Parshat Tzaria 5768: What is Tzarat?

Moving from all the death of animals for food and death of offspring in industrial accidents of last week, this week we move into part two of the three part theme on biblical public health. We start with the procedure for a mother after giving birth, then discuss some gynecological problems. We then move into the beginning of a rather long two portion discussion of the issue of what in that text is called tzarat and at a later time would be translated leprosy.

The rabbis were pretty clear on the causes of the disease called tzarat. For them it was a spiritual punishment:

(i) Haughty eyes, (ii) A Iying tongue, and (iii) Hands that shed innocent blood; (iv) A heart that divises wicked thoughts, (v) Feet that are swift in running to evil; (vi) A false witness that breathes out lies, and (vii) He that sows discord among brethren. R. Johanan said: All these are punished by leprosy. [Leviticus Rabbah XVI: 1]

For ten things [i.e. sins] does leprosy come upon the world: (i) idol-worship, (ii) gross unchastity, (iii) bloodshed, (iv) the profanation of the Divine Name, (v) blasphemy of the Divine Name, (vi) robbing the public, (vii) usurping [a dignity] to which one has no right, (viii) overweening pride, (ix) evil speech, and (x) an evil eye. [Leviticus Rabbah XVII: 3]

Certain types of bad behavior, much of it socipopathic, caused tzarat. Also they note it is progressive in nature.

First they come upon [the fabric of] his house. If he repents, it requires the pulling out [of affected stones]; if not, it requires pulling down [the house]. Then they [i.e. the plagues] come upon one's clothes. If he repents, they require washing; if not, they require burning. Then they [i.e. the plagues] come upon his body. If he repents, he undergoes purification; if not, HE SHALL DWELL ALONE (XIII, 46). [Leviticus Rabbah XVII: 3]

The rabbis and the biblical text saw this as s spiritual and social problem. If a person changes and repents, the problem goes away. Part of the biblical text however has remained around for quite a long time:

All the days when the disease shall be in him he shall be unclean; he is unclean; he shall dwell alone; outside the camp shall his habitation be. [Leviticus 13:46]

In English translations, tzarat had been associated with leprosy for quite a long time. Part of tzarat is the quarantine of the individual. Such a commandment had led to the creation of leper colonies, places of isolation, often in the worst of conditions. But was tzarat really leprosy?

Leprosy, in modern nomenclature called Hansen’s disease is caused by a very interesting rod shaped bacteria Mycobacterium leprae. Mycobacteria have a very thick and strong cell wall made up of waxy configurations of fats and sugars, making them rather impervious to the most common ways of indentifying bacteria and some of the methods used to kill them. However, in 1873 Gerhard Hansen did isolate and indentify the causative organism. The disease affects the skin and nervous tissue, leading to a loss of feeling. It is a secondary effect of this loss of feeling that causes people to not notice other conditions and injuries which might cause loss of skin tissue, not the leprosy itself. The U.S. Centers of Disease control has as part of their case definition the following symptoms:

Tuberculoid: one or a few well-demarcated, hypopigmented [i.e. light colored], and anesthetic skin lesions, frequently with active, spreading edges and a clearing center; peripheral nerve swelling or thickening also may occur Lepromatous: a number of erythematous [i.e. reddish] papules and nodules or an infiltration of the face, hands, and feet with lesions in a bilateral and symmetrical distribution that progress to thickening of the skin Indeterminate: early lesions, usually hypopigmented macules, without developed tuberculoid or lepromatous features

In comparison to the CDC definition, Tzarat, unlike anything else in the biblical text has one of the most detailed, if not clinical descriptions:

3. And the priest shall look on the disease in the skin of the flesh; and if the hair in the plague has turned white, and the disease looks deeper than the skin of his flesh, it is a disease of leprosy; and the priest shall look on him, and pronounce him unclean. 4. If the bright spot is white in the skin of his flesh, and it looks not deeper than the skin, and the hair on it has not turned white; then the priest shall shut up him who has the disease for seven days; 5. And the priest shall look on him the seventh day; and, behold, if the disease appears to have stayed in place, and the disease has not spread over the skin; then the priest shall shut him up seven days more; 6. And the priest shall look on him again the seventh day; and, behold, if the disease is somewhat dark, and the disease did not spread in the skin, the priest shall pronounce him clean; it is a scab; and he shall wash his clothes, and be clean. 7. But if the scab spreads out in the skin, after that he has been seen by the priest for his cleansing, he shall be seen by the priest again; 8. And if the priest sees that, behold, the scab spreads in the skin, then the priest shall pronounce him unclean; it is a leprosy.

While a lot of these symptoms are similar, the CDC definition mentions nothing about hair, not does the Biblical one mention anything about losing feeling in the lesions or the papules (hard raised areas of skin). Indeed Leviticus notes the disease is going down into the flesh, not moving up.

Even more puzzling is that Tzarat does not just affect people, but also non living things, including completely inorganic things. First we have clothing (13:47-49) both of plant and animal materials, then in next week’s portion houses with tzarat growing in the bricks. (14:37) In both of these cases, the text mentions not white but red or green growths. This is not the behavior of bacteria, but something else: fungi.

To understand Tzarat as a mold is found in Leviticus 14. After a home owner reports the possibility of disease to a priest, the house is emptied of all its possessions, and then:

37. And he [i.e. the priest] shall look on the disease, and, behold, if the disease is in the walls of the house with depressions, greenish or reddish, which in look lower than the wall; 38. Then the priest shall go out of the house to the door of the house, and shut up the house seven days; 39. And the priest shall come again the seventh day, and shall look; and, behold, if the disease has spread over the walls of the house; 40. Then the priest shall command that they take away the stones in which the disease is, and they shall throw them into an unclean place outside the city; 41. And he shall cause the house to be scraped inside around, and they shall pour out the dust that they scraped outside the city into an unclean place; 42. And they shall take other stones, and put them in the place of those stones; and he shall take other mortar, and shall plaster the house. 43. And if the disease comes again, and break out in the house, after he has taken away the stones, and after he has scraped the house, and after it is plastered; 44. Then the priest shall come and look, and, behold, if the disease has spread in the house, it is a malignant leprosy in the house; it is unclean. 45. And he shall break down the house, its stones, and its timber, and all the mortar of the house; and he shall carry them out of the city into an unclean place. [Lev 14 37-45]

This is very close to the same guidelines the U.S. Environmental Protection Agency has for the remediation of mold. Fungi can cause types of dermatitis which can be similar to the symptoms mentioned above, some can grow on inorganic substances like rock or plaster, not to mentions infect leather wool and linen equally.

The rabbinic pattern of Tzarat first showing in the house, then clothes then people may not be farfetched. As the rabbis of Midrash Rabbah were people living in the same region as their ancestors, they were exposed to the same building materials, clothes, and climatic conditions as their ancestors. In rainy seasons, the plaster used in building constriction may have gotten wet and wicked the moisture into the area between stone and plaster, where the mold began to grow. Form there other items, including clothing would be affected. At the same time as it was the rainy season, people stayed indoors more often. Transmission of skin contact or through moldy clothes is not outside the range of possibilities for mold which would cause symptoms similar to the ones described, including the loss of pigmentation not only in skin, but in the hair.

Under these circumstances, Isolation and proper disposal of contaminated materials is the proper approach to the problem. In Miriam’s bout with leprosy, God commands Moses to shut out Miriam from the camp seven days (Numbers 12:14), the same procedure for tzarat as mentioned in Leviticus. The isolation was outside the camp not just to prevent contamination of others, but also prevents the person from having further exposure to the original source of the problem. For similar reasons everything inside of the house needs to be removed to prevent re-infection of the house with exposed materials. As Leviticus 14:46-47 notes anyone entering a sick building needs to be considered exposed for the rest of the day, anyone eating or sleeping in a quarantined home needs to be washed down.

I’ve had problems with the health claims for kosher. Yet for tzarat I’m willing to make the health claim. Granted, there is a spiritual component, and as I wrote last year, the kind of psychopathic activities the Rabbis ascribe as Tzarat for a punishment provide us with a reason for isolating such individuals. As someone involved with environmental health, the procedures ands details in the mitzvot of tzarat point to a environmental health concern above all else. Sick building syndrome is a real threat. The slightest water damage can cause immense health damage. In the aftermath of hurricane Katrina, we saw this on a horrible scale, not only among residents but among relief workers. After the flood waters receded, mold was everywhere, and the effects of mold were well. The Centers for Disease Control found that 54% of New Orleans police officers and 49% of the city’s Firefighters working at the disaster responding to the poll reported skin rashes for example (MMWR 4/28/06). No study I found has yet looked at long term effects, but based on evidence of earlier smaller flooding situations, they too may be devastating.

While Mycobacterium leprae may very well go extinct as a public heath issue within a decade according to the World Health Organization, molds and their mycotoxins never will. Tzarat will be around for quite a while I believe. Yet the reason for this and next week’s readings to be primarily a public health text in a spiritual text, outside of the rabbi’s insistence on lashon hara as its cause is still a mystery. We’ll look at that more next week when we discuss the other public health problem these texts discuss.