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Earlier today, while playing a PC game called Port Royale 2, I encountered a passage in the game that explained some of the history of scurvy, the infamous disease that afflicted many sailors during the Age of Exploration. The segment of text from the game claimed that the treatment for scurvy had not been discovered until the time of James Cook (1728-1779), who had been able to successfully prevent scurvy on his long voyages by providing his crew with fresh fruits and sauerkraut. I was somewhat skeptical of this claim because I remember reading in some history texts (and also in references from other seafaring types of PC games) that the cure for scurvy in the form of citrus fruits and their juices had been used a century or two before Cook’s voyages. After digging into this subject a little further, it turns out that I was at least partially right; treatments for scurvy had been discovered and used before Cook’s time, but it was not until the latter half of the 18th century that the prevention and treatment of this disease became widely known or standardized in any way.

Scurvy is a disease that is caused by a lack of vitamin C (ascorbic acid) in the diet. Vitamin C is needed to catalyze the hydroxylation of proline and lysine to form collagen, an important protein needed by the human body for formation and regeneration of skin and connective tissue. If a person is deprived of vitamin C for long periods of time (usually 1-2 months or more), scurvy will occur, resulting in symptoms such as swollen and bleeding gums, soreness of joints, bleeding under the skin, bruises and blemishes on the legs, and wounds that do not heal. If left untreated, the disease is eventually fatal.

Treatment of scurvy is relatively simple. One must consume foods or supplements containing vitamin C (ascorbic acid) , up to a minimum of 50 mg per day for adults or 35 mg per day for infants to effectively treat and/or prevent the disease. The most famous sources of vitamin C include citrus fruits such as lemons, limes, oranges, and grapefruits. However, many other fruits and vegetables are excellent sources of this nutrient, including strawberries, watermelons, kiwi fruit, mango, guava, papaya, broccoli, cauliflower, tomatoes, peppers, potatoes, spinach and cabbage. Almost all commercially available multivitamin supplements contain vitamin C as a standard ingredient.

Hippocrates was probably the first historical figure to describe the symptoms of scurvy back in the fifth century BC. During the Crusades in the 12th and 13th centuries, scurvy was a significant factor in many campaigns, often causing the crusaders to retreat from battles or abandon their outposts. The incidence of scurvy was most prevalent during the Age of Exploration, when it became more common for naval crews to remain at sea for long periods of time during voyages. Portuguese explorer Vasco da Gama lost 100 of 160 crew members to the disease during his famous voyage around the Cape of Good Hope in 1497.

According to legend, the island of Curacao (Portuguese for “cure”), was founded by Portuguese crew members from the ships of Christopher Columbus who were dying of scurvy and asked to be dropped off on this island. The Portuguese, who had originally intended to die on the island as an alternative to dying at sea and being fed to the sharks, ate some of the island’s fruits and vegetables and miraculously recovered. In 1535-36, another successful treatment of scurvy occurred when Jacques Cartier and his crew landed at Stadacone (modern Quebec) and were treated by native Indians who made a tea by boiling the needles of white cedar trees (arbor vitae) in water and giving it to the afflicted crew members. Later, modern analysis determined that this tea contained about 50 mg of vitamin C per 100 grams of liquid.

As early as 1593, explorers such as Richard Hawkins recommended “sower oranges and lemmons” as the most fruitful treatment of scurvy. In 1601, an unintentional controlled experiment in scurvy treatment occurred when Captain James Lancaster noticed that after four months at sea, the crew on three of the four ships in his fleet were very weak and dying of scurvy while the crew on the fourth ship, which was the ship Lancaster personally commanded, remained healthy and unaffected by the disease. The difference between the two groups of sailors was that on Lancaster’s ship, the captain was smart enough to bring several bottles of lemon juice along, which he gave to himself and the crew at the rate of three teaspoonfuls per day. Meanwhile, the amazingly ignorant (and possibly stupid) “controls” on the other three ships lacked this critical ingredient. Lancaster noted this curious difference and reported it to the Admiralty.

In a treatise called The Surgeon’s Mate (1636), John Woodall, renowned as the “father of naval hygiene”, unequivocally recommended fresh vegetables and the juice of lemons and oranges as a preventive treatment of scurvy. Yet despite Woodall’s recommendation and other similar accounts, ignorance and stupidity persisted as many captains and sailors continued to resist innovations such as newfangled medical treatments and basic hygiene practices. Louis H. Roddis, in A Short History of Nautical Medicine noted that between 1600 and 1800 approximately 5000 sailors per year, or a total of almost one million people died from this easily preventable disease. Roddis went on to state, “there are in the whole of human history few more notable examples of official indifference and stupidity producing such disastrous consequence to human life”.

Some 111 years later (1747), a Scottish physician named James Lind performed what seems to be noted (at least in the searchable Internet sources) as the most famous experiment in scurvy treatment. On the 74-gun Salisbury, Lind divided his scurvy-ridden sailors into several groups, giving each group a different diet. One of the groups was given two oranges and one lemon per day as part of their normal rations. After about one week, the group that had consumed the citrus fruits had recovered to the point that they were able to care for the other sailors who were still suffering from the scurvy. Eventually, all of the sailors in the other groups died. Lind presented his findings to the British Admiralty.

In 1768-71, James Cook managed to circumnavigate the world in 3 years while losing only one sailor (who died of tuberculosis) to disease. For such a long voyage, this amazingly low death rate was virtually unheard of during this time period. With Cook’s proven successes in scurvy prevention, word began to spread throughout the British navy as some naval personnel began to take the earlier findings more seriously. Although the basic ideas for scurvy treatment had finally found their way into the public mainstream, it was not until 1795 that the British navy finally established lemon and/or lime juice as a mandatory and standardized ration for sailors. It was from this provision that the term “limey”, a slang term used to refer to British sailors and later extended to British people generally, originated.

Even after known scurvy treatments were somewhat standardized, pockets of ignorance still persisted. During some of the 19th century Arctic expeditions, the belief among many of the Royal Naval personnel was that things like good overall hygiene, regular exercise, and the maintenance of high crew morale (but not necessarily fresh food) prevented scurvy. This resulted in even more needless scurvy suffering, in spite of the fact that civilian whalers and explorers in the Arctic region were already using fresh meat as a practical anti-scurvy preventive treatment. The prevailing medical theory in the early 20th century, the period when Robert Falcon Scott headed two expeditions to the Antarctic, was that scurvy was caused by “tainted” canned food. Finally, in 1932 scientists established the definitive link between scurvy and vitamin C (ascorbic acid) deficiency specifically.