Consultant Leprologist, Technical Medical
Adviser, American Leprosy Missions, Inc.;
formerly Principal of the Christian Medical College, Vellore, Madras,
The greater part of this booklet appeared as an article in the January 1961 issue of In the Service of Medicine, and the final section, 'The Justification for Modern Leprosy Missions', was published in the March 1961 issue of The Christian Graduate. An article on this subject originally appeared in The Life of Faith (January 19, 1956, Vol. LXXX, No. 3474, p. 41). This was written by request, and acknowledgement is given to the Editor of The Life of Faith for permission to use material which has already been published in that periodical.
A SUGGESTED INTERPRETATION
Although it is generally accepted that leprosy is a chronic disease, which is at some stages infective but of low pathogenicity, such is the fear of the disease that the very name is surrounded with prejudice. While diseases such as tuberculosis, rheumatoid arthritis, disseminated sclerosis, poliomyelitis are not outside the pale, so far as medicine is concerned, leprosy is - as is shown by the dearth of doctors willing to undertake full-time leprosy work either in the mission field or elsewhere. All this is a reflection of the fact that the general approach to leprosy is largely based on an appeal to the emotions. The appeal to the public of such societies as The Mission to Lepers, The British Leprosy Relief Association, The American Leprosy Missions, The Medical and Leper Crusade of the World Evangelization Crusade, was formerly, and is at times even today, based on equating modern-day leprosy with the disease, or diseases, described in biblical literature. Sermons are too often preached in which leprosy is taken as a type of sin and equated with the disease we know as leprosy today. Therefore, in view of the importance leprosy has at last achieved in the realm of medicine, it would be well to look into the whole question of leprosy, particularly in regard to its origins, and to endeavour to ascertain whether the word leprosy, as applied in Scripture, has anything to do with the disease we know as leprosy today.
THE ORIGINS OF LEPROSY
Whether and where leprosy existed in ancient times is difficult to determine. There is no direct evidence that the Children of Israel, when in the land of Goshen, suffered
from leprosy, but it is of interest to note an article by Yeoli (1955) which tells of the finding of a clay jar in a section of the Amenophis III temple. On this jar is depicted a face which is very similar to that of a sufferer from lepromatous leprosy, and, for comparison, alongside the photograph of the jar have been placed two pictures showing advanced nodular leprosy as seen today. The caption given to this illustration by Yeoli is '"Facies Leontina" of Leprosy'. The jar dates back to the period 1411-1314 bc, which brings it within the period of the Exodus, and if this is a genuine portrayal of leprosy it would support the contention that leprosy was introduced into the camp after the Israelites arrived in Canaan. Doubts, however, have been cast on the claim that this moulding really represents lepromatous leprosy, for, in the first place, it is known that in ancient times such grotesque figures were moulded on jars, and, further, because such words as leprosy and blindness were used as curses, it would hardly be likely that a drinking vessel, or one for storing grain, would be given such a representation. Again, some believe that this type of jar was comparable to the Toby jug, commonly seen in villages in this country, and that the likeness to lepromatous leprosy is just fortuitous. Nevertheless, whatever the explanation, the similarity between this clay moulding and lepromatous leprosy is very striking.
Before discussing the meaning and significance of biblical leprosy it might be well to look into the question concerning the period at which leprosy, that is the disease we know as leprosy today, was first authentically described.
It has been claimed that leprosy was in existence in Babylonian times; but Oppenheim (1956) in his work Interpretation of Dreams in the Ancient Near East quotes the word which has been translated leprosy as 'covered with dust' or 'scaly'. The Akkadian word 'epqu', which was
translated leprosy in the Chicago Assyrian Dictionary, also means scaly; as does the word Saharsubbu; and even the statement that leprosy was described in the Ebers Papyri (von Deines, 1958) is somewhat doubtful. I am told by Professor D. J. Wiseman that the word translated leprosy is only named, and not described, and that it was a complaint of an external character for which an ointment was prescribed. The date of the Ebers Papyri was in the Eighteenth Dynasty, or about 1300-1000 BC. Rogers (1924) states in the Croonian Lectures that 'Munro in articles in the Edinburgh Medical Journal, 1877-79, refers to an Egyptian record of 1350 bc of leprosy among negro slaves from the Sudan and Dafur', but if his source is the Ebers Papyri one can legitimately doubt the validity of this reference.
Hippocrates was born 467 bc, but, from a study of a translation of his works, it seems doubtful whether the father of modern Medicine really recognized leprosy. Lucretius, the great Greek philosopher (91-55 BC), in his De Natura Rerum makes reference to a possible source of the disease when he states:
'High up the Nile midst Egypt's central plain
Springs the dread leprosy and there alone.'
In this connection, Lowe (1942) states that: 'Unless more recent work has produced new evidence, it appears that we have no definite proof that leprosy was common or even known in ancient Egypt. We have to come to far later times for the first definite reference to leprosy in Egypt.'
It would, therefore, appear very difficult to substantiate the existence of leprosy in early times in the Near and Middle East.
The land between the Euphrates and Tigris is traditionally the cradle of the human race and archaeological discoveries during the last twenty years have indicated the tremendous
wealth of evidence of ancient civilization buried in the dust of millennia. Assyria, Media, Babylonia and Persia are the ancient homes of civilization and it is reasonable to assume that at the time of the Patriarchs caravan routes extended to India and China. Therefore, because of the influence of these ancient countries on the Promised Land, it would be of great interest to know whether there was any evidence of the existence of leprosy in India and in China from the time of Moses to the time of our Lord.
It is interesting to note that there does not seem to be any accurate account of leprosy before about 600 bc either in India or in China. Leprosy is mentioned in the Vedic writings of India. Rogers and Muir (1946) state that leprosy is mentioned as Kushtha in the Vedas of about 1400 bc. Both these writers and Lowe (1942) are not really certain that Kushtha meant leprosy. Dharmendra (1960) states that 'in Sushruta Samhita (600 BC) one finds a reasonably good account of the clinical features and treatment of the disease'. The same authority states that 'in this ancient book references to leprosy are made under Vat Rakta or Vat Shonita and Kushtha'. Lowe (1942) mentions that some writers maintain that 'the Laws of Manu contain definite instructions about the prophylaxis of leprosy'. The date of these Laws has been given as between 1300 BC and 500 BC. Lowe (1942) continues to say: 'Possible references to leprosy are made in four places. The Sanskrit word Shitri almost certainly meant leucoderma, and Kushtha meant skin diseases in general, prominent among which was possibly or probably leprosy.'
So far as China is concerned, authoritative references to leprosy appeared about 600 BC. It is claimed that a disciple of Confucius (circa 551-478 BC) had leprosy, but this would not date the disease as a particularly ancient one, because it is known that leprosy existed in China in 600 BC. The most
authentic account of leprosy is found in the book entitled Nei Ching by one Huang Ti. The date of these writings, however, is very problematic; some authorities place them as far back as 5,000 years ago, but nothing is really known as to the actual date of the writings. A very large margin of error exists, for the date given is between 230 and 2005 BC. Therefore all we can conclude is that leprosy is an ancient disease in China, and certainly existed before 600 BC, and possibly the history of this disease extends to 1000 BC or more. Up to the present there have been found no manuscripts which can definitely be dated before 600 BC or which have not been amended by the work of later redactors.
LEPROSY IN THE OLD TESTAMENT
While it is interesting to note that there is no authentic evidence of the existence of leprosy in any country further back than about 600 BC, yet the curse 'May you be stricken with leprosy and blindness' is of very ancient origin. It is upon references to leprosy and blindness as the worst types of punishment which could befall mankind that Skinsnes (personal communication) bases his opinion that biblical leprosy was actually the leprosy we know today, for he suggests that in ancient times diseases were not particularly well differentiated, and if he were to choose a disease which bore out the significance of such a curse he could think of no worse disease than leprosy, with its long course, its terrible mutilation and its end results. The assumption that diseases were not differentiated accurately enough to recognize the existence of leprosy in days as far back as 1500-2000 BC cannot altogether be substantiated for, in the early Babylonian times, we find excellent descriptions of disease; for instance, epilepsy was well known and well described. It would seem extraordinary that if the ancients
knew epilepsy, and could describe it accurately, they would miss the equally obvious, or at any rate advanced, leprosy; and nowhere, as it has already been pointed out, can one align any description of a condition or conditions, translated as leprosy, with the disease which we know as leprosy today, and which is caused by the Mycobacterium leprae. Therefore the general conclusion is that nowhere earlier than 600 BC can leprosy be recognized as a definite clinical entity, unless one places the date of the Nei Ching very much further back, and modern scholarship tends to bring the date of this excellent treatise of medicine forward rather than backward.
We now see that legends which have been built up around the word leprosy have little or no historical foundation, and etymologically there is no justification for believing that the word so translated described the disease known today. Why, then, use the word leprosy at all? Many advocate that this word should be dropped out of our vocabulary entirely. But none of the suggested alternatives have been very satisfactory, and 'Hansen's Disease' is a misnomer, for Hansen described a bacillus and not a disease. If one is to attach the name of any person to leprosy the disease should be called Galen's Disease, or the Disease of Araetus, for these were the first two Greek physicians to give an accurate description of leprosy. If what we have said here is correct, and I believe it is, then we must pass on to consider the real meaning of the Hebrew word Tsara'ath, which has been taken by Bible translators to indicate leprosy. Let us turn to the chapters in Leviticus (Lv. 13 and 14) and examine this word in the light of present-day medical knowledge. In approaching this subject, I must state that I accept the authenticity of the first five books of the Bible as originally the work of Moses, but I am equally convinced that the disease, or diseases, which the Levitical record describes cannot be leprosy.
It is problematic whether leprosy existed in Egypt at the time of the bondage of the Children of Israel. Nevertheless, even assuming that it did, there is no evidence that the diseases, described in the Levitical record, included leprosy. If classical leprosy had occurred among the tribes of Israel there surely would have been a more accurate description of it. In the absence of such a description, it seems to me reasonable to conclude that, in those early days, Abraham and his descendants were careful to separate themselves from the surrounding people. The first sign of this separation is seen in the story of Lot and Abraham, when Lot chose all the plain of Jordan (Gn. 13: 11-14) and Abraham went on and chose the more unpromising land away from the cities. During the time of the Egyptian captivity the Children of Israel were segregated in the land of Goshen and there was no integration between the slave people of Israel and the proud Egyptians.
An illustration of how localized leprosy can be was seen during a survey in South India. A high-caste village was found to have an incidence of leprosy of approximately four to five per cent. The high-caste and the low-caste people do not mix one with the other and the amount of contact between the two was negligible. Thus, the low-caste people in a nearby village who worked only as menial servants, and never married into the high-caste village, or came into skin-to-skin contact with members of the higher castes, were free of leprosy. I cannot, here, go into the evidence for the statement that leprosy is in all probability conveyed by skin-to-skin contact - either through direct contact or through indirect contact, such as using a patient's bedding or wearing an infected person's clothes.
There is, however, considerable evidence to show that leprosy is not a disease of nomadic people. Some years ago, when I was travelling in the Congo, I asked a senior medical
missionary whether there was leprosy among the pygmies in the Central African forests, and his reply was that he seldom saw a case of leprosy among them. Several years later, when I was in the same district, I asked the same missionary the same question. He replied that leprosy was now appearing among the pygmies. This was because the Government had brought the pygmies from the depth of the forests to clearings and they were beginning to settle down and mix with the local population. So leprosy began to be introduced among them.
When I mentioned this to a missionary working in Northern Nigeria he told me that the nomadic Fellaheen were known to have leprosy. The old Minnesota focus in America was the result of leprosy being introduced by the Scandinavian immigrants in the early days of the settlement of America, where it remained a sporadic focus of leprosy for over a hundred years and only recently died out. So the Fellaheen, being descendants of the Ancient Egyptians, are an exception to the general rule that nomadic tribes do not have leprosy and leprosy has remained among them as a sporadic disease to this day. One must therefore conclude that there is no categorical evidence that leprosy appeared among the Children of Israel before they settled in Canaan, and circumstantial evidence is very strong in supporting this claim. There is certainly nothing in the Levitical record which would make one suspect the presence of leprosy among the diseases described in the thirteenth chapter of the book of Leviticus. But once Israel settled down with the local peoples, or, as the Bible so graphically puts it, went a whoring after other gods (Ex. 34: 15; Lv. 20: 5-7), social conditions arose among them that made it possible for leprosy to develop. Diseases from which Israel hitherto had been protected could now be introduced into their midst. The Israelites became a settled population, and, because they
disobeyed the Word of the Lord, the sicknesses and illnesses of the neighbouring tribes were brought upon them (Dt. 28: 58-61).
Diseases included in the Levitical record under the term 'leprosy'
The first mention of leprosy in the Old Testament is found in Exodus 4: 6, where the Lord commanded Moses to put his hand into his bosom, and when he took it out, 'behold, his hand was leprous as snow'. Frequently in the description of leprosy in the Old Testament the disease is referred to as a blemish 'as white as snow'. Other references are found in Numbers 12: 10, with reference to Miriam and Aaron's complaint against Moses, and in verses 9 and 10 it states that 'the anger of the Lord was kindled against them; and he departed. And the cloud departed from off the tabernacle; and, behold, Miriam became leprous, white as snow'. In neither of these two references to leprosy could it possibly have been the disease as we know it today, for the lesions of leprosy are never white. A further reference to 'leprosy' is found in 2 Kings 5: 27, and is another instance of 'leprosy' appearing as the result of disobedience. The verse reads, 'The leprosy therefore of Naaman shall cleave unto thee, and unto thy seed for ever. And he went out from his presence a leper as white as snow.' It is interesting to note that leucoderma in India is referred to as 'white leprosy', and those who suffer from leucoderma are fearful of this disfigurement, for they believe it is related to leprosy; and I have frequently been asked, when a child or a young girl has been brought to me with leucoderma, 'Doctor, has she got leprosy?'
Turning now to the Levitical record of the description of leprosy in Leviticus 13, it is interesting to note that there is not one single sign by which one could attribute the conditions there described to leprosy as we know it today. In
the first place it should be noted that all the references to leprosy are preceded by the definite or indefinite article. In Leviticus 13: 2, 'like the plague of leprosy'. The same phraseology occurs in verses 3, 5, 6, and in verse 8, 'it is a leprosy'; in verse 11 'it is an old leprosy', and in verse 12 'and if a leprosy break out'. In other words this description suggests that 'the plague of leprosy' does not cover one single disease, but blemishes caused by any one of a whole group of diseases which cause a person so afflicted to be ceremonially unclean before the Lord.
Further, one reads that a person who is suspected of having 'a leprosy' is frequently separated from the camp for periods of seven days. Leviticus 13:6 reads, 'And the priest shall look on him again the seventh day: and, behold, if the plague be somewhat dark, and the plague spread not in the skin, the priest shall pronounce him clean; it is but a scab.' But in verses 7 and 8 the description obviously refers to a deep-seated ulcer, which is much more than a mild break in the skin and may be of the nature of a phagedenic ulcer, which, in the period described, would spread and not heal and would therefore be considered to be 'a leprosy'. There is an interesting reference in verse 13 to the plague having 'all turned white'. This would suggest that albinism was not classified as 'a leprosy', but the whiteness of psoriasis was probably included because it refers to the fact of 'raw flesh appearing', for it is well known that when one scrapes the surface of a patch of psoriasis small bleeding points occur. However, this description might refer to the fact that there has been an extensive condition of the skin, which has left its tell-tale marks, but is no longer active. In verse 30 an interesting word is used - 'scall'; and in the latter part of the verse 'it is a dry scall'. The Shorter Oxford Dictionary defines 'scall' as 'a scaly or scabby disease of the skin, especially of the scalp and appears to be synonymous with
psoriasis'. Dr. Gramberg (1952), however, translates the word 'scall' as 'an itch' and suggests that this description covers fungus disease such as favus or tinea capitus. It is further interesting to note that in verse 26 of chapter 13 of the Levitical record the words describing the development of leprosy are 'somewhat dark'. The instruction then is to continue to observe the person for a further seven days and if the darkness 'spread much abroad in the skin, then the priest shall pronounce him unclean: it is the plague of leprosy' (verse 27). But in the very next verse it states 'if the bright spot stay in his place, and spread not in the skin, but it be somewhat dark; it is a rising of the burning, and the priest shall pronounce him clean'. The former description obviously refers to a progressive disease, possibly, again, some form of tinea. In verse 28 the reference probably is to a hyperpigmentation taking place after an inflammatory affection of the skin, for it is well known that, particularly in the dark skin, when inflammation occurs the end result is a permanent hyperpigmented spot or area. The same author (Gramberg) states that the three most important words in the description of leprosy in Luther's translation, namely se'th, sappahath and bahereth were translated 'tumor, ulcer, and blister', not as 'swelling, eruption and spot'.
There are two details in the Levitical record which cannot apply to leprosy - its 'whiteness' and the affection of the scalp. In the first place leprosy lesions are never white. In the second place leprosy of the scalp very rarely occurs, and does not occur apart from advanced lepromatous leprosy. In the Old Testament the only possible description that could fit leprosy is the reference to Uzziah, where in 2 Chronicles 26: 19, it states: 'Then Uzziah was wroth, and had a censer in his hand to burn incense: and while he was wroth with the priests, the leprosy even rose up in his forehead before the priests in the house of the Lord, from beside the incense
altar.' This could be a form of true leprosy, because, in Africa particularly, the forehead is a predilection site for an initial lesion of leprosy. However, it could be a patch of leucoderma for, in the Old Testament, leprosy is always mentioned as white, and under emotional strain the surrounding erythema of the skin might make a leucoderma spot more obvious.
We could take each of the Levitical descriptions of 'leprosy' and relate them to one or other of the various skin diseases, but not to classical and modern leprosy. Infections such as a carbuncle, or extensive favus of the scalp, or a ringworm of the body, all these came within the description of 'the plague of leprosy' in the Levitical record. In addition to this, various ulcerative conditions in the scalp and beard area are also put down to 'a plague of leprosy'. Deep-seated infections of the hair follicle, such as impetigo, may well be included in these descriptions. Sycosis barbae in all probability was also among the diseases included in this term 'leprosy'. Nowhere is there any suggestion that leprosy is associated with anaesthesia! The laws of the cleansing of the 'leper' are so meticulously laid down that one is bound to conclude that in the Old Testament record provision was made for the cleansing of the patient who had 'the plague of leprosy' and that healing of the disease was a common phenomenon. It appears, therefore, that one must conclude that in the Levitical record there is no evidence that any of the diseases so described and actually diagnosed as 'leprosy' had any relationship to the disease known as leprosy today.
Simons (1950) is of the opinion that 'Old Testament tsara'ath was not present-day leprosy' and that 'the word was a collective noun for numerous skin diseases'. Muir (1948) wrote: 'The highly contagious condition described in the Jewish Law has obviously nothing to do with leprosy.' Lendrum (1952) states that 'Leviticus 13 and 14 demonstrate
to the most sceptical that the word which is translated as leprosy did not apply to the condition officially called "leprosy" at the present day, and indeed did not define a disease entity at all'. It is interesting to note that Tas (1953) and Israeli scholars stress 'that at the time of the Septuagint the word lepra meant nothing but a symptom: scaled skin'.
In conclusion, therefore, it will be noted that only a small minority of physicians, notably Sitanala (1937) and Ketting (1922), maintained that the word Tsara'ath should be translated leprosy, but the consensus of opinion is that the disease we now know as leprosy was not described before 600 BC and that there is no evidence of the existence of leprosy at the time of Israel's bondage. The conclusion, therefore, in regard to the Old Testament is that a disease, or a group of diseases, the mere mention of which struck terror into the hearts of men, was referred to in the Old Testament in connection with ceremonial purposes, and that such sufferers were unclean before the Lord until they were healed and ceremonially cleansed. I trust that I have given sufficient evidence to convince my readers that if we translate the Hebrew word Tsara'ath in the Old Testament as leprosy, without any explanatory note whatever, we are making an error, for the consensus of opinion among those who have studied the subject is that Tsara'ath was a generic name for a group of diseases, and there is no evidence whatever that the Children of Israel suffered from leprosy in any form. Therefore one is in error if one takes what is a conception of a group of diseases, representing ceremonial uncleanness, and applies it to one specific disease.
THE EXEGETICAL INTERPRETATION OF LEPROSY
OLD AND NEW TESTAMENTS
The key to the understanding of the condemnation of 'the leper' in the Old Testament is found in Exodus 19: 6: 'And ye shall be unto me a kingdom of priests, and an holy nation.' The Israel of God had to be holy unto the Lord, just as the new Israel (1 Pet. 2: 9), the Church, the Bride of Christ, was to be pure and unblemished (Rev. 21: 2, 11). Further, we have the same injunction to holiness in Leviticus 20: 7: 'Sanctify yourselves ..., and be ye holy: for I am the Lord your God.' In Leviticus 10: 10 comes the command and stern directive, following on the committal of gross sin in the realm of worship, to 'put difference between holy and unholy, and between unclean and clean'.
I must, at this point, remind my readers that the derivation of the word 'holy' is the same as that of the words 'health' and 'wholeness', and, therefore, anything that was unhealthy (unholy) was a defilement in the camp of Israel. I have received confirmation from a Chief Rabbi that to translate the word Tsara'ath as 'defiled' or 'stricken' is correct so far as the Hebrew is concerned. If, then, instead of adopting the conventional translation of the word Tsara'ath as 'leprosy', we give it its correct meaning - defilement - we are at once reminded that in the Old Testament Scriptures there were two kinds of defilement.
(i) The defilement of temporary uncleanness - related in Leviticus 12 and 15. In 15: 31 the Word of God says: 'Thus shall ye separate the children of Israel from their uncleanness; that they die not in their uncleanness, when they defile my tabernacle that is among them.' Restoration to communion and fellowship was allowed after certain days of separation and after the sacrifice of a lamb or two turtle doves. It is interesting that all the Mosaic regulations relating to what was clean and unclean, including clean and unclean food,
had an important public health significance. In our teaching of preventive medicine, particularly among the more primitive peoples, we should do well to give attention to these Old Testament regulations concerning that which is clean and unclean, for to heed these directives would result in better health, which is symbolic of holiness. Nothing that is unclean or ungodly must, therefore, defile the camp of Israel. Paul also has this in mind when in 1 Corinthians 3: 16, 17 he says: 'Know ye not that ye are the temple of God ... the temple of God is holy, which temple ye are.' The apostle reiterates the same thought in 6: 19, 20 and ends with the exhortation, 'therefore glorify God in your body, and in your spirit, which are God's'.
(ii) The defilement of permanent uncleanness. This usually resulted in perpetual separation from the camp of Israel. Only exceptionally was this defilement removed. The Hebrew word Tsara'ath covered all those conditions which resulted in a prolonged separation of the offending individual from the camp of Israel. This more serious uncleanness was found in a group of maladies, or infections, which by virtue of disease of the body were dangerous to others, or, in the case of garments and houses, were dangerous by virtue of contamination. From temporary defilement there was a hope of recovery; therefore laws for the cleansing of such persons were formulated. In this latter instance, however, the defiling condition was dangerous and irremediable: therefore the garment was burnt (Lv. 13: 52) and the house had to be demolished (Lv. 14: 34-57). It was this group of conditions, symbolical of permanent defilement, which came under the sentence 'Unclean, unclean without the camp shall his habitation be' (Lv. 13: 45, 46). This interpretation is strengthened by the alternative rendering in the marginal reference of Isaiah 53: 8, 'For the transgression of my people was the stroke (the curse) upon him', alluding to the curse
of the crucified (Gal. 3: 13 and Dt. 21: 23, margin ref.).
The Hebrew word Tsara'ath, therefore, was used of a disease or blemish which showed itself as gross or permanent defilement of man or materials. This word, however, was translated (in the av) 'leprosy', and the sufferer 'a leper', because, in the days when the Bible was translated into English, leprosy, because of its mysteriousness, its mutilating power and its incurability, was symbolic of all that was dreadful in the life of man. As I have said, the modern disease of leprosy bears no resemblance to that described in the Bible, and in any case only a small fraction of leprosy cases among the total who are afflicted can be described as loathsome to look upon.
The full significance of the verse in Isaiah 53: 4 is brought home in the Vulgate rendering. General Mac Arthur, the eminent and erudite medical historian, reminds us that this verse in the Latin Vulgate translation reads: 'We did esteem Him as if He were leprous, smitten of God and afflicted.' In Wycliff's translation the rendering is: 'Vereli ourse sicnesses he tooc, and oure sorewes he bar; and wee heelden hym has leprous, smyten of God, and mikid (afflicted) of God.'
And verse 8 of the same chapter by the same token should be rendered, 'For the transgression of my people was He leprous - was the stroke or curse upon Him.'
Stanley Browne (1962) emphasizes the significance of the ceremonial aspect in regard to leprosy, for he says: 'The ancient Jewish attitude, based on the mosaic code, was
essentially concerned with a ceremonial uncleanness, and secondarily with a scaly skin disease, possibly infectious.'
Further, as General Mac Arthur pointed out in his article on 'Mediaeval "Leprosy" in the British Isles' (1953), the word 'leper' comes from a Greek word meaning a scale or parchment, and the Latin word for book (liber) has the same origin.
It must therefore be concluded that historically, medically, exegetically and almost certainly etymologically there is no justification for applying the Old Testament conception of leprosy to the disease we now know by that name.
THE NEW TESTAMENT AND LEPROSY
This conception of holiness without blemish was carried over into the New Testament. In Ephesians 5: 25-27, with reference to the Church, Paul says: 'As Christ loved the church, and gave himself for it; that he might sanctify and cleanse it... and present it... a glorious church, not having spot, or wrinkle, or any such thing; but that it should be holy and without blemish.' The apostle Paul is referring to the Song of Solomon, which is accepted as being the love story of Christ and His Church: 'Thou art all fair, my love; there is no spot in thee' (4: 7).
There are only three references to Christ's cleansing 'the leper'. The first of these is recorded by the three synoptic writers (Mt. 8: 1-4; Mk. 1: 40-45; Lk. 5: 12-14). Luke adds a physician's touch, 'full of leprosy'. The second incident is recorded only by Luke, that of the ten 'lepers' (Lk. 17: 12-19). It may be significant that the word 'healed' in connection with leprosy was used only in Luke's account of the cleansing of the ten lepers. Further, our Lord did not repeat the command to go to the priest to the Samaritan, for the Samaritan did not recognize the Jewish priesthood.
Tradition has it that Luke belonged to the School of Hippocrates, and nowhere in the Hippocratic writings, which I have been able to trace, is there an accurate description of leprosy. Leprosy, in these writings, is confused with many other diseases. Nevertheless, it may be that this was the case of true leprosy, for leprosy was known in Israel by the time our Lord was on earth. Whether this was so is immaterial to my argument, for the Lord was a Jew and would apply the Jewish Law to all such cases, for they would be included among the many who had permanent blemishes.
There is only one other reference in the Gospels to leprosy, and that is the statement that Jesus visited the house of Simon the leper (Mt. 26: 6; Mk. 14: 3). It is right to assume that Jesus had cleansed Simon. It was in Simon's house that Mary anointed Jesus' head with precious ointment. This was symbolic of the anointing of Aaron and his sons with the holy anointing oil (Ps. 133: 2; Ex. 30: 25-30), consecrating him and his sons to the High-Priestly offices of meditation, intercession and forgiveness.
After the synoptic Gospels there is no reference to leprosy. Surely this was because Jesus, being a Jew, came to fulfil the Law (Mt. 5: 17), and He therefore accepted and honoured the Mosaic code and bade the cleansed 'leper' go to the priest 'and offer for thy cleansing those things which Moses commanded' (Mk. 1: 44). Our Lord, in so far as biblical leprosy was concerned, fulfilled the Law of Moses. While no mention of leprosy occurs after our Lord's resurrection and ascension, this idea of ostracism and shame is found in Hebrews 13: 12, 13. Here we are reminded that our Lord and Saviour took upon Himself all our shame and our sin, and suffered without the gate. He also took upon Himself the guilt and penalty of sin, thus identifying Himself with the stricken of God (leprous). We too, in accepting His great salvation and the gift of His Holy Spirit, in the eyes of the
world bear the same reproach, for He died for us 'without the gate' and we are, thereby, 'made nigh by the blood of Christ' (Eph. 2: 13).
CEREMONIAL CLEANSING ABOLISHED
If this interpretation of the 'law of leprosy' (Lv. 14: 54) is correct, one would not expect any reference to the cleansing of 'leprosy' after the death and resurrection of Christ, for these commands were commands under the Law, and we are no longer under the Law but under grace (Gal. 2: 16-21). Our Lord, being a Jew, the Messiah of God, having come to fulfil the Law and to meet its just demands, paid the full penalty of our sins by His death upon the cross, and 'made us accepted in the beloved' (Eph. 1: 6). There is now no more need for ceremonial cleansing, for there is no more possibility of getting rid of the defilement of sin by ceremonial cleansing than there is for the blood of bulls and goats to be effective to take away our sins (Heb. 10: 4). It is the blood of Christ that cleanses us from all sin (1 Jn. 1: 7).
Many of our ideas concerning leprosy, therefore, belong to the dispensation of the Law, and not of grace. It is for this reason, I believe, that there is no reference to leprosy in Scripture after the dispensation of grace had opened at the death and resurrection of our blessed Lord. To apply, then, the biblical conception of leprosy to the disease we know by this name is unfortunate, for it makes a particular illness, which is frequently a disease of innocent childhood, a religious synonym for sin, and places the sufferer under the mental agony of thinking that he is cursed above all men. The perpetuation of this idea has brought untold misery to men and women, and it is unfair to select a particular disease and suggest that it is a type of sin. This results in a misinterpretation of suffering.
THE JUSTIFICATION FOR MODERN LEPROSY MISSIONS
If, then, 'ceremonially unclean' is the correct meaning of biblical leprosy, what is the justification for Leprosy Missions? It has happened that God in His mercy has overruled the mediaeval misunderstanding regarding leprosy and used it for His glory. Through it He has wrought a marvellous work, leading His Church into fresh avenues of service among people who, the world over, were utterly despised and rejected. Here is another instructive episode in Christian history. God reveals to men from time to time human injustices which must be put right, and through His servants He issues the challenge that these things must not be. Abraham Lincoln in America and Wilberforce in this country were used of God to convince mankind of the horror and cruelty of slavery. Florence Nightingale was called to awaken a nation into caring for the sick and wounded in war. Livingstone was chosen to open up the Dark Continent of Africa to the liberating influence of the gospel of Christ. Elizabeth Fry initiated prison reform, and emancipated women from a life of sin and degradation, challenging the Victorian age in respect of the position of women and the unequal standards which society condoned with regard to sexual sin. Shaftesbury, Müller, Barnardo, and a host of others, were raised of God to shame the country with regard to the treatment of orphans and deserted children.
The Christian Church through St. Francis, Father Damien, and many consecrated lives, was likewise stimulated into action so that a cruelly despised people might be restored to fellowship with God the Father. In this connection it is well to remember that, while the whole civilized world honours the name of Damien, six years before he went to Hawaii a Protestant pastor had seen the plight of the outcast leprosy sufferers and started a spiritual work, serving those isolated
under the appalling conditions on Molokai Island. And it was Wellesley Bailey, a young missionary schoolmaster, who was the chosen servant of God to challenge the Church to respond to the need of caring for those with leprosy in India. Through the loving devotion of three consecrated Irish women, he started work which brought into being The Mission to Lepers in Great Britain, its auxiliaries in many parts of the Christian world, and the American Leprosy Missions, all of which have contributed so signally to the present-day advances in leprosy. God has used such organizations to open up countries which had hitherto been unreached by the gospel.
Our whole approach to the concept of leprosy has, during the past thirty years, been gradually altered and revolutionized. Leprosy missions are still necessary to challenge and lead the way in this work which the Lord has so richly blessed. Devoted and well-trained personnel are still in urgent demand. There are thrilling opportunities for research, leading to a better understanding of leprosy, so that our knowledge might be advanced. Thus, under God, we shall be better able to fight this disease which has been a scourge and a heartache to mankind for so many centuries.
SUGGESTED ADDITIONAL READING
Browne, S. G. (1962) 'Leprosy: The Christian Attitude', The Expository Times, 73, 8. 242-245.
Chaussinand, R. C. (1950) La Lèpre. Expansion Scientifique Francaise.
Cochrane, R. G. (1947) A Practical Textbook of Leprosy. Oxford University Press.
(1959) Leprosy in Theory and Practice. Bristol, John Wright & Sons Ltd.
Dharmendra, N. S. (1960) Notes on Leprosy. Pub. Ministry of Health, Government of India, New Delhi.
Gramberg, K. P. C. A. (1952) Bijdrage tot de kennis der geschiedenis der lepra in Nederland. Thesis, Amsterdam University.
Klingmüller, V. (1930) Handbuch der Haut- und Geschlechtskrankheiten Band X, Die Lepra. Berlin, Julius Springer.
Llendrum, F. C. (1952) 'The Name "Leprosy", Am. J. Trop. Med. & Hyg., 1, No. 6.
Lowe, J. (1942) 'Comments on the History of Leprosy', Ind. Med. Gazette, 77, 11, 680-685. Reprinted in Leprosy Rev., 18, No. 2 & 3, 54-64, 1947.
Mac Aarthur, W. (1953) 'Mediaeval "Leprosy" in the British Isles', Leprosy Rev., 24, No. 1.
Muir, E. (1948) Manual of Leprosy. Edinburgh, E. & S. Livingstone. P. 3.
Oppenheim, L. (1956) 'Interpretation of Dreams in the Ancient Near East', Trans. Am. Phil. Soc., N.S. 46, 3. 179-373.
Rogers, L. (1924) 'Croonian Lectures', Anns. Trop. Med. Parasit., 18, 267.
Rogers, L. and Muir, E. (1946) Leprosy, 3rd Edn. Bristol, John Wright & Sons, Ltd. P. 1.
Simons, R. D. G. Ph. (1950) Dermatologie de Tropen. Amsterdam, Scheltema & Holkema.
Sitanala, J. B. (1937) Geneeskundige Tjidschrift voor Ned. Indie.
Tas, J. (1953) 'On the Leprosy of the Bible', Actes du 7e Congress Intern. d'Histoire des Sciences a Jerusalem.
von Deines, H., Grapow, H. and Westendorf, W. (1958) 'Ubersetzunder Medizinischen Texte', Grundrissder Medizinder A.A. iv, Berlin, I. p. 208 and III. p. 48.
Yeoli, M. (1955) 'A "Facies Leontina" of Leprosy on an Ancient Canaanite Jar', J. Hist. Med., 10, 331-333.
 I am indebted to the publication Leprosy and the Bible of the United Bible Societies for this information, particularly that of K. P. C. A. Gramberg.
 The word 'leprosy' was first found in the Latin Vulgate translation, where the Greek word 'lepros' (scaly) - feminine 'lepra' - was translated into Latin as leprosus. The Greek Physician, Claudius Galenus, in the year ad 150, gave an accurate account of leprosy, and called the disease elephantiasis Graecorum.
 I am indebted to General Mac Arthur for the rendering of the Vulgate Version, which reads: 'Et nos putavimus eum quasi leprosum.'