By Lawrence D. Townsend, M.D.
The narratives of the early, long voyages of discovery are replete with descriptions of disease and death coming upon crews which had been at sea for several months. Narrators usually referred to the condition as “scurvy”. Today it is thought, however, that these abnormalities which were often clearly described, consisted of multiple deficiency states, whereas true scurvy is a disease resulting from a deficiency of ascorbic acid (Vitamin C) in the body.
Scurvy is a true vitamin deficiency disease. The first symptoms appear after a depletion period of several months durning which time the subject is consunning an inadequate amount o ascorbic acid in his diet and at the same time is metabolizing his bodily stores of the vitamin.
Vitamin C, in an adequate serum concentration, is essential in maintaining the integrity of the intercellular cement substance which functions to keep intact the lining membranes of the finer blood vessels, especially the capillaries. Deficiencies in available ascorbic acid in tissues produce an impairment of the intercellular cement substance through changes in its chemical structure. Such weakened blood vessel linings permit loss of blood through the abnormal vessel wall.
The symptoms of scurvy are largely related to the tendency for the ascorbic acid deficient subject to sustain hemorrhages within tissues. Such hemorrhages may occur within any organ or tissue, but are most prone to develop in gums, skin, muscles, and under the periosteum of bones. This gives rise to the characteristic symptoms of swollen and bleeding gums, purplish and other discolorations of the skin, swelling and violent pains with associated weakness of skeletal muscle, pain about the joints and on pressure over boney prominences, bleeding on the surface of the body, into the bowels, into the pleural, pericardial, abdominal and intraocular spaces, and signs of cardiac weakness. Another well-known character of scurvy is the loosening of teeth. This results in part from hemorrhage, but in a much larger degree from a disturbance of the balance between osteoblasts and odontoblasts in the dentine, and with the destruction of the thin layer of this substance surrounding the roots of the teeth.
Beri beri is a disease resultinq from faulty metabolism, caused by a dietary deficiency of thiamin (Vitamin B,) and other vitamins of the B complex. It is obvious from early descriptions, and from later observations of experiments on deficiency diseases, that beri beri occurred coincidentally with scurvy. Sometimes when it occur-red as a pure disease it was confused with scurvy. Beri beri is characterized by a degenerative nervous system changes, generalized edema, serous effusions, and cardiac enlargement. The symptoms appear within a few days to several weeks after the adoption of a faulty diet. Thus the period of depletion is shorter than in ascorbic acid deficiency. The observed symptoms follow from the degenerative changes produced by the faulty diet. Degeneration and weakness of muscles occurs after nerve involvement, giving rise to diminished reflexes, abnormal gait, and disturbances of sensation. Edema results in swelling of the extremities, collections of fluid in various cavities of the body including the pericardium, and enlargement of the heart.1
Maritime diets during the period of discovery consisted chiefl of refined carbohydrates in the form of sea biscuits, dried cereals and legumes, and dried or salt meat, and were typically deficient in both ascorbic acid and thiamin, with probably a less acute shortage of thiamin. There is little wonder then in the light of modem nutritional knowledge that both scurvy and beri beri almost universally became manifest in sea voyages lasting four or five months or longer. But all of the foregoing information is based upon present day knowledge. It is the state of knowledge on this subject in the eighteenth century that is of real interest.
Scurvy was known as a disease entity by Pliny and a fair description is to be found in Book 25 of his “Natural History”. The modern description, which is classical, came from the pen of John Huxham of England, who wrote in 1747:
… That the State of the Blood, in the common Sea-scurvy, is of this
Nature, appears from the stinking Breath of the Sick, their rather corroded
Gums, high-coloured foetid Urine, sordid Ulcerts, black, blue and brown
spots, and Eruptions on the Skin, frequent feverish Heats, foul Tongues,
bilious and bloody Dysenteries, which more or less attend it. Now it is also
well known, that a vegetable acescent Diet and Regimen, fresh Air, fresh Provisions, subacid and vinous Drinks, are its certain and speedy Cure, when
not very far advanced. Apples, Oranges, and Lemons, alone have been often
known to do surprising Things in the Cure of very deplorable scorbutic
Cases, that arose from bad Provisions, bad water, &c. in long voyages.2
He noted that officers who carried “Wine, Cyder, Lemons, fresh Provisions, &c.” were less afflicted with scurvy than were the common sailors who were not so provisioned. Besides producing a graphic description of the main features of the disease, Huxham made intelligent recommendations for prevention. He advised that every sailor should have at least a pint of “cyder” a day, that there should be more vinegar in the seaman’s diet, that apples should be carried in barrels, and that lemons, oranges and also mixtures of lemon juice and rum should be on board. The latter was an eighteenth century concoction called “shrub”.
James Lind, surgeon of the Haslar [Naval] Hospital at Portsmouth, is credited with making the first concrete suggestion to be eventually carried out for preventative measures against scurvy. He usually had three to four hundred cases at a time and occasionally as many as one thousand cases. In 1773 he described a means of producing lemon and orange juice concentrates, recommending that they be carried on all vessels of the Royal Navy. It was not uritil forty years after his suggestion was made that the first ships sailing to Madras were thus equipped. There was immediate success. In 1780 there were 1457 cases of scurvy admitted to Haslar Hospital. Early in the nineteenth century the disease became so rare among naval personnel that there was no case at the hospital for seven years.3
Scurvy continued to take a terrible toll on British and other merchant ships. It was not until 1865 that the British Board of Trade made lemon and orange juice concentrates mandatory rations on all vessels. Thereafter, British seamen, formerly referred to as tars were called “limey”. It is interesting to observe that lime concentrates were never widely used, and that of all common citrus fruits, limes possess the least anti-scorbutic property.
While scurvy was an accompaniment of all prolonged early voyages or expeditions, it is of interest to cite the references to the disease in the records of Portolá’s travels. The rations of this expedition were probably fairly adequate in vitamins of the B complex, and the descriptions appear to refer to pure scurvy without complicating beri beri. It is interesting to reflect that the very area in which Portola’s men were dying of scurvy in 1770 would become one of the world’s largest sources of natural vitamin C, one and one-half centuries later.
One of the factors which led to Galvéz’s decision to dispatch an overland expedition was his concern about the success of the maritime expedition. Since, Costanso had noted “…the diseases to which crews are frequently exposed on long voyages…”
Galvéz concern for the sea borne section of the expedition was
adequately justified. The San Carlos beat off the California coast
and landed at San Diego 110 days after leaving La Paz.
But its crew and the troops on board-whose fatigue could not be otherwise than excessive on so protracted a voyage in the depth of winter-arrived in a deplorable condition. Scurvy had attacked all without exception, so that by the time they entered the Port of San Diego, two men had already died of this disease, while the majority of the crew and half of the soldiers were confined to their beds. Only four seamen were remaining on their feet, and they, assisted by the soldiers, had to trim and furl the sails and work the ship.4
Although the San Antonio had made the voyage in 59 days, half of its crew also was down with scurvy, and two had died. On Portolá’s overland expedition there were seventeen men afflicted with scurvy on October 1, 1769.
After Portolá mistakenly left Monterey for the north, rains
came in the latter part of October. The party developed an epidemic of diarrhea which attacked all of the members. This might be thought to be a manifestation of a vitamin B deficiency state known as pellagra, but more likely it was a simple epidemic of enteritis. The people ate leafy weeds which sprang up following the rains and made almost miraculous improvement.
It was feared that this disease [diarrhea), which exhausted the strength and broke the spirit of the men, would entirely put an end to the expedition. But quite the contrary happened: for all those who were ill and suffering from the scurvy-being crippled and swollen in all their limbs, and tormented with pains-from now on began to feel relief from their ailments. The swellings gradually disappeared, the pains ceased, they recovered the use of their limbs, and ultimately were restored to perfect health without any medication whatever.5
Meanwhile, scurvy was making inroads on the party at San Diego. On Portolá’s return there he found a number of additional members dead, and the surgeon, Don Pedro Prat, was just recovering from scurvy. Eight of the fourteen volunteers left at San Diego had died. Deficiency diseases are thus seen to have left their mark on the explorations in our own region almost simultaneously with the observations of Huxham which led to their eventual practical extermination.
1. Hess, Alfred F. “Recent Advances in Knowledge of Scurvy and the Antiscorbutic Vitamin,” Journal American Medical Association, April 23, 1932.
2. Huxham, John. “A Method for Preserving the Health of Seamen on Long Cruises and Voyages,” published with “An Essay on Fevers,” London, 1757. (In: Major, Ralph H. Classic Descriptions of Disease, with Biographical sketches of the Authors,” Springfield, 1932, pp. i-xxvii, 1-630 (558-559).
3. Lind, James. On the Most Effectual Means of Preserving the Health of Seamen,” London, 1779. (In: Major, Ralph H., “Classic Descriptions of Disease, with Biographical Sketches of the Authors,” Springfield, 1932, pp. i-xxvii, 1-630 (-556-558).
4. Costansó, Miguel. The Narrative of the Portolá Expedition of 1769. (Ed.) by Adolph Hemert-Engert and Frederick J. Teggart. Publications of the Academy of Pacific Coast History, 1 (4), 1910, p. 27.
5. Portolá, Gaspar De. Diary of Gaspar de Portolá During the California Expedition of 1769-1880. (Ed.) by Donald Eugene Smith and Frederick J. Teggart. Publications of the Academy of Pacific Coast History, 1 (3), 1909, pp. 33-89.