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 22
OBJECTIVE EXAMINATION OF THE PATIENT
Immediately
after the injury, Jacob's prototype was not examined by a physician. The field
conditions in which he was located did not allow him to visit a medical or
health facility. In Jacob's caravan, the only mid-level medical specialist
present was a midwife (Gen. 35:17). It should be taken into account that the
victim's lifetime fell in the Middle Bronze Age. The accident occurred on the
territory of modern Jordan. At that time, human sciences had reached a
significant level of development only in Mesopotamia and Egypt. Written sources
dating back to approximately 2000 BCE report Mesopotamian hospitals
(2007RetiefFP_CilliersL). Ancient Egyptian texts imply the possible presence of
an infirmary at the Heliopolis temple (2006RetiefFP_CilliersL). The site of the
joint injury was localized far from the centers of these civilizations. Even
the settlements near the Jabbok River mentioned in the Old Testament – Penuel
and Succoth – appear to have emerged later (Judg. 8:8, 9, 17; 1 Kings 12:25).
Following the logic of the Book of Genesis, the diagnosis of Jacob's hip joint
pathology became possible only after the relocation to Egypt. According to our
calculations, the authors date the clarification of the victim's injury to
approximately 1607 BCE.
In
the primary source, there is no description of Jacob's local status at the time
of arrival in the Nile Delta. The purpose of the work was not to record medical
details for a case history. We suggest that an elderly man aged around 70
exhibited clinical features of a degenerative-dystrophic process in the hip
joint. This could manifest as one of the forms of osteoarthritis, as well as in
the form of consequences of avascular necrosis of the femoral head, deformation
of the acetabulum and the proximal end of the femur, pelvis, and lumbar spine.
A contracture developed in the affected joint. There was absolute and relative
shortening of the ipsilateral lower limb, a change in its shape, and muscle
hypotrophy. Pathological relationships in the mobile joints seem to have caused
posture impairment with asymmetric shoulder height. The exact extent to which
these signs were pronounced is unknown, but presumably, they were significant.
This assumption is made considering Jacob's active physical labor, prolonged
periods of standing during the working day, long treks over rough terrain, the
use of additional support, as well as the 33 years that elapsed after the
injury. Such long-term use of a diseased joint inevitably leads to severe
disorders in the musculoskeletal system.
An
ancient Egyptian physician somehow identified damage to the ligament of the
head of femur in the patient. However, this pathology cannot be diagnosed by
history taking or routine examination alone. This means that the doctor
conducted a specialized examination. By collecting the medical history, it was
possible to ascertain the fact of a hip joint injury (Gen. 32:25–26). Based on
a clarifying interview and the preservation of the ability to walk, the
physician concluded that no hip dislocation had occurred (Gen. 32:26, 32).
Jacob's prototype was able to perform multiple forward bends of the torso (Gen.
33:3). Taking this fact into account, it was necessary to rule out injury to
the roots of the lumbosacral nerves, spinal cord, and major nerves of the lower
limb – primarily the sciatic and tibial nerves – sacroiliac joints, lumbosacral
joints, joints and intervertebral discs of the lumbar spine, pelvic ligaments,
and contractures of muscles tightening the tensor fasciae latae (2008БакупК).
The
pathology involved a single hip joint (Gen. 32:26, 32–33). For a specialist,
stating that a patient has a "disease" of a mobile joint is
insufficient. Clarification of the identified pathology is required. Currently,
magnetic resonance arthrography, preferably with a 3-T scanner, followed by a
transition to hip arthroscopy, is used as the primary method for diagnosing
lesions of the ligament of the head of femur (2018ShakoorD_DemehriS).
Professional consensus recommendations indicate that to detect pathology of the
ligament of the head of femur, in addition to magnetic resonance imaging and
arthrography, computed tomography arthrography should also be used
(2020ReimanMP_DijkstraHP). The ancient Egyptian physician who diagnosed Jacob's
prototype could not use the listed techniques. Having limited technical capabilities
without modern tools and techniques, the doctor nevertheless identified a
lesion of the ligament of the head of femur. How? Hope for finding an answer is
offered by a phrase of Nobel laureate Hans Selye (1907–1982): "a vast
contribution to the study of stress was achieved by simple means" (1960СельеГ).
Earlier,
we undertook a reconstruction of the symptoms of hip joint damage in literary
Jacob. The use of specialized diagnostic techniques would have helped in
recognizing the disease. This methodology was clearly unknown either to the
victim or to his companions. Did the ancient Egyptian diagnostician know the
signs of damage to the ligament of the head of femur and the testing
techniques? Rather, the answer is yes. Possibly, some of them were contained in
the lost second part of the Edwin Smith Papyrus – an ancient Egyptian
encyclopedia dedicated to injuries of the musculoskeletal system
(1930BreastedJH; 2013MahmoudEL; 2013SerageldinI). When examining patients in
the Middle Bronze Age, Egyptian physicians applied techniques and methods that
are currently accepted in medicine: history taking, inspection, auscultation,
observation, palpation, and testing. The latter, with respect to hip joint
pathology, is performed during walking, standing, sitting, and lying down:
prone, supine, and side-lying (2007NofsingerCC_KellyBT). In orthostatic
positions, testing for changes in the ligament of the head of femur should be
carried out in a double-leg stance, both symmetrical and asymmetrical, as well
as in a single-leg stance, both tense and relaxed (2012,2023АрхиповСВ).
[ii]
Most
of the known signs and tests indicating hip joint pathology are non-specific.
It has been noted that pronation-supination movements provoking hip joint pain
indicate an intra-articular nature of the lesion (2007NofsingerCC_KellyBT). The
technique of most diagnostic tests is based on this rule. For the direct
detection of pathology of the ligament of the head of femur, a limited number
of tests have been proposed throughout history. Moreover, in medical
literature, the ligament of the head of femur is first mentioned in the treatise
Instruments of Redactions (Mochlicus) by Hippocrates of Cos (born ca. 460 BCE)
(1844LittréE; 1886AdamsF; 1941Гиппократ). The earliest information regarding the
possibility of its damage dates back to the 3rd–2nd centuries BCE and is
associated with the names of ancient Greek physicians Heraclides of Tarentum
and Hegetor of Alexandria (1829KühnCG; 1965KolleschJ_KudlienF).
C.
Lampert (2009) showed that in diagnosing abnormalities of the ligament of the
head of femur using the FABER test (Flexion Abduction External Rotation Test),
a positive result is observed in more than 80% of cases with proven tears. At
the same time, it has been established that this technique is non-specific for
the pathology of the ligament of the head of femur, as it provokes pain not
only in the presence of changes in the hip joint, but also in the lumbar spine
and the sacroiliac joint (2014MageeD).
Insufficient
diagnostic accuracy when conducting known tests contributed to further search.
Two clinical tests were proposed: the "axial distraction apprehension
test" and the "dial test," which records the amplitude of
external rotation (supination) of the thigh. They assist in detecting hip joint
"laxity" without being pathognomonic for an isolated injury of the
ligament of the head of femur, yet they increase physician awareness that
reconstruction may be required. The axial distraction apprehension test is
performed with the patient in the supine position without anesthesia, with an
assistant stabilizing the pelvis. Manual axial distraction is applied to the
leg in order to stretch the joint and induce subluxation of the femoral head.
The test is considered positive if, during distraction of the patient's
attention, apprehension of pain onset occurs. The external rotation dial test
primarily assesses the "laxity" of the anterior joint capsule. It is
considered normal if the leg lies in a neutral position or if an end point is
reached with manual external rotation. In the case where the leg lies rotated
outward, and during external rotation an end point is not reached, a positive
test is recorded (2012PhilipponMJ_GaskillTR). We suggest that in the latter
case, supination is not limited to the ligament of the head of femur.
A
test has been developed to detect pathology of the ligament of the head of
femur (Ligamentum teres test) in the lying position, when the patient's thigh
is maximally flexed at the hip joint without pelvic tilt and abducted backward
by 30°. From this position (full flexion minus 30°), the thigh is placed in
full abduction and then moved backward by 30°. After this, the thigh is rotated
inward and outward through the full range. The purpose of the movements is to
stretch both portions of the ligament of the head of femur while avoiding
impingement of soft tissues and bones (2013AmenabarT_O'DonnellJ).
The
test described above was later refined and presented in a modified version. In
this version, to diagnose damage to the ligament of the head of femur, the
examined thigh is flexed to approximately 70° and abducted to 30°, the knee is
flexed to 90°, after which the thigh is rotated first inward and then outward.
Provocation of pain constitutes a positive test (2014O'DonnellJM_SinghPJ). The
sensitivity and specificity of this technique according to the authors were 90%
and 85%, respectively, with a positive predictive value of 84% and a negative
predictive value of 91% (2014O'DonnellJ_PritchardM). The test was developed
based on the hypothesis that the ligament of the head of femur will be in a
state of maximum tension and provoke pain at the end of the range of internal
and external rotation (2019MartinRL_KivlanBR). The developers believe that the
test recreates the end point of tension during multiplanar movement during
inflammation and/or tear of the ligament of the head of femur, causing a pain
response (2018O'DonnellJM_AroraM). Due to the fact that the diagnostic method
is based on reproducing pain, the test is sometimes useless for individuals
with a complete tear of the ligament of the head of femur
(2015MartinRL_MartinHD). According to current consensus recommendations, the
discussed technique (Ligamentum teres test / Ligamentum teres tear test) has a
moderate post-test probability of confirming the diagnosis of the state of the
ligament of the head of femur. It should be taken into account that the
presented data were obtained from a single high-quality study
(2020ReimanMP_DijkstraHP).
To
detect pathology of the ligament of the head of femur, certain clinics apply
the anterior "shuck" test (shuck or anterior apprehension test),
which is performed in the prone position, with the knee flexed to 90° and
maximum external rotation of the thigh. During testing, pressure is applied to
the dorsal portion of the greater trochanter to displace the femoral head
anteriorly, and the resulting pain or instability indicates a positive test
result (2013DombBG_JacksonTJ; 2020RosinskyPJ_DombBG,a). The posterior
"shuck" test (shuck or posterior apprehension test) is performed in
the supine position, with the hip and knee flexed to 90° during external
rotation of the thigh. Subsequently, a posteriorly directed force is applied to
the knee, and hip pain or instability indicates a positive test result
(2020RosinskyPJ_DombBG,a).
In
our view, the ten described tests for detecting pathology of the ligament of
the head of femur in the lying position are insufficient. Virtually none of the
proposed maneuvers allows detecting the damage with acceptable accuracy. It
cannot be ruled out that some of the discussed testing techniques were used
during the examination of Jacob's prototype. Some are capable of yielding
positive results, while others yield negative ones. Which diagnostic techniques
were known and personally developed by the physician who wrote the Book of Genesis
is impossible to say. No records of his remain, with the exception of the
surviving mention of the ligament of the head of femur (Gen. 32:33).
[iii]
Examination
in the standing position makes it possible to identify deformations of the
musculoskeletal system, fixed contractures, and changes in segment lengths. The
primary text states that the victim walked independently to the audience with
Pharaoh (Gen. 47:7, 10). Consequently, he retained the ability to maintain an upright
posture. Based on this, we assume that ancient Egyptian physicians had access
not only to inspection, but also to testing in the orthostatic position of the
patient. In such positions, it is suggested to perform certain movements and
note the presence or absence of pain and unusual sensations.
A
loaded extension hip rotation test is known, which, according to the author's
findings, proves positive in 78% of cases involving injury to the ligament of
the head of femur (2009LampertC).
Based
on experimental and clinical studies, a test has been proposed for identifying
damage to the ligament of the head of femur, in which a person squats from a
standing position while simultaneously attempting to cross one leg behind the
other (2012MartinRL_MartinHD). The significance of this diagnostic technique
for pathology of the ligament of the head of femur has not been established.
We
have proposed a test for detecting dysfunction of the ligament of the head of
femur while standing. When studying the maintenance of an upright position
supported on one leg, the patient is asked to reproduce a pelvic tilt to the
non-weight-bearing side in the frontal plane, which is characteristic of an
unrelaxed single-leg orthostatic stance. In doing so, attention is paid to
seven visually determined and subjective parameters: "tremor of the
weight-bearing lower limb," "stability," "weight-bearing
time," "pain in the hip joint area," "comfort,"
"pelvic position," and "spinal position." In cases of
pathology of the ligament of the head of femur, upon transitioning to an
unrelaxed single-leg orthostatic stance, the torso leans toward the
weight-bearing side. In the frontal plane, the pelvis progressively shifts
toward the weight-bearing leg, assuming a position tilted toward it. During testing
of young patients with hip joint pathology, the transverse axis of the pelvis
is usually oriented approximately parallel to the horizon. In virtually all
subjects, the longitudinal axis of the spine acquires a C-shaped curve. Lumbar
lordosis increases, and the shoulder girdle is set obliquely in the frontal
plane with a tilt toward the weight-bearing side. Most patients report
instability, postural discomfort, as well as emerging or intensifying pain in
the weight-bearing hip joint area, sometimes radiating to the knee joint,
lumbar spine, sacrum, groin, and buttock. We observed oscillatory movements of
the body in the frontal plane, and frequently the posture was unnatural.
Certain individuals involuntarily sought additional support, balancing with wide
arm movements. Muscle tension in the weight-bearing leg increased, and its
tremor appeared. Patients metaphorically described the pain and muscle
contraction as a sensation of a "driven rod" in the area of the
greater trochanter and abductor muscle group of the weight-bearing diseased hip
joint. The single-leg position could be held for less than a minute due to
intensifying pain and loss of stability. The presence of pain in the hip joint
area, discomfort, unnaturalness of posture, as well as an elevated or
horizontal position of the pelvis indicates pathology of the ligament of the
head of femur (2012,2023АрхиповСВ). Atypical pelvic tilt toward the weight-bearing side combined with
body lean toward the weight-bearing lower limb is sometimes referred to as the
reverse Trendelenburg–Duchenne sign (2007СкворцовДВ).
Ancient
Egyptian doctors appear to have applied testing in orthostatic positions. The
aforementioned signs could also have been identified during the examination of
patients with hip joint injuries. The phenomena we have described in the
single-leg orthostatic stance are caused by dysfunction of the ligament of the
head of femur. In turn, this dysfunction can be observed in complete or partial
injury, absence, changes in the localization of attachment sites, as well as
elastic (reversible) and plastic (irreversible) elongation. This disrupts the
biomechanics of the hip joint, primarily its weight-bearing function (2018АрхиповСВ).
We
do not rule out that ancient Egyptian physicians surmised the role of the
ligament of the head of femur. If so, they were aware of the visual and
functional manifestations of the pathology of this anatomical element. The
authors of the Book of Genesis drew attention to the limp (Gen. 32:32).
Undoubtedly, they noticed changes in the position of the body and limbs in
orthostatic postures. Following this assumption, it is only "half a
step" to developing a test for the patient's vertical stance.
In the Edwin Smith Papyrus (Case 7), a victim with an open fracture of the cranial vault is described. Below, an examination in the standing position is implied, and it is noted that he staggers very heavily (1930BreastedJH). Remarkably, Egyptian texts called for the acceptance and integration of individuals with physical and mental disabilities (2016TassinariJ_SistiA). In particular, Amenemope, a sage who lived during the reign of Amenhotep III (1391–1354 BCE), urged respect for people with disabilities: do not laugh at a blind man, nor mock a dwarf, nor interfere with the life of a cripple (2011KozmaC_LachmanR). Such an ethical stance promotes a thoughtful analysis of pathological phenomena and stimulates efforts to decipher the pathogenesis of diseases.
Despite
the injury sustained, the function of walking in literary Jacob was preserved,
but accompanied by a limp (halted) "on the hip" (Gen. 32:32). For
almost the entire day following the incident, the patriarch made treks and
engaged in construction (Gen. 33:3, 14, 17). Later, he actively moved across
the "land of Canaan" and erected monuments (Gen. 35:5–6, 15–16, 22, 27).
Upon reaching Egypt, our protagonist remained capable of walking independently
(Gen. 47:7, 10). This testifies to the accessibility of examining the victim
through gait analysis.
To
date, the diagnosis of pathology of the ligament of the head of femur based on
examination during walking has not been fully developed. We studied gait in
this aspect using a digital video camera. The specified testing is also
possible during observation without the use of technical means. We have
identified seven visually determined and subjective parameters in the
single-leg stance phase of gait: "limp, asymmetry, and arrhythmia of limb
movements and single steps," "pain or discomfort in the hip joint and
pelvic area during the stance phase," "deviation of the spine toward
the support side in the single-leg stance phase of gait," "forced
forward trunk lean in the single-leg stance phase of gait," "absence
of pelvic tilt toward the non-weight-bearing side in the single-leg stance
phase of gait," "impaired arm balancing and its abduction in the
single-leg stance phase of gait," and "deviation of the head toward
the support side in the single-leg stance phase of gait."
According
to our data, in pathology of the ligament of the head of femur during walking,
in the vast majority of cases, the non-weight-bearing half of the pelvis in the
middle of the single-leg stance phase of gait was noticeably higher than the
horizontal plane or, in a smaller number of observations, the transverse axis
assumed a horizontal position, and pain appeared or intensified in the
single-leg stance phase of gait. In isolated cases, discomfort in the
weight-bearing hip joint area and impairment of spontaneous rotational
movements of the pelvis in the horizontal plane were noted. To shift the
overall body center of mass forward and rotate the pelvis in the same
direction, patients frequently performed a forced forward trunk lean. Excessive
arm abduction on the affected side and deviation of the cervical spine and head
toward the weight-bearing leg were observed. Natural rotation of the shoulder
girdle in the horizontal plane during the stance phase on the diseased leg was
absent, which led to impaired balancing of the ipsilateral arm. In pathology of
the ligament of the head of femur, the amplitudes and directions of movements
executed by the head, spine, and arms were also altered, causing overall
asymmetry and arrhythmia of body and limb movements (2012,2023АрхиповСВ).
Modern
technologies, namely motion analysis video systems, allow recording the
movements of each body segment during walking with greater precision, noting
deviations from normal parameters. The additional use of electromyography
reveals changes in muscle activity around the hip joint. For example, an
anomaly in the bioelectrical activity graph of the gluteus medius muscle in the
middle of the single-leg stance phase of gait is a symptom of pathology of the
ligament of the head of femur (2018АрхиповСВ).
Hip
joint instability during walking caused by damage to the ligament of the head
of femur was suggested by Galen of Pergamon, who practiced in the 2nd–3rd
centuries. Discussing the gait of such patients, the ancient physician wrote:
"If due to a rupture of the ligament the hip has become dislocated, then
even with immediate reduction it will not be able to remain in its place. Since
the acetabulum is sloping and the great weight of the entire leg, the hip will
easily instantly slip out of its place if anyone during walking attempts to
step a little faster or step over something beneath their feet. Thus, if anyone
were to make small movements with the hip on level ground, it might always
maintain its natural position, but this, apparently, is impossible. For even if
a person could do nothing else, he will inevitably be forced to raise [his
legs] to enter the bathhouse" (1829KühnCG;). The words of the ancient
doctor imply the caution with which individuals with an injured ligament of the
head of femur walk. Expecting a bout of pain due to locking or subluxation,
patients take short steps with reduced weight-bearing time on the diseased leg.
There
is no reason to reject the examination of patients' gait by ancient Egyptian
physicians. The registration of most of the phenomena we have described in the
single-leg orthostatic stance and during walking was accessible to them.
According to our experimental and clinical studies, in the vast majority of
cases, these phenomena are caused by dysfunction of the ligament of the head of
femur (2012,2018,2023АрхиповСВ). Just as in the case of impaired maintenance of an upright stance,
dysfunction of the ligament of the head of femur specifically alters hip joint
biomechanics during walking and running. The physician who examined Jacob's
prototype in Egypt at least assumed the normal weight-bearing function of the
ligament of the head of femur in the locomotor act. Having detected a limp with
compensatory movements of body segments, it was not difficult for the
diagnostician to form an understanding of the role of the damaged anatomical
element during walking.
The
symptoms identified during testing in the orthostatic position combined with
observation of an impaired gait likely helped establish the correct diagnosis
in the patient who served as Jacob's prototype. The Book of Genesis describes a
limp "on the hip" (Gen. 32:32). This means that the doctor saw
asymmetry in the movements of the arms, legs, shoulder girdle, and pelvis. The
amplitude of oscillations of the arm segments on the side of the affected hip
joint was smaller than on the opposite side, or the arm even hung atonically.
Spontaneous forward rotation of the pelvis during weight-bearing on the
diseased leg was absent. Naturally, compensatory rotation of the shoulder
girdle in the opposite direction did not occur. The legs and arms moved
rhythmically and asymmetrically. The weight-bearing time on the compromised
lower limb increased. Concurrently, the swing period of the opposite arm
lengthened. The amplitude of body trunk oscillations toward the diseased hip
joint increased. The head could also deviate in the same direction due to
movements in the cervical spine, while the ipsilateral arm was abducted to the
side.
The
primary text mentions slow walking (Gen. 33:14). We have observed that with
accelerated walking in patients with an injury to the ligament of the head of
femur, pathological movements of the body and limbs manifest to a greater
extent. A diagnostician who paid attention to the gait of a patient with
pathology of the ligament of the head of femur could have identified the
phenomenon we noted. It is possible that the ancient Egyptian physician did so
much earlier by asking the limping patient to walk faster.
The
gait of patients interested medical practitioners of Middle Kingdom and Second
Intermediate Period Egypt. Ancient Egyptian texts narrate foot and leg pain
after walking in the Kahun Gynaecological Papyrus (2021LopesHT_PereiraRGG). The
Edwin Smith Papyrus also pays attention to gait changes in examined
individuals. In Case 8, which tells of the consequences of a cranial injury,
the physician notes that the patient walks shuffling with his sole. The
commentator clarifies: he [the doctor] speaks of his walking with a dragging
foot, so that it is not easy for him to walk [i.e. walks slowly?], when this
[his foot?] is weak and turned, and the tips of his toes are pressed to his
sole [flexed], and they [the toes] move scraping the ground (1930BreastedJH).
The description resembles the gait of individuals with focal brain lesions, as
well as ischemic or hemorrhagic cerebral stroke.
[v]
A
decade ago, researchers stated that unfortunately, there is no specific test to
detect tears of the ligament of the head of femur, and the signs known at that
time were non-specific and observed in other intra-articular hip pathologies (2010CerezalL_Pérez-CarroL).
After a decade of research, the practical applicability of a specific clinical
sign for determining the state of the ligament of the head of femur remains
unknown (2020ReimanMP_DijkstraHP). To date, the accuracy of testing its pathology
during physical examination necessitates resorting to other, primarily
instrumental, diagnostic methods.
As
our brief overview has shown, over the past 3,600 years since the examination
of Jacob's prototype, medicine has failed to identify definitive symptoms and
tests indicating pathology of the ligament of the head of femur. The proposed
methods and discovered signs only indirectly suggest its alterations. In
isolated cases, a test provokes pain during impingement of the ligament of the
head of femur. Other tests demonstrate disturbances in hip joint biomechanics.
We assume that variations of the techniques described above were used by the
ancient Egyptian physician who participated in writing the Book of Genesis.
Apparently, he developed a specialized diagnostic system, the essence of which
has been lost and is yet to be reconstructed.
In
the primary source under study, Esau's words are present: "let us take our
journey, and let us go" (Gen. 33:12). The phrase indicates that the
characters spend part of the conversation sitting. Accordingly, upon completing
their communication, the brothers stand up. If Jacob had sciatica (ischialgia),
rising with extension in the lumbar spine would have been extremely difficult.
Difficulties in standing up are also observed in individuals with traumatic
pathology of the hip joint. Such patients, when rising from a seated position,
prefer to use external support or lean on their hands or knees, bending
forward. This reduces muscle tension around the injured joint and compression
of the cartilaginous surfaces. If an excessive amount of synovial fluid or
blood is present inside, the pressure of tense muscles on the stretched joint
capsule will increase intra-articular pressure. The latter circumstance usually
causes acute pain in the affected joint. Such a technique could have been used
by the ancient Egyptian physician for differential diagnosis, namely to rule
out pathology of the spine and nervous system.
W. Henke (1863) drew attention to the involvement of the ligament of the head of
femur in providing support to the femur in the seated position: if one leg is
placed on the opposite knee, the raised femur will not sink down only because
for this it would need to be rotated even more around its longitudinal axis,
provided, of course, that the leg is to remain on top; this is prevented by the
ligament of the head of femur. A similar phenomenon was noted by H. Beaunis andA. Bouchard (1868): the ligament of the head of femur is even more taut during
external rotation when the hip is flexed; thus, for example, the ligament holds
the knee raised if the outer border of the foot rests on the knee of the
opposite side.
B.
R. Kivlan et al. (2013) experimentally established that the ligament of the
head of femur has the potential to provide hip joint stabilization sling-like
during multiplanar movement resembling a squat. In the cross-legged seated
posture, the ligament of the head of femur is capable of providing support for
the leg resting on the opposite thigh during flexion and supination at the hip
joint (2018АрхиповСВ).
If Jacob sat cross-legged during the conversation, pain could have arisen in
the hip joint with the damaged ligament of the head of femur in this posture.
In such a case, the uncomfortable sensations would be caused by the
incarceration of the distal fragment of the torn ligament of the head of femur
into the joint space, locking the joint and further tensioning the external
ligaments. As we have noted, ancient Egyptian wall paintings more frequently
depict seated figures with knees bent. Exceptions include depictions of scribes
with scrolls lying on their laps. Therefore, it cannot be denied that Jacob's
prototype sat on his knees and, despite the injured ligament of the head of
femur, stood up independently.
As
a result of the sustained hip joint injury, the gait pattern was altered (Gen.
32:32). In addition to the visual sign of injury, the primary source states
that the victim traveled slowly, no faster than the children and livestock
(Gen. 33:14). This clearly implies a pain syndrome and a disruption of the
automatic nature of the locomotor act. We believe that to confirm the injury to
the ligament of the head of femur, the author describes a differential
diagnostic test: the patient performs multiple bows "to the ground"
(Gen. 33:3). The ability to unhinderedly bend the torso forward rules out
sciatic nerve pathology, radiculopathy, and vertebral fractures.
How
long ago did physicians begin using diagnostic tests? One of the earliest
testings of a patient for fertility issues and palpation as a diagnostic method
is described in the Kahun Gynaecological Papyrus (2021LopesHT_PereiraRGG).
Establishing a diagnosis in traumatological and neurosurgical pathology is
first described in the Edwin Smith Papyrus. Case 8 tells of a patient who had
previously suffered a comminuted fracture of the cranial vault with resultant
coordination impairment, as the victim could not touch the center of his palm
with a finger (1930BreastedJH). This is an original coordination test. Missing
the palm of the opposite hand when attempting to touch it with a finger
resembles the finger-to-nose test. It is widely used in neurology and addiction
medicine to clarify the nature of brain dysfunction and motor coordination.
In
Case 48 of the Edwin Smith Papyrus, the ancient clinician tests a patient with
a spinal injury and respectfully asks: Please flex your [legs] at the hip
joints, and then extend them. Whereupon the victim will immediately flex them,
because it is difficult for him to extend them due to the pain arising in the
spine (1930BreastedJH). Movement in the hip joint is implied here, but the primary
meaning was likely the entire leg below the hip joint (1993WalkerJH).
When
lying down, it is impossible to extend the leg at the hip joint, just as it is
impossible to flex it at the knee joint without flexion at the former. From
what has been said, it is clear that the doctor proposes first raising the leg
by flexing at the hip and knee joints, and then extending it at the knee alone.
Pain appearing in the lower back will indicate a lesion of the lumbar spine
combined with nerve pathology. That is, Case 48 of the Edwin Smith Papyrus
contains the earliest description of a variant of the Lasègue test
(Ernest-Charles Lasègue, 1816–1883). The Lasègue sign of nerve tension is
tested in the supine position and is positive in lumbalgia due to various
causes, including sciatica. In the case of lumboischialgia – that is, with the
clinical picture of sciatic nerve involvement when standing and walking – the
patient spares the leg, and the lower back is "stiff" during gait
(2002КарловВА).
In
another manual for physicians, it is stated that in pathology localized in the
lumbar region, while standing, "flexion of the trunk with knees
straightened may be restricted due to pain and spasm, the lumbar region may be
flattened and immobile... Extension is restricted in vertebral fractures and
inflammatory processes." A similar picture is observed in the supine
position: "Straight leg raise is accompanied by tension of the L5 and S1
roots with the appearance of the Lasègue sign" (2006ВикторМ_РопперАХ). It should be noted that in lesions of the
aforementioned roots, flexion at the hip joints while standing and lying leads
to nerve tension and is accompanied by pain if extension at the knee joint is
performed simultaneously. The sciatic nerve is stretched, as well as the spinal
nerve roots and sacral plexus roots, which are already stretched due to
vertebral displacement in the injured region. We read of such diagnostic
provocation of pain syndrome in the Edwin Smith Papyrus.
In
our opinion, the Book of Genesis provides a description of an analogue of the
Lasègue test performed during walking. After sustaining the hip joint injury,
Jacob, walking ahead of the procession, "bowed himself to the ground seven
times, until he came near to his brother" (Gen. 33:3). To perform such an
action, one must stop. Bending the body trunk with a hand touching the
supporting surface is inevitably accompanied by flexion at the hip joints,
normally with extended knee joints. The primary source does not mention falling
to the knees, but only bowing. In the presence of an injury to the spine,
spinal nerve roots, or sciatic nerve pathology, Jacob would not have been able
to perform multiple forward bends. The impression is created that the discussed
part of the verse in the Book of Genesis conveyed a method for detecting the
sign of nerve tension while standing, described for the supine position in the
Edwin Smith Papyrus.
Thus, the Old Testament account of the ability to unhinderedly bend the body trunk forward rules out sciatic nerve pathology, radiculopathy, and vertebral fractures or dislocations. The reference to multiple bows is regarded by us as a description of performing a differential diagnostic test. Thereby, the author proves damage specifically to the hip joint. This is done in addition to describing the injury mechanism as rotation exceeding the physiological limit, as the text explicitly states: the socket of Jacob's hip was out of joint (Gen. 32:25/26). Further below, the text mentions the victim's preference for slow walking (Gen. 33:14). The aforementioned represents the clinical observations of a medical writer who was a contemporary of the author or scribe of the Edwin Smith Papyrus.
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 22. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-22.html
Note
Keywords
hip joint, hip dislocation, osteoarthritis, ligament of the head of femur, ligamentum teres, ligamentum capitis femoris, Minoan Eruption, Bronze Age, Ancient Medicine, Ancient Egypt, Edwin Smith Papyrus, Biblical Chronology, Genesis, Genesis Protograph, Bereshit
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
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