36 Epidemics and Pandemics

BACKGROUND
Diseases called leprosy had a long and complicated history in the ancient and
medieval worlds. The ancient Hebrews discussed, especially in the book of
Leviticus, the presence in their midst of tsara’ath, a “repulsive scaly skin dis-
ease” (as E. V. Hulse has translated it). That condition was perhaps identical
with medieval leprosy, and the Hebrews’ discussion of the rituals to be per-
formed when one was diagnosed with it entered into later Christian attitudes
toward leprosy. The ancient Greeks also described similar diseases, which they
called elefantiasis and sometimes lepra. Early Islamic authors described two
such diseases, one probably identical with medieval leprosy, the other what is
now called elephantiasis. In the early medieval West, some comments on lep-
rosy began as early as the eighth century.
Some confusion about the term for the disease played an important role in
medieval attitudes toward it. Medieval Christian scholars equated the disease
known to them with the ailment subject to the ritual isolation prescribed in
Leviticus, rendering (perhaps incorrectly) the Hebrew tsara’ath as their leprosy.

HOW IT WAS UNDERSTOOD AT THE TIME

In equating the Hebrew “repulsive scaly skin disease” with their leprosy, me-
dieval Christian writers imposed on it the notion that the disease was divine
punishment for the wrongdoing, or sins, of the sufferers. The ancient Hebrews
had not emphasized wrongdoing or sin as much as a neglect of divine ordi-
nances about cleanliness, a neglect that required rituals to appease God’s anger.
Priests of the community made the diagnosis of the signs of ritual uncleanness,
and prescribed the isolation and other rituals of atonement to be performed.
Medieval Christians followed Leviticus in assigning a diagnostic role to the
clergy. But for medieval Christian authorities, the issue was more mortal sin
than uncleanness, and the punishment was far more permanent and less
amenable to atoning by ritual. The sin most often held responsible for leprosy
was lust, although gluttony was sometimes blamed.
Medieval physicians (and others) interpreted the disease within the frame-
work of the humoral medicine derived from ancient Greek authors, especially
Galen and the body of writings attributed to Hippocrates. That approach be-
lieved that diseases resulted from imbalances in the four humors (blood, phlegm,
yellow bile, and black bile) that coursed through the body. Diseases that related
to passion, or lust, were associated with disorders and imbalances of blood, and
some symptoms of leprosy seemed to confirm that association, especially the