no other, earlier written sources
dedicated to diseases and injuries of the hip articulation, such as hip
dislocations. The first scientific description in the history of medicine of
various types of hip dislocation, their treatment, and consequences is
discussed exclusively by Hippocrates of Cos (born 460 BCE) in the treatises On
Joints and Mochlicus (Instruments of Redactions, On
the Lever) (1886AdamsF; 1941Гиппократ). Such a detailed analysis of a
relatively rare injury implies the accumulation of material over generations
and the transmission of knowledge from father to son, as was practiced in
Ancient Greece.
Following
the injury to his hip joint, Jacob developed a limp "in the thigh"
(Gen. 32:32). In other words, his gait pattern changed, caused by pain and biomechanical
disturbances due to damage to the ligament of the head of femur. Limping in hip
joint pathology has characteristic visual features. In general, the gait is
asymmetric and arrhythmic. When supporting oneself on the injured leg, the body's
torso deviates excessively toward the corresponding side, and the natural arm
swing as well as the horizontal rotation of the pelvis and shoulder girdle are
disrupted (2012,2023АрхиповСВ). We have found no descriptions or monumental sketches of such a gait
from the Bronze Age period.
In
a letter (ARM 26/1 266) from the Mari archives, a correspondent reports the
onset of sharp pain in his leg from the sole "to the lower back" and
expresses hope that he will heal in five days (1988DurandJ–M). Presumably, the
author of the missive suffered from "sciatica", in which gait is
lawfully impaired.
From
the surviving Ancient Egyptian writings, pain in the legs and feet after
walking is recounted for the first time in the Kahun Gynecological Papyrus.
These unpleasant sensations are linked to uterine pathology
(2021LopesHT_PereiraRGG). Pain in the lower extremities, as a rule, adversely
affects the locomotion pattern. The author of the Edwin Smith Papyrus draws
attention to changes in gait in the examined individuals. In case 8, which
discusses the consequences of traumatic brain injury, the physician notes that
the patient walks, limping / shuffling with the sole of his foot. The
commentator explains: he [the surgeon] speaks of his gait with a dragging sole,
so that it is not easy for him to walk [i.e., he walks slowly] when this [foot]
is weak and turned, and the tips of his toes are pressed against his sole
[bent], and they [the toes] move, scraping against the ground"
(1930BreastedJH). The cited manuscript contains no advice on treating locomotor
disorders. Composed nearly three centuries later, the Berlin Papyrus (Brugsch
Papyrus), in cases of gait pattern changes, advises introducing a mixture of
honey, "behen oil", salt, and beer into the rectum for 4 days in a row
(1909WreszinskiW). A precise explanation of the cause of the limp in our
primary source would make any sane healer doubt the appropriateness of per
rectum therapy. Intoxication and pain relief can be achieved, but curing a
damaged "sinew" is problematic.
In
the Tale of Sinuhe (20th–18th centuries BCE) we read: "legs no longer obey
a weary heart" (1978КоростовцевМА). In The Tale of the Eloquent Peasant (Middle Kingdom) there are words
implying the author's awareness of gait disturbance, but the term is used
allegorically: "honesty limps" (1979ЛившицИГ_РубинштейнРИ). A "lame" doorkeeper is mentioned
in the Papyrus Anastasi II, dating to the Ramesside period (2001КоростовцевМА).
Changes
in gait due to injuries and diseases of the lower limb girdle are widely known.
In soil layers aged from 2.8 ± 0.28 to 2.01 ± 0.05 million years in the
Sterkfontein Cave in southern Africa, a calcaneus of Australopithecus
africanus, partially fused with the talus, was found (1992FiskGR_MachoGA;
2010PickeringR_KramersJD). Until the moment of consolidation, the hominin was
forced to use additional support and limped when walking.
In
the Swartkrans cave (South Africa), a pelvic bone fragment of an
australopithecine (SK – 50, A. robustus), who lived approximately 1.6 million
years ago, was identified (2017RosenbergKR_DeSilvaJM). The vertical size of
this hominin's acetabulum is increased, which is apparently caused by a hip
dislocation (1978MayerPJ_vanGervenDP). Certain publications present an image of
the reconstructed pelvic bone of this individual, designated as Paranthropus
robustus (2026CromptonR_McClymontJ; human_fossil_record.org). According to our assessment, the
mentioned pelvic deformation resembles the consequences of a healed fracture of
the upper acetabular rim and a cranial hip subluxation in an individual injured
in older childhood. The well – developed acetabular fossa indicates the
completion of joint formation by the time of the injury, rather than congenital
pathology. This is perhaps the earliest evidence of a hip subluxation in a
bipedal human ancestor who jumped from a height and reliably limped "in
the thigh".
At
the Venosa – Notarchirico site in southern Italy, the remains of an adolescent
from the Homo heidelbergensis community were excavated; this individual lived
for over four months with a chronic inflammatory process of the femoral
diaphysis (2024MicarelliI_ManziG). In Spain, in the Sima de los Huesos cave,
the spine of a Heidelberg man (aged over 45 years), who lived approximately
530,000 years ago, was discovered with signs of lumbar kyphosis,
spondylolisthesis, and an asymmetric pelvis with sacroiliac joint pathology
(2009GraciaA_CarbonellE; 2010BonmatíA_CarbonellE). The mentioned individuals
unquestionably lost their natural gait in the final period of life.
On
the island of Java, a proximal femoral fragment of Pithecanthropus erectus was
unearthed (2004DeVosJ). The soil layer that conserved the mentioned find is
dated within the range of 0.54 ± 0.10 to 0.43 ± 0.05 million years ago
(2015JoordensJC_RoebroeksW). A feature of this femoral fragment is a massive
ossification at the site of attachment of the short adductor muscle (personal
examination of the museum exhibit in the Darwin Museum, Moscow). Such benign
neoplasms appear in the literature as "adductor insertion avulsion syndrome",
causing traction periostitis, bone reaction to stress, and femoral fracture
(2001AndersonMW_DussaultRG). Pithecanthropus experienced pain and restriction
of movement in the hip joint for a long time, and thus had an asymmetric gait.
In
the cave of the French commune of La Chapelle – aux – Saints, the remains of an
elderly Neanderthal who lived 59,000–44,000 years ago were unearthed (2013Gómez–OlivenciaA). Based on an evaluation of the bone configuration, it is assumed
that the individual died in his sixth or seventh decade of life. In both
acetabula, changes characteristic of progressive osteoarthritis with cartilage
destruction were noted (2019HaeuslerM_FraterN). Such bilateral stage 2–3
coxarthrosis implies a limp and Duchenne's sign – frontal swaying of the body
torso when walking.
Femoral
heads with lesions characteristic of osteoarthritis in prehistoric humans have
been described. They were recovered from a dolmen in Algeria, the Saint – Germain
dolmen, a burial in Haute – Garonne, and burials of primitive North American
Indians (1929PalesL).
Ancient
Egyptians unquestionably suffered from hip joint diseases and sustained
injuries after which limping was observed. When studying ancient skeletal
remains from Nubia, typical signs of idiopathic osteoarthritis and neoarthrosis
of the hip joint associated with a proximal femur fracture were revealed
(1910ReisnerGA_JonesFW). Based on the study of macerated bones from the
"tombs of the nobles" of the 18th–22nd Dynasties in Thebes, osteoarthritic
changes were found in about 18.5% of joints depending on the burial site.
Arthritic lesions primarily affected the knee and hip joints, which clearly
experienced significant mechanical stress due to heavy physical labor
(2000NerlichA_WeyssC). Osteoarthritis affecting all diarthrodial joints of the
body was discovered in numerous specimens from Ancient Egypt and Nubia
(1972BourkeJB). Computed tomography of mummies from various periods made it
possible to reveal hip osteoarthritis, juvenile aseptic necrosis of the hip
joint (Legg–Calvé–Perthes disease), pincer – type femoroacetabular impingement
(large acetabular osteophyte), as well as a fracture of the greater trochanter
(2015FritschKO_ThompsonRC). Computed tomography of the mummy of Ankhefenmut
(1085–950 BCE), a priest of the temple of the goddess Mut and a temple sculptor
who died at the age of 50–55, revealed signs of osteoarthritis in both hip and
knee joints (2015BrierB_JohnsonChapinE).
A
case of severe bilateral clubfoot is depicted on a fresco in the tomb of Baqet I (Middle Kingdom), above which the word "bent" is written. Pharaoh
Siptah (19th Dynasty) also suffered from clubfoot. Tomography of Tutankhamun's
(18th Dynasty) feet showed that he had a pronounced deformity, which is why he
was often depicted with a walking stick. Ruma, a doorkeeper of the 19th
Dynasty, is carved on a funerary stela with an atrophied leg, leaning on a
staff (2014SaidGZ). The listed Egyptians beyond any reasonable doubt limped
when walking. Incidentally, Jacob recalls his own staff in a prayer at the
Jordan River (Gen. 32:11).
The
Book of Genesis asserts that during the struggle, Jacob suffered a dislocation
in his hip joint. Such an injury is characteristic of subjects aged 16–40 years
(2010CleggTE_PratherBA). As a rule, high – energy trauma is required to
displace the femur from the acetabulum. Low – energy impact as a cause of a hip
joint dislocation is an exceptionally rare phenomenon. To date, only 4 cases of
low – energy hip dislocation resulting from falls in elderly individuals aged
72–89 years have been described (2023SchopferQ_TraversoA). Hip dislocations are
medical emergencies requiring immediate physician intervention within the first
6 hours to prevent irreversible complications (2018Dawson–AmoahK_WaddellBS).
A systematic literature review of the treatment outcomes of traumatic hip
dislocation revealed that in anterior dislocations, the incidence of avascular
necrosis of the femoral head reaches 0.333, and the incidence of post – traumatic
osteoarthritis reaches up to 0.700. In posterior dislocations, the incidence of
avascular necrosis of the femoral head is up to 0.430, and the incidence of
post – traumatic osteoarthritis reaches 0.586 (2016KellamP_OstrumRF). Overall,
only a quarter of patients after a hip dislocation show subjectively excellent
and satisfactory results on the HHS and Lequesne scales, and in 25% of cases,
hip joint replacement is performed 2 years after the injury due to post – traumatic
coxarthrosis (2026PrangenbergC_WelleK).
Patients
with hip joint dislocations are predominantly young. They are usually injured
in high – energy impacts, which leads to concomitant injuries of the head
(31.7%), chest (64.6%), abdomen (26.8%), spine (30.3%), extremities (53.9%),
pelvis (63.3%), aorta (2.1%), and face (14.3%) (2022WeberCD_HildebrandF).
According to the literature we examined, adverse consequences of directly
traumatic hip dislocations are conditioned by: fractures of the femur and
acetabulum, knee joint injuries, post – traumatic coxarthrosis and avascular
necrosis of the femoral head, heterotopic ossification, damage to the sciatic
nerve, its peroneal branch, and lumbosacral nerve roots, as well as recurrent
dislocations. The above indicates a high probability of a significant reduction
in the quality of life after a hip dislocation in patients who underwent
reduction.
The
Book of Genesis does not mention medical assistance being rendered to Jacob or
the reduction of the dislocated hip by a non – specialist. Guiding ourselves by
our own experience, it appears to us that the prototype inevitably had an
impaired gait. In the 18th century, J. Z. Platner wrote that in dislocation of
the hip joint "...it can rarely happen that it [the leg], being truly
dislocated, could be completely cured without ugly limping" (1761ПлатнерИЗ). Common sense suggests: if Jacob
suffered a hip dislocation from a low – energy trauma and no reduction was
performed, his gait was undoubtedly impaired. The Book of Genesis tells us
precisely this (Gen. 32:32). This means that the writer of our primary source
had the opportunity to observe both dislocations of the hip joint and their
consequences.
The
physical causes of many diseases remained a mystery to the Egyptians.
Attempting to make sense of the inexplicable, the healers of the Nile Valley concluded
that such diseases were the result of the action of hostile forces, which,
being of supernatural origin, could be neutralized (2005AllenJP). In connection
with the quoted passage, our assertion about the composition of the Book of
Genesis in Egypt appears premature. In Chapter 32, Jacob wrestles either with
an angel or a demon of disease, during which a dislocation in the hip joint
occurs (Gen. 32:26). Despite the received blessing, the victim turns out to be
lame (Gen. 32:30, 32). It turns out that mysticism is powerless to prevent
pathological gait changes following a hip dislocation. A materialist
explanation follows below: "because he touched the socket of Ya'akov's hip
in the sinew that shrank" (Gen. 32:33b). It must be emphasized: it was not
the touching of the hip joint or the dislocation itself that caused the limp,
but the impact on the "shrunken sinew", that is, the ligament of the
head of femur. It is known that the total length of the ligament of the head of
femur, once detached from its attachment site, does indeed decrease.
Colleagues
studying hip joint dislocation write that the femoral head is unable to
completely displace from a normal acetabulum unless the ligament of the head of
femur is torn or deficient (2010CleggTE_PratherBA). Physicians in the 17th and
18th centuries expressed themselves equally definitively on this matter. I. Diemerbroeck (1679) wrote: "...if a dislocation occurs from a violent
external blow, the internal round ligament is usually ruptured, since due to its
particular hardness it cannot stretch to such a degree as to displace from the
deep acetabulum without rupturing". In turn, J. L. Petit (1705) pointed
out: the ligament of the head of femur "cannot elongate significantly, and
the bone cannot be dislocated in such a way that the ligament does not
rupture". In the 19th century, J. Bell (1801) stated: the ligament of the
head of femur prevents the head from exiting the socket or dislocating at all
until it ruptures. According to H. J. Bigelow (1869), this structure is
ruptured in all complete and sudden dislocations. P. J. Tillaux (1879)
confirmed that the ligament of the head of femur, "though strong, can
nevertheless be ruptured during rotational movements of the limb". 20th – century
authors, in particular F. Treves and C. A. Mackenzie (1917), noted that the
ligament of the head of femur "is ruptured in all cases of complete
dislocation". These anatomists shared the views of ancient physicians:
Heraclides of Tarentum, Hegetor of Alexandria, Apollonius of Citium, and Galen of Pergamon (2020ArkhipovSV_ProlyginaIV). It
must be acknowledged that prior to the aforementioned physicians, humanity was
informed about the disruption of the integrity of the femoral head ligament
during a hip dislocation by an anonymous thinker working on the Book of
Genesis.
To
date, it has been established that the ligament of the head of femur can be
injured not only during a hip dislocation, but also during forced rotational
movements. Several cases of femoral head ligament pathology have been
documented during the turning of a loaded trolley in a supermarket, when
excessive external rotation of the supporting thigh occurred in one of the hip
joints (2008YamamotoY_PapavasileiouA). T. Boyer (2006) identified an avulsion
of the ligament of the head of femur in five dancers. It is reported that LCF
tears occur in combination with hip joint dislocations and subluxations. It is
hypothesized that external rotation during trauma is likely the most
significant factor in damaging the ligament of the head of femur
(2006RühmannO_BohnsackM). According to C. A. Lampert (2009), the ligament of
the head of femur is subjected to the greatest tension during adduction,
flexion, and external rotation; it can tear during these forced movements. Any
uncontrolled movement in the direction of maximum tension can lead to ligament
damage. Examples include a fall on the ipsilateral knee with a flexed hip
joint, creating flexion – adduction stress, or a sharp twist of the hip, usually
toward external rotation (2009BardakosNV_VillarRN). Accordingly, it is by no
means necessary to assume that a complete hip dislocation occurred in Jacob's
prototype; a fleeting high – amplitude adduction or supination in the hip joint
was quite sufficient.
Damage to the ligament of the head of femur is possible during rotation at the hip joint when the leg is flexed at a right angle at the knee joint. A similar technique is depicted in the tomb of Kheti (southern wall, second register from the top, sixth scene from the left) and Baqet I (southern wall, western part, top register, first scene from the right) (1893GriffithFL,b). In this scenario, the entire lower leg acts as a lever arm. On the side opposite the hip's centre of rotation, the rotational force is counteracted by the reaction force of the ligament of the head of femur. In adults, lower limb length accounts for 40% of standing height, with the thigh comprising 48% and the lower leg 43% of the total limb length (1963КовановВВ_ТравинАА). Accordingly, for an individual approximately 170 cm in height, the length of the lower leg is roughly 30 cm. According to our calculations, the lever arm length of the reaction force of the ligament of head of the femur is approximately 3.8 cm when accounting for the intraosseously located stromal fibres in the floor of the acetabular fossa (2019ArkhipovSV,a). Naturally, at the point of bony attachment, the lever arm of the reaction force of the ligament of the head of femur will be smaller, measuring 3.5 cm. Consequently, with a relatively modest force equivalent to 20 kg applied to the distal lower leg, the free portion of the ligament of the head of femur within the acetabular fossa floor will experience a tensile force equivalent to 171.4 kg. The mean tensile strength of ligaments ranges between 5 and 9 kg/mm² (1983НикитюкБА_ЧтецовВП). Given these parameters, the theoretical ideal ultimate tensile strength of an intact ligament of the head of femur ranges between 143.0 and 640.8 kg (2023АрхиповСВ). If a trained martial artist exerts a force equivalent to 80 kg to rotate an opponent's lower leg, the ligament of the head of femur will experience tension equivalent to 685.7 kg near the floor of the acetabular fossa. The hip rotator muscles are small in volume and are therefore incapable of generating a sufficient opposing force: the internal rotators of the hip can exert a force equivalent to 54 kg, while the external rotators can produce 146 kg (2009KapandjiAI). Thus, a complete tear of the ligament of head of the femur without hip dislocation can be guaranteed when employing a grappling submission technique involving external rotation of the thigh about its vertical axis.
Gait
disturbance resulting from damage to the ligament of the head of femur has been
observed by modern physicians (2001RaoJ_VillarRN; 2004ByrdJWT_JonesKS;
2008TiborLM_SekiyaJK; 2009BardakosNV_VillarRN). The very first explanation of
this phenomenon was proposed by M. R. Colombo (1559): the ligament of the head
of femur is meant to "strengthen the joint. However, when it weakens, it
frequently ruptures. And even if the bone returns to its place, a limp always
remains after a dislocation: this is explained by the fact that the ligament
prevents the bones from uniting". We put forward our own interpretation of
limping in a doctoral dissertation: pathology and dysfunction of the ligament
of the head of femur significantly impair the biomechanics of the hip joint
(2012,2023АрхиповСВ). This
opinion, based on clinical practice and experimental research, is consonant
with the observation of the medical co – author of the Book of Genesis, who
created 3,600 years ago.
We
believe the oldest written evidence regarding the ligament of the head of femur
belongs to the Sumerian – Akkadian civilization. From excavated cuneiforms, it
is known that medicine existed and developed in Ancient Mesopotamia. On clay
tablets dating roughly to 3000 BCE, the first records of Sumerian medicine are
documented (1976MillarJH; 1977AndersonFJ). During excavations at Ur, a text
dating to 2700 BCE bearing the name of the physician "Lulu" was
discovered. In addition to tablets, personal cylinder seals also testify to the
presence of developed medicine in Mesopotamia. On one of them, the name of the
physician "Urlugaledinn" can be read (2002КрамерС). The first collection of
prescriptions by Sumerian physicians from Nippur dates back to approximately
2200 BCE and is considered the first pharmacopeia (2000БелицкийМ). It has been noted that the texts
of medical prescriptions from the end of the 3rd millennium BCE in Akkadian and
Sumerian are practically devoid of magical formulas and incantations
(2007RetiefFP_CilliersL). In the mid – 18th century BCE, the Code of Hammurabi
established the framework for surgeons' activities in treating bone injuries
and joint diseases (1920HandcockPSP). At the same time, "...even the
physicians furthest removed from magic, adherents of 'pure' medicine, were
closely connected with the priestly class", and medicine itself depended
"on religion and magic" (2000БелицкийМ).
In Ancient Egypt, priests observed the slaughtering of sacrificial animals and were involved in their inspection (1917ВикентьевВМ). In the 5th century BCE, Herodotus described the procedure for preparing a bull for sacrifice: first they skin it, eviscerate it, and then "cut off the thighs, the upper part of the leg, shoulders, and neck" (1972Геродот). This enumeration implies that at a certain stage, exarticulation at the hip joint is performed, and to complete the procedure, it is necessary to sever the ligament of the head of femur. On the southern wall (eastern part) of tomb BH 2 of nomarch Amenemhat (Ameni) at Beni Hasan (12th Dynasty, 20th–18th centuries BCE), the lower register depicts the stages of butchering a bull carcass. On the left side of the sequence, the cutters appear to be preparing to sever the pelvic limbs. A similar drawing is found on the southern wall of tomb BH 3 of Khnumhotep II at Beni Hasan (12th Dynasty, 20th–18th centuries BCE), where further to the right the cutting off of a bull's front leg is depicted (1893GriffithFL,a).
On the tomb frescoes at Beni Hasan (BH17, 23, 29, 33), constructed during the Middle Kingdom, the motif of cattle carcass butchery is repeated (1893GriffithFL,b). Butchers dismembered the animals' limbs exclusively with knives rather than axes. This unequivocally indicates that they performed disarticulations at the proximal joints—the shoulder and the hip. At the very least, it is necessary to cut both the external ligaments and the ligament of the head of femur located inside the articulation, and then effect a dislocation at the hip joint. Above the scenes of the butchers' labour, it is depicted how the entire dismembered leg of an ox is presented to the ruler along with other sacrificial offerings. Thus, both the attendant and the nomarch could see a fragment of the severed ligament of the head of femur. In Egypt, there was a class of "Setenu priests", the slaughterers of sacrificial animals. Usually, this was an ox, but in Thebes, a ram was sacrificed (1917ВикентьевМВ). Consequently, they too were familiar with the anatomy of the hip joint of cattle and small livestock.
The aforementioned conclusion should also be extended to the pharaohs of the Old Kingdom. They likewise received offerings in the form of large limb parts of sacred animals and could personally see a portion of the ligament of the head of femur attached to the head of the femur. In the tomb of Pepi I (6th Dynasty, ca. 2289–2255 BCE), we find the following sayings: "You shall sit on a metal chair, with your front that of a jackal and your rear that of a falcon, and serve yourself a haunch from Osiris’s slaugh-terhouse and ribs from Seth’s slaughterhouse; your bread is god’s bread and that which is from the broadhall."; "Your head has been placed on your shoulders, that you may drink the waters of the inundation that are in the circular canal on the lips of the Winding Canal and receive a haunch from Horus’s butcher’s block and ribs from Thoth’s butcher’s block."; "Pepi ascends to the sky, the earth will be hacked up for him, a deposited offering will be laid down for him, a bowl shall be made for him." (2007AllenJP). Housed in the Louvre is the Stele of Khety, dated to 1944–1900 BCE, which depicts a bowl containing a limb of a sacrificial animal (collections.louvre.fr).
In
the 21st century, Professor Yoram Cohen of Tel Aviv University studied an Old
Babylonian period (2000–1600 BCE) clay tablet intended as a guide for a
diviner. This remarkable find is currently held in the storerooms of the
British Museum under the number BM 29663. It contains a list of body parts and
internal organs of a sheep in Akkadian. On the obverse in lines 5–14, a list of
sections and elements of the pelvic limb is recorded in sequence from bottom to
top. The enumeration begins with the "hock joint"; then a certain
"part of the leg" is indicated, apparently the tarsal region;
"hoof"; "calcaneus", or the bones of the midfoot and
hindfoot; "short bone", presumably the "shin/crus"; then
the "sciatic nerve / sinew"; in the next line a certain "inner
leg"; "back of the knee"; "tail"; and "anus /
rear" (2018CohenY). The concept "sciatic nerve / sinew" is
designated by the Akkadian word nimšū, which is equated to the Sumerian sa.meš
and to the Akkadian šerʾānu (2016CohenY). To this day, the anatomical element
from the concluding verse of Chapter 32 of the Book of Genesis is often
translated both as "sciatic nerve" and as "sinew" (1978БроерМ_ЙосифонД; 1999ГерцЙ). In modern renderings of the Torah, the named
anatomical element is correctly called a ligament (2010СафроновД). In the hip joint of sheep, a
ligament of the head of femur is indeed present. This well – defined structure
in sheep and goats measures from 20 to 22 mm in length (2026StanardI_KumarAH).
Hundreds of animals of both species were present in Jacob's caravan (Gen.
32:15).
In
The Assyrian Dictionary (CAD Š/2), we find the interpretation of the term
šerʾānu: "sinew, tendon, vein, muscle (cord – like parts of anatomy,
contrasted with soft parts)". Attention is drawn to the fact that since
this word refers to "ligaments, tendons, blood vessels", and all
kinds of cord – like anatomical structures, its meaning depends on the context,
the body part mentioned, and the described symptoms (1992RothMT).
The
Sumerian term sa in Mesopotamian religious and magical texts was used to
designate "sinew/tendon" not only in sheep, but also in gazelles and
cows. Furthermore, L. A. Craig in Assyrian and Babylonian Religious Texts
(1895) translates the concept sa as "ligaments" (1992RothMT). The
word sa also represented a general term for a cord – like structure of the body
consisting of "tendons, sinews, muscles, and blood vessels"
(2004BöckB). T. Abusch (2020) noted that the concept sa.meš in the sense of
"sinews/tendons" was used in incantations.
Regarding
the word ša – the "sinew/tendon of the hip" of a sheep in connection
with a ritual or spell for an unknown leg pathology in humans – it is mentioned
in a Sumerian text on tablet K 2453: if a person's leg is affected, you take
the sinew of the left hip of a sheep. The terracotta tablet belongs to the
Kouyunjik collection of the British Museum and dates approximately to 911–612
BCE (1906ThompsonRC). E. A. W. Budge (1906) in the preface to the
aforementioned edition noted that this is a copy of an inscription not older
than the seventh century BCE, but the compositions themselves were transmitted
from ancient times and based on traditional legends of ancient Sumerian priests
and magicians who practiced their craft in Mesopotamia before the Semitic
Babylonians entered their land, probably between 5000–4000 BCE. The phrase
containing the concept ša in the cuneiform of tablet K 2453 suggests that the
document is an instruction for a magician – healer when approached by a patient
with a disease affecting the lower extremity. At the same time, we allow that
the text implied not a ligament, but a hamstring/tendon of the hip.
According
to The Assyrian Dictionary... (CAD N/2, 235), the word nimšū has one meaning – "sinew"
(tendon/sinew) in the Old Babylonian and Standard Babylonian varieties of the
Akkadian language, as well as in the Boghazköi Hittite language (1980RothMT).
Certain researchers note that the rare term nimshu implies "vein/sinew,
tendon", which was used in individual sources in relation to sheep and
humans (1973LeichtyE). Taking into account the meaning of the related concepts sa.meš
and šerʾānu, nimšū also pertains to cord – like anatomical elements.
There existed an Akkadian concept gīdu, meaning "animal sinew" (1995OppenheimAL). In records discussing animal husbandry, the word sa.meš and its equivalent gīdātu are translated as "tendons" (1994Van DrielG_Nemet – NejatKR). For example, in the poetic debate The Bull and the Horse, likely recorded in the second half of the second millennium BCE, the horse's sinews are mentioned: "gīdātīya" (2022JiménezE). According to the Pennsylvania Sumerian Dictionary internet project, the Sumerian gid can mean "(to be) long", as well as "an elongated bead" (oracca.museum.upenn.edu). In other words, this corresponds to the description of a short, rounded element, which is what a torn fragment of the ligament of the head of femur looks like. An elongated bead suggests a channel for a thread. The presence of a canal within the ligament of the head of femur, through which blood vessels course, was discovered in the early 19th century (1820PallettaGB).
To designate it in the Book of Genesis in Hebrew, the concept
"גִּיד"
(gheed, gid) was chosen, which is translated as "thread, cord, sinew,
artery, tendon" (1903JastrowM). That a ligament is implied by
"sinew" ("גִּיד") was clearly made understood by the physician – rabbi Samuel (2nd–3rd centuries), whose words are cited in treatise Chullin (96a:11) of the
Babylonian Talmud. Regarding the localization of the attachment of the
discussed anatomical structure, the sage clarified: on the rounded projection
of flesh, having the shape of a [turned] spoon, located at the end of the thigh
bone (2018SteinsaltzA).
A
connection can be traced between "גִּיד" (gid) in Hebrew, on the one hand, and
the Sumerian concept gid and Akkadian gīdu, on the other. This allows for the
conclusion that the term used to name the ligament of the head of femur in our
text was likely borrowed by the translator into Hebrew from ancient Mesopotamian
languages.
At
the same time, the Book of Genesis discusses damage to the ligament of the
human femoral head. We have found no mentions of the specified anatomical
element in the accessible texts of the Tigris and Euphrates valley. They
contain no information about human joint ligaments either. There is no evidence
of knowledge of human anatomy in Sumerian culture and Babylonia
(1959KevorkianJ). There is no evidence that the Hittites knew human anatomy,
although they mentioned certain organs in ritual texts (2026ArnottR). In
contrast, in Ancient Egypt they possessed a definite understanding of internal
human morphology and the ligaments of synovial joints.
In
case 30 of the Edwin Smith Papyrus, damage to the ligaments between the
cervical vertebrae is implied, while case 7 recounts the ligaments of the lower
jaw (1930BreastedJH). In the area of the temporomandibular joint, two groups of
ligaments are located: the outer consists of two parts of lig. laterale, and
the inner – lig. sphenomandibulare and lig. stylomandibulare (1996СинельниковРД_СинельниковЯР). The commentator of the Edwin
Smith Papyrus regarding these structures explained: the ligament of his lower
jaw – this means the ligaments that bind the end of his jaw, as they say, the
binding of something (or like) in a splint. For ligaments, the ancient surgeon
used the old word w't, meaning "cord". The scribe noted below: this
corresponds to the new concept mt – w (plural), that is, "ligaments"
(1930BreastedJH).
The
archaic noun w't is found in the Pyramid Texts, written in 2350–2175 BCE. In
utterance 2080a–c concerning the construction of a ladder to heaven, it is
stated: "Its rungs are hewn by Šśȝ; the ropes which are on it are made
solid by means of sinews of Gȝśw.ti, the bull of heaven" (1922SetheK;
1952MercerSAB). The noun w't, equivalent to the concept "sinew/tendon",
implies tendons here, for ligaments are far too small to serve as raw material
for rope production.
In
spell 479 of the Coffin Texts (ca. 2134–2040 BCE), the tendons or ligaments of
Horus – the mythical counterpart of man – are mentioned: " Its lines, its
ropes and its cords are the line of Atum and the sinews [rwd.w] of Horus who is
on his papyrus – plant". In another utterance, 397, from the same corpus,
the ligaments or tendons, presumably of Seth, are discussed: "They are the
sinews [rwd.w] of him of whom all these are afraid" (1977FaulknerRO).
According to A. H. Gardiner's sign list, the hieroglyph rwd means a bowstring
(1957GardinerAH). Formerly, this element was manufactured from animal tendons.
In spell 850 of the Coffin Texts, there are words regarding surgical treatment,
likely of ligament damage: "Nut has come so that she may join your bones
together, knit up your sinews, make your members firm, take away your
corruption and take hold of your hand, so that you may live in your name of
'Living One'. May you live forever" (1978FaulknerRO). In this instance,
"ligaments" is preferable, since it is precisely these structures
that directly connect the terminal parts of bones.
According
to H. L. E. Lüring (1888), the Egyptian hieroglyph mt (met), equivalent to
Coptic "ⲙⲟϯ, ⲙⲟⲩⲧ, ⲙⲟⲩϯ", corresponds to the Latin concepts':
vinculum (bond/ligament) and junctura (joint/connection), as well as the German
terms for "joint, sinew, tendon" from the Book of Genesis. In the
Coptic translation of this work, the words "ⲙ̀ⲡⲓⲙⲟⲩⲧ" and "ⲛ̀ⲟⲩⲙⲟⲩⲧ" are used to designate the
ligament of the head of femur (1867deLagardeP). Coptic is recognized as the
final phase in the development of the Ancient Egyptian language
(1995LoprienoA). The first texts using it date to the 1st–2nd centuries CE
(1991AtiyaAS). Guiding oneself by the Coptic term "ⲙⲟⲩⲧ" in the corresponding version of the Book
of Genesis, it is clear that in Ancient Egyptian the ligament of the head of
femur could be named with the hieroglyph "mt" (met), and pronounced "mout"
or "mot" (see also the analogous Coptic term ⲙⲟϯ). The commentator of the Edwin Smith Papyrus
for case 7, where jaw ligaments were mentioned, used the term mt
(1930BreastedJH).
In
the Ebers Papyrus, various channels designated as mt appear, transporting
blood, water, air, and semen. They are present both in the limbs and in body
cavities. Some elements designated by the hieroglyph mt may be ligaments or
nerves, but differentiating them precisely is not possible (1889EbersG). Thus,
in one text fragment mt definitely refers to nerves, while in another,
seemingly clearly, it applies to blood vessels, with the exact interpretation
being clarified based on the level of knowledge ancient Egyptians possessed
regarding human body anatomy (1974BryanCP_SmithGE). It has been established
that this manuscript describes "deforming arthritis" as a
"hardening of the limbs", with prescriptions "to impart
flexibility to the joints" (1929GarrisonFH). The Ebers Papyrus dates to
the mid – 16th century BCE (1884BoltonHC; 1905vonKleinCH). According to our
hypothesis, by that designated period, the Book of Genesis, which mentions the
ligament of the head of femur and the injured joint, already existed.
E.
A. W. Budge in An Egyptian Hieroglyphic Dictionary (1920) translates the term
mt as "rope", "cord", "Sudanese (linen) cloth",
"linen", and another similar hieroglyph as "vein" and
"artery". When written, the hieroglyph mt has an upper element, as
well as one or more lower and adjacent elements. Certain authors refer only to
the upper element of the hieroglyph as mt, which they translated as
"phallus" (1957GardinerAH). Considering the initial level of
development of medical science and technology in that distant era, physicians
of Ancient Egypt could not fully differentiate anatomical structures.
Therefore, they used the common term mt (mt – w – plural) for blood vessels,
ligaments, tendons, channels (bronchi), nerves, muscles, and sinews,
designating "cord – like" elements with it (1930BreastedJH).
A
hieroglyph resembling mt is present in a text from the Sheikh Abd el – Qurna
necropolis, in the tomb of Amenemhet, priest of Amun under Thutmose III (18th
Dynasty) (1909SetheK). A papyrus with records of an official inspecting local
and regional tax collections south of Thebes during the reign of the 18th
Dynasty also contains the hieroglyph mt. In the same papyrus, in records
concerning the oversight of trade and work in the Temple of Amun, we identified
an inscription containing the hieroglyph mt (1909SetheK). On stela No. 2567 in
the Florence Museum, in the second register, we likewise find the hieroglyph mt
(1880MasperoG). These examples indicate that the hieroglyph mt was used to
denote anatomical elements or parts of the human body, as well as objects in
daily life.
The
first translator of the Edwin Smith Papyrus, James Breasted, noted regarding
the dating of the work: it seems belonging explicitly to the Hyksos era, and
was copied in Thebes (1930BreastedJH). A scribe with a similar level of
awareness from the same period could have participated in composing the Book of
Genesis. In that case, in its protograph in Ancient Egyptian, the ligament of
the head of femur would be designated by the hieroglyph mt and less likely by
w't.
Textual
analysis of the description of the circumstances surrounding the Old Testament
injury showed the presence of a significant amount of borrowing. One gets the
impression that the writers had an extensive library at their disposal, or that
they remembered a multitude of works verbatim. The former is preferable.
Pharaoh Neferhotep (13th Dynasty) personally visited the book repository (2001КоростовцевМА). Reading texts on coffins and
pyramid walls demonstrates the existence of lists of utterances in the past.
The plot of the injury, but to a greater extent the hypnopompic hallucination
or dream, is compiled from phrases and meanings created by other authors. The
passage of Chapter 32 examined by us represents the result of creative
plagiarism. Literary scholars will clarify for us whether this is pastiche or
compilation.
Large
– scale reception also affected the "medical section" of the Old
Testament narrative. The writer knew: joints, dislocations, ligaments, limping.
The listed concepts appeared before the New Kingdom era, which was preceded by
the Second Intermediate Period, at the end of which the Book of Genesis was
written. It is not surprising that advanced medical knowledge is reflected in
it, provided that a physician participated in its composition. At the same
time, absolute innovations are discernible in our primary source, though
without radical reinterpretation. A demon or angel "touched" the hip
joint, yet the limp was caused by a specific injury – a "dislocation"
(Gen. 32:26, 32). The mystical component is not entirely denied. Meanwhile, it
is explained in an exclusively materialistic manner that the gait disturbance
was caused by a lesion to the "shrunken sinew" [dry sinew] (Gen.
32:32–33). According to the narrative, the defect of the "sinew" is
undoubtedly a consequence of the dislocation of the "thigh" (Gen.
32:26, 33). The limp is also specific: "in the thigh" (Gen. 32:32).
The
mention of the human femoral head ligament appears to us as completely new.
Hippocrates of Cos (born 460 BCE) paid attention to this element for the first
time in his scientific work On the Lever (1886AdamsF; 1941Гиппократ). At least, this work is attributed
to him or to a student of his school. However, if a Judean scribe of the 5th
century BCE had written the text of the Book of Genesis "from scratch",
he would have had to possess knowledge at the level of the advanced Greek
medicine of his time, which is unlikely for a theological document. Prior to
the great Asclepiad, Homer hinted at the ligaments of the hip joint in the
Iliad, recounting the exploits of Diomedes in the 8th–7th centuries BCE
(1924Homer; 1960Гомер;
2000Vidal–NaquetP; 2011CroallyN_HydeR). The physician and anatomist G. F. Ingrassia (1603) wrote on this matter: "the large stone with which
Diomedes struck Aeneas hit the hip: where the femur joins the acetabulum, it
broke the acetabulum and tore two ligaments that connect it with the thigh. The
ligaments he called tendons that join such a joint: one encompasses the joint
from all sides, like other joints, although it is significantly stronger than
all the rest. The other is special for this joint (of which more later in the
text), round, cartilaginous, and very strong, originating from the middle of
the head of femur and attaching to the lower part of the acetabulum".
In
the treatise Mochlicus (On the Lever),
Hippocrates of Cos describes the ligament of head of femur as follows:
"...the femur itself bends outward and forward; its head is a round
epiphysis which gives origin to ligament (νεῦρον) inserted in the acetabulum of the hip – joint"
(1941Гиппократ; 2020ArkhipovSV_ProlyginaIV). The surgeon – translator F. Adams (1886) explained
in a special footnote that the ancient physician implies specifically the
ligament of the head of femur (translator's note:
"Allusion is evidently made to the ligamentum teres").
Hippocrates of Cos did not perform morphological studies (1959KevorkianJ). The
surgical knowledge of the brilliant Asclepiad was based on observations and
experience (1909SwainJ). Under the conditions of his era, treatment of patients
by physicians was carried out at home, where only incidental surgical
operations were performed (2006RetiefFP_CilliersL). Here it should be noted
that doctors in this era, besides incisions, performed: dressings,
cauterization, fracture reductions, splinting, as well as reductions of various
dislocations, both open and closed (1936,1941Гиппократ).
It
seems most likely to us that Hippocrates of Cos saw the human femoral head
ligament when examining a patient with an open hip dislocation. In such a
severe injury, the dislocated femoral head damages the surrounding muscles and
skin, coming out to the exterior of the body. If the ligament of the head of
femur during a hip dislocation detaches from the acetabulum or ruptures along
its length, the distal fragment is visible upon inspection of the femur
protruding from the wound. This appears to be precisely what is mentioned in On
the Lever (Mochlicus), which also contains information on open dislocations of
large limb bones (1941Гиппократ). Modern physicians studying cases of open hip dislocation have noted
that during wound revision they saw a "rupture of the intrinsic round
ligament of the hip" (2015ГузенкоСА_ГетманчукЮА). Analysis of illustrations in articles
devoted to open hip dislocation showed that sometimes a distal fragment of the
ligament of the head of femur, starting from the fovea capitis femoris, is
visible (2005SadhooUK_KaulA; 2016AtchiW_AssangD; 2018FreitasA_BandeiraVC). At
present, open hip dislocations are most often caused by motorcycle trauma,
motor vehicle collisions, falls, or impacts by massive blunt objects
(1974SchwartzDL_HallerJAJr; 1982GrundyM_KumarN; 1987LaforglaR;
1995RafaiM_TrafehM; 1998MataSG_GrandeMM; 2001KhanSA_GogiN;
2003LambertiPM_RabinSI; 2005SadhooUK_KaulA; 2009SabatD_GuptaA;
2011MuzaffarN_ShahN; 2012MuzaffarN_ShahN; 2013TawariAA_SubaramanR;
2014deOliveiraAL_MachadoEG; 2015ГузенкоСА_ГетманчукЮА; 2015JaliliA_ZareiM; 2016AtchiW_AssangD;
2017EsmailiejahAA_AhmadSS; 2017SnoapT_RobertsJ; 2018FreitasA_BandeiraVC).
In
Ancient Egypt, the construction of high buildings and pyramids was actively
carried out, the country participated in wars, and the population engaged in
physical labor and came into contact with large domestic animals. Systematic
study of the skeletons of ancient Egyptians revealed bone fractures in three
per hundred exhumed individuals (1930BreastedJH). In cases of falling from a
height, fractures of lower and upper limb bones generally occur, and
dislocations and fracture – dislocations cannot be ruled out. At the 5th
Dynasty cemetery of Naga ed – Deir, operating in 2730–2625 BCE, the remains of
a young woman were discovered with a fracture of the middle third of the
femoral shaft fixed with blood – stained wooden splints and linen bandages. The
researcher of the skeleton and artifacts reasonably assumes an open fracture in
the deceased and reports a series of observations of healed femoral fractures
found in other tombs (1908SmithGE). Among the ancient skeletons excavated in
Nubia, an iliac fracture from the Predynastic period was revealed, as well as a
case of polytrauma in the form of a fracture of the pelvis, femoral neck, and
sacrum (1910ReisnerGA_JonesFW). The Edwin Smith Papyrus reliably mentions
dislocations in three cases: of the lower jaw, the acromial end of the
clavicle, and a dislocation or subluxation of a cervical vertebra, while one
observation discusses a rib dislocation, though this appears to be Tietze
syndrome (1930BreastedJH). It is reasonable to assume that Egyptian doctors
encountered open hip dislocations. On a fresco in the tomb of the sculptor Ipuy
(ca. 1300 BCE), builders of a three – story tomb climbing scaffolding are depicted
(2013ColtonC).
The
frequency of hip joint dislocations in adults accounts for about 5% of all
traumatic dislocations (1962BravEA; 1990ЮмашевГС). The incidence of traumatic hip dislocations
in childhood varies from 0.6% to 11.1% (1970MatsubaraT). In children, open hip
dislocation is identified in 3.5% of traumatic dislocation cases
(1982BarquetA). Regarding the small group of open dislocations, the literature
relies significantly on descriptions of individual cases
(2021BakanÖM_AktugluK). For example, a review by M. A. Khalifa et al. (2019)
revealed only 15 reports of the most common open anterior hip dislocation prior
to the case presented in their article. Open dislocations in the hip joint are
a rare phenomenon in medical practice. In 33 years of work in traumatology
departments, we have not personally had the occasion to treat such an injury.
In
a tomb from the Old Kingdom era, a report was found concerning the fainting of
the chief builder of King Neferirkare (5th Dynasty), for whom "physicians
with their papyri were summoned" (2001КоростовцевМА). Accordingly, from the middle of
the 3rd millennium BCE, the Egyptians possessed medical literature and a form
of emergency medical service. This implies an accumulation of medical knowledge
and observations that had previously been passed down from teacher to student.
Certain Ancient Egyptian doctors, besides inspecting wounds, conducted digital
examination [palpation] of them. Palpation of a rib through a wound is
described in the Edwin Smith Papyrus (1930BreastedJH). The clinical cases
presented in the manuscript often stem from deliberate pathological anatomy
research, which was not unusual for the writer (1989RowlingJT). The performance
of autopsies on the human body by the author of the Edwin Smith Papyrus is
evidenced by the realistic description of morphological changes in a cervical
vertebra fracture, as well as the comparison of brain convolutions to
corrugations on metallic slag. The participation of this specialist in
dissections during embalming is indirectly suggested by his application of
linen bandages soaked with oil (fat) or honey (1930BreastedJH). Over a lengthy
medical career, such a professional could encounter an open hip dislocation and
see the distal fragment of the ligament of the head of femur connected to the
femoral head. This appears to have been observed by Hippocrates of Cos, as
reflected in the treatise On the Lever (Mochlicus) (1941Гиппократ). Regarding the author of the Edwin
Smith Papyrus and the medical co – author of the Book of Genesis, we are
justified in thinking that they had occasion to see the ligament of the head of
femur in the wound of a patient with catatrauma or during the mummification of
the deceased. According to the primary source, physicians are directed to embalm
the body of Jacob (Gen. 50:2). That is, the writers directly confirm the
participation of medical workers in autopsies, and thus in comprehending
internal human morphology in health and pathology.
In
the Book of Genesis, the interpretation of the pathogenesis of a specific
locomotor disturbance is perceived as revolutionary. Nothing similar is
encountered in any medical work until Galen of Pergamon (2nd–3rd centuries CE).
However, in Galen's Fourth Commentary on Hippocrates' On Joints, it is stated
only between the lines regarding an unsteady gait in cases of damage to the
femoral head ligament: "the thigh will easily and immediately come out of
its place if someone, when walking, attempts to step a little faster or step
over something beneath their feet" (1829KühnCG). In the 14th century,
professor of anatomy Mondino de Luzzi (ca. 1270–1326), surmised the connection
between damage to the ligament of the head of femur and changes in gait:
"when it [the ligament] is displaced, the person begins to limp, because
the leg lengthens and cannot be held, and the whole body cannot be securely
supported" (1541MondinoL_DryanderJ). Professor A. Piccolomini (1586) was
the first to link differences in gait pattern with the function of the ligament
of the head of femur. The anatomist G. Bauhin (1605) expressed himself more
explicitly: when the ligament of the head of femur "relaxes and lengthens,
this often causes dislocations, and sometimes ruptures, and although the bone
returns to its place, the dislocated leg always limps, as it no longer joins
properly as before".
The
medical writer who worked on the protograph of the Book of Genesis
significantly surpassed his era in knowledge. His name and body have vanished,
yet paradoxically, his observations and thoughts have survived. He synthesized
excerpts from works of Mesopotamia's Old Babylonian period, as well as Old and
Middle Kingdom Egypt. The plot he set forth concerning the injury near the
Jabbok stream is invented. However, the realism of the anatomical and medical details
demonstrates that Jacob had a prototype. An individual unknown to us sustained
a minor injury to the hip joint with damage to the ligament of the head of
femur (subluxation, forced rotation), as a consequence of which a gait
disturbance developed. Today we know that such an injury inevitably leads to a
disabling disease of the hip joint. The diagnosis "osteoarthritis" is
absent in the Book of Genesis. At the same time, the sequence of events,
clarifying morphological details, and the limp leave no doubt in the narrative
about the onset of a degenerative – dystrophic process in the hip joint. Jacob's
prototype suffered from osteoarthritis of this articulation. He rightfully
became the index case with the designated diagnosis. An outstanding Ancient Egyptian
doctor was the first to realize the cause – and – effect relationship and, in a
literary work, presented his vision of the algorithm for the development of
coxarthrosis.
An analysis of the literature shows that the principles of the onset of hip osteoarthritis are considered unknown, and there is no consensus on its pathogenesis (1991СоковЛП_РомановМФ; 2023АрхиповСВ). Alongside this, "to this day, the main cause of degenerative – dystrophic changes in the region of the hip joint, the primary link of pathological changes in the pathogenesis chain of arthrosis, its trigger mechanism, the localization of initial changes, and the sequence of their development in joint tissues remain unclarified" (1989СамчуковМЛ_СмирноваИЛ). 37 years have passed since the quoted words were written, yet what was said, unfortunately, remains relevant for the majority of medical specialists. In accordance with our theory, the development of coxarthrosis is inevitable if there is dysfunction of the ligament of the head of femur caused by its damage, elongation, transposition of attachment areas, or lack of tension. The above is easy to verify: identify the listed conditions, wait, observe, and record the degenerative – dystrophic process.
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 16. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-16.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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