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.

Biblical references to the face are both literal and metaphorical. The Hebrew word for “face” (paneh) frequently occurs in the plural in the OT (over 2,100 times), and it can express the numerous features of the face, that of God, humans, animals, and inanimate objects. It also can describe a surface, such as “the face of the ground” (Gen. 2:6 KJV) or “the face of the deep” (Gen. 1:2 KJV).

The concept of face must be understood in terms of the diverse emotional expressions and stratified social relationships of the biblical social world. This was a world of honor and shame, loyalty and betrayal. Where the modern person speaks of personal empowerment, the biblical person thought of social restoration. Life was tantamount to social acceptance. In the biblical world of strong corporate solidarity, the face was the most important part of a person’s body. Persons did not merely “contact” each other; rather, faces engaged each other. Face was synonymous with person (e.g., Lev. 19:32, where “the aged/elderly” is literally “the faces of the aged/elderly”). The face essentially describes interpersonal relationships.

Presence and nonpresence are noted in the expressions “hiding the face from” (Ps. 27:9) and “seeing the face of” (Gen. 32:20 KJV). These denote qualities of relationship through acceptance or rejection, especially to superiors. To “see someone’s face” who is a dignitary is to be granted a royal audience (Gen. 44:23). Yet it was not customary to show a sad face in a king’s presence (Neh. 2:2). A person could also try to hide his or her identity, since “face” marks a public expression of one’s character and social standing.

To literally “fall on the face” (Ezek. 1:28; Luke 5:12) shows humility and homage toward a superior. Personal intention or determination is shown in the expressions “set the face against/toward” (Ezek. 35:2) and “turn the face” (2 Kings 20:2). Dishonor and disrespect are expressed with a “fallen face” (Gen. 4:6; NIV: “downcast” face; cf. Gen. 40:7). Striking the face can be an act that humiliates (John 18:22), as with mutilation or having a soiled face (Lev. 21:18; 2 Sam. 19:4–5). By contrast, to speak “face to face” (Exod. 33:11) not only shows respect but also treats another as a social equal. Reflecting rich emotions, a face can be “cheerful” (Prov. 15:13), “aflame” with agony (Isa. 13:8), “red with weeping” (Job 16:16), and covered with “shame” (Ps. 69:7).

“Face” can be used as a metonym (i.e., substitution) for a person’s presence. Significantly, God’s rejection of a person or group can be expressed as them being hidden from his face (Gen. 4:14 KJV) or as God hiding his face from them (Isa. 54:8; Mic. 3:4; cf. Ps. 22:24). Those in distraught prayer ask why God has hidden his face (Job 13:24) or for how long (Ps. 13:1). Similarly, God acts against persons when he sets his face against them (Lev. 17:10; 26:17).

Believers anticipate the day when they will see God “face to face” (1 Cor. 13:12), having received the ultimate gift of God’s acceptance.

Referring to sickness or weakness, the word “infirmity” occurs most often in the KJV. The term appears far more frequently in the NT than in the OT. In the Gospels, the sense of physical sickness is arguably always in view (e.g., Matt. 8:17; Luke 5:15; 8:2; 13:11–12; John 5:5), but in the Epistles, where “infirmity” occurs rarely outside the KJV, the idea of weakness is most common (e.g., Rom. 6:19; 8:26; 2 Cor. 11:30; Heb. 4:15).

Referring to sickness or weakness, the word “infirmity” occurs most often in the KJV. The term appears far more frequently in the NT than in the OT. In the Gospels, the sense of physical sickness is arguably always in view (e.g., Matt. 8:17; Luke 5:15; 8:2; 13:11–12; John 5:5), but in the Epistles, where “infirmity” occurs rarely outside the KJV, the idea of weakness is most common (e.g., Rom. 6:19; 8:26; 2 Cor. 11:30; Heb. 4:15).

(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.

(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).

The desire to harmonize the differences between the canonical Gospels can be traced back to the second century, when Tatian (a second-century apologist) combined the four Gospels into one document known as the Diatessaron (Greek for “out of four”). This combined Gospel was used in the Syrian churches in the third and fourth centuries until it was replaced by the four canonical Gospels in the fifth century.

Material Common to More than One Gospel

All four Gospels portray Jesus as leading a group of disciples, preaching, healing, performing miracles, being crucified, and being raised from the dead. Matthew was written for a Jewish or Jewish Christian audience, reminding them that Jesus fulfills the Hebrew Scriptures. Mark was written for a Gentile audience, focusing more on narrative than on teaching and portraying Jesus as a man of miraculous, powerful action. Luke shows Jesus as one who is especially concerned for the poor and those on the fringes of society. John explains that Jesus, the eternal Word of God, is not a second god, but rather the one true God, sent by the Father to renew Israel.

People who are familiar with the content of the Gospel stories often confuse the information from different accounts. For example, there is actually no single story in the Bible about a “rich young ruler”: only Matthew describes the man as young (Matt. 19:20), and only Luke mentions that the man was a ruler (Luke 18:18).

Some material is found in all four Gospels, including information about John the Baptist, the miracle of the feeding of the five thousand, and the story of the crucifixion and the resurrection (although the individual accounts of the resurrection differ). Some material appears in three Gospels, especially in Matthew, Mark, and Luke. These three Gospels have therefore been labeled the “Synoptic Gospels” (syn = together, optic = view). Stories found in all three Synoptic Gospels include the transfiguration (Matt. 17:1–13; Mark 9:2–13; Luke 9:28–36); the healing of Jairus’s daughter and of a woman with a flow of blood (Matt. 9:18–26; Mark 5:21–43; Luke 8:41–56); and the rich young ruler (Matt. 19:16–30; Mark 10:17–31; Luke 18:18–30). The details do not agree in every respect in each account, but clearly they represent the same story and exhibit linguistic dependence on the same source(s).

A significant amount of material appears in two of the four canonical Gospels. Matthew and Mark have the story of a Syrophoenician woman (Matt. 15:21–28; Mark 7:24–30), and both Mark and Luke tell the story of a widow’s offering to the temple treasury (Mark 12:41–44; Luke 21:1–4). The most significant body of teachings and sayings found in two Gospels is the material shared by Matthew and Luke. Each of the Gospels contains material that does not appear in any other Gospel. Mark has the smallest amount of such material, John the largest.

The Gospel of John and the Synoptic Gospels

Based on a study of the material common to more than one Gospel, and the material unique to one Gospel, John’s Gospel usually is seen as distinct from the other three. The most likely explanation for this is that John was written later, with knowledge of the other Gospels, and therefore the author saw no need to repeat most of this material (except what was central to his purposes). Some of the distinctive features of John’s Gospel are the use of terminology such as “love,” “light,” “life,” “truth,” “abide,” “knowledge,” “world,” and the “I am” statements. Furthermore, certain Synoptic terms are either rare or absent—for example, “kingdom,” “demons,” “power,” “pity,” “gospel,” “preach,” “repent,” “parable,” “tax collector.” More so than the Synoptics, John is written from the vantage point of the resurrection and with the aid of hindsight as well as the Spirit. This is why the author of John’s Gospel does not refrain from adding commentary to Jesus’ words (e.g., 2:21–22; 7:39; 11:51–52; 12:16).

The Synoptic Gospels are more interrelated. In passages that appear in these three Gospels, there is often very close verbal agreement between them (e.g., the healing of the leper [Matt. 8:2; Mark 1:40–44; Luke 5:12–14]; the question of Jesus’ authority [Matt. 21:23–27; Mark 11:27–33; Luke 20:1–8]), implying a common source. In many sections that are found in all three Synoptic Gospels, two agree extensively and the third diverges (e.g., Matt. 20:24–28 and Mark 10:41–45 against Luke 22:24–27). When two Gospels agree and one disagrees, Matthew and Mark often agree against Luke, and Luke and Mark often agree against Matthew; but Matthew and Luke do not often agree against Mark and never do so in regard to the order of material. At other points, the Gospel accounts diverge quite significantly when referring to the same events. The infancy narratives in Matthew are quite different from those in Luke. The two accounts of the parable of the wedding banquet (Matt. 22:2–14; Luke 14:16–24) differ so significantly that it is difficult to decide whether they are two versions of the same parable or two different stories. Reports on the resurrection diverge across all four Gospels.

It is possible that these similarities and differences can be traced back to the oral presentation of the gospel. Apostolic preaching would have formed itself into set ways of retelling the events of Jesus’ ministry through repetition. These accounts may have been told originally in Aramaic before being translated into Greek to facilitate the Gentile mission. The authors of Matthew, Mark, and Luke could have been drawing from this common tradition in writing their Gospels. There is probably a degree of truth to this theory, but it cannot explain all the data. The theory does not account for similarities and differences in the order of events, nor does it explain why Matthew and Luke always return to Mark’s order after they deviate from it. A common oral tradition does not adequately explain similar editorial comments (e.g., cf. Matt. 24:15 with Mark 13:14), which suggest a common written source.

Some have argued that the apostles or others wrote records of the words of Jesus (memorabilia), which were collected and written down topically, from which the Synoptic Gospels were composed. As the church grew numerically and geographically, various collections of these memorabilia were made. Again, this is not beyond the realm of possibility; however, working against this theory is the complete absence of any reference to such records. Furthermore, as with the oral theory, it does not explain agreement in the order of material. It does, however, highlight the probability that the evangelists were using written sources.

Markan Priority and Q

On the assumption that the writers of the Synoptic Gospels employed a written source(s), several scholars have tried to reconstruct this original written Gospel from the material in the Synoptic Gospels. This document, which scholars call the Urevangelium (German for “original Gospel”), ended up bearing very close similarities with the Gospel of Mark. This is not surprising, since nearly all of Mark is repeated in Matthew and Luke. This led to the belief that Mark was the most primitive Synoptic Gospel, and that it was a common source for Matthew and Luke.

This belief in Markan priority, which has gained increasing popularity since the nineteenth century, has helped explain the similarities among the Synoptic Gospels. Traditionally, Matthew was thought to be the first Gospel to be written, hence the order of the Gospels in our NT. This belief in Matthean priority was upheld by several early church writers such as Augustine, who saw Mark as an abridgement of Matthew (Cons. 1.2). Augustine may have been more influenced by the traditional ordering of the Gospels than by an analysis of the Gospels themselves. Mark’s Gospel does not read like an abridgement; it is the shortest Gospel, but individual sections of it typically are longer and more detailed than in Matthew.

There are many reasons why the priority of Mark is probable. It is the shortest Gospel, containing 661 verses, whereas Matthew contains 1,068 and Luke contains 1,149. When their content is compared, 97.2 percent of Mark is paralleled in Matthew, and 88.4 percent of Mark is paralleled in Luke. It is easier to understand Matthew and Luke as using Mark and choosing to add additional material to it than to think of Mark as using Matthew, Luke, or both and deciding to omit material such as the birth narratives and the Sermon on the Mount. Mark has simpler Greek, which includes an extensive use of the present tense, redundancies (e.g., Mark 1:32: “that evening after sunset”; cf. Matt. 8:16: “when evening came”; Luke 4:40: “at sunset”), and various colloquialisms (e.g., the word for “mat” in Mark 2:4). Mark alone among the Gospels uses Aramaic terms such as abba (14:36), talitha koum (5:41), and ephphatha (7:34), although Matthew also mentions Eloi, Eloi, lama sabachthani (Matt. 27:46; Mark 15:34). It is easier to see how Luke and Matthew would have “improved” Mark than the reverse.

If we accept the priority of Mark, and Luke and Matthew’s dependence upon it, there are still the sections of Matthew and Luke that bear strong similarities with each other. From an analysis of the text of Matthew and Luke, it appears that these two evangelists did not know each other’s works. If one knew of the other’s work, why the divergence in some material such as the birth narratives? Alongside this, however, there are close similarities in other material: Matthew has 4,290 words that have parallels in Luke but not in Mark, and Luke has 3,559 words that have parallels in Matthew but not in Mark. The solution appears to be that Matthew and Luke were dealing with some material that they held in common, and that each of them also had other material that he drew on independently. The material held in common is commonly called “Q” (from the German word Quelle, meaning “source”); the material unique to Matthew is called “M” and that which is unique to Luke, “L.” Whether Q was a document is unknown, although it is more likely to be a collection of sources, as is also the case with M and L.

Many scholars argue that Q was a written rather than an oral source, based on the exact word parallels in the Greek text (e.g., Matt. 6:24 and Luke 16:13, where 27 of the 28 words are exactly the same). The presence of doublets (double accounts of the same incident) in Matthew and Luke may show dependence by the respective evangelists on both a Markan and a Q source (e.g., Luke 8:16; cf. Mark 4:21; Luke 11:33; cf. Matt. 5:15). Some scholars have tried to explain the sources geographically: Markan material originated in Rome, Q material in Antioch, M in Jerusalem, and L in Caesarea, but such speculations are far from proven.

Summary

Within all of this, in seeking to understand the harmony of the Gospels, it is important to be aware of what we do not know. Many of the solutions focus on a history behind the text to which we do not have access. Modern literary critics have tended to focus more on the text itself than its prehistory. There is merit in this because it affirms the priority of the text and allows the reader to understand how a part of the text functions within the larger literary unit. It also allows the evangelists to be more than collectors of sources, to have written distinctive theological accounts. Their different emphases may explain some of the differences between the Gospels. This approach, however, also has its dangers. Some who focus on the text over its original intent distance the text from the author’s purpose and therefore open the door for subjective interpretations that deny the difference between a correct and an incorrect reading of the text. It also raises the danger of reading an ancient text through modern eyes, losing sight of the original context.

The church has been well served by four Gospel traditions. The fact that esteem for the text has stopped overharmonization has been of great benefit, as the readers of the Gospels can appreciate various hues and emphases between the different accounts of the ministry of Jesus.

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).

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.

Those who offer themselves freely and willingly, without compulsion or consideration of value in return, to perform a task, make a vow, or serve another. In the OT, volunteers usually serve God (Deut. 23:23; 2 Chron. 17:16; Ps. 110:3), Israel (Ezra 7:13; Neh. 11:2), or a leader in Israel (Judg. 5:2, 9; 1 Chron. 28:21). God himself is the ultimate volunteer, as he freely gives place, purpose, and a partner to Adam (Gen. 2:15–22); unilaterally covenants with Abram to give him descendants, blessing, and land (Gen. 12:2–3; 15:17–21); liberates Israel from bondage in Egypt (Exod. 6:6–8; Deut. 20:1; Josh. 24:17; Ps. 81:10); and remains faithful to Israel despite its repeated failures (Pss. 68:35; 106:44–46).

In the NT, God is also the sender of Jesus (Matt. 10:40; Mark 9:37; Luke 4:18–21; John 4:34; 5:24, 30, 36–37), who heals of his own volition (Luke 5:13), gives rest to the weary (Matt. 11:28), and lays down his life of his own accord for our redemption (Mark 10:45; John 10:18; Gal. 3:13–14; Eph. 5:2; Titus 2:14; 1 Pet. 1:18–19). With Jesus as the standard, the concept of willingly giving of oneself and one’s possessions runs throughout the NT (Eph. 5:1–2). Christians are called to love and serve one another in spiritual and practical ways (Acts 2:44–45; Rom. 12:9–21; 1 Thess. 5:15–18; Philem. 14). They are also to love their enemies and pray for their persecutors (Matt. 5:44; Luke 6:27, 35). Those who wish to lead must first volunteer themselves as servants to others (Matt. 20:27; Mark 9:35; Luke 22:26). Elders are to shepherd voluntarily (1 Pet. 5:2). Paul, who urges Christians to offer their bodies as living sacrifices (Rom. 12:1), is himself a model of volunteerism and self-sacrifice (Acts 20:34–35; 21:13; 1 Cor. 9:19–23; 2 Cor. 4:5; 11:23–27).