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
would include syphilis and other treponematosis suffering
under the heading of leprosy are: (a) In ancient
Mesopotamia it was said that "if lepers were kept
away,people would not get the disease" (5). Also the
Old Testament quotes the story of Naaman, 'the leper'
who was told by Eli'sha to wash himself seven times
in the River Jordan. Another point was, that lepers
were segregated in leper homes, 'lazar', and buried in
special cemeteries. From the above it is clear that the
disease with which they were concerned was highly
contagious; as we know leprosy is not highly infectious
and needs long periods for many years, whilst
the incubation period of syphilis ranges between 9 to
90 days; therefore, not all patients in ancient time
were necessarily suffering from leprosy, perhaps
some were cases of syphilis or other treponematosis.
(b) During the Crusades, the concept of 'venereal leprosy'
gradually developed and we since know that it
is more true of syphilis, which is a sexually transmitted
disease. (c) It was also mentioned that a child
could be born with "leper" or congenital leprosy, this,
like (b), is not true for leprosy but is true for syphilis.
(d) The Arabs used mercury from the earliest time;
mercury was a well known ancient remedy for leprosy
and was recorded in ancient writing. Also
reported in the early part of this century was the fact
that the Bedouins in both the Syrian Desert and Arab
Peninsula used mercury inhalation as a method of
treating the Bejel (2). Mercury has no effect on leprosy,
but has effect against treponematosis (5). This
supports the longevity of Bejel in the Arab area.
Indigenous Idea
The physicians in Deir-Ez-Zor said that treponema
was brought to the region by Egyptian troops
under the command of Ibrahim-Ali in the 19th century;
probably through troops having sexual relations in
the city and as a result venereal syphilis occurred in
townsmen and was called 'Franji'; this disease may
have spread to rural areas, amongst tribes and the
Bedouins in a non-venereal method and the result
was a disease called 'Bejel, which locally means in
Arabic, 'sore'. Iraqi physicians suggested that Bejel
was brought to Iraq by tribes emigrating from Deir-
Ez-Zor in Syrian Desert which a neighbor of Iraqi
Bedouin in the West Desert to Iraq.
JISHIM 2004, 3
Kathem K. AL-RIBIAY
Summary of Clinical Aspect of Bejel
Bejel diseases a similar clinical feature of syphilis
with few differences (8-10). The onset mainly during
childhood, 25% of cases before the age of 6 years and
66% of cases before the age of 16 years. Sex ratio
was female slightly over male 1.1:1. The incubation
period unknown, other suggested that it was similar
to syphilis. There is a possibility that insect vector
may play a role in the transmission of this disease this
was suggested by for two reasons; first, most cases
were near the marshes, and second, fresh infectious
cases appeared in spring and summer when insects
and flies were numerous.
Clinical stages: this consist of the following;
1 - Early stage or primary lesion
2 - Latency stage
3 - Late stage
Early Stage: Mucous patches: commonly seen in
the mouth. and may be the first manifestation. Skin
lesion: generalised skin eruption, resembling the
lesion in syphilis .Skeletal involvement mainly
ostealgia and osteoperiostitis
The Latency Stage: The patient may become a
symptomatic at any time especially within the first
four years of the disease. The result of this stage is
that one third of the patients become a symptomatic,
and only serologically positive.
Late stage: The findings consist of skin gummata
which is common manifestation. The nasopalatal
destruction, resulting in the saddle nose ,the skeletal
changes as in early stage. Other rare findings like pigmentary
change ,juxta-articular nodules and hyperkeratosis.
There were controversial questions not settled
at that time. The questions were whether this disease
could involve the cardiovascular system or the
nervous system and whether congenital disease can
occur as in venereal syphilis. Hoff and Shabby (1940)
reported two cases from the Royal Hospital in
Baghdad with nervous involvement (17).
Rhahim and Akrawi (1951) reported aortitis in a
Bejel patient (18).
Lab Studies: Endemic syphilis should be suspected
in persons with chronic skin or bone lesions who
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