The Great Physician XXI: Hairy Sores

The sores in the early verse of Leviticus 13 had hair. The hair plays an important part in the priestly diagnosis of this skin condition. Hair color is defined by the ratio red, black/brown pigment. Color in hair is controlled by melanocytes of the hair and their presence or absence is genetically determined.  The number of melanocytes in any hair follicle declines with age from about thirty years onward but relatively few diseases cause graying or whitening of the hair.  In pathological states, hair whitening and loss of hair, are likely to be due to poor nutrition of the hair follicles by unsatisfactory circulatory or metabolic conditions.   Hypothyroidism and malnutrition may cause whitening and thinning of the hair but Hansen’s disease does not.  As I said in the last post based on language translation alone…this is not leprosy as we understand it today. The only other candidates then is Favus and Vitiligo are associated with whitening and loss of hair.

So…is this referring to abnormal hair growth within the lesion. Unlikely, what the Bible is referring to here was probably common enough to warrant warnings in the Bible and abnormal hair growth from the sore is so rare as to be highly improbably.  It seems therefore probable that this is hairy skin areas of the head and beard area. This is made more probable by the other description of ulceration taking place in hairless skin such as was considered in the previous verse.  White lesions that appear deeper than they really are. This could be psoriasis and favus. I believe this is unlikely as psoriasis is hard to mistake for an ulceration. I’ve had both. Ulcers in my mouth and psoriasis on my neck in the winter months.

When we reach verse 4 there are some classifiers. The next five verses until verse 10 are about what is, today, called differential diagnosis or observations, made over time, that allow the examiner to arrive at a clear diagnosis by the inclusion and exclusion of evidence. Whiteness of the skin without ulceration or any change in hair color is not enough to declare the patient impure. Verse tells us that the person needs to be ‘separate’ or quarantined for seven days to prevent possible spread. If re-examination shows the condition persists it will go another week.

After fourteen days, the patient is reassessed at a third meeting with the priest on the fourteenth day after his initial presentation.  This verse sets out the criteria for confirming the condition as being a minor impurity.  For this to be the case, the lesion must have faded and must not have spread in this is the ‘official diagnosis’ is a מספח or σημασία…. i.e. a scab; and the priest may, as a result, declare him clean/cleansed/pure/purified. What follows the diagnosis in order to obtain full purification is bathing and laundering of one’s clothes. 

Leviticus 13:7- 46: Further Symptoms & Signs

This group of verses deals with reappearing signs and more specific features seen in the differential diagnosis. There is a substantial amount of repetition in the text, but also pointers to additional diagnostic features and presentations in specific anatomical situations. They are as follows.

Leviticus 13:7-9: The Spread of The Condition

Leviticus 13:10-12: Whiteness 

Whiteness is emphasized here; a white swelling in the skin that has turned hair white.  There is no obvious physiological or pathological reason why this should’ve happened. Whiteness is usually associated with old scarring, scarred, or avascular flesh.  Raw or ulcerating flesh, in contrast, exposes granulation tissue which usually has a good blood supply and a velvety-red appearance.  Very frequently it becomes secondarily infected by bacterial invasion and the presence of pus may mislead one into believing it to be turning white.

Leviticus 13:13: Extensive Spread & Whiteness 

Leviticus 13:18-28 Boils and Burns

In the second half of the chapter we are introduced to a further case resulting from a pre-existing ‘boil’ Today, the expression boil is taken to mean an acute infective lesion usually due to an infecting bacterial agent such as Staphylococcus aureus and producing a localized inflammatory swelling. The lesion progressively becomes distended with pus and heals into a scar once the swelling has ruptured or has been incised and the pus has drained.   Boils are associated with poor skin hygiene and there is nothing to suggest their specific association with any type of specific disease. In the Bible, boils are viewed as a dreaded condition imposed upon an individual who has ignited the wrath of God. 

This idea is to be found especially in violation of the covenant, (Exodus 9:9 – 11, 2 Kings 20:7, Isaiah 38:21, Job 2:7 and Deuteronomy 28:27, 35).  It is very easy, in an age where antibiotics are taken for granted, to dismiss the seriousness of such a condition. It was very prevalent and was a painful scourge caused by poor cleanliness. Burns seem self-explanatory and a resultant infection from lack of cleanliness was not uncommon.