Scurvy: By the End, Death is a Mercy

By Annetta Black, 5-1-12

Identified by Hippocrates and by the Egyptians as early as 1550 BC, Scurvy was originally a relatively rare and mysterious ailment which struck on land during long campaigns and overland journeys when fresh provisions failed.

Caused by a lack of Vitamin C in the diet, with the notable exception of humans and the guinea pig, most plant and animal species synthesize vitamin C, and do not require it in the diet, but we do. Which, as it turns out, is a real problem.

But let's begin at the beginning, and meet that strange beast known as:

“Land Scurvy” Curse of the Crusaders!
Dec 1217 - While the Crusaders trudged through in Egypt: “..Soldiers with violent pains in the feet and ankles, their gums became swollen, their teeth loose and useless, while their hips and shin bones first turn black and putrefied. Finally, an easy and peaceful death, like a gentle sleep, put an end to their suffering.”

Later between 1249 and 1254, while Jean de Joinville traveled with the 7th Crusade he wrote: “the disorder I spoke of very soon increased so much in the army that the barbers were forced to cut away very large pieces of flesh from the gums to enable their patients to eat..”

But while the "land scurvy" of the crusades was bad, Scurvy's true golden age was about to begin...

“Purpura Nautica:” An Age of Discovery - and not all of them good.
Scurvy, once rare, flourished with the advent of long sea voyages of trade, discovery & conquest. Scurvy takes approximately six weeks to set it, and on month long voyages, it struck down entire crews. There are stories of Spanish galleons found floating, staffed only by the dead. The disease was nicknamed “purpura nautica” for the purplish bruises that served as the first indication of the disease. An estimated two million sailors died of scurvy between 1500-1800.

Among those lose to scurvy were Vasco de Gama in 1499 claiming 116 to 170 men. In 1520, Magellan’s round the world journey was wracked by scurvy, claiming most of the men not left to fend for themselves on a distant shore or killed by natives in the final battle. His voyage returned with only 18 out of the 230 men who originally set sail. Score one for scurvy.

This of course, was a big problem. Not just for the sailors but for the monarchs who were bankrolling them. Exploration is expensive, and governments, military and individual physicians began exploring the possible causes and cures. Luckily as early as 1593, Admiral Richard Hawkins recommended the use of citrus as an preventative measure! Score one for sailors!

In 1614, The East India Company published a pamphlet titled “The Surgeon’s Mate” which also prescribed fresh food, citrus.... and sulfuric acid. By the early 1700s saw a general increase in the knowledge that fresh foods & citrus... or possibly acids, helped the situation, but the specific cause was still a mystery and hotly contested.

In 1747 the Scottish physician James Lind conducted what is widely considered to be the first example of a clinical trial wherein he tested alleged cures on 12 scurvy-ridden sailors. They were divided into teams of two and each given a course of one of the following :

• cider  • sulfuric acid  • vinegar  • seawater  • oranges & lemons   • spices and barley water

The ambitious program was cut a bit short when they ran out of fruit in just 6 days, but by then the indications of success were clear for Team Orange/lemon. Less so for Team Seawater and Team Sulfuric Acid.

Lind published his findings in 1753 in “A Treatise on Scurvy”, but died before he could see his advice widely adopted. Following this discovery, the British military slowly began to invest in antiscorbutics. James Cook packed watercress seeds for his second epic voyage of 1772-1775 and suffered virtually no scurvy. In 1794 the Suffolk administered rations of lemon juice and had no scurvy. This was no small thing: During the preceding century scurvy had caused more losses in the British navy than were suffered in ALL enemy action.

In 1953, the British Navy Surgeon & Vace Admiral Sir Sheldon Dudley said: “The application of Lind’s recommendations suddenly killed naval scurvy in 1795...intelligent naval senior executive officers asserted that this event was the aquivelent of doubling the fighting force of the navy... it is no idle fancy to assert that Lind, as much as Nelson, broke the power of Napoleon.” Success! No more scurvy forever...right?

Limeys: When it all started to go downhill:
The British establishment grasped onto the concept of citrus, and then did it really really wrong. First, they substituted cheap and easy to get limes - readily available from British holdings in the Caribbean - for the more effective lemons or oranges. Then they further boiled the limes in copper vessels, which had the non-helpful side effect of reducing the (thus far unknown) Vitamin C content even further.

People began to suspect that perhaps this whole citrus thing was not as effective as it had been claimed. Of course by then steam engines in ships brought the age of sail and voyages of longer than 6 weeks to an end. Semi-success-via-roundabout-ways!

Of course, there was still a few very long sea voyages that those Victorians had left to make...

The Arctic: At least the blood freezes?
By the time the Race for the Poles began at the turn of the 19th/20th centuries, scurvy became a deadly problem once more. Despite all of the work of previous generations, Arctic & Antarctic expeditions set out to the icy wasteland armed with poorly tinned food, pemmican, hard tack, tea and whiskey.

The complete failure of John Franklin’s ill-fated third arctic expedition in 1847 has been partially blamed on scurvy.

Robert Falcon Scott’s 1903 and 1911 expeditions were both struck with the disease. His description: “The symptoms of scurvy do not necessarily occur in a regular order, but generally the first sign is an inflamed, swollen condition of the gums. The whitish pink tinge next the teeth is replaced by an angry red; as the disease gains ground the gums become more spongy and turn to a purplish colour, the teeth become loose and the gums sore. Spots appear on the legs, and pain is felt in old wounds and bruises; later, from a slight oedema, the legs, and then the arms, swell to a great size and become blackened behind the joints. After this the patient is soon incapacitated, and the last horrible stages of the disease set in, from which death is a merciful release.“

Arctic explorer Vilhjalmur Stefansson noted that native Inuits did not suffer from scurvy, despite a lack of access to citrus and other similar known cures. It turned out that raw seal meat and blubber provide enough Vitamin C to prevent scurvy. A good day for arctic explorers.

VICTORY
It wasn't until 1927 that the cause and cure were finally discovered by Hungarian biochemist Szent-Györgyi (who won the 1937 Nobel Prize for Medicine), and the conclusive proof of ascorbic acid’s efficiency was not proven conclusively until 1932.

Modern Day
Now that the cause and cure are understood, and the cure readily available to most humans, scurvy should be firmly a thing of the past. But unfortunately it’s not - in inner cities and third world countries alike, scurvy continues to strike, particularly amongst poor children. Because scurvy is now so rare, and the effects in mild cases are confusable with other disorders, it is often misunderstood and ignored. More education and access to healthy foods for poor children is needed.

But finally you must ask yourself this, is that really gum disease you have...or is it SCURVY?

From: atlasobscura.com

Posted in: African American Doctors and Nurses,Disease Among The Civil War Troops,Scurvy