SCURVY 391 



of every disease could be recognized in scurvy (Bontekoe) . ISTot even Boer- 

 haave was able to rise entirely superior to these views, but he was sufficiently 

 critical to state that the disease had, during his time, appeared much more 

 rarely in The Netherlands. Keen and earnest critics were not lacking who 

 not only were opposed to the scurvy delusion, but went to the other extreme, 

 and denied absolutely the existence of scurvy. Sydenham with others pro- 

 tested against this, and asserted the rare occurrence of scurvy, while Kramer 

 furnished an accurate description of cases actually observed by him in which 

 he also declared that the disease was least known by those who most frequently 

 described it. In the year 1752 Lindas masterly treatise appeared, which up to 

 the present time remains one of the best descriptions of scurvy; in this he 

 compared the first accounts of the disease (which he characterized as chaos) 

 with the later views maintained regarding the affection, and anew so accurately 

 portrayed the clinical picture that it subsequently admitted of little change. 



Notwithstanding Lind's proof that scurvy was not an infrequent disease 

 in the previous century, the fact still remains that it occurred far more fre- 

 quently in the period in which Lind wrote than in our time. Hirsch has 

 zealously investigated these epidemics, and collected the records of all others 

 occurring on land, from 1556 to 1877, in so far as they have borne the test of 

 scientific criticism. 



Although we must admit that this compilation is not a complete history of 

 outbreaks of scurvy, since not every pandemic, and not nearly all of those lim- 

 ited to a small area, or occurring in a single institution, have been described, 

 still it enables us to draw conclusions regarding the frequency of the disease, 

 its geographical distribution, and the probable causes of its development. In 

 all 143 epidemics are mentioned, of which two occurred in the sixteenth, four 

 in the seventeenth, thirty-three in the eighteenth, and one hundred and four 

 in the nineteenth century. These figures make it strikingly apparent that the 

 views of Bugalenus and his adherents were exaggerated. 



Of the epidemics in the course of the previous century, that of Paris is 

 to be particularly mentioned; it occurred in 1870-71 during the siege of the 

 city, and spread owing to the scarcity of food. Among the French troops 

 who, in 1871, were held as prisoners of war in Germany, an epidemic occurred 

 in Ingolstadt which, however, according to Doring, did not attain great dimen- 

 sions; among 10,000 prisoners only 159 were attacked. In the Milbank Peni- 

 tentiary in London scurvy prevailed in 1824 and 1840 ; also in the prison in 

 Prague in 1831,1836 and 1842; in the workhouse of Ludwigsburg in Wiirttem- 

 berg in four successive years, from 1850 to 1853, and in the prison of the same 

 city, in 1857. The last epidemic in Germany worth mentioning occurred in 

 1875-76 in a penal institution in the city of Moringen; the last in France in 

 the spring of 1877 in the prison at Mazas. Epidemics occur more frequently 

 in Eussia, even to-day, usually under the influence of extraordinary circum- 

 stances, such as crop failure, famine, or other social evil. 



The majority of the epidemics in Hirsch's tabulations are found to have 

 occurred inEussia, and this country also furnishes interesting details regard- 

 ing the geographic distribution of the disease. Eussia with 35 epidemics is 

 followed by Germany with 19 epidemics. Prance with 15, Sweden, Norway 



