Internal bleeding, black gums, morbidly sensitive skin, even “scorbutic nostalgia,” in which victims imagined mirages of food, water, or home—these are just some of the symptoms of the disease associated with maritime travel: scurvy. Jonathan Lamb traces the cultural impact of scurvy and details the medical knowledge surrounding the disease, which stems from a vitamin deficiency and is still found today. Drawing on historical accounts from scientists and voyagers as well as major literary works, the book charts a unique eighteenth-century journey of discovery. Jonathan Lamb recently took the time to answer some questions about the book.
Why did you write a book about a disease that doesn’t trouble us anymore?
JL: Actually it does. On a trip to Easter Island I met a woman who got scurvy from dieting. A survey of North American college students discovered that 40% had levels of vitamin C below the minimum level required for good health. War veterans, recent widowers, children addicted to food lacking vitamins A, B, C and D, people caught in sieges like the citizens of Aleppo in Syria or Mount Sinjar in Iraq, they are all vulnerable. Like goiter, rickets, pellagra and beriberi, scurvy is a nutritional disease. That is to say, you don’t catch it, like ebola or bubonic plague, it lies in wait for an interruption in the ingestion of fresh food, and then inevitably (if the interruption is long enough) it makes its fatal appearance. True there are no great outbreaks such as those that killed two-thirds of the complement of George Anson’s naval squadron in the 1740s, but it does to remember that it was rife, for instance, in the penal settlements of early Australia, and on Scott’s Discovery expedition to Antarctic, and among the South Asian regiments of the British Army in Iraq during the First World War. Eric Newby got it sailing on a windjammer to South Australia in 1939. The symptoms of scurvy’s cousin pellagra, a staggering walk and a distracted mind, are evident in Primo Levi’s account of the so-called Muselmaenner of Auschwitz in his memoir If this is a Man.
What are the symptoms of scurvy?
JL: They are divided between purely physical effects and alterations in the nervous structure of the brain. Generally scurvy begins with sensitive gums, aching joints, blood-spots and bruising of the skin that eventually ulcerate. When this happens in the mouth, the gums turn black and swell. Sailors used to call it `bullocks’ liver.’ Teeth fall out, old fractures open up, cartilage disappears from the bones, artery walls weaken, the tendons shrink, and internal bleeding begins. Soon after this breathing becomes stertorous, the heart is under pressure, brain haemorrhages will occur, and death is not far away. While this is happening the mind is affected either with stupor or with powerful hallucinations and dreams. It was generally agreed by close observers of the disease that the imagination of scorbutic patients was desperately signaling to the body to get hold of the right kind of food: chiefly green vegetables, fish and meat. Of course dreams so vivid raised powerful expectations, and when the poor sailors awoke to find none of what they needed, they were prone to weep uncontrollably. The physical symptoms were owing to loss of collagen which the body cannot restore without an adequate supply of vitamin C: basically the scaffold and hydraulic system of the body collapse. The psychological symptoms were the result of free radicals, normally scavenged by the vitamin, clogging the synapses, resulting either in extreme lethargy or a morbid sensitivity to light, texture, smells and sounds.
Since we all know now that scurvy is cured by oranges and lemons, what was going to be new about your book?
JL: The thing is everybody always knew the cure of scurvy. If you could get hold of fresh fruit, kale, onions or potatoes you would soon recover. The problem was that at sea no fresh food was available, only salt meat, flour, dried peas, raisins, oil or butter and oatmeal. You needed a medicine capable of preventing or alleviating the symptoms of eating nothing but preserved food. But of course the medicine itself had to be preserved too. Ever since the days of Hawkins and Drake it was known that the juice of lemons, limes and oranges was a powerful antiscorbutic, the trouble was how to preserve it. Boiling got rid of the vitamin; sometimes the fruit (West Indian limes for instance) was naturally low in ascorbic acid; sometimes extremes of heat and cold ruined what virtue the juice had; and sometimes wicked contractors used imperfect fruit, or blended and diluted the juice to the point where it was useless. Besides these obstacles there was no agreement among surgeons and physicians as to whether a cure for scurvy was the same as a preventive. James Lind, famous for a clinical trial proving beyond doubt that citrus juice cured scurvy, had no faith in its value as a preventive, for like many other naval physicians he believed that scurvy was caused by defective food, not by food deficient in some vital principle. That is to say he thought the disease was caught from the environment, not from a genetic mutation in humans that prevents them from synthesizing a chemical crucial to life.
Well, even if Lind got it wrong, Cook got it right and there was no more serious scurvy after they got rid of it in his voyages of discovery, was there?
JL: That is the story that is generally told, but it is not quite true. On his three voyages to the Pacific scurvy occurred, but never fatally. Cook ran his ships with exemplary care for hygiene, warmth, dry clothes, clean air and regular stops for refreshment, and on top of that he was carrying a host of preserved dietary supplements that he hoped would keep scurvy at bay, including lime juice. He had a low opinion of the juice, privately favouring sauerkraut (fermented cabbage) and spruce beer (fermented malt sharpened with pine needles and bark). But nutritional politics played a large part in his official endorsement of malt wort, the brainchild of a physician called David MacBride who was patronized by powerful people. Malt was easily concentrated, and it was a lot cheaper than citrus juice, and so it received official backing and was used well into the 19th century, even though it had no antiscorbutic value whatsoever. Many historians think Cook contributed to postponing the reforms of Nelson’s navy by forty years. From 1795 onwards Gilbert Blane saw to it that every sailor in the British Fleet drank an ounce of concentrated lime-juice per day, to which was owing the health of British seamen during the Revolutionary and Napoleonic Wars. Hence `limeys,’ the derogatory name applied by American sailors to their British cousins.
So that was that, end of story?
JL: Not really. You see these were all either theoretical or empirical solutions to the problem of scurvy. MacBride for instance considered that scurvy was a shortage of air in the body, and he believed that malt released carbon dioxide into the organs, ventilating them. Thomas Beddoes had a similar theory about oxygen. Thomas Trotter on the other hand, physician to the Channel Fleet in the early 1790s, said the only treatment of scurvy worthy the name was based on observation and experience, and strongly advocated lime-juice as both a preventive and a cure, although he thought its acidic qualities might corrode the mucus tissue and the stomach lining. But none of these men knew for sure what it was in air or lime-juice that caused them to prevent or cure scurvy. However they were agreed that the body needed more from food than carbohydrates and protein.
They were getting closer to the truth, weren’t they?
JL: Yes, in a way, although the best investigators of scurvy in the 17th century had reached the same conclusion. Those who had a theory of deficient food were on the right track, while those who thought scurvy was caused poisoned by spoilt supplies were wrong. However, it was the latter school that was destined to triumph in the latter part of the 19th century. A series of disastrous expeditions to the Arctic were to blame, beginning with Franklin’s where the evidence pointed to tainted cans of meat as responsible for the first stage of the tragedy. A few years later Nares’s expedition was afflicted with scurvy even though a copious amount of preserved lime juice was distributed among the crew. It was even observed that the symptoms of scurvy worsened as more of the juice was consumed. It was not long before an influential physician, Sir Almoth Wright, instituted a germ theory of scurvy that dominated medical thinking until the discovery of vitamin C in 1933. Captain Scott referred to sealmeat as an `antidote’ to the ptomaine poisoning he believed damaged cans of meat were causing among his men.
And that is the story, right?
JL: I wasn’t sure it was. Scurvy was regarded as a shameful disease, associated with dirt and malingering and horrid to watch and smell. The French historian of smell, Alain Corbin, says that in the catalogue of noisome diseases, scurvy was far and away the worst. The most frequent testimony coming out of the experience of scurvy is that it was hard to say what it was like to have it, and that it was impossible to describe the condition of those suffering from it. So you will often find commanders and doctors trying to cover up its presence, usually by calling it something else, such as rheumatism, dysentery, typhus or erysipelas. It is common to find surgeons reporting that their scorbutic patients recovered nicely after they had been dosed with malt—either a mistake or a lie. In 1834 at the penal settlement of Port Arthur half the convicts were showing signs of the disease, 19 were in the last stages of scorbutic decline in the hospital, yet only a single death from scurvy was reported for the whole year. It is hard to find pictures of scorbutic bodies and with the exception of Thomas Trotter’s books on naval medicine, there are very few closely observed accounts of its progress. Since Jean-Jacques Rousseau had said scurvy was a matter for `shocking calculation’ why were accounts of it so coy or misleading? Here there was truly a `secret history’ to uncover.
You are a professor literature. Has scurvy anything to do with your specialism?
JL: Yes it does. There is a genre of utopian fiction that weaves stories around outbreaks of scurvy. Francis Bacon’s New Atlantis begins with scorbutic English sailors being cured with blood oranges; Diderot’s Supplement to the Voyage of Bougainville uses Bougainville’s experience of the same thing at Tahiti as the basis of fantasy about an island of free love, very similar in its outline to Henry Neville’s Isle of Pines. Gabriel Francois Coyer wrote a supplement to Anson’s voyage, turning a tale of a stricken crew landing at a verdant island into the discovery of a civilization devoted to idle forms of artifice, breeding horses too delicate to ride, growing fruits that are beautifully coloured but inedible, and amusing themselves with operas and romances. Bernardin de St Pierre’s famous novel, Paul et Virginie, is an exquisite pastoral tale set on Mauritius which the author first reached when his nerves were so disordered by scurvy he found every shrub, tree, animal and bird on the island repellent. A fascinating story to come out of Cook’s second voyage is called The Travels of Hildebrand Bowman, and tells the story of the alleged eleventh man in the Adventure’s cutter whose crew were cut off by Maori while in search of antiscorbutic herbs, then killed and eaten. Bowman’s travels take him to nations that each cultivate a sense well beyond the degree of gross normality: one whose citizens can see in the dark, another where they enjoy extraordinarily sensitive hearing, and lastly one where responsiveness to touch is so exquisite it has carried sexual pleasure to a new height. There is a unique pattern in this fiction, for each story is fashioned out of two versions of the same story, modeled on the succumbing to scurvy and the recovery from it, where inexpressible pains are transformed into wonderful delights. So there you are, scorbutic fiction—a newly discovered genre.
Jonathan Lamb is the Andrew W. Mellon Professor of the Humanities at Vanderbilt University. His many books include The Things Things Say (Princeton) and The Evolution of Sympathy in the Long Eighteenth Century. His most recent book is Scurvy: The Disease of Discovery.