AN 
INAUGURAL ESSAY
ON
SCURVY.
SUBMITTED TO THE EXAMINATION OF
THE
REV. JOHN EWING, S. T. P. PROVOST,
THE
TRUSTEES, AND MEDTCAL FACULTY OF THE
UNIVERSITY OF PENNSYLVANIA.
On the 22d day of May, 1798,
FOR THE DEGREE OF DOCTOR OF MEDICINE;
By JOHN CLAIBORNE, 
OF VIRGINIA, 
Member of the Philadelphia Medical and Chemical Societies.
PHILADELPHIA:
PRINTED BY STEPHEN C. USTICK,
1798. 

  

TO 
BENJAMIN RUSH, M. D.
PROFESSOR OF THE INSTITUTES AND CLINICAL 
MEDICINE,
IN THE UNIVERSITY OF PENNSYLVANIA;
SIR,
MANY considerations point out the propriety
of dedicating to you the following production. Besides
the debt of gratitude due you by all the Republic of
Medicine, for the many and important services you
have rendered the science, which as an individual I
feel very forcibly, obligations of a superior nature
demand this tribute of respect from me. As a Pre-
ceptor and Teacher, from whose private as well
as public instructions, I have derived most of the
principles, which are to conduct me in the arduous
task of alleviating the sufferings and afflictions of
humanity, I am peculiarly indebted to you.
In the hasty and undigested performance to which
your patronage is requested, you will discover an
humble attempt to follow the principles, so success-
fully pursued by yourself in explaining the nature of
Scurvy. I am sorry it is not more worthy your
attention; but am confident that your goodness will
induce you to look with an indulgent eye on all its
imperfections, and make those allowances which it
so much requires, and the occasion itself points out. 

iv 
Whatever may be your opinion of its merits, I
beg you to accept, Sir, the warmest wishes, for the
long continuance of your health, and successful
labours for the advancement of medicine, and the
medical character of our common country, which
will ever predominate in the breast of
Your affectionate
And grateful Pupil,
THE AUTHOR. 

TO
ROBERT WALKER, M. D.
OF VIRGINIA.
THIS Essay is respectfully Inscribed, not only
in consideration of his high merit as a Gentleman,
a Friend, and a Physician, for which he is so justly
esteemed by all his acquaintances; but also as a
grateful tribute of thanks for the valuable Instruc-
tions, and many marks of friendly Attention,
bestowed, while he had the direction of the early
medical pursuits of his
Affectionate Pupil,
And much obliged friend,
THE AUTHOR. 

 

Introduction. 
THE subject of the present Dissertation was
chosen, not for the great connection it has with the
immediate interest of this country, although the
increase of our trade to distant quarters of the globe
may, probably, render it an object of more concern
in a short time; but from the difficulty of finding
another, which has not already been so much
hackneyed, both in Inaugural Dissertations, and in
those of men of the first reputation in the medical
world, as to have become uninteresting.
Notwithstanding much also has been said on
Scurvy, and many different proximate causes have
been assigned, none of them appear to be entirely
accurate; and an attention to that part of the
subject, not yet sufficiently attended to in any publi-
cation, shall be a principal object in the following
observations. I shall follow my preceptor, Dr.
Rush, who has lately made it a slate of fever *.
Perhaps further investigation may be thought by
many of little importance, as the just knowledge of
the cure of the disease has arrived at the utmost extent
of success, to which we can well look forward; but
even to these it may not be disagreeable to trace, in
* MS. Lectures. 

viii
the present instance, the uniformity and simplicity of
Nature in all her operations.
For the history of the symptoms, and all the facts
contained in the following sheets, I am indebted to
the different authors who have treated on this
subject. I am not conscious of having mistated them
in any respect; and if I have been so unfortunate, it
was without such an intention, and an indulgent
public will attribute it to the short time I have been
able to devote to the subject, and not to any want of
candor. 

Essay on Scurvy.
IT is necessary to premise that in treating of
Scurvy, I shall not enter into the many trivial dis-
putes, which have so much, and so uselessly engaged
the attention of some of the Physicians who have
written on the subject. I shall, however, just mention
one or two of the points, on which there has been
a diversity of opinion. Among these, researches
into the antiquity of the disease have had no incon-
siderable share of industry and ingenuity bestowed on
them. Some have traced it back to the time of
Hippocrates, while others deny that any traces can
be found in his writings sufficient to fix their belief
in the assertion that it was known to him; and the
contest is not yet decided. But as it is a matter of
no practical importance to determine it, I shall very
easily be excused for passing over, without attempting
to add to the uninteresting pages of the dispute.
The fruitful genius of Pathologists has not been
idle in distinguishing this, like all other diseases, into
a number of species, varying they supposed from
different circumstances, not necessary to be mentioned
here; nor has any thing been established on this
point, as the standard of opinion, until within this
B 

10
last half century. It appears however to be gene-
rally agreed on at present, that it is the same disease
in every situation, whether at land or sea, differing
only in degree from the greater or less violence of
the causes producing it, and requiring the same
method of cure. But without further notice of
these subjects, I proceed to the history of the disease
under consideration.
HISTORY.
IT is not intended, in this place, to give a very
minute and circumstantial account of all the symp-
toms of Scurvy, in the precise order of their appear-
ance, but merely a brief view of the most common
and important phœnomena, which present them-
selves, as collected from the writings of Boerhaave,
Lind and others; and should any person wish more
accurate information on this head, I beg leave to
refer him to those authors.
Some physicians have called this a disease of cold
climates principally, and there is, no doubt, reason to
think them most favorable to the production of it;
but fatal experience has demonstrated, that it may
arise and prevail in any climate, by the concurrence
of causes hereafter to be enumerated.
The first appearance of this malady is announced
by the occurrence of a state of debility, in which
the patient complains of unusual languor and lassi-
tude, which is most remarkable after sleep, with 

11
aversion from motion, the countenance assuming a
pale, sallow, and bloated appearance. The respira-
tion soon becomes difficult, and from a little exertion
of body, a total suspension of that function is threat-
ened. The knees grow stiff and feeble, and walking
is performed with difficulty, from the pain which
attacks most of the muscles, but principally those of
the legs. The gums swell and bleed upon the least
friction. On inspection they appear spongy and
livid, and in the course of the disease, fungous and
even putrid. Very early the breath is considerably
fœtid, but when the complaint has advanced, the
stench is not only extremely disagreeable, but almost
insupportable. Hæmorrhages take place from vari-
ous parts; in the beginning they are trifling, and
chiefly from the nofe; but in the progress of the disor-
der, they proceed, not only from the surfaces, which
are most subject to hæmorrhagy, but also from the
skin itself, even where there is no sore. The skin
is often dry and rough, but generally smooth, and
shining spots of various colours and sizes appear on
it, chiefly on the lower extremities and rarely on
other parts. They are reddish and blue, or black
and livid.
Wandering lancinating pains encreasing by night
infest both the external and internal parts of the
body, scarcely any being exempt. The head in-
deed does not suffer so much as other parts, except
when there is considerable fever; but of all the
body, the breast most.—It is not long before the legs
and ancles become tumefied towards evening, the
tumefaction at first disappearing before morning; 

12
but at length they are more permantly affected.
The tendons of the hams contract, and the muscles
of the legs harden. Foul ulcers form on different
parts, but principally on the legs. These are ex-
tremely obstinate, and refuse to yield to all external
applications, and upon pressure readily become gan-
grenous. They do not afford a good pus, but a
thin, fœtid and ichorous discharge mixed with blood,
which presently assumes the appearance of blood
coagulated on their surface. Their edges are gene-
rally very livid. After some time they shoot out a
bloody fungus, which, on being destroyed, returns
again very speedily. They affect particularly parts
that have,been previously debilitated by a bruise,
wound, or ulcer.
The disease running on in this way, all the symp-
toms encrease. The gums ulcerate and form large
fungous granulations. The teeth are loosened in their
sockets, so as nearly to prevent any food being taken,
at least with ease, except such as is liquid. The
patient often loses the power of moving his limbs.
Frequent languors attack him, and after long con-
finement, he is subject to faint from the least
motion. Some, from hidden exposure to fresh air
immediately expire, and such is the state of debility,
that a violent noise will often produce instant death.
The state of the bowels in this complaint is very
various. Sometimes they are natural, sometimes
costive, and in other cases very loose, accompanied
with pain and a discharge of blood. 

13
From the beginning, the appetite is good, and
even in the latter stage it is not much impaired.
There have even been instances of death taking
place while the patient was in the act of mastica-
tion. The senses remain perfect, except that the
spirits are generally low.
Towards the conclusion of this disease a dyspnœa
takes place to a very violent degree, attended with
tightness and oppression of the bread, which often
terminates life very suddenly. The most general
fatal termination is, in other diseases, or more pro-
perly in symptoms ascribed to them.
The date of the pulse in this disease is very various,
and, indeed, it is hard to collect any thing satisfac-
tory on the subject, as there is considerable difference
of opinion as to the nature of the complaint; some
authors, among whom Van Swieten and Dr. Lind
stand foremost, doubting, and even denying, that
there is any fever essentially necessary for the produc-
tion of scurvy, alledging that the fevers which some-
times attend it are merely adventitious. This does
not appear to have been the opinion of older writers,
or even of Boerhaave, and I hope that hereafter,
when I come to treat of the proximate cause, I shall
be able to prove directly the reverse. But of this,
more in a more proper place. In the mean time the
date of the pulse would seem, as before observed, to
be different in different cases. Wierus says that it
was either small, hard, quick, or weak, and Dr.
Donald Monroe gives us a case in the London
Medical Transactions, in which it was so active as 

14
to require several bleedings, being as he expresses
himself, "quick, full, and strong." From the
whole however which I have collected, in the most
common cases, where they proceeded slowly and
regularly, the pulse, in the beginning, has been very
little different from that of health, except being a
little more feeble, slow *, and irregular, and, according
to the stage of the complaint, becoming still more
weak and unequal. It is proper to remark, that
fixed determinations on this point must be liable to
exception from a variety of causes.
The appearance of the blood drawn in this desease
is various. Dr. Lind did not find it differ much
from what is natural in the beginning. It was some-
times covered with a buffy coat, and sometimes it did
not separate into serum and crassamentum, and had a
florid appearance. Kramer says, that in his practice
the blood did not separate, but was covered with "a
white greasy film." Some speak of it as being
dissolved, but Rouppe never saw it so except in one
case, in which he says it was combined with yellow
fever †. The texture of it however, even when it
does not separate, is easily broken down, and this
is analagous to what we should expect.
A number of respectable writers, and among these
the justly celebrated Boerhaave, have considered
scurvy as contagious; while, on the other hand,
* Many of the old writers speak of the pulse as being quick,
hence the propriety of not being positive. 
† Rouppe on Diseases of Seamen. 

15
the experienced Lind, whose opinions are always to
be regarded, has given a different testimony; and
other gentlemen of credit have concurred with him.
But, although it is, without doubt, not so universally
and certainly entitled to the appellation, as Boerhaave
supposed; yet Dr. Lind's opinion appears to have
been formed upon a survey of what is most common,
and his conclusion of course too general, since there
are not wanting facts, which would seem to prove
that under certain circumstances it may be contagious,
and the case of a Guineaman in the inhuman and
disgraceful Slave Trade, mentioned by Dr. Trotter *,
in which the first slaves that were taken on board,
although numerous, remained some months before
they became afflicted by it, whereas those who came
on board after it had prevailed for some time, were
attacked in a few days, is very much in support of
that supposition. Other cases might be adduced to
the same effect, but it is unnecessary; and from
every view of the subject, it is presumed that there
is nothing very inconsistent in the belief, that the
effluvia arising from persons violently affected by
the disease, may assist in the production of it in
others.
REMOTE CAUSES.
In enumerating the remote causes of Scurvy, I
feel no hesitation in placing at the head of the
catalogue,
* See Trotter on Scurvy. 

16
1st. An impure atmosphere.
2d. Peculiar kinds of diet.
3d. Too long an abstinence from vegetable food.
4th. Too great a degree of idleness or a want
of due exercise.
5th. Depressing passions of the mind.
6th. Spiritous liquors.
7th, and lastly. All the remote causes of fever
in general.
Some of these are strictly and properly exciting
causes; but as a distinction is often difficult, and
sometimes impracticable between remote and occa-
sional or exciting causes, I shall not be accurate in
separating them.
First, then, Of an impure atmophere.—It would
be sufficient to know the immense and all powerful
agency of certain dates of the air, as yet not clear-
ly defined, in the production of the long train of
maladies, which affect mankind, to conclude that in
this case also, it must have considerable efficacy.
We are not however, left to reason on this subject
from analogy alone, and without any other con-
ductor. The important conclusion rests on a more
solid and substantial basis. Repeated experience
has fully ascertained that certain dates of the 

17 
weather, whether of moisture and cold, or moisture
and heat *, have great influence over this complaint
among soldiers and seamen. Dr. Lind has furnished
us with a number of instances of this morbid state
being produced as well as increased by cold and
moist weather, and one case particularly, where
there was a plentiful supply of fresh provisions, to
which so much has been attributed in the preven-
tion of it. Dr. R. Robertson gives us the case of a
ship in which, after leaving a warm and moist climate,
where the sailors had been much afflicted with Scurvy,
and getting into one more dry and cold, they expe-
rienced the most eminent relief, and convalesced upon
the same diet, they had before been using †.
These sensible qualities or the atmosphere certainly
give a predisposition to disease in this as in other
cases; but it seems very probable, that weather of
the kind above mentioned is most prejudicial to
seamen by earning vessels to be kept more close, and
less ventilated, than in good weather, thereby ren-
dering the air very impure and unfit for respiration.
—Of the pernicious effects of the confine a air of
jails, ships, &c. little is requisite to be said. The
vitiation is sometimes so considerable in vessels, as to
produce death immediately by suffocation, as we are
* Whether cold and heat, alone and of themselves, without the
aid of moisture, are equivalent to the originating of Scurvy is a
question, in the solution of which we have not so many satisfactory
testimonies to assist us; but it is imagined that either of them may
be competent to produce a state of predisposition to it.
† See his Inaugural Dissertation, Edinburgh, 1765.
C 

18
assured by Surgeon Renwick and Dr. Blane. Some-
times, when not quite so considerable, it destroys newly
impressed seamen in forty eight hours after coming
on board, and very commonly gives rise to a violent
and malignant fever. The injurious effects of an
impure and foul atmospere, are very clearly exhibited
in the case of the Guineaman above noticed. I
might here go on to enumerate the instances on
record of impure air in the holds of ships occasioning
this disease, but it would exceed the limits prescribed.
I cannot, however pass unobserved the so much
talked of marsh miasma. On this subject there are
several observations meriting attention. The first is
made by Lind, who has asserted, that in low fenny
situations, persons living in the upper part of a
house are less subject to the disease, than those who
occupy the lower floor and cellar. It is also said to
prevail in the neighbourhood of rivers that have
overflowed their banks; and for this reason was
formerly very common in Holland, where they
suffered frequent inundations. It was once preva-
lent in the vicinity of a lake in Germany, and was
very distressing; but since that lake has been dryed
up, it has entirely disappeared. Stronger evidence
of a fact so notorious, and important cannot be
wished or expected. The epidemic Scurvy in Hamp-
shire in England *, probably owed its existence to
marsh miasma. Perhaps also, there might have
been something of contagion in this case.
The precise nature of those impurities, which,
existing in the air, give rise to Scurvy, is not known.
* See Lind's Book on Scurvy. 

19 
They are probably various, and essentialy different
from each other, operating as I suppose, by a stimu-
lant power, which, under different modifications and
a difference of circumstances, produces all the peculiar
effects which present themselves. The very ingenious
Dr. Beddoes has attempted to account for all the
symptoms of the disease, by supposing an abstraction
of oxigene from the system, by which he thinks he
can explain every thing respecting it *. He has,
indeed, reasoned ingeniously, and deserves great
credit for his attempt to apply the present elegant
theory of chemistry to the explanation of the morbid
appearances and phœnomena in the animal œconomy;
but although I look forward with pleasure for the
time, when a happy application of chemical principles
will astonish the world with more perfect explanations
of the known, and detection of the at present
unknown, laws of animated creation, I cannot think
his theory sufficient for the present purpose. I will
not deny, nay, I think it probable, that in the course
of the disease the system may become incapable of
taking in so much of that vital principle as is necessary;
but cases have occurred, where no such curcumstance
as a defect of oxigene could have existed, and we
are obliged to recur to other causes. Besides, it has
been clearly and unequivocally proven by experi-
ment, that fixed air, which we may very naturally
conclude to be present in a very considerable
proportion in the confined births and hold of a ship,
does prove deleterious by a stimulant quality, if not
entirely, yet very materially; nor will it be spinning
* See his Observations on Scurvy, &c. 

20
our reasoning too far, or to a degree unwarrantable,
to suppose that other contaminations of a badly
constituted atmosphere act in a similar manner; and
the matter is reduced almost to a certainty that is
unquestionable, by a consideration of the conse-
quences arising from exposure to them, but which
need not be detailed in this place.—I cannot leave this
subject without observing, that impure air has a most
decided pre-eminence over all other causes in pro-
ducing the complaint, as appears from a mass of
proofs too numerous to mention. Much has been
said of. 
Secondly, Peculiar kinds of diet.—Among these,
most has been charged to the use of salt meats. The
immortal Dr. Cullen has indeed attributed the dis-
ease almost entirely to the long use of salted provi-
sions. Dr. Lind and several others of respectability
deny that it is owing to the meat being salted, but
rather to a degree of vitiation or corruption, which
it differs from long keeping and bad preservation,
thereby becoming unfit for nutrition, by not afford-
ing sufficient nourishment to the body. From seve-
ral trials, salt exhibited in form of sea water has ap-
peared rather beneficial that otherwise to scorbutics,
and the experience of the inhabitants of several
countries, who use a large proportion of salted
meats, and among these I would mention some of
my fellow-citizens of Virginia and other southern
states, whose food is principally of that kind, and
who nevertheless, are not peculiarly disposed to
Scurvy, is strongly opposed to the opinion of the 

21
illustrious professor *. Besides, persons have often
been confined a long time to sea diet, and have not
been affected with scurvy, but upon returning into
port, where they were supplied with an abundance
of fresh vegetables, it has attacked them very severe-
ly †. There are likewise instances of the disease
prevailing, where noting but vegetable food was
allowed, as in the case of the Guineaman alluded to
above. Further, some facts prove that a defect of
aliment may give rise to it, as was the case of Dr.
Stark, when experimenting on different subjects
relating to aliment ‡.
That salted meats, and other indigestible food
may operate on the body, especially when predis-
posed by the influence of the air, as an occasional
cause of the disease, no one can deny, and all that is
here contended for is, that they do not demand so
much attention in guarding against it, as the date of
the air. They should without doubt, as much as
possible, be avoided under circumstances of predis-
position.
Thirdly, Too long abstinence from vegetable
food.—It has been very well ascertained that food of
* Surgeon Thompson gives us an additional proof, in his
judicious observations on this subject, against the opinion of salt
being so active a cause, from the case of the people of the Shet-
land Islands, who, being deprived of their usual supply of vegetable
food, were obliged to live on salted fish, and sea weeds, a whole
winter, and yet escaped the scurvy.
† Lind on Scurvy. 
‡ See his Works. 

22
this kind has considerable power in preventing the
disease, and no small degree of efficacy in curing it;
but it is equally true, that a very long discontinu-
ance of the use of vegetables, has not created the
consequences alledged, and it is likely, that where
the person, without a full supply of them, is not
exposed to impure air or some other cause of fever,
he will very seldom suffer. It is also true, that even
at a time when they were in plenty, that date of the
system has taken place, which is fitted to give a
scorbutic affection. This effect has been ascribed by
some of the writers on the subject to a deficiency of
nourishment, and it is by no means incredible, that
this may give an aptitude to the system to be
acted on by other causes, so as to produce the
complaint; but a simple deficiency of nourishment is
hardly adequate in itself to that purpose.
How far it is possible for a human being to retain
his health under the exclusive use of animal food
without vegetables, is not well determined; but it
is very well known that fresh meats are so far from
being chargeable with causing Scurvy, that the
Laplanders, who live all winter on the fresh flesh of
the rein deer, are entirely exempt from it. Thus
also they cure Scurvy in Russia by the use of raw
fresh meat, and the practice is not peculiar to them *.
* Dr. Rush informed me of a case of some American soldiers
during the French war, as it was called, related to him by the
late Dr. Morgan, where, from the sudden appearance of a
superior force of French and Indians, they were obliged to shut
themselves up in a fort without other food than some cattle,
which were hastily collected. In a short time they were affected. 

23
Fourthly, Too great a degree of idleness, or a
want of due exercise, are observed to be among the
causes of this disorder.—From the known effect
which such habits have in producing debility, we
should not doubt of their influence, even if we were
destitute of observations to prove it. But it is
notorious, that the most idle and inactive are the
most liable to suffer, and several gentlemen, whose
opportunities for observation have been ample and
extensive, assure us that marines are more subject
to attack than sailors, and these last than the rowers.
Exercise should not, however, be excessive, as it
thence becomes prejudicial.
Fifthly, Depressing passions of the mind have been
generally and justly accused as fruitful sources of this
evil.—It would be needless to multiply authorities,
but I will take notice of a few. Dr. Lind mentions
several instances strongly illustrative of the truth of
the position. One is from the journal of Mr. Ives,
who gives an account of several ships, the crews of
which were much afflicted with Scurvy, while at sea.
Hearing that they were in a short time to engage
the French and Spanish fleets, they were greatly
elated, and recovered so fast, that in a few days,
with Scurvy to a violent degree. The effects of fresh meat in
Russia and elsewhere, in curing the disease, forbid our ascribing
it in this case solely to the meat, and Dr. Rush thinks it is very
likely that fear and depression of the spirits assisted very much.
Accordingly we shall hereafter find them not without effect.
The ingenious Professor of the Materia Medica in this University.
Dr. Barton, in his lectures, inculcated strongly the curative
powers of fresh meat in Scurvy, from several authorities. 

24
when the engagement took place, they were all at
their stations, except a very small number. They
shortly after relapsed, which Dr. Lind attributes to
the unfortunate event of the battle. He relates
several other extraordinary cases to the same purpose.
Dr. Robertson takes notice of some sailors, who,
being on the recovery from the disease, and acci-
dentally by bad weather and winds prevented enter-
ing the wished for port, suffered a return and
increase of the symptoms, from which some died,
although before they promised fair to recover.
Rouppe furnishes a very strong proof of the general
doctrine in the case of a sailor, who had no symptoms
that could countenance an expectation of death.
He happened to mention that he wished to be
discharged, and being told that he would soon get
well, and, further, that the officers would not
discharge him; he replied, "I shall enter, but
I shall soon die," and absolutely died that day.
Vander Mye has recorded, that during the siege of
Breda, good and bad news alternately diminished
and increased the sufferings of the sick in a remarkable
manner. In fine, such is the influence of the mind
over the body in this dreadful calamity, that it is
even said, that a medicine of little consequence
sent and passed on a parcel of soldiers, as a specific
by the Prince of Orange, afforded relief, while others
of more importance had produced no effect.—These
facts are sufficient to establish the baneful operation
of depressing passions on real scorbutics; but it is
likewise almost universally noticed by authors that
impressed seamen are liable to be first attacked in a
voyage, and no one can doubt that their wretched 

25
situation is favorable to passions of the most truly
depressing kind.—It is hardly necessary to observe,
that they act negatively by the abstraction of the
stimulating passions.
Sixthly, Spirituous liquors.—Rouppe, Lind, and
Ellis have all borne a decided evidence against them.
While every new research into the effects resulting
from their abuse, gives us a fresh instance of their
ravages, philanthropy is left to bewail the fate of
man, obstinately pursuing his own ruin, in the face
of the strongest evidence of impropriety, painted in
the highest colours that can be given by the most
eloquent powers, and supported by an hideous
assemblage of facts too terrible to think of; all
tending to prove their baneful consequences on the
constitution and morals of every description of
citizens, as well as of the unfortunate seaman.
Seventhly, and lastly, I must add all the remote
causes of fever in general.—In this I am justified by
the evidence of the Russian physician Nitzsch, who
describes the disease as prevailing in the Russian
army, and ascribes it only to the general causes of
fever. He supposes with much seeming propriety,
that they act gradually, and for a considerable time
before they produce the complaint. It has already
been remarked that Marsh Miasma, the fruitful cause
of many fevers, is not innocent in this case.
Several other causes might be particularized, but
they may very well be comprehended in what has
D 

26
been said. I shall therefore omit further notice of
them.
PREDISPOSING CAUSE.
THE predisposing cause of the disease is debi-
lity, whether constitutional, or artificial in conse-
quence of debilitating causes acting on the body,
either directly or indirectly. This is a point gene-
rally agreed on. It is remarked, cœteris paribus,
to attack most quickly those who have been reduced
by preceding indispositions. Fatigue, for the same
reason, is very friendly to this scourge among soldiers
and seamen. Nitzsch attributes the sufferings in
the Russian army to this source in a considerable
degree. To be short, debility is the predisposition
from whatever cause it arises.
PROXIMATE CAUSE.
I come now to consider the proximate cause of
Scurvy, a subject which has always been involved
in considerable difficulty and darkness.—Even to
name, without attempting to disprove all the theories
hitherto brought forward, would far exceed the
bounds I have prescribed myself. I must, however,
pay some attention to a few of them.
In the first place, then, the very learned Sir John
Pringle has placed the proximate cause in a gradual
putrefaction of the fluids, meaning no doubt, the 

27
blood in an especial manner. With respect to putre-
faction of the blood circulating in a living animal,
it is now put out of the question by the ingenious
experiments of Dr. Seybert *. Before these, the
doctrine had been strenuously opposed, and ably
confuted by the judicious Dr. Milman †. Among
many arguments, it has been urged with propriety,
against the validity of this opinion, that a date of
putrefaction so great as we should suppose must take
place in this disease, upon the supposition that it
originates from that cause, is more than we can
reconcile to the existence of life even for a short time.
Moreover, the effect of putrefaction is to dissolve the
blood; very different, however, is the date of it, as
appears from the observations of men, whose oppor-
tunities have been the most extensive and satisfactory
in that respect. It is also particularly to be observed,
that Lind found an equal quantity of the blood of a
scorbutic did not putrify sooner than other blood
under like circumstances of situation.
Dr. Cullen has laboured much to prove the
proximate cause to be a saline acrimony of the blood,
but his theory cannot be admitted, as it is contra-
dicted by the experiments of Lind, who found the
serum of scorbutic blood as mild and bland to the
taste, as it ever is in any date of the constitution.
It is true, that from some circumstances, as that of
the milk of nurses, a long time refraining from
nourishment, changing its quality considerably, it
* See his Inaugural Dissertation, Philadelphia, 1793.
† See his Enquiry into the Sources of Scurvy, &c. 

28
may appear that the state of the blood differs some-
times from what is natural and common; but it is
still very improbable that it ever contracts any thing
like an acrimony, while circulating in a system of
vessels so readily taking the alarm from the presence
of stimuli, the immediate consequence of which would
be very violent commotions in them.
Dr. Milman, after attempting a refutation of these
different hypotheses, has raised one of his own, more
elegant and more simple, and I wish I could add that it
was just, or consistent with the soundest reasoning on
the principles of our late enlightened system of Physi-
ology. He has made the diminution of the vital
power, as he has called it, the proximate cause.
Whatever this vital power may be, or on whatever
quality or principle it depends for its existence, it is
certain that it must be maintained through the
medium of the blood-vessels; and we presume with
considerable consistence, that although there may be
such an occurrence in the disease as a diminution of
this power, it is rather a consequence or effect of the
proximate cause, than what he has made it, the
proximate cause itself; and further, that any derange-
ment in that respect, is the result of morbid action
in the blood-vessels,
Dr. Rush has sufficiently established, that the
primary seat of all ordinary fever is in the blood-
vessels. He has also made scurvy a date of fever,
and, as I shall attempt to shew, with the utmost justice.
If this be proven, it will result as a necessary inference,
that not only the diminution of vital power, but all 

29  
other symptoms of this complaint, are the offspring
of a derangement of the action in that system.
Some attention has already been paid to the
beautiful explanation of the proximate cause by the
supposed abstraction of oxigene from the system;
but it demands further consideration.
It is a fact undeniable, and one that has been urged
at some length, that in most instances a badly consti-
tuted atmosphere, whether confined to a small or
extensive circle, has had the most eminent effect in
giving rise to Scurvy, existing either as an epidemic,
or in sporadic cases. How far there is a want of
oxigene in such cases, is not easy to determine; but
admitting it to be the case, it is still a desideratum of
magnitude to know how such a state of the air
operates on the body. Dr. Girtanner has supposed
that oxigene is the principle of irritability, and is
communicated from the blood to the muscular fibres.
That it, or one of its constituent parts, becomes the
principle of irritability, or excitability, in the
animal œconomy, I am not prepared to deny or
assert. Perhaps it may be so. If that supposition
be admitted, may not its continued deficiency create
such a state of the excitability of the system as to pre-
dispose to the peculiar action of Scurvy, from the
application of stimuli of a particular degree of force?
This may be the case at sea, and in confined unven-
tilated places, and may be the reason of its more
frequent prevalence in such situations; but it appears
highly probable, that upon the application of certain
causes, the action fitted to produce the disease may 

30
occur in places where no defect of oxigene can be
supposed to exist, as certainly as it does at sea or in
the most confined and impure jails, &c. There are
several cases to prove this last opinion. The much
lamented Dr. Stark was afflicted with Scurvy, while
experimenting upon vegetable diet alone, and when
we cannot conceive that he was supplied with less
oxigene than common. I shall pass over many
instances which might be cited, in which it has
occurred without a suspicion of any defect in the air;
but it is presumed that the history of the disorder, in
the Russian army, given by Nitzsch, is sufficient to
disprove the doctrine of Beddoes. Upon the whole,
although a deficiency of oxigene may have some
influence in modifying the disease, yet it is probable,
that even where it occurs, other qualities of the air
also exert a power which is the principal agent in the
production of this complaint, and this power may
fairly be presumed of a stimulant nature. Hence
other stimuli are competent to the same effect, where
impure air does not exist.
But here let it not be supposed, that the doctrine
already inculcated as to an impure atmosphere, is
relinquished. On the contrary, it is still insisted,
that although from other causes, a predisposition
may arise sufficient to induce the scorbutic action by
the intervention of an occasional cause, yet it is by
far the most general source of the disease.
Notwithstanding I have thus ventured to differ
from Dr. Beddoes, I indulge the pleasing hope, that
his repeated and continued exertions will open a new 

31
field to the physician; and that his further prose-
cution of pneumatic pathology will either confirm and
extend his present theory, or detect its errors, and
supply one more perfect in its place: and from the
great interest he has taken in the advancement of
medical science, we have every favorable presumption,
that the establishment of truth will be more an
object with him, than of any theory, however
pleasing it may have been at first view, or however
galling it may be to some minds to renounce first
impressions, even when convinced of their impro-
priety.
It has already been hinted that Dr. Rush has made
Scurvy a state of fever. This opinion strikes my
mind as being the most just of any that has as yet
been offered to the world. If it be true, the proxi-
mate cause of this state of fever must be the same
as that of others. But as some may object to it, I
shall be more definite, and assign the several reasons
which give it a preference with me.
That it is a fever, I infer from several consider-
ations, and
1st. Those who are most liable to it, being also
most subject to fever.
2dly. From the same causes producing it, and
other states of fever.
3dly. Its prevailing in the same places, and at the
same time with them. And 
 

32
4thly. From Its being accompanied with more of
less of the symptoms of common fever, more or less
evident in every instance.
First, then, Are persons labouring under debility,
from preceding sickness, depressed spirits, or in
general, any cause whatever, more liable to fevers
than others? So they are to Scurvy, as the free and
full consent of all medical writers on the subject has
satisfactorily evinced. This will be apparent in some
measure from preceding observations; but were it
necessary, I could adduce an accumulated weight of
proofs, which, on a point so plain, would be super-
fluous.
Secondly, The same causes produce it, and other
dates of fever. On a review of the causes enume-
rated above, it will be perceived that there are none,
but such as do often cause other states of fever.
Thus it is certain, that impure air is the most frequent
parent of fever, as well as of Scurvy, and it is
especially to be observed, that marsh miasma has
repeatedly been the source from whence this lad has
arisen. To mention more of the causes which are
common to it and fever, might easily be dispensed
with, but I cannot help again calling to recollection
the case of the Russian army, which is so decisive on
the subject. There is, moreover, another circum-
stance deserving attention, which is the great power
cold has in predisposing the system both to one and
the other *.
* It should be mentioned, that a Dutch physician, Solomon
De Monchy, has fully and clearly proved the sameness of the 

33
Thirdly, It prevails in the same places, and at the
same time with fevers. Facts heretofore adduced
for other purposes, present themselves here again.
Scurvy is common in confined jails and army-hospi-
tals; so is fever. Witness the many cases of their
occurrence, at the same time with which we are
furnished by navy and army surgeons. The works
of Pringle, Lind, Blane, Thomson, Renwick, and
Clark, not to mention many others, will afford all
that we can wish on this point.—Marshy, fenny, and
moist, also cold countries, differ from fevers: so they
do from Scurvy. To say no more, an instance of
this last prevailing to any extent, where fevers of
different grades do not show themselves, cannot be
adduced.
Fourthly, It is accompanied with more or less of
the symptoms of common fever, more or less evident
in every instance. Here I am aware of the very
weighty authority I have against me; but it must be
observed, that our ideas of fever are much too
limited; hence an increase of heat has been supposed
necessary to its existence, whereas it will be found
that as the name implies heat, it is improper, and is
only to be used in conformity to custom *. Fre-
quency of the pulse has also been considered insepa-
rable from fever; now fever, or morbid excitement
causes of Scurvy, and other dates of fever occurring on board
West India vessels. He does not, however, contend that like
them it is accompanied by fever, but is content with saying that;
the same remote causes produce a putrefaction of the blood, which
he has made their common proximate cause.
* Dr. Ruth's MS. Lectures.
E 

34
in the blood-vessels, we know exists with natural, and
even slow pulse. It is therefore impossible to confine
fever to any particular species or grade of action in
the arterial system, as indicated by the pulse; since
in different cases it varies from the natural date in
every way, from the greatest to an almost imper-
ceptible degree. Thus it happens sometimes, that
it may be slower and weaker than common, and yet
the disease which it attends is called fever as certainly
and justly as other cases prevailing at the same time,
in which the reverse of this state of the pulse
happens. Upon this ground, then, although Dr.
Lind and many others have observed the pulse to be
slower and more feeble in this disease than natu-
ral; I can discover no difficulty in granting it to be
the effect of febrile action, notwithstanding it be not
discriminated by all the most common symptoms of
fever; and we are warranted in that belief by the
actual appearance of very evident fever in some
cases hereafter to be given, as well as by a strong
analogy with other diseases. For instance, we see
the same effects produced by different grades of
action in different periods of time; as in the case of
enlarged or obstructed liver, which arises either from
violent bilious or yellow fever, from the intermittent
fever, or from the action of the same causes, which
produce them, being continued for a length of time
in a degree of violence not equal to the origination
of either of them in a clearly marked form, but
sufficient to create considerable disease.
That the pulse is not very remarkably affected in
the beginning of the complaint, it has been observed, 

35
is not a valid objection to the opinion of its being a
fever; as from the nature of the causes, and their
gradual and long continued operation, it is to be
expected that the system becomes insensible in a
great degree, and the diseased action must of course
be less obvious. Besides, we have seen that the
pulse, even under these circumstances, has not failed
to strike attentive observers as not being entirely
natural. But if it was not so obviously affected as
in most instances it is, we should not want an analogy
of fevers of no inconsiderable violence, where the
pulse has not deviated much from the natural standard.
Prosper Alpinus and Riverius very particularly incul-
cate, that such a state of the pulse occurs sometimes
when death is close at hand. And Dr. Blane has
seen it so in jail and yellow fevers. He has also
met with the same absence of thirst and heat of the
skin in them, which attends Scurvy.
Among those who are persuaded that it is accom-
panied by no idiopathic fever, and that when fever
presents itself it is merely adventitious, and not at
all essential to the existence of the disease, are Dr.
Lind and the Baron Van Swieten. Dr. Lind's own
account would induce us to differ from him in the
conclusion he has drawn, as he acknowledges that
he had seen fever in the beginning of the disease;
and in his observations on the pulse, he informs us
it was generally slow and feeble. Still he supposed
that the complaint was altogether of a chronic nature.
The last position I shall not deny, however much too
general it may be; but admitting it, I would still
ask, what proximate cause of this chronic affection 

36
can be alledged with so much probability as morbid
and preternatural action in the blood-vessels? And
I believe it would be difficult to find one equally
plausible, and consistent with the general operations
of a healthy or diseased system. The arguments of
Van Swieten on this head, if they amount to any
thing, militate against himself. He was very unfor-
tunate in his selection of an illustration, when he
asserted that Scurvy was not attended with fever in
the beginning any more than dropsy: for since it has
been very well ascertained, that dropsy seldom, or
perhaps never exists without being accompanied with
more or less fever, and he has denied a thing so well
confirmed, it may very fairly be supposed that he
was mistaken in both cases.
Different authors have given us proofs to establish
the presence of evidence fever before any proper
scorbutic symptoms appear, and I shall take the
liberty to mention some of them.
Mr. Murray, as we learn from Dr. Lind, saw
several cases in which Scurvy was apparently the
crisis of a fever. Kramer observed that it generally
followed repeated attacks of fever, and that "it
was always accompanied with remains of the fever
in the pulse and in the urine," and further, that
"it attacked only those, who, after frequent
relapses and recovery from fevers, used crude viscid
diet." Now, what is the common event of the use of
such food in a debilitated state? Most certainly fever,
more or less violent, with all its consequences. 

37
Dr. Robertson, in his Inaugural Dissertation, ex-
pressly says, "Sæpe febrem comitem scorbuti ineuntis
vidi, sed antequam ejus natura certa ad huc erat."
That illustrious observer of nature, Dr. Sydenham,
declared that he had seen the disorder as a symptom
of quartan fever, and Eugalenus remarks the same
as to a quotidian.
Dr. Donald Monro, in the London Medical
Transactions, relates a case of the disease, where
there was fever of considerable action from the
beginning.
I might go on adding authorities of the kind
without number, but it is impossible to attend to all.
One more case I will notice from Dr. Huxham *.
It was what he called a petechial fever, in which
the resemblance in all the essential symptoms to
Scurvy was so great, that every person must be
struck with the evident connection between them,
and agree that it affords at least a strong presump-
tion in favour of the doctrine advocated in this
essay.
Most of the authors, who take notice of what they
call fever attending Scurvy, have supposed it to be
symptomatic; which is not at all to be wondered at,
since in most cases of fever accompanied with local
affection, it was in almost every case fashionable to
call the former the effect of the latter.
* See his Essay on Fevers, page 62. 

38
Although I have thus quoted so many cases of
fever very clearly marked, both accompanying and
preceding Scurvy, and have by them sufficiently
shewn, that it is sometimes produced by fevers of
considerable force; I would by no means insinuate
that the antecedent fever is always so evident. The
reports of men of veracity forbid such a decision. It
may, however, be concluded, that it is always preceded
by some degree of fever. It seems to bear nearly
the same relation to jail fever, that dropsy does to a
remitting fever, or what are vulgarly called inward
fevers in the southern states to an intermittent.
There are still many sources, from whence addi-
tional confirmation of our doctrine may be drawn.
The blood sometimes, and that not unfrequently,
exhibits a buffy coat; and if we attend to all the
symptoms of the complaint, we have no reason to
desert our conclusion. A few of them will answer
the intention.
The symptoms common to Scurvy and fever, which
I shall mention, are
1st. Pain.—This is so clear as to need no discus-
sion. To what can we possibly attribute the Violent
lancinating pains which have been said to attack the
various parts of the body of the scorbutic, but to a
febrile action?
2dly. Costiveness or Diarrhœa.—These both
occur in fevers, and also in Scurvy. 

39
3dly. Hæmorrhagies, and 4thly. Petechiæ, are
equally common to both cases.
5thly. Rotten gums and fœtid breath, are like-
wise frequent in malignant fevers, as we have seen
is the case in the complaint under consideration.
The appetite being good, is no objection, as has
been supposed, to our idea. The same thing hap-
pens in consumption, and sometimes also in the last
stage of yellow fever. The state of the pulse, as
before stated, is equally, and upon the same prin-
ciples, reconcileable with our theory, as a number
of facts, in addition to those already noted, will
prove *.
It is possible to trace the same connection of many
other of the symptoms of the disease with fever, and
to take many different views of the subject all tending
to the same purpose, but I cannot consistently pursue
it further.
* It must not be omitted to observe, that, in Vol. X. of Dr.
Duncan's invaluable Commentaries, American edition, page 162,
we have the relation of several cases, where petechiæ occurred,
and in some of them hæmorrhagy also, without any symptoms of
common fever preceding. During the prevalence of plague,
persons are sometimes attacked with petechiæ, when they have
had no intimation of the approach of the disease. Thus also,
during the time of the yellow fever being epidemic, some are
seized with hæmorrhagy from the nose, when walking the streets,
before the occurrence of any other symptom to announce the
coming on of the complaint. In all these cases, and particu-
larly the last, we must suspect the presence of morbid action in
the blood vessels, or how shall we explain the phenomena? 

40 
Upon the whole, I conclude that Scurvy is as much
entitled to be called a state of fever, as dropsy and
many other diseases, whose claim is firmly established.
The proximate cause therefore need not be repeated,
as it is the same as that of ordinary fever, which is
exhibited in another place, in a manner much more
clear and satisfactory than can be expected from me.
CURE.
ON the cure of Scurvy, I shall be very concise,
and only take notice of the most prominent indica-
tions. These are,
1st. To abstract all remote, exciting, and predis-
posing causes, and particularly foul air, to which so
much has been attributed. For the purpose of
keeping the air pure in the hold of a ship, a venti-
lator, contrived by Mr. Benjamin Wynkoop of this
city, seems to merit attention. It is simple, and takes
up but little room, and at the same time appears to
be very effectual. It has been highly recommended
by the Academy of Medicine of Philadelphia, and
from the reports of those captains who have used it,
we are assured that it has been found very beneficial,
in preserving the health, as well as the cargoes, of
their vessels *.
* Captains, Geddes, Jones, and Irwin, have given certificates
of their experience with this ventilator, and all unite in saying,
that it was effectual, merely by the motion of the vessels, in
expelling foul and supplying pure air to their holds; that the
offensive smell of bilge water was prevented; that the perishable

41 
2dly. To reduce the action of the system, when
indicated by pain, the pulse, or habit of the patient.
The remedies here are
First, Venesection.—This is not generally neces-
sary, but it has been used frequently with advantage.
Dr. Brown, in a letter to Dr. Guthrie *, mentions
having used blood-letting, in the beginning, where
there was pain in the side, with success.
Secondly, Gentle purges; Thirdly, Diaphoretics;
and Fourthly, Diuretics.—These have all been found
of considerable benefit by most physicians. Dr.
Blane saw a striking instance of the salutary tendency
of a spontaneous diarrhœa, which in the course of
twelve hours removed the hard livid swellings of the
legs and contraction of the hams of a scorbutic. This
has its limits, however, in this as well as other
diseases, beyond which it is hurtful.
3dly. To restore healthy excitement by gentle
tonics. Pure air is here particularly useful. Vege-
part of their cargoes, and the paint of their cabins, were greatly
preserved from the usual damage, by them; and finally, that
their crews were remarkably healthy. Captain Geddes particu-
larly, has furnished a pointed proof of the advantage derived
from the use of the ventilator, in the case of his crew, who were
very healthy at the West-India port, where he discharged his
cargo, while those of other vessels were very sickly, of whom
many died.
* See American edition of Duncan's Medical Commentaries,
vol. vi. page 438.
F 

42 
table aliment gently stimulating, as garlic, &c. is
very serviceable. Pepper grass is especially worthy
attention, since it can be raised at sea on cotton
wetted with water *. Above all other vegetable
productions the citric acid is of most importance.
Other acids have also done good †. some praise a
solution of nitre in vinegar very highly. Sauer kraut
and wort very justly deserve the notice of seamen.
Is bark proper here? It is too disproportioned to
the state of the system. Dr. Poisonnier Desperrierres
found it hurtful, and there are few testimonies much
in its favor, while many have joined in declaring it
useless. Is grog proper? It probably may be so in
in some cases. That it should assist in curing a disease
as well as in the production of it, is by no means
paradoxical. Most of our medicines are unnatural
and hurtful to a person in health, however friendly
to him when diseased: so it is as respects this great
artificial evil of society, and no argument can be
drawn in favour of its indiscriminate use from its
curing diseases. As to wine, and malt liquors,
their advantages are much greater and less equivocal.
Lastly, chearful company, exhilarating passion, and
* Dr. Rush informed me that he once had his table plentifully
supplied, in winter, with pepper grass raised in this way.
† Since writing the above I have received the fourth number
of the Medical Repository, in which the oxigenated muriate of
potash is mentioned as having cured Scurvy. My ingenious
friend and fellow-graduate, Mr. Prioleau, has likewise informed
me that he had used the oxigenated muriatic acid in scorbutic
ulcers with success.                

43 
gentle exercise are of the most essential service, and
highly important. In a word, the cure rests on the
rejection of ancient forms of remedies, and a faithful
and rational accommodation of them to the situation
and state of the patient's system, regarding equally
his body and mind.
THE END.