162 REPORT—1840. 
some of its peculiarities might be interesting; for though frequently 
mentioned by travellers in Syria, Arabia and Persia, under the names 
of Aleppo button, Bagdad boil and Date mark, and also lately met 
with in the north-west provinces of India, no full description of the 
disease is to be met with in any of our systematic works. In Arabic it 
is called Khorma, or the date disease ; in Persian Salek, or the disease of 
a year; and is so prevalent in these countries, but especially in the 
towns of Arabia, that scarcely any one, whether native or European, 
escapes its attack. 
The disease commences like small pimples, which very gradually in- 
crease in size till they appear as ulcers covered with a dry crust, resem- 
bling that of Rupia syphilitica, with a small quantity of pus under the 
scab. These occur on different parts of the body at the same time, 
chiefly on the hands and legs of adults and the faces of children, but 
generally attended with little pain. They have always so much of the 
character of syphilitic sores, as to mislead any one previously unac- 
quainted with the disease, and as they continue to increase in size for 
a year, they occasionally present a horrible carcinomatous appearance. 
At the expiration of twelve months from its commencement the differ- 
ent ulcers suddenly heal of their own accord, leaving an ugly indelible 
scar. 
The natives make an absurd distinction of the disease into male and 
female, the sores of the former kind being larger and enduring for a yeay 
those of the latter smaller and healing in six months. Dr. Bell con- 
sidered the disease worthy of attention, not only on account of its great 
prevalence and the disfigurement produced by it in these countries, but 
as an instance of a disease attacking the constitution without fever or 
other symptoms, wearing itself out in a certain time, unaffected by treat- 
ment, by local applications, never appearing a second time in the same 
person, and occasionally driven out of the system by the attack of a 
more powerful disease, such as plague or typhus. 
In the treatment of the disease he has found the internal use of iodine 
and sulphureous baths beneficial, but has never succeeded by the use of 
any external application ‘to a single sore in causing it to heal a day 
sooner than the other coexistent ulcers purposely left untreated. 
Dr. Bell conceives that the extreme dryness of the atmosphere in 
all the countries where this disease is prevalent may exert a predispos- 
ing influence, but considers it strictly a contagious disease, propagated 
chiefly by the use of the public baths. It is difficult to say how long it 
may lurk in the system without making its appearance, but instances 
are numerous in which it has not shown itself till several months after 
the return of persons to this country from their travels in Syria and 
Arabia. 
By the natives it is not attributed to contagion, but to fanciful causes, 
such as eating dates, and is believed by them incurable till its destined 
period be expired, and they consequently very seldom submit to medical 
treatment, using only a few ineffectual local applications, a prejudice 
which unfortunately very much limits the means of ascertaining by 
experience the most efficacious mode of treatment. 
