Metzora: Ralbag, Tzarat and Medicine

In today’s פרשיות, we encounter intricate instructions regarding the procedure for identifying a מצורע. Various verses elaborate on the specific criteria, such as changes in color, size, and hair, that must be met to diagnose someone as a מצורע. However, the practical applications of these regulations are not explicitly mentioned.

There are several instances in תנ”ך where people are afflicted with what appears to be צרעת. These include Moshe Rabbenu during his conversation with God at the burning bush, Miriam after speaking with Aharon about Moshe, and the four מצורעים outside ירושלים who were the first to realize that the enemy had fled. However, the text does not explain why someone would contract this affliction. It is clear that this is not a simple medical condition, as the מצורע is instructed to seek the advice of a כהן, a servant of God. The כהן plays a central role in the process of identifying a מצורע, and waiting periods are often required to determine any changes in the condition.

It appears that צרעת is also a form of punishment. The פסוק describes the מצורע’s coat as torn and hair as unkempt, and their upper lip must be covered. The מצורע is also required to undergo a period of mandatory isolation outside the city. Overall, the affliction of צרעת seems to be a complex and multifaceted phenomenon, requiring the intervention of a religious authority and involving elements of both physical and spiritual purification.

And so, we must ask what is the reason one would get such an affliction? There are basically three approaches offered in the Rishonim: One, the whole idea of tzarat is one that is supernatural, two, there are some supernatural and some natural elements in the affliction and, three, tzarat is a purely natural disease process. We will focus on the third approach, presented by the Ralbag.

Rabbi Levi b. Gershon (1288-1344), also known as Gersonides, was a medieval Jewish philosopher, mathematician, physician, astronomer and astrologer. He never held a formal position as a rabbi possibly as a result of his extreme rationalistic views, for which the Rivash almost put him in cherem for. These views were published in his מלחמת ה’ which may be his response to, what he sees, as the Rambam’s too-diluted rationalistic approach. Interestingly enough, despite—or perhaps because of—his rationalistic tendencies, he was also somewhat of an astrologer and believed that to some extent that was the mechanism through which prophecy worked.

It is perhaps unsurprising then that according to the Ralbag, tzarat is a purely natural disease process. The Ralbag believed that tzarat was a physical ailment. He therefore argued that the symptoms of tzarat, such as the discoloration of the skin and the growth of hair, were caused by the body’s natural response to these factors. In his view, first the patient inflected with tzarat visits the dermatologist to begin the healing process for the physical disease. Only subsequently does the patient schedule a visit with the Kohen to begin to understand how to offer a religious response to the unfortunate circumstances of falling ill. The role of the Kohen is then simply to determine the טמא status, not to diagnose the underlying pathology. In fact, the Ralbag, possibly based on the Midrash, points out that the Kohen does not even need to understand what is or is not considered צרעת; he only needs to make the final declaration.

Isolation is required to control the spread of the disease. Interestingly, this means that צרעת was a contagious disease, and as a result, there is a requirement to burn the clothes that the מצורע wears to ensure that the disease has been completely eradicated.

According to the Ralbag’s view, a person fully covered in צרעת is not considered טמא because medically, this disease is actually less severe than a lesion that appears on only one location. Therefore, as טומאה reflects the medical reality, such a person is not טמא. However, the Ralbag notes that the hair must still be shaven, as it may contain some particles that cause the disease.

Indeed, the Ralbag’s explanation of צרעת being a result of the loss of life or potential of life may not fully account for the manifestation of the disease in the person’s house and clothes. This aspect of the disease is a point of difficulty and leaves what to be aspired for. Nonetheless, the Ralbag’s position satisfies many aspects of the laws of tzarat.

It is not within the scope of this platform to provide an in-depth discussion of the philosophical positions of the Ralbag in comparison to other Rishonim. However, we can consider the worldview that informs his perspective. The Ralbag maintains that supernatural events are rare and that the physical world we experience informs our spiritual reactions. It is important not to separate the physical and spiritual realms and disease processes should not be viewed in isolation from their spiritual implications. Diseases such as צרעת may be considered as a clear spiritual experience that requires the involvement of the Kohen and the בית המקדש. This framework can inform our response to all pathologies we experience. When we are afflicted with disease, we must address it on two levels: the physical—seeking medical attention—and the spiritual—increasing Torah study, prayer, or acts of kindness.

Our Torah portions provide us with a unique opportunity to discuss the intersection of the physical and spiritual in the context of disease, but this concept extends to all areas of our lives. As we know, Judaism is not limited to the confines of the synagogue, and every aspect of our physical lives is intertwined with our spiritual well-being. From the way we eat, drink, and wake up in the morning, to the way we spend our leisure time and consume news, everything we do requires a religious perspective. The physical informs the spiritual in all aspects of our lives.

This may sound daunting, but it is not meant to discourage us or make us feel overwhelmed. Rather, it is a call to action to ensure that our daily schedules are calculated through a religious lens. This means setting aside time for prayer, work, family, learning, acts of kindness, and relaxation, all with the understanding that the physical and spiritual are intertwined. Let us strive to live our lives with this perspective in mind and elevate our physical actions to a higher spiritual plane.