Description of scurvy by Kramer (1720,1737)

Description of scurvy by Kramer (1720,1737) Summary by James Lind (1772) This is James Lind’s English summary of a text on scurvy by Kramer in 1737, the original was published in Latin. J. G. H. Kramer, physician to the Imperial army in Hungary https://wellcomecollection.org/works/r7fpbavt/items?canvas=574 Yellow is used to indicate sections describing the symptoms of scurvy. This text is available at: https://doi.org/10.5281/zenodo.17224831 2025-9-29 This annotated version was prepared by: Harri Hemilä, University of Helsinki, Finland https://www.mv.helsinki.fi/home/hemila https://orcid.org/0000-0002-4710-307X https://www.ncbi.nlm.nih.gov/pubmed/?term=hemila+h https://scholar.google.com/citations?user=2mkomzUAAAAJ https://doi.org/10.5281/zenodo.17085738 Reports on scurvy uploaded to Zenodo by Harri Hemilä 1 James Lind’s comments on Kramer: p.17 What were the sentiments of a most judicious physician, may be seen by looking into Sydenham; what were the dreadful consequences of such writings, will appear by looking into Kramer: but how many unhappy patients must have suffered in this disease before the slaughter of thousands at a time (Kramer) began to open the eyes of mankind, is too melancholy a subject to dwell upon! https://archive.org/details/treatiseonscurvy1772lind/page/16/mode/2up p.25-26 … Mercury may be reputed a poison in the scurvy; Kramer gives an account of 400 men destroyed by it; yet Boerhaave recommends it… To so great an authority, which, as far as is consistent with truth and the good of mankind, I shall always respect, may be opposed a much greater, viz. the experience of a physician who had the greatest opportunity perhaps any one ever had, of being conversant with scorbutic patients; woful experience gained by being witness to the death of many thousands, when Boerhaave’s Aphorisms on this subject were of no use to him… Kramer epistol. p. 27, 28. https://archive.org/details/treatiseonscurvy1772lind/page/24/mode/2up p.31 Moreover, the sea-scurvy is called by several authors the Dutch distemper; especially by the celebrated Francis Gemelli Careri, who has wrote the best voyages in the Italian language. The French formerly gave it the name of the land evil. And indeed the symptoms of the malady are at this day uniform and the same, both at sea and land; in Holland, Greenland, Hungary (Kramer), Cronstadt, Wiburgh (Nitzsch), Scotland (Grainger), &c. which sufficiently evinces the absurdity of the assertion advanced by several authors, that since the first accounts of it were published, the face and appearances of the calamity have been greatly changed. https://archive.org/details/treatiseonscurvy1772lind/page/30/mode/2up 2 p.33 … But a heavier charge lies against them. When the true scurvy does really occur, their writings, so far from being useful, are rather hurtful to practitioners; which I think needs no farther proof, than Kramer’s letter to the college of phyficians at Vienna. Their doctrines have perverted the judgment of even some of the best writers. … The cure of scorbutic diseases contracted either at land or sea, is entirely the same. This will appear to any person who peruses Backstrom’s and Kramer’s observations, and several other histories related in this treatise. https://archive.org/details/treatiseonscurvy1772lind/page/32/mode/2up p.40 It has a most fatal influence on the practice. Thus the original and real disease has been lost and confounded amidst such indefinite distinctions and divisions of it, that it is sometimes not known by the best practitioners, when it really occurs. To this was owing the loss of so many thousand Germans in Hungary (Kramer), not many years ago, where the physicians to that army, together with the whole learned college of physicians at Vienna, assisted by all the books extant on the Subject, were at a loss how to remedy this dreadful calamity. And for this reason many unhappy people are daily injudiciously treated at land, as must have been observed by every one acquainted with the distemper. Thence likewise pernicious methods have been recommended at sea, and too often put in practice. https://archive.org/details/treatiseonscurvy1772lind/page/40/mode/2up p.42 Thus, when it lately raged with such a remarkable devastation among the Germans in Hungary, the physician to that army (Kramer) was surprised to find that not one officer, even the most subaltern, received the infection. https://archive.org/details/treatiseonscurvy1772lind/page/42/mode/2up 3 p.44-45 Thus, where the causes productive of it are general, and violent in a high degree, it becomes an epidemic or universal calamity, and rages with great and diffusive virulence: as happens often to seamen in long voyages; sometimes to armies (Nitzsch), very lately to the German soldiers in Hungary (Kramer); frequently to troops when closely besieged, as to the Saxon garrison in Thorn (Bachstrom), the besieged in Breda (Vander Mye), in Rochelle, as also Stetin: and at other times to whole countries; as in Brabant, in the year 1556; and in Holland, ann. 1562. https://archive.org/details/treatiseonscurvy1772lind/page/44/mode/2up p.49 That salt meats have sometimes no share in occasioning this disease, is demonstrable from the many Germans in Hungary destroyed by it, who eat neither salt beef nor pork; on the contrary, they had fresh beef at a very low price. Vid. Krameri epist. p. 33. https://archive.org/details/treatiseonscurvy1772lind/page/48/mode/2up p.61 This disease is not indeed peculiar to the ocean, there being many instances of its raging with equal violence at land (Vid. the case of the German troops in Hungary: Kramer etc.). https://archive.org/details/treatiseonscurvy1772lind/page/60/mode/2up p.78 In Hungary, where there must have been the strongest disposition in the air to produce the scurvy (Vid. Kramer), not only the officers, and natives of the country, but even the dragoons1, by having more pay, and consequently better diet, cloathing, and lodging, though equally subject to the other diseases of the country, yet kept free from the scurvy. Who were attacked by it? Only the Bohemians, who eat the coarsest and most indigestible food. The Bohemians used no other than what was the ordinary diet of their own country, as we are informed by Kramer. The seamen 1 Dragoons were originally a class of mounted infantry, who used horses for mobility, but dismounted to fight on foot. From the early 17th century onward, dragoons were increasingly also employed as conventional cavalry and trained for combat with swords and firearms from horseback. https://en.wikipedia.org/wiki/Dragoon 4 in the Channel cruisers had the very same provision as other ships who went upon different stations: yet it is evident one cause in both places was the diet; as a different diet prevented the disease, and change of diet quickly cured it. Now, there must have been a quality in the air of Hungary different from that of Bohemia; something which rendered a diet harmless in the one country, hurtful in the other. The indisposition of the air in Hungary was very obvious. The disease prevailed only in the spring, and during a wet season; was much more violent in some parts of the country than in others. Kramer enumerates the different places where it raged most, viz. where-ever the soil was damp and marshy. This observation has been made not only in Hungary, but in other parts of the world. https://archive.org/details/treatiseonscurvy1772lind/page/78/mode/2up p.143 Dr. Cockhurn. — The Doctor’s judgment is fully confirmed by experience. We find the college of physicians at Vienna sent to Hungary great quantities of the most approved antiscorbutic herbs dried in this manner; which were found to be of no benefit. Many of these would have their virtues as little impaired by drying as spinage, e.g. marsh trefoil. Kramer tried almost every species of dried herbs to no purpose. Vid. part 3. chap. 2. https://archive.org/details/treatiseonscurvy1772lind/page/142/mode/2up p.159 And if people had been less assiduous in finding out new remedies, and trusted more to the efficacy of these fruits, for preventing this fatal pestilence to seamen, the lives of many thousand sailors, and others2, (especially 2 Vid. Kramer’s observations, part 3. chap. 2. the best ever made on this disease; which abundantly confirm all that is here advanced. In a book published afterwards he makes the following remarks. The scurvy is the most loathsome disease in nature; for which no cure is to be found in your medicine chest, nor in the best-furnished apothecary’s shop. Pharmacy gives no relief, surgery as little. Beware of bleeding; shun mercury as a 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 a sufficient quantity of the 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 a 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. Krameri medicina castrensis. 5 during the last war) might in all probability have been preserved. https://archive.org/details/treatiseonscurvy1772lind/page/158/mode/2up p.172 The Dutch sailors are said to be less liable to the scurvy than the English, owing to this pickled vegetable carried to sea. Vid. Krameri epistolam de scorbuto. https://archive.org/details/treatiseonscurvy1772lind/page/172/mode/2up p.236-237 If it be said, That scurvy-grass, cresses, and other acrid alcalescent plants, are found highly antiscorbutic; it must likewise be remembered, that they are not perhaps altogether so efficacious as the acescent fruits; or at least become much more so by the addition of lemon-juice, oranges, or a little sorrel; which last the Greenlanders are taught by experience to join with them for their cure: these herbs not only strengthen the tone of the stomach and invigorate the organs of digestion, but restore the suppressed perspiration, promote a copious flow of urine, and encrease every secretion in the body, which is the most essential quality of an antiscorbutic composition. That they strengthen the powers of digestion appears not only from the quick increase of appetite occasioned by them, but from the belchings of wind which frequently follow each dose.3 https://archive.org/details/treatiseonscurvy1772lind/page/236/mode/2up https://archive.org/details/treatiseonscurvy1772lind/page/158/mode/2up 3Kramer observed, that in a thousand patients he had cured by the juices of scurvy-grass and cresses, each dose of the juices occasioned prodigious belchings and wind. It was so uncommon, that he imagined it proceeded from the active and volatile salts of the herbs set loose in the stomach; to which he ascribed their cure. He therefore strictly injoined his patients, to prevent as much as possible these salts from making their escape in this way. https://archive.org/details/treatiseonscurvy1772lind/page/236/mode/2up 6 Baron JH. Sailors’ scurvy before and after James Lind – a reassessment. Nutr Rev. 2009 Jun;67(6):315-32. https://doi.org/10.1111/j.1753-4887.2009.00205.x p.317 Some academic dissertations did formulate a unitary etiology, and thus a rational and successful therapy. In 1721, Johann Kramer, physician to the Hungarian army, advised “Seek the cure of scurvy neither in the armamentarium of the physician nor in the apothecary shops … On the other hand, employ fresh vegetables, the juice of fresh antiscorbutic plants, oranges and lemons or the juice of those fruits preserved in sugar; in this way without other means you will be able to overcome this terrible disease.” p.318 In his chronological abstracts, Lind clearly stated Kramer and Bachstrom’s unitary fresh vegetables hypothesis for cause and cure of scurvy. However, his own chapters on the causes and cures of scurvy are full of obscure and uncritical concepts, and one is left with his ideas that sea scurvy was due to excess perspiration, could be prevented by ventilation, and that many remedies could be used as well as citrus fruits and cresses. p.319 It is remarkable in the many descriptions of privations, both at land and sea, characteristic specific clinical features are recognizable today as those of scurvy, and only rarely of other diseases such as those caused by deficiencies of other vitamins (A, B, etc). Indeed, Lind cited the statements of other highly experienced clinicians. Kramer, who had seen more than a thousand cases in Hungary, wrote: “The appearances all are constantly uniform”… Moreover, most of those diagnosed then with scurvy responded rapidly, within hours or days, when given what we now know to be effective antiscorbutics, unlike the slower responses to treatments of other known avitaminoses. 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 p.215 Kramer (1720, 1737), early in the eighteenth century, when chief surgeon with the Austrian army in Hungary in the Turkish War and confronted with scurvy among his troops, received from Vienna in response to his appeals for help, a large and varied supply of dried ‘antiscorbutic’ herbs. They proved useless and thousands perished. The incident was in due course forgotten and is yet another example of the way in which many conclusive facts concerning the cause and cure of scurvy were continually set aside with tragic consequences. 7 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. Stockman R. James Lind and Scurvy. Edinb Med J. 1926;33(6):329-350. https://pmc.ncbi.nlm.nih.gov/articles/PMC5302666 p.344 On the Continent, Kramer, who had been a military surgeon in the Austrian-Turkish War of 1715, wrote of it very well from extensive first-hand knowledge, asserting emphatically that it is not the disease described by Eugalenus. Hess AF. Scurvy, Past and Present, 1920. https://www.gutenberg.org/ebooks/40505 https://wellcomecollection.org/works/r7mfk27h p.163 “We find the College of Physicians at Vienna sent to Hungary great quantities of the most approved antiscorbutic herbs dried in this manner; which were found to be of no benefit. Many of these would have their virtues as little impaired by drying as spinage, e.g., marsh trefoil. Kramer tried almost every species of dried herbs to no purpose.” (Treatise on The Scurvy. James Lind, London, 1772, p. 143.) p.230 “Seek the cure of scurvy neither in the armamentarium of the physician nor in the apothecary shops. The druggist will be of as little aid to you as the art of the surgeon. On the other hand, employ fresh vegetables, the juice of fresh antiscorbutic plants, oranges and lemons or the juice of those fruits preserved with sugar; in this way without other means you will be able to overcome this terrible disease.” This reads like the advice of some modern therapeutist; it is, however, the conclusion of a physician (Kramer) who wrote on scurvy almost two hundred years ago, and shows that the treatment of scurvy has undergone no fundamental change in the intervening years. Our resources, however, have been amplified by an increased knowledge of the relative value of antiscorbutic foodstuffs and by the introduction of some new ones. 8 The text on the following pages is the summary by Lind (1772, 3rd ed.) p.409-419. https://archive.org/details/treatiseonscurvy1772lind/page/408/mode/2up https://archive.org/details/b30511902/page/408/mode/2up https://babel.hathitrust.org/cgi/pt?id=ucm.5320216006&seq=433 https://hdl.handle.net/2027/ucm.5320216006 https://wellcomecollection.org/works/r7fpbavt/items?canvas=431 The original in Latin: Jo. Geo. Henrici Krameri dissertatio epistolica de scorbuto. https://books.google.com/books?id=DgteAAAAcAAJ https://books.google.com/books?id=19OM0QEACAAJ https://books.google.com/books?id=mnd0vwEACAAJ 9