Lands of Red and Gold #111: An Abscorbing Tale
From: The Riddle of Scurvy
By Lucas Montpelier, PhD, BMedMD, TjY
The riddle of scurvy is truly three riddles. The first is how the riddle of scurvy was solved in Europe. The second is how the riddle of scurvy was solved in Aururia. The third riddle is why the solution which was known for so many decades in Aururia was never found and applied by Europeans...
The truth of scurvy is well-known today. It is a lack of an essential micronutrient, ascorbic acid [Vitamin C], which is abundant in a wide variety of fresh foods but which is destroyed by most methods of cooking or food preservation. Throughout recorded history, scurvy has been a sporadic problem, particularly during winters in temperate or arctic climates where fresh food is harder to find. It became a much direr problem when people began undertaking long ocean voyages, especially during the Renaissance in Europe and since the emergence of the Nuttana in Aururia. During such voyages, access to fresh food was often impossible, and scurvy became the scourge of sailors...
In Europe, awareness of scurvy went back to Hippocrates or beyond, but knowledge of the treatment was lost and regained repeatedly. Scurvy probably remained a seasonal affliction of uncertain prevalence in much of medieval Europe, particularly more northerly latitudes, although surviving records are sparse. Its prevalence increased with the Age of Sail, as extended ocean voyages meant that fresh foods were consumed or decomposed and sailors could consume only ascorbate-free preserved foods.
The risks were greater the longer a voyage progressed, as bodily stores were exhausted and the disease robbed the sufferers of vitality and, all too often, of life. When Ferdinand Magellan’s expedition circumnavigated the globe in 1519, half of his crew died of scurvy. Two million sailors, it is thought, perished of scurvy during the height of the Age of Sail, between about 1500 and 1800.
Practical knowledge of how treat scurvy was common with some mariners, but alas often not transmitted widely, and largely spurned by the medical establishment. Since the time of Vasco da Gama in 1497, some Portuguese sailors recognised the curative power of citrus when treating scurvy. Some English sailors recognised the same benefit, with Admiral Hawkins promoting citrus juice in 1593 as a preventative for scurvy. This realisation was, alas, often not transmitted effectively, with travellers and mariners often not revealing the particular benefits of citrus. Even when they did, the limited food preservation and storage technologies of the era meant that fresh food could scarcely be kept sufficiently long to sustain sailors through extended voyages.
The European medical establishment, obsessed with following ancient medical sources and disparaging of practical knowledge, invented a great many fanciful theories for the origin of scurvy, but did not properly put them to the test. Medical thought was dominated by the writings of Hippocrates, and his theory of the four humours was sought as the explanation for all diseases, scurvy included. John Echth, a Dutchman, early in the sixteenth century deemed scurvy as a disease of black bile. The theory held sway over much of the medical establishment for the next two centuries, leading to many creative but futile proposals for curing scurvy by addressing the supposed imbalance in black bile.
Realisations of the value of fresh food in general and citrus in specificity held little influence in such settings. Even when the black bile theory was gradually abandoned, replacement theories focused on supposed problems with digestion and similar matters, and gave little heed to the discoveries of practical men. When presented with genuine knowledge, medical scholars developed further theories but made no effort to test those theories.
In a notable example, The evidence that lime and lemon juice could cure scurvy was tpresented to the English College of Physicians in London. Their reasoning was that these were acidic, and since good health required a balance of acid and alkaline in the body, scurvy must be caused by an imbalance of alkaline in the digestion, and therefore it could be remedied by consuming a stronger acid: sulphuric acid, or elixir of vitriol as it was called at this time. This led to the tragic situation where for over a century the Royal Navy sought to cure scurvy with elixir of vitriol, mixed with various flavourings to make it palatable, such as hard liquor, barley water, or a selection of spices.
Occasional scholarly publications about the value of fresh food in curing scurvy were still made, such as the Bavarian physician Wolfgang Blucher in 1731. Tragically, these were largely brushed aside by the medical establishment as not conforming with existing theories of disease.
While not penetrating into medical academia, more practical mariners nonetheless continued to apply various forms of fresh foods as preventatives or cures for scurvy. Mariners took to planting citrus trees and other suitable crops at islands and ports throughout the world, so that ships could conveniently resupply. Aururians had long known of the value of their local sweet sarsaparilla (Smilax glyciphylla), whose leaves could be made into a tea which quickly cured scurvy, and shared this knowledge with visiting Dutch sailors in the early seventeenth century. This led to Dutch and English sailors planting the vine to grow wild around many of the tropical and subtropical coasts across the globe, where it could be retrieved by any passing sailors to restore any scurvy-afflicted comrades to health. Regrettably, dried sarsaparilla suffered from the same problems as most other food preservation methods, with the ascorbic acid largely lost in the drying, and so it could not provide a proper preventative solution.
Citrus fruits and juices continued to be used intermittently, where available and amongst sailors who had heard of its properties. Some naval surgeons, who tended to be more practical than land-based theory-driven doctors, used citrus juice on occasion. Many other would-be cures were also used. Elixir of vitriol remained a perennial favourite. Vinegar was often tried, on the same acidic reasoning. Other popular cures, influenced by the writings of one medical scholar or another, included wort of malt (fermentable barley malt), sea water, cider in both the European and Aururian fashion, hard work, sweet-pepper water, and bleeding...
The first Europeans to conduct what were in effect clinical trials about treatments for scurvy were Herbert Shuttleworth, a naval surgeon, and Reverend Hector McGinty, a ship’s chaplain. On the HMS Kingfisher during the Nine Years’ War, Shuttleworth and McGinty obtained permission from the ship’s captain to try a variety of the proposed cures for a group of fifteen sailors who were suffering from severe scurvy. This type of practical trial was almost unknown amongst European medicine at the time, despite a similar practice being in place in Aururian medicine for centuries.
Shuttleworth provided two sailors each with lemons and limes, vinegar, sweet-pepper water, European cider, salt water, nutmeg, and elixir of vitriol. The remaining sailor was provided with fresh air on deck, another proposed cure. Shuttleworth found that the sailors provided with lemons and limes recovered rapidly, while the others showed no meaningful improvement.
Shuttleworth published his discoveries in a treatise called Observations on Scurvy in 1758. Tragically, while Shuttleworth’s proposed cure was efficacious, his reasoning was not. Shuttleworth thought that scurvy was caused because the humid atmosphere at sea, and particularly aboard crowded ships, causes the pores the skin to stop working. In turn, he thought that this lack of effective perspiration meant that toxins accumulated in the body, since at the time the belief was that this was the means which permitted toxins to be expelled from the body. Shuttleworth thought that lemon juice cured scurvy because it had a cleansing action which opened the pores and permitted the toxins to be cleared from the body [1]. The medical establishment rejected his theory because it could not explain other occasions of scurvy on land, such as during sieges, and thus the treatment of scurvy remained mired in bad cures.
During the second half of the eighteenth century, the dominant theory explaining scurvy shifted based on new findings, but remained unfortunately misguided. Sufficient publications showed that scurvy could be cured by non-acidic fresh vegetables, so the acidic theory became gradually abandoned.
Poul Sørensen, a Danish physician who had migrated to London, concluded that the common property of all of the known curative fruit and vegetables was that they were readily fermentable. He therefore recommended using a readily fermentable material, wort of malt, which is barley which has been moistened, partially sprouted, then heat-dried. This was normally used in brewing beer. Sørensen’s reasoning was that wort of malt was known to be fermentable even when stored on conditions similar to those on board ships, and that therefore it should preserve the same character of scurvy prevention. This was in one sense an advance, involving as it did the realisation that food preservation methods were linked to scurvy, but unfortunately still entirely incorrect.
The realisation of the proper value of citrus waited another three decades. Naval authorities and commercial traders were not idle in between, for as the eighteenth century marched onward, the volume of shipping grew ever larger, and the toll from scurvy ever greater. Many reputed antiscorbutics were applied, though wort of malt remained the most favoured, but no-one replicated the careful trials of Shuttleworth and McGinty, so it was not possible to distinguish between cures which were useful and those of no value.
The solution to the riddle of scurvy, or more specifically the European solution, came in 1789 when a French physician named Antoine Hébert convinced the Compagnie d’Orient to trial a ration of lemon juice preserved in brandy. This was applied in a voyage from Nantes to Jugara [Victor Harbor], where three ships were sent, each issued with sufficient preserved lemon juice to provide their sailors with a daily ration. After a voyage of ninety-five days without stopping anywhere en route, the ships arrived in Jugara. Not only had they not lost any crew members to scurvy, the crew were reported to be healthier than when they left. Scurvy had been vanquished.
Triumphant though this discovery was, to modern ears it is tragic that if those sailors had asked properly at Jugara, they would have heard a solution for scurvy which had been applied for most of the previous century...
In Aururia, records of scurvy are likewise ancient. Kuritja (c.65 BCE-AD 3), one of the pre-eminent early Five Rivers physicians [3], has had most of his works lost except those which are preserved through quotations in subsequent sources. One of his preserved quotations describes which is clearly scurvy, and prescribes any of several fruits as a remedy.
Pre-Houtmanian Aururian sources, both those in the Five Rivers and other states such as Teegal and Durigal, describe scurvy as a disease rare in frequency but widespread in location. It does not appear to have been particularly frequent, but happened in many regions on occasion, most commonly after wildfires or sometimes more severe winters. Traditional cures were equally widespread, inevitably involving some food or foods which are notably rich in ascorbic acid, yet usually ascribing the cure to the properties of those specific foods rather than the value of fresh food in general. The most frequent remedies were those involving Aururian Citrus species, sweet sarsaparilla, and a leaf vegetable little known outside the Third World whose most common native name translates as “tooth-tightener,” a reference to the gum disease and loosened teeth associated with scurvy, and the vegetable’s ability to cure that if eaten [4]. Tooth-tightener was valuable because it kept its leaves for most of the year, and so could be picked as a cure for scurvy even in conditions where few other foods were available.
In most respects, then, scurvy in pre-Houtmanian Aururia was much as it was in pre-Rennaissance Europe: an occasional malady but not especially worse than any number of other nutritional or infectious diseases which plagued both continents. This state of affairs began to change in Aururia for the same reasons it did in Europe, namely, when the first Aururians began to make long enough ocean voyages for scurvy to become a major risk.
For centuries before and after de Houtman, Aururia’s premier mariners were the Nangu, or as they later became, the Nuttana. Their pre-Houtmanian voyages were usually not long enough to risk scurvy, especially since Nangu sailors generally had a good diet [5]. Consequently, this malady did not meaningfully afflict the Nangu until they founded the Nuttana in 1634 and started longer voyages to Asia, India and in time other continents.
The Nuttana spent several decades seeking to manage scurvy by traditional cures, to scant meaningful success. Plantation of known cures in friendly ports assisted in the speedy recovery of afflicted sailors when they arrived, but this was only a small fraction of the problem, especially when visiting foreign ports where the locals could not or would not grow the necessary cures.
Scurvy presented a far greater problem to the Nuttana than it did to Europeans, due to one simple truth: the Nuttana were far more pressed for manpower than Europeans. Aururia in the seventeenth century faced dramatic population decline due to the toll of Old World diseases ravaging the continent. The Nuttana fared relatively better in this onslaught than most of their fellow Aururians, for reasons which are still debated, but even they were critically short of manpower. Losing large numbers of sailors to scurvy presented a graver threat for them than European mercantile and naval powers, since the lost manpower could not be conveniently replaced.
After the particularly severe toll of the 1660s and 1670s, when measles, diphtheria and pertussis [whooping cough] together ravaged Aururia, the need to preserve manpower became so pressing that the Nuttana bloodlines turned to an expensive solution. They sent a delegation to the newly-established Panipat in 1674, and offered to pay the physicians there to develop a cure or preventative for scurvy.
The Nuttana request provoked a heated dispute between different classes of Five Rivers medical professionals. For centuries, the Five Rivers had maintained a division between what were deemed natural and spiritual illnesses, with the distinction being approximately those diseases with clear external symptoms and those with only internal symptoms. The natural illnesses were treated by the physician class, who had a more practical mindset to identifying and curing illness and injury. The spiritual illnesses were treated by a separate class of priest-healers, whose methods did not involve physical contact. The priest-healers considered themselves superior, and generally the public did too, although physicians often held different views.
The priest-healers claimed that scurvy, in so far as it appeared in long-range ships, was a spiritual illness, and cited symptoms such as the general lethargy and listlessness associated with early scurvy, and changes in temperament often observed in later stages. Physicians disagreed, citing physical symptoms such as bleeding gums, skin changes, and skin bleeding as evidence that it was a physical disease. Physicians quoted early authorities of land-based scurvy which showed that it had been anciently considered a natural illness, while priest-healers retorted that naval scurvy was a new illness with greater malaise and temperament change.
The disputes were perhaps inevitable with the lucrative rewards offered by the Nuttana for cures. The determinative point was that the Nuttana had more trust in physicians than priest-healers, doubtless because of their own religious views, and so gave progress payments to physicians in preference to priest-healers. The priest-healers continued their own efforts, but had no more success than European doctors of the same period. While it is outside of this main tale, the success of the physicians and failure of the priest-healers in curing scurvy was a major factor into the shift of the Five Rivers priest-healer class into treating diseases of the mind, rather than the body...
Solving the problem of scurvy presented an immediate challenge, namely that first the physicians had to learn to induce scurvy. No Five Rivers physician had any interest in risking their own life or health in long sea voyages, so they first had to learn how to trigger scurvy in humans before they could attempt cures. Given that they had a general knowledge that fresh food could cure scurvy, this meant various groups of Five Rivers physicians adopting independent programs of inducing scurvy by depriving volunteers [6] of certain kinds of food on their diet, based around what they knew was harder to find during winters and post-wildfires. A couple of more astute physicians even replicated what they could of Nuttana sailors’ diets.
The process took several years, partly because there was not an unlimited number of volunteers, and because of the inevitable distraction of Five Rivers physicians into seeking to cure other diseases in an epidemic-ravaged continent. Indeed, some physicians themselves died during this period.
Despite setbacks, by the early 1680s several groups of physicians knew how to induce scurvy reliably. With that knowledge available, the physicians set about the more arduous process of trying potential cures. By modern standards, their trials were far from rigorous, since they often trialled multiple cures on the same patients, moved patients between groups, and often did not have control groups. Nonetheless, in comparison to contemporary European medical practice, their efforts were incredibly advanced.
For several more years, the physicians’ efforts largely found a group of solutions which did not work. They confirmed the known properties of the various Aururian plants which could cure the disease, and even experimented with various imported European crops such as onions and tomatoes and concluded that they, too, could cure scurvy when fresh. These cures were quickly shown to lose their value when dealing with dried or otherwise preserved foods, and were thus of no practical benefit aboard ships.
As with European doctors, Five Rivers physicians invented many possible theories to explain scurvy. The distinction was that the physicians were more practical in seeking to apply these to cures. The most common theory was that scurvy was linked to life-essence, which needed to be consumed fresh, and that this life-essence faded from preserved foods and so could not sustain life in the crew. Others thought that since most foods that cured scurvy were green, green foods maintained a common quality that was needed to maintain life, and sought to find a kind of green food which could keep well when dried and therefore might cure scurvy...
Eventually, after nearly two decades of failed efforts, two physicians discovered independent methods of preventing scurvy. In 1694, a Gutjanal physician named Banangra, working at the Panipat, discovered largely by accident that there was a preserved food which prevented scurvy almost entirely. For centuries, the Abunjay on the Tjibarri coast had used a method of preserving murnong, where they chopped it into small pieces, salted it, and stored it in sealed containers. This led to the murnong being fermented by lactic acid fermentation from naturally occurring bacteria. The Abunjay called this fermented murnong minabee, and enjoyed it for its distinctly sour taste, both when preserved alone and sometimes with flavourings as well.
The process of preserving minabee is similar to other fermented foods such as kimchi and sauerkraut. Foods preserved in this manner can keep for several months if sealed, particularly if kept in a cool location. Most importantly, this method of food preservation leaves the ascorbic acid content largely intact, and therefore can be consumed to prevent scurvy.
Banangra did not deliberately set out to test minabee as a preventative for scurvy. This particular dish was not popular in most of Tjibarr, but was occasionally imported by Abunjay who had migrated inland from the coast. When attempting to induce scurvy in preparation for testing his latest planned cures, Banangra was unable to obtain enough of the usual dried and salted foods used for that purpose, and added some minabee which happened to be available cheaply at the time.
To Banangra’s complete astonishment, the four volunteers fed his test diet simply did not develop scurvy within the expected period of four to six weeks. He prolonged the test for fifteen weeks, until he had run out of preserved foods entirely, but still the volunteers showed no signs of scurvy.
Banagra was alert enough to realise that all which had changed was the minabee diet, and he set about testing it again with fresh volunteers and in various forms. By August 1694, he felt confident enough to announce to his fellow physicians, and to the Nuttana, that he had found a method of preventing scurvy...
In 1696, another physician named Welbee adopted a more inspired approach where he reasoned that particular foods might be available on ships that could maintain sufficient health even with a generally scurvy-inducing diet. He sought to trial whether specific foods could be made or kept fresh on board ships, and still prevent scurvy. He had an early piece of fortune when he chose to trial feeding a goat the same diet as the volunteers, but then feed the goat’s milk to the volunteers. Welbee discovered, to his delight, that it appeared that goat’s milk could still maintain its properties of scurvy prevention with the diet that a goat ate on board ship. He therefore recommended ships carry several goats, milk them and feed the milk to sailors in rotation so that they could share in the antiscorbutic properties of goat’s milk...
Adopting ship’s goats caused no unmanageable problems, although ships could not realistically carry enough goats to supply the required amount of milk to prevent scurvy in all of their crew. In practice, the rotation of goat’s milk significantly slowed down the progress of scurvy, but it needed to be supplemented by abundant fresh food at stopovers to be effective. The Nuttana use of ship’s goats was still widespread and noted enough that sailors from other trading companies started to refer to first Nuttana sailors, then all Nuttana, as goaties.
The use of fermented food like minabee held more promise in some respects, but faced two problems. The known successful food, murnong, simply did not grow near the Nuttana homelands, and around their core cities the climate was too hot to permit convenient fermentation. Transporting it in bulk from southern Aururia was impractical even when it was available to buy. Fortunately for the Nuttana, around this period their farmers and gold miners were moving into the highlands [Atherton Tableland] near Dangelong [Cairns], which was sufficiently cooler for fermentation of suitable crops. The Nuttana experimented with sweet potatoes and lesser yams, both of which proved to have the same antiscorbutic properties as murnong when made into minabee. Nuttana ships therefore started to carry this food in their stores, too, and scurvy became much less of a problem for them...
The third and perhaps most perplexing riddle is why Europeans did not learn of and adopt Aururian methods of scurvy prevention. Some scholars have credited the Nuttana’s effort to keep their scurvy prevention method a trade secret, but it is plain that some of their sailors talked about it to Europeans, both while sailing and when foreign sailors working for the Nuttana returned home. This would-be explanation also ignores the greater problem that Five Rivers physicians wrote openly of their discovery of these two solutions, and indeed of further trials over the following decades where they identified refined methods of preventing scurvy. Five Rivers physicians wrote both in their own languages and sometimes in European languages, and their books were readily available in their higher learning institutions and elsewhere.
The Five Rivers, after all, were never fully isolated from European contact at any point from the 1630s onward. European sailors visited their ports, European travellers ventured inland on many occasions. The riddle becomes more troubling when it is realised that Five Rivers soldiers served alongside Europeans during the Nine Years’ War. It becomes the most troubling of all when one considers the time when Five Rivers sailors belatedly joined the naval commerce race and came into regular contact with European sailors over much of the world, but still the European trading companies did not recognise and apply the solution to scurvy.
The Tjibarri factions are known to have tried to sell the secret of preventing scurvy to European trading companies on several occasions in the first half of the eighteenth century. It appears that the East India companies were sceptical in most cases, based on the Tjibarri reputation for duplicity, and a general belief that there was nothing which they could learn from backwards heathens. On the few occasions where the solution was discussed, it was dismissed out of hand by doctors back in Europe...
Fundamentally, the failure to learn of the method of scurvy prevention can only be explained by European scholars’ general unwillingness to learn non-European languages, and an unhealthily strong but misguided belief in cultural superiority.
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[1] The first European to conduct clinical trials on scurvy historically, James Lind, had a similar belief which may have hindered takeup of his observations for curing scurvy.
[2] A similar cure was espoused historically by David MacBride, although based on a different view of preventing putrefaction and bad air rather than the allohistorical theory involving preservability.
[3] Five Rivers physicians draw from a long tradition of publication of their observations, but never had the same veneration of earlier physicians equivalent to the esteem in which Hippocrates was held in the European medical tradition, where until relatively recently his works were often searched for cures without applying experimentation. In the Five Rivers medical tradition, earlier sources are reviewed and applied where relevant, but often questioned and corrected by later physicians.
[4] This is the plant which is historically known as scurvy weed (Commelina cyanea), which early European colonists used to collect wild as a cure for scurvy because its edible leaves contained high levels of ascorbic acid.
[5] European sailors of the Age of Sail, particularly those conscripted into navies during wartime, were usually from the lower echelons of society, and generally had poor diets to begin with. This meant that that their bodies tended to have lower stores of ascorbic acid before they started the voyages, and therefore that they exhausted those stores sooner and were more vulnerable to scurvy. (It is no coincidence that scurvy was a more common affliction of enlisted sailors than officers, for example.) Being from a wealthy island with an abundance of imported food, including fresh food, and plentiful seafood, Nangu sailors usually went sailing with better bodily reserves of ascorbic acid and thus would need to sail for longer before scurvy became a danger.
[6] Some volunteers being more voluntary than others, presumably.
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Thoughts?
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