Are There Still Lepers? The History of Leprosy in 5 Chapters

Lepers populate ancient sources, including the Bible. There were leprosaria in the Middle Ages — dreadful places where lepers came to live and eventually died apart from the society that feared them.

The first symptoms of leprosy appeared as white spots on the skin, and as there were no modern diagnostic methods, people would hide the signs carefully. Society protected itself from infection with harsh methods, and any suspicion that one was sick ended with banishment or stoning. Potential patients would sometimes have to move into a leprosarium. And if the diagnosis was wrong and the white spot originated from a different cause — one would get infected there for real.

Being moved to leprosaria equaled a death sentence, and a horrifying death it was. Completely healthy people could end up here and die of leprosy. But the fear was often unjustified as Hansen’s disease, today’s medicine’s name for leprosy is not very infectious.

Hansen’s disease is caused by mycobacterium lepra. Its incubatory period is relatively long — between one to eight years. If untreated, it results in oozing blisters on the skin that smell terribly like rotting matter. Then the nerves are affected and limbs are damaged, the patient stops feeling them, and eventually, the skin bursts and deforms. The puss in the blisters is the only truly infectious symptom in the patient.

We can cure lepers today in all stages of the disease with antibiotics. Every year more than a quarter of a million people fall sick with leprosy, but the mortality rate is not that bad. The condition works slowly, and antibiotics eventually heal the body. However if skin, limbs, or bones have been affected, those cannot be cured as the damage is permanent. The diagnostics are tricky because mycobacteria leprae cannot be cultivated in vitro, and only humans can become lepers. Other animals are immune to the sickness, thus lab experiments are limited.

The Bible mentions lepers quite often. Leprosy is one of the most mentioned sicknesses in Scripture. But the Bible is a religious text; it uses symbols and metaphors, and we cannot read it as a scientific paper.

We can surely conclude that the ancient nations knew about leprosy. But not every case of Hansen’s disease mentioned in the Bible was caused by mycobacteria lepra. The moralists of the Bible connected leprosy with ritual impurity. The leper, as well as any woman currently in the wrong phase of their menstrual cycle, was considered unclean and unable to come into the presence of God. Old Testament morality connected sickness with well-deserved punishment from God, unlike New Testament ideology, which praises the ones who suffer.

Ancient Jewish priests looked for a cause of personal suffering and ugly diseases, like leprosy, in the patient’s conduct. They looked for their guilt. When one was so visibly in God’s disfavor as the leper was, society shunned them not only because of the fear of physical infection but due to spiritual corruption. Thus, the sources are unclear and don’t provide reliable information concerning numbers or the treatment of lepers.

Chapter 3: When Leprosy Was Not What it Seemed

Doctors today find it difficult to diagnose Hansen’s disease in living lepers. It is easier for archeologists. Advanced stages of leprosy mark the bones, and we can find epidemiological evidence in the corpses and bones of our ancestors. These sources tell us that leprosy was prevalent in ancient Greece, Rome, and throughout the Middle Ages. The most severe epidemic (if we can call it an epidemic) spread through Europe between 1000 and 1250. Yet, it seems that leprosy was purely a European disease, and comparing the biblical texts with other ancient written sources complicates things. It appears that leprosy was uncommon in ancient Palestine, and it is highly improbable that Jesus Christ would have found whole crowds of lepers to heal.

The fault lies with the Greek translators of both the Old and New Testaments. They identified the unknown ailment under the Hebrew name “tzaraath.” But scholars today have pointed out that the biblical “tzaraath” was not contagious. The ostracization of the “lepers” in the Old Testament was not due to the fear of infection but rather a ritually defined punishment. “Tzaraath” was a visible sign of God’s wrath, and the sinner had to cleanse their sin ritually. Although some of the “lepers” might have really had Hansen’s disease, most probably, the cause was not bacteria. The lepers in the Bible were afflicted with skin imperfections for long periods. Thus, the disease was definitely chronic. We believe the biblical lepers might have suffered from autoimmune diseases like vitiligo or psoriasis.

As explained, ancient and biblical lepers actually did not suffer from leprosy. But medieval lepers had mycobacteria leprae — or didn’t they? Well, not all of them. Between 1000 – 1250 every large city had its leprosarium, yet we know that only a tiny percentage of people that meet lepers get infected.

The number of lepers in medieval times does not make sense from the epidemical point of view; leprosy is not that contagious and does not spread so quickly. Asymptomatic patients are not infectious at all, and before puss emerges in the lesions, they would not pass on the infection. Archeological research also does not confirm what the written sources tell us about the number of lepers in medieval cities. How can this be?

It seems it was not such a bad fate to be called a leper in the Middle Ages. If you were poor or homeless, death by starvation or by a murderous gang on the street could considerably shorten your life. At the same time, lepers were given housing, clothing, and food. Wealthy and charitable people took care of lepers, founding leprosaria was a favorite form of charity, and god-fearing souls came to care for the sick inside.

If you were proclaimed a leper, you had to move into a leprosarium but the number of real lepers with the terrible Hansen’s disease must have been low. According to today’s research, only 1% of those exposed to mycobacteria leprae fall sick. The risk of dying on the street was much higher. Even if people get infected, they will remain completely healthy for one to eight years, and even then, the symptoms would develop very slowly. Last but not least, lepers were allowed to beg. City authorities would chase all the beggars from the streets, but lepers could stay in most cities.

In the first half of the 14th century, the lepers disappeared from written sources. Thus, they must have vanished from medieval cities as well. But where did they go? The disappearance of leprosy from medieval sources coincides with the plague’s emergence. For a while, scholars believed that plague builds immunity against Hansen’s disease and that the two illnesses cannot exist next to each other. But this theory proved false. You can fall ill with both leprosy and plague simultaneously and plague would kill you.

The theory mentioned above about false lepers provides a perfect explanation for the disappearance of leprosy. When the plague came, society broke down. There was no money, no resources, and no people to care for the lepers. Leprosaria closed down; the lepers stopped begging in the streets because suddenly being visibly ill would make people run away rather than spend money on a charitable deed.

The privileged position of lepers in medieval society depended on their relationship with God. Early medieval moralists believed that lepers were blessed because, unlike others who live happily, they repented their sins. They sinned (as did all), were punished for their sins, and publicly repented. But not in the late Middle Ages, with the plague killing whole villages mercilessly.

There was no place for individual sin and individual repentance. Moralists and prophets called the entire society, the whole of Christendom, to repentance. Whole villages publicly and spectacularly renounced their old sinful ways, and scapegoats were murdered in their hundreds. Because the plague was a collective punishment, collective guilt was pronounced. And what about the lepers? Who cared about some white spots on the skin that did not even hurt and could be carried for years without so much as a fever? Now, people discovered a black lesion on their skin and perished within 24 hours. When the plague came, the lepers were forgotten.

The idea of leprosy vanished, and so did leprosy itself. There are lepers today. A quarter of a million cases are reported every year. Most of the reports come from the less developed parts of India, Brazil, and Indonesia. Yet, we can be pretty sure that these lepers don’t suffer from the same illness as the biblical lepers or most of the reported medieval cases.