OF THE SCURVY.
Reading edition
The true Scurvy, attended with spungy fetid Gums of a livid Colour, with livid Blotches, and Ulcers of the Legs, and other Symptoms, began to shew itself at Bremen in January 1762; tho’ we had not the least Appearance of this Disorder in the Hospitals at any other Place, while I was with the Troops in Germany.
A great Variety of Disorders have been called by the Name of Scurvy: and the Disease has been divided into hot and cold; into the Acid, the Alcaline; and the Muriatic, according to the different Fancies of Authors, and the Causes they imagined it took its Rise from; but, from later and more accurate Observations, Dr. Lind has justly remarked, that the true Scurvy has been found to be the same in all the different Parts of the Globe, and to take its Rise from similar Causes; from Cold and Moisture, and living much upon salted Provisions, joined to a Want of fresh Vegetables, and of good generous fermented Liquors; and hence it is most frequent in low marshy Places in northern Climates, where there is a Scarcity of fresh Vegetables; and where the Inhabitants live much upon salted Provisions in Winter; and aboard of Ships in long Voyages or Cruizes, especially in the northern Seas; and hence this Disorder was so frequent at Quebec the first Winter it was in our Possession; and in some of the other Forts in North America, which were taken so late in the Year, that the Troops had not sufficient Time to lay in a Stock of Vegetables, and of fresh Meat to be preserved by the Frost[106]; but were obliged to live mostly on Ship Provisions.
It is observed, both at Sea and Land, that where the Scurvy rages, those People are least subject to it who are well cloathed; who live in dry Habitations, or lie in dry Births; who take proper Exercise, without being too much exposed to the Inclemency of the Weather; and who live well, and drink good Beer, Cyder, or Wine; as has been remarked by Dr. Pringle, Dr. Lind, and others.
At Bremen the Disorder was only observed among the Soldiers; not one of the Gentlemen belonging to the Hospital, or to the Commissariate, nor one of the military Officers, not even of the Serjeants, having the least Symptom of it. The Reason of its being frequent among the Soldiers was, that the Place is situated on a Plain naturally very damp; and the Soldiers were quartered in very low damp Houses; at the same Time, no Vegetables or Greens were to be bought in the Market; and fresh Meat, and other fresh Provisions, were at so high a Price, that the Soldiers could not afford to buy them; but were obliged to live on salted Meat, and salted Herrings, during the Winter; and what little Money they had remaining, they laid out on spirituous Liquors, which were sold cheap.
The Cure of this Disorder requires—living in a dry comfortable Place—good Cloathing—light Food of easy Digestion, such as good Bread, Panado, Milk, Whey, Broths made of fresh Meats—white Meats, with Greens, or other Vegetable, &c.—the Use of Liquors of the acid or acescent Kind, or the moderate Use of Beer, Cyder, good Wine, or weak Punch[107]—And, by Way of Medicine, gentle Purges, mild Diaphoretics; the free Use of acid or acescent Fruits, Lemons, Oranges, Apples, Pears, Currans, Grapes, &c. and of the antiscorbutic Plants and their Juices, as Succory, Endive, Water-Cresses, Scurvy-Grass[108], &c. on which a great Part of the Cure principally depends; and the Use of some of the strengthening Bitters[109], of which the Bark is not the least efficacious.
Bleeding is seldom requisite, except where there is much Heat or Fever; or a sharp Pain of the Side, or Difficulty of Breathing, or some Symptom of the like Kind; it is then sometimes necessary to take away some Blood: And in obstinate Cases, it is often found of Use to promote Sweats, by making the Patient, while in Bed, drink freely of warm Whey, or Sack Whey, mixed with the scorbutic Juices; or warm Barley Water, or the like, mixed with a small Quantity of the Antimonial Wine, or some other mild Diaphoretic.
And where the Patient is strong, and there is no Danger of Hæmorrhages, warm aromatic Baths have sometimes been found serviceable; but they are not to be used where the Patient is weak.
The first Time I saw this Disorder at Bremen, was in an old Invalid, James Long, who had come from Bristol to Embden, and from thence to Bremen. He was some Weeks in the Hospital before I discovered his Disorder to be the Scurvy. He at first complained only of great Weakness, and such a Giddiness, when he got out of Bed, that he could not walk, and of what he called flying rheumatic Pains of his Legs. He had no other visible Complaint; all which, I imagined, proceeded from Old-Age, and being worn out in the Service. At last, on the 25th of January, he complained of his Gums being sore; and, on examining him, I found his Breath fetid, his Gums swelled, soft, and spungy, his Legs covered with scorbutic Blotches, and other Symptoms, which evidently proved his Disorder to be the true Scurvy.
Upon which, I ordered him a low Diet, with the Addition of Greens for Dinner, and a Quart of Lemonade, with a Gill of Brandy in it, per Day, for his common Drink; and, by Way of Medicine, a Decoction of the Bark, with the Elixir of Vitriol; and, at the same Time, ordered his Gums to be scarified, where they were most swelled and spungy; and to be washed frequently with an astringent Gargle; and to be rubbed now and then with burnt Alum[110]. By these Means, in a Fortnight’s Time, his Gums became firmer, and his scorbutic Symptoms decreased. During that Course he took cold, and had a Stitch in his Side, for which he was blooded. The Blood threw up a very thin Buff, which was not of a firm Consistence[111]; the Crassamentum below was of a blackish Colour and of a loose Texture, and the Serum in a large Proportion. By the 2d of March his Gums had recovered their natural Firmness and Texture, and the scorbutic Spots and Pains of the Legs were gone, and he had recovered his Strength; the only remaining Complaint was a little Swelling about the Ankles, for which he continued the same Course, and took a Dose or two of Physic. By the 16th of March all these Symptoms were gone, and he was dismissed the Hospital free from all Complaints. I saw him well the last Week in May; and he told me, he had had no scorbutic Symptom since he left the Hospital.
In the Beginning of February, another of the Invalids, who had been in the Hospital for a Fever and rheumatic Complaints, had Blotches appear on his Legs, complained of great Weakness, and fainted away in attempting to walk; which made me suspect his Disorder to be the Scurvy; and, on examining him, I found his Gums soft and spongy, attended with the other Symptoms of the true Scurvy. I put him nearly on the same Course as in the last-mentioned Case: He used a low Diet, with the Addition of Greens for Dinner, which he eat with a little Butter and Vinegar; and he had a Quart of Lemonade, with two Ounces of Brandy, for his common Drink during the Day; and, by Way of Medicine, a Decoction of the Bark, with two Drachms of the confectio cordiaca to each Half Pint, which he took by Spoonfuls. Next Day he complained of a Pain in his Leg; and, on examining it more particularly, I found a large livid Blotch, yellow all round the Edges, on the fore Part, and a Tension all over that Leg. As he was so extremely low, as to be in Danger of fainting whenever he sat up, I was afraid lest a Mortification should ensue; and therefore ordered his Leg to be bathed Morning and Evening with a warm aromatic Fomentation, and a Poultice of Theriaca to be applied after it; and desired him to take as much of the Decoction of the Bark with the Cordial as possible; and allowed him a Glass of Mountain Wine every two or three Hours. By the Continuance of this Course for some Weeks, the livid Blotches, Pain, and Stiffness of his Leg, and most of the other scorbutic Symptoms, went away; his Gums were restored to their natural Firmness; and he recovered his Strength so much as to be able to sit up all Day long; though he still remained very weak when he was sent to England, in March.
In February and March, seven or eight more scorbutic Patients were sent to the Hospital I attended, who were all treated in the same Manner; and all did well. About the Middle of February this Distemper began to shew itself in the other Hospital attended by Dr. Miller, who treated the Patients nearly in the same Way, and they all recovered.
On the 5th of April, a young Man, belonging to the Eighth Regiment of Foot, came to the Hospital with all the Symptoms of the true Scurvy; his Gums were spungy and fœtid; he had livid Blotches on his Legs, and Contractions of the Hams, and a Stiffness and Hardness in the Calves of both Legs[112]. By following the same Course as the others, and the Use of frequent Fomentations, and rubbing the contracted Parts with soft Liniments, he mended daily; and, after taking a Dose or two of Physic, was dismissed perfectly recovered on the 10th of May. At his first Admission into the Hospital, he was taken with a severe Cough, attended with Pain of the Breast, and a Spitting of Blood for a Day or two, for which he was blooded. His Blood threw up a little Buff; the Crassamentum was of a blackish Colour and of a loose Texture, with a good Proportion of a yellowish Serum. This Bleeding relieved the Complaints of his Breast, and he had no Return of them while he remained in the Hospital.
The first Week in May four Invalids were admitted into the Hospital for this Disorder. The first had spungy Gums, a fœtid Breath, his Legs swelled and hard, and of a deep purple Colour. The second was a Case at first of a more doubtful Kind; there were no spungy Gums, though an offensive Breath; his Ancles and Feet were swelled, attended with Pain and Uneasiness, and a great Weakness and Lassitude; but no Fever, nor any livid Blotches. The Swelling of the Feet and Ancles seemed at first Sight rather gouty or rheumatic, than of the scorbutic Kind; but from the Man’s Way of Life, and the Disorder being so frequent, we discovered it to be the Scurvy. The third had a very fœtid Breath and spungy Gums, livid Spots and fungous Ulcers[113] on his Legs, with Pains and Weakness all over. The fourth had also spungy Gums and a fœtid Breath, Pains of the Legs and Arms, livid Blotches on his Legs, great Hardness and Contraction of the right Ham, and a livid hard Swelling on the Outside of the left Thigh, immediately above the Knee.
We treated them all four in the Method above-mentioned, adding a Mess of Greens to Dinner, giving Lemonade for Drink, and the Bark, with Elixir of Vitriol, by Way of Medicine. The Parts that were hard and swelled, were fomented, and rubbed with soft Liniments, and Poultices were applied to the hard Swelling on the Outside of the left Thigh; and the Ulcers of the Legs dressed with Digestives, and occasionally washed with spirituous Tinctures, and touched with Escharotics. Before I left Bremen, the first Week in June, the first and second Patients were perfectly recovered, and the third and fourth almost well. All of them had had the Disorder some Months before they came to the Hospital.