Popular Science Monthly/Volume 24/April 1884/Biblical and Modern Leprosy
|BIBLICAL AND MODERN LEPROSY.|
CLINICAL PROFESSOR OF DISEASES OF THE SKIN, COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK.
THE diseases which prevailed among the children of Israel were doubtless as numerous and as varied as those which now exist, and to a great extent they were probably identical with those affecting humanity at the present time. The most notable one spoken of in the Old Testament is called leprosy. As there exists at the present day a disease called by the same name, a consideration and comparison of the two may prove of interest.
The leprosy of the present day is found not only in distant parts of the world, but also in our own country. In Egypt, where it doubtless originated, and has prevailed for several thousand years, it still occurs. In Syria, India, China, and Japan, it is quite common. In Europe it is endemic chiefly along the shores of the Mediterranean and in Norway, although occasional cases are met with from time to time in many of the larger cities. In the West Indies and portions of South America it is also common, and in the Sandwich Islands it has increased rapidly in recent years, and now afflicts a large proportion of the native population. Coming nearer home, we find the disease existing among the Chinese in California, among the Norwegians in Minnesota, among the French and negroes in Louisiana, and among certain French Canadians in New Brunswick and Nova Scotia. During the past ten or fifteen years there have constantly been from one to a half-dozen or more cases in the hospitals of New York city, while other cases have been reported from Boston, Philadelphia, Baltimore, and other cities. Most of these cases have occurred among sailors or others, who have spent considerable time in the tropics or in regions where leprosy is common, and there contracted the disease. In New York there has occurred but one case in a person who had not been outside of the State, and in this case the origin of the disease could not be explained. It is an extremely difficult matter to determine beyond all doubt whether leprosy spreads only through hereditary transmission, or only through direct contagion, or in both ways. The disease is considered, by many who have had the best opportunities for studying it, to be hereditary in some cases, and at the same time capable of being propagated through inoculation. When leprosy once becomes prevalent in a community where vice, ignorance, and filth abound, it usually tends to increase, but it is far from being a highly contagious disease, as is commonly imagined. Physicians and hospital nurses have no hesitancy in caring for leprous patients, and the fear of the disease spreading through an intelligent community is based mainly upon sensational reports which have appeared from time to time in the newspapers.
I will not enter upon a detailed description of this dread malady. It is one which profoundly affects the constitution of its victim, and usually terminates fatally in from five to fifteen years. It can not be said to be an absolutely incurable disease, although the most that medical skill has succeeded in accomplishing, save in a few exceptional instances, has been to cause a temporary disappearance of the symptoms at the outset, or to mitigate the suffering of the patient in the later stages. In some cases, the disease appears in the form of dull, brownish spots upon the skin, with loss of its natural sensibility. This is the macular form of leprosy. In other cases the disease is characterized by the formation of dark, reddish-brown lumps upon the face and other parts of the body, which give the leper a peculiarly unsightly expression. This constitutes the more severe or tubercular form of the disease. In all cases the nerve-trunks are more or less affected, and the sense of touch in the extremities is greatly impaired. The hands shrivel, the fingers become bent like claws, ulceration takes place in some cases, and the joints drop off one by one. The leper now becomes an utterly helpless and pitiable object.
Such is leprosy as met with at the present day, and at once the interesting question arises, "Is this the leprosy of olden time the tsaraath of the Old Testament?" Without doubt the disease of which I have been speaking existed among the Egyptians and the Israelites in Moses's day, and from Egypt gradually made its way along the coasts of the Mediterranean to Greece and later to Italy. There is doubt, however, as to whether Moses was perfectly familiar with the leprosy which we now recognize, and distinguished it from other affections of a severe and contagious character. Certainly there are no scriptural references to any disease which is unmistakably the leprosy of the present day. We read that when Moses put his hand into his bosom and took it out again at the command of the Lord, "Behold his hand was leprous as snow." When the anger of the Lord was kindled against the sister of Moses, "Behold, Miriam became leprous, white as snow." Again, Gehazi, the servant of Elisha, was told by the prophet: "The leprosy, therefore, of Naaman shall cleave unto thee and unto thy seed forever. And he went out from his presence a leper as white as snow." Now, there are certain affections of the skin, met with at the present day, to which the expression "white as snow" would be applicable, but leprosy is not one of them. Indeed, in this disease, the skin usually becomes dark rather than light in color, and in none of the few score of cases which I have had the opportunity of observing would the phrase "white as snow" be other than highly inappropriate.
The somewhat detailed description of leprosy which is found in the thirteenth chapter of Leviticus is almost unintelligible in the light of our present knowledge, and, after making due allowance for the necessarily imperfect translation of the Hebrew scriptures, we are forced to believe that Moses associated leprosy with other diseases, as many distinguished medical writers have done in later years. Indeed, it is only during the past few decades that the disease has been carefully studied in various parts of the world and its identity thoroughly established.
In studying the Mosaic laws respecting leprosy, we find statements made and directions given for its recognition by the priests who could not have referred to the disease which we now call leprosy. For instance, it is stated that if the leprosy cover the whole skin of him that hath the plague, the priest shall pronounce him clean. This would hardly apply to modern leprosy, which never involves the whole skin, as far as my observation goes. But there are other cutaneous affections which frequently do cover the afflicted subject "from his head even to his foot." Why the leper should have been pronounced unclean while the disease was spreading, and clean when it had reached that point where further spreading was impossible, I will leave for others to determine, merely remarking that a law which permitted only such lepers within the camp as were covered by the disease from head to foot could certainly not have had a sanitary origin. Furthermore, the rule that the leper should be shut up for seven days, and then examined by the priest, with a view to noting the change that had taken place in the mean time, would seem to indicate some other disease than modern leprosy, for the latter is extremely chronic in its course, and never presents any noticeable change in so short a time even under the most active treatment. What was meant by the reference to leprosy of clothing and of houses is now difficult to understand. There are infectious diseases at the present day, the germs of which may dwell for a time in clothing and the walls of houses, but there is nothing in connection with the modern leprosy which would justify us in believing that it ever infects an inanimate object.
On the other hand, if we assume that the leprosy of ancient times was identical with that of the present day, it seems strange that Moses failed to mention the loss of sensation, the deformity of the hands, and other features which are the most striking characteristics of the disease. That the leprosy which I have described has not changed its type in the course of centuries, as other diseases have done in a comparatively short time, is shown by the fact that some of the earliest medical descriptions are so correct that they might answer their purpose in a modern text-book, and we are therefore led to the conclusion that Moses, though possessing all the learning of the Egyptian priests, including the highest medical knowledge of his age, did not note the distinctive characteristics of leprosy, but classed it under one name with other prevalent diseases.
In this connection, it may be of interest to consider very briefly the character of the disease mentioned as leprosy in the New Testament. However uncertain we may be as to the precise nature of the Mosaic disease, it appears to me to be almost certain that the leprosy cured by our Saviour, after his sermon on the mount, was not the leprosy of the present day, but a far more common disease which is now known as psoriasis. The earliest Greek writers on medicine were unacquainted with Egyptian leprosy, except by hearsay. Hippocrates, writing over four hundred years before Christ, speaks of it as "the Phœnician disease," and even at the time of the Septuagint translation of the Pentateuch this leprosy was practically unknown to the Greeks. The Hebrew word tsaraath was translated by the Greek word lepra, which was the name of a disease characterized by white scaly patches upon the skin. This differed totally in its nature from the disease which is now called leprosy, and which prevailed at that time in Egypt and Palestine. This disease, being subsequently introduced into Greece, was designated by a different name, elephantiasis. At the time when the Gospels were written, the Greek medical writers recognized two distinct diseases under these names, lepra and elephantiasis. The former was the psoriasis, or white, scaly disease of the present day; the latter was the modern leprosy. The description of each of these diseases by Greek writers is explicit and readily recognizable, and the Gospels of Matthew and Mark agree in the statement that it was lepra and not elephantiasis which was cured by our Saviour. In other words, it was psoriasis, and not the modern leprosy.