conglomeration of clinical conditions. Scurvy had become the Alpha and Omega of professional routine, the catchword of the day, the asylum ignorantiæ of the practical man. Into this chaos, as Hirsch expresses it, “the first beams of light fell when Lind’s classical work appeared.”

It will be of little value to consider the great number of epidemics of scurvy which occurred from this time to the present day. They may be found in tabular form in the excellent survey of scurvy by Hirsch. The literature of this long period may likewise be found in a work of encyclopædic character, that of Krebel, which gives the titles, with a summary of the various articles on this subject, appearing to the year 1859. If we look over the chronological table compiled by Hirsch, we note a remarkable similarity regarding the incidence of the recurring epidemics. In almost all cases they broke out among troops, whether in Russia, in India, in Africa, or in our United States. The epidemics which are not attributable to military life or campaigns are found to have taken place generally in prisons, insane asylums, poorhouses or houses of refuge and correction. It would seem that no war is omitted from this list of sickness and death. There are in all 143 land epidemics between 1556 and 1877, two occurring in the sixteenth century, four in the seventeenth, 33 in the eighteenth, and 104 in the nineteenth century. The marked increase in the nineteenth century occurred in institutions, in asylums and prisons, rather than in the armies. This fact may be ascribed to altered social conditions which led to a great multiplication of eleemosynary institutions.

Coming down to more recent times, we learn that scurvy occurred extensively during the Crimean War, and that it was prevalent also among the troops in our own Civil War. In the “Medical and Surgical History of the War of the Rebellion,” we find the following statements:

“A scorbutic tendency was developed at most of our military posts during the winter season, after the troops had been confined to the use of the ordinary ration with the desiccated vegetables. The latter in the quantities failed to repress the disease. At posts which could be readily supplied with potatoes only the taint was manifested, on account of a want of liberality in the issues.” And again: “Among the white troops during the five and one-sixth years covered by the statistics, 30,714 cases of scurvy were reported; and 383 deaths were attributed directly to that disease.”

Munson writes: “It (scurvy) prevailed among our troops during the Civil War and its recognition was a surprise and shock to professional ideas preconceived from practice in civil life.”

As is well known, the besieged in Paris during the Franco-Prussian War in the winter of 1870–71 suffered severely from scurvy. The accounts of their pitiable condition have been portrayed for us by numerous French writers (Delpech, Hayem, Lasèque and Legroux). The people lived mainly on rice and bread, with an occasional addition of potatoes or horse meat. The winter was exceptionally severe, which was supposed to have intensified the scorbutic condition. Not only were the inmates of the prisons on the Seine attacked, numbering about one thousand, but even the patients in the military hospitals developed the disease. It is of interest to remember that the siege lasted but little over four months, from September 17th to January 27th, the date of the armistice.

In the Russo-Japanese War, after the siege of Port Arthur, it was found that one-half of the garrison of 17,000 men had scurvy.

Although there are certain parts of the world where scurvy is of frequent occurrence, no country has been entirely free from it. As might be expected, it has been particularly prevalent in the North, where vegetation is scanty—in Greenland, Alaska, Russia and the Baltic States. It has likewise prevailed in the tropics when the crops have failed. India has been conspicuous for its large number of epidemics; some years ago scurvy occurred in Arabia among the English troops stationed at Aden, both among the British and the native troops. A recent communication from Aruba, a small island of Dutch Guiana, lying north of Venezuela, illustrates how devastating scurvy still is in some parts of the world. This account tells of 3000 cases of this disease which occurred in 1915 among a population of less than 10,000, owing to the fact that the crops had failed almost entirely during the years 1912, 1913 and 1914.

Fig. 1.—A comparison between the requisitioned quantity (in thousand pound units) of potatoes and other vegetables, and the quantity received per month by an institution in which more than 200 cases of scurvy occurred at the beginning of April, 1916. The total height of column represents the amount needed and requisitioned; the solid black portion the amount received. The number of inmates in the institution remained approximately the same.

The chart illustrates our great dependence on the potato during the winter months. This is due not only to its intrinsic antiscorbutic potency, but, probably quite as much, to the fact that fully twice as many pounds of potatoes are consumed during the winter as of all other vegetables combined. Therefore, if this crop fails or is dehydrated, scurvy will develop in the spring.

It is important for us to realize that we are still dependent on the annual crops for our protection from scurvy; in other words, the world is leading a hand-to-mouth existence in regard to its quota of antiscorbutic food. The truth of this condition has been realized for Ireland, sadly illustrated by numerous epidemics, notably the great epidemic of 1847 reported by Curran. It was demonstrated by the outbreaks of scurvy in Norway in 1904 and 1912, and was brought to the attention of many in the United States in the spring of 1916. In this year our potato crop fell far below the normal, with the result that scurvy appeared in various parts of the United States, especially in institutions (Fig. 1).

The fact that scurvy may occur in any land and climate, even in the garden spots of the world, is strikingly shown by the epidemics reported from Algiers, and the ravages of this disease among the gold seekers in California in 1849. Nothing could be more incongruous than the occurrence of a deficiency disease in this land of plenty.

Outbreaks at Sea.—It is doubtful, however, whether attention would have been focussed so early and so sharply on scurvy, had it not been for the voyages of exploration undertaken in the sixteenth century. These long trips on sailing vessels, where for many months little or no fresh vegetable or animal food was obtainable, were almost as if designed to make a test of the dietetic origin of scurvy. The result was inevitable—five to six months after the ships were out of touch with land, the majority of the crew frequently were incapacitated by this disease, thereby wrecking many an expedition.2

The earliest account of the outbreak of scurvy at sea is that of Vasco de Gama, who in 1497 discovered a passage to the East Indies by way of the Cape of Good Hope. The narratives of subsequent explorers, especially those of Cartier and of Drake, are replete with descriptions of the ravages of scurvy. The expedition of Lord Anson in 1740 is always cited as a memorable example of an