Early attempts to used preserved juices to halt the progression of scurvy were unsuccessful due to the fact that cooking and storage destroy the vitamin C in fresh fruits and vegetables. Still, the preserved juices were very popular for cooking and mixed drinks.
In her book, A New System of Domestic Cookery (1806), Eliza Rundell offers the following recipe for preserving Lime-Juice.
To Preserve Lime-Juice
Take any quantity of fresh lime-juice, strain it through a fine cloth, put it into an earthen vessel, and evaporate in a sand-bath, or over a gentle fire, constantly stirring it until it acquires the consistence of a thick syrup. This, kept in small bottles, will for years preserve the flavor of the lime. Tamarind-juice may be preserved the same way, and will be found exceedingly useful, being excellent in punch or sherbet, and invaluable as a fever drink.
Throughout Jane Austen’s life, she was to hold an affection for the British Royal Navy. This was due to the enlistment of two of her brothers, Francis and Charles. Readers of her novels will find a number of positive naval characters, none more so that Captain Wentworth of Persuasion. Officers like these would have been well aware of the dangers of scurvy and alert to its presence aboard ship.
Scurvy is a disease resulting from a deficiency of vitamin C. Scurvy often presents initially with fatigue, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. Spots are most abundant on the thighs and legs, and a person may look pale, feel depressed, and be partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, yellow skin, fever, neuropathy and finally death from bleeding.
Scurvy was at one time common among sailors, pirates and others aboard ships at sea longer than perishable fruits and vegetables could be stored (subsisting instead only on cured and salted meats and dried grains) and by soldiers similarly deprived of these foods for extended periods. It was described by Hippocrates (c. 460 BC–c. 380 BC), and herbal cures for scurvy have been known in many native cultures since prehistory. Scurvy was one of the limiting factors of marine travel, often killing large numbers of the passengers and crew on long-distance voyages. This became a significant issue in Europe from the beginning of the modern era in the Age of Discovery in the 15th century, continuing to play a significant role through World War I in the early 20th century.
Between 1500 and 1800, it has been estimated that scurvy killed at least two million sailors:
Jonathan Lamb wrote: “In 1499, Vasco da Gama lost 116 of his crew of 170; In 1520, Magellan lost 208 out of 230;…all mainly to scurvy.”
In 1593, Admiral Sir Richard Hawkins advocated drinking orange and lemon juice as a means of preventing scurvy.
In 1614 John Woodall, Surgeon General of the East India Company, published “The Surgion’s Mate” as a handbook for apprentice surgeons aboard the company’s ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds.
A 1707 handwritten book is by Mrs. Ebot Mitchell discovered in a house in Hasfield, Gloucestershire, contains a “Recp.t for the Scurvy” that consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine or beer.
In 1734, the Leiden-based physician Johann Bachstrom published a book on scurvy in
which he stated that “scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease” and urged the use of fresh fruit and vegetables as a cure. In 1740, citrus juice (usually lemon or lime juice) was added to the recipe of the traditional daily ration of watered-down rum known as grog to cut down on the water’s foulness. Although they did not know the reason at the time, Admiral Edward Vernon’s sailors were healthier than the rest of the navy because of the daily doses of vitamin C his sailors received. However, it was not until 1747 that James Lind formally demonstrated that scurvy could be treated by supplementing the diet with citrus fruit, in the first ever clinical trial. In 1753, Lind published A Treatise of the Scurvy, in which he explained the details of his clinical trial, but it occupied only a few paragraphs in a work that was long and complex and had little impact. In fact, Lind himself never actively promoted lemon juice as a single ‘cure’. He shared medical opinion at the time that scurvy had multiple causes – notable hard work, bad water and the consumption of salt meat in a damp atmosphere which inhibited healthful perspiration and normal excretion – and therefore required multiple solutions. He was also side-tracked by the possibilities of producing a concentrated ‘rob’ of lemon juice by boiling it. Unfortunately this process destroyed the vitamin C and was unsuccessful.
During the 18th century, scurvy killed more British sailors than enemy action. It was mainly by scurvy that George Anson, in his celebrated voyage of 1740–1744, lost nearly two-thirds of his crew (1300 out of 2000) within the first ten months of the voyage. The Royal Navy enlisted 184,899 sailors during the Seven Years’ War; 133,708 of these were “missing” or died by disease, and scurvy was the leading cause.
Although throughout this period sailors and naval surgeons were increasingly convinced that citrus fruits could cure scurvy, the classically trained physicians who ran the medical establishment dismissed this evidence as mere anecdote which did not conform to current theories of disease. They considered that scurvy was a disease of internal putrefaction brought on by faulty digestion caused by the naval diet. Although this basic idea was given different emphases by successive theorists, the remedies they advocated (and which the navy accepted) amounted to little more than the consumption of ‘fizzy drinks’ to activate the digestive system, the most extreme of which was the regular consumption of ‘elixir of vitriol’ – sulphuric acid taken with spirits and barley water and laced with spices. In 1764, a new variant appeared. Advocated by Dr David McBride and Sir John Pringle, Surgeon General of the Army and later President of the Royal Society, this idea was that scurvy was the result of a lack of ‘fixed air’ in the tissues which could be prevented by drinking infusions of malt and wort whose fermentation within the body would stimulate digestion and restore the missing gases. These ideas receiving wide and influential backing, when James Cook set off to circumnavigate the world (1768–1771) in HM Bark Endeavour, malt and wort were top of the list of the remedies he was ordered to investigate. The others were beer, sour crout and Lind’s ‘rob’. The list did not include lemons. Cook did not lose a single man to scurvy, and his report came down in favour of malt and wort, although it is now clear that the reason for the health of his crews on this and other voyages was Cook’s regime of shipboard cleanliness, enforced by strict discipline, as well as frequent replenishment of fresh food and green stuffs. Another rule implemented by Cook was his prohibition of the consumption of fat scrubbed from the ship’s copper pans, then a common practice in the Navy. In contact with air the copper formed compounds that catalytically oxidised the vitamin C, destroying its efficacy.
The first major long distance expedition that experienced virtually no scurvy was that of the Spanish naval officer Alessandro Malaspina, 1789–1794. Malaspina’s medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at Guam all five were healthy again. Spain’s large empire and many ports of call made it easier to acquire fresh fruit.
Although towards the end of the century McBride’s theories were being challenged, the medical establishment in Britain remained wedded to the notion that scurvy was a disease of internal ‘putrefaction’ and the Sick and Hurt Board, run by administrators, felt obliged to follow its advice Within the Royal Navy however opinion – strengthened by first-hand experience of the use of lemon juice at the siege of Gibraltar and during Admiral Rodney’s expedition to the Caribbean – had become increasingly convinced of its efficacy. This was reinforced by the writings of experts like Gilbert Blane and Thomas Trotter and by the reports of up and coming naval commanders.
With the coming of war in 1793, the need to eliminate scurvy acquired a new urgency. But the first initiative came not from the medical establishment but from the admirals. Ordered to lead an expedition against Mauritius, Rear Admiral Gardner was uninterested in the wort, malt and elixir of vitriol which were still being issued to ships of the Royal Navy, and demanded that he be supplied with lemons to counteract scurvy on the voyage. Members of the Sick and Hurt Board, recently augmented by two practical naval surgeons, supported the request and the Admiralty ordered that it be done. There was however a last minute change of plan. The expedition against Mauritius was cancelled. On 2 May 1794, only HMS Suffolk and two sloops under Commodore Peter Rainier sailed for the east with an outward bound convoy, but the warships were fully supplied with lemon juice and the sugar with which it had to be mixed. Then in March 1795, came astonishing news. Suffolk had arrived in India after a four-month voyage without a trace of scurvy and with a crew that was healthier than when it set out. The effect was immediate. Fleet commanders clamoured also to be supplied with lemon juice and by June the Admiralty acknowledged the groundswell of demand in the navy had agreed to a proposal from the Sick and Hurt Board that lemon juice and sugar should in future be issued as a daily ration to the crews of all warships.
It took a few years before the method of distribution to be all ships in the fleet had been perfected and the supply of the huge quantities of lemon juice required to be secured, but by 1800, the system was in place and functioning. This led to a remarkable health improvement among the sailors and consequently played a critical role in gaining the advantage in naval battles against enemies who had yet to introduce the measures
The surgeon-in-chief of Napoleon’s army at the Siege of Alexandria (1801), Baron Dominique-Jean Larrey, wrote in his memoirs that the consumption of horse meat helped the French to curb an epidemic of scurvy. The meat was cooked but was freshly obtained from young horses bought from Arabs and was nevertheless effective. This helped to start the 19th-century tradition of horse meat consumption in France.
Lauchlin Rose patented a method used to preserve citrus juice without alcohol in 1867, creating a concentrated drink known as Rose’s lime juice. The Merchant Shipping Act established in the year 1867 required all ships of the Royal Navy and Merchant Navy to provide a daily lime ration to sailors to prevent scurvy. The product became nearly ubiquitous, hence the term “limey”, first for British sailors, then for English immigrants within the former British colonies (particularly America, New Zealand and South Africa), and finally, in old American slang, all British people.
The plant Cochlearia officinalis, also known as “Common Scurvygrass”, acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. Its very bitter taste was usually disguised with herbs and spices; however, this did not prevent scurvygrass drinks and sandwiches becoming a popular fad in the UK until the middle of the nineteenth century, when citrus fruits became more readily available.
West Indian limes replaced lemons because they were more easily obtained from Britain’s Caribbean colonies and were believed to be more effective because they were more acidic, and it was the acid, not the (then-unknown) Vitamin C that was believed to cure scurvy. In fact, the West Indian limes were significantly lower in Vitamin C than the previous lemons and further were not served fresh but rather as lime juice, which had been exposed to light and air and piped through copper tubing, all of which significantly reduced the Vitamin C. Indeed, a 1918 animal experiment using representative samples of the Navy and Merchant Marine’s lime juice showed that it had virtually no antiscorbutic power at all.
The belief that scurvy was fundamentally a nutritional deficiency, best treated by consumption of fresh food, particularly fresh citrus or fresh meat, was not universal in Britain in the 19th and early 20th centuries, and thus British sailors and explorers continued to suffer from scurvy into the 20th century.
In the Royal Navy’s Arctic expeditions in the 19th century it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining the morale of the crew, rather than by a diet of fresh food. Navy expeditions continued to be plagued by scurvy even while fresh (not jerked or tinned) meat was well known as a practical antiscorbutic among civilian whalers and explorers in the Arctic. Even cooking fresh meat did not entirely destroy its antiscorbutic properties, especially as many cooking methods failed to bring all the meat to high temperature.
At the time that Robert Falcon Scott made his first expedition (1901-1904) to the Antarctic in the early 20th century, the prevailing theory was that scurvy was caused by “ptomaine poisoning”, particularly in tinned meat. Fortunately, Scott immediately discovered that a diet of fresh meat from Antarctic seals cured scurvy before any fatalities occurred.
Vilhjalmur Stefansson, an arctic explorer who lived among the Inuit, proved that the all meat diet they consumed did not lead to vitamin deficiencies. He participated in a study in New York’s Bellevue Hospital in 1935, where he and a companion ate only meat for a year while under close medical observation, yet remained in good health. Some Antarctic expeditions, such as Scott’s two expeditions and Shackleton’s Ross Sea party, suffered from scurvy, mainly during inland sledge journeys when the men had access to a very limited range of food, virtually none of it fresh. Scurvy was rare or absent when they had access to a wider range of stored food or relied on seal meat.
In 1907, the needed biological-assay model to isolate and identify the antiscorbutic factor was discovered. Axel Holst and Theodor Frølich, two Norwegian physicians studying shipboard beriberi contracted aboard ship’s crews in the Norwegian Fishing Fleet, wanted a small test mammal to substitute for the pigeons then used in beriberi research. They fed guinea pigs their test diet of grains and flour, which had earlier produced beriberi in their pigeons, and were surprised when classic scurvy resulted instead. This was a serendipitous choice of model. Until that time, scurvy had not been observed in any organism apart from humans and had been considered an exclusively human disease. (Some birds are susceptible to scurvy, but pigeons, as seed-eating birds, were later found to be unaffected by scurvy, as they produce vitamin C.) Holst and Frølich found they could cure scurvy in guinea pigs with the addition of various fresh foods and extracts. This discovery of a “clean” (reliable) animal experimental model for scurvy, which was made even before the essential idea of “vitamins” in foods had been put forward, has been called the single most important piece of vitamin C research.
James Lind (4 October 1716 – 13 July 1794) was a Scottish physician who may be credited with improving if not actually saving the lives of Jane Austen’s sailor brothers, Francis and Charles. The advancements he made in the treatement and prevention of Scurvy and Typhus were breakthroughs for their time and continue to be implemented today.
Lind is known for conducting the first ever clinical trial after he developed the theory that citrus fruits cured scurvy. He argued for the health benefits of better ventilation aboard naval ships, the improved cleanliness of sailors’ bodies, clothing and bedding, and below-deck fumigation with sulphur and arsenic. He also proposed that fresh water could be obtained by distilling sea water. His work advanced the practice of preventive medicine and improved nutrition.
Lind was born in Edinburgh, Scotland in 1716 into a family of merchants. He had an elder sister. In 1731 he began his medical studies as an apprentice of George Langlands, a fellow of the Incorporation of Surgeons which preceded the Royal College of Surgeons of Edinburgh. In 1739, he entered the Navy as a surgeon’s mate, serving in the Mediterranean, off the coast of West Africa and in the West Indies. By 1747 he had become surgeon of HMS Salisbury in the Channel Fleet, and conducted his experiment on scurvy while that ship was patrolling the Bay of Biscay. Just after that patrol he left the Navy, wrote his MD thesis on venereal diseases and earned his MD from the University of Edinburgh Medical School, and was granted a license to practice in Edinburgh, Scotland.
Scurvy is a disease now known to be caused by a Vitamin C deficiency, but in Lind’s day, the concept of vitamins was unknown. Vitamin C is necessary for the maintenance of healthy connective tissue. In 1740 the catastrophic result of Anson’s circumnavigation attracted much attention in Europe; out of 1900 men, 1400 had died, most of them allegedly from having contracted scurvy. According to Lind, scurvy caused more deaths in the British fleets than French and Spanish arms. Continue reading James Lind: Medical Pioneer