prevalent disease in the army, and that since the spring of 1917 it was widely disseminated among the German troops. Lobmeyer writes of scurvy among the Turkish troops, and Disqué reports 500 cases among prisoners captured in Turkestan.

Along the Western front very few cases are described. There is an account by Korbsch of 51 cases in this area in 1915. Schreiber describes 30 cases among the German prisoners of war captured in the beginning of 1917, which were diagnosed as purpuric rheumatism. Arneth recounts that sporadic cases of scurvy occurred among the German troops, especially among the older soldiers, and that in many cases this was combined with the hunger edema. He attributes the scurvy to a dependence on dehydrated vegetables in the ration.

From all these accounts it is evident that scurvy played an important rôle in the general nutrition of the troops on the Eastern front. Probably it was of the latent variety, which is exceedingly difficult to diagnose, but which increases the susceptibility to infection, and intensifies the severity of all medical or surgical diseases. Von Niedner takes this point of view, stating that although scurvy had been largely prevented in this war, the obscure rudimentary type had not been eradicated. He remarks upon a fact, noted in our Civil War and other wars, that under these conditions eruptions assume a hemorrhagic character in typhoid fever, cerebrospinal fever, rheumatism and other infections. Pick made a similar observation at a medical meeting in Vienna in reference to scurvy in the Austrian army, drawing attention to the hemorrhagic diathesis existing among the troops and expressing the opinion that scurvy was occurring in this war as in previous wars.

Very little scurvy seems to have broken out among the British troops in Europe. Thirty-two cases were reported as occurring in the middle of 1915 at a divisional rest station in France. It made marked inroads, however, on the health of the Colonial troops in Mesopotamia. In the report of the Mesopotamia Commission we read that 7500 men were lost to the force in 19 weeks as a result of scurvy, and that this happened in the summer of 1916 although additions had been made to the ration in the previous spring. A conception of the extent of the scurvy may be formed from the accompanying table, published by Willcox:

It will be noted that thousands of cases occurred among the Indian troops. This was due to the fact that the British ate more potatoes and fresh meat. In his official report of the outbreak of scurvy among Indian troops, Colonel Hehir writes: “The only vegetable now allowed is 2 ounces of potatoes and the only fresh meat 28 ounces a week. It is very doubtful whether this authorized ration, if not supplemented by other vegetables and more meat, is sufficient to prevent scurvy.” In the account which this officer gives of the medical conditions during the siege of Kut-el-Amara, it is stated that there were 1050 admissions for scurvy, fully developed, incipient and latent. It is remarked that those Indians who ate horseflesh were decidedly less affected. From the fact that special hospitals for scurvy were established in June, 1916, at Bagdad, Amora and Basrah, it is evident that a large number of cases must have been encountered. Most significant in this connection, however, are the preventive measures which were instituted by the British government. A body of 256 men, designated as the Madras Gardener’s Corps, were dispatched to Mesopotamia to plant gardens all over the country and to supply packets of seeds to various units. At Bagdad alone their output of vegetables was over 400,000 pounds. This certainly constitutes a remarkable innovation in the hygiene of armies.

The French army was not entirely spared from scurvy. In 1917 Harvier, an army surgeon, was surprised to discover that 95 per cent. of the 800 troops of which he had charge suffered from scurvy; he tells us that other epidemic centres were recognized later outside this sector. Elsewhere we read of the occurrence of scurvy in France, involving 40 per cent. of the 1700 men of the South African Labor Corps, and that this disorder was still more serious in another company owing to the fact that it was not recognized (Dyke).4 Benoit reported 63 cases which he discovered in 1917 among 300 laborers. According to his account, all these laborers received the same food, and those with scurvy recovered quite independently of any change in the dietary.

There are many accounts of scurvy among the Italian troops. Vannutelli gives a description of an epidemic of some 200 cases of infectious purpura with manifestations of hemorrhagic scurvy. Another writer informs us that in June, 1916, scurvy broke out among some Italian troops stationed at an altitude of 1500 to 2000 metres (Gingui). Vallardi gives an account of 180 cases among Italian troops in Macedonia, accompanied by slight jaundice and enlargement of the glands.

The American soldiers seem to have been practically spared from scurvy. This was due probably to their ample ration and to the fact that they were in the field for a comparatively short period. The Surgeon-General’s report to date, which has been kindly furnished me, showed but 5 cases in 1917 occurring in Europe and the United States, and but 15 cases reported during the year 1918.

The civilian population of the various warring countries was by no means spared. There are no reports from Russia to indicate the extent of scurvy, but from what is known of the food conditions prevailing there toward the end of the war, one can be certain that the number must have been large. The greatest amount of scurvy has been reported from Austria, more particularly from Vienna. Previous to the war scurvy was a rare disease in this city, both among adults and infants. During the war, however, as the result of a lack of fresh food and the dependence on dehydrated vegetables, a large number of cases developed. Tobler reports over 200 cases in children between the ages of two and fifteen years, which occurred in 1917 in child-caring institutions where the milk supply was markedly deficient, where fresh vegetables were lacking, and the supply of potatoes gave out about Christmas, 1916. A conception of the deficiency of the milk supply may be gained from the statement that there were but sixteen quarts a day for about 1500 people. Some of these children were undergoing fresh-air treatment and were out of doors in the “sun stations” day and night. For the cure of these children a simple decoction of fir-tops was used, a therapeutic procedure stated by Lind to have been of value in the Russo-Swedish War of 1708.

That scurvy must have occurred extensively among the infants in Vienna may be gathered from the report of Erdheim, who records 31 autopsies on infants under the interesting title of the “Barlow Heart.” In Berlin scurvy occurred also in the foundling asylums, as reported by Eric Mueller and by Brandt. This was caused by a diet of pasteurized milk and dehydrated vegetables. In an article bearing the suggestive title of “On a Marked Increase in Barlow’s