Observations on the Diseases of Seamen

by Sir Gilbert Blane

From the preceding view of the variety of causes which tend to keep up this disease, it will appear that great judgement and discrimination are necessary in varying the practice according to circumstances; and there is no disease in which there is room for more attention and nicety in adapting the different remedies to the different symptoms. We can hereby also account for the various characters that different remedies have had, some having been extolled by one practitioner while they have been pronounced insignificant by another; for no one remedy will suit all the various cases of this disease. As it is of the greatest consequence to distinguish these cases, I have been more particular and diffuse on this article than any other; and having laboured under this complaint myself, I was naturally led to take a greater interest in its treatment, and had also thereby a better opportunity of making observations on it.

CHAP. III.

Of the Scurvy.

I shall not be so minute either in the description or treatment of the scurvy, as of the preceding diseases. A detail of this kind would lead to unnecessary prolixity and repetition; for the prevention and cure of it consisting in diet rather than medicine, have been fully handled in the former parts of this work; and the subject, in the descriptive as well as the practical part, has, in a manner, been exhausted by Dr. Lind. With regard to the theoretical part, I refer the reader to the ingenious treatise lately published by Dr. Milman.

It has appeared that the principal source of scurvy is a vitiated or scanty diet, and that it is very much promoted by cold, moisture, filth, sloth, and dejection of mind. Hard labour has been assigned by some as a cause; but this is not conformable to my observation in general, and what has been related to have happened in the Conqueror[118], more particularly led me to be of a contrary opinion.

The principal differences of the symptoms of the scurvy in hot and cold climates, so far as I have observed, are, that in the former the livid hardness on the extremities is an earlier symptom, and in the latter the gums are sooner affected, and the difficulty of breathing is a more frequent and more uneasy symptom. This difficulty of breathing is one of the most fatal symptoms, and is most frequent in those cases in which there are the fewest external marks of the disease, and is probably that form of the complaint which attacks a vital part by a sort of translation from the extremities.

There is a remarkable symptom sometimes attendant on this disease which has escaped authors, and is mentioned in Mr. Telford’s Report, page 23. This is the nyctalopia, or weakness of the eye-sight, which was also common in the garrison of Gibraltar[119], among those who were affected with the scurvy, a disease that prevailed much during the late siege of that place.

With regard to the cure, enough has been said in the preceding parts of this work to prove that fresh vegetables are the most effectual antiscorbutics. I shall here mention a fact farther in proof of this, which has not before been taken notice of. When the fleet arrived at Barbadoes in May, 1781, part of the soldiers, who served as marines, were affected with the scurvy, and being sent to the army hospital, where, at that time, no fresh animal food was allowed, they recovered much faster by being confined to vegetable articles, than the seamen who were fed upon fresh animal food without any fresh vegetables.

It has farther appeared, that there is something in a particular class of fruit of the lemon and orange kind, which far surpasses every other remedy, whether dietetic or medicinal. Numberless instances have occurred, in the preceding part of this work, of men having recovered at sea from using the juice of this fruit alone, even under all the inconveniences of a sea diet. When the juice is intended to be kept for a length of time, it should be expressed and bottled, a small quantity of spirits being added to preserve it for if fire is used in preparing it, as in the form of a rob, I know for certain that its virtues will be thereby very much impaired. It is very difficult to say upon what principle these fruits act, for no sensible effects are produced by them except a small increase of some of the secretions.

It ought to be mentioned here as a fact of great consequence, though very little known, and never, I believe, published before, that the juice of limes and lemons is the best detergent of any external application that has yet been tried in scorbutic ulcers. Nothing was found so effectual in preventing these from spreading, and in disposing them to heal, as an emollient poultice with[120] lemon or lime juice sprinkled on its surface; or it was applied by soaking in it the lint with which the sore was dressed, and also as a lotion, in which case it was used diluted with two or three times its quantity of water; for if used pure, it was found too irritating, and was apt to bring on a fungous disposition. This precaution is particularly necessary with regard to limes, the juice of which is a much more concentrated acid than that of lemons. Mr. Lucas, surgeon of the Conqueror, favoured me with several valuable remarks in proof of this practice. A poultice was always found a good application in these cases, by its power of absorbing the acrimonious discharge, which would otherwise irritate the neighbouring parts. I have been informed by a navy surgeon, who served in the former war, that he has known the most obstinate ulcers cured by applying a paste of oatmeal and water, the surface of which was sprinkled with Goulard’s preparation of lead.