Contagion

Perspectives from Pre-Modern Societies

Lawrence I. Conrad, Dominik Wujastyk

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351949248
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

Contagion - even today the word conjures up fear of disease and plague and has the power to terrify. The nine essays gathered here examine what pre-modern societies thought about the spread of disease and how it could be controlled: to what extent were concepts familiar to modern epidemiology present? What does the pre-modern terminology tell us about the conceptions of those times? How did medical thought relate to religious and social beliefs? The contributors reveal the complexity of ideas on these subjects, from antiquity through to the early modern world, from China to India, the Middle East, and Europe. Particular topics include attitudes to leprosy in the Old Testament and the medieval West, conceptions of smallpox etiology in China, witchcraft and sorcery as disease agents in ancient India, and the influence of classical Greek medical theory. An important conclusion is that non-medical perceptions are as crucial as medical ones in people's beliefs about disease and the ways in which it can be combatted. Today we may not believe in the power of demons, but the idea that illness is retribution for sin retains great power, as was shown by the popular reaction to the spread of AIDS/HIV, and this is a lesson from the past that the medical profession would do well to heed.

Part III
Middle East and Europe

6 OLD TESTAMENT "LEPROSY", CONTAGION AND SIN

Elinor Lieber

The term contagion is often applied to any form of transmission of a communicable disease but, strictly speaking, it indicates the spread of an illness by direct or indirect contact and here it will be considered in that sense. Other contributions to this volume show that many ancient peoples possessed some idea of these concepts. As regards ancient Judaism, the Old Testament frequently alludes to the sudden infliction of "pestilences" and epidemics by God; but it is not at all clear whether the victims were struck down individually, or if the outbreak spread from person to person. However, while presenting few helpful details on acute epidemics, the Hebrew Bible provides more information regarding certain chronic endemic diseases, although here too, any references to physical contagion are only rarely specific. One exception is the description in Leviticus 15:2-13 of a man with a genito-urinary discharge.¹ Again, it seems clear from Numbers 19:11-16 that the "uncleanness" arising from contact with a corpse is due to the fear of contagion. In general, however, the existence of such a concept can only be determined indirectly.

This is particularly the case with reference to the Biblical ṣāra'at, a term that, in various forms, appears 35 times throughout the Hebrew Old Testament.² It generally refers to certain skin conditions in man, although, according to Leviticus 13:47-59 and 14:33-55, it also concerns garments and houses. In fact, only the ṣāra'at of houses is unequivocally described as contagious (Leviticus 14:46—7). In modern Hebrew, ṣāra'at is not used as a medical term. Its meaning and derivation are uncertain,³ but it may be related to the Akkadian saḫaršsubbū, which refers to some disease that "covers" the skin with white "dust" and is now usually translated as "leprosy".⁴

In the Septuagint, dating from the third century BC, ṣāra'at is rendered as lepros, which later passed to the Vulgate as lepra, both denoting "scaly", "scabby", or "rough". Yet, from its Biblical contexts, the Hebrew term seems to indicate some dreaded disease. Hence in almost every subsequent translation of the Bible ṣāra'at has been interpreted as "leprosy" (or its equivalent in other languages). Until quite recent times this was generally considered to indicate true leprosy (Hansen's disease), even though this condition affects neither garments nor houses.

However, according to Rufus of Ephesus, around AD 100, a disease named elephantiasis had been described some five centuries earlier by Straton, an Alexandrian Greek. From the accounts of the condition provided by Rufus himself and by his contemporary, Aretaeus of Cappadocia, this seems very like modern lepromatous leprosy, the most severe form of the disease.⁵ The latter attributes the Greek appellation to the elephant-like changes produced by the disease, such as fissuring of the skin. The (ps.-) Galenic Introductio seu medicus (XIV, 757-8 Kühn) refers to the "elephantine" appearance of the legs, or "woody oedema", which is still considered as an early sign of leprosy.⁶

True leprosy is a chronic, progressive, bacterial infection.⁷ Contrary to much modern dogma, in its common "low resistance" or lepromatous form it is contagious, although not all those affected present macroscopic signs of the condition. The infectivity of untreated cases depends on the stage of the disease and on the degree of contact with others. Individual predisposition, due to genetic and other familial factors, also plays a role. Death usually occurs from some secondary infection, often many years after the sufferer first becomes aware of the disease.

The contagious skin lesions, which constitute one of the earliest manifestations of lepromatous leprosy, are not only apparent to the sufferer but may also be noticed by others. They include hypopigmented areas that often appear whitish or white,⁸ although any hair in the lesion is not affected in this way. The skin becomes thickened, fissured and wrinkled, and raised nodules, or lepromata, appear over the body, particularly on the face and the ears. Typically, the skin of the forehead is thickened and the eyebrows are lost. While the skin lesions may ulcerate, the main means of spread is probably airborne infection from early involvement of the interior of the nose. Later, the nose and upper jaw may be destroyed, thus producing the terrible disfigurement known as a leonine facies (leontiasis), which from very early times has been considered as typifying true leprosy. The nerves are affected, but the resultant cutaneous anaesthesia, a well-known symptom of leprosy, may only appear late in the disease, as is the case with the highly visible deformities of the limbs. Other common, serious sequelae are sterility and lagophthalmos, which is often followed by blindness.

Yet, since the condition is usually well-established before its distinguishing features appear, leprosy can easily be confused with other chronic endemic diseases. In the Near and Middle East it must be differentiated above all from bejel (endemic treponematosis), from diffuse cutaneous leishmaniasis and, in its early stages, even from the non-contagious skin lesions of vitiligo and chronic psoriasis. Bejel and leishmaniasis will be considered below. The last two conditions are common worldwide and probably always have been so.

In vitiligo (leucoderma),⁹ hypopigmented light or white patches appear on the skin, but unlike psoriasis, the lesions are not scaly. Moreover, unlike both psoriasis and leprosy, or any other common condition, the hair in the lesions may turn white. Unless it serves as an indicator of some underlying generalized disease, it is simply a "cosmetic" disorder. This is a perfectly innocuous condition, but the unsightly lesions can cause psychological distress, as in the much publicized case of the black entertainer, Michael Jackson.

Although in chronic psoriasis the commonest signs appear in the skin, it is a systemic condition and may give rise to arthritis and other severe manifestations. However, none of the lesions are contagious, except in the rare cases when secondary infection occurs. In its typical form the skin becomes roughened by scaly, raised, white plaques or "scabs" on a salmon-pink base, particularly on the limbs and the scalp. The scales are characteristically shiny and silvery-white. The disease usually persists throughout life, in the form of attacks that spontaneously remit after a variable period of time. The sufferer may then appear to be "cured", but eventually the skin lesions reoccur. They are more disfiguring than those of vitiligo and may cause even greater distress to the sufferer. In the popular mind psoriasis has always been held to be contagious, probably due to its unsightly skin lesions, which may periodically discharge into the air showers of whitish scales (or "dust", corresponding with the Akkadian expression noted above), which might be thought to contaminate" other persons and objects. Such assumptions only add to the expressions of disgust and rejection directed at the unfortunate sufferers. Nothing is known of the cause of the condition, but familial and hereditary elements play a part, and the attacks may be triggered by psychological factors.¹⁰

Psoriasis in its turn is often associated and confused with other relatively harmless "rough" and "scaly" skin conditions, such as various types of eczema and seborrheic dermatitis, even though in these cases the scales are neither silvery nor bright. Hence the latter may be included in ancient descriptions of skin lesions that seem otherwise consistent with psoriasis.

Clearly, the terms lepros and lepra do not specifically refer to true leprosy. The (ps.-) Galenic Introdtictio defines lepra only as a condition in which the skin is white and rough, and in general these terms would more accurately apply to certain types of eczema and particularly to chronic psoriasis.¹¹

It is now similarly maintained that the criteria of Leviticus 13 do not correspond with the manifestations of leprosy, at least as we know it today. This conclusion is largely based on the mistaken assumptions that its lesions are never white and that those of ṣāra'at are described as "white as snow" (see n. 29 below). However, it has also rightly been noted that leprosy does not turn the hair white; that cutaneous anaesthesia and other pathognomonic signs of leprosy are not mentioned in the Bible; and that, unlike ṣāra'at (see Leviticus 14:3), this condition could not be "cured" in the past.¹²

In addition, the idea still prevails that true leprosy was not present in the Middle East or Egypt before the fourth century BC, but was possibly brought there by Alexander the Great on returning from his Indian campaign. As discussed in some detail below, it has lately been suggested, however, that the disease was present in Mesopotamia and perhaps even in Egypt from very early times,¹³ This has strengthened the minority view, which has always existed, that the term ṣāra'at applies essentially to true leprosy (with or without other lesser diseases).¹⁴

Even so, on the accumulated evidence, including the lack of palaeo-pathological findings, it is now generally assumed that true leprosy is not indicated in the Biblical ṣāra'at, or at most plays a very minor role,¹⁵ Yet, surprisingly enough, it has hardly ever been suggested that the term might also, or even alternatively, cover some other major disease.¹⁶ In fact, the interpretation of the ṣāra'at of objects (Leviticus 13:47-59) as some kind of "contagious" fungal infestation is perhaps the only "medical" identification on which there is now a consensus.¹⁷

Hence, even those who accept that the signs of ṣāra'at serve to indicate actual diseases now tend to consider this concept as solely of "ritual" or "cultic" significance. The "ritual impurity" was based not on the infliction of leprosy or any other dreaded contagious disease, but on the presence of some relatively harmless non-contagious skin conditions, such as eczema, vitiligo, scabies or psychosomatic disorders and above all, of chronic psoriasis.¹⁸

It has been further suggested that such lesions, particularly those of psoriasis, were categorized as ṣāra'at since, although quite innocuous, they are "scaly" or "flaky" and therefore "repulsive", and thus were considered "un-clean".¹⁹ Such lesser conditions would hardly account for the stringent provisions of Leviticus 13-14, and some do not even match the Biblical criteria. Thus, it was already long ago claimed by a doyen of modern dermatology that the term ṣāra'at referred "not to a particular disease—certainly not leprosy— but rather to a special kind of uncleanness," a "taboo". The mark on the skin simply represented a recognizable "token of God's wrath", imposed "as punishment for some secret sin of the subject".²⁰

Recently this theory has been given a new twist. It has been suggested that since isolation for ṣāra'at was decreed only for "moral contagion", the signs given in Leviticus 13 were intentionally made to fit no known disease, in order to exclude those whose only sin was to be affected by "an obvious cutaneous disease".²¹ According to another variant theory, in Leviticus 13 the term ṣāra'at'.

is applied to various skin diseases... which sooner rather than later may break out into open sores. It is this running sore with the naked blood that makes these skin diseases ritually unclean. Whether they are medically contagious or not is not the poi...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface
• Introduction
• I CHINA
• II INDIA
• III MIDDLE EAST and EUROPE
• Contributors
• Index