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ss nucleus - spring 1998,  Differential Diagnosis 23

Differential Diagnosis 23

2 Kings 20:1-11

Having been delivered divinely from the King of Assyria (1 Kings 18-19, see the last issue of Nucleus), Hezekiah now suffers a fatal illness related to a boil. Isaiah breaks the bad news: 'You are going to die!'

The Hebrew word, here translated boil, is also used in Exodus 9:9, Leviticus 13:18-23, Deuteronomy 28:27, 35 and Job 2:7. The exact nature of the disease described has been a matter of some debate (see Nucleus April 1994 and January 1995) but for now let's stick to the traditional translation. A boil is a pus-filled abscess resulting from infection of a hair follicle. The commonest causative organisms are Staphylococcus aureus and Streptococcus pyogenes. Most are self-resolving; rarely they can result in toxic epidermal necrolysis and toxic shock syndrome. The account does not mention the widespread exfoliation and erythema that accompanies these conditions so septicaemic shock seems a more likely diagnosis.

Hezekiah prays to the Lord. Isaiah returns and instructs him to lay a poultice of figs on the boil: he is healed.

Many ancient doctors based their treatments on the idea of the four elements: heat (fire), cold (earth), moisture (water) and dryness (air). Disease resulted from an imbalance in these elements and treatment was aimed at restoring that balance. Thus a 'hot' disease such as a boil was treated with a 'cold' poultice. The use of fig poultices is recorded by Pliny and in two ancient Ugarit texts. The practice still exists today and many testify to their ability to prevent the spread of infection and aid healing.

In his reflection on the illness, Hezekiah is able to say that he has seen good come out of it (Is 38:17).

Like Hezekiah, we need to trust God to bring good out of all situations (Rom 8:28). It's often hard to see this at the time and it is best if the person who is suffering is allowed to discover that good for themselves rather than have well meaning friends point it out to them (Jb 42:7-10).

As for Isaiah: he'll have to attend some extra communication skills seminars!

Differential Diagnosis 24

In 2 Kings 1:2 Ahaziah falls through a lattice of his upper room, injures himself and subsequently dies. Can you tell from the rest of the chapter what the cause of death was?

Luke's opinion in next issue.

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