Ancient Maladies: An Exploration of Disease and

Pathophysiology in Tanach and the Talmud

he canonical ancient Jewish sources, specifically Tanach and

the Talmud, are the guidebooks for how Jews live their lives.
They contain ageless morals and lessons, prescribe rules and
customs for a holy life, and provide a window into the history and
development of the Jewish people. Neither Tanach nor the Talmud
is primarily viewed as a reference for modern or medieval medical
procedures. Nevertheless, there are many examples in Tanach and
discussions in the Talmud that focus on cases of pathophysiology,
which are abnormal physiological changes associated with a disease.
Surgical or alternative disease treatments are also considered.
Various descriptions in Tanach, discussions among the rabbis in
the Talmud, and findings of medical historians provide a glimpse
at ancient medical afflictions, diagnoses, and treatments. It is
important to remember that the medical cases found in the Talmud
were not intended to act as a medical or scientific record; rather, the
Talmud recorded specific cases and discussions that were relevant to
religious practices and laws. There are also cases of pathophysiology
and medical care that are recorded in Tanach, including likely uses
of artificial respiration and medical explanations of Goliaths
easy defeat. The Talmud contains a detailed description of cranial
surgery and possible reasons and remedies for the gastrointestinal
problems experienced by priests of the Temple periods.
There are two well-known accounts in Tanach that can be used
to illustrate the early use of artificial respiration. These narratives
indicate that artificial respiration was used over a thousand years
before it became an accepted and discussed form of medical
assistance. The book of Kings I contains the story of Elijah and the
Shunamite woman. In return for the kindness the woman displayed
by hosting Elijah, she was informed that she and her husband
would be granted a child. However, when the child was just a
young boy, he became sick and died. When the Shunamite woman
approached Elijah for help, he stretched himself upon the child
three times and cried unto the Lord I pray thee, let this childs
soul come back into him (I Kings 17:21), and the child came back
to life [1]. Radak, a 13th century Biblical commentator, explains that
the purpose of lying on top of the child was to warm him and to
breathe life into him [2].
A similar situation is presented in the book of Kings II, which
involves Elijahs student Elisha. Like his teacher, Elisha promised a
child to a barren woman in the town of Shunam as thanks for her
hospitality. However, the child died at a young age. While there is
some speculation as to the source of the childs death, it is thought
to have been caused by sunstroke [3]. The child was revived when
Elisha lay upon the child, and put his mouth upon his mouth, and
his eyes upon his eyes, and his hands upon his hands (II Kings
4:34-35) [1]. Radak again interprets the purpose of lying upon the
child as an attempt by Elisha to warm the boy with his natural body
heat in an effort to revive him. Dr. Fred Rosner, a respected medical
ethicist, concludes that these two instances are both describing
mouth-to-mouth resuscitation [2].

Jeni Rossberg
Another incident in Tanach that warrants study from a medical
perspective is the story of David and Goliath. How was it possible
for David, a small shepherd boy, to defeat a giant, who was also an
experienced warrior, with just a slingshot and a pebble? The text
reads: David put his hand in his bag, and took thence a stone, and
slung it, and smote the Philistine in his forehead; and the stone
sank into his forehead, and he fell upon his face to the earth
(I Samuel 17:49) [1]. Dr. Stanley Sprecher, a specialist in nuclear
radiology, reports that the cause of Goliaths death was much
less straightforward than it appears in the text. He explains that
Goliath grew to be so large because he suffered from a pituitary
macroadenoma (a large tumor), which resulted in acromegaly,
a syndrome caused when a benign tumor on the pituitary gland
secretes excess amounts of growth hormone [4,5]. Among the
common symptoms of this condition are visual deficits, which
are caused by the tumor applying pressure on the optic chiasm,
the area of the pituitary gland through which optic nerves pass
through to the brain, and an enlarged paranasal sinus, which is a
group of air filled spaces around the nose and eyes. This pressure
often results in a thinned cranial frontal bone. Therefore, it is
possible that Goliaths sight was hindered, rendering him unable to
follow Davids swift movements. Moreover, a thinned frontal bone
can explain why the stone easily entered Goliaths skull. Sprecher
postulated that the stone was lodged in Goliaths pituitary gland and
caused a pituitary hemorrhage, resulting in excessive pressure on
Goliaths brain and his eventual death [4].
Dr. Vladimir M. Berginer, a consulting neurologist at Ben Gurion
University, presents an alternative theory to the cause of Goliaths
death. Like Sprecher, Berginer believes that Goliath suffered from
acromegaly and a visual deficit. However, he explains that the cause
of Goliaths death was not the stoneit was simply a result of
David cutting off the fallen giants head. He theorizes that the stone
merely caused Goliath to lose consciousness, which afforded David
the opportunity to sever the giants head. Berginer also suggests
other factors that could have led to Goliaths simple defeat. He
explains that either Goliath was slow and clumsy as a result of his
great size and the heavy weight of his armor, or that Goliath had
muscle atrophy or joint inflammation [6].
Another interesting malady mentioned in Tanach is the deadly
bowel disease that affected King Jeroham, a 9th-century king in
Jerusalem. The text reads: at the end of his life the Lord smote
him in his bowels with an incurable disease his bowels fell out by
reason of his sickness: so he died (II Chronicles 21: 18-19) [1].
According to Dr. Liubov Ben-Noun, a family medicine specialist
at Ben Gurion University, this is a description of bowel prolapse
with an unspecified cause. Ben-Noun discusses a few theories of
the possible cause of this unknown disease. However, based on the
description of the disease within the text, she concludes that the
king suffered from colorectal carcinoma, a type of colon cancer.

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She explains that although this is usually a familial disease, there

are no indications that any other family members had this disease,
and colorectal cancer is one of the only incurable diseases that
primarily affects the bowels. She expands on this diagnosis by using
the Dukes rating scale for rectal cancers to assess the severity of the
cancer, ultimately concluding that the kings cancer must have been
on the fourth stage of the scalethe final and worst stage. The
Dukes scale ranges from a small cancerous polyp within the inner
lining of the bowel in the first stage, to a large malignant cancer
spreading from the bowel to other parts of the body, including the
liver and lungs, in the fourth stage. From this diagnosis, it is possible
that the malignant, incurable course the cancer took caused it to
spread to the kings lymph nodes, and possibly to his blood [7].
The cases in the Talmud are presented in a different format than
those in Tanach. Instead of stories and narratives, Talmudic cases
are often presented as discussions regarding laws and ancient
practices. There is a descriptive and detailed case of a cranial
surgery in the Talmud (Ketubot 77b) presented in conjunction
with a discussion of situations and professions that are grounds
for a divorce. The Talmud explains that there are certain diseases
that provide a woman the right to have a lawful divorce from
her husband. One of the diseases listed is called raatan. Among
the symptoms of this disease is severe discomfort caused by the
skin being painful to the touch, as well as easy skin breakage. As
a result, a husband would refrain from having intimate relations
with his wife, thus violating the duty of a husband to satisfy his
wife sexually, one of the contractual obligations found in the
ketuba, the marriage contract. The Talmud explains that the
debilitating symptoms could be stopped and the marriage saved
with an invasive cranial surgery. It should be noted that the Talmud
does not condone invasive, dangerous surgery unless it was truly
warranted. The Talmud details the surgery itself, the environment
in which it should be done, the anesthetics that are to be used, the
materials required, and the recovery period [8].
Raatan can be interpreted as a growth that rests on the meninges,
the protective membrane that covers the brain and spinal cord.
In ancient Jewish texts it has been described as a form of boils.
According to Rosner, however, it could be a form of leprosy
or a reference to an insect in the brain. It is listed as the most
harmful of all skin diseases in the Talmud, possibly because it
affects potency (Vayikra Rabbah 16:1) [9]. Aside from skin lesions,
symptoms include teary eyes, a runny nose, foam at the mouth,
and flies swarming around the victim. The Talmud reads like a
surgical manual describing how the tumor should be removed. The
instructions state that the patient should be taken to a house made
out of marble with no draft, or a house with incredibly thick walls.
This ensures a sterile and clean environment. The Talmud then lists
ingredients for a balm to be used before and after the surgery to
soften the skull. These preliminary procedures were surprisingly
redolent of modern antisepsis or anesthetic procedures [8]. The
use of this balm, over a thousand years before the introduction of
antisepsis treatments to surgical practices in the 1800s, indicates
that the writers of the Talmud already understood the concept
of infection and disease prevention [10]. The first ingredients
listed are wormwood and pennyroyal, comparable to a mixture of

Derech Hateva

wormwood and rosewater that was introduced in 1170 CE as a

mixture to help with blood clotting during cranial surgery. After the
balm is applied to the patients head, the surgeon must tear open the
skull to expose an organism that rests on the meninges [8]. While
both Weinberg and Rosner discuss that the organism could be a
reference to an actual living, parasitic insect, Rosner explains that
it is possible that there was no insect; the organism could have
been nothing more than a growth or tumor [9]. In any case, once
the organism was revealed, the surgeon used four myrtle leaves
to lift each end of the growth, removed it with a pair of tongs, and
burned it completely. If not burned completely, the growth would
return [8].
The Talmud also contains accounts of personnel appointed to
treat medical ailments during the Temple period. Ben Achiya was
a Second Temple official who treated the gastrointestinal (GI)
disorders of Jewish priests. Dr. Leonard Hoenig, an internist,
expounds on the many GI ailments experienced by priests and their
possible origins. He explains that these problems were caused by
the priests working conditions and the food they ate. The priests
had a specific uniform that they were commanded to wear when
performing their priestly duties; however, these pieces of clothing
were not always appropriate for their working conditions. The
medieval commentator Rambam, who was also a physician, explains
that the Priests wore the same uniform throughout the year, and the
clothing was not always sufficient to protect them from the weather.
The Talmud posits that the priests were prone to GI problems
because they were forbidden from wearing shoes in the Temple, and
the cold floor beneath their bare feet chilled them. Priests were also
required to consume large quantities of sacrificial meat within small
periods of time. Though the Talmud does not specifically comment
on whether or not the heavy meat diet had an adverse effect on
the priests, it is possible that because of the time constraints the
meat was not always adequately cooked or cleaned, causing adverse
effects on the GI system as well.
Ben Achiya used his vast knowledge of both herbal medicine and
the positive effect of specific wines on the GI system to help the
Temple priests. The Talmud comments that old wines, in moderate
quantities, had the ability to help with stomach issues. Modern
medical scholars have discussed these ideas as well. It has been
proven that the ethanol in wine stimulates gastric secretions to help
with digestion, and certain pigments in wine have the ability to help
treat intestinal infections [11].
The aforementioned theories and accounts provide the ability to
better understand the descriptions of specific illnesses in both
Tanach and the Talmud through the lens of modern medical
knowledge. Though details given in textual descriptions are often
limited in regards to the causes and symptoms of specific diseases
or pathophysiologies, these narratives provide an opportunity
to examine interesting and plausible modern medical theories
with regard to ancient afflictions. They also provide evidence of
advanced techniques used by biblical and Talmudic personalities to
provide healing interventions that may have been unknown to the
greater scientific community of their time.

Acknowledgments:
I would like to thank my family for their constant love and support throughout all of my endeavors. Thank you to my brother Chaim for reviewing my
paper for its Torah content, and to my friends and family for their helpful comments and edits. I would also like to thank Dr. Babich for providing me with
the honor to write for this publication and for his commitment to the science students of Stern College.
References:
[1] Mechon Mamre. http://www.mechon-mamre.org/p/pt/pt08a17.htm. (Retrieved January 7, 2015).
[2] Rosner, F. (1969). Artificial Respiration in Biblical Times. New York State Journal of Medicine. 69:1104-1105.
[3] Rosner, F. (1972). Sunstroke in the Bible and the Talmud. Journal of the History of Medicine and Allied Sciences. 27:326-328.
[4] Sprecher, S. (1990). David and Goliath. Radiology. 176:288.
[5] Acromegaly.org. http://acromegaly.org/en/about/about-acromegaly. (Retrieved January 7, 2015).
[6] Berginer, V. (2000). Neurological Aspects of the David-Goliath Battle: Restriction in the Giants Visual Field. Israel Medical Association Journal 2:725727.
[7] Ben-Noun, L. (2004). Colorectal Carcinoma that Afflicted King Jeroham. Minerva Medica. 95:557-563.
[8] Weinberg, A. (2006). A Case of Cranial Surgery in the Talmud. Journal of the History of Neuroscience. 15:102-110.
[9] Rosner, F. (1977). Medicine in the Bible and the Talmud. Ktav Publishing House Inc., Hoboken, NJ.
[10] Brought to life: Exploring the History of Medicine. http://www.sciencemuseum.org.uk/broughttolife/people/josephlister.aspx. (Retrieved January 7,
2015).
[11] Hoenig, L. (1989). Ben Achiya: The First Gastroenterologist in Ancient Israel? Journal of Clinical Gastroenterology 11:61-63.

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