Neither bubonic nor dysentery
The data reported by the historical record are not satisfactorily explained by either bubonic plague or dysentery, the candidates proposed in the literature so far.
Bubonic plague is transmitted by Yersinia pestis in fleas living on rats [6]. The historical source does mention buboes and rodents, albeit not necessarily those linked to bubonic plague. Moreover, one is still left to explain bubonic plague in an area where no previous case is known, thus requiring strong evidence for the first manifestation of the disease, and the repeated failures for the disease to reoccur as in the subsequent centuries there are no records for bubonic plague in this area. One is also left to explain the mechanism of spreading, linked to the transfer of the box, and why the epidemic was confined to such a small territory, which would be atypical for bubonic plague [6]. Additionally, one is left to explain the fall of the Philistine idol.
The dysentery alternative fares no better. The sole evidence rests on the 17th century King James Version translation into English of the biblical text. This translation states that due to the plague, the Philistines “had emerods in their secret parts” (1Sa.5.9) [7]. However, other translations respecting the original text in Hebrew do not report any localization for the tumors. For instance, Chouraqui’s translation, which is considered to be the most literal one ever produced, has Philistines ulcerated by tumors, “ils sont ulcérés de tumescences” (1Sa.5.9) [8].
Even accepting for argument’s sake the possibility that tumors were only found in the perianal area, and were due to dysentery, this explanation ends up in a cul-de-sac. Dysentery is caused by either Shigellae [9], or amoebas [10], is characterized by diarrhea, and is linked to contaminated water. The text mentions neither contaminated water nor diarrhea [5], and focuses on lethality and tumors. Dysentery also fails to explain the mechanism of spreading of the epidemic, as well as the odd detail of the idol falling at night in the temple.