But the LORD afflicted Pharaoh: But, as used in most English translations, indicates a contrast between the good the king did to Abram and the punishment the LORD gave to him. Afflicted translates the intensive form of the verb meaning “to touch or strike,” and in relation to illness the sense is to send a disease, or cause someone to be ill. And his house means all the people of his household, those who lived in his palace.

With great plagues: great is the usual translation of the Hebrew word, but when used with an unusual event or object, the sense is, according to Speiser, “strange, wondrous, awesome,” or as Good News Translation says, “terrible.” Plagues translates the plural noun form of the verb rendered afflicted. It refers to diseases that are associated with divine retribution, that is, sent by God or the gods to punish people for wrongdoing. In this case the wrongdoing is having taken Sarai as his wife. A translation that states the reason directly says “But the LORD sent a really bad sickness on the king and all the people in his household. He sent that sickness because the king had taken Abram’s wife Sarai.” In some languages the reason must be stated before the consequence. For example, “But because the king had taken Abram’s wife Sarai, the LORD sent terrible diseases and made the king and all those in his palace ill.”

Quoted with permission from Reyburn, William D. and Fry, Euan McG. A Handbook on Genesis. (UBS Helps for Translators). New York: UBS, 1997. For this and other handbooks for translators see here .