Clinics in Dermatology (2016) 34, 3–7

☆

Leprosy in the Bible Andrzej Grzybowski, MD, PhDa,b,⁎, Małgorzata Nita, MD, PhD c

aDepartment of Ophthalmology, Poznan City Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland of Ophthalmology,Poznań City Hospital, PolandbDepartment of Ophthalmology, University of Warmia and Mazury, ul. Żołnierska 14 C, Olsztyn, PolandcDomestic and Specialized Medicine Centre “Dilmed”, ul. Bohaterów Monte Cassino 3, 40-231 Katowice, Poland

Abstract For many years, the biblical term tzaraat has referred to leprosy. In fact, the disease or diseasesdescribed under this name have no relationship to leprosy, as it was known in the Middle Ages or today;moreover, the term referred not only to skin disease, but also to the state of the ritual impurity andpunishment for the sins.

Although the real nature of tzaraat remains unknown, the differential diagnosis might include thefollowing: Psoriasis, seborrheic dermatitis, favus, dermatophyte infections, nummular dermatitis, atopicdermatitis, pityriasis rosea, crusted scabies, syphilis, impetigo, sycosis barbae, alopecia areata, furuncles,scabies, neurodermatitis, scarlet fever, lupus erythematosus, lichen sclerosus et atrophicus, folliculitisdecalvans, morphea, sarcoidosis, and lichen planopilaris.

Leprosy became interchangeable with the biblical leprosy due to two inaccurate translations:The Hebrew tzaraat was first translated into Greek as leprosy in the sixth century, and later, the wordleprosy was translated into Arabic as lepra in the ninth century.© 2016 Elsevier Inc. All rights reserved.

Introduction

Chapters 13-14 of the Book of Leviticus, the third book ofthe Bible (the third of five books of the Torah or Pentateuch),that is in the Old Testament of the Christian Bible, is the sourceof biblical leprosy.1–4 The book contains material that it datesback to the time ofMoses, was created by anonymous scholars,and in present form was finished only in the Persian period,538–332 BCE. Leviticus was the divine code of proceedingrules for Levites (in historical Judaism, they were the priestlyclasses with exclusive rights to learn and teach Torah to others,served particular religious duties for the Israelites, and had

☆ All biblical references are to the English text according to The NewJerusalem Bible, Garden City, New York, 1985.

⁎ Corresponding author. Tel.: +48 505 074 224.E-mail addresses: ae.grzybowski@gmail.com (A. Grzybowski),

dilmed@wp.pl (M. Nita).

http://dx.doi.org/10.1016/j.clindermatol.2015.10.0030738-081X/© 2016 Elsevier Inc. All rights reserved.

political responsibilities as well) and instructs collection for thelay people, regulating and controlling all aspects of life.Chapters 13-14 relate to impurity and ritual purity, which isessential for an Israelite to be able to approach God and remainpart of the community.5

The Hebrew term tzaraat, originally used in chapter 13 ofLeviticus, is the root word and refers to collective skin diseases,among them also to biblical leprosy, which, according to theOld Testament, rendered one ritually unclean. An uncleanperson was physically separated from other members of thecommunity to prevent moral contamination rather than formedical concerns of physical contaminations.1,3 The wordstzaraat in the Old Testament and lepra in the New Testamentappear at least 68 times.6,7,⁎

⁎ Ex. 4:6; Lv. 13 and 14: Lv. 21:16-22:9; Nb. 5:2; Nb. 12:10; Dt. 24:8; 2S. 3:29; 2 K. 5; 2 K. 7:3-16; 2 K. 15:1-7; 2 Ch. 26, Mt. 8:2-3; Mk. 1:40-44;Lk. 5:12-13; Mt. 26:6; Mk. 24:3; Mt. 10:8, Lk. 4:27; and Lk. 17:12-19.

4 A. Grzybowski and M.ł Nita

In the Hebrew of the period, tzaraat had a broad meaningand was related to almost all types of skin diseases andconcerned four forms:

• lesions on previously normal glabrous skin• lesions on previously abnormal skin• lesions in areas of diffuse alopecia• localized alopecia.

To make matter more complex, each form had its ownprimary and secondary characteristics.3

Chapter 13 of Leviticus describes seven conditions whichcould make a person unclean:

• bright spot—baheret• swelling—se’et• white inflammation—shechin• erythema that turns white or red-white—baheret• hair shaft breakage, yellow, and thin hair—netek• anterior scalp hair loss—gibachat• posterior scalp hair loss—karachat.1

Tumefaction, eruption, or spot (Lv. 13:1-8), suspicion ofulcers (Lv. 13:18-23), leprosy on burn (Lv. 13:24-28), leprosyon head or chin (Lv. 13:29-37), urticaria (Lv. 13:38-39), orleprosy in the bold (Lv. 13:18-23), when confirmed by a priest,justified the diagnosis of tzaraat.

Medical knowledge in that era, needless to say, waslimited. The term leprosy was also used in the reference tothe relatively less harmful diseases, such as psoriasis andfungal infections. The term leprosy was also applied inreference to the raiment (Lv. 13:47), which meant the fabricsbeing affected with some sort of mold and also to buildings(Lv. 14:33), which might be moldy.4 In the Biblical sense,leprosy was described as a swelling of the skin, with crustand whitish patch, which severity might have been evaluatedby the depth of the affected skin.8

Fig. 1 Christ healing a Leper. Rembrandt, circa 1650-55;Rijksmuseum, Amsterdam, Holland.

Leprosy in the Biblical aspect

The early Israelites believed that illness was the punishmentfor sin and the particular heinous set of syndromes referred totzaraat.2 Leprosy, then, was both a punishment for a sin (Lb.12,10; 2 Krn. 26,19-21) and divine curse because it was achronic and incurable disease until our times.4,8 In the Bibleone can find numerous examples of the punishments for sins.

Miriamwas made leprous “as white as snow” (Nb. 12:9-10)by order of the Lord, because she criticized Moses, her father.2

King Uzziah was stricken with tzaraat (2 Ch. 26:16-21) whendiscovered in the Temple by the chief priest attempting to burnincense on the altar.9 Gechazi, servant of prophet Eli’sha waspunished with leprosy for his greed (2 K. 5:26-27).2

Rarely, as it was in Job’s story, leprosy was cast by God,as a sort of trial of faith.10

Chapter 5 of II Kings tells the story of healing the leprosyfromNaaman, a non-Israelite, who came fromSyria to visit theprophet Eli’sha; at his order, he dipped himself in the JordanRiver and was cured (2 K. 5:14). The Synoptic Gospels ofMathew, Mark, and Luke (Mt. 8:1-4; Mk. 1:40-45; Lk.5:12-16) contain the story about healing of theGalilean leprosysufferer, who came to Jesus, who healed him (Mk. 1:41-44)(Figures 1 and 2). Saint Luke (Lk. 17:11-19) tells the storyabout the healing of ten leprosy sufferers by Jesus and theapproach of the grateful Samaritan (Mk. 1:40-45) (Figure 3).11

In the biblical Jewish culture, each of the skin diseaseswouldmake a person culturally impure.11,12 The “Law of Purity” ofancient Israel, which refers to the set of rules concerning dealingwith the sick, included regulations referring to leprosy. Theleprosy sufferer during the disease’s duration was impure andwould have been totally excluded from his community in ordernot to pass his impurity to healthy people. On what was to beconsidered as real leprosy was a decision for the priests. Whenthe priest confirmed a diagnosis, the person suspected of havinglepra was placed in a 7-day quarantine. If the clinicalmanifestations abated or disappeared after the ritual purificationand an offering, the person could return to society. When signsstill were observable, the priest claimed the person to be impure,and the sufferer had to abandon his family and his relatives. Inthese biblical times, the leprosy sufferers remained excludedfrom society, relegated to living outside of the villages incommunities of similar people.13

Modern interpretation of leprosy in the Bible

It is generally assumed that the diseases which existed inthe biblical times are similar to the diseases known today1;however, the difficulties connected with using the contem-porary countertype of biblical leprosy ignore the fact that

Fig. 2 Cleansing of the ten lepers. Unknown author, circa1035-1040; from: Codex Aureus Epternacensis (ie, an 11th-centuryilluminated Gospel Book created in the approximate period1030-1050); The Germanisches National Museum, Nuremberg,Germany.

5Leprosy in the bible

none of the contemporary disease or diseases meet thecriteria for the diagnosis of biblical tzaraat.1 In addition, theterm tzaraat referred to a group of skin diseases and not toone particular disease.1,8

Modern leprosy (ie, Mycobacterial leprosy or Hansen’sdisease) has long been thought to be the disease referred inthe Bible as to tzaraat,14 but tzaraat differs from our present

Fig. 3 Christ cleanses the Leper. Instalment in the series of 12th centurydi Monreale. Monreale, Sicily, Italy.

understanding of Hansen’s disease and is not similar to anywell-known dermatologic disease.4 There is a growingconsensus that the term leprosy used in the Bible for agroup of diverse cutaneous disorders bears no resemblance toHansen’s disease, as it is known today.3,4

Leprosy takes its name from the Latin word lepra, whichmeans "scaly," while the term “Hansen's disease” wascoined for the disease later,15,16 after identification of itspathogen, Mycobacterium leprae, in the year 1873, by theNorwegian physician Gerhard Henrik Armauer Hansen(1841-1912).17

There are several arguments against considering Hansen’sdisease as biblical leprosy. Leprosy is one of the leastcontagious human disease, children are more susceptiblethan adults, infection is transmitted probably by respiratorydroplets, it has slow progression (changes can be seen just after5 or even 20 years), and the symptoms of the disease do not everregress or show remission without the treatment.1,15,16,18,19

Tzaraat, on the other hand, was very contagious andmight haveundergone complete remission in 1 to 2 weeks.2 Skin lesions ofHansen’s disease16 do not have the biblical features of netek(presence of golden hair in an area of localized alopecia), andeven the skin patches of mycobacterial leprosy are poorlypigmented, they are neither pruritic nor painful (the affectedareas are anesthetic to heat and pain), and redness, inflamma-tion, or induration of the skin are associatedwith secondary skininfections.1,3

Potential countertypes of biblical leprosy include psori-asis, seborrheic dermatitis, favus, dermatophyte infections,nummular dermatitis, atopic dermatitis, pityriasis rosea,crusted scabies, syphilis, impetigo, sycosis barbae, scabies,neurodermatitis or scarlet fever (although in both cases thereare no hair color changes), lupus erythematosus, lichensclerosus et atrophicus, folliculitis decalvans, morphea,sarcoid and lichen planopilaris, and psoriasis.2,3,8,20-29 Itwas suggested that the leprosy of Israelites entirelydisappeared and depended on some fungus which attached

new roman mosaics of the Basilica Cattedrale di Santa Maria Nuova

Fig. 4 Cauterization of leprosy lesions. Charaf-ed-Din, 1466;Bibliotheque Nationale, Paris, France.

6 A. Grzybowski and M.ł Nita

itself to the hair of people and animals, produced a crustsimilar to favus, only of a white color, and was found notonly on men, but also on the skin of animals worn asgarments and on the walls of the houses.21

Confirmation of the thesis that the biblical tzaraatwas notleprosy in the contemporary meaning can also be made bylooking at the chronology of the historic events and thedouble mistake in the translation work of both the Old andNew Testament, done by the Greek translators.

The latest date of the final Leviticus redaction is during orjust after the Jewish exile in Babylon 587-538 BCE.1,2 Theancient roots of the leprosy derive from either Central Asia orEasternAfrica30–32; however, according to the classic concept,the cradle of the worldwide leprosy epidemics is India.32–34

Mycobacterial leprosy was described in India around600 BCE,35 but there is no historical, osteo-archaeological,literary, or artistic evidence of Hansen’s disease existence inPalestine or Syria before the return of Alexander the Great'sarmies from India in Society of 325-324 BCE,36 which meansthat the Old Testament was written before the introduction ofthe Mycobacterial leprosy (true leprosy) on the territoryinhabited by Hebrews, and the skin disorders described inLeviticus could not possibly be modern leprosy (Hansen’sdisease) as it is known now.1

Hansen’s disease became interchangeable with biblicalleprosy also as a result of two inaccurate translations, sinceHebrew tzaraat was first translated into Greek as leprosy,and then leprosy was translated into Arabic as lepra.1,2 Thestory of the mistranslation is quite a complex one.

In the first translation of original Hebrew Bible scripturesfrom 587-538 the word tsaarth was translated as lepra(a generic term for skin disease),1,8,37,38 because there wasnot equivalent for tsaarath in Greek. Mycobacterial leprosywas known in Greece at that time and called elephantiasisgraecorum, due to the thickening of the skin.2,8,39

The second mistranslation was made in ninth century,when the Arabic texts were translated into Latin, and

elephantiasis graecorum (Hansen’s disease) was called lepragraecorum.23,39 For some unknown reason, the termelephantiasis was discontinued and lepra was applied toboth tzaraat and mycobacterial leprosy8; moreover, inancient times, many scaling diseases were wrongly diag-nosed as leprosy (in Greek language lepo means to scale);the most spectacular is psoriasis, which was called lepra(lepra vulgaris, lepra alphoides, and lepra nigra) until the19th century.1

The term lepra was also used in the Vulgate40 as theequivalent of tzaraat, and transliterated into the first Englishversion of the Bible in 1382 CE as leprosie, so leprosybecame firmly the English equivalent for tzaraat.2

Conclusions

Leprosy has long been thought to be the disease referredin the Bible to tzaraat, which referred to a variety ofinflammatory granulomas with pigmentary disturbances oronly to a spiritual concept of moral and ritual cleanliness.Tzaraat (the disease or diseases) have no relationship toleprosy as it was known in the Middle Ages or today (ie, toMycobacterial leprosy or Hansen’s disease); however, a fewmay have been originally leprosy. Mistranslation of thebiblical term tzaraat as “leprosy,” without regard to themodern medical terminology, led to not only a lack of themedical knowledge and the therapeutic possibilities (Figure 4),but also to the multicentury discrimination of the leprosy-affected persons, in agreement to the concept of tzaraat,understood as the punishment for the sins.

According to the above, biblical leprosy was defined as “acomedy of errors,”2 and other authors suggest that a moreappropriate translation of tzaraat would be “sign ofimpurity” or “spiritual uncleanliness,”1 and they postulatethat in modern Bible translations, the term leprosy should bereplaced again by the term tzaraat, which should prove thatwe do not know what this term meant, or use the literary term"plaque," which indicates an infectious disorder of greatconcern for the person, for his or her clothes, and home.4

Acknowledgments

Tomasz M. Dąbek, a Biblicist, from Tyniec Abbey ofBenedictines, in Kraków, reviewed the manuscript to insurethe correctness of the biblical references and their substance.

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