SCURVY 397 



proven beyond doubt, and I could cite other typical and convincing cases 

 from my own experience. 



That a particular climate cannot be considered etiologically is evident 

 from the geographical distribution of the disease. Great stress has been laid 

 upon the prevalence of damp, cold weather during the time of epidemics, yet 

 it appears from numerous communications that in winter and in summer, with 

 a moist as well as with a dry air, the disease has been widely distributed. The 

 conditions of the soil have little absolute importance. 



According to our present knowledge the disease appears to be induced by 

 unhygienic, above all by improper alimentary, conditions. The enumeration 

 of these and the history of the disease show that by far the greatest number 

 of epidemics have occurred upon long sea voyages, in camps, in besieged for- 

 tresses, in barracks, in prisons, in almshouses, in foundling asylums, etc. 

 Under such circumstances a great number of injurious factors act conjointly, 

 and it is a question to which of these the greatest importance is to be attached. 

 Besides insufficient clothing, contaminated air as the result of over-crowding of 

 rooms, and other influences that take part in the etiology of the disease, there 

 is great unanimity among observers of all times and countries as to the decided 

 influence of faulty nutrition in the causation of scurvy. However, the views 

 diverge widely as to what errors in diet are most important. Scurvy has sel- 

 dom occurred after a famine, although very frequently after a failure of crops. 

 On the contrary, it has been attributed to the almost exclusive use of salt 

 meat; this was the prevailing opinion before modern methods of preserving 

 made it possible to supply better food to ships, and at a period when sea voyages 

 were much longer than at present, so that a crew for months at a time sub- 

 sisted exclusively on meat which had been salted. Many races in the far 

 north, however, year in and year out, live almost wholly upon salt meat and 

 fish, and in spite of this scurvy is almost unknown among them; numerous 

 observers, too, have reported epidemics in which there was absolutely no de- 

 ficiency of fresh meat. The lack of fresh water has also been mentioned, but 

 only in isolated cases (the report of Beckler of the expedition of Burke to the 

 interior of Australia in 1861). 



The number of observations showing the importance of a deficiency of 

 fresh vegetables in the food is almost overwhelming. We regret we cannot 

 £nter into the details of these, but refer the reader to Hirsch, who, in a " short " 

 compilation to which he devotes many pages, relates the full particulars. 



We shall only briefly state that Bachstrom was the first to point out the 

 influence of a deficiency of fresh vegetables in the food. Lee tells us that 

 the severe epidemic in 1823 in the south of Eussia began when great swarms 

 of grasshoppers devastated the fields. Almost all the reports of the epidemic 

 of scurvy during the siege of Paris in 1870-71 agree in stating that it devel- 

 oped only when the supply of fresh vegetables, especially of potatoes, was ex- 

 hausted, in spite of the unhygienic and evil social conditions previously ex- 

 istent. 



Delpech cites the case of a wine merchant, aged forty-five, who was attacked 

 by scurvy -although living in easy circumstances, in a sanitary, dry, and well- 

 heated house, and partaking plentifully of fresh meat, yet in his dietary no 



