Scurvy, or SCORBUTUS, is a disease characterised by a depraved condition of the blood. In consequence of this morbid state of the blood there is great debility of the system at large, with a tendency to congestion, hæmorrhage, &c. in various parts of the body, and especially in the gums. It has probably existed from the earliest times, but the first distinct account of it is contained in the history of the crusade of Louis IX. in the 13th century against the Saracens of Egypt, during which the French army suffered greatly from it. In the 16th century it prevailed endemically in various parts of the north of Europe, and it seems only to have abated towards the close of the 18th century. It was in badly-fed armies, in besieged cities, and on board ship that its ravages were most appalling, and it is believed that more seamen perished from scurvy alone than from all other causes combined, whether sickness, tempest, or battle. For instance, only 1512 sailors and marines were killed in all the naval battles of the Seven Years' War; but 133,708 died of disease or were missing, and scurvy was the principal disease. Whole crews were prostrated by this scourge, as in the well-known case of Lord Anson's (q.v.) memorable voyage. It is now met with under similar conditions, though cases are comparatively rare (in 1873 only 19 cases were reported to the Board of Trade, in 1881 as many as 99), and also among the lower classes in large towns, navvies engaged in railway work, &c., when they confine their dietary to tea, bread, ham, salt-fish, &c., to the exclusion of fresh vegetables and meat.
The first effect of the disease is generally a decline in the general health, and the patient becomes depressed, is easily fatigued, and has a peculiar sallow complexion. After a variable period the more characteristic symptoms appear, the chief of which are hæmorrhages and sponginess of the gums. The hæmorrhages closely resemble those of Purpura (q.v.), and occur into and under the skin, where they give rise to red or purple discolorations which change colour like the marks of bruises; into the muscles and other deeper tissues, where they cause brawny swellings; and into internal organs or cavities. Hæmorrhage also frequently takes place from the mucous membranes of the nose and alimentary canal. The affection of the gums is still more characteristic, and is rarely absent, except in the very young or very old, who are without teeth. The gums are swollen, discoloured, detached from the teeth, and bleed extremely easily, while the breath becomes very fetid. This condition sometimes precedes but often follows the occurrence of hæmorrhage in other situations.
The cause of scurvy is now well known to be an improper dietary, and particularly an insufficient supply of fresh vegetable food. The disease is never known to have occurred in any one who had eaten freely and habitually of such articles of diet. Even preserved vegetables, if kept in a juicy condition, prevent the occurrence of the disease. In the absence of vegetables abundant fresh meat and in a less degree milk are antiscorbutic. But the most efficient protective if fresh vegetable food is not attainable is lemon or lime juice; and the constant use of the latter during long voyages undoubtedly prevents the occurrence of scurvy when it would otherwise be inevitable. It is more apt to affect those who are deprived of fresh air and sunlight, are mentally depressed, and have had their health enfeebled by previous disease. In what way the deprivation of fresh vegetables acts on the blood to produce scurvy is as yet unknown. Dr Garrod's theory, that the element wanting is a sufficient supply of potash salts, is not generally accepted; for it has never been proved that potash salts by themselves are sufficient to prevent the disease.
Although the virtues of lemon-juice in scurvy were known in England as far back as 1636, when John Woodhall, Master in Surgery, published The Surgeon's Mate, or Military and Domestic Medicine, this invaluable medicine was not made an essential element of nautical diet till 1795, the author of the change being Sir Gilbert Blane (q.v.). The effect of this official act may be estimated from the following numbers. In 1780 the number of cases of scurvy received into Haslar Hospital (a purely naval hospital) was 1457, while in 1806, as also in 1807, there was only one case. Many naval surgeons of the present day have never seen a case of the disease. The potato possesses almost equally great antiscorbutic properties, and fortunately potatoes when cooked are as active as when taken raw. Dr Baly (1814-61), to whom we are indebted for this discovery, states that 'in several prisons the occurrence of scurvy has wholly ceased on the addition of a few pounds of potatoes being made to the weekly dietary.' For the cure, as for the prevention of the disease, the diet is by far the most important agent; lime, lemon, or orange juice should be given freely. Sometimes the condition of the mouth prevents the administration of potatoes and other vegetables; but when possible they should be given freely. Washes of chlorate of potash, tannin, or Condy's fluid should be used for the gums; if they are severely affected solid nitrate of silver may be applied to them with advantage.