EPILOGUE:

THE MYSTERY SOLVED

NEITHER JAMES LIND nor James Cook lived to see the tremendous benefits to the Royal Navy brought about by the defeat of scurvy. While he effectively eliminated scurvy aboard his ships, Cook left a vague and muddled report on antiscorbutics that was later used by John Pringle to promote a fashionable but useless cure that contributed to the Royal Navy’s problems during the War of American Independence. Still, Cook is often erroneously given credit for the defeat of scurvy, and opinions of Lind have not been consistently favourable. During Lind’s own life, he remained an obscure and perhaps not entirely respected individual—he received no national honours and was never elected a fellow of the Royal Society. He was ignored and forgotten by almost everyone, apart from a few perceptive disciples. By the mid-twentieth century, however, he was regarded as the founder of naval hygiene, with some writers claiming that he alone solved the scurvy problem, and that he understood why citrus fruits were powerful medicines against scurvy, which clearly he did not. Now a more balanced appreciation of his character and accomplishments highlights both his successes and his failures, which should not minimize his overall contribution to solving the mystery of scurvy. The climate of theories and ideas in which he laboured was so convoluted that to overcame it required more energy than one single man could have mastered, and it is a testament to his integrity and strength of character that he persevered in promoting what were obviously unpopular ideas that ran counter to prevailing notions. Without Lind’s work as a foundation, and Cook’s morale-boosting success against scurvy in the Pacific, Blane would have had little information upon which to base his own efforts to eradicate the affliction.

More than half a century after Blane helped eliminate scurvy from the Royal Navy, and several decades after his death, the disease resurfaced in Europe. It was still not entirely understood. In the mid-nineteenth century, limes from British plantations in the West Indies had been substituted for Mediterranean lemons because they were a source of citrus juice securely under British control. Merchant sailors of the East India Company, who frequently crossed the Atlantic on their return voyages pushed by winds and the Gulf Stream, became known as “lime juicers” because of the great quantity of limes they purchased in the West Indies. (In 1854 the Merchant Shipping Act required that all British sailors on private ships be provided with antiscorbutics, which usually meant lime juice.) Later, the nickname Limeys came to apply to all the English. The West Indian sour lime, however, is a source of ascorbic acid far inferior to the Mediterranean lemon, although this was not known until the twentieth century. Sour limes contain only about a third of the ascorbic acid of oranges and lemons.

By the mid-nineteenth century, lime juice was being mass-produced in large quantities, not just for the Royal Navy but for the merchant marine and for shipping to America and Europe. Production was not tightly controlled, however, and inferior batches that were allowed to settle too long in holding tanks, were exposed to prolonged heat, or were run through copper pipes in the bottling process frequently found their way to market. Lime and lemon were then being used interchangeably, and it is impossible to know whether a supply was of lemon juice or the inferior lime. The daily ration of three-quarters of an ounce of lemon juice was itself barely adequate to ward off scurvy in the absence of fresh foods, and when that ration was replaced by lime juice with one-third the potency or less (depending on the manufacturing process) scurvy was bound to reappear on lengthy voyages or expeditions.

French troops suffered horribly from scurvy during their military campaign with Britain and Turkey against Russia in the Crimean War in the mid-1850s. Scurvy also appeared on several polar and Antarctic expeditions, and it undoubtedly killed many slaves on transport ships from Africa to the Americas. It was certainly common on the ships that transported thousands of British convicts to Australia, although in the absence of accurate medical reports, it would be impossible to disentangle the impact of scurvy from that of other diseases, such as tuberculosis, yellow fever, infections, or even malaria. Scurvy regularly appeared in prisons and in prisoner-of-war camps into the twentieth century when there were insufficient food supplies, and it was a frequent ailment of troops in the American Civil War, between 1861 and 1865. It ran rampant during the California Gold Rush, between 1848 and 1850, and made an appearance in the late nineteenth century in infants of wealthy families in Europe and America, when women switched from breast-feeding to the newly fashionable bottles of condensed milk, or when babies were weaned and then fed on a diet of oatmeal or other mashed grains. The condensed milk contained no vitamin C, and the symptoms were frequently misdiagnosed as rickets.

The key difference between the nineteenth-century occurrences of land scurvy and scurvy during the Age of Sail was that none of these later incidences had any significant impact on global events. As well, the cure was generally known, even though it might have been temporarily unavailable. Nevertheless, when the disease reappeared, it gave rise to some interesting debate and questions as theorists, researchers, and physicians sought again to more clearly define it. Each outbreak of scurvy sparked new theories that looked for the causative agent behind it: a lack of protein, a lack of potassium, bacterial infection, excessive acidity in the blood, ptomaine poisoning from tinned meat, excessive heat in the sterilization of milk, self-poisoning from blocked bowels, etc. Even though scurvy was no longer a complete mystery, it was still not understood—indeed it was not possible to truly understand the nature of the disease with nineteenth-century technology. The endless debate was not resolved until the early twentieth century, when new discoveries in nutrition began to raise the possibility of a negative factor for scurvy—that is, that it was caused by a lack of something.

With advancements in chemistry and more rigorous scientific method, theories could more easily be proved or disproved. Between 1907 and 1912, two Norwegian researchers, Axel Holst and Theodor Frolich, discovered that guinea pigs fed a diet of grain developed symptoms similar to scurvy and then died. They showed that when they added fresh vegetables and fruit—the same substances considered antiscorbutic in humans—the scurvy symptoms disappeared. It was a remarkable achievement: they had shown that scurvy could be induced by diet and eliminated by diet. Since almost all animals produce their own ascorbic acid internally and are immune to scurvy, Holst and Frolich’s use of guinea pigs was particularly fortunate, and the discovery of a suitable test animal greatly sped up the process of isolating the active antiscorbutic agent in fresh foods and citrus juice.

There were a great number of studies looking into scurvy and its complex chemistry after the First World War. Yet it was not until 1932 that the active antiscorbutic compound was isolated by a Hungarian scientist, Albert Szent-Gyorgyi, while he was working at the University of Cambridge. He called it hexuronic acid, and it was later renamed ascorbic acid, after “antiscorbutic.” In 1933, a Swiss team headed by Tadeus Reichstein and an English team headed by Sir Norman Haworth rushed to understand and decipher the molecular structure of the acid. They were both successful. In 1937, Szent-Gyorgyi was awarded a Nobel Prize in physiology and medicine and Sir Norman Haworth was awarded a Nobel Prize in Chemistry, partly for their work on vitamin C. Reichstein devised a method for synthesizing the acid commercially, and vitamin C is now a common food additive, easily and cheaply available.

Knowledge and technology have converged to eliminate scurvy from the daily lives of much of the world. Not only is synthetic ascorbic acid common, but refrigeration and canning can preserve foods for months or even years. In spite of the availability of synthetic ascorbic acid and vitamin C—fortified foods, however, scurvy will always be with us. It is not a disease that can be vaccinated against. It will arise anywhere and anytime diet is insufficient in ascorbic acid. Hundreds of thousands of people worldwide routinely suffer from scurvy—during droughts, the wet season, the dry season, when food distribution networks are disrupted by wars or natural disasters, and in refugee camps. Wherever there is famine, scurvy will be one of the handful of deficiency diseases that run rampant. Even in the wealthy democracies of the Western world, scurvy occasionally crops up in people who eat extremely poorly balanced diets or those who eat only junk food.

But after the defeat of Napoleon in 1815, scurvy was never again a determiner of global history. The clash between France and England during the Napoleonic Wars was the climax of scurvy’s influence on world affairs, when it could cripple entire navies and hold the survival of nations in the balance. With the development of steam power in the mid-nineteenth century, which liberated mariners from the whim of the wind and the need for long detours chasing favourable currents, ships spent far less time at sea between ports and the illness faded for good, as an occupational disease for sailors, into the pages of history.

Many historians have commented on the strange and peculiar story of the quest for scurvy’s cure, and on the improbability of such a seemingly simple solution requiring such a long time to discover. “Perhaps one of the most bewildering aspects of the history of scurvy,” wrote J. J. Keevil in 1957, “is the manner in which a cure was repeatedly found, only to be lost again because of a wrong theory of its manner of operation, or because some uncontrollable factor offered a preferable explanation when it came to accounting for deaths.” K. J. Carpenter commented in 1985 on how medical theorists and academics got in the way of a practical cure that was at one time common and accepted. “It is a humbling moral to the story,” he wrote, “that, after all the attempts to apply new scientific concepts and hypothesis, the final solution came from rejection of theory and a return to the practical experience of previous centuries.” In 1936, F. M. R. Walshe wrote that “the Lords of the Admiralty, concerned at the existence of an agency more effective than the enemies’ guns and with a deference for hygiene characteristic of all military bodies, adopted Lind’s recommendations for the Navy after an interval of only forty years.” After only forty years! Tens of thousands of men died in that interval, and Lind’s method for creating the rob was flawed anyway. It seems that Walshe must have had a keen sense of irony, in light of the Admiralty’s stubborn ignorance of hygienic matters for most of the eighteenth century and the almost painfully convoluted and roundabout path that finally led to scurvy’s being vanquished. But perhaps he was indeed being earnest. After all, the French and Spanish navies didn’t solve the problem despite the comparative ease with which they might have obtained lemons and the equally compelling motivation of national defence and military conquest.

But it was Gilbert Blane, writing a decade before his death, long after scurvy had ceased to be a major problem for the Royal Navy, whose commentary expressed a timeless wisdom that transcends the theatre of warfare and nationalism within which he wrote it. Indeed, it is an observation that applies to a good many aspects of human endeavour and to society in general. “There is not probably to be found in the whole range of human affairs,” he wrote, referring to the eradication of scurvy following the introduction of the daily ration of lemon juice in 1795, “a finer illustration of the practical benefits of progressive knowledge in promoting the great interests of mankind: so that science, while it lends an aid, also sheds a grace and dignity over the useful arts: nor can there be a more striking proof of the maxim, that humanity, like every other mortal virtue, is the best policy.”