at the island, with a plentiful supply of fresh beef, procured at considerable expense, but neglected to provide them with vegetables and limes, which abound in the island. The consequence was, that scurvy broke out soon after they set sail, and before the ship arrived in this country one half the men before the mast had died of it, and the rest were disabled" (p. 77). 70. H. It is not alone requisite to use the above means of prevention, as they may severally be possessed by individuals or communities, under circumstances which render the ap. pearance of scurvy either probable or certain; but all the predisposing and exciting causes (§ 33, et seq.) ought to be carefully avoided, as far as this can be effected. I believe that no mean cause of the prevalence of scurvy in the navy, as well as in trading ships, was the habit, morning and evening, of washing the decks, thereby keeping in a constant state of humidity and evaporation, and the air either cold and humid, or close and humid, according to concomitant circumstances. This evil is partly abated by adopting dry scrubbing and similar means; but it still should be kept in recollection, as the adoption of it depends upon the knowledge or caprice of the captain, who in this, as well as in other matters connected with naval service, may thus occasion an unhealthy state of air, an artificial malaria, the humidity favouring the concentration of emanation from the hold and other parts of the ship, and from the individuals confined during the night in a limited space and in a close air. Harassing duties, fatigue, and whatever lowers the general standard of health, or depresses the vital powers, ought also to be avoided. 71. I. Much, as will be seen from the above, depends upon the victualling of ships, especially those which proceed upon long voyages. The sailors should have a sufficient supply of cocoa, tea, coffee, fresh lemon-juice, sugar, or molasses; and while spirituous liquors are allowed in very moderate quantity, and only when wet or fatigued, they should either be withheld, or allowed in very small quantity only, when these exigencies do not exist. In circumstances tending to depress the mind, endeavours should be used to amuse and to excite it, in such ways as may the least tend to be followed by depression. In these respects, as well as in others, the means adopted by Sir E. PARRY deserves both praise and adoption, as far as the latter is possible.* [Potato or corn starch, which is now extensively manufactured, ought to enter largely into the dietaries of seamen, especially since it is so prepared and put up that there is no danger of deterioration by age or climate. An abundant supply of potatoes, sliced and dried, was taken out in the late United States Exploring Expedition in search of Sir John Franklin, and answered an admirable purpose in preventing scurvy. Dried apples and peaches should also be supplied in liberal quantities to the navy, and more frequent supplies of fresh meat and vegetables should be furnished, by a more frequent resort to ports where they can be procured. More attention is also need ed, in our mercantile and public vessels, to ventilation, the quality of stores, personal cleanliness, and to the abolition of the spirit-ration, which is a constant source of both moral and physical evil. The forecastle on board our merchantmen is either cold, wet, and uncomfortable, or hot, suffocating, and filthy, with all manner of offensive smells, and no ventilation whatever. Since the recent enactments by Congress in regard to the regulation of emigrant vessels and packet ships, many of the abuses which formerly existed have been done away with; still there is great neglect in enforcing the law; and the consequence is, that typhus fever, dysentery, &c., often prove very fatal 72. VIII. TREATMENT OF SCURVY.-What has already been stated with reference to the prevention of scurvy applies equally to the treatment of it, especially in its early stages, and less complicated or less severe states. But it is occasionally observed that, owing either to the continued influence of certain causes which are overlooked, or cannot be removed, or to the presence of some complication, the disease resists the usual means of cure, and even those remedies which have generally been efficacious in the most severe cases. Lime-juice, and especially fresh lemons and limes, have been found the most efficacious means of cure in pure scurvy; but instances have been recorded very recently in which lime-juice has failed. These instances of failure have, however, been adduced in too general terms, and without a sufficient and precise record of the several circumstances in which the failure occurred, or of the particulars in which the disease varied in its character from that usually observed. The distemper has commonly been stated to have been scurvy arising out of the usual causes; and lime-juice has been said to have been given without benefit; but no particulars are adduced as to the existence or non-existence of one or more of those predisposing and concurring causes described above (§ 33, et seq.), as not merely contributing to the production of the malady, but also actually perpetuating, modifying, or aggravating it, if they are allowed to continue in operation during the treatment. When lemons, limes, shaddocks, and oranges can be procured, they are preferable to other means; but otherwise the preserved lime-juice or crystallized citric acid should be substituted. In respect of the preserved juice, we have no adequate information as to the time it will retain its antiscorbutic properties or it is not unreasonable to infer-inde has been proved-that, when this juice has been kept two or three years, as is not infrequently the case, it may have lost much of its virtues, the failure of it under such circumstances being sufficiently evident, without looking for the cause of failure in the nature of the disease itself, or in the inefficacy of the remedy. 73. One of our oldest English writers on scurvy, JOHN WOODALL, in his meritorious work, entitled the "Surgeon's Mate"-a name too vulgar to be noticed by doctors of modern manufacture observes that "we have many good things that heale the scurvy well on land, but the sea chirurgeon shall do little good at sea with them, neither will they endure. The use of the juyce of lemmons is a precious medicine, and well tried; being sound and good, let it have the chiefe place, for it well deserves it; the use whereof is it is to be taken each morning, two or three spoonfuls, and fast after it two hours; and if you add one spoonful of aqua vita thereto, to a cold stomach, it is the better. Also, if you take a little thereof at night, it is good to mixe therewith sugar, or to take of the syrup thereof is not amisse." This good advice was given in 1636, and farther insisted upon subsequently by MARTIN LISTER, DELLON, and many on board these vessels. Were the regulations, however, fully carried out with regard to the number of passengers, the quality and quantity of food, ventilation, and cleanliness, these diseases would rarely be observed on board, if, indeed, they ever appeared, except sporadically.] others; and yet, when Lord ANSON proceeded | der it more palatable, and a few drops of oil of on his circumnavigation, no provision of the peppermint, and a little alcohol. An ounce of kind was made against scurvy; the prevention this solution was a dose; and from three to and cure of disease, and rewards for those who eight doses, according to the stage and severity devote themselves to those laudable undertak- of the disease, were given at equal intervals, ings, never having been considered of any im- from six in the morning until eight at night. portance by British governments, or, at least, of very minor importance only; the aggrandizement of party and family connexions always absorbing and utterly annihilating considerations of public justice and patriotism. 76. It has been contended by Dr. STEPHENS that the state of the blood in scurvy indicates the exhibition of the non-purgative salts, and not of acids. His own experience appears not to have furnished him with sufficient evidence in this matter. But I may mention that, in states of disease closely allied to scurvy, I have given, from an early period of my practice, the chlorate of potash, as well as the carbonates of soda and potash, with very marked benefit. In obstinate or complicated cases, or when the above means fail, a combination of these salts of the nitrate and chlorate of potash, and the carbonate of soda or potash-may be tried; or the chlorinated solutions of lime or of soda. When diarrhoea is present, lime-water with milk, or small and frequent doses of the chloride of lime, or of creas ole, in any demulcent vehicle, may be of use; and when hæmorrhages are present, small or moderate doses of the terebinthinates, or of the spirits of turpentine* (§ 68, 69), should be exhibited in any suitable form, or on the surface of spruce-beer, when that beverage can be procured. 74. Since the works of LIND, TROTTER, and BLANE established the reputation of lemon-juice and acidulous fruits for the cure of scurvy, these, with the use of fresh succulent vegetables, have been generally adopted. Nevertheless, other means have been resorted to, owing either to the failure of the lemon-juice, or to the form of, and circumstances attending, the malady. The other vegetable acids, and the mineral acids, have been found very remarkably inferior to the citric in the treatment of scurvy; but the amount of benefit which various kinds of salts, and the alkaline carbonates, are capable of affording, has not been ascertained, excepting in the single instance of nitre. Mr. PATTERSON, a naval surgeon, writing in 1794, showed the good effects of a solution of nitrate of potash in vinegar. He advised four ounces of nitre to be dissolved in a quart of vinegar, and gave half an ounce of this solution twice or thrice daily, 77. When the disease is complicated with pleuand bathed the local sores with it as often. He risy or with congestive pneumonia, the nitre, with states, that "some patients cannot bear the so-lime-juice and camphor, will be found benefilution without the addition of water, while others, without the least inconvenience, bear it undiluted. The discharges by stool, or the presence of gripes or nausea, guide me with respect to increasing or diminishing the dose; but, at the same time, it is not a slight degree of nausea, colic, or diarrhea that renders an altera-mittent or remittent fevers, the preparations of tion in the quantity of the medicine necessary. To a great number of scorbutic patients, eight ounces of this strong solution, containing one ounce of nitre, have, in the course of the day, as long as such a quantity was necessary, been administered to each with the greatest success. Also, large and frequently-repeated doses of this medicine have been given in cases of scorbutic dysentery, and, instead of increasing, I have always found it remove the disease." cial; and epithems or embrocations applied to the chest or over the seat of pain, consisting of the compound camphor and turpentine liniments, will prove of essential service. When the disease is associated with disease of the spleen, as often occurs when it follows inter cinchona or quinine, of serpentaria, guaiacum, &c., have frequently been found of service. In these, as well as in complications with ague, the remedies just mentioned should be exhibited in decided or sufficient doses; or various chalybeate preparations may be substituted, or given as circumstances may suggest. If the functions of the liver be torpid, or if congestions of this organ or of the spleen be indicated, the nitro-hydrochloric acids may be taken in weak solution, as the common drink, and the surface of the trunk, or the lower extremities, sponged or bathed with the tepid or warm solution of these acids. In many circumstances of the disease, the compound decoction of sarsaparilla, or other preparations of this medicine, will be taken with advantage; and several of the substances mentioned above (9 68, et seq.) will be beneficially conjoined with others, according as circumstances arise. 75. Mr. CAMERON, another experienced naval surgeon, states, that having on several occasions observed the excellent effects of a solution of nitre, as recommended by Mr. PATTERSON, in scurvy, he was induced to employ it when the disease broke out among the prisoners on board of a convict-ship proceeding to Sydney in December, 1829, under his care. As soon as he commenced the use of this solution, many almost hopeless cases began to improve rapidly, and, before one third of the voyage was accomplished, the health of the sick improved so fast under the new treatment, that he did not think it necessary to go into any port; and the general health of the prisoners (216), when they arrived at Sydney, was much better than when they embarked in Ireland. Some of the * Very recently the spirits of turpentine has been reccases manifested a severe pulmonary complica-ommended for hæmorrhages, as a new medicine for this class of diseases. I may mention that, in a memoir, with tion, but these also recovered. Mr. CAMERON'S experiments on the use of this remedy in disease, publishpreparation consisted of eight ounces of nitre, ed by me in 1821, in the London Medical and Physical dissolved in sixty ounces of vinegar. Some- Journal, it was strongly advised to be prescribed for all hæmorrhagic affections; and the same advice has been times equal parts of vinegar and lime-juice were used: a little sugar was generally added, to ren 78. During the course of scurvy, whether simple or complicated, the bowels are often more or less disordered. When costiveness occurs, it should be removed by the less irritating but efficient means. The most appropriate and the given for these affections, as well as for numerous others, in this work. most successful is a solution either of the cit-order for the due performance of the animal rate of magnesia or of the phosphate of soda; or a sufficient quantity of magnesia, taken shortly before exhibiting the lemon-juice or the solution of citric acid. In order to keep the bowels sufficiently open, and to procure a return of the functions of the skin, magnesia may be taken conjoined with the precipitated sulphur and a little powdered ginger, in repeated doses. If diarrhea or dysentery supervene, the means already mentioned, or those advised in another place (see DYSENTERY, SCORBUTIC), should be employed. If the evacuations be very offensive as well as frequent, lime-water with milk, or the chloride of lime, or powdered charcoal, or tar-water, or creasote, will be found very beneficial; and to either of these the calamus aromaticus, or other similar substances, may be added. M. BRACHET states that he has cured several cases of scurvy with powdered carbon alone. functions. By a process of oxygenation, the various solids and fluids are being constantly thrown off in various forms, as urea, lithic acid, lactic acid, bile, sweat, &c., and they must as constantly be supplied, though the relative quan. tity may vary with the age and the circumstances in which an individual is placed; more lime and iron, for example, being required in the early periods of life. But the food must supply elements equal to the waste. Now animal food, as well as vegetable seeds, furnish nitrogen in that form which is most easily assimilated; while succulent roots supply the inorganic elements, the alkalies, lime, sulphur, and phosphorus; while the carbonaceous element of the farinaceous substances serves for combustion, and the production of animal heat. Now, under favourable circumstances, it is possible that some of these elements may be wanting in the food, and still the health not appear 79. As the disease approaches to, or assumes to suffer; but where other causes co-operate the characters of putro-adynamic or maculated with this, scurvy or some analogous affection fever, as observed sometimes under circum- is very sure to occur. The constituent warstances favouring this occurrence, the remedies ing may be organic or inorganic. Dr. GARROD advised above (68) for the complication of the has attempted to show that in all scorbutic didistemper with ague; and various antiseptics, ets potash exists in much smaller quantities especially those recommended for the treatment than in those which are capable of maintaining of putro-adynamic or typhoid fevers (see FEVERS, health; that all antiscorbutics contain a large $585, et seq.), should be prescribed with due de- amount of potash; that in scurvy the blood as cision, and appropriately to the features of in- well as urine is deficient in potash; and, lastly, dividual cases. In all the states or complica-that the disease is effectually cured by the same tions of scurvy, as in low states of fever, approaching in character to those of scurvy, an expectant practice is not only a most dangerous, but a fatal one. The medical journals of the daythe middle of the 19th century-teem with the histories of cases of low fever, in which the practice was either expectant or inappropriate, as far as the treatment is recorded; the post-mortem changes revealing the results, which, by the experienced and observing phy-The nitrate of potash, as well as the bitartrate sician, may have generally been anticipated. 80. The diet and regimen during the course of the malady constitute the chief part of the treatment, and, as such, have been sufficiently noticed, in respect both of the prevention and cure of the malady. A warm, dry, and pure air (avoiding exposure to cold and wet), and moderate mental excitement, amusement, &c., will contribute very remarkably to the removal, as well as to prevention of scurvy. [The facts stated by our author with regard to the causes and successful treatment of scurvy may perhaps be so generalized, by careful induction, as to lead to a knowledge of the principles involved. It is very evident that the elements of healthy secretion and excretion must be found in sufficient quantity in the food, or that the fluids will deteriorate, and the health suffer. Every part of the body, the bones, the nervous matter, the muscles, the cellular tissue, &c., each must have those elements supplied in the food, which belong to its normal constitution, as lime, phosphorus, sulphur, potash, &c., or disease will be the consequence. In all cases where scurvy has existed, some of these elements have probably been wanting ⚫ There must be sufficient protein, oxygen, nitrogen, hydrogen, and carbon for the soft tissues, as well as phosphate of lime for the bones, phosphorus for the brain and nerves, sodium and sulphur for the bile, and iron for the blood, in agent, without making any change in the diet. It is certain that in salt beef and pork, owing to the action of the soda, there is a gradual exosmosis of the potash, and loss of this element; while in milk, fish, potatoes, and in most vegetable juices and fruits, it is very abundant. It also abounds in wine, cider, spruce-beer, wort, the pine, juniper, and spruce, the vegetable acids, and, in fact, in all antiscorbutic articles of food. and the oxalate, have also proved valuable remedies in the disease. The rapidity of the cure will generally be proportioned to the nutritious quality of the food, together with the variety; but in all cases, fresh vegetables, which abound with the salts of potash, are the most beneficial.] Basil, 1567.-. BIBLIOG. AND REFER.- Hippocrates, De intern. Affectionibus, edit. Foësi, p. 557.-Celsus, lib. ii., cap. 7.-Pliny, Histor. Natural., lib. xxv., cap. 3.- Olaus Magnus, Hist. Sept. Nat., lib. ix., cap. 38.-J. 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Bona, Tractatus de Scorbuto, 4to. Veronæ, 1761.-J. Travis, The Use of Copper Vessels in the Navy, a Cause of Scurvy. In Med. Obs. and Inq., vol. ii., 8vo. Lond., 1762.— C. E. Endier, Die längst gewünschte Cur des Scharbocks, 8vo. Hamb., 1764. — Clergyman, A Remarkable Cure of an inveterate Scurvy, 8vo. Lond., 1766.-J. Hill, On the Power of Waterdock against the Scurvy, 8vo. Lond.. 1765.-Anon., Method of Treating the Scurvy at Sand use of Wort in it, 8vo. Lond., 1767.-J. Pringle, Address to the Royal Society. 1776-D. Macbride, An Historical Account of a new Method of treating the Scurvy, 8vo. Lond., 1767.-N. Hulme, Libus de Natura, Causa Curationeque Scorbuti, 8vo, Lond., 1768. A Proposal for preventing the Scurvy in the Navy, 8vo; Lond., 1768.W Jervey, Practical thoughts on the Prevention and Cure of the Scurvy, 8vo. Lond., 1769.-W. Logan, Observations on the Effects of Sea Water in Scurvy and Scrofula, 8vo. Lond., 1770.-J. Morley, An Essay on the Nature and Cure of Scorbutic Disorders, 8vo. Lond., 1770.-G. V. Zeviani, Sopra lo Scorbuto, 8vo. Verona, 1770.- Dinkgreve, De Similitudine Indolis Scorbuti et Febris Putrida. Leyd. Bat., 1772.-L. Rouppe, Abhandlung vom Scorbut, 8vo. Gotha, 1775-E. Salmon, Scorbutus. In Linnæi, Amoen. Acad., t. ix., 4to. Ups., 1775.-J. Badenoch, On the Use of Wort in the Cure of Scurvy. In Med. Obs. and Inq., vol. v., 8vo. Lond., 1776 —J. le Meilleur, Traité sur le Scorbut., 12mo. Par., 1777. — C. de Mertens, Observations on 8vo. Paris, 1801.-J. C. Jacobs Traité du Scorbut en Par., appeared in the United States Squadron in the Gulf of See Braithwaite and Ranking's Abstract for 1848, '49, '50, haute, Ger. CLASSIF. See art. PERITONEUM, PLEURA, &c. p. 92, 105, et pluries.-E. Stanley and J. Paget, A Descrip- SHOCK, VITAL OR NERVOUS.-SYNON.- CLASSIF.-I. CLASS, I. ORDER (Author). DEFINIT.-Sudden or instantaneous depression of organic nervous or vital power, often with more or less perturbation of body and mind, passing cither into reaction or into fatal sinking, occasioned by the nature, severity, or extent of injury, or by an overwhelming moral calamity. 1. A shock, whether physical or moral, may present any grade of severity, from merely a slight but sudden depression of the vital functions to the rapid extinction of these functions. From its slighter forms, the powers of life react sooner or later, especially when judiciously aided; but its more intense states are either removed with great difficulty, or they proceed, with various rates of celerity, to a fatal issue; the vital sinking increasing more or less rapidly, and extending from the organs more strictly vital to all other parts-from the seat of injury to the solar ganglion, and thence to the heart, respiratory apparatus, brain, spinal chord, muscles, and senses -until the functions of all are extinVital shock varies, not only in severguished. 1. The pathology and discases of serous and synovial membranes have been so fully considered in the articles Peritoneum, PLEURA, BRAIN, MEMBRANES OF, that a description of the organic changes presented by these membranes would be only a repetition of what has been already stated under these heads. As respects these changes, whether those consequent upon the several states of inflammation, or those arising from constitutional causes or vice, and altogether independent of inflammation, I believe that they will be found to be more fully described at the places now referred to than any where else. Since these articles were written, the very excellent works of ROKITANSKY, and the able treatise of Dr. BRINTON on the pathology of serous and synovial membranes have appeared; but, after attentively perusing these, Iity and fatal tendency, but also somewhat in its find nothing that requires to be added, at this phenomena, according to the constitution and place, by way of appendix to the articles just vital energies of the sufferer, and the nature of enumerated. Indeed, there is one lesion, or rather ultimate change, consequent, in rare instances, upon chronic peritonitis and chronic pleuritis, lately seen by me in these maladies, which is not noticed by either of these writers, viz., the complete degeneration of the greater part of the organized exudation, false membranes, or adhesions produced by these diseases, as well as by chronic inflammation of the serous membrane of the spinal marrow, into fat. This ultimate change, observed by me in these three situations, in old or very chronic cases of these maladies, appeared to be not merely a far-advanced change, but also a reparative one, admitting of a partial return of the functions of the parts adjoining. (See art. PLEURA, ◊ 100.) 2. The contractions, also, produced in cases of chronic inflammation of the peritoneum, described by Dr. HODGKIN and myself, have also not been mentioned by these writers. (See art. PERITONEUM, 116.) 3. It is almost unnecessary to state that the organic changes met with in the membranes usually denominated serous occur also in those commonly termed synovial, their intimate structures being alike, although their connexions are different. the cause. 2. Although the effects of shock have been recognised by most observing persons, even by the uneducated, yet they have received extremely little attention from medical men; they have not been noticed, either in medical or in surgical writings, excepting very casually in some surgical works; and I believe that they are now treated of for the first time in a systematic medical work. It is necessary to distinguish shock from concussion; for, although concussion, whether of the head or of the spine. is generally attended with more or less of vital shock, still concussion concerns chiefly the functions of either the brain, or spinal chord, or of both, according as the injury is directed to either or both of these quarters. The severity and danger of shock depends not upon the amount of pain produced, but rather upon the suddenness and violence of the injury, relatively to the amount of vital resistance; for when a cannon The diseases of the CACUM and its Appendix were fully described, and their treatment pointed out in this work, long before they received any adequate attention elsewhere. Some years afterward. papers were published on that subject in the Transactions of the Medical and Chirurgical Society; and the learned author of these pa pers commenced with the veracious statement that the BIBLIOG. AND REFER. -See the Bibliography and Ref. subject had never engaged the attention of any previous erences to the articles PERITONEUM, PLEURA, and to BRAIN, writer, although the comprehensive article on the subject MEMBRANES OF, &c.; also, C. Rokitansky, Anatomie Pa- in this work is sufficiently extensive to make a small volthologische: transl. by C. H. Moore, vol. iii., p. 17, et seq.- ume, and it was then in the hands of many thousand W. Brinton, Cycloped. of Anatomy and Physiology, vol. readers. It is to be hoped that the present article may iv., p. 528.-G. Williamson, Catalogue of Preparations, &c., receive attention, but not quite similar attention, espe in Morbid Anatomy, &c., in the Museum of the Army Med. cially from surgical readers, whom it more especially inical Department, Fort Pitt, Chatham, 8vo. Lond., 1845,❘terests. "Sic vos non vobis," &c. |