…that’s not acne, it’s the wrath of God

[The Leaven – exploring the relationship between science and religion (cont)]

Communities in the Biblical era knew nothing about the causative agents of disease. Despite this, the Old Testament contains valuable guidance on how to cope with the challenges presented by contamination and disease. In this period many extremely unpleasant diseases, such as smallpox and bubonic plague, would have been endemic and had the potential to wipe out entire communities. Unsurprisingly, epidemics were thought to be plagues summoned by supernatural beings, especially as some sectors of a population would appear to have greater vulnerability than others. When Ethiopian soldiers occupied the city of Mecca in 568 AD they were so afflicted by a severe disease that the conflict was forced to end. The migrating population had no acquired immunity to this disease, which was believed to be smallpox.

Smallpox was a viral infection and a major scourge at the time the Bible was written. The first detailed observations of it were recorded in 910 AD by al-Razi, an Arabic physician. Al-Razi was in charge of a hospital in Baghdad where he wrote a treatise on smallpox. His research gave some accurate epidemiological descriptions of the disease. For instance he noted that it was seasonal, occurring predominantly in the spring and he also distinguished the symptoms of smallpox from those of measles. The treatise was translated into Greek and Latin enabling Europeans to prepare for the disease as it spread towards their continent and other parts of the world. It is not clear if smallpox was as virulent a disease in ancient civilisation as it is today, but there were clearly references to dreaded skin diseases and plagues of boils in the Old Testament. Additionally, facial lesions that could have been caused by smallpox were found on the mummified body of Ramses V, who died as a young adult. As the pustules were still clearly visible the disease may have been the cause of his death. Smallpox eventually spread globally as a consequence of migration and trading. The Spanish introduced smallpox to South America in 1507 where members of an enslaved African community spread it to the local population. The disease spread around the Caribbean and in 1520 it was transferred to Mexico. It was believed that a member of a Spanish crew was suffering from the disease when one of their ships landed in Mexico. As it was an entirely new disease the indigenous people had no natural immunity or experience in dealing with it. When it arrived from Europe it practically obliterated the indigenous people of Mexico, the Yucatan and Guatemala.

Plague in the Bible. Painting by Matthias Gerung c1530-1532

As with smallpox, bubonic plague also spread globally through migration and trading. The causative agent of bubonic plague is the bacterium Yersinia pestis. It is a characterised by dark buboes, fevers and vomiting. Whereas smallpox is restricted to humans, bubonic plague could afflict both humans and animals resulting in a higher number of transmissible routes. Recent research believed that the disease originated from Nile rats and was then transferred to Black or Ship rats via its vector the tropical rat flea. It is thought that the disease may have become more virulent in the Black rat as it seemed to cause more fatalities in Europe than in the countries it originated from, or perhaps this was quite simply because the Europeans had no innate immunity towards the disease, a similar scenario to the one that allowed smallpox to devastate the indigenous population of the Americas. In 439 BC, an epidemic of bubonic plague that originated from Ethiopia arrived in Europe; the Greek, Thucydides, who survived the disease, recorded its progress. It caused the death of one in three people in Athens, including the statesman Pericles, and is thought to have contributed to the fall of classical Greece.

There is no doubt that plagues and skin diseases preoccupied ancient societies. Hebrews believed that illness and disease were the wrath of a powerful deity and therefore religion playing a prominent role in disease management. The High Priest had the unenviable responsibility of devising and implementing a programme of disease prevention by compiling and implementing rules and regulations:

The Lord gave Moses and Aaron these regulations. If anyone has a sore on his skin or a boil or an inflamation which could develop into a dreaded skin-disease, he shall be brought to the Aaronite priest. The priest shall examine the sore, and if the hairs in it have turned white and the sore appears to be deeper than the surrounding skin, it is a dreaded skin disease, and the priest shall pronounce the person unclean.
[Lev. 13. 1-4].

These regulations were a type of quarantine to prevent the spread of disease ensuring that infected individuals were segregated from the community until they were proven to be clean:

A person who had a dreaded skin-disease had to wear torn clothes, leave their hair uncombed, cover the lower part of their face, and call out, ‘Unclean, unclean!’ They remained unclean as long as they had the disease, and they had to live outside the camp, away from others, as did any other person that came in contact with an unclean person.
[Lev. 13.45-46]

Tuberculosis was another affliction that was very widespread and seemed to occur frequently. Evidence of it has been found in human skeletal remains. The bacteria that caused this disease are similar to the Bacilli that give rise to leprosy. Therefore people who had managed to survive tuberculosis were more likely to have immunity to leprosy, which was thought to be fairly rare at the time despite it being mentioned frequently in the Bible. When leprosy is mentioned in the Bible it is probably also referring to other more common infectious conditions such as ringworm, a fungal infection that gives rise to white hairs within infected areas, as described in the text of the Old Testament:

If anyone has a boil that has healed and if afterwards a white swelling or a reddish white spot appears where the boil was, he should go to the priest. The priest shall examine him, and if the spot seems to be deeper than the surrounding skin and the hairs in it have turned white, he shall pronounce him unclean. It is a dreaded skin disease that started in the boil.
[Lev. 13. 18-20]

Another Bacillus that caused skin lesions and may well have been the disease referred to as boils in the Old Testament, was Bacillus anthracis, the causative agent of anthrax.  B. anthracis is nearly always fatal when inhaled leading to respiratory failure and septic shock within two to three days. Prognosis is also not good when the B. anthracis is digested after eating infected meat. Cutaneous anthrax is the most common form of the disease accounting for 95 percent of all cases, if untreated the fatality rate is 5-20 percent, relatively low when compared to the other forms. Anthrax legions only occur in exposed areas, such as the hands and face, and are accompanied by local swelling. Ancient remedies for treating the disease included laying figs directly upon the sore. There may have been some benefit in this as figs have been found to contain a good source of natural antibiotics and vitamin A. Other natural materials with antibacterial properties such as sesame oil and wine were frequently used to dress wounds. The Hebrews discovered that these materials had beneficial properties through trial and error, in much the same way as how they knew that leaven could sometimes be impure.

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