Description of scurvy in the Russian Army by Nitzsch (1747)

Description of scurvy in the Russian Army by Nitzsch (1747) Summary by James Lind (1772) This is James Lind’s summary of Nitzsch’s description of scurvy in Russian Army in 1747. Yellow is used to indicate more important sections such as the symptoms of scurvy. This text is available at: https://doi.org/ 10.5281/zenodo.17296087 2025-10-7 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 Nitzsch: 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.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), of the Russian armies (Nitsch)). https://archive.org/details/treatiseonscurvy1772lind/page/60/mode/2up 2 The text below is from James Lind (1772; 3rd ed) p.421-439. https://archive.org/details/treatiseonscurvy1772lind/page/420/mode/2up https://archive.org/details/b30511902/page/420/mode/2up https://babel.hathitrust.org/cgi/pt?id=ucm.5320216006&seq=445 https://wellcomecollection.org/works/r7fpbavt/items?canvas=443 A digitized version of the original German version is available: https://play.google.com/store/books/details/Abraham_Nitzsch_Theoretisch_practische_Abhandlung?id=szFh66Kk64kC 1747 Theoretisch practische abhandlung des scharbockes, wie sich derselbige vornemlich bey denen kayserlich Ruszischen armeen an verschiedenen orten geaussert und gezeiget hat, &c.: or, A theoretical and practical treatise on the scurvy, as it has appeared chiefly in the Imperial Russian armies, together with a circumstantial description of its causes, its two classes and their different species, the ordinary and extraordinary symptoms, the remedies for it, and the necessary regimen. By Abraham Nitzsch. p.422 Three different opinions of physicians concerning this disease deserve censure. 1st, Some extend the term of scurvy by much too far, comprehending under it almost all diseases in which there is a considerable impurity or corruption of the juices. 2dly, Some though not entirely denying the existence of the scurvy, yet limit or circumscribe it within too narrow bounds. 3dly, Others have described its causes, its different kinds and its cure, in too vague and indefinite a manner. It has been difficult for physicians to make a perfect system of this disease, as it does not usually occur in their common practice; being confined chiefly among the poorer sort of idle people, who are in distressed circumstances, and who live in a moist air. Besides, the frequent modern practice of drinking tea and coffee, by thinning the blood and diluting its salts, has in place of the scurvy in many countries where, according to the relation of credible authors, it in former times greatly prevailed, introduced a new disease, viz. the purpura, as Dr. Hoffman has shewn. It may be proper to premise that I am p.423 unacquainted with the nature and appearances of the scurvy, so common and fatal at sea; but that this disease was among the first which occurred to my observation in the army, and it arose to such a pitch of violence, as not only to require the utmost care and skill of the physicians and surgeons, but also to command the attention of the generals. This evil has been attributed to the use of salted flesh-meats, the vapours arising from the sea have also been blamed; but such opinions are confuted by daily experience. Others would ascribe it to a mere want of a sufficient quantity of vegetables, neglecting more considerable circumstances, as will appear by the following observations. There being two classes of this distemper, that which is denominated the 3 slow or cold scurvy, may rather be said to proceed from a concurrence of causes, and their operation for a considerable time, viz. a constitution impaired by trouble and diseases; improper, gross, and corrupt aliment; much fatigue, grief, or anxiety of mind; a moist air, accompanied either with cold or with heat; confinement in low damp crowded places; as also drinking impure putrid water. These acting in conjunction produce the scurvy, and are sufficient to heighten the evil to an extreme degree of violence. p.424 As such causes operate but slowly in the human body, the progress of the malady is very gradual. The healthful colour of the face more and more disappears. There is a general lassitude. The thighs and legs feel heavy, and a remarkable weakness is perceived in the knees and ancles. At the same time, the gums begin to swell and corrupt. The preternatural colour of the face afterwards encreases, the legs begin to be painful, the cheeks and joints to swell, the gums become surprisingly rotten, the body more feeble, and a difficulty of breathing ensues upon using of exercise, the knees and joints being stiff. Finally, the appetite gradually decays, and the body becomes constipated. In a certain kind of this disease, commonly several blue spots appear all at once. By these, and the former symptoms daily gaining ground, the true nature of the distemper fully and plainly appears. And this is the slow or cold scurvy, which is by far the most frequent malady; the symptoms and causes of the other, or hot scurvy, being very different. It arises from an inert chyle tending to putrescence in the first passages, with a great laxity of the viscera and of the secretory and excretory organs, as also of all the solids: from whence the blood acquires a thickness, and is rendered in a manner putrescent, shewing itself by a rep.425 markable bad colour, and a preternatural swelling or inflation of the body. It is usually a tedious troublesome disease. The hot scurvy is not so commonly met with. It proceeds from a prevailing alcalescent acrimony and thinness of the blood, occasioning a total waste of the body, and at all times the most violent symptoms, attended with great pain and a constant fever. In both there is a general weariness; a particular debility of the joints; the gums are partly spungy and fetid, partly hard, swelled, and hot; the pains in the limbs are sometimes fixed, at other times they shift; the knees are stiff, and sometimes also swelled, nay, much inflamed and violently pained; more or less hypochondriac1 symptoms, and a fever attend it. And these are the genuine essential signs of scurvy: but before we proceed to the hot scurvy, of which there is but one single species, it may be proper to distinguish the different kinds of cold scurvies. The first is what occasions large, black, and blue spots, on the legs and joints; sometimes on the breast and back, not unusually on one or both eyelids, and on the white of the eye; which appears swelled, and of a deep red colour. The gums are greatly swelled, discoloured, and very lax or spungy; and when pressed, discharge either a yellow ill-scented blood, or matter. p.426 The parotid glands are also usually much enlarged and hardened. This species, proceeding from a remarkable coagulation of the red globules of the blood, I call a livid scurvy; being the only species that is accompanied with dark or reddish large spots, or livid streaks upon the skin. The patient commonly when they appear is 1https://en.wikipedia.org/wiki/Hypochondrium 4 very feverish, and the pains are very violent, It occurred chiefly at Wiburg, ann. 1732;2 and again at Petersburgh, ann. 1733. In the second species, the red globules of the blood are not so much coagulated; it proceeds chiefly from a viscidity of the watery or serous parts of the blood. The spots appear of a deep red, turning afterwards to a darkish yellow; being very small, so as to resemble lentils, flea-bites, or petechiæ; and are discovered no where else but on the legs and thighs, attended with a pain in those parts. Sometimes reddish blue spots appear above the knee, and in the ham; according to the redness of which the pain and swelling there, as also the quickness of the pulse, is always increased. The gums are not so lax as in the former species: the upper part of them, however, is commonly excoriated. On the palate or inside of the gums several tumours appear, or on the inside of the cheeks may be observed swellings, somep.427 times hard, knotty, and wart-like: and sometimes a uniform hard swelling extends itself even to the back part of the mouth. This species, from the form of the spots, is denominated a lenticular or petechial scurvy. The patient spits more, and the breath is more fœtid, than in any other species of scurvy. Sometimes the temporal muscle is swelled and hardened under the zigomatic process; but the parotid glands never are. It shewed itself, ann. 1732, at Wiburg, only in a few patients; but afflicted much greater numbers, ann. 1737, in the intrenchments at Ust-Samara.3 A third species of this disease proceeds from a corruption of the fat or oily particles of the blood. There being no viscidity of the blood, there are consequently no spots. On the contrary, an universal pale swelling covers the body; which becomes of a yellowish colour, when those oily particles turn rancid. When the fat assumes a hardness like tallow, the thighs and arms are vastly swelled, and so hard as not to yield to the impression of the finger; and very hard tumours, or tophi, form on the hands and fore-part of the legs. Now in this species the serous or watery parts of the blood become much more easily and quickly vapid than in the others, and the saline particles daily more and more acrimonious. Hence the cheeks are more p.428 swelled, the knees more violently contracted, the teeth looser, and the gums much more lax and spungy. Sometimes a fungous flesh rises at the angle of the lower jaw, and the jaws are locked either with or without an induration of the parotid gland, crotaphite or masseter muscles. When this vapid serum or water is accu2 Vyborg. A Russian city near the Finnish border. https://en.wikipedia.org/wiki/Vyborg See Nitzsch (1732) report: https://doi.org/10.5281/zenodo.17295495 3https://en.wikipedia.org/wiki/Samara 5 mulated in the cellular membrane under the skin, an universal dropsy4 is produced; or when within the substance of the lungs an asthma, upon which a dropsy of the breast ensues; when in the belly, a dropsy is formed there; and lastly, when discharged by the glands of the intestines, a flux distresses the patient. Further, when this vapid serum, by an addition of oily and saline particles, has acquired an acrimony, it occasions the most violent and gnawing pains in various parts of the body. Whereever the serum corrupts, the pains become there altogether intolerable; chiefly upon those parts where the ribs are joined to the breast bone; part of the bones of which may be taken out quite carious. It also produces a convulsive suffocating asthma, a wasting painful flux, and afterwards a gangrene of the cheeks, or an incurable dropsy of the belly. This species is of longer duration than any other, continuing often the whole summer, until late in autumn. And as it is accompanied with no p.429 spots, it may be denominated the pale scurvy; but more particularly when the fat of the body is only thick and viscous, it might then be called the mucous pale scurvy; and when it is become rancid, the rancescent scurvy; or when hard, and tallow-like, the tophaceous scurvy; lastly, when the serum is become acrimonious, the muriatic scurvy. The mucous sort was the first the author met with, and remarked it most frequent before Asoph,5 in the general fieldhospital at St. Anne; as also in the Neister campaign. He observed the tophaceous first in Finland, at Borgo,6 ann. 1742; and the muriatic, where the cartilages of the ribs were entirely separated from the breastbone,7 as was plainly to be seen and felt, at the field-hospital at Abo,8 ann. 1743. These are the chief kinds of the slow scurvy, which occurred in the Russian armies, and fell under the author’s observation. There is indeed yet another species of it, proceeding probably from a total dissolution of the red part of the blood; which occasions an extraordinary weakness and redness of the body, swelled pendulous cheeks, a bloated habit of body extremely stinking, fungous gums, full of a bloody humour, with somewhat contracted or rather 4 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://pmc.ncbi.nlm.nih.gov/articles/PMC10949735 https://pmc.ncbi.nlm.nih.gov/articles/PMC8913583 5 Asoph. Azov. https://en.wikipedia.org/wiki/Azov https://en.wikipedia.org/wiki/Sea_of_Azov 6 Porvoo in Finnish; Borgå in Swedish. A city in Southern Finland. https://en.wikipedia.org/wiki/Porvoo 7 Cases similar to these at Paris. Vid. dissections, part 2, cap. 7. https://archive.org/details/treatiseonscurvy1772lind/page/238/mode/2up Poupart in Paris, cases 3 to 21. https://babel.hathitrust.org/cgi/pt?id=ucm.5320216006&seq=263 The Poupart (1708) report: https://doi.org/10.5281/zenodo.16846396 https://doi.org/10.1098/rstl.1708.0035 8 Turku in Finnish; Åbo in Swedish. A city in Southwest Finland. https://en.wikipedia.org/wiki/Turku 6 weak knees, &c. But this he never obserp.430 ved, except in some few patients in the intrenchments of Ust-Samara. Thus much of the cold scurvy. There remains the other general branch of this disease, viz. the hot and painful scurvy. It is distinguished from the former, 1st, By there being no fullness or swelling of the body; on the contrary, there is rather a decay or wasting. 2dly, The gums are neither so spungy nor do they yield so bloody, fœtid, or discoloured an humour; but are rather very hard, swelled, hot, and so painful, that the gentlest touch gives agony. 3dly, The pains are not so fixed as in the cold scurvy. The patient makes continual complaints, sighing and bemoaning his unhappy condition; and has a constant, though irregular, fever. The pains fly from one member to another; sometimes from the joints and back to the whole or half of the head, teeth, and neck; where, after occasioning the most exquisite torture, they again instantly attack the outside or inside of the breast, occasioning extreme oppression, stitches, &c.: afterwards, seating themselves in the belly, they produce colics, nephritic pains, and stoppage of p.431 urine, and in the limbs all sorts of convulsive contractions. 4thly, The knees are inflexible and contracted: but, unless it has been occasioned by some outward accident, they are not so much swelled or inflamed as in the cold scurvy. 5thly, No spots are seen. 6thly, There is a difference to be perceived in the urine, which in the livid and petechial scurvies, though not accompanied with any remarkable degree of fever, is commonly of a deep red colour, and undergoes little alteration by standing; but in the hot scurvy, as there is always a fever, it drops a copious sediment, and shews a film swimming at the top. This hot scurvy he has remarked sometimes; but he no where saw more patients labouring under it than at Wiburgh and Cobilack. It may not be improper to describe the various causes which produced this calamity, viz. principally the pale scurvy, in the order in which they occurred. 1st, As to the siege of Asoph:9 This place was attacked in the spring ann. 1736, in p.432 very piercing cold weather, accompanied with frequent rain, fleet, and sometimes with snow. And as there were no woods in the neighbourhood, the troops suffered extremely, during this rigorous season, for want of fuel. Nor did the regiments fare better who were ordered to join us; as most of them were obliged to begin a long journey by land, upon a very short warning; or were transported in boats down the Don,10 together with the artillery, from the garrison of Nova Pawloffsky, and the adjacent places. Now, as this siege, by various accidents, was protracted for three months, the inconveniencies and hardships which the troops suffered, were extremely great. 1st, The weather became afterwards excessive hot; and was quite unsupportable during sun-shine, and on calm days. 2dly, We had a great deal of moist rainy weather; which greatly incommoded our army, which was incamped on slippery and hilly ground; as also the sick in their tents, who were not well attended; their tents were also ill contrived, and badly sheltered. 3dly, Sickness was occasioned by the too fre9 Siege of Asoph 1736. https://en.wikipedia.org/wiki/Siege_of_Azov_(1736) https://en.wikipedia.org/wiki/Russo-Turkish_War_(1735%E2%80%931739) https://commons.wikimedia.org/wiki/File:Siege_of_Azov_(1736).jpg 10 https://en.wikipedia.org/wiki/Don_(river) 7 quent eating of fish badly dressed, with which the plentiful river Don abounds. 4thly, The bread was not sufficiently baked, for want of fewel. 5thly, The water was very impure, being taken up from the fordable parts of the Don, and it became every p. 433 day more impure. To which may be added, the preceding camp-disorders, viz. fluxes and obstinate quartan agues; besides the passions of the mind raging in the breasts of the soldiers, viz. revenge, anger, discontent, &c. and the great fatigues they underwent. As to what regards the fortress of St. Anne;11 though this place is situated pretty high, yet the country about it lies so low with respect to Great and Small12 Russia, that it is from thence annually overflowed, generally in the months of March and April, for thirty versts13 around, upon the breaking loose of the ice and snow. It appears at this time like a great sea; and many parts are sunk several fathom below water. This inundation of the Don brings along with it an incredible number of excellent and very fat fish; which were sold excessively cheap, and eat in immoderate quantities. During the inundation, the air is very raw, cold, and windy. At the time of its drying up, the days are excessively hot; and the sun is scorching, when the weather is fair; but the nights, on the contrary, are intolerably cold, and the air is foggy and moist. As the morasses dry up, and the remaining fish (especially cray-fish, of which there is an astonishing quantity left behind) begin to putrify, the air becomes offensive; and so thick, that it is several hours every morning, p.434 before the sun has power to dissipate the noxious vapours. Upon the retreating of the flood, the ground shews a sandy bottom, and is formed into little islands and banks of sand, surrounded with fords filled with stagnating water. What was drank, was often not taken where the stream was quick and deep, but in such fords where it was muddy and greasy. The fish remaining behind, were eat in immoderate quantities badly dressed. The barracks were built on morass, damp ground, and too low. Lastly, The soldiers being the only inhabitants of the garrison, were obliged to stand every day up to their middle in water, in order to unload the necessary wood; which is always sent them for fewel14 and building from the Ukraine. The principal reason why, of those regiments who marched to Oczakow,15 such a considerable number were attacked by the scurvy, and brought into the hospital at Cobilack, was, the excessive fatigues they underwent through the whole winter, partly in cutting open the ice of the Neiper,16 to prevent the incursions of the Tartars; and partly in performing other hard and severe military duties, either in stormy rainy weather, or during excessive frost and cold, without having proper conveniences, 11 Annensky fortress ruins (1730) near Starocherkasskaya. https://en.wikipedia.org/wiki/Starocherkasskaya 12 Small Russia. Largely current Ukraine. ”Up to the very end of the 19th century, Little Russia was the prevailing term for much of the modern territory of Ukraine that was part of the Russian Empire” https://en.wikipedia.org/wiki/Little_Russia 13 Verst. About 1 km. https://en.wikipedia.org/wiki/Verst 14 Fewel. Archaic spelling of fuel. 15 Oczakow. Ochakiv. A city in Ukraine. https://en.wikipedia.org/wiki/Ochakiv 16 River Dnieper. https://en.wikipedia.org/wiki/Dnieper 8 lodgings, or diet. Even those who underwent no fatigue, being afflicted with difp.435 ferent complaints, for want of sufficient attendance, rest, and quiet, in the army, became also scorbutic. As to what regards the great number of scorbutic patients, which occurred not only during the march of the army from Oczakow, but also during the Neister campaign; the author treats only of the latter, as having been there in person; and because, according to his best information, the occasions and causes of the malady in both differed very little, or rather not at all. The most part of the recruits required to complete the army, joined it seldom sooner than when either the army was ready to march, or was actually in motion. And though they were generally young raw fellows, excessively fatigued after a long and tedious journey; yet it was not possible then to grant them any rest or necessary refreshment. They were directly incorporated into the respective regiments; and entered at once upon a new way of life, viz. of constant disquiet, military hardships and severities, and of great fatigue. The marches were begun early in the morning, often during thick fogs and dews, heavy rains, or severe cold. Towards the middle of the day, they were oppressed with intolerable scorching heat, and clouds of dust, or with much rain. The march was protracted for the most part till noon, p.436 and often beyond that time, according as water, wood, and forage were to be met with in those desert places. Thus the poor soldier, after a fatiguing journey, quite spent with thirst, and enfeebled by the excessive heat of the sun, or drenched in rain, arrived at last at the camp. But often, even here, no rest could be permitted him. He was obliged, according as it was his tour, to go upon the piquet, tabunen, or the centinel’s duty. Another great hardship was the want of good and clean water upon the roads. Overcome by the excellive heat, some threw themselves naked into every dirty muddy pond they met while others endeavoured to allay their violent thirst, occasioned by the dust and sun, by greedily drinking up every drop of filthy stagnating water they saw upon the ground. This bred many diseases, especially continual inflammatory fevers, &c. men full of blood were attacked with apoplectic fits; which if not removed by immediately blood-letting, they quickly expired. Their blood was so inflamed, that it came out of the veins as thick as pitch. But the hardships which the sick underwent, were still greater. They were by most regiments carried in open carts, exposed to all the inclemencies of the climate and weather, viz. to rain, dust, and wind, heat and cold. In passing the defiles, being p.437 generally the last, it was always several hours before they arrived in camp after their regiments; notwithstanding on the marchingdays they set out early in the morning, long before the rest of the army; and after having been quite wet with rain in their carts, were then taken out, and laid upon their bed stretched out under moist canvas, upon the cold wet ground. Nor, in such afflicting circumstances for the sick, was it a small addition to their misery, that, in this desolate and uninhabited country, proper food and drink could not be procured, in order to restore them to health. Hence it is not to be wondered at, that from such causes, as also by reason of the great preceding sickness and fevers in the camp (which, for want of conveniencies and proper treatment, were not brought to a perfect crisis) the scurvy raged with such uncommon destruction. 9