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History and Treatment of Scurvy

April 30th, 2007

scurvy-dog-pirate.jpgEarlier 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.


***UPDATE 8/18/09***

Many of you have been asking for statistics on modern incidence of scurvy. Today I ran across a reference to a study that was done by the American Journal of Clinical Nutrition and published a few days ago (August 12). Interestingly, this survey of 7,277 Americans found that approximately 7 percent showed overt signs of vitamin C deficiency, otherwise known as scurvy. There were many others who technically did not have scurvy but were still considered vitamin C deficient according to their blood concentrations. This is somewhat surprising for a region that has a generally abundant food supply, lots of fortified foods, and plenty of vitamin supplements floating around. Here is a link to the article I found that explains the results of the study and references some other relevant statistics:

Americans Are Vitamin C Deficient by Bill Sardi

Here is a link to the abstract page for the original study from the American Journal of Clinical Nutrition:

Serum Vitamin C and the Prevalence of Vitamin C Deficiency in the United States



17 Responses to “History and Treatment of Scurvy”

  1. comment number 1 by: Joe Henrich

    Hi,

    What was your source for the material on James Lancaster. I’d like to track that down.

    thank
    joe

  2. comment number 2 by: Karlonia

    Joe,

    Actually I used several different sources when I did the research for this article, and then put the information together in my own words. Most of these can be found by searching on the keyword “James Lancaster scurvy”. I am also somewhat of a history buff, so I knew about some of this stuff already.

    Earlier today, I tracked down two of the sources that I remember using for this. The first is here:

    saveyourheart.com/historyofthenutritionalcure_heartdiseasehealth.html

    The relevant information is contained in two paragraphs below the boldfaced headline “An Unintentional Controlled Study”.

    Another one that described pretty much the same thing that I did is this:

    mnwelldir.org/docs/history/vitamins.htm

    The information on James Lancaster’s experiment is found in the seventh paragraph.

    Meanwhile, if you’re looking for real primary source material (for example, the actual ship’s log that James Lancaster might have kept during his voyage back in 1601), we will need to dig a little deeper. For this we can look into historical journals from libraries (offline), or we can perform more specific online searches in the hopes that someone has scanned or transcribed this kind of material onto a web page somewhere.

  3. comment number 3 by: Anonymous

    U NEED STATISTICS

  4. comment number 4 by: Karlonia

    @Anonymous:

    Actually, you’re right - I have been receiving an increasing number of search queries recently that are asking for some type of statistics related to scurvy and my current article does not yet address this.

    Therefore, if you happen to find any scurvy-related statistical information during your research, please let me know about it (you can use the contact page) so that I can compile and review it, after which I will add the relevant content and references to my original article. Otherwise, I will eventually do the research myself and add whatever useful info I can find as soon as I have the time.

  5. comment number 5 by: daniel mitchell

    hi

  6. comment number 6 by: sienna

    hi there i am doing an assignment for science i found your infomation really helpful thanks :)..

    hehehhehe i love leaving random comments at the bottom of websites its like my new fettish …..i cant help it it takes my mind of endless hours of typing useless dribble i have left comments on the bottem of a cheese rolling website (yess i know what ur thinking ..who the hell does an assignment on cheese rollling…I DO !!) anyway where was i hmm i cant rember to tired but i must finish assignment its DUE TOMORROW why do i leave things to last minuet..hmm unorganised springs to mind..or is it disorganised ..as eliza often corrects me lol well i guess i am sorta running out of things to type and if i keep typing i wont get my assignment done soo i guess i better go ….i just have one thing to say……I LOVE HAMISH BLAKE SOOOO HAWWWT XXXX(my shame full celeb crush lol)

  7. comment number 7 by: sienna

    BTW IM IN AUSTRALIA…SO ITS ACTUALLY LIKE 11PM OVER HERE i do plan on sleeping actually once i did stay up til 3am doing an assignment ..i fell asleep at the desk ans woke up to a song on the radio that was saying somthing about “wangchong”

  8. comment number 8 by: joy

    Good job! Your “Scurvy Dog” post is very informative and helpful to this copywriter. Joy

  9. comment number 9 by: Sjs info

    Quite an informative post. Though i knew a lot about Scurvy & its effects. But learning about about anything you already know, is not bad. In fact it adds on to one’s knowledge.

  10. comment number 10 by: samantha

    Im doing a poster for a history class..this information helped a lot .. thank you!

  11. comment number 11 by: matt gaffney

    I am wondering about the claims of fermented sauerkraut being the reason behind the protection against scurvy…is there any truth to this notion. My research pointed to oranges and limes as well, I also read they tried to boil these fruit juices for preserving measures, which failed to protect the sailors.

    but i am really trying to find out about the fermented sauerkraut and its validity…thanks in advance to anyone with any color on this

    cheers

    MCG

  12. comment number 12 by: Karlonia

    @Matt:

    I did a quick search on this earlier today and it turns out that yes, the sauerkraut certainly could have helped — many sources report that it is rich in vitamin C. Here is a relevant excerpt from an informative article that I found at Westonaprice.org:

    Sauerkraut and its juice are traditional folk remedies for constipation. Fermentation actually increases nutrient values in the cabbage, especially vitamin C. Fermented foods are also said to facilitate the breakdown and assimilation of proteins. They have a soothing effect on the nervous system.

    Before the days of refrigeration, sauerkraut served as the only source of vitamin C during the winter in northern climates. It was used on long ship voyages to prevent scurvy.

    Apparently sauerkraut was used during the Civil War to prevent smallpox deaths as well.

  13. comment number 13 by: Philip Murphy

    Centuries before the British Royal Navy learned to combat scurvy with rations of lyme juice the Chinese had solved the problem by supplying ships with ordinary dried beans which were moistened as needed to make bean sprouts, a rich source of vitamin C. China ruled the sea in the early 15th century sending hundreds of ships (some as much as 400 ft. long) across the Indian Ocean to the east coast of Africa. The fleet was manned by as much as 28,000 sailors. After the last great voyage of the Chinese navy in 1433, however, ocean going shipping was totally surpressed as well as most records of previous discoveries. This ended medieval China’s interest in the outside world.

  14. comment number 14 by: Andrea

    I’m doing a report for cooking class and this was helpful.

  15. comment number 15 by: Karlonia

    @Andrea:

    I’m glad that I could help with your report. Are you really studying about scurvy in cooking class? On the surface this seems like an unusual blend of topics, although I suppose the nutritional benefits of vitamin C could be the important link.

    @Philip Murphy:

    I have read about some of the Chinese voyages — really interesting stuff. There has even been speculation that the Chinese might have sailed east and discovered America before Columbus (as far as I know, this has never been confirmed).

    By the way, do you happen to know the source for your information? That passage reads like it was excerpted from a history book!

  16. comment number 16 by: Philip Murphy

    The source I came across for the Chinese use of bean sprouts for vitamin C during the great voyages of discovery during the 15th century was “Dark Age Ahead” by Jane Jacobs (Random House, NY) 2004. She was interested in periods of advance and regression during the long history of Chinese Civilization. However, no serious professional historian today believes that the Chinese discovered America. They certainly could have but they were not driven by the pursuit of profit. If they had made contact with the New World they would have spread Old World diseases which had to wait until the European voyages.

  17. comment number 17 by: matt gaffney

    i am following up on concept of vit C and pasteurization and the ‘denaturing’ effect it has on Vit C. I remember reading somewhere that 17th century sailors were not protected with boiled fruit juice. I know that vitamins in general are sensitive to cooking/heating/pasteurization. Do you have any info on this?

    cheers

    MCG

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