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 7
OBSTETRIC AND PREPUBERTAL HISTORY
In
the Book of Genesis, it is repeatedly stated that men beget offspring. For
example: "Sheth lived a hundred and five years, and begat Enosh"
(Gen. 5:6). Similarly: "Noah begat three sons: Shem, Ham, and
Japheth" (Gen. 6:10). Also: "Terach begat Abram, Nachor, and
Haran" (Gen. 11:27). Such an approach to describing childbirth does not
allow for the compilation of a complete obstetric history. Viewing men as
giving birth to children reflects Egyptian mythologism. The authors of our
primary source imitate ancient legends recounting how the sun god Ra brought
forth offspring. According to the Book of Knowing the Creations of Ra and of
Overthrowing Apep, the main deity says: "That which I spewed forth was
Shu; that which I spat out was Tefnut" (2021МюллерМ). In the Babylonian myth of
Atrahasis, it is said of the great god Marduk: "his father begot him"
(1999LambertWG_CivilM). A similar "anomaly," presumably aimed at
deification, is noted regarding Abraham, who "begot Isaac" (Gen.
25:1). Further in our epic, children appear only through the participation of
women. Rebekah and Isaac give life to Jacob and Esau (Gen. 25:25–26).
Jacob's
parents married when Isaac reached the age of 40 (Gen. 25:20). For a long time,
the marriage remained childless due to Rebekah's primary infertility (Gen.
25:21). From the text, it is clear that her children were born after 20 years
of married life, on Isaac's sixtieth birthday (Gen. 25:26). We consider this a
literary exaggeration, but also an indirect indication of gynaecological
pathology. From our point of view, Isaac reached the age of about 28–29 years.
Rebekah's age is not reliably known, but it can be assumed that she was
approximately the same age as her husband or slightly younger. We draw this
conclusion because she is mentioned when Isaac is referred to as a
"lad" (Gen. 22:5, 23). If Isaac was 5 years older than his wife, then
Rebekah gave birth at the age of 23–24. The authors did not provide reliable
data, but merely wished to demonstrate the significant age of the woman in
labor. In the Early Bronze Age, average life expectancy was 32.1 years,
increasing in the Middle Bronze Age to 34.7 years (2012GabrielRA).
A
similar reproductive problem was observed in Rachel, the daughter of Laban,
Rebekah's brother (Gen. 29:16, 31, 30:1–2). Rachel gave birth 7 years after
entering into marriage (Gen. 30:25, 31:38, 41). Her date of birth is unknown.
We believe she was born 6–7 years later than Jacob. Provided that Jacob turned
31 at the time of Joseph's birth, the mother was 24 or 25 years old. Primary
infertility was also noted in Sarah, Isaac's mother (Gen. 11:30, 15:1–2).
According to our primary source, Sarah gave birth "in old age"
("having grown old"), namely at 90 years old (Gen. 17:17, 21:2, 7,
24:36). We believe that this event falls on the 48th or 49th year of her life,
after more than 30 years of marriage. Her spouse was ten years older – 58 or 59
years old. However, the authors claim that Abraham was 100 years old (Gen.
17:17, 21:5). According to the material in the Book of Genesis, a deliberate
exaggeration of the spouses' ages was observed in the families of the patriarchs.
Our
primary source reliably describes female infertility in Sarah, Rebekah, and
Rachel. Prior to Isaac's conception, Abraham had a son, Ishmael, born to him by
the concubine Hagar (Gen. 16:3–4, 16). Jacob, Rachel's husband, had become a
father 10 times by the period of her pregnancy through his elder wife Leah and
two handmaidens – Zilpah and Bilhah (Gen. 29:32–35, 30:5–7, 10–12, 17–21). In
light of what has been said, it appears that this is the first systematic
description of a case of familial infertility. This pathology has been known in
Ancient Egypt at least since the Middle Kingdom. In the Kahun Gynaecological
Papyrus, written around 1825 BCE, original methods for diagnosing infertility
and pregnancy are proposed (2005Haimov-KochmanR_HurwitzA; 2011SmithL;
2021LopesHT_PereiraRGG). Male and female infertility is mentioned in the
Sumerian myth of the creation of humans from clay (1965КрамерС; 1981KramerSN). The status of the
"barren woman" is analysed in §§ 144–146 of the Babylonian Code of Hammurabi
(1920HandcockPSP). According to Plutarch (1st–2nd centuries CE), the goddess
"Nephthys, having become the wife of Typhon [Set], was at first
barren" (1996Плутарх).
Sarah,
Rebekah, and Rachel, as well as their spouses, shared a common male ancestor in
the person of Terach, son of Nachor (Gen. 11:24). Sarah was the daughter of
Terach, while Abraham was his son by another mother (Gen. 20:12). Rebekah was a
great-granddaughter of Terach, granddaughter of his middle son Nachor, and
daughter of his grandson Bethuel (Gen. 22:20–23). Rachel, daughter of Laban,
son of Bethuel, was a great-great-granddaughter of Terach (Gen. 28:5, 29:10,
16). Another great-great-granddaughter of Terach, Leah, also a daughter of
Laban, did not suffer from primary infertility. Being a first cousin of Jacob,
Leah gave birth to six sons and a daughter (Gen. 30:20–21). Marriages between
brothers and sisters in the families of Egyptian kings were contracted to
preserve the royal blood (2012EshraghianA_LoeysB). Such unions were "a most
common occurrence" among Egyptians (2021МюллерМ). A spell in the "Coffin Texts" (c.
2134–2040 BCE) states that "The lightning flash
strikes, the gods are afraid, Isis wakes pregnant with the seed of her brother
Osiris. She is uplifted, (even she) the widow, and her heart is glad with the
seed of her brother Osiris. She says: 'O you gods, I am Isis, the sister of
Osiris, who wept for the father of the gods, (even) Osiris who judged the
slaughterings of the Two Lands" (1973FaulknerRO). From the history
of the 4th Dynasty, it is known that Meresankh, daughter of Prince Kawab,
married his brother Khafre, also a son of King Khufu (Cheops), though
apparently by a different wife (2002BunsonMR).
Consanguineous
ties are not forbidden in the Book of Genesis. This is evident from the story
of Lot and his daughters who conceived by him (Gen. 19:36–38). The narrator
does not condemn adultery and does not bring down punishment upon the
endogamous family. It appears he knew of Nefertkaw, who was the daughter and
wife of the 4th Dynasty Pharaoh Sneferu. During the New Kingdom, two daughters
figure as wives of Ramesses II (2002BunsonMR). In contrast to the Ancient
Egyptian tradition, the Mesopotamian Code of Hammurabi (c. 1760 BCE) punished
sexual relations between father and daughter: such men were banished from the
city (1920HandcockPSP).
Modern
statistical studies conducted in Egypt have shown that the practice of
consanguineous marriages is explicitly linked to the relative prevalence of
recessive pathologies (2012TemtamyS_AglanM). Close consanguineous family unions
among Egyptians correlate in offspring with diseases of the central nervous
system, malformations of the limbs and skeleton, disorders of sexual
differentiation, anomalies of the eyes, ears, and oral cavity, as well as
genetic syndromes (1991TemtamySA_MeguidNA). Tutankhamun (18th Dynasty), likely
the son of Akhenaten, married his daughter Ankhesenamun, who gave birth to two
stillborn infants (2002BunsonMR). Consanguinity of the spouses appears to be
the cause of fetal death in the pharaoh's family.
Sarah,
Rebekah, and Rachel, as well as their husbands, were descendants of Terach.
With an increase in the degree of consanguinity and an enlarged portion of the
genome in a homozygous state, the manifestation of recessive hereditary
pathologies becomes more frequent (2020БобджоноваОБ_АбдурахмановаФМ). Consanguineous marriages increase the
incidence of congenital malformations and postnatal mortality
(2009TadmouriGO_HamamyHA). Blood relationship, diseases, and partner age over
25–30 years are crucial factors in the absence of pregnancy
(2018VanderBorghtM_WynsC). It is known that during the expression of a rare
allelic gene inherited from common ancestors, an autosomal recessive trait
responsible for infertility manifests itself (2002SchmiadyH_NeitzelH).
The
data we have presented suggest that the Book of Genesis discusses a case of
hereditary primary female infertility. From our point of view, the most
probable cause of Old Testament infertility was polycystic ovary syndrome
(PCOS). This is indicated by late pregnancies in Sarah, Rebekah, and Rachel
that resulted in childbirth (Gen. 21:2, 25:25–26, 30:23, 35:16–18). Childbirth
at an advanced reproductive age is more common among women with polycystic
ovary syndrome than among those without it (2011RoosN_StephanssonO). Genetic
studies have established a strong hereditary component in the pathogenesis of
polycystic ovary syndrome, associated with genes regulating gonadotropin
secretion and action, androgen biosynthesis, glucose homeostasis,
folliculogenesis, and menopausal age (2025LouwersYV_LavenJS). The death of
Rachel during the birth of her second child further supports this assumption
(Gen. 35:16–19).
Women
with polycystic ovary syndrome face an increased risk of pregnancy-related
complications, such as gestational diabetes, gestational hypertension,
preeclampsia, preterm birth, and caesarean section (2018PalombaS_LaSalaGB). In
turn, eclampsia, hypertension, and hemolysis with elevated liver enzymes and
low platelet count (HELLP syndrome) represent a life-threatening triad
predisposing to critical obstetric hemorrhage (2024AkaishiT_SaitoM). The most
frequent causes of maternal mortality worldwide are preeclampsia and postpartum
hemorrhage, which are more prevalent among populations of low economic status
(2016ChoeSA_ChoSI).
In
addition to physiological manifestations, polycystic ovary syndrome is
associated with anxiety, depression, eating disorders, psychosexual
dysfunction, and negative body image perception (2024Stener-VictorinE_PiltonenTT).
Psycho-emotional "outbursts" are recorded in all the aforementioned
biblical women with primary infertility. Sarah perceives disrespect from the
handmaid whom she herself gave as a wife to Abraham (Gen. 16:3–4). Rebekah
experiences an anxiety disorder "because of the daughters of Heth,"
accompanied by a wish to end her life (Gen. 27:46). Rachel is visited by
suicidal thoughts (Gen. 30:1). "Grasping at straws," she demands an
aphrodisiac in the form of mandrake from her sister and "sells" a
night with her husband in exchange for the herb (Gen. 30:14–15). A letter (ARM
26/2 304) from the Mari archives informs the king about a young woman deprived
of her husband's attention who uttered the threat: "I will throw myself
from the roof" (1988CharpinD_LafontB).
The
medical writer demonstrates that Rachel is capable of childbearing, as
amenorrhea is absent (Gen. 31:35). The materialistic cause of her infertility
is not disclosed and is "profoundly" explained by divine providence
(Gen. 30:2). It should be noted that Isis's childlessness during her life with
Osiris also remains unexplained in Egyptian mythology (1995RegulaT). In the
course of presenting the material in the Book of Genesis, the author
masterfully dispels the popular belief regarding the effectiveness of mandrake
in overcoming conception problems. Thus, Rachel receives the plant but remains
unable to conceive for a long time, whereas the sister who surrendered the
desired item gives birth to two sons and a daughter (Gen. 30:14, 17–21). In
antiquity, there existed a belief that this flowering plant induced madness and
influenced sexual relations, being considered effective in potions as a means
to enhance sexual activity and a component boosting fertility (1905RandolphCB).
The
Berlin Papyrus 3038 (Brugsch Papyrus), compiled around 1350 BCE, recommends
fumigation with hippopotamus dung for infertility (1909WreszinskiW;
1952LeakeCD; Science in Ancient Egypt, sae.saw-leipzig.de). The Chester Beatty XIII Papyrus,
written during the 19th or 20th Dynasty (1307–1070 BCE), contains an
incantation allegedly aiding conception (Science in Ancient Egypt, sae.saw-leipzig.de). In contrast to the exotic
"treatment" methods of the New Kingdom and prayer, our primary source
repeatedly emphasizes that children are born through the involvement of men
synthesizing reproductive products (Gen. 30:4–5, 30:16–17, 38:9, 18). The
creator of the work demonstrates an awareness of the physiology of the female
fertile system and the limited reproductive lifespan of both sexes (Gen.
18:11–12, 31:35).
From
the epic of Genesis, it appears that Rachel's labor began prematurely during
the caravan's journey from "Beth-el" to "Ephrath, which is
Bethlehem" (Gen. 48:7). The child was born on the road almost suddenly,
for it is said: "And there was still a distance to go to Ephrath"
(Gen. 35:16). Had his wife shown early signs of approaching labor, Jacob would
not have risked striking camp in Beth-el to proceed south through the
mountains. The unexpected delivery was characterized as "hard,"
resulting in the salvation of the child but the death of the mother (Gen. 35:16,
19). It appears that Rachel died as a result of massive postpartum hemorrhage.
According to the primary source, death was caused by the "departing of her
soul" (Gen. 35:18–19). Earlier in the text, a parallel is drawn between
the "soul" and the "blood" of a person. In particular, God
says: "for the blood of your lives will I require; at the hand of every
beast will I require it, and at the hand of man; at the hand of every man's
brother will I require the soul of man" (Gen. 9:5–6). Later, in the Book
of Vayikra (Leviticus), it is explained: "For the soul of all flesh is its
blood," and in another reading: "for the soul of all flesh is the
blood thereof" (Lev. 17:14). A similar analogy was developed by the
1st-century BCE poet Virgil in the Aeneid (10:487): "The blood and life
pour out along the same path" (1979Вергилий). Rachel would have benefited from a drug
stimulating uterine contractions, hemostatic agents, or manual removal of the
placenta. The Ebers Papyrus proposes a dubious remedy to "constrict"
this organ, though it remains unclear whether it was intended "to
accelerate labor, expel the placenta, or assist the uterus in returning to its
normal size after childbirth" (2002NunnJF).
It
is likely no coincidence that in the lines describing the fatal complication of
delivery, a "midwife" appears for the first time (Gen. 35:17). The
biblical midwife proves powerless to assist in the face of profuse hemorrhage.
At the same time, as a high-level professional familiar with ethics and
deontology, the midwife encourages and comforts the dying patient (Gen.
35:17–19). The oldest discussion regarding the treatment of uterine hemorrhage
is included in the Kahun Gynaecological Papyrus, which recommends external
applications and a certain liquid potion for oral administration (2011SmithL;
2021LopesHT_PereiraRGG). The London Medical Papyrus (14th century BCE) offers a
series of incantations (1992SteinerRC; Science in Ancient Egypt, sae.saw-leipzig.de). Papyrus "Leiden I 348,"
compiled during the 19th Dynasty to expel the placenta, advises exclusively
magical spells, among other things, for "hard labor" (Science in
Ancient Egypt, sae.saw-leipzig.de). Remarkably, in the tale from the
cycle "Pharaoh Khufu and the Magicians" concerning a woman delivering
triplets, it is stated: "her labor was hard" (1958КацнельсонИС_МендельсонФЛ). Overall, Egyptian physicians
lacked an understanding of the pathophysiology of this complication, and the
therapy employed must be recognized as extremely rudimentary.
Female
physicians and midwives were present in Hittite society. Among the Hittite
texts, two cuneiform tablets (KUB 39. 31 and KUB 30.42 I 8) from Boğazköy have
been discovered to date, describing the practice of Hurrian female healers of
the 2nd millennium BCE (2004NúñezJAÁP). Hittite midwives participated in
childbirth and associated rituals, first assisting the laboring women and then
reciting incantations for the well-being, health, and longevity of the newborn
child (2002BryceT). Furthermore, two types of such specialists existed, though
the distinction between them has not been definitively established. The first
type: a practicing midwife, literally termed "a woman who knows internal
organs," as well as "child-bearer" or
"midwife-specialist," identified with the "wise woman" of
the family or community, whose specialization could include that of midwife,
nanny or wet nurse, and magic-ritual assistant, as well as other general
healing rituals and actions (2026ArnottR).
The
midwife who traveled as part of Jacob's caravan hailed from the Harran valley,
a territory close to Anatolia. It is reasonable to assume that her training in
midwifery was carried out in the traditions of Mesopotamia and the Hittite
Kingdom.
Along
with the possibility of maternal death, the creators of the Book of Genesis
demonstrate a fundamental awareness of the potential for fetal death. As
applied to humans, such an outcome of pregnancy does not figure in our primary
source, but it is noted among animals. Jacob, in accusing his father-in-law,
states: "your ewes and your female goats have not miscarried" (Gen.
31:38). There are numerous causes of spontaneous abortion, including the
influence of external factors. From the quoted words, it is clear: the shepherd
protected his animals in every possible way, preventing miscarriages.
Undoubtedly, Jacob cared for his wives with equal dedication. The opinion has
been voiced that the name of Jacob's younger wife, Rachel, derives from the
Hebrew word for "ewe," while Leah was named at birth "cow"
(2000MeyersC_KraemerRS). In our view, Rachel is a derivative of the Akkadian
reḫu (ra-ḫe-e), meaning "fertilized" (1999ReinerE_RothMT). In turn,
the name Leah is closer to the Akkadian le’u (le’au), which means, among other
things, "victor" or "one who has overcome another"
(1973OppenheimAL).
Presumably,
the first case of polycystic ovary syndrome recorded in literature is
associated with the woman who served as the prototype for the Egyptian goddess
Isis. Commentators on her myth write: "Isis grieved greatly because during
Osiris's lifetime she had not managed to give birth to a son" (2004РакИВ). According to Plutarch, her full
sister Nephthys, being the wife of Set, was initially childless (1996Плутарх). Both women later brought forth
children: Isis gave birth to the god Horus, and Nephthys to the god Anubis. In
these myths, we discern the oldest allusion to primary infertility resulting
from polycystic ovary syndrome. In Ancient Egypt, it was believed that a
married woman ought to become pregnant, and infertility not only drew societal
condemnation but was also viewed as a sign of divine wrath. Therefore, young
women feared being barren (2016ДжарманОА_МикиртичанГЛ). According to legend, Isis, knowledgeable in
the secrets of magic and sorcery, was able "to conceive a child even from
her spouse's mummy" (2004РакИВ).
Supernatural
powers facilitate the conception of the childless Rebekah (Gen. 25:21). A
similar miraculous outcome occurs with Rachel: "God listened to her, and
opened her womb. And she conceived, and bore a son" (Gen. 30:22–23).
Through the intervention of either God or angels, ninety-year-old Sarah, who
was in menopause, became the mother of Isaac (Gen. 17:15–17, 18:11–13, 21:1–3).
Despite this, the writer with medical training demonstrates knowledge of the
transformation of the female reproductive function in advanced age. The Hittite
King Hattusili III (13th century BCE) appealed to Ramesses II with a request to
send a specialist who could cure his sister Matanazi of infertility (Letter
652/f-28/n+127r). In reply, Ramesses II writes that this woman is 60 years old,
so a medicine cannot be prepared for her to get pregnant (1976EdelE). The
correspondence between the rulers demonstrates that the Hittites, in contrast
to the Egyptians, possessed a limited understanding of female fertility even at
the end of the 2nd millennium BCE.
Further
in the text of our primary source, the medical writer's understanding of the
normal menstrual cycle is evident (Gen. 31:35). Earlier in the work, the
author's awareness of natural labor is noted. Thus, God says to Eve: "in
pain you shall bring forth children" (Gen. 3:16). The quoted words find an
echo in the Egyptian legend of the goddess Isis, who "suffered terribly
from labor pains" (2008МеексД_Фавер-МеексК). Information on obstetric practice
in Ancient Egypt was reliably accumulated and analyzed from the period of
2100–1900 BCE, as demonstrated by the Kahun Gynaecological Papyrus
(1992ReevesC). Such scientific-medical texts were not created by peoples other
than the Egyptians in the early to mid-2nd millennium BCE. In our view, Ancient
Egyptian literary works also reliably described childbirth. As an example, one
should cite a Middle Kingdom tale told to Pharaoh Khufu, in which the goddesses
Isis, Nephthys, Meskhenet, and Heqet, acting as midwives, assist the woman in
labor, "accelerating" delivery – presumably by applying abdominal
pressure – cut the umbilical cord, and wash the newborn (1978КоростовцевМА).
Reviewing
the fate of the aforementioned women from Abraham's clan, we observe described
features indicative of polycystic ovary syndrome. It is possible that their
prototypes were the goddesses Nephthys and Isis, revered by the ancient
Egyptians. Imitation of myths allowed the creators of the Book of Genesis to
fashion archetypes remarkably familiar to the inhabitants of the Nile Valley.
The co-author with medical training clearly encountered primary infertility.
His description of a large number of polycystic ovary syndrome manifestations
leads us to assume the existence of real prototypes for Sarah, Rebekah, and
Rachel. Therefore, their images entered the text, forming the oldest series of
cases of a hereditary disorder of the female reproductive system that
supplemented the Kahun Gynaecological Papyrus.
In
polycystic ovary syndrome, an increased incidence of multiple pregnancy has
been noted. At least, this is reported in individual studies: 9–10% instances
of polyploidy in polycystic ovary syndrome compared to 1.1% in the control
group (2001MikolaM_TiitinenA; 2020MannA_SubbaiahM). Furthermore, it has been
observed that the rates of severe maternal morbidity and mortality are
significantly higher in multiple pregnancies compared to singleton ones
(2018SantanaDS_WHO).
According
to the Book of Genesis, Rebekah became pregnant 20 years after entering into
marriage, having initially been "barren" (Gen. 25:20–21, 26). The
pregnancy proved to be multiple (Gen. 25:22, 24). Apparently, Rebekah consulted
a diviner, who identified the presence of twins (Gen. 25:23). During the Middle
Kingdom era in Egypt, there were specialists who "predicted" the
future in the domain of obstetrics and gynecology. In the Ramesseum Papyrus
Tomb, which likely belonged to a priest, magician, or physician, various
figurines associated with such magic were found (2020MiniaciG). A method for
diagnosing pregnancy, specifically detecting a child in the mother's womb, is
set forth in the Kahun Gynaecological Papyrus (2021LopesHT_PereiraRGG).
According to the Book of Genesis, Rebekah "went to inquire of the
Lord" (Gen. 25:22). This is stated as though the patient headed to the
diviner's "office" or to a nearby temple. In reality, at the time of
her pregnancy, the family was nomadic in the vicinity of the well
"Be'er-Lahai-Roi" in the desert region of the "Negev" (Gen.
24:62). "Seers" were demonstrably present in the territory of Canaan.
In Bet She'an (on the right bank of the Jordan south of the Sea of Galilee), an
Old Babylonian cylinder seal was found bearing the inscription: "Manum,
diviner, servant of Ea" (2019CohenY). In the desert, finding such a
specialist would not have been possible.
Reconstructing
how Rebekah's labor proceeded is difficult. A professional midwife did not
assist her. However, a nurse/wet nurse arrived with her from Mesopotamia to
Canaan (Gen. 24:59). This means that assistance could indeed have been
provided. Hittite midwives delivered babies with the laboring woman in a seated
position, a posture practiced since the Neolithic period (2026ArnottR).
In
Ancient Egypt, a woman in labor sat upon bricks that substituted for a bed
(2004РакИВ). First,
Rebekah gave birth to a twin displaying signs of a congenital anomaly termed
hypertrichosis. This genetic pathology is described in the words: "And the
first came out red, all over like a hairy garment" (Gen. 25:25). Following
Esau, Jacob is born (Gen. 25:26). Later, he states: "my brother is a hairy
man, and I am a smooth man" (Gen. 27:11). Significant visual differences
point to the birth of dizygotic (fraternal) twins. The presence of two ova
simultaneously mature for fertilization can be viewed as a form of ovulatory
dysfunction, which is considered an important diagnostic criterion for
polycystic ovary syndrome (2016AzzizR_YildizBO).
In
the oldest Old Hittite myth, originating from the initial period of Hittite
history, the Queen of Kanesh gives birth to thirty twin sons and disposes of
them, but the gods save the infants. Later in the text, we learn that one
enters into an incestuous marriage with his sister (1996ПрохоровА). In the Hurrian poem
"Kingship in Heaven" (dated prior to the mid-2nd millennium BCE), we
find: "When the Earth cried out, she gave birth to twins. A messenger
arrives with news. God Ea, sitting on his throne, listens to him with approval:
'I hear good news: Earth has given birth to twins.'" The translator comments:
"This episode remains isolated in the Hurrian epic cycle. Apparently, the
twins – children of Earth and Ursa Major – later play the role of gods (in a
lost section), possibly as patrons and forebears of the Hurrians" (1977ИвановВВ).
Presumably, the birth of opposite-sex
twins is narrated for the first time in the Pyramid Texts (2350–2175 BCE): to
the god Atum "twins were born, Shu and Tefnut" (1952MercerSAB). In an
Ancient Egyptian tale from the cycle Pharaoh Khufu and the Magicians, composed
during the Middle Kingdom, the birth of three male twins with the assistance of
midwife-goddesses is related (1978КоростовцевМА). Philologists believe that the tale contains
an allusion to the first three kings of the 5th Dynasty (1979ЛившицИГ_РубинштейнРИ). This is a classic example of
political propaganda announcing the presence of a divine plan. We discern a
similar meaning regarding the birth of the twins Jacob and Esau. Someone
foretells to Rebekah: "two nations are in your womb, and two nations shall
be separated from your body" (Gen. 25:23). Further in the text follow
numerous narratives in which Rebekah's children appear as earthly incarnations:
one of the god Set, and the other of Osiris.
Jacob
was born to a woman at an advanced reproductive age, presumably suffering from
polycystic ovary syndrome. Behind the veil of artistic narrative lies an entire
complex of health problems in the laboring woman. The twin pregnancy proceeded
uneasily: "the children struggled together within her" (Gen. 25:22).
This worsened Rebekah's psychosomatic state, expressed in the words: "if
it be so, why am I thus?" (Gen. 25:22). At present, it is customary to
maintain heightened vigilance regarding older primigravidas. This is associated
with frequent complications of late pregnancies, which served as the reason for
establishing a dedicated code in the International Classification of Diseases:
supervision of elderly primigravida (Z35.51).
A
woman with polycystic ovary syndrome has a higher probability of pregnancy
complications, adverse birth outcomes, neonatal complications, and congenital
anomalies (2006BoomsmaCM_MacklonNS; 2018PalombaS_LaSalaGB). At least two
pathological phenomena are described by the writers of the Book of Genesis.
First, the twin Esau is born to Rebekah with genetic abnormalities (Gen.
25:25). The second, Jacob, turns out to be in an atypical position: his hand
appears first from the birth canal (Gen. 25:26). Today, this situation is
designated as the "prolapse of small fetal parts" (hands, feet) and
umbilical cord during the act of labor, occurring in 4–8% of cases (1989СеровВН_МаркинСА). From the biblical narrative, it appears that
after the birth of Esau, the second amniotic sac ruptures prematurely. This,
again, predominantly occurs in polycystic ovary syndrome (2020MannA_SubbaiahM).
In
multiple pregnancies, fetal malpresentation is noted 5 to 10 times more
frequently than in singleton pregnancies (1989СеровВН_МаркинСА). In the verses of our primary source,
reference is made to the presentation of the upper fetal limb, which is
classified as a complex obstetric situation. Such a complication occurs in
approximately 0.1–0.2% of cases and is associated with preterm labor, low birth
weight, and multiple pregnancy (2017PilliodR_CaugheyA). Shoulder presentation
of a hand in premature delivery requires surgical intervention
(2009TarsaM_MooreTR). A clinical observation of a multiple pregnancy outcome is
described: death of the first twin and premature birth of the second with hand
prolapse, necessitating a caesarean section (1997HöniglW_RoseggerH). A high
risk of early onset of labor and operative delivery are characteristic of
patients with polycystic ovary syndrome (2018PalombaS_LaSalaGB).
In
the second stage of labor, a distally displaced upper extremity is inevitably
compressed by the fetal head against the inner walls of the birth canal. This
complication sometimes leads to a fracture of the humeral diaphysis, while
manual assistance frequently causes epiphyseolysis of the proximal humerus
(1994КоржАА_БондаренкоНС). A humeral fracture in a newborn
may be accompanied by radial nerve paralysis (1952Watson-JonesR; 1972Уотсон-ДжонсР). Clavicle fractures occur less frequently,
usually during obstetric intervention (1986ТрубниковВФ). A case of pneumothorax, fracture of the
proximal radius, and multiple subcutaneous hematomas is known during hand
presentation in a newborn (2021CarterE_WrightR). Hand prolapse is often a
prerequisite for damage to the scalene muscles and brachial plexus in the form
of compression, tears, and partial tears, leading to paralyses and deformities
of the upper limbs (2005КорниловНВ_ГрязнухинЭГ).
In
addition to injuries to the shoulder girdle, a malpositioned hand at birth
contributes to head trauma. The head becomes wedged in the space between the
inner surface of the birth canal and the fetal arm, as the transverse dimension
of the emerging body increases. A similar complication is recorded during
shoulder dystocia in spontaneous vaginal births and is complicated by
hypoxic-ischemic encephalopathy (2024RehmaniD_KhanA). In premature hand
prolapse and spontaneous vaginal delivery, one should expect in the head
region: abrasions, subcutaneous hemorrhages, hematomas, cranial vault
fractures, subarachnoid hemorrhages, and brain injuries of the newborn.
In
the Book of Genesis, regarding the birth of Jacob, we read: "and afterward
came his brother out, and his hand took hold on Esau's heel" (Gen. 25:26).
From this, it is clear that the second twin was also delivered vaginally. The
birth took place in a desert area, far from any large settlements with a
functioning healthcare system. Specialized obstetric care could not be provided
to Rebekah. Extremely unfavorable circumstances had developed for both the
laboring mother and the twins. Fortunately, both fetuses were in a cephalic
presentation. The first emerges from the birth canal unimpeded, while the
second, as we suspect, suffers a combined birth injury. His upper limb and head
are damaged, and his chest and lungs might also have been affected. For Rebekah,
injury to the pubic symphysis, soft tissues of the perineum, massive
hemorrhage, and subsequently the development of necrosis of the rectal or
vesical wall with the formation of a vaginal fistula cannot be ruled out. The
status of a primigravida woman would have contributed to this. The mother
survived, but she appears to have developed some chronic condition of the
musculoskeletal or reproductive system. Could this be the reason why Rebekah
had no further offspring?
A
fracture of the humerus with helpless dangling of the arm, possibly combined
with radial nerve damage, is described in Case 36 of the Edwin Smith Papyrus.
In Case 8, the weak spot of a child's skull – the so-called
"fontanelle" – is mentioned, alongside a discussion of the diagnosis
of a closed cranial vault fracture in an adult, symptoms of the trauma, and its
consequences (1930BreastedJH). The creator of the manuscript unequivocally
understood the structural peculiarities of cranial formation in childhood. He
had experience treating traumatic brain injuries. Analyzing this work, medical
scholars wrote: "Here, for the first time, we encounter an understanding
of the structure of the brain, its meninges, its pulsations, and a recognition
of the connection between injuries to the skull and vertebrae, on the one hand,
and paralysis of the limbs, on the other" (1931MeyerhofM). Had the author
of the Edwin Smith Papyrus participated in the composition of the Book of Genesis,
he could have conveyed to the reader the natural-scientific component of
complicated labor in multiple pregnancies. This possibility cannot be entirely
dismissed.
Today,
in cases of arm prolapse during labor, obstetricians advise waiting to see
whether the limb moves aside as the head descends (2009TarsaM_MooreTR). In
instances of persistent compound presentation with prolonged labor, attempts
are made to gently reduce the fetal arm by applying upward pressure from below
(2017PilliodR_CaugheyA). Timely diagnosis of complications and successful
repositioning of the hand aid in completing the delivery without inflicting
severe trauma on the fetus or the mother's perineum (2002VaccaA). In our view,
such a manipulation is implied in the primary source. In the story of the birth
given by Tamar, who was pregnant with twins like Rebekah, we read: "And it
came to pass, when she travailed, that the one put out his hand: and the
midwife took and bound upon his hand a scarlet thread, saying, this came out
first. And it came to pass, as he drew back his hand, that, behold, his brother
came out" (Gen. 38:28–29). Below, negative consequences for the mother and
children are not mentioned. From this, it is reasonable to conclude that the
midwife was well informed regarding possible complications for both mother and
fetus. She gently repositioned the prolapsed upper limb or, inducing benign
pain by pinching the arm between contractions, facilitated the withdrawal of
the limb (2021CarterE_WrightR). Naturally, the writer does not elaborate on
these purely medical maneuvers, as the work is, after all, a literary
narrative.
By
tying the scarlet thread, the biblical midwife likely pushed the hand upward
gently and then applied external pressure on the uterine fundus. The
repositioned upper limb cleared the birth canal, into which the head of the
next twin rushed (Gen. 38:30). This effective maneuver is preceded by the sly
words: "How have you broken through?" (Gen. 38:29). Behind this, one
discerns the composure and good nature of an exceptionally skilled Bronze Age
midwife. Accompanying her work with phrases meant only for her assistants and
the laboring woman, the healthcare worker distracts their attention, masks the
tragic nature of the situation, and, preventing panic, applies the required
manual technique. Tying the scarlet thread marked the arm that was potentially
injured during repositioning. This allowed for immediate post-birth immobilization
of the affected limb in anticipation of a bone fracture.
Ancient
Egyptian midwives, in addition to manual assistance, acted upon patients
verbally. As evident from Papyrus Ramesseum IV, written during the Middle
Kingdom, the midwife is recommended to recite an incantation over the laboring
woman (Science in Ancient Egypt, sae.saw-leipzig.de). A special verbal formula for a
woman giving birth to twins is contained in Berlin Papyrus 3027, composed at
the beginning of the New Kingdom (1901ErmanA; Science in Ancient Egypt, sae.saw-leipzig.de). In the Egyptian tale told to
Pharaoh Khufu, midwives speak to the unborn child, bestow a name, and proclaim
the future (1978КоростовцевМА).
A
similar action is discernible in the biblical verses. Particularly revealing is
the aforementioned exclamation: "How have you broken through?" (Gen.
38:29). An Ancient Egyptian legend, recounted in the 1st–2nd centuries by
Plutarch, is implied here. The historian sets forth the circumstances of the
birth of the god Set: "On the third day Typhon [Set] was born, but not at
the proper time or in the proper manner: he burst forth through his mother's
side, striking through it" (1996Плутарх). These beliefs have their origins in the
Pyramid Texts, dated to 2350–2175 BCE, which state: "Thou whom the
pregnant brought forth, as thou didst cleave the night, thou art equipped like
Set, who mightily broke forth" (1952MercerSAB). Set, emerging earlier than
expected, was described "in the form of a man with a beast's snout, with
eyes as red as glowing desert sand, and a similarly red mane" (2007РакИ). Over time, Set was made into
"a representative of any evil ('all red things'), a true Satan, whose name
was best left unpronounced" (2021МюллерМ). Therefore, the Old Testament midwife does
not say: "You broke through like Set". Hinting at him, the clearly
Egyptian physician ties specifically a scarlet thread onto the prolapsed hand
of the unknown twin (Gen. 38:28, 30). This creates the impression of obstetric
assistance provided with the participation of a resolute, resourceful, and
highly qualified professional with the training of an obstetrician
knowledgeable in the myths of the Nile Valley.
Among
the ancient Egyptians, the goddess Meskhenet, patroness of women in labor and
helper of midwives, was associated with pregnancy and childbirth. There also
existed the cult of the goddess Heqet, who assisted in childbirth, and the
women supporting laboring mothers were termed "servants of Heqet"
(2016ДжарманОА_МикиртичанГЛ). Today, the majority of
obstetricians and gynecologists are women. From Egypt's past, there is evidence
of female physicians (1996WillersonJT_TeaffR). On the wall of the tomb of a
5th–6th Dynasty courtier, Peseshet, overseer of female healers, is mentioned
(2020KwiecinskiJM). In our primary source, the creators reflected both the
tragedy of the obstetrician-gynecologist's profession and admiration for a
colleague. The Book of Genesis preserved the image of an unknown Middle Bronze
Age healthcare worker: literate, resourceful, careful, and smiling. We had
occasion to encounter a similar specialist, neonatologist Alexandra Borisenko,
in video clips on the Instagram social network. Apparently, one of the authors
personally knew the prototype of the biblical midwife. One would like to
believe that this was Assenath, the wife of Joseph (Gen. 41:45, 50, 46:20).
In some manner, it was "established" that Rebekah was carrying twins (Gen. 25:23). The impression is formed that the midwife assisting in Tamar's delivery was also aware of the multiple pregnancy (Gen. 38:29). The diagnosis might have been based on external signs – a large abdomen – or the result of auscultating two heartbeats. In this way, the specialist was able to mentally prepare for potential complications. Regarding Rebekah, this did not occur; the authors merely point to the presence of a diviner (Gen. 25:22–23). The woman gave birth without medical support, which could have affected both her condition and the health of the newborns. Home twin deliveries recorded in Nigeria were accompanied by perinatal mortality in nearly 1/3 of cases (2000AisienAO_ImadeGE). The prototype of Jacob survived; he was unbelievably fortunate.
Pregnancy
with two or more fetuses is a rare situation in obstetrics, bringing with it an
entire complex of problems for both the mother and the twins. Between 1980 and
2009 in the United States, twins accounted for 2–4% of all births and emerged
prematurely in 60% of cases (2012AnanthCV_ChauhanSP). In 2007 in the United
Kingdom, multiple pregnancies accounted for 1.6% of all births, characterized
by high mortality, an increased risk of prematurity, intrauterine growth
restriction, as well as other complications, specifically cerebral palsy
(2018KilbyMD_OepkesD). According to data by A.I. Dubovik (1972), among term
twins, a lag in physical development was noted in 13.1% of cases, and in mental
maturation – in 10.9% of observations (1989СеровВН_МаркинСА). A study conducted in Beijing showed that
multiple pregnancy is significantly associated with older maternal age, caesarean
section, preterm birth, gestational diabetes, hypertensive disorders,
intrauterine growth restriction, low birth weight, and neonatal admission to
the intensive care unit (2015SuRN_YangHX).
Among
twin pregnancies, there is an increased incidence of preterm birth with the
following neonatal outcomes: death, respiratory distress syndrome, early-onset
sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, pneumonia, and
seizures (2010RefuerzoJS_HarperM). The most common cause of seizures in
newborns is hypoxic-ischemic encephalopathy (2019AcarDB_UsluSC;
2020HaqueS_QuaderMMU). In twin births, low birth weight, intrauterine growth
restriction, and more frequent neonatal complications are observed in
comparison with singleton pregnancies, with the condition of the second child
being worse than that of the firstborn (2021Esteves-PereiraAP_daGamaS). The
second twin has a fourfold higher risk of death caused by oxygen deprivation
during labor (2007SmithGC_WhiteIR).
The
biblical pregnancy under discussion concluded with a spontaneous vaginal
delivery. As a result, two male infants were born: Esau and Jacob (Gen.
25:25–26). In connection with this, Jacob is called the younger of the twins
(1982ОренИ_ЗандМ). It must be assumed that he was
exposed to more adverse factors at birth than his brother. On the positive
side, he exhibited no signs of any genetic abnormality.
In
the postnatal period, twins experience a higher rate of hospitalization across
all disease groups compared to children from singleton pregnancies (2023WainstockT_SheinerE).
In addition to an increased risk of mortality, children born from multiple
pregnancies exhibit a higher incidence of cerebral palsy, intellectual
disability, as well as delays in speech development, cognitive development,
motor skills, behavioral issues, and difficulties in parent-child interaction
(2006SutcliffeAG_DeromC).
By
examining Rebekah's obstetric history, we obtain prognostic information
regarding the children's health status. It is clear that the first twin, Esau,
was born with the congenital anomaly hypertrichosis. The second – Jacob, under
the preferred scenario, entered life with skeletal and traumatic brain
injuries, and was subjected to oxygen deprivation at the moment of birth. These
pathologies undoubtedly affected his subsequent life.
At
the same time, the nurse/wet nurse Deborah, who accompanied Rebekah to Canaan
from Mesopotamia, assisted in caring for the twins (Gen. 24:59, 35:8). In the
Pyramid Texts, dated to 2350–2175 BCE, wet nurses of gods and pharaohs are mentioned
(1952MercerSAB). Women of this specialization were present in the royal
families of Mari, as evidenced by Usur-awassu's letter to his lord Yasmah-Addu
(1988CharpinD_LafontB). Assistance to the laboring woman by the wet nurse
apparently ensured the survival of Jacob, who had been traumatized during
birth.
The
Book of Genesis does not dwell on the childhood period of Esau and Jacob. It
merely states: "And the boys grew: and Esau was a cunning hunter, a man of
the field; and Jacob was a quiet man, dwelling in tents" (Gen. 25:27). Jacob
is defined by an eloquent epithet: "quiet" / "gentle". The
concept denotes: "quiet, modest, humble, loving, lenient; not
hot-tempered, quick to anger, long-suffering" (1881ДальВИ). In his meekness, diligence,
eloquence, and restraint, Jacob resembles the attractive figure of the shepherd
Batu from the tale of "The Two Brothers," close and understandable to
the ancient Egyptians (1917ВикентьевВМ). Even greater similarities exist between Jacob and Osiris. According
to the legend recounted by Plutarch, Osiris was a untiring worker who charmed
people with his good nature, persuasive speech, singing, and music, being
transformed from good spirits into a god (1996Плутарх). Osiris became the deity most beloved and
revered by the Egyptians (2004РакИВ). Like him, his mother's beloved son, Jacob was distinguished by
softness and obedience (Gen. 25:28, 27:6–14, 43–45). In our opinion, his
prototype suffered a birth injury to the shoulder girdle and head. For this
reason, he exhibited differences in the dynamics of growing up compared to his
brother. Esau seems to have engaged in hunting from childhood, whereas Jacob
remained under the control of adults in the camp (Gen. 25:27). A child
traumatized at birth was assigned manageable tasks, such as cooking food (Gen.
25:29).
From
the narrative, Jacob emerges, figuratively speaking, as a "homebody".
A defect of the musculoskeletal system and possibly a brachial plexus
neuropathy did not allow him to become a successful hunter. A calm disposition,
brain injury during birth, and residual disability accounted for his mother's
pity and overprotectiveness. It is difficult for us to add anything further
with greater certainty. It appears that the medical writer had repeatedly
observed such patients. He knew that despite a traumatic brain injury at birth,
individuals could attain a high level of intellectual development. Motor
impairment is often compensated for, and mental activity is trained through
diligence, multiple repetitions, and positive reinforcement from parents.
Setting out from Be'er-Sheba, Jacob erects a pillar from a rock fragment (Gen. 28:11, 18). In Harran, he managed to roll away "the stone from the well's mouth" without outside help (Gen. 29:10). Upon returning to his homeland, Jacob "took" and set up a stone "for a pillar" (Gen. 31:45). To perform these actions required considerable muscle strength, good coordination, and functional integrity of all limbs. He clearly and persuasively proves his righteousness to Laban (Gen. 31:36–42). His colorful speech is recorded in his prayer on the eve of his meeting with Esau (Gen. 32:10–13). Virtually in poetic verse, Jacob foretells the future of his sons (Gen. 49:2–30). It is evident that our patient possessed highly developed cognitive abilities: memory, attention, thinking, speech, and learnability.
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 7. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-7.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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