THE Scurvy is a name given to so many disorders of the body seemingly of a different kind, that it may justly be said to be a manifold and complicated disease. The chief symptoms of it however are clearly described by several authors, which are such as these: the gums rot first; then the skin is defaced with livid and black spots; ulcers ensue, especially in the swelled legs; and these are with difficulty, if ever, cured. In the last stage of the distemper, even the bones become carious.
It is therefore very plain, that this malady is a kind of corruption of the blood, and the blood, and the whole mass of the bodily humors. This, when the cause is long continued, increases to a degree of putrefaction. All writers are agreed in their opinion, that it is a northern disease; imputing it to the cold and moist air of those climates, together with the use of stagnating and saltish waters, and the unwholesome food of hard, dried and salted meats. They therefore observe that it rages most, even to be, in a manner, universal, among the inhabitants of the Baltic sea, in Finland, Norway, Denmark, and the places adjacent to the Germanic ocean. And indeed not only the new Latin name, Scorbutus; but our English one too, is plainly made from the Saxon Schorbock or Schorbuck, denoting a griping or tearing of the belly (a).
This is the same distemper, which Pliny, from the ulcers in the mouth and legs, calls by the names of Stomacace, (or rather Stomocace) and Sceletyrbe; ascribing it to the drinking of bad waters; and for which, be says, the herba Britannica, which is our hydrolapathum or waterdock, was found to be a remedy (b).
But long before this Hippocrates (c) himself took notice of this disease, as a distemper of the Spleen, proceeding very much from cold, raw, and turbid waters.
Such is this distemper at land. At sea, in long voyages, it is much more violent; so far, that many are of opinion, that upon the two elements it is a malady of a different kind. But it plainly appears from comparing what has been said of that at land, with what I am going to mention of the same at sea, that the difference is only in the degree of malignity.
The history of the progress of this cruel enemy is so judiciously and exactly related in lord Anson's voyage round the world (d) when he came into the South sea, where his men were in a most terrible manner afflicted with it, that I cannot give a more lively description of it, than by taking out of this most entertaining and instructive book the most material circumstances, which occurred in its several stages. This I am the better enabled to do, because being incited by the extraordinary events to make a full enquiry into this whole affair, I have not only had the honour of discoursing with his lordship upon it, but have also been favoured with the original observations of his two ingenious and skilful surgeons (e), from which I have leave to transcribe whatever I find to my purpose.
The first appearances are much the same in the two diseases at land and at sea; but at sea they soon run to a much higher degree. Nothing is more surprising than the malignity of this, as it were corrosive, poison, exerting itself so far, that the scars of wounds, which had been many years healed, were often forced open again. Nay the callus of broken bones, which had been completely formed for a long time, was found dissolved, and the fracture seemed as if it had never been consolidated.
This malady as likewise accompanied with many other dangerous symptoms, particularly putrid fevers, pleurisies, the jaundice, an obstinate costiveness, and, at the latter end, a difficulty of breathing. This last was found to be the most deadly of the all: for it never was without such a faintness and weakness, that many expired upon the least motion, and endeavouring to get out of their hammocks, died before they could reach the deck.
Moreover, a strange dejection of the spirits, with shiverings, tremblings, and dreadful terrors on the slightest accidents, was so constant an attendant, that whatever discouraged the sick never failed to add new force to the distemper.
Such are the strokes of this compounded calamity; and many more might be enumerated: but it is time to proceed, and to inquire into the manner, by which they are produced.
It is certain, that such bad diet as has been mentioned, will corrupt the blood and humors; but nothing is clearer from the whole history of this voyage, than this, that the air is even more than any other agent, concerned in bringing on the mischief (f). It may indeed justly seem strange, that the writers of physick should not have observed so remarkable a cause; but they described the land scurvy only. Nay, so great was the efficiency of the aerial fluid, that even a warmer climate did not mitigate the scorbutic virulency; neither did fresh provisions, and plenty of wholesome rainwater avail; altho' these are certainly of great importance in preserving the body from the fatal disorder. Of so much consequence it is to resist the first approaches of an enemy.
Now the manner, in which the aforesaid causes act, is this. Whoever understands the use of respiration, and the way by which the several offices necessary to life are performed by means of it, will readily comprehend how the sea air acquires such noxious qualities.
To set this in a clear light, it must be observed, that air entering into the lungs does by its gravity and elasticity press upon the blood circulating in the vessels there. The effect of this pressure is twofold; first, a comminution and division of it into smaller particles; secondly, some subtle elastic matter passes into the blood, and exciting in it an intestine motion, disposes and prepares it for the secretions of several liquors, when, in its course round the body, it arrives at the glands contrived for the separation of such and such juices.
Whatever therefore alters this gravity and elasticity, makes the air unfit for the purposes, for which it was designed. In the first place, moisture weakens its spring; next, a combination of foul particles, such as are contained in the breadth of many persons crowded together, and some perhaps diseased; then, the filthiness of water stagnating in the bottom of the ship; lastly, salts imbibed from the sea, some of which may probably have proceeded from putrefied animals in that element, may insinuate themselves into the blood, and, in the nature of a ferment, corrupt its whole mass. Neither is it amiss to add, that the animal spirits themselves must necessarily partake of the vitious disorder of the fluid, from which they are derived. This is plain from that unaccountable faintness, and weakness of the body, and dejections of mind, which, as we have taken notice, accompany the other symptoms.
It is needless to shew how all the enumerated complaints, and indeed many more, may follow upon such a disturbed state of things, especially when the other mentioned causes concur. It may be very satisfactory to put down the observations, which the above-named surgeons made upon the blood of their patients, and upon the dissection of dead bodies,in the several stages of the distemper.
In the begining, as it flowed out of the orifice of the wound, ti [sic] might be seen to run in different shades of light and dark streaks. When the malady was increased, it ran thin and seemingly very black, and after standing some time in the porringer, turned thick, of a dark muddy colour, the surface, in many places, of a greenish hue, without any regular separation of its parts. In the third degree of the disease, it came out as black as ink, and though kept stirring in the vessel many hours, its fibrous parts had only the appearance of a quantity of wool or hair floating in a muddy substance.
In dissected bodies, the blood in the veins was so intirely broken, that by cutting any considerable branch, you might empty the part, to which it belonged, of its black and yellow liquour. When found extravasated, it was of the same kind. And lastly, as all other kinds of hæmorrhages are frequent at the latter end of the calamity, the fluid had the same appearance, as to colour and consistence, whether it was discharged from the mouth, nose, stomach, intestines, or any other part.
The effects we mentioned of the violence of the scorbutic humor being so malignant, as to open the scars of old wounds, and dissolve the calli of fractured bones, which had for a long time been formed, appear to many to be quite incredible; the rather, because, as they commonly say, a bone thus reunited is stronger in that part than in any other of the same joint. This indeed, I dare venture to affirm, is not true in fact. The case is thus: a callus is no more than a kind of cementation made by filling up the space between the broken ends of the bone, with the nutritious juice from the part. This, when nicely examined, is found to be more porous, and to have less solidity, tho' the bone often appears bigger than the part above and below it; the fibres are smaller, shorter, and not so regularly disposed as in the natural texture. In short, a callus is an imperfect ossification. For this reason, when the nutritious particles themselves have acquired a corrosive acrimony, they may, like a menstruum, work upon and break the texture of this superadded cement. Which is indeed a most surprising phænomenon.
It is proper after all to observe, as a confirmation of this reasoning, that although the callus is dissolved by the disease, yet upon the patient's recovery, it is gradually formed again, in proportion to his coming to a right habit of body. I have before me a remarkable instance of this kind. A sailor had one of his clavicles fractured in December, which was immediately reduced, and soon united. The dressing were taken off in January, and he made use of his arm as before. In the following April, as he was suspending his body by the arms, the same clavicle was disunited, and the callus gave way as at first. He at that time complained of some symptoms of the Scurvy; which daily increased till June following. At that time he was carried ashore at the island of Juan Fernandez. The bandages being removed, the fracture appeared in the same condition as when the accident first happened, without the least remains of a callus: notwithstanding the proper applications he could not use his arm, until the middle of October; the callus having continued more than three months in a flexible state. From that time, by the use of a vegetable diet, and living on shore, he gradually recovered from the distemper; the callus was confirmed, and his usual strength returned,
But it is time to come to the cure; which will be, first to prevent the attacks; and in the next place, to remove the effects of this virulent evil.
The first care to be taken is of the diet. And here I must take the liberty to make some observations upon the manner of victualling out ships. The trials already made, as I have been informed, of mr Lowndes's salt made from brine, prove it to be much preferable, for salting provisions, both flesh and fish, to that made from sea-water, even to the bay-salt. Some experiments of its use I have made myself; and our college, being consulted by the lords of the admiralty, gave their opinion in its favour. There is in this nothing of that noxious quality, whatever it be, which is always found in the marine salt, and cannot, by any known methods, be separated from it; and which, as we see, makes the sea air, as well as its water, unwholsome. And I cannot but say, that I am sorry to see some of our physicians, of late years, so fond of prescribing the drinking of it to their patients, particularly in scrophulous distempers. I am well assured, that it has sometimes brought on scorbutic symptoms, besides other mischiefs.
I must add, that if, instead of our salt-fish, stockfish, which is dried without any salt, were provided, it would be more wholsome. The Dutch do so; and also, in lieu of oatmeal, they put on board gort, which is, as I have been informed, a kind of barly ground; and is not so hot and drying as oatmeal.
I will here relate what that experienced and brave admiral sir Charles Wager, once told me in a discourse I had with him concerning the health of out seamen. He said, that one year, when he commanded our fleet in the Baltic, his sailors were terribly afflicted with the Scurvy: but he observed, that the Dutch ships, then in company with ours, were much more free from this disease. He could impute this to nothing but their different food, which was stock-fish and gort; whereas ours was salt-fish and oatmeal. He was then come last from the Mediterranean, and had, at Leghorn, taken in a great quantity of lemons and oranges. Recollecting, from what he had often heard, how effectual these fruits were in the cure of this distemper, he ordered a chest of each to be brought upon deck, and opened every day. The men, besides eating what they would, mixed the juice in their beer. It was also their constant diversion to pelt one another with the rinds; so what the deck was always screwed and wet with the fragrant liquor. The happy effect was, that he brought his sailors home in good health.
It is very commonly known, that, in our East-India ships returning home, the men are very much affected this way, and that upon their very approach to the island of St Helena, they are strangely relieved by the fresh odoriferous air; and perfectly recovered, after some days, by eating the fruits we have mentioned, and living chiefly upon the vegetables, which kind nature has supplied that place with in profuse plenty.
What has been said may serve for a very good proof of the reasonableness of the advice given some years ago, by out college, to the lords of the admiralty, viz. that a quantity of wine-vinegar should be allowed to the company of every ship. This qualifies the salt of the food, and makes some amends for the want of subacid fruits. But I must remark, that the vinegar of strong beer has neither the flavour not the virtue of that from wine; and out indeed to be forbidden our tables.
I shall conclude what I have to say with regard to feeding on herbs, in the Scurvy, with a remarkable relation, contained in a book published, not many years since, by a Dutch physician, on this subject (g). A sailor, in one of the Greenland ships, was so intirely broken, and disabled by this disease, that his companions, when the fishing was over, put him into a boat, and sent him ashore; leaving him there to perish, without the least expectation of recovery. The poor wretch had quite lost the use of his limbs; he could only crawl about upon the ground: this he found covered nothing else to support life, he, continually grasing like a beast of the field, plucked up with his teeth. Every country is, by the bounty of providence, provided with antidotes against the diseases, to which its inhabitants are chiefly liable. In a short time, he was by this means perfectly recovered to his strength, and after his return home, related the fact to this writer. It was soon after observed, that this herb was cochlearia, or scurvy-grass. Some of it was, for inquiry's sake, brought over hither in pots, and was found to be somewhat different from that of our country, being more mild, and not so pungent and sharp.
Thus much for the vegetable diet. I must add, that besides the herbs and fruits mentioned, there are many others very wholsome in this disease. Some like cochelaria, of a subtle and volatile juice, as the nasturtium, beccabunga, or brooklime; others more cooling, and therefore more proper in hot constitutions, or feverish hearts, as sorrel, endive, lettuce, purslain; &c. And indeed, I think it will be best to join in use the hotter with the colder, that they may qualify each other; especially, because the acid fruits were found, in lord Anson's voyage, to be of most extraordinary benefit (h).
Neither ought it to be omitted, that milk of all kinds, when it can be had, and its whey, which may be clarefied with some of the herbs now named, is an antiscorbutic food and physic.
But, as the design of this discourse is to demonstrate the usefulness of the preceding machine, it will be right to add some illustrations and observations to those I formerly made in my paper read before the royal society, and reprinted in mr. Sutton's book (i).
I have already taken notice, that the reason why the writers upon this disease have not ascribed it more to the air, than they have done, must be, because they were more acquainted with it at land than at sea. Now, it is very plain, that as the hurtful qualities of the sea-air must be hightened by its being closely confined, without due circulation, particularly when it is also saturated with effluvia from the breath of many persons almost stifled up together; so the continual shifting and changing of this element, must of course be attended with great advantages, nay such perhaps, as one unacquainted with the nature of things, would hardly be brought to believe. But I refer to my mentioned paper, and mr Sutton's additions.
I must lastly remark, that it is almost incredible how soon the sick, even tho' just dying, begin, when brought ashore, to feel the salutary effects of the land: for whereas the admiral had buried twenty-one men in two days before his arrival at the island of Tinian; yet he did not lose above ten, during his two months stay there (k), For so healing, and contrary to the malignity and bad qualities of the sea-air, was that of the land, that the patients, even upon their being exposed upon the ground, immediately recovered.
But it may seem still more marvellous, that the vapor of the cold earth itself should also contribute to their speedy recovery. Lord Anson told me, that one of his men, who rowed the boat ashore, was so weak, that he fell down at the oar almost dead: when landed the poor man desired his mates, that the would cut a piece of turf out of the soft ground, and put his mouth to the hole: upon doing this, he came to himself, and grew afterwards quite well. This puts me in mind of what I have formerly seen done by the boys on shrove-tuesday, the too cruel anniversary martyrdom of cocks; when one of these creatures was knocked down and expiring, it was sometimes brought to life again, by instantly putting its head, for a short time, into a fresh-made hole in the earth.
This sudden good effect of fresh air affords a plain proof of what we have before said, that, besides the blood, the animal spirits themselves are very much affected in this disease: for such immediate relief could only be given by the means of this active fluid, the main instrument of all vital motions. And as the protracting this advantage in the open air is the cure at hand; so the making a constant circulation even of that, which is not so wholsome, in the ship, must do a great deal towards the prevention of the distemper.
R.M.
The END
(a) Vid. Eugalen. de Scorbuto, & in primis Sennert. Lib. iii. Part v.
(b) Nat. Histor. Lib. xxv. Sect. vi.
(c) De internis Affection. Sect. xxxiv. & de Aërib. Aquis & Locis. Sect. x.
(e) Mr. Ettrick and Mr. Allen.
(g) Observationes circa Scorbutum, auctore Johanne Fred. Backstrom. Lugduni Batavor. MDCCXXXIV. 12mo. p. 8.
(h) See Voyage, pag. 117, and also pag. 308.
Samuel Sutton: An Historical Account of a New Method for extracting the foul Air out of Ships, &c.; with the Description and Draught of the Machines, by which it is performed: In two Letters to a Friend, by Samuel Sutton, the Inventor. The Second Edition, to which are annexed two Relations given thereof to the Royal Society, by Dr. Mead and Mr. Watson: and A Discourse on the Scurvy by Dr. Mead.
J. Brindley, London, 1749. pp 93-120.
Transcribed by Lars Bruzelius.
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