THE BIBLE AND MEDICINE
Ahead of its Time
In the last century childbirth was hazardous, for even after the baby had been born and ‘both were doing well’ there remained a high risk that mothers would die subsequently from puerperal infection or ‘childbed fever’. Strangely, the risk seemed to be highest when mothers were attended not by a midwife, but by a consultant! In some hospitals, of every four mothers who entered, one would die from this disease.
Yet, the patients of one obstetrician, Philip Ignaz Semmelweis, had a very much higher chance of survival. Of his patients only about eight women in a thousand died, that is, less than 1%!!
What was his secret? It was very simple: Dr Semmelweis washed his hands!
Today we take it for granted that medical practitioners wash their hands before examining patients and again afterwards. Surgeons “scrub up” vigorously before they put on their sterile gloves.
But in the 19th century doctors usually went from the mortuary, after conducting a postmortem examination, or from the dissecting room after teaching students anatomy, straight onto their rounds of the hospital wards, hardly stopping to wipe their hands on their already soiled aprons.
Semmelweis realised that the doctors themselves were spreading the disease from the infected patients to the healthy ones. By simply washing his hands and thus curtailing the spread of the infection he was able to reduce significantly perinatal mortality.
When he used what today we would call an “antiseptic” solution, instead of soap, the results were even better.
For some time the medical profession did not accept his conclusion and he was ostracised. Eventually, he had to leave Vienna and practised in Budapest.
But time proved that he was right and Joseph, Lord Lister, the father of modern aseptic surgery confessed: “Without Semmelweis my achievements would be nothing. To this great son of Hungary, surgery owes most.”
Yet this apparently radical breakthrough in preventing the spread of infection was not so original as might at first be thought. For about three and half thousand years previously the Law of Moses had set provisions which, if they had been adopted in the last century, would have prevented this terrible and unnecessary toll of lives of young women. Three of them are particularly relevant.
Firstly there were provisions for preventing the spread of infection:
“When any man has a bodily discharge, the discharge is unclean… this is how his discharge will bring about uncleanness: Any bed the man with a discharge lies on will be unclean, and anything he sits on will be unclean. Anyone who touches his bed must wash his clothes and bathe with water, and he will be unclean till evening. Whoever sits on anything that the man with a discharge sat on must wash his clothes and bathe with water, and he will be unclean till evening. Whoever touches the man who has a discharge must wash his clothes and bathe with water, and he will be unclean till evening. If the man with the discharge spits on someone who is clean, that person must wash his clothes and bathe with water, and he will be unclean till evening… Anyone the man with a discharge touches without rinsing his hands with water must wash his clothes and bathe with water, and he will be unclean till evening.”
Prevention of the Spread of Infection
Although the word “unclean” primarily referred to the person’s religious status, it would also cover what we today would call “infectious”. The emphasis on washing contaminated clothing and bathing on the part of those tending the patient would ensure that the risk of spreading the infection would be minimised.
The reference to the need to avoid the spread of disease on infected hands and its prevention by rinsing in water seems particularly relevant to the Semmelweis case.
There are provisions for the return of the patient to the community after he is cured, including a seven day wait and further ablutions.
Secondly, the treatment of mothers who had just given birth is also covered in the Law.
“A woman who becomes pregnant and gives birth to a son will be ceremonially unclean for seven days…”Leviticus 12:2
This provision ensured that the woman would be regarded as potentially infectious and, if she proved to be, would give time for the disease to become evident.
Thirdly, the treatment of those who had come in contact with a corpse, either at autopsy or in anatomical teaching, is covered.
“Whoever touches the dead body of anyone will be unclean for seven days…” Numbers 19:11
Application of this law would mean that medical staff could not perform autopsies or dissect bodies and then go onto the wards. Had all these measures been applied then the chances of spreading childbed fever (or any other diseases) would have been minimal. Today we understand how infectious diseases are caused by bacteria and viruses which may be spread by physical contact. How did the ancient people of Israel “know” this, some 3,500 years ago? Why are so many of the provisions of the Law of Moses still relevant after all this time? In other words, how is it that the Bible was so much a book ahead of its time?
The explanation is given in the Bible itself:
“See, I have taught you decrees and laws as the LORD my God commanded me, so that you may follow them in the land you are entering to take possession of it. Observe them carefully, for this will show your wisdom and understanding to the nations, who will hear about all these decrees and say, ‘Surely this great nation is a wise and understanding people’…
And what other nation is so great as to have such righteous decrees and laws as this body of laws I am setting before you today? Only be careful, and watch yourselves closely so that you do not forget the things your eyes have seen or let them slip from your heart as long as you live. Teach them to your children and to their children after them.” Deuteronomy 4:5-9
Isolation and Quarantine
Before the last century the cause of infectious diseases was not understood. For example, malaria was thought to be caused by the vapours coming from lakes, ponds and ditches; hence the name, from the Italian Mal’aria, ‘bad air’. Now we know that it is caused by a microscopic organism spread by mosquitoes which breed in still water. The link with water was evident but the real cause was not understood. For most other diseases, the way in which disease-causing organisms (bacteria or viruses) were spread from infected individuals through the population as a whole was not appreciated.
Not only did the Law of Moses deal with the transmission of infectious disease but it also had provision for the isolation of infected individuals with contagious (and incurable) diseases.
“When anyone has… an infectious skin disease, he must be brought to… a priest… the priest is to put the infected person in isolation for seven days. On the seventh day the priest is to examine him, and if… unchanged… he is to keep him in isolation another seven days. On the seventh day, the priest is to examine him again, and… if the rash does spread in his skin after he has shown himself to the priest… it is an infectious disease.
… As long as he has the infection he remains unclean. He must live alone; he must live outside the camp.” Leviticus 13:2-8, 46
Note how the patient is isolated and checked again after seven days, just as patients today are told by their doctor – “come again and see me in a week’s time”- by which time it will be evident whether the problem is clearing up or whether it may be necessary to consign the patient to an indefinite quarantine. ‘Quarantine’ comes from the Italian word for 40, quaranta, that is, the number of days a ship carrying a sick crew was kept isolated offshore. By the end of this period they would be cured or dead!
Not so long ago ‘isolation hospitals’ were part and parcel of everyday life, established to try to reduce the spread and consequent mortality from infectious diseases such as scarlet fever and tuberculosis.
Even today it is necessary to consign some patients to an isolation ward in order to prevent the spread of certain diseases. Even more rigorous measures must be instituted for such diseases as Lassa fever and viral hepatitis for the protection of those who nurse and care for patients.
Although powerful drugs such as antibiotics are available in order to treat many infectious diseases, preventing the spread of infection through rigorous attention to washing at isolation still remains a very high priority in our highly technologically advanced hospitals. This has been particularly important since the advent in many hospitals of MRSA (methycillin resistant Staphylococcus aureus), a strain of bacterium which has acquired resistance to even the most powerful antibiotics.
The Law of Moses required rigorous procedure before a previously isolated person could be admitted back into the community, once it had been established that they were now cured.
“The person to be cleansed must wash his clothes, shave off all his hair and bathe with water; … After this he may come into the camp, but he must stay outside his tent for seven days. On the seventh day he must shave off all his hair; he must shave his head, his beard, his eyebrows and the rest of his hair. He must wash his clothes and bathe himself with water, and he will be clean.” Leviticus 14:8-9
These provisions would ensure that any premature return could be detected and by removing all the hair, any small area of residual infection would become evident. Once it was certain that the person was fully cured, the final shaving and washing would eliminate any remaining bacteria. These measures are followed by presentation before the priest who would make a final check before pronouncing the person clean and making the prescribed offerings.
One of the major scourges of the present world is water-borne disease. It is an all too familiar problem in refugee camps where inadequate sanitation causes contamination of the water supply. Typically, typhoid, dysentery and cholera afflict the inmates.
Generally, water-borne diseases including parasitic diseases (e.g. bilharzia) are all too common in third-world countries and cause tremendous suffering and loss of life. These diseases also plagued European cities well into the last century. Sewage ran in the streets and contaminated the streams and wells from which drinking water was taken.
A well-documented case in London concerned the physician John Snow who provided epidemiological proof that the cholera epidemic of 1854 originated from the Broad Street pump. By removing the handle, users were forced to obtain water from a more distant, uncontaminated, source. Safe disposal of human wastes by burial is commanded in the Law of Moses:
“Designate a place outside the camp where you can go to relieve yourself. As part of your equipment have something to dig with, and when you relieve yourself, dig a hole and cover up your excrement.” Deuteronomy 23:12-13
If only this simple procedure had been adopted throughout the centuries, millions would have not died from water-borne diseases. The towns and cities of the so-called civilised world rarely had adequate means for the disposal of waste. Quite often, London’s Parliament had to move elsewhere when the stench from the River Thames became intolerable.
The residual, but fast-declining, custom of gentlemen walking on the outside of the pavement when accompanying ladies has its origins in the days when the contents of chamber-pots were unceremoniously emptied through the window into the street below, with or without an audible warning such as “gardyloo!”.
But eventually things did improve. The Victorian maxim “Cleanliness is next to Godliness” was reflected in the great pride which they took in establishing safe public water supplies (treatment works and pumping stations looked like cathedrals to hygiene!) and in building sewerage systems. Many Victorian sewers are operating efficiently today.
We readily accept the need for personal and public hygiene to help prevent the spread of disease. But this is a relatively new concept. It is said that Queen Elizabeth I had a bath once a year even when she did not need one! The Victorian legacy extended to public baths (not simply swimming pools but provision for taking a bath by those without facilities in their homes) and public wash-houses.
It is ironic to think that, three and a half thousand years before this “enlightenment”, God’s word had provided instructions regarding personal and public hygiene which prevented disease. No wonder the Jews in Europe were vilified when, during the numerous outbreaks of epidemics in mediaeval cities, their communities survived largely unscathed while thousands of others succumbed. Their Bible was way ahead of its time!
Sexually Transmitted Diseases
Sadly, we live in an age when sexual promiscuity is the norm. Fear of an unwanted pregnancy has largely disappeared through sex education and the wide availability of effective contraception, and the shame which once attached to being an unmarried mother has largely disappeared. But the Law of Moses, and in particular the seventh of the Ten Commandments, gave the clear command:
“You shall not commit adultery.” Exodus 20:14
This was a serious offence, as was homosexuality and also bestiality:
“If a man commits adultery with another man’s wife – with the wife of his neighbour – both the adulterer and the adulteress must be put to death…If a man lies with a man as one lies with a woman, both of them have done what is detestable. They must be put to death; their blood will be on their own heads… If a man has sexual relations with an animal, he must be put to death…” Leviticus 20:10-15
“If a man is found sleeping with another man’s wife, both the man who slept with her and the woman must die. You must purge the evil from Israel.” Deuteronomy 22:22
The Law provided clear teaching against fornication, adultery and incest (Leviticus 18:1-17). Before the advent of powerful drugs, especially antibiotics, the spread of venereal diseases by means of promiscuous sexual intercourse brought suffering, not only to those who indulged in the activity but also to the children who resulted from it. Syphilis and gonorrhoea are the most well-known of several sexually transmitted diseases. These are largely treatable today but because of sexual promiscuity the incidence of disease is still rising in epidemic proportions.
The latest sexually transmitted disease, Acquired Immune Deficiency Syndrome (AIDS), cannot be cured although some relief of the symptoms can be provided. This disease first became evident amongst the male homosexual community but now occurs throughout the population as a result of bi-sexual relationships and the sharing of contaminated hypodermic needles by abusers of injected drugs. Now HIV infection has become an epidemic in many countries with large proportions of the populations of the poorest countries, especially in central Africa, being HIV positive. This is beginning to have very serious consequences for nations which already are suffering economic hardships.
Not only did the Law against illicit sexual relationships prevent the spread of the then incurable venereal diseases, a situation akin to our AIDS problem, but it also contributed to the stability of marriage and family life. It seems highly probable that the ease with which casual sexual relationships may be indulged is a significant factor in the current breakdown in family life and one contributory factor in the high incidence of divorce which, in Britain at present, is about one in three marriages. To these figures must be added the break-up of once-stable relationships which are not formalised by marriage.
One aspect of the dietary laws of the Jews is very well known, namely the prohibition regarding pork. But this is only one of several foods which were forbidden:
“Of all the animals that live on land, these are the ones you may eat:
You may eat any animal that has a split hoof completely divided and that chews the cud. There are some that only chew the cud or only have a split hoof, but you must not eat them. The camel, though it chews the cud, does not have a split hoof; it is ceremonially unclean for you. The coney, though it chews the cud, does not have a split hoof; it is unclean for you. The rabbit, though it chews the cud, does not have a split hoof; it is unclean for you. And the pig, though it has a split hoof completely divided, does not chew the cud; it is unclean for you.” Leviticus 11:2-8
Several reasons for excluding the pig are suggested, including trichinosis and the pork tapeworm from the cysticercus of ‘measly’ pork. Also Echinococcus hydatid cysts affect the brain.
In the field of environmental health, before the vast increase in consumption of chicken and the risk of Salmonella, the highest incidence of food poisoning tended to be from pig meat, and especially derivatives (pies, sausages etc). The scavenging behaviour of pigs is also said to be a reason for their prohibition as food.
What is also problematic about pigs is their close similarity to man, not only in being omnivorous in diet but similar in physiology etc. The close affinity between men and pigs transmitted the influenza virus to humans and, later, swine vesicular disease was originally a human strain of a virus which pigs have caught from us.
Pig tissues, for example heart valves, are used in human transplant operations. Until recently, diabetics were dependent on pig insulin. More recently there has been considerable research to create a transgenic pig in which human genes have been incorporated in order to facilitate further organ transplants without rejection problems. These facts emphasise the close similarity between pigs and man and the inherent possibility for the transmission of disease.
The Mosaic food regulations also forbid shellfish and other sea foods. Again, this is a common source of food poisoning. Many shellfish are filter-feeding bivalves which strain minute particles from the water as their food source. A particularly rich source of food particles today is untreated marine sewage outfalls! The potential for contamination by human pathogens is the reason for current regulations regarding the treatment of shellfish which are intended for human consumption. This entails keeping them in clean seawater for a specified period in order to allow them to clear the contaminated material from their guts. Shellfish need careful cooking to eliminate pathogens, which doesn’t quite square with the fashion to eat oysters raw and alive!
The code which the Law of Moses applies to determine what is allowed is simple and effective:
“Of all the creatures living in the water of the seas and the streams, you may eat any that have fins and scales. But all creatures in the seas and streams that do not have fins and scales… you are to detest… you must not eat their meat… Anything living in the water that does not have fins and scales is to be detestable to you.” Leviticus 11:9-12
This simple rule excludes all mussels, oysters, clams, whelks, winkles and also lobsters, crabs, prawns, shrimps etc. but allows normal “fish”. It seems that strict observance by Jews excludes eels since, although they have evident fins, their scales are too small to be seen with the naked eye!
Jewish dietary laws prohibit the consumption of fat and blood:
“This is a lasting ordinance for the generations to come, wherever you live: You must not eat any fat or any blood.” Leviticus 3:17
This rules out “black puddings” at a stroke!
The Law did not only apply to animals offered in sacrifice:
The Lord said to Moses, “Say to the Israelites: Do not eat any of the fat of cattle, sheep or goats. The fat of an animal found dead or torn by wild animals may be used for any other purpose, but you must not eat it.… And wherever you live, you must not eat the blood of any bird or animal.” Leviticus 7:22-26
The normal western diet, high in fat (especially saturates) is regarded as a major cause of the present epidemic of circulatory and digestive disease, particularly heart attacks and bowel cancer. The current obsession with low cholesterol and low fat diets is a recognition of the need to reduce our fat intake.
On the positive side, the diet which the Jews consumed would be a healthy one. Meat was allowed but would not form a large part of the diet. Olive oil (low in saturates!) was used in cooking and milk products (butter and cheese) would provide the necessary dietary fat and minerals. Wholemeal bread and parched corn would provide fibre along with fruit such as grapes, dates, figs, pomegranates etc.
“Wine is a mocker and beer a brawler; whoever is led astray by them is not wise.” Proverbs 20:1
Actuarial data show that, in general, those who are “teetotal” have shorter life expectancy than those who drink alcohol in moderation. This is not, of course, advocating its consumption nor is it a criticism of those who abstain! However, the scientific evidence is clear and accords with Bible teaching.
Not only were provisions made prohibiting foods with a high health risk but rules were also laid down to ensure that food poisoning was not a danger from permitted foods. Rules were given regarding the cleanliness and procedures to be observed to avoid contamination. Recently there have been a number of very serious outbreaks of food poisoning in Britain and this in spite of our modern knowledge of the dangers. But the Law of Moses had laid down the relevant principles 3,500 years ago!
Modern refrigeration was not available to help keep food fresh so other provisions were made. Food must not be left too long before it is eaten: this is a wise precaution in middle-eastern temperatures.
“When you sacrifice a fellowship offering to the Lord… it shall be eaten on the day you sacrifice it or on the next day; anything left over until the third day must be burned up.If any of it is eaten on the third day, it is impure and will not be accepted.” Leviticus 19:5-7
“A clay pot that the [infected] man touches must be broken, and any wooden article is to be rinsed with water.” Leviticus 15:12
“This is the law that applies when a person dies in a tent… every open container without a lid fastened on it will be unclean.” Numbers 19:14,15
“When one of them [an unclean animal] dies and falls on something, that article, whatever its use, will be unclean, whether it is made of wood, cloth, hide or sackcloth. Put it in water; it will be unclean till evening, and then it will be clean. If one of them falls into a clay pot, everything in it will be unclean, and you must break the pot. Any food that could be eaten but has water on it from such a pot is unclean, and any liquid that could be drunk from it is unclean…” Leviticus 11:32-34
These instructions accord with our current knowledge of bacterial contamination. Porous clay vessels cannot be cleansed satisfactorily simply by washing, as bacteria could still remain in the pores. However, it is now known that wooden articles have bactericidal properties and so washing would be adequate. This is why there has been a recent reaction against plastic butchers’ chopping blocks and a clamour for the old fashioned scrubbed beech. In order to mimic the bactericidal action of wooden chopping-blocks, recently plastic blocks have been impregnated with a bactericide which is gradually released as the block is used.
All the regulations regarding unsafe foods with high propensity to cause food poisoning; the importance of a low-fat diet; the need for care in storing food, and the importance of clean containers and utensils are now fully appreciated. But we must remind ourselves that these laws were followed by the Jews over three thousand years ago!
How can we explain this? The only explanation is that the Jews were privileged to receive a direct revelation from God through Moses. In our present scientific age this may be difficult to accept but we have taken centuries to discover for ourselves what anyone could have read in their Bible.
Housing and Health
It is well established that much illness can be ascribed to poor housing. It is still a problem in relatively modern council housing where inadequate heating and ventilation produce damp and moulds, leading to chest disease and other conditions. Similarly, dry rot and wet rots need attention.
“… The owner of the house must go and tell the priest, ‘I have seen something that looks like mildew in my house.’ The priest is to order the house to be emptied before he goes in to examine the mildew… After this the priest is to go in and inspect the house. On the seventh day the priest shall return to inspect the house. If the mildew has spread on the walls, he is to order that the contaminated stones be torn out and thrown into an unclean place outside the town. He must have all the inside walls… scraped and the material… dumped into an unclean place outside the town. Then they are to take other stones to replace these and take new clay and plaster the house. If the mildew reappears in the house… the house is unclean. It must be torn down – its stones, timbers and all the plaster – and taken out of the town to an unclean place.” Leviticus 14:35-45
These provisions are very close to modern practice. When a surveyor examines a house, his report may have to include reservations if he has been unable to examine it properly because of furniture and fitted carpets etc.
Here the Law required the property to be emptied in order that the priest could make a thorough examination. The action required in an infected house also accords with present methods. For example, in the case of dry rot all the infected material is removed and replaced with new. When housing is “unfit for human habitation” it is condemned and “slum clearance” follows! It is also significant that the material is to be dumped and not reused in building another house since the fungal spores will, of course, still be present.
Rest and Recuperation
In today’s stressful world we recognise the value of holidays and times for relaxation. The provisions in the Law of Moses for rest and recuperation are unparalleled in ancient history. For example, the Egyptian 30 day month was divided into 3 “weeks” of 10 days each, with no guaranteed day of rest. The Babylonians had a five day week but no day of rest. This contrasts with the Jewish week of six days for labour and a day of rest.
“Observe the Sabbath day by keeping it holy, as the Lord your God has commanded you. Six days you shall labour and do all your work, but the seventh day is a Sabbath to the Lord your God. On it you shall not do any work, neither you, nor your son or daughter, nor your manservant or maidservant, nor your ox, your donkey or any of your animals, nor the alien within your gates, so that your manservant and maidservant may rest, as you do. Remember that you were slaves in Egypt and that the Lord your God… has commanded you to observe the Sabbath day.” Deuteronomy 5:12-15
The Sabbath rest also applied at the busiest times of the agricultural year such as ploughing and harvest (Exodus 34:21), something which is not observed in modern agricultural practice.
Although the feasts of the Law such as Passover, First fruits, Tabernacles (Numbers 28:16,26; 29:1,7,12) were primarily religious, they also provided periods of rest and recuperation.
Finally, there were provisions for retirement under the Law.
“The Lord said to Moses, “This applies to the Levites: Men twenty five years old or more shall come to take part in the work at the Tent of Meeting, but at the age of fifty, they must retire from their regular service and work no longer.” Numbers 8:23-25
It is evident from this, by no means exhaustive, review of medical and health issues considered in the Bible that this very ancient book is very much up-to-date. It is easy to forget how recently the health and hygiene procedures, which we take so much for granted, were rediscovered. Only when we consider what the contemporary nations surrounding Israel in Old
Testament times practised, or even European cultures until the 20th century, do we begin to realise how much the Bible was, and is, ahead of its time. Comparison of the Law of Moses with contemporary Egyptian medical papyri,10 of which the Ebers papyrus is probably the best known, demonstrates the heavy dependence of Egyptian medicine on magic. A medical historian12 has commented:
“Although the Bible is not a medical text, its historical accounts, laws and precepts, and even its wording, yield an abundant harvest of information concerning the structure of the human body, diseases, injuries, cares and, above all, preventative and sanitary procedures. The material contained in some portions of the Pentateuch… is so factual that even the sophisticated present-day student cannot help but be amazed at what he reads there. Especially the sanitary regulations of cleanliness and purity, such as the prohibition against the consumption of blood and quarantines for infectious diseases, are unique and do not occur in the codes of the civilized nations of antiquity that surround the Land of Israel.”
“The chief glory of Biblical medicine lies in the institution of social hygiene as a science.
Yet it is not principally a book about science or medicine. These matters are incidental to its main themes.
The Bible deals with issues and questions for which science has no answers. It is often said that science helps explain the ‘how’ of things but not the ‘why’. Why are we the way we are? Why is the world the way it is? The Bible explains these and, even more important, it sets out what will be our collective and individual destinies and the options which face us.
It is mainly concerned with what has come to be called the ‘human condition’. Our failure to be able to live up to the highest ideals of which most people approve and our tendency rather to do what we recognise to be wrong; what the Bible calls ‘sin’ and which leads ultimately to death:
“The wages of sin is death.” Romans 6:23
As the Apostle Paul explained:
“Therefore, just as sin entered the world through one man [Adam, the first human], and death through sin, and in this way death came to all men, because all have sinned…just as sin reigned in death, so also grace might reign through righteousness to bring eternal life through Jesus Christ our Lord.” Romans 5:12, 21
The Law provided for the well-being of God’s people by reducing the impact of disease and promoting physical health. But the main theme of the Bible points to something far better. It is concerned with the provision of spiritual health: a hope of redemption from the law of sin and death.
The Law which God gave to Moses not only taught important spiritual lessons regarding holiness and righteousness but primarily it was intended to prepare them for the coming of his Son.
“So the law was put in charge to lead us to Christ that we might be justified by faith.”. Galatians 3:24
It is significant that the majority of the miracles performed by the Lord Jesus concerned healing of the sick, both physical and mental illnesses. These miraculous cures provided tangible evidence of his power to heal and save, a foretaste of the future Kingdom of God when…
“God… will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away,” Revelation 21:3-4
Of course, we have to trust the Bible’s message: to show our faith in its truth. Some find this hard to do.
But, if the Bible was right 3,500 years ago about things which we only began to understand within the last 100 or so years, surely it must be right about these vital issues with which it deals? Bible medicine is a help to our faith: evidence of the supernatural character of the Bible. Evidence that not only was God prepared to reveal to his people how they might mitigate the effects of disease arising from the law of sin and death but evidence that his Word is the source of eternal life, through faith in his Son.
“For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life.” John 3:16
DR JOHN HELLAWELL