Journal - International Society for the History of Islamic Medicine

THE STORY OF BEJEL DISEASE IN IRAQ: BEJEL (ENDEMIC SYPHILIS)
DISEASE AMONG THE EUPHRATES ARAB BEDOUINS
married at an early age, usually between 14 to 16
years old. The Bedouins move around many times
during the year according to the weather. They go
where the rain falls and where there is grass for their
animals. The incidence of Bejel amongst the
Bedouins at one time affected 90% of them. The
Bedouins were similar to the peasants in that they had
neither schools nor dispensaries and other diseases
were prevalent, such as malaria, malnutrition and
tuberculosis (1,2).
Deir-Ez-Zor is virtually an oasis in the Syrian
Desert. It is important to mention these notes for two
reasons: (a) It is situated near the Western border of
Iraq. It was believed that the Bejel entered Iraq
through the their tribes emigrating from Deir-Ez-Zor.
(b) Bejel was first reported from this region in medical
literature in 1928 (2-8). When the first clinic was
opened by the 'American Presbytarian Mission' in
Deir-Ez-Zor in 1924, Dr. Hudson, who was in charge
of this clinic, studied this disease and he collected the
knowledge about the disease from the patients who
came to the clinic (3-5).
Discovery of Treponema
It may be useful to mention some of general considerations
about the discovery of Treponema and the various
forms of diseases caused by it. In 1905 Schaudinn
with Hoffmann discovered the organism of syphilis (6-
7). They named it spirochaeta pallido 'pale spiral hair';
but later he found that this name was also being used
for other geneses of the same family. Finally, he chosed
the term Treponema twisted thread. Diseases caused by
subspecies of the pathogenic treponemes are
Treponema pallidum (syphilis), Treponema pertenue
(yaws), Treponema endemicum (bejel or endemic
syphilis), and Treponema carateum (pinta) (8-10).
Some considered Bejel the same as the yaws of
subtropics. Indeed, this idea had been advocated by
Wadad in 1936 of Basrah - Iraq (11), but no support
was given to this idea. Other writers and observers
considered Bejel as a form of endemic syphilis
amongst the Arab Bedouins and peasants around the
Euphrates, and is caused by Treponema pallidum.
Also it is a disease found in primitive rural areas
affecting all ages, mainly children, with no relation to
sexual activity (3,8-10).
JISHIM 2004, 3
Kathem K. AL-RIBIAY
Origin of Bejel
(Epidemiological Theories)
Medical historians of Bejel were puzzled by the
absence of ancient information and writers failed to
describe it in the old medical writings (5). The origin
of Bejel is uncertain; whether it originated in the
Arab area or whether the disease was brought from
other regions by mass migration, slave trade, wars,
commerce, or pilgrimage is unknown.
We know the first who mentioned Bejel as a disease
in medical literatures was Dr. Hudson in 1928
under the title 'Treponematosis among the Bedouins
Arabs' (3). The following theories and hypothesis
may help to explain the nature of Bejel disease.
Unitarian Theory
This theory explains the evolution of treponematosis
in the world and it states that all pathogenic treponemes
have common ancestors, as free-living organisms
adapted themselves to man as commensals and as
a result of natural selection, climatic conditions,
domestic life and may be slight mutation resulting
from accidental fault in the DNA genetic code produce
a variety of lesions (12-14). It was suggested by
Hackett (1963) that the first disease was Pinta or 'the
blue stain disease", this disease was distributed
throughout the world (14). Further, Hackett considered
that Pinta gave rise to Yaws in Africa and the disease
was transmitted by "skin to skin' contact; the warm
humid climate was a contributory factor to transmission.
Further more, endemic syphilis (Bejel) evolved
from yaws; the climatic conditions in the Arab world
are such that it is warm during the day and cold at night
and although the skin was protected by clothes.
Spreading of the disease due to many factors such as
kissing, communal use of eating and drinking utensils.
The Arab Bedouins had similar customs lead to the
result that the disease spread rapidly and involved
mucous membrane, especially in the mouth. According
to this theory, venereal syphilis evolved from endemic
syphilis as socio-economic level and better hygiene,
and the result was sexually transmitted.
Colombian Theory
This theory explains the spread of syphilis to
Europe in 1494 from the West Indies. Members of the
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