Editing Scurvy (section)

=== 18th century ===
[[File:JamesLind.jpg|thumb|[[James Lind]], a pioneer in the field of scurvy prevention]]
In 2009, a handwritten household book authored by a Cornishwoman in 1707 was discovered in a house in Hasfield, [[Gloucestershire]], containing a "{{abbr|Recp.t|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.<ref>{{cite news|work=The Daily Telegraph |date=5 March 2009|url=https://www.telegraph.co.uk/news/newstopics/howaboutthat/4943570/Cure-for-scurvy-discovered-by-a-woman.html|title=Cure for Scurvy discovered by a woman|url-status=live|archive-url=https://web.archive.org/web/20090310021320/http://www.telegraph.co.uk/news/newstopics/howaboutthat/4943570/Cure-for-scurvy-discovered-by-a-woman.html|archive-date=10 March 2009}}</ref>

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.<ref>{{Cite journal|title = James Lind and scurvy: A revaluation |last = Bartholomew |first = Michael |date = 2002 |journal = Journal for Maritime Research |doi = 10.1080/21533369.2002.9668317 |pmid = 20355298|volume= 4|issue= 1 |pages = 1–14 |s2cid = 42109340}}</ref><ref>Johann Friedrich Bachstrom, ''Observationes circa scorbutum'' [Observations on scurvy] (Leiden ("Lugdunum Batavorum"), Netherlands: Conrad Wishof, 1734) p. 16. [https://books.google.com/books?id=bj8_AAAAcAAJ&pg=PA16 From page 16:] {{webarchive|url=https://web.archive.org/web/20160101135046/https://books.google.com/books?id=bj8_AAAAcAAJ&pg=PA16 |date=1 January 2016 }} ''"... sed ex nostra causa optime explicatur, quae est absentia, carentia & abstinentia a vegetabilibus recentibus, ..."'' (... but [this misfortune] is explained very well by our [supposed] cause, which is the absence of, lack of, and abstinence from fresh vegetables, ...)</ref><ref>''"The Blood of Nelson"'' by Glenn Barnett&nbsp;— Military History&nbsp;— Oct 2006.</ref>

It was not until 1747 that [[James Lind (physician)|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.<ref name=Lind1753/><ref>{{cite journal |last1= Baron |first1= Jeremy Hugh |title= Sailors' scurvy before and after James Lind - a reassessment |journal= Nutrition Reviews |volume= 67 |issue= 6 |year= 2009 |pages= 315–332 |doi= 10.1111/j.1753-4887.2009.00205.x|pmid= 19519673 }}</ref> As a naval surgeon on HMS ''Salisbury'', Lind had compared several suggested scurvy cures: [[hard cider]], [[vitriol]], [[vinegar]], [[seawater]], [[Orange (fruit)|oranges]], [[lemons]], and a mixture of [[balsam of Peru]], [[garlic]], [[myrrh]], [[mustard seed]] and [[radish]] root. In ''A Treatise on the Scurvy'' (1753)<ref name=Ag2015/>{{sfn|Lind|1753}}<ref name=Lind1753>{{cite book|author=James Lind|title=A Treatise on the Scurvy: In Three Parts, Containing an Inquiry Into the Nature, Causes, an Cure, of that Disease, Together with a Critical and Chronological View of what Has Been Published on the Subject|url=https://archive.org/details/b30511902|year=1772|publisher=S. Crowder (and six others)|page=[https://archive.org/details/b30511902/page/149 149]}}{{open access}} (Also archived [https://archive.org/details/treatiseonscurvy00lind second edition (1757)])</ref>
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."<ref name="Distillations"/><ref name="Lind1753"/> However, the experiment and its results occupied only a few paragraphs in a work that was long and complex and had little impact. Lind himself never actively promoted lemon juice as a single 'cure'. He shared medical opinion at the time that scurvy had multiple causes – notably hard work, bad water, and the consumption of salt meat in a damp atmosphere which inhibited healthful perspiration and normal excretion – and therefore required multiple solutions.<ref name="Distillations"/><ref>{{Cite journal|title = James Lind and Scurvy: a Revaluation |last = Bartholomew |first = M. |date = January 2002 |journal = Journal for Maritime Research |volume = 4 |pages = 1–14 |doi = 10.1080/21533369.2002.9668317 |pmid = 20355298 |s2cid = 42109340}}</ref> 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.<ref name="Distillations"/>

During the 18th century, scurvy killed more British sailors than wartime enemy action. It was mainly by scurvy that [[George Anson, 1st Baron Anson|George Anson]], in his celebrated voyage of 1740–1744, lost nearly two-thirds of his crew (1,300 out of 2,000) within the first 10 months of the voyage.<ref name="Distillations"/><ref>"[https://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_01.shtml Captain Cook and the Scourge of Scurvy] {{webarchive|url=https://web.archive.org/web/20110221073823/http://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_01.shtml |date=21 February 2011 }}" BBC – History</ref> The Royal Navy enlisted 184,899 sailors during the [[Seven Years' War]]; 133,708 of these were "missing" or died from disease, and scurvy was the leading cause.<ref>A. S. Turberville (2006). "''Johnson's England: An Account of the Life & Manners of His Age''". ISBN READ BOOKS. p.53. {{ISBN|1-4067-2726-1}}</ref>

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 [[John Pringle (physician)|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.<ref>{{Cite book|title = Physician to the Fleet; the Life and Times of Thomas Trotter 1760-1832|last = Vale and Edwards|publisher = The Boydell Press|year = 2011|isbn = 978-1-84383-604-9|location = Woodbridge|pages = 29–33}}</ref> These ideas received wide and influential backing, when [[James Cook]] set off to circumnavigate the world (1768–1771) in {{ship|HM Bark|Endeavour}}, 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.<ref>{{Cite journal |title = Captain Cook's Beer; the anti-scorbutic effects of malt and beer in late 18th century sea voyages | last = Stubbs | first = B. J. | date = 2003 | journal = Asia and Pacific Journal of Clinical Nutrition |volume= 12 |issue= 2 |pages= 129–37 | pmid = 12810402 }}</ref>

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.<ref>{{cite book |last= Fernandez-Armesto |first= Felipe |title= Pathfinders: A Global History of Exploration |year= 2006 |publisher= W.W. Norton & Company |page= [https://archive.org/details/pathfindersgloba00fern/page/297 297] |isbn= 978-0-393-06259-5 |url= https://archive.org/details/pathfindersgloba00fern/page/297 }}</ref> 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.<ref>{{Cite web|url=https://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_01.shtml|archiveurl=https://web.archive.org/web/20090303075047/http://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_04.shtml|url-status=dead|title=BBC - History - British History in depth: Captain Cook and the Scourge of Scurvy|archive-date=3 March 2009|website=Bbc.co.uk|access-date=5 March 2022}}</ref>

The first major long-distance expedition that experienced virtually no scurvy was that of the Spanish naval officer [[Alessandro Malaspina]], 1789–1794. Malaspina's medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at [[Guam]], all five were healthy again. [[Spanish Empire|Spain's large empire]] and many ports of call made it easier to acquire fresh fruit.<ref>{{cite book |last= Fernandez-Armesto |first= Felipe |title= Pathfinders: A Global History of Exploration |year= 2006 |publisher= W.W. Norton & Company |pages= [https://archive.org/details/pathfindersgloba00fern/page/297 297–298] |isbn= 978-0-393-06259-5 |url= https://archive.org/details/pathfindersgloba00fern/page/297 }}</ref>

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]]<ref>Blane, Gilbert (1785). Observations on the diseases incident to seamen. London: Joseph Cooper; Edinburgh: William Creech</ref> and [[Thomas Trotter (physician)|Thomas Trotter]]<ref name="TrotterMilman1786">{{cite book|author1=Thomas Trotter|author2=Francis Milman|title=Observations on the Scurvy: With a Review of the Theories Lately Advanced on that Disease; and the Opinions of Dr. Milman Refuted from Practice|url=https://archive.org/details/b21522819|year=1786|publisher=Charles Elliott and G.G.J. and J. Robinson, London}}</ref> 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, [[Alan Gardner, 1st Baron Gardner|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 {{HMS|Suffolk|1765|6}} and two [[Sloop-of-war|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.<ref>{{Cite journal |title = The Conquest of Scurvy in the Royal Navy 1793–1800: a Challenge to Current Orthodoxy |last = Vale |first = Brian |date = 2008 |journal = The Mariner's Mirror |volume= 94 | issue = 2|pages= 160–175|doi = 10.1080/00253359.2008.10657052 |s2cid = 162207993}}</ref>

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.<ref>{{cite web|url=https://knoxpediatrics.com/watch-out-for-spring-fever/|title=Watch out for spring fever!|date=11 April 2018 |access-date=20 March 2022|publisher=Knoxville Pediatric Associates|archive-date=21 May 2022|archive-url=https://web.archive.org/web/20220521061019/https://knoxpediatrics.com/watch-out-for-spring-fever/|url-status=live}}</ref>