Scurvy

26 Apr

Scurvy is due to a deficiency of ascorbic acid. It is cured by adequate quantities of vitamin C or citrus fruits.

At two recent talks about Shackleton I was asked about scurvy—did Shackleton get scurvy? Was the cause of the disease known in the early 1900s? The answers are; yes to the first question, no to the second

Shackleton did of course, famously suffer from scurvy in the 1902/3 ‘Southern Journey’ when, with Scott and Edward Wilson, he developed signs of the disease as they neared their furthest South point of 82° 11’S latitude. Shackleton was by far the worst on the return journey; in fact Wilson, at one point, thought he might die. When the party returned to base, Scott was sent him home on the relief ship ‘Morning’ on health grounds. This was a devastating blow for a proud and ambitious man and made him doubly keen to avoid the disease on his further expeditions.

Shackleton’s Imperial Trans Antarctic Expedition included the ship ‘Aurora’ that sailed to the Ross Sea. ‘Aurora’s’ brief was to provide supplies for Shackleton’s party at the end of their Trans Antarctic crossing (in fact his party dis not actually get onto the continent) and one of this Ross party died of scurvy. Shackleton’s main party do not appear to have suffered from the disease, probably probably because Shackleton was so well aware of the necessity of preventative action and provided seal meat and importantly, seal liver on a regular basis. He also took preserved fruit and vegetables.

But why was there still uncertainty about the disease in the early 1900s? This was because of a lack of conviction and consensus about the benefits of citrus fruits. Although for many years some ships’ doctors and sailors had used oranges and lemons to cure or prevent scurvy, many European physicians persisted in reviewing and quoting confusing literature in which all manner of possible causes were postulated.

The problem could have been solved by James Lind’s controlled therapeutic trial of 1747 in which twelve patients with scurvy (six pairs), were given treatments that had been suggested previously. The remedies were two weeks of: a quart of cider per day, half a pint of sea water per day, 25 drops of elixir of vitriol three times a day, two spoonfuls of vinegar three times a day, a purgative three times a day, OR two oranges and one lemon daily. The men receiving citrus fruit recovered rapidly. A problem subsequently was that in order to conserve citrus fruits on long expeditions, Lind almost boiled purified citrus fruit into a ‘rob’. This obviously damaged the heat labile ascorbic acid and was ineffective. Also, in his ‘Treatise on the Scurvy’ of 1753, he did not unequivocally recommend citrus fruits for general use. When he moved to the Royal Naval Hospital Haslar, in Gosport, Hampshire, he treated sailors with oranges and lemons and said that the juices should be used in the Royal Navy, as they had been so successful in merchant ships. After recommendations by other physicians, the Admiralty ordered lemon juice for the fleet in 1795 and by the middle of the 1800s there was ample evidence that scurvy was both preventable and treatable.

But there is a law of unintended consequences! In the late 1800s lime juice from the West Indies was substituted for lemon juice. Lime juice has considerably less antiscorbutic properties than lemon juice, also it was transported in containers that further reduced its potency. Scurvy returned. By the time Scott left on the ‘Discovery’ expedition he was advised by his Senior Surgeon and Sir Almoth Wright of St Mary’s Hospital, London that the cause of scurvy was acid-intoxication in the tins of food (Wilson had to taste and smell all food to be eaten each day and discard any he thought ‘tainted’).

When Shackleton went on his first three expeditions therefore details concerning the cause of scurvy were not known although Shackleton was clearly aware of the benefits of seal meat/offal after his first expedition. It was not until after his expeditions that scurvy was shown to be a dietary deficiency disease. And not until 1928 that Ascorbic acid was isolated.

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