A Treatise of the Scurvy

Front matter

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An inquiry into the Nature, Cauſes, and Cure, of that Diſeaſe.

Together with A Critical and Chronological View of what has been publiſhed on the ſubject.

Preface

T subject of the following sheets is of great importance to this nation; the most powerful in her fleets, and the most flourishing in her commerce, of any in the world. Armies have been supposed to lose more of their men by sickness, than by the sword. But this observation has been much more verified in our fleets and squadrons; where the scurvy alone, during the last war, proved a more destructive enemy, and cut off more valuable lives, than the united efforts of the French and Spanish arms. It has not only occasionally committed surprising ravages in ships and fleets, but almost always affects the constitution of sailors; and where it does not rise to any visible calamity, yet it often makes a powerful addition to the malignity of other diseases. It is now above 150 years since that great sea-officer, Sir Peter Hawkins, in his observations made in a voyage to the South sea, remarked it to be the pestilence of that element. He was able, in the course of twenty years, in which he had been employed at sea, to give an account of 10,000 ma destroyed by it. But I flatter myself, that it will appear from the following treatise, that the calamity may be prevented, and the danger of this destructive evil obviated: nor is there any question, but every attempt to put a stop to so consuming a plague, will meet with a favourable reception from the public.

It is a subject in which all practitioners of physic are highly interested. For it will be found, that the mischief is not confined to the sea, but is extended particularly to armies at land; and is an endemic evil in many parts of the world. This disease, for above a century, has been the supposed scourge of Europe. But how much even the learned world stands in need of farther light in so dark a region of physic, may appear from the late mournful story of the German troops in Hungary, the disaster in Thorn, and from many other relations in this treatise.

What gave occasion to my attempting this work, is briefly as follows.

After the publication of the Right Honourable Lord Ansons voyage, by the Reverend Mr Walter, the lively and elegant picture there exhibited of the distress occasioned by this disease, which afflicted the crews of that noble, brave, and experienced Commander, in his passage round the world, excited the curiosity of many to inquire into the nature of a malady accompanied with such extraordinary appearances. It was acknowledged that the best descriptions of it are met with in the accounts of voyages: but it was regretted, that those were the productions only of seamen; and that no physician conversant with this disease at sea, had undertaken to throw light upon the subject, and clear it from the obscurity under which it has lain in the works of physicians who practised only at land. Some time afterwards, the society of surgeons of the Royal navy published their laudable plan for improving medical knowledge, by the labours of its several members; who have opportunities of inspecting Nature, and examining diseases, under the varied influence of different climates, seasons, and soils. I then wrote a paper on the scurvy, with a design of having it published by them. It appeared to me a subject worthy of the strictest inquiry: and I was led upon this occasion to consult several authors who had treated of the disease; where I perceived mistakes which have been attended, in practice, with dangerous and fatal consequences. There appeared to me an evident necessity of rectifying those errors, on account of the pernicious effects they have already visibly produced. But as it is no easy matter to root out old prejudices, or to overturn opinions which have acquired an establishment by time, custom, and great authorities; it became therefore requisite for this purpose, to exhibit a full and impartial view of what has hitherto been published on the scurvy; and that in a chronological order, by which the sources of those mistakes may be detected. Indeed, before this subject could be set in a clear and proper light, it was necessary to remove a great deal of rubbish. Thus, what was first intended as a short paper to be published in the memoirs of our medical navy-society, has now swelled to a volume, not altogether suitable to the plan and institution of that laudable and learned body.

I cannot, however, upon this occasion, omit acknowledging with gratitude the many excellent practical observations I have been favoured with by some of its most worthy members; especially by the ingenious Mr Ives of Gosport; and Mr John Murray, an eminent surgeon at Wells, in Norfolk. Notwithstanding which advantages, I am sensible of many inaccuracies and imperfections in this performance. They are perhaps the more numerous, as it has been sent to the press sooner than was at first intended. There are, however, two things that may appear exceptionable, which I ought here particularly to mention.

The first is the plan of the work.

I am sorry to find myself under a necessity of offering what some of my readers may think very indifferent entertainment, and that at their setting out, in the critical chapters of the first part. But it was not easy to fall upon a method equally adapted to all readers: nor indeed is the arrangement of the several chapters a matter of any great importance. The order here followed, is that in which it ought to be perused by physicians and men of learning, who have made this disease their study, and are previously acquainted with former writings upon it. It was necessary, in order to prevail with some of these gentlemen to peruse the second part with less prejudice against me, to endeavour first to remove such objections as might arise from doctrines imbibed in younger years, in schools and universities. Others, who are not so well acquainted with the subject, I would advise to begin with the second part; which will enable them to form a better judgment of the first. The Bibliotheca scorbutica, or the collection of authors on the scurvy, is placed at the latter end of the book, as proper to be consulted in the dictionary-way. And it is to be remarked, that when, to avoid repetitions in the first and second parts, an author’s name is barely mentioned, recourse must be had to the Alphabetical Index; which points out the page where the title of the book referred to, or its abridgment in part 3. is to be found.

In the order of the chapters, the prevention of the disease precedes its cure: and the first being the most material, I have thrown great part of the latter into it; this method of treating the scurvy suiting it better than perhaps any other. It will appear, that in the plan I have pursued I had in view an author whose book has met with a general good reception, Astruc de morbis venereis; and were other diseases treated in like manner, it would greatly abridge the enormous, and still increasing number of books in our science.

What may be deemed by critics equally exceptionable with the order of the chapters, are some few repetitions. But in certain cases they were necessary, in order to obviate prejudices at the time they might naturally arise, and to inforce the argument.

As to the contents of the book in general:

In the first part, I have endeavoured, by a connected course of reasoning in the several chapters, to establish what is there advanced, upon the clearest evidence, confirmed by some of the best authorities; and have laid aside all systems and theories of this malady which were found to be disavowed by nature and facts. Where I have been necessarily led, in this disagreeable part of the work, to criticise the sentiments of eminent and learned authors, I have not done it with a malignant view of depreciating their labours, or their names ; but from a regard to truth, and to the good of mankind. I hope such motives will, to the candid, and to the most judicious, be a sufficient apology for the liberties I have assumed.

Dies diem docet.

The principal chapters of the second part, containing a description of this disease, its causes, the means of preventing and curing it, are also founded upon attested facts and observations, without suffering the illusions of theory to influence and pervert the judgment. For, that things certain may precede what is uncertain, the theory, and the inferences from it, are placed at the latter end.

In the third part, where I have given an abridgment of what has been written upon the subject by the most celebrated medical authors, and others, I have always endeavoured to express their sentiments with as much clearness and conciseness as I could. I have indeed through the whole aimed at perspicuity rather than elegance of diction, as most proper in a book of science. To know a disease, and to cure it, being the two things most essential to be learned; I have therefore transcribed the symptoms and cure of the scurvy from those authors, where they do not entirely copy from each other.

Part 1, Chapter 1

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I the first accounts given us of this disease, by Ronsseus, Echthius, and Wierus, it is surprising to find, not only an accurate description of it, but an enumeration of almost all the truly antiscorbutic medicines that are known to the world even at this day.

Ronsseus, who believed it to be the same disease that is described by Pliny, and is said to have afflicted the Roman army under the command of Cæsar Germanicus, observed, that in his time it was to be met with only in Holland, Friesland, and Denmark; though he had heard of its appearing in Flanders, Brabant, and some parts of Germany. From seeing some of those countries entirely free from this distemper, he was induced to ascribe its frequency in other places to their soil, climate, and diet. In order to prove which, he wrote his first epistle.

Echthius seems to be the first who gave rise to the opinion of its being a contagious or infectious lues. He was led into that mistake, by observing whole monasteries who lived on the same diet, and in the same air, at once affected with it, especially after fevers, which no doubt might become infectious in close and confined apartments. He imagined, therefore, that a scurvy might in a manner be the crisis of a fever, which as such he deemed contagious. But where Wierus transcribes the ſymptoms from this laſt author, (which he does almoſt verbatim), upon this occaſion he very juſtly differs from him. He obſerves, that the ſcurvy is not properly the criſis of a fever; but, like many other diſeaseſ, may be occaſioned after it by unſound viſcera, and a vitiated ſtate of blood. He imagines people were induced to believe it a contagious malady, by ſeeing many whole families alike affected; but this he aſcribed to the ſameneſs of their diet. He was however deceived (probably by the authority of Echthius) in thinking, that where the gums were putrid, the diſeaſe might be infectious: and accordingly makes it a doubt, whether in ſome parts of the Lower Germany, where it had lately appeared, it was owing to their diet, or to infection. But it ſhall be fully proved hereafter, that the ſcurvy is not contagious or infectious.

It may be proper to obſerve further, that Wierus had deſcribed the various and extraordinary ſymptoms of this malady, in ſo accurate a manner, that the ſucceeding authors for a long time did nothing more than copy him. It was a conſiderable time afterwards, when Solomon Albertus wrote a large treatise on this subject, wherein he assumes great merit to himself in discovering a symptom not taken notice of by any author, and which he had once or twice observed in this disease, viz. a rigor or stiffness of the lower jaw. However, Wierus still continued in the greatest esteem and reputation; and his book was deemed the standard on this subject, even till the time of Eugalenus, who gives it that just character, and refers to it almost entirely for the cure. He must be allowed therefore to have been a good judge of this distemper: and as he was a person of eminent learning, as well as probity, (which his writings on this and many other subjects sufficiently shew), his word may be relied upon, when he tells us, that in his time this disease was peculiar to the inhabitants of the countries upon the north seas: he had never met with it in Spain, France, nor in Italy; nor was it to be seen in the large tract of Upper Germany: and as to Asia and Africa, if ever it appeared there, it would no doubt be in such places as lay adjacent to the sea; where such a situation, and a gross diet, with the use of putrid water, might give rise to it, in the same manner as they do in the countries where it was endemic. These were not conjectures in our author; for he was a great traveller, and had visited all the places he talks of. A book wrote in those times by him, De præstigiis dæmonum, adds much to his reputation; as it shews he was neither so weak, nor credulous, as some later writers on the scurvy.

Brunnerus, who may be deemed the next judicious author after him on this subject, observed, that in his time, when the use of wine was become more common, the scurvy was not so frequent as formerly, even in those countries where it had been endemic.

Notwithstanding which, in a very short time after, we are surprised with accounts of this supposed contagious lues having spread far and wide. In less than thirty years after Wierus, Solomon Albertus, in his dedication to the Duke of Brunswick, after some very pathetic declamations on the vices of the times, observes, that he had met with the scurvy every where; and that it prevailed in Misnia, Lusatia, on the borders of Bohemia and Silesia, &c.

However, the disease as yet still retained the same face; the symptoms and appearances in it the same. For though this author (who practised in a place where Wierus says the scurvy was uncommon) had discovered one extraordinary symptom, before mentioned, sometimes accompanying it; and which certainly was but rarely to be seen, as it escaped the observation of every one but himself: yet in other respects, he, as well as his contemporary writers, gives us the same account of it as Wierus had done before; and particularly, that the putrid gums and swelled legs were the most certain and only characteristic signs of it.

But in eleven years after him, we are likewise acquainted by Eugalenus, with the surprising rapidity with which this contagious lues had made its progress over almost the whole world. And what is still more remarkable, the face of the disease was in a few years so much changed, that the putrid gums and swelled legs were no longer characteristical signs of it, as it often killed the patient before these symptoms appeared. And it is highly probable from the histories of above 200 cases of patients delivered in his book, wherein mention is made of the gums being affected in one person only, that such symptoms did now but rarely, if at all, occur.

This malady was also greatly increased in virulence, as he gives us to understand in different parts of his performance: all which he would persuade us to have proceeded from a very singular cause.

Its effects and symptoms were now various and innumerable: and it was also become a much more frequent calamity than it appears to have ever been formerly; at least, if we may take this author’s word for it, who upon this occasion expresses himself in very hyperbolical terms. And we must indeed allow him to have had a very extensive practice, since he informs us that he had seen almost innumerable patients afflicted with only one particular symptom of the malady.

But besides the natural reasons which he assigns, he is likewise pleased to introduce some moral considerations, to account for the great frequency and virulence of this distemper, and the extraordinary symptoms which he ascribes to it. In one place he attributes its irregular appearances to the operation of the devil. But in another, he thinks this new and surprising calamity sent, by divine permission, as a chastisement for the sins of the world. And as he really thought himself (as appears through the whole treatise) the most sagacious detector of this Proteus-like mischief, lurking under various and surprising appearances, he very religiously thanks Heaven for the important discovery.

Now, as this book has been often reprinted in different parts of Europe, has been recommended by the greatest authority, by Boerhaave to his pupils, by Hoffman, &c. and is looked upon at this day as the standard author on our subject; it may be worth while to inquire into the contents of it, as well as the merit of its author. And we shall begin with observing wherein he differs in his account and description of this disease, from all preceeding authors. For as to those who succeeded, they did little more than copy him. So that I shall have few remarks to make upon these, till we come to Dr Willis, who gives us a somewhat different account of its symptoms.

Eugalenus differs from all preceeding authors.

1st, In supposing the malady may be far advanced, before (what they judged) the most equivocal and uncertain signs appeared in it. “Thus, (says he), after a long continuance of the distemper, the patient has a constant languor, a numbness, a sense of heavy pain in his legs, or an acute pain in any part.” But such symptoms are by Echthius classed in a separate chapter, under the denomination of the remote signs common to this disease with others. And Forrestus, who had the greatest opportunity of being conversant with scorbutic cases, by living in a sea-port town, mentions them as the symptoms only of the approaching evil. He says, that upon their appearance he hesitated for some time, till the proper and peculiar symptoms of this disease appeared, viz. the putrid gums, &c. which put the matter out of all doubt. But Eugalenus supposes the scurvy often to destroy the patient before the appearance of these latter.

2dly, On the contrary, he supposes, that those symptoms which, according to all others, ap only in the last and most advanced stage of this malady, often occur in the very beginning, and without any other previous scorbutic sign; such as, frequent fainting-fits, atrophies, dropfies, &c.; which last are mentioned by Brucæus and others, as the consequences of the most inveterate and confirmed scurvy.

So that whereas formerly the malady had a regular progression of symptoms in its different stages, accurately related by Wierus and many others, it became in Eugalenuss time the most irregular and deceitful evil that we can well imagine.

3dly, Eugalenus differs from all preceeding authors in his description of many symptoms peculiar to this disease. Thus, scorbutic ulcers, according to him, are dry: whereas these ulcers are described formerly in this disease, as having quite a contrary appearance, viz. fungous, fœtid, &c. Also the dyspnœa in scorbutic persons, formerly most troublesome upon using exercise or motion, is described by Eugalenus with very different marks; as is the diarrhæa, and almost all the other symptoms.

4thly, He has ascribed to this disease many new symptoms, seemingly opposite to the genius of it; at least never taken notice of by any before him: though Dodonæus, Wierus, and many other writers, may be supposed to have had an opportunity of seeing it in its utmost virulence, when epidemic in the year 1556, in the places where they then lived; and where in all probability it has never since raged in such a degree. The symptoms he mentions, are cancers, buboes, ulcers of the penis, loss of memory, symptoms of the plague, &c.

Now, these different accounts and descriptions of the same disease, can be accounted for but in two ways.

This distemper must, in a very short time after the first accounts of it were published, have made an incredible progress, become an universal calamity, and assumed quite a new appearance and different symptoms. This was the opinion of Eugalenus; who, although he has given such a new and different relation of it, yet tells us expressly, it was the stomacacia of Pliny, the disease described by all other authors under the name of scurvy; with whom he agrees in aligning the same causes and cure. For which last, in particular, he refers us to these authors.

Or we may suppose, that this author might be mistaken, in thinking the disease he has described, to be precisely the same that was formerly known by that appellation: yet perhaps there may be found some analogy or resemblance betwixt what he deemed such, and the former accounts we had of the scurvy; so that they may be said to border on each other. Or at least he has given this denomination to a complication of various symptoms first described by himself; and thus has characterised under the name of scurvy, a particular disease, or class of diseases; in which he has been followed by succeeding authors.

Upon the first supposition, before we can give entire credit to him, and believe so great an alteration to have happened in this distemper, it is necessary we should know what grounds he had for his opinion, and what reasons induced him to believe, that so many diseases, various and opposite in their appearances, were nothing more than the scurvy lurking under these different forms. It is at least required, that there should have been in the effects or appearances of the diseases, some distant analogy or resemblance left; otherwise there will be a strong presumption that here he might be mistaken.

But instead of pointing out to us any such similarity or resemblance betwixt the diseases he has described, and the real scurvy as described by all others before him; he has fallen upon a most extraordinary method of proving their identity, by assuming for pathognomic and demonstrative scorbutic signs, such symptoms as had never been observed in the disease before; viz. such a state of urine and pulse as is entirely different from the description given of them by the most accurate writers

Now, upon a supposition that the pulse and urine, like the rest of the symptoms, had also varied in this distemper from their former appearances, it was then incumbent upon him to prove the identity of these diseases by other marks, and not by those symptoms wherein the disease differed from itself.

Besides the pulse and urine, which were to him the most demonstrative signs, he often mentions some other marks or diagnostics; upon which, however, he does not depend so much as on the former; though he often in

them to confirm the judgment he had formed of such diseases. And it may be proper, in justice to him, to take notice of them all; which I think may be properly referred to these two classes.

1st, Such symptoms as the before mentioned conditions of pulse and urine, that never were remarked in the scurvy by any but himself; and seem indeed more peculiar to other distempers; viz. recurring anxieties at the region of the stomach, under the diaphragm;—a ball in the throat;—a tumor moving from one part of the body to another;—retchings to vomit in the beginning of a fever.

2dly, Such as are common to this disease with many others; and which the authors who preceeded him, call the remote and doubtful symptoms; viz. an obtuse or dull pain of the legs, which he often mentions as a convincing proof of the scurvy;—dejection of mind; —being worse after purgatives;—a languor, rather than sickness;—a slow disease without any evident cause;—sometimes a vomiting, faintings, and a change of colour in the face;—an eruption on the face and breast in a fever;—nay, an eruption on the body after death, and not till then, he makes a demonstrative sign of the scurvy, or just at the approach of it.

But these diagnostics he seems to rely upon no further, than to corroborate the proofs he had from the pulse and urine.

Now, as these are the principal marks and diagnostics of the diseases described by Eugalenus; among which there are not to be found any of those symptoms which the authors preceeding him thought absolutely necessary to demonstrate the existence of the disease which they had described under the name of scurvy; and as Eugalenus assumed for demonstrative and constant signs of this disease, such as were never before observed in the true scurvy, nor are ever seen to occur in it at this day, as afterwards will be more fully proved: we must necessarily conclude, that he has described a different disease; which appears from his whole treatise, and will be further confirmed by what follows.

It is indeed surprising, in so extensive a practice as he pretends to have had, his book, that in containing 72 observations, and above 200 cases of different patients, given us by him or his editor, there is not mention made of one truly scorbutical case wherein the gums were affected, except in a very extraordinary and dubious relation of a clergyman; who contracted his indisposition by a costiveness, being accustomed when in health to have ten or twelve natural stools a-day; whom he cured by bleeding, and some antiscorbutics which he does not mention; and by restoring his belly to its usual lax state.

It is true, he maintains, that the scurvy often kills before it affects the gums or the legs. But is it credible, among such a number of patients as he treated in this disease, which in many places he tells us were almost innumerable, that in the before mentioned case alone the putrid gums were observed; which formerly, during the most virulent rage of this evil, and at this day, as shall be afterwards proved, is the most constant, chief, and characteristic symptom of it?

For a specimen of the questions he asked his patients, see p. 32. & 98. where he recapitulates all his diagnostics of scorbutic diseases; and it does not appear he ever looked for such signs.

He gives but one instance of the teeth being loose; where he observes there were much more demonstrative signs of the scurvy, viz. the pulse, urine, oppression on the præcordia, and faintings; adding it in the last place, as a symptom of the least moment.

He takes notice of spots as a sign of this disease, only in the scorbutic atrophy; though he produces but one very doubtful scorbutic atrophical case wherein they appeared.

We shall compare him in this respect once more with the authors who preceeded him. Reusnerus wrote but four years before him; and has collected into a volume of considerable bulk, almost all that had been written upon the scurvy. After describing the putrid gums and spots, he expresses himself thus. “These are the pathognomic signs of the scurvy, without whose appearance the disease cannot subsist.”

It may be said, that though the diseases were not precisely the same, yet Eugalenus under the same name has characterised a certain disease, or species of diseases, in which he has been followed by all other authors; and his successful cures, to which he so often appeals, seem to confirm it. This leads me to the only diagnostic which I have omitted to mention; being reserved for this place, as the most distinguishing characteristic of all the diseases described in his book, and which is to be met with almost in every page. It is there called Regula diagnostica generalissma, viz. its being a disease not properly described by the ancients: to which he often adds, its not submitting to the cure prescribed for it by these old authors.

He recommends the perusal of his book to such only as are conversant in the writings of the ancient Greek and Roman physicians; otherwise he observes they will never be able to distinguish old diseases from the new. The last of which, or what he imagined to be such, he has promiscuously classed, without any other distinction, under the general name of scurvy.

To give the reader the true idea the author had of the scurvy, by which he may be enabled to judge what particular disease, or species of diseases, he has characterised; it is precisely this.

He seems to have been of opinion, with an eminent physician of that age, who takes occasion from Solomons saying, there was nothing new under the sun, to assert, that all distempers were

the same formerly as at present. To this our author, however, makes two exceptions, in the pox and scurvy, (p. 250.); where he imagines that the one travels from the north, the other from the south; and that, upon their meeting, they communicate and intermingle their poison with each other. But he was entirely unacquainted with hysteric and hypochondriac ailments, and a train of others now going under the name of nervous. He knew very little of the rheumatism, rickets, and many others; which, if at all, have been very imperfectly described by the ancients. Hence, whenever such cases occurred, with this peculiarity, of not being described in ancient authors, he directly pronounced them scorbutic.