The Abana and Pharpar Syndrome

[This syndrome was recognized in 1973 by Kelsey.]

In the Old Testament, in the Second Book of Kings, Chapter 5, you may read the story of Naaman, a Syrian General. Naaman had leprosy, and was sent to Israel, to Elisha, to be cured. But Elisha did not come himself, to pray and to lay on hands. Instead he sent a servant to advise Naaman to bathe seven times in the Jordan river.

Naaman at first rejected the advice: "Are not Abana and Pharpar, waters of Damascus, better than all the waters of Israel?"

However he was prevailed upon to do as Elisha said, and his leprosy was cured.

So now we may speak of the 'Abana and Pharpar Syndrome': the angry rejection of a physician's advice, because it contradicts a patient's expectations, or is not delivered in a manner considered appropriate.

All physicians know the syndrome, avoiding it is in the art of medical practice, but it is more difficult in the age of information. The internet and TV are rich sources of erroneous, inapplicable or impracticable opinion and advice. Patients come to the clinic knowing what they need: woe betide the physician who demurs.

But the story of Naaman is a good yarn: here it is in full, in the glorious English of the King James' version. 

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1. Now Naaman, captain of the host of the king of Syria, was a great man with his master, and honourable, because by him the Lord had given deliverance unto Syria: he was also a mighty man in valour, but he was a leper.

2. And the Syrians had gone out by companies, and had brought away captive out of the land of Israel a little maid; and she waited on Naaman's wife.

3. And she said unto her mistress, Would God my lord were with the prophet that is in Samaria! For he would recover him of his leprosy.

4. And one went in, and told his lord, saying, Thus and thus said the maid that is of the land of Israel.

5. And the king of Syria said, Go to, go, and I will send a letter unto the king of Israel. And he departed, and took with him ten talents of silver, and six thousand pieces of gold, and ten changes of raiment.

6. And he brought the letter to the king of Israel, saying, Now when this letter is come unto thee, behold, I have therewith sent Naaman my servant to thee, that thou mayest recover him of his leprosy.

7. And it came to pass, when the king of Israel had read the letter, that he rent his clothes, and said, Am I God, to kill and to make alive, that this man doth send unto me to recover a man of his leprosy? Wherefore consider, I pray you, and see how he seeketh a quarrel against me.

8. And it was so, when Elisha the man of God had heard that the king of Israel had rent his clothes, that he sent to the king, saying, Wherefore hast thou rent thy clothes? Let him come now to me, and he shall know that there is a prophet in Israel.

9. So Naaman came with his horses and with his chariot, and stood at the door of the house of Elisha.

10. And Elisha sent a messenger unto him, saying, Go and wash in Jordan seven times, and thy flesh shall come again to thee, and thou shalt be clean.

11. But Naaman was wroth, and went away, and said, Behold, I thought, He will surely come out to me, and stand, and call on the name of the Lord his God, and strike his hand over the place, and recover the leper.

12. Are not Abana and Pharpar, rivers of Damascus, better than all the waters of Israel? May I not wash in them, and be clean? So he turned and went away in a rage.

13. And his servants came near, and spake unto him, and said, My father, if the prophet had bid thee do some great thing, wouldest thou not have done it? How much rather then, when he saith to thee, wash, and be clean?

14. Then went he down, and dipped himself seven times in Jordan, according to the saying of the man of God: and his flesh came again like unto the flesh of a little child, and he was clean.

15. And he returned to the man of God, he and all his company, and came, and stood before him: and he said, Behold, now I know that there is no God in all the earth, but in Israel: now therefore, I pray thee, take a blessing of thy servant.

16. But he said, As the Lord liveth, before whom I stand, I will receive none. And he urged him to take it; but he refused.

17. And Naaman said, Shall there not then, I pray thee, be given to thy servant two mules' burden of earth? For thy servant will henceforth offer neither burnt offering nor sacrifice unto other gods, but unto the Lord.

18. In this thing the Lord pardon thy servant, that when my master goeth into the house of Rimmon to worship there, and he leaneth on my hand, and I bow myself in the house of Rimmon: when I bow down myself in the house of Rimmon, the Lord pardon thy servant in this thing.

19. And he said unto him, Go in peace. So he departed from him a little way.

20. But Gehazi, the servant of Elisha the man of God, said, Behold, my master hath spared Naaman this Syrian, in not receiving at his hands that which he brought: but, as the Lord liveth, I will run after him, and take somewhat of him.

21. So Gehazi followed after Naaman. And when Naaman saw him running after him, he lighted down from the chariot to meet him, and said, Is all well? 

22. And he said, All is well. My master hath sent me, saying, Behold, even now there be come to me from Mount Ephraim two young men of the sons of the prophets: give them, I pray thee, a talent of silver, and two changes of garments.

23. And Naaman said, Be content, take two talents. And he urged him, and bound two talents of silver in two bags, with two changes of garments, and laid them upon two of his servants; and they bare them before him. 

24. And when he came to the tower, he took them from their hand, and bestowed them in the house: and he let the men go, and they departed.

25. But he went in, and stood before his master. And Elisha said unto him, Whence comest thou, Gehazi? And he said, Thy servant went no whither.

26. And he said unto him, Went not mine heart with thee, when the man turned again from his chariot to meet thee? Is it a time to receive money, and to receive garments, and oliveyards, and vineyards, and sheep, and oxen, and menservants, and maidservants?

27. The leprosy therefore of Naaman shall cleave unto thee, and unto thy seed for ever. And he went out from his presence a leper as white as snow.

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Gehazi did wrong, but his punishment was cruel and excessive - no mercy, no appeal, and inflicted on innocent descendants; barbaric, a stain on Elisha's reputation.

As for Jordan water in the treatment of leprosy, this appears to be anecdotal evidence of  a single case: I have seen no controlled trials.

Rifampicin, clofazimine and dapsone work by science, not miracle; but for many lepers their benefit is little short of miraculous.