The Biblical Hebrews may have inherited a number of their beliefs from ancient Mesopotamian cultures, among them a conviction that disease was divine punishment and therefore a mark of sin. This belief was passed on as a basic concept to Christian medieval Europe. Assyro-Babylonian taboos against close proximity to the sick were also continued by the Hebrews in their isolation of the unclean, who, in addition to the diseased, included the dead, a potential source of soul transference among the Mesopotamian peoples.
Hebrew reliance on strict codes which controlled virtually all behavior was another Mesopotamian characteristic. Furthermore, the assignment of the Sabbath as a day of rest, observed by orthodox Jews even today, matches the severe Assyrian restriction of activities on the seventh day of the week, when the king engaged in no official business and physicians were not even permitted to treat the sick.
There were, however, important differences between Hebrew and Assyro-Babylonian concepts. For instance, the Biblical Hebrews, although they believed in supernatural causation of disease, did not envision the world as filled with demons and spirits. (Many centuries later, however, in medieval times, Jewish folk superstition did subscribe to cabalistic views on possession by spirits.) To the ancient Hebrew it was essentially Jehovah, God Himself, who was to be placated as the giver and taker of health. In the same vein, contamination was not a matter of evil spirits having passed from the sick to the well but a sign of one’s spiritual impurity from having violated the prohibition against touching the unclean, the sick person being punished by God. Hygienic laws were to be obeyed for religious and disciplinary rather than medical reasons. These regulations reached into virtually every activity: isolation of the sick, time and location of burial, frequency of sexual intercourse, washing before meals, bathing after coitus and menstruation, slaughtering of animals, and preparation of food.
Much has been made of a presumably medical basis for the food prohibitions in Jewish tradition, but there may be other explanations. One recent suggestion is that the taboo against pigs was originally related to their competition with humans for water and grain (scarce commodities in a barren land), in contrast to cattle and sheep which consume relatively little water and graze on forage inedible to man. Since transmissible parasitic diseases and infestations such as tapeworm are also found in sheep and cows, singling out trichinosis in pigs would not be wholly logical. However, to discourage the raising of swine so as to conserve water and grain resources for human consumption, a strict religious taboo may have been necessary—considering man’s nearly universal agreement on the delectableness of pork. Medical observations may indeed have been at the core of hygienic codes, but the Biblical listing of seemingly unrelated creatures prohibited as food is difficult to associate with purposes entirely hygienic.
Plagues and epidemics were mentioned often in the Bible, with special attention given to leprosy, which was feared and isolated, but, as among the Assyro-Babylonians, many skin diseases considered to be leprosy probably were not. There were, however, references to many other types of illnesses and symptoms in the Bible.
Physicians were drawn from the priestly tribe of Levites and were prohibited from practicing if deficient in vision; nor was examination permitted at twilight, on cloudy days, or in a dim room. Some passages in the Bible suggest that physicians were held in high esteem. “When thou feelest sick call upon God and bring the physician, for the prudent man scorneth not the remedies of the earth.” However, other statements in the Bible suggest that admiration was mixed at times with mockery. “In his disease he sought not the Lord but went to the Physicians. And Asa slept with his fathers.”
Hebrew medical practices were much like those of the peoples among whom they lived. A number of medications were mentioned in the Bible, such as mandrake, balsams, gums, spices, oils, and possibly narcotics, but the relatively limited list of drugs recorded is remarkable when one considers the abundant materia medica of Mesopotamian and Egyptian physicians. There was little reference to surgery in the Bible except for ritual circumcision, and that may have come from the Egyptians. Midwives were spoken of, but their ministrations seem not to have extended beyond comforting and attendance.
Although Biblical information on medicine is relatively limited, a rich collection of medical lore is found in the later Talmud, the authoritative collection of Jewish tradition. There are two Talmuds, the Jerusalem and the much longer Babylonian, both written over the same period (second to sixth century A.D.). The Temple of Solomon in Jerusalem was destroyed for the first time by the Babylonians in 586 B.C., and this marked the beginning of the Babylonian captivity of the Jews. In the first century A.D. Jerusalem was sacked again, this time by the Romans. After each of these catastrophes, Jews scattered over many lands and established schools for preserving their learned and religious traditions; the Talmud became the bedrock on which Jewish education rested. Although the Talmudic medical writings demonstrated remarkable insights and observations, they reflected as much the attitudes and methods of the various peoples among whom the Jews lived over the centuries as they did their own Biblical inheritance. For instance, the Talmudists relied on the humoral theories of the Greeks, which attributed disease to the imbalance of the four humors of the body: phlegm, blood, yellow bile, and black bile. Similarly, they followed Greek philosophers in specifying the four elements of the universe as air, fire, earth, and water.
Since Jews were among the many races and nationalities that flocked into the great center of Greek learning at Alexandria in the fourth century B.C., they followed the teachings there on anatomy and physiology, as well as on diet, massage, and drugs. The many medical sects numbered among them Jews whose writings found their way into the Talmudic commentaries. Although dead bodies were avoided as unclean, Jews evidently performed occasional human dissections, for Rabbi Ishmael in the first century A.D. is said to have boiled and then studied the body of a prostitute. However, most of the anatomical information in the Talmud came from Alexandrian human dissections and from examination of animals to determine whether they were free of abnormality and suitable as kosher food.
In terms of surgery, the Talmud discussed the means of reducing dislocations and the management of injuries to many organs. Sometimes detailed techniques were described, as, for instance, the methods for dealing with an imperforate anus whereby, after oiling and sunburning, a small incision would be made over the spot where the anus should have been. Of course, circumcision remained the “seal of the covenant” to be performed on all boys at a prescribed time after birth.
Although barbers and other uneducated healers might engage in the accepted practice of bloodletting and minor mechanical procedures, medicine was practiced by professionals called rophe, who seem to have participated in both medicine and surgery. The doctors who limited themselves entirely to surgical procedures were referred to as uman. There were probably also veterinary surgeons since one was mentioned in the Talmud by name.
The precepts and prohibitions of Biblical times on personal and public hygiene were continued in the Talmud. “Physical cleanliness is conducive to spiritual purity” (Avoda Zara in the Jerusalem Talmud). For instance, the leper continued to be regarded as unclean and his clothing was to be burned. A type of isolation outside the city for some of those with other sicknesses was also mentioned. The later Hebrews apparently recognized that certain diseases were transmissible through contaminated objects, and women, as in the Bible, were unclean and could not participate in religious or sexual activity until seven days after cessation of the menstrual flow. The restrictions on preparing food were maintained.
In much later times, during the Middle Ages, Jews were to be a repository of Greek and Roman learning. In the period of Islamic supremacy they acted as a bridge between the Muslim East and Christian West.