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ILLNESS AND HEALTH CARE

Healing practices have a long and complex history in biblical lands, and they should be treated as part of a health care system that includes, but is not limited to, the beliefs about the causes of illness, the options available to patients, and the role of governments in health care. Public hygiene, which refers broadly to the organized efforts of a community to promote health and prevent disease, is also part of any health care system.

Prehistoric and Early Periods

Hunter-gatherers in Syria-Palestine may have recognized the medicinal value of some plants and practiced some therapeutic rituals by the end of the Paleolithic era, the first period of human material culture ending approximately between 20,000-16,000 b.c.e. in the Near East.

During the Neolithic period (ca. 8500-4300) the domestication of animals probably introduced into human populations some new pools of diseases carried by animals (e.g., bovine tuberculosis). Human tuberculosis is reflected in skeletal material from Egypt and Bab edh-Dhra (Jordan) as early as the 4th millennium.

Throughout all prehistoric periods the family was probably the main caretaker for the ill. However, the long existence of healing specialists in Syria-Palestine is reflected in the trephinated skulls discovered at Neolithic Jericho, bone spatulas found at Tell Jemmeh (near Gaza) in the early 1st millennium, and the implantation of a bronze wire in a tooth at Horvat En Ziq, a small Nabatean fortress in the northern Negeb in the Hellenistic era. Liver models found at Hazor and Megiddo in the Late Bronze Age may have been used in medical consultations.

The Amarna Letters (14th century) mention epidemics and the traffic of physicians in Canaanite royal courts. Ugaritic texts (e.g., Keret Epic) indicate that El, the supreme god at Ugarit, was concerned with healing, especially infertility. In Tyre, Sidon, and other Phoenician city-states of the early 1st millennium, Eshmun was a healing god whose temples may have provided therapeutic services. Yahweh, Resheph, and other Near Eastern deities brought both disease and healing.

Preexilic Israel

Israel in the preexilic period probably shared many of the health problems that were common in Near Eastern settlements. The inadequate disposal of garbage and human waste was probably a constant threat to public health in Syria-Palestine. Towns (e.g., Gibeon) in areas of poor rainfall had to construct cisterns, which were vulnerable to contamination. Parts of Jericho, Tell Beit Mirsim, and other towns apparently had drains, some of which may have carried sewage, by the Middle or Late Bronze Ages. Although recent excavations in Jerusalem have recovered toilet seats (one of which was found in a separate cubicle of a house, dated to ca. 586), such amenities were probably uncommon in most of Israel.

Despite many textual references to washing and related hygienic activities (Gen. 18:4; Ps. 60:8[MT 10]), it is likely that personal hygiene was generally poor in the absence of abundant water supplies. Ruth 3:3 indicates that even bathing was sometimes seen as a special or uncommon event.

Archaeoparasitologists recently have established the probable existence of certain intestinal diseases (e.g., tapeworm [taenia] and whipworm [trichuris trichiura] infections) in ancient Israel, but the precise identification of most diseases in the Bible has been notoriously difficult, especially in cases of epidemics (Num. 25; 1 Sam. 5:6-12). Nonetheless, many plagues are viewed as the result of Israel’s contact with outside groups (e.g., Midianites in Num. 25). The stories of the plagues on Egypt in Exod. 7–10 also recognize that epidemics can alter the course of history.

The condition usually translated as “leprosy” (Heb. ṣāraʿa) receives the most attention in the Bible (Lev. 13–14), but it does not have a simple modern equivalent because it probably encompassed a large variety of diseases that produced a chronic discoloration of the skin. There are also various references to blindness (2 Sam. 5:8) and musculo-skeletal disabilities (9:3). Infertility, another illness frequently mentioned in the Bible (Gen. 16:1-2; 1 Sam. 1:5-6), diminished the social status of the afflicted woman (Gen. 30:1-20).

The OT has at least two principal explanations for illness. One, represented by Deut. 28, , affirms that health (Heb. šālôm) encompasses a physical state associated with the fulfillment of covenant stipulations that are fully disclosed to the members of the society, and illness stems from the violation of those stipulations. Therapy includes reviewing one’s actions in light of the covenant.

The book of Job offers a contrasting, yet complementary, view which argues that illness may be rooted in divine plans that may not be disclosed to the patient at all, and not in the transgression of published rules. The patient must trust that God’s undisclosed reasons are just.

Perhaps the most distinctive feature of the Israelite health care system depicted in the canonical texts is the division into legitimate and illegitimate consultative options for the patient. This division is partly related to monolatry, insofar as illness and healing rest ultimately upon Yahweh’s control (Exod. 15:26; Job 5:18), and insofar as non-Yahwistic options are prohibited. The meaning of “magic” is in great dispute in modern scholarship, and there is no agreement on whether distinctions between “legitimate” and “illegitimate” consultants can be classified by the relative use of “magical” or “nonmagical” approaches.

Since it was accessible and inexpensive, prayer to Yahweh was probably the most common legitimate option for a patient. Petitions and thanksgiving prayers uttered from the viewpoint of the patient are attested in the Bible (e.g., Isa. 38:10-20).

Many psalms (e.g., Pss. 38, 39, 88, 102), in particular, may be intended as prayers for use by patients. These psalms also record important Hebrew concepts concerning illness and health care. In Ps. 38 the author attributes illness to Yahweh’s anger and “hand” (v. 2[MT 3]). This concept is similar to the frequent Mesopotamian use of “the hand” (Akk. qātu) of a deity to describe the divine origin of an illness. As in many descriptions of illness in Mesopotamia, the patient in Ps. 38:4(5) attributes the deity’s anger to the patient’s own sin. Confession is regarded as part of the therapy (Ps. 38:18[19]), and the patient complains about the social consequences of illness (vv. 11-12[12-13]).

Tangible treatments mentioned in the Bible include “bandages” (Ezek. 30:21), “mandrakes” for infertility (Gen. 30:14), and “balsam” from Gilead, which may have been an important source of medicinal substances exported to Egypt (Jer. 46:11). Incense, oil, and combs found in various sites in various periods (e.g., Late Bronze Megiddo) may have been used to combat lice and other ecto-parasites that may have been significant vectors of disease.

Illegitimate options, which were probably widely used by Israelites, included consultants designated in Hebrew as rōpĕʾîm (2 Chr. 16:12; NRSV “physicians”), non-Yahwistic shrines (2 Kgs. 1:2-4), and probably a large variety of “sorcerers” (Deut. 18:10-12). Female figurines found in most periods in Israel, especially in domestic contexts, may have been involved in fertility rituals. The largest known dog cemetery in the ancient world has been uncovered at Ashkelon, and may be associated with a healing cult of the Persian period.

Prophets are probably the foremost legitimate consultants in the canonical texts, and they were often in fierce competition with “illegitimate” consultants. Deut. 18:10-17 seems to advocate the monopoly by the Yahwistic prophet of all the consultation functions, including probable ones for illness, which had been previously distributed in a wide variety of consultants in Canaan. Stories of healing miracles (e.g., 2 Kgs. 4; 8) in the Deuteronomistic history may reflect an effort to promote prophets as the sole legitimate consultants. Their function was to provide prognoses (2 Kgs. 8:8) and intercede on behalf of the patient (5:11). Unlike some of the principal healing consultants in other Near Eastern societies, the Israelite prophets depended for their efficacy more on their relationship with God than on technical expertise.

Shrines of Yahweh were probably another significant legitimate option in the preexilic period. In 1 Sam. 1 Hannah visited the temple at Shiloh to help reverse her infertility. 2 Kgs. 18:4 indicates that prior to Hezekiah the bronze serpent made by Moses as a therapeutic device (Num. 21:6-9) was involved in acceptable therapeutic rituals in the temple of Jerusalem. Metal serpents have been found in temples (e.g., the Asclepieion at Pergamum) known to have been used for therapy during the 1st millennium. Metal serpents, such as those found in or near Late Bronze Age shrines at Timna, Tell Mevorakh (1441.2156), and Hazor, may have been involved in therapeutic rituals, but other functions cannot be excluded.

The centralization of the cult in Jerusalem and the reforms attributed to Hezekiah (715-687) and Josiah (640-609) may have wrought significant changes, whether in theory or in practice, to the health care system. Shrines which may have formerly functioned as therapeutic centers (e.g., Shiloh) may have been destroyed.

The prayer of Solomon (1 Kgs. 8) may be seen, in part, as an attempt to mitigate the loss of the therapeutic roles of the temple of Jerusalem and outlying shrines. The prayer in effect announces that it is not necessary to come to the temple for therapy, as extending the hands toward the temple is sufficient to receive healing (1 Kgs. 8:38-39). The story of Hezekiah’s illness in 2 Kgs. 20:1-11 also shows that coming to the temple was not necessary for healing; Hezekiah, in fact, intends to go to the temple after he is healed (v. 5).

Postexilic Israel

By the postexilic period the Priestly code, which may be viewed as an extensive manual on public health that centralizes in the priesthood the power to define illness and health for an entire state, severely restricted access to the temple for the chronically ill (e.g., “lepers” in Lev. 13–14; cf. 2 Sam. 5:8 on the blind and the lame) because of fear of “impurity.” Laws concerning pure foods (e.g., Lev. 11) were associated with the maintenance of excellent health in some biblical passages (e.g., Dan. 1:15), but the motives for the food laws may not be always restricted to health practices.

The theology of impurity, as a system of social boundaries, could serve to remove socioeconomically burdensome populations, and especially the chronically ill, from society. “Leprosy” alone probably encompassed a wide variety of patients. In effect, the Priestly code minimizes state responsibility for the chronically ill, leaving the eradication of illness for a future utopia (Ezek. 47:12; cf. Isa. 35:5-6).

Thanksgiving or “well-being” offerings (Lev. 7:11-36) after an illness were probably always acceptable and economically advantageous for the temple. Offerings after an illness also may have served as public notice of the readmission of previously ostracized patients to the society (Lev. 14:1-32).

Relative to the Priestly code, the community responsible for the Miqsat Maʿaseh Torah (“some precepts of the Torah,” 4QMMT), the Temple Scroll (11QT), and other Qumran texts added to the list of illnesses excluded from the normal community and expanded the restrictions for “leprosy,” the blind, and the lame. Socioeconomic reasons, as well as the fear of magical contamination, may be responsible for such increased restrictions.

The demise of the prophetic office in the early Second Temple period probably led to the wide legitimation of the rōpĕʾîm (cf. Sir. 38), but various types of folk healers and midwives (Exod. 1:15-21) may actually have been the most common health care consultants.

Early Christianity

During the 1st century c.e. a variety of health care systems were available in Palestine. These included those associated with the Egyptian goddess Isis and the Greek god Asclepius. In addition, there were secular Greco-Roman traditions associated with Hippocrates, Celsus, and other physicians.

Early Christianity may be seen, in part, as a critique of the levitical health care system. Matt. 10:8; Mark 14:3; and other passages indicate that Jesus and his disciples appear to target chronically ill populations (“lepers,” blind and the lame) that may have been marginalized by the health care policies reflected in Leviticus.

In the early Christian period illness may be caused by numerous demonic entities who are not always acting at Yahweh’s command (Matt. 15:22; Luke 11:14), and not necessarily by the violation of covenant stipulations (John 9:2). Illnesses mentioned include fevers (Mark 1:30), hemorrhages (Matt. 9:20), and what has been identified by some scholars as epilepsy (Mark 9:14-29). The cure for illness may be found in this world, and not simply in some utopian future.

Christianity also may have attracted patients who were too poor to afford fees charged in many Greco-Roman traditions (cf. Matt. 10:8). Some Greco-Roman traditions insisted that travel to a shrine was necessary for healing, but Christianity, with its emphasis on the value of faith alone, in effect announced that travel to a shrine was not required (Matt. 8:8). Likewise, Christianity resisted temporal restrictions on when healing could be administered (Mark 3:2-5). Nonetheless, early Christianity preserved many older Hebrew traditions regarding miraculous healings (Acts 5:16; 9:34) and collective health (Jas. 5:16), although some scholars have also seen the influence of Hellenistic healing traditions (e.g., the Asclepius traditions).

Conclusion

Most health care systems in biblical lands had a variety of options that were probably arranged hierarchically, depending in part on the needs and means of the patient. Prayer was probably one of the first, and most economical, options chosen by patients in all systems. A variety of healing specialists existed, but they were not all regarded as legitimate by biblical writers. However, it is probable that most patients availed themselves of whatever treatment they found accessible and affordable. In all biblical periods the family was probably the main caretaker of the ill (2 Sam. 13:5-6; Matt. 8:14).

The best medical technology (e.g., scalpels, forceps, dental drills, and splints) may have helped only simple problems (e.g., extraction of lodged weapons). In general, trauma (from accidents, strife), malnutrition, and disease limited life expectancy to under 40 years during the biblical periods.

The study of health care is an increasingly promising avenue of research in biblical scholarship, especially as it becomes more apparent that health care issues shape and are shaped by religion. Attention is due the role of health care consultants in ancient Israel and the role of health care in the rise of Christianity, as also the integration of medical anthropology, sociology, and biblical studies.

Bibliography. H. Avalos, Illness and Health Care in the Ancient Near East. HSM 54 (Atlanta, 1995); F. H. Cryer, Divination in Ancient Israel and Its Near Eastern Environment. JSOTSup 142 (Sheffield, 1994); G. Majno, The Healing Hand: Man and Wound in the Ancient World (Cambridge, Mass., 1975); J. Preuss, Biblical and Talmudic Medicine (1978, repr. Northvale, N.J., 1993); K. Seybold and U. B. Mueller, Sickness and Healing (Nashville, 1978); J. Zias, “Death and Disease in Ancient Israel,” BA 54 (1991): 146-59.

Hector Avalos







Eerdmans Dictionary of the Bible (2000)

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