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Medical research: Mariners' malady

Nature volume 540, page 338 (15 December 2016) | Download Citation

Tilli Tansey on how the ruinous trajectory of scurvy marked the age of discovery.

Scurvy: The Disease of Discovery

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Princeton University Press: 2016. 9780691147826

The effects of scurvy, drawn by surgeon Henry Mahon of the HMS Barrosa in 1842. Image: Natl Archives, London/Mary Evans

It was called the 'scourge of the sea'. Scurvy — a painful, weakening disease in which limbs may swell and gums rot — became prevalent among sailors in the early eighteenth century as adventurers voyaged around the globe. By 1800, citrus fruit was widely used to cure or even prevent the disease; the active principle, vitamin C, was finally identified in the 1930s. But as cultural historian Jonathan Lamb's intriguing Scurvy reveals, there is vastly more to this malady.

The key is in the subtitle. Lamb reveals a wider perspective on the disease in the context of the creation of new knowledge, as a number of primarily European explorers encountered new lands such as Australia, with new peoples, flora, fauna and foodstuffs. The story of scurvy is also entwined with medical developments, including the rise in theories about what causes disease, such as contagion, and the long search for treatments.

Lamb draws widely on explorers' records, including the diaries and logbooks of captains James Cook and William Bligh, as well as the works of ships' surgeons, apothecaries and natural philosophers such as Erasmus Darwin. Writers as diverse as Herman Melville and Nancy Mitford offer striking passages. The figure of Death in Samuel Taylor Coleridge's 1798 poem The Rime of the Ancient Mariner clearly displays symptoms of the disease. And in George Orwell's Nineteen Eighty-Four (1949), a starving Winston Smith weeps as his inquisitor pulls a tooth from his scurvy-destroyed gums.

The route to a cure was riddled with detours, and a lack of consensus lasted into the twentieth century. In the early 1790s, for instance, British physician Thomas Beddoes — inspired by the discovery of oxygen and a nitric acid 'cure' for syphilis — searched for an acidic gas to combat scurvy, tuberculosis and catarrh. Although he found no remedy, his laboratory did manufacture nitrous oxide, subsequently investigated by Humphry Davy (M. Peplow Nature 533, 175–176; 2016). Some believed that scurvy was caused by a poison arising from rotting provisions or bad air; others, that an invisible element necessary for life was somehow lost. Captain Cook insisted on clean, warm clothing, dry, hygienic ships and plenty of rest to prevent an outbreak.

Other captains and naval surgeons, including James Lind and particularly Thomas Trotter, offered evidence that regular provision of fresh food could halt or prevent the disease, and that specific preparations involving ingredients such as citrus fruits might be curative. Verification was inconsistent, because the supply of these antiscorbutics was often irregular, or the quality poor. By the end of the eighteenth century, concentrated lemon juice was routinely issued on British naval vessels — but even then, its efficacy was neither completely proved nor accepted.

One difficulty was that the disease was viewed as a badge of dishonour, and often denied or disguised by ships' officers. Among the many challenges faced by Bligh on the infamous voyage of the Bounty (which ended in mutiny in 1789) was scurvy among the crew. “A disgrace to a ship,” Bligh called it, claiming that the symptoms were due to rheumatism. More than a century later, in the Antarctic, Captain Robert Falcon Scott of the Discovery emphasized in his log that the “great thing is to pretend that there is nothing to be alarmed at”. That attitude was later adopted when convenient by authorities, including the British Ministry of Health during the Second World War, when scurvy among civilians was reported. The ministry deemed the cause to be wilful self-neglect rather than chronic food shortages.

Lamb interprets 'scurvy' broadly, perhaps wisely making no attempt at retrospective differential diagnosis. Purists may baulk at his inclusion of pellagra, beriberi and other disorders of malnutrition, but that allows for a richer range of material and interpretation. For example, the chapter on 'scorbutic nostalgia' — the psychological and emotional impacts of the disease, including hallucinations of food, water or home — is woven through an examination of the depression attributed to 'calenture', or sea-fever.

This book is not, however, an easy read. The erudition and calls to multiple authorities can be wearisome. Take, for instance, the formulation: “The importance of air ... led by way of MacBride's notion of the fixed air in malt to the pneumatic theory of Beddoes, espoused with certain qualifications by Trotter”. Accounts of enforced seafarers, especially slaves and convicts, make for harrowing reading, as do the descriptions of skin eruptions and vomiting. In places, the narrative is weirdly disturbing. During John Davis's horrific sixteenth-century voyage on the Desire from South America, for instance, the only food was dried penguin. This rotted and became infested with maggots that devoured almost everything on the ship, including the flesh of living men and the wood of the vessel.

Not surprisingly, given the size, scope and ambition of Scurvy, there are irritations. One is the sometimes anachronistic use of terms, for instance in the context of Cook's reliance on malt as an antiscorbutic “even though it contained no vitamin C”. Lamb also uses the term interchangeably with 'ascorbic acid' (its chemical name) or 'ascorbate', any salt of ascorbic acid. He attempts physiological and pathological explanations that 'ascorbate' is essential for a healthy nervous system because of its role in, for example, the synthesis of dopamine and 5HT, but these are weak. And an appendix by neuroscientists James May and Fiona Harrison adds little. It is neither helpful nor revealing to extrapolate from a knockout vitamin-C-deficient mouse model to eighteenth-century seafarers with several confounding factors and other illnesses. Indeed, these efforts at modern scientific explanations detract from the richness of Lamb's cultural explorations of discovery and knowledge.

Describing Scurvy as a 'bit of a lemon' would be glib and unfair. It is much better than that, but remains something of a curate's egg.

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  1. Tilli Tansey is professor of the history of modern medical sciences at Queen Mary, University of London.

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Correspondence to Tilli Tansey.

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