Scurvy: A Horrible Disease in the 1700 and 1800s

Scurvy was first noticed as a disease in the time of Hippocrates, and, during the Crusades, soldiers reported suffering from some mysterious ailment that Jean de Joinville described as a disorder that “soon increased so much in the army … barbers were forced to cut away very large pieces of flesh from the gums to enable their patients to eat.”[1]

Between 1500 and 1800 some two million sailors died from the “scourge of sailors” and it appeared to be medical mystery. One twentieth-century historian provides details of what sufferers experienced:

“After about three months with no vitamin C, the sufferer begins to feel tired and listless. Within another two months, the skins is affected, first becoming rough and dry; by around the end of the sixth month, hemorrhages in the legs appear and wounds will not heal. At seven and a half months the victim’s gums soften, swell and turn purple − historical sources add that teeth became loose as well, and that old wounds opened up again. The conditions appears to become life-threatening in the period between seven and nine and a half months.”[2]

A British naval physician, named James Lind, learned about the dangers of scurvy because of the voyages of the British Commodore George Anson, 1st Baron Anson, who circumnavigated the globe. He brought it to Lind’s attention noting that he “lost 1,855 men out of his original complement of 2,000; numerous causes of death were listed, but most of the sailors had died of scurvy.”[3] Lind’s interest was piqued. He investigated scurvy and wrote “A Treatise of the Scurvy” in 1753, which he dedicated to Anson. 

Around the same Lind also learned that a British surgeon named Edward Ives had given crew members cider to prevent scurvy and no one suffered from scurvy until the cider ran out. This greatly interested Lind and he decided to set up a trial in 1747 to test the efficacy of antiscorbutics. At the time, Lind and others believed beer was the best antiscorbutic, but because it was difficult to carry on ships, Lind resorted to giving his crewmen either citrus fruit, cider, or other substances. Lind used twelve sailors suffering from scurvy for his trial. To guard against bias and confounding factors, he ensured the twelve men were as similar as possible, and he maintained a similar environment for them and had them eat the same diet.

“Without stating what method of allocation he used, Lind allocated two men to each of six different daily treatments for a period of fourteen days. The six treatments were: 1.1 litres of cider; twenty-five millilitres of elixir vitriol (dilute sulphuric acid); 18 millilitres of vinegar three times throughout the day before meals; half a pint of sea water; two oranges and one lemon continued for six days only (when the supply was exhausted); and a medicinal paste made up of garlic, mustard seed, dried radish root and gum myrrh.”[4]

Lind’s trial proved citrus fruits could prevent ill-health and cure the disease, but Lind was not necessarily clear when he wrote his book. Sometimes he wrote contradictory passages, which left readers confused. Unfortunately, Lind died before his findings were widely adopted.

“[H]is therapeutic findings made little impact on medical opinion in Britain: indeed, the year after their publication the Navy’s Sick and Hurt Board rejected a proposal to provide sailors with supplies of fruit juice. In fact, aware of the storage problems for adequate amounts of fresh fruit or fruit-juice during long cruises, Lind recommended that a condensate (called ‘rob’) should be prepared by evaporating a dilution of fresh fruit juice in nearly boiling water over several hours. Unfortunately, as we now know, heat destroys much of the ascorbic acid in fresh juice, and it is unsurprising that subsequent observers were unable to detect any beneficial effect of the condensate.”[5]

By the end of the eighteenth century, Britain’s Royal Navy, based largely on recommendations of the physician Sir Gilbert Blane, began rationing each crewman three-quarters of an ounce of either lemon or lime juice a day, which is how the term “limey” originated. Citrus juice rationing removed the threat of scurvy among British sailors. Still scurvy remained a scourge for other armies and navies throughout the world. For instance, scurvy was an issue during the Napoleonic Wars when Napoleon Bonaparte‘s sailors suffered from it, as did his soldiers retreating from Russia.

The harmful effects of a lack of vitamin C became even more apparent in the mid 1800s. That was when the Irish potato famine of 1840 struck and scurvy became epidemic in Ireland and Scotland because the people were no longer eating potatoes rich in Vitamin C. In 2005, a mass burial site dating to the famine was discovered in the Irish city of Kilkenny at the Kilkenny Union Workhouse. As a result, an examination and study of those skeletons was undertaken. The study concluded:

“Scurvy occurred with an exceptionally high prevalence and it appears to have had a significant impact on the mortality profile of the population. … Scurvy is potentially a severely painful disease and these unfortunate people would undoubtedly have been subjected to arduous and repetitive labor during their time in the workhouse. As such, it can be concluded … that many of them would have endured a very painful existence during the last weeks or months of their lives. Clinical research has also indicated that Vitamin C deficiency can have a negative effect on a person’s mental wellbeing and can lead to the development of depression and apathy.”[6]

Although Lind had shown citrus fruit could prevent scurvy, and published more about scurvy in his 1757 “An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy,” and his 1768 “An Essay on Diseases Incidental to Europeans in Hot Climates,” physicians of the late nineteenth century began to search for a microorganism. They believed a germ caused the disease and wasted some thirty years trying to find it. However, the mystery was eventually solved by a Norwegian professor of hygiene and bacteriology, Axel Holst. He published his findings in 1907 after determining there was indeed a connection between diet and scurvy. Unfortunately, at the time, his findings were unpopular with the scientific community and conclusive proof was not established until 1927 by Hungarian biochemist Szent-Györgyi.

References:

• [1] Donohoe, Kevin J. and Annick Van den Abbeele, Teaching Atlas of Nuclear Medicine, 1876, p. 414-415.
• [2] Beck, Stephen V., ed. Kiple, Kenneth F., “Scurvy: Citrus and Sailors,” in Plague, Pox & Pestilence, 1997, p. 68
• [3] Ibid., p. 70.
• [4] Milne, I., Who was James Lind, and what exactly did he achieve?, in James Lind Library, 2012.
• [5] Tröhler, U., “Lind and scurvy: 1747 to 1795,” in Journal of the Royal Society of Medicine, 2005.
• [6] Geber, Jonny and Eileen Murphy, “Scurvy in the Great Irish Famine: Evidence of Vitamin C Deficiency From a Mid-19th Century Skeletal Population,” in Wiley American Journal of Physical Anthropology, 2012.