Verse 3 contains the universally accepted truism “That man does not live by bread alone.” In its fullest manifestation this characteristic is unique to our species. It explains all that is wonderful about mankind – poetry, art, music, science, mathematics, and much more. But there is an evil side to needing more than sustenance – war, riot, genocide, conceit, the passionate embrace of error, and again much more.

But I wish to concentrate on verse 4: “The clothes upon you did not wear out, nor did you feet swell these 40 years.” Moses, of course, is referring to the 40 years sidetrack that the Israelites were forced to make because of prior bad behavior. He recites all the good things that God did to allow the people to survive four decades in the dessert.

This lack of dependent edema (nor did your feet swell) has an obvious medical significance. I have found no commentary about the medical implications of this verse.

There is a class of diseases – the edematous diseases – that cause the feet to swell. These include congestive heart failure, the nephrotic syndrome, kidney failure, protein losing enteropathy, and acute salt retaining glomerulonephritis. There are also local causes of foot swelling: trauma, inflammation, and venous and lymphatic obstruction to the lower extremities. That the Israelites avoided all of these afflictions for 40 years is as miraculous as the manna that sustained them during their peregrinations.

One can suppose that trauma to their feet was prevented by the sturdy shoes that they must have worn. After all their footwear lasted intact for 40 years. I’ll ignore the other local causes to focus on the serious diseases of the heart, liver, and kidneys that did not manifest themselves during the 40 years of wandering. In the modern developed world these diseases account for close two thirds of all deaths.

Remember why they were out there. And the Lord’s anger was kindled against Israel, and he made them wander in the wilderness forty years, until all the generation that had done evil in the sight of the Lord was gone. (Numbers 32:13) So they were dying at the usual rate. But if we are to take the bible at its word (and how else should we take it?), they weren’t dying of heart, liver, and kidney disease. So what was killing them?

We are not told, so I can only surmise. No great plagues are described, so a large death toll secondary to infectious diseases is unlikely. The only great killer left is cancer. Did God decide to let the generation that had offended him perish from cancer? A very tentative yes seems permissible.

This raises the obvious question as to whether modern Jews have an increased rate of cancer. Here the data are better and while some cancers are more common and others less common in Ashkenazi Jews the answer to my question is no. Jews are no more likely to die from cancer than any other distinct population.

If the generation of the dessert was not killed predominantly by cancer there’s no way to tell what did them. A certain lesson, however, is do not offend God.