Bown, Stephen R.
Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail.
Thomas Dunne Books / St. Martin's Press.
Stephen R. Bown, a Canadian historian of science and exploration, has written a comprehensive and engaging account that traces efforts to understand this disease. The book summarizes how the work of James Lind (surgeon), James Cook (mariner), and Gilbert Blane (gentleman) led to solutions combating scurvy.
Scurvy, "the plague of the sea," killed over an estimated two million sailors during the Age of Sail. Far more naval personnel died from scurvy than all other diseases combined, including deaths from combat, storms, disasters, and shipwrecks. The author cites numerous graphic examples of scurvy's tragic consequences from the late 15th to the early 19th century. Scurvy is a gradually debilitating disease that destroys the body's connecting tissues, causing lethargy, blotchy skin, rotting gums and teeth, and reopening of old wounds or healed fractured bones. If not treated, scurvy leads to death. Its causes were imperfectly diagnosed according to prevailing medical theories and assumptions. Mandated treatments prescribed included bleeding and a host of concoctions, some of which would now be considered potentially harmful (e.g. mercury and sulphuric acid). Increased workload was ordered to cure listlessness brought on by scurvy. Unsanitary, overcrowded living conditions aboard sailing ships accelerated other diseases prevalent amongst sailors, men often not in good physical condition. The routine diet of "salt port, biscuit, and grog" could never stem this plague.
Scurvy is an entirely preventable and treatable disease, occurring during long sea voyages. It was not caused by the assumed "vapours or viruses" but by the absence of Vitamin C (ascorbic acid) in the diet. An understanding of chemistry and food specifically, the consumption of oranges and lemons, led to the prevention of scurvy. Ironically, treatment by food containing ascorbic acid was discarded due to prevailing medical opinion or bureaucracy, at times directed by persons inexperienced or unfamiliar with maritime conditions. Scurvy is not eradicated, for it will reappear anytime ascorbic acid is absent from diets for an extended time.
James Lind (1716-1794), an Edinburgh surgeon, conducted experiments as surgeon on Salisbury over two months in 1747. His controlled trial, perhaps the first in medical science, selected sailors sick with scurvy who received a common diet but were given different remedies. Lind tested six treatments: cider, elixir of vitriol (sulphuric acid), vinegar, purging by sea water, a medicinal paste (garlic, dried mustard seed, dried radish root, balsam of Peru, and gum myrrh), and oranges and lemons.
Consumption of oranges and lemons was the only productive treatment for two fortunate sailors in the control group. Cider caused some abatement of the disease but insufficient for the seamen to return to active duty. Lind published his 400 page Treatise on Scurvy in 1753. His objections of theories and treatment methods by his contemporaries led to strong criticism from those higher placed in the medical or scientific communities.
During the remainder of his career, Lind continued to treat scurvy as head of Haslar Hospital, then England's newest and largest hospital for sailors, near Portsmouth. Although correct in treatment of scurvy by oranges and lemons, Lind could not explain why citrus was effective. His theories on the origin of the disease were neither accurate, nor acceptable to others. Incomplete understanding also existed about the loss of ascorbic acid through manufacture of concentrated lemon or orange juice or understanding its loss by prolonged storage. For example, use of copper pots or tubing significantly reduced ascorbic acid content of concentrated products. Moreover, wort of malt emerged as the preferred, and inexpensive, treatment, compared to citrus fruit. The accepted etiology of scurvy was the "putrification" of body tissue. It was believed the fermentation process inherent in wort of malt delayed or replaced the "fixed air" released through "putrification" and therefore it decreased scurvy. This theory supporting treatment by wort received favour from the Admiralty and Sir John Pringle (1707-1782), President of the Royal Society.
Captain James Cook experimented with a variety of alternatives to combat scurvy. Bown writes, Cook used "a regiment regimen of cleanliness, fresh air, and an antiscorbitic diet." The author notes Cook "eagerly embraced" the Admiralty's tactics by stocking on board a range of antiscorbitics such as sauerkraut, wort of malt, carrot marmalade, and concentrated (robs) of orange and lemon juice, among other treatments. He encouraged naturalists who sailed on voyages to identify edible plants to fight scurvy. Fresh vegetables and fruits were added to the ships' food supply (e.g., scurvy grass, wild celery, the Kerguelen Cabbage).
Not all solutions were popular or understood. After Cook ordered sauerkraut served daily at the "Cabbin Table", the once-reluctant sailors ate it as well and "murmurings" against it ceased. Ironically, on the First Voyage, Joseph Banks observed the value of lemon juice in combating signs of his own scurvy but his journal comments were not published until much later. Moreover, the Admiralty, as well as Sir John Pringle, promoted wort of malt as "a cheap and simple solution" for scurvy.
Bown characterizes Cook's experiments as "rigid enforcement of diet and cleanliness" leading to "unheard of accomplishment." While scurvy appeared amongst sailors on Cook's long sea voyages, no sailor died of scurvy. A range of antiscourbitics, some useful and some ineffectual were used, although the efficacy of all treatments was not fully understood at the time. On the Second Voyage Cook discovered a marked difference between the company of Resolution and that of Adventure, commanded by Captain Tobias Furneaux. Cook ordered Furneaux to adopt his methods of diet and cleanliness that included "a liberal dosage of all antiscourbitics at regular intervals." This reduced scurvy in Adventure.
One firm conclusion from Cook's voyages was the inclusion of specific beneficial foods in sailor's diets. However, Cook's own conclusions remained ambiguous. He credited orange and lemon juice as well as wort of malt in treating the disease. Bown concludes, "Cook had won the battle against scurvy, still no one knew exactly how." In 1776, the Royal Society awarded Cook the Copley Gold Medal in recognition of Cook's contributions toward improving the health of seamen even though, as Bown writes, "Cook could only offer vague and unqualified opinions on the most effective antiscorbutics because he was not conducting controlled trials." Bown concludes that the Royal Navy failed to understand why Cook had been successful, and "many more voyages left port with very uncertain futures".
Sir Gilbert Blane (1749-1834) obtained medical education in both Edinburgh and Glasgow. He served as personal physician to Admiral George Rodney (1719-1792) in the West Indies, sailing in 1780. Blane's social standing from a prominent Ayrshire family, as well as connections with Admiral Rodney and others in the higher ranks of society and government, eventually enabled his conclusions to be accepted by a wider scientific audience and the Admiralty, a barrier neither James Lind nor Captain Cook could breach.
Blane was familiar with work by Lind and Cook in treating scurvy and used their work in a manuscript he published and distributed to the Fleet, A Short Account of the Most Effectual Means of Preserving the Health of Seamen.
It emphasized maintenance of cleanliness, regular washing of sailors' clothes and bedding, and routine inclusion of citrus juice as well as wort of malt in seamen's diet. Blane collected statistics on the health of sailors and deaths from disease, including scurvy. He ultimately concluded that lemon and orange juice were "of the greatest efficacy" in treating scurvy. He ignored the Admiralty's direction to promote wort of malt. After an appointment to London's St. Thomas Hospital he published Observations on the Diseases Incident to Seamen (1786), further emphasizing use of citrus fruit, noting James Lind "first ascertained" this conclusion.
In 1795, Blane, now a Commissioner on the Sick and Hurt Board, persuaded the Admiralty to issue a daily ration of three quarters of an ounce of lemon juice to all Royal Navy sailors. Blane's work connected the all-important relationship between ascorbic acid in the diet with the concept that ascorbic acid will also cure scurvy.
Prevention and cure were joined.
The incidence of scurvy dramatically declined. In addition to the daily dose of ascorbic acid, lemon juice was also often added to daily rations of grog. From 1795 to 1815, the Royal Navy purchased over 1.6 million gallons of lemon juice. Bown argues that during the naval blockade of the French and Spanish fleets in the wars with Napoleon, the capability of the Royal Navy to remain on the seas constantly and prevent a Napoleonic invasion of England was due to the superior health of British sailors because scurvy was prevented or correctly treated.
The 217 pages of Bown's text are supplemented in an appendix that includes a timeline chronicling key events in combating scurvy and a table identifying the ascorbic acid content of commonly used fruits and vegetables. The book contains no footnotes but it includes a chapter-by-chapter listing of sources utilized as well as a bibliography and index. The book is suitable for the general reader or specialist. The author presents a well written, often dramatic and exciting historical perspective chronicling resolution of this medical mystery.
James C. Hamilton
Originally published in Cook's Log, page 44, volume 33, number 2 (2010).