Tag Archives: James Lind

SHACKLETON’S SCURVY —- OR ITS ABSENCE

5 Oct

.I make regular presentations on Shackleton and the question of scurvy (or more particularly its absence) on the expeditions that he led to Antarctica comes up frequently.

Scurvy is a disease resulting from a lack of vitamin C (ascorbic acid), which is needed in humans to make the building blocks for collagen. A lack of vitamin C results in disease that develops in approximately three months. Early symptoms include weakness, tiredness and painful limbs. Without treatment the red blood cells decrease in number, gum disease and bleeding from the skin occurs and, as the condition progresses, there is poor wound healing. Personality changes may follow as may death due to infection or bleeding.

Scurvy was the dread disease of all long voyages. In the 18th century it killed more British sailors than enemy action – for example, in 1740 on his ‘mission to ‘Annoy and Distress’ the Spaniards, Admiral of the Fleet, George Anson, lost nearly two-thirds of his crew (1,300 out of 2,000) to scurvy, within the first 10 months of his voyage.

But in 1747, James Lind, a naval doctor, showed that supplementing the diet with citrus fruit could treat scurvy – this was one of the first controlled clinical trials reported in the history of medicine.

Lind treated sufferers with: cider, vitriol, vinegar, seawater, oranges, lemons, and a mixture of balsam of Peru ( garlic, myrrh, mustard seed and radish root). In his Treatise on the Scurvy (1753), he concluded ‘the results of all my experiments was, that oranges and lemons were the most effectual remedies for this distemper at sea’. However, Lind did not appreciate that scurvy was a deficiency disease. He thought it resulted from ill-digested/putrefying food.

Citrus fruit as a cure fell out of favour for several reasons. The navy began buying limejuice from the Caribbean (lass vitamin C) and transporting it in copper vats that probably destroyed its potency. As a result, men developed scurvy on expeditions during which ineffective citrus fruit had been given out. Eminent medical authorities disbelieved the ‘citrus fruit theory’ in the early 1900s.

By Shackleton’s first voyage on Discovery, poor hygiene, damp, food and numerous other theories were considered to be the cause of scurvy. He became painfully conscious of the problem when he suffered from the disease, along with Wilson and Scott, during their ‘Southern Journey’ on the 1901-1904 expedition led by Scott. On Wednesday 24th December 1902, Edward Wilson, the doctor of the expedition wrote (when the three were marching south on the Ice Barrier), ’As a result of today’s medical examination I told the Captain that both he and Shackleton had suspicious looking gums’. In January 1903, Wilson wrote, ‘there is no doubt that we all three have definite, though slight symptoms of scurvy’. The symptoms improved with an increased allowance of dried seal meal and no bacon (which Wilson believed was responsible for scurvy), but by the 14th January Shackleton wrote (later), that he had collapsed completely. Wilson wrote on the following day that Shackleton had had a very bad night and was very breathless (he thought Shackleton might die). On the 28th January Shackleton was breathless, restless, unable to move and, for the first time he seemed to lose his courage.

When the three returned to base, Scott sent Shackleton home on medical grounds. There is no doubt that Shackleton WAS suffering from scurvy though it is now thought likely that he had, in addition, an intermittent cardiac problem.

 

How did Shackleton avoid scurvy on his subsequent expeditions?

Before he set off on the Endurance expedition Shackleton wrote that, on his own Nimrod expedition of 1907-1909, there was not a single case of scurvy. He was convinced that as much fresh food as possible would be an answer to the problem. He took hermetically sealed tins of vegetables, compressed cubes of dried vegetables and as much fresh food as he could.

He explained his precautions in an article in the Daily Telegraph dated 7 July 1914. His aim was that the expedition diet should incorporate the latest scientific advances. He consulted Colonel Beveridge, Director of Hygiene at the Royal Army Medical College, for help in working out the best food supplies for the prevention of scurvy – he wrote that this was the first occasion that Polar Explorers would have the benefit of science as well as practical experience.

Important considerations were:

1) The food must be wholesome and uncontaminated. Only the most nutritious and (as far as possible), most varied food could keep the dreaded disease of scurvy at bay.

2) The food taken on sledging expedition should be as light as possible, but also be substantial, as ‘excessive concentration’ diminishes its nutritive value and renders it ‘less easy of assimilation’. Shackleton wrote that bulk was as essential as nutritive value.

3) Fatty and farinaceous foods in as liberal quantities as circumstances allowed should be included because in very low temperatures the heat of the body which, he stated, is the life of the body, could only be maintained with these nutrients.

4) Sledging food must not need much cooking, as the amount of fuel that could be carried was limited (and if it ran out, there was no means of replenishing it).

5) If no fuel was available the food should be of a character that could be eaten without cooking.

6) Shackleton also commented on the benefit of the greater variety of food in the winter quarters.

In 1912 Kazimierz Funk (1884 – 1967), a Polish biochemist had suggested the concept of vitamins (called “vital amines” or “vitamines”). He was consulted about the proposed sledging rations.

In the event, in his 1914-16 Endurance expedition Shackleton did not reach the Antarctic for his proposed stupendous sledging journey, but the rations suggested were an important guide, though presumably not used throughout the expedition. The diet emphasized the importance Shackleton had learnt to place on nutrition as one of the means of maintaining his men’s wellbeing and morale.

For sledging the diet provided 5,512 calories per day for each man – since a man’s usual daily diet was approximately 2,500 calories, in Polar conditions there would be a surplus 3,000 calories daily.

The ‘hooch” had a large fat and carbohydrate content, protein with meat fibre (provided by Bovril), vitamin C, and A, sugar and raisins. Advice was given to eat as much fresh meat as possible and to grow vegetables – mustard and cress for its vitamin C content. Penguin eggs were advised for a supply of vitamin B.

Colonel Beveridge’s rations

(Glidine is a vegetable protein. Trumilk had the advantage over ordinary dried milk in that has not been subjected to a heat that destroyed vitamins)

 

 

BREAKFAST

 

Wt. oz     Protein. g     Fat. g           Carb. g        Cals.

Bovril B ration

Oatmeal,                      2            12.94           5.34           33.02         236

Lard                             3½                0         99.23                   0         923

Sugar, 1oz                   ½                   0                0             14.17           58

Beef powder              1½            35.29           2.37                  0 .       166

Glidine,                         ½            11.78           0.14               0.82          53

Raisins

Biscuits                       1                  9.21          0.85             14.45         105

Trumilk                        1                  6.70         8.00              11.68         150

Sugar lump,               1½                     0                  0          42.51        174

Total                           11 ½             75.92         115.93        126.55     1,805

 

 

 

 

LUNCH

 

 

Biscuits                          1             46.05            4.25             72.25       525

Nut-food +Trumilk      1+6           27.20           54.15             81.03       948

Trumilk                             ¼           1.74              1.99              2.90          35

Total                               11¼          75.09           60.38          156.18     1508

 

 

SUPPER

Bovril S ration

Oatmeal                             2            12.94           5.34             33.02        236

Lard                                   4½                0        127.57                     0      1187

Sugar                                   ½                0                0               14.17         58

Beef powder                      1½         35.29            2.37                    0        166

Glidine                                  ½         l1.78              0.l4               0.82          53

Biscuits                               1             9.21             0.85             10.85         105

Trumilk                                1            6.70             8.00             11.68          150

Sugar lump                          ½                0                 0              14.17           58

Total                                  11 ½          75.92          144.27            126.55     2139

 

Meat extract, ½ oz, at supper.

Tea, ½ oz. at lunch.

Concentrated Lime Juice, ½ oz.

Cerebos Salt ½ oz.

Virol (extract of meat)

Total Calories per day = 5,512.

Total Fat per day = 320.58 grams

Total Protein per day = 226.93 grams

Total Carbohydrates per day = 409.28 grams

The rations were packed in oblong boxes of Venesta wood (light and durable) weighing 60lb. each. They were refrigerated until arrival at the first destination. Lime juice was concentrated down at a temperature of not more than 93 degrees Fahrenheit, to preserve its anti-scorbutic properties.

No alcohol was taken save a small quantity of brandy for medicinal emergencies (given apparently, to combat frost bite or surgical procedures such as a tooth extraction), plus the occasional celebration.

Beveridge thought that the men would like the diet and be healthy on it. He was right. There was no apparent scurvy on Shackleton’s party as they drifted remorselessly around the Weddell Sea. The men on Shackleton’s Ross Sea party however seem not to have followed the scientific advice so conscientiously. Scurvy took its hold on the depot-laying mission to the Beardmore Glacier and the Reverend Spencer-Smith died.

Nowadays scurvy is prevented by a diet containing vitamin C (preferably in the food but sometimes as a supplement).90 mg is recommended for men.

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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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MORE ON SCURVY

16 May

Really enjoyable visit to Vervey and the British Residents Association.

Interest was expressed in scurvy, which so bedevilled the Scott expeditions, and it occurs to me that many will be unaware of the history of a disease, which killed thousands and thousands of people; in many years practicing as a doctor I never saw it (and if I had, the treatment would have been straightforward), but in Scott’s time vitamins were unknown and vitamin C (the deficiency of which causes scurvy), was not isolated till the 1930s (and then in the laboratory of the famous scientist, Sit Almoth Wright, who had been emphatic against the connection of the vitamin and the disease).

Scurvy was the dread of all long sea voyages. It was known to the Crusaders, British sailors in the American Revolution, Soldiers in W.W.1. The vitamin is necessary for collagen formation in humans. A lack of the vitamin causes, after about three months, lassitude, fatigue, swelling of the joints and lower limbs, spongy gums, lesions in the limbs that can break down and coalesce so that the victim seems to be rotting to death, also cardiac problems: a most unpleasant death that all were only too keen to avoid.

James Lind, a naval surgeon, cured scurvy in a controlled trial as early as the 1750s when he gave orange and lemons to some sufferers and alternative treatments to other sufferers. He did not think of the disease as a deficiency disease, but rather, a digestive problem. The Navy did introduce citrus fruits for its men, but by the 1900s the citrus fruit cure has lost credibility for the understandable reason (it seems to me), that men were given citrus fruits but still developed scurvy. This was because of the problem of Unintended Consequences. Limes from the Caribbean were utilised by the navy, rather than lemons from the Mediterranean. Limes have less vitamin C than lemons and the juice was transported across the Atlantic in copper containers, which damaged the vitamin’s potency. i.e. the final product was ineffective but the reason for this not understood.

So, by the early 1900s, scurvy was thought to be due to the unpleasant sounding ‘ptomain poisoning’ putrefaction in tins and Wilson’s duty on ‘Discovery’ was to sniff and taste all tins to be eaten each day (virtually everything was in tins) and to throw away any suspicious item. As we know this remedy was ineffective and scurvy broke out when ‘Discovery’ had left England for a year.

Vitamin C is present in citrus fruits and some plants and vegetables. Scurvy can now be quickly cured by oral doses of the vitamin.

I was fascinated to read that James Cook thought that one of his greatest achievements was to have avoided scurvy on his three-year voyage to the Antarctic in the 1700s. He gave his crew sauerkraut also fresh fruit (whenever they landed in a Pacific Island). I understand the Inuit apparently avoided scurvy by eating raw fish and the skin of the Beluga Whale.

We don’t know how lucky we are.

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