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In all patients, SpotOn showed higher than the rectal temperatures. The SpotOn temperature was analyzed to be 0. Discussion and conclusion: Rectal temperature measurement is the gold standard method for pediatric patients in ICU despite several complications of rectal injury. One possible explanation could be that the abundance of brain blood flow of children affected the results. Our study concluded that SpotOn system could be used as a highly reliable noninvasive core body temperature measurement for small pediatric patients.
An evaluation of a zero-heat-flux cutaneous thermometer in cardiac surgical patients. Anesth Analg. Comparison of temporal artery thermometer to standard temperature measurements in pediatric intensive care unit patients.
Pediatr Crit Care Med. Introduction: Viral bronchiolitis VB remains one of the leading causes of hospitalization in early childhood. Methods: This is a retrospective single center observational cohort study that examined children 0—2 years of age admitted to the PICU with VB and respiratory failure RF from — Clinical and demographic data was collected.
Patients with a diagnosis of congenital heart disease or pre-existing chronic lung disease were excluded. Data was expressed as median with IQR ranges. Test of bivariate association were performed using Mann Whitney U test and chi square test. Median age was 5 2,11 months and the median weight was 6.
Pediatric acute respiratory distress syndrome:consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatric Crit Care Med Jun; 5: — Bronchiolitis: recent evidence on diagnosis and management. Pediatrics ; — Introduction: Mean platelet volume MPV seems to be a marker of platelet activation and may be related to severity of illness. On other hand, the sensitivity of PLC to detect complications day1 was Conclusions: MPV dynamics and PLC have prognostic roles and could be used in determining several complications in critically ill pediatric surgical patients.
Mean platelet volume in very preterm infants: a predictor of morbidities. Eur Rev Med Pharmacol Sci. Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit. Clin Respir J. Introduction: Impairment in physical function is a significant problem for survivors of critical illness [1,2]. There is growing urgency to develop a core set of outcome measures which can be adopted in clinical and research practice to evaluate efficacy in response to interventions such as rehabilitation.
There is currently not a single outcome measure which can be used across the continuum from ICU admission to hospital discharge for individuals with critical illness . Methods: Multi-centre prospective observational study conducted across four sites internationally. Results: participants have been recruited into the study to date across the four sites. A new transformed scale based on rasch analytical principles is promising combining features of both tools for evaluation of functional recovery of critically ill.
Introduction: Limited information exists regarding the association between functional status at ICU admission at and outcomes. Objectives: We hypothesized that initial functional status assessment as well the amount of physical therapy delivered would be associated with outcomes in ICU survivors. Methods: We performed a retrospective cohort study in one Boston teaching hospital on 2, adults who received critical care from to and survived hospitalization. All patients had a formal evaluation by a physical therapist in the week prior to ICU admission and at hospital discharge.
The exposure of interest was functional status determined by a licensed physical therapist based on the functional mobility sub scales of the Functional Independence Measure. All patients received physical therapy to improve functional performance. The primary outcome was day all-cause mortality. We used logistic regression to describe how day mortality differed with functional status at ICU admission.
Negative binomial regression was utilized to describe how functional status at hospital discharge differed with functional status at ICU admission, the extent of physical therapy received and hospital length of stay. The median [IQR] hospital length of stay was 8 [4, 14] days. The day mortality rate was Functional status at ICU admission was robustly associated with day mortality. In a logistic regression model adjusted for age, gender, race, surgical patient type, Deyo-Charlson index, acute organ failure, sepsis, length of stay and the extent of physical therapy received, the second lowest and lowest quartiles of functional status at ICU admission was associated with a 1.
Conclusions: In critically ill patients, decreased functional status at ICU admission is associated with increased day mortality. Increased intensity of physical therapy is associated with improved mortality outcomes. Both functional status at ICU admission and the intensity of physical therapy contribute to functional status determined at hospital discharge. Early rehabilitation has been demonstrated as a safe and effective method of improving functional status at the point of critical care discharge and reducing both ICU and hospital length of stay McWilliams et al.
Objectives: This study aimed to analyse the impact of enhanced physiotherapy incorporating early mobilisation on the rate of muscle decline for patients admitted to critical care. Patients were randomised to either enhanced physiotherapy or standard care groups as part of a larger RCT. Baseline measurements were taken on the day of recruitment and then repeated at critical care discharge.
Muscle mass was measured using ultrasound to calculate cross sectional area of quadriceps and biceps. To ensure validity , 2 measures were taken and the average of these taken as the final value. All scans were reviewed for agreement by 2 therapists trained in muscle ultrasound.
Results: 40 patients were included in the analysis. Patients in the enhanced physiotherapy group mobilised earlier and achieved a higher level of mobility at the point of critical care discharge see Table 2. All subjects demonstrated a reduction in muscle mass of both quadriceps and biceps over the course of their critical care stay.
Conclusions: A programme of enhanced physiotherapy appeared to be associated with a lower rate of muscle loss in both biceps and quadriceps in comparison to standard care. An appropriately powered RCT is required to assess these findings.
Journal of critical care. Introduction: Survivors of critical illness experience a range of impairments after intensive care, including physical, cognitive and psychological compromise. The provision of information using a diary to describe the intensive care unit ICU experience is one strategy that has been proposed to improve psychological health.
Objectives: The purpose of this study was to explore similarities and differences in patients' and relatives' perceptions of information containing strategies, including ICU diaries, to assist recovery after critical illness.
Semi-structured interviews were conducted 3—5 months after ICU discharge. Transcripts were analysed using content analysis. Results: Twenty-two patients and 19 relatives consented to participation and completed interviews prior to reaching data saturation. Patients raised similar themes to relatives, although with diverse opinions.
Themes of wanting to have a diary kept and considering they would find a diary helpful were consistent across a majority of participants, although with a minority expressing a desire to 'move on' and would not have liked a diary kept.
Differences between patients and relatives arose in the areas of the purpose, content, ownership and timing of delivery of a diary. Patients viewed the diary as a therapeutic tool while relatives considered it as an information sharing mechanism, including as a mechanism to demonstrate to the patient 'how sick he really was' and 'what he put us through'. Possibly as a result of these differences, patients considered that ownership of the diary rested with them while some relatives envisaged shared ownership.
Patients were more likely to note that the diary should not be provided to them until some weeks after ICU while relatives considered an early time point soon after ICU discharge to be appropriate. Patients were more likely to raise concerns about the potential negative impact of information sharing strategies including diaries and return visits to the ICU. Conclusions: Patients and relatives expressed common themes related to information sharing strategies after ICU, but with some important differences.
Differences in purpose, content, ownership and timing of delivery of a diary suggest there is a need to consider whether the same intervention meets the needs of both groups of stakeholders. In research environment, this tool has a very high sensitivity and specificity 1. However, in clinical settings, it may not be reproducible mainly because of inadequate training in CAM-ICU by bedside nurses 2. Methods: The study was conducted in a bed tertiary private hospital in Sao Paulo, Brazil.
A pre-training questionnaire to test bedside nurses about their knowledge of the correct application of CAM-ICU was applied. A post-training test was applied. Results: A total of 50 nurses participated in the training, with a mean graduation time of seven years and mean hospital admission time of five years. After theoretical and practical training sections, all of the bedside nurses correctly answered the post-training test.
Introduction: In the Intensive Care Unit ICU several patients are disturbed in their cerebral function due to their critical illness and medication, leading to discomfort, agitation, restlessness, pain and delirium. Rocking chair studies have shown concrete results to improve patient satisfaction, balance and well-being in patients who suffered from dementia 1. Objectives: The purpose of the study was to evaluate whether RCMT could be used in the rehabilitation of critically ill patients in the intensive care.
The focus was to explore the impact of RCMT on critically ill patients comfort, pain, agitation and delirium. The RCMT session lasted 20 minutes. Patient comfort was assessed by the patients as well as by the nurses during the session. Results: 47 sessions with RCMT were evaluated. The results showed a decrease in patient agitation level and an increase in patient consiousness.
A decrease in delirium where 11 patients were assessed CAM-ICU positive before the session and 4 patients after the session. Assessment and evaluation of comfort by patients themselves and by the nurses, who cared for the particular patient, showed that RCMT was associated with a high degree of patient relaxation and comfort. Watson, Nancy M. Introduction: Critical illness and immobility in the Intensive care unit ICU lead to a loss of muscle mass and reduced exercise capacity for many years following hospital discharge.
Nutritional recommendations are for a high protein diet to minimise muscle breakdown and support protein synthesis during rehabilitation. Nevertheless, during the rehabilitation period little is known of patients' protein intake and physical functioning. Objective: To investigate physical functioning, frailty and dietary protein intake after 6 months of ICU discharge.
Patients cognitive and physical functioning is assessed as part of their rehabilitation therapy with the Functional Independence Measure FIM score. The FIM contains 18 items on motor 13 and cognitive 5 functions that are scored on a 7-point ordinal scale based on the amount of assistance a person requires to perform specific activities.
In addition, frailty was assessed based on a scale ranging from very fit to very severely frail, terminally ill and patients were asked to complete a protein food frequency questionnaire. Results: Twenty patients were assessed.
Data are reported as mean and standard deviation. Paired t tests of the changes in FIM scores from discharge showed significant increments; 9. Dietary intake was also inadequate with a protein intake of 0. Conclusion: There was improvement in FIM score after discharge but that was mainly from cognitive function.
A lower improvement was observed in motor functioning supporting the vulnerable to moderately frail scale and a reduced protein intake. Functional disability 5 years after acute respiratory distress syndrome. Performance profiles of the functional independence measure. Am J Phys Med Rehabil.
Frailty in the critically ill: a novel concept. Critical Care. These state:' Patients receiving rehabilitation should be offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week of therapy per day, at a level which enables them to meet their goals for as long as they are continuing to benefit from the therapy and are able to tolerate it.
Objectives: We have examined our current rehabilitation service against the recommended 32 minute target for active therapy in the critical care unit to see if we achieve these core standards. Methods: We recorded the therapy time provided per day to our emergency critical care patients on a documented Critical Illness Rehabilitation Pathway. Respiratory physiotherapy was excluded in the treatment times.
The study time run over 4 weeks with prospective data collection. Results: A total of 53 patients were included with physiotherapy contacts over the study period. Patients are offered two treatment sessions per day Monday to Friday and once at a weekend, standard practice in our critical care unit. Patients were described as one of 3 categories: self-ventilating, ventilated via tracheostomy and ventilated via Endotracheal Tube ETT. Conclusions: These results demonstrate that the major limiting factors in achieving the core standards are principally driven by factors unrelated to physiotherapy provision.
The ventilated via ETT group, although receiving significant respiratory physiotherapy input receive less rehabilitation due to sedation. The Intensive Care Society. Core standards for Intensive care units Introduction: Rehabilitation in the Intensive Care Unit ICU aims to enhance health, wellbeing and recovery beyond survival of critical illness.
Current rehabilitation practice requires description and measurement of effect to enhance exercise prescription 1. Objectives: Physiotherapy rehabilitation is a recognised component of ICU care. The Intensive Care Society - Core Standards 2 recommends that rehabilitation is ' at a level that enables the patient to meet their rehabilitation goals for as long as they…are able to tolerate it '. In order to investigate and measure the terms ' tolerate ' and ' level ', physiological measurements and their relationship with self-perceived exertion and tolerance were analysed.
A convenience sample, of ICU patients undergoing active physiotherapy led rehabilitation, were observed between July and September A Modified Exertion Scale was used to measure patients' perceived effort. Patients also rated tolerance of the session using a Tolerability Scale, created based on the exertion scale.
Sessions were timed, heart rate, blood pressure and oxygen saturation were monitored and the cardiovascular impact of the session measured using Heart Rate Reserve HRR. Results: Nine rehabilitation sessions were observed; mean length of 17 minutes range 9— Of the 9 patients, 6 were able to use the tolerability scale and 7 the exertion scale.
There did not appear to be a relationship between HRR and either perceived scale measurements. There did appear to be a link between perceived exertion and perceived tolerability with 5 of the 6 patients scoring within 3 points. Conclusions: Reported perception of exertion and physiological markers could both indicate the 'level' patients are working at. We were able to measure effects of rehabilitation on heart rate.
The majority of patients were able to use exertion and tolerance scales. However, the change in heart rate was not great enough to suggest a training effect, despite their exertion scores implying high effort levels. To fulfil the ICU society recommendations, a good understanding is needed of how hard patients are working during rehabilitation. Further research is needed to determine why there may be disparity between heart rate and patient-reported measures of exertion; and if either is a useful guide for exercise prescription with ICU patients.
Calvo-Ayala, E. Farber, M,. Ely, E. Core Standards for Intensive Care Units. Introduction: Critically ill patients are at risk of developing deconditioning, muscle atrophy and functional impairments long after hospital discharge. There is evidence demonstrating benefits of mobilization in critically ill patients - improved functional outcome and reduced ICU and hospital length of stay. However, there is limited information about how these advances are translated to clinical practice.
Objectives: To obtain a baseline data on patients who are eligible for mobilisation in ICU and how many of these patients are optimally mobilised in ICU. Methods: Setting. The mobilisation team composed of physiotherapists, bedside nurses and respiratory therapists who worked along with an intensivist.
Prospective audit conducted to collect data on the patients who met the eligibility criteria of mobilisation over a 3-month period. CPIP team. RCA revealed a total of 21 barriers and through multi-voting and pareto-charting, we identified the top 3 barriers to change. Key barriers identified were: 1.
Mobility not being a part of the daily review routine 2. Staff were unsure of the eligibility criteria 3. Lack of knowledge the benefits of optimal mobilisation in the critically ill. The team proposed following strategies to overcome the barriers: 1. Providing a bedside decision-making algorithm on eligibility criteria, displayed within visibility of staff's work area. Undertake sharing session with ground staff on the importance and benefits of optimising mobility of the critically ill.
Conclusions: Our audit revealed that less than half of eligible patients received early mobilisation. Our CPIP - a quality improvement initiative identified barriers in translating knowledge into clinical practice. Through various tools of CPIP, we identified the key barriers and strategies to overcome these barriers and thereby achieving the goal of optimising mobilisation in ICU patients. Engel, Heidi J et al. Crit Care Med 41 9 SS Comprised of multi-disciplinary stakeholders - frontline staff and patient representative.
A brainstorming storming process identified various barriers to optimal mobilisation. Quality improvement tools such as Affinity diagram. Introduction: Bed rest and immobility during critical illness may result in profound physical deconditioning. The multidisciplinary team in intensive care includes physiotherapists, who are responsible for performing diagnoses and procedures for critically ill patients, such as ventilation, respiratory monitoring and assessments of musculoskeletal, neurological, metabolic and cardiovascular diseases, and for the prevention and treatment of the effects of prolonged immobility.
Methods: A retrospective before-after study was designed to assess some quality indicators within the intensive care unit between July and September , where there were no physiotherapists specially trained for respiratory care, and from January to March , where the physiotherapists integrated a multidisciplinary team.
The quality indicators analyzed were: the average duration of mechanical ventilation, prevalence of ventilator associated pneumonia and the rate of ventilated patients with non-invasive ventilation. The study population comprised 62 patients for and 71 for Furthermore, it is also observed a decrease ventilator associated pneumonia, and a significant relation between this indicator and the respiratory physiotherapy. Conclusions: In this study it is demonstrated the respiratory therapy influences in some quality indicators, namely regarding the reduction of ventilation associated pneumonia and the promotion of non-invasive ventilation in the ICU of the CSE.
Revista Brasileira de Terapia Intensiva , 26 1 , 7— Skip to main content. Search all SpringerOpen articles Search. Download PDF. Volume 4 Supplement 1. Velasquez 1 , G. Mackey 2,3 , J. Lusk 2,3 , U. Kyle 2,3 , T. Fontenot 2 , P. Marshall 2 , L. Shekerdemian 2,3 , J. Coss-Bu — Texas Children's Hospital, Intensive Care, Houston, United States Introduction: Critically ill children in the pediatric intensive care unit PICU are at high risk for developing nutritional deficiencies and undernutrition is known to be a risk factor for morbidity and mortality.
But there is another class of dittographies present in our version which are due to incorporation in the text of duplicate renderings. Thus in xxx. This conclusion is confirmed by the Latin version which shows no such dittography. We have the evidence of the same version for excising the dittography in xxiii. Other duplicate renderings, which have found their way into the Ethiopic version, our text exhibits in xx.
Possibly in xxxii. These two prose lines intervene in the midst of a poem. They are corrupt in all the MSS, but by an easy emendation could be adapted to follow after the first clause of the preceding verse. See note in loc. Another passage is v. I have treated it as interpolated or else as transposed from after xxxiv. It is possible, however, that these verses did belong to the original.
Thus 10 b refer to the final judgment and the renewal of the world. The subject of the final judgment is there further dealt with in its general character in , and in the writer turns aside to show the special grace accorded to Israel on that day if they observe the Day of Atonement. But I still incline to the view that are foreign to their present context.
Again, i. Poetical Element in Jubilees Just before completing my commentary on Jubilees, I was so fortunate as to discover that no small proportion of it was originally written in verse. Accordingly the reader will find the following passages arranged as verse : x. This discovery not only adds to the interest of the book but also illuminates many a dark passage, suggests the right connections of wrongly separated clauses, and forms an admirable instrument of criticism generally.
Thus, if the reader turns to xxxvii. Our recognition of this fact enables us to excise as an interpolation the unintelligible words occurring in the MSS at the close of the first stanza. Even if we emended these words we should only have a distich, which would be suspicious in the midst of a poem consisting of tristichs. But not only is the form against their genuineness here, but also their subject matter see notes in loc.
The most important of these poems is the apocalypse in xxiii. Of the rest some are composed in distichs, as xii. Jubilees from one Author, but based on Earlier Books and Traditions Our book is the work of one author, but is largely based on earlier books and traditions.
The narrative of Genesis forms, of course, the bulk of the book, but every page of it contains materials characteristic of the age of our author. By referring to Index I. But our present chief interest is the relation of our author to non-canonical Jewish literature.
Thus he borrows vii. Of this book happily the greater part of x. Our author had before him also the greater part of the Book of Enoch vi. Besides these he also made use of current traditions and legends, which were already reduced to writing, and have come down to us in Hebrew and Greek in other inde- pendent works. Thus the war of Jacob and his sons against the Amorite kings, xxxiv.
Judah , a contemporary work, in the Midrash Wajjissau, which contains if not the original legend, at all events a very early recast of it, and in the Book of Jashar — a late work. Again, our author drew on existing writings for his description of the fratricidal war between Jacob and Esau in xxxvii.
Here the only contemporary authority that still exists for our text is Test. But with a few reservations the same state- ment may be made of the Hebrew document preserved in the Jalkut Shimeoni i. Patriarchs, are the story of Bilhah's dishonour at the hands of Eeuben during Jacob's absence Jub. Eeuben 3 ; Levi's dream as to the priesthood xxxii. Levi 2, 4, 5, 8, 9 , and his consecration to it by Isaac xxxi. Levi 9 ; the names of the wives of Levi and Judah xxxiv.
Levi 11; Test. Other legendary matter in Jubilees, for which con- temporary or earlier documents are, as a rule, not at hand, though most probably belonging to ancient tradition, furnishes us with a large number of proper names — par- ticularly the names of women — 'A wan, wife of Cain iv.
As other proper names of persons we might observe : Baraki'el iv. Again, as names of places : 'Elda hi. Enoch vii. Other legendary matter was in many instances see notes in loc , and possibly in all, the source of the following state- ments and incidents : the period of five days spent by Adam in naming the creatures iii. In his hands the history of the nation is so recast as to make it a history of the church, the temple and its cultus, and to represent David and his pious successors as observing all the prescripts of the law according to the Priests' Code, b In the course of this process facts that will not square with the writer's pre- suppositions are omitted or transformed in character.
This applies particularly to breaches of the Priests' Code; also to statements such as that in 2 Sam. This temptation the Chronicler attributes to Satan 1 Chron. Thus according to it " Noah may build no altar, Abraham offer no sacrifice, Jacob erect no sacred pillar. No offering is recorded till Aaron and his sons are ready" Carpenter, The Hexateuch, i. Thus he omits 2 the sending out of the raven Gen.
The omissions in the history of Joseph are numerous, but they can be explained almost wholly on the ground of the author's desire for brevity. But as regards Gen. It is 1 See pp. Nor yet was the reference to fasting on the Day of Atonement see xxxiv. Our author through- out reverses this relation, and everywhere sets Levi before Judah. Again, like the Chronicler he takes offence at the fre- quent mention of men being tempted or slain by God in Genesis and Exodus, and after the example of the Chronicler he represents the temptation of Abraham to offer Isaac Gen.
Again, just as we must not suppose that the peculiar im- press which the Chronicler gave to his historical materials was the result of his individual activity but rather the out- come of a process, which in the course of successive genera- tions had in many respects been transforming history into legend, so we must be careful to recognise in our author's book only a more advanced stage of the process above referred to.
Possibly this process would not, in the natural course of things, have thrust the completed law further back than the time of Moses, but the exigencies of our author's time and the corroding influences of Hellenism seemed to him to demand the recognition of the law as superior to time, though revealed in time, and valid not only unto eternity but from eternity. The materials which suggested such a view were already at hand.
If the earthly tabernacle was only a copy of a heavenly original Exod. Hellenism had for many a decade been undermining circumcision and the observance of the Sabbath, 1 which were the bulwarks of Judaism, before these destructive tendencies came to a head. Our author is a late representative of the strong reactionary movement which asserted the everlasting validity and sanctity of these elements of the law.
Thus he teaches that, though circumcision was first ordained in Abraham's time, it had been ordained in heaven from the beginning, for the two highest orders of the angels had been created circumcised, and that Israel was through circumcision sancti- fied together with them xv. Similarly the Sabbath, though first ordained in Jacob's time see ii. Israel was to unite with these angels in observing it. It was to be a sign like circumcision marking off Israel from all the other nations of the earth ii.
Jubilees — an Esoteric Tradition according to its Author. According to 4 Ezra xiv. This second appears from our author to have embraced in a final authenticated form various revelations which had been made to the patriarchs, and constituted in their hands an esoteric tradition.
This secret tradition had been handed down from father to son. Noah in turn entrusted all his 1 See 1 Mace. Between Shem and Abram the knowledge of the sacred language was lost. But the latter was taught this language by an angel, and he thereupon studied "the books of his fathers" xii.
From these books of his forefathers embracing the writings of Enoch and Noah, Abraham instructed Isaac xxi. These books contained regulations regarding sacrifices as well as other matters vii. To Jacob also Abraham transmitted the traditions directly xxv. Again, Jacob educated Joseph from the writings of Abraham xxxix.
Thus this secret tradition was to be preserved in the hands of the priest- hood till the time should come for its publication. From this last statement it would not be unreasonable to infer that our author was a member of the priestly caste. The object of our author is to defend Judaism against the disintegrating effects of Hellenism.
Our author defends Judaism a by glorifying the law as an eternal ordinance and representing the patriarchs as models of piety; 6 by glorifying Israel and insisting on its separation from the Gentiles ; and c by denouncing the Gentiles generally and particularly Israel's national enemies. The law, as a whole, was to our author the realisation in time of what was in a sense timeless and eternal. He is careful to set forth the historical occasions when the various elements of the law were first celebrated on earth, and herein he followed a tendency already well established in post-exilic Judaism.
We shall now enumerate these briefly. The levitical law of purification after childbirth was enacted after the creation of Adam and Eve iii. On the expulsion of Adam from Eden the law of covering one's shame was enacted iii. This law does not belong to the Mishna or later Jewish legislation. It was manifestly levelled against the custom of baring the person in the Greek games, and is not explicable of any other than the early Maccabean period.
The daily incense-offering began after Adam's expulsion from Eden iii. The law relating to the jubilees was first set forth by Enoch iv. The law of retribution in kind — " an eye for an eye " — was first carried out in the case of Cain iv. Noah instituted the feast of weeks, which had been observed in heaven since the creation vi.
Abram enacted the law of tithes xiii. The penalty of death was ordained for intermarriage with the heathen in connec- tion with the destruction of Shechem xxx. Levi was ordained priest by Jacob at the feast of tabernacles xxx. Jacob offered tithes through Levi at the feast of tabernacles — also the second tithe xxxii. The law regarding incest was published in connection with Eeuben's outrage xxxiii. The day of Atonement was instituted as a day of fasting and mourning in commemoration of the day when the news of Joseph's death arrived xxxi v.
The law of incest was re-enacted and extended in connection with Judah's sin with Tamar xli. Jacob celebrated the feast of the first-fruits xliv. They are transformed into saints by our author. It is for this reason that Gen. Abram, according to our author, knew the true God from his youth xi. Jacob is 1 In the course of rewriting Genesis from the standpoint of the law our author explains certain difficulties.
According to Gen. This was fulfilled : for one day is a thousand years in the testimony of the heavens, and Adam died at iv. Esau gave up his birth- right because he was suffering from the famine in the land xxiv. This explanation our author arrives at by transposing Gen. Isaac's failure to recognise Jacob was due to a dispensation from heaven xxvi. The passages relating to Jacob's devices for increasing his flocks Gen.
Indeed our author represents Jacob as declaring that he was not afraid xxvii. The text in Gen. Not Japheth Gen. Israel, moreover, was God's son ; and not only did the nation stand in this relation to God, but also 1 Our author is careful to show that Abram did not leave Terah xii. Jacob did not leave Isaac till the latter approved and sent him off with a blessing xxvii. Esau stole the possessions of his father, but Jacob supplied all his parents' need four times a year xxix. According to this division Palestine fell to the descendants of Shem, and thus our writer justifies the subsequent annihilation of the Canaanites by Israel.
Again, Abraham's marriage with Keturah is defended on the ground that Hagar was already dead xix. Reuben was not so guilty because the law against which he offended had not yet been revealed xxxiii. Levi's destruction of Shechem is declared to be the ground of his election to the priesthood xxx.
As our author took up this standpoint he had to omit the league that was formed between Jacob and Shechem and the reception of circumcision by the latter Gen. Israel was to receive circumcision as a sign that they were the Lord's xv.
They were also to unite with God and these two orders in the observance of the Sabbath ii. Finally, the destinies of the world were bound up with Israel. The world was to be renewed in the creation of the true man Jacob xix. Israel to be separate from the Gentiles. Tacitus, more than two centuries later, called attention to this characteristic of the Jews " adversus omnes alios hostile odium," Hist.
Judaism regarded its own attitude to the Gentiles as not only justifiable but also just, because it was but a reflection of the divine. God had placed the nations under the authority of spirits or angelic guardians with the object of compassing their destruction xv. Here, most probably, the ultimate result of an action is declared to be the immediate object of it. First of all our author's maledictions are fulminated against the Philistines hoth in this world and in the next.
The chief cities of this nation were either subjected or destroyed by the Maccabean princes see xxiv. Next they are directed against Edom. Thus Isaac is represented as declaring in the bless- ing of Esau, that, if Esau's seed rebelled against Israel, they should be "rooted out from under heaven" xxvi.
A war between Jacob and Esau is described in xxxviii. Again, in a descrip- tion of a war between Jacob and seven kings of the Amorites, the writer forecasts the Maccabean victories of later times xxxiv. In an earlier passage he enumerates the chief seats of the Amorites. These were associated with Macca- bean victories, in which the Amorites were all but annihilated xxix.
Of the Amorites who were "wicked and sinful " and had " wrought to the full all their sins," our author grimly remarks " they have no longer length of life on earth " xxix. This was practically the result of the Maccabean wars. Angelology and Demonology of Jubilees Angelology. There are two supreme classes, the angels of the presence and the angels of sanctification ii. The two first classes joined with Israel in observing the Sabbath and circumcision see p.
The duties assigned to the angels in connection with mankind are numerous. They brought Adam into the Garden of Eden and afterwards Eve iii. They report to God all the sin committed on the earth iv. The order called "Watchers" descended in the days of Jared to instruct the children of men iv. The angels showed to Enoch all that was " on earth and in the heavens " during years iv. They bound the fallen "Watchers in the depths of the earth v. In the presence of an angel the earth was divided among Noah's sons viii.
Angels bound nine-tenths of the demons in the place of condemna- tion x. An angel bade Abram to go to the land of promise xii. Angels announced to Abraham the birth of Isaac and admonished Sarah for laughing xvi. An angel comforted Hagar xvii. Angels tested Abra- ham's patience after the death of Sarah xix. The angels will remember unto a thousand generations Levi's righteous judgment on Shechem xxx.
An angel showed Jacob in a vision of the night seven tablets which recorded all that would befall him and his posterity, and bade him copy them xxxii. An angel delivered Moses out of the hands of Mastdma xlviii. Angels prevented the magicians from furnishing any remedies to the Egyptians xlviii. An angel made known to Moses the Sabbaths, year-weeks, and jubilees, etc. This kingdom is governed by " the prince of the Mastema," 1 where Mast6ma is in point of derivation and meaning the equivalent of Satan.
His subjects comprise both satans and demons. The demons are the spirits which went forth from the bodies of the slain children of the Watchers and the daughters of men x. According to Eth. By means of these demons the prince of the satans is able to compass his evils, which are the seduction and destruction of men. But these have no power over the righteous and over Israel see note on x. The Date of Jubilees The date of our book can only be established by a series of indirect evidence.
But this evidence is so plentiful and powerful, when apprehended, that no room is left for reason- able doubt. First of all the look was written during the pontificate 1 In all the Ethiopic MSS the phrase is wrongly given as " prince Mastema" in xvii. They appear to have assumed it as reviving the order of Melchize- dek when they displaced the Zadokite order of Aaron. Jewish tradition ascribes the assumption of this title to John Hyrcanus, but it seems to have been already assumed by Simon ; cf.
If, how- ever, we follow the Jewish tradition in this matter, we must fix on B. Notwithstanding the objections of the Pharisees to this title, it was used by the Maccabean princes down to the time of Hyrcanus II. Next, it was written before 9 6 B. Indeed, it is hard to conceive of its com- position after the public breach between Hyrcanus and the Pharisees which is described in Josephus Ant.
After that event — unfortunately the year is not given by any authority — Hyrcanus joined the Sadducean party, and forbade, under penalties, the observance of Pharisaic ordinances. Hence we may con- clude that our book was written between and the year of Hyrcanus' breach with the Pharisees. The above conclusions are confirmed by a large mass of evidence, which may be arranged under seven heads. Our look points to the period — already past — of stress and persecution that preceded the recovery of national inde- pendence under the Maccabees.
It was not unnaturally derived from Gen. This law was observed in the creation of the highest angels xv. Yet Israel will, our author says, neglect it and " treat their members like the Gentiles'"' xv. Antiochus for- bade circumcision under the penalty of death 1 Mace, i.
There may be a reference also in our text to the Jews uncircumcising themselves, a practice which they resorted to under Antiochus Epiphanes in order to escape the scoffs of the heathen in the palaestra 1 Mace. Non-observance of the Sabbath had been prevalent accord- ing to our author xxiii. Antiochus had forbidden the Jews to keep it 1 Mace. Our text lays down the strictest sabbatical laws, such as were not in force at any time save in the second century B.
Thus war is absolutely forbidden 1. But it was soon found impossible in practice see note just referred to , and warfare on the Sabbath was subsequently permitted under a variety of circumstances Bab. Again, a man is forbidden to cohabit with his wife 1. This was the practice of the early Chasids ; but this ascetic attitude to marriage is abandoned in the Mishna see 1.
Again, riding on any beast is forbidden 1. The enforcement of the law during the Syro- Grecian suzerainty is mentioned in the Talmud. To give one's daughter to a Gentile was to give her to Moloch xxx. This question had for a long time before our author's date been of vital importance to Israel.
But at no time could the danger from this source have been greater than during B. Our book presupposes as its historical background the most flourishing period of the Maccabean hegemony. Thus he ascribes to Levi's descendants the supreme offices of high-priest and civil ruler xxxi.
Our author seems to imply that the royal descendants of David are no more, and that till the Messiah comes the Maccabees would hold the offices of high -priest and king. In later days when the Maccabees became a name of reproach, they were charged with usurping the throne of David Pss. In these wars the Edomites had sided with the Syrians till they were made tributary by John Hyrcanus. This subjection of Edom is referred to in xxxviii. See notes on xxxvii. This period also best explains the hatred which trans- formed Isaac's blessing of Esau into a curse xxvi.
Judah The cities, Tappuah, Hazor, and Bethoron, which are mentioned here, are associated with notable victories and incidents in the Maccabean war. See notes on xxxiv. So also Bousset, Zeitschrift f. NTliche Wissensch. But the reference to the Amorites is much more obvious in xxix.
Their practical annihilation, which is here referred to, was effected by Judas see notes on xxix. It declares that they will be put to the sword by the Kittim, i. Our author gives in an apocalypse a history of the Maccabean times xxiii, , from the persecution of Antiochus Epiphanes to the Messianic kingdom, the advent of which is just at hand. In this section we have the rise of the Chasids, who rebuke their elders for forsaking the law and the covenant xxiii.
Our author stands already on the threshold of this happy time. It is, therefore, in the most prosperous days of the Maccabean dynasty, i. Our book was used by the author of Eth. Enoch xci. The textual affinities of our text connect it more closely with the form of Hebrew text, which is presupposed by the LXX B. Our text preserves older forms of the Haggada and Halacha than are found in the Talmud and later Jewish literature.
The details will be found on referring to the notes on the various passages. In ii. According to ii. In xi. In xii. In xix. In xxx. Later Judaism on the whole accepts the judgment pronounced on them in Genesis. Again our author records honestly the marriages of Simeon, Judah, and Joseph, to Gentile women, though such marriages must have in his eyes, been full of offence.
In xxxvii. Later developments of these legends are found in rabbinic litera- ture. Again, our text retains the original form of the traditions in Genesis, where later Judaism explained them away as offensive. Thus in iv. See also notes on iv. Again the strict halacha in xv. This strict law was subsequently relaxed in the Mishna. In xxxii. As regards the halacha laid down in iii. See also iii. Finally, we might draw attention to the fact that the Pharisaic regulation about pouring water on the altar Jer.
We know that the attempt of the Pharisees to enforce its adoption on Alexander Jannaeus resulted in a massacre of the former. The following facts postulate a pre-Christian date for the composition of our book : — a The calendar was in an unsettled state when our author wrote. No strict Pharisee, such as our author, could have advanced such a system as is laid down in vi. With it we may compare an allied system in Eth.
Enoch lxxii. There are good grounds for believing that our author grounded his system on the chronological statements regarding the flood in Genesis see notes on p. This frequency, as appears in the note on xxxvi. When once, however, the Maccabeans had assumed the title "priests of the Most High God," the divine title would naturally remain popular amongst those who, like our author, recognised the validity of the Maccabean pontificate.
On the other hand, we should expect a decline in its use to set in with the rising unpopularity of the Maccabean dynasty. This disuse, indeed, is not apparent in the oldest anti- Maccabean work, Eth. There the title " Most High " occurs nine times. But in the Pss. Enoch xxxvii. In the latter half of the first cent. The Jubilees and Years used by our Author Our author claims that his chronological system is derived from the heavenly tables.
From these tables it was made known to Moses directly by the angel of the presence, who assured Moses with regard to his disclosures on the solar year of days: " It is not of my own devising, for the book lies written before me, and on the heavenly tables the division of days is ordained" vi. For the convenience of the reader I have reduced the jubilee reckonings to years and placed them in the margin. The Jubilees. Each jubilee consists of seven year-weeks, and each year- week of seven years.
It is probably on the ground of the sacred character of the number seven, and possibly also for the sake of symmetry, that our author makes his jubilee consist of forty- nine years instead of fifty, which was the usual reckoning among the Jews. Here the jubilee is reckoned at forty-nine and a fraction, which varies unintelligibly in extent, if the text is correct.
It is noteworthy also that, whereas our author applies the jubilee reckoning from the creation to the date of Israel's entering into Palestine, the Talmudic treatise Erachin 3a and the Samaritan Chronicle make the jubilee to begin with the settlement of Israel in Palestine, and while the former carries it down to the destruction of the first temple, the latter carries it down to many centuries after the Christian era.
Thus i. Again, in x. Thus from the creation to the Messianic kingdom there would be eighty-five jubilees. In one other work, the Seder Olam 23, 25, the jubilee period is occasionally used in the history of Israel and Judah contemporary with the reigns of Sennacherib and Nebuchadnezzar. The Tears. The civil year consisted of twelve months iv. The ecclesiastical year consisted of thirteen months of twenty -eight days each, and in accordance with it were regulated the great festivals, the Sabbaths, Passover, and least of "Weeks see notes on vi.
Furthermore, this impossible solar year of days was undoubtedly put forward in Pharisaic circles in the second cent. See note on vi. In my edition of the Ethiopic Enoch in I was the first to point out pp. We shall now find that the above critical results are confirmed in the main by the evidence of our text. Thus in my note on iv.
Enoch vi. In confirmation of the conclusions in that note we should observe also that v. Enoch see also Index I. To begin with, these two writings exhibit certain resemblances. In both there is a temporary Messianic kingdom and an immortality of the soul implied or taught. On the other hand, the tone of Jubilees is optimistic and was written before the breach between the Pharisees and the Maccabean rulers, whereas Eth.
We shall now adduce a variety of passages from both books which will establish the dependent relation of this section of the Eth. Enoch on Jubilees. Enoch ciii. In our text Sheol is not yet associated with fire and burning ; but this stage, which combines the characteristics of Sheol and Gehenna, is already attained in the latter work.
In the despondent Eth. Enoch xcv. Enoch civ. Also ciii. Enoch xcix. Enoch xcviii. Throughout all the older sections of Enoch the law is not mentioned. Qc The references to " the plant of righteousness " Eth. Enoch xciii. The phrase, however, occurs already in Eth. Enoch x. I Eth. Enoch ci. Enoch, i. Thus, in Eth. Enoch iii. Levi 9. Again, Eth. Enoch v. Enoch i. Patriarchs, a sister work of Jubilees, but this subject cannot be pursued further here.
The Booh of Noah. Our author, moreover, has taken over bodily two considerable sections from it and incorporated them in vii. Thus the Book of Noah was written before B. But its com- position goes back to a much earlier date. Chapters vi. Enoch lxxxviii. Hence in its present form it is earlier than B. Chapters lx. There appears to be no adequate ground for assigning these sections of that ancient work to a later date than those above discussed.
The above facts throw some light on the strange vicissi- tudes to which even the traditional legends were subject. Thus it would appear that the Noah saga is older than the Enoch, and that the latter was built up in part on the debris of the former. And just as the Noah saga made way for the Enoch, so the Enoch saga in turn made way for the Seth, as I have shown at some length in the notes on pp. PaTEIAECHS From a comparison of the passages in our author and the Testaments which treat of the same subjects, it is clear that neither of the two works is dependent on the other, but that both draw independently from the same sources.
See notes on xxviii. I hope to treat this question exhaustively in my edition of the Testaments. In the next place our author was a supporter of the Maccabean pontificate. He glorifies Levi's successors as high-priests and civil rulers xxxi. He was not, however, so thorough-going an admirer as the authors of the Test. Levi 18, or Psalm ex. That our author was a priest might be reasonably inferred from the exaltation of Levi over Judah xxxi.
In Jewish and Samaritan Literature. On Eth. There are, however, amid great differences, strong affinities between them. Thus both teach a temporary Messianic kingdom and a blessed immortality of the soul. In Jubilees apparently for the first time God is called the Father of the righteous individual Israelite i. Again in Jubilees the law of retaliation is enunciated in its most literal form iv.
Finally either xlviii. In Jub. This sense we recover from the Greek on omitting the gloss : " In retribution for even a single child that was exposed Thou didst take away the multitude of them. Jubilees as in Hosea viii. Thus we have: "In 1 Observe independently the awkwardness of tzkvoiv after avrtav. I have found the same corruption in Ethiopic MSS. The haec here refers to Jubilees see i. In 4 Ezra vi.
These books were kept by Enoch according to our text iv. If with Joseph. Again on p. See also Konsch, Das Buch der Jubilaen, pp. Chronicles of Jerahmeel. At times it reproduces the actual words of our text. I have no doubt that our text was iused by some of the authors of this compilation. See Index II. Midrash Tadshe. By con- sulting Index II. The Booh of Jashar. The Hebrew text of this book which I have quoted occasionally, is that which was published at Venice in Generally, however, I have referred to the French translation of it in Migne's series.
The Samaritan Chronicle. It appears to contain a deliberate polemic see vi. In keeping with the fact that our author gives his calendar in connection with the flood vi. For a remarkable point of agreement between this Chronicle and our text see note v. Konsch p. On the other hand these two works hardly ever harmonise on the ages of the post-diluvian patriarchs till Terah's time, and the Chronicle, as we should expect, omits Kainam which our text viii.
In Christian literature. Authors who cite Jubilees or the Little Genesis by name. Patristic and other writings which reproduce its text or matter i. Authors who cite Jubilees or the Little Genesis by name : Didymus of Alexandria or to or a. Epiphanius ob. Be iv! Fabricius, Cod. See Jub. For passages where Epiphanius has used our text without acknowledgment see Index II. Jerome ob. For other quotations see Index II. Decretum Gelasii. Severus of Antioch ob. On this question see above, p.
Nicephorus, Catena, i. Before the words quoted from this work in the note on x. Syncellus flor. Dindorf , i. For passages where Syncellus has used our text without acknowledgment see Index II. Cbdeenus ed. Bekker , i. Be irpwTov Mania-? For some of the passages where Gedrenus has used our text without acknowledgment see Index II. Zonaeas , ed.
Pinder , i. Bekker , p. See also p. For some of the passages where Glycas has used our text without acknowledgment see Index II. See Gutschmidt, Kleine Schriften, v. Okigen in Genesin in Eusebius' Praep. The passage which is quoted from Origen in the note on xxxii.
Another quotation will be found in the note on xlv. Coislinianus used by Montfaucon, and in each catalogue immediately after the Harpidpxat, cf. Eonsch, p. According to Nicephorus it consisted of stichoi — the same number as the Testament of Moses, which was identi- fied by some writers with Jubilees.
Both Origen torn. Another fragment of Origen preserved in the Catena of Nicephorus, i. Isidore Peltjsiota of Alexandria, who lived in the fifth cent. This exposition regarding Levi is based on Jub. Isidore of Seville ob. Nam prima die vii opera fecit, id est : materiam informem, angelos, lucem, coelos superiores, terrain, aquam atque aerem.
Seeunda die firma- mentum solum. Tertia die quattuor : maria, semina, sationes atque plantaria. Quarta die tria : solem et lunam et stellas. Quinta die tria : pisces et reptilia aquarum et volatilia. Sexta die quattuor : bestias, pecudes, reptilia terrae et hominem. Et facta sunt omnia xxii genera in diebus sex. Et xxii generationes sunt ab Adam usque ad Jacob,. Observe that it confirms our view of a lacuna after ii. Ill, Turn rursus.
Abel autem Azrun. Kain invidit fratri suo. Natus et Sharna, cujus temporibus coluerunt homines idola, unoquoque quod sibi alliberet colente. Sharna is corrupt for Serug. Accepit ergo Abraham uxorem suam Saram, quae et ipsi ex patre soror erat. For other parallels see notes on pp. Suidas, a Greek grammarian of the tenth or eleventh cent. Fabricius, i. See also note on xii. Joel, Chronographia ed. Bekker, , extending to the year a. This writer, whom I have referred to occasionally in my notes, is generally dependent on Syncellus, Cedrenus or Glycas for any matter which he has in common with our text.
It is possible, as Eonsch p. LXX MS thirteenth cent. The scholia in this MS attest many of the personal names which are found in Jubilees. I have cited all of these in their appropriate places in my Ethiopic Text of Jubilees, and many of them in the notes to my translation.
See notes on v. Gregorius Barhebraeus Influence of Jubilees on the New Testament The points of connection between the gospels and our author are very slight, except in the beliefs respecting angels and demons — a subject to which we shall return later. We shall now place the passages side by side where the New Testament is dependent on our text, or presupposes it, or presents a close parallel.
Mark hi. Acts vii. This is the oldest source of the tradition in Acts. Acta ix. In that case years exactly elapse between this confirmation of the covenant and the law according to Jubilees. The Midrash Tanchuma on Exod. See note on i. The law was given in Isaac was born in , or exactly years before the legislation on Sinai according to Jubilees.
Contrast xv. The " old wives' fables " may be an allusion to the large role played by women in it. The author of Jubilees enforces the same view by representing Mastema as suggesting the tempta- tion of Abraham to sacrifice Isaac xvii. Besides the angels of the presence and the angels of sancti- fication there are the angels who are set over natural phenomena ii. These angels are inferior to the former. They do not observe the Sabbath as the higher orders; for they are necessarily always engaged in their duties ii.
Again, the guardian angels of individuals, which the New Testament refers to in Matt, xviii. Their fall and punishment are recorded in Jub. These demons attacked men and ruled over them x. Their purpose is to corrupt and lead astray and destroy the wicked x. They are subject to the prince of the Mastema 1 x. Men sacrifice to them as gods xxii. They are to pursue their work of moral ruin till the judgment of Mastema x. So in the New Testament, the demons are disembodied spirits Matt.
Their chief is Satan Mark hi. They are treated as divinities of the heathen 1 Cor. They are not to be punished till the final judgment Matt. On the advent of the Millennium Satan will be bound Eev. Enoch lxxxiii. He makes, however, only one reference to this Messiah, and no role of any importance is assigned to him see xxxi. The Messianic expectation showed no vigorous life throughout this century till it was identified with the Maccabean family.
If we are right in regarding the Messianic kingdom as of temporary duration, this is the first instance in which the Messiah is associated with a temporary Messianic kingdom. The Messianic Kingdom. We have there seen that it was to be brought about gradually by the progressive spiritual development of man and a corresponding transformation of nature. Its members were to attain to the full limit of years in happiness and peace.
During its continuance the powers of evil were to be restrained xxiii. The last judg- ment was apparently to take place at its close see note on xxiii. On the probable derivation of this view from Mazdeism see note on i. The writer of Jubilees, we can hardly doubt, thought that the era of the Messianic kingdom had already set in. Such an expectation was often cherished in the prosperous days of the Maccabees.
Thus it was entertained by the writer of Eth. Indeed his contemporaries came to regard him as the Messiah himself, as we see from Psalm ex. Levi The tame effusion in 1 Mace. Simon was succeeded by John Hyrcanus in 1 3 5 B. Levi 8 he embraced in his own person the triple office of prophet, priest, and civil ruler see note on xxxi. Eeuben 6, he was to " die on behalf of Israel in wars seen and unseen. Hyrcanus is only to introduce the Messianic kingdom, over which the Messiah sprung from Judah is to rule.
It would be interesting to inquire how far the writer of Hebrews was indebted to the history of the great Maccabean king-priests for the idea of the Melchizedekian priesthood, of which he has made so fruitful a use in chap. The Law. Volkes, 3 i. The Future Life. The souls of the righteous will enjoy a blessed immortality after death xxiii.
This is the earliest attested instance of this expectation in the last two centuries B. It is next found in Eth. Enoch xci-civ. The Jewish Calendar. Words or letters so enclosed are supplied by the editor from some source mentioned in the notes. Apostasy of Israel, Captivity of Israel and Judah, Return of Judah and rebuilding of temple, Moses' prayer for Israel, God's promise to redeem and dwell with them, , Moses bidden to write down the future history of the world the Book of Jubilees?
And an angel to write down the law, This angel takes the heavenly chronological tables to dictate therefrom, to Moses, This is the history of the division of the days of the law and of the testimony, of the events of the years, of their year weeks, of their jubilees throughout all the years of the world, as the Lord spake to Moses on Mount Sinai Prologue.
This short introduction Throughout all tlie years of the world.
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