Lectures on the disorders resulting from defective nutriment / [George Budd].

  • Budd, George, 1808-1882
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the disorders resulting from defective nutriment / [George Budd]. Source: Wellcome Collection.

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    Teiere is no subject of more interest to the physiologist, of more practical importance to the physician, or that more urgently de¬ mands the grave consideration of the states¬ man, than the disorders resulting fi*om defec¬ tive nutriment. Yet, vrith all its interest, and with its vast social importance, it is a sub¬ ject which, until lately, has engaged but little steady attention. Large numbers of men at sea, and in our prisons and asy¬ lums, have, at various times, been kept on a diet insufficient in quantity and variety for the support of the body—diseases of strange kind have appeared among them—the cause has been recognized, and the remedy applied, in the individual case, but the lesson has been forgotten—mankind in general have been no gainers—and at a short interval of time, and in a different plaice, a knowledge of the imperious necessity of nutriment more abundant or more varied is again dearly bought by the experience of wholesale sick¬ ness and death. Of late, the attention of some of our most eminent physiologists has been directed towards this subject, and their experiments have led to many striking and unexpected results : but those experiments have been performed on the lower animals, and we are still but imperfectly acquainted with the various, disorders that result from deficient nutriment in man. These disorders are, no doubt, frequently presented to us by the destitute poor in our large towns ; but from their occurring in a scattered manner, and from our not being acquainted with all the circumstances in which they arise, their real cause escapes us. It is only—as in ships, garrisons, prisons, and asylums—when large numbers of men, with the daily routine of whose life we are acquainted, become affected with one disease, that our attention is fixed upon it, and that we can succeed in discover¬ ing its cause by considering what is peculiar in the circumstances in which the sufferers have been placed. There are three different forms of disease, which are already traced to defective nutri¬ ment. The first and best known of these is scurvy, properly so called ; of the second, the most distinctive character is a peculiar ulceration of the cornea; the third is chiefly marked by softness, or imperfect develope¬ ment of the bones. There is perhaps a fourth, whose most striking symptom is diarrhcea. These diseases are not only dif¬ ferent in appearance, but they ai'ise from different causes—the defect or error of diet, on which they depend, is different for each— and any one of them may occur quite inde¬ pendently of the rest. The chief indications of scurvy are, a pallid and somewhat dusky complexion ; spongy and livid gums ; and a remarkable proneness to hemorrhage, which shows itself in bleedings from the nose and gums, in discharges of blood from the stomach and bowels, and in petechise and large ecchy- moses on the skin. The lividity and swelling of the gums, which form perhaps the most striking cha¬ racter of scurvy, appear first at their free edges, but gradually extend until, in some cases, the gums are converted into a black, spongy mass, bleeding at the slightest touch, and completely concealing the teeth. This remarkable change of texture is strictly li¬ mited to the gums. The tongue is clean, and moist, and pale ; and the inside of the lips and cheeks, smooth and pallid, as in chlorosis, and in striking contrast to the livid and spongy gums. When the gums are much affected the teeth become loosened in their sockets, and they not unfrequently drop out without having suffered decay. The ecchymoses on the skin appear first, and are always in greatest number, on the legs ; from the influence, no doubt, of gravi¬ tation. In advanced stages of the disease they are often seen on the arms and trunk ; but very rarely on the face or head. They occur in small, circular, petechial spots, and in large irregular spots', of a variegated vio¬ let and green Tint, which resemble in every respect the marks of a severe bruise. In addition to these symptoms, we not unfrequently find the calf, or ham, hard and brawny, and the knee contracted, from an effusion of blood between layers of muscles, or in the deep-seated cellular tissue. The effects of scurvy, as of other diseases w'hich depend on an altered state of the blood, are usually first seen in parts that have been previously injured. The bruise¬ like marks on the legs often surround an old scar, or appear on a part that a long time previously had been the seat of some injury. In some cases, in advanced stages of scurvy, wounds long healed break out afresh; and fragments of bone consolidated after fracture become again disunited. But, notwith¬ standing this, there is very little dispo¬ sition to ulceration in parts that have not previously been ulcerated. I have never met with ulcers of the cornea in a scorbutic pa¬ tient ; and although I have often had to treat sailors who had been confined to their hammocks six or eight weeks in a high