The incidence of scurvy at sea and its treatment - article ; n°312 ; vol.84, pg 339-346


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Revue d'histoire de la pharmacie - Année 1996 - Volume 84 - Numéro 312 - Pages 339-346
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Source : Persée ; Ministère de la jeunesse, de l’éducation nationale et de la recherche, Direction de l’enseignement supérieur, Sous-direction des bibliothèques et de la documentation.



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J. Burnby
A. Bierman
The incidence of scurvy at sea and its treatment
In: Revue d'histoire de la pharmacie, 84e année, N. 312, 1996. pp. 339-346.
Citer ce document / Cite this document :
Burnby J., Bierman A. The incidence of scurvy at sea and its treatment. In: Revue d'histoire de la pharmacie, 84e année, N.
312, 1996. pp. 339-346. - THERAPEUTIQUE 339 PRATIQUES
The incidence of scurvy
at sea and its treatment
Wirksworth, ENGLAND
Prince Henry the Navigator of from fevers and dysentery but most scurvy. It soon became apparent Portugal in about 1430 established his
that the progression of scurvy was school at Sagres, near Cape St. Vince
directly related to the length of the nt, in order to study the art of navi
voyage l. Christopher Columbus in his gation. Its success was such that by
epoch-making voyage of 1492 lost only 1488 Bartholmeu Dias had rounded
one man from the disease, and it is the southern tip of Africa and nine
now known that the expedition had years later Vasco da Gama set off on
been accomplished before the body his successful bid to reach the Indies.
stores of Vitamin C had been exhausHe returned to Lisbon in August 1499
ted 2. And the same can be said of John having travelled some 27,000 miles
Cabot's voyages in 1497 and 1498 from but with only 54 of his original crew
Bristol to Nova Scotia and Newfoundlof 170 men. The ship had been
and3. adequately provisioned with salt beef,
The search for anti-scorbutics biscuits, sardines, lentils, onions, garl
began, but without anybody having ic, plums, almonds and honey as well
the slightest idea that it was due to a as a daily ration per man of 1,25 pints
dietary deficiency. Some were found of wine and 2,5 pints of water which
by accident and some by design, and was replenished at the Cape Verde
none until the late eighteenth century Islands and at the Cape. It was not
were sytematically applied except durlong after they had left the tip of South ing the pioneering voyages of James Africa that a bewildering disease Cook. struck them. The men suffered from Jacques Carder's crew on his
an increasing lassitude, their gums second voyage to Canada during the
became swollen and teeth fell out, the winter of 1536 were cured by an
skin was covered with purple blotches infusion of the bark and leaves of a
and their limbs became contorted ; tree which the Indians called "Ameda"
many died before they reached Momb or "Annedda", now thought to have
asa. They had fallen victim to scurvy been Thuja occidentalis . Curiously
which was to prove the scourge of on the enquiries of another French
long-distance voyaging in the seven man it proved impossible only
teenth and eighteenth centuries. 72 years later to track down either the
Ferdinand Magellan, who began trees in question or the Indians with
his circumnavigation of the world in this knowledge.
1519, fared even worse for he lost no There is little doubt however that
in northern lands the idea of using less than 208 men out of 230, some ACTES DU XXXIP CONGRÈS INTERNATIONAL D'HISTOIRE DE LA PHARMACIE 340
spruce twigs was known. Scurvy was It is recorded that in the winter "Grel" not uncommon amongst the civilian of 1632 on board the Dutch ship
a garden was laid out in order to propopulation of Sweden yet the army of
vide fresh foods ; horse radish, cresses Charles XII on the European main
and scurvy grass were all cultivated. land was not afflicted. This is thought
to have been due to the influence of Gardening on board ship became so
popular that the Dutch Company in the chemist Urban Hjàrne, FRS and
1677 had to forbid it owing to the physician to the Swedish king, who
damage that the ships were receiving proposed that each soldier should
from tree roots. The idea was never drink every day a pint of ale in which
however totally abandoned. fresh pine shoots had been steeped 5.
John Livingstone, surgeon of the When Joseph Banks made his trip
East Indiaman, the "Cirencester", to Newfoundland in the mid eight
reported in the Edinburgh Medical and eenth century he too came across a
Surgical Journal (Vol. 1 (1805 p. 165) similar preparation to which has been
that when the ship had sailed on given the name spruce beer6.
5 June 1795, they had been unable to By the late sixteenth century the
procure any lime-juice, "the only value of oranges and lemons appears
article on which any dependence to have been fairly widely known. could be placed in combatting this Ronsseus in 1564 claimed that Dutch
dreadful complaint". By September sailors afflicted with scurvy had found scurvy was "pretty general on board"
when loading citrus fruit in Spain for but the lives of many were saved Holland that their condition because their commander, Captain improved 7. Sir Richard Hawkins who Martin Lindsay, "converted a part of in 1593 set out in the "Daintie" for his own apartments into a garden
his passage of the Straits of Magellan, which he managed himself with wond
gave an account of scurvy, adding, erful success."
"That which I have seene most fruitful Sir Hugh Plat an Elizabethan for the sicknesse is sower oranges and merchant who provisioned ships but
lemons... infirmitie" a 8. certain remédie for this also had an interest in botany gave
bottled lemon juice preserved in alco
The 1598 voyage of the Dutch East hol to Sir James Lancaster, the com
India Company under Van Neck and mander of the first fleet of the English
Van Warwyck certainly carried lemon Honorable East India Company which
juice and it is obvious that the Dutch left on 13 February 1601 for Sumatra.
knew the value of fruit 9. On their voy It was only the crew of the flagship, the
age of 1614 to the East, they stopped "Red Dragon" which received a daily
at Sierra Leone because of scurvy and allowance of lemon juice and it was
there bought by barter 3,000 -lemons noticeable that it was only they who
and then a further 25,000 10. were relatively free from scurvy. It is
They established vegetable gard known that the third and fifth voyages
ens and orchards at Mauritius and also used lemon juice, and it is prob
St. Helena and their colonisation at able that the second and fourth did
the Cape in 1652 was undertaken to also 12.
supply fresh provisions from the Comp Most telling of all is the book The
any's farms and gardens, where by Surgion's Mate published in 1617 by
1661 there were a thousand citrus John Woodall who had been
appointed the HEIC's first Surgeon- trees growing n. PROFESSIONNELLES - THERAPEUTIQUE 341 PRATIQUES
was a 'sea scurvy' and a land scurvy'. General five years earlier. Woodall
described the signs and symptoms of It was J. F. Bachstrom in his Obser-
vationes circa scorbutum published in scurvy and the general care of the pati
ent in which he advocated neither 1734 who came out strongly against
this idea, giving examples. He wrote bleeding nor purging as they were too
debilitating. The greatest emphasis that there was only one cause of
was placed on the administration of scurvy - the absence of fresh veg
citrus juices. "The Chirurgeon or his etables for a long period. No drugs
Mate must not fail to persuade the were of any help, nor were mineral
Governour or Purser in all places acids, a diet rich in green vegetables
where they touch in the Indies, and and fruit was all that was required as
a preventive or for treatment 17. may have it, to provide themselves of
Juices of Oranges, Limes or Lemons, The final blow to all the wilder
and at Banthame of Tamarinds... The ideas of treatment and prevention, one
use of the juice of Lemons is a pre would have thought, should have been
cious medicine and well tried, being dealt by the publication of James
sound and good ; let it have the chief Lind's famous Treatise on the Scurvy
place, for it will deserve it" 13. in 1753. After an apprenticeship with
Thereafter it was normal for George Langlands, an apothecary and
lemon water', as it was called, to be surgeon of Edinburgh, Lind joined the
supplied until 1625, indeed Woodall Royal Navy in 1739 as a surgeon's
himself says, "... there is good quantiti mate, and on 20 May 1747 began an
es of juice of lemons sent in each ship experiment on H.M.S. Salisbury.
out of England by the great care of Today it would receive little credit as
the Marchants..." 14. But then the Feb there were no controls and the numb
ruary minutes relate that the Com er of patients few, but the results
pany was not to provide it because the were convincing, so convincing that
"woman supplying it wanted 12d. a he felt constrained to write about his
gallon above the usual price", and that work.
instead it was to be obtained in Spain He took twelve patients suffering
which was of better quality anyway. from scurvy, divided them into six
The return voyage of October 1626 groups and dosed each couple with
was badly afflicted with scurvy different medicines but otherwise
because they had bought tamarinds in received a common diet. Two were
the East Indies which were then ordered a quart of cider a day, two
thought to be as effective as lemons 15. took 25 drops of Elixir Vitriol three
Indeed all sour fruits and even acids times a day and used an acidulated
such as vinegar, sulphuric and nitric gargle, two others had two spoonfuls
acids came erroneously to be thought of vinegar three times a day and their
as being anti-scorbutic. food well acidulated with it, whilst two
The Austrian doctor G. H. Kramer more had an electuary three times a
wrote in 1720 that, "If one could have day made of garlic, mustard seed,
available a supply of green vegetables, horse radish root, Balsam of Peru and
or... oranges, limes or lemons... then gum myrrh. Two more were put on a
one could cure this dreadful dis- course of half a pint of sea-water daily,
ease . and it is possible that Lind considered
The whole question of scurvy was these two men as being something in
much confused by the belief which the nature of controls. Finally the last
couple had two oranges and a lemon persisted for many years that there ACTES DU XXXIP CONGRÈS INTERNATIONAL D'HISTOIRE DE LA PHARMACIE 342
shown this to reduce the vitamin con- every day for six days (these being all
the citrus fruits available on board), ten by 50 % in the freshly made 'rob',
although the experiment in fact lasted which is further reduced to 87 % after
two weeks. 28 days storage 19.
He wrote in conclusion, "The Captain James Cook carried out
consequence was that the most sud his three famous voyages of explo
ration in the years 1768-1771, 1772- den and visible good effects were per
ceived from the use of the oranges and 1775, and 1776-1780. lemon."
Undoubtedly he knew of the disas
Lind was also an advocate of trous effects of scurvy, his own ship
sauerkraut and believed that Dutch H.M.S. Pembroke in 1757, with
ships were less afflicted with scurvy others, at Halifax, Canada having had
because their sailors were provided so many sick on board that they were
with it 18. He also approved of other unable to support Wolfe's military
Dutch practices and gave directions activities. Cook made every attempt,
for a "method of raising a sallad at attempts that were to prove successful,
sea. Let wet cotton be spread thin on to reduce the incidence of scurvy in
the surface of water about two or three long-distance voyaging.
inches from the bottom of the vessel In the journal of his first voyage
to give room for the roots to shoot there are constant references to fresh
down. The seeds being sown upon the food and water, insisting on the collec
cotton, the cresses will in a few days tion of fresh, particularly green, veg
come up." He then adds, "The water etables at every port of call and
here used is not lost, it becomes landing place. As with many other
strongly impregnated both with the ships, he took on onions at Madeira
flavour and taste of cresses, and may which have about 30 mgms of Vitamin
be scurvy." used as a preservative against the C per 100 Grammes when raw, and
even 2.8 mgms when boiled. Even on
These ideas of Lind's were all out-of-the-way islands the crew and
sound but unfortunately some of his officers were urged forth to collect
others were not. He believed pickled wild celery, varieties of scurvy grass
onions as valuable antiscorbutics or Lady's smock ; in New Zealand they
as fresh onions, but in fact the Vitamin gathered the leaves of the cabbage
C content is leached out during the tree, in Tahiti, sweet potatoes and
bread-fruit both of which have satipickling process.
Probably more serious was his sfactory "Rob" amounts of lemons of ascorbic and oranges acid. were
advocacy of a method of "preserving
the virtues of oranges and lemons in taken, but quite rightly, Cook did not
a convenient and small bulk". His think much of them. He was however
instructions for the preparation of an very enthusiastic about sauerkraut
inspissated juice or "rob" included (Sour Krout) ; 7,860 lbs of it being
taken, which worked out at about 2 lbs pouring the depurated juice into a
china or glazed earthern basin which per man per week for a year or
was placed into a pan of water. The approximately 150 mg Vitamin C
weekly for the total of 95 men on water was then brought "almost to the
boil, and continue [d] nearly in a state board 20.
Dr McBride's "wort of malt" was of boiling for several hours" until the
juice was of the consistency of syrup also tried ; the general view however
when cold. Modern experiments have was that it might be useful, but doubt PROFESSIONNELLES - THERAPEUTIQUE 343 PRATIQUES
was expressed. A further trial was Rodney, he accompanied him to the
made of this sweet wort on the second West Indies station in 1780, and there
voyage when the conclusion was effected seamens' a health. great improvement He wrote of in the his
reached that it neither prevented nor
cured scurvy. experiences in Observations on the
Diseases of Seamen in 1785, but inspite The marmalade of carrots, much
vaunted by Baron Storsch of Berlin, of the good contacts he had he was
proved ineffective. The new addition unable to persuade the Admiralty to
materially increase the issue of lemon
beer' on this fermented second with voyage juice was of wort 'spruce and juice and fruit until he became himself
molasses 21. Cook believed this beer to a Commissioner of the Admiralty
Board in 1795 - and no doubt the exigbe very beneficial, so much so, that
encies of war proved an even greater he made it again on his third voyage
spur to the Board. when in British Columbia. There is no
doubt that a number of conifers do A man of lesser influence but of
contain high quantities of Vitamin C, equally great importance for the sea
as for example Abies balsamea with men's health was Thomas Trotter
270 mgm per 100 G. of leaves. appointed Physician to the Channel
Thus it can be seen that by the Fleet in April 1794. Trotter had already
mid-eighteenth century the value of published a book on scurvy eight years
fresh vegetables and fruit, particularly before (1786), and had come to the
same conclusion as earlier writers, citrus fruit, had been proved over and
that "fresh vegetables of all kinds will over again, consequently one may well
wonder why greater attention to diet cure it, but those fruits abounding
with acids such as the citrus class, are was not paid in both the Navy and the others" more effective than 22. He mercantile marine. Certainly, there
was an element of the belief that se made every effort to see that the Chann
amen were expendable, whilst on the el Fleet and his hospital ship had veg
merchant ships there was a lack of the etables, salads, lemons and oranges,
even to the point that he personally discipline necessary to overcome the
crew member's innate conservatism visited the stalls on market days when
and suspicion of innovation. There the victuallers proved dilatory.
were however further considerations The story now moves from medic
than these. al practitioners to druggists and
There was for example the prob pharmacists, from England to
lem of sheer impracticability. How Sweden. Carl Wilhelm Scheele
does one store many thousands of reported in his Chemical Essays pub
oranges or lemons on an over-crowded lished in 1784 that he had isolated
man-of-war laden with guns, gun from lemon juice a crystalline organic
acid to which he gave the name of powder and shot? Using the juice of
citrus fruits was certainly a space- citric acid. Trotter reported, this time
saver but it readily became mouldy, in the Medical Physical Journal of 1 800
(vol. 4, p. 154-6), that he had great sucespecially under poor storage con
ditions which were usually the case. cess in curing scurvy "by the Citric
Acid, in the concrete form, as preIt is true that efforts were made
pared... after the manner of Scheele." to improve the situation, notably by
Sir Gilbert Blane, probably the most Trotter was already aware of the
noted naval physician of his time. As great practical problem of preserving
personal to Admiral Lord lemon juice, one, which with his 344 ACTES DU XXXIP CONGRÈS INTERNATIONAL D'HISTOIRE DE LA PHARMACIE
crystals from a Mr Coxwell of Temple down-to-earth attitudes he tried to
solve. As the concentrated juice known Bar, London24.
as "rob" had proved almost useless, Henry Coxwell had gained his
Trotter tried "concentrating the juice Freedom of the City of London on
6 October 1781 having been apprentby freezing (and removing the ice) to
l/8th of its bulk" and after treating a iced to Edward Bulkeley on 26 Janu
ary 1770. The two brothers, Edward patient with it concluded that it
retained "all the virtues of the fruit in and Philip Bulkeley, were wholesale
its recent state" 23. If this "something" and manufacturing chemists & drugg
ists in Fleet Street, near Temple Bar. (as Trotter called it) found in "recent
vegetable matter" could be obtained Mortimer's Universal Director of 1763
under the heading of "Chemists", in crystalline form then to Trotter's
wrote warningly, "The number of mind this was an even better solution
those who pretend to be Chemists to the problem.
almost exceeds belief, but the followHe received many encouraging
ing, [a list which included the Bulke- reports from the sea-surgeons and he
leys] are really artists, having all strongly recommended the use of regular laboratories..."
these citric acid crystals to the Admira
Examination of the records of the lty which, to give it its due, ordered
Sun Fire Insurance shows this to be trials to be carried out on two ships ;
true. In 1781 Edward Bulkeley, Henry they finally concluded to Trotter's bit
Coxwell and William Bromel at 199- ter disappointment that the use of the
200 Fleet Street (which is close to crystals would be too expensive.
where the Temple Bar used to be) Dr. M'Gregor writing on the dis insured all their "utensils and stock in eases of the 88th. Regiment in Bom
their now dwelling House being two bay in the Edinburgh Medical & houses laid into one with warehouses Surgical Journal of 1805 recorded sev communicating" all and Elaboratory eral cases of scurvy one of which pro of which were of brick except part of
ved fatal. He said "Nitric acid was a warehouse which was timber, for
prescribed and got a fair trial, but the £ 3,000. Three weeks later the same
citric acid was found necessary to the three men insured stock which was
cure", whilst Sir Gilbert Blane in "not hazardous" in their warehouse
another of his books, Elements of near the Rose and Crown at Stone
Medical Logic published in 1 8 1 9, wrote Wharf, Temple Lane, Whitefryars (sic)
of "the speedy and complete cure of for £1000 2*.
scurvy by the citric acids, the scientific As they had a laboratory, it is
term in chemistry for the juice of the probable that the Bulkeleys and Henry fruits of the genus Citrus..." Coxwell made their own citric acid
Were all these men wrong in crystals by Scheele's method, which is
believing that citric acid had effected tedious, but by no means complicated.
a cure, or as Carpenter suggests, were The question then arose could the
they confused in their reports between crystalline citric acid so obtained be,
the crystalline chemical and citrus in effect "contaminated", by ascorbic
juice which contained citric acid from acid, and so bring about the citric
which they believed the anti-scorbutic acid's anti-scorbutic activity?
effect was derived? It was decided to try and repeat
We know from Trotter's writings Scheele's method of citric acid pro
that he had obtained his citric acid duction and test the end product for PROFESSIONNELLES - THERAPEUTIQUE 345 PRATIQUES
the presence of ascorbic acid. Briefly, Finally, the syrupy solution is
either evaporated on porcelain plates his method consisted of heating clear
on warm sand, or else placed in a cool lemon juice in a large glass flask on
room when it would gradually crystalla sand bath and when gently bubbling
ise "like sugar candy" 26. to add gradually chalk until there was
Knowing that fuel, especially in no further frothing, stirring with a
the cities, was expensive and manufactwooden spatula. The flask was then
uring chemists liked to keep its use removed from the sand and set aside to a minimum, we decided not to use until the "calx citrata" had settled at any heat in our experiment. We used
the bottom. The supernatant fluid was
glass "cheated" vessels to the and extent stirring of rods, using and dispoured off and the deposited powder
washed a number of times. tilled water and calcium carbonate of
vitriol" was added pharmacopoeial standard, and at no Diluted "acid of
time did the pH rise above approxiand the flask replaced in the sand bath
mately 6.5. for fifteen minutes. After cooling, the
Citric acid crystals were obtained gypsum, as Scheele termed it, was fi when the solution was placed for sevltered off, and the remaining liquid eral hours in a warm atmosphere. evaporated in an open flask until it But alas for our hypothesis, on
was the consistency of a thin syrup. testing, no ascorbic acid was detected.
Any further deposition of gypsum was The experiment was then repeated
again filtered off and the fluid checked with equally disappointing results.
for any undecomposed "calx citrata" Sadly we came to the conclusion
that "The Answer was a Lemon." in it, as it hinders crystallisation.
Notes and References :
1. - The "Ysselmonde" left Holland in September 1696 and by December had two cases of
scurvy, this increased to forty in January, eighty in February, 109 in March and no less
than 202 by April.
2. - Columbus left the Canary Islands on 6 September 1492 and landed on the Bahamas on
12 October.
3. - Serious loss of Vitamin C in the body's reservoir usually becomes apparent after eight to
twelve weeks.
4. - Cartier gave one of the first full descriptions of scurvy and there is no doubt that this was
the illness afflicting his crew.
5. - KoDICEK, E. H. & Young, F. G. : "Captain Cook and scurvy", Notes and records of the Royal
Society of London, June 1969, vol. 24, p. 25, quoting from a thesis by U. Frieberg, (Stockholm,
1958). The original recipe included horse-radish, water-cress and cubes of lemon.
6. - BANKS, J. : The voyage to Newfoundland and southern Labrador, (1766).
7. - Watts, J. Sir : "Medical aspects of the long voyages of exploration", Marques, M. G. &
Cule, J. (eds.) : The great maritime discoveries and world health, Lisbon, Escola Nacional
de Saude Publica, 1991, p. 26.
8. - Anon. "Vitamins and their kind", Glaxo Jnl, 1953, quoting from Sir. Hawkyns, R. : The
observations of Sir Richard Hawkyns, Knight, in his voyage into the South Seas, 1593, London,
1847, p. 81.
9. - Watts, op. cit., p. 26, quoting from Schoute, D. : Occidental therapeutics in the Netherlands
East Indies... 1600-1900, Batavia, 1937, Netherlands Indies Pacific Health Service, p. 15.
10. - Carpenter, K. J. : The History of scurvy and vitamin C, Cambridge Univ. Press, 1987, p. 22.
11. - Ibid., p. 22.
12. - Sir Foster, W. : England's quest of eastern trade, London, 1966 (re-print) Black, p. 155,
quoting from the East India Company's court minutes of 3 Feb. 1607 and 13 Feb. 1609. ACTES DU XXXIP CONGRÈS INTERNATIONAL D'HISTOIRE DE LA PHARMACIE 346
13. - WOODALL, J. : The surgion's mate, London, 1617, p. 185.
14. - Ibid.
15. - Carpenter, op. cit., p. 21.
16. - Kodicek & Young, p. 61, quoting from Harris, L. J. : Vitamins in theory and practice,
Cambridge Univ. Press, 1938.
17. - Carpenter, op. cit., p. 44 ; Kodicek & Young, op. cit., p. 61.
18. - Watts, op. cit., p. 26.
19. - Hughes, R. E. : "James Lind and the cure of scurvy : an experimental approach", Medical
History, 1975, vol. 19, p. 347.
20. - Kodicek & Young, op. cit., p. 46-47.
21. - Ibid., p. 49, 53, 55. In fact they used the leaves of a New Zealand tree which botanically
speaking is not a spruce.
22. - Carmichael, J. : "Thomas Trotter, 1760-1832 : physician to the fleet", Gardner-Medwin,
D., Hargreaves, A., Lazenby, A. (eds.) : Medicine in Northumbria, Newcastle-upon-Tyne,
1993, Pybus Scy., p. 175.
23. - Trotter, T. : Medical and chemical essays, London, 1795, Jordan, p. 58.
24. - Carmichael, op. cit., p. 177.
25. - Guildall Library, London, Sun Fire Office Insurance, MS. 11936, vol.294, No. 448742,
vol.296, No. 450071.
26. - Dobbin, L. (trans.): The collected papers of Carl Wilhelm Scheele, London, 1931, G.Bell,
p. 260-1.