Rosemary Margaret Luff, Clare Hall - Health Hazards in First-Century Palestine. (2019) - The Impact of Jesus in First-Century Palestine

114
Health Hazards in First-Century Palestine
[L]ife in first-century Galilee – though not necessarily dissimilar to other parts

of the Mediterranean – was substantially different from the modern world
and cannot be characterized as stable. Chronic and seasonal disease, espe-
cially malaria, cut down significant segments of the population and left even
the healthy quite often ill.
(Jonathan Reed 2010, 34)
[In the modern world] [i]nfectious diseases remain the world’s leading killer,
accounting for one in three of all deaths. Each year 17 million people, mostly
young children, die from infectious diseases. Acute respiratory infections kill
almost 4 million people; diarrhoeal diseases kill 3 million; HIV/AIDS kills
2.5 million, tuberculosis kills 2 million, and malaria kills 1.5 million. The dis-
crepancy between rich and very poor countries is huge: infections cause 1–2%
of all deaths in the former, yet over 50% in the latter.
(Tony McMichael 2001, 95)
Infectious and Parasitic Diseases

Jonathan Reed (2010) has recently challenged the notion that economic
prosperity fuelled the growth of settlements in early Roman Galilee,
instead proposing that a high fertility rate and a low density of people,
unimpeded by infectious diseases more characteristic of urban envir-
onments, allowed the Galilean population to mushroom. But he also
claimed that ultimately it would be the cities that curbed growth, con-
comitant with the building and habitation of settlements in low-lying
areas near standing water conducive to malaria.1 Infectious diseases were
1
Reed 2014, 242–250.
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Health Hazards in First-Century Palestine 115
probably2 the prime cause of death in antiquity, as indeed today, and

it is therefore important to determine what diseases existed in Galilee
and Judea and how they affected the people, the more so since Jesus
was clearly in demand as a healer. Documentary and palaeopathological
research undertaken with regard to Roman Italy has demonstrated con-
clusively that malaria was a ‘killer’ disease at certain times of the year and
in particular environments.3 Indeed, it may well have been a major factor
in the fall of the Roman Empire.
The recovery of human remains from rock-cut tombs in Israel has
been affected by tomb robberies, pressurized deadlines for excavation,
and, since 1994, ultra-orthodox rabbinic concerns of not disturbing the
dead.4 Although the condition of these remains raises some issues, this
section will address what kinds of palaeopathological and demographic
information have been gleaned from the bones. Tuberculosis and lep-
rosy have both been identified morphologically and molecularly in early
first-century bones recovered from the rock-cut tombs located outside
Jerusalem. However, the suggestion that malaria in its more virulent
form was widespread in first-century Palestine still needs verification.
Documentary evidence indicates its presence but does not confirm that
it was directly fatal; in this chapter I suggest that additional factors,
including environmental and behavioural ones, could in combination
have precipitated death. The ratio of subadult to adult burials will also be
examined with special attention paid to the mortality of infants (nought
to five years old), that segment of the population especially vulnerable to
acute infections.
Leprosy and Tuberculosis

The Tomb of the Shroud is a first-century rock-cut tomb in the cemetery
of Akeldama located in the lower Hinnom Valley at the base of Mount
Zion, Jerusalem; it was discovered by Shimon Gibson in conjunction with
James Tabor in 2000. Due to the importance of the finds an emergency
excavation was swiftly undertaken by Gibson, Tabor, and Boaz Zissu.
The following account is based on Gibson (2009, 139–147), and also
2
It is important to note that over 90% of skeletons show no evidence as to how each indi-
vidual died; infectious disease is a plausible explanation but many people may have died
from starvation as a result of famine or from injuries to their soft tissues (Piers Mitchell,
pers. comm.).
3
Shaw 1996; Soren 2003; Scheidel 2013.
4
Balter 2000, 34–35; Gibson 2009, 140–141.
116
116 Jesus in Context: The Archaeological Evidence
Matheson et al. (2009), who undertook the molecular research. Inside
the tomb an adult individual was discovered sealed into a loculus5 with
plaster, a feature rarely observed with Jerusalem burials; the body had
been wrapped in a shroud and still retained hair. The shroud consists of
a number of woollen and linen wrappings, demonstrating a warp that
was both Z-spun and S-spun; the textiles of Z-spun warp had not been
manufactured locally and would have been imported probably from
Syria or Anatolia, or possibly even from Greece or Italy.
While a morphological examination of the bones from this primary
burial showed that the individual was an adult male, a molecular ana-
lysis indicated the presence of the DNA of both Mycobacterium leprae
and Mycobacterium tuberculosis. Indeed, one bone (metatarsal?) showed
an ‘advanced lesion’ typical of tuberculosis, thus underlining the chronic
nature and severity of the disease. Two infants were also discovered
sealed into a wall niche with plaster, although these were secondary
burials; M. tuberculosis was again identified in the remains of both chil-
dren. Matheson et al. point out that the identification of M. tuberculosis
in the tooth pulp extracted from all three individuals indicates that this
pathogen was in the bloodstream and therefore rife in the body as mil-
iary tuberculosis, an acute form, which would have led to almost certain
death. That this was a family tomb is indicated by an analysis of the mito-
chondrial DNA, which showed that the adult was related to at least five
other individuals (eleven in total) in the tomb.
The hair of the man is well-cut and clean, showing no evidence of head
lice.6 This level of grooming, the quality of textiles comprising the shroud,
and the location and size of the tomb indicate that he emanated from the
upper and wealthier section of society. It is important to note that ‘the
presence of both M. tuberculosis and M. leprae DNA is associated with
immuno-suppressed individuals, which is a feature of the multi-bacillary
or lepromatous form of leprosy’ (Matheson et al. 2009, 12). While lep-
rosy is a ‘chronic, debilitating and disfiguring infection’, the leproma-
tous form of the disease is the most severe (Carmichael 1993, 834–839).
5
A niche carved at right angles to the tomb wall.
6
The clean hair of the adult is striking given the widespread occurrence of the human
head louse, Pediculus humanus (Zias 1991, 148). Hair combs and hair from the Dead
Sea dating to the first and second centuries ce were examined from Qumran, Masada,
Murabbaᶜat, and the Negev: 50% of the artefacts examined were infested with lice and
lice eggs (Mumcuoglu and Zias 1988). A body louse in association with textiles was
found in a storeroom at Masada, the context being that of the Jewish Revolt (Mumcuoglu
et al. 2003).
117
‘Whether a person develops lepromatous leprosy (affecting the hands,

feet, face), tuberculoid leprosy (affecting one nerve and the muscles/skin
it supplies), or any of the spectrum in between (borderline lepromatous,
borderline, borderline tuberculoid, primary polyneuritic) depends on the
immune response of the infected person; a good immune response using
white blood cells leads to a tuberculoid form of the disease and some-
times a cure, while an immune response that fights infection with anti-
bodies does not work well and this leads to the lepromatous form of the
disease’ (Piers Mitchell, pers. comm.).7
Gibson (2009, 146) has suggested that since the Tomb of the Shroud
lies in close proximity to the Tomb of Ananus, the geographical loca-
tion of which is described by Josephus (Jewish War v.506), then it may
have belonged to a ‘priestly or aristocratic family’. Clearly, this was a
man who had been cared for and it calls into question the widespread
assumptions that lepers were shunned and of lower-class origin. Indeed
it raises another question as to just when this leprosy, or rather Hansen’s
Disease (true leprosy), first appeared in Palestine.
Joseph Zias (1989, 30) has pointed out that ‘the fact that compilers
of the Old Testament never made direct reference to forbidden sexual
practices as a vehicle for contracting the disease, while religious author-
ities of the Roman–Byzantine period consistently did, suggests that
today’s leprosy appeared in the Holy Land sometime after the First
Temple period and was already well established during the first centuries
of the common era’. The term zara’ath or tsara’ath mentioned in the
book of Leviticus in the Old Testament is generally considered to refer
to a wide range of skin diseases. It has been claimed that the Greek word
lepra in the New Testament does not mean modern leprosy since the
Greeks called this affliction elephantiasis graecorum;8 however, there is
still disagreement concerning the precision with which such terms were
used by ancient writers.9
Morphologically, the Tomb of the Shroud contains the first bones to
exhibit leprosy in Palestine. The earliest evidence in the Near East is to
be found in four human skulls from the Dakhleh Oasis, Egypt dating
to the Ptolemaic period. Because the skulls are not typical of that area, being
7
Clinical features described by Diana N. J. Lockwood in the Oxford Textbook of Medicine,
edited by David A. Warrell, Timothy M. Cox, and John D. Firth, http://oxfordmedicine
.com/view/10.1093/med/9780199204854.001.1/med-9780199204854-chapter-070627
(updated 28 November 2013).
8
Aufderheide and Rodríguez-Martín 1998, 148.
9
Zias 2002, 261.
118
European as opposed to Negroid, it was suggested that they belonged to

individuals from the higher echelons of society who had been segregated
from distant more urban areas.10 The dating of the skulls relates closely
to the timing of Alexander the Great’s campaign in India (327–326 bce),
and thus it has been suggested that it was Alexander’s soldiers who, on
their return home, brought leprosy to the Mediterranean.11 But equally
trade routes between the Near East and Far East could well have spread
the disease much earlier.12
Two young adult males interred in the Roman cemetery (Kellis 2) at
the Dakhleh Oasis demonstrate bone pathologies indicative of multi-
bacillary (lepromatous) leprosy.13 On a molecular analysis, using PCR,
each adult proved, as with the man in the Tomb of the Shroud, to be
co-infected with both M. leprae and M. tuberculosis.14 It has long been
thought that leprosy died out in Europe because cross-immunity protected
tuberculosis-infected individuals from leprosy. However, Donoghue et al.
(2005), using material from the Roman period to the thirteenth century,
suggest that ‘the immunological changes found in multi-bacillary leprosy,
in association with the socio-economic impact on those suffering from
the disease, led to increased mortality from tuberculosis and therefore to
the historical decline in leprosy’. In other words there was a synergetic
relationship between leprosy and tuberculosis, and the weakening of the
immune system by the leprosy bacillus allowed the tubercle bacillus to
terminate life swiftly and thus prevent the spread of leprosy.
Notably the Kellis 2 burials had not been isolated from the main ceme-
tery but were included within it, and Molto (2002, 179) has suggested
this indicates a ‘level of tolerance towards leprosy at Kellis’. This is true
of the Tomb of the Shroud adult burial, although it was clearly of much
higher status. Interestingly, Grmek (1989, 202) relates that individuals
with leprosy in nineteenth-century Greece were ‘grouped into small col-
onies that were not strictly isolated from the rest of the population’. And
in the early twentieth century there were about 250 people with leprosy in
Palestine, most of whom were segregated in Jerusalem, Ramleh, Nablus,
or Damascus, where they occupied houses provided by the government.15
Notably the first effective treatment for leprosy only became available
10
Dzierzykray-Rogalski 1980, 72.
11
Anderson 1969, 45; Roberts and Manchester 2010, 201.
12
Zias 2002, 267.
13
Molto 2002.
14
Donoghue et al. 2005, 390.
15
Masterman 1918, 66.
119
in the 1940s. Due to the generally slow appearance of symptoms from

three to five years, the disease is slightly contagious and is transmitted
through the skin or respiratory passages.16 On the other hand tubercu-
losis is highly contagious.
Since prehistoric times tuberculosis (TB) has been endemic in most of
Europe, Asia, and North Africa. It was originally thought that humans
contracted the tubercle bacillus through cattle domestication; however, it
is now clear that M. tuberculosis did not evolve from M. bovis at the time
of domestication.17 Recent DNA research has indicated that M. bovis
evolved from M. tuberculosis, suggesting that humans may have given
TB to cattle.18 Moreover, bovine tuberculosis, while a disease of cattle,
can afflict other wild mammals, with humans being secondarily infected.
A mother and child were recently recovered from the site of Atlit Yam19
in Israel, one of the first Neolithic villages (7,250–6,160 bce) with evi-
dence of agriculture and animal domestication, and a molecular analysis
confirmed that the individuals had contracted TB through the agent of
M. tuberculosis.20
Besides the findings in the Tomb of the Shroud (Jerusalem) a tuber-
cular lesion was positively identified on the proximal part of an adult
femur from a Second Temple period tomb in the cemetery of Arnona,
Jerusalem (Zias 2006b, 118–119). Zias has argued that the low frequency
of tubercular lesions observed on ancient bones, taken in conjunction
with data concerning the low frequency of tuberculosis in present-day
Jews, suggests that early Roman Jews might have had a ‘high resistance’
to the disease. But molecular research has pinpointed that the tubercu-
losis identified in Roman Jerusalem was the acute rather than chronic
form, which would allow little time for the skeleton to be affected. It
has been concluded that the occurrence of tubercular bone lesions in the
‘preantibiotic era’ was low, approximately 5–7%.21 Indeed, Roberts and
Cox (2003, 395), in an extensive palaeopathological survey of Britain
spanning the Palaeolithic to modern periods, identified few pathological
bones in the late and postmedieval periods, which sharply contrasted
with the strong documentary evidence for the disease in those periods.
They have suggested that researchers may be using different methods of
16
Carmichael 1993, 834.
17
Roberts and Manchester 2010, 184 citing Brosch et al. 2002.
18
Namouchi et al. 2012, 723, fig. 1 (Piers Mitchell, pers. comm.).
19
Now submerged off the coast of Israel, 10 km south of Haifa Bay.
20
Hershkovitz et al. 2008.
21
Steinbock 1976, 175; Aufderheide and Rodríguez-Martín 1998, 133.
120
diagnosis: ‘Most workers diagnose the condition on the basis of Pott’s

disease in the spine, and this will be a very small percentage of those
affected by tuberculosis … many people could have had the disease but
their skeletons were not affected when they died.’
Out of all the infectious diseases today TB is the most ubiquitous
and the number one killer.22 It can affect any part of the body but is
commonly linked with the lungs.23 The disease is usually chronic, which
eventually leads to bone abnormalities, but can be acute especially in the
case of infants and young children. Johnston (1993) has stressed that the
aetiology of tuberculosis is strongly associated with crowding, quality
of nutrition, and working conditions; age, gender, and immunogenetic
factors also play a part. Since the disease is spread through the air by
simply ‘talking, coughing, sneezing, spitting and sighing’, crowded
housing particularly in urban environments would certainly have
increased its incidence. And those most at risk would have been infants,
adolescents, and the aged, all individuals having low resistance. The dis-
ease engendered considerable horror and fear in early twentieth-century
Palestine; Dr E. W. G. Masterman, a medical doctor, wrote that ‘there is a
growing dread of infection from this disease and many poor sufferers are
shockingly neglected by their relatives who are afraid to associate with
them’ (1918, 65).
Grmek (1989, 202) claimed that both leprosy and tuberculosis were a
‘by-product of indigence’. Clearly the poor were at great risk in Palestine;
however, it is evident that those with more affluent life styles were not
immune to such infections.
Malaria and Anaemia

Malaria24 is caused by a protozoan parasite (Plasmodium sp.), which
is transmitted to its human host by the bite of a female mosquito
(Anopheles sp.).25 There are four species of human malaria, three of
which are endemic to Mediterranean countries, Plasmodium vivax,
Plasmodium malariae, and Plasmodium falciparum, the latter being the
22
Roberts and Buikstra 2007, 213.
23
Johnston 1993, 1059–1060.
24
Unless otherwise stated, the information on malaria in the first two paragraphs is based
on the research of Sallares et al. (Sallares 2002; 2004).
25
F. L. Dunn 1993, 854. There are approximately 3,500 species of mosquitoes grouped
into 41 genera. Human malaria is transmitted only by females of the genus Anopheles.
Of the approximately 430 Anopheles species, only 30–40 transmit malaria (i.e. are
‘vectors’) in nature (www.cdc.gov/malaria/about/biology/mosquitoes/).
121
most deadly. A recurring fever marks malaria out from all other diseases.
Hence ancient Greek and Roman authors describe malaria by the peri-
odicity of the fever: tertian (P. falciparum and P. vivax), which recurs
every second day, and quartan (P. malariae), which recurs every third day.
Sallares et al. (2004, 314) summarize its extensive early history: ‘[T]here
are plenty of references to the intermittent fevers characteristic of mal-
aria in ancient literature such as the works of the Hippocratic Corpus in
Greece in the fourth and fifth centuries bc, in ancient Indian texts (diffi-
cult to date), and in Chinese literature of the first millennium bc. These
accounts leave no doubt whatsoever that benign tertian fever (caused by
P. vivax) and quartan fever (caused by P. malariae) were endemic in the
Old World from Greece to as far as India and China by 500 bc. Evidently
these types of human malaria arrived in Greece sometime between the
end of the last Ice Age and 500 bc.’
During the reign of the emperor Tiberius (42 bce to 37 ce), Celsus
(De Medicina 3.3) describes malaria to the extent of differentiating
the tertian fevers; he used the term semitertian to specify the more
prolonged attack of the deadly P. falciparum, and tertian fever for
the less harmful P. vivax. Thus it is clear that falciparum malaria was
widely known in early first-century Rome and her empire. Both the
Greek physicians Asclepiades (129–40 bce) and Galen (129–216/217
ce) also indicate in their writings that falciparum malaria was common
in ancient Rome. There is no doubt that this strain of malaria had
a great impact on the mortality rates of classical Greece and ancient
Rome, but as Sallares et al. (2004) point out, ‘only within strictly
circumscribed geographical areas’. This is because only certain mos-
quito species carry the parasite, and mosquitoes in themselves are not
noted for flying long distances.
Documentary evidence shows that malaria was certainly present in
Israel during the first century bce. Josephus in Jewish War (i.105–106)
and Jewish Antiquities (xiii.398) describes Alexander Janneus (103–
76 bce, a Hasmonean king of Judea) dying on a military campaign of
complications associated with what appears to be quartan26 malaria of
three-year duration. However, Rosen (2000, 673) emphasizes that the
texts indicate that it was probably physical exertion that killed Alexander,
not necessarily the infection; furthermore, in all the detailed descriptions
of Roman manoeuvres in Judea prior to and during 70 ce Josephus makes
no reference to problems with malaria. Nevertheless, Josephus describes
26
Probably caused by P. malariae (Neuburger 1922, after Rosen 2000).
122
the Great Plain (the Jordan Valley) between Tiberias and the Dead Sea
as exceedingly hot with an unwholesome air, the only water being in the
River Jordan (Jewish War iv.457–458). And Tacitus also reports the Dead
Sea area as having an unhealthy air (Histories v.7). But there is no hint
of major malarial problems and certainly no indication that falciparum
was present.
Reed (2010, 356) has not specified which malaria he supposes was
around in first-century Galilee, but his comparison of parts of Galilee,
that is sites near the lake and low-lying valleys, to the malaria-infested
Egyptian Fayum27 is suggestive of falciparum. He further argues that
the high death rate from malaria of Jewish settlers in Galilee in the early
twentieth century demonstrates the dangers of living in such areas, for
example ‘the Huleh Valley down past the Gennesar Plain to Tiberias
and over along the Beit Netofah Valley, which until modern irrigation
flooded often’. This does not necessarily indicate that these places were
death traps in the early first century. Indeed, this point was raised by
Rosen (2000) with reference to the Roman settlement of Horvat ‘Eleq,
an area that was highly malarious in the early 1900s, and also Roman
Caesarea only 8 km away, the inhabitants of which used water from the
spring at Horvat. Why would the Romans have built in such a place if
it had been so badly infected with harmful mosquitoes? Since Caesarea
thrived during the Byzantine period, certainly a time of immense growth
in Israel, the virulent form of malaria could not have posed a serious
threat to health.28 Nevertheless, malaria was viewed with fear and
trepidation by some at that time, as evidenced by amulets which were
worn as protection.29 A bronze amulet was discovered at Sepphoris in
Galilee in a late fourth/early-fifth century context with a charm written
in Palestinian Jewish Aramaic.30 The first few lines translate as follows:
An amulet against fever
Protracted that burns
And does not cease.
It is interesting to note that one of the additional symptoms of malaria

besides a high fever is dry burning skin.31
27
Scheidel 2001.
28
Rosen 2000, 675.
29
Naveh and Shaked 1985, 44–55.
30
McCollough and Glazier-McDonald 1997, 146.
31
Bullard 2004, 212.
123
Walter Scheidel (2013, 48) has underlined that the killing propensity

of falciparum malaria was greatly enhanced by its synergistic interaction
with ‘other seasonal infections such as gastro-intestinal disorders and
respiratory diseases’. This would have been true of other strains of mal-
aria, and, significantly, Galen did indeed recognize that tuberculosis was
a major complication of quartan fever.32 So while the Palestinian type of
malaria may not have been as lethal as that at Rome, individuals could be
weakened and rendered much more susceptible to dangerous infections
such as tuberculosis, just like those initially infected with leprosy were
vulnerable to the deadly effects of tuberculosis (see above).
Two genetic anaemias characterized by abnormal haemoglobin,
sickle-cell anaemia and thalassaemia, give some resistance to malaria.33
Today thalassaemia is commonly found in the Mediterranean, Middle
East, and Far East. It is claimed that the earliest evidence for the disease
comes from the Near Eastern Neolithic village of Atlit Yam (7250–6160
bce; see above).34 The proximal humerus of a young male skeleton (16–
17 years of age) was found to exhibit a premature and irregular fusion of
the growth plates, which is characteristic of thalassaemia; however, for
a more definite identification there would need to be several long-bone
epiphyses affected.35 Sickle-cell anaemia occurs throughout sub-Saharan
Africa and in small pockets in the Mediterranean region, the Middle East,
and the Indian subcontinent.36 Scanning-electron microscopy of a male
skeleton excavated on the island of Failaka in the Persian Gulf showed
erythrocytes with the characteristic sickle shape, thus demonstrating
sickle-cell anaemia existed by the Roman period.37
With regard to the human skull, porosities in the outer table of the
cranial vault (porotic hyperostosis) and orbital roof (cribra orbitalia) are
commonly seen in ancient human remains. The active form of this path-
ology is always found in subadults. Evidence of cribra orbitalia has been
found in Galilee, Judea, and the Dead Sea (see section below on patterns
of death). Angel (1966) originally proposed that this cranial pitting was
related to the hereditary haemolytic anaemias, that is thalassaemia and
sickle-cell, and that these anaemias frequently occurred in populations
where malaria was endemic. However, there has been a long-standing
32
After Sallares 2002, 136.
33
Steinbock 1976; Sallares 2002, 33; Roberts and Manchester 2010, 232–234.
34
Hershkovitz et al. 1991.
35
Exarchou et al. 1984, cited by Molto 2000, 107.
36
Williams and Weatherall 2012.
37
Sallares 2004.
124
belief that such lesions are characteristic of iron-deficiency anaemia,38

although it is important to note that the skull changes are essentially
the same for all the anaemias.39 Hence, the precise aetiologies of porotic
hyperostosis and cribra orbitalia have not been completely resolved.
Recently Walker et al. (2009, 119) rejected the idea that this pitting
was caused by iron-deficiency anaemia and suggested persuasively that
‘porotic hyperostosis and many cribra orbitalia lesions are a result of the
megaloblastic anemia acquired by nursing infants through the synergistic
effects of depleted maternal vitamin B12 reserves and unsanitary living
conditions that are conducive to additional nutrient losses from gastro-
intestinal infections around the time of weaning’.
It is striking that gastrointestinal disease was the prime cause of infant
and child mortality in early historical populations; indeed, Celsus recorded
in ancient Rome that children up to the age of ten years were the main
casualties of diarrhoea and dysentery.40 Significantly Masterman (1918,
71) recounted on his travels in Palestine at the turn of the nineteenth cen-
tury that infant mortality was very high, infants commonly dying from
diarrhoea, dysentery, and particularly malaria. Moreover, he states that
malaria was the main disease affecting all classes, and observed that its
incidence depended primarily on the water supply and the area where the
disease lingered the most. He states:
In Jerusalem, the larvae of the two first-mentioned varieties [Anopheles
maculipennis; Pyretophorus palestinensis] breed in countless numbers in the
semi-closed rainwater cisterns attached to almost all the houses, and it is there-
fore little wonder that malarial fevers are there continuously propagated.
(Masterman 1918, 62)
This is interesting given that water was stored in cisterns during the
Roman period, as for example at Jerusalem and Sepphoris. Miqwa’ot
could have been similarly affected, as well as the huge reservoirs/pools
sited around the perimeter of Jerusalem itself.41 However, we do not
have concrete evidence for this. According to Masterman, water stored in
cisterns was perfectly drinkable providing the containers were regularly
cleaned; further, such rainwater collected from roofs was probably safer
than that of a public supply, where water-borne diseases could spread
swiftly throughout the city. But the cisterns of the poor often leaked and
38
Ortner 2003.
39
Roberts and Manchester 2010, 233.
40
Sallares 2002, 124; Celsus, De Medicina 2.8.30.
41
Miqwa’ot = Jewish ritual pools. For reservoirs see Magness 2012b, 168–169.
125
were at risk of being infected with sewage from cess pits. Presumably this
may also have been a problem in the Second Temple period.
Several toilets following Roman lines have been found in Iron Age
contexts in Jerusalem, whereby latrines largely consisted of wooden or
stone seats set over cess pits dug into earth.42 At Pompeii, Ostia, and
Rome scarcely any houses were connected to street drains43 and this
would appear to be the case at Jerusalem. So even if cess pits were used
any material would have to be collected in conjunction with refuse regu-
larly thrown into the streets. However, no toilets have been reliably iden-
tified in the early Roman levels, for example the opulent residences of the
Jewish Quarter. This is perhaps not too surprising since the inhabitants
of these mansions were clearly zealous in their practice of the Jewish
purity rituals, as evidenced by the numerous miqwa’ot, not to mention
the bathtubs and foot baths underlining their adherence to cleanli-
ness. It would seem at odds to have a toilet in the vicinity, and more
in line to have chamber pot(s) enabling a swift removal of excrement
and urine elsewhere. Taking aside toilets, in first-century Italy ‘at Pompeii
and elsewhere there is abundant evidence showing that many people
relieved themselves in streets, doorways, tombs and even behind statutes’
(Scobie 1986, 417), and this possibly occurred in Second Temple Jewish
settlements too.
It is important to remember that in antiquity human faeces were
deemed valuable and used for agricultural purposes.44 Notwithstanding,
there is no evidence of this practice in strictly Jewish settlements and Ken
Dark’s settlement survey between Nazareth and Sepphoris would tend to
support this (Dark 2008). And it is highly likely the Jewish purity laws
would have prohibited this.
Streets were regularly cleaned during the Second Temple period.45 An
enormous dump of rubbish (at least 200,000 cubic metres) was found
outside the walls of the Old City of Jerusalem, just below the Temple
Mount on the western slopes of the Kidron Valley; associated artefacts
indicate that the garbage was gathered from approximately the middle of
the first century bce to 70 ce. Rubbish had regularly been collected at a
rate of 2,000 cubic metres per year, over a period of roughly 120 years.
To remove this amount of material from the city could only have
42
Magness 2012b, 128.
43
Scobie 1986, 409.
44
Scobie 1986, 414.
45
The following two paragraphs are based on the research of Reich and Shukron 2003.
126
involved the use of an organized task force. A comparison of the numis-

matic and artefactual evidence gathered from garbage recovered from the
main street inside the city by the Temple Mount and the dump outside
indicates a striking difference. Garbage from the street contained coins
only of the last five years of the Jewish Revolt, 66–70 ce, while no such
coins were excavated from the city dump, thus giving a terminus ad quem
of 66 ce when it ceased to be used. It is therefore evident that rubbish
rapidly accumulated in Jerusalem and was not collected during the five-
year period of rebellion when the Romans laid siege to the city. Such a
build-up of material would have constituted a major health hazard, and
with the dense concentration of hungry people infectious diseases would
have spread rapidly.
The Dog Tapeworm (Echinococcus granulosus)

Two cysts of the human and animal parasite Echinococcus granulosus
were recovered from the abdominal cavity of a man buried in a rock-cut
tomb at Akeldama,46 and one was found in an ossuary from a tomb at the
Mount Scopus Observatory.47 Echinococcus granulosus was also found
in human faecal remains from eighth-century bce Jerusalem.48 The para-
site is transmitted to humans from dogs that have consumed the flesh of
infected animals, most often sheep; at this stage the parasite comprises
a ‘saclike container of larvae, the hydatid cyst’ (Patterson 1993, 703).
Normally the adult form of the tapeworm is found in dogs or other
canids. However, the larval stage can lead to severe disease in humans.
The Akeldama man exhibited a partially collapsed vertebral body and
Zias (1996a, 118) suggests that this is possibly a ‘clinical expression of
infestation by the tapeworm Echinococcus granulosus’.’49 A large part of
the economy of Jerusalem at the time concerned sheep/goat husbandry,
thus it is not coincidental that these parasites have been found.
Summarizing this section, the remains of a Jew from the upper echelons
of late Second Temple Jewish society was discovered sealed into a burial
niche in a rock-cut tomb; this high-class adult male had been co-infected
with leprosy and tuberculosis, thus indicating the prevalence of these
46
Zias 1996a, 117.
47
Arieli 1998, 40.
48
Cahill et al. 1991.
49
‘Skeletal involvement in echinococcosis of the hydatid type is approximately 2%, and
nearly half the skeletal lesions occur in the vertebral column. The segments of the spine
most often affected are the middorsal and sacral regions’ (Zias 1996a, 118, citing Ortner
and Putschar 1985, 229).
127
diseases in first-century Palestine. Two infants from the same tomb had
died of tuberculosis. Documentary and archaeological evidence clearly
show that malaria was present in Roman and Byzantine Palestine, but the
type of malaria has yet to be identified. In nineteenth-century Jerusalem,
mosquitoes were a serious problem in that they carried malaria and
infested domestic water cisterns, and the same may well have been true in
Roman times. The urban environment in the Graeco-Roman world was
a known health hazard, particularly in relation to the disposal of human
and animal waste which harboured pathogenic organisms. Evidence of
echinococcosis was also found and was likely transmitted from dogs to
humans.
Patterns of Death in Palestinian Rock-Cut Tombs

Life expectancy at birth for the Roman upper classes and indeed emperors
was from twenty to thirty years.50 And in the Graeco-Roman world as a
whole the average life expectancy at birth ranged from twenty to thirty
years, although earlier or later deaths may sometimes have resulted from
high-risk (densely populated, low-altitude, watery, malarious) or low-risk
(sparsely populated, high-altitude) environments.51 In Rome, Scheidel
(2007, 39) has underlined that ‘endemic infectious disease acted as the
principal environmental determinant of local age structure’. Infants were
especially vulnerable, particularly those who had just been weaned and
were subject to dirty receptacles and contaminated food,52 not to mention
excrement from dogs and swarms of flies. However, unlike the Romans
who practised infanticide, the Jews refused to adopt this procedure for
religious reasons, and they were also disinclined to practise contraception
and abortion.53
Since 1967 over a thousand tombs have been discovered on the ridge
encircling Jerusalem.54 In the Herodian period stone-carved ossuaries
were used as receptacles to house the bones gathered from secondary
burial (see section on ossuaries in chapter 4).
The degree of preservation of human bones should be addressed
before any judgements on issues of demography are made, and unfortu-
nately there has been a lack of detail concerning this in many osteological
50
Scheidel 1999, 280.
51
Scheidel 2007, 39.
52
Scobie 1986, 422.
53
Goodman 1996, 769.
54
See Kloner and Zissu 2007.
128
reports. Due to the damp environment, bone has not preserved well in
some of the limestone ossuaries that have been excavated in the Jerusalem
tombs.55 However, Zias describes ‘excellent preservation’ in the undis-
turbed ossuaries from a tomb at Arnona, Jerusalem (Zias 2006b, 117).
At Jericho, Hachlili and Smith (1979, 67) state with reference to the bone
assemblage from the Goliath Tomb: ‘As is frequently the case in lime-
stone ossuaries, the bones were extremely friable and difficult to study.’
Children’s bones do not preserve as well as adults since they have a
lower bone mineral density, and thus are susceptible to attack by the
acidic products of organic matter decomposition and acid environments,
and also to being crushed.56 This leads to their under-representation on
sites. Bones of the skull vault are frequently missed in excavation and
consequently the detection of specific pathological conditions such as
porotic hyperostosis and cribra orbitalia is seriously affected.57 Yet these
Palestinian bones are important, having been discovered in contexts of
great significance, and it is essential to attempt to glean as much informa-
tion as possible from them.
Figures 5.1 and 5.258 shows the minimum number (MN) of subadults
(0–18 years) compared with infants (0–5 years), each expressed as a
percentage of the total number of individuals recovered from a selec-
tion of tombs and burial caves in Judea and Galilee. Note the subadult
counts include those of the infants. For comparative purposes data
from Roman/Byzantine Tell Hesban in Jordan,59 classical sites in the
55
Arensburg and Rak 1975, 69; Smith 1977, 121; Zias 1992a.
56
Guy 1997.
57
Djurić et al. 2011, 259.
58
In order to be able to compare and contrast sites, the grouping into infant (0–5 years),
subadult (0–18 years), and adult reflects the way that the data has been presented in the
osteological reports. The tombs used for analysis are as follows and the number of indi-
viduals (MN) are also included: Caiaphas (63 MN, Zias 1992a); Arnona (41 MN, Zias
2006b); Akeldama (115 MN, Zias 1996a); Mt Scopus Observatory (143 MN, Arieli
1998); Mt Scopus West Slope (88 MN, Zias 1992b); Giv’at ha-Mivtar (35MN, Haas
1970); French Hill late Hellenistic (33 MN, Smith and Zias 1980); French Hill Roman
(64 MN, Arensburg and Rak 1975); Jericho (192 MN, Arensburg and Smith 1983);
Goliath Tomb Jericho (31 MN, Hachlili and Smith 1979); Dead Sea Ein Gedi (164 MN,
Arensburg and Belfer-Cohen 1994); Dead Sea Caves Hellenistic and Roman (99 MN,
28 MN, Goldstein, Arensburg, and Nathan 1981); Meiron, Upper Galilee (197 MN,
Smith, Bornemann, and Zias 1981); Tell Hesban Jordan (99 MN, Grauer and Armelagos
1998); Bedouin C19 (216 MN, Goldstein, Arensburg, and Nathan 1976); Eastern
Mediterranean (144 MN, Angel 1969).
59
Grauer and Armelagos 1998.
129
Figure 5.1 Minimum number (MN) of subadults (0–18 years) expressed as a

percentage of the total number of individuals.
eastern Mediterranean dating to 650–350 bce,60 and nineteenth-century

Bedouins61 have also been included.
If one considers the subadult (0–18 years) section of society, the
Jerusalem tombs (Caiaphas, Arnona, Akeldama, Mount Scopus, Giv’at
ha-Mivtar), and those at Meiron in Galilee, Dead Sea Ein Gedi, Dead Sea
Caves (Roman), Tell Hesban in Jordan and the eastern Mediterranean, all
show that over 40% of their remains comprise subadults. Notwithstanding,
it is the tomb of Caiaphas62 which stands apart from these and the other
sites in demonstrating a much higher percentage of deaths – 68%. Here
the subadult to adult ratio exceeds that of 50:50 prevalent in agricul-
tural societies. Given that taphonomic factors would have affected the
more fragile bones of infants and children, this percentage is significant
as better preservation would have increased the figure. In contrast to the
other tombs, 32% of this subadult group (22% of the total number of
individuals) were between six and twelve years of age. Also in contrast
to other Palestinian tombs this tomb has the highest percentage of infant
deaths (41%, Figure 5.2).
60
Angel 1969.
61
Goldstein et al. 1976.
62
See chapter 4, p. 98n72 for the reliability of identification of Caiaphas’ tomb.
130
Figure 5.2 Minimum number (MN) of infants (0–5 years) expressed as a per-

centage of the total number of individuals.
The patterning of the Jerusalem tombs (Caiaphas, Arnona, Akeldama,

Mt Scopus West Slope, and Observatory), the Goliath Tomb at Jericho,
and Meiron in Galilee is similar in that the subadult remains comprise
a large proportion of infants (0–5 years of age), an age group extremely
prone to infectious diseases. This is also true of the Tell Hesban tombs
in Jordan and the eastern Mediterranean sites. In Egypt for the greater
part of the nineteenth century approximately 50% of children died under
five years of age,63 and this high infant mortality was something that had
been observed by contemporary medical doctors in Palestine.64 So we can
assume that a similar mortality would have been experienced by Second
Temple Jews and other coeval societies. However, if the proportion of
0–1-year-old infants is separated out from the total number of infants,
as shown in Figure 5.3, clear differences can be observed (note the 0–5-
year-old sample is a percentage of the total number of individuals, while
the 0–1-year-old sample is a percentage of the 0–5-year-old minimum
number of individuals). Five sites in particular demonstrate 50% or
more of the infants are 0–1 years old: Tell Hesban (78%); the eastern
63
Tucker 1985, 115.
64
Masterman 1918, 71.
131
Figure 5.3 Minimum number (MN) of infants (0–5 years) expressed as a per-

centage of the total number of individuals, compared with the minimum number
(MN) of infants (0–1 years) expressed as a percentage of the total number of
infants.
Mediterranean (72%); the Akeldama tombs (67%), the remains of which

include eighteen perinatal births; the Goliath Tomb at Jericho (55%); and
Meiron (50%). It is important to realize that a high percentage of 0–1-
year-old infants is normal in agricultural societies and demonstrates high
fertility; indeed, ‘populations of the ancient world were characterized
by a regime of high fertility and mortality’ (Scheidel 2007, 38). What
is more, this is an age group that is greatly under-represented in many
Palestinian tombs through poor preservation of the osteological material.
With regard to Figure 5.2, it is striking that the French Hill (Roman)
tomb contained one of the lowest percentages of infant remains, just
16%. Clearly the assemblage has been affected by poor environmental
conditions and indeed Arensburg and Rak (1975, 69) described finding
some of the bones crumbling into a white powder: ‘The ossuaries were
locked by a stone cover, but were not sufficiently hermetic to prevent
humidity or the penetration of water. Therefore, the condition of the bones
is rarely good, and these bones were decayed and sometimes degenerated
into a white dust which, when touched, lost any form.’ Leaving aside
the Goliath Tomb, the amalgamation of Jericho tombs contained the
132
lowest number of infant burials. Arensburg and Smith (1983) concluded

that their estimation of age at death pointed to a longer life span and
lower infant mortality at Jericho as opposed to Jerusalem, with a higher
percentages of adults surviving beyond the age of fifty years. They related
this difference to climate, Jericho’s winters being warm and mild while
those at Jerusalem were cold and damp, where respiratory infections and
rheumatic conditions are common even today. This is an attractive but
flawed proposition since the infant remains are vastly under-represented
and undoubtedly more are to be discovered; one burial cave incompletely
excavated had revealed two layers of infant remains buried below a
plastered floor.65 The Goliath Cave at Jericho has yielded results similar
to the Jerusalem tombs, showing fatal infectious diseases strike the young
regardless of climate.
In the Goliath Tomb, two ossuaries were discovered containing only
an infant (five to six months old) in one and a child (six years old) in the
other. Infants were normally buried with adults, as demonstrated by two
mothers who were interred with their infants; these women died at forty
to forty-five years old,66 demonstrating an impressive fecundity.67 The
tomb is very closely dated to three generations (sixty years), that is 10–70
ce, and its large size, delicate frescoes on the walls of the upper chamber,
and high proportion of inscribed ossuaries indicate the high status of the
owners.68 However, long bone measurements of eighteen infants from
the Akeldama tombs ‘fell far below normative figures given for newborns
in Ashqelon during the Roman Period’ (Zias 1996b; Smith and Kahila
1992), and this is indicative of non-viable premature births. Importantly
this is also a measure and indication of poor maternal health.
65
Arensburg and Smith 1983, 133.
66
The average age of the menopause is fifty years in modern western populations and
there has been scant change in the age of onset in human populations over the past two
millennia (Chamberlain 2006, 55).
67
Hachlili and Smith 1979, 68. In 1989 at Beit Shemesh in Israel archaeologists discovered
a Roman tomb dating to the late fourth century ce and containing a young girl who had
died in childbirth; 7 grams of Cannabis sativa was found with the mother and unborn
child (Zias 1996b, 16). Hashish is mentioned in the ancient Egyptian Ebers medical
papyrus dating to the second millennium bce and is associated with mothers and chil-
dren; it was probably used to stem haemorrhage in childbirth. Papaver somniferum, the
opium poppy, was also known as it was depicted on coinage of King Herod the Great
in conjunction with ears of wheat to celebrate the local cult of Demeter and Kore at
Samaria. The earliest use of opium in Israel dates back a thousand years earlier to the
Bronze Age, where ceramic juglets closely resembling poppy heads were found to contain
the substance detected through a gas chromatography analysis (Zias 1996b, 17).
68
Hachlili and Smith 1979, 70.
133
The Meiron tomb in Galilee is an undisturbed cave dating from the

first century bce to the fourth century ce. 48% of the individuals died
before reaching eighteen years of age (see Figure 5.1).69 Within this age
range the highest mortality occurred within the first five years of life, that
is 74%. Cribra orbitalia was observed in most children’s skulls.70 The
Dead Sea Cave excavations also yielded the remains of children showing
cribra orbitalia from the Hellenistic (65%) and Roman periods (ten out
of eleven children).71 There was little evidence of active lesions in the
Tell Hesban sample, indicating the population overall was not unduly
stressed; even so over 50% of the orbits showed ‘indications of slight
pinpoint porosity and remodelling’, indicating juvenile stress (Grauer
and Armelagos 1998, 118). Three children from Giv’at ha-Mivtar also
showed evidence of cribra orbitalia.
The Dead Sea Roman skeletal sample most likely represents Jewish
refugees fleeing and sheltering from Roman sieges.72 Here there is a
high proportion of subadult remains with a considerable proportion of
infants. However, the overall number of remains is small, so care should
be taken in their interpretation. A similar proportion of infant remains
was found at Ein Gedi, but there was no mention of cribra orbitalia in the
osteological reports. Also the low number of infant remains in the French
Hill Roman period tombs argues for poor preservation in general.
To conclude this section: one major finding has been the high proportion
of infant burials (0–5 years) discovered in the tombs (Jerusalem: Caiaphas,
Arnona, Akeldama, Mount Scopus; Jericho: Goliath; Galilee: Meiron),
and indeed, where recorded in osteological reports, the high incidence of
those aged 0–1 years (Jerusalem: Akeldama; Jericho; Galilee: Meiron).
Certainly with better bone preservation the numbers would have greatly
increased. This is a common finding in agricultural societies. Infants and
neonates were accorded proper burial and in some cases were buried in
their own ossuaries. The subadult to adult ratio of roughly 40:60 for
many of the Jerusalem sites approximates the 50:50 of agricultural soci-
eties, and with more favourable environmental conditions this correl-
ation could have been reached.
In general the Jerusalem and Jericho (Goliath) tombs demonstrate a
similar trend but the tomb of Caiaphas stands out with a particularly high
69
Smith et al. 1981, 110.
70
Smith et al. 1981, 117.
71
Goldstein et al. 1981, 15.
72
Goldstein et al. 1981.
134
incidence of subadult remains, a large proportion of which were infants

and children aged between six and twelve years of age. This mortality
pattern possibly represents an epidemic of some sort, perhaps related to
environmental conditions, where the young were more susceptible than
the old who had through exposure gained some immunity; Zias (1992a)
has suggested that a drought in Jerusalem (41–48 ce) may well have
accounted for these deaths.73 Certainly a great famine occurred during
the reign of the emperor Claudius, as mentioned in Acts (11:28–30)
and Josephus (Jewish Antiquities xx.51–53, 100; iii.32) (Jensen 2012b,
321). It is notable that during 25 to 24 bce Herod the Great organized
a massive importation of grain from Egypt to counteract the effects of a
drought in Judea which had precipitated famine and various epidemics.74
Poor maternal health is suggested by long-bone measurements of the
newborn infants recovered from the Akeldama tombs, which are well
below the norm for the period. Moreover, the high incidence of cribra
orbitalia identified on the Meiron child skulls possibly points to low nutri-
tional diets for the mothers. Clearly, higher social status and wealth did
not grant any particular health advantages over those less well endowed.
Interpersonal Violence in the Early First Century

The remains of three individuals from the Mount Scopus tombs demon-
strate evidence of trauma during the Herodian period. Firstly, the distal
end of a humerus, belonging to a woman aged fifty to sixty years, had
been cleanly sliced through by a sharp blade, and the direction of the
blow through the elbow indicates that the woman had attempted to
parry the attack; she did not survive, as evidenced by a lack of bone mod-
elling and any signs of infection. Secondly, in an adjacent tomb a young
man, twenty-five to thirty years, exhibits a well-healed depression frac-
ture on the right frontal bone of the skull. And thirdly, in the same tomb
a man, aged fifty years, appears to have been decapitated by two blows
through the neck, which sliced one cervical vertebra and cut another.75
Zias questioned the likelihood of this being the result of a judicial execu-
tion on the basis that there were two attempts at severance.
73
This can only be a tentative suggestion since a statistical analysis would not be appro-
priate because of the poor preservation of the bones and the limited excavation of most
of the tombs.
74
Josephus, Jewish Antiquities xv.299–300.
75
Zias 1983, 233–234.
135
Interestingly, in an extensive survey of several hundred Roman

decapitations (outside Palestine and mainly in Britain) Craig A. Evans
concluded that ‘in about one half of the cases two or more strokes of
the sword or axe were required before the head was separated from the
body’ (C. A. Evans 2011b, 94). Evans has also pointed out that in the
‘bloody battle’ of Towton (fifteenth-century ce Britain), where similar
weapons were used to those in first-century Palestine, an analysis of the
skeletal remains of several hundred soldiers yielded only one possible
decapitation; half the men had fatal head wounds and the other half fatal
cuts via swords/spears to the body. His point is that if there are so few
decapitations when men are armed to the hilt with swords and spears, then
it is highly unlikely that such mutilations would arise through domestic
disputes. Thus the aforementioned injuries involving head removal are
most likely decapitations in the form of judicial executions.
Another possible decapitation, this time of an elderly (possibly) female,
was found at Giv’at ha-Mivtar (Abba cave), whereby the ferocity of the
blow had ‘cut through the mandible shearing off most of the face’.76 The
cut marks at Giv’at ha-Mivtar indicate that the instrument used was a
sword rather than an axe. It is pertinent to note that in Acts (12:2) Herod
had James the brother of John put to death by the sword, and earlier he
had given the order for John the Baptist to be beheaded (Mark 6:27).
I would therefore suggest that the sword rather than the axe was used
for decapitation.
In addition to the material already described from Mount Scopus,77
an ossuary from another tomb contained the bones of a young man,
aged eighteen to twenty-five years, who had been brutally cut down by
a series of blows which had severed an arm, penetrated deeply into the
other, and had lacerated the skull, spine, and pelvis; since there were no
observable wounds on the forearms, indicative of a defensive stance, Zias
(1991, 153–154; 1992b, 101) suggested that such butchery had not been
sustained in battle but rather had been incurred as punishment inflicted
by the Romans.
A punishment commonly used by the Romans to terrorize and thus
control its citizens and client kingdoms was that of crucifixion. Josephus
relates that when the Romans blockaded Jerusalem during the Jewish
rebellion of 66–70 ce over 500 Jews a day were crucified outside the city
(Jewish War v.450–453). Notwithstanding, despite the fact that a goodly
76
Smith 1977, 123–124.
77
Zias 1983.
136
number of tombs have been excavated in the vicinity of Jerusalem, only

one has yielded evidence for crucifixion, that at Giv’at ha-Mivtar; here
the victim, a young man aged between twenty-four and twenty-eight years
old, had been interred in an ossuary with a three- to four-year-old child.78
The man’s heel bone had been transfixed with a large nail.79 Zias (2013,
1849–1852) proposed two reasons for the apparent lack of evidence for
crucifixion in Palestine: 1) iron nails were considered to be ‘one of the
most powerful healing amulets in antiquity’ and clearly were sought-after
items; and 2) the fragile nature of the calcaneum, largely consisting of
spongy bone with a thin outer cortex, does not lend well to preservation.
Another reason for the lack of crucifixion victims is that such a death
was reserved for the lower members of society, and tomb contents reflect
those from the upper end of the social scale. But human bones in general
have not preserved well in the tombs surrounding Jerusalem, and this
accounts for the low levels of violence recorded, together with the fact
that many people may have died from soft tissue injuries.
Summary
Leprosy and tuberculosis have both been identified in archaeological
human remains from a first-century tomb outside Jerusalem. It is of some
significance that the co-infection was identified in a person, possibly
a priest, from the higher echelons of society. Additionally, two infants
from the same tomb tested positive for tuberculosis. Only through an
analysis of the DNA were these findings established, and this underlines
the importance of continuing such molecular research, paying rigorous
attention to methodology. Thus some of the leprosy cases mentioned in
the Gospels may well have been true leprosy, rather than a common skin
complaint such as psoriasis.
Malaria is described by Josephus with reference to a Hasmonean king
in the first century bce, and it is suggested that the parasite involved
was P. malariae. So far there is no evidence that malaria was a serious
problem in the first century, and certainly there is no evidence for the
deadly falciparum form. Parasites such as head lice (and eggs) and cysts
from the hydatid tapeworm have been recovered from human hair and
body cavities of Second Temple Jews.
78
Haas 1970, 42, 49–59.
79
Zias 1991, 155.
137
An analysis of the human bones from Palestinian tombs, in particular

the ones relating to the urban sites of Jerusalem and Jericho, demonstrates
a high level of subadult deaths, especially of infants. Endemic infectious
disease coupled with a poor understanding of hygiene affected all classes.
Those socially and economically advantaged were equally at risk with
those less well off when faced with an aggressive and persistent pathogen.
Notwithstanding, the tomb of Caiaphas stands apart from other burial
sites in containing a high incidence of subadult remains, comprising not
only infants but young children aged between six to twelve years old. This
is unusual and is suggestive of some epidemic following an environmental
misfortune, possibly a drought leading to crop failure and food shortages,
which in turn would have had a deleterious effect on the populace.
Although the bones demonstrate little in the way of interpersonal
violence, those that do show a brutality likely reflective of Roman pun-
ishment: for example the crucifixion (male), two beheadings (one male,
one possibly female), and the extensive butchery to the upper torso of a
young man.
Connection with Textual Materials of Chapter 3

Why are Judean health concerns important in the Jesus story? How does
Jesus’ healing ministry relate to his eschatological outlook? And what are
the main factors accounting for Jesus’ apparent healing success?
That evening after sunset the people brought to Jesus all the sick and demon-
possessed. The whole town gathered at the door, and Jesus healed many who had
various diseases. He also drove out many demons …
(Mark 1:32–34)
As an apocalyptical and eschatological prophet, Jesus sought to heal

those of impurities which would hinder their entering the kingdom of
God, the presence of God. This proposal was recently made by Jodi
Magness (2016b) with reference to diseases, deformities, disabilities, and
demonic possession, and, in agreement, I believe it is fundamental to any
discussion concerning Jesus’ healing ministry (see below). Most of the
afflictions Jesus healed were chronic as opposed to acute diseases, and,
given recent medical research concerning long-standing illness, a large
proportion of those afflicted would have responded well and gained
much benefit from the influence of an uplifting character, such as Jesus,
a person who cared and could instil confidence and command respect.
Thus I propose the impact Jesus made on his disciples, as described in
138
chapter 3, is of immense importance in understanding why he became

renowned as a great healer and exorcist, major themes running through
all the Gospels. While the bioarchaeological remains in chapter 5 do not
directly inform on Galilee, they provide vital information concerning
Judean society which puts Jesus and his mission in context.
The diseases and mortality patterns so far described in chapter 5 per-
tain to the urban environment of Jerusalem, not the rural areas of Galilee,
and incorporate more acute infections.80 Nonetheless this information
is important. One cannot view and understand Jesus in the isolation of
first-century Galilee – what is happening to the people in Judea is of
major concern. While Jesus’ eschatological mission centred in Galilee (he
was after all a Galilean), he also had contacts with Judea, in particular
the village of Bethany outside Jerusalem, which is mentioned in all four
Gospels (see below). Further, it is evident that he was highly aware of the
corrupt behaviour of the priesthood with regard to the way they ran the
Temple, and their contemptible treatment of the poor (see chapter 2).
These points highlight his close association with people in and around
Jerusalem.
The Gospels scarcely record Jesus frequenting urban environments: his
ministry focused on the Galilean village and its environs. This has often
been commented on and a variety of reasons for this have been proposed;
however, one contributory reason not already considered might well have
been the need to avoid dangerous diseases prevalent in the cities, such
as tuberculosis, normally chronic in manifestation, but (as identified at
Jerusalem) deadly in combination with the leprosy bacillus. Those with
more wealth clearly had no advantage over the less fortunate where any
infection was concerned. This is evident from the information gleaned
from the Judean tombs, those at Jerusalem and Jericho. Indeed the
Akeldama tombs (Jerusalem) were among the most splendidly decorated
tombs, yet osteological data indicate that the rich women interred suffered
poor maternal health, likely related to nutritional deficiencies. And inter-
estingly this was also suggested for the skeletal remains from Meiron in
Upper Galilee. The lower strata of Judean society would have been even
more exposed to such major infections through poor housing and sani-
tation, but additional stress factors were also affecting them, such as the
accumulation of large debts and unemployment (see chapter 2, p. 46;
chapter 6, pp. 184–185). As shown in chapter 4, a common Judaism
80
Here the highly infectious TB identified in its acute form is especially important in
understanding the stressors on Judean society.
139
linked Judea and Galilee and many Galileans would have regularly visited
Jerusalem to attend the annual festivals. These pilgrims would have been
exposed to infectious diseases easily spread by such throngs; thus Judean
health concerns are of relevance to Galilee. Moreover, Jerusalem at these
times can also be regarded as a melting pot for infections, minor or major,
carried by the diaspora.
Many of the physical diseases Jesus healed can be classed, as already
stated, as chronic disorders rather than acute infections leading to death: for
example, deafness (Mark 7:31), dumbness (Mark 7:31), blindness (Mark
8:22; 10:46; Matthew 9:27; 20:30; Luke 18:35; John 9:1), haemorrhaging
(Mark 5:25; Matthew 9:20; Luke 8:43), fever (Mark 1:30; Matthew 8:14;
Luke 4:38; John 4:46), paralysis (Mark 2:3; Matthew 9:2; Luke 5:18),
withered hand (Mark 3:1; Matthew 12:9; Luke 6:6), oedema (Luke 14:1),
and even leprosy (Luke 17:11).81 Significantly, Jodi Magness (2016b,
115) has pointed out that similar conditions are listed in the Rule of the
Congregation (1QSa 1[2]:3–9) of the Essenes at Qumran, a sect living
apart in the Judean desert near the Dead Sea and coeval with Jesus.
No man with a physical handicap – crippled in both legs or hands, lame, blind,
deaf, dumb or possessed of a visible blemish in his flesh – or a doddering old man
unable to do his share in the congregation – may en[ter] to take a place in the
congregation of the m[e]n of reputation. For the holy angels are [a part of] their
congregation.
(1QSa 2:5–9; translation by Michael Wise et al. 1996, 146)
This rule82 states that only those men who are free of such defects83 will
ultimately be allowed to enter the Essene eschatological community; in
other words, only those who were perfect and pure could enter the presence
of God. In direct contrast to this, Jesus was healing such complaints so
the people could enter his conception of the kingdom of God. This is
an important feature of Jesus’ ministry highlighted by Magness – the
inclusive nature of Jesus’ movement: ‘whereas Jesus’ attitude towards the
81
The leprosy mentioned may have been a common skin complaint. The pagan god
Asclepius ‘was credited with bringing sight to the blind, voices to the mute and the ability
to restore paralysed limbs’ (Bond 2012, 105), and there is a significant link between this
pagan practice of healing and Jesus’ at the Pool of Bethesda (see chapter 4, pp. 111–113).
82
Based on the Mosaic law described in Leviticus 21:16–23 for the priests of Aaron.
83
Bleeding is not mentioned in the Rule of the Congregation but Jesus is recorded as
healing a haemorrhaging woman who had suffered from the complaint for many years
(Mark 5:25–34). This is allied to the purity laws, as described in Leviticus 15:25: ‘When
a woman has a discharge of blood for many days at a time other than her monthly period
or has a discharge that continues beyond her period, she will be unclean as long as she
has the discharge, just as in the days of her period.’
140
diseased and disabled can be characterized as inclusive and proactive, the

Qumran sect was exclusive and reactive’ (Magness (2016b, 115).84 So
Jesus’ healings represent his consciousness of the holiness of God and his
resolve to heal the sick, so that they could enter the divine presence in a
pure and unblemished state. It is the healed people made whole itemized
in the parable of the Great Banquet (Luke 14:16–24/Matthew 22:1–10),
the eschatological banquet, who will enter the kingdom of God first,
that is the ‘poor, the crippled, the blind and the lame’ in preference to
the rich who blatantly ignored the invitation. Indeed, Dunn (2011b, 67–
68) has drawn attention to the fact that Luke (14:12–14, 21) repeatedly
emphasizes this point in his chapter, thus indicating this was a strong
memory of Jesus, recalling his aversion to such exclusion.85
Furthermore, in answer to John’s messengers asking the disciples who
he was, Jesus answered, ‘Go back and report to John what you have seen
and heard: “The blind receive sight, the lame walk, those who have lep-
rosy are cleansed, the deaf hear, the dead are raised, and the good news
is proclaimed to the poor” ’ (Luke 7:22–23/Matthew 11:4–6). Siting the
healing of such diseases alongside the poor in this verse clearly underlines
the wider social context of Jesus’ healing ministry.86 Indeed, such healings/
miracles are promised in Isaiah and 4Q521, and, importantly, 4Q521
mentions the appearance of a Messiah who possibly would undertake
this work (see chapter 1, p. 16).
In a pre-antibiotic era some of these disorders would have been com-
monplace (see below with reference to blindness), causing not only
physical suffering but economic hardship leading to poverty, and ultim-
ately ostracism, since throughout biblical times there was a great stigma
attached to illness, which was considered related to sin. Purification rites
could not change and cure these conditions either for the men of Qumran
or the ordinary Palestinian individual. This is why Jesus’ approach to
healing was so important to the people (not just his promises concerning
entry into the eschatological kingdom); there were few other avenues
open to them for help since Jewish miracle workers were uncommon (see
chapter 3, p. 60), and doctors were expensive (Mark 5:26). Clearly he
was singularly successful as he drew large crowds, as evidenced by all the
Gospels, but, more to the point, why was he successful?
84
See also Dunn 2011b, 67 n. 60.
85
Indeed, Helen Bond (2012, 109) states: ‘Jesus shows a complete disregard for the age,
gender and social status of those he heals (even perhaps healing the occasional Gentile,
see Mark 5.1–20 and 7.24–30).’
86
Eve 2009, 57.
141
The success of Jesus’ healing ministry pivoted on his ability to enable

the individual to have faith in the healing process – to have faith that God
would enact a cure. And it is this faith factor that clearly distances Jesus
from Judaic and Hellenistic miracle workers.87 Significantly it was only
in his healing miracles that Jesus called upon the faith of the person to
be healed or that of his/her friends (see chapter 3, p. 60).88 Gerd Theissen
(2010, 54–55), who believes in the reality of Jesus’ healings, has stated
that ‘faith and confidence can support the healing processes on the side of
both the patient and physician’ and he has suggested ‘the placebo effect’
was central to Jesus’ cures. I agree with this proposition since recent med-
ical research concerning the ‘placebo effect’ is beginning to demonstrate
that it is a real phenomenon, the effectiveness lying in the relationship
between patient and therapist.89 However, for this ‘interpersonal healing’
to work it needs to operate within the parameters of illness rather
than of disease.90 There is a key distinction between the terms; ‘disease
adversely affects the organism’ while ‘illness adversely affects the person’
(Miller et al. 2009, 523). This point was also recognized by Theissen
through the application of cultural anthropology methodology; signifi-
cantly, he pointed out that the healer was not necessarily curing a disease
but making an illness easier to live with (Theissen 2010, 54–55). And,
importantly, this enabled the sufferer to be returned to family, friends,
and society in general.91
By asking whether the sick person had faith Jesus was getting the
man or woman into the right frame of mind to effect a healing and to
receive forgiveness for any perceived sin. He was activating the mind–
body connection so boosting the patient’s immune system, which dir-
ectly affects mental states. But to raise human expectations he needed to
gain the trust and confidence of the sick person. And the way Jesus did
87
Dunn 1975, 168.
88
Luke 7:1–10/Matthew 8:10 (centurion’s servant); Mark 2:1–5, Matthew 9:2–8, Luke
5:18–26 (paralytic); Mark 5:25–29, Matthew 9:20–22, Luke 8:42–44 (bleeding woman);
Mark 10:46–52, Matthew 20:29–34, Luke 18:35–43 (blind Bartimaeus).
89
Miller et al. 2009; Finniss et al. 2010. See Meggitt 2011, 33 for the effectiveness of
the placebo response in a range of clinical trials across a broad spectrum of ailments.
Importantly he notes that ‘placebos have been shown to affect not just a patient’s sub-
jective perception of a symptom (such as pain) but also bodily processes that are object-
ively observable and measurable’.
90
‘Disease consists of biological dysfunction of the human organism – the primary focus
of diagnosis and treatment within biomedicine. Illness is the experience of detriments to
health, including the symptomatic manifestations of disease’ (Miller et al. 2009, 523).
91
Eve 2009, 57.
142
this was to act and speak with authority, an attribute peculiar to him
in that it came from him alone and not from contemporary or indeed
earlier Judaism (see chapter 3, p. 69). This trait is frequently mentioned
in conjunction with his teachings and exorcisms as well as his healings.
Jesus did not make use of complicated rituals or prayers: his healings
were simply and commonly accomplished through touch, by either him
touching or being touched (Mark 1:41; 3:10).
Blindness is an affliction commonly mentioned in the New Testament;
Jesus healed several blind people in Capernaum, Bethsaida, Jerusalem,
and Jericho (Mark 8:22–26, 10:46–52 [blind Bartimaeus begging in
Jericho]; Matthew 9:27–31, 20:29–34 [two blind beggars at the side of
the road outside Jericho]; Luke 18:35–43 [blind beggar at Jericho]; John
9:1–12). Patricia Bruce (2005, 42) has pointed out that ‘being sick or
disabled often went hand in hand with poverty and such people were
frequently reduced to begging’. Evidently some of the aforementioned
individuals were indeed beggars, and, interestingly, beggars in urban
environments – towns. Notably at the turn of the nineteenth century
in Palestine, Masterman, a medical doctor, observed that there were
an ‘extraordinary’ number of blind beggars in and around the towns
(Masterman 1918, 69) – and inflammation of the eye was widespread.
Bacterial conjunctivitis is one of the most commonly found eye problems
in medicine. Highly contagious and potentially leading to blindness, it is
preventable by hand washing92 and good hygiene practices. Trachoma93
is another bacterial eye infection and is the leading cause of prevent-
able blindness worldwide. A 1931 census reported a high incidence of
blindness in the villages of southern Palestine; summer epidemics of acute
conjunctivitis and trachoma prevalent in Palestine were responsible for
most of this blindness.94
John’s account of the healing of the blind man at Jerusalem is intri-
guing since Jesus took a distinctly pragmatic approach whereby he
mixed clay with saliva and applied this to the infected eye (John 9:6–7).
This calls to mind the natural healing properties of some of Israel’s and
indeed Jordan’s soils and clays. The Dead Sea mud for all the present-day
92
It is notable that hand washing was an accepted practice by the Pharisees and Jews at the
time of Jesus (Mark 7:3). And many two-handled stone mugs suitable for this purpose
have been recovered from Jewish sites, the mug easily being passed from one hand to
the other.
93
Trachoma is a contagious bacterial infection of the eye causing inflamed granulation on
the inner surface of the lids.
94
Shimkin 1935, 548–576.
143
advertising does have anti-bacterial properties;95 test micro-organisms

(Escherichia coli, Staphylococcus aureus, Propionibacterium acnes, and
Candida albicans) rapidly lost their viability when added to Dead Sea
mud.96 And Jordan’s red soils have antibiotic properties due to the pro-
liferation of antibiotic-producing bacteria, which kill organisms such as
Micrococcus luteus and Staphylococcus aureus.97 Thus there is the dis-
tinct possibility that Jesus as a healer was aware of the potency of such
natural healing remedies.98
In the account of Jesus healing Simon’s mother-in-law, Luke (4:38–
39) is the only Evangelist to use the words ‘great fever’; Matthew (8:14–
15) and Mark (1:29–31) simply use the word fever.99 We can surmise
that Luke, a physician (Colossians 4:14), used a more exact terminology
and was hence referring to malaria, but there is no suggestion that the
woman’s life was in danger. Furthermore, others have claimed that this
was simply a bad bout of influenza based on the ‘the brief duration, high
fever, and abrupt cessation of fever’ (Hon et al. 2010). Certainly the rapid
95
The general term ‘antimicrobials’ is used for any compound with a direct action on
micro-organisms used for treatment or prevention of infections. Antimicrobials are
inclusive of anti-bacterials, anti-virals, anti-fungals, and anti-protozoals. The term
‘antibiotics’ is synonymous with that of anti-bacterials (www.hma.eu/fileadmin/dateien/
Veterinary_ medicines/ 00- HMA_ Vet/ 02- HMA_ Task_ Force/ 03_ HMA_ vet_ TF_ AMR/
2012_11_HMA_agreed_AB_AM_definitions.pdf).
96
Ma’or et al. 2006.
97
Falkinam et al. 2009.
98
Eric Eve (2008) has compared Jesus’ use of saliva in healing a blind man at Bethsaida
(Mark 8:22–26) with that of Vespasian using spittle in curing a blind man at Alexandria
(Tacitus, Histories iv.81; Suetonius, Vespasian 7.2; and Cassius Dio, Roman History
lxv.8). There had been a rapid turnover of emperors after the suicide of Nero in 68
ce, and these accounts indicate that Vespasian’s healings were acts calculated to help
legitimize his claim to being emperor. Vespasian had been sent by Nero to suppress the
Jewish Rebellion of 66 ce to 70 ce, and to Jews a healing by Vespasian would ‘have
sounded like a usurpation of traditional messianic hopes’ (Eve 2008, 1). Moreover, if the
Gospel of Mark was written after 70 ce, then the aforementioned histories of Vespasian’s
healings would have been readily available. Thus Eve proposes that the Evangelist Mark
was aware of Vespasian’s healing and used his healing reference to Jesus to ‘contrast the
messiahship of Jesus with such Roman imperial “messianism” ’. In other words this was
a rhetorical device used on the part of Mark. However, in contrast to Mark’s Gospel the
key element of the healing in Johns’ Gospel is mud, and as we have seen this is highly
significant, given its possible anti-bacterial properties. I would therefore question Eve’s
assertion that the Markan accounts have no basis in reality. Moreover, there is good evi-
dence that part of Mark’s Gospel was written pre-70 ce (see chapter 2).
99
According to the AKJV: ‘And he arose out of the synagogue, and entered into Simon’s
house. And Simon’s wife’s mother was taken with a great fever; and they besought him
for her. And he stood over her, and rebuked the fever; and it left her: and immediately she
arose and ministered unto them’ (Luke 4:38–39).
144
recovery of the woman would argue for this. However, in John’s account
of the healing of the official’s son at Capernaum there is an expectation
of imminent death with this fever, and on that basis I would argue that
the boy was most likely suffering from a form of malaria (John 4:46–53).
It is evident that on occasion Jesus was not afraid to associate with
potentially dangerous infections, for instance when he visited a leper at
Bethany (Mark 14:3). All the Gospels refer to Bethany, but the Gospel of
Mark mentions the village many more times (seven) and associates it with
a man called Simon the Leper. Interestingly, one of the Dead Sea Scrolls,
the Temple Scroll, records that those with ‘skin diseases’ were to live out-
side and to the east of Jerusalem, and this accords with the location of
Bethany, which was also well out of sight of the city itself (11Q19 42:16–
18). The Synoptic Gospels record Jesus healing leprosy (Mark 1:40–44;
Matthew 8:2–4; Luke 5:12–14; 17:11–14), but whether this was true lep-
rosy or not is debatable. In all cases the Gospels record that the lepers
were ‘cleansed’ and that Jesus told them to show themselves to the priest.
The aforementioned complaints would appear to have a physical cause,
especially since such afflictions are commonplace in less advantaged soci-
eties with inadequate healthcare systems. However, a psychosomatic
element should not be ruled out in Jesus’ healings, particularly in relation
to demonic possession. Notwithstanding, there is insufficient evidence
to determine whether this was so or whether oppression (political, eco-
nomic, social, and/or domestic) was a major factor giving rise to this. Jesus
was immensely successful as an exorcist, and his deliverances (healing of
mental illness) were closely allied to his eschatological teaching. Casting
out demons was a signal that the kingdom of God was actually in the
process of arriving (Matthew 12:28; Luke 11:20).
In conclusion of this section Jesus evidently had connections with
Judean society and, in order to fully comprehend his story, it is important
to be aware of the highly contagious infections that seriously impacted
Judean urban society, such as tuberculosis. He appears to have mainly
avoided such environments. Jesus healed a wide range of chronic illnesses
to enable the sick to gain entry to the kingdom of God in a state of
wholeness, physically and mentally, and indeed morally (see chapter 3).
The sufferers of such maladies would have responded well to the placebo
effect, implemented by a strong charismatic character with a commanding
presence. This latter factor is of the greatest importance in accounting for
Jesus’ healing success.

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114

Health Hazards in First-Century Palestine

[L]ife in first-century Galilee – though not necessarily dissimilar to other parts

Infectious and Parasitic Diseases

Health Hazards in First-Century Palestine 115

probably2 the prime cause of death in antiquity, as indeed today, and

Leprosy and Tuberculosis

116 Jesus in Context: The Archaeological Evidence

Health Hazards in First-Century Palestine 117

‘Whether a person develops lepromatous leprosy (affecting the hands,

118 Jesus in Context: The Archaeological Evidence

European as opposed to Negroid, it was suggested that they belonged to

Health Hazards in First-Century Palestine 119

in the 1940s. Due to the generally slow appearance of symptoms from

120 Jesus in Context: The Archaeological Evidence

diagnosis: ‘Most workers diagnose the condition on the basis of Pott’s

Malaria and Anaemia

Health Hazards in First-Century Palestine 121

122 Jesus in Context: The Archaeological Evidence

It is interesting to note that one of the additional symptoms of malaria

Health Hazards in First-Century Palestine 123

Walter Scheidel (2013, 48) has underlined that the killing propensity

124 Jesus in Context: The Archaeological Evidence

belief that such lesions are characteristic of iron-deficiency anaemia,38

Health Hazards in First-Century Palestine 125

126 Jesus in Context: The Archaeological Evidence

involved the use of an organized task force. A comparison of the numis-

The Dog Tapeworm (Echinococcus granulosus)

Health Hazards in First-Century Palestine 127

Patterns of Death in Palestinian Rock-Cut Tombs

128 Jesus in Context: The Archaeological Evidence

Health Hazards in First-Century Palestine 129

Figure 5.1 Minimum number (MN) of subadults (0–18 years) expressed as a

eastern Mediterranean dating to 650–350 bce,60 and nineteenth-century

130 Jesus in Context: The Archaeological Evidence

Figure 5.2 Minimum number (MN) of infants (0–5 years) expressed as a per-

The patterning of the Jerusalem tombs (Caiaphas, Arnona, Akeldama,

Health Hazards in First-Century Palestine 131

Figure 5.3 Minimum number (MN) of infants (0–5 years) expressed as a per-

Mediterranean (72%); the Akeldama tombs (67%), the remains of which

132 Jesus in Context: The Archaeological Evidence

lowest number of infant burials. Arensburg and Smith (1983) concluded

Health Hazards in First-Century Palestine 133

The Meiron tomb in Galilee is an undisturbed cave dating from the

134 Jesus in Context: The Archaeological Evidence

incidence of subadult remains, a large proportion of which were infants

Interpersonal Violence in the Early First Century

Health Hazards in First-Century Palestine 135

Interestingly, in an extensive survey of several hundred Roman

136 Jesus in Context: The Archaeological Evidence

number of tombs have been excavated in the vicinity of Jerusalem, only

Health Hazards in First-Century Palestine 137

An analysis of the human bones from Palestinian tombs, in particular

Connection with Textual Materials of Chapter 3

As an apocalyptical and eschatological prophet, Jesus sought to heal

138 Jesus in Context: The Archaeological Evidence

chapter 3, is of immense importance in understanding why he became

Health Hazards in First-Century Palestine 139

140 Jesus in Context: The Archaeological Evidence

diseased and disabled can be characterized as inclusive and proactive, the

Health Hazards in First-Century Palestine 141

The success of Jesus’ healing ministry pivoted on his ability to enable

142 Jesus in Context: The Archaeological Evidence