Scurvy

There are other facts which seem to show that too much is attributed by Dr. Trotter to fresh vegetables. Linnæus informs us, that the Laplanders are unacquainted with the scurvy ; they feed all the winter on the fresh flesh of the reindeer. This exemption of the Laplanders from the general distemper of the north , says Pringle, “is the more observable, as they seldom taste vegetables, bread 'never.' ( Cook 's Voyages, from 1772 to 1775. vol. ii. p. 376 .)

A discourse upon some late improvements of the means for preserving the health of mariners. Delivered at the anniversary meeting of the Royal Society, November 30, 1776. By Sir John Pringle, Baronet, President. Published by their order:

Pringle, John, Sir, 1707-1782.

https://quod.lib.umich.edu/e/ecco/004801344.0001.000/1:2?rgn=div1;view=fulltext

It hath been said, that the scurvy is much owing to the coldness of the air, which checks perspiration; and it is therefore the endemic distemper of the Northern na∣tions, and particularly of those around the Baltic*. The fact is partly true, but I doubt not so the cause. In those regions, by the long and severe winters, the cattle destitute of pasture can barely live, and are therefore unfit for use; so that the people, for their provision during that season, Page  10are obliged to slaughter them by the end of autumn, and to salt them for half the year. This putrid diet then, on which they must subsist so long, and to which the inha∣bitants of the South are not reduced, is the chief cause of the disease. And if we reflect, that the lower people of the North have few or no greens nor fruit in the win∣ter, little fermented liquors, and often live in damp, foul, and ill-aired houses, it is easy to conceive how they should become liable to the same indisposition with seamen; whilst others of as high a latitude, but who live in a different manner, keep free from it. Thus we are informed by LINNAEUS, that the Laplanders, one of the most hyperbo∣rean nations, know nothing of the scurvy*; for which no other reason can be assigned than their never eating salted meats, nor indeed salt with any thing, but their using all the winter the fresh flesh of their rain-deer.

This exemption of the Laplanders from the general dis∣temper of the North is the more observable, as they seldom taste vegetables, bread never, as we farther learn from that celebrated author. Yet in the very provinces which border on Lapland, where they use bread, but scarcely any other vegetable, and eat salted meats, they are as Page  11much troubled with the scurvy as in any other country*. But let us incidentally remark, that the late improvements in agriculture, gardening, and the other arts of life, by extending their influence to the remotest parts of Europe, and to the lowest people, begin sensibly to lessen the fre∣quency of that complaint, even in those climates that have been once the most afflicted with it.

It hath also been asserted, that men living on shore will be affected with the scurvy, though they have never been accustomed to a salt-diet; but of this I have never known an instance, except in those who breathed in an air that is marshy, or otherwise putrid, and who wanted exercise, fruits and green vegetables: under such circumstances it must be granted that the humours will corrupt in the same manner, though not in the same degree, with those of ma∣riners. Thus, in the late war, when Sisinghurst Castle in Kent was filled with French prisoners, the scurvy broke out among them, though they had never been served with salted victuals in England; but had daily had an al∣lowance of fresh meat, and of bread in proportion, though without greens or any other vegetable. The surgeon Page  12who attended them, and from whom I received this information, having formerly been employed in the navy, was the betterable to judge of the disorder, and to cure it. Besides the deficiency of greens, he observed that the wards were foul and crouded, the house damp (from a moat that surrounded it) and that the bounds allotted for taking the air were so small, and in wet weather so sloughy, that the men seldom went out. He added, that a representation having been made, he had been empowered to furnish the prisoners with roots and greens for boiling in their soup, and to quarter the sick in a neighbouring village in a dry situation, with liberty to go out for air and exercise; and that by these means they had all quickly recovered. It is probable, that the scurvy sooner appeared among these strangers, from their having all been taken at sea, and con∣sequently being the more disposed to the distemper. My informer farther acquainted me, that in the lower and wetter parts of that county, where some of his practice lay, he had now and then met with slighter cases of the scurvy among the common people; such, he said, as lived the whole winter on salted bacon, without fermented li∣quors, greens, or any fruit, a few apples excepted; but, he remarked, that in the winters following a plentiful growth of that fruit, those peasants were visibly less liable to that ailment.

Considering fresh meat, or the muscular part of animals, chemically, I see no reason why it should not be efficacious in preventing or curing the scurvy. Oxygene it contains, when raw , in a state of loose combination , though probably not in such large proportion as vegetable substances, even such as are not acid. I had noticed in travellers of great respectability passages that confirm this idea. The nations inhabiting the cold and dreary regions on the eastern shores of Asia , and the opposite coasts of America, seem to have learned from experience, that fresh, or at leaſt unsalted fish is a preventative of the scurvy, or a remedy for it .

Thus Dr. Pallas (Reise, iii. 47) describes the Ostiack Tartars of the Oby, as preparing their winter stores altogether without salt. “They are extremely apt, when disabled by age or infirmities, to become scorbutic. In winter they ravenously devour their frozen fish raw, a practice which the neighbouring Russians imitate , esteeming them a preservative against the 'scurvy.' (46.) 

Mr.Meares (Voyage, Introd. p. 30 .) speaking of an American tribe, says, “She made us sensible that the same disorder (scurvy) prevailed in her nation; and that whenever the symptoms appeared, they removed to the southward, where the climate was more genial, and where plenty of fish was to be obtained, which never failed to prove the means of their recovery.”

The reader will probably agree to consider the frozen as fresh fish. If it were possible to preserve meat on ship board, in this simple manner, one great source of the scurvy would probably be cut off. Cookery combines the oxygene anew; would our sailors eat raw animal food?

Dr. Lind, though he has full confidence in green vegetables, and affirms that the scurvy never can become a general, fatal, and destructive calamity, where they abound, and the proper method of treatment is known and pursued (p. 541.); he concludes from a number of comparative trials (p. 538), that certain patients in Haslar hospital in general grew better, notwithstanding they abstained altogether from vegetables.

"This strict abstinence from the fruits of the earth," says he, "was continued long enough to convince me, that the disease would often, from various circumstances, take a favourable turn, independent of any diet, medicine, or regimen ." We have nothing, I presume, to oppose in point of conclusiveness to such experiments made by a physician so intelligent and so experienced in this particular disease.

Among the Africans, of whose sufferings on board the slave ship Dr. Trotter has given so particular and affecting an history, corpulence seems to have been , as it were, the first stage of scurvy. “When a negro was becoming rapidly fat,'” says he, “it was no difficult matter to determine how soon he would be seized with the scurvy; so that corpulence seems here to have been the harbinger of the scurvy. Writers have been particular in noticing that this disease seldom or never produces emaciation. Dr. Trotter, upon whose information we may place full reliance , tells us, that having purposely inquired among his medical acquaintances in the navy, he did not find one who considered the wasting of the flesh or absorption of fat as a symptom congenial to scurvy . He immediately subjoins some observations of his own, that clearly indicate a connection between the scurvy and obesity (p. 98 , 99.). "In a corpulent state of the body,” he says, “the most hideous features of the disease are expressed; such are the bloated looks and countenance, & c. In a mess of midshipmen, who lived altogether on the ship’s fare, the only one he ever saw affected with the scurvy was a young man remarkably corpulent. From the whole of his observations it appears clearly that obesity predisposed his patients to scurvy, or rather was to them what cachexia is to dropsy.

SECT. III

Of the appropriate Treatment of the Diabetes Mellitus.

THE principles of the treatment, as established by our cases of the disease, by the view we have given of the proximate cause, and we may further add, by the general success, consist;

1. In the prevention of the formation or evolution of the saccharine matter in the stomach.

2. In the removal of the morbidly increased action of the stomach and in its restoration to a healthful condition. 

Whatever may be the cause of the formation of the saccharine matter, it is necessary to prevent it, as on its general stimulus in the system, and particularly on the kidneys, very general affections are maintained. Besides, the means employed to prevent such formation may tend to the removal of the morbid action of the stomach and lacteal absorbents, and the increased and altered state of the gastric fluid, on which its production probably depends. Animal food, and confinement, with an entire abstinence from every kind of vegetable matter, afford the general means ; but which may be facilitated by the daily use of alkalines, calcareous and testaceous substances. The quantity of animal food should be restricted, and given in as small quantities as possible to satisfy the stomach : see page 54. 

When the urine points out the absence of the saccharine matter, and at the same time its quantity continues more than natural, containing likewise more of the extractive matter in a viscid, or tenacious form, while the appetite remains keen, it may be presumed that the increased morbid action of the stomach is not removed. It becomes then necessary to exhibit the hepatifed ammonia, with an opiate and antimonial at night, and to continue them until the morbid condition of the stomach is removed; the marks of which are, a scarcity and high coloured state of the urine, with turbidness, furnishing on evaporation an offensively smelling and saltish tasted residuum, without tenacity, accompanied with a want of appetite and loathing of food. At this time the tongue and gums will be found to have lost their florid colour, and to have become pallid. 

When such a state occurs, exercise is to be enjoined, a gradual return to the use of bread, and those vegetables and drinks which are the least likely to furnish saccharine matter, or to become acid in the stomach, with the occasional use of bitters, &c. Should this period of the disease be overlooked, and the confinement and animal food rigidly persevered in, scurvy, or something akin to it, might be produced. That such might be the termination of Diabetes, the appearances which arose, more especially in Captain Meredith's case, render extremely probable. The gripings, and offensive stools; the oiliness on the surface, and the high colour of the urine; the foetid breath and saltish taste; the great latitude and heaviness, with indifference to either eating, drinking, or moving; were strong marks of a state approaching to scurvy.

When the disease has continued long, it may leave local effects, which may prevent the entire restoration of health ; the most ample form of which might be supposed to consist in mere dilatation, or enlarged capacity of vessels, as those of the kidneys; or in a habit acquired by long continued action. Our first case shows, that these, when the disease has not been of very long duration, may be soon removed. They may, however, prove one of the circumstances retarding recovery in such a length of disease as that of our second case ; but even in this, the kidneys very early partook of apparently their ordinary action. Dissection has shown some morbid condition or derangement of the mesenteric or lacteal absorbent glands, and some altered appearance of the kidneys. There may also arise some derangement of stomach structure, of pancreas, spleen, liver, and possibly of lungs. Such sequelae would probably be sooner and more certainly formed in scrofulous habits. Whenever they occur, recovery must be retarded, if not finally prevented. They, however, will not interfere with the actual removal of the diabetic disease. We suspected some affection of the mesenteric glands, and of the stomach, in our second case; but we are warranted in alleging, that want of steadiness in the patient solely prevented the complete removal of the complaint. The nature of its sequelae, or whether they will remain, so as to maintain a state of chronic disease depending on them for its cause, requires still to be determined. Of this determination we must now continue entirely ignorant, as the patient from unsteadiness died, and was not examined after death. 

These are the general means of treatment, and they will be found adequate to the most common circumstances of the disease. We think it, however, necessary to particularise certain cases and states of the complaint. The former, are those of short, or long continuance, acute or chronic in degree; the latter comprehend the progress and fleps of recovery. It is necessary to attend to these distinctions, as they must direct the remedies and regimen to be employed. 

When the disease has been of short duration, an entire use of the animal diet may be immediately pursued, with an abstraction of all vegetable food and fermented drink which may have been formerly taken. In this state of the disease it may be acute arid then the diet should be spare; blood-letting and blistering may be necessary, with the use of opening and diaphoretic medicines. But when the disease has been of long continuance, especially in persons advanced in years, and whose habits have been luxurious in point of living, it may be proper to regulate the plan of cure by gradually adopting the animal diet: see the case of the Gentleman of 77 Page 179 and Dr. Stoker's continuation, page 253. 

On the removal of the general symptoms, and the return of the urine to a natural condition, which may be ascertained by a comparative examination with the healthy standard of it, as described by Mr. Cruickshank, vegetable substances may be cautiously tried. In the selection of which, the preference should be given to those least likely to furnish sugar, or excite disturbance in the stomach. The urine should now be very frequently examined, and on any appearance of a return of the diabetic state of it, the animal diet must be again strictly renewed. In this way the diet must be varied, until we are certain not only of the removal of the disease, but of the disposition to it. In the prosecution of the plan much steadiness and perseverance are required. We have to lament, that our mode of cure is so contrary to the inclinations of the sick. Though perfectly aware of the efficacy of the regimen, and the impropriety of deviations, yet they commonly trespass, concealing what they feel as a transgression on themselves. They express a regret, that a medicine could not be discovered, however nauseous, or distasteful, which would superfede the necessity of any restriction in diet. 

The vegetable substances we have hitherto found the safest, in the change from the animal diet, are, broccoli, spinach, cauliflower, cabbage, and lettuce. These do not seem to furnish sugar when prudently used in the diabetic stomach, after a proper adoption of the animal diet ; but under certain circumstances they have been supposed to produce an acid urine : see the Cases of Mess. Houston and Thomas. When these vegetables have been safely taken, a return to a very small quantity of bread has reproduced the saccharine matter in the urine, and the general symptoms of distress, as thirst, &c. It becomes, therefore, a principal object in the treatment, to vary the articles of diet, so as to gratify the earned desire of the patient, without bringing on a return of the complaint.

Page 369:

During the winter of 1866-7, and following summer, Captain Libby, of our Telegraph Service, with nearly forty men, stopped at this inaccessible place. At Grantley Harbour, a good titation, and other houses (which have been left there), and portions of the telegraph line, were built by these men. It was, as before stated, the spot intended for the Bering Strait cable “landing” on the American side, and it has been already mentioned as the central point at which the natives of Kotsebue and Norton Sounds, and the neighbouring country, meet the Tchuktchis from the Siberian coast. Many whalers annually visit this harbour for trading purposes, and I expect to hear of a permanent white settlement being formed there. The experience of the earlier Arctic explorers, as of our telegraph men, shows that it is a good spot to winter in. Some of our men there, at one time very short of provisions, lived for months at an Indian village near Cape Prince of Wales. Supplies from the resources of the country were very uncertain. In 1866-7, the natives in the neighbourhood were almost starving, and were at one time reduced to boiling down their old boots and fragments of hide, in order to sustain life. “ Yet,” said a correspondent (a member of our expedition), writing from thence, “ the party under Captain Libby although without bread or flour for some weeks, escaped the scurvy entirely. The generally received opinion that scurvy is generated from want of flour, does not seem to be correct. At the station (Fort St. Michaers), where plenty of flour was received, and freely used, they wore afflicted with this disease; while at Port Clarence, where they were almost entirely dependent upon the resources of the country for some weeks, living upon walrus and seal meat, without flour or bread, no symptom of scurvy made its appearance.”

Page 293:

https://archive.org/details/in.ernet.dli.2015.37317/page/n293/mode/2up?q=Scurvy 

Some few of the workmen had suffered from frost-bite and scurvy. A propos of the latter terrible scourge, it is to be remarked, that our men at Port Clarence, the worst fed of all our parties, who had lived for a long time on a native diet of walrus and seal blubber, had not suffered from it at all, while those in Norton Sound, who got a fair amount of flour, &c., from the Russian posts, suffered severely from the disease.