“Bridegroom of blood” - a biblical reference to hemophilia?

The earliest reference to X-linked, hereditary hemophilia has been traced back at least 1,400 years to a passage appearing in the Babylonian Talmud.¹ The passage involves the tale of four sisters from the town of Tzippori, three of whom had sons die as a result of circumcision; when the fourth sister bears a son, she is instructed not to proceed with circumcising him.² As such, it has been read as reflecting rabbinic awareness of a maternally linked pattern of circumcision risk – centuries before mechanisms of heredity and coagulation were formally understood. We, however, posit a more explicit biblical reference to hemophilia, one that predates – and in many ways anticipates – the Talmudic account.

Exodus 4:25–26 is an enigmatic passage, set during the Israelite bondage in Egypt, in which Żipporah, the wife of Moses, is found circumcising her son, seemingly under duress.

“So Żipporah took a flint and cut off her son’s foreskin, and touched his legs with it, saying, “You are truly a bridegroom of blood to me!”. And when [God] let him alone, she added, “A bridegroom of blood because of the circumcision.”³

The idiom ‘bridegroom of blood’ appears nowhere else in the Bible. Its meaning has long puzzled commentators and scholars, many of whom understand the term symbolically as signifying a blood covenant.⁴ Left unresolved, however, are the vivid detail and emotional intensity surrounding the circumcision itself. Departing from conventional interpretations, we argue that term ‘bridegroom of blood’ refers instead to literal bleeding - what we would now recognize as hemophilia.^a This interpretation helps make sense of the narrative’s heightened emotion as well as its evocative textual references to trauma and recovery.^b No doubt, circumcision of such a child would have been dramatic and worthy of biblical narration!

We suggest that Żipporah was, in fact, a carrier of X-linked hemophilia. She is identified as one of seven sisters – brothers conspicuously absent – hinting, perhaps, at male siblings who either died young or suffered life-long disability.^c Awareness of a bleeding tendency among male family members would have made Żipporah apprehensive when it came to her son. Indeed, any bleeding accompanying her son’s circumcision would have provoked understandable panic, prompting the anguished cry: ‘You are truly a bridegroom of blood to me!’ The story, however, is ultimately one of recovery and healing. The child evidently survives the ordeal, culminating in the declaration that a ‘bridegroom of blood’ is fit for circumcision.^d Interestingly, the Talmudic account of the four sisters from Tzippori echoes the biblical narrative in a number of ways.^e Among the striking parallels is the portrayal of a woman performing circumcision – a departure from rabbinic norms which regard female performance of the rite as atypical at best.⁵ In both narratives, the protagonist – who is introduced as having multiple sisters – faces a decision about circumcising a son in the face of potential danger. And while the Exodus account concludes with the child’s recovery, declaring the ‘bridegroom of blood’ fit for circumcision, the Talmud introduces an exception for families with a history of fatal outcomes. These textual links raise the intriguing possibility that in contending with high-risk circumcision the rabbis may have preserved a narrative trace of the Exodus episode.

Understood in this light, the ‘bridegroom of blood’ in Exodus 4:25-26 would represent by far the earliest literary depiction of X-linked hemophilia, predating the Talmudic account by perhaps a millennium or more. This reading sheds new light on a cryptic biblical episode and offers a fresh perspective on how medical phenomena may have been encoded in ancient narrative. If borne out, it would lend support to the idea that familial bleeding diatheses were indeed recognized in the ancient world and that this knowledge was passed down through the generations much earlier than previously thought.

Footnotes

• Received July 3, 2025
• Accepted July 22, 2025

Correspondence

J. M. KOSOWSKY - jmkosowsky@partners.org

Disclosures

No conflicts of interest to disclose.