Under Old Testament Law a woman who was suspected (but not proven) to be guilty of marital infidelity was made to drink a mixture of holy water and dust from the tabernacle floor (v 17). If she was innocent, nothing untoward would happen, but if she was guilty, the Lord would cause her 'thigh to waste away' and 'abdomen to swell' (v 21) and render her incapable of having children (v 28).

There is no obvious natural explanation as to why 'bitter water' should produce this constellation of clinical features. Abdominal swelling and thigh wasting may occur in kwashiorkor and protein losing enteropathy or nephropathy as a result of ascites and muscle depletion. Peritoneal tuberculosis or intra-abdominal malignancy are also possible diagnoses, although death is not mentioned as a complication in this passage. The fact that this syndrome is a result of sexual sin raises the possibility that the ovaries could have been the target of the curse in some way, and a large benign ovarian tumour could certainly account for the observed changes. Meig's Syndrome, although rare, interestingly does combine ovarian neoplasia with ascites.

Luke admits to being flummoxed by this case, but prefers kwashiorkor as the diagnosis on the basis that common things occur commonly and that someone with a guilty conscience could conceivably reduce protein intake.