Observations on the scurvy

XXXI. Observations on the scurvy. Charles De Mertans. Philosophical Transactions of the Royal Society of London 1778;68:661-680. https://doi.org/10.1098/rstl.1778.0032 https://www.jstor.org/stable/106342 https://archive.org/details/philtrans02417030 https://archive.org/details/paper-doi-10_1098_rstl_1778_0032 This easier to read version was prepared by Harri Hemilä, MD, PhD, University of Helsinki, Helsinki, Finland. https://orcid.org/0000-0002-4710-307X https://pubmed.ncbi.nlm.nih.gov/?term=hemila+vitamin+c https://scholar.google.fi/citations?user=2mkomzUAAAAJ Yellow is used to indicate the description of the symptoms of scurvy This text is available at: https://doi.org/10.5281/zenodo.16846145 1 Charles De Mertans. XXXI. Observations on the scurvy. Philosophical Transactions of the Royal Society of London 1778;68:661-680. THE diseases of a great multitude of p.661 people, who live in the same manner, and are obliged to live upon unwholesome food, are to be corrected by a correction of the food itself, and not by any medicines properly so called. Consistently with this principle, I have always thought that the salt provisions used by sea-faring people being the principal cause of the scurvy which makes such fatal havoc amongst crews engaged on long navigations, it was p.662 necessary to find out some food of an opposite nature to this, capable likewise of being preserved at sea. Salt provisions are hard of digestion; and we all know that all food, which our powers of digestion cannot reduce to a good chyle, undergoes in the primæ viæ such alterations as are proper to the respective species of it in regard to heat and humidity; consequently, the chyle produced by salt provisions partakes altogether of an animal nature tending to putrefaction. When it mixes with the blood, it increases this disposition which our fluids have of themselves; and thus, by degrees, introduces that slow putrid degeneration which we call scurvy, of which, I am persuaded, there is but one sort, different in its degrees. I am likewise persuaded, that the sea and land scurvy are the same disorder, arising from similar causes, that is, living upon salt meat or fish, few p.663 or no vegetables, damp houses, &c. To prevent then or correct this alteration in the humours, we must find out some antiseptic aliments, which may keep a great while, and not be subject to be damaged from the alteration of climate. Now, I used to think, that sour-krout, or fermented cabbage, so frequently used in Germany, had these qualties; that though it did not always please those who eat it for the first time, every body soon grew used to it, and found it good and wholesome food; that sailors in particular were very fond of it, especially when they had no other greens. I had accordingly several conversations upon the subject, twelve years ago, with Messieurs PRESTON and LANGLEY, 2 in which I expressed my wishes that sour-krout might p.664 be carried out and made part of the ships provision. For some years past I have seen, with great pleasure, in the public papers, and the relations of travellers, that the trials I wished for have been crowned with success; and that the preservation of the healths of many crews, which have gone round the world, has been owing to sour-krout. The preservation of sea-faring people is an object so important to many nations, and whoever contributes towards it does so essential service to mankind, that I will now communicate other methods, which, joined to the first, will serve to keep off the scurvy, as well as to cure it more readily and more surely. These methods are likewise in the food, and they consist of vegetables eaten in a state of crudity, and such as the earth affords them. I am convinced, that all the greens used p.665 in our kitchens are much more antiscorbutic when they are raw than after they have been boiled in water1, or have gone through any other preparation by fire. I ground my opinion upon experience, the safest of all guides, and shall therefore begin with the facts which led me to it. I was surprized to find, during an abode of many years at Moscow, that many gentlemen merchants and strangers were attacked by a slow scurvy, having their gums soft, swollen, and blueish, the breath strong, and many scorbutic spots at the legs, whilst it was rare to find among the lower people, either of town or country, a single person with these marks. The nourishment of the former consists of a great deal of meat, both salt and p.666 fresh, and likewise of fish; they seldom eat any greens, except now and then a soup made of sour cabbage, exactly resembling the German sour-krout in every thing, save that this cabbage is chopped small, whereas the sour-krout is cut according to the length of the cabbage. Their common drink is very sour small beer, called quas,2 besides which they drink wine, the beer of the country, English beer, and a small glass of brandy at least before every meal. They eat very little bread. The common people live all the year upon this sour cabbage soup, in which they boil salt meat on common days, and salt or dried fish on meager days and during their 1 Perhaps it is because they lose a great deal of fixed air by ebullition. 2 Quas. A slightly alcoholic beverage of eastern Europe made from fermented mixed cereals and often flavored. 3 four lents3 (which are more than a third of the year) when they add to it very stinking lin-seed oil instead of grease or butter. In this soup, which is called schsti, both p.667 in the meager and other seasons, they boil meal, principally that of Saracen wheat. They eat cucumbers like the others in summer, and salt them for the winter. They likewise feed very much upon oat bread. The common people live in small wooden houses, generally very low, in which they get together both night and day during three parts of the year, on account of the great cold. There is little air in the room, the windows of which are very small. Here they stew together in humidity and nastiness; for, except the bath, which, as well as thole I have mentioned first, they use once a week, they are extremely nasty. Here then are many reasons, all of which (except the constant use of sour cabbage and bread) should make them more subject to the scurvy than the people of p.668 fashion, or those who live at their ease; a constant use of meat or fish that is salt (for they esteem neither so much when they are fresh) much more brandy, filth and damp in their houses, less change of cloaths or linen. I was many years making these observations, and inquiring what it was that could preserve them from the scurvy, which, on so many accounts, they ought to have been more subject to than the others. It appeared to me that, exclusive of the daily use of the sour cabbage, which I consider as the most powerful of all preservatives, they were indebted for their safety to the great quantity of raw greens, such as onions, leeks, raddishes, turnips, peas in the pod, and others, which they eat. The berries of Vaccinium, with others much resembling them, called kloukna, which are of the size of a small cherry and very p.669 acid, are, together with apples, strawberries, and rasberries, almosl the only fruits of these countries. In the Foundling Hospital, of which I was a physician, there were every winter several scorbutic patients. This hospital was built near the conflux of two rivers, in a place the soil of which has been raised at a great expence. As near back as the year 1770 there were still stagnated waters to be seen in the place; but only a part of the children lived there, the remainder lived in a stone house, situated upon an eminence in the neighbourhood. 3 Lent. Church holiday. 4 The usual symptoms of the scurvy on these children were, the swelling of the gums, the nauseous breath, a great languor and dejection; they used to become cachectic, and of a leaden colour. In process of time the swelp.670 ling of the gums increased; they were used to assume a livid colour: pustules were formed in the mouth, the infection of the breath grew most horrible, the gums and all the inside of the mouth became gangrenous, the jaw bones were carious, the fall of the teeth followed, and the bones of the alveoli fell to pieces. The sick could scarce stir, though they had as yet no fever, and had a very good appetite. The legs of some amongst them were from the first covered with scorbutic spots, and dried crusts, like scales; others only had these symptoms after the mischief had made a great progress. Most of them had their legs swelled. In some, the flexor tendons of the legs grew shorter, and stiffened in such a manner that they were forced to keep always in a lying posture, with the legs near the thighs. In two cases the same p.671 thing has happend to the arms. The gangrene of the gums and mouth, as well as the caries of the bones, used insensibly to increase to such a degree, that the bones of the alveoli and the spongious part of those of the upper jaw used to fall out. The mischief was used, however, to make a slow progress; there often elapsed a fortnight, and sometimes more, after the beginning of the gangrene of the mouth and caries of the bones; and many months between the first symptoms and the stage of the disorder I have been describing. Even in this stage, dreadful as it was, they still took nourishment sufficient, and even much more than it would be thought possible they should have taken in such a situation. It was impossible, however, they should live long in such a state, and death soon put an end to their torments. I have often been surprized at not hearp.672 ing any cries of anguish come from them in so lamentable a situation; but they were used almost continually to complain of their voice being feeble. The mode of treatment which I commonly made use of in curing the greater part, provided the mischief had not made a considerable progress in the spongious bones of the upper jaw, was this: the first thing I did was to put them on a vegetable diet, and order them soups, with a great many greens dressed in light broth, such as 5 sour cabbage, carrots, turnips, and onions, &c. to which I added stewed onions and sorrel. The drink of the bigger sort was quas or sour small beer; the lesser ones (none of which were ever seized with the scurvy under two years old) drank water. During the spring, those who had the scurvy took, in p.673 proportions suitable to their ages, a drink made of whey, in which were infused antiscorbutic plants, such as cochlearia, nasturtium aquaticum, becca bunga, acetosa. This infusion was sweetened with plain syrup, or syrup of sugar. Besides this, in the course of the day, they used a gargle, made of an infusion of herbs, rue, sage, agrimonia in water, to which was added spirit of cochlearia, and honey of roses. When the gangrene began to shew itself at the mouth, besides the remedies I have mentioned, they used to take a strong decoction of bark, part of which decoction I likewise added to the gargle. I likewise had the gangrened parts touched with honey of roses, mixed with a small quantity of spirit of sea salt. This method of treatment had succeeded perfectly p.674 well the three first years; insomuch, that the greater part of the sick, as well adults as infants, were commonly cured in the space of three weeks or a month, when the distemper was not far advanced. It was in spring and winter that the scurvy used to be most fatal. In autumn 1770, the foundling children, who remained in town to the number of a thousand4, were lodged, contrary to my advice, in the wing of the house finished but about a year since. In a climate where the summer is so short, new walls made of bricks take a great time in drying, and this house was situated on a soil which had been a bog5 a few years before. Notwithstanding all the possible precautions that could be taken, a damp was felt in the room the whole winter. The scurvy p.675 shewed itself early in the spring, and I had many more children ill than I had had the preceding seasons. The violent symptoms were likewise much more frequent. Many had gangrenous pustules at the mouth, the jaw bones were carious in some; the limbs, particularly the legs of many, were drawn up and stiff. I put all these sick persons in the wooden house, which 4 The greater part of the sucking children were at nurse in the country. 5 Bog. Wet spongy ground. 6 had already served many years as an hospital for the scurvy, and gave them the food and medicines abovementioned; but the disorder was more stubborn than ever it had been, and all I could do could hardly keep it down. In the middle of May, seeing that the remedies I had formerly tried were unsuccessful, I began to think of other methods. The reflections communicated above, which I had made upon the diet of the lower people, dep.676 termined me to give my patients those vegetables raw which they had before been used to eat boiled. In consequence thereof, I ordered them, every morning, radishes, sweet turnips, carrots, and young onions, which they eat like apples. At dinner, besides the soup and greens as usual, they eat sallad with a little vinegar and a very little oil; in the afternoon the same roots as in the morning, and at night, greens and sallad. The remedies were continued as before. In a few days all the bad symptoms decreased: those who were at the worst, and had been ill for some time, began to grow better; those who had been but slightly seized were soon well, so that at about a month’s end there only remained a few of those who had been the worst, and they too were getting well at a great pace. This change for the better was app.677 parent in all a very few days after they had begun to eat the raw greens. I had not at that time read the observations of the English physicians and surgeons on malt, or I should certainly have made use of it. Quas, which I have mentioned above as the principal drink of the common people, comes near it, with this difference only, that it is not drunk in a state of fermentation. It is a species of sour small beer, to which, instead of hops, they add the wild mint. The same method of treatment was attended with success in 1772 and 1773; in both which springs I had scorbutic patients with the same symptoms, but not in such numbers as in 1771 (when there were near sixty) because the house, having now dried, was become very wholesome, and because the soil had been again consip.678 derably raised. I shall not propose carrying out vegetables on a voyage for the whole crew, because that, in order to preserve them, they must be kept in dry sand, which (if not altother impracticable) would be extremely difficult in such large quantities, not to add that even then a great part 7 would be spoilt: but might it not be possible to provide a certain quantity of carrots, turnips, &c. and stow them in sand, in a part of the ship where they might not be exposed to get damp or wet, whence they might be given in such cases as the sour-krout alone would be sound insufficient to cure? for I am apt to think that these greens, joined to an infusion of malt, would soon get the better of the disorders. But if this cannot be so well done at sea, it is obvious, p.679 that the cure of the scorbutic persons will be much accelerated, if raw greens are given them as soon as they come on shore; a mode which will have the additional advantage of shortening the stations ships are obliged to make, for the recruiting their sick. Nature will of herself dispose the sick to make use of this remedy, especially as I have observed that the stomach is never affected by it. In Austria, as well as several other parts of Germany, the people eat sour turnips, which are prepared in the same manner as the sour-krout; that is, after having been chopped thin, salt is put to them, and they are left to ferment. They are put in tubs, and keep from one year to another. I propose this vegetable as a valuable addition to the antiscorbutic regimen of sea-faring people. It p.680 has nearly the same taste as sour-krout, and will, I believe, be found to have the same virtues: and if so, though it should have no other advantage, it will at least vary the diet, which is itself no inconsiderable advantage on a long voyage. 8