738 Journal ofthe Royal Society ofMedicine Volume 79 December 1986

Biblical ills and remedies

J R Gwilt PhD FRSC Vice-President Commercial Development, Sterling Drug Inc.; New York, USA

Keywords: , illnesses, remedies, preventive n)edicine

Abridged from the In Ecclesiastes, the Preacher said 'there is-nothing There are two references to rat-borne diseases: Winthrop Lecture new under the sun' (Eccles. 1:9). Thus cot death (sud- after the Philistines captured the Ark of the to the Worshipful den infant death syndrome) was reported in the time Covenant, they were struck with bubonic plague Society of of Solomon (1 Kings 3:19), and a clear description (1 Sam. 5:6), while another, probably pneumonic Apothecaries, are Jerusalem 10 December 1985 of epilepsy is given by Mark (9:18-27). So there plague, struck the Assyrians besieging instances in the Bible where a disease is named or in 701 BC (2 Kings 19:35). Finally, there are two we can recognize it. Sometimes we have additional predictions ofplagues. One will strike those warring evidence from contemporaneous writers such as against Jerusalem in the end-times: 'their flesh shall Josephus, but often we can only identify a disease rot while they stand on their feet, their eyes shall from the context, its outcome, and our knowledge of rot in their sockets, and their tongues shall rot in endemic diseases ofthe times. their mouths' (Zech. 14:12), suggesting chemical or Biblical physicians had limited diagnostic powers radiation damage. Revelation predicts 'everyIkind of and few effective means of treatment. Only two are plague' (Rev. 11:7) which we cannot specifically mentioned by name: Asa, King ofJudah (910-870 BC), identify as they have not happened - yet! who died from senile gangrene (2 Chron. 16:12), and Malaria-- was endemic in' Palestine and was Luke who was Paul's 'beloved physician' (Col. 4:14). proybably the ague- threatened upon the Israelites Asa could not heal himself and Luke-was unable to for wrong-doing (Deut. 28:22), and caused Peter's heal his colleagues: Paul (2 Cor. 12:7), Timothy (1 mother-in-law to be bed-ridden (Mark L:31). Recur- Tim. 5:23), (2 Tim. 4:20) and rent or relapsing fever (Deut. 28:22) is transmitted-by (Phil. 2:30). He pronounced Eutychus dead and left the body louse and 'the shepherd scours his clothes to Paul to revive him (:10). rid them of lice' (Jerem. 43:12). Then -when Paul 'The woman with menorrhagia had spent all her was shipwrecked on Malta, he treated the chief money on doctors,' but had only got worse (Mark magstrate's father for severe gastroenteritis, which 5:26), and Tobit's eyesight deteriorated further with was causing fever and dysentery (:8). the prescribed ointments (Tobit 2:10). So biblical Several biblical figures had cardiovascular prob- references to doctors are generally not complimen- lems. Sarah's sudden death (Gen. 23:1) may have tary and Job summed up his experiences: '... worth- been due to a heart attack when she learned that less physicians are you all' (Job 13:4). Indeed, the Abraham had been about to sacrifice Isaac (Gen. most dramatic OldTestament healings are attributed 22:11). Ananias (:5) and Sapphira (Acts 5:10) to major prophets such as Elijah (1 Kings'17:21), certainly died from heart failure when their hypo- Elisha (2 Kings 4:35) and Isaiah (2 Kings 20:7). Then crisy was revealed. Jacob suffered a syncope (Gen. in the - in addition to healings by 45:26) when told that Joseph was still alive, and in the - there are several performed by Nabal had a coronary thrombosis (1 Sam. 25:37) when Peter (:7) and by Paul (Acts 20:10). his wife told him she had fed David's guerrillas. Men Nevertheless, Jeremiah (at 8:22) called wistfully suffering strokes include Jeroboam (1 Kings 13:4), for a physician and Jesus emphasized (Matthew 9:12) Alcimus (1 Maccab. 9:56) and HerodAgrippa; all were that the sick need a doctor. stress-related.

Ills Hormonal matters The word 'plague' is used in the Bible as a generic It is challenging to interpret some of the biblical term for various epidemics. Among the ten affecting accounts. It seems likely that Esau suffered from con- the Egyptians immediately prior to the Exodus, genital adrenal hyperplasia; this is based on his three were disease-related: anthrax of cattle (Exod. appearance at birth (red, hairy all over [Gen. 25:25]), 9:6), skin-anthrax of man (Exod. 9:9) and the still- his exhaustion due to vigorous exercise with a feeling inexplicable death ofthe first-born (Exod. 12:29). ofimminent death, and his rapid recovery after a high One benefit of the years of isolation in the protein meal (lentil soup and bread) (Gen. 25:34). wilderness was the integration of the Israelites into Then the relationships of Joseph with his brothers, a homogeneous theocracy. However, towards the first as a boy (Gen. 37:2-24) and later as a man in end ofthe time, certain of the Israelites participated Egypt (Gen. 42:8), suggest delayed sexual develop- in ment to with 0141-0768/86/ Moabite religious rites (Numb. 25:1), and they due gonadal hypoplasia pituitary 012738-04/$02.00/0 were struck with what may have been a particularly insufficiency which - probably some time after his 0 1986 virulent sexually-transmitted disease to which they encounter with Potiphar's wife - righted itself so that The Royal had no immunity. Later, a sudden, virulent and his brothers later did not recognize him. Society of short-lived plague visited them when David took an was a little man (Luke 19:3) and may Medicine unauthorized census (2 Sam. 24:15). have been an achondroplastic dwarf; as a superin- Journal ofthe Royal Society ofMedicine Volume 79 December 1986 739

Figure 1. Moses and the brazen serpent (Numbers 21:8). (Courtesy Bettman Archives) tendent oftaxes, he certainly had all the characteris- Leprosy tics - ruthless, aggressive. On the other hand, Goliath Because the leper was treated as an outcast from was over nine feet tall (1 Sam. 17:4) and probably suf- society (Numbers 5:2), it was necessary for the fered from acromegaly. This is usually caused by a Israelites to distinguish between leprosy and other tumour of the pituitary, which also compresses the skin diseases. The typical appearance oflepromatous optic nerves, resulting in loss of temporal vision, so leprosy is described (Lev. 13:9) and, ifconfirmed seven David was able to come up on Goliath's blind side. days later, the patient was expelled from the camp Finally menorrhagia is mentioned in both the Old (Lev. 13:46). Burns were also examined, apparently (Lev. 15:25) and New (Luke 8:43) Testaments. to ensure that they had not occurred due to the loss of sensation in leprosy (Lev. 13:25). Other skin conditions differentiated by the priests may have Individual problems included leukodermia (Lev. 13:39), which generally Some psychiatric problems triggered physical ills, is benign and self-limiting; psoriasis (Lev. 13:13); e.g. the paralysed man brought to Jesus on his pallet eczema (Lev. 13:6); scabies (Deut. 28:27); decubitis (Matth. 9:2) and the dumb man (Luke 11:14); we can- ulcer (Lev. 13:15); chancroid, ringworm (Lev. 13:43) not identify the causes. However, Saul suffered from and possibly allergic reactions. It is most unlikely recurrent depression (1 Sam. 16:14), causing paranoia that the Israelites would suffer from scurvy in the and irritability. Nebuchadnezzar developed invol- modern sense (Deut. 28:27) and this was probably utional melancholia, which proved to be self-limiting psoriasis or eczema. (Daniel 4:36), and Elisha showed evidence of per- Leprosy was also used in the divine punishment of secution mania (2 Kings 2:24). David actually saved Miriam (Numbers 12:10), of Gehazi (2 Kings 5:27) and his own life by feigning lunacy (1 Sam. 21:13). We ofUzziah (2 Chron. 26:19). also have instances of paranoia (Luke 4:35) and Blindness still is a scourge of the Middle East, chronic mania with periodic outbursts of violence caused partly by ophthalmia and partly by the glare (Mark 5:2). Finally, Zechariah suffered a nine-month ofthe sun. However, the men pestering Lot's guests in long hysterical dysphonia with deafness (Luke 1:22). Sodom were stricken with amaurosis (Gen. 19:11) and The illnesses ofother characters have caused great Leah suffered from blepharitis ciliaris (Gen. 29:17). speculation. Jacob suffered a ruptured and prolapsed Priests were prohibited from serving if they suffered intervertebral disc when wrestling with the , from cataract or keratitis (Lev. 21:20) - or, indeed, resulting in intractable sciatica (Gen. 32:31). Other any physical defect (Lev. 21:17) - and anyone with entities include speech defect (Moses; Exod. 4:10); (ophthalmic) gonorrhoea was ritually unclean (Lev. poliomyelitis (Mephibosheth; 2 Sam. 4:4); palmoplan- 15:3). tar keratoderma (Jezebel; 2 Kings 9:35); ulcerative Zoonoses were rife in biblical times. Antiochus colitis with bowel prolapse (Joram; 2 Chron. 21:19); Epiphanes suffered a painful lingering death from tuberculous osteomyelitis of the spine (Luke 13:11), dracunculiasis (2 Maccab. 9:5-10) and the brazen and so on. serpent set upon a pole in the wilderness (Figure 1; Paul's 'thorn in the flesh' (2 Cor. 12:7) has been Numb. 21:8) may have been a demonstration by interpreted as malaria, epilepsy or migraine, but the Moses of how the worm should be removed, by most likely cause was temporal arteritis; his sight breaking through the skin and winding it onto a was such that he could form only large letters (Galat. stick. Later, died suddenly from 6:11) and he regretted that eye transplants were not anaphylactic shock due to rupture of a hydatid cyst available (Galat. 4:15). Similarly, there have been (:23). many suggestions for Job's illness: tubercular leprosy, elephantiasis, eczema, smallpox, etc., but the Raising the dead disease best fitting the symptoms (Job 2:7, etc.) is a Until comparatively recently, clinical death was rare skin condition, dermatitis herpetiformis. difficult to confirm. There are two instances ofcardio- 740 Journal ofthe Royal Society ofMedicine Volume 79 December 1986

pulmonary resuscitation: Elijah and the widow's son Medicines at Zarephath (1 Kings 17:21), and Elisha and the About 180 BC, Simon ben Joshua ben Sirach wrote: Shunnamite boy (2 Kings 4:35). However, Taylor 'The Lord has created medicines from the earth' Caldwell' implied that some 'raisings' may have (Ecclesiasticus 38:4). We can interpret the 'earth' involved cases of catalepsy. Examples might be the in two ways: literally, e.g., minerals such as red daughter ofJairus (Luke 8:54) and the widow's son at mercuric sulphide (the 'vermilion' of Jerem. 22:14), Nain (Luke 7:11), both raised by Jesus, and sulphur (Job 18:15), kaolin, etc; or metaphorically, in raised by Peter at Joppa (:40) through the that medicinals such assalicylates (from willow [Lev. power ofprayer. Nevertheless, Caldwell's suggestion 23:40]), aloe (Numb. 24:6), myrrh (Psalm 45:8), cassia does not detract from the miraculous nature of such and cinnamon (Prov. 7:17) are obtained from plants healings without the use of drugs or other medical growing in earth. aids. There are few references to the actual internal use Lazarus is the only example ofsomeoneraised after ofmedicines. Mandrake has tranquillizing properties being in the tomb for several (four) days and and so may help in borderline fertility from which obviously he had not been embalmed (John 11:39).We Rachel apparently suffered (Gen. 30:15). Sour wine do not know his experiences ofthe process ofdyingor mixed with water was used to quench thirst (Matth. how he would face his final death. 27:48) and similarly vinegared water was used by desert troops in World War II. Paul told Timothy: 'stop drinking nothing but water; take a little wine Preventive medicine ... for your frequent ailments' (1 Tim. 5:23); and the The first organized health service was that of the 'Daughters of Jerusalem' offered myrrh dissolved in Israelites in the wilderness, and its management was wine to ease the intense pain of crucifixion (Mark assigned to the priesthood. The programme started 15:23). Finally, when the Israelites were weakened by with the precept that holiness could lead to cleanli- fever in the wilderness, quail were sent to augment ness (Deut. 23:14) and covered: their diet (Numb. 11:31). (1) diet, particularly the banning ofunclean animals So although the Bible mentions a substantial and of the drinking of blood, both of which could number of medicinal herbs2, it is mainly from know- transmit parasitic infections (Lev. 11:2 et seq.), but ledge ofmedical practices in Egypt and Mesopotamia also recommending a diet low in animal fats (Lev. that we can infer the use of 'medicines from the to avoid earth', such as colocynth, rue, charcoal, garlic, 3:17) atherosclerosis; pomegranate and aloe. (2) the diagnosis and isolation ofcontagious disease, Most biblical treatments were therefore topical. particularly the differentiation of skin conditions The Good Samaritan (Luke 10:34) treated the wounds (Lev. 13:2); of the crime victim with olive oil (to soothe bruises) (3) the operation of quarantine precautions (Lev. 15:31) still followed today; (4) camp sanitation (Deut. 23:13), using rules subse- quently followed during 1939-45 desert warfare; (5) the isolation of soldiers after battle while their bodies, clothes and any booty were disinfected (Numbers 31:19-23) to prevent infection ofcivilians; (6) the purity of water supplies (Lev. 11:35). Specific treatments were used: Moses sweetened the bitter water at Marah with a log of barberry wood (Exod. 15:25), possibly by displacing the standing water so that fresh could well up, and Elisha usedsalttopurify the spring at Jericho that was causing spontaneous abortion (2 Kings 2:21).

Holistic health care Much of the biblical treatment of patients was holistic in the sense (in today's terms) of bringing together the skills of the physician and pastoral counsellor in dealing with the spiritual, emotional, mental and physical dimensions ofthe patient. Jesus in particular was a 'total care-giver'. Many healings involved some degree of personal responsibility as well as faith in God's power to heal. The rich young ruler was encouraged to change his life-style (Luke 18:22); others were healed of bodily infirmity by having their sins forgiven, e.g. the paralysed man let down through the roof (Mark 2:5). Today we would call those stress-related or guilt-inflicted problems. But the body itself was not ignored: Paul wrote: '... the training ofthe body does bring limited Figure 2. Jesus uses clay and spittk to heal congenital blind- benefit' (1 Tim. 4:8). ness (John 9:6). (Courtesy Bettman Archives) Journal ofthe Royal Society ofMedicine Volume 79 December 1986 741 and wine (to disinfect cuts). Hydrotherapy was pres- cribed for Naaman's leprosy (2 Kings 5:10) and was sought by the arthritic man at the pool of Bethesda (John 5:5). Isaiah successfully treated Hezekiah's abscess or carbuncle with a poultice of figs (2 Kings 20:7). Tobit's blindness, due perhaps to granular trachoma, was cured by application offish bile (Tobit 11:13); and Jesus variously used spittle (Mark 8:22) or a mixture of clay and spittle (John 9:6) to treat blindness (Figure 2), and spittle alone to cure the deaf and dumb man (Mark 7:33). The water ofritual purification included the ashes of a red heifer (Numb. 19:9), and everything that could not be sterilized in a flame (Numb. 31:23) was with and cleaned by repeated rinsing water exposure - h/ e i to sunlight (Lev. 15:13). Job scrubbed his hands with lye, and his body with soap (Job 9:30) made by saponifying olive oil. Finally, to prevent infection the priests burned aromatic herbs between themselves and the populace Figur 3. The Quen of Sheb vi8s Sooo (I Kigij (Numb. 16:48); similarly, Job, spread 'magic herbs' about his tent and sprinkled his home with sulphur (Job. 18:15). of th hnciiie word un-s~tQ~ilthIdaa a buIFrst in52Bad th lan reere to dsert. Preparation ofmedicines Herbs were ground in stone mills. Sophistication by unscrupulous traders was controlled by buying unground vegetable drugs from reliable suppliers and manufacturing the galenicals in-house. Oint- ments were prepared by methods still used today, for Job speaks of the crocodile who 'whips up the lake like ointment in a mixing bowl' (Job 41:31). Sabc- hec h eifta Quie;enh ofSheba The better-quality ointments were perfumed (Eccles. 7:1), but a reference to 'dead flies make the Figue 3.oTheyQueniof Sheb vitsookmonsa(1uKins10:1) perfumer's sweet ointment turn rancid and ferment' (CourtesywhB ettmanbArchies) lnatosaJrco (Eccles. 10:1) suggests that the need for preservatives burst ui542tBCyad bythelan Revete to deser. in emulsions was not understood even though spices were used to preserve foods. Excipients still in use andofdthesthen-civiiewhercinii curltvantionfoworld,iuntilnfo aotheaothaAdhouanatdatdhouanatda today were available then - tragacanth (Gen. 37:25), catume fromeAbyssiniaSheftook balsambuends to honey (hence the quotation still used by Tate & Lyle: Solomonexwhomewest therepantaeiosmate Jse,riso 'out of the strong came forth sweetness' [Judges Ethopebbica ilsbelibeviedntofiehavoebeenclnizuedsro 14:14]), fruit juices (Numb. 6:3), cane sugar (Isaiah 43:24) and ofcourse wine and oil. Perfumes were prepared by distillation (Song of Songs 5:13) or by enfleurage (Exod. 30:23). Their secular use was initially associated with prosti- tution, sacred or otherwise (Gen. 38:14). Jezebel's notoriety ('a painted Jezebel' (2 Kings 9:30]) persists we cannot understand, some still appear to have been to this day (note Rev. 2:20) as a symbol of apostasy, miracles. though it was actually part ofher worship ofBaal. It Suffice it to say that miracles (1) belong to periods was not until the time of Solomon that the use of of revelation; (2) occurred in clusters - during the cosmetics became generally acceptable (e.g. Song of leadership of Moses (1285-1240 BC), in the times of Songs 4:3). Elijah and of Elisha (910-890 BC), during the first 60 years AD; (3) were generally conferred upon non- believers or possibly new believers, and were worked Queen ofSheba through those strong in the Spirit. The most fruitful source of spices and herbs was the What is clear is that the healers of the Bible Kingdom of Sabaea (Sheba) in what is now North could distinguish between true illness and demon Yemen. The river Adhanat had been dammed for irri- Refyearecspossession.A;()wrThey recognizedeealevil forofrewhat itpnnnwas, and gation purposes and many valuable plants were 1bCaidellri thea pow T.ofDearblhesandwSpirigeloioues,t1he phscan.ifo t andGardeno cCity,d grown and exported, initially by sea, but the taming Newug Yhork: Dtoubedy 199:3(theS ppi52,537 of the camel led to the development of overland trad- ing routes, particularly the Spice Road northwards to 2ossesiontJR,yGwiltgPR.zedicinalfrwand othe naturald Israel. This occurred about the middle of the tenth century BC, approximately coincidental with the visit of Queen Balkis, ruler of Sabaea (the 'Queen of Sheba') to Solomon (Figure 3). She came to establish productseinThe Bibe.rPanglrmouJhysiian.ard79 City trade and cultural relations (1 Kings 10:1). Most