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The tragic tale of Scurvy: how beliefs trumped science

While Great Britain was at war with Spain in 1740, Commodore George Anson led a squadron of eight ships on a mission to disrupt or capture Spain's Pacific possessions. Returning to England in 1744 by way of China and thus completing a circumnavigation, the voyage was notable for the capture of an Acapulco galleon but also horrific losses to disease
with only 188 men of the original 1854 surviving. The world was horrified.

Dr James Lind (1716-1794), a surgeon, was a pioneer of naval hygiene, and his Doctoral thesis was on venereal disease. His studies on Typhus, a debilitating parasitic disease that greatly afflicted sailors in dirty overcrowded conditions, led him to recommend that sailors be regularly stripped, shaved, scrubbed, and issued with clean clothes and bedding.
It resulted in British sailors no longer suffering from this disease and was a major contributor to their outperforming the French.

In Lind's day, the concept of vitamins was unknown. While Lind was not the first to suggest citrus fruit as a cure for scurvy, he was, in 1747 (seven years after Anson), the first to apply a systematic experiment to examine this centuries-old rumour that citrus cured scurvy. It was arguably the first ever clinical trial in medical history. Lind actually believed that scurvy was due to putrefaction of the body which could be helped by acids, and thus included a dietary supplement of an acid in the experiment.

Lind, now a surgeon on HMS Salisbury in the Channel Fleet, started his trial when the ship’s sailors became scorbutic (symptomatic) which typically occurred after about two months. At that point he divided 12 scorbutic sailors into six pairs. All pairs received the same diet and one of:
A quart of cider/day
25 drops of vitriol (sulphuric acid)
Six spoons of vinegar
A half pint of seawater
Two oranges and a lemon
Spice paste and barley water
The citrus pair ran out of fruit after only 6 days, but both men were already fit for duty again, while the other ten subjects did not improve.

In 1753 he published A treatise of the scurvy (which was virtually ignored) but then, ruinously, marketed extracted lime juice which proved ineffective (due to the oxidisation of Vit C), and hence citrus was again questioned and then discarded by naval command, who had their own beliefs. And so scurvy continued.

In 1758 he was appointed chief physician of the Royal Naval Hospital Haslar at Gosport. Eight years later, 1766, James Cook went on his first voyage and carried wort (low: 0.1 mg vitamin C per 100 g), sauerkraut (moderate: 10–15 mg per 100 g) and a syrup, or "rob", of oranges and lemons (high: 40–60 mg of vitamin C per 100 g) as antiscorbutics. When
an experiment on board showed that sauerkraut prevented scurvy, Cook enforced its consumption when the citrus ran out. The regular resupply of fresh produce from the islands would certainly have helped as well.
Cook was particularly proud that his ships remained free of scurvy.

In 1762 Lind's Essay on the most effectual means of preserving the health of seamen appeared. In it he recommended growing salad—i.e. watercress (662 mg vitamin C per 100 g)—on wet blankets. This was actually put in practice, and in the winter of 1775 the British army in North America was supplied with mustard and cress seeds.

In the navy however, experience had convinced many officers and surgeons that citrus juices provided the answer to scurvy even if the reason was unknown. In 1794, on the insistence of senior officers led by Rear Admiral Alan Gardner, lemon juice was issued on board the Suffolk on a twenty-three week, non-stop voyage to India. The daily ration of two-thirds of an ounce mixed in grog contained just about the minimum daily intake of 10 mg vitamin C. There was no serious outbreak of
scurvy. This astonishing event resulted in a widespread demand within the Navy for lemon juice.
The following year the Admiralty accepted its recommendation that lemon juice should be issued routinely to the whole fleet.[8]] This was not the immediate end of scurvy in the Navy, as lemon juice was at first in such short supply that it could only be used in home waters as a cure under the direction of the surgeons rather than issued routinely as a preventative.

What happened in the 19C?
In 1867 Lauchlin Rose patented his concentrate "Rose's lime juice" from Spanish (not West Indies) fruit. The Royal and Merchant Navy authorities made this a required daily ration, hence the origin of the term "Limey" for British sailors (see footnote).

Through the 19th century, fresh meat (most animals manufacture their own Vit C) was shown to prevent scurvy. For example, during the Napoleonic wars amongst the French soldiers, fresh horse meat was effective. The
disease was only seen in people eating preserved or canned foods, but not in people eating any sort of fresh diet, including arctic diets primarily based upon meat.

These observations that scurvy was only associated with preserved foods, prompted explorers to blame scurvy upon some type of tainting or poison which pervaded tinned foods.

But the zigzagging path to curing scurvy took yet another backward turn when the Navy substituted West Indian limes for the Spanish fruit, because these were more easily obtained from the Caribbean colonies and were known to be more acidic, and hence suited the putrefaction hypothesis. This was a mistake because these limes had a much lower content of Vit C and the extraction method reduced it further. In a Naval trial in the lqte 19C, this lime juice concentrate was shown to be
completely ineffective.

Serendipitously, this coincided with the beginning of Arctic and later Antarctic exploration.  Equally misguided, fresh meat was also dropped by the Royal Navy, and the prevailing belief became hygiene, regular exercise and strong morale would prevent it! This despite Arctic explorers and whalers recognising the value of fresh meat.

Out of all this confusion, in a world that was now enthusiastically embracing the newly discovered " germ" theory of disease, arose the belief that scurvy was caused by ptomaine, a waste product of bacteria, particularly in tainted tinned meat. This theory was applied on Scott's and other expeditions of the Heroic Age of Antarctic exploration. Each
tin had to tasted for "tainted meat" by the doctor or expedition leader, before being used. Scott never mentioned scurvy in his journals, given the stigma of poor hygiene and low morale associated with it. While at base camp, fresh seal meat prevented the problem. Amundsen slaughtered his dogs along the way, thus providing a regular source of fresh meat.

“Swollen gums --- are due to nothing more than clay pipes, strong tobacco, coarse feeding, neglect of the toothbrush and the constant use of foul language”
                                                      Edward Wilson’s Diary

How did it all end? In 1927, Hungarian biochemist Szent-Gyorgyi isolated "hexuronic acid" from animal adrenal glands. He suspected it was antiscorbutic, and when he supplied it to a lab in University of Pittsburgh, they showed it to be "Vitamin C", the third vitamin to be identified and isolated. Szent-Gorgyorgi was awarded the Nobel Prize for Medicine in 1937.

Limey is an old slang nickname, often pejorative, for the British, originally referring to their sailors. It has since been used as a derogatory term that relates to English people. The term is believed to derive from Lime (fruit), referring to the Royal Navy and Merchant Navy practice of supplying lime juice to British sailors to prevent scurvy.[1] The benefits of citrus juice were well known at the time thanks to the acute observations of surgeon James Lind who studied the
effects of citrus on scurvy in 1747.[2]
Limes replaced lemons because limes were more readily available from Britain's own Caribbean colonies. Lemon juice was reintroduced after scurvy again became a problem because of lime juice lacking sufficient vitamin C compared with Spanish lemons and oranges.

By Doctor Bob

Geschreven door:
Bob Baigrie | Ships doctor

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