Scurvy has been called “the plague of the sea,” a dreaded disease associated with epic voyages, bad food, and pirates. Its symptoms were recognized by ancient Greek physicians, and effective treatments discovered by the 1750s, but scurvy’s mysterious cause wasn’t identified until the 20th century. Here are a few facts from scurvy's long and miserable history.
1. Scurvy is a deficiency in vitamin C.
Somewhere along our evolutionary path, humans lost the ability to synthesize vitamin C internally, likely because early hominids ate a lot of raw meat, fruits, and vegetables rich in the nutrient. In contrast, most animals can make vitamin C endogenously. The exceptions include primates, fruit bats, guinea pigs, capybaras, and some species of birds and fish.
That evolutionary development means that humans must continually replenish vitamin C intake through foods. Not getting the recommended daily amount of vitamin C—which is 75 milligrams for healthy adult women and 90 milligrams for healthy adult men, equivalent to roughly 6 ounces of orange juice—can result in a deficiency. After a few months, the lack of vitamin C may manifest as scurvy.
2. Vitamin C performs essential biological functions, keeping scurvy at bay.
You’ve probably heard of vitamin C as an antioxidant that fights the effects of aging and may lower the risk of developing certain cancers and cardiovascular disease. Vitamin C is needed to biosynthesize collagen, the fibrous material in connective tissue among bones, muscles, and tendons. Collagen keeps joints and skin flexible and promotes wound healing. Vitamin C also helps the body absorb other essential nutrients, like iron from plant sources.
3. Scurvy symptoms include spongy gums and loose teeth.
Without vitamin C, connective tissues start to fall apart. Scurvy sufferers have described swollen, blackened, or bleeding gums and loose teeth; bruising easily and developing rashes, seeing healed wounds open up again, and even growing corkscrew-shaped hairs (a result of capillaries in the hair follicles breaking down). Extreme lethargy, depression, and fatigue often accompany the physical symptoms. Late-stage scurvy gets even worse: Sufferers can have swelling in the legs and painful joints, spontaneous bleeding, fever, and convulsions eventually ending in death.
Today, scurvy is easily cured by giving patients vitamin C supplements. But that wasn’t always the case.
4. Scurvy has been around for thousands of years.
In 2016, archaeologists announced they had established the earliest-known evidence of probable scurvy in a human skeleton. The bones of the ancient Egyptian infant, who lived between 3800 and 3600 BCE, bore telltale lesions associated with vitamin C deficiency. Scurvy was also detected in a woman’s bones dating from 3600 to 3200 BCE found in Chile’s Atacama Desert and likely in the skeleton of a Bronze Age child who lived in present-day England between 2200 and 1970 BCE. The ancient Greek physician Hippocrates also described scurvy symptoms and treatments.
5. Scurvy was a big problem on long sea voyages.
Scurvy killed more than 2 million mariners during the Age of Sail, a period from the 1490s to the 1850s. As Stephen Bown writes in his book Scurvy, naval captains signed up more sailors than they needed because they expected to lose many of them to scurvy during their voyages.
One of the worst scurvy-related disasters at sea occurred on Captain George Anson’s 1740-1744 voyage around the world. His crew began showing symptoms a few months into the expedition, despite being given a daily ration of substances supposed to prevent it. By the time Anson returned to England, about 1400 of the original 1900 crew members had died from scurvy or starvation [PDF].
Scurvy continued to affect major expeditions for decades. More than a century later, the British Arctic Expedition led by George Strong Nares attempted to reach the North Pole, but was forced to return to England after scurvy decimated the crew.
6. People tried all kinds of cures for scurvy.
Anecdotal evidence among sailors pointed to fresh fruits and vegetables as treatments for scurvy, but they were hard to come by on long voyages. Naval officials supplied ships with foodstuffs that were thought to prevent scurvy, such as vinegar, pickles, and sauerkraut. A ship’s surgeon would administer wort of malt (a byproduct of brewing beer), elixir of vitriol (a blend of alcohol and sulfuric acid), and various patent medicines to alleviate symptoms. Some even prescribed exercise, since laziness was thought to be a cause of the disease. Of course, none of these treatments would have helped.
French explorer Jacques Cartier witnessed one remedy that did work. While his crew was trapped in the frozen St. Lawrence River in the winter of 1535, Huron people showed them how to make a tea brewed from conifer leaves and bark, which cured the men of scurvy. Historians have debated which species of tree supplied the tea; likely candidates include Eastern white cedar, black or white spruce, or Eastern white pine [PDF].
7. James Lind conducted a groundbreaking study on scurvy.
Scottish naval surgeon James Lind performed medicine's first well-documented controlled study when he attempted to identify a cure in 1747. Aboard the HMS Salisbury, he divided 12 scorbutic patients into six pairs and had each pair ingest a different treatment over several days: cider, elixir of vitriol, vinegar, seawater, oranges and lemons, or pellets containing mustard seed, garlic, and pine resin. “The most sudden and visible good effects were perceived from the use of the oranges and lemons,” Lind wrote, while the others failed to improve. He published his review of the literature and his results as A Treatise on the Scurvy in 1753.
While Lind identified an effective treatment, he could not point to the cause, and mused that it was a result of living in damp air, laziness, or a melancholy disposition (none of which was uncommon on long voyages). Other physicians suggested ptomaine poisoning, protein deficiency, or contagious miasmas.
8. Progress against scurvy helped the British Empire expand.
Forty years went by before the naval physician Sir Gilbert Blane convinced the Royal Navy to take Lind’s advice. In 1795, the Admiralty began supplying ships’ crews with lemon juice. According to a 2009 review in the journal Nutrition Reviews, the Admiralty distributed 1.6 million gallons of lemon juice between 1795 and 1814, and Admiral Horatio Nelson, commander of its Mediterranean fleet, “turned Sicily into a vast lemon juice factory.”
Scurvy gradually disappeared from the ranks (polar expeditions were an exception, since sterilizing lemon juice for years-long voyages actually destroyed its vitamin C). Bown argues that the decrease in cases helped British forces beat back French advances in the Napoleonic Wars, and specifically aided Nelson’s victory in the Battle of Trafalgar. The pivotal defeat of Napoleon’s fleets laid the groundwork for the rout at Waterloo and the expansion of the British Empire in the 19th century.
9. British sailors were nicknamed after a scurvy cure.
The Royal Navy occasionally ran out of lemons and instead supplied lime juice to its sailors, which was easier to obtain from British colonies. Sailors’ constant consumption of antiscorbutic fruits led others to dub them limeys.
10. Scientists didn’t understand the cause of scurvy until the 1920s.
Hungarian chemist Albert Szent-Györgyi set up an experiment in guinea pigs—which can’t synthesize vitamin C—to determine the nature of a newly identified molecule he called hexuronic acid. He fed one group of guinea pigs boiled vegetables containing no hexuronic acid, and gave another group fresh foods enriched with the molecule. After a few weeks, the boiled-food group showed symptoms of scurvy, while the group eating fresh foods remained healthy. Szent-Györgyi concluded that hexuronic acid was the biologically active ingredient in citrus and renamed it ascorbic (meaning “anti-scurvy”) acid, a.k.a. vitamin C.
11. Today, scurvy mainly occurs in severely malnourished people.
Scurvy is rare in developed countries now. People who are most at risk for vitamin C deficiency are elderly, those with conditions that reduce appetite (like undergoing chemotherapy for cancer), and those with eating or substance abuse disorders. A 2006 study found that 11 patients diagnosed with scurvy at the Mayo Clinic between 1976 and 2002 also had gastrointestinal disease, abused alcohol, or followed fad diets.