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Sunday, April 21, 2019

צרעת = Leprosy?


Introduction

The nominal and verb forms of the root צרע occur 54 times in the Hebrew bible, and corresponding Greek terms occur an additional 14 times in the New Covenant books.  These terms are always translated as references to leprosy in modern European languages.  This automatically brings up the question as to whether these references actually are referring to clinical leprosy as it is known today.  According to rabbinic opinion, צרעת has nothing to do with the disease known today as leprosy, or Hansen’s disease.  According to this opinion, צרעת is a condition imposed by YHWH on individuals for certain types of covenantal unfaithfulness.  As such, it may be imposed for the remainder of the individual’s life, or it may be spontaneously cured by God.  Levitical priests were assigned the responsibility of examining suspected individuals, houses, and garments and assessing whether or not צרעת was present.  For the entire time that an individual is afflicted with צרעת, he (or she) remained expelled from the covenant community.  How accurately does this rabbinic opinion reflect the usage in the Hebrew bible, and is there any correspondence between צרעת and Hansen’s disease?

What is Clinical Leprosy?

Hansen’s disease is caused by a bacterium called Mycobacterium leprae.  This bacterium has two peculiarities: 1) It is incapable of growing outside of some animal or human host; 2) Once it has infected a host it grows very slowly, so a person may remain asymptomatic for months following initial infection.  As a result of these factors, the method of transmission is not always clear.  Leprosy is contagious, but not highly so, and medical professionals estimate that up to 95% of the world population is naturally immune to the disease. 

The disease may attack any part of the skin, mucus membranes at body openings, or the eyes.  The infection has three different manifestations.

1.      Paucibacillary (PB), or tuberculoid, Hansen’s disease is characterized by one or a few hypopigmented or hyperpigmented skin macules that exhibit loss of sensation (anesthesia) due to infection of the peripheral nerves supplying the region. The body’s immune response may also result in swelling of the peripheral nerves; these enlarged nerves may be palpated under the skin, and may or may not be tender to the touch.
2.     Multibacillary (MB), or lepromatous, Hansen’s disease is characterized by generalized or diffuse involvement of the skin, a thickening of the peripheral nerves under microscopic examination, and has the potential to involve other organs, the eyes, nose, testes, and bone. The nodular form of this condition is the most advanced form of the disease. Ulcerated nodules contain large numbers of M. leprae acid-fast bacilli packed in macrophages that appear as large foamy cells.
3.     Borderline, or dimorphous, Hansen’s disease is the most common form. When compared to tuberculoid or lepromatous forms, it is of intermediate severity. The skin lesions seem to be of the tuberculoid type, but are more numerous, and may be found anywhere on the body. Peripheral nerves are affected as well, with ensuing weakness and anesthesia.

Regardless of the particular manifestation, the disease can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). The bacteria attack the nerves, which can become swollen under the skin. This can cause the affected areas to lose the ability to sense touch and pain, which can lead to injuries, like cuts and burns. Usually, the affected skin changes color and either becomes:
·       lighter or darker, often dry or flaky, with loss of feeling, or
·       reddish due to inflammation of the skin.

If left untreated, the nerve damage can result in paralysis of hands and feet. In very advanced cases, the person may have multiple injuries due to lack of sensation, and eventually the body may readsorb the affected digits over time, resulting in the apparent loss of toes and fingers.  Corneal ulcers and blindness can also occur if facial nerves are affected. Other signs of advanced Hansen’s disease may include loss of eyebrows and saddle-nose deformity resulting from damage to the nasal septum.

The disease was widely known and feared in antiquity as a highly contagious and debilitating condition.  My father, who was a doctor for some 40 years, encountered exactly one case of leprosy during his entire career.  In his day, leprosy could be arrested but not cured.  Today leprosy is known to be only mildly contagious; it can be treated and the infection cured through the use of multiple combinations of antibiotics.  The cause of the disease can be eliminated from the patient, but the damage caused by the infection prior to treatment cannot be reversed.  Despite all this, the disease remains a significant health problem in some parts of the world.  According to figures from the World Health Organization, something less than 200,000 new cases of leprosy were reported world wide in 2015.  Locations most severely affected were Brazil, sub-Sahara Africa, India, and south-east Asia.

What is the Biblical Description of צרעת?

According to the Hebrew bible, the infection of צרעת may occur on a garment, on the plaster of a house, or on the skin of a person.  Because Mycobacterium leprae is not capable of multiplying outside of a living host, the manifestation of צרעת in a garment or the plaster of a house is clearly unrelated to leprosy as we know it today.  These may have been the result of dry rot, mold, fungus, or some other phenomenon.  Symptoms of צרעת in a human as described in the bible are as follows:

·      The skin of one afflicted with leprosy was described as white as snow (Ex 4:6, Num 12:10).
·      A swelling, scab or bright spot on a person’s body in which the hair has turned white and the infection has penetrated below the surface is designated as צרעת (Lev 13:2).
·      The skin exhibits white swelling, the hair has turned white, and there is raw flesh in the swelling (Lev 13:12).
·      The skin has a healed boil or sore with a white swelling or with a reddish-white bright spot that penetrates into the skin and the hair has turned white (Lev 13:19, 20).
·      The person had a burn, and the raw flesh develops a reddish-white or white spot that penetrates into the skin and the hair has turned white (Lev 13:24, 25).
·      A scaly infection on the head that is deeper than the skin surface and has thin yellowish hair (Lev 13:30).
·      A person becomes bald or partially bald with a reddish-white infection that penetrates the skin (Lev 13:43).

Apart from these diagnostic references to צרעת the Hebrew bible contains four passages in which YHWH or a prophet is directly involved in inflicting an individual with the infection of צרעת:

·      In Ex 4:6, 7 YHWH first infected Moses’ hand with צרעת instantaneously, and the just as suddenly restored it to health.  This was the second of three signs that God used to persuade Moses that he was the God of his fathers and that this God had absolute power over conditions on earth.
·      In Num 12 Aaron and Miriam confronted Moses, so YHWH called out the three of them and rebuked Aaron and Miriam.  When the presence of YHWH departed Miriam was afflicted with צרעת.  Moses then prayed for her, so YHWH promised to restore her to health after a week of exile from the camp.
·      In 2 Chron 26:16-21, Uziah became proud and usurped the role of the priests by offering incense before YHWH in the temple.  For this affront, Uziah was stricken with leprosy immediately, and he remained a leper for the rest of his life.
·      The narrative in 2 Kings 5 is different from the previous three.  In this passage, Naaman was a Syrian military commander who was infected with צרעת.  He went to Israel with a significant treasure because he had heard that a prophet there might be able to cure him.  He ultimately appeared before the home of Elisha, who sent word that he should bathe seven times in the Jordan River.  After he finally complied, he was cured as promised.  Immediately he returned and offered the entire treasure to Elisha, but Elisha refused to accept anything.  After Naaman departed to return home, Gehazi, Elisha’s servant, decided to gain some part of the reward.  He then ran after Naaman, and by means of a lie he gained a small part of the treasure.  After he returned to his master, he again lied about his activities.  Elisha was aware of the lie, so he pronounced judgment: The leprosy that had departed from Naaman would cleave to him and his descendants forever.

These four passages constitute the basis for the rabbinic interpretation concerning צרעת.  There are several other passages where individuals with צרעת are mentioned, but there is no description concerning the cause of infection, and there is no reference for the restoration of any of them to health.

Linguistic Evidence

The Hebrew bible contains a noun form – צרעת – and a denominative verb from the root צרע.  BDB lists just two cognate references for this root: an Arabic root meaning throw down, prostrate, and a Sabean root meaning humble oneself.  I have found no example of this root being attested in later Aramaic dialects, and I have found only one  reference to leprosy other than those in translations of the Hebrew bible.  The translations I have examined in detail are the Aramaic targums, the LXX, and the Syriac Peshitta.

·      Targums.  In every instance the targums use various forms of סגיר as the translation for both the nominal and verbal forms of צרע.  The Aramaic term is derived from the root סגר, meaning that the individual afflicted with this condition was shut up or confined.  That is, the term is a description of how a person with this condition was to be treated and not a translation of the Hebrew term itself.
·      LXX.  The Septuagint used various forms of the noun λεπρα as the translation for צרעת and forms of the verb λεπραω as the translation for the verbal root.  Latin uses the terms lepra and leprosus.  This usage provides an explanation for the terminology found in modern translations, but the Greek term was far broader than the modern concept of leprosy.
o   Λεπρα – a condition causing rough or scaly skin, which could be leprosy
o   Λεπρος – scaly
o   Λεπραω – have leprosy; become scaly, rough
o   Λεπριαω – develop a nail fungal condition
o   Λεπρομαι – become leprous
o   Λεπρυνομαι – be rough, scaly (of snakes)
·      Peshitta.  The Syriac translation of the Hebrew bible uses various forms of the root גרב for every occurrence of צרעת and צרע.  The nominal form of this root is attested three times in the Hebrew bible with the meaning of itch or scab.  The form girba is attested in Mandanaic with the meaning of leprosy.  The range of meanings for this root in the Syriac dialect are as follows:
o   G-rev – Verb form; become leprous
o   G-reb – Noun form; a leper
o   Garve – Noun; leprosy
o   Garbene – Noun; a leper
·      Modern Hebrew – Garav – eczema; Garevet – eczema (Med); tzar’at – leprosy

Conclusions

If the root etymology for צרע offered by BDB is accurate, then the base meaning of צרעת indicates that the individual so afflicted is bowed down, humbled, thrown down.  Such a meaning describes the inevitable result of the condition for any individual so afflicted in the ancient world.  According to symptoms listed in modern medical references, anybody afflicted with Hansen’s disease according to the modern medical definition would ultimately have been designated as one infected with צרעת on the basis of the Levitical standards.  However, there are a variety of other skin conditions – like psoriasis, shingles, and other inflammatory skin conditions – that might also have been so designated.  All such individuals would have been expelled from the community, and by living in close contact with one another true Hansen’s disease could have propagated among them.

Now, the assertion that צרעת is a covenant-based judgment for certain types of transgression cannot be dismissed.  YHWH’s claim in various parts of scripture is that he gives health and prosperity for covenant faithfulness, and he withholds these and even causes death and exile for faithlessness.  If the medical estimate that 95% of the world population is spontaneously immune to leprosy, then approximately 30 million out of 6 billion people are susceptible.  According to the records from 2015, less that 0.6% of those susceptible were recorded as new cases during that year.  Surely God is capable of changing that percentage up or down locally or worldwide.  No such form of judgment has been predicted by the ancient prophets, so I am inclined to doubt that such a form of judgment will occur.

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