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 9
Epidemiological and Sanitary-Hygienic HISTORY
In
general, Jacob's epidemiological history should be characterized as
"unremarkable". No mass infection or deaths are described in his
immediate environment. Our attention was drawn only to the account of the
consecutive deaths of two young men. First, Jacob's grandson Er, the firstborn
son of Judah, died (Gen. 38:6–7). Shortly thereafter, the younger brother of
the deceased, Onan, passed away (Gen. 38:8, 10). No symptoms of disease are
indicated for the deceased, nor is there any information regarding trauma,
prolonged incapacity, or disability. What they had in common was premature
death at a young age, belonging to the same tribal group, and marital relations
with the same woman, Tamar. No deterioration of her health is reported.
The
death of a man who has not reached middle age from an acute surgical pathology
is plausible, but the development of such a condition consecutively in two
individuals is unlikely. Rather, a certain infectious disease transmitted from
person to person arose in the family. The close genotype of the deceased
suggests a similar immune system that failed to withstand an identical
pathogenic agent. Unlike her husbands, Tamar's protective mechanisms coped with
the infection. We do not rule out that the pathogen circulated in Judah's camp.
After many days had passed, his wife also died (Gen. 38:12). These events did
not affect Jacob, as his family resided in a different location (Gen. 38:1).
In
the Book of Genesis, untimely death is rarely mentioned. One such case is the
death of Haran, the brother of Abraham, in Ur of the Chaldees (Gen. 11:28). The
man dies at a young or middle age after the "birth" of his son Lot
(Gen. 11:27). Haran's wife apparently died as well. Her name remains unknown,
as does her fate. The assumption of the young parents’ death is based on the
fact that Lot is subsequently cared for by his grandfather Terсah, who takes him to Haran (Gen.
11:31). After Teraсh
dies, Abraham takes his nephew "under his wing" (Gen. 12:4). Lot's
mother, again, does not figure among the migrants from Ur of the Chaldees. Nor
is she among the companions of Abraham who set out "into the land of
Canaan" (Gen. 12:5). Accordingly, it is reasonable to assume an identical
contagious pathology and a fatal outcome for Lot's parents.
Infectious
diseases were reliably present in Mesopotamia. A patient apparently affected by
typhoid fever was depicted in the Epic of Gilgamesh. In the seventh tablet, we
find: "Disease entered Enkidu's entrails; he lay alone on the couch of
night..." Further in the verses follows a description of the visual
hallucinations of the dying patient. In the eleventh tablet, a certain epidemic
is mentioned: "Would that the plague-god [Erra] had risen up and smitten
mankind!" (1961ДьяконовИМ).
Evidence
of mass diseases has been reflected in cuneiform tablets from the Mari
archives. Yasim-El informs Shunuhra-Halu by letter (ARM 26/2 403-bis) of the
progression of his serious illness and the death of two servants. The same is
written in a letter (ARM 26/2 403) addressed to the king (1988CharpinD_LafontB).
In a letter (ARM 26/1 185) from Shibtu to King Zimri-Lim, several sick servants
are mentioned. In a letter (ARM 26/1 261), Ikshud-appasu reports an illness
with weakness and fever, as well as the spread of an epidemic in the cities of
Zapat and Zurubban. The sender of a letter (ARM 26/1 274) informs the king of
the death of a mutual acquaintance and the provision of two large barges to
transport numerous sick soldiers of the Babylonian army. A letter (ARM 26/1
260) announces the end of the "Hand of God" epidemic that raged along
the banks of the Euphrates and throughout "the whole land," during
which "ten men and five children" died daily. In another letter (ARM
26/1 263) addressed to Yasmah-Addu, the end of the epidemic and the burial of
many deceased are mentioned. Apparently, information regarding the cessation of
this outbreak of a contagious disease is contained in letter ARM 26/1 265,
noting the death of a large number of servants and farmers (1988DurandJ-M). At
least three cuneiform tablets (kt. 90/K174, kt. n/k 1339, kt. 88/k 507/b22)
from the mid-2nd millennium BCE report an epidemic in the Anatolian trading
centres of Kanesh and Burushattum (1995ÇeçenS). Densely populated urban centres
were exposed to numerous diseases that were endemic to the Near East and
Eastern Mediterranean at that time (2026ArnottR).
Epidemic
diseases were known in Ancient Egypt, but could not be differentiated due to
the insufficient development of medicine. In the Tale of Sinuhe, the ruler of
Upper Retenu (Syria) mentions the goddess Sekhmet and a "year of
pestilence" (1979ЛившицИГ_РубинштейнРИ).
In another rendition of the story, it is stated that the lands trembled as
"before the war goddess Sekhmet in the year of the black pestilence"
(1956КацнельсонИС_МендельсонФЛ). The goddess Sekhmet was
associated by the Egyptians with violence and disease (2007AllenJP). It was
believed that Sekhmet struck evildoers and spread plague. The goddess was
depicted as a woman with the head of a lioness, and her clergy consisted of
physicians and magicians (2002BunsonMR).
The
image of Sekhmet is present in the Pyramid Texts "his heart belongs to
Sekhmet, the great"; "N. was conceived by Sekhmet, it is Šsmt.t who
gave birth to N." (1952MercerSAB). B. Turaev (1916) discovered a mention
of a priest of the goddess Sekhmet named Ranseneb in a papyrus of the 12th
Dynasty (2001КоростовцевМА). In the Edwin Smith Papyrus, there are spells against epidemics
mentioning Sekhmet, along with references to fever (1930BreastedJH). In the
tomb of the Ramesseum papyri (Middle Kingdom), belonging perhaps to a priest,
magician, or physician, a statuette of a goddess resembling Sekhmet was found
(2020MiniaciG). In our view, the statuette from the Ramesseum tomb is rather
the goddess Beset (Besit), as is evident from the images published by Egyptologists
(2004РакИВ; 2021МюллерМ). Beset was the patroness of
pregnancy and children. She was often identified with Isis, the supreme mother
goddess (1999DeliaDiana).
Signs
of epidemics are reflected in Egyptian literary works. In an episode of the
Tale of the Eloquent Peasant, there are words implying the author's knowledge
of contagious diseases: "For you surpass even the Lady of Pestilence"
(1979ЛившицИГ_РубинштейнРИ). In the Admonitions of Ipuwer
(Ipu-ser), we find: "plague is throughout the land, blood is everywhere...
death... no one buries the dead. Indeed, many dead are buried in the
river" (1978КоростовцевМА). This work is attributed to the late Middle Kingdom (2006LichtheimM).
The specified period is usually associated with the end of the 12th Dynasty to
the end of the reign of the 13th Dynasty Pharaohs, or approximately 1800 to
1640 BCE (2002BunsonMR). In another rendition of the prophecy of the "sage
Ipuwer," we read: "Pestilence throughout the land. Blood everywhere.
Death on all sides... the bodies of many are now thrown into the river"
(1958КацнельсонИС_МендельсонФЛ). There is another translation of
this passage: "Plague rages throughout the land," the dead are
everywhere (1909GardinerAH). In antiquity, "plague" was a general
term for any widespread epidemic (2003HolmesC). The events depicted in the
Admonition of Ipuwer find archaeological parallels. In the region of the site
of Tell el-Daba (Avaris), signs of partial abandonment and emergency burials
dating to the period of 1740–1710 BCE (13th Dynasty) have been discovered,
testifying that an epidemic swept through the city (1996BietakM). The absence
of a significant number of mass graves in Egypt can be explained by emergency
burial in the river, as stated in the Admonitions of Ipuwer.
From
the chronicles of Egyptian dynasties, it is known that around 1733 BCE Pharaoh
Sahathor died, and in 1731 BCE Neferhotep I passed away. Earlier, in 1732 BCE,
the throne was inherited by his brother Sobekhotep IV. Moreover, Sahathor was
listed as pharaoh for only a few months and apparently died while co-ruling
simultaneously with his brother Neferhotep I (1997RyholtKS_Bülow-JacobsenA). It
is assumed that the little-known king of the 13th Dynasty, Sahathor, was the
successor of his brother Neferhotep I, with whom he may have had a brief
coregency (2002BunsonMR). Based on the analysis of meager evidence, it has been
proven that before Sobekhotep IV, Neferhotep I briefly shared the throne with
Sahathor (1981HabachiL). There is an opinion that this pharaoh, while serving
as coregent, passed away due to an untimely death less than a year later,
though one cannot rule out that the three brothers simply ruled sequentially
(2016NealeH).
Sahathor
ruled briefly between his two blood brothers, as confirmed by the Turin King
List and available archaeological evidence (2020WegnerJ). Neferhotep I sat on
the throne for approximately eleven years (ca. 1742–1731 BCE), while Sobekhotep
IV ruled for no more than twelve years (ca. 1732–1720 BCE) following the
premature death of his brother Sahathor (2015WegnerJ_CahailK).
From
our perspective, the cause of death of Sahathor and Neferhotep I was an
epidemic of an especially dangerous disease. Tentatively dating to this period
are the aforementioned mass burials at Avaris, some of which consisted of pits
containing the bodies of the deceased (1996BietakM). A real epidemic is capable
of striking not only the pharaoh, but also his courtiers. Is this not the very calamity
reflected in the Admonitions of Ipuwer, where the author writes: "butlers
[cupbearers] are destroyed" (1978КоростовцевМА)? The author could have retold a familiar plot
or copied it rather than observing the epidemic itself. In Ancient Egyptian
literature of that era, imitation and borrowing played a huge role (2001КоростовцевМА).
According
to our hypothesis, the creators of the Book of Genesis intentionally linked
Abraham's visit to Egypt with an epidemic during the 13th Dynasty. One of the
goals was to establish a benchmark in the dating of the epic; another was to
add realism. Whether the prototype of Abraham ever visited the banks of the
Nile remains uncertain. It seems highly improbable that an Asiatic shepherd
would be granted an audience with the king (Gen. 12:18–20). The transformation
of Sarah from the wife of a nomad into a spouse of the ruler is likewise
doubtful (Gen. 12:15, 19–20). According to the co-authors’ design, Abraham
arrives in Egypt around 1733 BCE. During Sarah's stay in the royal quarters,
"the Lord afflicted Pharaoh [Par’o] and his house with great plagues"
(Gen. 12:17). From the text, it is clear: the king and his courtiers fall ill,
and the disease manifested visually with large skin ulcerations. The enraged
pharaoh summons Abraham and demands an answer: "What is this you have done
to me?" (Gen. 12:18). The outbreak of a contagious disease is directly
linked to the arrival of Asiatic foreigners. It appears that the ruler's
indignation was caused by an epidemic with fatal outcomes and fear for his own
life; otherwise, a mild illness among his subjects would have gone unnoticed by
him.
Analyzing
the text of our primary source, it is impossible to establish the fate of the
afflicted pharaoh. It is unclear what his name was: perhaps Sahathor or
Neferhotep I. The causes of death of these 13th Dynasty rulers could be
revealed by their mummies, which have not yet been identified. In Abydos,
fragments of the tombs of Neferhotep I and Sobekhotep IV have been excavated,
robbed, and completely destroyed during the Second Intermediate Period
(2015WegnerJ_CahailK). This discovery confirms that finding the mummified
bodies of these rulers is out of the question. In the immediate vicinity of the
tombs of Neferhotep I and Sobekhotep IV, an abandoned royal burial chamber was
found, which was apparently constructed for Sahathor but was not used for its
intended purpose. For unknown reasons, the construction of this pharaoh's tomb
was halted at an early stage, and he was evidently buried elsewhere (2020WegnerJ).
This inspires hope for an accidental discovery, in a hastily prepared tomb, of
Sahathor's mummy showing signs of anthrax lesions. In its contents and
furnishings, his burial chamber should resemble the tomb of Tutankhamun, which
was constructed on an emergency basis.
Abraham
possessed "flocks and herds," donkeys, and camels (Gen. 12:16).
Naturally, the animals occasionally fell ill. An infectious disease of cattle,
accompanied by elevated temperature and "clouded" eyes, is described
in the Kahun Veterinary Papyrus, composed during the 12th Dynasty
(1898GriffithFL; 2016LordC). Taking into account the mention of large ulcers in
our primary source, anthrax – transmitted from livestock to humans – should be
recognized as the most probable pathology. The cutaneous form of this disease
develops upon contact of a wounded surface with infected livestock products or
through the bite of a vector insect (2008WHO). Bacillus anthracis can be
transported by blood-sucking insects over distances of up to 4 km (2013FasanellaA_AdoneR).
There is no doubt that Sarah came into contact with livestock and their
processed products. The potential wife of the pharaoh, or her personal item
contaminated with the pathogen, could have unintentionally acted as a vector
for the anthropozoonotic disease in the palace. This is precisely what a writer
with a medical background hints at. Pastoralists in the ancient world faced a
high probability of contracting zoonotic diseases due to their extremely close
proximity to domestic animals (2026ArnottR).
Lacking
proof and unaware of pathogenic microorganisms, the materialist physician
devised a divine "punishment" (Gen. 12:17). Such an explanation
satisfactorily fitted the level of knowledge in the Middle Bronze Age regarding
the causes of mass afflictions in humans and livestock. According to our
calculations, at the time of her arrival in Egypt, Sarah had passed 22 years of
age. In the Bronze Age, life expectancy averaged 34.7 years (2012GabrielRA).
Thus, Sarah had lived two-thirds of her expected lifespan. For comparison: with
an average age of the deceased in our time of 75 years, two-thirds constitutes
half a century. According to the text, Sarah's age was over 65 years, as she
was a decade younger than her husband (Gen. 12:4, 17:17). It is appropriate to
cite once again the words from the letter of Ramesses II to the Hittite king
Hattusili III, written in the 13th century BCE: for a sixty-year-old woman, one
cannot prepare a medicine so that she may become pregnant (1976EdelE). The selection
of an elderly woman as a spouse for the pharaoh serves as compelling evidence
of the legendary character of the narrative as a whole and of the story of the
biblical epidemic.
Outbreaks
of anthrax occur predominantly after wet spring months followed by a very hot
and dry summer, or directly under severe drought conditions (2019LewisR). In
our primary source, we find: "And there was a famine in the land. And
Abram went down into Egypt to dwell there, for the famine was severe in the
land" (Gen. 12:10). The preferred cause of "famine" in a
pastoral community is the underfeeding of livestock due to a prolonged dry
period. Observant Ancient Egyptian doctors apparently associated certain
epidemics with this climate transformation. In favor of this speaks the written
evidence on the verso of the Edwin Smith Papyrus, where several spells against
the "yearly plague" are inscribed (1930BreastedJH).
There
are reasonable doubts as to whether the epidemic that began in Egypt under
Abraham was anthrax. We have at our disposal only a Hebrew translation of the
original literary text. In the Hebrew version, the manifestation of the disease
in Pharaoh's palace is designated by the term nega’im (נְגָעִים) (Gen. 12:17; 1922LeeserI; sefaria.org). The word nega is understood today
as: "stroke, plague/pestilence, mark/impression, ulcerated spot"
(1907Brown_BriggsCA). To characterize the lesion in the Old Testament text, the
term nega’im gedolim (נְגָעִים גְּדֹלִים) is applied (Gen. 12:17;
1922LeeserI; sefaria.org). Here gedolim is the plural of the
adjective gadol (גָּדוֹל),
meaning "great" or "large" in size (1907Brown_BriggsCA). In
the Ancient Egyptian language, there was a hieroglyph aat-t, which translates
as "ulcer, disease, epidemic" (1920BudgeEA). In the verse concerning
the illness in the Egyptian king's quarters, the Hebrew text employs the term
Par’o (פַּרְעֹה) (Gen.
12:17; 1922LeeserI; sefaria.org). This term is of Egyptian origin,
denoting "great house". Initially, it referred to Pharaoh's residence
and the royal administration. Under the 12th Dynasty, the concept became
associated with the three wishes following the royal name (life, prosperity,
health), and in the New Kingdom, it began to be used as a title for the king
himself (2021NoonanBJ). Thus, our story of the epidemic features an ancient,
intrinsically Egyptian concept used prior to 1550 BCE. The Ancient Egyptian
aat-t and the Hebrew "נְגָעִ֥ים" (nega’im) are concepts close in meaning, equivalent to the modern
terms "ulcerative skin defect" or "wound-ulcer".
Translators could have used the Hebrew word to denote a type of infectious skin
lesion. Taking into account the ancient meaning of the term "ַפְרעֹה" (Par’o = administration,
palace) and "גָּדוֹל"
(gadol = large), the meaning of the verse regarding the epidemic may be
translated as the appearance of "large ulcers on the skin of the
courtiers". In this way, they differed from small and solitary skin
defects in other infections such as smallpox, mycosis, or leishmaniasis.
In
the cutaneous form of anthrax, red spots first appear, followed by pustules,
and ultimately painless ulcers covered with a black eschar and surrounded by
tissue edema (2002ЛобзинЮВ_ЗахаренкоСМ).
Anthrax crusts measure 1–5 cm and are surrounded by significant edema
(1999McGovernTW_EitzenEM). In Case 45 of the Edwin Smith Papyrus, similar local
non-inflammatory swellings or ulcers on the chest, termed bn-wt, are discussed.
The physician notes the absence of pain, fluid contents inside, the discharge
of a certain liquid, and upon palpation draws attention to the coolness of the
tissues. In the scribe's commentary, it is added that the affected areas of the
skin are hard, large, and widespread (1930BreastedJH). From the text, it is
clear that the "ulcers" or "swellings" were observed by the
original author of the manuscript and were also seen firsthand by the scribe
who composed the gloss. Neither the doctor nor the scribe discusses the
etiology of the skin disease, being unaware of or not understanding it. R. Hannig
(1997) translates bnwt as "(gangrenous) ulcer (probably edema),"
pointing out that bnw can mean "disease" and "swelling of an
ulcer". In Case 39 of the Edwin Smith Papyrus, an ulcer or swelling
(bn-wt) with inflammation is mentioned, arising after a blow to the chest wall
(1930BreastedJH). Here, unlike Case 45, the discussion concerns a long-standing
purulent post-traumatic wound rather than multiple defects that feel cool upon
palpation.
The
Edwin Smith Papyrus was written during the 16th–17th Dynasties, more
specifically around 1600 BCE (2005AllenJP). At the turn of the 17th–16th
centuries BCE in Egypt, both physicians and scribes apparently had an
understanding of anthrax epidemics. This knowledge was not exclusive to the
inhabitants of the Nile Valley. In the Mari archive, a letter (ARM 26/1 278)
was discovered in which Yaqqim-Addu addresses King Zimri-Lim regarding a
recurrence of anthrax in an elite woman and requests that a physician be sent
(1988DurandJ-M). The Mesopotamian collection of tablets from the city-state of
Mari dates to the first half of the 18th century BCE (1956Munn-RankinJM).
Later
evidence from ancient literature concerning an outbreak of a disease resembling
anthrax is also known. From our perspective, a description of such an epidemic
is present in the Book of Exodus (Shemot), which recounts events of the
Ramesside period (ca. 1295–1069 BCE). We are not alone in this view. Other
researchers likewise believe that the biblical story of the Exodus reflects the
clinical picture of anthrax affecting domestic animals and Egyptians
(2002WitkowskiJA_ParishLC). In the ninth chapter, we read: "Behold, the
hand of the Lord is upon thy cattle which is in the field, upon the horses, upon the asses, upon the camels, upon the
oxen, and upon the sheep: there shall be a very grievous murrain. And the Lord
shall sever between the cattle of Israel and the cattle of Egypt: and there shall nothing die of all that is the
children's of Israel. And the Lord appointed a set time, saying, Tomorrow the
Lord shall do this thing in the land. And the Lord did that thing on the morrow, and all the cattle of Egypt died: but
of the cattle of the children of Israel died not one. And Pharaoh sent, and, behold, there was not one of the cattle of the
Israelites dead. And the heart of Pharaoh was hardened, and he did not let the
people go. And the Lord said unto Moses and unto Aaron, Take to you handfuls of ashes of the furnace, and let Moses
sprinkle it toward the heaven in the sight of Pharaoh. And it shall become
small dust in all the land of Egypt, and shall
be a boil breaking forth with blains upon man, and upon beast, throughout all
the land of Egypt. And they took ashes of the furnace, and stood before
Pharaoh; and Moses sprinkled it up toward heaven; and it became a boil breaking
forth with blains upon man, and upon beast. And the magicians could not stand
before Moses because of the boils; for the boil was upon the magicians,
and upon all the Egyptians" (Exod. 9:3–11). Prior to the development of
the livestock disease, a plague of "lice" is mentioned, which
appeared "upon man, and upon beast," while "all the dust of the
land became lice throughout all the land of Egypt" (Exod. 8:17).
Subsequently, the deity sent arov (a mass of wild beasts or insects), and
"the houses of the Egyptians" were filled with them (Exod. 8:21).
Analyzing this from a scientific standpoint, the appearance of biting midges of
the genus Culicoides and stable flies (Stomoxys calcitrans) vectoring diseases
is assumed (1996MarrJS_MalloyCD). The concept arov is a translation from Hebrew
of the unclear term ‘arov (עָרֹב), likely meaning a swarm or infestation of biting flies
(1907Brown_BriggsCA). A pragmatic evaluation of the Old Testament legend has
led to the suggestion that the primary cause of the disaster was anomalous
warming, which initiated a series of catastrophes, specifically arthropod-borne
and arthropod-induced diseases (2008EhrenkranzNJ_SampsonDA). It seems that the
ulcers on the body of Pharaoh and his courtiers appeared after the onset of drought,
which caused the famine in Canaan (Gen. 12:10, 17). It is difficult to
establish a definitive diagnosis based on the narrative in Exodus (Shemot) in
the absence of a precise description of symptoms. Four possible diseases can be
envisioned: rinderpest, foot-and-mouth disease, Rift Valley fever, and anthrax
– the latter due to its endemic nature, the species of animals affected, and
the grave prognosis (2005HaliouaB_ZiskindB).
Diseases
similar to anthrax became established in the Fertile Crescent in connection
with the concentration of susceptible domestic animals and the persistence of
pathogens in the soil for decades or even centuries, periodically reactivating
in new populations of livestock and humans (2010JonesSD). Besides cattle,
sheep, and horses, the soil serves as a natural reservoir for the anthrax
bacillus (1999McGovernTW_EitzenEM). As will be recalled, Abraham possessed
"flocks [sheep, goats], and herds [cows], and asses... and she asses, and
camels" (Gen. 12:16, 21:28–30, 24:35). Transmission of cutaneous anthrax
can occur through direct contact, non-biting flies (including houseflies), and
biting flies, among which horseflies are the most significant
(1980McKendrickDRA). Bacillus anthracis spores are easily transmitted through
air, water, and soil (2025SangwanN_SinghY). The bacillus spores can persist in
the soil for years, retaining their viability and pathogenic properties (2002ЛобзинЮВ_ЗахаренкоСМ). Anthrax most frequently affects herbivores
infected while grazing on contaminated soil, and can be transmitted to humans
through contact with infected animals, consumption of their meat, inhalation of
spores from wool or hides, or entry through the skin (2020MavesRC_BerjohnCM).
The cited information finds parallels in the biblical text, allowing naturally
for the legendary nature of the narrative. Notably, the Edwin Smith Papyrus
contains a spell for cleansing from a flying insect (1930BreastedJH). The
creator of the spell discerned a connection between an insect entering the body
and subsequent illness.
Another
early description of the cutaneous form of anthrax is found in Homer's Iliad
(ca. 8th century BCE). The first book recounts the initial pathology in
animals, followed by that in humans: "Phoebus Apollo, enraged at the king,
sent a foul plague upon the host, and the people perished... First he attacked
the mules and swift dogs, but then he let fly his deadly shaft at the men
themselves; and the funeral pyres of the dead burned unceasingly. For nine days
the god's arrows flew through the army... Does the god demand that we deliver
the Achaeans from this disastrous plague? Thus having spoken, Achilles sat
down" (1960Гомер).
The
poetic events of the Iliad unfold in the lands of Anatolia at the beginning of
the 1st millennium BCE. The verses of the Book of Exodus recount the migration
of a Semitic tribe at the end of the 2nd millennium BCE from the Nile Delta to
the south of the Levant. The legend of the Book of Genesis describes an
epidemic in Egypt at the end of the 18th century BCE. The aforementioned letter
from the Mari archive mentions a case of anthrax in Mesopotamia in the early
18th century BCE. These regions possessed close ties in the Middle Bronze Age.
Facts proving the migration of tribes across the lands of the Fertile Crescent are available from archaeological, written, and iconographic sources. Genes of the inhabitants of the Tigris and Euphrates interfluve were discovered in the remains of an Egyptian potter who lived in 2855–2570 BCE (2025MorezJacobsA_Girdland-FlinkL). In the Story of Sinuhe, which recounts events from the end of the reign of Amenemhat I (2000–1980 BCE), the main protagonist flees Egypt to "Retenu," to lands encompassing the region of northern Palestine and Syria (1956КацнельсонИС). A procession of "Asiatics" who arrived in Egypt is depicted on a fresco in the tomb of the official Khnumhotep II, constructed in 1897–1878 BCE (2009KamrinJ). In Phoenician Byblos, around 1800 BCE, a case of a Lycian from Anatolia residing there was recorded (1966KitchenKA). Along with the movement of people and livestock, anthropozoonotic diseases also spread. Therefore, we have no doubt that literary works of the 2nd and 1st millennia BCE reflected real epidemics. At the same time, it is difficult to perform an exact retrospective verification of the diseases that gave rise to the plots of these oldest verses based on the writings of non-medical authors.
[ii]
Following
the conversation with Pharaoh, the story recounts the expulsion of Abraham from
Egypt and his reverse migration to the south of the Levant (Gen. 12:20, 13:1,
3). If a carrier of the pathogen was present in the patriarch's family or
livestock, it was returned to Canaan, where a focus of infection spread
emerged. During Jacob's lifetime, no major epidemic is described, but it is not
ruled out that anthrax circulating in the southern Levant caused the death of
Judah's wife and his sons: Er and Onan (Gen. 38:6–8, 10, 12). The inhabitants
of Canaan were aware of outbreaks of this infection. Direct observation of sick
animals and humans made it possible to realistically describe an epidemic of
anthrax in the Book of Exodus (Shemot) (Exod. 9:3–11).
Drawing
on our own medical experience, it seems to us that the expulsion of Abraham was
a sanitary and anti-epidemic measure. In the Book of Genesis, it is said:
"And Pharaoh commanded his men concerning him: and they sent him away, and
his wife, and all that he had. And Abram went up out of Egypt" (Gen.
12:20, 13:1). From the text, we see that the command is issued by the afflicted
pharaoh himself, as we read earlier: "And the Lord plagued Pharaoh and his
house with great plagues" (Gen. 12:17). It is thought that the authors
implied King Sahathor or Neferhotep I. The latter proved to be an inquisitive
ruler who visited libraries, and in the second year of his reign instructed his
nobles to conduct a "great search" in order to learn "how he was
created, how the gods came to be" (2018ВейгаллА).
At
the beginning of Neferhotep I's reign, Senebsumai, the high steward of the
preceding pharaoh Sobekhotep III, was promoted to the position of treasurer
(2019StefanovićD). Among the titles of the latter were listed: "king's
acquaintance," chamberlain of the inner palace, nobleman, governor, royal
seal-bearer, overseer of seal-bearers, and follower of the king (1984FrankeD).
Perhaps the title "overseer of the king's followers" was conferred as
a sign of close relations with the royal family. In favor of this speaks also
the title "king's acquaintance". The version is supported by the
position of "chamberlain of the inner palace". Such officials had
access to the monarch's quarters and were responsible for organizing the
household of the royal family. Senebsumai was the patron or supervisor of the
physician Ameni, whom he commemorated on a votive stela (Cairo CG 20023) along
with a scribe of the House of Life named Keku. Egyptian Houses of Life were
centres of scribal activity: it was there that medical and religious books were
composed, and scientific topics were resolved in discussions. Employees of the
House of Life, primarily scribes, engaged in medicine and magic in addition to
literary activity. Working in this institution required very great talent and
knowledge (1938GardinerAH).
Here
we must enter the realm of conjecture once again. It seems to us that when the
epidemic began affecting Pharaoh's "court," Senebsumai turned to
physician Ameni for advice. As is clear from the Edwin Smith Papyrus, Ancient
Egyptian medical practitioners, at least as early as the Second Intermediate
Period, encountered multiple necrotic skin lesions and mass illnesses
(1930BreastedJH). Ameni provides recommendations or himself organizes sanitary
work and anti-epidemic measures. In doing so, those who died were hastily
buried without mummification in mass graves, as noted during the 13th Dynasty
(1996BietakM). As stated in the Admonitions of Ipuwer, composed in the late
Middle Kingdom, many of the deceased were buried in the river (1978КоростовцевМА; 2006LichtheimM). By eschewing
mummification and rituals, it was possible to reduce contact between healthy
individuals and infected bodies. Disposal of corpses into the river prevented
contamination of the soil, in which anthrax spores are capable of persisting
for centuries (2010JonesSD). In the Hittite Kingdom, it was believed that
diseases could spread from an object to a person or from one person to another
upon physical contact, even if there was no understanding of the nature of
pathogens and their vectors (2026ArnottR).
An
observant Egyptian physician could notice the connection between drought,
diseases of domestic animals, and illnesses in humans, predominantly
pastoralists. The latter group arrived in Egypt from Asia, among other places,
as proven by the fresco from the 19th-century BCE tomb of the official
Khnumhotep II (2009KamrinJ; 2021BietakM_RensburgA). It seems reasonable to
remove potential carriers of the pathogenic agent from the country: both animal
breeders and their livestock. This was easier to do with respect to nomadic
tribes. Apparently, this is precisely how they acted with Nubian, Libyan, and
Asiatic settlers. The story of sending Abraham's family away from the Nile
Valley is a fiction, but one based on knowledge of the transmission routes of
anthrax and the reservoir of the pathogen. It is not necessarily true that the
measure was developed by the 13th Dynasty physician Ameni, but clearly by a
seasoned medical professional.
The
authors of the Book of Genesis hint at the presence of a carrier of the pathogenic
agent in Abraham's community, and therefore describe how the patriarch's tribe
with their livestock is "escorted" out of the country under guard
(Gen. 12:20, 13:1–2). As a preventive measure against infecting the native
population and the soil, the foreigners are calculatedly neither put to death
nor deprived of their property, which might have been contaminated. The nomadic
tribe proceeds "as far as Beth-el," that is, leaves the Nile Valley
for Canaan (Gen. 13:3). What is described appears to us as standard isolation
of people and domestic animals (observation/quarantine), removal of the source
of the disease, and interruption of the potential transmission route. How to
prevent the spread of a dangerous infection was undoubtedly suggested to Pharaoh
by Egyptian physicians. Dr. Ameni could have related this to Senebsumai, and
the chamberlain to the king – Neferhotep I or his coregent Sahathor. The latter
died in 1733 BCE, as is evident from the chronicles, and in 1731 BCE Neferhotep
I passed away (1997RyholtKS_Bülow-JacobsenA).
We
have formed the impression that, according to the storytellers’ design, Abraham
arrives in Egypt in 1733 BCE. Immediately, anthrax begins to rage. Among the
first to perish is Prince Sahathor, presumably the prospective husband of
Sarah. Subsequently, Neferhotep I fell ill and died, having managed to appoint
Sobekhotep IV as his successor. A statue depicting Sahathor at a young age as a
prince has survived (1981HabachiL). Nothing is known about his wives or heirs;
the sculpture reveals no external signs of congenital pathology, which
indirectly testifies in favor of premature death. Meanwhile, Neferhotep I had a
spouse named Senebsen and two children. It is doubtful that the writers put
words implying Sarah into the mouth of the aforementioned king: "and I
might have taken her to me for a wife" (Gen. 12:19). Thus, the phrase:
"the Lord afflicted Pharaoh," that is, the pharaoh, "with great
plagues because of Sarai," was, according to the authors’ design, uttered
by Sahathor (Gen. 12:17). More than a year must have elapsed between the deaths
of Sahathor and Neferhotep I. Under the subsequent ruler Sobekhotep IV, an
official named Senebsumai is not mentioned. His successor in the position of
treasurer does not figure under Neferhotep I. He and Senebsumai, who had access
to the ruler's chambers, could have fallen victim to the same infection and
died almost simultaneously, but later than Sahathor. This pharaoh, it seems,
resided in a separate palace where the epidemic began, which then spread to the
courtiers of Neferhotep I. In view of the contagious nature of the disease, the
king's wife could have died, as well as the children – potential heirs to the
throne. The fate of the pharaoh's family remains unknown.
According
to this scenario, we tentatively date the expulsion of Abraham's family from
Egypt to 1732–1731 BCE. Discerning a connection between the pestilence and the
arrival of foreigners, Neferhotep I farsightedly spares their lives, but orders
them pushed out of the state along with their livestock (Gen. 12:19–20). This
extraordinary ruler strove for knowledge, personally visited libraries and
archives (2018ВейгаллА).
It is not ruled out that the creator of the lines concerning an especially
dangerous infection intentionally places the protagonists in the reign of
Neferhotep I, who followed the advice of specialists and was of non-royal
origin (1997RyholtKS_Bülow-JacobsenA). His closeness to commoners allows the
reader to entertain the thought of meetings between the specified king and
Senebsumai with Abraham. In reality, communication between a pharaoh and an
ordinary nomad seems unrealistic. Even in the Ancient Egyptian tale The Tale of
the Eloquent Peasant, the king does not communicate directly with the peasant
(1979ЛившицИГ_РубинштейнРИ). In the Old Kingdom, only the
chosen few could behold the "earthly deity". In the Middle Kingdom,
pharaohs communicate with nomarchs and members of the nobility, participate in
military campaigns, and in the New Kingdom, pharaohs already "manifest
themselves before the eyes of the crowd – for example, during religious
festivals" (2004РакИВ). In the Story of Sinuhe, the king meets with an official, apparently
in the capital of the 12th Dynasty "between Medum and Memphis," which
is at Lisht (1915ТураевБА;
1958КацнельсонИС_МендельсонФЛ). A dialogue between Pharaoh and
the shepherd Abraham could not have taken place in reality during the Middle
Kingdom under Neferhotep I. This is a literary fantasy of the Second
Intermediate Period or the New Kingdom.
It
is incredible that a woman who served as the prototype for Sarah actually
became betrothed to a pharaoh (Gen. 12:19). This is a literary plot needed to
create the prerequisites for Joseph's ascension to power. According to the
text, it turned out that he was the great-grandson of the spouse of Egypt's
ruler, while his great-grandfather was admitted to the palace and received
royal gifts (Gen. 12:16, 18–19). For tendentious commentators, these
constituted weightier factors for sparing the lives of Abraham and Sarah. The
spouses had personal acquaintance and kinship ties with the pharaoh. To raise a
sword over those close to the autocrat, direct and exceptionally compelling
grounds were required, which were lacking apart from conjectures. Following the
king's death, certain benefits and honors were naturally due to the widow.
Therefore, escorting them away presented the best solution to the dilemma. The
head of state could not have made a mistake in choosing a spouse and been struck
down as a result of "her magic". Any speculation had to be nipped in
the bud. As follows from our legend, neither formally nor legally was the
marriage contract dissolved. Sarah remained a claimant to the
"position" of lawful spouse of the king, but with the qualification
of "former".
Expelling
a person who is a carrier of disease is a method of epidemic prevention known
in ancient Mesopotamia. In a letter (ARM 26/1 279) from the Mari archive, a
certain Tilani-Hesuda reports a sick servant girl, her removal from the palace,
and the need for "purification" of the chambers (1988DurandJ-M). It
should be noted that the Asiatic woman who served as the prototype for Sarah
might have been a handmaid or concubine rather than the wife of a king or noble.
As is clear from a letter (ARM 26/1 263) addressed to Yasmah-Addu, after the
epidemic that struck Mari, "exorcists and wailers purified the city"
(1988DurandJ-M). The action was, in essence, similar to sanitary treatment and
disinfection, albeit virtual. The verso of the Edwin Smith Papyrus contains
three spells for driving away epidemics associated with certain pests, winds,
and spirits, using a "papyrus amulet of Sekhmet," as well as a
magical formula recited during the disinfection of food, belongings, and
bedding with mention of the goddess Sekhmet (1930BreastedJH). From this
manuscript, it is not clear exactly how decontamination was carried out:
verbally, mechanically, or by fumigation.
In
a tomb beneath the mortuary temple of Ramesses II in the Theban necropolis, a
library was discovered known as the Ramesseum Papyri, dating to the 13th
Dynasty or 1755–1640 BCE. The last person buried in this multi-chamber tomb
possibly originated from a family of priests associated with writings, magic,
rituals, and healing. In addition to scrolls of a medico-magical nature, a box
with items for magical practice, a statuette of a goddess resembling Sekhmet,
and an impressive bundle of reed pens were found there (2009ParkinsonRB;
2012RavenMJ; 2020MiniaciG). The Pyramid Texts, dating to 2350–2175 BCE, have
preserved a spell of a magician-scribe who was forced to reckon with a
competitor like himself (1952MercerSAB). Houses of Life were closely tied to
magic, which played a great role in the spiritual life of ancient Egyptians (2001КоростовцевМА). Knowing this, we have every right
to expect that magic was practised by the scribe of the House of Life Keku,
depicted opposite Dr. Ameni on stela Cairo CG 20023 (1938GardinerAH).
In
the Book of Genesis, Joseph's father-in-law Potiphera figures as a priest of
On, that is, serving in Heliopolis (Gen. 41:45, 50, 46:20). In the text, there
is mention of Egyptian "magicians" and "wise men" at
Pharaoh's disposal (Gen. 41:8, 24). Joseph practices divination using a cup
(Gen. 44:2, 5). This introduces a mystical component into the narrative,
characteristic of Egypt in the Middle Bronze Age.
In
the tomb of Harkhuf, a 6th Dynasty contemporary and nomarch of Elephantine, the
title khery-hebet (khery-heb) is mentioned, denoting "a priest who recited
magical formulas and gained a reputation as a magician" (1915ТураевБА). In the tale King Cheops and the
Magicians (Pharaoh Khufu and the Magicians), there appear the chief
lector-priest Ubaoner and Djadjaemankh, as well as the "magician"
Djedi, a commoner (1958КацнельсонИС_МендельсонФЛ).
In another translation of this text, the priest's position is designated as
"chief khery-heb" (1979ЛившицИГ_РубинштейнРИ). Such highly educated individuals, in
cooperation with physicians, were fully capable of organizing anti-epidemic
measures.
In
our primary source, a prohibition against joint dining between Egyptians and
foreigner-shepherds is recounted (Gen. 43:32). The brothers encountered this
preventive measure at the feast with Joseph (Gen. 43:32–34). The latter also states:
"every shepherd is an abomination unto the Egyptians" (Gen. 46:34).
This represents a reasonable precaution rather than contempt for another
culture. Constant contact between livestock and nomads fostered their
adaptation to specific animal pathogens. Naturally, individuals not engaged in
animal husbandry were assumed to lack such resistance.
Despite
the severe danger of anthrax, mortality accounts for approximately 20% in
untreated cutaneous cases without antibiotics and less than 1% when they are utilized
(2002BrookI). Furthermore, ingestion or exposure to an attenuated strain of
Bacillus anthracis induces immunity (2015GoelAK). Theoretically, resistance to
pathogenic agents could have spontaneously developed in Abraham's kin through
contact with thermally and chemically processed contaminated milk, meat, and
hides. During the widespread deaths in Pharaoh's household, Sarah proved immune
to the infection. It is not ruled out that the woman had previously acquired
immunity to anthrax and undeniably practised personal hygiene. Between the
lines, the authors write of this, having observed cases in which shepherds and
nomadic families did not suffer from anthropozoonotic diseases.
Asiatic
nomads did not possess a highly developed concept of sanitation and hygiene,
which was cultivated in Ancient Egypt. Plutarch (1st–2nd centuries CE) mentions
the purifying rituals of Egyptian priests and their special attitude toward
clothing: "having once put on this garment, the priests subsequently
remove it and keep it invisible and inviolable" (1996Плутарх). According to Herodotus (5th
century BCE), clergy in Egypt cared for hygiene: "Every third day the
priests shave their whole bodies... Twice a day and twice every night they wash
themselves in cold water". Furthermore, the Egyptians wash their eating
utensils and "wear linen garments, always freshly washed" (1972Геродот). In the Nile Valley, ceremonial
purity "was obligatory in all periods and was considered no less important
than moral holiness. Even a layman could not enter the temples without
diligently purifying himself" (2021МюллерМ). In the Admonitions of Ipuwer, we find a
reference to the personal hygiene of priests: "keep away from performing
services a priest unclean of body. Violation of this is a sin and defilement of
the heart" (1978КоростовцевМА). In the Story of Sinuhe, after visiting the king, the protagonist
recalls: "I was shaved, my hair was combed. I gave back dirtiness to the
desert, my clothes to the sand-dwellers. I was clothed in fine linen"
(1915ТураевБА). In
Hittite texts, there is evidence of a belief in a connection between certain
types of diseases and the use of dirty utensils and food preparation sites.
Impurity possessed magical properties, which led to insistent recommendations
in temples and palaces to maintain absolute cleanliness required when preparing
offerings to the gods (2026ArnottR).
The
creators of the Book of Genesis made it clear that Jacob possessed an
understanding of personal hygiene and demanded its observance from his tribesmen.
Following the conflict at Shechem, he said "unto his household, and to all
that were with him: Put away the strange gods that are among you, and be clean,
and change your garments" (Gen. 35:2). Before the meal with his brothers,
Joseph "washed his face" (Gen. 43:31). In the execution of this
action, the hands are cleansed simultaneously with water. When sending his
brothers home, Joseph "gave each of them changes of raiment; but to
Benjamin he gave... five changes of raiment" (Gen. 45:22). This implies a
commitment to the cleanliness of attire and its replacement upon soiling.
The
characters of our work care for personal hygiene, comparing their inner world
to it. Abimelech "says" in a dream: "In the integrity of my
heart and innocency of my hands have I done this" (Gen. 20:5). We also
discern the characters' attention to consumed food. For a sacrifice to God,
Noah "took of every clean beast, and of every clean fowl" (Gen.
8:20). Priests and laymen who offered sacrifices burned a portion of the
"clean" meat and ate the rest without fear. Nutritional hygiene is
developed in greater detail in the Book of Exodus, where, for instance, eating
meat "raw" or undercooked is forbidden, and it must strictly be fresh
(Exod. 12:9). According to Herodotus, the pig was considered an unclean animal
among the Egyptians, whereas clean animals included bulls and calves devoid of
specific distinguishing marks (1972Геродот). In Egypt, directing a sacrifice "to the
sky through burning was always known, but did not enjoy such popularity as in
Asia" (2021МюллерМ).
In the Akkadian Epic of Gilgamesh, Utnapishtim recounts the sacrifice: "I
offered a sacrifice, on the mountain peak I poured out a libation: seven and
seven censers I set up, into their bowls I scraped myrtle, reed, and
cedar" (1961ДьяконовИМ). The blending of rituals, sanitary rules, and personal hygiene is
fully understandable at the dawn of medical science.
Practically
everywhere Jacob wandered, sanitary and hygienic conditions proved unfavourable
due to water scarcity. Thus, his sanitary-hygienic history must be judged as
"unfavourable" (burdened). Our patient spent his childhood and youth
in the south of the Levant in desert and semi-desert conditions, where wells
served as sources of drinking water (Gen. 26:19, 21, 25, 32). Occasionally,
these were fouled and filled in with dirt (Gen. 26:15, 18). In the absence of
sanitary rules, these acts of sabotage complicated access to clean drinking
water and the performance of hygienic procedures. This problem is reflected in
the dispute between Isaac's herdsmen and the Philistines over the ownership of
wells (Gen. 26:20–21, 30–31). At the same time, the story of the Old Testament
pastoralists' struggle for access to water appears to be invented to lend
significance to Joseph's grandfather. He could have acquired water sources by
force of arms. Isaac was the heir to Abraham's estate, meaning he had at his
disposal an armed force of no fewer than "three hundred and eighteen"
blades (Gen. 14:14). These armed forces had once defeated "Chedorlaomer,
and the kings that were with him" – namely, armies led by "the king
of Elam, and Tidal king of nations Goyim, and Amraphel king of Shinar, and
Arioch king of Ellasar" (Gen. 14:9, 17). This coalition possessed an
impressive combined armada composed of detachments led by Bera, Birsha, Shinab,
Shemeber, and the king of Zeboim (Gen. 14:2, 10–11).
In
his youth, Jacob lived and worked in Northern Mesopotamia, in the vicinity of
Haran. Here, too, water was drawn from wells (Gen. 29:2–3). In the Story of
Sinuhe, the protagonist recounts wells in the pastures (1979ЛившицИГ_РубинштейнРИ). According to our primary source,
the locals covered the wells with a large stone (Gen. 29:2, 8, 10). The
covering protected against debris, dust, leaves, insects, small animals, and
children, prevented the water from heating and algae from blooming, while the
coolness hindered the proliferation of microorganisms and zooplankton. The
presence of covers on wells and water pits in Canaan is not specified (Gen. 37:24,
28–29). On this basis, we conclude that the quality of moisture from individual
sources remained low. This contributed to intestinal infections, which were
exacerbated by insufficiently developed sanitary and hygienic skills.
In the twilight of his days, Jacob lived in the Nile Delta (Gen. 47:27). Water intake here was possible from river branches, canals, and wells. However, overall sanitary and hygienic conditions appear unfavourable due to high humidity near waterways, the presence of parasitic flatworms, and an abundance of insects inhabiting reed thickets. Research has established that up to 65% of Egyptian mummies tested positive for schistosomiasis, 40% had head lice, 22% were infected with malaria, and 10% with visceral leishmaniasis (2024MitchellPD).
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 9. About the round ligament of the femur. October 23, 2026. https://roundligament.blogspot.com/2026/10/medical-record-chapter-9.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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