297 
PATHOLOGY. 
plaints,” Dr. Lind obferves, “the patient has had, es¬ 
pecially bruifes, wounds, &c. or whatever prefent dis¬ 
orders he labours under, upon being afflicted with the 
Scurvy, his old complaints are renewed, and his preSent 
rendered worSe.” Indeed the Scurvy often firft (hows 
itSelf by the changes in diSeaSed parts. “Thus, when a 
perSon has had a preceding fever, or a tedious ficknefs, 
by which he has been much exhausted, the gums for the 
mod: part are firft affefled, and a laflitude conftantly at¬ 
tends} whereas, when one has been confined from ex- 
ercife by having a fraCtured bone, or from a bruife or 
hurt, thefe weak and debilitated parts become almoft al¬ 
ways firft Scorbutic. As for example, if a patient labours 
under a ftrain of the ankle, the leg, by becoming Swelled 
.and painful, and Soon after covered with livid Spots, 
gives the firft indication of the difeafe. And, as old ul¬ 
cers on the legs are very frequent among Seamen, in this 
cafe likewiSe the legs are always firft affeCled, and thefe 
ulcers put on a Scorbutic appearance, although the pa¬ 
tient Seems otherwise perfectly healthy, and preferves a 
Srefti good colour in his face.” The effeCt of the difeafe 
upon former maladies is ftrongly depicted by the elegant 
writer of Lord Anfon’s Voyage. “But a 1110ft extraor¬ 
dinary circumftance,” Says that gentleman, “and what 
would be Scarcely credible upon any fingle evidence, is, 
that the Scars of wounds which had been for many years 
healed, were forced open again by this virulent diftern- 
per. Of this there was a remarkable inftance in one of 
the invalids on-board the Centurion, who had been 
wounded above fifty years before at the battle of the 
Boyne; for though he was cured Soon after, and had 
continued well for a great number of years paft, yet, on 
his being attacked by the Scurvy, his wounds, in the pro¬ 
gress of his difeafe, broke out afrefti, and appeared as if 
they had never been healed. Nay, what is Still more afto- 
niftiing, the callus of a broken bone, which had been 
completely formed for a long time, was found to be 
hereby diffolved, and the fraCture Seemed as if it had ne¬ 
ver been consolidated.” (Voyage round the World in 
1740—4, by Lord Anfon, compiled by the Rev. R. Wal¬ 
ter, Chaplain to the Centurion, p. 102.) The ulcers, 
which occurred in the legs of the Scorbutic patients on 
this occafion, are Said to have been “ of the worft kind, 
attended with rotten bones, and Such a luxuriancy of 
fungous fleSh as yielded to no remedy.” The edges of 
thefe Scorbutic ulcers are of a livid colour, and puffed up 
with the fungous excrefcences, which are not inaptly 
called by the Sailors bullock's liver , Since to this fubftance, 
when boiled, Dr. Lind Says, they bear a near refemblance, 
both in confiftence and colour. They often arife in the 
courfe of a night to a monftrous fize; and, although de¬ 
stroyed by cauftics or the knife, (in which laftcafe, a co¬ 
pious bleeding commonly enfues,) are found at the next 
drefiing as large as ever. Dr. Lind affirms, however, that 
“ they continue in this condition a considerable time 
without tainting the bone.” (Lind on Scurvy, pt. ii. 
ch. 2.) Thefe Scorbutic ulcers, which are lingular and 
uniform in their character, are diftinguifhed from all 
others by being So remarkably offenfive, bloody, and fun¬ 
gous. 
In addition to thefe affeCtions of the lower extremities, 
(to which however they are not exclusively confined,) in 
the advanced ftage of the Scurvy, the patients moft com¬ 
monly lofe the ufe of their limbs, having a contraction 
of the tendons in the ham, with a fwelling and pain in 
the joint of the knee. Indeed, a ftiffnefs in thefe ten¬ 
dons, and a weaknefs of the knees, appear pretty early 
in this difeafe, generally terminating in a contrasted and 
■Swelled joint. 
In the progrefs of the Scurvy, the patients commonly 
complain of pains, which are often moving from part to 
part. Some complain of a general pain in their bones, 
which is moft violent in the limbs and loins, and espe¬ 
cially in the joints and legs 5 and a pain, with tightnefs 
and oppreffion, in the breaft, is very common. The head 
is Seldom or never affeCted, unlefs the patient is feverifh, 
which is unufual; for, as Dr. Lind well obferves, the 
difeafe is altogether of a chronic nature, and fever may 
be juftly reckoned among its adventitious Symptoms. 
It is remarkable, indeed, that in the worft ftages of the 
Scurvy, with all the Severe Symptoms above deferibed, 
with painful Spreading ulcers of the Surface, with con¬ 
tracted limbs, hemorrhages, Spongy, putrid, Stinking, 
gums, over-run with Sprouting fleSh, and often deeply 
ulcerated, with inability to make the lead mufcular ex¬ 
ertion, without fainting, or perhaps dying ; yet the pa¬ 
tients, even in this ftage, have a good appetite with 
their Senfes entire; and, though eafily dejected and made 
low-fpirited, yet, when in bed, they make no complaint 
of pain or Sicknefs, and appear to be in tolerable health. 
This Singular characteristic of the difeafe is well depicted 
by the reverend author before quoted. “ Indeed, the 
effeCts of this difeafe,” he fays, “ were in almoft every 
inftance wonderful; for many of our people, though 
confined to their hammocks, appeared to have no incon- 
fiderable Share of health ; for they ate and drank hearti¬ 
ly, were cheerful, and talked with much Seeming vigour, 
and with a loud Strong tone of voice; and yet on their 
being the leaft moved, though it was.only from one part 
of the Ship to the other, and that in their hammocks, 
they have immediately expired ; and others, who have 
confided in their Seeming Strength, and have refolved to 
get out of their hammocks, have died before they could 
well reach the deck. And it was no uncommon thing 
for thofe who were able to walk the deck, and to do 
Some kind of duty, to drop down dead in an inStant, on 
any endeavours to aCt with their utmoft vigour; many 
of our people having perished in this manner during the 
courfe of this voyage.” 
The principal phenomena deferibed in the necrotomy 
of Scorbutics, are the general extravafation of blood, 
and the dissolution and Separation of parts naturally 
united. Thus the bodies of the mufcles are often found 
Swelled and hard, from the blood fixed among their fibres, 
So that the limbs remain bent or contraCIed ; and the 
epiphyfes of the bones are found Separated, the cartilages 
of the Sternum loofened from their union with the bony 
part of the ribs, or the ligaments of the joints are corro¬ 
ded and loofe. The mefenteric glands are generally ob¬ 
structed and enlarged, and the Spleen bigger than natural, 
often falling to pieces as if it confided of coagulated blood. 
It is now generally understood that no medicines are 
of avail in the cure of Scurvy unlefs the diet be impro¬ 
ved ; and that, if this be done, medicines are Scarcely 
ever required. It has been found, that in the worft cafes 
the administration of frefli vegetables has restored the 
Sufferer to health. Among thefe vegetable productions, 
lemons hold the firft rank. Indeed So univerfal has been 
the Succefs which has attended the treatment of Scurvy 
by the vegetable acids, that Some have inferred that a 
want of oxygen in the blood is the proximate caufe of 
this difeafe ; an hypothefis however which is unsupported 
by faCts. When lemons cannot be preferved, as in long 
voyages, citric acid is a very ufeful Substitute. The 
Scurvy, which was once So formidable in our navy as to 
deftroy whole fleets, is now So far got under by the regu¬ 
lations introduced into our navy (chiefly through the ex¬ 
ertions of Dr. Trotter), that it is Scarcely more frequent 
than other difeafes. 
Genus XIII. Exangia, [from to pour out 
from a veffel.] Enlargement or rupture of a blood-veffel, 
without external opening. There are two Species. 
1. Exangia aneurifma, aneurifm : pulfating tumour of 
an artery. Three varieties. 
a. A. cyfticum, eneyfted aneurifm: tumour circum- 
feribed; formed by a dilation of the arterial coats with¬ 
in the fphere of the enlargement. 
/ 3 . A. diffufum, diffufed aneurifm: tumour diffufe: 
formed by the flow of arterial blood into a Subcutaneous 
cavity. 
