The Wartburg Project

September 26th, 2023

93. Leprosy in the Bible

I recently watched a movie, the Hawaiians, in which the Hawaiian government’s harsh treatment of lepers played a prominent role. Lepers and suspected lepers were exiled to a remote leper colony on the island of Molokai. Did the Bible’s practice of separation of unclean lepers from society play a role in this harsh treatment of lepers in Hawaii? Was it a result of the strong influence of American missionaries in Hawaii in the 1800s?

We can dispense with one issue quite quickly. The “leprosy” that was such a scourge in Hawaii was not the same as the “leprosy” described in Leviticus 13 and cured in Leviticus 14. The disease, or rather the complex of diseases, described in Leviticus 13 was not the equivalent of modern “leprosy” (i.e. Hansen’s disease, HD). The leprosy in the Bible[1] included a wide array of skin conditions such as eczema, psoriasis, boils, etc. In fact, some of the diseases described in Leviticus 13 cannot be identified. This “leprosy” was very often self-healing, disappearing within weeks. However, some of the cases of prolonged leprosy in the Bible, including some of those healed by Jesus, may have been the more devastating Hansen’s disease. In other words: the biblical diseases tzaraath and lepra cannot be equated with Hansen’s disease. The symptoms of Hansen’s disease would, however, cause a person to be included in the biblical category tzaraath.

A key difference is that in the treatment of biblical leprosy, the emphasis was on cure and rapid restoration of the victim. In the Hawaiian treatment of Hansen’s disease the emphasis was on permanent isolation of the victim.

Leprosy (Hansen’s disease) has been one of the world’s most feared and stigmatized diseases, yet it is one of the least communicable diseases. Most of the world’s population has natural immunity to this disease. The great dread of “lepers” probably comes from the horrifying appearance of the victims of Hansen’s disease.

People, both ancient and more recent, have been ready to point to any occurrence of a specific disease as a punishment from God, especially when they could think of no other cause. Today, we know that the immediate cause of Hansen’s disease is a kind of bacteria. The disease can be transmitted through direct person-to-person contact usually over a prolonged period of exposure. To get infected, a person needs to come into direct contact with mucous discharge of a leprosy patient. Months, or even years, can pass before symptoms begin to appear.

The disease attacks the nerves, causing severe skin and eye damage. Patients suffer from sores on the skin and a loss of feeling and paralysis in the limbs. Over time, these effects can lead to permanent disfigurement, crippling, and blindness. Eventually, the body’s weakened immune system is unable to fight off other sicknesses, resulting in death. Some patients, however, can survive for decades.

Ironically Gerhard Armauer Hansen’s identification of bacteria as the cause of the disease in 1873—a critical step toward finding a cure—strengthened the case for strict isolation, which had previously been based largely on fear and revulsion, not on science.

In spite of many experiments, no dependable cure was found until the 1940s. In 1941, Dr. Guy Faget used a newly developed sulfone drug, Promin, to treat patients at the U.S. Public Health Service National Leprosarium in Carville, Louisiana. After months of treatment with the new drug, the disease’s physical effects and transmission capacity were completely arrested. A cure had finally been found. Today Hansen’s disease is considered to be nearly eliminated, but not totally eradicated.

Leprosy in Hawaii

The large-scale immigration of Chinese sugar-field workers to Hawaii increased after 1850, and it is believed that they played a significant role in bringing leprosy to the islands. The Hawaiian name for the disease was Ma’i-Pake, which means “Chinese sickness.” The disease created strong emotional impact because it was recognized as a foreign invader, and it was ugly and frightening. The cause and the treatment of the disease were unknown. Fear took over.

In 1865, King Kamehameha V, a native Hawaiian, approved “An Act to Prevent the Spread of Leprosy,” passed by the legislative assembly of the Hawaiian Islands. The law called for land to be set apart to isolate leprous persons, and a peninsula on Molokai’s north shore seemed to be the perfect place for such a colony. The flat land was favorable for farming and raising livestock; the ocean was full of fish. The whole peninsula was isolated by a cliff up to 2000 feet high and by rough sea conditions.

All people in Hawaii who were suspected of leprosy had to be examined and treated in a medical detention facility on Oahu. If judged to be in an advanced stage of the disease, the patients had to be separated from their families and sent to the Kalaupapa settlement on Molokai for life. 

Initially life there was harsh, but the patients, with help from Father Damien and his associates, built a community with churches, police, marriages, and a form of government.

Lessons to be Learned

Although the Hawaiian leprosy crisis occupies a relatively small place in the history of epidemics, it furnishes a number of lessons about understanding how the human race deals with such epidemics, lessons which are relevant also to Bible students and to society today.

First of all, for Bible translators, there is the issue of preventing the confusion caused by the changing meaning of words like leprosy. The EHV addresses this issue by using translations like “impure skin disease” in Leviticus 13 and 14, where the various forms of biblical “leprosy” are being diagnosed and cured. Footnotes provide an explanation of the distinction from Hansen’s disease. In the familiar stories of Jesus healing lepers, the traditional terms leper and leprosy are retained in the text, with an explanation of the history of the term leprosy in the footnotes.

The main point of the leprosy law in Leviticus is not the effects of these ”leprosies” on health or their contagion, but it is on how the symptoms serve as symbols of the effects of sin. The law is not primarily a health regulation but is a religious law, part of what we call the ceremonial law. Since the fall into sin, our body is subject to decay and death from the time of our birth. Modern-day readers do not have to get too bogged down in the details of the diagnosis in Leviticus but can direct their attention to the basic lesson: as little as it is possible for people living in a sinful world to escape damage to their body, so little is it possible for sinners to remain pure. Such sin creates separation. But there can be cure and restoration. This is the main point of the leprosy law.

The tendency to assume that people who are suffering from disease must be at fault and must deserve God’s punishment, which was present in Hawaii, is still a temptation today. It is true that every suffering and disease is a result of sin, but it is not necessarily a result of a specific sin. Passages that warn against the common temptation to attribute blame to the victims include the book of Job, which exposes the sorry example of Job’s friends; Luke 13:1-5, in which Jesus rejects the idea that those who suffer disaster are greater sinners; and John 9:1-41, in which Jesus rejects the opinion that either the man born blind or his parents must be to blame for his plight.

Today some people are eager to interpret almost every crisis through the lens of a particular form of racism. The Hawaiian leprosy crisis was and is no exception. The Hawaiians named the plague the Chinese disease. There may have been an element of racial resentment involved in the term, but if there was, the racism was from native Hawaiians versus the recently arrived Asians. To some degree, the name was simply a recognition of the fact that the surge of leprosy followed the mass arrival of the Chinese. We should not be too surprised by this because there have been many diseases named from their supposed point of origin from the Spanish flu to Hong Kong flu to bird flu.

A very troubling question to the Hawaiian natives must have been that they seemed to be much more susceptible to the Chinese sickness than the Chinese.

Critics are quick to point out that the leper colony must have been racist because the majority of detainees were native Hawaiians. In a typical population at the colony of 800, more than two-thirds were Hawaiian or part-Hawaiian. The other significant block was Chinese. Then there was a sprinkling of Portuguese and only one or two “Americans.”[2] 

This race-centered interpretation of the colony ignores the fact that the colony system was set up and enforced by the native Hawaiian government because of their fear of and their fear for their own people. (Though to be sure, there was “American” influence on the Hawaiian monarchy,” and many Hawaiians with their values of strong ties of family and community, objected to the forced separation of families.) The main reason for the predominance of ethnic Hawaiians in the colony (euphemistically called the hospital or the settlement by the government) does not seem to have been racial bias against Hawaiians,  but the susceptibility of the native population to Hansen’s disease because they lacked the natural or herd immunity which the Chinese and other ethic groups had. The threat of leprosy to the “American” population of Hawaii was very low because they did not have close physical contact with the infected population. It was not even a significant threat to their pocketbooks because it affected only a small percentage of their plantation workforce.  

The numerical effects of the disease were relatively minor—eight thousand victims at the colony in over 100 years. There were many other diseases imported into Hawaii in the 18th and 19th centuries that brought much more devastating results to the native Hawaiian population than leprosy (syphilis and smallpox were two among many). This is paralleled by the tragic experiences of Native Americans. The reverse effect is also true. The newcomers to a land can also be devastated by diseases to which they have no natural immunity, as many European missionaries to Africa were. Lack of herd immunity is devastating without regard to ethnic boundaries. Commerce, travel, and colonization spread disease with little regard for ethnic boundaries.

There is a near universal tendency that with the arrival of a new threat, fear of the unknown leads to an accelerated search for scapegoats to blame, and for taking measures wildly out of proportion to their usefulness in countering the threat. This seems to have been true in Hawaii, but is not hard to find more recent examples in other lands.

There is a strong tendency in discussions like this to single out one ethnic group and focus only on the good they did or on the bad, rather than on the inevitable mix of good and bad. There were Hawaiians who disowned their afflicted relatives, but in many other cases healthy members of the family voluntarily went into exile on Molokai with their loved ones to serve as “helpers.”  The movie The Hawaiians portrays the first inhabitants of the colony as a zombie-like mob of the living dead, banding together to rob and rape the newcomers. This may reflect some horrors of the early years of the colony, but it does not give much attention to the efforts of the exiles to build a supporting community. The movie portrays native Hawaiians as the main enforcers of the exile, but the most heroic character among the exiles is a Chinese woman. The next most heroic character fighting against the ban is an American pineapple tycoon, but that is to be expected since this character is a black-sheep, non-religious descendant of a missionary family, and he is played by Charlton Heston. The most vehement racism in the film is between hostile ethnic factions of the Chinese immigrants, though haole social ostracism of Hawaiians and Asians is given due attention.

It is easy to be shocked by the appalling quarantine policies of the Hawaiian government, but other nations soon made mandatory isolation a government priority. The United States opened its first major isolation center in 1894 in Carville, La. In 1917, Congress passed a law that would force sufferers into isolation. The United States detained its last leprosy patient in 1960, although federal regulations allowed mandatory isolation until 1974, five years after Hawaii lifted its 103-year ban. On the other hand, the cure for Hansen’s disease was produced by a US government facility. Norway, the country where the cause of the disease was discovered, had one of the most liberal detention policies. The United States, where the cure was discovered, had one of the most stringent. Such crises are filled with sad irony.

In assigning blame and dispensing praise, everyone needs to beware of indulging in stereotyping ethnic individuals and groups and of rushing to assume that they have the wisdom to play the role of God in explaining things they do not understand. These lessons are universal and apply to every time and race.

The biblical view of lepers and leprosy is clear. Almost everything else in the discussion is muddled. The abundant online sources on the topic are a battle of conflicting “truths as writers select evidence to prove the assumption they started with, in order to make the case for their truth. Even Father Damien, the saint of Molokai, is seen both as a selfless hero, offering himself for others, and as a dictatorial tyrant. It seems likely that there is an element of truth in both views.  Life, people, and motivations are complicated. People are prone to select the data to confirm their theory. Critically examine the claims of the writers of history, and beware of using any movie labeled “based on a true story” as a fair picture of the true history.

In the passages cited above, Jesus gives us guidance for reacting to such crises. His guidance is that the most important outcome should be self-reflection and repentance. As far as our understanding of the situation, our conclusion will often have to be “Someday we will see clearly that God has loved us dearly.”

[1] Hebrew נֶגַע צָרָעַת nega tzaraath; in Greek - lepra, the source of the English word “leprosy”

[2] In the 1890s 36% of the population of the islands was Hawaiian or part Hawaiian. Only 7% was haole (white); 14% was Portuguese; 20% was Chinese, and 22% was Japanese. It is interesting that the Portuguese were not classified as haole, very likely because, like the Chinese and Japanese, they were imported as plantation workers, and maybe their skin was a shade closer to the Hawaiians. The distinction may have been based more on social status than skin color.