of Disease, especially Consumption and Scrofula, &c., 8vo. | Lond., 1849, p. 47.-G. C. Holland, Nature and Cure of Consumption, Indigestion, Scrofula, and Nervous Affections, 8vo. Lond., 1850. [AM. BIBLIOG. AND REFER. - Few if any Monographs have been written on Scrofula in this country. See John C. Warren, Surg. Observ. on Tumours, with Cases and Observations, 8vo. Boston, 1837.-L. Shattuck, Report of the Sanitary Commission of Massachusetts, 8vo. Bost., 1850.- Levick, on Cod-liver Oil, and its uses in Tubercu lar Disease. Am. Journ. Med. Sci., Jan., 1851, p. 21. T. M. Markoe, In New York Med. Gazette, Feb. 9, 1842. -C. L. Payne, Case of Scrofula, successfully treated by lodine, in vol. vi., Am Journ. Med. Sci.-Shattuck, In Am. Journ. Med. Sci., vol., xliv., p. 80, 85.-C. A. Lee, Review of Lugol, in New York Med. and Phys. Journ., 1829.] SCURVY-SYNON.-Scorbutus, Sauvages, Vogel, Cullen, &c.-Scorbutus Nauticus, Young. Porphyra Nautica, Good. Scharbock, Skorbut, Germ. Skiorbug, Dan. Scorbut, Fr. Scorbuto, Ital. Scorb, Scarbock, Skörbut, Scorbie, &c., Saxon; hence Scorbutus, Scurvy. CLASSIF.-4th Class, Cachectic Diseases. 3d Order, Impetiginous Affections (Cullen). 3d Class, Sanguineous Diseases. 4th Order, Cachexies (Good).-CLASS IV., ORDER IV. (Author in Preface). 1. DEFIN.-Lassitude, debility, lowness of spirits, fator of the breath and sponginess of the gums, followed by livid sub-cutaneous patches and spots, especially on the lower extremities and roots of the hair; and, lastly, by spontaneous hemorrhages from mucous canals, by contractions and pains of the limbs, and superficial ulcers, &c., the disease proceeding from an alteration of the blood, caused by the nature of the food, and chiefly by the privation of fresh vegetables and fruit. 2. I. HISTORICAL SKETCH.-Some writers have supposed, with SENNERTUS, MEAD, and MILMAN, that scurvy was known to the ancients, while others have believed, with FRIEND, that there is nothing to be found in their writings to warrant this supposition. HIPPOCRATES, in mentioning enlargement of the spleen—σnhìν μέyaç—notices but one symptom which is applicable to scurvy, and that is ulceration of the legs; and, in describing Convolvulus Sanguineus-Elλeòç aluarirns-he adduces the dark discoloration of the skin, the eruption of ulcers on the legs, and the difficulty of walking, as more particularly distinguishing it; but these remarks are insufficient to show that he was actually acquainted with true scurvy. It has been supposed that the disease, with which PLINY states the army of CESAR GERMANICUS to have been afflicted after a long encampment in Germany beyond the Rhine, near the sea-coast, and which was ascribed to the water which was drank, was that now under consideration. He states that "the teeth dropped out, and the knees became paralytic. The physicians called the malady Stomacace and Sceletyrbe. They discovered a remedy against it, viz., Herba Britannica." What this plant, of which PLINY adds a very short and imperfect description, actually was has not been shown by his commentators. Subsequent ancient writers, not even the Arabians, have furnished any thing in addition to what I have now adduced. 3. The earliest account of scurvy is that given by the Sieur JOINVILLE, as it appeared in 1260, in the army of Louis IX. in Egypt, owing to the nature and scarcity of the food, and the scarcity of water. The next notice taken of it is by FABRICIUS, who states that it was very prevalent and fatal in Misnia during 1846. As soon as long voyages were undertaken, scurvy appeared in an unmistakable form. During the voyage of VASCO DE GAMA, who first made the passage to the East Indies by the Cape of Good Hope, more than 100 of his men out of 160 died of this malady. The History of Portuguese discoveries, by W. LOPES DE CASTENNADA, contains the relation of this voyage which furnished the first account of this disease as it occurred at sea. 66 4. That scurvy was not then, nor for some time afterward, known, is evident from the account given by CARTIER of his second voyage to Newfoundland in 1535. After mentioning the characteristic symptoms, he adds that, "about the middle of February, of a hundred and ten people there were not ten whole." Eight were already dead, and more than fifty sick, seemingly past all hopes of recovery. This malady being unknown to us, the body of one of our men was opened, to see if by any means possible the occasion of it might be discovered, and the rest of us preserved. But in such sort did the calamity increase, that there were not now above three sound men left. Twenty-five of our best men died, and all the rest were so ill that we thought they would never recover again, when it pleased God to send us the knowledge of a remedy for our health and recovery." The remedy was a decoction of the leaves and bark of a tree, which was called by the natives ameda or hamuda, and which has been considered to have been a species of spruce-fir. 5. Dr. LIND states that the name of this disease is said to be mentioned in the history of Saxony, by ALBERT KRUNTZ; and if so, he will be found the first author now extant who calls it the scurvy. It is next taken notice of by EURITIUS CORDUS in his Botanologicon, published in 1534, where it is observed that the herb chelidonium minus is called by the Saxons Schorbock rout, being an excellent remedy for that disease. In the year 1539, it is mentioned by J. AGRICOLA in his Medicina Herbaria. OLAUS MAGNUS, in his history of the northern nations, published in 1555, observing what diseases are peculiar to them, gives a long description of scurvy, mentioning that it is vulgarly called Schoerbuck, which is synonymous with the cachexy of the Greeks. He refers it chiefly to the nature of the food, and mentions that the habitual use of absinthiated beverages is had recourse to in order to prevent and to cure it. About this period, four treatises on the disease were published by RONS SEUS, ECTHIUS, WIERUS, and LANGIUS. FORESTUS States that the description by ECTHIUS was contained in an epistle sent in 1541 to BLIENBURCHIUS, a physician in Utrecht. The first book published expressly on scurvy was by RONSSEUS, who remarks, in a reprint, that if he had first seen the accurate description by WIERUS, his own should not have been published. 6. WIERUS states that scurvy had been long peculiar to the inhabitants of the countries near the North Seas, and that he had never met with it in Spain, France, or Italy, nor in Asia or Africa. There can be no doubt of the existence of scurvy in the northern countries of Europe from the earliest ages, although no account of it had appeared previously to the appearance of the works now mentioned; and it is equally manifest that years of scarcity, wars, sieges, &c., must have rendered it more or less endemic, or even epidemic, in various places and localities. During severe winters and early spring, the food of the | inhabitants of these countries, the dried and imperfectly-cured meats and fish, and the want of succulent and other vegetables, particularly in the countries adjoining the Baltic, and the North-states that, during the siege of Breda by the ern and German Oceans, must have occasioned a remarkable prevalence of this malady, even although nature had provided them with the best preventives and means of cure in the spruce-fir, and numerous other antiscorbutic plants and herbs with which they abound. The comparatively recent culture of succulent vegetables, and more especially of the potato, in these countries, accounts not only for the rarer appearance of this malady in these parts in recent times, but also for the prevalence of it during earlier ages. frequent occurrence, the ravages of the disease were often great in winter and spring, especially in years of scarcity, and in besieged towns or fortifications, and in armies. VANDER MYE Spaniards in 1625, the garrison and inhabitants were greiviously affected by this disease, 1608 soldiers having been attacked up to the fourth month of the siege, the numbers having increased daily until the place surrendered in June, after a siege of eight months. BACKSTROM has recorded that, in 1703, when Thorn, in Prussia, was besieged by the Swedes, 5000 of the garrison, besides many of the inhabitants, were carried off by scurvy during the five month's siege; the besiegers being altogether exempt from it. During the war between the Austri7. Of the four ships which sailed from England ans and Turks in 1720, when the imperial the beginning of April, 1609, for the establish- army wintered in Hungary, many thousands of ment of the East India Company, three were so the common soldiers, but not one officer, were severely visited by scurvy as to have lost near- cut off by scurvy. Dr. KRAMER, physician to ly one fourth of their crews when they arrived the army, being unacquainted with a remedy for at the Cape of Good Hope. The commodore's it, requested a consultation of the College of ship was not attacked. This immunity arose Physicians at Vienna. Their advice was, howfrom three table-spoonfuls of lemon-juice having ever, of no avail; the disease, which broke out been served daily to each of his men. Notwith- at the end of winter, continued until, at the apstanding this evidence of the success of lemon- proach of summer, the earth became covered juice in preventing scurvy-evidence the most with greens and vegetables." BACKSTROM (Obconclusive-this valuable remedy and preven-servat. circa Scorbutum, &c., 1734) states, that tive was altogether slighted for 150 years afterward, although scurvy destroyed often one half or three fourths of the crews of our fleets, and was even more destructive to our armies than either battles or sieges, independently of the deaths it occasioned, both on land and at sea, in trading vessels. Sir R. HAWKINS states, in his observations on his voyage to the South Sea in 1593, that upward of ten thousand mariners had died of scurvy under his own observation alone, during the twenty years that he had been 10. Dr. NITZSCH, in 1747, gave a detailed acat sea. (PURCHAS's Collect. of Voyages, vol. i. count of the prevalence of scurvy in the Rusand iv.) Admiral HOSIER, who sailed in April, sian armies, especially at Wiburgh, and during 1728, with seven ships of the line to the West the siege of Asoph, in 1736. At these and other Indies, buried his crews twice, and died broken-places, the mortality was great during winter hearted in consequence. Lord ANSON's expedition, at the end of two years from its leaving England in 1740, had lost from this disease more than four fifths of the number that sailed in it. The voyages of DRAKE, CAVENDISH, DAMPIER, BYRON, and of numerous other navigators, furnish similar details, and show how recklessly the lives of sailors were sacrificed. both in the siege of Thorn and in the imperial army, as soon as the former was raised, and vegetables and greens from the country were admitted into the town, and when the latter procured the same articles of food, the disease entirely disappeared. From these and other facts, he concludes that an abstinence from recent vegetables is altogether and solely the cause of the distemper, and so these alone are its effectual remedies. and spring, and was, as on most other occasions, ascribed to the unwholesome nature of the food, and the want of fresh succulent vegetables. In the spring of 1760, the British troops, forming the garrison of Quebec after its capture from the French, suffered so severely from cold, and the want of vegetables, that, before the end of April, 1000 of them were dead of scurvy, and 8. But it was not only in fleets and single more than twice that number unfit for service. ships that scurvy was so destructive, but also M. FODÉRÉ states that scurvy was remarkably in towns, fortifications, camps, and armies, and prevalent in the French army of the Alps in wherever the population was subjected to the 1795; and LARREY says that, in 1801, during causes which occasioned it in fleets. That scur- the siege of Alexandria, which was commenced vy was endemic, and also epidemic, in northern in May, and ended with August, 3500 scorbutie European countries, has been stated to be man- patients were received into the military hosifest from the early works on the disease, and pitals of the city. During the war in Siam and from the nature of the food upon which their Ava, the native and British troops suffered most inhabitants subsisted. Owing to the difficulty severely from scurvy and scorbutic dysentery,* of procuring fresh, succulent vegetables, and owing to causes which will be referred to in the from their ignorance of the disease and of its sequel. In 1836, the troops in the province of several preventives and cures, the early fre- Adelaide, near the Cape of Good Hope, also sufquenters of Hudson's Bay, of Newfoundland, fered severely from scurvy, although abundantly and the coast of Labrador, were frequently al-supplied with good fresh meat; but they had been most altogether destroyed; and the early French settlers in Canada experienced so severe losses in winter and early spring from this disease, as almost to induce them to abandon the settlement. long without fresh vegetables and fruit. Scur During 1827, the directors of the East India Company allowed me to inspect the regimental and other returns preserved in the India House, respecting the Causes, Na ture, and Treatment of this disease as it occurred in the expedition to Ava, and of the cholera then prevalent in 9. While sporadic cases of scurvy were of India. vy was seldom or never seen in Great Britain | since the end of the last century, up to 1847, excepting in jails and penitentiaries. In 1823 it appeared in the form of scorbutic dysentery in the Millbank penitentiary, owing to a poor and watery diet, without fresh or succulent veg-patches are first observed, and are most numeretables; and, in 1836, 1837, and 1838, it occurred in several jails, owing to the same causes, more especially to the privation of fresh succulent vegetables. During the early months of 1847, 1848, and 1849, scurvy has appeared in various parts of England, Scotland, and Ireland, owing chiefly to the potato-blight. The Lit erary History of this disease will more fully appear from the BIBLIOGRAPHY AND REFERENCES appended to this article. [It would seem that scurvy has almost invariably attacked the early colonists of northern latitudes, while those within or near the tropics have, from the abundance of fruits and vegetables, escaped. The early Massachusetts colonists, especially those who came in the May flower, and landed at Plymouth, Massachusetts, were dreadfully afflicted, more than half having died the first season. This disease has occasionally appeared in the United States army and navy; but more frequently among our merchant whaling vessels, which continue for many months at sea-in which there is little regard paid to personal cleanliness, and which are often excessively filthy and offensive. Notwithstanding, there is no instance on record, so far as we know, where the disease has prevailed on board of any vessel which had a good supply of fresh potatoes. In 1809, the scurvy proved very fatal among the United States troops on the lower Mississippi, 600 men having fallen victims to it. From 1819 to 1839, it prevailed occasionally in the United States army. sometimes proving quite fatal, as at Council Bluffs and St. Peter's, in 1820, when there were 503 cases and 168 deaths. It also was observed to some extent during the Florida war, in 1837 and 1838 (FOVRY), and also among the American troops during the late Mexican war. Dr. FALTZ, surgeon, has described the disease as it existed on board the United States squadron in the Gulf of Mexico, in the summer of 1846 (Am. Jour. Med. Sci., vol. xv., N. S.); and within the last two years it has committed extensive ravages among the early colonists, especially the miners, in California.] 11. II. DESCRIPTION.-i. Of the symptoms of scurvy, the earliest are observed in the countenance. The face, as well as the rest of the surface, is pale and bloated. The carunculæ of the eyes and lips have a dirty or greenish hue. The expression of the features is depressed. The gums are swollen, spongy, soft, livid, and bleed on the slightest friction. The odour of the breath is offensive. The patient complains of lassitude and debility, frequently of pains in the lower extremities, resembling rheumatism. He is averse from any kind of exertion; and when he attempts to exert himself he complains of stiffness of the joints, feebleness of the limbs, of panting or breathlessness, and of extreme fatigue. The skin is dry and harsh, and it generally continues dry throughout the course of the malady. Sometimes it is rough, resembling the goose-skin appearance; but it is more frequently shining, with patches, streaks, or spots of a reddish The brown, bluish, greenish, black, or livid hue, resembling those following a severe bruise. The size of these patches varies from a small point to that of a handbreadth, and it generally increases with the progress of the malady. The ous on the legs and thighs; but they soon appear on the arms and trunk, and on the scalp, very rarely on the face, which, however, assumes a more dingy and bloated hue. ankles swell, and the legs and feet become edematous. In addition to these, the patient often complains of shifting pains; and, if the disease have supervened upon rheumatism or ague, these pains are more or less severe, and are referred to the bones, to the back, thorax, or joints. When the disease follows ague, obscure or irregular remissions or intermissions of febrile symptoms are observable, and more or less enlargement, with pain in the region of the spleen, is often detected. The above may be considered as the first or early stage of the distemper. [As described by our naval surgeons, "lassitude and debility" are not usually among the symptoms which usher in this disease; on the contrary, there is generally great activity, and not unfrequently cheerfulness, good appetite, and sound sleep at night, for weeks after the teeth were loosened, the gums ulcerated, the limbs oedematous and discoloured. The nervous symptom was commonly the last to be invaded, and then it was not an indisposition to corporeal exertion, but an actual disability. The countenance became pale, languid, cadaverous, the respiration oppressed and irregular, and the pulse feeble, fluttering, intermittent, simultaneous with this muscular prostration. Slight efforts to turn, sit up, or move about, were followed by tremours and syncope; and these symptoms usually indicated an early fatal result.] 12. These symptoms may continue a longer or a shorter time, or may be removed quickly by an appropriate treatment; but otherwise they may remain stationary; or, if the cause continues, they increase in severity. The gums become more tumid, more livid, and bleed from the slightest touch, and the breath remarkably offensive; the patches on the surface of the body enlarge, increase in number, and present a deeper and darker ecchymosed appearance. The pains are more severe, and are accompanied with swellings of the hams, stiffness and contractions of the knee-joints and ankles, and often with a brawny feel of the parts, owing to effusion of lymph between the integuments and aponeuroses, preventing the motion of the skin over the swollen parts. With the exudation of lymph, red globules, &c., into the tissues, chiefly into the connecting cellular tissue and periosteum, exudations of blood take place, giving rise to more or less marked hemorrhage from mucous canals, especially from the nostrils, mouth, and bowels, and from the vagina; much more rarely from the bronchi, urinary organs, and stomach. The tendency to hæmorrhage increases with the progress of the malady, and the loss of blood is often so great as to rapidly sink the vital powers of the patient. In this advanced stage, the livid patches are generally as sociated with hard and painful swellings in va rious parts, particularly in the lower extremi ties, and in the calves of the legs; and these often pass into superficial fungous ulcers. Old cicatrices frequently open afresh, and become the seats of foul scorbutic sores. The teeth fall out; the gums present foul, livid, spongy ulcers. The respiration becomes remarkably short and hurried on the least exertion, and deliquium or faintness is apt to supervene. The contractions of the joints, the oedema, induration, and pain of swollen parts, the discolora- | tion of the patches, and the number of the ulcers, are all more and more developed, and the debility and vital depression greater. 16. As the disease approaches an unfavourable issue the breathing becomes remarkably frequent, and the dyspnea extreme. The patient coughs, and expectorates a frothy mucus, sometimes tinged with dark blood. The chest was generally every where resonant on percussion; the respiratory murmur was loud and distinct; and the sounds of the heart were loud and extensive, but unaccompanied by any morbid bruit in six cases examined by Dr. BUDD. In the most advanced states of scurvy, not only may ulcers, and injuries or wounds which have healed up for many years, break out afresh, but old and well-united fractures may become disunited. The tendency to swoon in the most severe cases is sometimes so great that the slighttrifling exertion, may be followed by fatal syncope. It is stated in the account of Lord ANSON's voyage, that many of the men, although confined to their hammocks, eat and drank heartily, were cheerful, and talked with much seeming vigour, and in a strong tone of voice; and yet, on their being the least moved, although it was only from one part of the ship to another, and that in their hammocks, they have immediately expired; and others, who have confided in their seeming strength, and have re 13. From the commencement of the disease the alvine evacuations are more or less disordered. The stools are morbid; but at first they are not so remarkably so as to attract atten-est motion, or the erect posture, or even any tion, and costiveness is then often experienced; but, as the disease advances, they are not only much disordered, but are much more frequent, and very offensive. Diarrhoea and colicky pains often supervene, and, with more or less attendant hæmorrhage, rapidly sink the patient at this stage. Under certain circumstances, the disease passes into a state of scorbutic dysentery, or dysentery and scorbutus supervene upon each other, and thus become associated, as shown when treating of DYSENTERY (see that art., § 39, et seq.). The urine is scanty and high-solved to get out of their hammocks, have died coloured (see § 20). 14. The pulse is often little affected at an early stage, but is more generally slower and feebler than in health; but in more advanced cases, or when the malady is associated with some degree of asthenic or sub-inflammation in the seats of effusion, the pulse is often remarkably frequent, as well as small or weak. When the pulse is slow and feeble, the patient is often chilly, the surface cool, and the temperature of the body lower than natural. This state of the disease was called the cold scurvy by the earlier writers. When much swelling and hardness, with pain, is occasioned by effusion in the connecting cellular tissue, or even below the periosteum, the pulse is generally frequent, varying from 100 to 120 in a minute, probably owing to some degree of inflammatory irritation produced by the effused matters in these situations, as indicated by the great tenderness which always is present. This state of febrile action gave rise to the distinction of hot scurvy, according to various authors. 15. The tongue is generally clean and pale, but commonly broad, flabby, and indented at its edges by the teeth. The insides of the cheeks and lips are pallid, and contrast remarkably with the appearance of the gums. Thirst is not much complained of, unless in the more febrile state of the disease, or when the supply of fluids is scanty. The appetite is not impaired. It may be even greater than in health; and digestion is not very manifestly impaired. Sleep is not deficient, unless at a far advanced stage, when wakefulness or disturbed sleep is experienced. The mental faculties are not impaired, although the spirits are generally more or less dejected and anxious; but towards a fatal issue the patient becomes indifferent and torpid. The memory is generally unimpaired, but the eyesight is occasionally weakened.* * [Nyctalopia, or moon-blindness, is a symptom which is not uncommon as a precursor or attendant on scurvy, and has been particularly noticed by Dr. COALE in his account before they could reach the deck. And it was no uncommon thing for those who could do some kind of duty, and walk the deck, to drop down dead in an instant, on any endeavour to act with their utmost vigour. 17. Emaciation is not necessarily a phenomenon of the disease, unless there has actually been considerable privation of food; but it is occasionally observed, and anæmia is not infrequent. Dr. BUDD observes that, although there is a remarkable tendency to the breaking out of old ulcers or wounds long previously healed, yet there is very little disposition to the occurrence of bed-sores from pressure. The separation of the epiphyses from bones has been mentioned by some writers as having occurred in children attacked by this malady, but it has not been often observed in adults, or, if observed, not mentioned by many writers. 18. Scorbutic ulcers exude a thin, fetid, sanious fluid, instead of pus. Their edges are of a livid colour, and, as if puffed up, a coagulum soon forms on their surfaces, which is separated or wiped away with difficulty. The parts underneath it are soft, spongy, or putrid. When this coagulum is removed, the same change again occurs after a few hours, forming a soft, bloody fungus, resembling boiled bullock's liver, of the disease as it existed on board the United States frigate Columbia in 1843, and also by Dr. FOLTZ, U. S. N. The blindness is represented as coming on soon after sundown, the conjunctiva becoming injected, when the blindness was so perfect as to prevent vision, even at a few inches distance. Dr. FOLTZ, in his history of the disease, as it appeared on board the United States frigate Raritan, remarks as follows: "Nyctalopia occurred in five, and bad that the patient could not move about the even decks, hemarolopia in two cases. One case of the latter was so with which he was perfectly familiar, without the greatest difficulty. There were other affections of the eyes, owing obviously to this scorbutic diathesis, such as inflammation accompanied with a copious acrimonious discharge. The of the conjunctiva, induration, and irritation of the cilia, usual collyria were used without any benefit, and the eyes improved or became worse in proportion to the arrest or progress of the scurvy; and ultimately, as the disease was eradicated, the ophthalmic affections permanently disappeared."-Loc. cit.] This fungus exudation, Dr. LIND states, sometimes rises in a night's time to a great size, and, although cut off, in which case a plentiful hæmorrhage generally ensues, at the next dressing is as large as ever.* 19. ii. THE CHEMICAL ANALYSES OF THE BLOOD AND URINE in scurvy have been few, and even these unsatisfactory. It is manifest that the states of the blood and of the excretions in this disease will depend much upon the treatment adopted, and upon the time during which the treatment has preceded the analysis.-A. SIMON'S "Animal Chemistry" furnishes no information as to the blood in scurvy; but Dr. DAY, in his additions to the work, states that Mr. Busk, in three well-marked cases of scurvy, found the composition of the blood as follows, comparing the scorbutic blood with the healthy, according to his analysis of the latter : 20. B. The urine in scurvy is commonly of a dark reddish brown, and sometimes of an almost black colour. Although it is slightly acid as it is evacuated, it very soon becomes alkaline, and emits a strong and disagreeable ammoniacal odour. Blood is often discharged with the urine, and the urine then assumes a dark reddish-brown colour, in consequence of the presence of hæmatoglobulin; in this case it develops hydrosulphate of ammonia, and soon becomes putrid. Dr. SIMON examined the urine in three cases of scurvy in SCHÖNLEIN's clinical wards-two men and one woman. The urine was very similar in these three cases in its physical characters. It was scanty, and of a deep dark-brown colour; after standing a few hours, it emitted a disagreeable ammoniacal odour. The three specimens resembled each other, and were found to approximate the chemical characters of the urine in typhus. The urea was less than in healthy urine, not exceeding 25-30ths of the solid residue. The fixed salts were diminished in the two male cases, being 14-18ths of the solid residue; but in the female they were 27, or a little above the normal average (25). The uric acid was slightly above the healthy standard in all, being from 1 to 3 of the solid residue. 21. iii. APPEARANCES ON DISSECTION.-Scurvy at the present day seldom proves fatal, unless in ships or in besieged towns, where opportunities of minutely examining the bodies after death are rarely enjoyed; and the observations of early writers on this subject are gen tails. The best account of the appearances after death has been furnished by Dr. BUDD, from the cases which were brought to the Dreadnought Hospital Ship. He states, "The general inferences to be drawn from preceding facts are, that, in the inspection of the bodies of persons who die of scurvy, the chief indications of that disease are met with in the colour of the skin, in the state of the gums, and in the presence of fibrinous effusions, and of ecchymoses, or effusions of blood. These effusions occur most frequently in the skin, in the subcutaneous cellular tissue, and between the muscles of the lower extremities, between the periosteum and bones of the lower extremities and of the jaws; and in the peritoneal coat, and in the muscular and mucous coats of the intestinal canal. The numerous traces of hæmorrhage observed in the coats of the intestines are in accordance with the frequency with which scorbutic persons pass blood by stool." * [Dr. FOLTZ, United States navy, maintains that the Land Scurvy (Morbus maculosus, Werlhofii) is a "totally different" disease from Sea Scurvy. "In their symp-erally devoid of precision, and the necessary detoms there is, in the early stages, a slight assimilation; but, as they progress, in their pathological character they are perfectly dissimilar. Among the troops employed in Florida during the Seminole war, the morbus maculosus committed extensive ravages. Nyctalopia was a common symptom; some thirty cases of the disease occurring among the marine corps, co-operating with the army, were transferred from the field to the Marine Hospital at Washington, then under our charge. These cases, as well as a number we witnessed at Point Isabel, in May, in the forces engaged under General TAYLOR, were totally distinct from the scurvy as it occurs on board ships at sea. Purpura oedema, the cadaverous and fetid effluvium which follows the extreme emaciation, the fainting upon the slightest exertion, and the extent of disease in the respiratory and circulatory systems, which always occur in the scurvy on board ships, are never met with in the land scurvy. In the latter we have sponginess of the gums, ulceration, which terminates in dysenteries and fevers, the first in duced by a cachectic diathesis, but never involving that complete anæmia of the blood, which amounts to a universal septic tendency." Is not this difference in the phenomena of the disease owing solely to the fact that on board of vessels at sea men are compelled to breathe a confined, vitiated, and impure air, while upon land this cause of deterioration of the blood is removed? It is much to be regretted that the internal arrangements, with the accommodations for officers and crew, on board many 22. The slight effusions of blood between the of even our large public vessels are so defective-the periosteum and bone do not destroy the muscuhold being small, badly arranged, and imperfectly venti lated, while the berth-deck is low, with very small air- lar connexions between these parts, so that the ports, which are only opened in port, or at anchor, and in latter does not generally present farther alterathe best weather; while the apartments for the officers tion. Beyond a paleness of tissue, there is no are small, dark, and contracted. The ventilation is imperfect below, because the hatches leading to the berth-deck change characteristic of scurvy observable in are so arranged that wind-sails cannot pass in a perpen- the brain. The organs of respiration, the heart dicular line from the spar-deck to the berth-deck or hold; and large blood-vessels, the glandular system while the sick-bay in the bows of the ship, on the berth- and the bones, presented no remarkable changes deck, and the cockpit, are without light and air, with a temperature sometimes of between 80 and 90° for weeks in the cases inspected by Dr. BUDD. His obtogether, and no hatch for the admission of a wind-sail. servations furnished him with no direct informWhen to these we add the low dismal ward-room, poorly lighted and ventilated; and the coldness, and dampnessation respecting the blood, except that it is dein winter, incident to daily washing and wetting, the daily use of salt beef and pork, long preserved, and consequent ly innutritious; the daily spirit-ration, and personal uncleanliness, we need not be surprised at the occasional appearance of scrofula, in its most malignant form, in the United States navy.] ficient in red particles; that it does not impart a stain to the lining membrane of the heart or vessels; and that it has not lost the property of coagulating. The change observed in the skin and in the complexion is to be ascribed to |