Tzaraath

Purification ritual

then shall the priest command to take for him that is to be cleansed two living clean birds, and cedar-wood, and scarlet, and hyssop.

— Leviticus 14:4

Spring water is placed in an earthenware vessel, over which one of the birds (traditionally recognized as being a sparrow,^[15]) is slaughtered and into which the blood is allowed to run. The kohen (priest) then dips the remaining bird and other items into the bloodied water and sprinkles the metzora (the afflicted) seven times on the back of the hand. Some say the sprinkling was done onto his or her forehead.^[16] The identical procedure was performed for a house struck by tzaraath, with the sprinkling done on the lintel. The slaughtered bird was buried in the presence of the metzora and the live bird was freed into the open field.^[16]

The metzora washes their garments from impurity and shaves off all their hair, save for that located in places similar to those in which nega'im are not subject to impurity (Mishnah Nega'im 2:4). The metzora then waits for seven days to begin the final steps of his or her purification ceremony (Leviticus 14:8–9). On the seventh day, the metzora again washes the garments he or she had been wearing from impurity and again shaves off all of his or her hair. (Mishnah Nega'im 14:3) On the eighth day, the metzora brings three animal sacrifices to the Temple in Jerusalem: a sin offering of a female lamb and a guilt offering and a burnt offering, both of male lambs (Leviticus 14:10).

Blood from the slaughtered guilt offering was placed on the right ear, right thumb and right big toe of the metzora (Leviticus 14:14). The need for this to be done was cause for some complication, because the metzora was not allowed into Temple grounds prior to his purification process and the blood of the offering was not allowed out of the Temple grounds. To reconcile this dilemma, the metzora stuck these body parts through the gateway one at a time to receive the blood. The same was done with the oil from the flour offerings of the metzora. If the metzora lost any of these body parts after he was ready for purification, he could never obtain purification (Mishnah Nega'im 14:9).

Patches of the skin

Patches of the skin are confirmed as tzaraath by the occurrence of one of three signs:^[17]

1. white hair (והיא הפכה שיער לבן) – if at least two hairs within the confines of the negah turn white^[18]
2. healthy flesh (ומחית בשר חי) – if skin of a normal appearance appears within the confines of the patch^[18]
3. spreading (ואם פשה תפשה המספחת בעור) – if the patch became enlarged since the time of the initial examination by the Kohen^[19]

Whereas baldness is not a form of tzaraath, patches that occur on a bald scalp may be tzaraath if they meet the criteria as mentioned by the Torah. Such an eruption on a bald scalp must appear in a distinct fashion but is regulated by rules similar to that of nega'im on the skin; however, it can only occur on men. For a scalp eruption to be tzaraath, the lesion must be a white patch tinged with red (נגע לבן אדמדם).^[20] This can occur in one of two places: within what are referred to as a man's posterior baldness (קרחת) and anterior baldness (גבחת).

If someone cuts off some skin or a part of his body to remove a negah, he becomes impure, even if he had no confirming signs. He may become pure only after another negah forms.^[21] The exception is when a negah appears on the tip of the foreskin and is cut off during circumcision, which is permitted, because a positive commandment overrides a negative commandment.^[21]

Boils and burns

Boils and burns, as occur naturally as a result of an abscess, blunt force trauma or thermal insult to the skin, are not tzaraath and do not carry impurity. During the healing phases of these wounds, however, if certain signs that mimic those of the aforementioned patches appear, tzaraath may occur. Confirmation is by the occurrence of one of two signs:^[22]

1. white hair (ושערה הפך לבן and נהפך שער לבן בבהרת) – similar to that in patches (Leviticus 13:20 and 13:25)
2. spreading (ואם פשה תפשה בעור and אם פשה תפשה בעור) – similar to that in patches (Leviticus 13:22 and 13:27)

Bald patches or lesions of the scalp or beard

The initial symptom of this type of negah is patches of hair loss. According to Maimonides, scalp and beard nega'im are characterized by hair loss without any change to the skin of the bald spot ^[23] The Tosefta, however, maintains that the skin of the bald spot does indeed become altered in a negah. There are two confirming signs:^[24]

1. thin yellow hair (ובו שער צהב דק) – if at least two-and-a-half hairs from within the bald patch turn yellow (Leviticus 13:30)
2. spreading (והנה פשה הנתק בעור) – if the balding spreads, according to Maimonides. According to Abraham ben David, who quotes the Tosefta, this spreading would refer to spreading of a skin change as well (Leviticus 13:36).

Inspection of nega'im of human flesh, and tzaraath determination

For all of the different types of nega'im of human flesh, there is a similar protocol put in place by the Torah for determining whether or not the skin eruption is indeed tzaraath. The individual with the eruption must visit a kohen, who is a male possessing direct lineage to Aaron, who was the High Priest and brother of Moses. The kohen, trained in examining lesions and diagnosing tzaraath, will examine the lesion and determine whether or not it meets the specifications of tzaraath. Specifically, he will evaluate the lesion for the criteria mentioned above, except of course for the final criterion of spreading, which can only be diagnosed at a follow-up examination, should one be necessary. If during the initial examination, the characteristics of the lesion meet the criteria for tzaraath, the kohen will declare the individual tamei (טמא, "ritually impure"). (Leviticus 13:3, 20, 25, 30)

If the criteria are not met by the lesion during the initial examination by the kohen, the individual is confined in his home for seven days, pending a follow-up examination (Leviticus 13:4, 21, 26, 31) If the criteria for tzaraath are again not met and the lesion has not spread, there is a difference in protocol depending on the type of lesion.

• For patches of the skin, another confinement period of seven days is imposed.^[25]
• For boils or burns, the kohen declares it merely a צרבת (tzarevet, "scar") and there are no further examinations (Leviticus 13:23 and 28)
• For bald patches or lesions of the scalp or beard, another confinement period of seven days is imposed. However, prior to this second confinement period, the individual is shaved around the nesek (והתגלח ואת הנתק לא יגלח – "he should be shaved but the nesek should not be shaved), leaving a rim of two hairs completely surrounding the bald spot to make any spreading recognizable^[26] (especially according to Maimonides, who asserts that these lesions manifest as pure hair loss without any concomitant skin eruption.)

After the second confinement period of seven days, both those with patches on the skin as well as those with bald patches are re-evaluated once more.^[27] If the criteria for tzaraath have still not been met, the afflicted individual is declared tahor (טהר, "ritually pure").^[27] He or she, does, however, have to wash both his or her body and garments;^[27] due to the confinement, he or she is considered impure in some sense.^[28]

If the negah was declared ritually pure and later it spread, it must be shown once again to a kohen, who will then declare it tzaraath.^[29] There are many other regulations regarding the inspection:

• The kohen must be able to see the entirety of the lesion. Thus, if the skin eruption or bald spot wraps around either the body or body parts, or occurs at the tip of terminal body parts—any place that would preclude the observation of the entire lesion at one time (i.e. wrapping around the torso, scalp or arm, or occurring at the tip of a finger or toe) – there can be no declaration of tzaraath.^[30]
• In a similar vein, a kohen who is blind in one eye or who cannot see well may not perform the inspections.^[31] An eligible kohen may inspect anyone, including his relatives, except himself.^[32] However, it is not necessary that a kohen perform the inspection; anyone who is proficient in the laws of nega'im may perform the examination. However, only a kohen may declare purity or impurity. A non-kohen examiner may inform an accompanying inexpert kohen of his determination that a negah is or is not tzaraath and the kohen declares "purity" or "impurity".^[33]
• Nega'im do not render impurity on parts of the body that are naturally concealed by other parts of the body according to specific regulations. For skin eruptions on the legs, men are inspected standing as though they are hoeing and women standing as though they are rolling dough. For eruptions on the arms, men raise their arms as though they are picking olives and women raising their arms as though they are weaving or spinning.^[34]
• Nega'im do not render gentiles impure.^[33]
• A groom is exempt from visiting the kohen until the eighth day after his wedding for any nega'im on his flesh, garments or house. Similarly, there are no inspections carried out on the days of Passover, Shavuot or Sukkot.^[35]
• Even on the days when inspections are performed, they are only allowed for two hours each day: during the fourth and eighth hour of the day (corresponding roughly to 9–10 AM and 2–3 PM).^[36]

If, however, the criteria for tzaraath have been met, either during the initial exam or at either of the two follow-ups (when applicable) or even after a previous declaration of purity, the individual is declared tamei (טמא, "ritually impure"). The individual is declared impure even if the lesion did not worsen or spread but remained the same—the skin eruption must become dimmer in appearance for it to be declared pure at the second follow-up examination.^[37]

The metzora: management of tzaraath of human flesh

The individual who is declared impure with tzaraath is referred to as either^[38] a tzarua (צרוע) or a metzora (מצורע). The metzora is shunned and must live alone outside the confines of the community (Leviticus 13:46) The metzora tears his or her garments in mourning like those who are in mourning for a close family member and does not cut his or her hair. The metzora must also cover his or her face until the upper lip in the fashion of mourners, and he or she calls out "impure, impure" to warn others to keep their distance (Rashi Commentary on Leviticus 13:45).

The metzora remains confined outside of the community until his tzaraath vanishes. The metzora is evaluated by a kohen, who leaves the community to examine him. When the kohen observes the resolution of the tzaraath, he begins a procedure that ultimately reverses the impure status of the metzora (Leviticus 14:4).

Interpretations

Rabbi Samson Raphael Hirsch clams that tzaraath was not to be interpreted as a medical malady, but rather as a spiritual affliction. The verse itself arguably suggests this, as it directs those who find themselves afflicted to seek out a Kohen (priest) and not a doctor, while the Torah does permit and even encourages those who are in need of medical care to seek treatment from physicians.^[39]

The Torah's emphasis is clearly on the tum'ah (טומאה, "ritual impurity") that results from a diagnosis of tzaraath because the verses focus on the kohen's declaration of "unclean" – וראהו הכהן וטמא אתו ("The kohen will see [the eruption] and [declare] him impure").

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:^[40]

• an evil tongue (malicious gossip) (elsewhere, this is supported by the wordplay metzora (leper) - motzi [shem] ra (slanderer)^[41])
• murder
• a vain oath
• illicit sexual intercourse
• pride
• theft
• miserly behavior

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 Rabba 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 only required 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 of houses as having a practical benefit. According to one, as well as being a punishment for miserliness, it also demonstrated that the house owner was lying, if they had said they did not own certain objects neighbours had asked to borrow, since the biblical regulations require the house owner to take all their possessions outside prior to confinement.^[42] On the other hand, Rashi, basing his view on the Leviticus Rabbah,^[43] states that tzaraath of houses was a reward for the homeowner, arguing that the Israelite homes had previously been those of Canaanites, who had hidden their valuables in the walls; the tzaraath required the house owner to remove the bricks, and so find the treasures hidden there.^[44]

Rather than following the biblical descriptions of the symptoms of tzaraath in the manner of modern doctors, classical rabbinical literature took an extremely literal view.^[3] 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;^[45] 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 or burn subsequently heals, it still doesn't indicate tzaraath, unless the other symptoms occur in parts of the body not previously diseased.^[46] 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 that occur in the location of an unhealed boil or burn, and those that occur in hairy parts of the body, do not indicate tzaraath.^[47][48]

The items used in the purification ritual were specifically included to deliver a message to the metzora. The sin most associated with tzaraath is lashon hara (an "evil tongue",^[49] to speak derogatorily about others consistently to one's friends is likened to birds, who chatter endlessly.^[49] In a similar vein, the one who speaks ill of others is haughty, holding himself or herself high above others and is likened to the tall cedar. To be healed, the metzora must erase arrogance, making themselves lowly like a worm. This is a play on words—the word tola'as (תולעת) means both "red" and "worm" – as well as hyssop.

The remaining portion of the olive oil from the purification offering, called in Hebrew log shemen shel metzora, is retained by the kohen at the completion of his service. This portion is listed as one of the twenty-four kohanic gifts.

Appearance, inspection and management of tzaraath in clothing

Tzaraath appears in clothing as an intense green (ירקרק – yerakrak) or red (אדמדם – adamdam) eruption,^[53] and must be brought to the kohen for inspection. In regards to garment tzaraath, there are no criteria by which it can be declared impure upon initial examination. The garment is confined for seven days, and if on the seventh day, the negah has spread, it is a negah of tzaraath and is declared impure.^[54] Subsequent to a declaration of tzaraath, the garment, whether wool, linen or leather, is completely burnt (באש תשרף); if the tzaraath was confined to the woof or warp, only that need be burnt.^[55]

Upon re-evaluation after the seven-day confinement, the kohen may instruct that the garment with the eruption be washed and confined once more for seven days.^[56] If upon a second re-evaluation after the second seven days of confinement, the kohen sees that the eruption did not dim and did not spread, the garment is declared impure and must be completely burnt.^[57]

If the second re-evaluation reveals a dimming of the eruption, the kohen tears the area with the eruption from the garment and burns the torn out portion completely.^[58] The torn out area is patched to allow for a reinspection of the area for return of the negah.^[59] If, the eruption returns to the patch, there is no confinement period instituted and the entire garment is completely burnt.;^[60] if a negah reappears on the garment but not on the patch, the garment must be burned but the patch can be saved.^[61] To recapitulate, if the negah remained as it was after the first week of confinement, it is washed and reconfined. If it remained as it was after the second week of confinement, it is burned.^[59]

If, however, upon the second re-evaluation, the negah disappears, the garment must be immersed in a mikveh (מקוה, "ritual bath") and is then pure.^[62]

Tzaraath of the skin

Scholars suspect that the descriptions of tzaraath of the skin actually refer to a number of different skin diseases,^[71][72][73] which, owing to the undeveloped state of medical science at that period, were not distinguished.^[3] A wide range of diseases known to modern medicine have been suggested as differential diagnosis of tzaraath, including psoriasis, seborrhoeic dermatitis, favid, dermatophyte infections, nummular dermatitis, atopic dermatitis, pityriasis rosea, crusted scabies, syphilis, impetigo, sycosis barbae, alopecia areata, boil, scabies, lichen simplex chronicus, scarlet fever, lupus erythematosus, lichen sclerosus et atrophicus, folliculitis decalvans, morphea, sarcoidosis, and lichen planopilaris.^[74]

Of the particular situations that Leviticus 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^[2][71][75]
• the spreading of sores is regarded by scholars as most symptomatic of impetigo^[71]
• the spreading of swellings or spots in a burn injury, according to scholars, is most probably a result of erysipelas^[71]
• 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^[71]
  • 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^[71]
  • the additional presence of sores on the head or chin is thought by scholars to most probably indicate the presence of ringworm^[2][71]

Russian pathologist Gregory Minh discovered that leprosy is contagious; assuming that biblical tzaraat is non-contagious, he therefore concluded that tzaraath is in fact vitiligo. Similarly, Reuven Kalisher suggested that vitiligo is the most likely candidate for biblical tzaraath, as it is non-contagious, cause the hair located within the discolored area to turn white (also known as poliosis or leukotrichia), and can grow in size within a week to two-week period. Yehuda L. Katzenelson added that while vitiligo lacks the safachat characteristic of biblical tzaraat, the Mishna (Negaim, chapter 1) also does not mention this characteristic. However Katzenelson concluded his analysis by listing many unanswered difficulties with Minh's opinion.^[76]

Similar conditions not considered tzaraath

In addition to simple rashes,^[77] inflammations,^[78] and swellings,^[79] the biblical text mentions a number of other conditions that could be confused with tzaraath. Among other situations the text considers harmless are the appearance of dull white spots,^[80] white patches of skin without sores,^[81] and baldness without sores;^[79] the latter two of these are thought by scholars to most probably refer to vitiligo and alopecia, respectively,^[71] and the Bible remarks that the former – the dull white spots – are merely a form of freckles.^[82] 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),^[83] and those of reddish-white sores in areas of baldness;^[84] the former condition is identified by the Bible as plague, and scholars regard its symptoms as pointing to a diagnosis of smallpox,^[71] while the latter is unidentified in the biblical text, but considered by scholars to indicate favus.^[71]

In clothing fabrics

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.^[85] The biblical description of tzaraath in such fabrics is strikingly analogous to that of tzaraath in the skin,^[3] with, for example, spreading of the infection being tested for by isolating the fabric in question for first 7 days.^[86] The principal symptoms are described as being very green or very red spots,^[87] which spread within a week,^[86] or that do not change appearance at all after a fortnight, having been washed after the first week,^[88] or that return a week after having been torn out, if they also had faded with washing prior to being torn out.^[89] These descriptions are regarded by scholars as most probably indicative of certain moulds,^{[2][71][72][90]} and especially matching infections by Penicillium (the fungus that produces penicillin).^[2]

In houses

Mildew infecting a flat

Dry rot

The biblical text also describes tzaraath as infecting the walls of houses;^[91] the symptoms it describes are depressions in the wall, which are very green or very red,^[92] and spread over a period of seven days.^[93] The description is regarded by scholars as again being strikingly similar to the wording of the description of tzaraath infections in the skin,^[3] but still somewhat obscure;^[2] it would seem to fit some form of fungal growth,^[71] especially dry rot, which produces yellowish-green and reddish patches on walls.^[2]

After cure

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,^[105] some occurring straight away,^[106] and some occurring a week later.^[107] According to critical scholars, these are really two independent rituals spliced together, with the first group^[108] being the ritual that was originally part of the regulations for tzaraath of skin, and the other group^[109] 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.^[110] 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;^[111] 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 ezov, into the blood;^[112] this combination was used to sprinkle the formerly infected person seven times with the blood.^[113] Once the surviving bird was released over open fields,^[113] 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.^[114] 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;^[71] killing animals over running water was a widespread ancient custom.^[71] The cedar and ezob have more practical applications, with cedarwood having medicinal properties, and ezob being a good implement to use for sprinkling.^[71]

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),^[114] after which they must shave off absolutely all of their hair, including their eyebrows, and then wash themselves.^[115] 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^[71]), and a guilt offering (to apologise for the cause of the tzaraath^[71]);^[116] if people are too poor to afford that, the Bible allows the standard alternative set of sacrificial victims to be used instead.^[117]

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,^[118] 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 the formerly infected person's right ear lobe, right thumb, and right big toe,^[119] and then the rest of the oil from the priest's palm was to be poured onto the formerly infected person's head;^[120] critical scholars regard the Priestly Code, of which the tzaraath regulations are a part, to have been written in the early 7th century,^[121] 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 Nicanor) 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 that achieve this.^[71]