Symptoms of scurvy have been recorded in
Ancient Egypt as early as 1550
BC. It was first reported amongst soldiers and sailors having inadequate access to fruits and vegetables which resulted in vitamin C deficiency. In
Ancient Greece, the physician
Hippocrates (460–370 BC) described symptoms of scurvy, specifically a "swelling and obstruction of the
spleen."
Pliny the Elder described sailors consuming
sea kale to prevent scurvy in his
Naturalis historia (77–79 AD). In 406 AD, the Chinese monk
Faxian wrote that
ginger was carried on Chinese ships to prevent scurvy. The knowledge that consuming certain foods is a cure for scurvy has been repeatedly forgotten and rediscovered into the early 20th century. Scurvy occurred during the
Great famine of Ireland in 1845 and also the American Civil War. In 2002, scurvy outbreaks were recorded in Afghanistan following the most intense phase of the war.
Early modern era The Portuguese planted fruit trees and vegetables on
Saint Helena, a stopping point for homebound voyages from Asia, and left their sick who had scurvy and other ailments to be taken home by the next ship if they recovered. These travel accounts did not prevent further maritime tragedies caused by scurvy, partly because of the lack of communication between travelers and those responsible for their health, and because fruits and vegetables could not be kept for long on ships. In the 1519-1521 circumnavigation, Magellan's crew suffered from scurvy: "above all other calamities this was the worst: in some men the gums grew over the teeth, both lowers and uppers, so that they could not eat in any way and thus they died of this sickness. Nineteen men died." In 1536, the French explorer
Jacques Cartier, while exploring the
St. Lawrence River, used the local
St. Lawrence Iroquoians' knowledge to save his men dying of scurvy. He boiled the needles of the
aneda tree (generally believed to have been
eastern white cedar) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams. Such treatments were not available aboard ship, where the disease was most common. Later, possibly inspired by this incident, several European countries experimented with preparations of various conifers, such as
spruce beer, as cures for scurvy. In 1579, the Spanish friar and physician
Agustin Farfán published a book in which he recommended oranges and lemons for treating scurvy, a remedy that was already known in the Spanish navy. In February 1601, Captain
James Lancaster, while commanding the
first English East India Company fleet en route to
Sumatra, landed on the northern coast of Madagascar specifically to obtain lemons and oranges for his crew to stop scurvy. Captain Lancaster conducted an experiment using four ships under his command. One ship's crew received routine doses of lemon juice while the other three did not receive such treatment. As a result, members of the non-treated ships started to contract scurvy, with many dying as a result. It is possible that Lancaster learnt about the importance of fresh fruit from his previous voyages. Researchers have estimated that during the
Age of Exploration (between 1500 and 1800), scurvy killed at least two million
sailors. A 1609 book by
Bartolomé Leonardo de Argensola recorded several different remedies for scurvy known at this time in the Moluccas, including a kind of wine mixed with cloves and ginger, and "certain herbs". The Dutch sailors in the area were said to cure the same disease by drinking lime juice. In 1614,
John Woodall, Surgeon General of the
East India Company, published ''The Surgion's Mate'' as a handbook for apprentice surgeons aboard the company's ships. He repeated the experience of mariners that the cure for scurvy was fresh food or, if not available, oranges, lemons, limes, and
tamarinds. He was, however, unable to explain the reason why, and his assertion had no impact on the prevailing opinion of the influential physicians of the age, that scurvy was a digestive complaint. Besides afflicting ocean travelers, until the late Middle Ages scurvy was common in Europe in late winter, when few green vegetables, fruits, and root vegetables were available. This gradually improved with the introduction of potatoes from the Americas; by 1800, scurvy was virtually unheard of in Scotland, where it had previously been endemic.
18th century In 2009, a handwritten household book authored by a Cornishwoman in 1707 was discovered in a house in Hasfield,
Gloucestershire, containing a "Recipe for the Scurvy" amongst other largely medicinal and herbal recipes. The recipe consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine, or beer. In 1734,
Leiden-based physician
Johann Bachstrom published a book on scurvy in which he stated, "scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease", and urged the use of fresh fruit and vegetables as a cure. was a pioneer in the field of scurvy prevention It was not until 1747 that
James Lind formally demonstrated that scurvy could be treated by supplementing the diet with citrus fruit, in one of the first controlled clinical experiments reported in the history of medicine. As a naval surgeon on HMS
Salisbury, Lind had compared several suggested scurvy cures:
hard cider,
vitriol,
vinegar,
seawater,
oranges,
lemons, and a mixture of
balsam of Peru,
garlic,
myrrh,
mustard seed and
radish root. In
A Treatise on the Scurvy (1753) Lind explained the details of his clinical trial and concluded "the results of all my experiments was, that oranges and lemons were the most effectual remedies for this distemper at sea." Lind was also sidetracked by the possibilities of producing a concentrated 'rob' of lemon juice by boiling it. This process destroyed the vitamin C and was therefore unsuccessful. Although sailors and naval surgeons were increasingly convinced that citrus fruits could cure scurvy throughout this period, the classically trained physicians who determined medical policy dismissed this evidence as merely anecdotal, as it did not conform to their theories of disease. Literature championing the cause of citrus juice had no practical impact. The medical theory was based on the assumption that scurvy was a disease of internal
putrefaction brought on by faulty digestion caused by the hardships of life at sea and the naval diet. Although successive theorists gave this basic idea different emphases, the remedies they advocated (and which the navy accepted) amounted to little more than the consumption of 'fizzy drinks' to activate the digestive system, the most extreme of which was the regular consumption of 'elixir of vitriol' – sulphuric acid taken with spirits and barley water, and laced with spices. In 1764, a new and similarly inaccurate theory on scurvy appeared. Advocated by Dr
David MacBride and
Sir John Pringle, Surgeon General of the Army and later President of the Royal Society, this idea was that scurvy was the result of a lack of 'fixed air' in the tissues which could be prevented by drinking infusions of malt and
wort whose fermentation within the body would stimulate digestion and restore the missing gases. These ideas received wide and influential backing, when
James Cook set off to circumnavigate the world (1768–1771) in , malt and wort were top of the list of the remedies he was ordered to investigate. The others were beer,
sauerkraut (a good source of vitamin C), and Lind's 'rob'. The list did not include lemons. Cook did not lose a single man to scurvy, and his report came down in favor of malt and wort. The reason for the health of his crews on this and other voyages was Cook's regime of shipboard cleanliness, enforced by strict discipline, and frequent replenishment of fresh food and greenstuffs. Another beneficial rule implemented by Cook was his prohibition of the consumption of salt fat skimmed from the ship's copper boiling pans, then a common practice elsewhere in the Navy. In contact with air, the copper formed compounds that prevented the absorption of vitamins by the intestines. Although towards the end of the century, MacBride's theories were being challenged, the medical authorities in Britain remained committed to the notion that scurvy was a disease of internal 'putrefaction' and the Sick and Hurt Board, run by administrators, felt obliged to follow its advice. Within the Royal Navy, however, opinion – strengthened by first-hand experience with lemon juice at the siege of Gibraltar and during Admiral Rodney's expedition to the Caribbean – had become increasingly convinced of its efficacy. This was reinforced by the writings of experts like
Gilbert Blane and
Thomas Trotter and by the reports of up-and-coming naval commanders. With the coming of war in 1793, the need to eliminate scurvy became more urgent. The first initiative came not from the medical establishment but from the admirals. Ordered to lead an expedition against Mauritius,
Rear Admiral Gardner was uninterested in the wort, malt, and elixir of vitriol that were still being issued to ships of the Royal Navy, and demanded that he be supplied with lemons, to counteract scurvy on the voyage. Members of the Sick and Hurt Board, recently augmented by two practical naval surgeons, supported the request, and the Admiralty ordered that it be done. There was, however, a last-minute change of plan, and the expedition against Mauritius was canceled. On 2 May 1794, only and two
sloops under Commodore Peter Rainier sailed for the east with an outward bound convoy, but the warships were fully supplied with lemon juice and the sugar with which it had to be mixed. In March 1795, it was reported that the
Suffolk had arrived in India after a four-month voyage without a trace of scurvy and with a crew that was healthier than when it set out. The effect was immediate. Fleet commanders clamored also to be supplied with lemon juice, and by June the Admiralty acknowledged the groundswell of demand in the navy and agreed to a proposal from the Sick and Hurt Board that lemon juice and sugar should in future be issued as a daily ration to the crews of all warships. It took a few years before the method of distribution to all ships in the fleet had been perfected and the supply of the huge quantities of lemon juice required to be secured, but by 1800, the system was in place and functioning. This led to a remarkable health improvement among the sailors and consequently played a critical role in gaining an advantage in naval battles against enemies who had yet to introduce the measures. Scurvy was not only a disease of seafarers. The early colonists of Australia suffered greatly because of the lack of fresh fruit and vegetables in the winter. There, the disease was called
Spring fever or
Spring disease and was described as an often-fatal condition associated with skin lesions, bleeding gums, and lethargy. It was eventually identified as scurvy and the remedies already in use at sea were implemented.
19th century The surgeon-in-chief of
Napoleon's army at the
Siege of Alexandria (1801), Baron
Dominique-Jean Larrey, wrote in his memoirs that the consumption of
horse meat helped the French to curb an epidemic of scurvy. The meat was cooked but was freshly obtained from young horses bought from Arabs, and was nevertheless effective. This helped to start the 19th-century tradition of horse meat consumption in France. Lauchlin Rose patented a method used to preserve citrus juice without alcohol in 1867, creating a
concentrated drink known as
Rose's lime juice. The Merchant Shipping Act 1867 required all ships of the
Royal Navy and
Merchant Navy to provide a daily "
lime or lemon juice" ration of one pound to sailors to prevent scurvy. The product became nearly ubiquitous, hence the term "
limey", first for British sailors, then for English immigrants within the former British colonies (particularly America, New Zealand, and South Africa), and finally, in old American slang, all British people. The plant
Cochlearia officinalis, also known as "common scurvygrass", acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. Its bitter taste was usually disguised with herbs and spices; however, this did not prevent scurvygrass drinks and sandwiches from becoming a popular fad in the UK until the middle of the nineteenth century, when citrus fruits became more readily available.
West Indian limes began to take over from lemons, when Spain's alliance with France against Britain in the
Napoleonic Wars made the supply of Mediterranean lemons problematic, and because they were more easily obtained from Britain's Caribbean colonies Even cooking fresh meat did not destroy its antiscorbutic properties, especially as many cooking methods failed to bring all the meat to high temperature. The confusion is attributed to several factors: Infantile scurvy emerged in the late 19th century because children were fed pasteurized cow's milk, particularly in the urban upper class. While pasteurization killed bacteria, it also destroyed vitamin C. This was eventually resolved by supplementing with
onion juice or cooked potatoes. Native Americans helped save some newcomers from scurvy by directing them to eat
wild onions.
20th century By the early 20th century, when
Robert Falcon Scott made his first expedition to the
Antarctic (1901–1904), the prevailing theory was that scurvy was caused by "
ptomaine poisoning", particularly in tinned meat. However, Scott discovered that a diet of fresh meat from Antarctic seals cured scurvy before any fatalities occurred. But while he saw fresh meat as a cure for scurvy, he remained confused about its underlying causes. In 1907, an animal model that would eventually help to isolate and identify the "antiscorbutic factor" was discovered.
Axel Holst and
Theodor Frølich, two
Norwegian physicians studying shipboard
beriberi contracted by ship's crews in the Norwegian Fishing Fleet, wanted a small test mammal to substitute for the
pigeons then used in beriberi research. They fed
guinea pigs their test diet of grains and flour, which had earlier produced beriberi in their pigeons, and were surprised when classic scurvy resulted instead. This was a serendipitous choice of animal. Until that time, scurvy had not been observed in any organism apart from humans and had been considered an exclusively human disease. Certain birds, mammals, and fish are susceptible to scurvy, but pigeons are unaffected since they can synthesize ascorbic acid internally. Holst and Frølich found they could cure scurvy in guinea pigs with the addition of various fresh foods and extracts. This discovery of an animal experimental model for scurvy, which was made even before the essential idea of "vitamins" in foods had been put forward, has been called the single most important piece of vitamin C research. In 1915, New Zealand troops in the
Gallipoli Campaign had a lack of vitamin C in their diet which caused many of the soldiers to contract scurvy.
Vilhjalmur Stefansson, an Arctic explorer who had lived among the
Inuit, proved that the all-meat diet they consumed did not lead to vitamin deficiencies. He participated in a study in New York's
Bellevue Hospital in February 1928, where he and a companion ate only meat for a year while under close medical observation, yet remained in good health. In 1927, Hungarian
biochemist Albert Szent-Györgyi isolated a compound he called "
hexuronic acid". Szent-Györgyi suspected hexuronic acid, which he had isolated from adrenal glands, to be the antiscorbutic agent, but he could not prove it without an animal-deficiency model. In 1932, the connection between hexuronic acid and scurvy was finally proven by American researcher
Charles Glen King of the
University of Pittsburgh. King's laboratory was given some hexuronic acid by Szent-Györgyi and soon established that it was the sought-after anti-scorbutic agent. Because of this, hexuronic acid was subsequently renamed
ascorbic acid. 21st century Rates of scurvy in the developed world are low due to the greater access to vitamin C-rich foods. Those most commonly affected are
malnourished people in the
developing world and
homeless people. There have been outbreaks of the condition in
refugee camps. Case reports in the developing world of those with poorly healing wounds have occurred. In 2020, the overall incidence of scurvy in the US was about one in 4,000 people, up significantly from even a few years before. About two-thirds of all scurvy is found in
autistic people. Children and young people with autism are at risk of developing scurvy because some of them only eat a small number of foods (e.g., only rice and pasta). For some of them, the restricted diet takes the form of
avoidant/restrictive food intake disorder (ARFID).
Human trials Notable human dietary studies of experimentally induced scurvy were conducted on
conscientious objectors during World War II in Britain and the United States on Iowa state prisoner volunteers in the late 1960s. Men in both studies, on a diet devoid or nearly devoid of vitamin C, had blood levels of vitamin C too low to be accurately measured when they developed signs of scurvy, and in the Iowa study, at this time were estimated (by labeled vitamin C dilution) to have a body pool of less than 300 mg, with daily turnover of only 2.5 mg/day. == In other animals ==