Scurvy, a history of forgetting — Parshat Ekev

Nowadays, I expect there is less focus on historical white men, but when I was at school, Captain James Cook was one of the New Zealand heroes they taught us about.

Forget about the fact that he was not a captain in 1769, when he led the crew of the Endeavour to observe the transit of Venus, mapped the coastline of New Zealand and became the first European to have contact with the Maori. In fact, he was never a maritime captain, though by his third voyage, he was promoted to the rank of post-captain, which apparently is higher than captain.

They also never taught us that in one of the most horrific examples of nominative determinism, his body was cooked by the Hawaiians after they killed him as they gave him a funeral usually reserved only for chiefs and elders.

Official portrait of Captain James Cook. (Public Domain, Nathaniel Dance-Holland/ Wikimedia Commons)

Captain James Cook was a national treasure. His ship was on the back of the 50-cent coin, and his name was used in all sorts of place names across the country.

One of Cook’s many triumphs – or so we were taught – was that he was the first explorer to defeat scurvy by ensuring his men ate fresh fruit regularly.

It turns out that is almost entirely wrong.

We now know that scurvy is caused by a vitamin C (ascorbic acid) deficiency. It is easily treated by giving a patient fresh fruit or vegetables or vitamin C supplements. However, vitamin C was not discovered until 1912 and only isolated in 1928.

It was only in 1939, when John Crandon, a second-year medical student in Boston City Hospital intentionally gave himself scurvy, that many of the details of the horrible disease were examined in detail.

Crandon set himself a scurvy-inducing diet – eating only cheese, bread, crackers, eggs, beer, coffee, and chocolate every day for weeks and months. This was a dangerous experiment – in 1769, 29-year-old William Stark had tried something similar, but died of scurvy in less than a year.

In the 20th century, Crandon had the advantage of being able to test his vitamin C levels regularly. At three months, everything seemed normal. He continued operating on patients and felt fine. However, shortly afterwards, he developed fatigue. Then by day 155, his blood pressure dropped. On day 180, he experienced a sense of imminent death, his heart rate reached 190, he collapsed and temporarily lost consciousness. He had hemorrhages on his legs and a scar from his appendectomy 15 years earlier began opening. Eventually, his colleagues gave him intravenous vitamin C and forced him to end the experiment. Within 10 days, he had recovered fully.

This proved clearly both the cause and the cure of scurvy. But it had taken centuries to reach this point.

The history of scurvy treatments is not at all unique; it demonstrates how scientific discovery is rarely a straight line from theory to cure. The history of science is often the story of experiment, confusion, insight, lost knowledge and eventually an answer, or in the case of medicine, a cure.

The thing about Vitamin C deficiency is that it has no effect for the first couple of months. And scurvy can be confused with several other diseases, such as beriberi and pellagra.

So there were so many competing theories of how to cure scurvy, many of which appeared to work, even though in reality, most had no impact.

Furthermore, among its many horrific symptoms, scurvy makes the patient smell odious. And it induces fatigue. So, in many class-based societies (including aboard Cook’s ships) scurvy was a disease of those who did not care about personal hygiene, the poor, and the lazy. It was also considered to be the result of a moral deficiency.

The earliest description of scurvy was found in ancient Egypt, in the Ebers papyrus, dated to 1500 BCE. Not only does it describe the disease, but the document also prescribes onions – a common source of Vitamin C – as a cure.

Unfortunately, that knowledge was soon lost. Hippocrates, the 4th century BCE Greek described as the Father of Medicine, described scurvy patients who have, “foetid breath, lax gums, and h[e]mmorrhage from the nose.” However, whatever cure he suggested did not work, because he wrote that it often “accompanied a patient to his death.”

In 406 CE, the Chinese monk Faxian wrote that Chinese ships carried ginger to prevent scurvy. However, ginger has only a 10th of the Vitamin C of oranges, so it probably had little effect.

In the 13th century, the crusaders suffered from scurvy. Hess wrote that, “The barber surgeons were forced to cut away the dead flesh from the gums to enable the people to masticate their food.” However, this outbreak occurred during Lent, when the crusaders did not eat meat, and they blamed the disease on their diet of eel.

However, the real era of scurvy began when sailors took to the sea for extended voyages. In 1497, Vasco da Gama set out with 160 men to discover a sea route to the East Indies. It is believed that 100 of his men died of scurvy. Da Gama’s suggested cure was for the afflicted men to wash their mouths with their own urine. Unsurprisingly, this did not cure them.

However, this is not the entire story. Because on January 11, 1498, before most of his crew were dead, when da Gama’s ships reached Mombasa, the king fed them oranges and lemons, and everyone was cured. A year later, on January 7, 1499, his ships anchored at Malindi and the sailors immediately asked for oranges.

So, although he had no idea how or why it worked, da Gama had the cure for scurvy. Yet he never thought to take fruit with him, and most of his men died.

Between the 16th and 18th centuries, it is estimated that more than two million sailors died of scurvy. When Ferdinand Magellan attempted to sail around the globe in 1520, 80% of his crew died of scurvy.

Having never known about the ancient Egyptian onion cure, and forgetting da Gama’s citrus cure, doctors recommended such treatments as malt, bloodletting, and “earth bathing” which involved burying sick sailors in a barrel of earth (since they only developed scurvy at sea).

James Lind. (Public Domain/ Wikimedia Commons)

In 1753, a Scottish doctor named James Lind conducted what was perhaps the world’s first clinical trial. Aboard the HMS Salisbury, he took a dozen sailors suffering from scurvy. He divided them into six pairs and gave each pair a potential treatment. The first pair was given cider; the next, elixir vitriol (dilute sulfuric acid); another was given vinegar; the fourth, seawater; the fifth, a paste of plant extracts; and the final, two oranges and a lemon each day.

Within three days, the duo who received the citrus fruit were completely cured. Unfortunately, at that point the ship ran out of fruit.

Even more unfortunately, in his 1753 book, “A Treatise on Scurvy,” Lind spent only a few pages describing the experiment. He then wrote another 450 pages suggesting other cures for scurvy, including fresh air and exercise.

To make matters worse, knowing that it would be difficult to store citrus fruit on long sea voyages, Lind recommended boiling the oranges and lemons to make a “rob” that men should drink. Unfortunately, boiling the fruit destroyed almost all the vitamin C.

So once again, having discovered the cure for scurvy, it was promptly ignored or rejected. When Cook gave his crew rob on his first voyage, he reported no discernable benefit. He attributed the fact that nobody on his ship died of scurvy to the malt and wort he fed them. Cook’s contribution to the history of scurvy was to delay the real cure by a couple of decades.

However, in 1779, Gilbert Blane was appointed physician to the Royal Navy. He was convinced by Lind’s experiment that citrus was the cure for scurvy. He realized that adding ethyl alcohol to lemon juice would preserve it without destroying its life-saving properties. From 1795, every sailor in the Royal Navy received ¾ of an ounce of lemon juice each day, and just like that, scurvy was cured.

By the beginning of the 19th century, Sicily was covered in lemon trees to provide fruit for the British Navy.

However, in 1804, the second phase of the Anglo-Spanish War began, and there were no more lemons. So, the Navy switched to providing its sailors with limes grown in the Caribbean, which was under British control. This is why British sailors became known as “limeys.”

Unfortunately, limes have only a quarter of the vitamin C of lemons, which was reduced further after sitting in tanks exposed to air. Luckily, at the beginning of the 19th century, the British Navy switched from sailing ships to steamships. This meant that the boats traveled quicker, and the sailors were rarely away from port for more than the two or three months it took for the first signs of scurvy to appear. Unluckily, this meant the Navy thought the limes were the antidote to scurvy, which they really were not.

This became only too evident when the Navy began its Arctic expeditions at the end of the 19th century. Suddenly, the explorers were once again plagued by scurvy. A new theory was proposed – that scurvy was caused by ptomaine, which came from tinned meat that had gone bad.

Portrait of Nobel Prize laureate Albert Szent-Györgyi. (Public Domain, J.W. McGuire/ WIkimedia Commons)

In 1903, during his first expedition to the Antarctic, Robert Falcoln Scott suffered from scurvy, along with team leader Ernest Shackleton, who almost died from the disease. But since Scott believed the problem was with tinned meat, he took no citrus with him when he set off on his attempt to become the first man to reach the South Pole. Not only was he beaten to his goal by Roald Amundsen, but scurvy ultimately caused the fatigue and despair that led to the deaths of Scott and the four men who accompanied him to the Pole.

This partial history of scurvy shows how many missteps there were along the way. Millions of people could have been spared a horrible death if they had eaten onions – the ancient Egyptian scurvy preventative.

There was so much confusion about the cause and cure for scurvy. Partially this was due to ignoring the evidence, but also because they couldn’t see a direct line from the orange to the cure. Only after Albert Szent-Györgyi discovered Vitamin C could medical professionals understand how to prevent or cure scurvy.

I was reminded of this confusion about cause and effect when I read the following verses in this week’s Torah portion of Ekev:

Be careful, lest you forget the Lord, your God… Lest you eat and are satisfied, build nice houses and settle, have many herds and flocks and much silver and gold… And your heart becomes proud and you forget the Lord, your God, who brought you out of the land of Egypt from the house of slavery, who led you through the great and terrible desert… Who gave you water from the rock of flint, Who fed you manna in the desert… and you say in your heart, ‘My strength and the power of my hand gave me all this bounty.’

As long as the Israelites could see God directly, through the water flowing from a rock, through the manna that they ate each day, they knew they were powerless and dependent. Sure, they occasionally rebelled even while in the desert, but ultimately there was no confusion as to the source of their existence.

But once they built homes in the Land of Israel, when they started farming and engaging in commerce, it became harder to see the hand of God. Moses promised them that if they kept the mitzvot, God would provide rain and bounty. Yet once they achieved success, it became harder to remember where it came from.

Mistaking their hard work for God’s Providence was like not-Captain Cook thinking the malt and wort was preventing scurvy on his ship. He could have used lemon juice to save the lives of his men and the untold number of people who subsequently died of scurvy. Instead, he focused on the wrong thing and set back the real cure by decades.

A person can’t live on miracles. We must put in the effort to achieve our goals. But the Torah warns us that we must also be aware that the ultimate source of everything is God. We occasionally have flashes where we see the hand of God directly in our lives. But like the ancient Egyptian cure for scurvy, we forget it and even sometimes ultimately deny it.

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Thanks to Tim Harford and Cautionary Tales for teaching me about Scott and scurvy. And to No Such Thing as a Fish for teaching me about John Crandon.

My next series on WebYeshiva begins on August 30th. It is entitled “The 6 Historical Events of Rosh Hashanah” and will be live over four Tuesdays. You can listen to the live or recorded Torah classes on WebYeshiva. I’ve also started sharing more of my Torah thoughts on Facebook. Follow my page, Rabbi Sedley.