LEPROSY (IN THE BIBLE)

Leprosy, also known as Hansen's disease, is the only sickness whose traditional complex of social, legal, religious, and hagiographical aspects have made its history inseparable from that of the Bible and the Church. It is also unique in that the treatment, cure, and rehabilitation of millions of victims are seriously impeded today by widespread errors concerning it, which are historically associated with the Bible and the Church.

Nature of True Leprosy. Hansen's disease is a chronic infectious sickness caused by a rod-shaped acidfast bacillus, Mycobacterium leprae, discovered by G. A. Hansen in Bergen, Norway, in 1873. It chiefly affects the skin, mucous membranes of the upper respiratory tract, eyes, and certain peripheral nerves. The disease is neither congenital nor hereditary. Its exact mode of transmission—probably

direct contact—remains unknown. Only a small percentage of persons having prolonged contacts with patients contract the disease. A natural immunity, therefore, appears to prevail in most people, dependent on unexplored racial or genetic factors. Hansen's disease is considered less infectious than tuberculosis. Its average incubation period is about three years, but it may be shorter or longer. Apart from indeterminate and borderline cases, the two main types, presumably based on high or low resistance, are: (1) tuberculoid, having few bacilli, but with nerve involvement causing anesthesia, paralysis of some muscles, and disintegration of toe and finger bones; these so-called closed cases are considered noninfectious except during reaction, and often result in spontaneous recovery ("burnt-out cases"); and (2) lepromatous, characterized by lesions and swellings containing numerous bacilli, expecially on the face ("leonine face") and in the upper respiratory tract and vocal cords, with frequent eye-involvement; these so-called open cases are infectious. Often decades after infection, death usually results, not from the disease itself, but from secondary infections and other causes. Until the 20th century, leprosy was thought to be highly contagious and generally incurable.

So-called Leprosy in the Bible. Before discussing the Biblical disease that has been traditionally called leprosy, it is good to consider the evidence concerning the existence of genuine leprosy in the ancient world during Biblical times.

Modern medical historians, notably G. Sticker, have disproved often repeated errors concerning leprosy in pre-Christian times that have resulted from mistranslations of generic ancient terms unaccompanied by clinical descriptions. The oldest recognizable reference to Hansen's disease occurs in the Indian medical treatise Sushruta Samhita, compiled in its present recension about 600 b.c., but including more ancient traditional knowledge. The term kushta in the still older Vedas and Laws of Manu designates skin diseases in general. In Chinese medical literature, leprosy is not recognized until 500 to 300 b.c. and clinically described only in a.d. 200 to 300 by Hua T'o.

Of direct relevance to the problem of so-called leprosy in the Bible is the still confused history of Hansen's disease in ancient Egypt. References in the Ebers medical papyrus (c. 1550 b.c.) to sicknesses named aat and uchedu have been mistranslated as leprosy. B. Ebbell's identification of "Chon's swelling" as leprosy has been rejected by leprologists J. Lowe and Dharmendra; G. Grapow, a leading expert on ancient Egyptian medicine, has not thoroughly analyzed the problem. A. Bloom has shown that the terms used by Flavius josephus (Contra Apionem, 1.26) and other writers to designate a disease that allegedly afflicted the people of Israel in Egypt under Moses do not refer to leprosy. Bloom also reports no evidence of leprosy in ancient Egyptian statuary and art that clearly depict other sicknesses. As to skeletons and mummies, he records only one case indicating leprosy, but it came from a Christian cemetery of the Christian era. In 1962 V. Møller-Christensen examined 18,000 human remains from ancient Egypt, Palestine, and Europe, but found no trace of Hansen's disease older than c. a.d. 500. Lucretius' reference to elephas morbus (De rerum natura, 6.1112)—if it means genuine leprosy, a disputed point—would prove only that it existed there in the first century b.c., which no one denies.

Evidence of Hansen's disease in the Middle East before the armies of Alexander the Great probably imported it from India is limited to a few references to unidentified skin diseases in Herodotus and in Persian and Babylonian texts. In Palestine, the only hint is a "leonine face" of the Egyptian god Bes on a Canaanite jar of c. 1411 to 1314 b.c. found at Beth-San (Bethshan) in 1925. It would therefore seem probable that cases of Hansen's disease were sporadic rather than endemic in the Near East during the millennium between Moses and Alexander the Great, i.e., in Old Testament times.

In the Old Testament. Concordances list up to 83 references in both the Old Testament and the New Testament to various forms of the Hebrew root ṣ r' and the Greek words λέπρα and λέπρός that are inaccurately translated as leprosy, leper, or leprous in modern Bibles. The root of the Hebrew noun ṣāra‘at that is used in the Old Testament (often accompanied by nega', "blow," "plague") probably means etymologically affliction, prostration, or defilement; hence it designates, according to the context, a condition of ritual or cultic uncleanliness manifested in certain skin disorders and blemishes or in incrustations of fungi or molds in linen, leather, or stones.

Explicit rules for the priests on how to diagnose ṣāra‘at in human beings are given in Lv 13.1–46; however, modern translations of clinical terms in that chapter are confusingly disparate. The affliction called ṣāra‘at was diagnosed from the following symptoms: subcutaneous lesions with hairs turning white (Lv 13.3), spreading lesions (Lv 13.7–8), lesions with ulceration (Lv 13.11), secondary infections with ulceration (Lv 13.15), deepseated lesions spreading from a healed ulcer (Lv 13.22) or from the healed scar of a burn (Lv 13.25, 27), spreading lesions on scalp or chin or forehead (Lv 13.30, 36,43). Superficial local skin infections that improved or failed to spread after a quarantine of a week or two were not considered ṣāra‘at (Lv 13.6, 23, 28, 34, 37, 39). Moreover, a man in whose skin ṣāra‘at developed into a generalized eruption covering the entire body that later healed by desquamation (scaling) was declared clean (Lv 13.12–13,16–17).

Once a man was diagnosed as having ṣāra‘at, he had to keep his clothes rent and his head bare, muffling his beard and calling out, "unclean" (Lv 13.45); he was obliged also to dwell outside the camp (Lv 13.45; Nm5.2; 12.15) or in a separate house (2 Chr 26.21) "as long as the sore is on him" (Lv 13.46). When a priest found that the ṣāra‘at had healed, the man underwent an expiatory rite of purification (Lv 14.1–32). Another rite was prescribed for the purification of houses in which ṣāra‘at of walls had not spread after replastering (Lv 14.49–53).

Nine other passages shed helpful light on the Old Testament concept of ṣāra‘at : Ex 4.6–7 (Moses' hand); Lv 22.4 (disqualification for the priesthood); Nm 5.2 (isolation); Nm 12.9–14 (Miriam); 2 Sm 3.29 (Joab); 2 Kgs5.1–14, 27 (Naaman and Gehazi); 2 Kgs 7.3–11 (four outcasts of Samaria); 2 Chr 26.17–23; See Also 2 Kgs 15.5 (King Azariah) and Dt 24.8–9, which merely stresses Leviticus ch. 13–14 and Nm 12.10. These texts demonstrate that sāra’at in human beings referred to skin disorders that might be disfiguring and serious (Nm 12.12), and chronic or even lifelong (2 Kgs 7.3;2 Chr 26.21), but they might also be cured or cleansed (Lv 13.12; Lv 14.3; 2 Kgs 5.14). In several instances they are described as a sign (Ex 4.6–7) or punishment (Nm 12.9–10; 2 Sm 3.29; 2 Kgs 5.27; 2 Chr 26.17–23) inflicted by God, as were other maladies (Dt 28.21–22, 27, 35, 59).

As a stain or blemish, ṣāra‘at, like other sources of defilement, e.g., touching a corpse (Nm 19.11–22), rendered a person technically "unclean," i.e., temporarily impure or unholy, hence unacceptable in proximity to the ark of the covenant, which could be approached only by the pure and unblemished (see pure and impure).

Scholars disagree as to whether ṣāra‘at was contagious in a hygienic sense, because of the failure of some to make the necessary distinction between bacterial infection, unknown as such in the Bible, and the cultic concept of uncleanliness. The latter was highly contagious (Leviticus ch. 11–15)—but only among Israelites (Mishnah, Negaim, 3.1). The case of the Gentile Naaman (2 Kgs5.1) proves that ṣāra‘at was not considered medically infectious. Nevertheless, it is obvious that the Levitical regulations had an effective prophylactic influence.

Almost without exception, modern leprologists agree that the symptoms of ṣāra‘at do not resemble those of Hansen's disease. Stressing the omission of such characteristic features as anesthesia, leonine face, hoarseness, blindness, mutilations, slow evolution, and incurability, leprologists suggest that ṣāra‘at designated skin disorders of various kinds, including leucoderma, vitiligo, psoriasis, eczema, yaws, sycosis or tinea barbae, ringworm of the scalp, or impetigo, as well as fungi and molds. Consequently, they conclude that Hansen's disease is not described in the Old Testament. However, owing to the sporadic presence of genuine leprosy in the Near East in early Old Testament times and its gradual spread in late Old Testament centuries, some of its victims may have been included among those diagnosed as having ṣāra‘at. Incidentally, Job's skin disorder is not called by that name and was probably scabies crustosa, according to H. P. Lie. The passing allusions to sāra’at in the writings of the qumran community and the extended dermatological treatise Negaim in the Mishnah serve to underline the persistence of the cultic aspect.

Of crucial importance to an understanding of ṣāra‘at is the choice of the Greek word λέπρα (Latin lepra ) by the learned rabbis who made the Greek translation, known as the Septuagint (LXX), of the Pentateuch in the third century b.c. at Alexandria, which was then a Hellenistic scientific center. The Hippocratic and later Greek medical writings apply λέπρα to curable scaling skin affections such as vitiligo and psoriasis. The standard Greek term for genuine leprosy, significantly appearing only after 250 b.c. (and not in Hippocrates) was ἐλεφαντίασις, later Latinized as elephantiasis Graecorum.

In the New Testament. Following the pattern of the LXX, λέπρα was used to designate cases of ṣāra‘at in the New Testament, with a direct reference to the Levitical rules in Mk 1.44 and to Naaman in Lk 4.27. Stressing the cultic aspect, cures were called cleansing (καθαρίζω: Mk 10.8;11.5; Mk 1.40–42: Lk 4.27: 17.14), excepting that of the grateful Samaritan, for whom Luke the physician used healing (ἰάομαι: Lk 17.15). These cleansings were one of the messianic signs (Mt 10.8; 11.5). Of significance for the future was the detail that Jesus "had compassion on and touched" the outcast (Mk 1.41; See Also Mt 8.3; Lk 5.13). Also noteworthy was his befriending of "Simon the leper" (Mt 26.6; Mk 14.3). The beggar Lazarus is described as being covered with sores (Lk 16.20), but as with Job, he is not called λεπρός (leprous). Outside the Gospels, there is no mention of any form of leprosy in the New Testament.

Noting that none of the passages in the Gospels supply clinical descriptions, leprologists conclude that the lepra of the New Testament, being the equivalent of the sāra’at of the Old Testament, was not Hansen's disease. However, it is more probable, since genuine leprosy was endemic in the Near East in the first Christian century, that some of its victims may have been included among those diagnosed as having lepra. In any case, whatever the particular disease was, the instantaneity of the cures effected by Christ testifies to their miraculous nature.

Bibliography: General. v. klingmÜller, Handbuch der Hautund Geschlechtskrankheiten 10.2 (Berlin 1930) 4–21. k. grÖn, ibid. 806–842. g. sticker, ibid. 23 (1931) 264–642. e. jeanselme, La Lèpre (Paris 1934) 9–67. a. weymouth (i. g. cobb), Through the Leper-squint: A Study of Leprosy from Pre-Christian Times to the Present Day (London 1938). j. lowe, "Comments on the History of Leprosy," Leprosy Review 18 (1947) 54–64. Antiquity. b. ebbell, "A Contribution to the Earliest History of Leprosy," International Journal of Leprosy 3 (1935) 257–263. dharmendra, "Leprosy in Ancient Indian Medicine," ibid. 15 (1947) 424–430. m. yoeli, "A 'Facies Leontina' of Leprosy on an Ancient Canaanite Jar," ibid. 30 (1962) 211–214. v. mollerchristensen, "The Origin and Antiquity of Leprosy," ibid. 31 (1963) 562. a. bloom, La Lèpre dans l' ancienne Ègypte et chez les anciens hébreux. La Lèpre dans la Bible (Cairo 1938). h. grapow, Grundriss der Medizin der alten Agypter, 7 v. (Berlin 1954–61). o. k. skinsnes, "Leprosy in Society," Leprosy Review 35 (1964) 21–35, 106–122, 175–182. Bible. h. p. lie, "On Leprosy in the Bible," ibid. 9 (1938) 25–31, 55–67. f. c. lendrum, "The Name 'Leprosy,"' American Journal of Tropical Medicine and Hygiene 1 (1952) 999–1008. Leprosy and the Bible (pamphlet; London 1961), repr. of four articles from The Bible Translator 11 (1960) 10–23, 69–80, 80–81; 12 (1961) 75–79. r. g. cochrane et al., in j. hastings and j. a. selbia, eds., Dictionary of the Bible (Edinburgh 1942–50) (1963) (rev. ed. New York 1963) 575–578. w. leibrand, Lexikon für Theologie und Kirche, ed. j. hofer and k. rahner (Freiberg 1957–65) 1:1115–16. Encyclopedic Dictionary of the Bible, tr. and adap. by l. hartman (New York 1963) 1322–23.

[r. brown]