14- GENERAL DISORDERS OF NUTRITION. 



tions in the pleura and pericardium of scorbutic persons. Owing to 

 the variety and irregularity in the succession of the symptoms of this 

 disease, the few cases which have come under my observation have 

 presented very different aspects. 



Its course is chronic, and, if the pernicious influences under which it 

 has arisen be not allayed, it is often extremely tedious. In these pro- 

 tracted cases the prostration of the patient becomes excessive ; some- 

 times he faints with every attempt to sit upright ; he complains of a 

 distressing palpitation and great dyspnoea; the action of the heart 

 grows very weak and rapid, extensive oedema arises in the subcuta- 

 neous connective tissue, while the soreness of the gums, the ecchy- 

 moses, the brawny infiltration of the areolar tissue, and the other local 

 affections, increase greatly in extent and intensity. A marked feature 

 of the disease consists in the rapidity of its abatement and the sudden 

 transformation from a condition of the utmost distress to one of rela- 

 tive convalescence, often terminating in full recovery, when the patient 

 is rescued from noxious influences, and placed in a condition favorable 

 to a cure. It is true that, under such circumstances, their recovery is 

 very slow, and they always retain a great tendency to relapse. 



A fatal termination of scurvy occurs either late in the disease from 

 extreme exhaustion and general dropsy, or else it takes place earlier 

 and before the prostration has acquired much intensity from pleurisy, 

 pericarditis, profuse bloody diarrhoea, or other complications. 



TREATMENT. In modern days the sea-scurvy has become rare, 

 owing to the shortening of voyages, and to the better supplying of 

 ships, especially by the provision now made of lemon-juice, sauer-kraut, 

 and hermetically sealed vegetables. Land-scurvy also, which formerly 

 was of much more common occurrence, has become a rare disease in 

 this country, from the wholesomeness of the dwellings and the improved 

 diet which paupers now enjoy, thanks to the progress of modern cul- 

 ture, so that a prophylaxis against scurvy is no longer talked of. In- 

 deed, precautionary remedies are now superfluous, excepting when 

 several cases of scurvy break out in a barrack, or workhouse, or similar 

 institution, causing apprehension of an epidemic appearance of the dis- 

 ease. These precautions consist in the most scrupulous attention to 

 cleanliness, warmth of clothing, ventilation of apartments, exercise in 

 the open air, a sufficient allowance and proper choice of food, which 

 should consist of fresh meat, and, if possible, also of fresh vegetables, 

 and salad. Good beer should also be provided, and, where this is un- 

 obtainable, brandy-and-water should be administered. The cost of 

 Buch attentions is amply compensated for, if we succeed in putting a 

 check upon the disease. 



In cases of pronounced scurvy, the freshly-expressed iuice of certain 



