The ‘putrefaction’ theory, expanded upon by Sir John Pringle in a paper read at the Royal Society in 1750, was that disease came about from putrefaction which was best treated by alkalis. David MacBride took Pringle’s theories a little further, deciding that carbon monoxide, which he called ‘free air’ and which came from fermentation, would prevent putrefaction. He proposed a cure based on the fermentative quality of fresh vegetables and malt. Lind also subscribed to the putrefaction theory but felt that both alkalis and acids were needed; he recommended oranges and lemons for their acid qualities.
Lind’s experiment, carried out in 1747, consisted of dividing twelve sailors with scurvy into six groups, treating each with a different remedy. Their main diet was identical for all: fresh mutton broth, puddings (undefined), boiled biscuit with sugar, barley, raisins or currants, rice, sago and wine. Group one were given a quart of cider each day, group two had twenty-five drops of elixir of vitriol, group three had six spoonsful of vinegar, group four had half a pint of seawater, group five had two oranges and one lemon each day and group six had a paste made of garlic, mustard seed, horseradish, Balsam of Peru and gum myrrh and a drink of barley water acidulated with tamarinds and cream of tartar. Group five were reported as eating their fruit with greediness, and despite the treatment stopping after six days when Lind ran out of fruit, one of those men was by that time fit for duty and the other was well enough to help in nursing the others. Group one showed some recovery after two weeks, and the others showed no effect.
Shortly after conducting this experiment, Lind left the navy to concentrate on his doctoral thesis. This was not on scurvy but on an aspect of venereal disease; however, it won him his degree and licence to practice as a physician, first privately and then at Haslar naval hospital at Portsmouth. In 1753 he published his Treatise of the Scurvy; it was virtually ignored. There were louder voices crying their own theories, one of these being MacBride whose answer to the problem was wort, the thick concentrated form of beer produced by long simmering. This was one of the ideas originally tried as an answer to running out of beer at sea, the theory being that if mixed with water (one part wort, twelve parts water) it would quickly turn into beer. It actually did do this, but having got the reputation of being a medicine, this beer was rejected by the men.
Cook carried wort on his first voyage and reported on his return that he found it an effective antiscorbutic, but then contradicted himself by remarking that ‘we have been a long time without any, without feeling the want of it…’. This statement was omitted when the report was presented at the Royal Society in Cook’s absence. Cook also carried, and made his men eat, sauerkraut which is mildly antiscorbutic, as well as syrup of oranges and lemons, and went ashore for fresh food whenever he could. These latter aspects were also ignored. MacBride published two reports on sea trials of wort: these were, however, flawed, one having been carried out by his brother, the other involving a voyage which included a stay of several days on an island where the scorbutic men soon recovered.11
Meanwhile, various voices were crying about the effectiveness of fresh food and others about lemon juice. The fresh food believers tended to be those who thought scurvy was caused by salt; they thought it was fresh meat which principally effected the cure. At first only a few realised that the fresh vegetables which traditionally accompanied fresh meat had anything to do with the cure, but the idea that fresh vegetables were helpful gradually came to be accepted. There is, incidentally, a little Vitamin C in fresh meat, but only if you eat it soon after slaughter; when the meat is hung, the Vitamin C is gradually lost. This was the reason rats were an effective antiscorbutic: they were eaten soon after being killed. Nelson was of the ‘fresh meat and vegetables’ persuasion and he placed much faith in onions, arranging for them to be bought in large quantities whenever possible. Onions are anti-scorbutic, 100g of raw onions containing the minimum daily dose of 10mg of Vitamin C. Another of the prominent naval doctors of the time, Thomas Trotter, was also a fan of fresh vegetables. When serving as Physician to the Channel Fleet in 1795, he insisted on fresh vegetables for the fleet, going round the growers and markets to such effect that one greengrocer complained that Trotter had ruined his business by sending all the salad to Spithead.12
Lind, in his essay on preserving the health of seamen, recommended that ships’ companies should grow their own salad (cress) on wet cloths and to put out blankets in rainy weather to soak them before sowing the seeds, so that ‘the whole ship both above and below shall be replete with verdure’.13 In 1775, Messrs Mure, Son & Atkinson, the contractors supplying the British army in America in the winter of 1775, sent out a supply of mustard and cress seeds, suggesting that they could be grown on wet blankets or shallow trays of earth.14 Pasley had such trays with him on board Jupiter in 1781 and his could not have been shallow, as when some of his scurvy sufferers asked to be covered in earth to alleviate their sufferings, he said he buried them in the trays, so these must have been at least 12 inches deep. This odd treatment seemed to work, although its effect can only have been psychotherapeutic: ‘the men who were carried and lifted in and out of it, incapable of moving a limb, walked of themselves today.’15 Pasley’s salad trays seem to have been for his own use, rather than intended for the crew, but in 1803 a letter to the Naval Chronicle from Sir W Young, who had lived in India for several years, recommended sprouting peas to provide a ‘living vegetable’. His method reads exactly like the modern method for sprouting mung beans (as used in Chinese cooking): take some small tubs of about two-gallon capacity, three-quarter fill them with pease, add water to just cover and leave them to sprout. He suggests feeding them to the men twice a week, ideally raw.16
Lind, Trotter, Nelson and his surgeon Leonard Gillespie also advocated citrus fruit. Others were only semi-convinced that the fruit itself or its juice were necessary. Citrus fruit is acidic, they reasoned, the curative property was acid, so it would work just as well if they used cheaper acids, such as vinegar or ‘oil of vitriol’ (sulphuric acid!). The high cost of citrus fruit (or the sugar required to make it palatable) is a recurring theme in the ongoing history of treating or preventing scurvy. It is interesting to note that the French navy’s answer to scurvy, sorrel (Rumex acetosa), also tastes acidic.
The person who had turned the tide in favour of citrus juice is generally believed to have been Dr Gilbert Blane, who had been personal physician to Sir George Rodney and Physician to the Fleet before he became one of the Commissioners for Sick and Wounded Seamen (commonly known as the ‘Sick and Hurt Board’). Blane was a strong believer in citrus juice, but dubious of the efficacy of the ‘rob’ (syrup) which Lind had advocated, believing – correctly as it happens – that heat impaired the properties of the juice; however, it seems that although he publicised the idea, he was not responsible for the Sick and Hurt Board’s enthusiasm, which came from an experiment conducted just before he joined the Board.17 In 1794 an experiment was made using fresh lemon juice on Suffolk, on a non-stop twenty-three week voyage to India. Two-thirds of an ounce of lemon juice with two ounces of sugar was mixed with grog and given to every man in the ship. Only fifteen showed signs of scurvy, which disappeared when the lemon juice ration was increased. The dosage of two-thirds of an ounce of lemon juice gives just short of the modern recommended minimum daily allowance of Vitamin C. It should be mentioned, however, that the requirement for such things is not absolute; requirements differ between individuals. It is interesting to note when studying ships’ sick returns that even on ships where there is not a serious outbreak of scurvy, there are always one or two cases each week. There are various possible reasons for this: perhaps these men were debilitated when they joined the ship, perhaps they did not like the taste of lemon juice and did not drink their ration, or perhaps they were heavy smokers or tobacco-chewers and thus needed more than the usual amount of Vitamin C.
The successful experiment on Suffolk, together with Blane’s influence as a member of the Sick and Hurt Board, persuaded the Ad
miralty to arrange for an issue of lemon juice in the following year. This tends to be lauded as the end of scurvy in the navy. It might have been, if it was a regular, general issue to every man on every ship, but that is not what happened. In 1795, the Admiralty had agreed to send a supply of lemon juice and sugar to the two squadrons blockading Brest and Quiberon Bay, to be issued ‘at the discretion of the ship’s surgeon’.
This phrase ‘at the discretion of the ship’s surgeon’, together with the influence of the Physician of the Channel Fleet, Trotter, meant that the lemon juice was not used as it should have been. The problem with Trotter was that while he advocated citrus juice as a cure for scurvy, he was very much against using it as a preventive. He believed that daily doses of lemon juice weakened the constitution. When St Vincent succeeded to the command of the Channel Fleet in 1800, having seen the efficacy of lemon juice in his previous command in the Mediterranean, he almost immediately clashed with Trotter on this, and other, health matters, and within a few weeks Trotter was ousted and replaced by Dr Andrew Baird, who did agree with St Vincent.18 This led to supplies of lemon juice eventually being issued to all ships of the Channel Fleet and this, together with regular supplies of fresh vegetables and fruit, allowed the blockading ships to remain on station for longer periods.
By 1803, when Nelson took over the Mediterranean Fleet, most ships going on foreign service carried a supply of lemon juice, again to be issued ‘at the discretion of the ship’s surgeon’; it was not included in the list of standard rations or as a substitute for fresh food. This was because it was still regarded as a medicine and thus under the control of the Sick and Hurt Board, not the Victualling Board. In 1806, when a new edition of the Regulations was issued, the single mention of serving out lemon juice was in the chapters for surgeons, where it states that on long voyages, if there is insufficient lemon juice for the whole ship’s company, they are to give the captain a list of those men most in need. The instructions for the Physician of the Fleet say ‘he is to point out to the commander-in-chief whatever he may think necessary for the recovery of the health of the crew of a ship particularly sickly, or for the preservation of the health of the fleet in general’. Even as late as 1825, the Instructions to Pursers state that lemon juice is not to be issued while the ship’s company are ‘making use of beer, or are furnished with fresh beef, or enjoying a supply of fruit or vegetables; nor during the space of a fortnight after the issue of [the above listed items] unless for the state of health of the crew, the surgeon should think the same necessary.…’19
The responsibility for dispensing lemon juice was divided. The Sick and Hurt Board wanted to keep control, but also wanted the Victualling Board to store and issue it. At the point at which it was agreed that it should be issued to all ships on foreign service or blockade duty, the Sick and Hurt Board wrote to the Admiralty to inform them that they were ready to start delivering packed lemon juice to the Victualling Board stores and asking for the Victualling Board to provide a list of ships it went to, so they could send instructions to the surgeons on how to use it. This request was passed on to the Victualling Board who promptly pointed out that it would be more sensible if they were given a supply of the instructions to deliver with the lemon juice, as otherwise ships might have sailed before the instructions reached them.20
This shuffling of responsibilities continued: in 1806 the Sick and Hurt Board was put under the control of the Transport Board (and in 1816 became a department of the Victualling Board). In 1812 the Transport Board suggested that as lemon juice had ‘now become a class of victualling of the first necessity’, the Victualling Board should take on its provision ‘in the same manner as other articles of provisions, furnishing such quantities thereof as the Transport Board … require for the use of the sick’. The Victualling Board did not want to do this and replied that they did not agree that lemon juice fell under the denomination of a ‘regular article of diet’. Its use had been introduced by the medical department and they felt that the responsibility for it should stay there, adding rather waspishly that it was difficult enough to find enough space for ‘indispensable articles of the first necessity’ let alone anything else.21 However, it seems they were obliged to take on this task, for in 1813 they were complaining about the cost of the sugar that was traditionally served with lemon juice, and managed to persuade the Admiralty that they should revert to serving it only as a cure, not a preventative.22
When the decision was made to supply lemon juice (and they did refer to it as juice, not rob) on a grand scale, in 1796, it was packed in cylindrical bottles in sectioned cases, each case containing eighteen half-gallon bottles. Earlier bottles had been much larger, some containing as much as eight and a half gallons.23 It had originally been proposed that the bottles should be square, but these were found to break more easily than the round ones.24 There had been some experimentation with the preparation of the juice, and it was finally decided that owing to the risk of adulteration at source if bought ready-squeezed, the lemons should be squeezed in Britain. There was some discussion about the extra cost of importing whole fruits but the conclusion was that the difference in freight cost between lemon juice and whole lemons was about the same as it would have cost to set up a reliable squeezing operation abroad and that they would prefer to have this done ‘under the eye of the board’. One wonders what they did with the peels: were they just thrown away, or did some enterprising person see their possibilities for making lemon marmalade or drying them for lemon ‘pepper’? By 1804, when Nelson’s Physician of the Fleet, Dr Snipe, went to Sicily to supervise the Board’s contract for lemons, the situation seemed to have changed, as he ordered juice rather than lemons: a total of 50,000 gallons, at least 10,000 gallons of which went to Nelson’s fleet while the rest went back to England.25
What about actual scurvy cases? During the early stages of the Brest blockade, before fresh vegetables and lemon juice were provided, the commander-in-chief, Lord Bridport, sent back two reports of numbers of sick: on 16 August 1795 this consisted of some 475 cases in thirteen ships, most of these scorbutic, but during September this figure had risen to 861 cases in ten ships. While lemon juice was only used as a cure not a preventive, the situation changed little, but when St Vincent took command in 1801 there was a significant difference; we do not have specific figures on scurvy, but we do have those for numbers of sick men at Haslar hospital at Portsmouth: 15,141 in 1779, 1667 in 1804.26 For the Mediterranean Fleet which he had previously commanded, and where he had used lemon juice as an antiscorbutic, the picture was very different. The number of cases reported on the available forms for 1800 to 1805 rarely reached even double figures – this in squadrons totalling between 3000 and 7000 (Keith’s) or 4500 and 6000 men (Nelson’s) – except on the occasions when there was an outbreak on specific ships. The figures for ulcers, although still representing only about 0.5 per cent of the men, is higher, running between 35 and 50 cases each week. Overall the level of sickness in these squadrons, judging by the returns which have survived, was very low, running at a level which rarely exceeded 5 per cent of the numbers borne.27
Nelson commented on various occasions on the remarkable healthiness of his fleet.28 We do not know how he was judging this, other than the figures reported by the Physician of the Fleet, or what he was using as a comparison; if it was the recent experience of a similar squadrons in a similar location (Keith’s), as we have seen above there is little difference between them. It may have been his experience of serving in the West Indies in the 1780s, when yellow fever and other tropical diseases cut a swathe through British sailors.29 Alternatively it may have been his experience at Corsica in 1794 when he reported ‘we have upwards of one thousand sick out of two thousand, and the others not much better than so many phantoms’; at one point, the crew of Agamemnon became so weak that they were unable to raise the anchor and had to buoy it and cut the cable.30
In this context of remarkable health and scurvy cases it is interesting to study the logs of a
couple of Nelson’s ships in the Mediterranean, Triumph and Gibraltar. Between January and May 1803 Triumph was at Malta, where she took on considerable quantities of provisions; by the middle of June she had joined the main battle squadron off Toulon. Apart from a two-week period at the end of July when she was in Gibraltar having her bowsprit replaced and waiting for a convoy of transports, she remained with the group off Toulon during the next year. When she had been at Gibraltar she received daily supplies of fresh beef and substantial quantities of other provisions; off Toulon she received occasional small amounts of various items from other ships in the squadron, but otherwise, with the exception of live sheep and bullocks whilst at the Maddalena Islands, all her provisions were the basic ration items and these came from transports, either at sea or whilst moored at Palma Bay or the Maddalena Islands.
Her master’s log gives frequent details of provisions received and it is noticeable that she reports receiving only three amounts of onions (fourteen bags on 19 December 1803, three bags on 16 March and 1000 pounds on 22 March 1804) and no citrus fruit or juice after September 1803. From this it appears that the only Vitamin C available after July 1803 was the small amount present in fresh meat and those few onions. Hardly surprisingly, by May 1804 she had thirty-seven men with scurvy; her captain reported this to Nelson, who ordered a special issue of lemon juice. It is possible that she had none on board, as during the course of the following month she received eight casks of lemons from Royal Sovereign, and a total of eleven cases of lime juice from transports.31
Gibraltar had been in the Mediterranean for some time when Nelson arrived in July 1803, and by this time she was an unhealthy ship. At the end of March 1803 she had discharged twenty-one sick men into a transport, and between then and the beginning of May she had sent eleven men to hospital, one of them the surgeon. Between 28 June and 21 July three men died on board the ship; no reason is given for their deaths, or for sending the other men to hospital, but one can speculate that the reason for at least some of this sickness was scurvy, as on 6 August she moored at the Maddalena Islands, built a tented hospital and sent 135 scurvy cases on shore. She remained there for ten days, where she reports receiving sixty-four bullocks (and killing eighteen of them) and 16,700 onions, 101 pumpkins and 100 pounds of grapes ‘for the sick’. One man died in the hospital, but by 16 August the rest were back on board and they went back to rejoin the squadron with the commander-in-chief. She was then sent to Naples, arriving on 20 September, and there she stayed for the next eight months, apart from making a two-week round trip to Sardinia to collect the Duke of Genevois and his retinue. While she was at Naples, she received deliveries on most days of fresh beef, cabbages, pumpkins and onions or leeks, as well as other provisions and wine. During the whole of her time at Naples she reported no further deaths or outbreaks of scurvy.32
Feeding Nelson's Navy Page 20
