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Hastings' Dictionary of the New Testament

Leprosy

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LEPROSY (λέπρα, Mark 1:42, Luke 5:12; and λεπρός, [leper] Matthew 8:2; Matthew 10:8; Matthew 11:5; Matthew 26:6, Mark 1:40; Mark 14:3, Luke 4:27; Luke 7:22; Luke 17:12).—The name of a disease common in Palestine in the time of Christ, for the cleansing of which many mighty works were performed. The great difficulty in knowing the exact nature of the disease from which the leper suffered lies in the fact that the word ‘leprosy’ is used as the English equivalent of three different foreign words—the Heb. צרַעַח (ẓãráath), the Gr. λέπρα, and the Gr. ἐλέφας and ἐλεφαντίασις. And the subject is further complicated by the fact that the term last mentioned, elephantiasis, is used to-day for a disease of quite another nature from that described under that name by the early Greek medical writers.

(1) צרַעַח (ẓâra‘ath) is the word translation in Authorized and Revised Versions ‘leprosy’; the root meaning is to smite. The symptoms of ẓâra‘ath are fully described in Leviticus 13, and we have other scattered references to the disease in the OT. To enter into a full examination of OT leprosy would be out of place here, but it may be said that neither true leprosy (in the modern sense) nor any other known disease answers to all the signs described. We must either suppose, as is conceivable but not highly probable, that the disease described in Leviticus 13 has disappeared or greatly changed its character from new environment, or that the term ẓâra‘ath included a great variety of skin diseases, some infectious in the modern sense, but all of them regarded in ancient times as rendering their victims ceremonially impure. Of these diseases, to take a few examples, we seem to be able to recognize psoriasis in the expression ‘a leper white as snow’; favus (a common disease among Eastern Jews to-day) and perhaps ‘ringworm’ in the description of the ‘plague of the head and the beard’ (Leviticus 13:29-30); and the disease vitiligo in the symptom termed ‘freckled spot’ (בֹּהַק, Leviticus 13:39), the exactly equivalent word بهق (bohak) being used for this condition in Palestine and Arabia to-day. On the other hand, there are in the references to ẓâra‘ath an extraordinary absence of the symptoms of true leprosy which will be mentioned lower down; the extremely slow process of this latter disease, and its practically hopeless outlook, ill tallies with either the frequent examinations—at intervals of seven days—or the elaborate directions, evidently meant for use, for restoration of a cured person to the community.

The history of medicine shows that in the undeveloped state of medical science many diseases which a later age learns to differentiate are classed as one disease; of no department has this been truer than of diseases affecting the skin. In the Middle Ages many persons affected with syphilis were put in the lazar hospitals of Northern Europe through the mistaken idea that they were lepers.

(2) λέπρα (meaning ‘rough’ or ‘scaly’) was the name given by the Greek physicians to a disease known to-day as psoriasis. It is a non-contagious, irritating, but by no means fatal disease, in which white scales form on various parts of, and occasionally all over, the body. In such cases the expression ‘a leper white as snow’ might be not inappropriate. The disease is not hereditary nor in any marked degree repulsive, unless, as is unusual, the face is attacked; in this respect it is the very opposite of true leprosy, with which, moreover, it cannot be confused.

In the LXX Septuagint λέπρα is used as the equivalent of ẓâra‘ath; and as the former was well known, the translators apparently regarded this disease as the nearest equivalent to that described in the OT. In the same way the Synoptists, and among them Luke, the ‘beloved physician,’ in using λέπρα and λεπρος, were using words which had a definite meaning to the outside world.

(3) True leprosy—the ἐλεφαντίασις of the Greeks—is certainly no new disease, and references to it are found in Egyptian inscriptions many centuries before the Israelites left Egypt. It is also said that it was known in India at an equally primitive period. Hippocrates appears to refer to it under the name of the ‘Phœnician disease,’ and Galen under the name ‘elephantiasis.’ It is stated by Pliny that it was brought to Europe from Syria by the army of Ptolemy (61 b.c.). From this time references to it are common, but always under the name elephantiasis.

It is evident, therefore, that at the time of the Gospels, λέπα—in the classical medical sense—was primarily the well-known skin disease psoriasis. At the same time it is highly probable that the disease elephantiasis—true leprosy—together with other skin affections, e.g. vitiligo, favus, etc., were, from the point of view of ceremonial uncleanness, included in the term lepra, the word having, as is usual with medical terms, a much wider signification among the lay public than among the medical authors. The fact that tradition has from the earliest period pointed to true leprosy as the disease of the Bible, certainly makes it probable that it at least was one of the diseases recognized by the Rabbis as ẓâra‘ath; and doubtless its specially horrible and fatal character has caused it to gradually displace all others in the popular mind.

It might be thought that Rabbinical commentaries or existing Jewish custom might help to throw a light on the subject, but neither of these is any real help. The Talmud teaches that ẓâra‘ath refers to any disease with cutaneous eruptions or sores, and indeed some references appear to demonstrate that the writers considered the disease non-contagious; as, for example, the rule that a bridegroom, suspecting himself affected, might wait till seven days after his marriage before reporting his condition. The Rabbinical comments, instead of correlating the Levitical description with known medical facts, are rather engaged in impressing the importance of a literal adherence to the text of the Mosaic law.

Modern custom among the Jews in the East does not seem to view true leprosy with the aversion of even Moslems and Christians. Of six cases of well-marked leprosy among the Jews of Jerusalem which the present writer can recall, only one of them, a stranger from India, was in any way isolated, and he only after he had been in the English Hospital for some days among all the other patients; when he could no longer be kept he was sent to the Leper Hospital, where he died. The other cases, a Russian Jewess, three Spanish Jewesses, and a Spanish Jewish boy, all lived at home and mixed freely with their friends; the boy, indeed, long after he had marked symptoms of anaesthetic leprosy, continued to attend a large Jewish boys’ school without any sign of opposition or trouble. The Eastern Jews, on the other hand, manifest at times great fear of the contagiousness of tuberculous, or as they would popularly be called, ‘scrofulous’ affections of the skin and of the lymphatic glands. These seem by tradition to be recognized as contagious.

When it is remembered that it is only in very recent years, in the life of the present generation of medical men, that the true nature both of leprosy (elephantiasis) and of ‘scrofula’ has been discovered, it is difficult to believe that the Jews of Palestine, even in NT times, recognized the sharply-defined varieties of disease we do to-day. It is therefore probable that, while the leprosy of the NT certainly included some developments of the disease we now know as psoriasis and allied affections with a scaly eruption, and almost certainly a proportion of cases of ‘true leprosy,’ it may also have included cases of ‘lupus,’ ‘scrofulous’ (i.e. tuberculous) glands, and varieties of parasitic skin affections, such as ‘ringworm’ and favus, both of which are very common among the Jews of the East to-day.

True leprosy (elephantiasis) has for so many centuries been identified with the disease now called by that name, and, indeed, is likely to be for so many generations, that some description of this disease, especially as it occurs to-day in the Holy Land, is here not out of place. It is a disease of world-wide distribution, though apparently dying out of most European lands, where, as in England and France, it was once rampant. India, China, South Africa, and the Sandwich Islands are to-day the great habitats of leprosy. Climate appears to have no real effect on it. It is not hereditary; the children of lepers, if removed to healthy surroundings at an early age, seldom take the disease, while advance of the disease usually produces sterility. There is no doubt that it is contagious, but only by close personal contact; attendants on lepers run very little risk if they are careful; and they cannot, as was once supposed, carry the contagion to others. Although the almost world-wide custom of isolating lepers is founded upon the doubtful tradition of this being the special and peculiar disease described in the Mosaic law, yet from every point of view this is desirable both for the poor victims themselves, who are always to some degree incapacitated and suffering, and for the sake of their healthy neighbours. Although a leper in the street is no danger to the passer-by, he must in his home be a danger to his family, and no other disease reduces a human being for so many years to such a hideous wreck.

With respect to the ultimate cause of leprosy, Hansen has demonstrated (1871) that it is due to a special micro-organism, the bacillus leprœ, similar in appearance, and to some extent in the action on the human tissues, to the tubercle bacillus. How the poison enters the body is not known. The disease occurs so sporadically that there must be some cause other than contagion; but what this may be has never been proved. The theory recently revived by Mr. Jonathan Hutchinson, F.R.C.S., that the disease is due to a diet of fish, is not borne out by the facts. In Palestine, in particular, the great majority of the lepers have never eaten fish at all, as they come from inland villages: fish is very seldom eaten by the Moslems in Palestine, and the only people who eat it—the Jews regularly, and the Christians at their fasts when living in the cities—suffer least from this disease.

Leprosy manifests itself in three forms: (1) the tubercular or nodular, (2) the anaesthetic, and (3) the mixed. Chronic cases, however they begin, tend to assume in the later stages the third or mixed type.

(1) In the tubereular form, after a prodromal period of indefinite duration during which there is a gradual loss of power and vivacity, obscure pains in the limbs and joints, feverish attacks and loss of appetite, the first definite signs to appear are symmetrical discoloured blotches, especially over the back. These blotches are at the first most marked during feverish attacks. Soon afterwards, definite tubercles, at first pink but later brownish, arise; the skin in these places is thickened and found to be infiltrated. The tubercles have a special tendency to form on the folds of the cheek, the nose, the lips, and the forehead. At this time some amount of ulceration about the soft palate often assists the diagnosis. The nodules enlarge and from time to time ulcerate and become encrusted with discharge. In cases where the face is particularly attacked the expression is entirely altered, and a most characteristic ‘lion-like’ or ‘satyr-like’ expression is developed. The leontiasis of Aretaeus and the satyrias (= satyriasis) of Aristotle (de Gen. [Note: Geneva NT 1557, Bible 1560.] Animal. iv. iii. 22) are both supposed on these grounds to have been true leprosy. As a rule the eyebrows fall out, and the eyes, in addition to suffering from keratitis, become staring in appearance through scarring about the eyelids. The voice is often hoarse, and the breathing loud and wheezing through ulceration of the vocal chords. The hands and feet, sometimes the first to suffer, always in time become ulcerated, though the most severe changes in them are probably secondary to nerve lesions. The disease from first to last has an average duration of nine years; if it runs its full course and is not terminated, as is usual, by the onset of tuberculosis, it leads to gradual mental decay, coma, and death.

(2) The anœsthetic variety, if not complicated, is not nearly so horrible nor so fatal. Here the incidence of the disease falls on the nerve trunks, which may quite early in the disease be felt thickened from inflammation due to bacterial infection. The prodromal symptoms are similar to those described, but the onset of the disease is often not remarked until the patient finds that certain parts of the body are without sensation. Thus it is narrated of Father Damien that, although he had vague symptoms which made him suspicious, he was not convinced that he was a leper until be found he had placed his feet in scalding water without feeling the heat. As the disease progresses, the nerve lesions cause various discoloured patches and blisters on the skin, wasting of muscles and contraction of the tendons, a peculiar claw-like appearance of the hands,—the result of partial paralysis,—disfigurement of the nails, deep chronic ulceration of the foot, and finally progressive loss of various fingers and toes, and even of the feet and occasionally of the hands. Many of these later changes also occur in the tubercular form as the nerves become affected. An anaesthetic case which keeps to this type may last 20, 30, or even more years, and some such cases become ‘cured,’ that is, the disease actually ceases to progress, though the results of its work can never be remedied.

(3) In Palestine, as has been already suggested, the great majority of cases are of the mixed form; cases of pure anaesthetic type are exceptional.

Leprosy in modern Palestine is not a common disease, but is prominently to the front from three causes: firstly, because of the interest excited in Christians of all Churches, and the special appeal made to their charitable feelings from the traditional view that these sufferers are the veritable lepers of the OT and NT; secondly, because its results are so manifest and repulsive, and its progress so slow, that a comparatively small number of cases are very much in evidence; and, lastly, because practically all the lepers in the land are segregated together by order of the Government in a few chief towns, all resorted to by travellers. There the lepers, being unable to work for a living, sit in groups in prominent places, and endeavour by an exhibition of the miseries of their condition to touch the sympathy of the passer-by. In Jerusalem, at any rate, they collect in this way large sums for their community. They live in huts provided by the Government at Silwân (near Jerusalem), Ramleh, and Nâblus. At Damascus also there is a community, some members of which are also drawn from Palestine, but the majority from Syria and around Damascus; the traditional ‘House of Naaman’ is their home. In addition to these, there is the voluntary community—now numbering nearly 60—at the excellent Moravian Hospital in Jerusalem; the patients there are not allowed to go begging, and are employed in various ways on the premises. Including these last, there must be between 100 and 120 lepers in Jerusalem, some 25 at Ramleh, about 40 at Nâblus; altogether, allowing for some Palestine lepers in the Damascus community, there are not more than 200 known victims of this disease in the country. It is quite possible that sometimes cases may be hidden away, as with the Jewish cases above mentioned, by their relatives; but this cannot often happen in the villages, as the village sheikhs are very prompt in detecting early signs of the disease, and a suspected case is soon expelled from the community. Sometimes the heads of the village make mistakes; cases of this sort have come to the medical officer of the Leper Hospital in Jerusalem, and their friends learning that they have been mistaken, they have been restored to their rights.

It has been mentioned that one of the striking things about leprosy is that it occurs so sporadically. It is not the rule in Palestine, at any rate, that whole villages or families become leprous, but a case arises here and there. To illustrate this, we give a list of villages from which came some 60 cases that were in the Moravian Hospital during 1903. They are as follows:—From Ramallah and ‘Ain Arîk, 3 cases each; from Zeta, Bait Ammar, Nahalîn, Saidna Ali, ed-Dîr, Deir Diwân, and Nazareth, 2 cases each; from Abu Dîs,’ Ain Kairem, Bîr Zait, Bait Ummar, Bait Jebrîn, Bettîr, Beita, Biddu, Bait Hanîna, Bait Jala, Bait Safafa, ‘Asîreh, Dûra, Jerusalem, Feddar, Yasîneh, ‘Allâr, Mesar‘a, Fara‘un, Marassa, Kefrenji, Kefr Akâb, Kefr Hâris, Shafât, es-Salt, and Jummain, 1 each. In addition there were 3 Bedawîn from scattered tribes, one gipsy, one case from Mosul, and two from Greece. Any one who will consult a map of modern Palestine will appreciate from how wide an area, both W. and E. of the Jordan, these cases come. Probably there is no district that does not furnish cases at some time.

The only kind of treatment that can alleviate the disease is a well-managed Leper Home. In the Jerusalem Leper Hospital (founded in 1867 and formally taken over by the Moravian Brethren in 1881) all that medical science and Christian kindness can accomplish is done.

Leprosy in the Gospels.—It has been often pointed out that, whereas the cure of disease in general is called ‘healing’, (ἰᾶσθαι), that of the lepers is called ‘cleansing’ (καθαρίζειν). This was, no doubt, appropriate on account of the very evident restoration of cleanness of skin, but primarily because the miracle enabled the leper to become ceremonially clean. Doubtless the lepers drifting about the land had intractable skin diseases, and as they were shut out from the temple, the synagogues, certainly in all the towns, and to a large extent from the social life of their fellow-beings, their lot was truly pitiable. Their ‘cleansing’ meant much more than getting rid of a disagreeable and often, doubtless, painful disease, repulsive to all their fellow-men; it meant restoration to the worship and service of God.

Of lepers mentioned in the NT we have but one named, Simon of Bethany (Matthew 26:6, Mark 14:3), probably a grateful recipient of the Saviour’s mercy. Tradition has made the Lazarus of the parable a leper, and the terms lazzaro for leper and lazar-house for leper hospital were a result of this. Also the order of the Knights of Lazarus, founded during the Crusades, made the care of lepers one of their special duties, and they had always a leper as their Grand Master. But though Lazarus was ‘full of sores,’ the very account in the parable that he lay in such intimate contact with passers-by would, apart from the express omission of the statement in the parable, make his being a leper highly improbable.

In spite of the great prominence given to the cleansing of lepers both in Jesus’ account of His own works (Matthew 11:5, Luke 7:22) and in His directions to His disciples (Matthew 10:8), we have only two actual incidents described. (1) The incident of the man whom Jesus touched, with the words, ‘I will, be thou clean,’ and whose grateful excess of zeal prevented Jesus from entering that ‘certain city,’ and drove Him to seek seclusion in the wilderness (Matthew 8:2 || Mark 1:42 || Luke 5:12). (2) The story of the nine thankless lepers and the grateful tenth, who was a Samaritan (Luke 17:11 ff.). It is noticeable that he turned back because he was healed (ἰᾶσθαι); but he was not yet finally cleansed (καθαρίζειν), because he had not yet been to the priest; unless, indeed, it is because he was a Samaritan that he is spoken of as healed rather than cleansed.

Literature.—This is enormous. Here only a selection of modern articles in English is given, which will furnish all necessary information and references for following up the subject:—P. S. Abraham, art. ‘Leprosy’ in Allbutt’s System of Medicine, ii. 41; J. R. Bennett, Diseases of the Bible, R.T.S. 1887; T. Chaplin, ‘Diseases of the Bible,’ Proceedings of Victoria Institute, vol. xxxiv.; C. V. Carter, Leprosy and Elephantiasis, 1874; Hansen and Looft, Leprosy in its Clinical and Pathological Aspects, 1895; A. Macalister, art. ‘Leprosy’ in Hasting's Dictionary of the Bible ; do. by C. Creighton in EBi [Note: Bi Encyclopaedia Biblica.] ; Report of the Leprosy Commission to India, 1893; A. S. Waldstein, art. ‘Leprosy’ in Jewish Encyclopedia. On the moral aspects of leprosy in NT, see Edersheim, Life and Times, i. 491 ff.; Expositor, iv. vi. [1892] 443 ff.

E. W. G. Masterman.


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Bibliography Information
Hastings, James. Entry for 'Leprosy'. Hastings' Dictionary of the New Testament. https://www.studylight.org/dictionaries/hdn/l/leprosy.html. 1906-1918.

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