the alteration of the blood, and the hæmorrhages doubtless proceed, at least in part, also from this alteration. Former writers have noticed more or less of a fluid or dissolved condition of the blood, and a soft, flabby state of the heart; this latter change accounting for the swooning and fatal deliquium sometimes occurring in the more extreme cases. The liver has been found pale, or of a pale buff colour, or of a nutmeg appearance; and the bile in the gall-bladder of a pale or yellowish colour. The spleen is generally soft, of a plum colour, and often more or less enlarged. The lungs are sometimes œdematous, especially in their more depending parts. The kidneys and urinary passages seldom present any change in the uncomplicated states of the disease.

of scurvy upon ague, or upon enlargements of the spleen, or upon affections of the bowels, is not infrequent, especially in the winter and spring months, when fresh vegetables and fruits have become scarce, and when cold, humidity, and these diseases have predisposed the frame to this malady; and it was certainly much more common in former ages, before potatoes came into general use.

25. The complication of scurvy with dysentery was the most prevalent and fatal disease during the Burmese war, and was entirely owing to the nature of the food in connexion with malaria and bad water. But it is unnecessary to add, at this place, to what I have stated when treating of the forms and complications of DYSENTERY (see 39, et seq.). Although rheumatism is undoubtedly in some cases, and at certain seasons, occasionally associated with scurvy, still the pains, which are most commonly attendant upon the latter, are rather to be imputed to the infiltrations of blood which take place between the

than to any rheumatic complication. A moderate attention to the matter will be sufficient to distinguish the nature of the case, as well as the existence of enlargement of the spleen, and the connexion of the disease with ague.

23. According to the descriptions of POUPART, LIND, and others, the blood discharged from the mucous canals during life, as well as that found in the cavities of the heart and vessels after death, was remarkably altered, fluid, broken down, and presented more or less of a green-muscular fasciculi and under the periosteum, ish-black hue. The spleen was generally much enlarged, and so soft as to break down on being handled. Adhesions often existed between the costal and pulmonic pleura, and sometimes dirty serous effusions were found in the pleural cavities. Black, corrupted blood was generally effused between the muscles, or infiltrated between their fasciculi, and under the skin and periosteum; and the auricles were remarkably distended by coagulated blood, in those who died suddenly. In young subjects the epiphyses were loosened from the shafts of the long bones, and the ribs had separated from their cartilages. In some the glands of the mesentery were more or less enlarged. The kidneys were occasionally altered. The alterations found in the bones, especially those now mentioned, most probably arose from the effusion of blood between the periosteum and osseous structure, and from the consequent destruction of the vessels of the former, which nourish the latter.

26. Persons labouring under scurvy are very liable, when exposed to cold and humidity, to experience severe attacks of pleurisy, or of pericarditis, or of peripneumonia, or of bronchitis, which may carry off the patient in a short time, without materially influencing the symptoms of scurvy. In these cases, the dyspnoea, cough, and difficulty of expectorating become urgent; the expectoration, varying with the state of pectoral disease, from a slight mucous, frothy matter, to a dirty brown, or dark red, or sanious substance. Effusion into the pleural cavities, or effusion into the air-cells and small bronchi, and splenification of the substance of the lung, ultimately hasten or occasion a fatal issue. In rarer instances changes in the kidneys, which I have ascribed to cachectic inflammation of the secreting structure of these organs (see art. KIDNEYS, 80, et seq.), supervene, and, by embarrassing the functions of these organs, superinduce dropsy upon the scorbutic disease, and thereby occasion or accelerate an unfavourable termination.

24. iv. COMPLICATIONS, &c.-Much of the diversity observed in the symptoms and progress of scurvy, as well as in the appearances after death, depends upon the nature of the food, or of the privations causing the malady, and upon antecedent, concurrent, or intercurrent disease; for, as will be shown in the sequel, although the 27. III. DIAGNOSIS.-Of the numerous writers privation of fresh vegetables and fruit is mainly who preceded LIND, very few pointed out with productive of it, still much is owing to the food due accuracy the diagnostic characters of scurupon which the patient has been living up to vy, or distinguished sufficiently between this the time of his attack and during its progress. disease and malignant or putrid fevers. In many The diseases which commonly precede and fa- circumstances, and on many occasions, some of vour the appearance of scurvy are agues and which I have myself witnessed, it is difficult to remittent fevers, enlargement of the spleen or determine as to the presence of scurvy or of liver, rheumatism, dysentery, or chronic diar-putrid fever, at first sight, or until a more parhoea; and either of these may complicate, in a more or less evident manner, the scorbutic state, especially in its more chronic form, or may appear as an intercurrent malady. These complications are most apt to occur in warm or temperate climates, and wherever malaria is present; and probably the association with rheumatism is most common in colder regions and seasons. When they do appear, they are readily recognised when the physician is alive to the probability of their association, and when the causes on which they chiefly depend are observed to be in operation. The supervention

tient and close observation has shown the difference, so insensibly or gradually, in such circumstances, some of which I observed in Germany and France after the last war, does the one malady approach the characters of the other. In Ireland, in 1847, owing to the failure of the potato-crop, and general misery, scurvy was intimately associated with putro-adynamic fe ver, and it was most difficult to distinguish between them, or to say which was the primary malady. The same observations equally apply to purpura, which often arises from similar causes to those producing scurvy, and is more

or less closely allied to, although generally | hæmorrhages from the bowels be copious, then distinguished from, scurvy, the more extreme great danger may be apprehended, and with points of difference between the two having still greater reason, if the adoption of a suitbeen laid hold of as diagnostic characters, while able diet and remedies is not soon followed by the closest resemblances have been kept out of any amendment. view. It will be more just, more conducive, moreover, to accurate pathological views, and certainly tend more to the adoption of sound indications and means of cure, to look closely at diseases as they occur in practice, to consider both alliances and differences, and to proceed in our treatment on the comprehensive basis thereby furnished us.

above described; and to this circumstance in part, and to others about to be noticed, should be ascribed the scurvy and fever so frequently breaking out in ships after their provisions have been used sufficiently long to produce their effects. To the unwholesomeness and nature of the food, and to the state of the water, even independently of the want of fresh vegetables and fruit, the diversity of characters presented by scurvy and fever in ships, armies, prisons, &c., is in great measure to be imputed, as well as the want of success in treating these diseases by the more usual remedies, or by those more generally found efficacious under other circumstances the same causes not merely predisposing to these forms of disease, but actually producing them, and giving them their distinctive features.*

same time of succulent vegetables and fruits. Nevertheless, the question remains, Are salted meats more favourable to the supervention of scurvy than fresh meats? I believe, after having paid some attention to the matter, that recently-salted or uninjured salt meats, if they have been of a good and healthy description, and quite fresh when salted, are not materially more productive of scurvy than fresh meats; but while the quality of the latter is generally manifest, that of the former is not always so evident. The salted provisions supplied to ships have frequently been long cured, even before they are received on board, and are so often of the most inferior and unwholesome character, as to account in great measure for the appearance of cachectic maladies in those who live upon them. It was notorious, during Queen Anne's wars, that, owing chiefly to collusion 36. Much of the mischief observed in those between the heads of the commissariat or others who had lived long on salt provisions was forin power and the contractors, and even in more merly, and still is by many imputed to the salt recent times, that the salted provisions supplied by which these are cured, or at least to the state to the navy and army often consisted not only of the provisions; and by others to the supposiof long or imperfectly cured meats, but also of tion that salted meats are not so nutritious as the flesh of animals which had died of disease; fresh. But when these provisions have been that horse-flesh was often placed in casks of from the first wholesome and good, have been beef; and that similar villainous acts were not salted while quite fresh, and have not been aftconfined to salted provisions, but extended also erward kept so long as to produce any sensible to the flour and biscuits supplied to these serv- or unpleasant change, they may then be considices, both of these having been adulterated, and ered as having had no farther share in the prothe latter mouldy, and swarming in maggots duction of scurvy, even although it should have and weevils. Owing to this cause, as shown appeared during the use of such provisions, than by some medical writers of the day, a much that they have constituted the chief or only food, greater number of human lives were lost from to the neglect of other articles requisite to corscurvy, scorbutic dysentery, and putro-adynam-rect the effects of so exclusive a diet, such as ic fever by diseases caused by the unwholesomeness of the provisions-than from all other diseases, and from naval and military actions, sieges, and other causes combined.*

fresh vegetables and fruits. On this subject Dr. BUDD justly remarks, that "the circumstances showing that scurvy may prevail to a frightful extent among persons living solely on fresh meat; that persons who, from the nature of their occupations, are continually absorbing saline particles, are exempt from scurvy; that scurvy is not brought on by the use of sea-wa

* [In the United States navy, the salt beef and pork, which constitute a great portion of the daily ration of the seamen, are very generally deteriorated by age, and often unwholesome and innutritious; and, as the navy is supplied with these articles by contract, they are generally long kept, and nearly spoiled before they are served out. The salt, moreover, which is used in curing them is frequently of an inferior quality. As Dr. FOLTZ has stated, when new beef and pork are delivered to the government in a sound and wholesome state, they are carefully stowed away until the old stock on hand is consumed, by that which was nearly in a state to be condemned, if surveyed.

35. Not only were both salted and farinaceous provisions frequently deleterious, but the supply also was insufficient to both army and navy, up to the mutiny at the Nore, the causes of which were generally misrepresented by those in power, and misunderstood or glazed over by historians. In times more recent, acts similar to the above have been perpetrated in more places than one. The returns made to the Medical Boards in India by the medical officers, and which are preserved at the India House, are full of complaints as to the unwholesome nature of the provisions supplied to the army in the Burmese war; even the rice having been either unripe or damaged. The remarkable prevalence of scorbutic dysentery, and low fever among the troops in that war, was ascribed chiefly to this cause; the mortality continuing great until more wholesome provisions were procured. But it was not only in the public services-in fleets, armies, and transport vessels-boiled, was scarce supportable. The biscuit was very that these enormities were practiced; tradingvessels, emigrant ships, &c., were sometimes, and are occasionally up to the present day, supplied with the cheaper kinds of Irish provisions, which are frequently of a similar kind to that

*From a tolerably extensive field of observation in various parts of Europe and within the tropics, between the years 1815 and 1819 inclusive, I can state, that, of the various kinds of unwholesome cured meats, pork is perhaps the most injurious, especially when it has been imper. fectly salted or too long kept; and, more particularly, if it have been coarsely fed, or diseased, or not cured immediately upon being killed: scorbutic and other forms of dysentery generally resulting.

which time the new has reached the same condition as

Dr. COALE (United States navy) states that "the best beef that could be procured" (on board the United States frigate Columbia, previous to the appearance of the scurvy), "had been salted so long that all characteristics as an article of food seemed to be lost, and its odour, when

dark, required generally a hammer to break it, and the fracture mostly resembled a vitreous lustre." - (Am. Journ. Med. Sci., Jan., 1842.) The daily rations supplied

to the United States seamen are as follows:

Bread, fourteen ounces; whiskey (at option), half a pint

daily; and in addition, on Sunday, suet, quarter of a pound; beef, quarter of a pound; flour, half a pound. Monday, pork, one pound; beans, half a pint. Tuesday, cheese, two ounces; beef, one pound. Wednesday, pork, one pound; rice, half a pint. Thursday, suet, quarter of a pound; beef, one pound and a quarter; flour, half a pound. Friday, cheese, four ounces; butter, two ounces; rice, half a pint; molasses, half a pint. Saturday, pork, one pound; beans, half a pint; vinegar, half a pint. It would doubtless conduce very much to the health of our sailors if potatoes could enter somewhat largely into the dietaries of our vessels, and form part of the daily rations.]

alone which predisposes, but more especially in predisposing the body to this or some allied the nature of the malady. Agues, remittent fevers, enlargement of the spleen, and rheumatism, and previous disorder of the digestive organs, especially the former, have been generally considered by medical writers as more or less influential in the production of scurvy. The previously impaired assimilation and nutrition, and the consequent state of the blood, in connexion with exhausted organic nervous energy, readily account for the readiness with which scurvy supervenes upon those maladies when its causes are in operation.

malady, arising from the contamination of the circulating fluids, and from the depression of vital or organic nervous power, by the accumulation of these emanations in the air which is respired for a longer or shorter time. Nor would it be improbable that the emanations arising from a number of scorbutic patients, in places insufficiently ventilated, may convert the scorbutic malady into putrid, maculated, or putroadynamic fever, or into scorbutic dysentery, or even may more directly develop these diseases. 45. K. Age and Sex have probably out little influence on the production of scurvy, for it is observed at all ages, and in both sexes; but there is no doubt that it occurs much more freadvanced age, than in children, and in males than in females, chiefly in consequence of the greater exposure of adult males to the causes, owing to the circumstances in which they are liable to be placed.

42. G. The state of the mind is influential both in predisposing to and warding off scurvy; the depressing passions favouring the appearance, and the exciting emotions preventing or delay-quently in adults, or from early puberty until far ing the occurrence of the malady. Disappointed expectations; anxiety; hope deferred; longings to return to more desired scenes; prolonged confinement; a want of exciting, amusing, and exhilarating occupations; breathing the same kind of air in the same locality; a monotonous and unexciting course of existence; losses of relations and friends, and extinction of those hopes or expectations which render privations endurable-all have their influence in predisposing the body to scurvy or its allied states of cachexy.

46. ii. THE EXCITING CAUSES OF SCURVY may be briefly stated to be the use, for a longer or shorter period, of all kinds of animal meats, too long or imperfectly cured or preserved; of dried, or smoked, or tainted meats or fish; or mouldy, old, damaged, diseased, or unripe farinaceous articles of food, to the exclusion of, or without possessing the advantages of, fresh or succulent vegetables and fruits, or of other preventive articles of diet, or of medicine; more especially when the use of the former kinds of food, and the want of the latter, are aided by one or more of the predisposing or concurring causes already considered. That the want or neglect of those vegetable productions which have been found so beneficial, both in preventing and in curing scurvy, has a greater influence in the production of the malady, than even the prolonged use of the several kinds of animal food, however cured or preserved, has been proved on various occasions. But it cannot be denied that damaged, tainted, or too-long-cured substancespork, the viscera and blood of the animals gen

43. H. The seasons have no small influence on the appearance of scurvy, but mainly in consequence of the privation of fresh vegetables and fruits, which is experienced chiefly during winter and spring; so that in armies, as well as in fleets in, or departing from, cold or temperate countries, a deficient supply of those dietetic means of prevention is more likely to be experienced at those seasons than at any other. Suppressed perspiration, produced by the cold and humidity of these seasons, may also not be altogether uninfluential, as shown above (§ 39), in favouring the evolution of this malady. In northern countries, where the inhabitants, the seamen, and the soldiers, live chiefly upon cured meat provisions, as salted and smoked meats, and dried fish, during winter and spring, and un-erally used for food-the flesh of animals which til the commencement of summer, when vegetables and fruits begin to appear, their constitutions have made considerable progress to the scorbutic diathesis; so that, when these preventive articles of diet cannot be obtained at this latter season, owing either to states of siege, and to the provisioning and other circum-tained. stances of armies or fleets, scurvy is then much more apt to break out in spring, and even in summer, than at other seasons.

44. I. The early writers on scurvy were inclined to ascribe a contagious influence to this disease, chiefly from the number attacked with it in the same place and circumstances; but it was clearly shown that contagion had no share in producing it, by LIND and others, who wrote about the middle and end of the last century, the causes inducing the malady being common to all affected by it in the same locality. But, although the disease is actually uncontagious, it is by no means unreasonable to infer that the putrid emanations from a number of persons in an advanced stage of the disease, confined often in very limited spaces, either on board of ships, in the crowded hospitals of a besieged town, or in crowded prisons, are not altogether innocuous, or are not without some influence

have died of disease, &c., are much more likely to occasion scurvy, and its various complications, than fresh and wholesome meats; although even these last may be followed by the disease, when too long or exclusively used, and when fresh vegetables and fruits cannot be ob

47. Although I cannot admit that scurvy is to be ascribed entirely and always to the absence or want of fresh succulent vegetables and fruits, as articles of diet, as contended for by Dr. BUDD, yet I will not deny that such a privation is the most common and exciting cause of the malady, especially when no suitable means are employed-none of the numerous preventives about to be noticed ( 54, et seq.) is had recourse to, in order to supply the deficiency, or to counteract the effects resulting from the nature or state of the aliments. In this, as well as in other diseases, we cannot with propriety ascribe the sole agency to one cause; generally more than one, frequently several, although of diversified amount of power, are concerned in developing the result, whether that result be simple, definite, or specific, or whether it be complicated more or less, or contingently associated.

48. iii. The chief causes insisted on by writers