The improvements which, at the suggestion principally of the late Sir G. Blanc, were introduced into the victualling of the navy at the end of the last century, and especially the free employment of lemon-juice, have banished this disease from our navy, though it is still by no means infrequent in the merchant service.
The use of salt provisions has been very generally regarded AA one of the most powerful exciting causes of scurvy. This notion, however, is not altogether free from error, for scurvy occurs even among those who never taste salted food. Such was the case with some of our troops quartered in the province of Adelaide at the Cape of Good Hope, among whom scurvy appeared in the year 1838. The men st that time had no hard duty to perform, and were supplied with fresh meat in abundance, but were deprived of vegetables. The annual occurrence of scurvy among the inmates of the lunatic asylum at Moorshedabad in India is an additional confirmation of the same fact. We may with more propriety refer the disease to the absence of vegetables' than to any directly injurious effects produced by salt provisions.
The greatest attention to ventilation was not found during Lord Anson" voyage to diminish the severity of the disease; and this circumstance, coupled with other facts, such as the non-occurrence of scurvy in the ill-ventilated houses of the poor in London, warrants the conclusion that impure air is not an exciting cause of scurvy.
Some facts have led to the supposition that cold and moisture tend much to produce scurvy, but Dr. Budd, in his able treatise on scurvy, in the' Library of Practical Medicine,' states that the men admitted with scurvy into the Dreadnought hospital-ship come almost exclu sively from the Mauritius, India, Ceylon, or China. The non-existence of scurvy at Venice, and in other similar situations, proves that moisture alone cannot produce the disease.
It has been asserted, but never satisfactorily proved, that scurvy is propagated by contagion; an opinion which is now usually regarded as erroneous.
From all investigations, we may conclude that there is one condition which never fails to produce scurvy in persona, however various their situations may be in other respects, namely, a prolonged abstinence from succulent vegetables or fruits, or their preserved juices, as an article of food. But we are hardly warranted in asserting, as some men of eminence have done, that a deficiency of vegetable food is the only cause capable of producing scurvy. A disease very similar to scurvy, which used to attack the negroes in the West Indies, was attributed to their liviug exclusively upon bananas, and its cure con sisted in changing their diet, and giving them fish and flesh to eat.
Bad nutriment, of whatever kind, will, according to M. Foderd, some times produce the disease, and Dr. Henderson, a naval surgeon, recently stated in a medical periodical, that he has seen scurvy occur iu persons who were taking daily doses of lemon-juice as a prophy lactic against the disease.
From these facts Dr. Garrod was led to suppose that the real cause of scurvy was some deficiency in the food which was supplied by vegetable diet. Having examined the constituents of food that pro
duced scurvy, he was led to conclude that such food was deficient in potash. Having aualysed those vegetable foods which prevent and cure scurvy, as potatoes, water tresses, cabbages and lemon-juice, he found in all these a considerable quantity of potash. It is difficult to test this theory by withholding vegetable food and administering the salts of potash to patients afflicted with scurvy. It has, however, this characteristic of a true theory, that it explains the phenomena of the cure of scurvy by the addition of fruits or vegetables to the diet.
It was at one time supposed that the citric acid of the' lemon-juice was the active cause of cure in cases of scurvy, and when this acid was separated it was substituted in the navy for the lemon-juice, but it entirely failed to arrest the disease.
Previous debility appears to predispose to scurvy, as does also an advanced age • the disease being rarest between twenty and thirty years of age, though it occurs more frequently between the fifteenth and twentieth year than in the succeeding ten years. The first symptoms of the affection are a change of the natural healthy com plexion to a pale or sallow tint, accompanied with pains in the legs and loins, great languor and despondency, and indisposition to exercise. The gums soon become sore, apt to bleed on the slightest touch, livid and spongy. As the disease progresses the debility becomes greater, the slightest exertion inducing breathlessness and palpitation, and the complexion assumes a brownish or clingy hue. The gums become more livid, and swell more,'so as sometimes to conceal the teeth, which drop out without undergoing decay. ilxmorrhage takes place from the lungs and from various internal organs, ecchymoses appear, and blood is effused under the akin in various parts, especially on the lower extremities and around the seat of any old injury. Iu the ham this effusion of blood is sometimes so considerable as to cause con traction of the knee-joint. Any wounds or ulcers put on an unhealthy appearance, and become covered with coagulated blood, and the slightest scratches degenerate into troublesome sores. In high degrees of scurvy, as in the case of Lord Anson'" sailors, old wounds break out afresh, and a broken bone will become disunited, although the fracture may have been consolidated for some time. With these symptoms there is not so much deraugement of the general functions as might be expected. The appetite usually continues good, though the patients are unable, owing to the state of their gums, to masticate their ordinary food; they sleep well, and the intellect is unaffected, though the spirits are much depressed. Scorbutic persons swoon readily, and not unfrequently die suddenly on making some more considerable exertion than usual.
If the disease should prove fatal, discoloured spots are found in many internal organs, while their tissue generally is of a paler colour than natural. The blood contains a leas quantity of red particles than usual, but they are not dissolved in the serum, as some have supposed. SCUTAGE. [Esectioe.]