392 THE HEMORRHAGIC DIATHESES 



and Denmark with 14, and England with 11. The other European countries 

 present much smaller figures. Of foreign countries India heads the list with 

 14 epidemics, then follows North America with 17, and Algiers with 7. The 

 disease may even to-day be looked upon as endemic in Eussia, and occasionally 

 it shows extraordinarily wide distribution, as is evident from the reports of 

 the Obuchow Hospital in St. Petersburg. 



In the great epidemic of 1849 which distributed itself over a wide area of 

 the Russian Empire, Krebel reports that among 360,444 persons 60,958 died. 

 In Asiatic Russia also, especially along the coast of the Arctic Sea, in the 

 Siberian-Chinese boundary land, and upon the peninsula of Kamchatka, scurvy 

 is frequently seen to-day. In northwestern Europe scurvy' never played a 

 prominent role, and although, for example, a famine with scurvy appeared in 

 Iceland in the years 1836-37, the scurvy did not assume an endemic character. 

 The conditions are the same in other European countries; only now and then 

 localized epidemics are reported from prisons. Epidemics have prevailed ex- 

 tensively in Algiers without assuming a distinctly endemic character; scurvy 

 appeared among the French troops in Egypt in 1801 ; in Abyssinia the disease 

 has been observed almost exclusively in travellers, the natives being spared, 

 although they usually live under decidedly more unfavorable and insanitary 

 conditions than the strangers, and these conditions are powerful factors in the 

 distribution of the disease. On the other hand, in the Eastern Soudan and 

 in the entire rain zone of East Africa the disease is said to occur frequently 

 among natives as well as strangers. In South Africa, on the contrary, the 

 disease is reported to be quite unknown among the negroes. 



In Asia, India in particular is subject to the disease; a great number of 

 epidemics there are reported ; these occurred chiefly among the poorer popula- 

 tion, and were widespread. Upon the coast of Dschemenia (Arabia) the dis- 

 ease is endemic; in 1839 the English troops in Aden were attacked by it; in 

 China, especially in the northern provinces in which the population live in a 

 squalor elsewhere unequalled, epidemics are not rare; also among the poorer 

 population in Japan scurvy is quite frequent. 



In Australia, in numerous expeditions to the interior which were under- 

 taken for purposes of discovery, the affection has been very serious, and lately 

 it has appeared endemically among the shepherds upon the wide grazing plains 

 of that country. 



In the southern parts of America the disease appears to be unknown, 

 and in the north the natives show no susceptibility to the affection. The epi- 

 demics which have been reported occurred among United States troops who 

 were exposed to great privations at outlying stations, in lumber camps in the 

 interior of Canada, but particularly in California during the gold fever, among 

 adventurers who had collected from all parts of the earth and who lived under 

 circumstances of great privation. These reports now have renewed interest 

 because great numbers of people have rushed to the gold fields of Alaska, 

 where, after Greenland, scurvy is more prone to occur than in any country of 

 the Arctic regions, and where all the conditions are favorable for the outbreak 

 of an epidemic. 



Among the members of the well-known ISTansen expedition, from July, 



