Scurvy: Apples and Oranges

Aliases: scurvy, amalati de la boccha (curse of the mouth), Cheadle disease, Barlow disease

Scurvy is one of the oldest diseases in human history. It was first recorded in an Egyptian medical scroll in 1550 BCE. (The suggested treatment? Vegetables. Nailed it!). It even got a mention by Hippocrates, the originator of the Hippocratic oath, who wrote the first formal description of the disease. Yet despite our long association with scurvy, it took until the 20th century and the discovery of vitamin C for a definitive cure to be found.1 In our ignorance about human nutrition we circled the answer for centuries and kept passing the right conclusion by like ships in the night (pun intended).

Scurvy is the bane of both the bold and the disenfranchised, dogging explorers and anyone else in situations of deprivation. Scurvy plagued the crews of the 15th and 16th century explorers; between 1500 to 1800 CE, scurvy killed more sailors than all other diseases and disasters combined.3 The disease was so prevalent among seamen that some suggested that the illness was caused by the sea itself. The theory went on to suggest that a simple return to land should provide a cure.4 (To our ancestor’s credit, that idea was quickly dismissed, especially when outbreaks of the disease started to occur regularly on land.). Scurvy flourished wherever fresh vegetables were scarce, afflicting far-flung outposts, including gold miners in California and the polar expeditions of the 19th century. It was also common in areas of conflict and prisons, heaping injury upon injury, as disease so often does.1

The threat of scurvy did not escape the attention of the very explorers it afflicted. Captain James Cook was particularly famous for his study of scurvy. Through careful observation he found two ways to successfully combat scurvy on his long sea voyages (among other less accurate proposals, like beer): procuring fresh food whenever possible, and carrying and using preserved foodstuffs thought to prevent scurvy, like sauerkraut and portable broth (a soup prepared from cattle offal and vegetables that was evaporated into hard cakes). His hard work was rewarded when he was awarded the Sir Godfrey Copley’s medal by the Royal Society of London (awarded annually to the “most useful and most successful experimental inquiry”) for his experimentation on the treatment of scurvy during his 1772-1775 voyage in the South Pacific.4

But despite the mounting evidence for the medicinal effects of fresh fruit and vegetables, doubts remained. This is due in part to the complexity of the problem and the specificity of the solution. Vitamin C deficiency results in a huge array of conditions, and many appear unrelated.3 And although fruit and vegetables alleviate scurvy, it’s really apples and oranges. Not all sources of vitamin C are equal; there is a wide range of vitamin C concentrations among fresh foods. This kept us dancing around the truth even when it was staring us in the face. The unfortunate scientist James Lind even managed to show that oranges successfully treated scurvy in 1753. But because he could not pinpoint the cause of the disease (which wasn’t demonstrated until the 1930s) his findings were not widely accepted, resulting in nearly two more centuries of mistreatment.1

scurvy
What’s cooking, Captain? See (C?) what I did there?

Cause: Scurvy is the result of severe vitamin C deficiency. Really, really severe. For clinical symptoms to develop, the body’s store of vitamin C (an essential nutrient for collagen and bone formation, among many other things) has to diminish from 1500mg (a normal body store) to 350mg or less. That requires the total elimination of vitamin C from your diet for 60-90 days.3 Although scurvy is most common when fruit and vegetables are scarce, it can also result from malnutrition, which can be caused by a whole suite of conditions, including malabsorption issues, eating disorders, and allergies.2

Consequence: Common symptoms of scurvy include irritability, bone pain, limping, rash, and spongy, bleeding gingiva (the soft mouth tissue surrounding the teeth). More extreme symptoms include seizures, heart failure, bone fractures, and pseudoparalysis. Left untreated, scurvy is often fatal.3

Cure: Despite the seriousness of the condition, scurvy is shockingly treatable and the cure is simple. Treatment involves flooding the body with the maximum dose of vitamin C. The body’s stores can be replenished within just a few days, and patients generally improve within 24 hours. Their pain usually decreases over 2-4 days and mouth lesions heal in 2-3 weeks.3 Full recovery takes just 3 months2 and there is usually little to no permanent damage after treatment. So, while an apple (about 8mg of vitamin C) a day can keep the doctor away, an orange (60mg of vitamin C) is better.3

References

  1. Magiorkinis, E., A. Beloukas, and A. Diamantis. 2011. Scurvy: past, present and future. European Journal of Internal Medicine, 22:147-152.
  1. Levavasseur, M., C. Becquart, E. Pape, M. Pigeyre, J. Rosseaux, D. Staumont-Sallé, and E. Delaporte. 2015. Severe scurvy: an underestimated disease. European Journal of Clinical Nutrition, 69: 1076-1077.
  1. Popovich, D., A. McAlhany, A.O. Adewumi, and M. McKim Barnes. 2009. Scurvy: forgotten, but definitely not gone. Journal of Pediatric Health Care, 23: 405-416.
  1. Stubbs, B. 2003. Captain Cook’s beer: the antiscorbutic use of malt and beer in late 18th century sea voyages. Asia Pacific Journal of Clinical Nutrition, 12:129-137.

Image source: Creative Commons, https://en.wikipedia.org/wiki/James_Cook