SCORBUTUS.

Scurvy.

Scorbatus, Sauv. gen. 391. Lin. 223. Vog. 318. Sag. 127. Boerh. 1148. Hoffm. III. 369. Junck. 91. Lind on the Scurvy. Halme de Scorbuto. Rouppé de Morbis Navigantium.

Description. The first indication of the scurbutic diaethis is generally a change of colour in the face, from the natural and healthy look to a pale and bloated complexion, with a little thirst, and aversion from every sort of exercise; the gums soon after become itchy, swell, and are apt to bleed on the slightest touch; the breath grows offensive; and the gums, swelling daily more and more, turn livid, and at length become extremely fungous and putrid, as being continually in contact with the external air; which in every case favours the putrefaction of substances disposed to run into that state, and is indeed in some respects absolutely requisite for the production of actual putridity.

The symptoms of the scurvy, like those of every other disease, are somewhat different in different subjects, according to the various circumstances of constitution; and they do not always proceed in the same regular course in every patient. But what is very remarkable in this disease, notwithstanding the various and immense load of diffrets under which the patients labour, there is no sickness at the stomach, the appetite keeps up, and the senses remain entire almost to the very last: when lying at rest, scurbutic patients make no complaints, and feel little distress or pain; but the moment they attempt to rise or air themselves, then the breathing becomes difficult, with a kind of straitness or catching, and great oppression, and sometimes they have been known to fall into a syncope. This catching of the breath upon motion, with the loss of strength, dejection of spirit, and rotten gums, are held as the essential or distinguishing symptoms of the disease. The skin is generally dry, except in the very last stage, when the patients become exceedingly subject to faintings, and then it grows clammy and moist; in some it has an anemic appearance: but much oftener it is smooth and shining; and, when examined, is found to be spread over with spots not rising above the surface, of a redish, bluish, livid or purple colour, with a sort of yellow ring round them. At first these spots are for the most part small, but in time they increase to large blotches. The legs and thighs are the places where they are principally seen: more rarely on the head and face. Many have a swelling of the legs, which is harder, and retains the impression of the finger longer than the common dropical or truly oedematous swellings. The slightest wounds and bruises, in scurbutic habits, degenerate into foul and untoward ulcers; and the appearance of these ulcers is so singular and uniform, that they are easily distinguished from all others. Scurbutic ulcers afford no good digestion, but give out a thin and fetid ichor mixed with blood, which at length has the appearance of coagulated gore lying caked on the surface of the fore, not to be separated or wiped off without some difficulty. The flesh underneath these ulcers feels to the probe soft and spongy, and is very putrid. Neither detergents nor emetics are here of any service; for though such ulcers be with great pains taken away, they are found again at the next dressing, where the same languidous putrid appearance always presents itself. Their edges are generally of a livid colour, and puffed up with excrescences of proud flesh arising from below the skin. As the violence of the disease increases, the ulcers shoot out a soft bloody fungus, which often rises in a night's time to a monstrous size; and although destroyed by cauteries, actual or potential, or cut away with the knife, is found at next dressing as large as ever. It is a considerable time, however, before these ulcers, bad as they are, come to affect the bones with rottenness. These appearances will always serve to assure us that an ulcer is scurbutic; and should put us on our guard with respect to the giving mercurials, which are very generally pernicious in these cases.

Scurbutic people, as the disease advances, are seldom free from pains; though they have not the same seat in all, and often in the same person shift their place. Some complain of universal pain in all their bones; but most violent in the limbs, and especially the joints: the most frequent seat of their pain, however, is some part of the breast. The pains of this disease seem to arise from the distention of the sensitive fibres by the extravasated blood being forced into the interstices of the periosteum and of the tendinous and ligamentous parts; whose texture being so firm, the fibres are liable to higher degrees of tension, and consequently of pain.

The states of the bowels are various; in some there is an obstinate constipation; in others a tendency to a flux, with extremely fetid stools: the urine is also rank and fetid, generally high coloured; and, when it has flooded for some hours, throws up an oily scum on the surface. The pulse is variable; but most commonly slower and more feeble than in the time of perfect health. A stiffness in the tendons, and weakness in the joints of the knees, appear early in the disease: but as it grows more inveterate, the patients generally lose the use of their limbs altogether; having a contraction of the flexor tendons in the ham, with a swelling and pain in the joint of the knee. Some have their legs monstrously swelled, and covered over with livid spots or ecchymoses; others have had tumours there; some, though without swelling, have the calves of the legs and the flesh of the thighs quite indurated. As persons far gone in the scurvy are apt to faint, and even expire, on being moved and brought out into the fresh air, the utmost care and circumspection are requisite when it is necessary to stir or remove them.

Scurbutic patients are at all times, but more especially as the disease advances, extremely subject to profuse bleedings from different parts of the body; as from the nose, gums, intestines, lungs, &c., and likewise from their ulcers, which generally bleed plentifully if the fungus be cut away. It is not easy to conceive a more dismal and diversified scene of misery than what is beheld in the third and last stage of this distemper; it being then that the anomalous and more extraordinary symptoms appear, such as the bursting out of old wounds, and the dissolution of old fractures that have been long united.

Cayes. The term scurvy has been indiscriminately applied, even by physicians, to almost all the different kinds of cutaneous foulness; owing to some writers of the last century, who comprehended such a variety of symptoms under this denomination, that there are few chronic distempers which may not be so called, according to their scheme: but the disease here meant is the true putrid scurvy, so often fatal to seamen, that with many it has got the name of sea-scurvy, thought to be a disease frequently occurring on shore, as was experienced by the British garrisons of Bolton, Minorca, and many other places. Indeed no disease is perhaps more frequent or more destructive to people pent up in garrisons without sufficient supplies of sound animal food and fresh vegetables. It is sometimes known to be endemic in certain countries, where the nature of the soil, the general state of the atmosphere, and the common course of diet, all combine in producing that singular species of corruption in the mass of blood which constitutes the scurbutic diathesis; for the appearances, on affecting scurbutic subjects, sufficiently show that the scurvy may, with great propriety, be termed a disease of the blood.

Dr Lind has, in a postscript to the third edition of his treatise on the scurvy, given the result of his observations drawn from the dissection of a considerable number of victims to this fatal malady; from which it appears that the true scurbutic state, in an advanced stage of the distemper, consists in numerous effusions of blood into the cellular interstices of most parts of the body, superficial as well as internal; particularly the gums and the legs; the texture of the former being almost entirely cellular, and the generally dependent state of the latter rendering these parts, of all others in the whole body, the most apt to receive and retain the stagnant blood, when its crisis comes to be destroyed; and when it loses that glutinous quality which, during health, hinders it from escaping through the pores in the coats of the blood-vessels or through exhalant extremities.

A dropical indiglutition, especially in the legs and breast, was frequently, but not always, observed in the subjects that were opened, and the pericardium was sometimes found distended with water: the water thus collected was often so sharp as to shrivel the hands of the dissector; and in some instances, where the skin happened to be broken, it irritated and fettered the wound.

The flabby fibres were found to extremely lax and tender, and the bellies of the muscles in the legs and thighs to stuffed with the effused stagnating blood, that it was always difficult, and sometimes impossible, to raise or separate one muscle from another. He says that the quantity of this effused blood was amazing; in some bodies it seemed that almost a fourth part of the whole mass had escaped from the vessels; and it often lay in large concretions on the peritoneum, and in some few instances under this membrane immediately on the bone. Notwithstanding this distended and depraved state of the external flabby parts, the brain always appeared perfectly sound, and the viscera of the abdomen, as well as those in the thorax, were in general found quite uncorrupted. There were spots indeed, from extravasated blood, observed on the meniscus, intestines, stomach, and omentum; but these spots were firm, and free from any mortified taint; and, more than once, an effusion of blood, as large as a hand's breadth, has been seen on the surface of the stomach; and what was remarkable, that very subject was not known while living to have made any complaint of sickness, pain, or other disorder, in either stomach or bowels.

These circumstances and appearances, with many others that are not here enumerated, all prove to a demonstration a putrefactive, or at least a highly depraved state of the blood; and yet Dr Lind takes no small pains to combat the idea of the scurvy's proceeding from animal putrefaction; a notion which, according to him, "may, and hath misled physicians to propose and administer remedies for it altogether ineffectual."

He also, in the preface to his third edition, talks of the mischief done by an attachment to delusive theories. He says, "it is not probable that a remedy for the scurvy will ever be discovered from a preconceived hypothesis, or by speculative men in the closet, who have never seen the disease, or who have seen at most only a few cases of it;" and adds, "that though a few partial facts and observations may, for a little, flatter with hopes of greater success, yet more enlarged experience must ever evince the fallacy of all positive assertions in the healing art."

Sir John Pringle, however, is of a very different opinion. He "is persuaded, after long reflection, and the opportunities he has had of conversing with those who to much sagacity had joined no small experience in nautical practice, that upon an examination of the several articles which have either been of old approved, or have of late been introduced into the navy, it will appear, that though these means may vary in form and in mode of operating, yet they all some way contribute towards preventing putrefaction; whether of the air in the cloister parts of a ship, of the meats, of the water, of the clothes and bedding, or of the body itself."

What Dr Lind has above advanced is the more remarkable, as, in the two former editions of his book, he embraced the hypothesis of animal putrefaction being the cause of the fever; and if these effusions of blood, from a destruction of its crisis and the distended state of the muscular fibres, together with the rotten condition of the mouth and gums, do not betray putrefaction, it is hard to say what does, or what other name we shall bestow on this peculiar species of depravation which constitutes the fever.

The blood, no doubt, derives its healthy properties, and maintains them, from the due supplies of wholesome food; while the insoluble, superfluous, effete, and acrid parts, are carried off by the several discharges of stool, urine, and perspiration.

Our senses of taste and smell are sufficient to inform us when our food is in a state of soundness and sweetness, and consequently wholesome; but it is from chemistry that we must learn the principles on which these qualities chiefly depend.

Experiments of various kinds have proved, that the soundness of animal and vegetable substances depends very much, if not entirely, on the presence of their aerial principle. Rottenness is never observed to take place without an emission of fixed air from the putrefying substance; and even when putrefaction has made a considerable progress, if aerial acid can be transferred, in sufficient quantity, from some other substance in a state of effervescence or fermentation, into the putrid body, the offensive smell of this will be destroyed. If it be a bit of rotten flesh with which the experiment is made, the firmness of its fibres will be found in some measure restored.

The experiments of Dr Hales, as well as many others made since his time, show that an aerial principle is greatly connected with, and remarkably abundant in, the gelatinous parts of animal bodies, and in the mucilage or farina of vegetables. But there are the parts of our food which are most particularly nutritive; and Dr Cullen, whose opinion on this as on every other medical subject must be allowed of the greatest weight, affirms, in his Lectures on the Materia Medica, that the substances on which we feed are nutritious only in proportion to the quantities of oil and sugar which they respectively contain. This oil and sugar are blended together in the gelatinous part of our animal food, and in the mucilaginous and farinaceous part of succulent vegetables; and, while thus intimately combined, are not perceivable by our taste, though very capable of being developed and rendered distinct by the power of the digestive organs; for in consequence of the changes produced during digestion, the oily and the saccharine matter become manifest to our senses, as we may see and taste in the milk of animals, which is chiefly chyle a little advanced in its progress toward sanguification; the oil is observed to separate spontaneously, and from which a quantity of actual sugar may be obtained by a very simple process.

Thus much being premised, we can now readily comprehend comprehend how the blood may come to lose those qualities of smoothness, mildness, and tenacity which are natural to it. For if, in the first place, the fluids, and organs subservient to digestion, should be so far distempered or debilitated that the nutritious parts of the food cannot be properly developed, the blood must be deprived of its due supplies; which will also be the case if the aliment should not originally contain enough of oily and saccharine matter, or should be so circumstanced, from being dried or salted, as to hinder the ready extrication of the nutritious parts; or, lastly, if the natural discharges should be interrupted or suspended, so that the superfluous, acrid, and effete fluids are retained in the general mass; in all these instances the blood must of necessity run into proportionate degrees of depravation.

And hence we may understand how it may possibly happen, that when persons are greatly weakened by some preceding disorder, and at the same time deprived of the use of proper bodily exercise, the scurvy diathesis should take place, even though they enjoy the advantages of pure air and wholesome diet. But these are solitary cases, and very rarely seen; for whenever the scurvy fevers numbers, and can be considered as an epidemic disease, it will be found to depend on a combination of the major part, or perhaps all, of the following circumstances:

1. A moist atmosphere, and more especially if cold be joined to this moisture. 2. Too long cessation from bodily exercise, whether it be from constraint, or a lazy slothful disposition. 3. Dejection of mind. 4. Neglect of cleanliness, and want of sufficient clothing. 5. Want of wholesome drink, either of pure water or fermented liquors. 6. Above all, the being obliged to live continually on salted meats, perhaps not well cured, without a due proportion of the vegetables sufficient to correct the pernicious tendency of the salt, by supplying the bland oil and saccharine matter requisite for the purposes of nutrition.

These general principles respecting the causes and nature of scurvy, seem to afford a better explanation of the phenomena of the disease than any conjectures respecting it that have hitherto been proposed. It must, however, be allowed, that Dr Lind is by no means the only writer who is disposed to consider this disease as not referable to the condition of the circulating fluids. In a late ingenious treatise on this subject by Sir F. Milman, he strenuously contends, that the primary morbid affection in this complaint is a debilitated state of the solids arising principally from want of aliment. But his arguments on this subject, as well as those of Dr Lind, are very ably answered by a still later writer on this subject, Dr Trotter, who has drawn his observations reflecting it from very extensive experience, and who considers it as clearly established, by incontrovertible facts, that the proximate cause of scurvy depends on some peculiar state of the blood.—That this disease does not depend on a debilitated state of the solids, is demonstratively proved from numerous cases where every possible degree of debility occurs in the solids without the slightest appearance of scurvy. Dr Trotter, in the second edition of his Observations on the Scurvy, from the result of farther observation and later discoveries in chemistry, has attempted, with much ingenuity, to prove that the morbid condition of the blood, which takes place in scurvy, arises from Scrobutus, the abstraction of vital air, or, as it is now generally called, oxygen; and this opinion, though still, perhaps, in some particulars requiring further confirmation, is, it must be allowed, supported by many plausible arguments.

Prevention and Cure. The scurvy may be prevented, by obviating and correcting these circumstances in respect of the non-naturals which were mentioned as contributing to the disease, and laid down as causes. It is therefore a duty highly incumbent on officers commanding at sea, or in garrisons, to use every possible precaution; and, in the first place, to correct the coldness and moisture of the atmosphere by sufficient fires; in the next, to see that their men be lodged in dry, clean, and well ventilated births or apartments; thirdly, to promote cheerfulness, and enjoy frequent exercise, which alone is of infinite use in preventing the scurvy; fourthly, to take care that the clothing be proper, and cleanliness of person strictly observed; fifthly, to supply them with wholesome drink, either pure water or sound fermented liquors; and if spirits be allowed, to have them properly diluted with water and sweetened with molasses or coarse sugar; and lastly, to order the salted meats to be sparingly used, or sometimes entirely abstained from; and in their place, let the people live on different compositions of the dried vegetables; fresh meat and recent vegetables being introduced as often as they can possibly be procured.

A close attention to these matters will, in general, prevent the scurvy from making its appearance at all, and will always hinder it from spreading its influence far. But when these precautions have been neglected, or the circumstances such that they cannot be put in practice, and the disease has actually taken place, our whole endeavour must be to restore the blood to its original state of soundness; and happily, such is the nature of this disease, that if a sufficiency of new matter, of the truly mild nutritious sort, and particularly such as abounds with vital air, such as recent vegetables, or different acid fruits, can be thrown into the circulation while the flabby fibres retain any tolerable degree of firmness, the patient will recover; and that in a surprisingly short space of time, provided a pure air, comfortable lodgings, sufficient clothing, cleanliness, and exercise, lend their necessary aid.

This being the case, the plan of treatment is to be conducted almost entirely in the dietetic way; as the change in the mass of blood, which it is necessary to produce, must be brought about by things that can be received into the stomach by pints or pounds, and not by those which are administered in drops or grains, drams or ounces. For here, as there is no disorder of the nervous system, we have no need of those active drugs which are indispensably necessary in febrile or nervous diseases; the scurvy diathesis being quite opposite to that which tends to produce a fever or any species of spasmodic disorders; nay, Dr Lind lays, he has repeatedly found, that even the infection of an hospital fever is long resisted by a scorbutic habit.

It will now naturally occur to the reader, what those alimentary substances must be which bid the fairest faiest to restore the blood to its healthy state; and he needs scarcely to be told, that they are of those kinds which the stomach can bear with pleasure though taken in large quantities, which abound in jelly or mucilage, and which allow those nutritious parts to be easily developed; for though the viscera in scorbutic patients may be all perfectly sound, yet we cannot expect that either the digestive fluids or organs should possess the same degree of power, which enable them during health, to convert the crude dry famine, and the hard salted flesh of animals, into nourishment. We must therefore search for the antiscorbutic virtue in the tender sweet flesh of herbivorous animals; in new milk; and in the mucilaginous acid juices of recent vegetables, whether they be fruits, leaves, or roots.

The four juices of lemons, oranges, and limes, have been generally held as antiscorbutics in an eminent degree, and their power ascribed to their acid; from an idea that acids of all kinds are the only correctors of putrefaction. But the general current of practical observations shows, and our experiments confirm it, that the virtue of these juices depends on their aerial principle; accordingly, while perfectly recent and in the mucilaginous state, and especially if mixed with wine and sugar, the juices of any one of these fruits will be found a most grateful and powerful antiscorbutic.

Dr Lind observing, "that the lemon juice, when given by itself undiluted, was apt, especially if overdosed, to have too violent an operation, by occasioning pain and sickness at the stomach, and sometimes vomiting; found it necessary to add to it wine and sugar. A pint of Madeira wine, and two ounces of sugar, were put to four ounces and a half of juice, and this quantity was found sufficient for weak patients to use in 24 hours; such as were very weak tipped a little of this frequently according as their strength would permit; others who were stronger took about two ounces of it every two hours; and when the patients grew still stronger, they were allowed eight ounces of lemon juice in 24 hours."

While this very pleasant mixture, which is both a cordial and an antiseptic, may be had, it would be needless to think of prescribing any other; but when the fresh juice cannot be procured, we must have recourse to such other things as may be obtained. But the various modes of combining and administering these, so as to render them perfectly agreeable to the stomach, must always be regulated by circumstances, and therefore it will be in vain to lay down particular directions; since all that we have to do is, to fix on such fruits and other fresh vegetables as can be most conveniently had and taken, and contrive to give them in those forms, either alone or boiled up with flesh meat into soups, which will allow the patients to consume the greatest quantities.

The first promising alteration from such a course is usually a gentle diarrhoea; and if, in a few days, the skin becomes soft and moist, it is an infallible sign of recovery; especially if the patient gain strength, and can bear being stirred or carried into the open air without fainting.

But if the belly should not be loosed by the use of the fresh vegetables, nor the skin become soft and moist, then they must be assisted by stewed prunes, or a decoction of tamarinds with supertartrate of potash, in order to abate the coliciveness; and by drinking a light decoction of the woods, and warm bathing, in order to relax the pores of the skin; for nothing contributes more to the recovery of scorbutic patients than moderate sweating.

With regard to particular symptoms, antiseptic mouth waters composed of a decoction of cinchona and infusion of roses, with a solution of myrrh, must be used occasionally, in order to cleanse the mouth, and give firmness to the spongy gums. Swelled and indurated limbs, and stiffened joints, must be bathed with warm vinegar, and relaxed by the steam of warm water, repeatedly conveyed to them, and confined to the parts by means of close blankets; ulcers on the legs must never be treated with unctuous applications nor sharp elastics; but the dressing should consist of lint or soft rags, dipped in a strong decoction of cinchona.

This disease at no time requires, or indeed bears, large evacuations, either by bleeding or purging; and as has been already mentioned, the belly must only be kept open by the fresh vegetables or the mildst laxatives. But we are always to be careful that scorbutic persons, after a long abstinence from greens and fruits, be not permitted to eat voraciously at first, lest they fall into a fatal dysentery.

All, however, that has now been laid down as necessary towards the cure, supposes the patients to be in situations where they can be plentifully furnished with all the requisites; but unhappily these things are not to be procured at sea, and often deficient in garrisons; in order therefore, that a remedy for the scourge might never be wanting, Dr Macbride, in the year 1762, first conceived the notion, that the infusion of malt, commonly called wort, might be substituted for the common antiscorbutics; and it was accordingly tried.

More than three years elapsed before any account arrived of the experiments having been made: at length, ten histories of cases were received, wherein the wort had been tried, with very remarkable success; and this being judged a matter of great importance to the seafaring part of mankind, these were immediately communicated to the public in a pamphlet, under the title of An historical account of a new method of treating the scurvy at sea.

This was in 1767; but after that time a considerable number of letters and medical journals, sufficient to make up a small volume, were transmitted to Dr Macbride, particularly by the surgeons of His Majesty's ships who had been employed of late years for making discoveries in the southern hemisphere. Certain it is, that in many instances it has succeeded beyond expectation. In others it has fallen short; but whether this was owing to the untoward situation of the patients, or inattention on the part of the persons who were charged with the administration of the wort, not preparing it properly, or not giving it in sufficient quantity, or to its own want of power, must be collected from the cases and journals themselves.

During Captain Cook's third voyage, the most remarkable, in respect of the healthiness of the crew, that ever was performed, the wort is acknowledged to have been of singular use. In a letter which this very celebrated and successful circumnavigator wrote to Sir John Pringle, he gives an account of the methods pursued for preserving the health of his people; and which were productive of such happy effects, that he performed "a voyage of three years and 18 days, through all the climates from 52° north to 71° south, with the loss of one man only by disease, and who died of a complicated and lingering illness, without any mixture of scurvy. Two others were unfortunately drowned, and one killed by a fall; so that out of the whole number 113 with which he set out from England, he lost only four."

He says, that much was owing to the extraordinary attention of the admiralty, in causing such articles to be put on board as either by experience or conjecture were judged to tend most to preserve the health of seamen; and with respect to the wort, he expresses himself as follows:

"We had on board a large quantity of malt, of which was made juice wort, and given (not only to those men who had manifest symptoms of the scurvy, but to such also as were, from circumstances, judged to be most liable to that disorder) from one or two to three pints in the day to each man, or in such proportion as the surgeon thought necessary, which sometimes amounted to three quarts in the 24 hours: this is without doubt one of the best sea antiscorbutic medicines yet found out; and if given in time, will, with proper attention to other things, I am persuaded, prevent the scurvy from making any great progress for a considerable time: but I am not altogether of opinion that it will cure it, in an advanced state, at sea."

On this last point, however, the captain and his surgeon differ; for this gentleman positively affirms, and his journal (in Dr Macbride's possession) confirms it, that the infusion of malt did effect a cure in a confirmed case, and at sea.

The malt being thoroughly dried, and packed up in small casks, is carried to sea, where it will keep sound, in every variety of climate, for at least two years: when wanted for use, it is to be ground in a hand mill, and the infusion prepared from day to day, by pouring three measures of boiling water on one of the ground malt; the mixture being well mellowed, is left to infuse for 10 or 12 hours, and the clear infusion then strained off. The patients are to drink it in such quantities as may be deemed necessary, from one to three quarts in the course of the 24 hours: a panada is also to be made of it, by adding biscuit, and currants or raisins; and this palatable meal is used by way of solid food. This course of diet, like that of the recent vegetables, generally keeps the bowels sufficiently open; but in cases where colicineless nevertheless prevails, gentle laxatives must be interposed from time to time, together with diaphoretics, and the topical assistants, fomentations and gargles, as in the common way of management.

Captain Cook was also provided with a large stock of sour kraut; (cabbage leaves cut small, fermented and stoppered in the second stage of fermentation, and afterwards preserved by a due quantity of salt.) A pound of this was served to each man, twice a-week, while they were at sea. Sour kraut, since the trial made of it on board Captain Cook's ships, has been scorbust extensively used by direction of the British government in many other situations, where scorbust has prevailed; and it has been found to be highly serviceable both in preventing and in curing the disease. It was particularly found, during the late American war, to be highly beneficial to the British troops beleaguered in Boston, who were at that time entirely fed on salt provisions sent from England, and among whom true scorbust was very fatal till the four kraut arrived. The scorbust at one period broke out among them with very alarming appearances; but by the reasonable arrival of a quantity of four kraut, it was effectually overcome. Care, however, must be bestowed, that this article be properly prepared and properly kept. When due attention is paid to these particulars, it may be preserved in good condition for many months; and is considered both by sailors and soldiers as a very acceptable addition to their salt provisions. But when served out to them in a putrid state, it is not only highly disagreeable to the taste, but probably also pernicious in its effects.

Among other means of preventing scorbust, Captain Cook had also a liberal supply of portable soup; of which the men had generally an ounce, three days in the week, boiled up with their pease; and sometimes it was served to them oftener; and when they could get fresh greens, it was boiled up with them, and made such an agreeable meal, that it was the means of making the people eat a greater quantity of greens than they would otherwise have done. And what was still of further advantage, they were furnished with sugar in lieu of butter or oil, which is seldom of the sweetest sort; so that the crew were undoubtedly great gainers by the exchange.

In addition to all these advantages of being so well provided with every necessary, either in the way of diet or medicine, Captain Cook was remarkably attentive to all the circumstances respecting cleanliness, exercise, sufficient clothing, provision of pure water, and purification of the air in the closer parts of the ship.

From the effect of these different means, as employed by Captain Cook, there can be little doubt that they will with due attention be sufficient for the prevention and cure of the disease, at least in most situations: but besides these, there are also some other articles which may be employed with great advantage.

Newly brewed spruce beer made from a decoction of the tops of the spruce fir and molasses, is an excellent antiscorbutic; it acts in the same way that the wort does, and will be found of equal efficacy, and therefore may be substituted. Where the tops of the spruce fir are not to be had, this beer may be prepared from the essence of spruce as it has been called, an article which keeps easily for a great length of time. But in situations where neither the one nor the other can be had, a most salutary meal may be prepared from oatmeal, by infusing it in water, in a wooden vessel, till it ferments, and begins to turn fourth; which generally happens, in moderately warm weather, in the space of two days.—The liquor is then strained off from the grounds, and Impetigines and boiled down to the consistence of a jelly, which is to be eaten with wine and sugar, or with butter and sugar.

Nothing is more commonly talked of than a land fever, as a distinct species of disease from that which has been now described; but no writer has yet given a description so clear as to enable us to distinguish it from the various kinds of cutaneous foulness and eruption, which indeed are vulgarly termed scorbustic, but which are akin to the itch or leprosy, and for the most part require mercurials. These, however, are very different diseases from the true scorbustus, which, it is well known, may prevail in certain situations on land as well as at sea, and is in no degree to be attributed to sea air.