Two of these were ordered each a quart of cider a day. Two others took twenty-five drops of elixir vitriol, three times a day, upon an empty stomach; using a gargle strongly acidulated with it for their mouths. Two others took two spoonfuls of vinegar three times a day upon an empty stomach; having their gruels and their other food well acidulated with it, as also the gargle for their mouths. Two of the worst patients, with the tendons under the ham rigid (a symptom none of the rest had) were put under a course of sea-water. Of this they drank half a pint every day, and sometimes more or less, as it operated by way of gentle physic. Two others had each two oranges and one lemon given them every day. These they ate with greediness, at different times upon an empty stomach. They continued but six days under this course, having consumed the quantity that could be spared. The two remaining patients took the bigness of a nutmeg three times a day of an electary recommended by a hospital-surgeon, made of garlic, mustard-seed, rad. raphan, balsam of Peru, and gum myrrh; using for common drink, barley water well acidulated with tamarinds; by a decoction of which, with the addition of cremor-tartar. they were gently purged three or four times during the course.

40 Howard and Ingvaldsen, Bull. Johns Hopkins Hosp. 28, 222, 1917.

41 Robb, Science 62, 510, 1020.

42 Lind, Treatise on Scurvy, London, 2nd Ed. 1767.

The consequence was, that the most sudden and visible good effects were perceived from the use of the oranges and lemons; one of those who had taken them being at the end of six days fit for duty. The spots were not indeed quite off his body, nor his gums sound; but without any other medicine than a gargarism of elixir vitriol, he became quite healthy before we came into Plymouth, which was on the 16th of June. The other was the best recovered of any in his condition; and being now deemed pretty well, was appointed nurse to the rest of the sick.

Next to the oranges, I thought the cider had the best effects. It was indeed not very sound, being inclinable to be aigre or pricked. However, those who had taken it were in a fairer way of recovery than the others at the end of the fortnight, which was the length of the time all these different courses were continued, except the oranges. The putrefaction of their gums, but especially their lassitude and weakness, were somewhat abated, and their appetite increased by it.

The regular administration of lemon juice prescribed by the British Admirality in 1780 and the similar regulation adopted by the Board of Trade in 1865 has resulted in the complete disappearance of the disease from the navy and mercantile marine. Whereas in 1780 the number of cases of scurvy received into Haslar Hospital (a purely naval hospital) was 1457, there was only one case in 1806 and one more the following year. Dr. Baly 43 states that in several prisons the occurrence of scurvy wholly ceased on addition of a few pounds of potatoes being made to the weekly diet. Hoist44 asserts that when the Eskimos suffer from this disease they turn to the liver of seals or better to fresh "matok," a preparation from the skin of whales, for cure.

While the experience of generations has pointed to fresh fruits and vegetables as the preventive and cure of scurvy, only after the discovery of Hoist and Frolich,45 that the disease could be induced in guinea pigs by restricting them to a diet of oats and water and that the symptoms thus produced responded to the same treatment which had been found effective in human scurvy, did it become possible to classify foods into those which do and those which do not possess antiscorbutic power.46 Tradition has placed the juice of lemons and oranges first among the curative substances, and modern research largely confirms this view, although certain other vegetable products have been found to be equally efficacious. Tomatoes, raw or canned, the uncooked juice of the Swedish turnip, leafy vegetables, especially cabbage, eaten raw, the sprouted seeds of cereals, peas, or beans are all efficient antiscorbutics. It is an interesting fact that the Swedish turnip, which might at first sight appear to be quite unrelated to the other classes of vegetables named, is really a member of the order Cruciferae, to which belong the cabbage and the "scurvy-grass" (Cochlearia officinalis) much esteemed in olden days as a cure for the disease.

Bachstrom, in 1734, told how a sailor in the Greenland ships, so disabled with scurvy that he could only crawl about the ground, was put ashore by his companions and left to perish. In his desperate state he nibbled the grass growing on the shore, which chanced to be scurvy grass, and in a short time recovered so that he was able to find his way home.47

43 1814-61, quoted by the University Encyclopedia.

44 Hoist, " 15th International Cong, of Hyg." Wash., 1012, ii, 588.

45 Hoist and Praiich, J. Hyg. 7, 634, 1907; Z. f. Hyg. Infekt. 72, 1, 1912.

46 For detailed classification see Chap. 4 and Appendix. Distribution of C.

Fig. 17. - A Dormal guinea pig. 15 c.c. daily of summer pasture milk protected against scurvy when the remainder of the ration consisted of heated alfalfa flour 25 parte, rolled oats 74 parte, and common salt 1 part. Photographed in the 12th week of restriction to this diet.

Fig. 18. - A scorbutic guinea pig. 15 c.c. daily of dry feed milk did not protect against scurvy when the remainder of the ration consisted of heated alfalfa flour 25 parte, rolled oats 74 parts, and common salt I part. Photographed after 4 weeks' restriction to this diet.

Fig. 19. - Showing early stages of scurvy. 15 c.c. daily of winter-produced milk (silage + dry grain and dry hay) did not effectively protect against scurvy when the remainder of the ration consisted of heated alfalfa flour 25 parts, rolled oats 74 parte, and common salt 1 part. Photographed after 4 weeks' restriction to the diet. The silage was made from field-dried, but non-frosted corn.

Figs. 17, 18 and 19 supplied through the courtesy of Messrs. E. B. Hart, H. Steenbock, N. R. Ellis and Journal of Biological Chemistry 42, 396, 1920.

The minimum daily doses of fresh citrus fruit juices required to protect a guinea pig from scurvy were found by Davcy (Biochem. J. 15, 83, 1921) to be as follows: Lemon 1.5 cc, orange 1.5 cc. and lime 5 cc. To avoid the acid effects of these juices they were first partially neutralized with sodium carbonate.

Animal food, while of undoubted value, is less effective than vegetable products. Cow's milk contains comparatively little of the necessary factor, especially after pasteurization. Fresh meat is effective if eaten in sufficiently large quantities, but the necessary cooking lessens its value. In general, heating and drying decrease the antiscorbutic effect of foodstuffs, the deterioration being proportional to the time of exposure, but some foods, for instance, tomatoes, withstand such unfavorable conditions better than others. Chick and Dalyell48 have reported many cases of scurvy developing among children who were under treatment for tuberculosis and consequently on a diet rich in antiscorbutic foodstuffs. Investigation showed that these foods had been subjected to prolonged cooking in the course of which the antiscorbutic properties had evidently been completely destroyed. Similar cases of a theoretically adequate diet being rendered scorbutic by over-cooking of the food occurred from time to time in the armies during the war.

It is to be remembered that our data as to the antiscorbutic efficiency of different foods is in large measure derived from guinea requirement for this factor it is quite possible that certain foods which would appear from these experiments to be entirely devoid of antiscorbutic vitamin may actually contain an amount which would afford sufficient protection to a less susceptible animal. For practical purposes, however, the guinea pig test is quite satisfactory, since it serves to distinguish those foods which are relatively high from those which are at least relatively low in antiscorbutic content.

47 Quoted in Rep. 38, Med. Res. Com. London, 1919. 48 Chick and Dalyell, Z. Kinderheil. 26, 257, 1920.

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