Harry Goldin
Skokie, Illinois, United States

 

“‘Unclean! Unclean!’ … ” Underwood and Underwood Publishers, 1896. Crop of photo by Thomas Fisher Rare Book Library, UofT on Flickr. CC BY-NC 2.0.

The descriptions of “leprosy” in chapter 13 of the Book of Leviticus in the Hebrew Bible are complex and difficult to understand. This confusion has led to misleading modern English translations of biblical “leprosy” such as “malignant,”¹ “contagious,”² and “virulent”³ skin disease. The preferred term for the biblical “leprosy” is the transliteration of the original Hebrew, “tzara’at.”

There is no evidence of modern-day leprosy or Hansen’s disease in the Land of Israel during the biblical period. Tzara’at was not Hansen’s disease and was not considered to be a contagious disease.⁴ This raises the question: What exactly was tzara’at?

The dermatologic approach to evaluating a skin condition is to create a differential diagnosis based on the primary and secondary lesions. The text of Leviticus 13 presents three primary lesions for tzara’at: Se’it, sapakhat, and baheret. Unfortunately, the meanings of these terms have been lost over time.

One might expect the Septuagint, the earliest translation of the Hebrew Bible (into Greek) and written between 300–200 BC, to provide the most accurate definitions of these primary lesions. However, the Septuagint translates the first primary lesion, se’it, into the ancient Greek word oulie, which itself is not clearly understood. Oulie has been translated into English as a discoloration,⁵ barleycorns,⁶ and a scarred-over wound.⁷ Later rabbinic interpretations (first to sixth centuries AD) consider se’it to be a swelling, since the root of the word means to raise or lift.⁴ Thus, it is not clear whether se’it was a flat lesion (macule/patch) or a raised lesion (papule/plaque). Similar problems exist for the two other primary lesions, sapakhat and baheret.

Another major obstacle is understanding what is meant when the text repeatedly describes tzara’at as either appearing or not appearing “amok” or “shafal” in the skin. “Amok” is derived from the Hebrew root for valley and is often translated as “deeper” than the skin. Similarly, “shafal” is derived from the Hebrew root for low point and is frequently translated as “lower” than the skin. Kaplan translates both terms as “penetrated the skin.”⁸ In order to develop a differential diagnosis, it is critical to know whether a lesion is an atrophic, “valley-like” depression or if it is a dermal or subcutaneous infiltrative process.

Modern, non-dermatologist biblical scholars have associated tzara’at with skin conditions such as psoriasis, vitiligo, or alopecia areata. These attempts are futile because they require guessing whether the primary lesion is a macule or papule, and whether the lesion is atrophic or infiltrative. Problems with these associations also arise when one considers that tzara’at could also affect clothing and walls, and that some categories of the condition change over a one to two-week quarantine. While some skin diseases may correlate with certain features of specific categories of tzara’at described in the text, there is no single skin condition that fully matches all the descriptions provided.

Because it is not clear what tzara’at was, religious biblical commentators have looked beyond the actual descriptions in the text and often define tzara’at as a divine punishment. The Hebrew Bible describes many instances of people developing tzara’at after committing transgressions, and the word “nega,” meaning touch, is often used in the text to refer to God punishing sinful behavior. They also support this notion with wordplay, pointing out that the term for a person with tzara’at (“m’tzorah”) is like “motzi ra,” meaning to bring out bad or evil.⁴ However, the text of Leviticus 13 does not mention sin, and while these scholars may attribute sin as the cause of tzara’at, sin does not define or explain what it was medically.

Other biblical scholars hold the view that tzara’at refers to a “scaly condition.” This interpretation is reflected in certain Jewish translations of tzara’at that use the term “scaly affliction.”⁹ This is supported by the Septuagint translation of tzara’at as lepra, the Greek term for scaly conditions. Also, in the Bible, Moses (Exodus 4:6), his sister Miriam (Numbers 12:10), and the prophet Elisha’s servant Gehazil (2 Kings 5:27) are afflicted with “tzara’at like snow.” While traditional commentators associate the phrase “like snow” with the color of the skin lesion, Hulse proposes that it refers to flakes of snow produced when the affected skin was rubbed, indicating a scaly condition.¹⁰

The position of chapters 13 and 14, which deal with tzara’at in the Book of Leviticus, also supports this notion of a scaly condition. These chapters are sandwiched between sections concerning bodily discharges. Leviticus 12 deals with childbirth and Leviticus 15 concerns genital discharges such as menstruation and male ejaculation. The placement in Leviticus suggests that the scales of tzara’at are a type of skin discharge. However, while scale is a possible secondary feature, it does not provide insight into the primary lesions described in Leviticus 13 and does not explain what exactly tzara’at was.

The concept of tzara’at is strongly associated with death, and there are numerous references to death in relation to the condition. For example, Aaron prayed for Miriam not to become like a corpse after she developed tzara’at (Numbers 12:12). Fragments of the Dead Sea Scrolls refer to tzara’at as “the addition of the living part [of the body] to the dead part,” and the force of healing is referred to as the “spirit of life.” Leviticus prescribes similar purification rites for a person with tzara’at and one contaminated by contact with a corpse. In the Talmud, a person with tzara’at is like a dead person.⁴ Finally, the Hebrew phrase “basar khai” or “live flesh” is used in association with tzara’at, implying a contrast with “dead flesh.”

In ancient Israel, the dead were placed in crypts, and families would visit, bringing food, lamps, and personal effects. These visits would continue until the soft tissue of the corpse decomposed, leaving only bones, which were then placed into ossuaries.¹¹

As the body decomposed, ancient Israelites would observe various colors on the surface of the corpse and changes and loss of hair.¹² These observations are consistent with the descriptions of tzara’at in Leviticus 13, such as “streaked with red,” “all white,” “weak, golden hairs,” and bald areas.

When ancient Israelites observed changes in the skin and hair, clothing, or walls, it would remind them of the findings they witnessed as their loved ones decomposed. To these Israelites, tzara’at represented death developing on a live person, clothing, or wall.¹³ Since death was the ultimate form of impurity, those individuals or objects with tzara’at needed to be removed from the community to preserve the overall purity of the society.

In summary, the definitions of the primary lesions of “tzara’at” are unclear. As a result, it is impossible to develop a reasonable differential diagnosis for tzara’at. Since no single condition matches all the descriptions provided in Leviticus 13, the most comprehensive explanation is that tzara’at represents death appearing on a living body, object, or wall, rendering the affected person or object impure and unclean.

 

References

1. The New English Bible. The Old Testament. Oxford University Press, Cambridge University Press; 1970. p. 144.
2. The New Jerusalem Bible, Reader’s Edition. Doubleday; 1990. p. 103.
3. The Revised English Bible with the Apocrypha. Oxford University Press, Cambridge University Press; 1989. p. 92.
4. Milgrom J. Scale Disease. In: Leviticus 1-16: A New Translation with Introduction and Commentary. The Anchor Bible. New York: Doubleday; 1991. p. 768-824.
5. BibleHub. Interlinear Bible: Leviticus 13. Available from: https://biblehub.com/interlinear/apostolic/leviticus/13.htm. Accessed April 25, 2023.
6. Biblissima. Eulexis-Web. Available from: https://outils.biblissima.fr/fr/eulexis-web/?lemma=%CE%BF%CF%85%CE%BB&dict=LSJ. Accessed April 25, 2023.
7. Biblissima. Eulexis-Web. Available from: https://outils.biblissima.fr/fr/eulexis-web/?lemma=%CE%BF%CF%85%CE%BB%CE%AE&dict=LSJ. Accessed April 25, 2023.
8. Kaplan A. The Living Torah: The Five Books of Moses. Brooklyn, NY: Maznaim Publishing Corporation; 1981. p. 559.
9. Plaut WG, editor. The Torah: A Modern Commentary. Union of American Hebrew Congregations; 1981. p. 831-834.
10. Hulse EV. The nature of biblical “leprosy” and the use of alternative medical terms in modern translations of the Bible. Palest Explor Q. 1975; 107:87‐105. doi:10.1179/peq.1975.107.2.87.
11. Kraemer D. Jewish Death Customs Before the Rabbis. In: The Meaning of Death in Rabbinic Judaism. New York: Routledge; 2000. p. 22.
12. Pinheiro J. Decay Process of a Cadaver. In: Schmitt A, Cunha E, Pinheiro J, editors. Forensic Anthropology and Medicine: Complementary Sciences from Recovery to Cause of Death. Totowa, NJ: Humana Press; 2006. p. 91.
13. Kraemer D. Leprosy and the Affliction of Flesh. Forward. April 7, 2000;21.

 

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HARRY M. GOLDIN, MD, graduated from the University of Kentucky Medical School and completed residencies in internal medicine at Michael Reese Hospital and in dermatology at Cook County Hospital, both in Chicago. Dr. Goldin is board certified in internal medicine and dermatology and practices dermatology in a private practice setting. 

 

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