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Atlas of Cardiac
Catheterization and
Interventional
Cardiology
EDITED BY

Mauro Moscucci, MD, MBA

Chairman, Department of Medicine, Sinai
Hospital of Baltimore
Baltimore, Maryland
Adjunct Professor of Medicine, University of
Michigan Health System
Physician Consultant, Joint Commission
Resources
Baltimore, Maryland

ASSOCIATE EDITORS

Mauricio G. Cohen, MD, FACC,

FSCAI
Professor of Medicine
Cardiovascular Division, Department of Medicine
University of Miami Miller School of Medicine
Director, Cardiac Catheterization Laboratory
University of Miami Hospital and Clinics
Miami, Florida
Stanley J. Chetcuti, MD
Professor of Medicine
Eric J. Topol Professor of CVM
Director Cardiac Catheterization Laboratory
Co-Director Structural Heart Service
Division of Cardiovascular Medicine
Department of Internal Medicine
University of Michigan
Ann Arbor, Michigan
Acquisitions Editor: Sharon Zinner
Product Development Editor: Ashley Fischer
Editorial Coordinator: Louise Bierig
Editorial Assistant: Nicole Dunn
Marketing Manager: Rachel Mante Leung
Production Project Manager: Marian Bellus
Design Coordinator: Holly McLaughlin
Manufacturing Coordinator: Beth Welsh
Prepress Vendor: TNQ Technologies

Copyright © 2019 Wolters Kluwer

All rights reserved. This book is protected by copyright. No part of

this book may be reproduced or transmitted in any form or by any
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Publisher.
This work is provided “as is,” and the publisher disclaims any and all
warranties, express or implied, including any warranties as to
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This work is no substitute for individual patient assessment based

upon healthcare professionals’ examination of each patient and
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prior medical conditions, medication history, laboratory data and
other factors unique to the patient. The publisher does not provide
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Healthcare professionals, and not the publisher, are solely
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shop.lww.com
Dedication

To my many mentors and colleagues, and particularly

to Kenneth Borow,
John Carroll, Donald Baim, and William Grossman,
recognizing their charismatic vision
and support that put me on this pathway.

And to my wife Adriana for her continuous

understanding, love, and support.
Her willingness to continue to adapt her life to the
many months of night
and weekend work that were required to create this
Atlas will be unforgettable.
Preface

The evolution of photography and more recently of

medical imaging has been one of the major advances
of this past century. An image can tell a story, even
without caption, and there is nothing more powerful
than images when introducing new technology, new
techniques, and new processes.
In 2010, I had the privilege to be asked by
Wolters Kluwer to take over the eighth edition of
“Grossman and Baim’s Cardiac Catheterization,
Angiography, and Intervention”. That new edition,
capitalizing on the outstanding work from prior
editions, had an additional emphasis on cardiac
imaging. Yet, it looked like there was still an
opportunity for a book fully dedicated to images.
Thus, following further discussion with the Wolters
Kluwer team, the idea for this Atlas was developed.
The purpose of this Atlas is to provide a visual
overview of cardiac catheterization and interventional
cardiology. Given the emphasis on imaging, the
opening chapter is on integrated imaging modalities
in the cardiac catheterization laboratory. We hope
that our readers will enjoy the unique cases
illustrated in this chapter. The remaining chapters
can be divided into 2 main groups. Chapters 2-15 are
focused on basic elements of cardiac catheterization
and interventional cardiology including complications,
vascular access, pressure measurements, pitfalls in
the evaluation of hemodynamic data, pericardial
disease, pediatric cardiac catheterization, coronary,
peripheral, and pulmonary angiography, coronary
anomalies, evaluation of myocardial blood flow, and
intravascular ultrasounds. Chapters 15-25 cover key
areas of interventional cardiology, from percutaneous
transluminal coronary angioplasty (PTCA) to
advanced epicardial access.
Our readers will notice that the chapters have 2
basic formats: (1) a clinical, case-based structure
with images and (2) a primarily image-based
structure. Given the diversity of topics, we felt that
this flexible approach could provide the most value to
our readers. In addition, the chapters on PTCA and
coronary stenting focus on basic concepts,
equipment characteristics, basic techniques, and
clinical trials, rather than on clinical cases. The
decision of how to structure these chapters was
based on the fact that general training in
interventional cardiology not always incorporates
formal training about the history, the development,
and engineering of interventional devices.
This book and the stories told through images
would have not been possible without the work of
the many pioneers who contributed to the
development of cardiac catheterization and
interventional cardiology. Our gratitude to them will
continue to be immeasurable.

Mauro Moscucci. MD, MBA

Baltimore, Maryland
Acknowledgments

First and foremost, I would like to thank the many

mentors who I was fortunate to have through my
career in cardiology and interventional cardiology,
including Dr. Kenneth Borow, Dr. John Carroll, Dr.
Donald Baim, and Dr. William Grossman for their
charismatic mentorship and guidance during my
initial training in cardiology at the University of
Chicago, and my 2 years of training at the Beth
Israel Hospital in Boston in the early 1990s. Their
continued friendship and support over the following
decades have been inspiring. I would also like to
thank Julie Goolsby, who as acquisition editor for
Wolters Kluwer supported my initial proposal, and
Sharon Zinner, who in her role as senior acquisition
editor continued to provide an incredible support
while we were developing the Atlas. In addition, I
would like to thank Ashley Fischer, for her
outstanding assistance and patience as the product
development editor, and Louise Bierig, for her
support as development editor. The incredible
support of the Wolters Kluwer team was what that
made this Atlas becoming true. Finally, I am
extremely grateful to my associate editors, Dr.
Stanley Chetcuti and Dr. Mauricio Cohen, and to all
the authors and many colleagues and friends who
have contributed to this Atlas.
Contents

chapter 1 Integrated Imaging Modalities in

the Cardiac Catheterization
Laboratory
MICHAEL S. KIM, MD, AND ROBERT A. QUAIFE, MD

chapter 2 Complications of Percutaneous

Coronary Intervention
MAURO MOSCUCCI, MD, MBA

chapter 3 Percutaneous Vascular Access:

Transfemoral, Transseptal, Apical,
and Transcaval Approach
MICHAEL DAVID DYAL, MD, FACC AND CLAUDIA A.
MARTINEZ, MD

chapter 4 Radial Artery Approach

CARLOS ENRIQUE ALFONSO, MD, TEJAS PATEL, MD,
DM, FACC, FSCAI, FESC, AND MAURICIO G. COHEN,
MD, FACC, FSCAI

chapter 5 Cutdown Approach: Femoral,

Axillary, Direct Aortic, and
Transapical
 ROSS MICHAEL REUL, MD, PHILIP L. AUYANG, MD,
AND MICHAEL JOSEPH REARDON, MD

chapter 6 Catheterization in Childhood and

Adult Congenital Heart Disease
ADA C. STEFANESCU SCHMIDT, MD, MSC, SAMUEL
L. CASELLA, MD, MPH, MICHAEL J. LANDZBERG, MD,
AND DIEGO PORRAS, MD

chapter 7 Pressure Measurements

MAURO MOSCUCCI, MD, MBA, AND CALIN V. MANIU,
MD

chapter 8 Hemodynamics of Tamponade,

Constrictive, and Restrictive
Physiology
YOGESH N. V. REDDY, MBBS, MAURO MOSCUCCI,
MD, MBA, AND BARRY A BORLAUG, MD

chapter 9 Pitfalls in the Evaluation of

Hemodynamic Data
MAURO MOSCUCCI, MD, MBA

chapter 10 Coronary Angiography and Cardiac

Ventriculography
ROBERT N. PIANA, MD, AARON KUGELMASS, MD,
AND MAURO MOSCUCCI, MD, MBA

chapter 11 Coronary Anomalies

MAURO MOSCUCCI, MD, MBA
chapter 12 Pulmonary Angiography
KYUNG J. CHO, MD

chapter 13 Angiography of the Aorta and

Peripheral Arteries
HECTOR TAMEZ, MD, THOMAS M. TU, MD, RUBY LO,
MD, AND DUANE S. PINTO, MD, MPH

chapter 14 Myocardial and Coronary Blood

Flow and Metabolism
MATHEW LIAKOS, MD, KIRAN V. REDDY, MD, FACC,
AND ALLEN JEREMIAS, MD, MSC

chapter 15 Intravascular Imaging

MASAYASU IKUTOMI, MD, PHD, YASUHIRO HONDA,
MD, FAHA, FACC, PETER J. FITZGERALD, MD, PHD,
FACC, AND PAUL G. YOCK, MD

chapter 16 Endomyocardial Biopsy

MAURO MOSCUCCI, MD, MBA

chapter 17 Percutaneous Circulatory Support:

Intra-Aortic Balloon
Counterpulsation, Impella,
Tandem Heart, and Extracorporeal
Bypass
CARLOS D. DAVILA, MD, MICHELE ESPOSITO, MD,
AND NAVIN K. KAPUR, MD

chapter 18 Percutaneous Transluminal

Coronary Angioplasty
 MAURO MOSCUCCI, MD, MBA

chapter 19 Atherectomy, Thrombectomy, and

Distal Protection Devices
KARIM M. AL-AZIZI, MD AND AARON KUGELMASS,
MD

chapter 20 Coronary Stenting

MAURO MOSCUCCI, MD, MBA

chapter 21 Percutaneous Interventions for

Valvular Heart Disease
HONG JUN (FRANCISCO) YUN, MD AND STANLEY J.
CHETCUTI, MD

chapter 22 Interventions for Adult Structural

Heart Disease
HONG JUN (FRANCISCO) YUN, MD AND STANLEY J.
CHETCUTI, MD

chapter 23 Peripheral Interventions

JAYENDRAKUMAR S. PATEL, MD, SAMIR R. KAPADIA,
MD, AND MEHDI H. SHISHEHBOR, DO, MPH, PHD

chapter 24 Thoracic Aortic Endovascular

Repair
ARNOUD KAMMAN, MD, KAREN M. KIM, MD, DAVID
M. WILLIAMS, MD, AND HIMANSHU J. PATEL, MD

chapter 25 Percutaneous Epicardial

Techniques
JUAN F. VILES-GONZALEZ, MD, FACC, FAHA, FHRS
AND ANDR D’AVILA, MD

Index
Contributors

Karim M. Al-Azizi, MD
Structural Heart Disease Fellow
Department of Interventional Cardiology
The Heart Hospital–Baylor Scott & White
Plano, Texas

Carlos Enrique Alfonso, MD

Assistant Professor of Medicine
Cardiovascular Division
University of Miami Miller School of Medicine
University of Miami Hospital & Clinics
Miami, Florida

Philip L Auyang, MD
Resident Physician
Houston Methodist DeBakey Heart and Vascular
Center
Houston, Texas

Barry A. Borlaug, MD
Associate Professor
Department of Cardiovascular Diseases
Mayo Clinic
Rochester, Minnesota

Samuel L. Casella, MD, MPH

Clinical Fellow
Department of Pediatrics
Harvard Medical School
Massachusetts Hall
Cambridge, Massachusetts
Department of Cardiology
Boston Children’s Hospital
Boston, Massachusetts

Stanley J. Chetcuti, MD
Professor of Medicine
Eric J. Topol Professor of CVM
Director Cardiac Catheterization Laboratory
Co-Director Structural Heart Service
Division of Cardiovascular Medicine
Department of Internal Medicine
University of Michigan
Ann Arbor, Michigan

Kyung J. Cho, MD
Emeritus Professor of Radiology
University of Michigan Health System
Department of Radiology
Division of Interventional Radiology
Ann Arbor, Michigan

Mauricio G. Cohen, MD, FACC, FSCAI

Professor of Medicine
Cardiovascular Division, Department of Medicine
University of Miami Miller School of Medicine
Director, Cardiac Catheterization Laboratory
University of Miami Hospital and Clinics
Miami, Florida

André D’Avila, MD
Director
Cardiac Arrhythmia Service Hospital
SOS Cardio
Florianopolis, SC, Brazil

Carlos D. Davila, MD
General Cardiology Fellow
The Cardiovascular Center
Tufts Medical Center
Boston, Massachusetts

Michael David Dyal, MD

Interventional Cardiology Fellow
Department of Medicine
University of Miami
Miami, Florida
Michele Esposito, MD
Cardiovascular Disease Fellow
The Cardiovascular Center
Tufts Medical Center
Boston, Massachusetts

Peter J. Fitzgerald, MD, PhD, FACC

Professor Emeritus, Medicine & Engineering
Director, Stanford Center for Cardiovascular
Innovation
Division of Cardiovascular Medicine
Stanford University School of Medicine
Stanford, California

Yasuhiro Honda, MD, FAHA, FACC

Clinical Professor of Medicine
Director, Stanford Cardiovascular Core Analysis
Laboratory
Division of Cardiovascular Medicine
Stanford University School of Medicine
Stanford, California

Masayasu Ikutomi, MD, PhD

Division of Cardiovascular Medicine
Stanford University School of Medicine
Stanford, California

Allen Jeremias, MD, MSc

Director of Interventional Cardiology Research
Department of Cardiology
St. Francis Hospital
Roslyn, New York

Arnoud Kamman, MD
Surgical Resident
Department of Surgery
Ikazia Hospital Rotterdam
Rotterdam, the Netherlands

Samir R. Kapadia, MD
Professor of Medicine
Section Head, Interventional Cardiology
Director, Sones Cardiac Catheterization Laboratory
Cleveland, Ohio

Navin K. Kapur, MD
Associate Professor
Department of Medicine and Cardiology
Tufts Medical Center
Boston, Massachusetts

Karen M. Kim, MD
Department of Cardiac Surgery
Frankel Cardiovascular Center
University of Michigan
Ann Arbor, Michigan
Michael S. Kim, MD
Medical Director
Structural Heart & Valve Disease Program
Cardiovascular Institute of North Colorado
Banner Health
Greeley, Colorado

Aaron Kugelmass, MD
Professor
Department of Medicine
Univeristy of Massachusetts Medical School-Baystate
Medical Director
Heart and Vascular Program
Chief of Cardiology
Baystate Health System
Springfield, Massachusetts

Michael J. Landzberg, MD
Associate Professor of Medicine
Harvard Medical School
Boston, Massachusetts
Immediate-Past Director, Boston Adult Congenital
Heart (BACH) Group
Department of Cardiology, Department of Medicine
Boston Children’s Hospital and Brigham and Women’s
Hospital
Boston, Massachusetts
Matthew Liakos, MD
Stony Brook University Medical Center
Stony Brook, New York

Ruby Lo, MD
Assistant Professor
Vascular and Endovascular Surgery
Brown University
Providence, Rhode Island
Boston, Massachusetts

Calin V. Maniu, MD
Director
STEMI Program Lifebridge Health
Baltimore, Maryland

Claudia A. Martinez, MD
Associate Professor
Department of Medicine
University of Miami
Miami, Florida

Mauro Moscucci, MD, MBA

Chairman, Department of Medicine
Sinai Hospital of Baltimore
Baltimore, Maryland
Adjunct Professor of Medicine, University of Michigan
Health System
Physician Consultant
Joint Commission Resources
Baltimore, Maryland

Himanshu J. Patel, MD
Joe D. Morris Collegiate Professor
Section Head
Department of Cardiac Surgery
University of Michigan
Ann Arbor, Michigan

Jayendrakumar S. Patel, MD
Fellow
Department of Interventional Cardiology
Heart and Vascular Institute, Cleveland Clinic
Cleveland, Ohio

Tejas Patel, MD, DM, FACC, FSCAI, FESC

Professor
Department of Cardiology
Sheth V.S. General Hospital
Chairman & Chief Interventional Cardiologist
Apex Heart Institute
Ahmedabad, India

Robert N. Piana, MD
Professor of Medicine
Director, Adult Congenital Interventional Cardiology
Division of Cardiovascular Medicine
Vanderbilt University Medical Center
Nashville, Tennessee

Duane S. Pinto, MD, MPH

Harvard Medical Faculty Physicians (HMFP)
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Diego Porras, MD
Assistant Professor
Department of Pediatrics
Harvard Medical School
Department of Cardiology
Boston Children’s Hospital
Boston, Massachusetts

Robert A. Quaife, MD
Professor of Medicine and Radiology Director
Advanced Cardiac Imaging University of Colorado
Anschutz Medical Campus Aurora
Division of Cardiology
University of Colorado Denver
Aurora, Colorado

Michael Joseph Reardon, MD

Professor of Cardiothoracic Surgery
Allison Family Distinguished Chair of Cardiovascular
Research
Department of Cardiovascular Surgery Associates
Houston Methodist Physician Specialty Group
Houston, Texas

Kiran V. Reddy, MD, FACC

Interventional Cardiologist
Division of Cardiology
St Francis Hospital
Roslyn, New York

Yogesh N.V. Reddy, MBBS, MSc

Advanced Heart Disease Failure Fellow
Division of Cardiovascular Diseases
Mayo Clinic
Rochester, Minnesota

Ross Michael Reul, MD

Attending Surgeon of Cardiovascular Surgery
Associates
Department of Cardiovascular Surgery Associates
Houston Methodist Physician Specialty Group
Houston, Texas

Ada C. Stefanescu Schmidt, MD, MSc

Clinical and Research Fellow
Adult Congenital Heart Disease
Boston Children’s Hospital
Harvard Adult Congenital Heart Disease Fellowship
Department of Cardiology
Boston, Massachusetts

Mehdi H. Shishehbor, DO, MPH, PhD

Clinical Assistant Professor of Medicine
Department of Cardiovascular Medicine
Director, Interventional Cardiovascular Center,
University Hospitals
Heart & Vascular Institute
Cleveland Clinic
Cleveland, Ohio

Hector Tamez, MD
Co-director of Chronic Total Occlusion Projection
Instructor of Medicine
Division of Cardiology
Department of Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Thomas M. Tu, MD
Director, Cardiac Catheterization Lab
Baptist Health Louisville
Interventional Cardiology
Department of Medicine
Baptist Hospital Medical Group
Louisville, Kentucky

Juan F. Viles-Gonzalez, MD, FACC, FAHA, FHRS

Associate Professor
Director, Cardiac Electrophysiology
Tulane University School of Medicine
Heart and Vascular Institute
New Orleans, Louisiana

David M. Williams, MD
Kyung J. Cho Professor of Radiology
Department of Radiology
Frankel Cardiovascular Center
University of Michigan
Ann Arbor, Michigan

Paul G. Yock, MD
Martha Meier Weiland Professor of Bioengineering
and Medicine
Founding Director, Stanford Byers Center for
Biodesign
Stanford, California

Hong Jun (Francisco) Yun, MD

Interventional Cardiology Fellow
Division of Cardiovascular Medicine
Department of Internal Medicine
University of Michigan
Ann Arbor, Michigan
chapter 1
Integrated Imaging
Modalities in the Cardiac
Catheterization Laboratory
MICHAEL S. KIM, MD, and ROBERT A. QUAIFE,
MD

INTRODUCTION
Over the last decade, there has been an exponential
growth in the number of transcatheter therapies
designed to treat both congenital and acquired
structural heart disease (SHD) pathologies. Along
with this growth have come major advances in image
guidance including three-dimensional
transesophageal echocardiography (3D TEE), cardiac
computed tomographic angiography (CCTA), and
magnetic resonance imaging and angiography
(MRI/MRA). In contemporary practice, catheter-
based treatments of various structural heart and
valve diseases have become increasingly reliant on
accurate preprocedural imaging assessment and
intraprocedural guidance to maximize outcomes and
minimize complications.1 For example, CCTA has
become the “gold standard” in aortic annulus
analysis in preplanning for transcatheter aortic valve
replacement (TAVR) procedures.2,3 Similarly, 3D TEE
has become a mainstay in both preprocedure
evaluation and intraprocedural guidance for
transcatheter mitral valve repair with the MitraClip
device.4,5
A major challenge facing all SHD interventionalists
and imaging specialists, however, centers on the
importance of integrating efficiently multiple imaging
modalities so as to prevent “sensory imaging
overload.” Oftentimes, many operators also struggle
with “mentally translating” two-dimensional (2D)
imaging sequences (eg, CCTA, 2D echocardiography)
into accurate and useful 3D spatial images in their
own minds to both effectively preplan and efficiently
perform complex SHD procedures. To overcome
these barriers, imaging manufacturers are actively
developing new software tools that are designed to
take the complexities of multimodality imaging
integration out of the hands of the operators, while
simultaneously giving back to the operator a
simplified and efficient mechanism by which to
manipulate and analyze the processed images.6-8
This chapter, through several clinical examples,
will highlight how both high-quality preprocedure
imaging and intraprocedural imaging using novel
multimodality image integration tools can be
effectively used to guide complex SHD interventions.

CASE 1 Right Ventricular to Left Atrium

Fistula Repair
A 55-year-old male with a history of an endocardial cushion defect
that was surgically repaired at age 7 years with a patch at the
septum primum and inlet ventricular septal defect (VSD) was
referred to evaluate and treat a residual right ventricular (RV) to
left atrial (LA) fistula. He had a recent biventricular
pacemaker/internal cardiac defibrillator (ICD) placed for
asymptomatic complete heart block in the setting of left ventricular
(LV) dysfunction. After device implantation, he began complaining
of new visual symptoms (intermittent vision loss in his left eye)
concerning for transient ischemic attacks (TIAs); a brain MRI could
not be obtained owing the presence of his ICD. A transthoracic
echocardiogram (TTE) was performed demonstrating a residual
defect/fistula between the RV and LA with at least moderate right
to left shunting following injection of agitated saline contrast
(FIGURE 1.1; Video 1.1). Given the concern that the patient
would be at risk for forming small thrombi on his ICD leads that
both may have and could in the future embolize paradoxically, the
decision was made to proceed with transcatheter closure of the
residual fistula.

Video 1-1

As part of his preprocedure evaluation, the patient underwent a

CCTA to better elucidate the size and location of the fistula
(FIGURE 1.2; Video 1.2). The CCTA demonstrated a clear
communication between the RV and LA with a tract diameter of
approximately 5 to 7 mm (depending on timing within the cardiac
cycle) and a length of approximately 6 mm. Intraprocedure 3D TEE
was used as image guidance (FIGURE 1.3). Using an antegrade
approach (transvenous access with transseptal puncture and defect
crossing from the LA), the patient underwent an uncomplicated
fistula closure using a 6 × 6 Amplatzer Duct Occluder II device
(FIGURE 1.4). Postprocedure TEE and TTE demonstrated no
residual flow across the device. The patient was discharged on
postprocedure day 1 and remains in good condition.

Video 1-2
FIGURE 1.1 TTE agitated saline contrast (“bubble”) study through a
peripheral vein demonstrating a communication between the RV and
LA (arrow) with right to left shunting.
 FIGURE 1.2 Multiplanar re-
construction of the CCTA demonstrating the fistula between the RV
and LA (arrows) in orthogonal planes. The fistula was dynamic in
nature and measured approximately 7 mm in diameter and 6 mm in
length during ventricular systole.
 FIGURE 1.3 Intraprocedure TEE. A and B, 4 chamber and LV
outflow tract view showing color flow between the LA and RV. C and
D, Location of the transseptal puncture inferior (C) and posterior (D).
E and F, Orientation of the steerable guide catheter directly into the
location of the fistula from the LA. G and H, Occluder device across
the fistula with absence of flow by color Doppler indicating complete
closure.

FIGURE 1.4 Fluoroscopic images of RV to LA fistula closure. A, With

the steerable guide catheter (arrowheads, positioned guide catheter)
pointed into the LA side of the fistula, a Magic Torque wire is
advanced across the defect and out the LV outflow tract across the
aortic valve into the ascending aorta (Ao). B, A 5 French diagnostic
catheter is advanced over the wire into the ascending Ao, and the
wire is removed. C, Amplatzer Duct Occluder II device (arrow,
showing deployed device) is fully deployed across the fistula. D, Final
angiography demonstrating stable placement of the occluder device.
CASE 2 Prosthetic Mitral Paravalvular Leak
Repair
A 70-year-old female with a history of rheumatic heart disease
underwent surgical mitral valve replacement with a 29 mm porcine
bioprosthesis. Although her immediate postoperative course was
uneventful, she presented several weeks after surgery with
decompensated heart failure symptoms (New York Heart
Association Class III-IV). A TTE and TEE confirmed the presence of
a severe paravalvular leak located on the posterior aspect of the
sewing ring. There was also evidence of mild hemolysis. A
cardiothoracic surgeon was consulted who felt that a reoperation
would put the patient at excessive risk given her current clinical
state, and thus she was referred for transcatheter paravalvular leak
(PVL) repair.
The patient underwent a preprocedure CCTA to evaluate the
size and extent of the posterior PVL as well as assess for any
additional defects (FIGURE 1.5). The CCTA clearly demonstrated
the presence of a large, crescentic defect located on the posterior
aspect of the bioprosthetic valve sewing ring. The defect measured
approximately 10 mm in diameter at its widest segment and
approximately 24 mm in total length. Intraprocedure 3D TEE
coupled with novel live echo-fluoro image integration technology
(EchoNavigator—Philips Healthcare, The Netherlands) was used for
image guidance (FIGURE 1.6; Video 1.3). Using an
antegrade approach, the patient underwent an uncomplicated PVL
closure with implantation of a 14 and 12 mm Amplatzer Vascular
Plug II device (St Jude Medical, Inc., St Paul, MN) across the large
posterior PVL, resulting in complete eradication of the PVL
(FIGURE 1.7; Video 1.4). The patient was discharged on
postprocedure day 2 and remains in excellent clinical condition
with NYHA Class I symptoms and no evidence of hemolysis.
Video 1-3

Video 1-4
 FIGURE 1.5 CCTA of posterior mitral paravalvular leak. A-C, 2D
multiplanar reconstruction of the mitral annulus demonstrating a
large paravalvular leak located on the posterior aspect of the sewing
ring (arrows). D, 3D en face view of the prosthetic mitral valve
localizing the size and extent of the posterior paravalvular leak
(arrow) immediately opposite to the Ao.
 FIGURE 1.6 Intraprocedural TEE with live echo-fluoro image
integration technology (EchoNavigator) to guide transcatheter mitral
paravalvular leak repair. A, LV outflow tract view demonstrating
severe paravalvular regurgitation located posteriorly on the sewing
ring. B, 3D en face view of the prosthetic mitral valve demonstrating
a crescentic defect located on the posterior aspect (6 o’clock) on the
sewing ring (arrow). C, 3D en face view with color Doppler showing a
crescentic leak originating from approximately 4 o’clock to 7 o’clock
(arrowheads). D, Live echo-fluoro image integration technology with
the PVL labeled with the red dot (arrows). The steerable guide
catheter is located medial to the location of the PVL. E, Live echo-
fluoro image integration showing that torqueing the steerable guide
catheter posteriorly and slightly advancing it further into the LA aligns
it directly above the location of the PVL.
 FIGURE 1.7 Intraprocedural TEE with live echo-fluoro image
integration demonstrating eradication of the mitral paravalvular leak.
A, Fluoroscopy showing 2 Amplatzer Vascular Plug II devices across
the sewing ring (arrow) in the area of the paravalvular leak. B, 3D
TEE view demonstrating the posterior location of the 2 vascular plug
 devices (arrowheads). C and D, Live echo-fluoro image integration
technology demonstrating location of the vascular plug devices
(arrowheads) and complete eradication of paravalvular leak with
absence of color flow across the sewing ring (arrows).

CASE 3 Left Ventricular Apical

Pseudoaneurysm Repair
A 75-year-old female with severe, symptomatic aortic stenosis who
was deemed prohibitive risk for surgical aortic valve replacement
owing to frailty, severe lung disease, and prior pericardiectomy in
the 1980s for chronic pericarditis was referred for TAVR. She also
had a history of severe peripheral arterial disease (PAD) with
bilateral femoral-popliteal bypass surgery in the past. Given her
severe PAD, she underwent attempted TAVR via a transapical
approach. The procedure was aborted owing to severe bleeding
during placement of the pledgeted sutures in the LV apex. The
patient fortunately had an uneventful postoperative course. The
procedure plan was then changed to attempt TAVR using a self-
expanding transcatheter heart valve via a subclavian approach
once she had recovered from her index procedure. A repeat CCTA
performed to evaluate the suitability of using her left subclavian
artery for access incidentally also detected the presence of a large,
LV apical pseudoaneurysm (PSA) that had developed in the interim
postoperative recovery period (FIGURE 1.8). The neck of the PSA
measured 3 mm with the PSA body measuring 12 mm × 25 mm.
Given the size of the PSA and the inherent risk of rupture, the
decision was made to attempt transcatheter repair of the PSA
concomitantly with the planned TAVR procedure.
 FIGURE 1.8 CCTA demonstrating the evolution of LV apical PSA. A,
Baseline CCTA before attempted transapical TAVR. B, Repeat C CTA
demonstrating the interval development of a new LV apical PSA
(arrow, aneurysm chamber). C and D, Measurements of the PSA with
a neck diameter of 3 mm and body dimensions of 12 mm × 25 mm.

Successful and uncomplicated TAVR via left subclavian access

was performed, and a 29 mm Medtronic CoreValve transcatheter
heart valve (Medtronic, Minneapolis, MN) was implanted. LV
angiography performed post-TAVR confirmed the presence of a
large LV apical PSA (FIGURE 1.9; Video 1.5). 3D TEE was
then used as adjunctive imaging during the PSA repair (FIGURE
1.10). The patient underwent successful PSA repair using a 6 × 6
Amplatzer Duct Occluder II device (St Jude Medical, Inc., St Paul,
Other documents randomly have
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The Project Gutenberg eBook of A Class-Book
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Title: A Class-Book of Biblical History and Geography

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*** START OF THE PROJECT GUTENBERG EBOOK A CLASS-BOOK

OF BIBLICAL HISTORY AND GEOGRAPHY ***
 A

CLASS-BOOK

OF

BIBLICAL HISTORY

AND

GEOGRAPHY:
 WITH NUMEROUS MAPS.

BY
PROF. H. S. OSBORN, LL. D.

AMERICAN TRACT SOCIETY,

150 NASSAU STREET, NEW YORK.

COPYRIGHT, 1890.
AMERICAN TRACT SOCIETY.
 Transcriber’s Notes
The cover image was provided by the transcriber and is
placed in the public domain.

Punctuation has been standardized.

Most abbreviations have been expanded in tool-tips for

screen-readers and may be seen by hovering the mouse over
the abbreviation.

This book was written in a period when many words had not
become standardized in their spelling. Words may have multiple
spelling variations or inconsistent hyphenation in the text. These
have been left unchanged unless indicated with a Transcriber’s
Note.

Footnotes are identified in the text with a superscript number

and have been accumulated in a table at the end of the text.

Transcriber’s Notes are used when making corrections to the

text or to provide additional information for the modern reader.
These notes have been accumulated in a table at the end of the
book and are identified in the text by a dotted underline and
may be seen in a tool-tip by hovering the mouse over the
underline.

Several maps at the end of this book were displayed over two
pages. In reproducing these as illustrations, a small strip was
lost due to the binding.
 PREFACE.
This work is a Class-Book of the Old and the New Testaments
treated as consecutive history. It includes the Jewish history of the
centuries between the close of the Old Testament and the beginning
of the New.

It presents those important elements of Biblical history which

distinguish it from all other histories and which illustrate the plan
and the purpose of the Bible as one Book. Whatever modern
scholarship has accomplished to aid in the understanding of the
original languages of Scripture in important points has been made
use of, and whatever monumental or topographic discoveries would
contribute to a better understanding of the geography or
archæology of the text-statements have been introduced where the
history required it.

The history of the centuries between the close of the Old

Testament canon and the beginning of the Christian era includes that
of its Jewish literature. This history greatly helps us to appreciate
that singular tenacity with which the earliest Christian church held to
the Mosaic ritual.

In the treatment of this history we have allowed no space for

mere opinions or speculations. The work is purely historical, and its
text is illustrated only by that which is pertinent and well
authenticated, in either geographic or archæological discovery.

The entire subject matter is divided into Periods and chapters and
subdivided into sections and paragraphs, the latter presented in such
a form as generally to suggest to the teacher the question and to
the reader the topic of the paragraph.
 TABLE OF CONTENTS.

PERIOD I.
THE ANTE-DILUVIAN ERA.

CHAPTER I.
Creation, Eden: Chronology and its Sources.

CHAPTER II.
The Significance of Names.

CHAPTER III.
The Descendants of Adam.

CHAPTER IV.
The Lineage of the Patriarchs.

CHAPTER V.
The Flood.

PERIOD II.
THE PATRIARCHAL ERA AFTER THE FLOOD TO THE
DEATH OF JACOB.

CHAPTER I.
The Two Ararats. The Sons of Japheth.

CHAPTER II.
The Sons of Ham. Their More Recent Names.

CHAPTER III.
The Descendants of Shem. Job.

CHAPTER IV.
The Confusion of Tongues.

CHAPTER V.
The History of Abram and his Times.
CHAPTER VI.
The Patriarchs Isaac and Jacob.

CHAPTER VII.
Egyptian Testimonies.

PERIOD III.
THE THEOCRACY TO THE JUDGES.

CHAPTER I.
The Israelites in Egypt.

CHAPTER II.
The Physical Geography of Sinai and the Desert.

CHAPTER III.
The Entrance into Canaan.

CHAPTER IV.
The Battles of the Conquest.

CHAPTER V.
The Introduction of Idolatry.

PERIOD IV.
THE PERIOD OF THE JUDGES.

CHAPTER I.
The Nature of the Office. The Chronology.

CHAPTER II.
The Scribes of the Age.

PERIOD V.
THE PERIOD OF THE KINGS TO THE CAPTIVITY.

CHAPTER I.
Origin of the Monarchy. Reign of Saul.

CHAPTER II.
The Reigns of David and of Solomon.

CHAPTER III.
The Division of the Kingdom.
CHAPTER IV.
Analysis of the Reigns of Judah and Israel.

CHAPTER V.
The Institution of the Prophetical Office.

PERIOD VI.
THE CAPTIVITY OF JUDAH TO THE CLOSE OF THE
CANONICAL PERIOD.

CHAPTER I.
The Various Captivities.

CHAPTER II.
The Comparative Religious Spirit.

CHAPTER III.
The Captivity Ended.

CHAPTER IV.
The Canonical Books. Samaritan Pentateuch.

CHAPTER V.
What Was Scripture? The Septuagint.

CHAPTER VI.
The Origin of the Talmud.

CHAPTER VII.
Concluding Remarks.

PERIOD VII.
THE NEW TESTAMENT ERA.

CHAPTER I.
From the Birth of Christ to his Public Ministry.

CHAPTER II.
The Public Ministry of our Saviour.

CHAPTER III.
From the First Passover to the Second.

CHAPTER IV.
From the Second Passover to the Third.
CHAPTER V.
The Third Passover.

CHAPTER VI.
The Beginning of the Christian Church.

CHAPTER VII.
The Gospel for Gentiles as well as Jews. Paul’s First Mission.

CHAPTER VIII.
The Second and Third Missionary Tours of Paul.

CHAPTER IX.
Paul at Rome. The Seven Churches. Colosse and Hierapolis.
BIBLICAL HISTORY AND
GEOGRAPHY.

PERIOD I.
THE ANTE-DILUVIAN ERA.

CHAPTER I.
CREATION: CHRONOLOGY AND
ITS SOURCES.
 1. The first book of the Bible, which is Genesis, begins with a
history of the Creation. The words “In the beginning,” with which it
opens, give us no chronological data by which we are able to form
any estimate of the time. Seven divisions, called “days,” have special
appointments assigned to each in that which is usually called “the
work of creation,” including the appointment of a day of rest.

Before the beginning of the days there existed a state of chaos,

the earth being “without form and void” and darkness being upon
the face of the waters.

The first act was the calling into being Light The appointment of
Day and Night closed the work of the first day.

The separation of the waters beneath “the firmament,” or

expanse, from those above “the firmament” constituted the work of
the second day.

The formation of dry land, called earth, and the appearance of

vegetable growth, called grass, herbs, and trees, occurred on the
third day.

On the fourth day lights appeared in “the firmament,” or expanse,

and on the fifth day the first animal life moved in the waters and
birds in the air, the latter called “winged fowl.” On the sixth day the
earth brought forth living creatures, “cattle, creeping things, and
beasts;” and finally man was created, made after God’s image, with
dominion over all that had been here created.

The seventh day was set apart as a day of rest, a day of which it
is said, “God blessed the seventh day and sanctified it.” Gen. 2:3.

2. After the creation of man he was placed in a garden which

the Lord God planted “eastward in Eden.” The locality of Eden is
unsettled, but the opinion of many scholars is that it is not far off
from the head of the Persian Gulf. The garden is described as
“eastward in Eden,” and it is supposed to have been in the eastern
part of a district called Eden. Prof. Sayce derives Eden from an
ancient word meaning “the desert.” If this be correct, the garden of
Eden was more remarkable for its contrast with the great Syrian
desert in its immediate vicinity. The rivers mentioned by name are
Pison, Gihon, Hiddekel, and Euphrates. The Euphrates at the present
day joins the ancient Hiddekel, which is now called the Tigris, at a
point one hundred miles northwest from the Persian Gulf, and the
stream formed by the union of the two rivers is called the Shat el-
Arab. The Pison and Gihon have not been satisfactorily identified.

It should be remembered that the geographical condition of this

region is very unlike that which existed at the time we are
considering. Dr. Delitzsch calculates that a delta of between forty
and fifty miles in length has been formed since the sixth
century B. C. Prof. Sayce says that in the time of Alexander,
B. C. 323, the Tigris and Euphrates flowed, by different mouths, into
the sea (gulf), as did also the Eulæus, or modern Karun, in the
Assyrian epoch.1

The increment of land about the delta has been found to be a mile
in thirty years, which is about double the increase of any other delta,
owing to the nature of the soil over which the rivers pass.2 Under
these changes it is probable that any but very large streams might
disappear.

3. The Euphrates passes along a course of more than 1,780

miles from the head-waters of the Mourad Chai3 and for about 700
miles it passes through a nearly level country on the east of the
great Syrian desert. It varies in depth from eight to twenty feet to its
junction with the Tigris; after its union with the Tigris its depth
increases. It is navigable for about 700 miles or more from the
Persian Gulf.

The Tigris is shorter, being about 1,150 miles in length, and

navigable for rafts for 300 miles. Some of the extreme head-sources
of this river approach those of the Euphrates within the distance of
two or three miles. The name Hiddekel is the same word as Hidiglat,
which is its name in the Assyrian inscriptions, as Purat is the ancient
Assyrian for Perath in Hebrew.4

The land of Havilah, which was encompassed entirely by the river

Pison, is unknown, but the “Ethiopia” encompassed by the river
Gihon is in the Hebrew called Cush, and recent discoveries have
proved that in very early times Cushite people inhabited a part of the
region near the head of the Persian Gulf.

There is little doubt that the land so called was a part of the plain
of Babylonia where the cities of Nimrod were planted, Gen. 10:10,
Nimrod being a son of Cush.

These discoveries show that, in after ages, the Cushites left

Babylonia and emigrated southward along the Persian Gulf into
Arabia, of which they occupied a very large part, and from its
southern part crossed over to Africa to the country which in after
times was called by the Greek geographers Ethiopia.

Dr. F. Delitzsch supposes that Havilah was the district lying west of
the Euphrates and reaching to the Persian Gulf, and that the Cush of
the text was the land adjoining on the east, having the present Shat
el-Nil for its border line. The long stream west of the Euphrates,
which was known to the Greeks as Pallacopas, Dr. Delitzsch
considers as the Pison, and the Shat el-Nil as the Gihon (see the
map). The Garden of Eden he places at that part where the
Euphrates and Tigris approach each other very nearly, being at that
place only twenty-five miles apart.5

4. In the Garden of Eden the Lord God put the first pair. Of the
man it is said that he was placed in the garden “to dress it and to
keep it;” and of the woman, that she should be “a help meet for
him.” How long this state of things continued is not related, but,
through the serpent, temptation entered into the mind of Eve, and
she gave of the forbidden fruit unto her husband and they did eat,
“and their eyes were opened,” apparently to the sense of guilt in
violating the command which forbade them to “eat of the tree of the
knowledge of good and evil.” The curse then followed, and they
were driven out from the garden, to which they were never to
return.

5. After the expulsion Cain and Abel were born, and the first
murder took place in the killing of Abel by Cain, the latter being
punished by being driven out “from the presence of the Lord.” Cain
went eastward and dwelt in the land of Nod, and his first-born son,
Enoch, built the first city, which was named after him, Enoch.
Neither the land of Nod nor the city Enoch has been certainly
located.

6. We now have an account of the descendants of Adam, with

the statement of their several ages. Upon this statement of ages a
chronology has been based, usually called the Biblical Chronology. It
is derived from that account which is recorded in the Hebrew, the
language in which the history was originally written. But there is
another account which was given in the earliest extant translation of
the Hebrew history, and this is called the Septuagint Greek, made
about 286 B. C.; and the chronology of this old translation differs
materially from the Hebrew original. There is yet another authority,
the Samaritan Pentateuch, the manuscript of which is kept at
Shechem, in Palestine, and is the oldest known manuscript of the
Bible in the world, having been written before the Captivity and in
the old Hebrew letters.6

These are the only three records of any importance, and the
variations in these records are seen in the following table:7

Lived before After birth

Total.
birth of sons. of sons.
HEB. SAM. SEP. HEB. SAM. SEP. HEB. SAM. SEP.
Adam 130 230 800 700 930
 Seth 105 205 807 707 912
Enos 90 190 815 715 905
Cainan 70 170 840 740 910
Mahalaleel 65 165 830 730 895
Jared 162 62 162 800 785 800 962 847 962
Enoch 65 65 165 300 300 200 365
Methuselah 187 67 187 782 653 782 969 720 969
Another translation 167 802
of Septuagint 165
Lamech 182 53 188 595 600 565 777 653 753
Noah 500

It will be seen by the above table that the Hebrew text affords
data which give us 1,656 years from the creation of Adam to the
Flood, for we must add 100 to Noah’s age of 500, since the Flood
began when Noah was 600 years old (Gen. 7:6). The Samaritan text
takes away 100 years from the life of Jared, 120 from that of
Methuselah, and 129 from that of Lamech, as compared with the
Hebrew text, making the Flood occur 1,307 after Adam’s creation,
while the Septuagint adds 100 to the lives of each of the first five
and to that of Enoch, and six to that of Lamech, making the Flood
begin 2,262 years after the creation of Adam, according to one
reading of the Septuagint, or 2,242 according to another.

So that the aggregates of time from the Creation to the Flood, as

deduced from the Hebrew, the Samaritan, and the Septuagint,
severally are 1,656, 1,307, and 2,262. The Samaritan is the oldest
manuscript, but it cannot be made certain that the dates as given in
that manuscript have suffered no alteration; and hence the Hebrew
account has been followed in our entire English version, the
chronology of which was arranged by Archbishop Ussher (usually
written Usher), A. D. 1580,8 but it “is of no inspired authority and of
great uncertainty.”
 7. The subject of Biblical Chronology, as derived from data
recorded in the Scripture, is necessarily unsettled; and this is so
partly because9 the sacred writers speak of descendants of a given
progenitor as his sons, in accordance with Eastern custom, and
partly perhaps from the use of letters, for figures, in the early
manuscripts,10 which have suffered changes in subsequent
transcriptions. But although these variations occur, discoveries
connected with the remains of other nations than the Jewish, and
connected with other histories than the Jewish, are beginning to
throw light upon the Scripture history and chronology.

These collateral histories allude to persons and events of Jewish

history and afford such data that in many instances we can
determine from them the actual year of Scripture events. This aid is
particularly important as derived from both Assyrian and Egyptian
discoveries, and this we shall have reason hereafter to show.
 CHAPTER II.
THE SIGNIFICANCE OF NAMES.
1. In the earliest periods of human history names, either for
persons, places, or things, had meanings which were in some sense
applicable to the person, place, or thing named. This was specially
true in Hebrew history, and of this we have already had illustrations;
for when Eve was brought to Adam “he called her name woman,
because she was taken out of man,” but afterwards, because Eve in
the Hebrew meant life, he “called his wife’s name Eve, because she
was the mother of all living.”

Adam’s name denoted his relation to the ground (Hebrew,

Adamah), from the dust of which he was taken; and as Eve’s body
was derived from that of Adam, the name of the two was Adam
(Gen. 5:2), which was the name given by God “in the day when they
were created,” and this name was exclusively the description of the
first man and the first woman.

In Gen. 2:23 we have the generic name given to the race in the
Hebrew terms “Ish” and “Ishah” for “man” and “woman,” given by
Adam to himself and to the woman: “This is now bone of my bones
and flesh of my flesh: she shall be called woman (Ishah), because
she was taken out of man (Ish).”

2. The root, or primitive meaning, of Ish is uncertain, but from its

subsequent use we may infer that it denoted a characteristic of
humanity higher than that expressed by the word Adam, and may
have occurred to the father of men while naming the animals as an
appellative distinguishing his own from the inferior order of the
animate creation.11

It is remarkable that the ancient Assyrian name for the first man is
Admu or Adamu, the Assyrian form of the Hebrew Adam.12

3. In the Hebrew history, therefore, names are not to be

regarded as mere sounds or combinations of sounds, attached at
random to certain objects or persons, so as to become the audible
signs by which we distinguish them from each other, but very
frequently proper names had a deeper meaning and were more
closely connected in men’s thoughts with character and condition
than among any other ancient nation with the history and literature
of which we are acquainted.13 Thus it is that, as Archbishop Trench
says, words are often the repositories of historical information.14
 CHAPTER III.
THE DESCENDANTS OF ADAM.
1. As the history proceeds it becomes very plain that the
descendants of Adam are selected with a purpose, which a general
acquaintance with Scripture reveals. That purpose was to record the
ancestry of Abraham and so of the children of Israel. Other
descendants are occasionally mentioned when any interesting or
important event suggests itself to the historian, but the main
purpose is never lost sight of.

Thus the descendants of Cain are briefly enumerated through his

first-born, Enoch, “the teacher,” as his name signifies. He was the
first builder of a city, and may, as Geikie suggests, have been the
first to teach men “the culture of city life,” or “the elements of
physical life.”

2. His descendants were Irad, “the swift one,” perhaps because

of his hunter’s life; Mehujael, “the stricken of God,” for some
unrecorded transgression; Methusael, probably bearing the name
God in the syllable “el,” and meaning “champion of God,” suggesting
some religious act; as if, even among the race of Cain, God “had not
left himself without a witness.”15

3. But we find Lamech, “a wild man,” who first introduces

polygamy, for ever hereafter to be associated in origin with the
race of Cain. One of his two wives was named Adah, a Hebrew term
for “ornament,” and is found in the compounds Adaiah, “whom
Jehovah adorns,” and Maadiah, “ornament from Jehovah.” There
must have been a personal attraction which made the name
appropriate.

4. In the other wife’s name, Zillah, it has been supposed that the
termination “ah” has reference to the name of Jehovah; it is more
probable, however, that the meaning is confined to the root of this
word, which signifies “a shade.” To her son, Tubal-Cain, we are
indebted for the first work in copper and iron, as the sentence
“instructor of every artificer in brass and iron” means. Perhaps we
may say “bronze” for “brass,” since brass is a compound of zinc and
copper, and bronze is a compound of tin and copper, and the latter
has been discovered in the most ancient ruins, which has not been
true as to brass. Brass, however, is used in Scripture in some
instances as the name for copper.16 Chisels have been taken from
ruins in Egypt containing copper 94 per cent., tin 5.9, and iron 0.1;
and a bowl from Nimrud, about twenty miles south of Nineveh, was
composed of copper 89.57 per cent., and of tin 10.43. In the
sepulchral furniture with which the oldest of the Chaldæan tombs
were filled we already find more bronze than copper.17 The
excavations at Warka, the ancient Erech of Gen. 10:10, ninety-five
miles southeast of Babylon, seem to prove that the ancient
Chaldæans made use of iron before the Egyptians.18

5. The name given to Jabal, the son of Adah, suggests that he

led a pastoral life with his cattle. His name means “wanderer,” and
hence he was very appropriately “the father of such as dwell in
tents.” “His brother’s name was Jubal; he was the father of all such
as handle the harp and organ;” the latter name suggesting some
wind instrument or pipe. His name significantly means “the player.”

6. To this list of “first things” may be added the first instance of

poetical utterance, for the address of Lamech to his wives is in
the form of the earliest Hebrew poetry. Gen. 4:23.
 Adah and Zillah, hear my voice,
Wives of Lamech, hear my speech.
I have slain a man for wounding me,
A young man for hurting me.
If Cain shall be avenged seven-fold,
Surely Lamech seventy-and-seven.

With this ends the history of the descendants of Cain. The history
of those descendants of Adam through whom the children of Israel
traced their lineage is begun in the fifth chapter of Genesis.
 CHAPTER IV.
THE LINEAGE OF THE
PATRIARCHS.
1. Ten generations are given, from Adam to the Flood, and the
remarkably long lives of the Patriarchs have suggested to many the
probability of error or misunderstanding. Some have supposed that
each name represents a tribe, the lives of whose leading members
have been added together. Others have understood the years to
mean only months, and others that numbers and dates are liable in
the course of years to become obscured and exaggerated.19

2. But as to all these opinions it must be remembered, First,

that the era from the creation of Adam to the Flood, 1,656 years, is
to be divided by the number ten, the number of the Patriarchs,
which would require an individual length of life much longer than
that enjoyed at the present day; and, Secondly, no scientific reasons
can be offered why human life should be limited in duration to its
present length. It varies now according to the contingencies of
accident and disease, and old age itself may be only a modified form
of disease and not essential to a human organism. A clock made to
run twenty-four hours is expected to run down in about that time,
but the clock-maker may, by adding one wheel, or to the length of
the weight-cord, or by some other very simple rearrangement, make
the very same clock run a week or a month. It is only a question of
life, about which, as to its nature, we know little or nothing. Thirdly,
as to the historic probability, it is a fact that traditions other than
those of the Hebrew nation represent that in the earliest ages there
was an enjoyment of exceedingly long lives. The chronology of
Berosus, a Chaldæan priest and historian, B. C. 279 to 255, gives to
the ten Babylonian kings who in the earliest traditions of that people
reigned before the Babylonian deluge 2,221 years, or only 21 years
less than the period given in the Septuagint as having elapsed
between the Creation and the Deluge.20 The earliest Aryan tradition
states that the first man lived 1,000 years in Paradise.

Other nations have kept the same tradition of long lives in the
earliest times, which nations could not have received the tradition
from the Scriptures.

3. But there is a probability arising from the fitness of long

lives, and that is seen in the necessity of a history which could thus
be obtained by tradition when no written language existed. It will be
seen that from Adam to the Flood tradition was delivered through
only one person, so that Lamech could repeat to Noah what Adam
had narrated to him of all the dealings of God in Eden and after the
expulsion. Although Lamech lived during the lifetimes of all the
Patriarchs down to the Flood, which took place 1,656 years after the
creation of Adam, he himself was only 777 years old at death. Thus
we see that tradition was more trustworthy then than at any time
since.

4. Moreover, Shem lived nearly a century before the death of

Lamech, who could have narrated the story of Eden and the trials
and experiences of his after-life, as well as the history of the
Patriarchal times, to Shem, who was alive in the times of Abraham
and his son Isaac. By that time writing was invented, and doubtless
much of the history of the times before and after the Flood had been
committed to writing, which was invented several centuries before
the death of Shem, as we learn from the ancient Chaldæan records.
 5. After the Flood long lives continued, but in much shorter
terms, Arphaxad, Salah, and Eber each lived about four centuries,
and each of the next three patriarchs lived over 200 years, and it
was not till after the time of Judah, seven centuries after the Flood,
that the length of a human life was reduced to about a century.
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