Leprosy In Ancient Hebraic Times*
HAROLD M. SPINKA, M.D.
Department of Dermatology
The University of Illinois College of Medicine
Chicago, Illinois

From: JASA 11 (September 1959): 17-20.

Historical:

Pusey¹ states that the first fully described symptom of today's leprosy was made by Aretaeus (100 AD)² as

"thick dense condition like an elephant, with decreased sensitivity to impressions," as Barbadoe's legs.

At this time, elephantiasis in Greece, Juzam in Arabia,³ were true leprosy, while the Greek lepros (round scaly superficial lesions and crusting as described by Aegueta⁴) and baras in Arabia,⁵ leuce or melos of the Alexandrian Greeks⁶ was probably chronic psoriasis vulgaris of today. Some hold that the vitiligo of Celsis (25 B.C.) is true leprosy,⁷ others judge it was psoriasis⁸ or scabies with psoriasis.⁹

Johansen¹⁰ states that the conditions including leprosy are recorded in the Egyptian Ebers papyrus (1350,2020 BC) but Rosen¹¹ reports on studies on mummies of the 20th dynasty (1100 BC) revealing the presence of a vesicular and bullous eruption with the form and distribution of small pox.¹² Dharmendra,¹³ in reviewing the Ebers papyrus supposed that uchedu was leprosy found among the Negro slaves from the Sudan while Ebbel^l4 interpreted uchedu as a pyoderma. Johansen¹⁰ also reports that conditions including leprosy were recorded in the Indian Vedas (about 1500 BC). Dharmendra¹³ commenting on the Vedas, interprets their general word, Kushtha, as skin diseases in general, but in one of their subdivisions, Arun-Kushtha is described as today's anesthetic and lepromatous types of leprosy, and in the chapter on the nervous system, Vat-Rakta, or Vat shonita, the hyperesthetic type with its loss of sweat in the affected parts and curvature of the fingers. Therefore, the descriptions in the Vedas do describe today's leprosy.

Similarly, the Hebraic equivalent of the Indian Kushtha, Zara-ath, means any skin disease; it con notes something rough, scaly, and its primitive mean ing being to sting, to smite, and general cutaneous distress.²⁵ Others claim it means white, glistening or dull white²; and on the basis of the Septuagint and Vulgate translations, it is interpreted as today's chronic psoriasis vulgaris.²

*Paper presented at the 13th Annual Convention of the American Scientific Affiliation at Iowa State College, August. 1958.

**From. the Revised Standard Version of 1952.

that the priests were in charge of infectious diseases, as well as of the moral and religious welfare of the nation. The differential diagnosis between infectious and non-infectious cutaneous diseases is quite modern.

Since the first modern scientific classification of skin lesions was made by Plenck in 1776,15 one must translate into today's language, the descriptions found in the ancient writings.

1. . .. . . . . a swelling, eruption, or a spot . . . . . on the skin of the body" Lev. 13:2 and appearing spontaneously;

2 . .. . . . . if there is a white swelling in the skin, which has turned the hair white, and there is quick raw flesh in the swelling," Lev. 13:10.

3. " and when there is in the skin of one's body a boil that has healed, and in the place of the boil there comes a white swelling or a reddish-white spot . . . . Lev. 13:18-19.

4. "Or, when the body has a bum (hot burning in the King James version, 1611) on its skin, and the raw flesh of the burn becomes a spot, reddish-white or white . . . . . .. Lev. 13:24.

It is not leprosy if :

1. the rash fades under two weeks of observation in isolation, Lev. 13:6.
2. the rash does not spread, Lev. 13:6.
3. it is not deeper than the skin, Lev. 13:3.
4. if the hair merely falls out, Lev. 13:40.
5. if a boil or burn heals and does not spread, and leaves a scar: Lev. 13:23, and Lev. 13:28.
6. if there is a white skin disease all over the body from head to foot. Lev. 13:38.

In Table 1, biblical definitions are translated into modern scientific descriptions and terms.

The earliest skin lesion of today's leprosy is often a macule, flat, level with the skin, varying in number from one to many, of various sizes and shapes, varying in color from loss or depigmentation, to an excess or hyperpigmentation, often with a reddened sometimes are translated into terms

 
raised border and a paler center, and accompanied by a decrease in sensation due to local involvement of the
nerves in the lesion.¹⁶ Today, we also think of the or dinary brown pigmented nevus, a superficial cancer of
the skin that today is ruled out by a microscopic exam ination of the lesion, and circumscribed scleroderma,
or morphea, a collagen or connective tissue disease, which, during the Middle Ages, was considered as the
first sign of leprosy⁸. 

Early in the maculo-anesthetic type of today's lep rosy, we find macules, vesicles and bullae.¹⁷ Today, when we see these lesions, we clinically eliminate from our thinking, herpes zoster (shingles), herpes simplex (the common cold sore), chicken pox, the pemphigus group, dermatitis herpetiformis, and bullous erythema multiforme. The macular stage of leprosy later develops an infil tration that may raise the center or the edge, while others may be raised with fine papules within it.¹⁶

Today, we eliminate papular syphilis from our thinking in these cases. The bullae may rupture to give the raw flesh appearance, and rarely today, may be followed by gangrene producing the lazarine form of leprosy.¹⁷ When the body tissue has a strong bac terial defense, the macular stage proceeds to the be nign tuberculoid or nodular stage of leprosy. When there are several nodules on the face, the text-book picture of a lion-like appearance results.

Since sensory nerve changes are present in leprosy, some patients notice a sense of burning or itching.¹⁷ In association with external injury, i.e. trauma will re sult in the typical trophic ulcer of the foot, or thermal injury will produce the common severe self-induced burn on anesthetic areas of the skin. Itching dermaatoses such as scabies, lichen planus, prurigo, and parasitic infestations, are eliminated from our thinking in these cases. When inflamed sores or boils are present, we usually consider the pyodermas,¹⁴ the deep mycotic or fungus infections, i.e. actinomycosis, small pox, scabies,² anthrax,⁹ the venereal diseases including syphilis, and tuberculosis of the skin. When a fine scale appears on papules covering the entire body, we usually think of secondary syphilis; if a thick white mica-like scale results, it is usually chronic psoriasis vulgaris.

In Biblical leprosy, there are two distinct types of scalp lesions:

2. The hair is thin and yellow (Lev. 13:29). These cases were probably chronic psoriasis vulgaris, or the fungus diseases of the scalp, favus, and tinea capitis.¹⁹

This evaluation indicates that the earliest manifestations of clinical leprosy, the macule, the burning, or itching, the anesthetic areas with self-induced burns producing lesions, the appearance of nodules, vesicles, and bullae, with ulceration or decapitation of the bullae producing a quick raw flesh, are accurately described and considered in the differential diagnosis, to determine if the patient is clean (non-contagious) or unclean (contagious). Friendenwald¹⁹ concludes that most of the cases labelled leprosy were true leprosy as we know it today. It is my opinion, that leprosy as well as the diseases mentioned in the differential diagnosis, e.g., chronic psoriasis vulgaris, syphilis, pemphigus and dermatitis herpetiformis, small pox, fungus infections as well as the pyodermas were included under the general label of leprosy.

The period of 14 days of isolation by the priest allowed the disease to progress under observation, to permit a more accurate diagnosis. At the end of this period, the patient was labelled clean (not contagious) and allowed to rejoin his tribe, or classified unclean (contagious) and expelled from the confines of the tribal community.

It has been stated that leprosy of the Old Testament is not the same as today's leprosy, for the advanced stages of the nodular leonatious facies, the nerve paralyses, the claw hands, etc., are not recorded as being present.14 These were the patients already labelled contagious and were excluded from the activities of the tribe.

For the following reasons, I judge that some of the cases labelled leprosy were syphilis:

1. Syphilis is probably the oldest skin disease of man.²¹ Ducrost found in the excavation at Solutre, a female skeleton among a heap of bones f rom the Stone Age, and the tibiae showed characteristic syphilitic exostoses.

This opinion was concurred in by Broca, Parrot, and Virchow. Zambuco in 1900 exhibited photos of bones from Egyptian graves at Abydos dating before 1700 BC of skulls with exostoses, and long bones showing evidences of syphilis.

2. We find in Lev. 22:4: "None of the line of Aaron who is a leper, or suf fers a discharge . . . . ..

A discharge (running issue, in the King James Version), was probably gonorrhea. Today, gonorrhea and syphilis are often found in the same patient.

3. Leprosy was considered contagious by conversation and coitus with a leprous woman.8 Today, syphilis is almost always acquired by the latter method.

4. We read in Deut. 28:27: "The Lord will smite you with the boils of Egypt . . . . 

This was acquired from worship the temples of debauchery and syphilis.²¹

1. In some cases of early psoriasis before lesions appear on the body, one finds a moderate amount of scaling in the scalp.

2. Lepra vulgaris of ancient times is today's chronic psoriasis vulgaris.14

3. The case of Naaman's leprosy (2 Kings 5:1) was probably psoriasis.^{14, 22} It is possible that some cases of Biblical Leprosy were small-pox. Ruffer" in studies of mummies found a case of small pox (1200-1090 BC) indicating that perhaps there were others. This could have spread to the Jewish nation due to the highly contagious and epidemic nature of the disease. Ebbel1¹⁴ doubts this.

There is a marked divergence of opinion as to the leprosy of job (job 2:7-8). Lie thinks it was scabies crustosa,2 Gordon feels that it was pemphigus foliaceus.²³ Pruess judged that it was generalized eczema,⁴ Ebbel⁴ and Friendenwald ²⁰ thought it was hemorrhagic small pox, and Brim²⁴ thinks it was pellegra.

Careful scrutiny of the column of the degree of contagion of Table 2, reveals that the common belief that the isolation techniques applied to Biblical leprosy were too rigid, is incorrect. When a scientific paper is given concerning portions of the Holy Bible, the speaker usually concludes at this point. He is so intent in his minute study of the tree, that he misses the entire forest.

Today's dermatologist, using the latest medical therapeutic agents as tabulated in Table 2, cures or controls the diseases tabulated as possible Biblical leprosy in from 2 days to 12 months, but our Lord, Jesus Christ cured 10 lepers immediately (Luke 18:14). He performed a super-human act, a miracle, even by today's standards and therapeusis. But people don't want miracles to happen; they wish there were no miracles so that they could get around them. They only want to believe the miracle of the natural law, so that they can order the earth for his own well being, and object to any interference with this latter way.