History and Geography

The story of bejel is intimately bound up with the work of Ellis Herndon Hudson, a physician and medical historian. He first described the disease in 1928, after observing it among the Bedouin Arabs. In 1937

he summarized all available information on this form of nonvenereal syphilis and stated that the Arab word bejel had been introduced into the literature to distinguish this nonvenereal and endemic form of syphilis from the venereal variety.

In 1946 he emphasized the intermediary nature of bejel between yaws and syphilis and presented a unitarian concept of treponematosis, which stressed the evolutionary relationship among yaws, endemic syphilis, pinta, and venereal syphilis, and held that they were all varieties of a single disease caused by one parasite, T. pallidum.

Not all agree. Some, for example, argue that the various treponemal infections are due to changes in the treponemal strains themselves - to mutations. Others feel that the treponemal infections are essentially different diseases, caused by different parasites, whereas E. I. Grin has advanced the argument that venereal syphilis has reached villages (in the Sudan at least) from towns, only to become endemic (i.e., nonvenereal) in a rural environment.

There is, however, general agreement that nonvenereal syphilis is a very old disease. Hudson argues that it flourished in the villages that first appeared during the early Neolithic period and that it was the "venereal leprosy" of the Middle Ages, the "sibbens" of Scotland, the "button-scurvy" of Ireland, the radesyge of the Scandinavian countries, and the skerljevo of the Balkans. Apparently, it never took root in the Americas.

Because endemic syphilis fades in the face of the cleanliness associated with civilization, and because of the high efficacy of penicillin as a cure, the disease has withdrawn from most of Europe. But the bejel of the Middle East has its counterparts in the njovera of Rhodesia, the dichuchwa that plagues the Bushmen, and the irkintia of the Australian aborigines.

Kenneth F. Kiple

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