Subotin was the Fortress Sanitary Inspector, immediately subordinate to the Commandant, and he did his best; but there was no independent central organization in the Medical Service of the Fortress, which could have looked ahead and taken steps to distribute the sick properly in the hospitals during attacks. The Medical Service was dependent on the combatant authorities, whose hands were much taken up with fighting. What was required was a central administration, which could have foreseen what might happen and have controlled the arrangements. The officer in charge should have been invested with high rank and great authority, and should have had a properly trained personnel. Scurvy first made its appearance in the Fortress at a very early date: as early as April it appeared among the crew of the _Pallada_, but, thanks to timely and energetic measures, it was then stamped out. Unfortunately, no material preventive measures were taken against its recurrence, with the exception of vague suggestions as to better food and to add green food to the rations, though where better food could be got or vegetables could be bought was difficult to say. The scurvy cases increased from hundreds in October and thousands in November to 10,000 in December. The hospitals were so full of it that men were afraid of going into them, and at the end of the siege preferred to remain on duty, even when sick. Of 18,000 sick and wounded reported on the day the garrison marched out, 6,000 only were wounded; the balance were cases of scurvy. There were really more, as many men only slightly ill were doing duty. Dr. Kefel, of the Naval Hospital, on making an inspection of the men on one section of the right flank on December 11, found that 21 per cent. of these on duty had scurvy. Exactly a fortnight afterwards, on his inspecting the same section, he found 40-1/2 per cent. suffering from it. These were the same men, for they had not been relieved. It was pointed out in his report on this that: 'If the spreading of scurvy increases in the above arithmetical progression, then in every fortnight we shall have 200 more on the sick list out of every thousand in the fighting line, and in one and a half months there will be no men left fit for duty.... 'If extreme measures are immediately taken, and we make use of all the meat, white bread, and antiscorbutic diet available, we may hope that those who are now well may not catch it, that the slight cases will not become worse, and that the worse cases will do tolerably well. Therefore there are before us two alternatives: to keep our food-supply and have, after a month and a half, not a single serviceable soldier, or to have eaten up our supplies of provisions at the end of six weeks, but during all that time to have kept the garrison in fighting strength. The strategist, not the arithmetician, can decide which is the more advantageous choice to make for the Fortress.'