MEDICINE. 



Prctle. morbid change in their physical and chemical composi- 

 < "Y"" tion ; for not only do we find a depravation of all the 

 functions, but, if we except the bones, there appears to 

 be an alteration in the nature of all its constituents, 

 both solid and fluid. The exciting causes of Scurvy 

 are ascertained to be all those circumstances which de- 

 prive the body of its due quantity of nutrition, or 

 weaken the action of the digestive organs, and prevent 

 them from completing the office of chylification, such 

 as exercise and fresh air ; and upon the same principle 

 we find, that whatever depresses the spirits has a pow- 

 erful influence in aggravating scorbutic affections. As 

 it- name imports, it generally makes its appearance 

 among sailors during long voyages, when they have 

 been for a long time without a supply of fresh provi- 

 sions; but precisely the same symptoms have made 

 their appearance among the inhabitants of besieged 

 towns, or among armies who were exposed to the same 

 deficiency of fresh food ; and from a similar cause" 

 Scurvy is generally endemic in Greenland, and the 

 .jgther northern countries, where the inhabitants are ne- 

 cessarny rtsp^! 1 ; durin g the K 1 **" P"t of the year, 

 of all vegetable food. Tile .;::px,mate cause of Scurvy, 

 or the way in which the exciting i:!<s induce the 

 symptoms, has been the subject of much specv stion, 

 jand has given rise to many pathological .."jxjtneses, 

 all of which, however, we apprehend will prove to uS 

 without foundation. The symptoms which arise from 

 the mere privation of food, do not correspond to those 

 which form the leading features of Scurvy, nor do we 

 know in what way the peculiar condition of the soft 

 parts which constitutes this disease can proceed from 

 the use of salted provisions, of impure water, or of a 

 putrid state of the substances received into the sto- 

 mach. With respect to the theories which ascribe 

 Scurvy to some chemical change in the blood, such as 

 a defect of oxygen, they may be considered as altoge- 

 ther unfounded, and resting entirely upon the most 

 fanciful analogies; and although the old hypothesis, 

 which conceived the fluids to be in a putrid state, is 

 deficient in evidence, still it appears to be less incon- 

 sistent with the acknowledged phenomena. We must 

 therefore consider this to be one of those points of me. 

 dical theory which are not yet ascertained, and not, as 

 far as we can judge, referable to any general principles. 

 Treatment. Fortunately, however, the want of a correct theory 

 has not prevented us from acquiring an effectual man- 

 ner of treating the disease, for we may consider Scurvy 

 as one of the few complaints for which we possess a cer- 

 tain specific, which in all cases removes the disease, 

 provided no circumstance intervenes to counteract its 

 effects. This remedy is the citric acid, which effec- 

 tually cures Scurvy almost in its worst form, provided 

 only that we have it in our power at the same time to 

 remove the exciting causes. We find indeed that when 

 we are able to afford the patient a proper supply of 

 fresh vegetable food, the symptoms will generally yield 

 without the use of the citric acid, although this will, in 

 all cases, contribute to expedite the cure. It does not 

 appear that any other acid possesses the same power in 

 Scurvy with the citric, except so far as they may con- 

 tribute, in certain states of the digestive organs, to aid 

 in the process of chylification. 



Nauticl We may remark, in connexion with this subject, 

 dldne. that no department of the medical profession has con- 

 ferred more benefit upon mankind than that which re- 

 spects the health of seamen. To so great a degree of 

 perfection are we arrived in every part of the naval 



police, with respect to footl, clothing, and discipline, Practice, 

 both moral and medical, that scurvy is now become a ' 

 comparatively rare occurrence ; the longest voyages are 

 accomplished with little risk of disease, and even with 

 less injury to the health than what usually happens to 

 the same number of men placed under the ordinary 

 circumstances of civil life. 



SECT. IX. Hydrops. Dropsy. 



The third order of the Paratrepses consists of the Hydro 

 Hydropes, a set of diseases which appear to originate 

 from an affection of the minute vessels belonging to 

 the serous membranes that line the close cavities of the 

 body. These vessels, in their natural state, secrete a 

 serous fluid, which is taken up by the absorbents as 

 rapidly as it is discharged ; but in certain conditions of 

 the system these two operations do not proceed in ex- 

 act proportion to each other, in consequence of which 

 an accumulation of fluid ensues, which produces the 

 diseases in question. This accumulation may take 

 place in the cellular texture, whicli pervades all parts of 

 the body, essentially consisting of a series of small cells, 

 that are furnished each of them with the appropriate 

 apparatus for secretion and absorption. 



This species of Dropsy has obtained the name of Anasarc*. 

 Anasarca, and, according to circumstances, it either 

 extends through the whole of the cellular texture, or 

 occupies certain portions of it only. The exciting 

 causes of Anasarca, as well as of Dropsy in general, are 

 various and not well ascertained ; it is a frequent se- 

 quel of other diseases, by which the vital powers in 

 general, and especially the contractility of the mus- 

 cular fibre appear to be weakened ; it is also induced 

 bv other debilitating causes, as excessive evacuations, 

 want of proper nutrition, over fatigue or exhaustion. 

 There is also another set of exciting causes, which ap- 

 pear to be more of a mechanical nature, and which 

 may be all referable to a physical obstruction of the 

 absorbent vessels ; and there is a third set of exciting 

 causes of dropsy, which are not strictly to be included 

 in either of the preceding classes, viz. various circum- 

 stances which impede the digestive functions, espe- 

 cially structural diseases of the different abdominal 

 viscera. In some cases indeeu these affections may be 

 attributed to the pressure of the parts, when they be- 

 come indurated, upon the thoracic duct or the trunks of 

 the absorbents, but in other cases it would seem to pro- 

 ceed from a constitutional cause ; the Dropsies that are 

 produced in this way are principally those of the cavity 

 of the abdomen, to which the term Ascites has been 

 applied. There appears to be, in some individuals, 

 what may be called a Dropsical Diathesis, where serous 

 effusion, in one or more parts of the body, is liable to 

 take place from very slight causes, or perhaps without 

 any assignable cause whatever. 



The proximate cause of Dropsy must obviously con- Proximate 

 sist either in increased secretion or in diminished ab- cause. 

 sorption of the serous fluid, unless we suppose that 

 these two states can exist at the same time ; we have, 

 however, considerable difficulty in deciding to which 

 of the two causes each individual case should be refer- 

 red, or to determine in what manner some of the ex- 

 citing causes can operate. As they are in most cases 

 debilitating, we might conclude that the deficiency of 

 absorption was a more frequent occurrence than the 

 excess of secretion; and the treatment wiiich is found 

 most successful in Dropsy, may probably seem to 



