[43] “We find the College of Physicians at Vienna sent to Hungary great quantities of the most approved antiscorbutic herbs dried in this manner; which were found to be of no benefit. Many of these would have their virtues as little impaired by drying as spinage, e.g., marsh trefoil. Kramer tried almost every species of dried herbs to no purpose.” (Treatise on The Scurvy. James Lind, London, 1772, p. 143.)
[44] The cabbage was subjected to a preliminary drying for 8 days at 37° C. It was then put in an air-tight desiccator which contained a dish of phosphorus pentoxid. (The pentoxid was replaced for several weeks until it ceased to liquefy.) It was then placed in cylinders which had been rendered air free by means of a suction pump and which contained phosphorus pentoxid. This was kept at 37° C. and examined after 10, 18 and 26 months. A similar result was not obtained when calcium chlorid was employed, the temperature held at 37° C. and the cabbage was kept in an air-tight cylinder rather than in a vacuum. However, under these conditions if the cabbage was placed in the ice-box at a temperature of 4°, 10° or 12° C. the antiscorbutic property was conserved after boiling.
[45] The pulses, after having been soaked in water for 24 hours, were kept moist, with access of air, for about 48 hours at room temperature, and during this time germinated, developing a radicle usually about 1 cm. in length.
[46] As the result of an experience with thousands of cases of scurvy in the Serbian army, Wiltshire has recently laid great emphasis on this follicular hyperkeratosis. He states that the earliest recognizable sign of scurvy is an enlargement of the hair follicles of the inner and anterior aspects of the thigh and upper leg, which show numerous conical elevations about the size of a pin’s head. A hair, broken or unbroken, frequently pierces the follicle.
[47] There seems to be some misconception as to the pathogenesis of the subperiosteal hemorrhage in scurvy. In most reports this lesion is described as if it resulted from a hemorrhage burrowing its way beneath the periosteum and raising it from the subjacent bone. In point of fact, such an event is impossible, as will be fully realized when one experiences the great difficulty in separating periosteum from normal bone. The scorbutic process involves the periosteum so that it is no longer normal but becomes insecurely attached to the shaft of the bone, and is readily stripped off by hemorrhage.
[48] Senator regarded the marrow in scurvy as being aplastic. Nobécourt, Tixier and Maillet report postmortem examinations where the marrow showed an increased number of myelocytes and nucleated red cells of various kinds. They consider the typical blood change an intense myeloid reaction of the blood.
[49] A blood-pressure band, or tourniquet, is placed about the arm, and the pressure increased until the forearm becomes cyanosed and the radial pulse is almost obliterated. The pressure is then maintained at this level for 3 minutes. The principle of this test consists in subjecting the capillaries and venules to increased intra-vascular pressure to observe whether this strain results in the escape of blood. In infants the pressure was usually raised to 90 mm.; in some cases it had to be raised higher in order to entirely obstruct the return flow of the blood.
The test is considered to be “positive” when the forearm shows many petechial spots. In normal infants petechiæ were almost always absent, or there were few to be seen. This is not a specific test for scurvy, but demonstrates a weakness of the vessel walls, whatsoever may be the cause. It is found to be positive in the majority of cases of scurvy.
[50] We have been unable to ascertain through inquiries from the Surgeon-General’s Office the nature of the experience which led to their incorporation in the ration, and whether they were added specifically as an antiscorbutic. They appear for the first time in the revision of the Army Regulations of 1895. The only reference to the antiscorbutic property of canned tomatoes which we have been able to find in the literature is in the excellent treatise by Munson on Military Hygiene.
[51] Since the above was written, an article has appeared by P. W. Bassett-Smith (Scurvy: With Special Reference to Prophylaxis in the Royal Navy. Lancet, London, 1920, I, 1102) showing that lemon juice can be prepared in tablet form and preserve its efficacy for at least three months. Each tablet contained the equivalent of 24 c.c. of lemon juice, and less than one-fifth of a tablet was sufficient to protect a guinea-pig from scurvy. This therapeutic procedure seems of great promise in providing an antiscorbutic ration for the navy or the army.