Land scurvy

American Medical Times 1862;5(9; Aug 30):125. https://archive.org/details/sim_american-medical-times_1862-08-30_5_9/page/124/mode/2up https://doi.org/10.5281/zenodo.15582119 LAND SCURVY. [To the Editor of the AMERICAN MEDICAL TIMES.] Francis R Lyman, M.D. SIR:—In a letter from Brigade-Surgeon CHAS. H. RAWSON,1 in the MEDICAL TIMES for July 19, 1862, I find the following observations, which have been so fully corroborated in my experience, and are so vitally important, that I desire to call the attention of the profession to them, so that in future the disease which Dr. Rawson so well describes, may be prevented, and that where it now exists undetected, it may become known and cured, Speaking of the diseases most prevalent in the army of the west, he says :—“But the most singular of all diseases is a species of land scurvy that is very insidious in its effects, and I think many men are suffering from it, who are being treated for many other diseases.” The symptoms are many, and are well described in the letter alluded to; general debility appears to be an important cause of this malady; the men complain that they are daily becoming weaker, great muscular weakness, sometimes soreness with red spots, ecchymotic and swollen feet and legs, rheumatic pains affecting bones, muscles, or any and every portion of the body. Some have pale, waxy, puffy, and anæmic swelling about the face; a few show ulcerated gums and mucous membrane, but they are comparatively few, appetite capricious, and bowels irregular, but generally have diarrhœa. In short, all of the symptoms of scorbutus as described in our Text Books. But I refer the reader to the letter itself, containing much else that is interesting and valuable in a short space, for a fuller exposition of Dr. R.’s views; I wish here simply to second them. There have been, since the 9th of July, about one hundred sick soldiers treated in the wards of the 3d Medical Division, Dr. Loomis, visiting physician, until Aug. 1st.— since which time Prof. Flint has had charge of the service. Of these patients, many were convalescents from typhoid fever, but of the remainder fully one half, about 35 per cent. of the whole number, were, and are affected with this disease. To be sure, quoting again, “Many of these men show no symptoms by mouth or countenance, and the indications 1https://archive.org/details/sim_american-medical-times_1862-07-19_5_3/page/42/mode/2up https://doi.org/10.5281/zenodo.15581966 1 of health are so striking” that one would at first glance pronounce them fit for duty, but a closer examination reveals their trouble. Quite a number, in whom there were no symptoms referable to the mouth and gums, have developed them while under treatment. That the men themselves were unaware of their disease, was evident from the answers they made to the question, “What is the matter with you?” Kidney disease, chronic rheumatism, swelling of feet and limbs, etc. etc.; and in one or two instances one of these a lieutenant, soreness of the gums, looseness of teeth and hæmorrhages from mouth, were the answers most commonly given. The men under treatment were all from the Army of the Potomac, some of them from the Richmond hospitals. Many of these men have fleshed up, gained strength, appetite, and spirits, but are still weighed down with the stiffness and swelling of the limbs, and the excruciating pains, with the sore gums. They are all having the vegetable diet, with tonics, iron, and quinine. The diarrhœa in these patients seems to be checked in proportion as they recover their general health and tone. General debility, instead of being a cause, as Dr. Rawson seems to think, appears to me to be another and most important symptom of scurvy, and sometimes has been the only symptom present, except the wandering “shooting” pains, on which to found a diagnosis. No deaths have occurred from this disease in the hospital. Measures have now been taken to supply the army with vegetables, and the subsistence order of Gen. Pope coming into effect, will tend to prevent the future ravages of this disease, but still it is to constant vigilance and prompt action on the part of the medical staff, alone, that the coming six hundred thousand recruits must owe their safety from scurvy. Respectfully yours, FRANCIS R LYMAN, M.D. House-Physician. BELLEVUE HOSPITAL, NEW YORK, AUG. 20, 1862. 2