“Oranges and Lemons,” by Alpha Unit

Humans are among the few mammal species unable to synthesize Vitamin C from glucose. All of our Vitamin C has to come from our diets. If you were somehow to end up with no Vitamin C in your diet whatsoever for a prolonged time – say, three or four months and counting, indefinitely – it is no exaggeration to say that the repercussions could be dire.

Without Vitamin C we can’t make collagen, and without collagen your body can’t repair your skin, bone, cartilage, ligaments and tendons, blood vessel walls, and teeth. You need fresh food in your diet, either from plant or animal sources, to get this done.

Wherever you find people going without fresh food for long periods, you’ll find Vitamin C deficiency, or scurvy.

Scurvy has been prevalent throughout much of human history. It likely began to occur in humans during the development of agriculture. According to biologist Thomas Jukes, once people in temperate zones adopted an agrarian lifestyle they were able to store grains for use during winter. They were also able to spread into other temperate regions previously uninhabitable due to the lack of food supply during winters.

But because stored grains are extremely low in Vitamin C, it is likely that these ancient peoples developed scurvy during the long winter months because grain dominated their diets.

During long journeys or overland campaigns, such as the Crusades, scurvy inevitably appeared.

The first written account of a disease likely to be scurvy comes from the Eber Papyrus of ancient Egypt, dated to 1550 BC. The Papyrus not only diagnosed scurvy but prescribed that its victims be given onions, which contain Vitamin C.

Throughout maritime history, people had to figure out not only how to transport themselves across seas and oceans but how to stay healthy along the way. They were clearly relatively successful at both. Millennia ago, Austronesians were the first humans to invent oceangoing vessels; they colonized a large part of the Indo-Pacific region. Early Polynesians were superb seafarers and traveled thousands of miles exploring and settling the region we know as the Polynesian Triangle (drawn by connecting the points of Hawaii, New Zealand, and Easter Island).

Somali seafarers developed extensive trade networks, and Somali merchants at one time led commerce between Asia and Africa. Chinese merchants sailed the Indian Ocean and traded throughout Southeast Asia, the Arabian Peninsula, and East Africa.

How did ancient seafaring peoples deal with scurvy?

Stefan Slater writes that Polynesian seafarers relied on freshly caught fish, crustaceans, and octopi, and would sometimes slaughter some of the animals they were transporting for breeding stock. Jin Ding, Chaojan Shi, and Adam Weintrit report that the diet on Chinese sailing ships included green tea, which contains more Vitamin C than black tea. They also say that Chinese ships began to carry gardens with them, growing soybean sprouts, which are high in Vitamin C.

So there is some evidence that ancient seafarers knew the importance of keeping fresh vegetables and meat in their diets on long voyages.

For Europeans, it wasn’t until the Age of Sail that the problem of scurvy truly came into focus. Wealth and national interest were at stake in ways they hadn’t been before.

Advances in naval technology and a rush for exploration and conquest brought Europeans the “plague of the sea.” Scurvy was the main occupational disease of what historians call the European Age of Exploration. More sailors died of scurvy than all other causes combined, including battles, storms, and other diseases.

Jason A. Mayberry makes the case that a unique confluence of conditions made scurvy and seafaring a deadly combination for Europeans. In his essay “Scurvy and Vitamin C,” he draws upon the work of Stephen Bown, author of Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail.

First, countries had difficulty maintaining sufficient crews for their naval vessels, so they relied on impressment: the taking of men into the military by compulsion, with or without notice. It had been legally sanctioned in Britain since the time of Edward I.

It was basically kidnapping. Gangs of men would go into port towns looking for “recruits.” They would club a man and drag him back to the ship. The man’s family might have no idea what happened to him, and many of the men never made it back home.

Some had experience at sea, some didn’t. Some were in poor health to begin with, being homeless, convicts, or elderly. On average a third of a ship’s crew was made up of impressed men.

Even the men who volunteered for naval service were often in poor health. Many would volunteer in order to secure a place to sleep and get regular meals. Sometimes boys who were orphans or runaways would join.

A second reason that Vitamin C deficiency was hastened during this period were the working conditions on ships. Discipline was harsh and included flogging, keelhauling, and starvation. The body needs more Vitamin C when it is under stress, and sailors had heightened stress in the form of physical exertion, exposure to the elements, fear of battle, and sleep deprivation.

The third and main factor in the development of scurvy was clearly the diet onboard ships. What mattered most for food supplies was that the food be storable for long periods without spoiling. The nutritional content of the food was of little concern for those in charge. What was most important to them was to maintain a suitable labor force at the least possible cost.

A typical weekly ration for a sailor, according to Bown:

• 1 lb. hardtack (biscuit) daily
• 2 lbs. salted beef twice weekly
• 1 lb. salted pork twice weekly
• 2 oz. salted fish 3 times weekly
• 2 oz. butter 3 times weekly
• 4 oz. cheese 3 times weekly
• 8 oz. dried peas 4 times weekly
• 1 gal. beer daily

Sometimes the rations included dried fruit or barley meal. But the lack of fresh fruits and vegetables left the diet almost completely devoid of Vitamin C.

Compounding this problem was that even the food sailors had access to wasn’t always fit to eat. Spoilage was a huge problem on ships. Ships were a dark, damp, and sometimes waterlogged environment for sailors and their food, and this led to moldy, worm-eaten bread, or other dried foods. Meat would begin spoiling almost as soon as it left port, no matter how salt-laden it was.

European navies did provide surgeons and surgeon’s mates on ships, but most of a surgeon’s time was spent caring for battle wounds instead of focusing on the treatment and prevention of disease.

All of these factors made scurvy the leading cause of death during the Age of Sail.

The onset of scurvy is a slow progression, Bown and others inform us, usually appearing after 60 to 90 days of a Vitamin C-deficient diet. This is when the body’s lingering stores of Vitamin C are depleted. The initial symptoms are fatigue and muscle aches. Upon waking, a scurvy victim’s joints will ache.

During the second stage, his gums begin to swell and will bleed with slight pressure. The teeth become loose at the roots. He also feels pain throughout his joints and muscles.

During the third stage, the gums begin to rot. They also bleed profusely. The victim’s flesh becomes gangrenous and will spontaneously hemorrhage. His skin, especially on the legs and feet, develop ulcers that turn gangrenous. As connective tissue fails, long-healed broken bones begin to refracture, and long-healed wounds begin to reopen. The legs cramp so severely that the person cannot walk.

At this point the person is in excruciating pain.

In the final stage of scurvy, the person gets a high fever. His skin develops black spots and he begins having tremors. He will drift in and out of consciousness for a while, and then he dies.

An estimated two million sailors died of scurvy between the 15th and 18th centuries. The science at the time was of very little use in treating them – even though various people throughout European history had made the connection between citrus fruits and the prevention of scurvy.

On July 8, 1497, Vasco da Gama set sail from Lisbon, Portugal, in search of a passage to India. On January 11, 1498, the fleet anchored off Mozambique. After five weeks at sea, the crew began showing the symptoms of scurvy.

Fortunately, some weeks later, they arrived at Mombasa, on the coast of Kenya, where they met local traders who traded them oranges. Within six days of eating them, the crew recovered. Da Gama left Africa and began his voyage across the Indian Ocean to Kozhikode (or Calicut to Westerners).

After staying in India for four months, da Gama left for a three-month journey at sea in which scurvy killed many of his sailors. On January 7, 1499, the ships anchored at Malindi, Kenya, where the sailors, remembering their previous cure in Mombasa, asked for oranges. Still, more sailors died of the disease “which started in the mouth.” Six months later the survivors made it back to Lisbon.

Did Vasco da Gama alert any ship owners or controlling authorities of what he had discovered about treating scurvy? No one knows.

Sir Richard Hawkins had discovered a cure for scurvy in 1593 when it appeared in his crew in southern Brazil. He reported that oranges and lemons had been a remedy for his men. To whom did he report this? What did they do with the information?

The Dutch had known about the value of citrus fruits since at least the late 16th century. According to J. Burnby and A. Bierman, who wrote “The Incidence of Scurvy at Sea and Its Treatment,” the Dutch East India Company bartered for lemons in Africa and also established vegetable gardens and orchards in their colonies to provide fresh citrus to their ships. How did the Dutch manage to keep this knowledge to themselves? Was that their intention?

Burnby and Bierman also write about an Elizabethan merchant, Sir Hugh Plat, who had an interest in botany and gave bottled lemon juice to the commander of the first fleet of the English East India Company. It was only the crew of the flagship, Red Dragon, which received a daily allowance of lemon juice. It was also the only crew that remained relatively free of scurvy. What did the English East India Company do with this information?

In the early 1600s John Woodall, a surgeon for the same East India Company, described the symptoms of scurvy and recommended that ships’ surgeons inform Governors of “all places they touch in the Indies” that the juices of oranges, lemons, limes, and tamarinds be used as medicine for scurvy.

The East India Company actually supplied “lemon water,” as it was called, for its ships until 1625, when the Company chose not to provide it because “the woman supplying it wanted 12d. a gallon above the usual price.” The return voyage of 1626 was badly afflicted with scurvy because they had bought tamarinds in the East Indies which they presumed to be as effective as lemons. All sour fruits and even acids such as vinegar were erroneously thought to be cures for scurvy.

J. F. Bachstrom, a Lutheran theologian and physician, wrote in 1734 that there was only one cause of scurvy – the absence of fresh fruits and vegetables for a long period. No drugs would help, nor would mineral acids. Were any companies or government entities aware of his findings? If so, did they take them seriously?

Europe was slowly making headway against this problem nevertheless. In 1739 James Lind, a former physician’s apprentice, volunteered for the Royal Navy and was designated a surgeon’s mate. After seven years in that position, he was promoted to surgeon on HMS Salisbury. It was on this ship that he performed his famous scurvy experiment.

Lind showed an insight ahead of his time by understanding that, to develop a cure, treatments must be compared simultaneously in similar patients. He had envisioned the concept of clinical trials, as rudimentary as his idea might have been.

After eight weeks at sea, and when scurvy was beginning to take its toll on the crew, Lind decided to test his idea that the putrefaction of the body caused by the disease could be prevented with acids. He divided 12 sick patients into six pairs, and provided each pair with a different supplement to their diet: cider, vitriolic acid (diluted sulfuric acid), vinegar, sea water, two oranges and one lemon, or a purgative mixture.

Only the pair who took the oranges and lemons improved.

You would think that Lind had established a clear connection between citrus and scurvy and that the Navy would have taken immediate action. But neither happened.

Lind continued to believe that there were multiple causes of scurvy. He also advocated a method of preserving the virtues of oranges and lemons that involved boiling the juices. Unbeknownst to Lind, boiling destroyed the active ingredient in citrus juices – Vitamin C. When the boiled juice was tried on ships as a preventative measure and found lacking, people began to dismiss the whole idea that citrus fruits were effective against scurvy!

In 1753 Lind published his Treatise on the Scurvy, considered a classic of medical science. But it took the Royal Navy over 40 years to adopt Lind’s recommendations. This happened under the direction of Sir Gilbert Blane, who had been appointed Physician to the Fleet.

Blane was familiar with Lind’s work and had the power and initiative to bring about change, Mayberry states. He organized an experiment on HMS Suffolk on a 23-week trip to India. The sailors were given a mixture of rum, water, sugar, and lemon juice. A few sailors developed a slight case of scurvy. They were given additional rations of lemon juice and the scurvy was quickly cured.

With the results from the HMS Suffolk and the power of his position, Blane was able to ensure that fresh citrus juice became a staple in the British Navy. For the British, scurvy had finally been conquered.

The question remains: why did it take so long, when so many had found the cure time and time again?

Burnby and Bierman note that there was the view among ship owners and government authorities that seamen were expendable. They also suggest that seamen themselves might have been reluctant to take part in experiments that might have settled the issue. But they mention other considerations, mainly the problem of “sheer impracticability.”

How does one store many thousands of oranges and lemons on an overcrowded man-of-war laden with guns, gunpowder, and shot? Using the juice of citrus fruits was certainly a space saver but it readily became moldy, especially under poor storage conditions, which were usually the case.

Speaking of practical considerations, how long can it be practical to treat your work force as if they are expendable? There were no sailors’ advocates at the time to make it impractical for businessmen and governments to do so. Nothing stopped or even slowed Europe’s exploration and colonization, so losing sailors to scurvy was just one of the costs of doing business.