Exhaustion and weakness, swelling of the arms and legs, softening of the gums, excessive bruising, hemorrhaging from the nose and mouth, foul breath, diarrhea, muscle pain, loss of teeth, lung and kidney problems—the list of symptoms of scurvy is long and horrible. Death generally results from an acute infection such as pneumonia or some other respiratory ailment or, even in young people, from heart failure. One symptom, depression, occurs at an early stage, but whether it is an effect of the actual disease or a response to the other symptoms is not clear. After all, if you were constantly exhausted and had sores that did not heal, painful and bleeding gums, stinking breath, and diarrhea, and you knew that there was worse to come, would you not be depressed, too?
Scurvy is an ancient disease. Changes in bone structure in Neolithic remains are thought to be compatible with scurvy, and hieroglyphs from ancient Egypt have been interpreted as referring to it. The word scurvy is said to be derived from Norse, the language of the seafaring Viking warriors who, starting in the ninth century, raided the Atlantic coast of Europe from their northern homelands in Scandinavia. A lack of vitamin-rich fresh fruit and vegetables would have been common on board ships and in northern communities during winter. The Vikings supposedly made use of scurvy grass, a form of Arctic cress, on their way to America via Greenland. The first real descriptions of what was probably scurvy date from the Crusades in the thirteenth century.
SCURVY AT SEA
In the fourteenth and fifteenth centuries, as longer voyages were made possible by the development of more efficient sets of sails and fully rigged ships, scurvy became commonplace at sea. Oar-propelled galleys, such as those used by the Greeks and Romans, and the small sailing boats of Arab traders had stayed fairly close to the coast. These vessels were not seaworthy enough to withstand the rough waters and huge swells of the open ocean. Consequently, they would seldom venture far from the coast, and supplies could be replenished every few days or weeks. Access to fresh food on a regular basis meant that scurvy was seldom a major problem. But in the fifteenth century, long ocean voyages in large sailing ships heralded not only the Age of Discovery but also reliance on preserved food.
Bigger ships had to carry cargo and arms, a larger crew to handle the more complicated rigging and sails, and food and water for months at sea. An increase in the number of decks and men and the amount of supplies inevitably translated into cramped sleeping and living conditions for the crew, poor ventilation, and a subsequent increase in infectious diseases and respiratory conditions. Consumption (tuberculosis) and the “bloody flux” (a pernicious form of diarrhea) were common as, no doubt, were body and head lice, scabies, and other contagious skin conditions.
The standard sailor’s food did nothing to improve his health. Two major factors dictated the seafaring diet. Firstly, aboard wooden ships it was extremely difficult to keep anything, including food, dry and mold free. Water was absorbed through wooden hulls, as the only waterproofing material available was pitch, a dark-colored, sticky resin obtained as a by-product of charcoal manufacture, applied to the outside of the hull. The inside of the hull, particularly where ventilation was poor, would have been extremely humid. Many accounts of sailing journeys describe incessant dampness, as mold and mildew grew on clothing, on leather boots and belts, on bedding, and on books. The standard sailor’s fare was salted beef or pork and ship’s biscuits known as hardtack, a mixture of flour and water without salt that was baked rock hard and used as a substitute for bread. Hardtack had the desirable characteristic of being relatively immune to mildew. It was baked to such a degree of hardness that it remained edible for decades, but it was extremely difficult to bite into, especially for those whose gums were inflamed by the onset of scurvy. Typically, ship’s biscuits were weevil infested, a circumstance that was actually welcomed by sailors as the weevil holes increased porosity and made the biscuits easier to break and chew.
The second factor governing diet on wooden ships was the fear of fire. Wooden construction and liberal use of highly combustible pitch meant that constant diligence was necessary to prevent fire at sea. For this reason the only fire permitted on board was in the galley and then only in relatively calm weather. At the first sign of foul weather, galley fires would be extinguished until the storm was over. Cooking was often not possible for days at a time. Salted meat could not be simmered in water for the hours necessary to reduce its saltiness; nor could ship’s biscuits be made at least somewhat palatable by dunking them in hot stew or broth.
At the outset of a voyage provisions would be taken on board: butter, cheese, vinegar, bread, dried peas, beer, and rum. The butter was soon rancid, the bread moldy, the dried peas weevil infested, the cheeses hard, and the beer sour. None of these items provided vitamin C, so signs of scurvy were often evident after as little as six weeks out of port. Was it any wonder that the navies of European countries had to resort to the press-gang as a means of manning their ships?
Scurvy’s toll on the lives and health of sailors is recorded in the logs of early voyages. By the time the Portuguese explorer Vasco da Gama sailed around the southern tip of Africa in 1497, one hundred of his 160-member crew had died from scurvy. Reports exist of the discovery of ships adrift at sea with entire crews dead from the disease. It is estimated that for centuries scurvy was responsible for more death at sea than all other causes; more than the combined total of naval battles, piracy, shipwrecks, and other illnesses.
Astonishingly, preventives and remedies for scurvy during these years were known—but largely ignored. As early as the fifth century, the Chinese were growing fresh ginger in pots on board their ships. The idea that fresh fruit and vegetables could alleviate symptoms of scurvy was, no doubt, available to other countries in Southeast Asia in contact with Chinese trading vessels. It would have been passed on to the Dutch and been reported by them to other Europeans as, by 1601, the first fleet of the English East India Company is known to have collected oranges and lemons at Madagascar on their way to the East. This small squadron of four ships was under the command of Captain James Lancaster, who carried bottled lemon juice with him on his flagship, the Dragon. Anyone who showed signs of scurvy was dosed with three tea-spoons of lemon juice every morning. On arrival at the Cape of Good Hope, none of the men on board the Dragon was suffering from scurvy, but the toll on the other three ships was significant. Despite Lancaster’s instructions and example, nearly a quarter of the total crew of this expedition died from scurvy—and not one of these deaths was on his flagship.
Some sixty-five years earlier the crew members on French explorer Jacques Cartier’s second expedition to Newfoundland and Quebec were badly affected by a severe outbreak of scurvy, resulting in many deaths. An infusion of needles of the spruce tree, a remedy suggested by the local Indians, was tried with seemingly miraculous results. Almost overnight the symptoms were said to lessen and the disease rapidly disappeared. In 1593 Sir Richard Hawkins, an admiral of the British navy, claimed that within his own experience at least ten thousand men had died at sea from scurvy, but that lemon juice would have been an immediately effective cure.
There were even published accounts of successful treatments of scurvy. In 1617, John Woodall’s The Surgeon’s Mate described lemon juice as being prescribed for both cure and prevention. Eighty years later Dr. William Cockburn’s Sea Diseases, or the Treatise of their Nature, Cause and Cure recommended fresh fruits and vegetables. Other suggestions such as vinegar, salt water, cinnamon, and whey were quite useless and may have obscured the correct action.
It was not until the middle of the following century that the effectiveness of citrus juice was proven in the first controlled clinical studies of scurvy. Although the numbers involved were very small, the conclusion was obvious. In 1747, James Lind, a Scottish naval surgeon at sea in the Salisbury, chose twelve of the crew suffering from scurvy for his experiment. He selected men whose symptoms seemed as similar as possible. He had them all eat the same diet: not the standard salted meat and hardtack, which th
ese patients would have found very difficult to chew, but sweetened gruel, mutton broth, boiled biscuits, barley, sago, rice, raisins, currants, and wine. Lind added various supplements to this carbohydrate-based regime. Two of the sailors each received a quart of cider daily. Two others were dosed with vinegar, and another unfortunate pair received diluted elixir of vitriol (or sulfuric acid). Two more were required to drink half a pint of seawater daily, and another two were fed a concoction of nutmeg, garlic, mustard seed, gum myrrh, cream of tartar, and barley water. The lucky remaining pair was issued daily two oranges and one lemon each.
The results were sudden and visible and what we would expect with today’s knowledge. Within six days the men who received the citrus fruit were fit for duty. Hopefully, the other ten sailors were then taken off their seawater, nutmeg, or sulfuric acid regimes and also supplied with lemons and oranges. Lind’s results were published in A Treatise of Scurvy, but it was another forty years before the British navy began the compulsory issue of lemon juice.
If an effective treatment for scurvy was known, why wasn’t it acted upon and used routinely? Sadly, the remedy for scurvy, though proven, seems to have not been recognized or believed. A widely held theory blamed scurvy on a diet of either too much salted meat or not enough fresh meat rather than a lack of fresh fruit and vegetables. Also, there was a logistical problem: it was difficult to keep fresh citrus fruit or juice for weeks at a time. Attempts were made to concentrate and preserve lemon juice, but such procedures were time consuming, costly, and perhaps not very effective, as we now know that vitamin C is easily destroyed by heat and light and that long-term storage reduces the amount in fruits and vegetables
Because of expense and inconvenience, naval officers, physicians, the British admiralty, and shipowners could see no way of growing sufficient greens or citrus fruit on heavily manned vessels. Precious cargo space would have to be used for this purpose. Fresh or preserved citrus fruit was expensive, especially if it was to be allocated daily as a preventive measure. Economy and the profit margin ruled—although, in hindsight, it does seem that this was a false economy. Ships had to be manned above capacity to allow for a 30, 40 or even 50 percent death rate from scurvy. Even without a high death rate, the effectiveness of a crew suffering from scurvy would have been remarkably low. And then there was the humane factor—rarely considered during these centuries.
Another element was the intransigence of the average crew. They were used to eating the standard ship’s fare, and although they complained about the monotonous diet of salt meat and ship’s biscuit when they were at sea, what they wanted in port was lots of fresh meat, fresh bread, cheese, butter, and good beer. Even if fresh fruit and vegetables were available, the majority of the crew would not have been interested in a quick stir-fry of tender crunchy greens. They wanted meat and more meat—boiled, stewed, or roasted. The officers, who generally came from a higher social class, where a wider and more varied diet was common, would have found eating fruit and vegetables in port to be normal and probably highly acceptable. It would not have been unusual for them to be interested in trying exotic new foodstuffs to be found in the locales where they made landfall. Tamarinds, limes, and other fruits high in vitamin C would have been used in the local cuisine that they, unlike the crew, might try. Scurvy was thus usually less of a problem among a ship’s officers.
COOK: HUNDREDS-SCURVY: NIL
James Cook of the British Royal Navy was the first ship’s captain to ensure that his crews remained scurvy free. Cook is sometimes associated with the discovery of antiscorbutics, as scurvy-curing foods are called, but his true achievement lay in the fact that he insisted on maintaining high levels of diet and hygiene aboard all his vessels. The result of his meticulous standards was an extraordinarily good level of health and a low mortality rate among his crew. Cook entered the navy at the relatively late age of twenty-seven, but his previous nine years of experience sailing as a merchant seaman mate in the North Sea and the Baltic, his intelligence, and his innate seamanship combined to ensure his rapid promotion within the naval ranks. His first experience with scurvy came aboard the Pembroke, in 1758, on his initial voyage across the Atlantic Ocean to Canada to challenge the French hold on the St. Lawrence River. Cook was alarmed by the devastation this common affliction caused and appalled that the deaths of so many crew, the dangerous reduction of working efficiency, and even actual loss of ships were generally accepted as inevitable.
His experience exploring and mapping around Nova Scotia, the Gulf of St. Lawrence, and Newfoundland and his accurate observations of the eclipse of the sun greatly impressed the Royal Society, a body founded in 1645 with the aim of “improving natural knowledge.” He was granted command of the ship Endeavour and instructed to explore and chart the southern oceans, to investigate new plants and animals, and to make astronomical observations of the transit of planets across the sun.
Less known but nonetheless compelling reasons for this voyage and for Cook’s subsequent later voyages were political. Taking possession in the name of Britain of already discovered lands; claiming of new lands still to be discovered, including Terra Australis Incognita, the great southern continent; and the hopes of finding a Northwest Passage were all on the minds of the admiralty. That Cook was able to complete so many of these objectives depended to a large degree on ascorbic acid.
Consider the scenario on June 10, 1770, when the Endeavour ran aground on coral of the Great Barrier Reef just south of present-day Cooktown, in northern Queensland, Australia. It was a near catastrophe. The ship had struck at high water; a resulting hole in the hull necessitated drastic measures. In order to lighten the ship, the entire crew heaved overboard everything that could be spared. For twenty-three hours straight they manned the pumps as seawater leaked inexorably into the hold, hauling desperately on cables and anchor in an attempt to plug the hole by fothering, a temporary method of mending a hole by drawing a heavy sail under the hull. Incredible effort, superb seamanship, and good fortune prevailed. The ship eventually slid off the reef and was beached for repairs. It had been a very close call—one that an exhausted, scurvy-inflicted crew could not have summoned the energy to answer.
A healthy, well-functioning crew was essential for Cook to accomplish what he did on his voyages. This fact was recognized by the Royal Society when it awarded him its highest honor, the Copley gold medal, not for his navigational feats but for his demonstration that scurvy was not an inevitable companion on long ocean voyages. Cook’s methods were simple. He insisted on maintaining cleanliness throughout the ship, especially in the tight confines of the seamen’s quarters. All hands were required to wash their clothes regularly, to air and dry their bedding when the weather permitted, to fumigate between decks, and in general to live up to the meaning of the term shipshape. When it was not possible to obtain the fresh fruit and vegetables he thought necessary for a balanced diet, he required that his men eat the sauerkraut he had included in the ship’s provisions. Cook touched land at every possible opportunity to replenish stores and gather local grasses (celery grass, scurvy grass) or plants from which he brewed teas.
This diet was not at all popular with the crew, accustomed as they were to the standard seamen’s fare and reluctant to try anything new. But Cook was adamant. He and his officers also adhered to this diet, and it was by his example, authority, and determination that his regimen was followed. There is no record that Cook had anyone flogged for refusing to eat sauerkraut or celery grass, but the crew knew the captain would not hesitate to prescribe the lash for opposing his rules. Cook also made use of a more subtle approach. He records that a “Sour Kroutt” prepared from local plants was initially made available only to the officers; within a week the lower ranks were clamoring for their share.
Success no doubt helped convince Cook’s crew that their captain’s strange obsession with what they ate was worthwhile. Cook never lost a single man to scurvy. On his first voyage of almost three years, one-third of his crew died after contr
acting malaria or dysentery in Batavia (now Jakarta) in the Dutch East Indies (now Indonesia). On his second voyage from 1772 to 1775, he lost one member of his crew to illness—but not to scurvy. Yet on that trip the crew of his companion vessel was badly affected by the problem. The commander, Tobias Furneaux, was severely reprimanded and instructed yet again by Cook on the need for preparation and administration of antiscorbutics. Thanks to vitamin C, the ascorbic acid molecule, Cook was able to compile an impressive list of accomplishments: the discovery of the Hawaiian Islands and the Great Barrier Reef, the first circumnavigation of New Zealand, the first charting of the coast of the Pacific Northwest, and first crossing of the Antarctic Circle.
A SMALL MOLECULE IN A BIG ROLE
What is this small compound that had such a big effect on the map of the world? The word vitamin comes from a contraction of two words, vital (necessary) and amine (a nitrogen-containing organic compound—it was originally thought that all vitamins contained at least one nitrogen atom). The C in vitamin C indicates that it was the third vitamin ever identified.
Structure of ascorbic acid (or vitamin C)
This system of naming has numerous flaws. The B vitamins and vitamin H are the only ones that actually do contain nitrogen. The original B vitamin was later discovered to consist of more than one compound, hence vitamin B1, vitamin B2, etc. Also, several supposedly different vitamins were found to be the same compound, and thus there is no vitamin F or vitamin G.
Among mammals, only primates, guinea pigs, and the Indian fruit bat require vitamin C in their diet. In all other vertebrates—the family dog or cat, for example—ascorbic acid is made in the liver from the simple sugar glucose by a series of four reactions, each catalyzed by an enzyme. Thus for these animals ascorbic acid is not a dietary necessity. Presumably, somewhere along the evolutionary path humans lost the ability to synthesize ascorbic acid from glucose, apparently by losing the genetic material that enabled us to make gulonolactone oxidase, the enzyme necessary for the final step in this sequence.
Penny le Couteur & Jay Burreson Page 4
