A Treatise on the Scurvy

3-d of Lind, ScurvyFirst of all, what does the word mean? It started off as an adjective in the 1540s, meaning ‘covered with scabs’, and is apparently related to ‘scurf’, as in dandruff. Juliet’s Nurse helpfully calls someone ‘Scurvy knave! I am none of his flirt-gills. I am none of his skains-mates.’ As an adjective, it also took on the metaphorical sense of ‘contemptible, despicable, mean’.

As a noun, ‘it took on the narrower meaning of Dutch scheurbuik, French scorbut, “scurvy”, in reference to the disease characterised by swollen and bleeding gums, prostration, etc., perhaps from Old Norse skyrbjugr, which is perhaps literally “a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages”; but the OED has alternative etymology of Middle Dutch or Middle Low German origin, as “disease that lacerates the belly”, from schoren “to lacerate” + Middle Low German buk, Dutch buik “belly”.’ Quite a lot of perhapses there… The Latin name, ‘scorbutus’, appears to be a back-formation: it was first used in medical treatises during the Renaissance, but presumably created from the Italian ‘scorbuto’.

And what is the disease? ‘Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of  collagen in humans. Scurvy often presents itself initially as symptoms of malaise and lethargy, 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 with the ailment looks pale, feels depressed, and is partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, jaundice, fever, neuropathy and death.’

Dr James Lind (1716–1794) went to sea as a naval surgeon in 1738, after a medical apprenticeship in Edinburgh, and spent nine years aboard ships, mostly in the English Channel. He then returned to Edinburgh and received his M.D. in 1748, spending the next ten years in private practice in the city, but his period at sea had left him with an abiding interest in the health and welfare of seamen, and in particular in the problem of scurvy, which, while familiar as a disease on land, was the scourge of the navy. To give only one statistic: in a small squadron under Admiral Lord Anson, on a four-year voyage between 1740 and 1744, of 1400 crewmen, very nearly 1000 died from scurvy (see our reissue of Anson’s account) .

In 1753, Lind published his Treatise on the Scurvy, dedicated to Anson. The book is divided into three parts: first, a ‘critical history’ of the disease, summarising the work of previous investigators, and examining (and sometimes discarding) their theories of origination and cure. In the second part, Lind describes the symptoms of the disease, the conditions which appeared to him to give rise to it, and his proposed remedies. The third part is a survey of ancient writers (including Hippocrates) and modern publications (including on Anson’s voyage), which described the disease.

Lind describes an experiment which he carried out with scurvy sufferers on board H.M.S. Salisbury in 1747. Twelve men were paired off, and each pair was dosed one of the following: cider; elixir of vitriol(!); vinegar; sea water(!!); oranges and lemons; and a purge prepared from garlic, mustard seed, and other substances. The two given the citrus fruit recovered almost immediately – Q.E.D., you would have thought.

However, Lind believed that scurvy arose in circumstances where natural toxins accumulating in the body could not be discharged through the skin and so built up internally. He was convinced that environment was part of the problem – that cold and damp surroundings (such as the hold of a warship on patrol at sea for months on end) were conducive to its development, and that its cure would be effected by improving the warmth and dryness of living conditions. Moreover, the great success of Captain Cook in keeping his crews disease-free, by making fresh fruit and vegetables of all sorts a part of their diet, disguised the greater efficacy of citrus in delivering the necessary levels of vitamin C, the absence of which was the actual cause of the disease. (The word ‘vitamin’ was not coined until 1912, and vitamin C (ascorbic acid) was isolated only in 1932.)

Cook, in fact, in command of small expeditions, and able to take on fresh supplies on each occasion that he made land, was in a better position to maintain a healthy crew that the commanders of the naval fleets at the various stations round the world, who might not touch land for months at a time and whose basic supplies were of salt meat and dried bread.

In 1758, Lind moved south to take command of the Royal Naval Hospital at Haslar, near Gosport (where James Clark later trained), and his treatment of scurvy there, though it included oranges and lemons, continued to focus on the whole lifestyle. He wrote two further books, both extremely practical, about the need to improve the health of seamen – seen as vital to the growing global power and prosperity of Britain – and suggesting all sorts of ways, from distilling drinking-water to providing uniforms, which would help to achieve it.

It was not until a year after Lind’s death that Sir Gilbert Blane, who had been making his own observations and coming to similar conclusions, persuaded the Admiralty to use lemon juice to all seamen: the reduction of illness and mortality was immediate and dramatic, and made its own contribution to British naval supremacy in the French Revolutionary wars. (However, the discovery was not accepted completely until the twentieth century: polar expeditions continued to suffer from scurvy up to the time of Scott.)

Blane acknowledged his debt to Lind, who has been regarded as the effective discoverer of a cure for scurvy. But how strange that amid his detailed research among medical writings and his own observations and experiments, he found, but then did not give enough emphasis to, the simple and practical cure which he saw effected on H.M.S. Salisbury.

Caroline

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One Response to A Treatise on the Scurvy

  1. Pingback: The Vampyre Man | Cambridge Library Collection Blog

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