Leprosy

I do not take upon me to decide, whether the leprosy among the Jews differed from the Elephantiasis of other nations; but I venture to believe that it had somewhat of peculiarity, from the account given of it in Scripture. It was, without doubt, among the Hebrews, not only a loathsome disease in itself, but was intended to denote in the strongest characters the nature of sin both original and actual. And this, I think, is plain, from this one striking circumstance; namely that it was deemed an impious presumption of theprerogative of God, to attempt by any human means to cure it. I refer the reader to the word of God for the account of it, (Lev. 13. and 14.) both for the nature of the disease, and the rites and sacrifices appointed for the cleansing; all which very fully prove the sad state of the leper, shut out of all civil and religious communion, to testify, perhaps, the odious nature of sin in the sight of God, and to set forth, by the shadowy representations of washing and sacrifice, that nothing but the blood of Christ and the regeneratingpower of the Holy Ghost can effect the cure of the leprosy of sin. What a beautiful and endearing view have the evangelists given of the tender mercy of the Lord Jesus, manifested to that poor leper which came to Christ at the foot of the mountain. (See Matt. 8. 2, 3. Mark i. 40. Luk 5:12.) The poor man could have had no conception, that Jesus in the cure would have done what was never done before, put his hand upon him: but, as it was sweetly said of Jesus, "himself took our infirmities, and bare oursicknesses;" so Christ, as if to shew the love of his heart and sympathy to our poor nature, not only healed the leper, but put forth his hand and touched him, (Matt. 8. 17. Isa. l3: 4.) There is somewhat in such views of Christ as tends to endear him in the highest possible degree of endearedness, and which ought never to be lost sight of in the mind of his people.

See DISEASES.

Leprosy is a name that was given by the Greek physicians to a scaly disease of the skin. During the dark ages it was indiscriminately applied to all chronic diseases of the skin, and more particularly to elephantiasis, to which latter, however, it does not bear the slightest resemblance. The disease, as it is known at the present day, commences by an eruption of small reddish spots slightly raised above the level of the skin, and grouped in a circle. These spots are soon covered by a very thin, semi-transparent scale or epidermis, of a whitish color, and very smooth, which in a little time falls off, and leaves the skin beneath red and uneven. As the circles increase in diameter the skin recovers its healthy appearance towards the center fresh scales are formed, which are now thicker, and superimposed one above the other, especially at the edges, so that the center of the scale appears to be depressed. The scales are of a grayish white color, and have something of a micaceous or pearly luster. The circles are generally of the size of a shilling or half-crown, but they have been known to attain half a foot in diameter. The disease generally affects the knees and elbows, but sometimes it extends over the whole body; in which case the circles become confluent. It does not at all affect the general health, and the only inconvenience it causes the patient is a slight itching when the skin is heated; or, in inveterate cases, when the skin about the joints is much thickened, it may in some degree impede the free motion of the limbs. It is common to both sexes, to almost all ages, and all ranks of society. It is not in the least infectious, but it is always difficult to be cured, and in old persons, when it is of long standing, may be pronounced incurable. It is commonly met with in this country and in all parts of Europe. On turning to the Mosaic account, we find three species mentioned, which were all included under the generic term of Bahéret, or ’bright spot.’ The first is called Bóhaq, which signifies ’brightness,’ but in a subordinate degree. This species did not render a person unclean. The second was called Bahéret lebanáh, or a bright white Bahéret. The third was Bahéret kéháh, or dusky Bahéret, spreading in the skin. These two last were also called ’a stroke,’ as if a chastisement, and rendered a person unclean. The characteristic marks of the Bahéret lebanáh mentioned by Moses, are a glossy white and spreading scale upon an elevated base, the elevation depressed in the middle, the hair on the patches participating in the whiteness, and the patches themselves perpetually increasing. There are some other slight affections mentioned by name in Leviticus, which the priest was required to distinguish from leprosy. If a person had any of the above diseases he was brought before the priest to be examined. If the priest found the distinctive signs of a contagious leprosy, the person was immediately declared unclean. If the priest had any doubt on the subject, the person was put under confinement for seven days, when he was examined a second time. If in the course of the preceding week the eruption had made no advance, he was shut up for another seven days; and if then the disease was still stationary, and had none of the distinctive signs above noticed, he was declared clean (Leviticus 13).

It may be useful here to subjoin a description of elephantiasis, or the leprosy of the Middle Ages, as this is the disease from which most of the prevalent notions concerning leprosy have been derived, and to which the notices of lepers contained in modern books of travels exclusively refer.

Elephantiasis first of all makes its appearance by spots of a reddish, yellowish, or livid hue, irregularly disseminated over the skin and slightly raised above its surface. These spots are glossy, and appear oily, or as if they were covered with varnish. After they have remained in this way for a longer or shorter time, they are succeeded by an eruption of tubercles. These are soft, roundish tumors, varying in size from that of a pea to that of an olive, and are of a reddish or livid color. They are principally developed on the face and ears, but in the course of years extend over the whole body. The face becomes frightfully deformed; the forehead is traversed by deep lines and covered with numerous tubercles; the eyebrows become bald, swelled, furrowed by oblique lines, and covered with nipple-like elevations; the eyelashes fall out, and the eyes assume a fixed and staring look; the lips are enormously thickened and shining; the beard falls out; the chin and ears are enlarged and beset with tubercles; the lobe and ala of the nose are frightfully enlarged and deformed; the nostrils irregularly dilated, internally constricted, and excoriated; the voice is hoarse and nasal, and the breath intolerably fetid. After some time, generally after some years, many of the tubercles ulcerate, and the matter which exudes from them dries to crusts of a brownish or blackish color; but this process seldom terminates in cicatrization. The extremities are affected in the same way as the face. The hollow of the foot is swelled out, so that the sole becomes flat; the sensibility of the skin is greatly impaired, and, in the hands and feet, often entirely lost; the joints of the toes ulcerate and fall off one after the other; insupportable fetor exhales from the whole body. The patient’s general health is not affected for a considerable time, and his sufferings are not always of the same intensity as his external deformity. Often, however, his nights are sleepless or disturbed by frightful dreams; he becomes morose and melancholy; he shuns the sight of the healthy, because he feels what an object of disgust he is to them, and life becomes a loathsome burden to him; or he falls into a state of apathy, and after many years of such an existence he sinks either from exhaustion, or from the supervention of internal disease. The Greeks gave the name of elephantiasis to this disease, because the skin of the person affected with it was thought to resemble that of an elephant, in dark color, ruggedness, and insensibility, or, as some have thought, because the foot, after the loss of the toes, when the hollow of the sole is filled up and the ankle enlarged, resembles the foot of an elephant. About the period of the Crusades elephantiasis spread itself like an epidemic over all Europe, even as far north as the Faroe Islands; and henceforth, owing to the above-named mistakes, everyone became familiar with leprosy under the form of the terrible disease that has just been described. Leper or lazar-houses abounded everywhere; as many as 2000 are said to have existed in France alone. The disease was considered to be contagious possibly only on account of the belief that was entertained respecting its identity with Jewish leprosy, and the strictest regulations were enacted for secluding the diseased from society. Towards the commencement of the seventeenth century the disease gradually disappeared from Europe, and is now confined to intertropical countries. It existed in Faroe as late as 1676, and in the Shetland Islands in 1736, long after it had ceased in the southern parts of Great Britain. The best authors of the present day who have had an opportunity of observing the disease do not consider it to be contagious. There seems, however, to be little doubt as to its being hereditary.

Leprosy. The predominant and characteristic form of leprosy in the Old Testament is a white variety, covering either the entire body or a large tract of its surface, which has obtained the name of Lepra mosaica. Such were the cases of Moses, Miriam, Naaman and Gehazi. Exo 4:6; Num 12:10; 2Ki 5:1; 2Ki 5:27. Compare Lev 13:13. But, remarkably enough, in the Mosaic ritual diagnosis of the disease, Lev 13:1; Lev 14:1, this kind, when overspreading the whole surface, appears to be regarded as "clean." Lev 13:12-13; Lev 13:16-17.

The Egyptian bondage, with its studied degradations and privations, and especially the work of the kiln under an Egyptian sun, must have had a frightful tendency to generate this class of disorders. The sudden and total change of food, air, dwelling and mode of life, caused by the Exodus, to this nation of newly-emancipated slaves, may possibly have had a further tendency to produce skin disorders, and severe repressive measures may have been required in the desert-moving camp to secure the public health or to allay the panic of infection.

Hence, it is possible that many, perhaps most, of this repertory of symptoms may have disappeared with the period of the Exodus, and the snow-white form, which had pre-existed, may alone have ordinarily continued in a later age.

The principal morbid features are a rising or swelling, a scab or baldness, and a bright or white spot. Lev 13:2. But especially a white swelling in the skin, with a change of the hair of the part from the natural black to white or yellow, Lev 13:3-4: Lev 13:10; Lev 13:20; Lev 13:25; Lev 13:30, or an appearance of a taint going "deeper than the skin," or, again, "raw flesh" appearing in the swelling, Lev 13:10; Lev 13:14-15, was a critical sign of pollution.

The tendency to spread seems especially to have been relied on. A spot most innocent in other respects, if it "spread much abroad," was unclean; whereas, as before remarked, the man so wholly overspread with the evil that it could find no further range was on the contrary "clean." Lev 13:12-13. These two opposite criteria seem to show tha, whilst the disease manifested activity, the Mosaic law imputed pollution to and imposed segregation on the suffered, but that the point at which it might be viewed as having run its course, was the signal for his readmission to communion.

It is clear that the leprosy of Leviticus 13-14 means any severe disease spreading on the surface of the body in the way described, and so shocking of aspect, or so generally suspected of infection, that public feeling called for separation.

It is now undoubted that the "leprosy" of modern Syria, and which has a wide range in Spain, Greece and Norway, is the Elephantiasis graecorum. It is said to have been brought home by the crusaders into the various countries of western and northern Europe. It certainly was not the distinctive white leprosy, nor do any of the described symptoms in Leviticus 13 point to Elephantiasis. "White as snow," 2Ki 5:27, would be inapplicable to Elephantiasis as to small-pox.

There remains a curious question as regards the leprosy of garments and houses. Some have thought that the garments worn by leprous patients was intended. This classing of garments and house-walls with the human epidermis, as leprous, has moved the mirth of some and the wonder of others. Yet modern science has established what goes far to vindicate the Mosaic classification as more philosophical than such cavils. It is now known that there are some skin diseases which originate in an acarus, and others which proceed from a fungus. In these, we may probably find the solution of the paradox.

The analogy between the insect which frets the human skin and that which frets the garment that covers it -- between the fungous growth that lines the crevices of the epidermis and that which creeps in the interstices of masonry -- is close enough for the purposes of a ceremonial law. It is manifest also that a disease in the human subject caused by an acarus or by a fungus would be certainly contagious, since the propagative cause could be transferred from person to person.

(Geikie in his "Life of Christ" says: "Leprosy signifies smiting, because it was supposed to be a direct visitation of Heaven. It began with little specks on the eyelids and on the palms of the hands, and gradually spread over different parts of the body, bleaching the hair white wherever it showed itself, crusting the affected parts with shining scales, and causing swellings and sores.

From the skin, it slowly ate its way through the tissues, to the bones and joints, and even to the marrow, rotting the whole body piecemeal. The lungs, the organs of speech and hearing, and the eyes, were attacked in turn, till at last, consumption or dropsy brought welcome death. The dread of infection kept men aloof from the sufferer; and the law proscribed him as above all men unclean. The disease was hereditary to the fourth generation.")

Leprosy in the United States. -- The Medical Record, February, 1881, states that, from the statistics collected by the Dermatological Society, it appears that there are between fifty and one hundred lepers in the United States at present.

Is modern leprosy contagious? -- Dr. H.S. Piffard of New York, in the Medical Record, February, 1881, decides that it is in a modified degree contagious. "A review of the evidence led to the conclusion that this disease was not contagious by ordinary contact; but it may be transmitted by the blood and secretions.

A recent writer, Dr. Bross, a Jesuit missionary attached to the lazaretto at Trinidad, takes the ground that the disease, in some way or other, is transmissible. It is a well-established fact that, when leprosy has once gained for itself a foothold in any locality, it is apt to remain there and spread. The case of the Sandwich Islands illustrates the danger. Forty years ago, the disease did not exits there; now one-tenth of the inhabitants are lepers."

This is further confirmed by the fact, stated by Dr. J. Hutchinson, F.R.S., that "We find that nearly everywhere the disease is most common on the seashore, and that, when it spreads inland, it generally occurs on the shores of lakes or along the course of large rivers."

Leprosy as a type of sin. -- "Being the worst form of disease, leprosy was fixed upon by God to be the especial type of sin, and the injunctions regarding it had reference to its typical character." It was

(1) hereditary;

(2) contagious;

(3) ever tending to increase;

(4) incurable except by the power of God;

(5) a shame and disgrace;

(6) rendering one alone in the world;

(7) deforming, unclean;

(8) "separating the soul from God, producing spiritual death; unfitting it forever for heaven and the company of they holy, and insuring its eternal banishment, as polluted and abominable."

(9) Another point is referred to by Thompson (in "The Land and the Book"): "Some, as they look on infancy, reject, with horror, the thought that sin exists within. But so might any one say, who looked upon the beautiful babe in the arms of a leprous mother. But time brings forth the fearful malady. New-born babes of leprous parents are often as pretty and as healthy in appearance as any; but by and by, its presence and workings become visible, in some of the signs described in the thirteenth chapter of Leviticus." -- Editor).

(See LEPER.)

This loathsome and, for millennia, incurable disease is often mentioned in scripture. Some persons were smitten with leprosy as a direct judgement from God, as were Miriam (though she in grace was subsequently cured), Gehazi, and Amaziah; in the case of Gehazi the disease was to descend also to his seed. God’s power alone could cure the leper, as seen in the case of Naaman the Syrian, and in the many lepers that the Lord cured when on earth. Amaziah dwelt in a separate house, and the lepers were enjoined to proclaim their own condition by calling out, "Unclean, Unclean." Lev 13:45.

Leprosy is a vivid type of sin, and its insidious working, producing an unclean condition. Lev 13 and Lev. 14 treat of the way it was to be discovered and dealt with by the priests as those having the mind of God. The instruction in Lev 13:12-13, though seemingly paradoxical, is significant: when the leprosy covered all the skin, the priest was to pronounce the man clean: "it is all turned white: he is clean." That is, the leprosy, instead of striking inwards, had worked itself out, typical of a man truly confessing his sin; then the effect only of the defilement remains.

Besides leprosy in the person, laws were also given as to leprosy in a garment, answering to the sin that may be in a person’s surroundings, which must be cleansed or destroyed. There is also leprosy in the house (when they were come into the land), answering to manifest sin in a christian assembly, which must be removed, or the assembly must be dissolved. Holiness becomes God’s house.

LEPROSY (λέπρα, Mar 1:42, Luk 5:12; and λεπρός, [leper] Mat 8:2; Mat 10:8; Mat 11:5; Mat 26:6, Mar 1:40; Mar 14:3, Luk 4:27; Luk 7:22; Luk 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’ (Lev 13:29-30); and the disease vitiligo in the symptom termed ‘freckled spot’ (בֹּהַק, Lev 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 (Mat 26:6, Mar 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 (Mat 11:5, Luk 7:22) and in His directions to His disciples (Mat 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 (Mat 8:2 || Mar 1:42 || Luk 5:12). (2) The story of the nine thankless lepers and the grateful tenth, who was a Samaritan (Luk 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.

():

By: Emil G. Hirsch, J. F. Schamberg, Joseph Jacobs, A. S. Waldstein, Maurice Fishberg

Chronic skin-disease characterized by ulcerous eruptions and successive desquainations of dead skin.

—Biblical Data:

According to the Levitical text, the characteristic features of leprosy were: (1) bright white spots or patches on the skin the hair on which also was white; (2) the depression of the patches below the level of the surrounding skin; (3) the existence of "quick raw flesh"; (4) the spreading of the scab or scall.

Comparison with Modern Leprosy.

There are two forms of modern leprosy—the tubercular, or nodular, and the anesthetic, or nervous; generally both forms are present. The nodular form begins, as a rule, as round or irregularly shaped spots, commonly of a mahogany or sepia color. These often disappear, and are followed by the appearance of nodules. In an advanced stage the face is covered with firm, livid, nodular elevations: the nose, lips, and ears are swollen beyond their natural size, the eyelashes and eyebrows are lost, and the eyes are staring; the whole producing a hideous disfigurement. As the disease progresses, insensibility of the skin and paralysis ensue, and the fingers and toes may rot away.

In the Biblical description, one is immediately impressed by the absence of all allusion to the hideous facial deformity, the loss of feeling, and the rotting of the members. If such conspicuous manifestations had existed they could not possibly have escaped observation. The Levitical code prescribed that the several examinations of the person suspected should be made at intervals of seven days, thus enabling the priest to note the progress of the disease. Leprosy is an exceedingly slow disease, particularly in the beginning, and a fortnight would show absolutely no change in the vast majority of cases. Moreover, the "lepra Hebræorum" was a curable disease. When the leper was cured the priest made an atonement before the Lord, and expiatory sacrifices in the form of a sin-offering and a trespass-offering were made also. Modern leprosy is, except in isolated instances, incurable.

Nature of "Ẓara'at."

The probabilities are that "ẓara'at" comprised a number of diseases of the skin, which, owing to the undeveloped state of medical science at that period, were not distinguished. The white spots, upon which so much diagnostic stress was laid, were in all likelihood those of vitiligo, a disease quite common in tropical countries, and characterized by bright white spots, the hairs on which also become white. Vitiligo begins as small patches, which slowly spread, often involving ultimately large areas of the body's surface. The disease is harmless, but most disfiguring in those of swarthy complexion.

In the Septuagint "ẓara'at" is translated by "lepra." It is reasonable to assume that the Hebrews attached the same meaning to "ẓara'at" that the Greeks did to "lepra," which is derived from "lepros" (= "rough" or "scaly"). According to the medical writings of Ægineta, Ætius, Actuarius, Oribasus, and others, lepra was uniformly regarded as a circular, superficial, scaly eruption of the skin; in other words, their lepra was the psoriasis of modern times. There is absolutely nothing in the Greek description of lepra that suggests even in a remote manner the modern leprosy. The Greeks, in speaking of true leprosy, did not use the term "lepra," but "elephantiasis." It is evident, therefore, that they meant by "lepra" an affection distinct and apart from the disease of leprosy as now known. The confusion and obscurity that have enveloped this subject for centuries have resulted from the use of different terms in successive ages to designate the same disease, and from the total change in the meaning and application of the word "lepra."

Segregation.

There is much reason to believe that the segregation of lepers was regarded, at any rate at certain periods, more in the light of a religious ceremonial than as a hygienic restriction. Ẓara'at was looked upon as a disease inflicted by God upon those who transgressed His laws, a divine visitation for evil thoughts and evil deeds. Every leper mentioned in the Old Testament was afflicted because of some transgression. "Miriam uttered disrespectful words against God's chosen servant Moses, and, therefore, was she smitten with leprosy. Joab, with his family and descendants, was cursed by David for having treacherously murdered his great rival Abner. Gehazi provoked the anger of Elisha by his mean covetousness, calculated to bring the name of Israel into disrepute among the heathen. King . . . Uzziah was smitten with incurable leprosy for his alleged usurpation of priestly privileges in burning incense on the golden altar of the Temple" (Kalisch). It would have been quite natural for the people by a posteriori reasoning to have regarded persons afflicted with ẓara'at as transgressors; they had violated the laws of God and their transgressions had been great, else they would not have been so afflicted.

Writers who hold the view that the exclusion of lepers had chiefly a religious significance conclude from these facts that lepers were obliged to remain outside the camp because they were regarded as likely to morally infect others. As long as the signs of the disease remained upon them they were obliged to live outside the camp. It is reasonable to believe that, although Biblical and modern leprosy are, in all probability, not the same disease, thepresent custom of segregating lepers had its origin and stimulus in the Biblical example of segregating those afflicted with ẓara'at. Had the Bible never been written it is probable that lepers would to-day be permitted to go in and out among their fellows unhindered, for leprosy is a much less actively communicable disease than several other well-known affections in the case of which segregation is not practicable.

The Biblical description of leprosy of garments and houses is strikingly analogous in its wording to that of leprosy of persons. The passages in Leviticus (xiii. 47-59) are at present inexplicable in the light of modern science. The probabilities are that the description refers to stains upon garments produced by pus and blood from boils and ulcers of various kinds. Thus alone could the greenish and reddish stains be accounted for. That the description in Lev. xiv. 33-48 could not have applied to a leprosy of walls of houses is beyond reasonable doubt: such conceptions may possibly be ascribed to Oriental fancy and love of metaphor. Chemical incrustations and mildew were doubtless in this manner endowed with the symptoms of a living and spreading disease.

—In the Talmud:

The subject of leprosy is treated chiefly in the treatise Nega'im. The Talmud maintains that Lev. xiii. 1 et seq. refers generally to any disease that produces sores and eruptions on the skin (Sifra 60a). The following epitomizes the Talmudic treatment of leprosy:

Not Contagious.

1. Leprosy was not considered contagious. While all peoples of antiquity, from earliest times up to some centuries after the Talmudic period, held (as at the present day; Katzenelenson, in "Ha-Yeḳeb," p. 75, St. Petersburg, 1894) that leprosy was contagious, the Talmudic writers treated it as not contagious. The following evidences this: (1) The Mishnah does not consider a leprous pagan or an unnaturalized proselyte ("ger toshab") ritually unclean (Neg. iii. 1, xi. 1). (2) If a bridegroom, on his weddingday, observes symptoms of leprosy on his skin, he is not required to submit himself for examination at once, but he may postpone it until the seven days of his nuptials are over. Similarly, one who is affected with it during the holy days may postpone examination until they are over (Neg. iii. 2). Under other circumstances, one afflicted with leprosy is forbidden intercourse with his wife (Ḥul. 141a). (3) The Mishnah says that doubtful cases (with two exceptions) are not to be considered unclean (Ḥul. 9b et seq.). (4) The Bible commands that if the priest finds white hair on the parts affected he shall declare the subject unclean, for the white hair is a certain symptom of leprosy. But the Mishnah says that if the hair is plucked out before the examination takes place the person is clean (Neg. viii. 4). It was not, then, fear of contagion that led to regarding the leper as unclean.

2. Talmudic tradition, basing its definitions on the etymology of the Biblical terms used, knows of four different degrees of white in cases of leprosy, but not of "neteḳ." (Lev. xiii. 30). "Baheret" is of the whiteness of snow; the second degree recognized is of the whiteness of lime; "se'et" is of the color of the white of an egg; and the next degree of whiteness is that of white wool. The Mishnah adds, also, some intermediate shades; but it calls "bahaḳ" all those beyond the four shades in question (Neg. i. 1-3).

Limited Leprosy.

3. While the Bible divides the disease into "white leprosy" and "ulcerous leprosy" ("miḥyah"), the Mishnah divides it into "limited" ("ḳeṭannah") and "extended" ("gedolah") leprosy (Neg. viii. 9). Accordingly it expounds Lev. xiii. 9-11 as referring to "limited" leprosy, and Lev. xiii. 12 et seq. as applying to "limited" leprosy which has extended, and as such has become clean.Leprosy if "extended" at the outset is to be treated as limited leprosy (Neg. viii. 7); extension does not render leprosy clean, unless following upon a disease which has shown sure symptoms of real leprosy (Neg. viii. 3). Leprosy should, moreover, be considered extended only when it invades the face (Neg. x. 9) and, if the individual is bald and beardless, the scalp and chin (Neg. vi. 8, viii. 5). If, after the scales of leprosy have spread over nearly the whole body, a bleeding and scaleless ulcer (miḥyah) is observed, the subject is unclean. Similarly, if the scales, having covered almost the whole body, fall off in one place and uncover an old bleeding ulcer, the subject is unclean (Neg. viii. 2).The bleeding ulcer must be of the size of a lentil in order to render one unclean, in cases both of "limited" and of "extended" leprosy. In case the ulcer develops on the extremities of the body, as on the fingers or toes, or on the ears, nose, breast, etc., the person is not considered unclean (Neg. vi. 7). But if this ulcer had once been covered with scales and had then become open again, the person is unclean, unless the remaining scales are smaller than a "gruel" ("geris"; Neg. viii. 1). Finally, the miḥyah does not make a person unclean if it invades a place previously affected by a "sheḥin" or a burn, or if it develops on the hairy parts of the body, or in the recesses and cavities (Neg. vi. 8). When it settles on parts from which the hair has fallen out, or on parts previously affected by sheḥin or a burn, but which have become entirely healed before the appearance of the leprosy, two cases are to be distinguished, according as the miḥyah has previously been covered with scales or not; in the latter case it does not render the subject unclean.

Consequent on Burns.

4. In regard to leprosy consequent upon sheḥin or a burn (Lev. xiii. 18-28), the Mishnah maintains: (1) If the sheḥin or the burn has not been healed before the appearance of the scales of leprosy, the person is clean (Neg. ix. 2). (2) Where these affections have become completely healed before the appearance of leprosy, only that is to be considered as leprosy which invades parts of the body never before diseased (ib.). (3) Finally, leprosy consequent upon sheḥin or a burn is not rendered unclean by the development of a miḥyah, and one so affected can be isolated for seven days once only, not twice, as in the case of an ordinary leper (Neg. iii. 4).

5. In regard to leprosy on the scalp and chin (Lev. xiii. 29 et seq.), the Mishnah contains the following:(1) The symptoms of leprosy here (i.e., leprous scales) may present any color; but in any other part of the body only one or more of the four degrees of white can be presented (Sifra 60a). (2) As the Mishnah distinguishes a "limited" and an "extended" leprosy, so it distinguishes a "limited" and an "extended" neteḳ (Neg. x. 9). (3) The neteḳ does not become unclean in consequence of the presence of a miḥyah, but through the presence of fine white or yellow hair, and through the extension of the disease ("pisyon"; Neg. x. 1). (4) Finally, if the hair of the head or of the chin has fallen out, those parts are to be treated like other parts of the body (Neg. x. 10).In the Talmud the classification or definition of leprosy and of its symptoms seems to be determined not by medical ideas, but by a literal and indiscriminating adherence to the letter of the Levitical law; Talmudic sages were satisfied merely with communicating the Biblical decisions. The Rabbis appear at times even to confuse true leprosy with eczema.

Bibliography:

Rabbinowicz, La Médecine du Thalmud, pp. 107 et seq., Paris, 1880.

—In Modern Times:

Leprosy among Jews is seldom mentioned in modern medical literature. Zombacco ("Bul. de la Société d'Anthropologie de Paris," Oct., 1891) states that the disease is very frequent among the Jews of Constantinople. Buschan, quoting this statement ("Globus," lxvii. 61), argues that the predisposition of the Jews to leprosy is a racial characteristic hereditarily transmitted from the ancient Hebrews to the modern Israelites. In support of this he mentions that the Karaites of Constantinople have not been observed by Zombacco, during his twenty years of medical practise among them, to suffer from leprosy. These Jews Buschan considers Jews only by religion, not by virtue of blood-relationship to the Semites. Ethnically he considers them as derived from the Chazars and other peoples of "Finnic" blood. On the other hand, the Rabbinic Jews of Constantinople, who are derived from "Syro-Arabic Semitic" race, have been often observed by Zombacco to suffer from the disease. He further states that the Mohammedans, Christians, Greeks, Armenians, and other non-Jews in Constantinople are free from it, notwithstanding the fact that they come in contact with the Jews. All this tends to show that the alleged predisposition of the Jews to leprosy is an ethnic trait.

This allegation, based as it is on very scanty evidence, is not confirmed by any other observer. In Russia, where in some provinces leprosy is endemic, the Jews are not observed to be frequently affected, while in some Oriental countries the evidence available tends to show that, on the contrary, the Jews are peculiarly free from leprosy. Thus, Nicholas Senn, speaking of leprosy in Jerusalem, says: "Most of the lepers are Arabs; and the Jews are singularly free from this disease. . . . Among the 47 inmates [of the Jesus Hilfe Hospital] there is only one Jew. Dr. Einsler, during his long and extensive practise in Jerusalem, has seen only five Jews affected with leprosy; and of these one came from Salonica and of the remainder two from Morocco. It seems that the Jerusalem Jews have in the course of time acquired an immunity from this disease, notwithstanding the increase of poverty and unsanitary surroundings" (N. Senn, "The Hospitals in Jerusalem," in "American Medicine," iv. 509-512).

LEPROSY.—This term, as used in Scripture, seems to include not only true leprosy (elephantiasis)—probably the disease of Job—but also such skin diseases as psoriasis, ring-worm, and vitiligo. For the priestly regulations as to the diagnosis of the disease and the treatment of lepers, see art. Clean and Unclean, § 5. The ‘leprosy’ in garments (Lev 13:47 ff.) seems to be an effect of fungus or mildew, while that in houses (Lev 14:34 ff.) is probably dry-rot.

(Greek: lepo, peel)

A chronic disease of an infectious nature, caused by the germ bacillus leprae, which produces bodily deformations and mutilations, including destruction of tissue, and bodily decomposition, motor paralysis, anaesthesia, etc. It is fatal in the majority of cases although various methods of treatment, including the application of chaulmoogra oil which has met with appreciable success, have reduced the mortality. Bad nutrition and insanitary conditions are favorable to its generation and propagation, and it is endemic in certain localities, as parts of Africa, Arabia, China, Japan, India, Italy, Spain, etc.; it is also found in the United States, particularly in Louisiana and California. It was carried to the Western world from Egypt where it was believed to be contagious and hereditary (2 Kings 29) and entailed exclusion from the community, the afflicted being shunned as "unclean." The New Testament contains references to the miraculous cure of lepers by Our Lord, notably the healing of ten at one time (Luke 17). In the early Christian era it was prevalent throughout Europe and strict regulations regarding lepers were adopted; they were prohibited from public meeting places and churches, although in some of the latter they were permitted to watch services celebrated on the main altar by means of a hagioscope, or small opening in the chancel wall of the church. They were obliged to carry wooden clappers to signal their approach, and were gradually segregated in leper houses or "Lazaries," under the administration of religious communities, each of which had its own churchyard, chapel, and ecclesiastics. The view that leprosy is due to the consumption of fish and that hence the Church is responsible for much of the disease is exploded by the fact that it is not as prevalent in Catholic as in other localities, and Catholics, though obliged to abstain from meat, are not obliged to eat fish. The Church which from very early times has promoted the spiritual and temporal welfare of the leper continues the work in various leper colonies, including Carville, Louisiana, where the Sisters of Charity of Saint Vincent de Paul minister to them, and Molokai, scene of the heroic labors of Father Damien and "Brother" Joseph Dutton.

Leprosy proper, or lepra tuberculosa, in contradistinction to other skin diseases commonly designated by the Greek word lepra (psoriasis, etc.), is a chronic infectious disease caused by the bacillus leprœ, characterized by the formation of growths in the skin, mucous membranes, peripheral nerves, bones, and internal viscera, producing various deformities and mutilations of the human body, and usually terminating in death.I. HISTORY OF THE DISEASELeprosy was not uncommon in India as far back as the fifteenth century B. C. (Ctesias, Pers., xli; Herodian, I, i, 38), and in Japan during the tenth century B. C. Of its origin in these regions little is known, but Egypt has always been regarded as the place whence the disease was carried into the Western world. That it was well known in that country is evidenced by documents of the sixteenth century B. C. (Ebers Papyrus); ancient writers attribute the infection to the waters of the Nile (Lucretius, "De Nat. rer.", VI, 1112) and the unsanitary diet of the people (Galen). Various causes helped to spread the disease beyond Egypt. Foremost among these causes Manetho places the Hebrews, for, according to him, they were a mass of leprosy of which the Egyptians rid their land (" Hist. Græc. Fragm.", ed. Didot, II, pp. 578-81). Though this is romance, there is no doubt but at the Exodus the contamination had affected the Hebrews. From Egypt Phœnician sailors also brought leprosy into Syria and the countries with which they had commercial relations, hence the name "Phœnician disease" given it by Hippocrates (Prorrhetics, II); this seems to be borne out by the fact that we find traces of it along the Ionian coasts about the eighth century B. C. (Hesiod, quoted by Eustathius in "Comment. on Odyss.", p. 1746), and in Persia towards the fifth century B. C. (Herodotus). The dispersion of the Jews after the Restoration (fifth century) and the campaigns of the Roman armies (Pliny, "Hist. Nat.", XXVI) are held responsible for the propagation of the disease in Western Europe: thus were the Roman colonies of Spain, Gaul, and Britain soon infected.In Christian times the canons of the early councils (Ancyra, 314), the regulations of the popes (e. g., the famous letter of Gregory II to St. Boniface), the laws enacted by the Lombard King Rothar (seventh century), by Pepin and Charlemagne (eighth century), the erection of leper-houses at Verdun, Metz, Maestricht (seventh century), St. Gall (eighth century), and Canterbury (1096) bear witness to the existence of the disease in Western Europe during the Middle Ages. The invasions of the Arabs and, later on, the Crusades greatly aggravated the scourge, which spared no station in life and attacked even royal families. Lepers were then subjected to most stringent regulations. They were excluded from the church by a funeral Mass and a symbolic burial (Martène, "De Rit. ant.," III, x). In every important community asylums, mostly dedicated to St. Lazarus and attended by religious, were erected for the unfortunate victims. Matthew Paris (1197-1259) roughly estimated the number of these leper-houses in Europe at 19,000, France alone having about 2000, and England over a hundred. Such lepers as were not confined within these asylums had to wear a special garb, and carry "a wooden clapper to give warning of their approach. They were forbidden to enter inns, churches, mills, or bakehouses, to touch healthy persons or eat with them, to wash in the streams, or to walk in narrow footpaths" (Creighton). (See below: IV. Leprosy in the Middle Ages.) Owing to strict legislation, leprosy gradually disappeared, so that at the close of the seventeenth century it had become rare except in some few localities. At the same time it began to spread in the colonies of America and the islands of Oceanica. "It is endemic in Northern and Eastern Africa, Madagascar, Arabia, Persia, India, China and Japan, Russia, Norway and Sweden, Italy, Greece, France, Spain, in the islands of the Indian and Pacific Oceans. It is prevalent in central and South America, Mexico, in the West Indies, the Hawaiian and Philippine islands, Australia and New Zealand. It is also found in New Brunswick, Canada. In the United States, the majority of cases occur in Louisiana and California, while from many other States cases are occasionally reported, notably from New York, Ohio Pennsylvania, Minnesota, Missouri, the Carolinas and Texas. In Louisiana leprosy has been gaining foothold since 1758, when it was introduced by the Acadians" (Dyer). According to the statistics furnished by delegates to the second international conference on leprosy (at Bergen, Norway, Sept., 1909), there are approximately 200,000 cases of the disease throughout the world: India, it is stated, coming first with 97,340 cases; the United States contributing 146 cases, and the Panama Canal Zone the minimum of 7 cases.II. PATHOLOGYHow leprosy originated is unknown: bad nutrition, bad hygiene, constitutional conditions (tuberculosis, alcoholism, probably heredity, etc.) seem to favour its production and propagation. The disease is immediately caused by the infection of the bacillus leprœ, a small rod bacillus from 003 mm. to .007 mm. in length and .0005 mm. in diameter, straight or slightly curved, with pointed, rounded, or club-shaped extremities, usually found in short chains or beads. This bacillus, discovered in 1868 by Hansen, has been described since 1880 by many specialists, particularly by Byron, who succeeded in cultivating it in agar-agar (Ceylon moss). It is present in all leprous tissues and the secretions (urine excepted; Köbner claims to have seen it in the blood), and has been repeatedly observed in the earth taken from the graves of lepers (Brit. Lepr. Commission of India). There is on record only one case — and this somewhat doubtful — of leprosy communicated by artificial inoculation. As to whether it is contagious from person to person, this was for years a much mooted question among specialists; although a scientific demonstration of contagiousness is so far impossible — the mode of contamination being as yet unascertained, as well as the period of incubation of the germ — still there are unimpeachable practical proofs of contagion, such as the effect of isolation on the spread of the disease, and cases of healthy persons contracting the disease when exposed (Fathers Damien and Boglioli, nurses, and attendants), even accidentally, as in the instance of a medical student who cut himself while making a post-mortem on a leper. In the international conference at Bergen, these evidences were deemed convincing enough to call for a declaration that the disease be considered contagious.The period of incubation is "estimated at from a few weeks to twenty and even forty years" (Dyer). Like most infections, leprosy has a preliminary stage, uncertain in its character: there are loss of appetite, dyspepsia, and nausea, neuralgia, rheumatic and articular pains, fever, intermittent or irregular, unaccountable lassitude and anxiety. These premonitory symptoms, which may last for months, are followed by periodical eruptions. Blotches, first reddish, then brown with a white border, appear and disappear in various parts of the body; sooner or later small tumours, filled with a yellowish substance fast turning to a darker hue, rise sometimes on the joints, but oftener on the articulations of the fingers and toes. These tumours, however, are not yet specifically leprous; at the end they may leave permanent spots, pale or brown, or nodules. Then the disease, manifested by the apparition of specifically leprous formations, diverges into different varieties, according as it affects the skin and mucous membranes (cutaneous leprosy), or the nerves (anæsthetic), or both (mixed, or complete); each of these varieties, however, merges frequently into the others, and it is sometimes difficult to draw the line between cases.Cutaneous leprosy is either macular or tubercular. The former variety is characterized by dark (L. maculosa nigra), or whitish (L. m. alba) spots, usually forming on the place of the old blotches; the eruption, at first only intermittent, turns finally into an obstinate ulcer with constant destruction of tissue; the ulceration usually begins at the joints of the fingers and toes, which drop off joint by joint, leaving a well-healed stump (L. mutilans); it is sometimes preceded by, and ordinarily attended with, anæsthesia, which, starting at the extremities, extends up the limbs, rendering them insensible to heat and cold, pain, and even touch. In the tubercular type, nodosities of leprous tissue, which may reach the size of a walnut, are formed out of the blotches. They may occur on any part of the body, but usually affect the face (forehead, eyelids, nose, lips, chin, cheeks, and ears), thickening all the features and giving them a leonine appearance (leontiasis, satyriasis). Tubercular leprosy develops rapidly, and, when attacking the extremities, its destructive process has the same effect of ulceration, mutilation, and deformity as has been mentioned above. Scarcely different from the preceding in the period of invasion is the course of anæsthetic leprosy, one of the characteristic symptoms of which is the anæsthesia of the little finger, which may occur even before any lesions appear. The ulcer, at first usually localized on one finger, attacks one by one the other fingers, then the other hand; in some cases the feet are affected at the same time, in others their ulceration follows that of the hands. Neuralgic pains accompany the invasion, and a thickening of certain nerves may be observed; motor-paralysis gradually invades the face, the hands, and the feet. Consequent upon this, the muscles of the face become contracted and distorted by atrophy; ectropion of the lower lids prevents the patient from shutting his eyes; the lips become flabby, and the lower one drops. The sense of touch and muscle-control being lost, the hands are unable to grasp, and the contraction affecting the muscles of the forearm produces the claw-hand. In the lower extremities analogous effects are produced, resulting first in a shuffling gait and finally in complete incapacity of motion. Then the skin shrinks, the hair, teeth, and nails fall, and the lopping-off process of necrosis may extend to the loss of the entire hand or foot. The mixed variety of leprosy is the combination and complete development of the two types just described. In all cases a peculiar offensive smell, recalling that of the dissecting-room mixed with the odour of goose feathers — the authors of the Middle Ages compared it to that of the male-goat — is emitted by the Leper, and renders him an object of repulsion to all who come near him. Add the torture of an unquenchable thirst in the last stages of the disease, and, as the patient usually preserves his mind unaffected to the end, the utter prostration resulting from his complete helplessness and the sight of the slow and unrelenting process of decomposition of his body, and it is easy to understand how truly, in the Book of Job (xviii, 13), leprosy is called "the firstborn of death".The average course of leprosy is about eight years, the mixed type being more rapidly concluded. "Death is the ordinary conclusion of every case, which may come (in 38 per cent of cases) from the exhaustive effects of the disease, from an almost necessary septicæmia, or from some intercurrent disease, as nephritis (in 22.5 per cent); from pulmonary diseases including phthisis (in 17 per cent), diarrhœa (in 10 per cent), anæmia (in 5 per cent), remittent fever (in 5 per cent), peritonitis (in 2.5 per cent)" (Dyer).So far leprosy has baffled all the efforts of medical science: almost every conceivable method of treatment has been attempted, yet with no appreciable success. Occasionally the treatment has been followed by such long periods of remission of the disease (fifteen or twenty years) as might lead one to believe the cure altogether complete; still, specialists continue to hold that in such instances the virulence of the bacillus is, through causes unknown, merely suspended, and may break forth again. It being admitted that the disease is both contagious and preventible, there seems to be no doubt that means of public protection should be provided. To answer this purpose, several countries (Norway and Sweden in particular) have by legislation ordered the isolation of lepers. In some other countries the Governments encourage, and, more or less generously, subsidize private establishments. Of all the states of the Union, Louisiana is the only one to have taken any definite steps: it partly supports the leper-home at Carville where some seventy patients are housed under the care of the Sisters of Charity of St. Vincent de Paul (Emmitsburg). Some, not unwisely, think that if the federal authorities do not deem it right to interfere, individual states, especially those which, like California are exposed to a constant danger of infection, should take means of preventing the spread of the disease.[Note: In fact leprosy has been easily and completely curable using multi-drug therapy (MDT) for many years now. Using MDT, the global prevalence of the disease has fallen by 90% since 1985 with over 12 million patients cured worldwide since that date. Moreover, the gross disabilities which were such a feature of the disease for millennia (and are featured so often in the Bible) are now becoming a thing of the past, with early detection and treatment. Leprosaria and the physical separation of patients from their families are completely unnecessary.]III. LEPROSY IN THE BIBLEThe foregoing sketch of the pathology of leprosy may serve to illustrate some of the many passages of the Bible where the disease is mentioned. From the epoch of the sojourn of the people of God in the desert down to the times of Christ, leprosy seems to have been prevalent in Palestine: not only was it in some particular cases (Numbers 12:10; 2 Kings 5:27; Isaiah 53:4) looked upon as a Divine punishment, but at all times the Hebrews believed it to be contagious and hereditary (2 Samuel 3:29); hence it was considered as a cause of defilement, and involved exclusion from the community. From this idea proceeded the minute regulations of Lev., xiii, xiv, concerning the diagnosis of the disease and the restoration to social and religious life of those who were cleansed. All decisions in this matter pertained to the priest, before whom should appear personally both those who were suspected of leprosy and those who claimed to be healed. If, at the first examination, the signs — coloured nodule, blister, shining spot (xiii, 2), discoloration of the hair (3) — were manifest, isolation was pronounced at once; but if some of the signs were wanting, a seven-days quarantine was ordered, at the term of which a new inspection had to take place; should then the symptoms remain doubtful, another week’s quarantine was imposed. The appearance of "the living flesh" in connexion with whitish blotches was deemed an evident sign of the infection (10). White formations covering the whole body are no sign of leprosy unless "live flesh" (ulceration) accompany them; in the latter case, the patient was isolated as suspect, and if the sores, which might be only temporary pustules, should heal up, he had to appear again before the priest, who would then declare him clean (12-17). A white or reddish nodule affecting the cicatrix of an ulcer or of a burn would be regarded a doubtful sign of leprosy, and condemned the patient to a seven-days quarantine, after which, according as clearer signs appeared or not, he would be declared clean or unclean (18-28). Another suspicious case, to be re-examined after a week’s seclusion, is that of the leprosy of the scalp, in which, not leprosy proper, but ringworm should most likely be recognized. In all cases of acknowledged leprous infection, the patient was to "have his clothes hanging loose, his head bare, his mouth covered with a cloth" and he was commanded to cry out that he was defiled and unclean. As long as the disease lasted, he had to "dwell alone without the camp" (or the city). Like the presence of leprosy, so the recovery was the object of a sentence of the priest, and the reinstatement in the community was solemnly made according to an elaborate ritual given in Lev., xiv.In connexion with leprosy proper, Leviticus speaks also of the "leprosy of the garments" (xiii, 47-59) and "leprosy of the house" (xiv, 34-53). These kinds of leprosy, probably due to fungous formations, have nothing to do with leprosy proper, which is a specifically human disease.IV. LEPROSY IN THE MIDDLE AGESAs a consequence of the dissemination of leprosy in Europe, legislation providing against the spread of the disease (which was considered to be contagious) and regulations concerning the marriage of leprous persons, as well as their segregation and detention in institutions — which were more charitable and philanthropic than medical, partaking of the character of asylums or almshouses — gradually came into operation. The historical researches of Virchow concerning leper-houses (leprosoria) have established the fact that such institutions existed in France as early as the seventh century at Verdun, Metz, Maestricht, etc., and that leprosy must even then have been widespread. In the eighth century St. Othmar in Germany and St. Nicholas of Corbis in France founded leper-houses, and many such existed in Italy. (See Virchow in "Archiv für pathologische Anatomie", XVIII-XX, Leipzig, 1860.) Legislative enactments against the marriage of lepers, and providing for their segregation, were made and enforced as early as the seventh century by Rothar, King of the Lombards, and by Pepin (757) and Charlemagne (789) for the Empire of the Franks. The earliest accounts of the founding of leper-houses in Germany is in the eighth and ninth century; in Ireland (Innisfallen), 869; England, 950; Spain, 1007 (Malaga) and 1008 (Valencia); Scotland, 1170 (Aldnestun); the Netherlands, 1147 (Ghent). The founding of these houses did not take place until the disease had spread considerably and had become a menace to the public health. It is said to have been most prevalent about the time of the Crusades, assuming epidemic proportions in some localities: in France alone, at the time of the death of Louis IX, it was computed that there were some two thousand such houses, and in all Christendom not less than nineteen thousand (Hirsch, "Handbook of Geographical and Historical Pathology", tr. Creighton, London, 1885, p. 7, note. Cf. Raymund) "Histoire de l’Eléphantiasis", Lausanne, 1767, p. 106). Mézeray (Hist. de France, II, 168) says: "Il y avait ni ville ni bourgade, que ne fust obligée de bâtir un hôpital pour les (lepreux) retirer". For Italy we have Muratori’s statement (Antiq. Ital. Med. Ævi, III, 53), "Vix ulla civitas quæ non aliquem locum leprosis destinatum haberet."There is, however, good reason to doubt the accuracy of the above figures (19,000) as estimated by our medieval informants. Besides, "it would be a mistake", writes Hirsch (op. cit., p. 7), "to infer from the multiplication of leper-houses, that there was a corresponding increase in the number of cases, or to take the number of the former as the measure of the extent to which leprosy was prevalent, or to conclude, as many have done, that the coincidence of the Crusades implies any intrinsic connexion between the two things; or that the rise in the number of cases was due to the importation of leprosy into Europe from the East. In judging of these matters we must not leave out of sight the fact that the notion of ’leprosy’ was a very comprehensive one in the middle age, not only among the laity but also among physicians; that syphilis was frequently included therein, as well as a variety of chronic skin diseases, and that the diagnosis with a view to segregating lepers was not made by the practitioners of medicine but mostly by the laity."Simpson, in his admirable essay on the leper-houses of Britain (Edin. Med. and Surg. Journal, 1841-42), writes: "I have already alluded to special Orders of Knighthood having been established at an early period for the care and superintendence of lepers. We know that the Knights of St. Lazarus separated from the general Order of the Knights Hospitallers about the end of the eleventh or beginning of the twelfth century (Index. Monast., p. 28). They were at first designated: Knights of St. Lazarus and St. Mary of Jerusalem. St. Louis brought twelve of the Knights of St. Lazarus to France and entrusted them with the superintendence of the ’Lazaries’ (or leper hospitals) of the Kingdom. The first notice of their having obtained a footing in Great Britain is in the reign of Stephen (1135-54) at Burton Lazars (Leicestershire). I find that the hospitals of Tilton, of the Holy Innocents at Lincoln, of St. Giles (London), Closely in Norfolk, and various others are annexed to Burton Lazars as ’cells’ containing ’fratres leprosos de Sancto Lazaro de Jerusalem’. Its [Burton’s] privileges and possessions were confirmed by Henry II, King John and Henry VI. It was at last dissolved by Henry VIII." (See LAZARUS, ST., ORDER OF.)As has already been stated, these institutions were intended principally as houses to seclude the infected, and not so much as hospices for the curative treatment of the disease, which was considered then, as now, an incurable disorder. They were founded and endowed as religious establishments, and as such they were generally placed under the control and management of some abbey or monastery by a papal Bull, which appointed every leper-house to be provided with its own churchyard, chapel, and ecclesiastics — "cum cimuterio ecclesiam construere et propriis gaudere presbyteris" (Semler, "Hist. Eccles. Select."). The English and Scotch houses were under the full control of a custos, dean, prior, and, in some cases — as in the hospital of St. Lawrence, Canterbury, which contained lepers of both sexes — a prioress. The ecclesiastical officers of the hospitals and the leper inmates were bound by the regulations laid down in the charters of the institution, which they had to observe strictly, especially as to offering up prayers for the repose of the souls of the founder and his family. The following extracts from the regulations of the leper-hospital at Illeford (Essex), in 1346, by Baldock, Bishop of London, illustrate this point: "We also command that the lepers omit not attendance at their church, to hear divine service unless prevented by previous bodily infirmity, and they are to preserve silence and hear matins and mass throughout if they are able; and whilst there to be intent on devotion and prayer as far as their infirmity permit them. We advise also and command that as it was ordained of old in the said hospital every leprous brother shall every day say for the morning duty, an Our Father and Hail Mary thirteen times and for the other hours of the day . . . respectively an Our Father and a Hail Mary seven times, etc. . . . If a leprous brother secretly [occulte] fails in the performance of these articles let him consult the priest of the said hospital in the tribunal of penance" (Dugdale, "Monasticon Anglicanum", II, 390). There was generally a chaplain under the prior and in some instances a free chapel was attached with resident canons. The hospital at St. Giles (Norwich), for instance, had a prior and eight canons (acting chaplains), two clerks, seven choristers, and two sisters (Monast., Index, 55).Matthew Paris has left us a copy of the vow taken by the brothers of the leper-hospitals of St. Julian and St. Alban before admission: "I, brother B., promise and, taking my bodily oath by touching the most sacred Gospel, affirm before God and all the Saints in this church which is constructed in honour of St. Julian (the Confessor), in the presence of Dominus R. the archdeacon, that all the days of my life I will be subservient and obedient to the commands of the Lord Abbot of St. Albans for the time being and to his archdeacon, resisting in nothing, unless such things should be commanded as could militate against the Divine pleasure: I will never commit theft, or bring a false accusation against any one of the brethren, nor infringe the vow of chastity nor fail in my duty by appropriating anything, or leaving anything by will to others, unless by a dispensation granted by the brothers. I will make it my study wholly to avoid all kinds of usury as a monstrous thing and hateful to God. I will not be aiding or abetting in word or thought, directly or indirectly in any plan by which any one shall be appointed Custos or Dean of the lepers of St. Julians, except the persons appointed by the Lord Abbot of St. Albans. I will be content, without strife or complaint, with the food and drink and other things given and allowed to me by the Master; according to the usage and custom of the house. I will not transgress the bounds prescribed to me, without the special license of my superiors, and with their consent and will; and if I prove an offender against any article named above, it is my wish that the Lord Abbot or his substitute may punish me according to the nature and amount of the offence, as shall seem best to him, and even to cast me forth an apostate from the congregation of the brethren without hope of remission, except through special grace of the Lord Abbot." It is interesting to compare with the passage on usury in this formula the statement of Mézeray (Hist. de France), that during the twelfth century two very cruel evils (deux maux très cruels) reigned in France, viz., leprosy and usury, one of which, he adds, infected the body while the other ruined families.The Church, therefore, from a remote period has taken a most active part in promoting the wellbeing and care of the leper, both spiritual and temporal. The Order of St. Lazarus was the outcome of her practical sympathy for the poor sufferers during the long centuries when the pestilence was endemic in Europe. Even in our own day we find the same Apostolic spirit alive. The saintly Father Damien, the martyr of Molokai, whose life-sacrifice for the betterment of the lepers of the Sandwich Islands is still fresh in public recollection, and his co-labourers and followers in that field of missionary work have strikingly manifested in recent times the same apostolic spirit which actuated the followers of St. Lazarus in the twelfth and two succeeding centuries.-----------------------------------BENNETT, Diseases of the Bible (London, 1887); DYER, Leprosy (New York, 1897); HANSEN AND LOOFT, Leprosy in its Clinical and Pathological Aspects (London, 1895); Report of the Leprosy Commission to India (London, 1893); THIN, Leprosy (London, 1891); BARTHOLINUS, De morbis biblicis (Copenhagen 1671); PRUNER, Die Krankheiten des Orients (Erlangen, 1847); TRUSEN, Die Sitten, Gebräuche und Krankheiten der alten Hebräer (Breslau, 1833); LELOIR, Traité pratique et théorique de la lèpre (Paris, 1886); SAUTON, La Léprose (Paris, 1901). See the works of MÉZERAY, MURATORI, VIRCHOW, and SEMLER, and the essay of SIMPSON in Edinb. Med. and Surg. Journal (1841-42), all quoted in the body of this article.CHARLES L. SOUVAYJ.F. DONOVANTranscribed by Douglas J. Potter Dedicated to the Sacred Heart of Jesus Christ The Catholic Encyclopedia, Volume IXCopyright © 1910 by Robert Appleton CompanyOnline Edition Copyright © 2003 by K. KnightNihil Obstat, October 1, 1910. Remy Lafort, CensorImprimatur. +John M. Farley, Archbishop of New York

(Matt 8)

- From the Greek "scaly". The word covers a variety of skin diseases, some infectious, of which leprosy was only one -

Among the health laws God gave to Israel through Moses were laws concerning leprosy. However, both biblical scholars and medical scientists have clearly shown that what the Old Testament calls leprosy is not always the disease that we today call leprosy. The word used of leprosy in the Old Testament had a broad meaning and denoted a number of infectious skin diseases, some of which could be cured. It applied even to germ-carrying fungus or mildew on clothes and buildings (Lev 13:1-17; Lev 13:47-59; Lev 14:33-53).

The laws given through Moses were concerned not with treating the disease, but with isolating infected people so that others in the community did not become infected. When people saw any abnormality in their skin, even if only a rash, boil or falling out of the hair, they had to report it to the priests. The priests then isolated the infected person till they could ascertain whether the skin condition was a dangerous disease. If it was not, the person carried out a cleansing ceremony and returned to normal life in the community. But if it was real leprosy the person was excluded from the community entirely (Lev 13:18-46).

This exclusion of lepers from normal society resulted in many of them becoming beggars (Lev 13:45-46; Num 5:2; 2Ki 7:3; 2Ki 7:8; Luk 4:27; Luk 17:12). Important people may not have become beggars, but they still had to be isolated from the community (2Ch 26:21).

If people had leprosy or any other infectious skin disease, they were ceremonially unclean and therefore unable to join in the normal religious life of the nation. If they were healed, they had to go to the priest and carry out a cleansing ceremony before they could join in religious activities again (Mat 8:1-4).

The cleansing ceremony lasted eight days. Those who were healed, previously ‘dead’ through their disease, symbolized their death by the ritual killing of a bird, symbolized their cleansing by draining the bird’s blood into a bowl of pure water, and symbolized their new life of freedom by releasing a second bird that had been stained with the blood of the first. They were then sprinkled by the priest with the blood of the bird seven times, after which they washed and shaved. They then returned to the community, but not yet to their own dwelling place (Lev 14:1-9). After waiting a further seven days, they offered sacrifices, then resumed normal religious, social and family life (Lev 14:10-32).

A very bad skin disease. The word

in the text has a broad sense, which

may include many different types of skin

disease.