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Christian Healing in Late Antique
Cappadocia: The Example of the Leper

Emily Marso

The status of the leper in the ancient world was one of marginality, pollution and defilement. Srboljub Zivonovic eloquently describes the physical and social consequences of the disease:

Leprosy is probably the disease which man has always most greatly feared. Probably no other disease has left man with so terrible an impression and filled him with such horror at the thought that he might fall victim to it. To contract this abhorrent disease meant to be isolated from the world, driven out of the company of men, stigmatized forever, without any hope of ever being cured. The sick man knew that he would be deformed permanently, that everyone would flee from him, that he would be forbidden entry into the community or any contact with his fellows. Leprosy was regarded as the most terrible of punishments, the most atrocious destiny that anyone could experience. (1982: 229)

The emergence of Christianity with its doctrines of healing and mercy brings about an important change in the status of the leper, and of the sick in general. The importance of healing was not unique to Christianity. Other Greco-Roman religions, notably the cult of Asklepios, also emphasized healing. What is unique to Christian tradition is the understanding of the healing of the sick, in concert with the care of the poor, as the highest virtue and a fundamental duty. Drawing from the examples of healings in the gospels as well as from tensions in fourth century society, the Cappadocian fathers made healing the focus of their humanitarian efforts. This focus was sharpened through the use of the leper as the symbolic locus of Christian attitudes towards elements of society otherwise marginalized and forgotten.

In this paper I intend to discuss the historical position of the leper in Greco-Roman and Jewish tradition at the time of the emergence of Christianity, and compare this position with the treatment of lepers in the gospels. The attitudes displayed towards lepers in the gospels, in concert with other gospel messages about compassion and mercy, allow the Cappadocian fathers to employ the leper as the symbolic focus of philanthropic endeavors in the fourth century. This paper will examine how and why the stance of Christianity towards the leper is different from that of the cultures in which it arose. An examination of attitudes towards the polluted in the gospels and the writings of the Cappadocian fathers combined with the unique situation of the Church[1] in the fourth century will help in establishing an understanding of the role of the leper in Late Antique Christian belief.

To understand the how leprosy was regarded in Late Antiquity, it is important to be familiar with the physical ramifications of the disease.[2] Leprosy is contracted by direct contact with a bacterium called Mycobacterium leprae. The disease manifests itself quickly and visibly in the body:

The local nerves are quickly attacked and become incapable of transmitting impulses, so the victim may suffer loss of sensation and at the same time local paralysis. These changes [nerve damage] lead to the gradual withering of certain parts of the body which results in the so-called ‘claw hand’ and deformed feet, though any part of the body may suffer. Since the sick man’s sensation is impaired, he may suffer injuries of which he is not aware . . . The face has a characteristic leonine appearance as the skin becomes furrowed and thickened, and nodules appear on the nose, the ear conchae and the cheeks. Sometimes these nodules burst open, creating terrible wounds, generally in the region of the nose, which destroy the nasal septum and the palate. The process develops little by little, perhaps lasting for decades, so that the sufferer usually dies from some other disease or from old age and not from leprosy itself. (Zivanovic 1983: 230)

Victims of leprosy are branded by their physical appearance. Physical effects such as those described above make it impossible for a leper to partake in society without his or her illness being apparent. Unlike many other life-threatening diseases, leprosy cannot be hidden or disguised. “It resorts in deformities and mutilations that provoke communal disgust” (Grmek 1989: 152). The leper’s body bears witness to the consequences of the disease.

The physicality of leprosy had a distinct impact on the attitudes of Greco-Roman culture towards the disease. Beginning in the first century C. E. literary evidence from the Greco-Roman world addresses concerns about a disease that can be identified as medical leprosy (Grmek 1989: 168). Writers from this period regard medical leprosy as a disease new to Greece and Rome, though not unknown in other parts of the Mediterranean world, especially Egypt. Out of the literary evidence of the period, the words of Aretaeus of Cappadocia speak most directly to the social attitudes towards the disease (Grmek 1989: 170).

Who would not wish to escape these diseased people, and who does not turn away from them in horror, even if one’s own son, father, or brother is among them? We fear the transmission of the disease. For this reason, there are those who abandon their most cherished relatives in the desert and the mountains, from time to time bringing them provisions, or they leave off doing even that and let them perish. (Grmek 1989: 171).[3]

Aretaeus was a first century physician trained in Alexandria and Rome, well qualified in the examination of disease. Here he is recording the very human reaction to serious disease. The sick are regarded by the healthy as ‘other’; they are feared and driven out to live in isolation in the deserts and mountains on the fringes of society. The leper, regardless of former identity, becomes categorized as sick and dangerous and is forcibly expelled from the rest of the community.

The same social marginalization can be seen in the Jewish tradition. In biblical law the social and physical rejection of the leper is formalized. In Leviticus 13 the conditions of leprosy are defined and the label of impurity is firmly fixed. Verse two states that if anyone is seen to have a “swelling or an eruption or a spot” on the skin he or she is brought to the priest for examination. If the priest determines that the person has any of the carefully detailed and enumerated signs of leprosy he or she is declared unclean and isolated for seven days. After seven days the suspect is examined again by the priest. If the symptoms still persist, another seven days of isolation are ordered. If the suspect is unchanged after the second period of isolation has ended the suspect is declared unclean and forced to leave the community, bearing visible marks of their ritual status:

The person who has the leprous disease shall wear torn clothes and let the hair of his head be disheveled; and he shall cover his upper lip and cry out, ‘Unclean, unclean.’ . . . He shall live alone; his dwelling shall be outside the camp. (Leviticus 13: 45-47)

The proscriptions surrounding leprosy in Leviticus present the same reactions of fear and exile as Aretaeus. The sick are understood as a threat to the community and are therefore rejected and forced into the margins of society.

There is controversy over the medical reality of what is translated as ‘leprous’ in the Bible. It is clear from the Leviticus passage that some of the skin qualities listed as possible signs of pollution are not consistent with the symptoms of medical leprosy. It seems that the signs in Leviticus also refer to other less debilitating ailments of the skin, such as psoriasis and eczema (Grmek 1989: 161). It does, however, seem probable that medical leprosy was included as one of many diseases of the skin which could be diagnosed by the signs listed in Leviticus. Though it cannot be disputed that the designation of the unclean in Leviticus is a religious act with ritual significance and not a medical diagnosis, it is justified to conclude that “leprosy (medical leprosy) is the only chronic skin disease whose seriousness justifies the social remedies of the biblical legislation” (Grmek 1989: 161).

The designation of lepers and those with other visible skin diseases as unclean is part of a larger structure of categorization in Jewish society.

Defilement is never an isolated event. It cannot occur except in view of a systematic ordering of ideas. . . . The only way in which pollution ideas make sense is in reference to a total structure of thought whose key-stone, boundaries, margins and internal lines are held in relation by rituals of separation. (Douglas 1966: 42)

Jewish society was firmly structured around ritual designations of clean and unclean, which were clearly demarcated in biblical law. Many aspects of daily life such as what food could be eaten, how it was to be prepared, who could attend temple, and what kind of clothing could be worn, are determined by classifications of purity in the Bible. The rules in Leviticus regarding lepers are part of this broader system:

Much of Leviticus is taken up with stating the physical perfection that is required of things presented in the temple and of persons approaching it. The animals offered in sacrifice must be without blemish, women must be purified after childbirth, lepers should be separated and ritually cleansed before being allowed to approach it once they are cured. (Douglas 1966: 52)

Placed in this social context, the restrictions against lepers become more discernible. The extremely visible physical marks the leper bears place him in a set of people and objects which are unclean because of their physical deviation from the norm.

In the New Testament, the ritual designation of the leper becomes a central theme. The leper becomes part of a larger attempt at inclusion by Jesus’ ministry for those sections of society Jewish law considers unclean. “Jesus is depicted as performing healings and exorcisms in such a way as to open up participation in the group of his followers in circumstances which directly violated Jewish . . . rules of separation” (Grmek 1989: 78). The gospel stories contain a number of moments when Jesus heals the unclean, changing their ritual designation in the process. The example of the healing of the hemorrhaging woman in Mark 5:24-34 is especially illustrative. In this passage a woman suffering from an unusual menstrual flow which had rendered her unclean for twelve years touches the hem of Jesus’ robe and is healed, both of her disease and of her polluted status.

Her “uncleanness” has been removed; she is no longer an outcast. She may now go home . . . in a state of wholeness and restoration . . . the healing of the woman with the hemorrhage is as much a purity miracle as anything else. Instead of conveying uncleanness to Jesus whom she touches, cleanness is conveyed to her. (Evans 1997: 368)

Under Judaic law, if a clean person were touched by a polluted person, the clean person became contaminated by the other’s pollution. Jesus’ touch reverses this paradigm; his touch conveys cleanness to the polluted.

The same power of touch is demonstrted in the healings of lepers in the gospels. In Mark 1:40 Jesus touches a leper and cleanses him, telling him to go back and show himself to the priest to formalize his new unpolluted status. In Luke 17:11 a similar cleansing of lepers occurs. Jesus again lays hands on those made unclean by leprosy and sends them to the priests for recognition of their cleansing. In Matthew 26:6 Jesus further emphasizes his acceptance of the polluted by being in the house of Simon, who is mentioned specifically as a leper. As these examples illustrate, in the gospels the leper is put forth as an example of one who is polluted to illustrate Jesus’ acceptance of the outcast and the oppressed. This is a marked change from the strict divisions of Jewish society and law.

In the context of a society which is concerned with purity and in which contact with the impure carries with it significant consequences, Jesus' touching of “sinful” people, lepers, corpses, and others who in various ways are understood to be cultically compromised is indeed remarkable. (Evans 1997: 360)

The polluted fringes of Jewish society are brought into the fold of the Christian flock through the change healing brought to their ritual designation. As part of the larger gospel message of love and mercy, “the socially and religiously ostracized are welcomed into the kingdom [of God]” (Evans 1997: 375).

By the fourth century, the ambiguous identification of leprosy in the Bible disappears and Christians begin writing unmistakably about medical leprosy. The reaction to this disease reflects and realizes the attitudes of Jesus towards the unclean in the gospels. The leper is not to be forgotten and exiled in these Christian texts, but embraced in a social program of mercy and almsgiving. The sermons of Gregory Nazianzus illustrate the Christian attitudes towards those suffering from medical leprosy. Like the Aretaeus of Cappadocia, Gregory is aware of the fear and loathing with which people perceive the disease. Gregory chooses to emphasize the emotional and psychological reaction to the disease in order to exhort his congregation to recognize that disease does not destroy the humanity of the sick. Medical leprosy is regarded as the most horrible example of the consequences of disease and, in that illustrative role, the leper becomes the central symbol of Gregory’s formation of an all-encompassing concept of charity.

In his sermon On the Love of the Poor and those Afflicted by Leprosy (1959: 43-64), Gregory Nazianzus identifies the greatest Christian virtue as “love of the poor [and] sympathy and compassion for our fellow man, “ to “open our hearts to those who suffer affliction, whatever the cause” (1959: 45). He mentions orphans, widows, and slaves enduring harsh treatment from their masters, among others, as deserving of mercy and compassion:

But above all these must we be moved to pity for those who are being destroyed by the sacred disease (leprosy), whose flesh is consumed even to the bones and marrow, betrayed by this weak, miserable and faithless body of ours. (1959: 45-46)

The obvious severity of the disease and of the reactions to it makes the leper become the focus and ultimate expression of Christian charity.

To enhance the reactions of his audience to the plight of the leper, Gregory describes in poignant detail the physical consequences of the disease:

Spread out before our eyes is a sight at once terrible and pitiful; unbelievable to all save those who look upon it. Men dead yet living; mutilated in parts of their bodies; so afflicted they scarcely know who they are or who they were or where they came from. Rather they are the unhappy remains of men; crying out, so as to be recognized, the name of a father, of a mother, a brother, or some place. . . . This is my name. You once knew me; you were my friend! And they cry out in this fashion because they can no longer be known by the faces they once possessed.
. . . Alone among mortals, they both hate and pity themselves. (1959: 47)

Entering the mind of the leper in this way allows Gregory to remind his audience of the humanity which exists even in a body ravaged by leprosy; to show his congregation that “we are all one in the Lord . . . sound or sick” (1959: 46). All men have been given a body created by God, and all men are equally susceptible to illness in this body. “Every man who has put on this body is brought close to the body’s dangers” (1959: 57).

This humanism continues in Gregory’s descriptions of the social prohibitions placed on the leper. His description of the reaction of communities to lepers in the fourth century differs little from Aretaeus’ testimony from the first century:

They are driven from the cities, shut out from the homes of men, from the market place, from the highways, from the gatherings of friends, from meetings. O the suffering! Even from water, from the streams which flow for the use of all men; even from the rivers, which are believed in some way to be tainted by them. And what is contrary to all belief, we drive them away as accursed. (1959: 48)

Gregory shows that the attitudes of the community towards the leper have not changed, despite centuries of Christianity and its doctrines of compassion and mercy for the oppressed.

In Gregory’s sermon, the leper gains a unique power despite, or rather because of, the poverty and isolation of his condition.

We must never neglect those that have fallen into this public infirmity [leprosy]; nor should we rejoice more that our own bodies are healthy, than we should grieve because our brothers suffer. Rather we should fix in our minds the thought that the salvation of our own bodies and souls depend on this: that we should love and show humanity to these. (1959: 46) .

With this statement, Gregory places the power of redemption in the person of the leper. It is only through being able to love and care for the leper that the Christian can be saved. The Christian needs the poor and the sick to be redeemed by acts of charity and love towards the less fortunate. “Far be it from me that I should abound in riches, while they suffer in want; that I should be healthy, and not bring help to their wounds” (1959: 51). Seeing humanity through the graphic physical deformities of leprosy forms the greatest test of Christian charity. “Even the best and kindliest of men will show himself hard and inhuman to these [lepers]” (1959: 47) and mothers and fathers will mourn their sick children as if they were dead. It is the role of the Christian to care for those whom society forgets, whose human family has deserted them. The Church regards the marginalized as “our brothers in God, whether you wish it or not” (1959: 48-49).

Fundamental to the concept of the lepers’ power to redeem is the biblical example of Luke 9:46-48: “Whoever welcomes this child in my name welcomes me, and whoever welcomes me welcomes the one who sent me; for the least among you is the greatest.” This passage makes it possible for Gregory to present the leper as Christ:

Visit Christ in His sickness, let us have a care for Christ in His sickness, let us give to Christ to eat, let us clothe Christ in His nakedness, let us do honor to Christ. . . . Let us give Him this honor in His poor, in those who lie on the ground before us this day, so that when we leave this world they may receive us into eternal tabernacles. (1959: 64)

Caring for the leper is caring for Christ, and such acts of mercy and charity are the key to redemption.

Gregory’s sermon was shaped by the attitudes of the fourth century. “The fourth century was a time of change and innovation, a century which began with the most ferocious persecution of Christians since the birth of the new faith in Jerusalem and ended with orders issued by a Christian Emperor to close all pagan temples” (Miller 1985: 68). Population growth, movement from rural to urban spaces, high rates of conversion, and the advantages of legal and favored imperial status all helped to place power in the hands of the bishops of important cities (Miller 1985: 68). The combination of these factors led to the shift of power from the ancient structures of city government to the formation of Church power in a new Christian city.

The first problem the bishops of these cities faced was the masses of the poor in the city streets. Due to population growth in rural areas in the East and the ensuing scarcity of farmland, many peasants moved to the cities in search of opportunity. “Most of these newcomers had been simple peasants; with no skills with which to make a living in their new urban homes, they soon sank into desperate poverty . . . forced to live in wretched deprivation, sleeping in alleys . . . without adequate food or clothing” (Miller 1985: 70). Church leaders saw in the urban poor a means to visibly demonstrate the doctrines of the church as well as a way to cement their power in the city. “The Church shouldered this heavy task both in response to Christ’s commands and as a result of the impotence of local polis governments in responding to the new conditions” (Miller 1985: 70).

Basil, bishop of Caesarea from 370–379, exemplifies the philanthropic endeavors of the fourth century. During his episcopacy Basil erected a complex of buildings, the ptochotropheion, designed to care for the poor and the needy outside of Caesarea. This complex was to be run by the monastic community, establishing a symbiotic relationship between the Church and the poor. By running the complex the monks could fulfill their duty to do good works and the needy could receive the aid they required (Miller 1985: 85). Caring for the poor through the establishment of the complex also bolstered the position of the Church. Basil identifies himself as “defender of the oppressed” (1955c: 292), and exhorts the government prefect of the province to “furnish your powerful assistance for the poor" (1955b: 291) by exempting the almshouse of the district from taxes.

In the ptochotropheion there is special emphasis on healing and care for the sick. In Letter 94 Basil writes that “those needing some treatment in their illness” are provided with doctors and nurses as well as a place to stay and food to eat (1955a: 210). In his funeral oration for Basil, Gregory Nazianzus writes of “the care of the sick and the practice of medicine, our common intellectual vocation” (1953: 79). He refers to the complex as “the new city” where “sickness is endured with equanimity (1953: 80).” The complex is the answer to the problems of the poor in the cities:

We no longer have before our eyes the terrible spectacle of men who are living corpses, dead in most of their limbs, driven away from their cities and homes, public places, fountains, even from their dearest ones, and more easily recognized by their names than by their bodily features. (Gregory 1953: 81)

These symptoms are reminiscent of those Gregory Nazianzus uses to describe lepers in “On the Poor” (1959). This similarity enforces the idea that the complex integrated the treatment of medical leprosy into its philanthropic mission. The leper is not only included among those receiving care and treatment, but also serves as the symbol of the humanitarian principles behind the hospital’s creation.

Others had their cooks and rich tables and enchanting refinements of cuisine, and elegant carriages and soft flowing garments. Basil had the sick, and the dressing of their wounds, and the imitation of Christ, cleansing leprosy not by word but in deed. (Gregory 1953: 81)

Caring for the leper becomes the mark of the Christian’s duty to treat all men as “one in Christ Jesus.”

The philosophy of Basil’s complex bears little resemblance to the practices of the cult of Asklepios, the contemporary Greco-Roman healing cult. The primary goal of the cult was the miraculous healing of the sick.

Asklepios' peculiar importance rests with the private cult; that is, the religious activity undertaken in the sanctuary by individuals for their personal well-being, and in particular the healing of illness. (Tomlinson 1983: 19)

People would come to the temple when the medical resources of the time had failed to bring about a cure, or if they had no access to a physician or lacked the resources to pay his fees. The process of healing in the temple is ritualized and miraculous:

Each individual had to approach the god by way of a set ritual. This included preliminary sacrifice and purification by ritual bathing. The general method of approach was for the suppliant to spend a night sleeping in the sanctuary. . . . While the suppliant was asleep the god manifested himself, generally in the form of a vision, which the suppliant subsequently remembered. (Tomlinson 1983: 20)

The healing would come as a result of this vision of the god. This cultic practice bears little resemblance to Basil’s hospital. There is no emphasis on creating a place for the poor to be cared for, nor is there a moral value to the healing practice. All persons had access to the miraculous intervention of the god, regardless of their status or ritual condition.

In the unique situation of the development of the Church, the leper comes to symbolize healing and compassion. The obvious physical consequences of the disease, the gospel precedents of its healing, and the unique social problems of the fourth century enabled the Cappadocian fathers to locate the symbolic focus of Christian charity in the body of the leper. This remained, however, an ideal model for the treatment of lepers. The fear and loathing the disease created in those who came face to face with its victims did not disappear as a result of the Church’s efforts in the fourth century. A Syrian bishop in the sixth century was not above exploiting the reaction to the more unsavory aspects of leprosy:

He took a band of (the inmates), all who were there, from the hospice of the lepers, which was outside the city . . . sent and lodged them in the house of a believer who was thus forced to leave his house and flee from their hideous and horrible appearance, seeing their faces misformed and their bodies all festering and putrefying, discharging abominable purulence, while their hands were dripping with blood and pus, fouler than those of corpses laid in graves. (Pseudo-Dionysius 1996: 36)

Though the use of bands of lepers to terrorize the population is an extreme example, it seems that while the disease may inspire great heights of human compassion, it is indeed a saintly effort to combat the instinctual fear and revulsion leprosy provokes.

References

Basil of Caesarea. 1955a. “Letter 94.” The Fathers of the Church, Vol. I. Ed. Roy Joseph Deferrari. New York: The Fathers of the Church.

————. 1955b. “Letter 142.” The Fathers of the Church, Vol. I. Ed. Roy Joseph Deferrari. New York: The Fathers of the Church.

————. 1955c. “Letter 143.” The Fathers of the Church, Vol. I. Ed. Roy Joseph Deferrari. New York: The Fathers of the Church

Brothwell, Don and Sandison, A. T, eds. 1967. Diseases in Antiquity. Springfiled, IL: Charles C. Thomas.

Douglas, Mary. 1966. Purity and Danger: An Analysis of the Concepts of Pollution and Taboo. London: Routledge.

Evans, Craig A. 1997. “Who Touched Me?’ Jesus and the Ritually Impure.” In Bruce Chilton and Craig A. Evans, Jesus in Context: Temple, Purity, and Restoration. Leiden: Brill.

Gregory of Nazianzus. 1953. “Oration 43.” In L. McCauley, trans., Fathers of the Church: Funeral Orations by Saint Gregory Nazianzen and Saint Ambrose. New York: Fathers of the Church.

Gregory of Nazianzus. 1959. “On the Love of the Poor and Those Afflicted by Leprosy.” (Or. 14). In M.F. Toal, trans., In The Sunday Sermons of the Great Fathers. Chicago: Regnery.

Grmek, Mirko D. Diseases in the Ancient Greek World. Baltimore: Johns Hopkins University Press.

Miller, Timothy S. 1985. The Birth of the Hospital in the Byzantine Empire. Baltimore: Johns Hopkins University Press.

Pseudo-Dionysius of Tel-Mahre. 1996. Chronicle, Part III. Trans. Witold Witakowski. Liverpool, England: Liverpool University Press.

Tomlinson, R.A. 1983. Epidauros. Austin, TX: University of Texas Press.

Zivanovic, Srboljub. 1982. Ancient Diseases: The Elements of Palaeopathology. Trans. Lovett F. Edwards. New York: Pica Press.

[1]. It is important to mention here that I am addressing the Church as it took shape in the Eastern Empire. An examination of the place of healing in the Western Church would require another paper entirely. The situation in the East was unique and separate from the issues which shaped the Church in the West. For more on this divergence see Miller 1985.

[2]. There is much debate as to whether the leprosy referred to in the Bible is the actual disease modern medicine now knows as leprosy. It seems that the biblical term for leprosy indicates a more general category of less debilitating skin diseases. I address this issue further in the paper, but it is important here for me to clarify the terms I am using. When referring to leprosy as the disease known by modern medicine, I will use the term ‘medical leprosy.’ For more on the debate of medical meaning, see Brothwell and Sandison 1967: 304, and Grmek 1989: 160-61.

[3]. I took this quote from Grmek, as there is no English translation of Aretaeus’ Greek. This passage can be found in Greek in Aretaeus of Cappadocia, Signa chron., II, 13.