Behcet's disease and the Old Silk Road - A lesson in history and geography

The relationship between history, geography and medicine is explored in this short lecture. This was presented in the British Association of Dermatologists Annual meeting held in 2005.

Here is the abstract of the paper: Br J Dermatology 2005;153:52.

A lesson in historical geography for dermatologists:Behçet’s disease and the Old Silk Road

P.D.YESUDIAN AND C.O’MAHONY

Epidemiological studies have always played an important part in derma-tology. No other disease has linked the triad of geographic distribution,genetic predisposition and prevalence more so than Behçet’s disease(BD), a chronic inflammatory disease characterized by recurrent oral andgenital ulcers, systemic vasculitis, uveitis and involvement of the skin,joints, central nervous system and gastrointestinal tract. There is a clus-tering of this condition along the ancient Old Silk Road, which extendsfrom Eastern Asia to the Mediterranean basin.Silk is obtained from the moth Bombyx mori, which specifically feedson the white mulberry plant, a combination that coexisted uniquely innorthwest China. Silk was a key commodity in the Chinese economy, and in order to set up trade links, the Han dynasty (206 BC–220 AD) sent a diplomatic mission to the West. This led to the establishment of theOld Silk Road, a trade route that passes from Eastern China through the northern Himalayas, Afghanistan, Iran and Iraq before bifurcatingtowards Syria and the Balkan states. The Silk Route prospered under theTan dynasty until the 10th century, when the discovery of the sea routebetween Europe and Asia by Vasco da Gama hastened its decline.Genetic, environmental, and immunological factors have been pro-posed as aetiological factors in BD. The prevalence of the HLA-B51 alleleis high among patients with BD who live in areas along the Silk Road.The allele also affects the severity of the disease, as it is more commonamong patients with posterior uveitis and progressive nervous systemdisease than among those with milder disease. This could suggest agenetic risk for BD that migrated in parallel with population movementbetween Eastern Asia and the Mediterranean.The trade route led not onlyto increased commerce but also to the spread of infections. It has beenpostulated that an environmental (infectious) agent also contributes toBD. Patients with BD do show hypersensitivity to streptococcal antigens and also exhibit a mycobacterial 65 kDa heat-shock protein that upregulates expression of gd T cells in their blood, lending credence to this theory. As quoted by Osler, ‘It is only by the historical method that many of the integral problems of medicine be profitably approached'.

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[MonishaMadhumita]

As a dermatology resident grappling to find my way in this vast speciality, I'm incredibly grateful for these lectures! Thankyou, Dr.Yesudian!

[shafeeqsalahudeen]

Thanks Deva. Excellent historical perspective of Behcet's disease.

[lb]

Fascinating lecture Deva. A journey into the past to treat us to a story of silk and medical genetics. Keep them coming!

[balakrishnansaravanan]

Dear Paul,
Very nice presentation incorporating the history of silk route and etiology of Behect's.Very concise presentation with interesting facts.Well done.

[WhiteleafWorship]

Enjoyed the history and geography linked with behcet’s disease😊

[monicajoseph]

Yes.. And bringing the connection between history and disease is great

[kannambalk]

Quite interesting history and geography