Account of the scurvy

Account of the scurvy In: MEMOIRS OF MILITARY SURGERY, AND CAMPAIGNS OF THE FRENCH ARMIES, ON THE RHINE, IN CORSICA, CATALONIA, EGYPT, AND SYRIA; AT BOULOGNE, ULM, AND AUSTERLlTZ; IN SAXONV, PRUSSIA, POLAND, SPAIN, AND AUSTRIA. FROM THE FRENCH OF D. J. LARREY, M. D. First Surgeon of the Imperial Guards, Inspector-general of the Medical Staff of the French Armies, &c. Baron of the Empire, Commandant of the Legion of Honour, Knight of the order of the Iron Crown, &c. &c. &c. BY RICHARD WILLMOTT HALL, M D PROFESSOUR OF MIDWIFERY AND OF THE DISEASES OF WOMEN AND CHILDREN IN THE UNIVERSITY OF MARYLAND. With Notes by the Translator. FIRST AMERICAN FROM THE SECOND PARIS EDITION. VOL. I. BALTIMORE 1814. Larrey describes the symptoms of scurvy during the siege of Alexandria. “Of 3500 scorbuticks who were admitted into the hospitals of Alexandria, 262 died between the first of July, and the 10th of October, 1801, when the troops embarked.” Yellow is used to indicate the most relevant parts. This 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+h+vitamin+c This text is available at: https://doi.org/10.5281/ zenodo.15582456 1 English translation in the USA in 1814 by RW Hall: Scurvy pp.383-396. https://babel.hathitrust.org/cgi/pt?id=hvd.hc2l2s&seq=413 https://wellcomecollection.org/works/k335c4vx/items?canvas=425 https://archive.org/details/2561003RX1.nlm.nih.gov/page/n423/mode/2up https://collections.nlm.nih.gov/catalog/nlm:nlmuid-2561003RX1-mvpart https://archive.org/details/memoirsmilitary00hallgoog/page/n418/mode/2up https://archive.org/details/memoirsmilitary01hallgoog/page/n412/mode/2up English translation in the UK in 1815 by J Waller: Scurvy pp.161-173. https://archive.org/details/b21461922/page/160/mode/2up https://archive.org/details/memoirsmilitary00wallgoog/page/n181/mode/2up https://dn720208.ca.archive.org/0/items/b21461922/b21461922.pdf French 1812, vol II. Scurvy pp.272-293. https://babel.hathitrust.org/cgi/pt?id=nnc2.ark:/13960/t8x930n9g&seq=282 https://archive.org/details/mmoiresdechiru02larr/page/272/mode/2up https://archive.org/details/mmoiresdechirur03larrgoog/page/272/mode/2up 2 Biographies: https://en.wikipedia.org/wiki/Dominique_Jean_Larrey https://www.frenchempire.net/biographies/larrey https://www.internationalparamedicsday.com/dominique-jean-larrey-biography https://wellcomecollection.org/works/zkuyrhtf/images?id=khnms4na https://library.si.edu/image-gallery/72857 Karamouzis K, Perdikakis M, Michaleas SN, Karamanou M. Baron Dominique-Jean Larrey (1766-1842): innovator of the triage. Acta Chir Belg. 2024;124(1):66-72. https://pubmed.ncbi.nlm.nih.gov/37815405 Turner MD, Shah MH. Dominique-Jean Larrey (1766-1842): The Founder of the Modern Triage System. Cureus. 2024;16(6):e62375. https://pubmed.ncbi.nlm.nih.gov/39006619 Welling DR, Burris DG, Rich NM. The influence of Dominique Jean Larrey on the art and science of amputations. J Vasc Surg. 2010;52(3):790-793. https://pubmed.ncbi.nlm.nih.gov/20573472 Ellis H. Dominique Jean Larrey: Napoleon's surgeon. Br J Hosp Med (Lond). 2016;77(6):366. https://pubmed.ncbi.nlm.nih.gov/27269755 Ramdhan RC, Rai R, Brooks KN, Iwanaga J, Loukas M, Tubbs RS. Dominique Jean Larrey (1766-1842) and His Contributions to Military Medicine and Early Neurosurgery. World Neurosurg. 2018;120:96-99. https://pubmed.ncbi.nlm.nih.gov/30172978 Gourgiotis S. Baron Dominique-Jean Larrey: Founder of military surgery and trauma care. Hektoen International. 2016;Spring https://hekint.org/2017/01/22/baron-dominique-jean-larrey-founder-of-military-surgery-and-trauma-care Tóth I, Rami-Porta R, Rendeki S, Molnár TF. First steps in the management of pericardial effusion: who was first to relieve the pericardial sac – Larrey or Romero? World J Surg. 2013;37(9):2242-2245. https://pubmed.ncbi.nlm.nih.gov/23722467 Roux FE, Reddy M. Neurosurgical work during the Napoleonic wars: Baron Larrey's experience. Clin Neurol Neurosurg. 2013;115(12):2438-2444. https://pubmed.ncbi.nlm.nih.gov/24120506 Welling DR, Rich NM. Dominique Jean Larrey and the Russian campaign of 1812. J Am Coll Surg. 2013;216(3):493-500. https://pubmed.ncbi.nlm.nih.gov/23063382 https://www.academia.edu/64989909 Remba SJ, Varon J, Rivera A, Sternbach GL. Dominique-Jean Larrey: the effects of therapeutic hypothermia and the first ambulance. Resuscitation. 2010;81:268-271. https://pubmed.ncbi.nlm.nih.gov/20036046 https://www.academia.edu/22433331 Wood MM. Dominique-Jean Larrey, chief surgeon of the French Army with Napoleon in Egypt: notes and observations on Larrey's medical memoirs based on the Egyptian campaign. Can Bull Med Hist. 2008;25(2):515-535. https://pubmed.ncbi.nlm.nih.gov/19227793 Skandalakis PN, Lainas P, Zoras O, Skandalakis JE, Mirilas P. "To afford the wounded speedy assistance": Dominique Jean Larrey and Napoleon. World J Surg. 2006;30(8):1392-1399. https://pubmed.ncbi.nlm.nih.gov/16850154 Blair JS. Jean Dominique, First Baron Larrey. BMJ Military Health 2005;151:207-208. https://doi.org/10.1136/jramc-151-03-13 3 Burris DG, Welling DR, Rich NM. Dominique Jean Larrey and the principles of humanity in warfare. J Am Coll Surg. 2004;198(5):831-835. https://pubmed.ncbi.nlm.nih.gov/15110817 O'Sullivan ST, O'Shaughnessy M, O'Connor TP. Baron Larrey and cold injury during the campaigns of Napoleon. Ann Plast Surg. 1995;34(4):446-449. https://pubmed.ncbi.nlm.nih.gov/7793796 Haas LF. Dominique Jean Larrey (1766-1842). J Neurol Neurosurg Psychiatry. 1994;57(2):133. https://pubmed.ncbi.nlm.nih.gov/8126493 Howard MR. In Larrey's shadow: transport of British sick and wounded in the Napoleonic wars. Scott Med J. 1994;39(1):27-29. https://pubmed.ncbi.nlm.nih.gov/8720755 Brewer LA. Baron Dominique Jean Larrey (1766-1842). Father of modern military surgery, innovater, humanist. J Thorac Cardiovasc Surg. 1986;92(6):1096-1098. https://pubmed.ncbi.nlm.nih.gov/3537533 Dominique Jean Larrey (1766-1842)—Surgeon-in-chief of the Grande Armee. JAMA. 1963;185(5):404–405. https://doi.org/10.1001/jama.1963.03060050082031 Robb JC. Baron Larrey (1766-1842); Napoleon's chief surgeon and his times. Ulster Med J. 1952;21(2):101-113. https://pubmed.ncbi.nlm.nih.gov/13029290 Munroe AR. Baron Larrey-Surgeon General to Napoleon's Army. Can Med Assoc J. 1943;48(2):145-148. https://pubmed.ncbi.nlm.nih.gov/20322700 Wiese ER. Larrey, Napoleon's Chief Surgeon. Ann Med Hist. 1929;1(4):435-450. https://pubmed.ncbi.nlm.nih.gov/33944291 4 Account of the scurvy Dominique Jean Larrey In: MEMOIRS OF MILITARY SURGERY, AND CAMPAIGNS OF THE FRENCH ARMIES. English translation in the USA in 1814 by RW Hall. Scurvy pp.384-396. On the 5th of May, 1801, I reported the state of the p.383 wounded, and the condition of the hospitals to the commander in chief, and on the 20th of May, I reported the number of wounded discharged from the hospital: more than 1000 had rejoined their respective corps in perfect health, and about 600 that remained in the hospital, were in a fair way of recovery: more than half of these, after their cure was completed, could perform sedentary work, and the remainder were enrolled in the invalid corps. In the month of June, the change of the wind to N.N.W., and the overflowing of lake Ma'dyeh, which reached our camp, produced a very severe ophthalmia, which crowded the hospitals that had just been evacuap.384 ted, with more than 3000 soldiers. This disease was treated with great success, but was soon succeeded by a scorbutick affection which made its appearance among the wounded, and became so extensive as to deserve the name of an epidemick. The ignorance of some persons inclined them to believe it contagious. In order to dispel these fears, and to point out the prophylaxis, I addressed a circular to the surgeons of the army. My opinion of the non contagious nature of this disease was supported by Dr. Savaresi, who officiated as physician general in lieu of M. Desgenettes, whose presence at Cairo was highly necessary, on account of the plague which raged there. I shall give a succinct account of the most prominent symptoms of the scurvy, as it appeared among the wounded, and those who had ophthalmia, under my care. To this account I shall add a short enumeration of the causes that I believe rendered the scurvy epidemick in Egypt, and then point out the different remedies that were exhibited in its different stages. In this scorbutick affection, as in that seen by me in 5 North America,1 I observed three different stages. In the first stage the soldier is uneasy and melancholy, is disposed to sit or lie constantly, his mind is affected by no circumstance of hope or fear; he loses his appetite, his sleep is painful, and interrupted by disagreeable dreams, his countenance is changed, and becomes pale, his eyes are heavy, and surrounded by a blueish circle: the gums are painful, and of a pale colour, and bleed eap.385 sily on the most trivial pressure; pains are felt in the lumbar region, and in the limbs, and especially in the legs; respiration is laborious, the pulse slow and unequal, cutaneous transpiration ceases, the skin is dry and rough, like the cutis anserina2; the stools are checked, the urine is small in quantity, and earthy, the cutaneous veins are swelled, particularly those of the groin. The patient experiences a lassitude and stiffness in all his limbs, and walks with difficulty. In this stage the wounds soon assume a different appearance; suppuration is diminished, and becomes sanguineous, the edges of the wound are discoloured, and the flesh sinks, becomes blueish and painful, and bleeds on the slightest touch. The cicatrices3 also assume a peculiar appearance, sometimes they ulcerate and fall into gangrene. This first stage indicates the loss of tone, general debility, and the failure of the vital principle. In the second stage, the symptoms assume a more serious character; debility increases, the pains are more severe, and attack the head and loins in particular; the patient falls into a state of stupor, and remains in his bed without motion: his limbs are contracted, and his body bent. The face and lips are livid, the circumference of the eyes are lead-coloured, the breath fœtid, the gums ulcerated, and the teeth covered with a blackish crust. 1 [Section in the same book “Voyage to North America”, p.16] During a voyage of six months we lost none of our crew but the second mate and a marine, who were lost in the road of St. Pierre. But about twenty-four of them were on the sick-list during this period, besides the shipwrecked sailors that we took off Belle-Isle. At least half of them were attacked by the scurvy with different degrees of violence; some were dangerously ill; others laboured under putrid, nervous, malignant and eruptive fevers— of the last was a confluent small pox of a malignant character. The remainder had catarrhal affections, diseases of the stomach, rheumatism, syphiles and ophthalmia. 2 Cutis anserina. Goose bumps, a temporary local change in the skin when it becomes rougher due to erection of little muscles, as from cold. 3 Cicatrices. The scar of a healed wound. 6 Respiration is difficult, and is attended with oppression and stricture of the thorax. The cellular substance of the legs is obstructed, especially between the tendo Achillis and the tibia; and it soon extends throughout the extremity: the swelling is more firm than œdema, and compression produces no pain. Blackish spots appear about the ankles, and along the course of the tibia, and they appear at the same time on the face and shoulders. The constipation increases, the abdomen swells, and the patient experiences a burning heat at the præcordia, and p.386 heavy pains in the hypochondria4; the pulse is accelerated, and there is an evening accession of fever, loss of sleep, and at the same time the pains become more intense. The gangrene that appeared in the wounds or in the cicatrices, advances: hæmorrhage is more frequent, and the blood thus discharged is blackish, very fluid, and scarcely coagulable. The callus of fractures becomes soft, and the bones disunited, and a species of moist caries attacks the fractured extremities, which lose their periosteum, and sometimes swell excessively. In this second stage, nature, endeavouring to overcome the obstacles that impede her functions, redoubles her energy to establish an equilibrium, and to recover the strength which she has lost, but generally in vain: a greater degree of asthenia soon succeeds this re-action. The last stage of the scurvy is really dreadful to the spectator: to the febrile paroxysms and the above symptoms, succeeds a general prostration. The swelling of the feet and legs increases perceptibly, and they are covered with blackish spots, which, by their rapid progress, give an appearance of sphacelus5 to the whole limb. This symptom has not been well attended to by practitioners. It takes place more generally in the land than in the sea scurvy; and no doubt depends on the difference of regimen by land and sea. During my voyage in 1778 to Newfoundland, of 80 cases of scurvy in our ship, not one had the legs affected.6 The scurvy in many cases had reached the third stage. yet its effects were confined to the mouth and thorax, and I was so fortunate as to bring them all in safety with me to France. These blackish spots, which are im4 Hypochondria. Lateral regions of the upper abdomen [old English]. 5 Sphacelus. Gangrene. 6 See my voyage to North America. 7 properly treated as gangrenous petechiæ, are nothing p.387 more than large spontaneous ecchymoses, caused by the rupture of the capillary vessels of the skin, and by the extravasation of blood, which appears to me supersaturated with carbon and hydrogen, and rendered more fluid, and of a blacker colour. The blood has lost its calorick and its vital properties: the celebrated Fourcroy has made the same remark. The blood and the vessels, without doubt, during the advanced stages of the disease, undergo a considerable change, and especially in the parts affected with atony and gangrene. This state of the parts appears to be the consequence of a powerful re-action of the system on the blood-vessels and nerves, the violence of which is disproportioned to their strength and resistance. The resolution of these apparently sphacelated spots, which generally extended over the whole of the inferiour extremities, also supports the opinion that I have advanced. These ecchymoses attacked the thorax, the arms, the shoulders, and the face; but they were here less extensive and less obstinate, because the vessels of these parts retained their tone for a greater length of time. I will notice other symptoms of the scurvy in its third stage. The tongue is covered with a brown viscous fur, the ulcerations of the gums extend deeper towards the alveoli and the interiour of the mouth, then attack the velum palati, and even the palatine arch. The teeth become loose, and when they drop out, hæmorrhage often succeeds, and is with difficulty arrested: the eyes are sad, and the eye lids swollen. A cold watery exudation, of a nauseous odour, covers the surface of the body, especially on the abdomen and extremities, and makes the surface of the body appear shining and marbled. The sphincter of the anus is relaxed, the bowels are open, or p.388 affected with diarrhœa, which often degenerates into a colliquative or dysenterick flux: micturition is difficult on account of the paralysis of the body of the bladder. It is often necessary, in this case, to introduce a catheter into the bladder, or keep it there. The difficulty of respiration and the oppression become extreme, violent paroxysms of coughing succeed, with difficult expectoration of a viscid matter, often tinged with black fœtid blood.— The pulse sinks and becomes vermicular7, and gradually fails altogether. The powers of the patient are quite ex7 Vermicular. Resembling a worm in form or motion. 8 hausted, and he faints frequently. The black spots which may be viewed as so many ecchymoses, become truly gangrenous, dropsy succeeds, and the vital functions cease. The scurvy may be divided into acute and chronick; the first is generally rapid in its progress. But I have observed that it never arrives to the third stage before the ninth or tenth day: after this it becomes violent, and the patient dies in five or six days. When the scurvy is chronick, the symptoms are less acute, but often equally fatal. On opening the bodies of those who died of the scurvy, in addition to the ecchymoses, of which we have spoken, the intestines were found collapsed, and suffused with black blood, the liver and spleen obstructed, the epiploon8 decayed, the lungs filled with violet-coloured serum, soft in their texture, and having a portion of the same fluid in their cavities. Such are the principal phenomena that the epidemick scurvy of Alexandria presented, during the continuance of the disease, and on inspection after death. The scurvy is not contagious, but when it has attained the third stage it may exert an injurious influence on those who have in its first stage, and may injure a healthy person who lies near the sick, by predisposing p.389 them at least to putrid diseases. Many other causes appeared to me to assist in the production of this epidemick. The discharge of the waters of lake Ma'dyeh into lake Mareotis, and the loss of our large caravan of camels deprived us of all communication with Egypt. It became necessary to calculate our resources for the siege of Alexandria, which was now complete. The soldiers were soon deprived of aquatick plants and fresh provisions. For want of wheat we were obliged to make our bread of equal parts of rice and flour. Besides the indigestible quality of rice, when it is taken in large quantities, it was supersaturated with salt;—being so prepared for the purposes of commerce. Hence our bread was very salt, and necessarily injured the digestive organs and the whole system. Our soldiers fed on this bread for two months; they also consumed a great quantity of salted fish, and made use of water from the cisterns9, which was spoiled by mixture with the water of the lake, that had overflowed 8 Epiploon. Omentum. 9