Scurvy

George Budd (1840) Scurvy. In: THE LIBRARY OF MEDICINE ARRANGED AND EDITED BY ALEXANDER TWEEDIE, M.D. F.R.S. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, PHYSICIAN TO THE LONDON FEVER HOSPITAL AND TO THE FOUNDLING HOSPITAL, ETC, PRACTICAL MEDICINE VOL. V. Budd G. Scurvy. In: The Library of Medicine; The System of Practical Medicine. Ed. Tweedie A. 1840;5:58-95. https://archive.org/details/b33096314_0005/page/58/mode/2up https://play.google.com/books/reader?id=NhgDAAAAQAAJ&pg=GBS.PA58 Biographies: https://history.rcp.ac.uk/inspiring-physicians/george-budd https://en.wikipedia.org/wiki/George_Budd https://en.wikisource.org/wiki/Dictionary_of_National_Biography,_1885-1900/Budd,_George_(1808-1882) https://doi.org/10.1177/096777209800600308 https://pmc.ncbi.nlm.nih.gov/articles/PMC9742754 This text is available at: https://doi.org/10.5281/zenodo.17455963 2025-10-27 Yellow indicates the most relevant parts, original page numbers are on the right-hand side. This annotated version was prepared by Harri Hemilä, MD, PhD, University of Helsinki, Helsinki, Finland. https://www.mv.helsinki.fi/home/hemila https://orcid.org/0000-0002-4710-307X https://pubmed.ncbi.nlm.nih.gov/?term=hemila+vitamin+c https://scholar.google.com/citations?user=2mkomzUAAAAJ https://doi.org/10.5281/zenodo.17085738 Reports on scurvy uploaded to Zenodo by Hemilä 1 Background Kenneth Carpenter (2003) wrote about the origin of the “vitamin” concept as follows: It is sometimes asked, “Who first had the idea of vitamins?” One can find tantalizing early quotations, but they were not followed up at the time… In 1842 George Budd also lecturing in London added, “Scurvy is only one of a number of diseases due to specific dietary deficiencies, another is rickets and a third is characterized by a peculiar ulceration of the cornea” https://wellcomecollection.org/works/b8epyvag Reprint of 5 papers by Budd (1842). Carpenter KJ. A short history of nutritional science: 1912-1944. J Nutr. 2003;133:3023-32. https://doi.org/10.1093/jn/133.10.3023 In the 1840 review on scurvy which is annotated in this document, George Budd formulated the vitamin concept as follows: We are ignorant of the essential element [~vitamin], common to the juices of antiscorbutic plants, on which the properties in question depend; but shall, probably, not be deemed too sanguine, if we anticipate that the study of organic chemistry, and the experiments of physiologists, will at no distant period throw some light on this subject. p.77 this text. When we reflect that the exclusive cause of scurvy, is prolonged abstinence from the juices of succulent plants and fruits; that by the use of these it may always be prevented; and that, when it exists even in its highest degree, it may be speedily cured by the same means, the inference is plain, that these juices contain some element essential [~vitamin] to the formation of healthy blood; and the history of scurvy shows that they cannot be replaced by any of the other elementary nutritive substances from the vegetable kingdom. p.90-91 this text. In the later series of five papers in 1842, George Budd extended the argument for the concept “element” or “principle” that is essential in food, for example: The element [~vitamin], whatever it be, which the vegetable juices furnish, and which is the true preventive of scurvy, is expended slowly. The better a person has been supplied with it, the longer he can subsist without it. p.714. The principle [~vitamin], whatever it be, is common to the juices of a great variety of vegetables and unripe fruits; and seems to reside in the juices of the plant only. p.715. https://archive.org/details/s2id13404640/page/714/mode/2up https://babel.hathitrust.org/cgi/pt?id=mdp.39015023953956&view=1up&seq=742 2 Budd’s 1840 review on scurvy has been cited in: Love SL, Pavek JJ. Positioning the potato as a primary food source of vitamin C. American Journal of Potato Research 2008;85:277-85. https://doi.org/10.1007/s12230-008-9030-6 Budd (1840), one of the first researchers to attribute scurvy to poor nutrition, stated that this common disease was due to the “lack of an essential element which it is hardly too sanguine to state will be discovered by organic chemistry or experiments of physiologists in a not too distant future.” p.278. Cook GC. Scurvy in the British Mercantile Marine in the 19th century, and the contribution of the Seamen’s Hospital Society. Postgrad Med J. 2004 Apr;80(942):224-9. https://pmc.ncbi.nlm.nih.gov/articles/PMC1742980 https://doi.org/10.1136/pgmj.2003.011122 In 1838 the Committee of the SHS [Seamen’s Hospital Society] encouraged George Budd FRS (1808–82) one of their physicians to determine the cause(s) and cure [of scurvy], and he also wrote an erudite review in which he confirmed that this was a dietary disease, and that lime and lemon juice had a role in both prevention and cure. p.224. Stone, who rightly considered that land and sea scurvy were identical, commented “Dr [George] Budd [see above], probably the highest authority on this disease says … that scurvy is caused neither by contagion, nor by cold weather, nor by impurity of the air, nor by the continued use of salt provisions … but the privation for a considerable length of time of fresh succulent vegetables.” p.227. Stare FJ, Stare IM. Charles Glen King, 1896-1988. J Nutr. 1988 Nov;118(11):1272-7. https://doi.org/10.1093/jn/118.11.1272 In 1840, however, George Budd, a much neglected figure in the history of nutrition, wrote that scurvy resulted from the lack of an essential factor that would be discovered by organic chemistry or experiments of physiologists in the near future. Glen King was an organic chemist. p.1273. Carpenter KJ. The History of Scurvy and Vitamin C. 1986. https://www.cambridge.org/fi/academic/subjects/history/history-medicine/history-scurvy-and-vitamin-c … Ten years later, George Budd [1840], at another of the London teaching hospitals, made the same analysis of scurvy as being a deficiency disease. He also seems to have been the first to explain Lind’s experience of the early appearance of scurvy in ships sailing from England in the spring, in terms of the depletion of the sailors’ reserves of the antiscorbutic element during the preceding winter, rather than in Lind’s terms of cold, wet weather being the inducing factor… As two authors have pointed out, Budd was a prophet. p.249. … the people such as Bachstrom, Lind, Elliotson, Budd, and Holst, who made contributions and drew conclusions that we now consider well founded, seem equally consistently to have escaped the usual marks of general recognition and appreciation. p.251. 3 Carter KC. The germ theory, beriberi, and the deficiency theory of disease. Med Hist. 1977 Apr;21(2):119-36. https://pmc.ncbi.nlm.nih.gov/articles/PMC1081945 In 1840 George Budd summarized clinical knowledge of scurvy in an article in Alexander Tweedie’s A system of practical medicine. Budd discussed various fruits and vegetables that were generally known to cure scurvy. Knowing of Francois Magendie’s experiments demonstrating the inadequacy of certain macronutrients, Budd speculated that “the study of organic chemistry and the experiments of physiologists” would ultimately shed light on the essential element common to the antiscorbutic plants. Two years later [1842],1 a series of Budd’s lectures was published in which he clearly and explicitly classified scurvy, rickets, and certain eye disorders as diseases resulting from dietary deficiencies. Budd’s 1840 article on scurvy was frequently cited by English physicians through the turn of the century. One reason for his continued influence was that he was among the last practising physicians to be particularly interested in the disease. p.120-121. https://pmc.ncbi.nlm.nih.gov/articles/PMC1081945/?page=2 Blackstone S, Hurley RJ, Hughes RE. Some inter-relationships between vitamin C (L-ascorbic acid) and mercury in the guinea-pig. Food Cosmet Toxicol. 1974 Aug;12(4):511-6. https://doi.org/10.1016/0015-6264(74)90065-0 “Shun mercury as poison” was Kramer’s advice to scorbutic patients according to George Budd, a London physician, in 1840. Budd himself claimed that in cases of scurvy “… mercury in every form should be religiously avoided [as] we have met with instances in which the scorbutic symptoms seemed to have been much aggravated by mercury, taken before the scurvy made its appearance” (Budd, 1840). Budd was an astute observer with a suitably cautious scientific approach and it is unlikely that he would have emphasized this apparent relationship between scurvy and mercury had he not a strong observational basis for doing so (Hughes, 1973a). p.511. The observations of Budd (1840) indicated that low tissue levels of ascorbic acid increased a person’s susceptibility to mercury poisoning (or, conceivably, that an increased intake of mercury exacerbated the scorbutic condition). As a possible corollary of this one would perhaps expect a state of tissue saturation with ascorbic acid to afford some degree of protection against mercury poisoning. p.511. Of the reductions in tissue ascorbic-acid levels associated with mercury treatment (Tables 2 & 3), the depression in brain ascorbic acid is of particular interest as brain ascorbic acid is in general more resistant to change than is the ascorbic acid of the other organs examined (Hughes, Hurley & Jones, 1971). It is therefore quite conceivable that in scorbutic or near-scorbutic subjects, mercury could still further reduce the already low levels of ascorbic acid and so precipitate or exacerbate the scorbutic symptoms, as described by Budd (1840). p.514-515. 1https://wellcomecollection.org/works/b8epyvag The 1842 papers, all 5 papers as a reprint. https://babel.hathitrust.org/cgi/pt?id=mdp.39015023953956&view=1up&seq=660 https://babel.hathitrust.org/cgi/pt?id=mdp.39015023953956&view=1up&seq=740 https://babel.hathitrust.org/cgi/pt?id=mdp.39015023953956&view=1up&seq=771 https://babel.hathitrust.org/cgi/pt?id=mdp.39015023953956&view=1up&seq=853 https://babel.hathitrust.org/cgi/pt?id=mdp.39015023953956&view=1up&seq=934 4 Hughes RE. George Budd (1808-1882) and nutritional deficiency diseases. Med Hist. 1973 Apr;17(2):127-35. https://pmc.ncbi.nlm.nih.gov/articles/PMC1081440 https://doi.org/10.1017/s002572730001841x Budd had considerable first-hand experience of scurvy during his period as physician to the Dreadnought Seaman’s Hospital Ship and by 1840 he had already contributed a comprehensive account of the disease to Tweedie’s Library of Medicine. p.128. Harris LJ. Vitamins in Theory and Practice. 4th ed. 1955. https://archive.org/details/in.ernet.dli.2015.549647/page/n3/mode/2up https://archive.org/details/vitaminsintheory0000lesl/page/n7/mode/2up The Prophet Budd. But to resume our story we see that at the beginning of the twentieth century it was clear that two diseases at least, scurvy and beri-beri, and probably a third also rickets could be cured by changes in the diet. Unfortunately the significance of these discoveries was not appreciated, for it was generally supposed that rickets beri-beri and scurvy were due to a germ—some bacterium, or toxin or the like—and not simply to a something missing. Perhaps the reason that it seems easier for the human mind to believe that ill is caused by some positive evil agency rather than by any mere absence of any beneficent property. Also the germ theory of disease following on Pasteur’s discoveries last century tended to rule all medical thought to the exclusion of everything else. But in 1840 a medical writer called Budd more far-sighted than his contemporaries seems to have foreseen the existence of the anti-scurvy vitamin—for he definitely expressed his belief that scurvy (to quote his own words) was due to the lack of an essential element which it is hardly too sanguine to state will be discovered by organic chemistry or the experiments of physiologists in a not too distant future. His prophesy has been fully justified. p.6-7. Chick H. Early investigations of scurvy and the antiscorbutic vitamin. Proceedings of the Nutrition Society. 1953;12(3):210-219. https://doi.org/10.1079/PNS19530050 There is also the instructive story of four ships which sailed from England in 1600 to establish the East India Company, in three of which 105 men died of scurvy on the voyage to Bombay. In the fourth ship, that of the Commodore, the crew received a daily ration of preserved lemon juice; they remained in good health and on arrival at port did all the unloading, as they alone were fit for work (Budd, 1840, p. 58). p.211. Their arguments were reinforced by a recent experience on board H.M.S. Suffolk which in the previous year, 1794, had sailed from England to Madras. Each seaman had received 2/3 oz. lemon juice with 2 oz. sugar served daily in the grog. The voyage lasted 23 weeks with the loss of not a single man; the crew remained entirely free from scurvy (Budd, 1840, p. 58). p.213. The scheduled allowance for the sailors in the Navy was fixed at 1 oz. lemon juice with 1½ oz. sugar, served daily after 2 weeks at sea, the lemon juice being often called ‘lime juice’ and our sailors ‘lime juicers’. The consequences of this new regulation were startling and by the beginning of the nineteenth century scurvy may be said to have vanished from the British navy. In 1780 the admissions of scurvy cases to the Naval Hospital at Haslar were 1457; in the years from 1806 to 1810 they were two (Budd, 1840, p. 58). p.213. 5 Glen King C. The Discovery and Chemistry of Vitamin C. Proceedings of the Nutrition Society. 1953;12(3):219-227. https://doi.org/10.1079/PNS19530051 p.220 Despite the excellent report on protective foods by Kramer (1721, 1737), and Budd’s (1841) clear suggestion that chemists would soon isolate the antiscorbutic substance (‘essential element’) from natural products, a key required for progress was not forged until Holst & Frolich (1907, 1912) reported their use of the guineapig as a means of measuring the nutrient that vanished so easily. Hess AF (1920). Scurvy: Past and Present. https://archive.org/details/scurvypastpresen00hessiala/page/32/mode/2up https://www.gutenberg.org/ebooks/40505 https://digital.library.cornell.edu/catalog/chla2903792 https://doi.org/10.5281/zenodo.10685194 Selected extracts of major relevance. It was evident to Lind in the seventeenth century that scurvy could be prevented and cured by means of fruits or vegetables, a fact which became increasingly clear to succeeding generations. Until the latter part of the nineteenth century, however, this miraculous virtue of plants stimulated little inquiry and no research. As far back as 1841 Budd realized that “the explanation depended on the study of organic chemistry, and the experiments of physiologists,” but until recently it was not perceived that the solution of the problem involved the introduction of a new chemical factor. p.32-33. Barlow T. On Cases Described as “Acute Rickets,” which are probably a combination of Scurvy and Rickets, the Scurvy being an essential, and the rickets a variable, element. Med Chir Trans. 1883;66:159-220.1. https://pmc.ncbi.nlm.nih.gov/articles/PMC2121454 Dr. Budd, in his article on “Scurvy,” in Tweedie’s System of Medicine [1840], describes a post-mortem on one case in which, although there was no swelling of the calf, there was a node-like swelling over one tibia, and on cutting down upon it there was found a thin layer of blood under the fascia and a solid clot of chocolate colour a line or two in thickness for a length of six or seven inches under the periosteum, the periosteum itself being thickened and infiltrated with blood in this region. Other subperiosteal haemorrhages were found on one femur, one fibula, the opposite tibia, and the upper and lower jaws. p.196. https://pmc.ncbi.nlm.nih.gov/articles/PMC2121454/?page=38 There is another observation by Dr. Godechen,2 a Russian physician, which is quoted by Budd, and is very important. In a case of scurvy, separation of the ribs from the costal cartilages and fractures of ribs near their anterior extremities occurred, without violence, whilst the patient was in the hospital. p.197. https://pmc.ncbi.nlm.nih.gov/articles/PMC2121454/?page=39 On the other hand, although scurvy in adults is generally an apyrexial disease, it must be remembered that, in the words of Dr. Budd, occasionally we find the skin hot and the pulse attaining or even exceeding the rate of 120 in the minute. In these cases, Dr. Budd remarks, the swellings are exquisitely tender and the slightest movement of the limbs occasions great suffering. p.199-200. https://pmc.ncbi.nlm.nih.gov/articles/PMC2121454/?page=41 2 GOEDECHEN, see Footnote 195 6 Ward SH. General and clinical remarks on scurvy. Lancet 1860;76:428-429. https://doi.org/10.1016/S0140-6736(02)34891-8 I need not make any apology for introducing Scurvy once more to the notice of my professional brethren, inasmuch as twenty years have elapsed since Dr. Budd’s paper appeared in the Library of Medicine [1840], and the subject has since been scarcely touched upon. p.428. In the year 1858, thirty-eight cases, in 1859 thirty cases, and up to the end of September of this year twenty-seven cases of scurvy were admitted into the Dreadnought under my care, and about as many more under the care of my colleague. The average entire number admitted yearly may be estimated at, at least, seventy. Dr. Budd, writing in 1838, says that during the year and a half in which he had acted as sole physician, about fifty cases of scurvy had been admitted. p.429. Turnbull J. Observations on scurvy. Lancet 1848;51:601-604. https://doi.org/10.1016/S0140-6736(02)87938-7 Dr. Budd seems to entertain similar views in regard to the probability of some other diseases becoming complicated with scurvy; and in the article on Scurvy, in the Library of Medicine [1840], he observes that it is his opinion, that a condition which might be correctly designated a scorbutic taint, must often occur in the lower classes in towns and especially in prisons and asylums, towards and at the close of long winters, when succulent vegetables are scarce and expensive. p.603. This neglect of the causes of scurvy would not, however, seem to be by any means confined to ships belonging to Liverpool, for Dr. Budd, in his able article on Scurvy [p.63], makes the following statement, from which it will be seen that the disease was, at the time he wrote, quite as prevalent in the ships entering the port of London. “The means which experience has proved to be of such certain efficacy, and which are so easy of adoption, are, in many instances, neglected. In proof of this, we need only mention, that in the space of a year and a half, during which we have been physician to the Seaman’s Hospital, ‘Dreadnought,’ we have had to treat nearly fifty cases of scurvy, and from information obtained from these patients, are led to estimate the number who entered the port of London affected with scurvy during the period, at no less than double that number. The wretched condition of some of these men has convinced us that the descriptions of the sufferings occasioned by scurvy in voyages of the early navigators have not been exaggerated.” p.603. 7 On the Pathology and Treatment of Scurvy. Br Foreign Med Chir Rev. 1848 Oct;2(4):439-474. https://pmc.ncbi.nlm.nih.gov/articles/PMC5199360 Dr. Budd, in his admirable article on scurvy, in the Library of Medicine [1840, p.66], adopts more unreservedly the same opinion: “Scurvy,” he says, “may occur in all climates, either on land or at sea; in persons who subsist on salt meat, or fresh, and in situations in which the utmost attention is paid to cleanliness and ventilation. There is one condition, however, which is necessary for the production of scurvy, namely, prolonged abstinence from succulent vegetables or fruits, or their preserved juices as an article of food. When this condition is fulfilled, we find scurvy arising in persons whose situations are the most various in every other respect in which we can compare them, while not a single instance can be cited of its occurring in a person well supplied with these vegetables or fruit.” p.441. https://pmc.ncbi.nlm.nih.gov/articles/PMC5199360/?page=3 We are of opinion, then, that the correctness of Dr. Budd’s opinion has met with additional support; and it may be confidently asserted, that an invariable antecedent of every case of scurvy is a deficiency or absolute want of fresh vegetable food. p.445. https://pmc.ncbi.nlm.nih.gov/articles/PMC5199360/?page=7 8 Budd G. Scurvy. In: The Library of Medicine. Ed. Tweedie A. 1840;5:58-95. https://archive.org/details/b33096314_0005/page/58/mode/2up SCURVY Historical details.—Causes.—Prevention.—Symptoms.—Anatomical characters.—Diagnosis.—Treatment THE English word scurvy, anciently scorbie, is of Saxon origin, and evidently p.58 derived from the same root as the vernacular names of the disease among the other nations of the Saxon race; namely, in the German language scharhock, which signifies a griping, or tearing of the belly; in the Dutch scheurbuik; in the Swedish skörbjugg; and in the Danish skörbug. The medical term scorbutus appears to be merely a latinised variation of the last of these.3 This disease was endemic two centuries ago, in all the northern countries of Europe. It became gradually less frequent as agriculture and gardening improved; and we have witnessed the almost complete extinction of scurvy on land, as the influence of these arts has extended to the most remote parts of Europe and to the humblest classes. It seems to have been very imperfectly, if at all known to the Greek, Roman, and Arabian physicians.4 Some passages in the writings 3 Budd refers to books by Lind, Trotter and Blane. The following text includes extracts of major relevance on scurvy from the three authors, and links to the biographies of the three authors https://doi.org/10.5281/zenodo.10685194 4James Lind was not convinced that old descriptions specifically indicated scurvy “Not that I would be understood to mean, that the scurvy never afflicted armies of old; but only that the accounts we have of it are dubious and imperfect. The first description of a true scurvy that I have met with, is what occurred in the Christian army in Ægypt, about the year 1260, under Lewis IX. But there mention is made, not only of the legs being affected, but also of the spots. The fungous and putrid gums are particularly described.” p.296 footnote https://archive.org/details/treatiseonscurvy00lind/page/296/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=320 https://doi.org/10.5281/zenodo.17341647 Scurvy on the Seventh Crusade by Joinville (1249) August Hirsch (1885) was also not convinced that early writings described scurvy: “The writings that have come down to us from antiquity and the middle ages give no help towards deciding whether scurvy occurred, or was known to medicine, in those times at all; or, if so, to what extent.” p.508 https://doi.org/10.5281/zenodo.17341647 https://doi.org/10.5281/zenodo.10104179 Section on scurvy separately https://archive.org/details/handbookofgeogra02unse/page/508/mode/2up Hermann Immermann (1878) was also not convinced that early writings described scurvy: “Attempts have not been wanting to prove the existence of scurvy in ancient times from certain descriptions of disease by the older writers, which have been supposed to refer to the affection in question. None of the evidence, however, will bear careful examination” p.108 https://doi.org/10.5281/zenodo.17341647 https://doi.org/10.5281/zenodo.17302867 Section on scurvy separately https://archive.org/details/63550630RX13.nlm.nih.gov/page/n127/mode/2up 9 early part of last century.28 But it is not only in armies and during sieges, that we meet with even modern instances of the occurrence of scurvy on land. From the earliest times, it has appeared occasionally in persons long confined in prisons and asylums; and an instance of its prevailing extensively, under such circumstances, happened in England so recently as in the year 1823. We allude to the disease which prevailed in the spring of that year among the inmates of the Milbank Penitentiary.29 The description of this disease, by Dr. Latham,30 shows that it was scurvy in conjunction with dysentery and other effects of starvation. This complicated malady was occasioned by a diet, of which fresh succulent vegetables31 formed no part, and the quantity and quality of which were not adequate to the support of health.32,33 The reports of the inspectors of prisons, for the years 1836, 1837, 1838, abound with instances of the occurrence of scurvy in our gaols and prisons. In 1836 it assumed a very malignant form in the county gaol at Norwich; not fewer than eighteen persons were severely affected with it. (First Report of Inspectors of Prisons; Northern Division, p. 39.) In the House of Correction at Swaffham, as appears from the statement of the surgeon, the prisoners frequently lose their teeth from the effects of scurvy; and when p.61 they were examined (1836) in presence of the inspector, sixteen were found presenting its early symptoms.34 (Ibid. p. 49.) In most of the instances mentioned in these reports, it appeared in prisoners 28 See Med. Gazette, vol. xx. Extract from the annual report of Dr. Murray, principal medical officer at the Cape of Good Hope. https://archive.org/details/s2id13404540/page/234/mode/2up https://archive.org/details/s2id13404540/page/906/mode/2up 29 “As the prison was progressively demolished its site was redeveloped. The principal new buildings erected were the National Gallery of British Art (now Tate Britain)” https://en.wikipedia.org/wiki/Millbank_Prison https://www.gutenberg.org/ebooks/49230 https://www.prisonhistory.org/prison/millbank-prison https://institutionalhistory.com/homepage/prisons/major-prisons/millbank 30 https://pmc.ncbi.nlm.nih.gov/articles/PMC5072770 https://archive.org/details/accountofdisease00lath/page/n13/mode/2up https://archive.org/details/b33490557/page/n3/mode/2up https://archive.org/details/b21504192/page/2/mode/2up 31 https://en.wikipedia.org/wiki/Succulent_plant 32 Scurvy showed itself in some of the prisoners soon after Christmas, and became very general in the month of February. The winter was very severe. 33 See a recent critical view on the actual prevalence of scurvy in the Millbank Penitentiary. McRorie Higgins P. The scurvy scandal at Millbank penitentiary: a reassessment. Med Hist. 2006 https://pmc.ncbi.nlm.nih.gov/articles/PMC1592637 https://doi.org/10.1017/S0025727300010310 34 For other instances, see First Report, 1836, No. 2. p. 55. 60. 63. 85, &c; Second Report, 1837, No. 1. p. 81. 217. 232, &c.; Third Report, 1838, No. 2. p. 71., No. 3. p. 79, &c. 16 who had been some months in confinement; and originated in a circumstance already specified, namely, prolonged use of a diet of which fresh succulent vegetables formed no part. We have said that notices of scurvy, as a disease peculiar to the northern nations of Europe, became frequent as soon as they began to cultivate letters; but two other circumstances, which happened about the same time, tended powerfully to direct men’s minds to the consideration of this disease, and, by exhibiting it in an isolated manner, to give them precise ideas respecting it. We allude to the frequent performance of long voyages at sea, and to the establishment of colonies in the northern part of the newly-discovered continent of America. The early northern colonies in America were dreadfully afflicted with scurvy. The French, especially upon first planting Canada, experienced such loss from the mortality it occasioned in winter, that they often had thoughts of abandoning their settlement. The same was the case with the English, on their settling in Newfoundland. The adventurers, who first wintered in Hudson’s Bay, were almost all destroyed by scurvy; and, after many unsuccessful trials, it was deemed impracticable to pass the winter in those parts. As early as the middle of last century, however, the persons employed in our factories at Hudson’s Bay, enjoyed extraordinary health, and were entirely exempt from scurvy; a circumstance which has been ascribed to the use of spruce beer,35 which they had adopted as a common beverage. But it is during long voyages that the ravages of scurvy have been most felt, and the existence of it, as a prevalent disease, maintained. The earliest account of the occurrence of scurvy at sea is to be met with in the narrative of Vasco de Gama, who first discovered a passage to the East Indies by the Cape of Good Hope, in the year 1497; about a hundred of his 35 See discussions of vitamin C content in spruce and fir trees https://doi.org/10.3138/cbmh.7.2.161 https://doi.org/10.1001/jamadermatol.2014.4582 https://doi.org/10.1126/science.99.2563.125.a https://doi.org/10.1126/science.98.2545.325.a https://doi.org/10.1126/science.98.2541.242.a https://doi.org/10.1126/science.98.2541.241 https://doi.org/10.1126/science.98.2536.132.a https://doi.org/10.1126/science.97.2520.354.c https://doi.org/10.1126/science.92.2376.35.b See also Footnotes 40, 132, 135 17 men, out of a hundred and sixty, died of this distemper.36 The narratives of subsequent navigators, especially Cartier, Drake, Cavendish, and Dampier, abound with descriptions of the frightful ravages of scurvy. In the account of the second voyage of Cartier to Newfoundland, in 1535,37 there is a very graphic description of the disease, which showed itself in his men soon after Christmas, and which he ascribed to their intercourse with the natives who were at that time affected with it. The following passage will give some idea of the sufferings it occasioned:— “With such infection did the sickness spread in our three ships, that about the middle of February, of a hundred and ten persons that we were, there were not ten whole; so that one could not help the other; a most horrible and pitiful case. Eight were already dead, and more than fifty sick, and, as we thought, past all hope of recovery. This malady being unknown to us, the body of one of our men was opened, to see if by any means possible the occasion of it might be discovered, 36 V. de Gama sailed on the 8th of July, 1497, and returned to Lisbon in the month of September 1499, more than two years after his departure. https://en.wikipedia.org/wiki/Vasco_da_Gama “no sooner were long voyages performed to distant parts of the world, by the great improvement of navigation, and by the discovery of the Indies, which happened much about the same period of time, than the seamen were afflicted with it; as appears by the voyage of Vasco de Gama, who first found out a passage by the Cape of Good Hope to the East-Indies, in the year 1497; above a hundred of his men, out of the number of a hundred and sixty, dying in this distemper” Lind p.298 https://archive.org/details/treatiseonscurvy00lind/page/298/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=322 “Many of our men fell ill here, their feet and hands swelling, and their gums growing over their teeth, so that they could not eat.” p.20-21 “Owing to frequent calms and foul winds it took us three months less three days to cross this gulf, and all our people again suffered from their gums, which grew over their teeth, so that they could not eat. Their legs also swelled, and other parts of the body, and these swellings spread until the sufferer died, without exhibiting symptoms of any other disease. Thirty of our men died in this manner—an equal number having died previously—and those able to navigate each ship were only seven or eight, and even these were not as well as they ought to have been. I assure you that if this state of affairs had continued for another fortnight, there would have been no men at all to navigate the ships. We had come to such a pass that all bonds of discipline had gone. Whilst suffering this affliction we addressed vows and petitions to the saints on behalf of our ships.” p.87 “These ships’ stores were supplemented by fish, caught whenever an opportunity offered, and by fresh provisions obtained when in port, among which were oranges, which proved most acceptable to the many men suffering from scurvy.” p.166 https://archive.org/details/ajournalfirstvo01ravegoog/page/n68/mode/2up https://www.gutenberg.org/ebooks/46440 A Journal of the First Voyage of Vasco da Gama 1497-1499 37 Cartier sailed from St. Malo on the 19th of May, 1535, and arrived at Newfoundland on the 7th of July. He spent the autumn in exploring the coast and the river St. Lawrence, which was discovered by him. https://en.wikipedia.org/wiki/Jacques_Cartier 18 and the rest of us preserved. But in such sort did the sickness continue and increase, that by the middle of March there were not above three sound men left. Twenty-five of our best men had died, and all the rest were so ill that we thought they would never recover again; when it pleased God to cast his pitiful eye upon us, and send us knowledge of a remedy for our health and recovery.” (Hakluyt’s Collection of Voyages, vol. iii.)38,39 The remedy alluded to was a decoction of the bark and leaves of a tree, called by the natives, Ameda, or Hanneda, by the use of which they were all p.62 perfectly restored in a short time.40 38 “With such infection did this sicknesse spread it selfe in our three ships, that about the middle of February, of a hundreth and tenne persons that we were, there were not ten whole, so that one could not helpe the other, a most horrible and pitifull case…” https://archive.org/details/cihm_37675/page/n307/mode/2up Hakluyt p.278 https://doi.org/10.5281/zenodo.17348074 Other translations 39 “unknown sickness began to spread itself amongst us, after the strangest sort that ever was either heard of or seen; insomuch that some did lose all their strength, and could not stand upon their feet; then did their legs swell, their sinews [tendon] shrunk, and became as black as a coal. Others had also their skin spotted with spots of blood, of a purple colour. It ascended up their ancles, knees, thighs, shoulders, arms and neck. Their mouth became stinking; their gums so rotten, that all the flesh came away, even to the roots of their teeth; which last did also almost all fall out…” https://archive.org/details/treatiseonscurvy00lind/page/298/mode/2up Lind p.299 https://wellcomecollection.org/works/xc2t7736/items?canvas=322 Dissection in Cartier’s report described by Lind. “[Case no.] 2. The heart was found white and putrid; its cavities were quite full of corrupted blood. The lungs were blackish and putrid; more than a quart of reddish water was found in the thorax. The liver was pretty sound; but the spleen somewhat corrupted, and rough as if it had been rubbed against a stone.” https://archive.org/details/treatiseonscurvy00lind/page/256/mode/2up Lind p.256 https://wellcomecollection.org/works/xc2t7736/items?canvas=280 40 “One day our captain [Cartier], seeing the sickness so violent and his people so smitten with it, being gone outside of the fort and walking by himself upon the ice, beheld a band of folks coming from Stadaconé, in the which was Dom Agaya, whom the captain had seen, only ten or twelve days before, very sick with the sickness which his people had; for he had one of his legs as big at the knee as a child of two years, and all the sinews of it shrunken, his teeth lost and spoiled, and his gums putrid and corrupted. The captain, seeing the said Dom Agaya sound and well, was glad, hoping to know from him how he was cured, so as to give aid and succor to his men. When they were arrived near the fort, the captain asked him how he was cured of his sickness; the which Dom Agaya responded that he was cured by the juice and refuse of the leaves of a tree, and that it was the only remedy for the sickness… They call the said tree in their tongue amedda. Soon after the captain had some of the beverage made in order to have the sick drink of it… Shortly after they had drunken of it they received benefit, which was found to be a real and evident miracle; for all the sick, of whatever they were infected, after having drunken of it two or three times, recovered health and vigor… After this was seen and understood there was such strife for the said medicine that they would have killed themselves to see who first should have it; so that a tree as big and as tall as any tree I ever saw was used up in less than eight days, which had such effect that if all the doctors of Lorraine and Montpellier had been there, with all the drugs of Alexandria, they could not have done so much in a year as the said tree did in six days; for it profited us so much that all those who would use it recovered health and soundness, thanks to God.” https://doi.org/10.5281/zenodo.17348074 Cartier’s second voyage; Baxter p.194-196 19 In the first voyage for the establishment of the East India Company, the equipment, consisting of four ships with 480 men, under commodore Lancaster,41 sailed from England on the 2d of April, 1600. The crews of three of these ships were so weakened by scurvy, by the time they had got only three degrees beyond the line, that the merchants who had embarked on this adventure, were obliged to do duty as common sailors. On the 1st of August, when they arrived at Saldanha, near the Cape of Good Hope, the commodore’s own ship was in perfect health, from his having given three table-spoonsful of lemon juice every morning to each of his men;42 while the other ships were so sickly that the commodore was obliged to send men on board to take in their sails and hoist out their boats; and there died, at sea and on shore at Saldanha, 105 men, nearly one fourth of their whole number. (Purchas’s Collection of Voyages, vol. i.) The memorable expedition of Lord Anson in 1740, and the four following years43, offers another example of the mortality formerly occasioned by scurvy during long voyages. At the end of two years from their leaving England, the vessels engaged in the expedition had lost, from this disease, a larger proportion than four in five of the original number of their crews. It is gratifying to turn from the descriptions of sufferings undergone in the voyages of earlier navigators, to the narrative of Captain Cook, who in 1772, 3, 4, and 5 44, in the Resolution, with a company of 118 men, performed a voyage of three years and eighteen days, in all climates, from 52° north to 71° south, 41 https://en.wikipedia.org/wiki/James_Lancaster https://pmc.ncbi.nlm.nih.gov/articles/PMC7932658 https://pmc.ncbi.nlm.nih.gov/articles/PMC3618161 https://pmc.ncbi.nlm.nih.gov/articles/PMC1296402 https://archive.org/details/voyagesofsirjame00markrich/page/60/mode/2up p.61-62 https://archive.org/details/treatiseonscurvy00lind/page/156/mode/2up Lind’s summary, p.156-157 https://wellcomecollection.org/works/xc2t7736/items?canvas=180 42 Baron (2009) re-evaluated Lancaster’s experiment with lemons, and was quite critical, see https://doi.org/10.1111/j.1753-4887.2009.00205.x p.316 43 Lord Anson left England in September, 1740, and returned in June, 1744. https://doi.org/10.5281/zenodo.17397300 Lind’s summary of scurvy on Anson’s voyage. https://archive.org/details/treatiseonscurvy00lind/page/430/mode/2up Lind p.431-439 https://wellcomecollection.org/works/xc2t7736/items?canvas=455 https://en.wikipedia.org/wiki/George_Anson,_1st_Baron_Anson https://en.wikipedia.org/wiki/George_Anson%27s_voyage_around_the_world https://pmc.ncbi.nlm.nih.gov/articles/PMC9662994 https://www.gutenberg.org/ebooks/16611 Anson’s Voyage Round the World by Richard Walter 44 Captain Cook sailed from Plymouth on the 13th of July, 1772. 20 with the loss of only one of his crew by disease.45 It is to the sagacity of this extraordinary man that we are indebted for the first impulse towards those improvements in the treatment of sailors by which scurvy is at present so effectually prevented in our navy. In 1780 scurvy was very prevalent in the Channel fleet. In the month of August the squadron under Admiral Geary, after a cruise of ten weeks in the Bay of Biscay, returned to Portsmouth with 2400 men affected with it.46 During the same year and the following, scurvy prevailed also to great extent in our fleet, under Lord Rodney,47 in the West Indies; it was, however, much mitigated by improvements which were then introduced, chiefly at the suggestion of Sir Gilbert Blane,48 into the victualling of the fleet. From this time scurvy was much less prevalent than before, but in the spring of 1795 it broke out in the Channel fleet under the command of Lord Howe,49 to such an extent as to endanger the safety of the whole fleet. Its uncommon violence was owing to the following circumstances. The winter had been extremely severe,50 and all vegetation was destroyed in the neighbourhood of Portsmouth, so that no vegetables could be procured, or they could be procured only at a price which put them out of reach of the sailor; beef, too, had much risen in price, and the Victualling Board had, in consequence, allowed fresh meat only one day a week. In the beginning of April, scurvy made its appearance, and soon after pervaded every ship. To suppress it, became, of course, an object of great national importance, and every effort was made by the commissioners of the Admiralty for the accomplishment of this purpose. Fresh meat, together with a plentiful supply of oranges and lemons, was granted. Vegetables at first could be procured 45 “the Resolution performed a voyage of three years and eighteen days, through all the climates from 52° North to 71° South, with the loss of one man only by disease, and who died of a complicated and lingering illness, without any mixture of scurvy. Two others were unfortunately drowned, and one killed by a fall; so that of the whole number with which I let out from England I lost only four.” https://doi.org/10.1098/rstl.1776.0023 https://www.jstor.org/stable/106286 https://archive.org/details/philtrans08393052/mode/2up 46 “The first trial of melasses was in the Foudroyant, and it answered so well, that, in a cruise under Admiral Geary in 1780, this was the only ship free from the scurvy, and out of two thousand four hundred men that were landed at the hospital with this disease, there were none from this ship.” https://archive.org/details/b2144092x/page/284/mode/2up Blane 1799, p.285 47 https://en.wikipedia.org/wiki/George_Rodney,_1st_Baron_Rodney 48 See extracts discussing scurvy in Gilbert Blane’s books and links to the books https://doi.org/10.5281/zenodo.10685194 49 https://en.wikipedia.org/wiki/Richard_Howe,_1st_Earl_Howe 50 “The frost in the month of December 1794, sat in extremely severe…” https://archive.org/details/b21351879_001/page/404/mode/2up Trotter 1804, p.405 21 only in small quantities; as the season advanced, they became more plentiful, and after the 31st of May, 5000 weight of salad was distributed daily among the ships at Spithead. The good effects of these refreshments were astonishing; on the 12th of June the squadron sailed again in good health. (See an admirable account of the health of the fleet in Trotter’s Medicina Nautica. 51) It was in the course of this year that an admiralty order was first given for furnishing the navy with a regular supply of lemon juice, which had been long known to be a remedy for scurvy, and which some recent experiments had proved to be equally efficacious in preventing it. From this time we may date p.63 the extinction of scurvy in the British navy. It has, indeed, shown itself on several occasions since, especially in some of the expeditions for the discovery of a north-west passage; but it has prevailed only in a slight degree, and has almost always been suppressed by an additional allowance of lemon juice. This happy result is far, however, from being realised in the commercial marine of this country.52 The means, which experience has proved to be of such certain efficacy, and which are so easy of adoption, are in many instances neglected: in proof of this we need only mention, that in the space of a year and a half, during which we have been physician to the Seamens’ Hospital, Dreadnought,53 we have had to treat nearly fifty cases of scurvy; and from information obtained from these patients, are led to estimate the number of sailors, who entered the port of London, affected with scurvy during this period, at not less than double that number. The wretched condition of some of these men has convinced us that the descriptions of the sufferings occasioned by scurvy in voyages of the early navigators have not been exaggerated. All the cases that have fallen under our observation, with the exception of four, occurred in sailors who had come from the Mauritius, Sidney, Ceylon, China, or some port in India; of these four, two happened in the spring of the present year (1838), in Russian sailors belonging to different vessels, each of 51 “We were, therefore, from the 31th of May, supplied with near five thousand weight of sallad every day which was distributed, under my own eye, to the different ships at Spithead…” https://archive.org/details/b21351879_001/page/414/mode/2up Trotter 1804, p.414 52 Budd (1839) argued that antiscorbutics should be obligatory for the commercial marine. https://doi.org/10.5281/zenodo.15647274 53 Dreadnought. https://en.wikipedia.org/wiki/Seafarers_Hospital_Society https://en.wikipedia.org/wiki/HMS_Dreadnought_(1801) https://www.rmg.co.uk/collections/archive/rmgc-object-531562 22 which had been several months in the Thames;54 one, in a sailor who came last from the West Indies; and the fourth, in a sailor recently arrived from the coast of Spain. We have no data for forming an accurate estimate of the mortality occasioned by scurvy before preventive measures were generally adopted. It has been supposed, however, to have destroyed more sailors than the other various accidents incidental to a sea-life, together with the terrific consequences of naval warfare; and history furnishes us with many examples, which tend to show that in this estimate the destructive effects of it have not been overrated. Sir R. Hawkins, who lived in the latter part of the sixteenth century, and whose description of this disease shows that he was well acquainted with it, informs us that he could give an account of ten thousand mariners, consumed by scurvy alone, in twenty years that he had been at sea.55 Admiral Hosier,56 who set sail in the month of April, 1726, with seven ships of the line for the West Indies, buried his ships’ companies twice, and died himself of a broken heart in consequence. We are told by Dr. Lind that during the war, which terminated in 1748, in the peace of Aix-la-Chapelle, scurvy proved more destructive, and cut off a greater number of valuable lives than the united efforts of the French and 54 One of these men was admitted on the 2d, the other on the 15th of March. The winter had been uncommonly severe. The diet of one of them consisted of black rye bread and Russian butter, with tea, mornings and evenings; and for dinner, one pound of salt beef, with boiled pearl barley, two days; one pound of Russian pork, with peasoup, three days a week; dry stock fish, with flour pudding on Saturdays; one pound of fresh meat, with barley soup, on Sundays. A small glass of brandy daily, but no beer or vinegar. The diet of the other had been nearly the same: in fact, this is the general diet of Russian sailors in merchant ships; the only variation being in the relative number of beef and pork days. On referring to the registers of the Dreadnought for former years, I find other instances of Russian sailors, engaged in the trade between Russia and this country, admitted for scurvy during the spring months. 55 Observations of Sir R. Hawkins, Knt., in his Voyage to the South Sea, A.D. 1593. (Purchas’s Pilgrim, vol. iv.) https://www.gutenberg.org/ebooks/57502 “Being betwixt three or foure degrees of the equinoctiall line, my company within a fewe dayes began to fall sicke, of a disease which sea-men are wont to call the scurvey… causeth a generall swelling of all parts of the body, especially of the legs and gums, and many times the teeth fall out of the jawes without paine. The signes to know this disease in the beginning are divers: by the swelling of the gummes, by denting of the flesh of the leggs with a man’s finger, the pit remayning without filling up in a good space. Others show it with their lasinesse: others complaine of the cricke of the backe, etc., all which are, for the most part, certaine tokens of infection.” p.56 https://archive.org/details/observationsofsi00hawk/page/56/mode/2up “in twentie yeares, since that I have used the sea, I dare take upon me to give accompt of ten thousand men consumed with this disease. That which I have seene most fruitfull for this sicknesse, is sower oranges and lemmons.” p.60 https://archive.org/details/observationsofsi00hawk/page/60/mode/2up 56 https://en.wikipedia.org/wiki/Francis_Hosier 23 Spanish arms. (Lind, preface, p. 5. 57) But the most striking illustration of the dreadful effects of scurvy in former times is the contrast, in point of health, which our present navy offers with the fleets of this country before effectual remedies were resorted to. The mortality in the navy had been gradually decreasing since 1780, when various improvements were made in the victualling of the fleet and in the general treatment of the men; but in 1795, when a regular supply of lemon juice was first granted, the mortality fell suddenly, and to a degree scarcely credible. The effect of all these salutary measures may be estimated by the fact mentioned p.64 by Sir J. Barrow, that between the years 1779 and 1813, the diminution of sick and of deaths in the British navy was in the proportion of four to one nearly. (See Supplement to Encyc. Britan, art. NAVY. 58) Causes. In the preceding sketch of the history of scurvy we have found it difficult to avoid allusion to its causes, and to the means by which it may be prevented. The following observations must be considered, therefore, as the complement of what we have already said in reference to these subjects. Salt provisions. In consequence of the frequent occurrence of scurvy at sea, and on shore, in persons whose diet, like that of sailors, consisted chiefly of salt meat, it was at one time supposed to be occasioned by excessive use of salt. A more extended view of the circumstances under which scurvy arises, is sufficient to show that this opinion is erroneous. Kramer,59 in the letter we have already quoted, informs us that the Germans, among whom scurvy occasioned such great mortality in the spring of 1720, in Hungary, ate no salt beef or pork, but, on the contrary, had plenty of fresh 57 “Armies have been supposed to lose more of their men by sickness than by the sword. But this observation has been much more verified in our fleets and squadrons; where the scurvy alone, during the last war, proved a more destructive enemy, and cut off more valuable lives than the united efforts of the French and Spanish arms.” https://archive.org/details/treatiseonscurvy00lind/page/n9/mode/2up p.v https://wellcomecollection.org/works/xc2t7736/items?canvas=9 58 The original data on the decline of scurvy were reported by Blane (1815) https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027 Table 1, p.539-540 https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027/?page=50 In 1779, 1:2.45 were sick, and in 1813, 1:10.75 were sick, corresponding to decline by ratio 4.4 A related document (1830) https://archive.org/details/b22391587/mode/2up https://archive.org/details/cihm_43003/page/n5/mode/2up 59 Description of scurvy by Kramer (1720,1737) https://doi.org/10.5281/zenodo.17224830 24 meat at a very low price. The soldiers in the Russian armies, who, in the early part of last century suffered greatly from scurvy, had also no salt provisions. We have already remarked that the same was the case with our regiments at the Cape, in which scurvy prevailed in the autumn of 1836. In the middle of last century, when Sisinghurst Castle in Kent was filled with French prisoners, scurvy broke out among them, although from the time of their arrival in England, they had eaten no salt provisions, but had been served daily with fresh meat and bread, but without greens or other vegetables.60 The severity of the winter of 1794-5, which we have already mentioned as the cause of the unusual prevalence of scurvy in the Channel fleet in the following spring,61 was also productive of scurvy on shore. During that spring cases of genuine scurvy were admitted into most of the London Hospitals; and Dr. Heberden has well described those of some patients that were under his own care in St. George’s.62 Speaking of one of these patients, he says, “His diet previously to the occurrence of scurvy, consisted of bread and butter, with tea for breakfast, fresh meat and bread for dinner, and water-gruel for supper. This was his common food at all times, excepting that he had been used to eat vegetables, which, on account of their high price, he had not been able to procure for some months.” (Med. Trans., vol. iv. [p.73]) From a paper published in the Trans. of Med. and Phys. Soc. of Calcutta, vol. iv.,63 it appears that in the lunatic asylum at Moorshedabad, in that presidency, 60 Address to the Royal Society, by Sir J. Pringle, 1776-7. “in the late war, when Sisinghurst Castle in Kent was filled with French prisoners, the scurvy broke out among them, though they had never been served with salted victuals in England; but had daily had an allowance of fresh meat, and of bread in proportion, though without greens or any other vegetable.” Pringle p.11 https://wellcomecollection.org/works/q7n4y77w/items?canvas=15 https://archive.org/details/b30790943/page/10/mode/2up https://quod.lib.umich.edu/cgi/t/text/text-idx?c=ecco;idno=004801344.0001.000 Pringle https://en.wikipedia.org/wiki/Sir_John_Pringle,_1st_Baronet 61 “The frost in the month of December 1794, sat in extremely severe… While the Fleet lay in Torbay… During this time, an Epidemic Catarrh had raged in every ship, and the debility which followed it, had certainly some share in predisposing the body for the attack of the Scurvy…” https://archive.org/details/b21351879_001/page/404/mode/2up Trotter 1804, p.405 62 “During nearly ten years, that I was physician to St. George’s Hospital, the following were the only cases, that fell under my care, which bore any relation to the true Scurvy…” p.71 https://archive.org/details/b24976957_0004/page/64/mode/2up Heberden p.65-84 https://archive.org/details/b2130449x/page/64/mode/2up https://wellcomecollection.org/works/u7hqmb3k/items?canvas=79 63 Med. and Phys. Trans, of Calcutta, vol. iv. p. 16. Land Scurvy among the Natives, by B. Burt, M.D. https://archive.org/details/s8id13658460/page/14/mode/2up 25 Lancaster in 1600, was principally owing to his having commenced the voyage in spring. In this instance cold had evidently no share in producing the disease. The same was the case with the squadron sent to the West Indies under Admiral Hosier in 1726. The history of our navy abounds with similar examples. ([Blane] Diseases of Seamen, p. 102. 148. 79) We shall content ourselves with mentioning another instance which occurred in the Channel fleet in 1795, and which is illustrative of the same point. We have already stated that scurvy raged with extraordinary violence in the fleet in the spring of that year, and that it was suppressed by the abundant supply of lemons and salad furnished to the ships at Spithead in the latter part of May and the beginning of June. On the 10th of June the fleet again sailed, and scurvy soon made its appearance; but it was found from the list of patients that, during the cruise, which was a long one, not a man who had shared in the allowance at Spithead showed the slightest symptom of the disease. ([Trotter] Med. Naut., vol. i. p. 423. 80) It has been brought forward by writers on scurvy, as a strong argument in favour of the great influence which they ascribed to cold in the production of this malady, that the sailors most prone to it were those engaged in the northern whale fishery, although the vessels employed in this service were better fitted out than any others, with respect both to variety and quality of provisions; the voyage from this country short; and the men kept constantly in action. The fact has been unnoticed that these vessels always left this country in spring. The great mortality occasioned by scurvy during the siege of Thorn, in 1703,81 admits of similar explanation. The siege, which lasted only five months, was carried on during the heat of summer. This circumstance, which rendered the mortality unaccountable to Bachstrom, Dr. Lind, and others, who believed that cold has great influence in causing this distemper, affords the true explanation of its unusual fatality. The siege was commenced in spring, when scurvy was already imminent in the inhabitants: had the siege been undertaken at the p.68 end of summer, they would have suffered comparatively little from the disease. 79 https://archive.org/details/observationsondi00blan/page/102/mode/2up Blane 1785, p.102 https://archive.org/details/observationsondi00blan/page/148/mode/2up Blane 1785, p.148 80 “not a man who shared of the large allowance of lemons and sallad at Spithead, towards the end of May and the beginning of June, had the least symptom of Scurvy during the long cruize with Lord Bridport.” Trotter 1804, p.423 https://archive.org/details/b21351879_001/page/422/mode/2up 81 Description of scurvy by Bachstrom (1734) https://doi.org/10.5281/zenodo.17225782 32 The history of the siege of Alexandria furnishes us with a precisely parallel instance. The fatal effects of scurvy have, in fact, been generally most felt during sieges commenced in spring, and in voyages entered on in spring from cold countries. The siege and the voyage have in these cases prolonged to the inhabitants and the sailors, not the cold indeed of winter, but abstinence from fresh vegetables, which, in former times, the cold of winter always occasioned. Predisposing causes. When a number of persons are placed in circumstances conducive to scurvy, the first to exhibit its symptoms are those who, from sickness or other causes, are in a state of debility.82 In the Channel fleet, in the spring of 1795, scurvy appeared chiefly in those men who were convalescent from an epidemic catarrh ([Trotter] Med. Naut., vol. i. p. 407. 83); and, during the siege of Alexandria, in 1801, those soldiers who had received severe injuries, or were reduced by the ophthalmia, which at that time prevailed among them, were the first to suffer from scurvy. (Larrey, Chir. Milit. t. ii p. 284. 84) It has often been observed to affect in especial manner persons recovering from intermittent fevers (Lind, p. 210. 85); and our own experience furnishes us with several instances which tend to confirm that observation. Age. Scurvy may occur in persons of all ages. Dr. Mertans, in a paper published in 1778, when he was physician to the Foundling Hospital at 82 Lind., p. 70. and 402.; Curtis’s Diseases of India, p.9 Curtis, p.9: “scurvy now also begins to make its appearance; attacking those first who have been reduced by previous fevers or flux. In such cases, the patient goes off in a sort of general cachexy, rather than with the symptoms of true formed scurvy. They continue pale and sallow, with very little appetite; a low latent state of fever remains, and they never recover any strength, but complain much of torpor and weakness, with difficult or oppressed breathing.” https://archive.org/details/McGillLibrary-osl_account_diseases_india_c9788a1807-20457/page/8/mode/2up https://archive.org/details/anaccountdiseas00curtgoog/page/n50/mode/2up 83 “The frost in the month of December 1794, sat in extremely severe… While the Fleet lay in Torbay … During this time, an Epidemic Catarrh had raged in every ship, and the debility which followed it, had certainly some share in predisposing the body for the attack of the Scurvy…” Trotter 1804, p.405 “Catarrhal complaints were the most prevailing during the month of March and part of April, many of which terminated in Scurvy.” p.407 https://archive.org/details/b21351879_001/page/404/mode/2up 84 Account of the scurvy by Larrey (1814) https://doi.org/10.5281/zenodo.15582455 85 “Intermitting fevers in a particular manner dispose the constitution to it.” Lind p.136 https://archive.org/details/treatiseonscurvy00lind/page/136/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=160 “It was observable, that in the longest cruise she made, while I was surgeon, there was but one scorbutical patient on board, who fell into the disease after having had an intermitting fever.” Lind p.56 https://archive.org/details/treatiseonscurvy00lind/page/56/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=80 33 Moscow, informs us that scurvy showed itself every spring among the children in that establishment, and that one year as many as sixty of them were affected with it. (Phil. Trans., vol. lxviii. 86) We have obtained from the registers of the Dreadnought the ages of 200 scorbutic patients received into that hospital; and have arranged these so as to show how many of them were under 20, between 20 and 30, 30 and 40, and so on. These numbers we have compared, in the subjoined table,87 with the average numbers of merchant seamen whose ages are comprised within the same limits. The average numbers have been derived by taking from the registers at the Custom House, where the age of every sailor who comes into the port of London is registered, the ages of 5000 sailors, entered in succession, by arranging these so as to show the numbers whose ages are comprised within the limits in question; and by reducing these numbers to the scale of 200.88 In this table, those in the first vertical column are almost all between the ages of 15 and 20; the second column (20-30.) includes all whose ages have 2 for the first figure; the third (30-40.) all whose ages have 3 for the first figure; and so on. It appears from this table that persons between the ages of 20 and 30 are of all persons above the age of 15, the least liable to scurvy; and that above the age of 30, the proportion of scorbutic patients continually increases with age. We are inclined to believe that the predisposing influence of age is even greater than is indicated by the preceding table. The average numbers in this p.69 table are derived from the ages of sailors, taken indiscriminately; whereas scorbutic patients all come from distant ports. Sailors engaged in the merchant service may be arranged in two classes: the one comprising those employed in the home, the other those in the foreign trade. Now, sailors advanced in life frequently leave the latter service for the former; and the mortality among seamen is greater in hot climates than in our own; so that there is reason to believe that the proportion of sailors of an advanced age is less in those engaged in the foreign trade, than in those employed at home. 86 Observations on the scurvy by De Mertans (1778) https://doi.org/10.5281/zenodo.16846144 https://doi.org/10.1098/rstl.1778.0032 87 See the table on page 68 https://archive.org/details/b33096314_0005/page/68/mode/2up 88 See art. CHOLERA. 34 Indolent, lazy habits, and despondency, have often been mentioned as exerting a powerful predisposing influence in the production of scurvy; and instances may be cited which seem to show the reality of such an influence.89 In ships that have contained marines as well as sailors, the marines have in general been more affected with scurvy than the sailors.90 The historian of Lord Anson’s voyage tells us, that “whatever discouraged the people, or at any time damped their hopes, never failed to add new vigour to the distemper; so that it seemed as if alacrity of mind and sanguine thoughts were no contemptible preservatives from its fatal malignity.” 91 It is probable, however, that the influence of these causes has been much overrated, and that listlessness and aversion to exercise, from being early and constant symptoms of the disease, have often been mistaken for its cause. Preventives. We come now to speak more in detail of the means by which scurvy may be prevented; and shall first mention as the chief of these means, the use of oranges, lemons, or limes; and, we believe, we might add, shaddocks,92 and all fruits which botanists have included in the order Aurantiaceæ.93 The efficacy of oranges in preventing and curing scurvy was discovered before the disease had been described by physicians. Ronsseus, one of the earliest writers on scurvy, in a work published in 1564, observes that seamen 89 “The lazy and indolent, and those of a sedentary life, as shoemakers, tailors, especially weavers, by reason of their working in damp places, are most subject to it while hard labourers, and those who use much exercise, though living on the same, or even grosser food, keep entirely free.” https://archive.org/details/treatiseonscurvy00lind/page/92/mode/2up Lind 1757, p.93. https://wellcomecollection.org/works/xc2t7736/items?canvas=117 90 See Diseases of Seamen, p. 322. and 465., and Rouppe, De Morbis Navigantium, Trans. [Translation to English], p. 121 “It is observed, that seamen are in general less subject to scurvy than marines and landsmen, which seems to be owing to the greater activity of their life and alacrity of their minds.” https://archive.org/details/observationsondi00blan/page/320/mode/2up Blane 1785, p.321 “It has been observed likewise, that the marines are more afflicted with this disorder than the sailors, and that more die of it, of which there is a remarkable instance in Anson’s voyage…” https://doi.org/10.5281/zenodo.17227637 Rouppe, p.120-121 https://archive.org/details/bim_eighteenth-century_de-morbis-navigantium-_rouppe-ludovicus_1772/page/ 120/mode/2up Rouppe, p.120-121 https://wellcomecollection.org/works/z6je83en Rouppe in Latin 91 “whatever discouraged our people, or at any time damped their hopes, never failed to add new vigour to the distemper…” https://doi.org/10.5281/zenodo.17397300 Lind 3rd ed, p.441-442 https://www.gutenberg.org/ebooks/16611 Anson’s Voyage Round the World, Chapter 7 92 https://en.wikipedia.org/wiki/Pomelo 93 https://www.c82.net/twining/plants/?id=41 35 in long voyages cure themselves of it by the use of oranges.94 He conjectures that Dutch sailors, afflicted with scurvy on their return from Spain with a cargo of these fruits, had by chance discovered their efficacy. Albertus, in a treatise on Scurvy, published in 1593,95 recommends the juice of oranges, and of sour and austere plants. He advises that this juice should be put into soups, and that meat, while roasting, should be sprinkled with it. In the same year, the virtues of lemon juice in the cure of scurvy were experienced by Sir R. Hawkins, whose crew, while within the tropics, were affected with it in an extreme degree.96 We have already given an instance of the extraordinary efficacy of lemonjuice as a preventive of scurvy, in the first voyage [by Lancaster] for the establishment of the East India Company in 1600.97 After this it seems to have been pretty generally used in the company’s ships; and, in a medical work published in this country in 1636,98 it is recommended as the best remedy for scurvy. From this time it is recommended by a series of writers who have treated of this subject;99 and instances which show its extraordinary efficacy are to be frequently met with in our naval annals. 94 “… remarks, that seamen in long voyages cure themselves of it by the use of oranges.” https://archive.org/details/treatiseonscurvy00lind/page/310/mode/2up Lind p.310 https://wellcomecollection.org/works/xc2t7736/items?canvas=334 Description of scurvy by Ronsseus (1564) https://doi.org/10.5281/zenodo.17093314 95 Albertus: “He treats of the diet proper in this disease at great length: recommends the juices of acid and austere fruits, viz. oranges, and the like; with which roast meats when on the spit are to be sprinkled.” https://archive.org/details/treatiseonscurvy00lind/page/320/mode/2up Lind’s summary, p.320 https://wellcomecollection.org/works/xc2t7736/items?canvas=344 96 See Footnote 55 97 See Footnote 42 98 Probably this refers to some reprint of Woodall’s treatise, originally published in 1617. Description of scurvy symptoms by John Woodall (1617) https://doi.org/10.5281/zenodo.10651214 99 John Drawitz, 1647; Une Voyage aux Indes Orientales, par M. Dillon, M.D. 1683; Martin Lister, 1694. Drawitzs [Lind’s spelling] https://archive.org/details/treatiseonscurvy00lind/page/356/mode/2up Lind p.357 https://wellcomecollection.org/works/xc2t7736/items?canvas=381 Dellon [Lind’s spelling] https://doi.org/10.5281/zenodo.17223800 https://archive.org/details/treatiseonscurvy00lind/page/372/mode/2up Lind p.373-376 https://wellcomecollection.org/works/xc2t7736/items?canvas=397 Lister https://archive.org/details/treatiseonscurvy00lind/page/380/mode/2up Lind p.380-381 https://wellcomecollection.org/works/xc2t7736/items?canvas=404 36 When Admiral Sir C. Wager100 commanded our fleet in the Baltic, in 1726,101 his sailors were dreadfully afflicted with scurvy. He had recently come from the Mediterranean, and had on board a great quantity of lemons and oranges, which he had taken in at Leghorn.102 Having often heard of the efficacy of these fruits, he ordered a chest of each to be brought upon deck, and opened every day. The men, besides eating what they liked, mixed the juice with their beer. It was also their constant diversion to pelt one another with the rinds, so that the deck was always strewed with them,103 and wet with the fragrant liquor: the happy result was, that he brought his sailors home in good health. p.70 (Mead on Scurvy.) Most of these proofs of the efficacy of oranges and lemons were collected by Dr. Lind, and published in his justly celebrated work on Scurvy in 1757.104 His earnest recommendation for the general employment of these fruits in the navy was, however, not acted upon for some time;105 the disease continued to depopulate our fleets, offering a striking example of the delay which sometimes attends the practical application of most important truths. To the cause of delay in the present instance, we shall allude particularly hereafter (see chap. on Diagnosis); at present we only mention the fact, as one of the most singular and instructive in the history of the disease. We have already noticed the prevalence of scurvy in our fleet in the West Indies in the years 100 https://en.wikipedia.org/wiki/Charles_Wager https://www.westminster-abbey.org/abbey-commemorations/commemorations/charles-wager https://www.rmg.co.uk/collections/objects/rmgc-object-14547 101 “One year when that brave Admiral Sir Charles Wager commanded our Fleet in the Baltic, his sailors were terribly afflicted with the scurvy…” https://archive.org/details/treatiseonscurvy00lind/page/152/mode/2up Lind p.153 https://wellcomecollection.org/works/xc2t7736/items?canvas=177 102 https://en.wikipedia.org/wiki/Livorno 103 “The learned Dr. Mead ascribes some salutary effects to the fragrancy of the fresh fruits, when he observes, that by the sailors pelting each other with the rinds in Admiral Wager’s ship, the decks were strewed and wet with this wholsome liquor.” https://archive.org/details/treatiseonscurvy00lind/page/162/mode/2up Lind p.163 https://wellcomecollection.org/works/xc2t7736/items?canvas=187 104 https://archive.org/details/treatiseonscurvy00lind/page/n5/mode/2up Lind’s 2nd ed. in 1757 https://wellcomecollection.org/works/xc2t7736/items?canvas=5 https://babel.hathitrust.org/cgi/pt?id=ucm.5320216015&seq=5 Selections of Lind’s texts and links to digitized books: 1st ed 1753, 3rd ed 1772, and links to numerous biographies on Lind https://doi.org/10.5281/zenodo.10685194 105 Lind did not unambiguously encourage fruit, see comments by Baron (2009) https://doi.org/10.1111/j.1753-4887.2009.00205.x James Lind firmly disagreed with Bachstrom, who had proposed that scurvy “is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the true primary cause of the disease.” See Lind’s comments in: Description of scurvy by Bachstrom (1734) https://doi.org/10.5281/zenodo.17225782 37 1780, 1, 2, and in the Channel fleet in 1795. The history of these fleets afford numerous proofs of the efficacy of the fruits in question; but in 1794 an experiment was made which established it beyond doubt. The Suffolk, of 74 guns, sailed from England for Madras on the 2d of April, 1794. She was provided with lemon juice; and two thirds of a liquid ounce of this juice, together with two ounces of sugar, were mixed with each man’s daily allowance of grog. The Suffolk was twenty-three weeks and one day on the passage, during which she had no communication with land. Scurvy showed itself in a few men in the course of the voyage, but soon disappeared on an additional quantity of lemon juice being given them; and the ship arrived at Madras, without the loss of a single man, and with her crew entirely exempt from scurvy.106 It is to the representations of Dr. Blair and Sir G. Blane, in their capacity of commissioners for the relief of sick and wounded seamen, enforced by the result of this experiment in the Suffolk, that we owe the systematic introduction of lemon juice into nautical diet, in 1795, by order of the Admiralty. We have already spoken of the improvement in the health of the navy consequent on this wise measure; but we may be permitted to mention the following circumstances which show how completely it has realised the expectations of its proposers. In 1780, 1457 cases of scurvy107 were admitted into Haslar Hospital:108 in 1810, 106 Sir G. Blane, Comparative Health of the Navy. Blane G. Statements of the comparative Health of the British Navy, from the year 1779 to the year 1814, with proposals for its farther improvement. Med Chir Trans. 1815;6:490-573. “One of the most impressive parts of their argument, was built on the report of the effects of it in the Suffolk of 74 guns. This ship sailed from England on the second of April 1794, and an experiment was made of supplying her with a quantity of lemon juice sufficient to serve out two-thirds of a liquid ounce every day, to every man on board.” p.496-497 https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027 https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027/?page=8 107 “Besides the means of information which occurred to him [Blane] while he was physician to the fleet in the West Indies and North America, during the four last years of the American war, and while he was commissioner of sick and wounded seamen, from the year 1795 to the year 1802, he has been furnished, by virtue of an application made in the name of the Society, with materials from the public offices of the navy, all of which most liberally supplied such extracts from their records as were necessary for his purpose.” p.490-491 https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027 “In 1780, 1457 cases of scurvy”: See Table III, p.542 https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027/?page=53 “One of the physicians of Haslar hospital has informed the author that he has seen but one case of it [scurvy] there, for the last seven years; and one of the physicians to Plymouth hospital reports, that only two cases have occurred to him the last four years.” p.498 https://pmc.ncbi.nlm.nih.gov/articles/PMC2129027/?page=9 A related text in 1830: https://archive.org/details/b22391587 https://archive.org/details/cihm_43003/page/n5/mode/2up 38 one of the physicians of that hospital informed Sir G. Blane that he had not seen a case of it for seven years; and, in the four years preceding 1810, only two cases were received into the naval hospital at Plymouth. At present, there are many surgeons in the navy who have never seen a case of scurvy, which has, in fact, been expunged from the list of diseases incident to seamen in the navy. The present allowance of lemon juice in the navy consists of a fluid ounce, which, after ships have been a fortnight at sea, is served daily with an ounce and half of sugar to each of the men. Dr. Lind recommended a rob, formed by evaporating the juice, by a slow heat, to the consistence of thick syrup. This was found to be very inferior in efficacy to the fresh fruit ([Blane] Diseases of Seamen, p. 56. 109; [Trotter] Med. Nautica, vol. i. p. 425. 110);111 and Sir G. Blane, in consequence, advised that the juice should be preserved by the addition of a small quantity of spirit, without the aid of heat; a plan now generally adopted. The juice with which the navy is supplied is brought from Sicily, and kept good by the addition of one part of strong brandy to ten of the juice. When preserved in this manner, its virtues seem unimpaired. These fruits, when employed in the treatment of scurvy, combine all the good qualities we can desire in a remedy. They have a specific influence in curing the disease, but produce no other sensible effect, except a small increase in some of the secretions; and the eating of them is attended with great pleasure. Dr. Lind tells us that he has often observed, upon seeing scorbutic people landed at our hospitals, that the eating of these fruits was attended with a pleasure more easily imagined than described; and his testimony is confirmed p.71 by that of other naval physicians. 108 “In the 1740s, it [Haslar Hospital] was the largest hospital in the world, and the largest brick-building in Europe.” https://en.wikipedia.org/wiki/Royal_Hospital_Haslar https://www.royalhaslar.com/history https://www.jameslindlibrary.org/articles/the-royal-hospital-haslar-from-lind-to-the-21st-century 109 “Vegetables, in the form of sallads, are more powerful than when prepared by fire; and I know, for certain, that the rob of lemons and oranges is not to be compared to the fresh fruit. Raw potatoes have been used with advantage in the fleet.” https://archive.org/details/observationsondi00blan/page/56/mode/2up Blane 1785, p.57 110 “We have also found, that the preserved juice is very inferior to the fruit, in its intire and recent state.” https://archive.org/details/b21351879_001/page/424/mode/2up Trotter 1804, p.425 111 Lind’s method of concentrating fruit juices caused degradation of vitamin C also in a recent experiment: Hughes RE. James Lind and the cure of scurvy: an experimental approach. Med Hist. 1975 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1081662 https://doi.org/10.1017/s0025727300020469 39 Oranges, lemons, and limes, seem to have nearly equal efficacy; and perhaps the same may be said of shaddocks, and all fruits of a like kind. Dr. Lind, however, from some comparative trials, was led to give oranges a preference to lemons. It is probable that the state of the fruit, as to maturity, has considerable influence on its virtues. That such is the case with the guava, appears clearly from an experiment made by Dr. Trotter.112 Having repeatedly observed scorbutic slaves throw away ripe guavas, while they devoured green ones with much avidity, he resolved to try if any difference could be remarked in their effects. For this purpose he selected nine blacks affected with scurvy in nearly equal degree. To three of these he gave limes, to three green guavas, and to three ripe guavas. They were kept under the half-deck, and served by himself two or three times a day. They lived in this manner for a week; at the end of which those restricted to ripe guavas, were in much the same state as before the experiment, while the others were almost well. Most sour fruits are in all probability antiscorbutic. The good effects of unripe grapes were noticed by Fodéré in the French army of the Alps, in 1795; and, in 1824, when scurvy prevailed among our troops at Rangoon,113 in India, great benefit was derived from giving the men the fruit of the Phyllanthus Emblica,114 or Anola; which, when dry, as sold in bazaars, has a rich and strongly acid taste, with a flavour resembling that of tamarinds. (Quarterly Journal of the Med. and Phys. Society of Calcutta, vol. i. p. 306.) The efficacy of apples, as a preventive of scurvy, was alluded to by Sir J. Pringle in an address to the Royal Society, in 1776; and the following proof of their curative virtues is given by Dr. Trotter:—When Lord Bridport’s fleet arrived at Spithead on the 19th of September 1795, almost every man in the fleet was more or less affected with scurvy. Large supplies of vegetables were provided, and 112 Trotter. Observations on the scurvy 1792, p.138 https://archive.org/details/observationsonsc00trot/page/138/mode/2up https://archive.org/details/b3308578x_0001/page/138/mode/2up https://archive.org/details/b3308578x_0002/page/138/mode/2up “Having repeatedly observed the scorbutic slaves throw away the ripe guavas, while they devoured the green ones with much earnestness, I resolved to try if there were any difference to be remarked in their effects. For this purpose I selected nine blacks, affected in nearly a similar degree with Scurvy. To three of these, I gave limes, to three, green guavas, and to three, ripe guavas. They were kept under the half deck, and served by myself twice or thrice a day. They lived in this manner for a week, which was about the time we left the coast of Africa; and it is to be remarked, that the three Negroes restricted to the ripe guavas continued in much the same situation, while the others were almost well. ” 113 Waddell (1827) https://doi.org/10.5281/zenodo.10207344 114 https://en.wikipedia.org/wiki/Phyllanthus_emblica 40 lemon-juice being scarce in consequence of the previous great consumption, fifty baskets of unripe apples were procured at the Isle of Wight for the use of the fleet. The Royal Sovereign, in particular, derived great benefit from them; and the cure of the disease was everywhere so speedy, that little remained to show Earl Spencer, when he visited the fleet at the end of the month. (Med. Naut., vol. i. p. 420.)115 As the expense of lemon juice offers great impediment to the employment of it in the commercial marine of this country, to the extent necessary for complete extinction of scurvy, it deserves to be ascertained whether the juice of apples preserved, like that of lemons, by the addition of a certain proportion of spirit, would not be an effective substitute. All succulent vegetables that are wholesome, are perhaps, as well as fruits, more or less antiscorbutic; but this property seems to be possessed in the highest degree, by plants comprised in the order Cruciferæ,116 in which most of the vegetables in common use, as the cabbage, turnip, radish, water-cress, &c. are included. In the earliest notices of scurvy, mention is made of the efficacy of herbs of this class in its treatment. Ronsseus, writing in 1564, informs us, that the common people cured themselves by scurvy-grass, brook-lime, and water-cresses. W. Cockburn, in a work published in 1796, entitled Sea Diseases,117 remarks the extraordinary efficacy of vegetables in the treatment of this distemper. As a proof of it he mentions the following circumstance:—When Lord Berkeley commanded the fleet in Torbay, Mr. Cockburn prevailed on his lordship to erect tents for the sick on shore. Above a hundred of the most afflicted scorbutic patients, perfect moving skeletons, hardly able to get out of their ships, were landed, and fresh provisions, including carrots, turnips, and other vegetables were given them. In a week they were able to crawl about; and before the fleet sailed, they returned healthy to their ships. The subsequent history of scurvy abounds 115 “On the 19th of September, Lord Bridport’s Fleet arrived at Spithead. The only disease that was known in the ships, was the Scurvy…” https://archive.org/details/b21351879_001/page/420/mode/2up Trotter 1804, p.420 116 https://en.wikipedia.org/wiki/Brassicaceae 117 Cockburn (1706) https://archive.org/details/b30519056/page/n3/mode/2up https://wellcomecollection.org/works/nn5h2hzq/items?canvas=5 Budd’s year is incorrect and the “Sea Diseases” does not seem to include words “Torbay” or “Berkeley” so the circumstance may be published elsewhere. 41 We can reconcile this with the testimony of Captain Cook, and others, in favour of the antiscorbutic properties of infusion of malt, only by supposing that those properties were impaired by the process of extracting the essence; just as those of lemon juice are impaired in the preparation of syrup. Molasses, also, was recommended about the same time; and, in the Foudroyant,143 the ship in which it was first tried, it answered so well, that in a cruise under Admiral Geary, in 1780, she was the only ship in the squadron that was free from scurvy, which prevailed to such extent in the other ships, that, on their return to Portsmouth, in the month of August, 2400 men were sent to the hospital affected with it (Ibid. p. 290.)144 Subsequently, by order of Lord Howe, molasses was served with rice to the men who were scorbutic, or threatened with scurvy, in the squadron which he commanded; and the benefit derived from it was so great, that, during the last two years of the war, molasses was made a regular article of ships’ victualling, and substituted for a certain proportion of oatmeal. (Ibid. p. 287.) The disease was unquestionably much mitigated by this regulation, but was far from being entirely prevented. It prevailed even to a great extent in some ships well supplied with molasses. (Ibid. p. 55.) There is reason to believe that the antiscorbutic properties of sugar-cane are greater than those of molasses, and that they are much impaired by the process employed in the manufacture of sugar. Fermented liquors. Spruce beer seems to be the most efficacious of fermented liquors. We have abundant proof in the experience of the Northern American colonies, and of the countries bordering on the Baltic, that it is not only an effectual preventive, but an excellent remedy. It has this advantage, that materials for it can often be procured, at all seasons, in countries in high latitudes, where the scarcity of fruits and vegetables renders a powerful antiscorbutic extremely valuable. These materials can also be carried about, and used p.75 occasionally; a plan adopted by Captain Cook with great advantage. Malt liquors possess similar virtues. Frequent notices of the benefit derived 143 https://en.wikipedia.org/wiki/HMS_Foudroyant_(1798) 144 “The first trial of melasses was in the Foudroyant, and it answered so well, that, in a cruise under Admiral Geary in 1780, this was the only ship free from the scurvy, and out of two thousand four hundred men that were landed at the hospital with this disease, there were none from this ship. It appears to be so similar in its nature and effects to essence of malt, that it seems hardly worth while for Government to be at the expence of providing the latter.” https://archive.org/details/observationsondi00blan/page/290/mode/2up Blane 1785, p.290 48 from the use of small beer at sea, are to be met with in the writings of our naval physicians; and Sir G. Blane has recorded a striking instance of the good effects of porter. (Dis. of Seamen, p. 301. 145) Instances are also to be found which afford evidence of the antiscorbutic properties of cider. (Lind, p. 150. 146; Sir J. Pringle’s Address to the Royal Society, p. 15. 147) Wine ranks next to spruce beer and malt liquor in efficacy, and it is perhaps to the habitual use of it that must be ascribed the fact, that the French fleets have generally been less subject to scurvy than our own. The superiority of wine over spirits in this respect has, indeed, been frequently noticed; and Sir G. Blane was so convinced of it, that in a memorial, presented to the Board of Admiralty in 1781, he recommended the substitution of wine for rum in the victualling of the fleet. He agrees with Dr. Lind in ascribing even a pernicious influence to distilled spirits.148 (Lind, p. 81. 149; Dis. of 145 “One of the greatest improvements that could be made in the victualling of the navy would be the introduction of porter which can be preserved in any climate for any length of time that may be necessary.” https://archive.org/details/observationsondi00blan/page/300/mode/2up Blane 1785, p.301 146 “Next to the oranges, I thought the cyder had the best effects. It was indeed not very sound, being inclinable to be aigre or pricked. However, those who had taken it, were in a fairer way of recovery than the others at the end of the fortnight.” Lind p.150-151 https://archive.org/details/treatiseonscurvy00lind/page/150/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=174 147 “Cyder is likewise good, with other vinous productions from fruit, as also the various kinds of beer.” Pringle p.15-16 https://archive.org/details/b30790943/page/14/mode/2up https://wellcomecollection.org/works/q7n4y77w/items?canvas=19 148 The opinion that distilled spirits have a pernicious influence, is warmly opposed by Dr. Nathaniel Hulme in a Latin thesis, in which the reader will find an elegant and very accurate description of the symptoms of scurvy. (Dissertatio Inauguralis, De Scorbuto.) https://history.rcp.ac.uk/inspiring-physicians/nathaniel-hulme https://wellcomecollection.org/works/q3h4y6vz/items?canvas=5 https://wellcomecollection.org/works/q3h4y6vz/items?canvas=107 https://archive.org/details/b30519780/page/n3/mode/2up https://archive.org/details/b30519780/page/n105/mode/2up A short text on scurvy by Hulme https://archive.org/details/bim_eighteenth-century_a-safe-and-easy-remedy-p_hulme-nathaniel_1778/page/n15/mode/2up https://archive.org/details/bim_eighteenth-century_a-safe-and-easy-remedy-_hulme-nathaniel_1778/page/n15/mode/2up 149 “Beer and fermented liquors of any sort will be found the best antiscorbutics, and most proper to correct the ill effects of their sea-diet and situation; whereas distilled spirits have a most pernicious influence on this disease.” Lind p.81 https://archive.org/details/treatiseonscurvy00lind/page/80/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=105 “We evidently see in this disease the good effects of spruce beer, cyder, ale, wine, and other vinous liquors, prone to fall into this state in the stomach; on the contrary, the pernicious effects of distilled spirits, which check such a fermentation.” Lind p.252-253 https://archive.org/details/treatiseonscurvy00lind/page/252/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=276 “distilled spirits, viz. brandy, and the like; all which infallibly increased the malady, and hastened their unhappy end.” Lind p.175 https://archive.org/details/treatiseonscurvy00lind/page/174/mode/2up https://wellcomecollection.org/works/xc2t7736/items?canvas=199 49 Seamen, p. 334. 150) The good effects derived from the use of lemons and other sour fruits, were naturally attributed to their most striking quality, acidity, and it was imagined that vinegar would prove of equal service. It was, in consequence, early recommended as a preventive of scurvy. Experience, however, has shown that this opinion is unfounded. Dr. Lind, in the middle of last century, when scurvy proved so destructive in our fleets, remarked that few ships had ever been in want of vinegar. (Lind, p. 158. 151) Testimony to the same effect has been given by other naval physicians. Vinegar was liberally supplied to our fleet, in which scurvy was so fatal, in the West Indies in 1780, and the two following years (Dis. of Seamen, p. 284.), and Dr. Trotter, in his account of the health of the channel fleet, in 1795, says that vinegar was carefully served to the messes of seamen, throughout the squadron, to be used with the salt meat; yet in those ships, in which the men took it in large quantities, it was not observed to retard the progress of the disease. (Med. Naut, vol. i. p. 418. 152) Our own experience furnishes us with many instances of the occurrence of scurvy in a high degree, in ships well supplied with vinegar, even in voyages of moderate duration; but, in the cases in which we have witnessed the disease in the most aggravated form, the crews had no regular allowance of this article. From the facts that have fallen under our own notice, we are led to ascribe to vinegar some antiscorbutic virtue, equal perhaps to that of malt liquor or cider, but not sufficient to render it a substitute for lemon or lime juice. There is indeed some degree of contradiction in the testimony of naval physicians respecting the antiscorbutic properties of vinegar, which renders it likely that 150 “Thirdly, The use of wine, in place of rum, has been found extremely conducive to health. In the course of my observation, I have met with the mosl unquestionable proofs of the benefit that would arise from this substitution. It is a farther reason for such a change, that good rum is seldom or never supplied in the West Indies.” https://archive.org/details/observationsondi00blan/page/334/mode/2up Blane 1785, p.334 “The most salutary kind of drink next to malt liquor, and spruce beer, is wine. The benefit which the fleet derived from it at different times, and the advantage it has over spirits, has been often taken notice of in the former part of this work. It seems to be owing to this that the French fleet sometimes enjoys superior health to ours, and is less subject to scurvy.” https://archive.org/details/observationsondi00blan/page/302/mode/2up Blane 1785, p.302-303 151 “Few ships have ever been in want of vinegar” https://archive.org/details/treatiseonscurvy00lind/page/158/mode/2up Lind p.158 https://wellcomecollection.org/works/xc2t7736/items?canvas=182 152 “Vinegar was carefully served to the messes of seamen throughout the squadron, to be used with the salt meat: yet in those ships where the men took it in large quantities, it was not observed to retard the advancement of the disease. Even porter failed to cure.” https://archive.org/details/b21351879_001/page/416/mode/2up Trotter 1804, p.417-418 50 these vary in some degree with the material from which the vinegar is prepared. All the substances which we have mentioned as preventives of scurvy, are derived from the vegetable kingdom; and it is probable that antiscorbutic properties are possessed exclusively by substances of vegetable origin. All the mineral acids, and, indeed, most medicines derived from the mineral kingdom, have been tried without success. The antiscorbutic virtue is, as we have seen, possessed in very different degrees by different classes of vegetables and fruits, but in the lowest degree, if at all, by those which are farinaceous.153 Dr. Lind remarked that scurvy was most commonly met with, on land, in persons who subsisted chiefly on dried or salt fish or flesh, and the unfermented farines; or upon bread made of peas, or a composition of peas with oats. (Lind, p. 93. 154) Kramer155 informs us that in his time the disease often occurred in Germany among people, who lived altogether on boiled pulses, without eating any green vegetables or summer fruits. We have already mentioned the prevalence of scurvy among Russian soldiers, whose principal food was rye-bread, and meal, p.76 and among the inmates of the lunatic asylum at Moorshedabad, where rice and split peas formed the chief articles of subsistence. Its occurrence has also been noticed in prisoners kept on a diet of bread and water. (See a Letter on Solitary Confinement, by J. G. Malcolmson, Esq.)156 Fresh leavened bread has, however, been supposed to be highly antiscorbutic, and has, in consequence, been recommended by many writers on scurvy; but we must bear in mind that the good effects, ascribed to it, have been witnessed in sailors, on their return from a long voyage, who were supplied not only with fresh bread, but also with vegetables, the efficacy of which was probably not duly appreciated. The antiscorbutic properties ascribed to bread, seem incompatible with the fact, of which we could bring many proofs, that 153 Farinaceous. Consisting of or containing starch, such as bread and macaroni. 154 “We see it most common among the poorer sort of people in the before-mentioned situations, who feed much on dried or salt fish and flesh, and the unfermented farines, without using green vegetables and fruits; or upon bread made of peas, or a composition of these with oats” https://archive.org/details/treatiseonscurvy00lind/page/92/mode/2up Lind p.93 https://wellcomecollection.org/works/xc2t7736/items?canvas=117 155 Description of scurvy by Kramer (1720,1737) https://doi.org/10.5281/zenodo.17224830 156 Malcolmson (1837) https://wellcomecollection.org/works/gausgz3s https://pmc.ncbi.nlm.nih.gov/articles/PMC5785134 https://pmc.ncbi.nlm.nih.gov/articles/PMC5775712 51 scurvy may occur in persons with whom bread forms the main article of subsistence.157 It has been supposed that flour is antiscorbutic in a much higher degree than biscuit, which has been subjected to the influence of a strong heat; and Sir G. Blane in consequence recommended that in the navy a portion of the present allowance of biscuit should be discontinued, and compensation given in flour, which might be made into bread or puddings. This advice was followed by Sir Edward Parry, who, in his first Polar expedition, by taking with him a supply of flour, was enabled to furnish his crew with a daily allowance of well fermented bread. There is, however, a preparation of oat-meal, which seems to have great efficacy in preventing and curing scurvy. This is sooins, or sowens, an article of food well known in Scotland. It is prepared by pouring hot water on some oatmeal in a wooden vessel, and allowing it to stand till the liquid grows acidulous, which, in a place moderately warm, happens in about two days; the liquid is then poured off from the grounds, and boiled down to the consistence of jelly. Sir J. Pringle has given a remarkable instance, not however from his own experience, of the efficacy of this preparation;158 and Sir G. Blane considered it of equal virtue with any antiscorbutic, except the juice of oranges and lemons; and informs us that he knows some well attested instances of crews saved from scurvy by this alone. (Dis. of Seamen, p. 291. 159) It would be interesting to ascertain whether the acetous fermentation, excited as in sooins, would impart similar properties to other farinaceous substances.160 We have already given examples of the occurrence of scurvy, in the highest 157 See Med. Trans., vol. iv.: and vol. ii. paper by Dr. Milman. https://archive.org/details/b24976957_0002/page/470/mode/2up 1786, vol. 2, Milman p.471-485 https://archive.org/details/s14id13413820/page/470/mode/2up https://archive.org/details/b24976957_0004/page/64/mode/2up 1813, vol. 4, Heberden p.65-84 https://archive.org/details/b2130449x/page/64/mode/2up https://wellcomecollection.org/works/u7hqmb3k/items?canvas=79 158 Address to the Royal Society in 1776, p. 18. https://archive.org/details/b30790943/page/18/mode/2up https://wellcomecollection.org/works/q7n4y77w/items?canvas=22 159 “there is a certain preparation of it which is an antiscorbutic of equal efficacy with any whatever, except the juice of lemons and oranges. This is flummery, or sowins, which is prepared by letting oatmeal and water stand together till they grow acidulous, and then boiling them into a jelly.” https://archive.org/details/observationsondi00blan/page/290/mode/2up Blane 1785, p.291 https://en.wikipedia.org/wiki/Flummery 160 The antiscorbutic properties of sooins require to be substantiated by facts. In the instance mentioned by Sir J. Pringle, no detailed account of the circumstances is given; it is noticed, however, that the sooins was seasoned with some prize wine which had turned sour, and which may with reason be supposed to have had some share in restoring the men. Sir G. Blane is content with expressing his opinion of the efficacy of sooins, without stating the facts on which that opinion was founded. 52 degree, in persons well supplied with fresh animal food; and instances are not wanting, which show that food of this kind is without much efficacy as a remedy. Dr. Lind tells us that in the Salisbury, during a Channel cruise in 1746, the scorbutic people, by the liberality of their commander, were daily supplied with fresh provisions, such as mutton broth and fowls, and even meat from his own table; yet, at the expiration of ten weeks, they brought into Plymouth eighty men, more or less afflicted with scurvy, out of a complement of 350. (Lind, p. 66. 161; see also Lind, p. 137. 162 and Dis. of Seamen, p. 462.) The opinion that scurvy can be prevented, or cured by fresh meat, is however still held by persons, by whom it is of the utmost importance that correct notions on this subject should be entertained. We have known the most fatal effects result from the erroneous opinions of captains of merchant vessels on this point. During the course of the present year, the captain of a vessel trading to the Mauritius furnished his men, while they stayed at the island, with a plentiful supply of fresh beef, which, being imported from Madagascar, is procured at p.77 considerable expense; but neglected to provide them with vegetables or limes, which abound in the island, and are sold at a price scarcely worth naming. The consequence was that scurvy broke out soon after they set sail; and before the ship arrived in this country, one half of the men before the mast163 had died of it, and the rest were totally disabled. Portable soup was much used by Captain Cook, and has been extensively employed by Sir Edward Parry, and other modern navigators. Its antiscorbutic properties must depend chiefly on the vegetables it contains. The facts we have adduced seem to lead to the following general conclusions:— 1. That antiscorbutic properties reside exclusively in substances of vegetable origin. 2. That these properties are possessed in very different degrees by different families of plants; and that vegetables and fruits, which are farinaceous, possess them in the lowest degree; while all those, which possess them in a very high 161 “Hon. (now Commodore) George Edgcumbe, daily supplied with fresh provisions, such as mutton-broth and fowls, and even meat from his own table; yet, at the expiration of ten weeks, we brought into Plymouth 80 men, out of a complement of 350, more or less afflicted with this disease.” https://archive.org/details/treatiseonscurvy00lind/page/66/mode/2up Lind p.66 https://wellcomecollection.org/works/xc2t7736/items?canvas=90 162 https://archive.org/details/treatiseonscurvy00lind/page/136/mode/2up Lind p.137 https://wellcomecollection.org/works/xc2t7736/items?canvas=161 163 Men before the mast. Having living quarters in the forecastle of a vessel. 53 degree, are succulent. 3. That the antiscorbutic virtue resides in the juices of the plant; that it is, in general, considerably impaired by the action of strong heat, and by the process of vinous fermentation; and that it varies, in some degree, with the state of maturity of the plant from which it is derived. 4. That these properties of vegetables are not destroyed, but in some instances seem even to be developed by the process of acetous fermentation. We are ignorant of the essential element, common to the juices of antiscorbutic plants, on which the properties in question depend; but shall, probably, not be deemed too sanguine, if we anticipate that the study of organic chemistry, and the experiments of physiologists, will at no distant period throw some light on this subject. We cannot bring this part of our subject to a conclusion, without insisting on the importance of making a certain proportion of succulent vegetables an occasional article of food in jails, poor-houses, and especially in lunatic asylums164; in fact, in all establishments where persons are kept a long time on a diet regulated by principles of economy, and subject to little variation. In the provisioning of troops, also, in districts which have been laid waste, or where the winter is long and severe, we would recommend the adoption of the same measure, particularly during spring; and, in cases in which difficulty of procuring fresh vegetables is likely to arise, that lemon juice, as in the navy, should be provided in their stead. Such a regulation would, we believe, contribute much to the health of the men, and would effectually prevent scurvy, which, we have little doubt, occurs much more frequently under the circumstances we have mentioned, than is generally imagined. The approach of the disease is, in fact, so gradual, that 164 We have already mentioned, that the inmates of the Lunatic Asylum at Moorshedabad are annually affected with scurvy; while those of the jail, which is very near the asylum, continue free from it. In the Lunatic Asylum at Madras, also, scurvy occasionally shows itself. The greater frequency of scurvy in lunatic asylums, than in other establishments in which the diet is in no respect better, is, we imagine, not owing to greater liability to the disease in lunatics, but to the great length of time they remain in those establishments. In the Milbank Penitentiary, in 1823, scurvy first appeared in those who had been longest confined there. The occurrence of scurvy in persons long insane, has also been noticed in this country. (See Prichard on Insanity, p.149) “Many lunatics in the advanced stage labour under a degree of cachexia bordering on scurvy…” https://archive.org/details/b21306692/page/148/mode/2up Prichard p.149 https://wellcomecollection.org/works/m9n5a9qb/items?canvas=171 54 it may advance far enough to reduce the strength of the men considerably, before the real nature of it is discovered by a surgeon, not familiar with its symptoms or not expecting to meet with it. Dr. Murray,165 in the report from which we have derived the account we have given of the prevalence of scurvy among our troops at the Cape, in the autumn of 1836, informs us that such was the case in that instance: “that it was not recognised for some time after it appeared, nor until the morbid diathesis had widely extended itself in the corps.” He adds also, “I candidly confess that, although I had before treated cases of this malady, I did not know it by its proper name, but used incorrectly p.78 to return it under the heads, Purpura, Cachexia, Neuralgia, Rheumatism, Œdema, &c. until its late extraordinary prevalence in the 75th regiment, (at the Cape), and the recent admission into the civil hospital there, from whaling vessels, of a number of sailors affected with it; which attracted my particular attention to its diagnosis.” Symptoms. A change in the complexion, from its natural healthy tint to a p.78 pale, slightly sallow, and dusky hue, is generally one of the earliest indications of scurvy. This change is attended with great languor and despondency, and with aversion to every kind of exercise, and the patient is readily fatigued, and complains of pains in the muscles, especially of the legs and loins, like those produced by over-exertion. The gums soon become sore, and apt to bleed on the slightest touch. On examination, they are found to be swelled and spongy, and of livid redness. Lividity of the gums first appears, and is always deepest at their free edges, diminishing gradually towards the roots of the teeth; while the lining membrane of the lips does not exhibit it in the slightest degree, but, on the contrary, is unusually pale. As the disease advances, all these symptoms become more marked; the complexion acquires a more dingy and somewhat brownish hue; the debility increases, so that the least exertion causes breathlessness and palpitation, and not unfrequently an alarming syncope; the gums become more swelled and more livid, forming, in some cases, a black spongy mass, which completely conceals the teeth, and they frequently slough, especially at their edges, leaving the crowns of the teeth exposed; the teeth themselves become loose, 165 “they did not recognize it for some time after it appeared, nor until the morbid diathesis had widely extended itself in the abovementioned corps.” https://archive.org/details/s2id13404540/page/906/mode/2up p.906 55 and often drop out, without having suffered decay; and the breath is remarkably offensive. The patient, from the beginning of the affection, is subject to hæmorrhages. These occur most frequently from the gums and nose, and from any ulcers he may happen to have; but often, also, from the intestines; occasionally from the stomach; and, in some rare instances, from the bladder. Of the last nine cases that have fallen under our observation, in all which the disease was advanced, seven presented epistaxis. In most of these, bleeding from the nose occurred, for the first time, at an early period of the disease, and recurred several times, but in all it ceased spontaneously. In three of these nine cases, blood had been passed by stool: it is probable that hæmorrhage from the intestines happened in a greater number of these cases, but was unobserved. In none of them was there any hæmorrhage from the stomach, lungs, or bladder. In taking notes of these cases, great attention was paid to this point. Of twenty-seven cases, the notes of which were taken previously, but not with equal care, three presented hæmetemesis; and in one of these three the vomiting of blood recurred several times. We have never had a patient affected with scurvy in whom hæmorrhage from the bladder, or hæmoptysis, was stated to have occurred.166 Ecchymoses also appear on the skin, in the form of petechial spots, particularly on the lower extremities; often, however, in advanced stages of the disease, on the arms and trunk, but rarely on the head or face. These petechiæ, which are sometimes very numerous, are generally small and circular; the centre of each spot being the point at which the skin is perforated by a hair. Besides these petechial spots, we often meet, especially when the disease is far advanced, with other spots, as large as the palm of the hand, sometimes much larger, in which the skin is of a variegated violet and green tint, and which resemble in every respect marks produced by a severe bruise. These bruise-like marks occur without the infliction of any blow, or at least of one sufficient to attract the patient’s attention, and often surround an old scar, or appear on a part, which, a long time previously, had been the seat of some injury. Like the smaller petechial spots, they are met with most frequently on the lower extremities, p.79 but are not uncommon on the arms and trunk, and in a few instances we have 166 We have stated that hæmorrhages occasionally take place from the bladder, on the authority of Dr. Lind, and other authors. 56 observed them along the border of the lower jaw. Effusions not, we imagine, of pure blood, but composed chiefly of its fibrinous portion, take place also in deep-seated cellular tissue, and between layers of muscles, particularly in the legs and thighs. The parts which are the seat of these effusions are painful, when pressed or moved, and are much swollen, and of a hardness like that of board, so that they resist the strongest pressure of the finger. The skin covering these parts is thickened, and firmly adherent to the parts beneath,167 from which a fold of it cannot be pinched up: it sometimes retains its natural colour, but more commonly presents the appearance of a bruise. These effusions are sometimes very partial, frequently confined to the calf or thigh of one leg; but their most common seat is the ham, where the swelling is often very considerable, and always attended with stiffness and contraction of the knee-joint. This swelling of the ham and contraction of the knee-joint, a symptom which has much attracted the attention of writers on scurvy, sometimes occurs very early, and in cases in which the other symptoms are mild. In a patient at present under our care, in whom the other symptoms of scurvy are by no means severe, the calf and ham of the left leg are much swollen, and the knee-joint is stiff and contracted, the leg being at right angles to the thigh. This swelling of the ham, and contraction of the knee-joint, came on at a very early stage of the complaint, and were attended with pain on any attempt to move the leg, and with some degree of tenderness on pressure, symptoms which have ceased, however, after a treatment of two or three days: the parts which are thus swollen are hard and brawny, and no impression is left by the finger, except over the tibia, where there is some pitting. The skin is thickened, and glued to the parts beneath, but presents no discolouration, except on the inner aspect of the calf, where, in a space nearly as large as the palm of the hand, it has the appearance of a bruise, and gives to the hand a sensation of greater heat than elsewhere. There is not at present, nor has there been from the commencement, any swelling or œdema of the foot. There are a few scattered petechiæ on this, and on the opposite leg, which is free from swelling, and of which he retains the perfect use. Contraction of the joint (which has been ascribed in such cases to contraction of the tendons), as well as swelling of the ham, result we imagine, from 167 This does not depend on the skin, being stretched. We have found the skin adherent in this way over the calf when the latter has been very slightly swollen, and but little larger in circumference than the calf of the opposite leg, which was unaffected. 57 well expressed in the following passage, which we have quoted from the narrative of Lord Anson’s voyage: —“Many of our people, though confined to their hammocks, ate and drank heartily, were cheerful, and talked with much seeming vigour, and in a loud, strong tone of voice; and yet, on their being the least moved, though it was only from one part of the ship to another, and that in their hammocks, they have immediately expired; and others, who have confided in their seeming strength, and have resolved to get out of their hammocks, have died before they could well reach the deck. And it was no uncommon thing for those who could do some kind of duty, and walk the deck, to drop down dead in an instant, on any endeavours to act with their utmost vigour; many of our people having perished in this manner during the course of this voyage.” 183 When the disease is considerably advanced, the breathing is often quicker than natural, the inspirations attaining the rate of twenty-four to twenty-six a minute, without cough or complaint of pain. We have generally found this symptom of the frequency of the act of breathing associated with increased frequency of the pulse. Occasionally, in the latter stages of the disease, the breathing is still more rapid, the inspirations thirty-six a minute, or more, and the patient has cough, and expectorates frothy mucus, or a transparent fluid of mucilaginous consistence. Towards the close of the malady the dyspnœa sometimes becomes extreme. When speaking of the morbid anatomy of scurvy, we shall give the details of a case in which this circumstance occurred. We have recently practised auscultation and percussion on six patients under our care at once, affected with scurvy in a high degree; and with the same result in all. The chest was everywhere unusually resonant, and the respiratory murmur louder than natural, and pure.184 The sounds of the heart were loud and extensive, but unaccompanied by any morbid bruit. In these cases the condition of the abdomen was observed at the same time; in all it 183 “For many of our people, though confined to their hammocks, appeared to have no inconsiderable share of health…” https://doi.org/10.5281/zenodo.17397300 Lind 3rd ed, p.443 https://archive.org/details/treatiseonscurvy00lind/page/434/mode/2up Lind p.435 https://wellcomecollection.org/works/xc2t7736/items?canvas=459 “… for many of our people, though confined to their hammocks, appeared to have no inconsiderable share of health…” A Voyage round the world by Anson. https://archive.org/details/voyageroundworld00walt_0/page/n165/mode/2up p.102 https://archive.org/details/voyageworldanson00walt/page/144/mode/2up p.145 184 The unusual resonance on percussion of the chest, results probably from an anæmic condition of the lungs. (See cases in the chapter on the MORBID ANATOMY OF SCURVY.) 64 was soft and flaccid, and without tenderness on the strongest pressure; in none could the liver or spleen be felt below the false ribs.185 We have already mentioned, that parts previously debilitated or injured are especially prone to assume the scorbutic appearance. Our own experience furnishes us with two instances which may serve as illustrations of this fact. The first occurred in a man, aged 60, who was admitted into the Dreadnought, on the 18th of April, 1837, in the last stage of scurvy. On the middle of his left shin was a livid spot, larger than the palm of the hand, and in the centre of this spot, a scar, which, he assured us, had been there twenty years, and resulted from a wound caused by the kick of a horse. The second instance was in a man aged 55, who came into the Dreadnought on the 4th of June, 1837. The right foot was swollen and painful, and all the outer part of that foot and ankle was the seat of an extensive bruise mark, which surrounded a scar occasioned by a blow he received in 1813. In high degrees of scurvy it is not unusual for ulcers, long healed, to break out afresh. Lord Anson relates the case of a man on board the Centurion, who had been wounded fifty years before at the battle of the Boyne. “His p.84 wounds soon healed, and had continued well for many years, when, in the progress of scurvy, they broke out afresh, and seemed as if they had never been healed; nay, what is still more extraordinary, the callus of a broken bone, which had been completely formed for a long time, was found to be hereby dissolved; and the fracture seemed as if it had never been consolidated.” 186 A case in which bones consolidated after fracture became disunited in the progress of scurvy, is mentioned by Dr. Mead; and not long ago an instance of the same kind was witnessed in a patient in the seaman’s hospital, Dreadnought. This man, while in China, broke one of his ribs, which united in the usual time; in the voyage home he became scorbutic; the rib which had been broken, became disunited, and was so on his arrival in this country, when 185 An account, published by Dr. Mead, of the dissection of a man who died of scurvy, and whose spleen weighed five pounds and a quarter, has, from the dearth of facts, illustrative of the morbid anatomy of scurvy, been quoted by many subsequent writers. This man, who came from Sheppey, was affected with ague as well as with scurvy; and it is, unquestionably, to the former disease, that the very large size of the spleen must be ascribed. 186 “who had been wounded above fifty years before at the battle of the Boyne; for though he was cured soon after, and had continued well for a great number of years past, yet on his being attacked by the scurvy, his wounds, in the progress of his disease, broke out afresh, and appeared as if they had never been healed.” https://doi.org/10.5281/zenodo.17397300 Anson’s voyage, Lind 3rd ed, p.442-443 https://archive.org/details/voyageroundworld00walt_0/page/n165/mode/2up p.102 https://archive.org/details/voyageworldanson00walt/page/144/mode/2up p.144-145 65 he was admitted into the Dreadnought. On his recovery from scurvy, the rib speedily united again. Another symptom, somewhat allied to the preceding, is mentioned by authors as occurring in children and young persons, in advanced stages of scurvy: namely, separation of the epiphyses, from bones. (See Phil. Trans. for 1669 and 1670. 187) No instance in which this occurred has ever fallen under our own notice, and the symptom has not been remarked by naval physicians; a circumstance unquestionably owing to the mature age of the generality of sailors. Although it is not unusual for ulcers that have been long healed to break out afresh in persons affected with scurvy, there is very little disposition to become ulcerated in parts that have not previously been so. We have often had to treat scorbutic patients, who had been confined to their hammocks six or eight weeks, and during that time had been scarce able to change their posture by reason of the pains occasioned by any attempt to move the legs; but we have never met with an instance, in which sores were produced by lying. We have at present under our care a man who has recently come from the Mauritius, in a vessel in which all the crew were in a dreadful condition from scurvy. On his passage outwards, seven months before he was received into the Dreadnought, he became hemiplegic; the paralysis of the arm and leg was complete, and he was quite unable to sit up in bed; his urine and fæces also passed involuntarily. Notwithstanding all this, he had no sores on the sacrum, hips, or any other part of his body. In advanced stages of scurvy we have generally found patients much emaciated. This, however, is not always the case; we have even met with an instance, in which, up to the last period of the disease, the patient had experienced no loss of flesh. Loss of flesh is not dwelt on by authors among the symptoms of scurvy. The persons in whom we have observed it were sailors, who had nothing to eat but hard salt beef and ship biscuit, which they could not masticate from the state of their gums. Many of them have assured us 187 Poupart (1708); scurvy cases in Paris in 1699 https://doi.org/10.5281/zenodo.16846396 “I observed at the opening of all those bodies or cadavers, in which we heard the aforesaid little noise, that the epiphyses were entirely separated from the bones, which by rubbing against each other occasioned this clattering.” p.224 “All the young persons under eighteen, had in some degree their epiphyses separated from the body of their bones, and by the least endeavour or force we separated them entirely.” p.225 66 that, although hungry, they had often passed the entire day without eating. Anatomical characters. Notwithstanding the great mortality occasioned by scurvy, and the attention it excited up to the present century among the most distinguished physicians, very little is known of its morbid anatomy. The records that we possess of dissections of persons, dead of this disease, are very few; and in these, the terms in which the state of organs is described are often vague, and leave us in doubt as to the meaning they convey. At the present day scurvy very seldom proves fatal, except at sea, in ill-equipped vessels; so that opportunities of supplying this deficiency in former treatises on scurvy, are extremely rare.188 We have had an opportunity of examining the state of the organs, in three subjects only, who at the time of their death were affected with scurvy. In the first of these instances, the patient, John Rumney, twenty-five years of age, died soon after his admission into the Dreadnought, simply of scurvy. p.85 He had come from the Mauritius in a vessel, in which scurvy prevailed to such a degree, that one half of the men, before the mast, had died of it in their passage homeward, and all the rest were so disabled that, for some time before they arrived in port, the vessel was worked entirely by the officers. The following were the appearances noticed in an examination made twenty188 For dissections of subjects who died of scurvy, see Narrative of Lord Anson’s Voyage; Phil. Trans. for 1669; Dict, des Sc. Médicales, art. SCORBUT; Rouppé, De Morbis Navigantium. See Lind’s summaries of reported dissections in the 2nd edition (1757): https://archive.org/details/treatiseonscurvy00lind/page/254/mode/2up p.255 https://wellcomecollection.org/works/xc2t7736/items?canvas=279 In the 3rd edition of Lind’s treatise (1772) there is additional discussion of dissections, p.495-504 https://archive.org/details/treatiseonscurvy1772lind/page/494/mode/2up https://wellcomecollection.org/works/r7fpbavt/items?canvas=517 Poupart (1708); scurvy cases in Paris in 1699; Budd seems to have confused with the years https://doi.org/10.5281/zenodo.16846396 In his book on scurvy, Alfred Hess (1920) listed 33 autopsy reports of cases of scurvy. See Table 2 on p.82 https://archive.org/details/scurvypastpresen00hessiala/page/82/mode/2up https://archive.org/details/cu31924073869996/page/n97/mode/2up https://archive.org/details/scurvypastpresen00hess/page/82/mode/2up Rouppe, p.178 forward https://doi.org/10.5281/zenodo.17227637 https://archive.org/details/bim_eighteenth-century_de-morbis-navigantium-_rouppe-ludovicus_1772/page/ 178/mode/2up See footnote 195 for a report of a dissection in St. Petersburg in 1834. 67 five hours after death:— The body was much emaciated; the extremities were rigid; and on the back there was an extremely faint violet stain. The mucous membrane of the œsophagus was pale and healthy. The stomach was large; its mucous membrane in the splenic extremity was thin and soft, and presented a dark grey stain in lines (apparently folds of the stomach); elsewhere, it was pale, of natural thickness and consistence, not mammellated. The duodenum contained a fluid tinged with a yellow bile; its mucous coat was pale and healthy. The mucous membrane of the small intestines, in all their extent was pale, and had no appreciable alteration in thickness or consistence. Many patches of Peyer’s glands were very conspicuous, from being dotted with black points, and of a darker cast than the surrounding membrane; but they had no unnatural thickness or softness. The coats of the jejunum offered, here and there, some dark (blackish) spots, about the size of split peas; the mucous and peritoneal coats, when stripped off, were free from this stain, which was confined to the intervening muscular coat or cellular tissue, and which probably resulted from ecchymoses. There were none of these discolourations in the ileum. The contents of the small intestines were natural. The large intestine was filled with solid fæces of a light yellow colour. Its mucous surface presented a blackish or dark grey stain in variable degrees; this stain was found to involve the mucous coat, which offered a few small, scattered, and very superficial ulcerations. Some of these ulcerations occupied the centres of stained spots, while others, as well as the surrounding mucous membrane, were perfectly pale. In the lower portion of the large intestine was some viscid mucus (probably resulting from the irritation of scybala), adherent to the mucous coat. The external surface of the large intestine, though in a much less extent than the internal, also presented some blackish stains; these stains were confined to the peritoneal coat, which, on being stripped off, retained this colour. There was no general discolouration of the peritoneum; no enlargement of the mesenteric glands; no blood in any portion of the intestinal canal. The liver was of nutmeg appearance, (colours contrasted, buff and red); of normal consistence, and 3 lbs. 9 oz. avoid. in weight. Liquid blood issued from some large vessels divided by incision. The gall-bladder contained some yellow bile of the consistence of thick syrup. 68 The spleen was soft, of a plum colour, and weighed ten ounces and a half. By squeezing it, the fluid portion made to exude, and a whitish spongy mass, was left. The pancreas was perfectly natural; the parotid also. The larynx and trachea contained a white, frothy fluid; their mucous membrane was pale and healthy. Both lungs were united to the pleura costalis by old adhesions, which were infiltrated with serum; and both of them were very pale, and remarkably œdematous. When they were cut into, there was an abundant flow of serum, which could be seen streaming from minute bronchial tubes; these were readily distinguished from the veins, which gave issue to liquid blood. The lower lobes of both lungs, on account of the œdema, gave no crepitus on pressure, but had a tough, doughy feel; there was no softening of their tissue, and all the serum could be squeezed out. The heart was about the size of the fist, and when emptied of its contents, 8 oz. avoid. in weight; it was flabby, and its muscular tissue remarkably pale; the proportions of the cavities were natural, as well as the thickness of their parietes; the valves perfectly healthy; the lining membrane of the heart and of the vessels, pale. In the left auricle was a white, fibrinous clot, which was firm, and of the size of a nutmeg, with, threads which extended into the vessels. In both cavities p.86 on the right side were larger white clots with threads; in the left ventricle, only a few small portions of fibrine, entangled in the chordæ tendineæ of the mitral valves. The pericardium, which had its usual polish, contained some ounces of limpid serum.189 In the large veins the blood was thin and liquid. The kidneys were pale but healthy; the weight of each, 6½ oz. A catheter was introduced into the bladder, and some urine drawn off, which was transparent, acid, and free from albumen. The surface of the brain was very pale, and presented considerable effusion of serum under the arachnoid. When the hemispheres were sliced, the surface of the incisions offered some bloody points; there was no softening of the cerebral substance. The choroid plexuses were very pale, and each lateral ventricle contained some colourless serum. The pectoral muscles were of good colour; the temporal, and the muscles of the thigh, paler then natural. There was no œdema of the legs, no swelling and hardness of the calves, an alteration so frequent in scorbutic persons. On the left tibia was a node-like 189 Limpid serum. Completely clear and transparent serum. 69 swelling, which had attracted our attention during the lifetime of the patient. This leg was injected with size, before it was examined; the injection was very successful, the fluid employed returning by the veins, and imparting a vermilion colour to the integument. On cutting down over the tibia, there was found under the fascia, a thin layer of coagulated blood, but no sensible extravasation of the size, and no injection of the clot. On cutting deeper, the periosteum was found to be separated from the bone, for the length of six or seven inches, by solid fibrinous effusion or clot, of chocolate colour, and a line or two in thickness. On the periosteal and osteal surfaces of this clot, there was a slight extravasation of the size, but the clot itself was beautifully injected. Small injected vessels could be seen in the clot by the naked eye, and by aid of a glass they were very manifest. When the periosteum, which was itself thickened and infiltrated with blood, was gently stripped from the clot, many threads were seen to pass from one to the other; these were evidently vessels, and some of them filled with size. On stripping the clot from the bone, some vessels were also seen filled with size, coming from the former, and entering the latter; but the vascular connection of the clot and bone was much less than that of the periosteum and clot. The clot in question surrounded the tibia, with the exception of the ridge on the anterior and outer surface of the bone; on this ridge the periosteum adhered to the bone, but could be readily stripped from it. A few lines beyond the limits of the clot the periosteum was perfectly natural in appearance, and adhered to the bone with its usual firmness. The bone itself did not appear diseased; it was firm, and resisted the saw as much as usual. The membrane lining the medullary canal was well injected, and the bone itself was injected in a slight degree. There were other clots separating the periosteum from the bone, on the fibula of the same leg; one on the femur, some on the tibia of the opposite leg. There was no extravasation of the size that could be detected by the naked eye, on the integument or between the muscles; in fact, none except that already mentioned between the periosteum and bone. The periosteum was separated by a clot from the bone of the lower jaw in its whole extent, except at the attachments of the temporal and pterygoid muscles; at the neck of the bone on each side; and also in a space, about an inch in breadth, inside and out, at the chin. The attachments of the genio-hyo-glossi were preserved; 70 those of the mylo-hyoid on both sides destroyed.190 Where the periosteum was detached from the bone, the intervening clot was black, and a line or two in thickness. A considerable portion of the gum, immediately surrounding the p.87 teeth, had sloughed. The bone had a dark stain in a space extending three or four lines from the edges of the alveoli; elsewhere it appeared healthy. There was no caries. On the upper jaw also the periosteum was separated from the bone by a dark clot, which extended as high as the zygoma. In portions of the bones of the leg or face, where there were no clots, the periosteum was healthy, and firmly adherent. There was no effusion between the muscles of the face; no enlargement of the salivary glands. There was a considerable ecchymosis between the muscles covering the abdomen. In this patient scurvy existed almost without complication. Before its accession, indeed, he had taken mercury, which, perhaps, rendered the state of the gums worse than it would otherwise have been, but which did not modify in any other way the progress of the disease. The great emaciation was probably occasioned by abstinence from food; for some time before his admission to the Dreadnought, he had nothing to eat but hard salt beef or pork, and ship biscuit, which, for many weeks, he must have been unable to masticate. To the same cause we may perhaps ascribe the softness and thinness of the mucous membrane in the splenic extremity of the stomach. Œdema of the lungs, and the extreme debility to which he was reduced, seem to have been the immediate cause of death. After death, the chief morbid appearances, observed in the organs of digestion, were softness and thinness of the mucous coat in the splenic extremity of the stomach; an alteration which the good appetite and the power of digestion, usually possessed by scorbutic persons, would lead us to suppose occurs seldom in scurvy; small, superficial ulcerations of the mucous membrane of the large intestine; and blackish stains in the muscular coat of the jejunum, 190 Dr. [John] Cook, in a letter to Dr. Lind, describing the scurvy that prevailed in the garrison at Riga, in the spring of 1751, says, “their rotten gums gangrened, as also their lips, which dropped off; the sphacelus [gangrene] spread to their cheeks and the muscles of their lower jaw; and the jaw-bone in some, fell down upon the sternum” (Lind, p. 280.) “Their rotten gums gangrened, as also their lips, which dropped off … ” https://archive.org/details/treatiseonscurvy00lind/page/278/mode/2up Lind p.279-280 https://wellcomecollection.org/works/xc2t7736/items?canvas=303 71 and in the mucous and peritoneal coats of the large intestine. The comparison of this case, with the two following, renders it very probable that these stains are referrible to the scorbutic habit, and that they resulted from hæmorrhages, the tendency to which is so characteristic of scurvy. It is worthy of remark, that no traces of disease were observable in the mesenteric or salivary glands. The bile, instead of being of its usual olive colour, was yellow; it is probable that this alteration in the character of that secretion resulted also from the scorbutic condition, and it may perhaps serve to explain the constipation so often remarked in cases of scurvy, as well as the peculiar cast of complexion in persons affected with this disease. In the lungs the only morbid change was the œdema, which must have taken place in the last days of life; and, with the exception of paleness and a flabby state of the heart, no appearances of disease were discovered in the central organs of circulation. Nothing was remarked of the state of the blood, except that it was thin and fluid in the large veins. That it was deficient in quantity, at least of red particles, was shown by the faintness of the violet stain on the back at the end of twenty-five hours after death; by the paleness of the muscles, and of the mucous membrane of the intestinal canal in its whole extent, of the mucous membrane of the bronchi, of the pulmonary tissue, of the brain and choroid plexures, and of the kidneys; as well as by the paleness of the tongue, and mucous membrane of the lips, observed during life. The fibrinous clots in the ventricles show, however, that it had not lost the property of coagulating: it is also worthy of remark, that it had imparted no stain to the lining membrane of the heart or vessels. But the most singular fact which this dissection discloses is the presence of clots between the periosteum and bones of the jaws and lower extremities. Painful nodes on the tibiæ, and swellings along the lower jaw, have been mentioned by many writers as symptoms of common occurrence in advanced stages of scurvy; but we are not aware that the cause of them has ever before been ascertained. The persistence of the vascular connexion of the periosteum with the bone, through the clot, renders it probable that the effusion took place very gradually, and serves also to explain p.88 the circumstance, noticed by Dr. Lind, that, although scorbutic nodes continue a long time on the tibiæ, they never give rise to exfoliation of bone. The fact that, notwithstanding the force used in injecting the leg, there was no extravasation of the size, that could be detected by the naked eye, on the 72 integument, in the subcutaneous cellular tissue, or betwen the muscles, affords an argument in support of the opinion that the hæmorrhages in scurvy result more from a change in the blood than from weakness of minute vessels. In the second fatal case the patient, aet.191 23, was admitted into the Dreadnought, immediately on his arrival from Calcutta, and was affected with albuminous dropsy,192 as well as with scurvy. At the time of his admission his legs were sprinkled with petechial spots, and his gums formed a black, spongy mass, which completely concealed the teeth. He was tapped two days after his admission, and three gallons and a half of serous fluid, slightly tinged with blood, were drawn off. This produced temporary amendment, but at the end of some days inflammation of the pleura supervened, and he died a fortnight after his arrival in this country. The following notes were taken of the morbid appearances. The body was very œdematous. In the cellular tissue, under the lower portion of the great pectoral muscle on the left side, and above the ribs, there was an infiltration of pus which had no communication with the pleura. The lower lobe of the left lung was united to the pleura costalis and diaphragm by very soft adhesions; the false membranes that formed these adhesions were imbued with pus, and the pleural cavity contained a considerable quantity of turbid serum. The pleura costalis presented a mottled rosy appearance: the lung itself was healthy. The cellular tissue over the pericardium was infiltrated with pus. The pericardium contained a small quantity of serum, and had its usual polish, except on the surface of the heart, where there were a few thin shreds of false membrane. The heart was natural in size; the parietes of the left ventricle thickened; in other respects it was normal. The valves were quite healthy. The right lung was healthy, but somewhat compressed by a considerable 191 Aet. Age. 192 Dropsy. The historical diagnosis of dropsy – which is now obsolete – indicated simply an abnormal accumulation of fluid. The word derives from the Greek hydrops (water). Alternative or supplementary terms included hydrothorax (fluid in the chest cavity), ascites (which still indicates excess free fluid in the abdominal cavity), anasarca (still used to describe generalized edema throughout the body). https://doi.org/10.1017/CHOL9780521332866.101 An ancient medical term used to indicate different conditions including chronic heart failure. https://doi.org/10.1016/j.ijcard.2017.07.104 Scurvy can cause heart failure, eg. https://doi.org/10.1186/s12890-024-02941-x https://doi.org/10.3389/fcvm.2022.789729 73 The cause of scurvy suggests considerations scarcely less interesting than those which arise from a study of its pathology. We here learn the great importance of considering food, not only in reference to digestibility and other qualities, but also as the material from which healthy blood is to be formed. We are of opinion that this point of view is too often overlooked, both as regards public health, and in prescribing diet in individual cases, and we hope these pages may call anew the attention of physicians to this interesting subject. We have seen that the approach of scurvy is gradual, and that prolonged abstinence from succulent vegetables is necessary for its full development; but it is our opinion that something short of this—that a condition which might be correctly designated a scorbutic taint—must often occur in the lower classes in towns, but especially in prisons and asylums, towards and at the close of long winters, when succulent vegetables are scarce and expensive. Such a condition of the system would necessarily modify the character and course of supervening acute diseases; and it is worthy of the most diligent inquiry whether that form of scarlatina, designated by the epithet maligna, and analogous types of other eruptive diseases, may not, in some cases, owe their peculiar aspect and character to the circumstance of a scorbutic taint already existing, when the system becomes subject to the specific poison of these several diseases.198 It appears to us, also, that by the common practice of physicians in many chronic diseases, patients are kept far too long a time on a diet consisting of farinaceous food, or of this with some proportion of animal food. When a moderate use of succulent vegetables is considered prejudicial, it would be advisable to supply the patient with their equivalent, namely, a certain proportion of orange or lemon juice.199 198 A fact which renders this probable is, that these types prevail most, during and at the close of long winters. We may here notice the extraordinary prevalence of typhus in the severe winter of 1837, 1838, and the petechial character of that epidemic. Sir G Blane has remarked, that the low spotted typhus is always most prevalent in long and severe winters. Willan states also, that the malignant form of scarlatina is usually limited to the winter months. The following paragraph from Huxham’s Essay on Small-pox, may also bear on this subject: “I have never observed either the vegetable or mineral acids of any great service in the crude crystalline pox, but I have often found them highly useful in the small, black, confluent kind, with petechiæ.” 199 On the 28th of May, of the present year, a patient was admitted into the Dreadnought, presenting the usual symptoms of scurvy. He entered a hospital in Scotland, on the 15th of the preceding November, on account of an injury on the leg, received the same day, and continued there till the 22d of May. During this period, he lived chiefly on oatmeal-porridge with milk; but latterly he had four ounces of meat, which he ate with bread, and three ounces of whisky daily. Occasionally he had broth without kale. No potatoes or other vegetables; no beer. The scorbutic symptoms disappeared in a few days, under the free use of lemon juice. 80 Physiologists have made experiments on animals to ascertain the effect of a diet composed of substances devoid of nitrogen. The condition of the system which this brings on is different from scurvy, and of far more serious nature. It appears from the experiments of Magendie, that after an animal has been kept a certain time on such a diet, the allowing him his customary food does not save him.200 The contrary is notoriously the case in scurvy, which, as far as we can judge, does no permanent injury to the constitution. Diagnosis. The history of scurvy shows, more completely than that of any other disease, the great practical importance of accurate diagnosis. It was owing to want of it, that scurvy continued to prevail, to a most fatal extent, for two centuries after effectual preventives and remedies had been discovered in the most abundant productions of nature. We have already mentioned that in the earliest accounts of the disease by Ecthius, Ronsseus, and Wierus, who wrote in the first half of the sixteenth century, there is not only an accurate description of its symptoms, but an enumeration of many of the vegetables and p.93 fruits which at present are the most distinguished for antiscorbutic properties. In the early part of the seventeenth century, however, a work on scurvy was published by Eugalenus, a Dutch physician, who laboured to prove that almost all cutaneous diseases, hypochondriasis, and various other maladies, were merely different manifestations of the scorbutic diathesis, and ought to be considered as one disease.201 The confusion was made still greater by subsequent writers, until at last physicians had comprehended under the term scurvy, almost every distemper incident to man. Sydenham202 tells us that, in his time, 200 The reader who is desirous of further information on this point, may compare the account of these experiments of Magendie with the description given by Mr. Malcolmson, of the effect produced by a diet of bread and water on the health of prisoners in India. (Letter on Solitary Confinement, &c.: by J. G. Malcolmson, Esq.) Budd wrote a longer discussion of Magendie’s work in 1842 https://archive.org/details/s2id13404640/page/744/mode/2up p.744 forward Malcolmson https://wellcomecollection.org/works/gausgz3s https://pmc.ncbi.nlm.nih.gov/articles/PMC5785134 https://pmc.ncbi.nlm.nih.gov/articles/PMC5775712 201 James Lind extensively criticized Eugalenus https://archive.org/details/treatiseonscurvy00lind/page/4/mode/2up p.5-16 https://wellcomecollection.org/works/xc2t7736/items?canvas=29 202 Lind’s comments on Sydenham https://doi.org/10.5281/zenodo.17223929 https://archive.org/details/treatiseonscurvy00lind/page/376/mode/2up p.377-380 https://wellcomecollection.org/works/xc2t7736/items?canvas=401 81 scurvy and malignity were the subterfuges of ignorant physicians; and Willis,203 writing in 1769, could make use of such expressions as these:—“Si accidens quoddam inusitatum nec prius auditum in corpore humano eveniat, cum ad aliud certum genus referri nequit, sine dubio statim illud scorbuticum pronuntiamus.” (Willis, De Scorbuto, cap. i. p. 14.) In the middle of last century Dr. Lind complained much of the same want of accurate diagnosis, and dwelt very impressively on the evils that resulted from it. (Lind, preliminary discourse, ch. iii. 204) It is to this author, who, as physician to the fleet, was well placed for observing the uniformity of the disease, that we are indebted for the final dispersion of most of the errors that prevailed on this subject. His patient investigation of the history of scurvy will ensure him the rank of a philosophic physician; while his perseverance in forcing on the public notice the means by which it might be prevented, and the beneficial influence which the adoption of these means has had on the condition of a numerous and important class of our fellow-subjects, will ever entitle him to a high place among the benefactors of mankind. At present, the subject of diagnosis is comprised within very narrow limits. The only disease with which scurvy can be confounded, is purpura. This term, in the language of modern pathologists, is intended to include every variety of petechial eruption, or of spontaneous ecchymosis (see Bateman and Biett); it consequently comprehends typhus, or petechial fever, scurvy, and probably other distinct diseases, which, until we have learned to discriminate between them, we are compelled to group under the generic term, Purpura. Petechial fever, indeed, is easily distinguished by the peculiar character of its symptoms from the other diseases, which, by the preceding definition, are included in the same class; but scurvy, and the maladies to which we would restrict the term purpura, are confounded by the best writers on diseases of the skin. They are, however, essentially different; they arise from different causes; they differ in the circumstances and mode of attack; and they require 203 Lind’s comments on Willis (1667); Budd has the year incorrectly. Lind criticized Willis’ views on scurvy https://doi.org/10.5281/zenodo.17226864 https://archive.org/details/treatiseonscurvy00lind/page/14/mode/2up p.15-17 https://wellcomecollection.org/works/xc2t7736/items?canvas=39 https://archive.org/details/treatiseonscurvy00lind/page/358/mode/2up p.359-366 https://wellcomecollection.org/works/xc2t7736/items?canvas=383 204 https://archive.org/details/treatiseonscurvy00lind/page/30/mode/2up Lind p.31 https://wellcomecollection.org/works/xc2t7736/items?canvas=55 82 different treatment. We have already stated that the essential cause of scurvy is prolonged abstinence from vegetable juices, and that the approach of the scorbutic habit is very gradual: purpura, on the contrary, often appears suddenly, and in many cases it cannot be attributed to any peculiarity in diet. Scurvy, when occurring on land, is, from circumstances we have before mentioned, met with almost exclusively at the end of winter, or in the early part of spring; purpura, on the other hand, is most common in summer and autumn. The livid and spongy state of the gums, which is pathognomonic of scurvy, and which, as well as the sallow and dusky hue of the skin, is a constant symptom of that disease, is not observed in purpura. Lastly, in scurvy, bleeding always does harm, and the disease is speedily cured by the use of succulent vegetables and fruits; while, in purpura, the abstraction of blood is often followed by relief, and the antiscorbutic juices are rarely, if ever, productive of much benefit.205 It has been supposed that there are varieties of scurvy, and that scurvy occurring on land is different from that which arises at sea. If, however, we compare the descriptions given by the early writers206 on scurvy, who observed p.94 it on land, or the cases recorded by Dr. Heberden, with the accounts of naval physicians, we shall perceive an entire agreement in the essential symptoms of the disease. Moreover, it is easy to see that the disease depending, as it does, on a single cause, must be identical wherever it occurs. Treatment. After the details into which we have entered respecting the causes and prevention of scurvy, we have little to say on the subject of treatment. The essential point is to administer liberally those articles of vegetable food, which have been distinguished for their antiscorbutic qualities. Oranges, lemons, or fruits of that class, if they can be procured, should be preferred. Their salutary effect is extraordinary, and such as would scarcely be imagined by persons who have not witnessed it. In the course of a few days, the complexion loses its sallow and dusky hue; the gums become firm and florid; the petechiæ and bruise marks on the skin disappear; the legs, if swollen and 205 This circumstance alone is quite sufficient to prove an essential difference between scurvy and the diseases to which we would limit the term Purpura. The effect of vegetable juices is so constant and so specific in real scurvy, that we may safely infer that a disease not benefited by them, is of essentially different nature. 206 Ecthius, Wierus, or in fact, any writer before the time of Eugalenus. See also Med. Gazette, vol. xx. report of Dr. Murray. https://archive.org/details/s2id13404540/page/234/mode/2up Murray p.934 https://archive.org/details/s2id13404540/page/906/mode/2up Murray p.906 83 rigid, begin to regain their natural size and pliancy; despondency and muscular weakness are replaced by cheerfulness and a feeling of strength:—in fact, the aspect and condition of the patient soon betoken return of health. If the state of the gums be such as to prevent the patient from masticating, he should be kept for two or three days on milk diet,207 or on soups, in addition to antiscorbutics. At the end of this time, or at the commencement, if the case be less severe, his diet should consist of fresh animal food, with vegetables, especially in the form of salads. As long as he continues very feeble, wine should be freely given him; afterwards, this may be replaced by porter or ale. In advanced stages of the disease, when debility is extreme, and the slightest exertion produces fainting, the patient should not be exposed to sudden change of air, or be even allowed to sit up in bed without great caution. Before he is moved or permitted to get up, a glass of generous wine, well acidulated with lemon or orange juice, should be given him. This injunction was first made by Dr. Lind, and we have more than once had to regret not having obeyed it. Sleep should be procured by an opiate at night, which we have often found to produce great comfort. Constipation, when it exists, may be removed by mild purgatives; and for this purpose none are preferable to moderate doses of castor oil. On account of the great debility, and the tendency to swoon, which in high degrees of scurvy is sufficient to cause alarm, all strong cathartics208 should be avoided. For the gums we may prescribe an astringent gargle; and none answers better than a weak solution of chloride of lime. For scorbutic ulcers, the best dressing is lint soaked in lemon or lime juice, diluted with two or three times its quantity of water. (Dis. of Seamen, p. 468. 209) The lint when placed on the ulcer, should 207 We have no evidence showing that milk is antiscorbutic. Dr. Lind mentions, on the authority of Sinopæus, that scurvy is common among the Tartars, who live chiefly on milk and flesh (Lind, p. 246.); and we have already noticed its occurrence in the Lunatic Asylum at Moorshedabad, in which milk was regularly supplied to the inmates. https://archive.org/details/treatiseonscurvy00lind/page/246/mode/2up Lind p.246 https://wellcomecollection.org/works/xc2t7736/items?canvas=270 208 https://en.wikipedia.org/wiki/Cathartic 209 “It ought to be mentioned here, as a fact of great consequence, though very little known, and never, I believe, published before, that the juice of limes and lemons is the best detergent of any external application that has yet been tried in scorbutic ulcers. Nothing was found so effectual in preventing these from spreading, and in disposing them to heal, as an emollient poultice with lemon or lime juice sprinkled on its surface. Or it was applied by soaking in it the lint with which the sore was dressed, and also as a lotion, in which case it was used diluted with two or three times its quantity of water; for if used pure, it was found too irritating, and was apt to bring on a fungous disposition.” https://archive.org/details/observationsondi00blan/page/462/mode/2up Blane 1785, p.463 84 be covered with oiled silk to prevent evaporation. Firm compression should be avoided, from the tendency it has to produce gangrene. If the legs be much swelled, stiff and painful, considerable relief will be procured by warm fomentations.210 But all these complaints yield readily to the general method of cure, and can only be palliated until that is undergone. Bleeding should never be had recourse to, although acute pains, heat of skin, quickness of pulse, and other febrile symptoms or a dangerous hæmorrhage may seem to render it advisable. In advanced stages of the disease patients do not survive it. (Lind, p. 216 211). Blisters are apt to produce gangrene, and for this reason we should abstain from their employment. (Larrey, Mém de Chir. Mil. tom. ii. p. 288.) Mercury, in every form, should be religiously avoided: even in very small quantities it has been known to produce dangerous salivation. We have met with instances in which the scorbutic symptoms seemed to have been much aggravated by mercury taken before the scurvy made its appearance. The ill p.95 effects of this medicine are indeed noticed by most writers on scurvy; and Kramer,212 who was physician to the imperial armies in Hungary, from 1720 to 1730, relates that of 400 men, affected with genuine scurvy, to whom, on the advice of Boerhaave, mercury was given so as to induce salivation, not one survived. In the writings of the physician whose testimony we have just given, is a passage which expresses so pithily and so truly almost all that we can say on the subject of treatment, that we cannot refrain from quoting it. “Scurvy is the most loathsome disease in nature; for there is no cure for it in your medicine chest; no, nor in the best furnished apothecary’s shop. Pharmacy gives no relief, surgery as little. Beware of bleeding: shun mercury as poison: you may rub the gums, you may grease the rigid tendons in the ham, to little purpose. But if you can get green vegetables; if you can prepare sufficient 210 Fomentation. The application of hot moist substances to the body to ease pain. 211 “As to evacuations: It is to be observed, that this disease, especially when advanced, by no means bears bleeding; even although the most acute pains upon the membranes, a high degree of fever, and dangerous hæmorrhages, would seem to indicate it. The patient generally dies soon after the operation.” https://archive.org/details/treatiseonscurvy00lind/page/216/mode/2up Lind p.216 https://wellcomecollection.org/works/xc2t7736/items?canvas=240 212 “I come now to what has been attempted, both by myself and others, towards, the cure: and must first observe, that 400 of the troops near Belgrade having taken mercury without my advice, the dreadful consequence was, they all died in a salivation !” Description of scurvy by Kramer (1720,1737) https://doi.org/10.5281/zenodo.17224830 Lind 3rd ed, p.412 https://archive.org/details/treatiseonscurvy00lind/page/402/mode/2up Lind p.406 https://wellcomecollection.org/works/xc2t7736/items?canvas=427 85 quantity of fresh, noble, antiscorbutic juices; if you have oranges, lemons, or citrons; or their pulp and juice preserved with sugar in casks so that you can make lemonade, or rather give to the quantity of three or four ounces of their juice in whey, you will, without other assistance, cure this dreadful evil.” 213 (Krameri, Medicina Castrensis.) 213 https://archive.org/details/treatiseonscurvy00lind/page/160/mode/2up Lind p.160 footnote https://wellcomecollection.org/works/xc2t7736/items?canvas=184 86