Remarks on the cause of scurvy and on the means by which it may be prevented in merchant ships

REMARKS ON THE CAUSE OF SCURVY AND ON THE MEANS BY WHICH IT MAY BE PREVENTED IN MERCHANT SHIPS. BY GEORGE BUDD, M.D. F.R.S FELLOW OF CAIUS COLLEGE, CAMBRIDGE; AND PHYSICIAN TO THE SEAMEN’S HOSPITAL, DREADNOUGHT. London PRINTED BY W. GILBERT, SALTERS-HALL COURT, CANNON STREET. 1839. Biographies: https://en.wikipedia.org/wiki/George_Budd https://history.rcp.ac.uk/inspiring-physicians/george-budd https://pmc.ncbi.nlm.nih.gov/articles/PMC1081440 https://doi.org/10.1177/096777209800600308 https://en.wikisource.org/wiki/Dictionary_of_National_Biography,_1885-1900/Budd,_George_(1808-1882) This report was identified in a project to search for the descriptions of scurvy symptoms in the early literature. The symptoms of scurvy are described on pp.18-20. George Budd also challenged numerous assumed causes of scurvy, and concluded that “All the substances which I have mentioned as preventives of Scurvy are derived from the vegetable kingdom; and it is probable that anti-scorbutic properties are possessed exclusively by substances of vegetable origin”, p.17. This was a novel conclusion at that time. The scanned version of this report is available at: https://www.jstor.org/stable/60203572 In 1842, Budd published a longer version of the same topic in London Medical Gazette: https://wellcomecollection.org/works/b8epyvag Yellow is used to indicate the most relevant parts. This version was prepared by Harri Hemilä, MD, PhD, University of Helsinki, Helsinki, Finland. https://orcid.org/0000-0002-4710-307X https://pubmed.ncbi.nlm.nih.gov/?term=hemila+h+vitamin+c This text is available at: https://doi.org/10.5281/zenodo.15647275 1 TO THE COMMITTEE AND GOVERNORS OF THE SEAMEN’S HOSPITAL SOCIETY. GENTLEMEN, As Physician to the Seamen’s Hospital, my attention has been frequently called to sailors affected with Scurvy, received into that establishment from merchant-ships engaged in the foreign trade, especially in that with the Mauritius, Sidney, and various ports in the Indian seas. The wretched condition of some of these men—the certainty that all their sufferings might have been easily prevented—and the persuasion that, in many cases, they have arisen solely from ignorance of the real cause of the disease—have induced me to publish the following brief remarks, in the hope that they may render the occurrence of Scurvy less frequent in our Merchantnavy. I dedicate these remarks to you, from knowing that p.4 you feel a deep interest in whatever relates to the welfare of seamen; and also, because, in doing so, I have an opportunity of acknowledging the kind attention which I have received at your hands, I have the honor to be, Gentlemen, Your obedient Servant, GEORGE BUDD. 9, BEDFORD PLACE, Nov. 7, 1839. 2 REMARKS ON THE CAUSE OF SCURVY, AND ON THE Means by which it may be prevented. TWO centuries ago, Scurvy was a common disease p.5 throughout all the northern countries of Europe. The writers, from whom we have derived accounts of it,1 agree in stating, that it generally showed itself towards the end of winter, or in the early part of spring, and that it uniformly disappeared during summer and autumn; but that it was at the close of long and severe winters, or when the country had been laid waste by war, and during long sieges, that its ravages were principally felt. As agriculture and gardening improved, Scurvy became gradually less frequent, and we have witnessed its almost complete extinction, on land, as the influence of these arts has extended to the most remote parts of Europe and to the humblest classes. But, even in recent times, there are instances, in which, under the peculiar circumstances I have specified, it has produced disastrous effects on shore. In the spring of 1795, it was very general among the p.6 French soldiers in the army of the Alps; and in 1801, during the siege of Alexandria2, it prevailed among the inhabitants and garrison to a most frightful extent. During the siege, which was commenced by the English in May, and which lasted only till the end of August, 3,500 scorbutic patients were received into the military hospitals, which the French had established in that city. But it is not only in armies and during sieges, that we meet with even modern instances of scurvy arising on land. In the reports of the inspectors of prisons, for the years 1836, 7, and 8, there is frequent mention of its occurrence in our gaols and prisons. These examples are sufficient to show that Scurvy is not peculiar to sea-faring men; but it is, unquestionably, during long voyages that its fatal effects have been most felt, audits existence, as a prevalent disease, maintained. 1 For example: Olaus Magnus (1555). Description of scurvy symptoms. https://doi.org/10.5281/zenodo.13380745 2 Larrey DJ (1814) Account of the scurvy. https://doi.org/10.5281/zenodo.15582455 https://en.wikipedia.org/wiki/Siege_of_Alexandria_(1801) 3 The narratives of all our early navigators abound with descriptions of the frightful ravages of Scurvy. Vasco de Gama, who first discovered a passage to the East Indies by the Cape of Good Hope, in 1497, lost a hundred of his men, out of a hundred and sixty, by this distemper.3 In the first voyage for the establishment of the East India Company, the equipment, consisting of four ships, with 480 men, sailed from England on the 2nd of April, 1600; and by the time they arrived at Saldanha, on this side of the Cape of Good Hope, there had died of Scurvy 105 men—nearly one fourth of their comp.7 plement.4 The memorable expedition under Lord Anson, in 1740 and the four following years, offers another example of the mortality formerly occasioned by Scurvy during long voyages. At the end of two years from their leaving England, the vessels engaged in the expedition had lost, from this disease, a larger proportion than four in five of the original number of their crews.5 Scurvy continued to prevail in all the fleets of this country, until the year 1795, when an admiralty-order was first given for furnishing the navy with a regular supply of lemon-juice, which had been long known to be a remedy for Scurvy, and which some recent experiments had proved to be equally efficacious in preventing it. From this time we may date the extinction of Scurvy in the British Navy. It has, indeed, shown itself on several occasions since, especially in some of the expeditions for the discovery of a north-west passage; but it has prevailed only in a slight degree, and has almost always been suppressed by an additional allowance of lemon-juice. 3https://doi.org/10.5281/zenodo.10685194 Find links with search for “Gama” https://en.wikipedia.org/wiki/Vasco_da_Gama 4https://doi.org/10.5281/zenodo.10685194 Find a summary and links with search for “Lancaster” https://en.wikipedia.org/wiki/James_Lancaster https://pmc.ncbi.nlm.nih.gov/articles/PMC7932658 https://pmc.ncbi.nlm.nih.gov/articles/PMC3618161 https://pmc.ncbi.nlm.nih.gov/articles/PMC1296402 https://archive.org/details/voyagesofsirjame00markrich [p.61-62] 5https://doi.org/10.5281/zenodo.10685194 Find a summary and links with search for “1748” https://en.wikipedia.org/wiki/George_Anson,_1st_Baron_Anson https://en.wikipedia.org/wiki/George_Anson%27s_voyage_around_the_world https://pmc.ncbi.nlm.nih.gov/articles/PMC9662994 https://www.gutenberg.org/ebooks/16611 https://catalog.hathitrust.org/Search/Home?lookfor=%22George+Anson%22 4 This happy result is far, however, from being realized in the commercial marine of this country. The means, which experience has proved to be of such certain efficacy, and which are so easily adopted, are in many instances neglected. In the space of a year and a half, nearly fifty cases of Scurvy have been admitted into the Seamen’s Hospital, Dreadnought;6 and from informap.8 tion obtained from these patients, I am led to estimate the number of sailors who have entered the port of London, affected with Scurvy, during this period, at not less than double that number. The wretched condition of some of these men has convinced me, that the descriptions of the sufferings occasioned by Scurvy in voyages of the early navigators, have not been exaggerated. Most of the cases of Scurvy received into the Dreadnought are from vessels that have come from the Mauritius, Sidney, Ceylon, China, or some port in India. CAUSES OF SCURVY. SALT PROVISIONS.—In consequence of the frequent occurrence of Scurvy at sea, and on shore in persons whose diet, like that of sailors, consisted chiefly of salt meat, it was at one time supposed to be occasioned by excessive use of salt. A more extended view of the circumstances under which Scurvy arises, is sufficient to show that this opinion is erroneous. The history of the disease furnishes us with numerous instances in which it has occurred in persons living entirely on fresh provisions. No longer ago than the autumn of 1836,7 Scurvy prevailed to a great extent among our troops p.9 stationed in the New Province of Queen Adelaide, at the Cape of Good Hope; when, according to the report of Dr. Murray, the principal medical officer at the Cape, the men had no harassing duties, and were abundantly supplied with good fresh meat, without having had an 6 Dreadnought. https://en.wikipedia.org/wiki/HMS_Dreadnought_(1801) https://en.wikipedia.org/wiki/Seafarers_Hospital_Society https://www.rmg.co.uk/collections/hms-nhs-nautical-health-service-transcription-project https://www.nautilusint.org/en/news-insight/telegraph/ships-of-the-past-the-dreadnought https://atom.aim25.com/index.php/dreadnought-seamans-hospital-2 7 Autumn at the Cape corresponds to Spring in the northern hemisphere. In the appearance of Scurvy at that season and in many other particulars mentioned by Dr. Murray, there is perfect agreement with some of the accounts left us of the occurrence of Scurvy in armies on the Continent in the early part of last century. 5 ounce of salt provisions. They had been, however, a long time without fruit or fresh vegetables. The circumstance that Scurvy may occur among persons living solely on fresh meat; and the fact, which the history of modern navigation has fully established, that it may be prevented for any length of time in persons who subsist on salt provisions, and can be readily cured even in those who continue the use of them, are sufficient to justify the conclusion that salt has no share whatever in producing it. SEA-AIR.—The frequency of this disease during long voyages, led also to the supposition that the Sea-Air, or some unknown marine agency, had an especial influence in causing it. At present this opinion scarcely needs refutation. Modern experience has amply proved, not only the harmlessness, but the extraordinary salubrity of Sea Air; the fact, that it exerts no particular influence in the production of Scurvy, was, however, first established by Captain Cook, who, in 1772, 3, 4, 5, in the Resolution, performed a voyage of 3 years and 18 days, in all climates, from 52° North to 71° South, with the loss of only one of his crew by disease. COLD; MOISTURE.—The fact that Scurvy, when it p.10 first attracted attention, prevailed exclusively in northern countries, early led to the opinion, that cold and moisture had a considerable share in causing it, and this opinion has been maintained up to the present time by the highest authorities on this subject. An attentive consideration of the history of Scurvy, is, I believe, sufficient to show that the influence of these causes, if indeed they have any influence, has been much over-rated, and that the comparative immunity from this disease formerly enjoyed by fleets in warm latitudes, was mainly owing to supplies of oranges and other fruits, with which Cadiz, Madeira, or the Islands of the West Indies, furnished them. Scurvy may occur in all climates; either on land or at sea; in persons who subsist on salt meat or fresh; and in situations in which the utmost attention is paid to cleanliness and ventilation. There is one condition, however, which is necessary for its production: namely, prolonged abstinence from succulent vegetables or fruits or their preserved juices, as an article of food. When this condition is fulfilled, we find Scurvy arising in persons whose situations are the most various in every 6 other respect; while not a single instance can be cited of its occurring in a person well supplied with these vegetables or fruits. This circumstance, together with the fact, that Scurvy is in all cases rapidly cured when a supply of such vegetables or fruits is furnished, lead us to consider the abstinence in question as its essential and sole cause. I have said that this abstinence must p.11 be prolonged: it would seem, indeed, that in a person previously well supplied with vegetable juices, privation of them from two to five months is necessary to produce the disease. On land, Scurvy has shown itself generally at the end of winter, or in spring: at sea, it has appeared after voyages of very different durations—in some cases, at the end of a month or six weeks; in others, after the lapse of five or six months. This difference depended on the time of year when the vessel left port, or rather on the previous diet of the men. The fatal effects of Scurvy have, in fact, been most felt during sieges commenced in spring, and in voyages entered on in spring from cold countries. The siege and the voyage have in these cases prolonged to the inhabitants and the sailors, not the cold of winter, but abstinence from fresh vegetables, which, in former times, the cold of winter always occasioned.8 PREVENTIVES. The most powerful means for the prevention of Scurvy is the use of oranges, lemons, limes, shaddocks9 —in fact, of any fruits of the orange tribe. I have already stated that lemon-juice was first systematically introduced into nautical diet in 1795, by a general order of the Admiralty, and that it has completely realized the p.12 expectations of those who proposed it.10 The present allowance of lemon-juice in the Navy consists of a fluid ounce, which, after ships have been a fortnight at sea, is served daily with an ounce and a half of sugar, to each of the men. 8 I have already noticed the great prevalence of Scurvy among the garrison at Alexandria [see footnote 2], during the siege of that city, which was undertaken in May and the dreadful mortality it occasioned in the first voyage for the establishment of the East India Company, which was commenced on the 2nd of April [see footnote 4]. 9 Shaddock. Pomelo. https://en.wikipedia.org/wiki/Pomelo 10 In 1780, 1457 cases of Scurvy were admitted into Haslar Hospital. In 1810, one of the physicians of that hospital stated that he had not seen a case of it for seven years; and in the four years preceding 1810, only two cases were received into the Naval Hospital at Plymouth. 7 It was originally sent to sea in the form of a rob, made by evaporating the juice by a slow heat to the consistence of thick syrup. This, however, was found to be very inferior to the fresh fruit;11 and it was in consequence recommended by Sir Gilbert Blane12, that the juice should be preserved by the addition of a certain proportion of spirit, without the aid of heat. When prepared in this manner, its virtues seem unimpaired. The juice with which the navy is supplied, is brought from Sicily, and kept good by the addition of one part of strong brandy to ten of the juice. Most sour fruits are in all probability anti-scorbutic, and instances are well authenticated of the good effects of grapes and apples. As the expense of lemon-juice offers some impediment to its employment in the merchant-ships of this country, to the extent necessary for the complete extinction of p.13 Scurvy, it deserves to be ascertained whether the juice of apples, preserved, like that of lemons, by the addition of a certain proportion of spirit, would not be an effective substitute. All succulent vegetables that are wholesome are, perhaps, as well as fruits, more or less anti-scorbutic; and this property seems to be possessed in a high degree by many of the vegetables in common use, as the cabbage, turnip, radish, water cress, &c. In the earliest notices of Scurvy, mention is made of the efficacy of herbs of this class in its treatment. The strongest proof of this efficacy is to be found in the fact that the disease, when it occurred on land, uniformly disappeared during summer and autumn, and that it gradually became less frequent, as the consumption of vegetables increased. There seems to be no country naturally destitute of remedies for the Scurvy. The fruits of tropical and temperate climates are replaced in countries within the polar circle by herbs of almost equal virtue. We are told that in Greenland, where Scurvy was formerly very common, the natives employed sorrel13 and scurvy-grass14 together, and that by the use of these herbs, which were put into broths, the most advanced cases were speedily cured: and Sir Edward Parry, in the narrative of his 11 Lind’s “Rob” was also tested experimentally by Hughes (1975), and was found to lack vitamin C, see: https://pmc.ncbi.nlm.nih.gov/articles/PMC1081662 12 https://doi.org/10.5281/zenodo.10685194 Find extracts of Blane’s texts and links with search for “Blane” 13 Sorrel. https://en.wikipedia.org/wiki/Sorrel 14 Scurvy-grass. https://en.wikipedia.org/wiki/Cochlearia 8 first polar expedition, has given from his own experience an instance of the good effect of sorrel, when, in consequence of a serious loss of lemon-juice from the bursting of the bottles by the frost, he was under the necessity of discontinuing the daily allowance of this article. It appears that vegetables are most anti-scorbutic p.14 when eaten raw. Herbs in the form of salads are more efficacious than when boiled, or in any way prepared by heat; and their anti-scorbutic properties are entirely destroyed by drying. But when vegetables are preserved as pickles, their anti-scorbutic properties are retained. It was observed that Dutch Ships were formerly much less subject to Scurvy than our own;15 and in some instances, when our fleet has acted in concert with that of the Dutch, our sailors have become affected with Scurvy, while the Dutch have continued free from it. This immunity on the part of the Dutch was owing to the use of Sour -krout, which was regularly supplied to their ships. In 1780, Sour-krout was furnished to the navy of this country; and in the history of our fleets about that time, we meet with many proofs of its good effects. The allowance was two pounds a week to each man. Sour-krout is prepared in the following manner: the soundest and most solid cabbages sliced, as we slice cucumbers, are put into a barrel in layers, hand high; over each layer is strewed a handful of salt and caraway16 seeds; the whole is then rammed down, and the process repeated till the barrel is full, when a cover is put over it and pressed down with a heavy weight. After standing some time in this state, the cabbage begins to ferment, and it is not till the fermentation has entirely ceased, that the barrel is finally shut up. Vinegar is not, as some have imagined, employed in the preparation of sour-krout. In Austria and in several parts of Germany people p.15 formerly ate sour-turnip, which was prepared in the same manner as sour-krout: in fact, most vegetables may be preserved by this process, and I most strongly recommend a trial of it, with scurvy-grass and sorrel, to navigators who may in future be compelled to winter in the Polar Seas. 15 Nixon JA. The East India company and the control of scurvy. https://pmc.ncbi.nlm.nih.gov/articles/PMC2077202 16 Caraway. https://en.wikipedia.org/wiki/Caraway 9 soon after he was brought to the Dreadnought. Of the p.24 four who formed the second mess, one was brought to the Dreadnought, the others went to their homes; all were in a very bad condition. Scurvy showed itself in these men about six or seven weeks after they left the Mauritius, and all of them, except two, had been confined to their hammocks since the latter part of April: of these two, one had been confined to his hammock only ten days; the other, though incapable of doing duty, continued to crawl about until they arrived in port. For ten days before their arrival, the vessel was worked entirely by the captain, steward, first mate, and boy, who messed together in the captain’s cabin, and continued free from Scurvy. The weather, during the voyage homeward, was fine; the vessel, a good one; and the work of the men before they became affected with Scurvy was not severe. Their diet, after they left the Mauritius, consisted of salt beef or pork, with biscuit, and tea, for breakfast; beef two days, and pork one day, alternately, with biscuit for dinner; and during the first half of the voyage, flour, in puddings, twice a week, and pea-soup twice a week. One glass of grog was given daily to each man nearly all the passage. They had no vinegar, lemon, or lime-juice. The salt provisions were of bad quality, but not of the worst; and the diet was as good in every respect in coming home as in going out, yet none of the crew showed any symptoms of Scurvy in their passage outward. While in the Mauritius, each man had two pounds of fresh beef, daily; but no fruits or vegetables of any description. The severity of the disease in this instance must be ascribed solely to complete and prolonged abstinence p.25 from vegetable juices. From the time of their leaving England, the men had been without vinegar, lemon, or lime-juice; and during their stay at the Mauritius, they had no fresh vegetables or fruits of any kind. In other respects, they were favorably circumstanced. They left this country in Autumn, the best season, as regards Scurvy, for the commencement of a long voyage; their vessel was a good one; and, during the early part of the voyage homeward, the weather was fine and their work easy. The salt provisions were, indeed, of bad quality, but all the men agreed that they had met with worse; and, in addition to the salt-meat and biscuit, they had flour twice a week, pea-soup twice a week, and a daily 16 allowance of grog. It is worthy of remark that none of the men exhibited symptoms of Scurvy in their passage out, which lasted between three and four months, yet all of them became affected with it in less than two months after they left the Mauritius, although the provisions were quite as good when they were returning as when they were going there, and during their stay at the island, they had been abundantly supplied with fresh animal food. This is explained by the circumstance that to produce Scurvy there must be abstinence from vegetable juices, and this abstinence must be prolonged. Fresh animal food has, as I have before remarked, very little effect, either in preventing or curing it; and, consequently, the time they staid at the Mauritius may be considered as so much time spent at sea. I have since met with an instance in which the crew of a vessel, likewise from the Mauritius, were reduced by Scurvy to a condition almost as bad as in the case of p.26 which I have given the details. In both instances the disease was owing, in part, to the want of lemon or limejuice during the voyage; in part, to the circumstance, that, while they remained at the Mauritius, they were unprovided with fresh vegetables or fruits. 17