that the moderns sometimes are not free from the opposite error. On my return from Russia in 1752, I found the name of nervous disorders very generally applied to what, among the lower orders, I had no hesitation to call scurvy. These people who seldom tasted fresh animal food, but lived for the most part on a spare diet of the farinaceous kind, and inhabited a cold damp soil, had several hypochondriac symptoms, a pale bloated look, wandering pains, and frequently a cutaneous eruption, quite sufficient to excite the suspicion of a scorbutic taint, and a cure very speedily brought about by the use of antiscorbutic remedies, showed that the suspicion was well founded. But even when the symptoms of scurvy were disguised under the appearance of other complaints, so as not to be detected by an ordinary practitioner, the successful use of antiscorbutics has shown the real nature of the disease. Riverius thought that the scurvy was hypochondriasis in a malignant form; but it is only in the very commencement that it assumes the appearance of hypochondriasis; and various scorbutic symptoms may exist for a long time, without the dreadful train usually enumerated. Often, too, these symptoms are very partial outwards, when the disease has made great ravages on the internal parts.

I do not pretend to discover scurvy by a small quick and unequal pulse, or by urine, nor do I affirm that every anomalous. eruption on the skin is symptomatic of scurvy; but if with these there exist quick breathing, palpitation, and laziness degenerating into lassitude, we may suspect scurvy. Fever is not a diognostic, though much oftener a concomitant of scurvy than Lind seems to be aware of, for not unfrequently it is complicated with a continued fever, or even with a tertian ague. In women the menses are colourless, and fluor albus is often present. Gout is known to be scorbutic by shifting suddenly from one joint to another; and atrophy, if scorbutic, cannot be cured but by anti-scorbutics.

When the causes that give rise to scurvy can be obviated, and when the disease is not far advanced, we may with great safety give a favourable prognosis; but it is otherwise when the disease is complicated or of long standing. In general, the weaker the constitution the more fatal the disease; and thus the patients, in my second constitution, especially when their disease is compli cated with phthisis, very speedily become victims to it. Both the plethoric and rigid constitutions withstand it longest, when due evacuations and proper correctives are employed; but should they be attacked by a putrid fever, it will almost infallibly carry them off in four, or at most seven days. Great evacuations of blood, suppuration of the liver, bursting into the abdomen, and Sss

VOL. IV. NO. XVI.

dropsy of the belly and thorax, and extensive mortifications are constantly fatal. Great difficulty of breathing often ends suddenly in death, and when the belly is covered with scorbutic blotches, the disease is mortal; and when there are buboes in the groins or armpits, with livid spots over every part of the body, death will ensue with as much certainty as in the plague. The sudden disappearance of eruptions is a dangerous symptom. An attack of putrid fever, I have said, is generally fatal; but when the body is much enfeebled by scurvy, the supervening of almost any other disease will induce death. Thus fever, which in the commencement of scurvy is beneficial, at the end of it proves mortal.

It is not easy to prevent scurvy where the situation is unfavourable, and where other remote causes act strongly; but even then, warm clothing, regular exercise, and such amusements will go a great length towards its prevention. But if in addition to these, we can supply the patient with pure water, milk, fresh animal food, vegetables and good bread; if we can procure for him dry and comfortable lodging, and make him observe the strictest cleanliness of person, the scurvy never can make much progress.

When the scurvy was genuine, that is, unconnected with other diseases, we commonly began the cure with a gentle purge or two, and then ordered the decoctum scorbuticum and essentia anti-scorbutica, as mentioned by Dr. Nitzch, his method of cure being very generally employed in Russia, especially by the German physicians and surgeons. We also gave the patients twice every day, mixed with a little brandy, the expressed juice of wild horse-radish, which grows in great abundance in the neighbourhood of Astrachan. They had fresh meat every day, and cut sallads with acid plants. We had no lemon juice. They washed once a-week; and their wards were regularly fumigated. Before they eat or drank, or took medicines, they gargled their mouths and throats; and they washed their mouths with tincture of myrrh, gum lac, &c. We endeavoured to get some of the largest tumours to suppurate, and then allowed them to discharge as long as possible. Every morning and afternoon, when the weather was fine, the patients were forced to walk, and otherwise to use as much excercise as their strength would permit, and they were allowed but a very moderate degree of sleep, at the same time they were interdicted from the use of salted, hung, and fat meats. In the hot scurvy, a cure could not be obtained without the use of mercurial and antimonial preparations, with decoctum and essentia lignorum, &c. as nodes and tophi were often present, attended by a lipoa:-even in hectic habits I found this mode of cure necessary, unless the case (which rarely happened) was pure scorbutic.

1

In the hospitals of Riga, we used the Peruvian bark in scorbutic mortifications, but without benefit. Such was my cure, adapted both for the land and sea scurvy; for I had charge of the naval hospital of Astrachan for several years; nor did I ever find it unsuccessful, except in the most inverate cases.

In glancing over the great variety of writings published on scurvy, since the appearance of Dr. Lind's book, I find a vast number of remedies recommended, such as cider, spruce beer, wine, malt, vitriolic acid, vinegar, lemon juice, &c.; in short, the same remedies that have been used for nearly two hundred years, echoed and re-echoed by their respective favourers; all of them useful, with the aid of fresh animal and vegetable food, pure air and exercise, cleanliness and dry warm clothing, but without that aid, I may safely venture to affirm, unavailing. From what I have said about constitutions, it will not appear surprising to any one that the mode of cure, as recommended by authors, is sometimes contradictory. One person recommends blood-letting, as the scurvy, in his opinion, is an inflammatory disease; another advises a rich nourishing diet, as it is evidently a disease attended with debility and exhaustion; but the practice of both parties may be vindicated if my view of the scurvy is a just one, and I see nothing in it repugnant to reason. I venerate the great masters of the healing art, I treat their theories with respect, and I adopt or reject, only in so far as I conceive them to be true Amicus Plato, sed magis amica veritas.

or untrue to nature.

British Review.

MEDICO-CHIRURGICAL TRANSACTIONS *.

THIS volume is prefaced by the following advertisement :"It has been resolved by the President and Council, that the Society shall publish, half-yearly, namely, on the first of July, and the first of February, such papers as shall have been ordered by the Council for Publication. It has also been determined that the Council shall adjudge out of the funds of the Society, a Prize to the author of the paper that shall appear to them most

Medico-Chirurgical Transactions. vol. xii. Part. I. 8vo. London, 1822.

deserving of that honour, amongst those that shall have been read to the Society during the Session. In selecting papers for the prize, the choice shall not be confined to those written by members only, but it shall extend to all papers which shall have been read to the Society." The only objection to this scheme which occurs to us, is that it is too indefinite, both in not stating the value of the prize, and in not fixing upon a subject for competition. In this view, it cannot operate in the least as a stimulus to contributors, and except it be intended to do so, we cannot perceive its design. We heartily wish, however, that we may be mistaken, and that it may operate advantageously for the credit of the Society, and the advantage of the profession.

The first paper is by Dr. Marshall Hall, giving the cases of four children who had attempted, by mistake, to drink boiling water from the spout of a tea-kettle, with observations on the seat and treatment of the effects of this accident. The author imagines that he is the first who has taken notice of this accident; and from Mr. Stanley's Appendix it appears that it was new to the members of the Society. We, however, can justly claim the priority for this publication, so far as the paper before us is concerned, our predecessors having adverted to it so long ago as May 1820, in reviewing M. Bayle's work on the diseases of the larynx; and in our number for April last, we gave a very interesting case by Mr. Wallace of Dublin, in which the operation was successfully performed. Dr. Hall, indeed, appears to have copied our language almost verbatim in describing the symptoms, namely, "The effects of this accident are not, as might be supposed à priori, the symptoms of inflammation of the oesophagus and stomach, but of inflammation of the glottis and larynx, resembling those of croup; and the case constitutes another instance in which the operation of laryngotomy, or of tracher tomy, may be performed with the effect of preventing impending suffocation, and perhaps of saving life."-(Compare Quart. Journ. II. 236. with Med. Chir. Trans. XII. 2.)

It appears probable, that the boiling water does not actually penetrate into the stomach, or even into the gullet, but that its course is arrested by a spasmodic action of the muscles of the pharynx, from the epiglottis and the parts around it being scalded, till at length the rima glottidis becomes completely obstructed.

The first CASE is that of a little girl, aged three, who drank water nearly boiling, from the spout of a tea-kettle. For three or four hours, during which she had no assistance, dispnoea supervened, for which a medicine "containing oil and syrup,” was recommended; but respiration continuing to become more

difficult, she was bled from the jugular vein, though this did not arrest the complaint, and leeches were ordered to be applied to the throat. Upon seeing the leeches she screamed violently, which had the effect of relieving the dyspnoea without the leeches, and the little sufferer recovered completely in the course of a week. The parents of the child suppose that the vesicles which impeded her breathing, were ruptured by the effort of screaming.

The next CASE was that of a boy, aged two, who had also drank water nearly boiling, from the spout of a tea-kettle. He cried out immediately, and in about four hours he began to labour and ruttle in breathing, these symptoms increasing gradually, till at length the face became livid, the feet cold, and he died from suffocation about 17 hours after the accident. He had no vomiting and little difficulty of swallowing. The dyspnoea was similar to that observed in croup. Oil and syrup, and bleeding, were prescribed without relief.

The third CASE was that of a little girl aged two years and a half, who also had drunk from the spout of a tea-kettle water nearly boiling. Upon her screaming out, she was immediately carried to a surgeon. We are not informed what was done for her; but whatever was prescribed was ineffectual, as she died from suffocation about ten hours after the accident. No dissection is mentioned.

The fourth CASE was that of a little girl, aged two years and a half, who had drunk from the spout of a tea-kettle water that had boiled ten minutes before. Oil, mucilage, and syrup were ordered; and five hours afterwards she was found to be affected with dyspnoea, and a hoarse croupy noise arising from the top of the larynx. There was no dysphagia nor coughing. The tongue and all the internal parts of the mouth were blanched and blistered. The pulse is mentioned to have been frequent; but we hold with Underwood, that the pulse is no good criterion of the state of the system in children, in consequence of their great susceptibility of irritation from slight causes. The dyspnoea increased so much as to threaten suffocation, tracheotomy was performed with immediate relief, twelve hours after the accident. The little patient sat up, played, and looked cheerful. The voice was gone, but respiration through the wound was quite free. Notwithstanding these favourable appearances, however, the patient died thirty-four hours after the operation, seemingly, as Dr. Hall thinks, from the exhausting influence of the primary disease. The DISSECTION is important. The epiglottis appeared to be swollen, blistered, and corrugated, as well as the fauces, tongue, and internal parts of the mouth. Neither the