Observations on the Diseases of Seamen

by Sir Gilbert Blane

The fleet was furnished with essence of malt; but its powers were so inconsiderable, that some of the surgeons denied that it had any. In trials, however, that were made in an early state of the disease, it was found to have a sensible effect in checking and removing it. It was also found of evident use in the bad ulcers so apt to arise in scorbutic habits, and in this intention was superior to the Peruvian bark as an internal alterative. Indeed, in those ulcers that were truly scorbutic, the bark was found to be of very little use; and, next to what has been already mentioned, joined to the advantages of diet, opium was found of the greatest service in disposing these, as well as all other ill-conditioned sores of hot climates, to heal.

I have mentioned the scorbutic habit as distinguished from the scurvy, but there seems to be no difference except in degree; for a person may be laid to labour under the disease before it betrays itself by any obvious symptom, and it must have gathered a certain degree of force before visible symptoms are produced. The chief mark of this latent and incipient stage of the disease is that incurable state of ulcers that has been mentioned, whether they appear spontaneously or in consequence of slight accidents. There is another mark of this scorbutic habit which is not mentioned in any description of the disease I have ever seen. It is a soft, indolent tumour which arises under the skin on a part which has received a small blow, or contusion, so slight as not to break the skin. It most commonly appears about the elbow or fore-arm, and generally disappears without any inconvenience, what it contains being absorbed. A surgeon, who opened one of them, (a practice, however, not to be approved of) informed me that it consisted of fluid blood. We may also reckon a languor, or sense of weight, as one of those marks of scurvy which occur before the more obvious symptoms appear.

In this state of the disease, the articles of lesser powers, such as malt and melasses, may be of service by preventing its farther progress, or the appearance of actual symptoms, and by restoring the constitution.

In some of the early stages of this disease the effervescing mixture of acids with fixed alkali may probably also be of use. I never could perceive any sensible benefit in those cases in which I tried it, though some of the gentlemen of the fleet reported to me that they thought it of service.

There is no article of the Materia Medica yet known that possesses any considerable power over this disease without the assistance of proper diet. With this assistance, however, it is found, that whatever tends to increase the fluid secretions, hastens very much the recovery of the scorbutic patient. I have observed a very striking instance of this in the effects of a spontaneous diarrhoea; for I have seen those hard livid swellings on the legs, that form one of the most constant symptoms of this disease, almost disappear, and the hams, from being contracted, become flexible in the course of twelve hours after the purging came on. I have endeavoured to imitate this with purgatives, but never with the same effects as the natural looseness. A free flow of urine is also found to promote the recovery, and vinegar of squills is one of the most effectual medicines in this intention. It is likewise of singular service to excite sweat; for an obstruction of perspiration seems to be one of the principal constituents of the disease. The goose skin, which is an early and constant symptom of this disease, seems to be owing to a constriction of the exhaling vessels. Dover’s powder has been employed with advantage as a sudorific, with decoction of the woods drank warm, and plentiful warm dilution. Camphor, combined with nitre, has been found one of the best remedies, and it acts both as a diaphoretic and diuretic.

Such external applications as relax the skin are found also to forward the cure. The contraction of the hams and the livid hardness of the calves of the legs are relieved by emollient cataplasms. Burying the legs in the earth, which has a sensible good effect, seems to act on the same principle, for it makes the parts sweat profusely.

There can be no doubt that in the scurvy there takes place in certain parts of the body a stagnation of the humours in the small vessels, particularly of the lower extremities, and that it is to this circumstance that the livid hardness of the fleshy parts of the legs is owing. The effect of medicine in removing this, must be to restore the action of those torpid vessels, so as to bring the stagnated fluids again into circulation[121] Purgatives seem to act upon it as they do in the dropsy, by exciting absorption. The irritation of the bowels and their increased secretion thus affecting the minute vessels in all parts of the body, is the result of that sympathy or balance established between every part of the system, in order to support the harmony and effect the purposes of the animal œconomy.

It has long appeared to me, that the scurvy is owing rather to a defect of nourishment than to a vitiated state of it. In fact, that sort of food which is supposed most commonly to induce the scurvy, is, in most cases, not putrid, but is in an unnatural and depraved state by being drained of its juices, which run off in brine; and perhaps some of the more subtile and nutritious parts are wasted by evaporation. It is not found that salt of itself has any effect in inducing the scurvy, and indeed it can be induced under a state of diet in which there is no salt, as we know from some instances quoted by Dr. Lind; and some cases are related by Dr. Monro and Dr. Milman, in the Medical Transactions, which are in proof of the same opinion. But the case most in point to prove that it depends on a defect of aliment, is that of Dr. Stark, who, by way of experiment on himself, reduced his diet to the least quantity he could subsist upon, and was thereupon affected with the symptoms of the sea scurvy. I have also known some symptoms of it arise in old people in consequence of long abstinence, owing to the want of appetite.

It would appear that the aliment we take in acts in two ways in increasing the vigour of the body. First, by assimilation, whereby it affords the matter of which the solids of the body are made, in order to carry on growth in youth; and to repair the waste of parts in adult age. A very small quantity of matter is necessary for these purposes; and as a proof of it, we see people supported equally well with very different quantities and qualities of food. Secondly, Food is necessary as a stimulus, either by a power it has of soothing the nerves of the stomach, and the other surfaces to which it is applied, or by its volume in distending the intestines and blood vessels. It is upon this principle that luxury renders the great quantities of food we take in necessary; and those species of food which satisfy most by their stimulus are by no means such as are the most nutritious. It is also upon this principle, that in cases of accidental hardship from want of food, or in barren and inclement countries where food is scarce, the body is supported, in some measure, by what contains little or no nutritious matter, such as pure water, or the bark of trees powdered and kneaded into a sort of bread, as we are told of the inhabitants of Lapland.

There are other familiar and well-established facts, which prove, that either from the influence of disease, from habits of life, or the nature of particular animals, life can go on for a length of time with little or no aliment. This is the case in fevers, in sea-sickness, in certain singular cases that have been recorded[122], in torpid animals, and in animals of cold blood. Though a man in health will die if deprived of food for a very few days, it does not follow that this is owing to the want of matter to repair the waste of the body. The craving for food, and the faintness from long abstinence, arise from the want of the accustomed stimulus, especially in those who are used to live well; and a person feels himself most refreshed by food and drink when newly taken in, and before it can be applied to the purpose of nutrition.