Tzaraath

Tzaraath (tzaraas, tzaraat, tsaraas, tsaraat; Hebrew צרעת) is a disfigurative condition named by the masoretic text of the Priestly Code in the Tanakh^[1]. The word is used for both skin conditions and for discolorations that affect clothes and buildings. Tzaraath is translated by the Septuagint as lepra, and was consequently translated by older English translations of the Bible as leprosy, with which lepra is cognate. Several of the symptoms mentioned by the biblical text are inconsistent with tzaraath being leprosy, and additionally, the most obvious features of leprosy are unmentioned in the description of tzaraath.

In Ancient Greece, lepra, which means rough/scaly, was used to refer to psoriasis rather than the condition now called leprosy, which the Ancient Greeks referred to as elephas and elephantiasis^[2]. The linguistic root of tzaraath means smiting, in reference to a mythological explanation of its cause as a punishment for sin^[3]; it is quite possible that tzaraath was a general term for certain types of skin disease, rather than a particular condition^[4], and the Talmud maintains a similar view, arguing that tzaraath referred generally to any disease that produces sores and eruptions on the skin^[5].

The biblical description of tzaraath is under the impression that it could also afflict clothes^[6] and houses^[7], not just skin, which is not true of leprosy, and not true of psoriasis either; Textual scholars regard the Priestly Code to have been compiled from several earlier independent documents, and the regulations for house tzaraath, for fabric tzaraath, and for skin tzaraath are considered by textual scholars to have once been independent of each other^[8].

The priestly code specifies three different manifestations of tzaraath in the skin:

• Whitening of the skin over the whole body with sores^[9].
• Spreading of sores, swellings which are white, or spots which are reddish-white^[10][11][12].
• Patches on the skin which are clearly suffering from subcutaneous disease, where the hair has turned white, and which contain sores, swellings which are white, or spots which are reddish-white^{[13][14][15][16]}.

In the case of non-subcutaneous infections without the hair whitening, the text specifies a mechanism for detecting whether spreading has occurred. When the symptoms are detected, the code requires the individual to be isolated for 7 days, and then checked for the spread of disease^{[17][18][19][20]}; in the case of sores, if spreading isn't witnessed after the first 7 days of isolation, the individual must be isolated for another 7 days, and then checked again^[21][22]. If sores occur on the head or chin, then the individual is required to shave themselves everywhere except where the sores occur, between the first week of isolation and the second week^[23].

The biblical text also provides rules that differentiate between tzaraath and other historically common skin diseases. When the symptoms include swellings or spots, the text only specifies that tzaraath is present if the swellings/spots occur in locations where a burn injury exists^[24][25], or where a boil had previously healed^[26][27]; in the latter case, if there is also spreading of the condition around the skin, it is considered by the text to be symptomatic of plague rather than tzaraath^[28]. The text also differentiates between general sores, and those present on the head or chin, and in the latter case, the text states that if the sores spread, tzaraath only exists if hair growing in the sores is a colour other than black^[29]; the Talmud argues that if the head hair and facial hair has fallen out, then sores on the head or chin should be regarded like those elsewhere on the body, implying that the biblical differentiation between the locations was due to the presence of this hair in these regions^[30].

Rather than following the biblical descriptions of the symptoms of tzaraath in the manner than modern doctors would, classical rabbinical literature took an extremely literal view^[31]. In the group of symptoms where the hair of the inflicted region has turned white, the Mishnah argues that plucking out the white hair was all that was required for the disease not to be considered tzaraath^[32]; similarly since the biblical text mentions tzaraath occurring where boils had previously healed, but not where unhealed boils exist, the Mishnah maintains that the appearance of the other symptoms in an unhealed boil or burn do not indicate tzaraath, and that if the boil/burn does subsequently heal it still wouldn't indicate tzaraath unless the other symptoms occur in parts of the body that were not previously diseased^[33]. The Mishnah also argues that sores smaller than the size of a lentil, those on the extremities of the body (such as the fingers, toes, ears, nose, breasts, etc.), those which occur in the location of an unhealed boil or burn, and those which occur in hairy parts of the body, do not indicate tzaraath^[34][35].

Scholars suspect that these descriptions of tzaraath, where it applies to skin conditions, actually refer to a number of different skin diseases^[36][37][38], which, owing to the undeveloped state of medical science at that period, were not distinguished^[39]. Of the particular situations that the Priestly Code describes as being tzaraath,

• the whitening of the skin over the whole body with sores, is considered by scholars to be most indicative of Psoriasis ^[40][41][42]
• the spreading of sores is regarded by scholars as most symptomatic of Impetigo^[43]
• the spreading of swellings or spots in a burn injury, according to scholars, is most probably a result of Erysipelas^[44]
• in regard to subcutaneous disease where the hair has turned white
  • the additional presence of swellings or spots in a burn injury are thought by scholars most likely to be Tropical Sores^[45]
  • the additional presence of bodily sores, and swellings or spots where there previously had been a boil, is one of the classical symptoms of Leprosy^[46]
  • the additional presence of sores on the head or chin is thought by scholars to most probably indicate the presence of Ringworm^[47][48]

In addition to simple rashes^[49], inflammations^[50], and swellings^[51], the biblical text mentions a number of other conditions that could be confused with tzaraath. Among the other situations which the text considers harmless are the appearance of dull white spots^[52], white patches of skin without sores^[53], and baldness without sores^[54]; the latter two of these are thought by scholars to most probably refer to vitiligo and alopecia, respectively^[55], and the bible remarks that the former - the dull white spots - are merely a form of freckles^[56]. The symptoms that the text considers to be indicative of disease include those of the spread of superficial swellings or spots (where there had previously been a boil)^[57], and those of reddish-white sores in areas of baldness^[58]; the former condition is identified by the bible as plague, and scholars regard its symptoms as pointing to a diagnosis of smallpox^[59], while the latter is unidentified in the biblical text, but considered by scholars to indicate favus^[60].

In addition to infecting the skin, tzaraath is described by the priestly code as being able to infect historically common clothing fabrics, specifically wool, linen, and leather^[61]. The Biblical description of tzaraath in such fabrics is strikingly analogous to that of tzaraath in the skin^[62], with, for example, spreading of the infection being tested for by isolating the fabric in question for first 7 days^[63]. The principle symptoms are described as being very green or very red spots^[64], which spread within a week^[65], or which don't change appearance at all after a fortnight, having been washed after the first week^[66], or which return a week after having been torn out, if they also had faded with washing prior to being torn out^[67]. These descriptions are regarded by scholars as most probably indicative of certain moulds^{[68][69][70][71]}, and especially matching infections by Penicillium (the fungus which produces penicillin)^[72]

The biblical text also describes tzaraath as infecting the walls of houses^[73]; the symptoms it describes are depressions in the wall, which are very green or very red^[74], and which spread over a period of seven days^[75]. The description is regarded by scholars as again being strikingly similar to the wording of the description of tzaraath infections in the skin^[76], but still somewhat obscure^[77]; it would seem to fit some form of fungal growth^[78], especially dry rot, which produces yellowish-green and reddish patches on walls^[79].

Although the medical and chemical conditions, which scholars consider the descriptions to fit, have obvious natural causes in the light of modern scientific knowledge, the biblical texts characterise it as a spiritual affliction with a supernatural cause, bringing ritual impurity to its victims. Each victim of tzaraas mentioned by the Bible is stated to have received the condition due to some transgression of biblical laws^[80], including Joab being cursed for the murder of Abner, Gehazi for being covetous, and Uzziah for infringing the exclusive rights of certain people to burn incense.

If a person was afflicted with tzaraath in their skin, they were required to wear torn clothes, keep their hair unkempt, cover the lower part of their face, cry out [ritually] impure, [ritually] impure, and reside away from other people^[81]; a few medical historians, such as Arturo Castiglioni, regard this as the first model of sanitary legislation^[82]. Nevertheless, this isolation isn't necessarily due to concerns over the contagiousness of the disease, but rather due to concerns about the risk of moral corruption to other people; the Talmud doesn't treat tzaraath as contagious^[83], and doesn't consider non-Jewish victims of tzaraath to be ritually impure^[84]. The Talmud states that if tzaraath hadn't been confirmed by a Jewish priest, then a bridegroom with suspected symptoms of it was allowed to postpone any isolation or inspection by a priest until a week after his wedding, and if a person developed suspected symptoms of tzaraath during a holy day, then the isolation and inspection by a priest could be postponed until the holy days had finished^[85].

Fabrics and clothing affected by tzaraath were required by the text to be burnt entirely^[86][87], unless it was the form of tzaraath which faded after washing but came back after being torn out, in which case it could be considered ritually pure as soon as the tzaraath had gone, and it had subsequently been washed^[88]. Tzaraath infections in houses were to be treated similarly harshly according to the biblical regulations, and didn't have any exceptions; stones showing the symptoms had to be removed, and the house had to be scraped, with the removed stones and scraped-off clay being cast into a rubbish heap outside the city^[89], and if the infection returned once replacement stones were laid and daubed with clay, then the whole house had to be dismantled, with the rubble again going to the tip outside the city^[90]. Additionally, people who had been in a house while it was infected with tzaraath was considered ritually impure until the evening came, and anyone who had eaten or slept there had to also wash their clothes^[91]

The Talmud, and the majority of historic Jewish literature in general, regards tzaraath as a punishment for sin; it lists seven possible causes for tzaraath^[92]:

• an evil tongue (malicious gossip)
• murder
• a vain oath
• illicit sexual intercourse
• pride
• theft
• miserly behaviour

One midrashic source categorically states that tzaraath only appeared as punishment for evil tongue, while others add further reasons to the list in the Talmud. Unlike the modern medical approach, which seeks to cure by natural means, the classical Jewish sources argue that cure from tzaraath only came about through repentance and forgiveness. In particular, the Midrash Rabbah sees the different types of tzaraath as increasing levels of punishment, which could be curtailed at any stage if repentance was made:

1. the first stage in the Rabbah's view was the infection of homes, and if repentance came here it would only require the removal of the affected stones for a cure,
2. in the second stage, the entire house must be torn down as the tzaraath would not go away, and the infection came upon one's clothes; if repentance came here it required only washing of the clothes for a cure
3. in the third stage of Rabbah's scheme, the clothes must be burnt, and the infection enters the person's skin; if repentance occurs here then purification could occur
4. in the fourth stage, which only occurs when the person has completely refused to repent, the person is forced to dwell alone

Other classical rabbinical writers saw tzaraath infections of houses as having a practical benefit. According to one, as well as being a punishment for miserlyness, it also demonstrated that the house owner was lying, if they had said they did not own certain objects which neighbours had asked to borrow, since the biblical regulations require the house owner to take all their possessions outside until the infection is cured^[93]. On the other hand, Rashi, basing his view on the Leviticus Rabbah^[94], states that tzaraath infecting houses was a reward for the home owner, arguing that the Israelite homes had previously been those of Canaanites, who had hidden their golden valuables in the walls; the tzaraath infection would require the house owner to remove the bricks, and so find the treasures hidden there^[95].

When the priest had certified that tzaraath had been cured, the biblical text requires that the formerly infected person undergo a number of ritual events^[96], some occurring straight away^[97], and some occurring a week later^[98]. According to textual scholars, these are really two independent rituals spliced together, with the first group^[99] being the ritual that was originally part of the regulations for tzaraath of skin, and the other group^[100] being a later attempt at replacing the first group of rituals, so that the regulations fitted better with the sacrifice-centric view of the Aaronid priesthood^[101]. The biblical text states that a ritual, almost identical to the first group of rituals for skin-tzaraath, also had to be carried out for houses that had been cured of infections from tzaraath^[102]; however, there is no further ritual for houses that could parallel the second group of rituals for skin-tzaraath.

The first group of requirements are that the formerly infected person kills a (ritually pure) bird over fresh water, in a clay pot, and dips another living bird, together with cedar wood, scarlet yarn, and ezob, into the blood^[103]; this combination was used to sprinkle the formerly infected person seven times with the blood^[104]. Once the surviving bird was released over open fields^[105], and the formerly infected person had shaved off all their hair, and bathed themselves and their clothes in water, they were counted as ritually pure^[106]. According to biblical scholars, this ritual is primarily an example of sympathetic magic, with the running water and living bird being symbolic representations of ritual impurity going away^[107]; killing animals over running water was a widespread ancient custom^[108]. The cedar and ezob have more practical applications, with cedarwood having medicinal properties, and ezob being a good implement to use for sprinkling^[109].

In the second group of requirements, having completed the first group, the formerly infected person is required to avoid their own home for a week (although they may mix with other people)^[110], after which they must shave off absolutely all of their hair, including their eyebrows, and then wash themselves^[111]. Having done this, the formerly infected individual was required to make a standard whole offering, a standard sin offering (to excuse the profanity of having had tzaraath^[112]), and a guilt offering (to apologise for the cause of the tzaraath^[113])^[114]; if people are too poor to afford that, the bible allows the standard alternative set of sacrificial victims to be used instead^[115].

Unlike other guilt offerings, the priest was required to put some of the blood from the sacrifice onto the formerly infected person's right ear lobe, right thumb, and right big toe^[116], then some of the oil for the sacrifice had to be poured into the priest's left palm, and applied with the priest's right forefinger onto to the formerly infected person's right ear lobe, right thumb, and right big toe^[117], and then the rest of the oil from the priest's palm was to be poured onto the formerly infected person's head^[118]; textual scholars regard the Priestly Code, of which the tzaraath regulations are a part, to have been written in the early 7th century^[119], and it is in this context that these additional rules have significance. By that era, non-priests were not allowed to pass beyond a certain gateway (the gate of Nicenor) in the complex at the Temple in Jerusalem, while the blood from sacrifices couldn't pass outside, thus for a person to be touched by the blood, they had to lean through the gateway without setting foot on the other side; the right ear, thumb, and toe, were symbolically the parts of the body which achieve this^[120].

• Metzora (parsha)
• Leprosy

• Heller RM, Heller TW, Sasson JM., Mold: "tsara'at," Leviticus, and the history of a confusion. Perspect Biol Med. 2003 Fall;46(4):588-91
• Spinka, Harold M. M.D., "Leprosy in Ancient Hebraic Times" Journal of the American Scientific Affiliation (JASA), XI, March 1959, 17-22
• Wycliffe Bible Encyclopedia, 1986, "Diseases", page 461, Moody Bible Press, Chicago, Illinois
• Wycliffe Bible Encyclopedia, 1986, "Leper, leprosy", pages 461, 1026-1027, Moody Bible Press, Chicago, Illinois

• Tzara'as (from Reb Chaim HaQoton)
• A Rough Guide to Tzaraat by Joshua Cohen