Thazria: Diagnosis

Thazria: Diagnosis

Most of this week’s parsha involves the diagnosis of tzoraath, a condition that afflicts people, and garments and houses (next week’s reading), rendering them tamei. Reading the parsha requires dealing with unfamiliar words and concepts. Only small remnants of ritual purity, the dimension of the tahor (pure) and tamei ( impure) remain. They have become mysterious restrictions in search of meaning, acts of faith motivated by loyalty to tradition.  We do not attempt to understand them.

The parsha is filled with words that are difficult or impossible to translate. These are descriptors of rashes, swellings, bright spots. They are shown to a trained provider, a Kohen (priest) who uses the published criteria to decide on the significance of the lesion. The difficulty of decision and ambiguity surrounding these diagnoses is reflected in the frequent use of temporary (week long) isolation to see if the lesion spreads or fades.

The King James committee translated tzoraath, the disease that most of the parsha deals with, as leprosy. Many modern translators keep that rendering.  It works because the reader understands neither tzoraath nor leprosy. Leprosy conveys the image of a very serious, horrible disease that affects the skin and requires the victims exile to a colony of the like- afflicted. [ The luckiest lepers go to Hawaii ( Kalaupapa). ] The translation attempts to convey the significance of the finding, not the bacteriology ( a much later concept) or the relationship between the mycobacterium and the disease(s) it produces (still not understood).

John Updike, semi-humorously, identified the cutaneous affliction in our parsha with the homonymic,  Greek derived psoriasis ( AT WAR WITH MY SKIN, New Yorker, 1985). The etymology officials do not connect the Hebrew with the Greek that becomes the English , despite the similarities in sound and afflicted organ.  Updike uses the biblical to magnify the seriousness and the social isolation that comes from this relatively common skin condition, now understood to have an autoimmune, cytokine mediated, mechanism and treatable with  heavily advertised pills and injections that sell for astronomical prices. The advertisements (to patients) emphasize the relief from (self-imposed) isolation that comes from the clearing of the skin. Does the biblical  demand for isolation for the tzoraath victim evolve into the exile of the psoriatic?

Some of the descriptors are words used only once in the Bible (hapax legomenon). Every year I look forward to the בֹּ֥הַק  bohack, a benign skin condition .  When I was a boy in New York, there was a grocery store chain named Bohack. I always thought of those stores as a benign rash in the city. I am fairly certain the name is a coincidence, but who knows?

I try to imagine diagnosing tzoraath. At first, I would be unsure and it would take a long time.  I would look at the lesions with a magnifying glass, under blue light as well as white, I would send a biopsy to the pathologist for analysis; I would send most people into the diagnostic quarantine  because of my uncertainty. With time, I would become more confident… and then overconfident. Experience would use my previous actions to dictate the current ones. I would constantly justify my past decisions in the now.  But I will never have to do that for tzoraath. I am not a Kohen. I just do that for other diagnoses.  

Diagnoses have evolved from the visible and palpable to the microscopic to the molecular. But diagnoses remain murky.  Often, they do not predict the consequences of treatment. Pathologic pronouncements (diagnoses) are often the product of conflicting data  and come down to the judgement of the doctor ( or the AI replacing her). It could be much better. Tradition is a major obstacle to improvement. Microscopic appearance dominates many decisions and misapplied privacy laws prevent the collection of adequate data.  We are still justifying our past decisions.

In mainstream, modern Judaism, Biblical and Talmudic medicine is not applied to current diagnosis and treatment. The tradition provides a framework for understanding one’s place in the world as history proceeds. The success of medicine and science justify their semi-independence from tradition. Contacts remain. Integrating the past into the present is always a challenge… especially when you do not really understand the words.