The credit for forcing a general acceptance of the antiscorbutic value of fresh food belongs to Lind. He did not, however, have an easy task, and in 1747, in order to convince those who still were skeptical, he resorted to an experiment on human beings. Twelve patients in his hospital were given the same diet, except that some received sea-water in addition to their dietary, others vinegar, or elixir of sulphuric acid, or a daily portion of cider, or oranges and one lemon daily. The last two groups, as we should expect, recovered quickly; one man who received cider improved, but in no other case was any alleviation noted.
Lind extols the value of lemons and oranges, of berries, of sour cabbage, of cider, and of all fresh fruits and vegetables. In spite of the fact, however, that Lind’s teaching was based on an experience with thousands of patients suffering from scurvy in the naval hospital, his ideas did not take root. It required an event which came directly under the official eye to bring about radical changes in the diet of the sailors. In 1795 the English Fleet suffered from a severe epidemic of scurvy, which was finally controlled by giving the sailors fresh vegetables and fruit. This therapeutic result was so convincing that thenceforth a daily ration of lime juice was ordered for the sailors and a regular issue provided for the navy. This marks the cessation of scurvy as a scourge of the British navy. From this time the disease appeared only sporadically. The sharp decrease in the incidence can be appreciated by Budd’s statement that 1457 cases of scurvy were admitted to the Royal Naval Hospital in 1780, whereas in 1810 an English physician reported that in the seven preceding years he had not treated a single patient in this hospital suffering from scurvy. In another marine hospital, between the years 1806 and 1810, only two cases of scurvy were admitted.
Nothing was done for the British merchant service until over half a century later, although scurvy continued to make its appearance among the sailors with varying severity. Smith states in the article on this subject in Allbutt’s System of Medicine: “In 1864 it was pointed out by Doctor Barnes that during the twelve years following 1851, 1058 cases of scurvy had been admitted into the hospital ship Dreadnought.” In 1854 a law was passed requiring every vessel to carry an adequate supply of lime juice. This law, however, failed in effect, due to the fact that a large part of the lime juice was adulterated. A new shipping-act was passed, therefore, in 1867, with the object of preventing adulterations, at the same time increasing the daily quota for each seaman from half an ounce to one ounce.
It may be of interest to add a few words concerning certain antiscorbutics which have been under discussion or recognized for so many years that they have acquired an historical aspect. One of these foodstuffs is sauerkraut, which was recognized by Lind in 1772 as having particular potency in this disease. It is interesting to note, in this connection, that this writer appreciated the close relationship of acidity to antiscorbutic virtue. “One quality,” he writes, “entering the most perfect antiscorbutic composition is a vegetable accescency.” He prized sauerkraut for its inherent value, and particularly, because he found that “sour cabbage will keep for an East-India voyage.”
The famous navigator Cook, whose voyages were remarkable for the freedom from illness which his sailors enjoyed and the absence of scurvy, always kept a large supply of sauerkraut on hand. It was believed by many that the immunity of the Dutch seamen to scurvy was due to their large consumption of this vegetable. As the result of this empirical knowledge, the English navy in 1780 introduced the use of sauerkraut into its ration. As just noted, however, this antiscorbutic was supplanted some few years later by an issue of lime juice.
It is common knowledge that outbreaks of scurvy follow closely upon a failure of the potato crop. This has been particularly the case in Ireland, where it was especially evident in relation to the great epidemic of scurvy in 1847. Holst and Froelich inform us that “all scurvy epidemics in Norway in the nineteenth and beginning of this century followed failure of the potato crop.” Nor is this danger past. In an article entitled “The Rôle of Antiscorbutics in Our Dietary,” the author recently reported that the partial failure of the potato crop in the eastern part of the United States led to the development of scurvy in numerous institutions, in one of which over 200 cases of definite scurvy developed in the spring (1916).
The occurrence of scurvy in the navy and on sailing vessels has been associated in the minds of many with the large amounts of salted meat which necessarily was included in the dietary. It was evident that meat that was salted had no antiscorbutic value, but the query has been raised whether eating a considerable amount of salted meat did not induce scurvy. Lind mentions “flesh long salted” as leading to the development of scurvy. The question of the value of meat as an antiscorbutic is of importance at the present time, chiefly in connection with Polar expeditions and army rations. As the result of an outbreak of scurvy in the Polar expedition of 1875–6, a British Arctic Survey Committee was appointed to make an investigation. In 1877 it reported that “although the scurvy was due to the absence of lime juice from the sledge dietaries, meat in large amounts is able to prevent the disease.” Stefánsson also emphasized the value of meat in preventing scurvy in the Polar regions. In his expeditions he has found that raw meat, if taken in sufficient quantity, is able to afford complete protection. Jackson, who lived for some years among the Samoyeds, tells us that this tribe, owing to the fact that they consumed considerable reindeer meat, never suffered from scurvy in spite of the fact that they ate no vegetables or fresh fruit during the winter.
The following account, a personal communication from Dr. Harrison J. Hunt, who spent four years in the Arctic regions, is of interest in this connection:
“For some four years I was with the Smith Sound Eskimos, on the northwest coast of Greenland. These people get nothing but animal food normally, and have lived that way for many generations, yet are healthy, of good physique, and are normal in other ways. Scurvy was unknown to them as far as I could ascertain; certainly there was none while I was among them. Much of their meat is eaten raw, and the rest only partly cooked; that is, ‘rare done.’
“Whalers who were accustomed to winter in Hudson Bay practically always had scurvy in the crew. It was common knowledge among the captains that fresh meat was curative of scurvy, and it was their practice to obtain meat from the Eskimos whenever possible for that purpose. The last English expeditions to the South Polar regions were afflicted with scurvy which was entirely and quickly eradicated by the use of fresh seal meat in the place of salt meats and canned foods. They do not state that this meat was eaten raw or even rare cooked. On the Danish coast of Greenland, during seasons poor in game, scurvy is quite common, but the natives there live largely on breadstuffs (very coarse rye bread). Personally, during my four years in the Arctic, I took no fresh vegetables whatever, or other commonly-called antiscorbutics, relying solely on rare or raw meat. I never was stronger or more healthy in my life. I did have dried fruits and vegetables, and usually plenty of fresh bread. Usually the Eskimos eat their raw meat in a frozen condition, and I can attest that it is extremely palatable in that condition.”
We do not wish to discuss, in this place, the value of meat as an antiscorbutic; in passing, however, it may be said that, as in the case of the other antiscorbutics, its efficacy will depend largely upon the amount consumed. The British Mesopotamia Commission Report of 1917 shows that scurvy can develop on a ration which includes 28 ounces of meat a week. We must remember, however, that this refers to cooked meat, whereas in the Polar expeditions meat generally was eaten in a raw state.