A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

It is important to distinguish biblical leprosy, which was primarily a discoloration of the skin, from Hansen’s disease, what we today call “leprosy.” Lepers were ritually impure, which caused them to be ostracized by other Israelites and banished from God’s presence (Lev. 13:45–46). They were one of three types of people who were to be excluded from the camp of Israel (Num. 5:1–4). Moderns are slow to draw a correlation between physical illness and moral failure, but the ancients rarely made a distinction between the aesthetic and the moral: ugly is evil, beautiful is good. The leper’s physical deformation would have been perceived by many as the outworking of a moral flaw. Some believed that leprosy was God’s judgment for slander. God judged Miriam with leprosy (Num. 12:10). God healed Naaman from leprosy through Elisha (2 Kings 5:1–14). Jesus cleansed several people from leprosy (Matt. 8:1–4 pars.; Luke 17:11–19). Of special significance is his willingness to touch the leper, which, were it not for the emanating purity of the Holy Spirit, would have rendered him impure. But instead the leper was purified.

To pity someone is to feel or express compassion toward that person. Of the two main Hebrew verbs translated “pity,” khus describes an attitude of merciful kindness toward a person (Deut. 25:12), and khamal refers to sparing someone from something negative (Lam. 2:2). When khus and khamal occur in the same sentence, the NIV generally translates them “pity” and “spare” respectively (e.g., Deut. 13:8; Ezek. 7:4). The Greek eleeō can also be translated “to have mercy” (Luke 17:13 NASB), while splanchnizomai graphically depicts compassion (Luke 10:33), as splanchna, from which splanchnizomai is derived, is the Greek word for “intestines” (compare English: “My heart goes out to you”).

Most often, when “pity” occurs in the Bible, lack of pity is under discussion. The Israelites were to show no pity to the Canaanites (Deut. 7:16), nor were they to pity those who violated the Mosaic law (Deut. 19:21; 25:11–12). God repeatedly warned the Israelites that he would show them no pity when he judged them (Isa. 9:17; Jer. 13:14; Ezek. 7:4). However, God does express pity (Ezek. 16:5–6; Zech. 8:14–15), particularly through Jesus Christ (Matt. 18:27; Mark 9:22; Luke 17:13–14) and Christians (1 John 3:17).

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

In the Bible, gestures are made with either parts of the body or items, such as clothing and rings, directly connected to the body. For this reason, it makes sense to classify biblical gestures in relation to the different body parts that are identified with the gestures. It is, however, challenging to know where to draw a line on classifying a gesture. For example, a devious person is described in Prov. 6:13 as one “who winks maliciously with his eye, signals with his feet and motions with his fingers.” It is unclear whether this is a single gesture or multiple ones, and whether all signify different things or the same thing.

Head

Gestures that relate to the head range from simple head motions to semiviolent acts such as hair pulling. Simple head motions include lifting of one’s head in honor (Gen. 40:13), bowing one’s head in mourning (Ps. 35:14), tossing one’s head in mockery and derision (2 Kings 19:21), and shaking one’s head as insult (Ps. 22:7; Mark 15:29).

A common action is the shaving of the head, which can be for purification (Lev. 14:8–9; Num. 6:9; 8:7 [includes all body hair]), mourning (Deut. 21:11–13; Job 1:20; Isa. 15:2; Jer. 16:6; 47:5; 48:37; Ezek. 27:31; Amos 8:10; Mic. 1:16), remorse (Jer. 41:5), or shaming (Jer. 2:16). However, priests are forbidden from shaving their heads even in mourning (Lev. 21:5; Ezek. 44:20), while the high priest is to wear a turban on his head during sacrificial duties (Exod. 29:6).

Anointing of the head is done when a priest or king is installed (Exod. 29:7; Ps. 23:5) or simply as a sign of God’s goodness and blessing on a person (Eccles. 9:8). Blessing may also involve placing a hand on the head of the person being blessed (Gen. 48:14–18; Exod. 29:19), while the same gesture on the head of sacrificial animals is a symbolic means of transferring sin (Lev. 3:2, 8, 13; 4:4, 15, 24, 29, 33; 8:18, 22).

In the OT, a woman’s head can be shaved in mourning (Deut. 21:12–13; cf. Jer. 47:5), but in the NT, a shaved head can be a cause for disgrace (1 Cor. 11:5–6).

Face. Facial gestures range from expressions to actions such as touching or covering the face. A face can be downcast in anger (Gen. 4:5–6) or bowed to the ground in honor (Gen. 48:12), in dejection (Josh. 7:6), in humility (Ruth 2:10), in worship (2 Chron. 20:18; Ps. 138:2), in subjection, supplication, reverence (1 Sam. 20:41; 25:41; 28:14; 2 Sam. 14:4, 22; 18:28; 24:20; 1 Kings 1:23; 1 Chron. 21:20), or in dread (e.g., Moses before Yahweh [Exod. 3:6]).

The face can be covered or veiled as an indication of uncleanness (Lev. 13:45), in grief/mourning (2 Sam. 19:4; Ezek. 24:17), in resignation (1 Kings 19:13), with intent to deceive in adultery (Job 24:15), or in horror of judgment (Esther 7:8; Ezek. 12:6, 12). It can also be buried in the dust in remorse (Lam. 3:29).

God can be described as hiding or turning away his face against wickedness and evil (Deut. 31:18; 32:20; Ps. 34:16; Isa. 8:17; Jer. 33:5; Ezek. 7:22; 15:7; 20:46; 21:2) or in an act of withholding blessings (Job 13:15; Pss. 10:1; 13:1; 27:9; 30:7; 34:16; Isa. 54:8; 59:2; 64:7). God can also turn his face toward a place in judgment (Ezek. 4:3, 7; 6:2). In 1 Sam. 5:3–4 the idol of the Philistine god Dagon falls facedown before the ark of the covenant, apparently overpowered by Yahweh.

Acts of humiliation or dishonor can involve spitting in the face (Num. 12:14; Deut. 25:9; Job 17:6; 30:10; Isa. 50:6), slapping the face (1 Kings 22:24; 2 Chron. 18:23; Job 16:10; Lam. 3:30; Mic. 5:1), pulling a skirt up over someone’s face in shaming judgment (Jer. 13:26; Nah. 3:5), and hooking and dragging someone by the nose (2 Kings 19:28). Although being struck on the cheek is humiliating, Jesus instructs his disciples to “turn the other cheek” as a sign of resistance to violence (Matt. 5:39; Luke 6:29).

One can lift one’s face in worship (2 Kings 20:2; Job 22:26; Isa. 38:2) or in confidence (Job 11:15) and can fail to lift it in shame and disgrace (Ezra 9:6). Although the shaving of beards in mourning is common practice (Ezra 9:3; Isa. 15:2; Jer. 41:5; 48:37), the forced shaving of beards is an act of shaming and insulting (2 Sam. 10:4; 1 Chron. 19:4–5; Isa. 7:20; 50:6).

Eyes. Winking the eye is perceived as an evil, deceptive, or malicious act (Ps. 35:19; Prov. 6:13; 16:30). Eyes can be lifted up in worship and expectation (Pss. 121:1; 123:1).

Mouth. Pursed lips can characterize an evil person (Prov. 16:30), while a hand can be clapped over the mouth in awe and submission (Job 21:5; 40:4). Psalm 72:9 looks to the righteous king before whom the desert tribes will bow and whose “enemies lick the dust” in defeat.

Ears. An Israelite slave for life is to have a hole punched through his or her earlobe, held against a doorpost, with an awl (Exod. 21:6; Deut. 15:17). Blood is sprinkled on the lobe of the right ear for purification (Exod. 29:20; Lev. 8:23–24; 14:17), while supplication can be described as asking for the turning of an ear (2 Kings 19:16; Ps. 31:2). Turning one’s ear signifies paying attention or taking something to heart (Ps. 49:4; Prov. 4:20; 5:13).

Neck. The neck can be adorned (Song 1:10) as a sign of pride and honor (Gen. 41:42; Judg. 5:30; Prov. 1:9; Ezek. 16:11) or outstretched in arrogance (Ps. 75:5 TNIV: “Do not lift your horns against heaven; do not speak with outstretched neck”). Jeremiah put a yoke on his neck as a prophetic sign of the approaching Babylonian conquest (Jer. 27–28). While putting someone’s neck in a yoke is an act of triumphal conquest (Ps. 105:18), stepping on the neck of a subdued enemy is an act of subjugation and humiliation (Josh. 10:24).

Body

Nakedness in public is considered shameful (Gen. 9:22–23; Nah. 3:5; Rev. 3:18), so that it is sometimes pictured as part of divine judgment (Deut. 28:48; Isa. 47:2–3; Lam. 1:8; Mic. 1:11) or as a sign of promiscuity (Isa. 57:8; Ezek. 16:36). An unkempt body can be a sign of mourning, as it is for Mephibosheth (2 Sam. 19:24). A certain kind of body covering is a sign of marriage proposal or protection (Ezek. 16:8; 23:18; Hos. 2:9). Body dismembering, even in war, is an act of humiliation (2 Sam. 4:12).

Chest. In self-mortification, one can pound one’s chest in mourning (Ezek. 21:12) or in remorse (Jer. 31:19; Luke 18:13). The breasts of sacrificial animals are waved before God as a “wave offering” before being eaten (Exod. 29:26; Lev. 7:30; Num. 6:20).

Hand, arm. Hand gestures include motions such as lifting hands in worship, clapping hands in joy, and clapping a hand over one’s mouth in awe. The expression “outstretched arm” (Exod. 6:6; Deut. 4:34; 5:15; 7:19; 9:29; 11:2; 26:8; 1 Kings 8:42; 2 Kings 17:36; 2 Chron. 6:32; Ps. 136:12; Jer. 21:5; 27:5; 32:17, 21; Ezek. 20:33–34) indicates power, might, strength. It is often used of God to indicate his ability to defeat powerful armies and enemies. God is implored by the psalmist to lift his hand and act for the sake of the righteous (Ps. 10:12).

Since the right hand is the hand of power, the act of sitting at the right hand indicates being favored (1 Kings 2:19; Ps. 110:1; Matt. 22:44; Mark 12:36; Luke 20:43; Acts 2:35; Heb. 1:3; 8:1; 10:12; 12:2; 1 Pet. 3:22). When taking an oath, one places a hand under the thigh/crotch (Gen. 24:2; 47:29), most likely the right hand (see Gen. 48:14, 17–18; Lev. 8:23; 14:14).

Clapping the hands can be a sign of awe (Ezek. 6:11), malice, or remorse (25:6), while a bared arm can be a sign of judgment (4:7). Job claps his hand over his mouth in awe of God and in submission and repentance (Job 40:4–5).

Hands can be lifted in worship (1 Kings 8:22; 1 Tim. 2:8), to beseech (Ps. 28:2), to protect and bless (Ps. 10:12), in an oath (Deut. 32:40), or to harm (Exod. 24:11; 1 Sam. 24:6, 10; 2 Sam.1:14; 18:12).

Pilate washes his hands to proclaim his innocence over the death of Jesus (Matt. 27:24), while 1 Pet. 5:6 urges believers to humble themselves “under God’s mighty hand,” so that in due time they will be lifted up.

Buttocks. Exposure of the buttocks can serve as a humiliating insult and provocation, as happens to David’s men (2 Sam. 10:4; 1 Chron. 19:4) and Egyptian and Cushite captives (Isa. 20:4).

Leg. The leg or thigh is often a euphemism for the male reproductive organs, so that putting one’s hand under a thigh in oath (Gen. 24:2; 47:29) may involve actually grabbing the genitalia. Animal thighs are waved to God in offering before being consumed (Lev. 9:21; 10:14; Num. 6:20), while oaths administered to uncover adultery cause a guilty woman’s thighs to waste (Num. 5:2–27).

The most common gesture involving the knee is bowing, in worship or reverence (Deut. 33:3; Isa. 45:23; Rom. 11:4; 14:11; Phil. 2:10), in defeat (2 Sam. 22:40; Ps. 18:38; Isa. 60:14), in distress (Ps. 57:6), or in respect (1 Kings 1:31). In what seems to be a somewhat awkward position, Elijah puts his face between his knees in prayer (1 Kings 18:42).

Feet. Gestures involving the feet are probably the most common gestures in the Bible. Feet can be washed in hospitality (Gen. 18:4; 19:2; 24:32; 43:24; 1 Sam. 25:41), in ablution (Exod. 30:19, 21; 40:31), or in supplication (1 Sam. 25:41). Feet can be bathed in oil as a blessing (Deut. 33:24), uncovered in marriage proposals (Ezek. 16:8; cf. Ruth 3:4, 7), and stamped in remorse (Ezek. 25:6), and sandals can be removed from them in honor (Exod. 3:1–10) or disgrace (Deut. 25:9). The heavenly seraphs cover their feet in supplication before the throne of God (Isa. 6:2), while the feet of humans can signal deception (Prov. 6:13).

Enemies can be placed under one’s feet in subjugation (1 Kings 5:3; Pss. 8:6; 18:39; 45:5; 47:3; 110:1; Mal. 4:3; Rom. 16:20), have their feet shackled or ensnared (Job 13:27; 33:11; Pss. 25:15; 105:18), and be forced to lick the feet of victors in humiliation and defeat (Isa. 49:23). The righteous will bathe their feet in the blood of their enemies in revenge (Pss. 58:10; 68:23).

Those overwhelmed can grovel at the feet of the powerful (2 Kings 4:27, 37; Esther 8:3; Matt. 28:9; Mark 5:33; 7:25; Acts 10:25), while those emboldened can rise to their feet in confidence (Ezek. 2:1–2; 3:24; Dan. 8:18).

In the NT, dust can be shaken off one’s feet as an indication of divine judgment (Matt. 10:14; Mark 6:11; Luke 9:5), even as lying at a person’s feet is a recognition of authority/submission (Matt. 15:30; Mark 5:33; Luke 8:28, 35, 41, 47; 10:39; 17:16; Acts 4:37; 5:2). A woman publicly washes Jesus’ feet with her tears, wipes them with her hair, and kisses and perfumes them in what seems an act of love and repentance; but Jesus indicates that she has prepared his body for burial (Luke 7:38–46; John 11:2; 12:3). Jesus washes his disciples’ feet as instruction on servanthood and discipleship (John 13:5–14).

Fingers, Toes. Different fingers seem to have different roles assigned them. A finger sprinkles blood in cleansing (Lev. 4:6, 17, 25, 30, 34; 8:15; 9:9; 14:16; 16:14, 19; Num. 19:4), while blood on the tip of the right thumb and on the right big toe is for cleansing (Exod. 29:20; Lev. 8:23–24; 14:17, 25, 28).

One wears a signet ring as a sign of power (Esther 3:10) or a gesture of restoration and forgiveness (Luke 15:22). But fingers can also motion in deception (Prov. 6:13) or point in blame (Isa. 58:9). Jesus writes with his finger on the ground, apparently as a gesture of indifference to those pointing accusing fingers (John 8:6).

Clothes and Shoes

Garments. Garments attain significance as they are related to specific emotions. Wearing sackcloth and ashes in mourning is common (Gen. 37:34; Ezek. 7:18; 2 Sam. 3:31), while ripping garments in mourning is also frequently attested (Gen. 37:34; 44:13; Lev. 10:6; 21:10; Josh. 7:6; 2 Sam. 1:11; 3:31; 13:31; 1 Kings 21:27; 2 Kings 2:12; 19:1; Esther 4:1; Isa. 32:11; 37:1; Jer. 41:5).

Ripping someone’s clothing to expose nakedness (Ezek. 16:39; 2 Sam. 10:4) or pulling a person’s skirts up over the face (Jer. 13:26) is an act of shaming or insulting. But tearing one’s clothes off can be a sign of fury (Matt. 26:65). Persons with defiling diseases are expected to warn off others by wearing torn clothes and shouting, “Unclean! Unclean!” (Lev. 13:45).

By laying their clothes at Saul’s feet, the crowd may be acknowledging his authority in the stoning of Stephen (Acts 7:58).

Sandals. A woman can remove a man’s sandal in contempt (Deut. 25:5–10), while a sandal can be removed by a kinsman-redeemer to indicate giving up a right or as a transfer of property (Ruth 4:7–8). A sandal can also be removed in mourning (Ezek. 24:17) or be cast over a piece of land to claim ownership (Pss. 60:8; 108:9).

Prophetic Gestures

Prophetic gestures in the OT are mostly concerned with the call to repentance and approaching judgments upon failure to heed the warning. Jeremiah puts a yoke on his neck (Jer. 27–28; cf. Deut. 28:48), Ezekiel cooks with dung (Ezek. 4:12) and sleeps on his left side for 390 days and then on his right side for 40 days (4:5–6), Isaiah strips off his clothing (Isa. 20:2–3; 32:11), and Hosea marries an unfaithful wife (Hos. 1:1–3).

In the NT, Jesus cleanses the temple as an act of symbolic judgment (Matt. 21:12; Mark 11:15; John 2:15). He also breaks bread and drinks wine (Matt. 26:26; Mark 14:22; Luke 22:19; 24:30, 35; Acts 2:46; 20:11; 27:35; 1 Cor. 11:24–25) and washes his disciples’ feet (John 13:1–13), thereby establishing symbolic Christian practices.

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

Laying hands on someone/something has two literal uses and two with symbolic significance. (1) Literally, to take something (e.g., Exod. 22:8–11; Esther 9:10–16; Matt. 26:51; Luke 9:62) or someone—that is, to make an arrest (e.g., Neh. 13:21; Matt. 26:50; Mark 14:46; Luke 20:19; 21:12; 22:53; John 7:30, 44; Acts 4:3; 5:18; 12:1; 21:27). (2) Literally, to lay hands on persons (or things) so as to hurt or destroy them (e.g., Gen. 22:12; 37:22; 1 Sam. 22:17; 24:5–13; 26:9–23; Job 1:12; 9:33; Isa. 11:14; Jer. 15:6; Ezek. 39:21). (3) Laying a hand over one’s mouth as a symbolic gesture of amazement (Mic. 7:16) or humility (Job 40:4). (4) A gesture to symbolize the transfer of something from one person to another. Transfer symbolism applications include the transfer of representative identity in sacrificing (e.g., Exod. 29:10–19; Lev. 1:4; 16:21; Num. 8:10–12; 2 Chron. 29:23–24), of authority in commissioning (ordination) (e.g., Num. 27:18–23; Deut. 34:9; Acts 6:6; 13:3), of blessing (e.g., Gen. 48:13–20; Matt. 19:13–15), of life and health (e.g., Matt. 8:3, 15; 9:18, 25, 29; 20:34; Mark 6:5; 7:32–33; 8:22–26; 16:18; Luke 4:40; 7:14; 13:13; 22:51; Acts 8:17; 9:12, 17; 28:8), and of the Holy Spirit and spiritual gifting (Acts 8:17–19; 9:17; 19:6; 1 Tim. 4:14; 2 Tim. 1:6).

Three additional things should be noted about this transfer symbolism. First, the laying on of hands is symbolic rather than purely causative. This is evidenced when Jesus and the apostles credit faith, and not mere touch, for healings (e.g., Matt. 9:22, 29–30; Luke 17:19; Acts 3:12–16; 14:9; cf. Matt. 13:58), when healings occur from a distance (e.g., Matt. 8:5–13; 15:21–28; John 4:46–54) and/or with no apparent touch involved (e.g., Matt. 8:28–34; 9:1–8, 32–33; 12:22; 17:14–21; Mark 1:23–28; Luke 17:11–19; John 5:1–9; 11:1–44; Acts 5:15; 9:32–35, 40–41; 14:8–10; 16:18), when the Holy Spirit comes upon people without touch (e.g., Acts 10:44–45), and when Peter strongly rebukes Simon Magus for assuming that the Holy Spirit is dispensed by mere touch (Acts 8:17–24).

Second, the early church used the laying on of hands for commissioning church workers (Acts 6:6), missionaries (Acts 13:3), and elders (Acts 14:23 [the Greek word used for “appointing,” cheirotoneō, is derived from the words for “extend,” teinō, and “hand,” cheir; cf. 2 Cor. 8:19). Since the act was conducted by apostles (Acts 6:6), by prophets and teachers (Acts 13:1–3), by Paul and Barnabas (Acts 14:23; 2 Tim. 1:6), and by church elders (1 Tim. 4:14), we may conclude that the early church had no established hierarchy for ordination.

Third, the NT has some guidelines for commissioning Christian workers (cf. Heb. 6:2). Church leaders have weighty responsibilities (Acts 20:28; 1 Tim. 3:1–13; 5:17; Titus 1:5–9; 1 Pet. 5:1–4), so it is not surprising that a church elder/overseer must not be a recent convert (1 Tim. 3:6) or hastily ordained (1 Tim. 5:22), and that a deacon must first be tested (1 Tim. 3:10).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

(Disabilities; Disability; Deformity; Deformities; Sickness] The Bible often speaks of health, healing, disease, and illness. Good health was a sign of God’s favor, and healing was also the work of God and his divinely empowered agents. These agents included the prophets (1 Kings 17:8–23; 2 Kings 5:1–15), the apostles (Acts 3:1–10), and the messiah (Mal. 4:2). The divine prerogative of Jesus was to heal (Mark 1:32; 6:56; Matt. 4:23; 8:16; 15:30; 21:14; Luke 6:10, 17–19), and miraculous healings were a sign of his messianic office (Luke 7:20–23). Disease, on the other hand, was regarded as a sign of God’s disfavor. Within a covenantal context, God could send disease to punish the sinner (Exod. 4:11; 32:35).

The Bible assigns a wide variety of names to various diseases and their symptoms. These terms are nontechnical and generally descriptive. Some are uncertain in meaning. In most cases they describe the symptoms of the disease, not the disease itself. Diagnosis often was based on incomplete observation and nonclinical examination. The Bible also presupposes supernatural intervention in the life of a person. Healing occurred when God’s agents touched individuals, cast out demons, and resurrected the dead.

Ancient Near Eastern Influences

In the ancient Near East the knowledge of disease and medicine was precritical. Bacteria and viruses were virtually unknown. Mesopotamian literature contains many references to medicine, physicians, and medical practice. Minerals, salts, herbs, and other botanicals were used to make up treatments. Babylonian physicians also administered prescriptions accompanied by incantations. Disease was considered to be the result of a violation of a taboo or possession by a demon. The Code of Hammurabi (1750 BC) includes laws regulating the practice of medicine and surgery by physicians. In Egypt medicine and healing were connected to the gods. Tomb paintings and several papyrus documents describe the developing state of Egyptian medicine, pharmacy, and surgery.

Greek physicians admired and sought to learn the skills of the Egyptians. However, the early Greek doctor Hippocrates (460–370 BC), called the “Father of Medicine,” is credited with being the first physician to reject the belief that supernatural or divine forces cause illness. He argued that disease is the result of environmental factors, diet, and living habits, not a punishment imposed by the gods.

It is clear that the biblical world shared with the ancient Near East the same types of maladies common to tropical or subtropical climates. These include malaria, tropical fevers, dysentery, and sunstroke. The tendency of the hot climate to produce frequent droughts and famine certainly contributed to similar types of diseases throughout the Fertile Crescent. Additionally, it must be remembered that Palestine was a land bridge between the Mesopotamian and Egyptian worlds. Migrations carry not only goods and products, but also parasites, communicable disease, and epidemics.

Biblical Concept of Disease

The religious tradition of the Hebrews repudiated the magical or demonic origin of disease. Hence, moral, ethical, and spiritual factors regulated disease and illness. This was true for the individual as well as the community. The Hebrews, like the Egyptians, also recognized that much sickness arose from the individual’s relationship to the physical environment. Great stress was placed on hygiene and preventive medicine.

Pentateuchal legislation offered seven covenantal principles designed to prevent the possibility of disease and sickness: (1) Sabbath observance for humans, animals, and the land, which enforced regular periods of rest (Gen. 2:3); (2) dietary regulations, which divided food into efficient categories of clean and unclean (Lev. 11); (3) circumcision, which carried physical benefits as well as religious and moral implications (Gen. 17:9; circumcision is the only example of Hebrew surgery); (4) laws governing sexual relationships and health, including a list of forbidden degrees of marital relationships (Lev. 18–20); (5) provisions for individual sexual hygiene (Lev. 15); (6) stipulations for cleanliness and bodily purification (Lev. 14:2; 15:2); (7) sanitary and hygienic regulations for camp life (Num. 31:19; Deut. 23:12).

In NT times magical charms and incantations were used along with folk remedies in an effort to cure disease. Jesus repudiated these means. He also suggested that sickness and disease were not direct punishments for sin (John 9:2). In the Sermon on the Mount (Matt. 5–7), Jesus confirmed that the ethical and religious standards of the new covenant promoted the total health of the community and the individual.

Circulatory Diseases

Nabal most likely suffered a cerebrovascular accident or stroke (1 Sam. 25:36–38). After a heavy bout of drinking, his heart “died” (KJV; NIV: “failed”), and he became paralyzed, lapsed into a coma, and died ten days later. Psalm 137:5–6 may contain a clinical example of the symptoms of stroke. The psalmist wrote, “If I forget you, Jerusalem, may my right hand forget its skill. May my tongue cling to the roof of my mouth if I do not remember you.” This description points to a paralysis of the right side of the body (right hemiplegia) and the loss of speech (motor aphasia) that result from a stroke on the left side of the brain. Basically, the exiled psalmist is wishing upon himself the effects of a stroke if he held anything other than Jerusalem as his highest priority. Some have considered the collapse of Uzzah when he reached out to stabilize the ark of the covenant (2 Sam. 6:6–7) to be the consequence of an apoplectic seizure. But since no actual paralysis was described and death occurred immediately, this seems unlikely. It is more probable that God struck him down with an aortic aneurism or a coronary thrombosis.

Paralysis

A possible case of paralysis may be described in the shriveled (atrophic) hand of Jeroboam I (1 Kings 13:4–6). In an angry outburst Jeroboam ordered the arrest of a prophet who condemned the altar at Bethel. When Jeroboam stretched out his hand, it “shriveled up, so that he could not pull it back.” Several complicated diagnoses have been offered to explain the “withered” hand, but it is possibly an example of cataplexy, a sudden loss of muscle power following a strong emotional stimulus. After intercession by the man of God, and the subsiding of the emotional outburst, the arm was restored.

The threat against the faithless shepherd of God’s people (Zech. 11:17), which included a withered arm and blindness in the right eye, may refer to a form of paralysis known as tabes dorsalis, or locomotor ataxia. Knifelike pains in the extremities and blindness characterize this disease.

Paralysis is frequently mentioned in the NT (Matt. 8:6; 9:2, 6; 12:10; Mark 2:3–5, 9, 10; 3:1, 3, 5; Luke 5:18, 24; 6:6; John 5:3; Acts 9:33; Heb. 12:12). The exact diagnosis for each of these cases remains uncertain.

The physician Luke’s use of the Greek medical term paralelymenos (Luke 5:18, 24) suggests that some of these cases were caused by chronic organic disease. Others clearly were congenital (Acts 3:2; cf. 14:8). It is not necessary to rationalize the origin of these examples of paralysis as hysteria or pretense. The NT writers regarded the healing of these individuals by Jesus and the apostles as miraculous.

Mental Illness and Brain Disorders

Cases of mental disease are generally described in the Bible by noting the symptoms produced by the disorder. The particular cause of a mental illness in the NT is often blamed on an unknown evil spirit or spirits (Luke 8:2). Such spirits, however, were subject to God’s control and operated only within the boundaries allowed by him (1 Sam. 16:14–16, 23; 18:10; 19:9). Accordingly, in the OT “madness” and “confusion of mind” were regarded as consequences of covenantal disobedience (Deut. 28:28, 34).

It has been argued that King Saul displayed early indications of personality disorder. Symptoms included pride, self-aggrandizement (1 Sam. 11:6; 13:12; 15:9, 19), and ecstatic behavior (10:11–12). A rapid deterioration in Saul’s character transpired after David was anointed and became more popular (16:14; 18:10–11). Since Saul demonstrated fear, jealousy, a sense of persecution, and homicidal tendencies, some scholars argue that he suffered from paranoid schizophrenia.

Nebuchadnezzar suffered a rare form of monomania in which he lived like a wild beast in the field eating grass (Dan. 4:33). David, in order to save his own life, feigned insanity or perhaps epilepsy before the Philistine king Achish (1 Sam. 21:12–15).

In the NT, individuals with mental disorders went about naked, mutilated themselves, lived in tombs (Mark 5:2), and exhibited violent behavior (Matt. 8:28). Such mental disorientation was often linked to demon possession. Examples include the Syrophoenician’s child (Matt. 15:22; Mark 7:25), the demoniacs at Gerasa (Matt. 8:28; Mark 5:2; Luke 8:27) and Capernaum (Mark 1:23; Luke 4:33), a blind and mute demoniac (Matt. 12:22; Luke 11:14), and a fortune-telling slave girl (Acts 16:16). While such behavior is clinically suggestive of paranoid schizophrenia or other mental disorders, the mind-controlling influence of some extraneous negative force cannot be ruled out.

Epilepsy (grand mal) causes the afflicted person to fall to the ground, foam at the mouth, and clench or grind the teeth (Matt. 17:15; Mark 9:17–18; Luke 9:39). The description of Saul falling to the ground in an ecstatic state (1 Sam. 19:23–24) and Balaam falling with open eyes may be indicative of an epileptic seizure. In the NT, Jesus healed many who suffered from epilepsy (Matt. 4:24; 17:14–18; Mark 9:17–18; Luke 9:38–42). Some scholars have linked the light seen by Paul on the road to Damascus with the aura that some epileptics experience prior to a seizure. His subsequent blindness has also been attributed to the epileptic disturbance of the circulation of the blood in the brain.

Childhood Diseases

The cause of the death of the widow’s son at Zarephath is unknown (1 Kings 17:17–22). The death of the Shunammite woman’s son has been attributed to sunstroke (2 Kings 4:18–37), although a headache is the only symptom recorded (v. 19). In both cases there is too little evidence to present an accurate diagnosis.

In the first case, the boy at Zarephath stopped breathing (1 Kings 17:17). This may leave the door open to argue that Elijah resuscitated the child. However, in the second case, the text clearly states that the Shunammite boy died (2 Kings 4:20), implying a resurrection.

Infectious and Communicable Diseases

Fever and other calamities are listed among the punishments for covenantal infidelity (Deut. 28:22). Three different types of fever may be intentionally described here: “fever,” “inflammation,” and “scorching heat” (ESV: “fiery heat”). Fever is also mentioned frequently in the NT (Matt. 8:15; Mark 1:30–31; Luke 4:38–39; John 4:52; Acts 28:8). Both Jesus and Paul healed individuals who had a fever. A number of these fevers were likely caused by malaria, since the disease was known to be endemic to the Jordan Valley and other marshy areas in Palestine.

Several epidemics in which numerous people died of pestilence or plague are mentioned in the OT (Exod. 11:1; 12:13; Num. 14:37; Zech. 14:12). The fifth plague of Egypt (Exod. 9:3–6) has been attributed to Jordan Rift Valley fever, which is spread by flies. Bubonic plague has been blamed for the malady that struck the Philistines (1 Sam. 5–6). However, it may have been the result of a severe form of tropical dysentery. Acute bacillary dysentery contracted in the military camp may also have been responsible for the epidemic that killed a large number of the Assyrian army (2 Kings 19:35).

Parasitic Diseases

Some scholars have repeatedly argued that the “fiery serpents” (NIV: “venomous snakes”) encountered by Moses and the children of Israel (Num. 21:6–9) were in reality an infestation of the parasitic guinea worm (Dracunculus medinensis). Microscopic fleas ingested in drinking water carry the larvae of this slender nematode into the body. The larvae move from the digestive tract to the skin. The adult worm, which may grow to a length of several feet, discharges its eggs into an ulcer on the skin. Death of the host occurs because of the resulting infection of the skin ulcers.

After the conquest of Jericho, Joshua cursed the individual who would endeavor to rebuild the city (Josh. 6:26). Later, Hiel of Bethel attempted to rebuild the city and lost two of his sons as a result of the curse (1 Kings 16:34). Elisha was then asked to purify the bad water at Jericho in order to allow a new settlement (2 Kings 2:19). Elisha obliged by throwing salt into the spring and thereby making the water potable (2:20–22). Recent archaeological study has discovered the remains of certain snails in the mud-bricks used to construct Jericho in the Bronze Age. These types of snails are now known to serve as intermediate hosts for the flatworm parasite that can cause schistosomiasis. The Schistosoma haematobium trematode infects the urinary tract and the bladder. It is possible that this type of parasite was responsible for the death of Hiel’s two sons.

In NT times, Herod Agrippa apparently died of the complications of a parasitic disease, perhaps being infested by the larvae of flies (myiasis) in the bowels. Luke mentions that he was “eaten by worms” (skōlēkobrōtos [Acts 12:23]). The father of Publius also suffered from dysentery (Acts 28:8).

Physical Deformities and Abnormalities

Individuals with deformities were disqualified from priestly service (Lev. 21:18–20). The list included lameness, limb damage, and dwarfism. The deformities mentioned here might have been congenital or acquired. Mephibosheth was dropped by his nurse (2 Sam. 4:4) and perhaps suffered damage to the spinal cord. Jacob possibly sustained injury to an intervertebral disk (Gen. 32:32) causing a deformity and a limp. The woman who was “bent over” (Luke 13:10–17) might have suffered from an abnormality of the spine similar to scoliosis. It is difficult to ascertain the origin of the “shriveled hand” of the unnamed individual healed by Jesus (Matt. 12:10–13; Mark 3:1–5; Luke 6:6–10). It could be congenital in character or a paralysis caused by any number of factors.

Diseases and Disabilities of the Eyes and Ears

Physical blindness is mentioned several times in the Bible. Blindness excluded one from serving as a priest (Lev. 21:18, 20). Blindness and deafness, however, were disabilities requiring special care from the community (Lev. 19:14; Deut. 27:18). The “weak eyes” of Leah may refer to an eye condition (Gen. 29:17).

Blindness in the biblical world was caused by various factors. Leviticus 26:16 speaks of a fever that destroys the eyes. Flies probably were responsible for much of the conjunctivitis found in children. John 9:1 mentions congenital blindness, which Jesus cured using mud made from spittle and dirt (John 9:6). In Mark 8:22–26 Jesus healed a blind man by spitting in his eye and laying hands on him (cf. Matt. 20:34 with Mark 10:52).

Congenital deafness would also be associated with mutism and speech defects because a child learning to speak depends on imitation and mimicry. Jesus healed a man who was deaf and could barely talk (Mark 7:32–37). The man’s inability to say much possibly pointed to a loss of hearing early in life.

Skin Conditions

Various skin and hair abnormalities are described in the Bible. Some made the individual unclean (Lev. 13:30; 14:54). The OT speaks of “the boils of Egypt” (Deut. 28:27; cf. Exod. 9:9). Skin ailments included tumors, festering sores, boils, infections, and the itch (Deut. 28:27, 35; Isa. 3:7). Job complained of a litany of ailments: broken and festering skin (7:5), multiple wounds (9:17), black peeling skin and fever (30:30), gnawing bone pain (2:5; 19:20; 30:17), insomnia (7:3–4), and wasting away (33:21). These symptoms have been diagnosed as indications of yaws or eczema. A poultice made of figs cured Hezekiah’s boil (2 Kings 20:7).

Leprosy was once thought to be a common problem in the biblical world. Leprosy (Hansen’s disease) is a slow, progressive chronic infectious disease caused by a bacterium. Symptoms include loss of sensation and loss of parts of the body. Evidence for this type of disease in Palestine is rare. Uzziah may have had a true case of Hansen’s disease. He was quarantined until the day he died (2 Chron. 26:21).

Scholars now suggest that the symptoms of the disease described in the Bible do not fit this pattern and thus do not signify leprosy (Hansen’s disease) as it is known today. Instead, the word that English versions translate as “leprosy” (Heb. root tsr’) probably refers to different types of infectious skin disease, often characterized by a long-standing, patchy skin condition associated with peeling or flakiness and redness of skin. Evidence points more toward psoriasis, fungal infections, or dermatitis.

This disease could appear in humans (Lev. 14:2), on buildings (14:34), and on clothing (14:55). It was not limited to the extremities but could occur on the head (14:42–44). It could run its course quickly (13:5–8). It made the individual ceremonially unclean, but it was also curable (Lev. 14:3; 2 Kings 5:1–27). Individuals with the disease were not necessarily shunned (2 Kings 7; Matt. 26:6 // Mark 14:3). Moses (Exod. 4:6), Miriam (Num. 12:10), and Naaman experienced this type of skin disease (2 Kings 5:1–27). Jesus healed many suffering from skin ailments (Matt. 8:2–3; Mark 1:40–42; Luke 5:12–13), including the ten “men who had leprosy” (Luke 17:12–14).

Ailments of an Unknown Nature

Some cases in the Bible present insufficient evidence for scholars to render a clear diagnosis. King Asa suffered a disease in his feet (2 Chron. 16:12). However, in the OT the Hebrew expression for “feet” is sometimes used euphemistically for the sexual organs (Judg. 3:24 KJV). Because of this, the exact nature of the disease is ambiguous. Jehoram was afflicted with “an incurable disease of the bowels” (2 Chron. 21:18–19). Other unknown ailments factor in the deaths of the firstborn son of David and Bathsheba (2 Sam. 12:15), of Jeroboam’s son in infancy (1 Kings 14:17), of Elisha (2 Kings 13:14), and of Ezekiel’s wife (Ezek. 24:16).

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.

A holy God wants a holy people. He had described the nation of Israel as holy (cf. Exod. 19:5–6) but also wanted them to live holy lives and grow increasingly holy. Holiness came, in part, by keeping the law; an important part of the law was the concept of cleanness.

Old Testament

Since Israel could become holy only by being clean, it is no surprise that the law’s first mention of prohibited food is accompanied by a command to be God’s holy people (Exod. 22:31). Nor is it unexpected that when God explains the laws about clean and unclean food, he tells the Israelites twice to “be holy, because I am holy” (Lev. 11:44–47).

Cleanness (Heb. tahor) does not refer to good hygiene, nor is it synonymous with morality, since a person could be unclean and still righteous. Cleanness allowed the OT believer to live a holy life and enabled that person to be made increasingly holy by “Yahweh, your sanctifier” (NIV: “the Lord, who makes you holy,” Lev. 20:8; cf. 21:8, 15, 23; 22:9, 16, 32; 31:13). Before considering how ritual purity led to holiness, we should summarize the purity laws themselves.

Purity laws. Impurity traveled along four channels: sexuality (e.g., nocturnal emission, menstruation, childbirth), diet (e.g., eating certain types of animals), disease (e.g., skin diseases, mildew), and death (i.e., contact with animal or human corpses). Impurities occurring naturally and unavoidably in the course of life (e.g., menstruation) were tolerated, representing no danger to the person or community as long as they were promptly addressed. Other impurities had to be avoided at all costs or else grave consequences would result to the person and community.

Tolerated impurities. We can further divide tolerated impurities into minor and major. Minor impurities resulted from touching an animal carcass or touching someone with a major impurity. Minor impurities did not make one contagious and could be addressed simply. Major impurities resulted from touching a human corpse, having a skin disease, or experiencing a nocturnal emission or menstruation. With these, one became “contagious,” purification took longer, and a sacrifice was required.

In order to become clean, the contaminant must be removed, with removal occurring in different ways. Tolerated impurities were removed by washing (bathing, laundering clothes, and sprinkling with water). What could not be washed away must be physically taken away, whether through burial, burning, or removal from the camp (e.g., scapegoat; Lev. 16:20–22).

Cleansing took time; generally the more serious the impurity, the longer the time, from one day for those who touch a dead animal, up to eighty days following the birth of a female child. Some tolerated impurities required sacrifices, with the animal’s blood being sprinkled against the side of the altar and poured out at its base (Lev. 5).

Ritual actions might accompany the sacrifices. For example, a person who had been healed of a contagious skin disease was to bring two live, clean birds to the priest. One bird was to be killed and its blood mixed with water, which was then sprinkled on the person. The other bird was dipped into the blood/water mixture and released, symbolizing the removal of the uncleanness. In the ritual of the red heifer (Num. 19), a combination of water and ashes was used to purify those who had touched a corpse.

Impurities to be avoided. Unlike the tolerated impurities that could not be avoided, certain objects and actions were completely off-limits to the holy people of God. Intentional violation brought more serious consequences, even being “cut off” from the community. Although it is unclear exactly what it meant to be cut off—perhaps excommunication, capital punishment, vulnerability to an untimely death, loss of progeny, or separation from one’s ancestors after death—the threat was ominous.

One prohibited impurity arose from eating food declared off-limits by God. All meat had to be thoroughly bled before being eaten (Gen. 9:3–4; Lev. 17:10–14; Deut. 12:16, 23). Edible land animals must both have a completely divided hoof and chew the cud (Lev. 11:3; Deut. 14:6), while water creatures had to have both fins and scales (Lev. 11:9; Deut. 14:9). Most birds were acceptable for food (exceptions are given in Lev. 11:13–19; Deut. 14:11–18), as were most insects (Lev. 11:20–23; Deut. 14:19–20) and some crawling animals (Lev. 11:29–31, 41–42).

Other prohibited impurities included what might be more readily identified as sinful acts. Sexual immorality (Lev. 18:6–25), idolatry (20:2–5), consulting mediums (20:6), and murder (Num. 35:33–34) defiled people and land. If such offenses were not “cleansed,” God would judge, whether by natural disaster (Isa. 24:1–13) or exile (Isa. 64:6–7; Mic. 2:10).

Reasons for the laws. Why did God declare certain things clean and others unclean? Some suggest that the distinction is arbitrary; the rules are given as a test of obedience. Others argue that the original audience knew of reasons now lost to us. Still others believe that God was protecting his people from disease. It is true that certain kinds of meat improperly prepared can transmit disease, but not all laws can be explained this way. Some believe that God identified things as clean because they represented a state of normalcy (e.g., fish normally propel themselves with fins, so those lacking fins are abnormal and thus unclean). A related view considers things as clean or unclean based on what they symbolized. So, for example, God identified objects as unclean if they were associated with death (e.g., vultures, corpses) because he is for life. Here again, it is difficult to explain all the laws by appeal to normalcy or symbolism.

Cleanness and holiness. While we may not know for certain why God chose these particular laws, we can see how they helped his people become holy.

First, these laws made possible access to the sanctuary, where holiness could be expressed and developed. The law of Moses contains repeated and stern reminders that those who are unclean may not “go to the sanctuary” (Lev. 10:10; 12:4; 15:31; Num. 19:13, 20). Only the clean could approach a holy God and participate in the rituals that demonstrated and developed their holiness.

Second, these rituals also fostered holiness by teaching the Israelites about impurity. Israel’s neighbors associated impurity with demons, but God indicated that it would be an Israelite’s uncleanness, not demonic activity, that kept that person from living a holy life.

Third, these purity laws taught the Israelites about the holy God, whom they were to imitate. If even innocent and otherwise good experiences prevented their association with him, God must be very holy indeed. These laws also reinforced God’s authority over every aspect of their lives. He determined when they could come to the sanctuary, but also what they could eat and when they could have sexual intercourse. These laws also reminded Israel that it was this same God who had provided a way to be clean and thereby holy. Cleansing was costly and humbling, but it was possible, coming as a gracious gift from God.

Fourth, a very practical consequence of these laws was to keep the Israelites separate from their neighbors. Not only were the Israelites to avoid pagan practices (e.g., rituals associated with mourning the dead; Lev. 19:27), but also they were to limit social contact with their pagan neighbors. Laws governing what could be eaten and how those animals must be slaughtered would help see to that. God was concerned that his people not be corrupted by their neighbors (cf. Deut. 7:1–6; 14:1–3).

New Testament

Ceremonial cleansing appears in the opening chapters of the Gospels. Mary underwent the required purification rituals after Jesus’ birth (Luke 2:22–24), and Jesus “cleansed” people from leprosy, instructing them to carry out the Mosaic purification rituals (Matt. 8:2–4; Mark 1:40–42; Luke 5:12–14; 17:11–19; cf. Matt. 10:8; 11:5; Luke 4:27; 7:22).

In one of his confrontations with the Pharisees, Jesus signaled a departure from how these laws had been practiced. He announced, “Nothing outside a person can defile them by going into them. Rather, it is what comes out of a person that defiles them” (Mark 7:15), to which Mark adds an explanation: “In saying this, Jesus declared all foods ‘clean’ ” (7:19). Peter’s rooftop vision in Acts 10 reflects this same perspective, as do the church’s decision regarding Gentile conversion (Acts 15) and Paul’s comments to the church at Rome (Rom. 14:14, 20–21).

The NT identifies the church as God’s holy people, called to be holy as he is holy (1 Pet. 1:16). Holiness still required purity, now manifested more ethically than physically. That is, one became unclean through sinful actions such as lying (1 Thess. 2:3) and licentiousness (Eph. 4:19) rather than by, for example, contact with a corpse. In the OT, all Israel was declared holy but was to live out that holiness in daily life. Purity came through ritual actions such as sacrifice and washing, with the assistance of a priest. So it is in the NT, though the sacrifice is now the once-for-all offering of Christ on the cross (Heb. 9:13–14; 1 John 1:7) as applied in the waters of baptism (Eph. 5:26; 1 Pet. 3:21) and assisted by Jesus the great high priest and by the priesthood of believers (2 Cor. 7:1; Heb. 4:14; James 4:8; 1 Pet. 1:22). Thus purified, believers can go on to live holy lives and become increasingly holy. Although the Testaments differ on the causes and solutions for uncleanness, they agree that a holy people has always been God’s goal, and that cleanness is a means to that end.