Scurvy
Encyclopedia
Scurvy is a disease resulting from a deficiency of vitamin C
, which is required for the synthesis of collagen
in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic ("of, characterized by or having to do with scurvy"). Scurvy often presents itself initially as symptoms of malaise and lethargy, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membrane
s. Spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, jaundice, fever, neuropathy and death.
Scurvy was at one time common among sailor
s, pirates and others aboard ships at sea longer than perishable fruits and vegetables could be stored (subsisting instead only on cured
and salted meats and dried grain
s) and by soldiers similarly separated from these foods for extended periods. It was described by Hippocrates
(c. 460 BC–c. 380 BC), and herbal cures for scurvy have been known in many native cultures since prehistory. Scurvy was one of the limiting factors of marine travel, often killing large numbers of the passengers and crew on long-distance voyages. This became a significant issue in Europe from the beginning of the modern era in the Age of Discovery
in the 15th century, continuing to play a significant role through World War I in the 20th century.
Today scurvy is known to be caused by a nutritional deficiency, but until the isolation of vitamin C and its direct link to scurvy in 1932, numerous theories and treatments were proposed, often on little or no experimental data. This inconsistency is attributed to the lack of vitamin C as a distinct concept, the varying vitamin C content of different foods (notably present in fresh citrus, watercress, and organ meat), and how vitamin C can be destroyed by exposure to air and copper.
Treatment by fresh food, particularly citrus fruit, was periodically implemented, as it had been since antiquity, but the ultimate cause of scurvy was not known until 1932, and treatment was inconsistent, with many ineffective treatments used into the 20th century. It was a Scottish surgeon in the British Royal Navy
, James Lind who first proved it could be treated with citrus fruit in experiments he described in his 1753 book, A Treatise of the Scurvy, though his advice was not implemented by the Royal Navy for several decades.
In infants, scurvy is sometimes referred to as Barlow's disease, named after Sir Thomas Barlow
, a British physician
who described it. (N.B. Barlow's disease may also refer to mitral valve prolapse
.) Other eponyms include Moeller's disease and Cheadle's disease.
Scurvy does not occur in most animals because they can synthesize their own vitamin C. However, humans and other higher primates (the simian
s and tarsier
s), guinea pigs, most or all bats, and some species of birds and fish lack an enzyme (L-gulonolactone oxidase
) necessary for such synthesis and must obtain vitamin C through their diet. Vitamin C is widespread in plant tissues, with particularly high concentrations occurring in citrus fruits (oranges, lemons, limes, grapefruits), tomatoes, potatoes, cabbages, and green peppers.
, so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason, but heat and storage destroy vitamin C. Human breast milk
contains sufficient vitamin C, if the mother has an adequate intake.
Scurvy is one of the accompanying diseases of malnutrition
(other such micronutrient deficiencies are beriberi
or pellagra
) and thus is still widespread in areas of the world depending on external food aid. Though rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.
is needed for a variety of biosynthetic pathways, by accelerating hydroxylation
and amidation reactions. In the synthesis of collagen
, ascorbic acid is required as a cofactor for prolyl hydroxylase
and lysyl hydroxylase
. These two enzymes are responsible for the hydroxylation of the proline
and lysine
amino acids in collagen. Hydroxyproline and hydroxylysine are important for stabilizing collagen by cross-linking the propeptides in collagen. Defective collagen fibrillogenesis impairs wound healing. Collagen is also an important part of bone, so bone formation is also affected. Defective connective tissue also leads to fragile capillaries, resulting in abnormal bleeding.
and lethargy. After 1–3 months, patients develop shortness of breath and bone pain. Myalgia
s may occur because of reduced carnitine
production. Other symptoms include skin changes with roughness, easy bruising and petechiae, gum disease, loosening of teeth, poor wound healing, and emotional changes. Dry mouth and dry eyes similar to Sjögren's syndrome
may occur. In the late stages, jaundice
, generalized edema
, oliguria, neuropathy, fever, and convulsions, and eventual death are frequently seen.
or lemons. Other sources rich in vitamin C
are fruits such as blackcurrants, guava
, kiwifruit
, papaya
, tomatoes, bell peppers, and strawberries. It can also be found in some vegetables, such as carrots, broccoli
, potatoes, cabbage
, spinach
and paprika
. Some fruits and vegetables not high in vitamin C may be pickled in lemon juice
, which is high in vitamin C. Though redundant in the presence of a balanced diet, various nutritional supplements are available that provide ascorbic acid well in excess of that required to prevent scurvy, and even some candies
and most soft drink
s contain vitamin C as a preservative.
Many animal products, including liver
, Muktuk
(whale skin), oysters, and parts of the centrail nervous sytem, including the brain, spinal cord, and adrenal medula, contain large amounts of vitamin C, and can even be used to treat scurvy.
Fresh meat from animals which make their own vitamin C (which most animals do) contains enough vitamin C to prevent scurvy, and even partly treat it. This caused confusion in the early history of scurvy, since the disease was only seen in people eating long-preserved diets or canned goods, but not in people eating any sort of fresh diet, including arctic diets primarily based upon meat. In some cases (notably in French soldiers eating fresh horse meat) it was discovered that meat alone, even partly cooked meat, could aleviate scurvy. Some of these observations that scurvy was only associated with preserved foods, prompted explorers to blame scurvy upon some type of tainting or poison which pervaded tinned foods.
, and Egyptians have recorded its symptoms as early as 1550 BC. The knowledge that consuming foods containing vitamin C is a cure for scurvy has been repeatedly rediscovered and reforgotten into the early 20th century.
frequently suffered from scurvy. In the 1497 expedition of Vasco de Gama, the curative effects of citrus fruit were known. In 1536, the French explorer Jacques Cartier
, exploring the St. Lawrence River
, used the local natives' knowledge to save his men who were dying of scurvy. He boiled the needles of the arbor vitae
tree (Eastern White Cedar) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams. Such treatments were not available aboard ship, where the disease was most common.
Between 1500 and 1800, it has been estimated that scurvy killed at least two million sailors. According to Jonathan Lamb, "In 1499, Vasco da Gama lost 116 of his crew of 170; In 1520, Magellan lost 208 out of 230;...all mainly to scurvy."
In 1593 Admiral Sir Richard Hawkins
advocated drinking orange and lemon juice as a means of preventing scurvy.
The British civilian medical profession of 1614 believed that it was the acidic principle of citrus fruit which was lacking, although they considered any acid acceptable when ascorbic acid (Vitamin C) was unavailable. In 1614 John Woodall
, Surgeon General of the East India Company
, published "The Surgion's Mate" as a handbook for apprentice surgeons aboard the company's ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds, or as a last resort, Oil of Vitriol (sulfuric acid
).
contains a "Recp.t for the Scurvy" that consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine or beer.
In 1734, the Leiden-based physician Johann Bachstrom
published a book on scurvy in which he stated that "scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease" and urged the use of fresh fruit and vegetables as a cure. In 1740, citrus juice (usually lemon
or lime juice) was added to the recipe of the traditional daily ration of watered-down rum
known as grog
to cut down on the water's foulness. Although they did not know the reason at the time, Admiral Edward Vernon
's sailors were healthier than the rest of the navy, due to the daily doses of vitamin C
the sailors received. However, it was not until 1747 that James Lind formally proved that scurvy could be treated and prevented by supplementing the diet with citrus fruit such as limes or lemons, though not by other acids, in the first ever clinical trial
. In 1753, Lind published A Treatise of the Scurvy, in which he explained the details of his clinical trial and how scurvy was successfully eradicated from his test subjects (nuns). He then attempted to sell extracted lime juice as a medicine, but the lime juice had no effect in treating scurvy, due to the oxidization of vitamin C. Therefore, this solution was not adopted by the Royal Navy until the 1790s, and the idea that any acid would suffice continued in Britain into the late 19th century.
During the 18th century, scurvy killed more British sailors than enemy action. It was mainly by scurvy that George Anson
, in his celebrated voyage of 1740–2, lost within the first ten months nearly two-thirds of his crew (1300 out of 2000). During the Seven Years War, the Royal Navy reported that it conscripted 184,899 sailors, of whom 133,708 died of disease or were 'missing', and scurvy was the principal disease.
James Cook
succeeded in circumnavigating the world (1768–71) in HM Bark Endeavour
without losing a single man to scurvy, but his suggested methods, including a diet of sauerkraut
and wort
of malt, were of limited value. Sauerkraut was the only vegetable food that retained a reasonable amount of ascorbic acid in a pickled state, but it was boiled to reduce it for preservation and much of the vitamin C content was lost. In Cook's time it was impractical to preserve citrus fruit for long sea voyages. More important was Cook's regime of shipboard cleanliness, enforced by strict discipline, as well as frequent replenishing of fresh food. The most effective regime implemented by Cook was his prohibition against the consumption of fat scrubbed from the ship's copper pans, then a common practice in the Navy. In contact with the hot copper, this fat acquired substances which possibly irritated the gut and prevented proper absorption of vitamins.
The first major long distance expedition that experienced virtually no scurvy was that of Alessandro Malaspina
, 1789–1794. Malaspina's medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at Guam
all five were healthy again. Spain's large empire
and many ports of call made it easier to acquire fresh fruit.
Despite advances, British sailors throughout the American Revolution
ary period continued to suffer from scurvy, particularly in the Channel Fleet. The eradication of scurvy from the Royal Navy in the 1790s was finally due to the chairman of the Navy's Sick and Hurt Board, Gilbert Blane
, who finally put Bachstrom and Lind's long-ignored prescription of fresh lemons to use during the Napoleonic Wars
. It led to a remarkable health improvement among the sailors and consequently played a critical role in naval battles, notably the Battle of Trafalgar
. Other navies soon adopted this successful solution.
helped the French to curb an epidemic of scurvy. The meat was cooked but was freshly obtained from young horses bought from Arabs, and was nevertheless effective. This helped to start the 19th-century tradition of horse meat consumption in France.
Lauchlin Rose patented a method used to preserve citrus juice without alcohol in 1867, creating a concentrated drink
known as Rose's lime juice
. The Merchant Shipping Act of that same year required all ships of the Royal Navy
and Merchant Navy
to provide a daily lime
ration to sailors to prevent scurvy. The product became nearly ubiquitous, hence the term "limey
", first for British sailors, then an English immigrant in the former British colonies (particularly America, New Zealand and South Africa), and finally, in old American slang, all British people.
The plant Cochlearia officinalis
, also known as "Common Scurvygrass", acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. Its very bitter taste was usually disguised with herbs and spices; however, this didn't prevent scurvygrass drinks and sandwiches becoming a popular fad in the UK until the middle of the nineteenth century, when citrus fruits became more readily available.
West Indian limes replaced lemons because they were more easily obtained from Britain's Caribbean colonies, and were believed to be more effective because they were more acidic, and it was the acid, not the (then-unknown) Vitamin C that was believed to cure scurvy. This was mistaken – the West Indian limes were significantly lower in Vitamin C than the previous lemons (having only ¼ the Vitamin C content), and further were not served fresh, but rather as lime juice, which had been exposed to air and piped through copper tubing, both of which significantly reduced the Vitamin C. Indeed, an 1918 animal experiment using representative samples of the Navy and Merchant Marine's lime juice showed that it had virtually no antiscorbutic power at all.
The belief that scurvy was fundamentally a nutritional deficiency, best treated by consumption of fresh food, particularly fresh citrus or fresh meat, was not universal in Britain in the 19th and early 20th centuries, and thus British sailors and explorers continued to suffer from scurvy into the 20th century.
In the Royal Navy's Arctic
expeditions in the 19th century it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining the morale of the crew, rather than by a diet of fresh food, so that Navy expeditions continued to be plagued by scurvy even while fresh (not jerked or tinned) meat was well-known as a practical antiscorbutic among civilian whalers and explorers in the Arctic. Even cooking fresh meat did not entirely destroy its antiscorbutic properties, especially as many cooking methods failed to bring all the meat to high temperature.
The confusion is attributed to a number of factors:
In the resulting confusion, a new hypothesis was floated, following the new germ theory of disease – that scurvy was caused by ptomaine, a waste product of bacteria, particularly in tainted tinned meat.
Infantile scurvy emerged in the late 19th century due to children being fed pasteurized cow's milk, particularly in the urban upper class – the pasteurization killed bacteria, but also destroyed vitamin C. This was eventually resolved by supplementing with onion juice or cooked potatoes.
made his two expeditions (1903 and 1911) to the Antarctic
in the early 20th century, the prevailing theory was that scurvy was caused by "tainted" meat, particularly tinned meat. Accordingly, Scott's expeditions suffered from scurvy, though he initially did not record this in his notes on his 1903 expedition, due to stigma associated with scurvy.
Vilhjalmur Stefansson
, an arctic explorer who lived among the Eskimos, proved that the all meat diet they consumed did not lead to vitamin deficiencies. He participated in a study in New York's Bellevue Hospital in 1935, where he and a companion ate nothing but meat for a year while under close medical observation, yet remained in good health. Some Antarctic expeditions, such as Scott's two expeditions and Shackleton's Ross Sea
party, suffered from scurvy, mainly during inland sledge journeys when the men had access to very limited range of food, virtually none of it fresh. Scurvy was rare or absent when they had access to a wider range of stored food or relied on seal meat.
In 1907, the needed biological-assay model to isolate and identify the antiscorbutic factor was discovered. Axel Holst
and Theodor Frølich, two Norwegian
physicians studying shipboard beriberi
contracted aboard ship's crews in the Norwegian Fishing Fleet, wanted a small test mammal to substitute for the pigeons then used in beriberi research. They fed guinea pig
s their test diet of grains and flour, which had earlier produced beriberi in their pigeons, and were surprised when classic scurvy resulted instead. This was a serendipitous choice of model. Until that time, scurvy had not been observed in any organism apart from humans, and had been considered an exclusively human disease. (Some birds are susceptible to scurvy, but pigeons, as seed-eating birds, were later found to be unsusceptible to scurvy, as they produce vitamin C.) Holst and Frølich found they could cure scurvy in guinea pigs with the addition of various fresh foods and extracts. This discovery of a "clean" (reliable) animal experimental model for scurvy, which was made even before the essential idea of "vitamins" in foods had been put forward, has been called the single most important piece of vitamin C research.
In 1927, Hungarian
biochemist
Szent-Györgyi (who won the 1937 Nobel Prize
for Medicine) for his studies in the biological functions of the compound "hexuronic acid" while working with antioxidant
compounds in the adrenal cortex
. Szent-Györgyi suspected hexuronic acid, which he had isolated from adrenal glands, to be the antiscorbutic agent, but could not prove it without an animal-deficiency model.
It was not until 1932 that the connection between hexuronic acid and scurvy was finally proven by American researcher Charles Glen King
of the University of Pittsburgh
. King's laboratory was given some hexuronic acid by Szent-Györgyi and soon established that it was "vitamin C". In honor of its antiscorbutic properties, hexuronic acid was named "ascorbic acid" by Szent-Györgyi.
suborders, the "Anthropoidea" (Haplorrhini
) (tarsiers, monkeys and apes, including human beings). The Strepsirrhini
(non-tarsier prosimians) can make their own vitamin C (these include lemur
s, the Aye-aye
, lorises, potto
s, and galago
s). Ascorbic acid is also not synthesized by at least two species of Caviidae
, the capybara
and the guinea pig
. There are known species of birds and fish that do not synthesize their own Vitamin C. All species that do not synthesize ascorbate require it in the diet. Deficiency causes scurvy in humans, and somewhat similar symptoms in other animals.
Vitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...
, which is required for the synthesis of collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic ("of, characterized by or having to do with scurvy"). Scurvy often presents itself initially as symptoms of malaise and lethargy, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
s. Spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, jaundice, fever, neuropathy and death.
Scurvy was at one time common among sailor
Sailor
A sailor, mariner, or seaman is a person who navigates water-borne vessels or assists in their operation, maintenance, or service. The term can apply to professional mariners, military personnel, and recreational sailors as well as a plethora of other uses...
s, pirates and others aboard ships at sea longer than perishable fruits and vegetables could be stored (subsisting instead only on cured
Curing (food preservation)
Curing refers to various food preservation and flavoring processes, especially of meat or fish, by the addition of a combination of salt, nitrates, nitrite or sugar. Many curing processes also involve smoking, the process of flavoring, or cooking...
and salted meats and dried grain
GRAIN
GRAIN is a small international non-profit organisation that works to support small farmers and social movements in their struggles for community-controlled and biodiversity-based food systems. Our support takes the form of independent research and analysis, networking at local, regional and...
s) and by soldiers similarly separated from these foods for extended periods. It was described by Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
(c. 460 BC–c. 380 BC), and herbal cures for scurvy have been known in many native cultures since prehistory. Scurvy was one of the limiting factors of marine travel, often killing large numbers of the passengers and crew on long-distance voyages. This became a significant issue in Europe from the beginning of the modern era in the Age of Discovery
Age of Discovery
The Age of Discovery, also known as the Age of Exploration and the Great Navigations , was a period in history starting in the early 15th century and continuing into the early 17th century during which Europeans engaged in intensive exploration of the world, establishing direct contacts with...
in the 15th century, continuing to play a significant role through World War I in the 20th century.
Today scurvy is known to be caused by a nutritional deficiency, but until the isolation of vitamin C and its direct link to scurvy in 1932, numerous theories and treatments were proposed, often on little or no experimental data. This inconsistency is attributed to the lack of vitamin C as a distinct concept, the varying vitamin C content of different foods (notably present in fresh citrus, watercress, and organ meat), and how vitamin C can be destroyed by exposure to air and copper.
Treatment by fresh food, particularly citrus fruit, was periodically implemented, as it had been since antiquity, but the ultimate cause of scurvy was not known until 1932, and treatment was inconsistent, with many ineffective treatments used into the 20th century. It was a Scottish surgeon in the British Royal Navy
Royal Navy
The Royal Navy is the naval warfare service branch of the British Armed Forces. Founded in the 16th century, it is the oldest service branch and is known as the Senior Service...
, James Lind who first proved it could be treated with citrus fruit in experiments he described in his 1753 book, A Treatise of the Scurvy, though his advice was not implemented by the Royal Navy for several decades.
In infants, scurvy is sometimes referred to as Barlow's disease, named after Sir Thomas Barlow
Thomas Barlow (medicine)
Sir Thomas Barlow, 1st Baronet KCVO FRS FRCP was a British royal physician, known for his research on infantile scurvy.Barlow was the son of a Lancashire cotton manufacturer and Mayor of Bolton, James Barlow...
, a British physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
who described it. (N.B. Barlow's disease may also refer to mitral valve prolapse
Mitral valve prolapse
Mitral valve prolapse is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. There are various types of MVP, broadly classified as classic and nonclassic. In its nonclassic form, MVP carries a low risk of...
.) Other eponyms include Moeller's disease and Cheadle's disease.
Scurvy does not occur in most animals because they can synthesize their own vitamin C. However, humans and other higher primates (the simian
Simian
The simians are the "higher primates" familiar to most people: the Old World monkeys and apes, including humans, , and the New World monkeys or platyrrhines. Simians tend to be larger than the "lower primates" or prosimians.- Classification and evolution :The simians are split into three groups...
s and tarsier
Tarsier
Tarsiers are haplorrhine primates of the genus Tarsius, a genus in the family Tarsiidae, which is itself the lone extant family within the infraorder Tarsiiformes...
s), guinea pigs, most or all bats, and some species of birds and fish lack an enzyme (L-gulonolactone oxidase
L-gulonolactone oxidase
L-gulonolactone oxidase is an enzyme that catalyzes the reaction of D-glucuronolactone with oxygen to L-xylo-hex-3-gulonolactone and hydrogen peroxide. It uses FAD as a cofactor...
) necessary for such synthesis and must obtain vitamin C through their diet. Vitamin C is widespread in plant tissues, with particularly high concentrations occurring in citrus fruits (oranges, lemons, limes, grapefruits), tomatoes, potatoes, cabbages, and green peppers.
Cause
Scurvy or subclinical scurvy is caused by the lack of vitamin C. In modern Western societies, scurvy is rarely present in adults, although infants and elderly people are affected. Vitamin C is destroyed by the process of pasteurizationPasteurization
Pasteurization is a process of heating a food, usually liquid, to a specific temperature for a definite length of time, and then cooling it immediately. This process slows microbial growth in food...
, so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason, but heat and storage destroy vitamin C. Human breast milk
Breast milk
Breast milk, more specifically human milk, is the milk produced by the breasts of a human female for her infant offspring...
contains sufficient vitamin C, if the mother has an adequate intake.
Scurvy is one of the accompanying diseases of malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
(other such micronutrient deficiencies are beriberi
Beriberi
Beriberi is a nervous system ailment caused by a thiamine deficiency in the diet. Thiamine is involved in the breakdown of energy molecules such as glucose and is also found on the membranes of neurons...
or pellagra
Pellagra
Pellagra is a vitamin deficiency disease most commonly caused by a chronic lack of niacin in the diet. It can be caused by decreased intake of niacin or tryptophan, and possibly by excessive intake of leucine. It may also result from alterations in protein metabolism in disorders such as carcinoid...
) and thus is still widespread in areas of the world depending on external food aid. Though rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.
Pathogenesis
Ascorbic acidAscorbic acid
Ascorbic acid is a naturally occurring organic compound with antioxidant properties. It is a white solid, but impure samples can appear yellowish. It dissolves well in water to give mildly acidic solutions. Ascorbic acid is one form of vitamin C. The name is derived from a- and scorbutus , the...
is needed for a variety of biosynthetic pathways, by accelerating hydroxylation
Hydroxylation
Hydroxylation is a chemical process that introduces a hydroxyl group into an organic compound. In biochemistry, hydroxylation reactions are often facilitated by enzymes called hydroxylases. Hydroxylation is the first step in the oxidative degradation of organic compounds in air...
and amidation reactions. In the synthesis of collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
, ascorbic acid is required as a cofactor for prolyl hydroxylase
Prolyl hydroxylase
Prolyl hydroxylase is an enzyme involved in the production of collagen, acting to hydroxylate proline to hydroxyproline....
and lysyl hydroxylase
Lysyl hydroxylase
Lysyl hydroxylase is an oxygenase enzyme that catalyzes the hydroxylation of lysine to hydroxylysine. This reaction is necessary to the formation and stabilization of collagen. It takes place following protein synthesis...
. These two enzymes are responsible for the hydroxylation of the proline
Proline
Proline is an α-amino acid, one of the twenty DNA-encoded amino acids. Its codons are CCU, CCC, CCA, and CCG. It is not an essential amino acid, which means that the human body can synthesize it. It is unique among the 20 protein-forming amino acids in that the α-amino group is secondary...
and lysine
Lysine
Lysine is an α-amino acid with the chemical formula HO2CCH4NH2. It is an essential amino acid, which means that the human body cannot synthesize it. Its codons are AAA and AAG....
amino acids in collagen. Hydroxyproline and hydroxylysine are important for stabilizing collagen by cross-linking the propeptides in collagen. Defective collagen fibrillogenesis impairs wound healing. Collagen is also an important part of bone, so bone formation is also affected. Defective connective tissue also leads to fragile capillaries, resulting in abnormal bleeding.
Symptoms
Early symptoms are malaiseMalaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
and lethargy. After 1–3 months, patients develop shortness of breath and bone pain. Myalgia
Myalgia
Myalgia means "muscle pain" and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections...
s may occur because of reduced carnitine
Carnitine
Carnitine is a quaternary ammonium compound biosynthesized from the amino acids lysine and methionine. In living cells, it is required for the transport of fatty acids from the cytosol into the mitochondria during the breakdown of lipids for the generation of metabolic energy. It is widely...
production. Other symptoms include skin changes with roughness, easy bruising and petechiae, gum disease, loosening of teeth, poor wound healing, and emotional changes. Dry mouth and dry eyes similar to Sjögren's syndrome
Sjögren's syndrome
Sjögren's syndrome , also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva....
may occur. In the late stages, jaundice
Jaundice
Jaundice is a yellowish pigmentation of the skin, the conjunctival membranes over the sclerae , and other mucous membranes caused by hyperbilirubinemia . This hyperbilirubinemia subsequently causes increased levels of bilirubin in the extracellular fluid...
, generalized edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
, oliguria, neuropathy, fever, and convulsions, and eventual death are frequently seen.
Prevention
Scurvy can be prevented by a diet that includes certain citrus fruits such as orangesOrange (fruit)
An orange—specifically, the sweet orange—is the citrus Citrus × sinensis and its fruit. It is the most commonly grown tree fruit in the world....
or lemons. Other sources rich in vitamin C
Vitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...
are fruits such as blackcurrants, guava
Guava
Guavas are plants in the myrtle family genus Psidium , which contains about 100 species of tropical shrubs and small trees. They are native to Mexico, Central America, and northern South America...
, kiwifruit
Kiwifruit
The kiwifruit, often shortened to kiwi in many parts of the world, is the edible berry of a cultivar group of the woody vine Actinidia deliciosa and hybrids between this and other species in the genus Actinidia....
, papaya
Papaya
The papaya , papaw, or pawpaw is the fruit of the plant Carica papaya, the sole species in the genus Carica of the plant family Caricaceae...
, tomatoes, bell peppers, and strawberries. It can also be found in some vegetables, such as carrots, broccoli
Broccoli
Broccoli is a plant in the cabbage family, whose large flower head is used as a vegetable.-General:The word broccoli, from the Italian plural of , refers to "the flowering top of a cabbage"....
, potatoes, cabbage
Cabbage
Cabbage is a popular cultivar of the species Brassica oleracea Linne of the Family Brassicaceae and is a leafy green vegetable...
, spinach
Spinach
Spinach is an edible flowering plant in the family of Amaranthaceae. It is native to central and southwestern Asia. It is an annual plant , which grows to a height of up to 30 cm. Spinach may survive over winter in temperate regions...
and paprika
Paprika
Paprika is a spice made from the grinding of dried fruits of Capsicum annuum . In many European languages, the word paprika refers to bell peppers themselves. The seasoning is used in many cuisines to add color and flavor to dishes. Paprika can range from mild to hot...
. Some fruits and vegetables not high in vitamin C may be pickled in lemon juice
Lemon juice
The lemon fruit, from a citrus plant, provides a useful liquid when squeezed. Lemon juice, either in natural strength or concentrated, is sold as a bottled product, usually with the addition of preservatives and a small amount of lemon oil.-Uses:...
, which is high in vitamin C. Though redundant in the presence of a balanced diet, various nutritional supplements are available that provide ascorbic acid well in excess of that required to prevent scurvy, and even some candies
Candy
Candy, specifically sugar candy, is a confection made from a concentrated solution of sugar in water, to which flavorings and colorants are added...
and most soft drink
Soft drink
A soft drink is a non-alcoholic beverage that typically contains water , a sweetener, and a flavoring agent...
s contain vitamin C as a preservative.
Many animal products, including liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, Muktuk
Muktuk
Muktuk is the English word for the traditional, pre-agrarian, Inuit/Eskimo and Chukchi meal of frozen whale skin and blubber...
(whale skin), oysters, and parts of the centrail nervous sytem, including the brain, spinal cord, and adrenal medula, contain large amounts of vitamin C, and can even be used to treat scurvy.
Fresh meat from animals which make their own vitamin C (which most animals do) contains enough vitamin C to prevent scurvy, and even partly treat it. This caused confusion in the early history of scurvy, since the disease was only seen in people eating long-preserved diets or canned goods, but not in people eating any sort of fresh diet, including arctic diets primarily based upon meat. In some cases (notably in French soldiers eating fresh horse meat) it was discovered that meat alone, even partly cooked meat, could aleviate scurvy. Some of these observations that scurvy was only associated with preserved foods, prompted explorers to blame scurvy upon some type of tainting or poison which pervaded tinned foods.
Prognosis
Untreated scurvy is invariably fatal. However, death from scurvy is rare in modern times. Since all that is required for a full recovery is the resumption of normal vitamin C intake, it is easy to treat if identified correctly. Consumption of dietary supplements and/or citrus fruits are means by which to accomplish this.History
Herbal cures for scurvy have been known in many native cultures since prehistory. Scurvy was documented as a disease by HippocratesHippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
, and Egyptians have recorded its symptoms as early as 1550 BC. The knowledge that consuming foods containing vitamin C is a cure for scurvy has been repeatedly rediscovered and reforgotten into the early 20th century.
Early modern era
In the 13th century, the CrusadersCrusades
The Crusades were a series of religious wars, blessed by the Pope and the Catholic Church with the main goal of restoring Christian access to the holy places in and near Jerusalem...
frequently suffered from scurvy. In the 1497 expedition of Vasco de Gama, the curative effects of citrus fruit were known. In 1536, the French explorer Jacques Cartier
Jacques Cartier
Jacques Cartier was a French explorer of Breton origin who claimed what is now Canada for France. He was the first European to describe and map the Gulf of Saint Lawrence and the shores of the Saint Lawrence River, which he named "The Country of Canadas", after the Iroquois names for the two big...
, exploring the St. Lawrence River
Saint Lawrence River
The Saint Lawrence is a large river flowing approximately from southwest to northeast in the middle latitudes of North America, connecting the Great Lakes with the Atlantic Ocean. It is the primary drainage conveyor of the Great Lakes Basin...
, used the local natives' knowledge to save his men who were dying of scurvy. He boiled the needles of the arbor vitae
Thuja
Thuja is a genus of coniferous trees in the Cupressaceae . There are five species in the genus, two native to North America and three native to eastern Asia...
tree (Eastern White Cedar) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams. Such treatments were not available aboard ship, where the disease was most common.
Between 1500 and 1800, it has been estimated that scurvy killed at least two million sailors. According to Jonathan Lamb, "In 1499, Vasco da Gama lost 116 of his crew of 170; In 1520, Magellan lost 208 out of 230;...all mainly to scurvy."
In 1593 Admiral Sir Richard Hawkins
Richard Hawkins
thumb|250px|right|Sir Richard HawkinsAdmiral Sir Richard Hawkins was a 17th century English seaman, explorer and Elizabethan "Sea Dog", and was the son of Admiral Sir John Hawkins....
advocated drinking orange and lemon juice as a means of preventing scurvy.
The British civilian medical profession of 1614 believed that it was the acidic principle of citrus fruit which was lacking, although they considered any acid acceptable when ascorbic acid (Vitamin C) was unavailable. In 1614 John Woodall
John Woodall
John Woodall was an English military surgeon, Paracelsian chemist, businessman, linguist and diplomat. He made a fortune through the stocking of medical chests for the East India Company and later the armed forces of England...
, Surgeon General of the East India Company
British East India Company
The East India Company was an early English joint-stock company that was formed initially for pursuing trade with the East Indies, but that ended up trading mainly with the Indian subcontinent and China...
, published "The Surgion's Mate" as a handbook for apprentice surgeons aboard the company's ships. In it he described scurvy as resulting from a dietary deficiency. His recommendation for its cure was fresh food or, if not available, oranges, lemons, limes and tamarinds, or as a last resort, Oil of Vitriol (sulfuric acid
Sulfuric acid
Sulfuric acid is a strong mineral acid with the molecular formula . Its historical name is oil of vitriol. Pure sulfuric acid is a highly corrosive, colorless, viscous liquid. The salts of sulfuric acid are called sulfates...
).
18th century
A 1707 handwritten book by Mrs Ebot Mitchell discovered in a house in Hasfield, GloucestershireGloucestershire
Gloucestershire is a county in South West England. The county comprises part of the Cotswold Hills, part of the flat fertile valley of the River Severn, and the entire Forest of Dean....
contains a "Recp.t for the Scurvy" that consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine or beer.
In 1734, the Leiden-based physician Johann Bachstrom
Johann Bachstrom
Jan Fryderyk or Johann Friedrich Bachstrom was a writer, scientist and Lutheran theologian who spent the last decade of his life in Leiden. His surname is sometimes spelt Bachstroem or Bachstrohm...
published a book on scurvy in which he stated that "scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease" and urged the use of fresh fruit and vegetables as a cure. In 1740, citrus juice (usually lemon
Lemon
The lemon is both a small evergreen tree native to Asia, and the tree's ellipsoidal yellow fruit. The fruit is used for culinary and non-culinary purposes throughout the world – primarily for its juice, though the pulp and rind are also used, mainly in cooking and baking...
or lime juice) was added to the recipe of the traditional daily ration of watered-down rum
Rum
Rum is a distilled alcoholic beverage made from sugarcane by-products such as molasses, or directly from sugarcane juice, by a process of fermentation and distillation. The distillate, a clear liquid, is then usually aged in oak barrels...
known as grog
Grog
The word grog refers to a variety of alcoholic beverages. The word originally referred to a drink made with water or "small beer" and rum, which British Vice Admiral Edward Vernon introduced into the Royal Navy on 21 August 1740. Vernon wore a coat of grogram cloth and was nicknamed Old Grogram or...
to cut down on the water's foulness. Although they did not know the reason at the time, Admiral Edward Vernon
Edward Vernon
Edward Vernon was an English naval officer. Vernon was born in Westminster, England and went to Westminster School. He joined the Navy in 1700 and was promoted to Lieutenant in 1702 and served on several different ships for the next five years...
's sailors were healthier than the rest of the navy, due to the daily doses of vitamin C
Vitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...
the sailors received. However, it was not until 1747 that James Lind formally proved that scurvy could be treated and prevented by supplementing the diet with citrus fruit such as limes or lemons, though not by other acids, in the first ever clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
. In 1753, Lind published A Treatise of the Scurvy, in which he explained the details of his clinical trial and how scurvy was successfully eradicated from his test subjects (nuns). He then attempted to sell extracted lime juice as a medicine, but the lime juice had no effect in treating scurvy, due to the oxidization of vitamin C. Therefore, this solution was not adopted by the Royal Navy until the 1790s, and the idea that any acid would suffice continued in Britain into the late 19th century.
During the 18th century, scurvy killed more British sailors than enemy action. It was mainly by scurvy that George Anson
George Anson, 1st Baron Anson
Admiral of the Fleet George Anson, 1st Baron Anson PC, FRS, RN was a British admiral and a wealthy aristocrat, noted for his circumnavigation of the globe and his role overseeing the Royal Navy during the Seven Years' War...
, in his celebrated voyage of 1740–2, lost within the first ten months nearly two-thirds of his crew (1300 out of 2000). During the Seven Years War, the Royal Navy reported that it conscripted 184,899 sailors, of whom 133,708 died of disease or were 'missing', and scurvy was the principal disease.
James Cook
James Cook
Captain James Cook, FRS, RN was a British explorer, navigator and cartographer who ultimately rose to the rank of captain in the Royal Navy...
succeeded in circumnavigating the world (1768–71) in HM Bark Endeavour
HM Bark Endeavour
HMS Endeavour, also known as HM Bark Endeavour, was a British Royal Navy research vessel commanded by Lieutenant James Cook on his first voyage of discovery, to Australia and New Zealand from 1769 to 1771....
without losing a single man to scurvy, but his suggested methods, including a diet of sauerkraut
Sauerkraut
Sauerkraut , directly translated from German: "sour cabbage", is finely shredded cabbage that has been fermented by various lactic acid bacteria, including Leuconostoc, Lactobacillus, and Pediococcus. It has a long shelf-life and a distinctive sour flavor, both of which result from the lactic acid...
and wort
Wort
Wort may refer to:* Wort, the liquid created by the mashing of malted barley to use in brewing beer* Worting, Hampshire, a large district and suburb of the town of Basingstoke, in Hampshire, England....
of malt, were of limited value. Sauerkraut was the only vegetable food that retained a reasonable amount of ascorbic acid in a pickled state, but it was boiled to reduce it for preservation and much of the vitamin C content was lost. In Cook's time it was impractical to preserve citrus fruit for long sea voyages. More important was Cook's regime of shipboard cleanliness, enforced by strict discipline, as well as frequent replenishing of fresh food. The most effective regime implemented by Cook was his prohibition against the consumption of fat scrubbed from the ship's copper pans, then a common practice in the Navy. In contact with the hot copper, this fat acquired substances which possibly irritated the gut and prevented proper absorption of vitamins.
The first major long distance expedition that experienced virtually no scurvy was that of Alessandro Malaspina
Alessandro Malaspina
Alessandro Malaspina was an Italian nobleman who spent most of his life as a Spanish naval officer and explorer...
, 1789–1794. Malaspina's medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at Guam
Guam
Guam is an organized, unincorporated territory of the United States located in the western Pacific Ocean. It is one of five U.S. territories with an established civilian government. Guam is listed as one of 16 Non-Self-Governing Territories by the Special Committee on Decolonization of the United...
all five were healthy again. Spain's large empire
Spanish Empire
The Spanish Empire comprised territories and colonies administered directly by Spain in Europe, in America, Africa, Asia and Oceania. It originated during the Age of Exploration and was therefore one of the first global empires. At the time of Habsburgs, Spain reached the peak of its world power....
and many ports of call made it easier to acquire fresh fruit.
Despite advances, British sailors throughout the American Revolution
American Revolution
The American Revolution was the political upheaval during the last half of the 18th century in which thirteen colonies in North America joined together to break free from the British Empire, combining to become the United States of America...
ary period continued to suffer from scurvy, particularly in the Channel Fleet. The eradication of scurvy from the Royal Navy in the 1790s was finally due to the chairman of the Navy's Sick and Hurt Board, Gilbert Blane
Gilbert Blane
Sir Gilbert Blane of Blanefield, 1st Baronet FRSE FRS MRCP was a Scottish physician who instituted health reform in the Royal Navy....
, who finally put Bachstrom and Lind's long-ignored prescription of fresh lemons to use during the Napoleonic Wars
Napoleonic Wars
The Napoleonic Wars were a series of wars declared against Napoleon's French Empire by opposing coalitions that ran from 1803 to 1815. As a continuation of the wars sparked by the French Revolution of 1789, they revolutionised European armies and played out on an unprecedented scale, mainly due to...
. It led to a remarkable health improvement among the sailors and consequently played a critical role in naval battles, notably the Battle of Trafalgar
Battle of Trafalgar
The Battle of Trafalgar was a sea battle fought between the British Royal Navy and the combined fleets of the French Navy and Spanish Navy, during the War of the Third Coalition of the Napoleonic Wars ....
. Other navies soon adopted this successful solution.
19th century
The surgeon-in-chief of Napoleon's army at the Siege of Alexandria (1801), Baron Dominique-Jean Larrey, wrote in his memoirs that the consumption of horse meatHorse meat
Horse meat is the culinary name for meat cut from a horse. It is a major meat in only a few countries, notably in Central Asia, but it forms a significant part of the culinary traditions of many others, from Europe to South America to Asia. The top eight countries consume about 4.7 million horses...
helped the French to curb an epidemic of scurvy. The meat was cooked but was freshly obtained from young horses bought from Arabs, and was nevertheless effective. This helped to start the 19th-century tradition of horse meat consumption in France.
Lauchlin Rose patented a method used to preserve citrus juice without alcohol in 1867, creating a concentrated drink
Squash (drink)
Squash is a non-alcoholic concentrated syrup that is usually fruit-flavoured and usually made from fruit juice, water, and sugar or a sugar substitute. Modern squashes may also contain food colouring and additional flavouring...
known as Rose's lime juice
Rose's lime juice
Rose's lime juice, often known simply as Rose's, is a line of juice products first patented in 1867. The range includes both the original concentrated squash or cordial and also diluted drink mixers...
. The Merchant Shipping Act of that same year required all ships of the Royal Navy
Royal Navy
The Royal Navy is the naval warfare service branch of the British Armed Forces. Founded in the 16th century, it is the oldest service branch and is known as the Senior Service...
and Merchant Navy
Merchant Navy
The Merchant Navy is the maritime register of the United Kingdom, and describes the seagoing commercial interests of UK-registered ships and their crews. Merchant Navy vessels fly the Red Ensign and are regulated by the Maritime and Coastguard Agency...
to provide a daily lime
Lime (fruit)
Lime is a term referring to a number of different citrus fruits, both species and hybrids, which are typically round, green to yellow in color, 3–6 cm in diameter, and containing sour and acidic pulp. Limes are a good source of vitamin C. Limes are often used to accent the flavors of foods and...
ration to sailors to prevent scurvy. The product became nearly ubiquitous, hence the term "limey
Limey
Limey is an old slang nickname, often pejorative, for the British, originally referring to their sailors. The term is believed to derive from Lime , referring to the Royal Navy and Merchant Navy practice of supplying lime juice to British sailors to prevent scurvy...
", first for British sailors, then an English immigrant in the former British colonies (particularly America, New Zealand and South Africa), and finally, in old American slang, all British people.
The plant Cochlearia officinalis
Cochlearia officinalis
Cochlearia officinalis, or Common Scurvygrass is a flowering plant of the genus Cochlearia in the family Brassicaceae....
, also known as "Common Scurvygrass", acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. Its very bitter taste was usually disguised with herbs and spices; however, this didn't prevent scurvygrass drinks and sandwiches becoming a popular fad in the UK until the middle of the nineteenth century, when citrus fruits became more readily available.
West Indian limes replaced lemons because they were more easily obtained from Britain's Caribbean colonies, and were believed to be more effective because they were more acidic, and it was the acid, not the (then-unknown) Vitamin C that was believed to cure scurvy. This was mistaken – the West Indian limes were significantly lower in Vitamin C than the previous lemons (having only ¼ the Vitamin C content), and further were not served fresh, but rather as lime juice, which had been exposed to air and piped through copper tubing, both of which significantly reduced the Vitamin C. Indeed, an 1918 animal experiment using representative samples of the Navy and Merchant Marine's lime juice showed that it had virtually no antiscorbutic power at all.
The belief that scurvy was fundamentally a nutritional deficiency, best treated by consumption of fresh food, particularly fresh citrus or fresh meat, was not universal in Britain in the 19th and early 20th centuries, and thus British sailors and explorers continued to suffer from scurvy into the 20th century.
In the Royal Navy's Arctic
Arctic
The Arctic is a region located at the northern-most part of the Earth. The Arctic consists of the Arctic Ocean and parts of Canada, Russia, Greenland, the United States, Norway, Sweden, Finland, and Iceland. The Arctic region consists of a vast, ice-covered ocean, surrounded by treeless permafrost...
expeditions in the 19th century it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining the morale of the crew, rather than by a diet of fresh food, so that Navy expeditions continued to be plagued by scurvy even while fresh (not jerked or tinned) meat was well-known as a practical antiscorbutic among civilian whalers and explorers in the Arctic. Even cooking fresh meat did not entirely destroy its antiscorbutic properties, especially as many cooking methods failed to bring all the meat to high temperature.
The confusion is attributed to a number of factors:
- while fresh citrus (particularly lemons) cured scurvy, lime juice that had been exposed to air and copper tubing did not – thus undermining the theory that citrus cured scurvy;
- fresh meat (especially organ meat and raw meat, consumed in arctic exploration) also cured scurvy, undermining the theory that fresh produce was essential to preventing and curing scurvy;
- increased marine speed via steam shipping, and improved nutrition on land, reduced the incidence of scurvy – and thus the ineffectiveness of copper-piped lime juice compared to fresh lemons was not immediately revealed.
In the resulting confusion, a new hypothesis was floated, following the new germ theory of disease – that scurvy was caused by ptomaine, a waste product of bacteria, particularly in tainted tinned meat.
Infantile scurvy emerged in the late 19th century due to children being fed pasteurized cow's milk, particularly in the urban upper class – the pasteurization killed bacteria, but also destroyed vitamin C. This was eventually resolved by supplementing with onion juice or cooked potatoes.
20th century
At the time Robert Falcon ScottRobert Falcon Scott
Captain Robert Falcon Scott, CVO was a Royal Navy officer and explorer who led two expeditions to the Antarctic regions: the Discovery Expedition, 1901–04, and the ill-fated Terra Nova Expedition, 1910–13...
made his two expeditions (1903 and 1911) to the Antarctic
Antarctic
The Antarctic is the region around the Earth's South Pole, opposite the Arctic region around the North Pole. The Antarctic comprises the continent of Antarctica and the ice shelves, waters and island territories in the Southern Ocean situated south of the Antarctic Convergence...
in the early 20th century, the prevailing theory was that scurvy was caused by "tainted" meat, particularly tinned meat. Accordingly, Scott's expeditions suffered from scurvy, though he initially did not record this in his notes on his 1903 expedition, due to stigma associated with scurvy.
Vilhjalmur Stefansson
Vilhjalmur Stefansson
Vilhjalmur Stefansson was a Canadian Arctic explorer and ethnologist.-Early life:Stefansson, born William Stephenson, was born at Gimli, Manitoba, Canada, in 1879. His parents had emigrated from Iceland to Manitoba two years earlier...
, an arctic explorer who lived among the Eskimos, proved that the all meat diet they consumed did not lead to vitamin deficiencies. He participated in a study in New York's Bellevue Hospital in 1935, where he and a companion ate nothing but meat for a year while under close medical observation, yet remained in good health. Some Antarctic expeditions, such as Scott's two expeditions and Shackleton's Ross Sea
Ross Sea
The Ross Sea is a deep bay of the Southern Ocean in Antarctica between Victoria Land and Marie Byrd Land.-Description:The Ross Sea was discovered by James Ross in 1841. In the west of the Ross Sea is Ross Island with the Mt. Erebus volcano, in the east Roosevelt Island. The southern part is covered...
party, suffered from scurvy, mainly during inland sledge journeys when the men had access to very limited range of food, virtually none of it fresh. Scurvy was rare or absent when they had access to a wider range of stored food or relied on seal meat.
In 1907, the needed biological-assay model to isolate and identify the antiscorbutic factor was discovered. Axel Holst
Axel Holst
Axel Holst was a Norwegian professor of hygiene and bacteriology at the University of Oslo, known for his contributions to beriberi and scurvy....
and Theodor Frølich, two Norwegian
Norway
Norway , officially the Kingdom of Norway, is a Nordic unitary constitutional monarchy whose territory comprises the western portion of the Scandinavian Peninsula, Jan Mayen, and the Arctic archipelago of Svalbard and Bouvet Island. Norway has a total area of and a population of about 4.9 million...
physicians studying shipboard beriberi
Beriberi
Beriberi is a nervous system ailment caused by a thiamine deficiency in the diet. Thiamine is involved in the breakdown of energy molecules such as glucose and is also found on the membranes of neurons...
contracted aboard ship's crews in the Norwegian Fishing Fleet, wanted a small test mammal to substitute for the pigeons then used in beriberi research. They fed guinea pig
Guinea pig
The guinea pig , also called the cavy, is a species of rodent belonging to the family Caviidae and the genus Cavia. Despite their common name, these animals are not in the pig family, nor are they from Guinea...
s their test diet of grains and flour, which had earlier produced beriberi in their pigeons, and were surprised when classic scurvy resulted instead. This was a serendipitous choice of model. Until that time, scurvy had not been observed in any organism apart from humans, and had been considered an exclusively human disease. (Some birds are susceptible to scurvy, but pigeons, as seed-eating birds, were later found to be unsusceptible to scurvy, as they produce vitamin C.) Holst and Frølich found they could cure scurvy in guinea pigs with the addition of various fresh foods and extracts. This discovery of a "clean" (reliable) animal experimental model for scurvy, which was made even before the essential idea of "vitamins" in foods had been put forward, has been called the single most important piece of vitamin C research.
In 1927, Hungarian
Hungary
Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...
biochemist
Biochemist
Biochemists are scientists who are trained in biochemistry. Typical biochemists study chemical processes and chemical transformations in living organisms. The prefix of "bio" in "biochemist" can be understood as a fusion of "biological chemist."-Role:...
Szent-Györgyi (who won the 1937 Nobel Prize
Nobel Prize
The Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...
for Medicine) for his studies in the biological functions of the compound "hexuronic acid" while working with antioxidant
Antioxidant
An antioxidant is a molecule capable of inhibiting the oxidation of other molecules. Oxidation is a chemical reaction that transfers electrons or hydrogen from a substance to an oxidizing agent. Oxidation reactions can produce free radicals. In turn, these radicals can start chain reactions. When...
compounds in the adrenal cortex
Adrenal cortex
Situated along the perimeter of the adrenal gland, the adrenal cortex mediates the stress response through the production of mineralocorticoids and glucocorticoids, including aldosterone and cortisol respectively. It is also a secondary site of androgen synthesis.-Layers:Notably, the reticularis in...
. Szent-Györgyi suspected hexuronic acid, which he had isolated from adrenal glands, to be the antiscorbutic agent, but could not prove it without an animal-deficiency model.
It was not until 1932 that the connection between hexuronic acid and scurvy was finally proven by American researcher Charles Glen King
Charles Glen King
Charles Glen King was an American biochemist who was a pioneer in the field of nutrition research and who isolated vitamin C at the same time as Albert Szent-Györgyi...
of the University of Pittsburgh
University of Pittsburgh
The University of Pittsburgh, commonly referred to as Pitt, is a state-related research university located in Pittsburgh, Pennsylvania, United States. Founded as Pittsburgh Academy in 1787 on what was then the American frontier, Pitt is one of the oldest continuously chartered institutions of...
. King's laboratory was given some hexuronic acid by Szent-Györgyi and soon established that it was "vitamin C". In honor of its antiscorbutic properties, hexuronic acid was named "ascorbic acid" by Szent-Györgyi.
Experimental human trials
Notable human dietary studies of experimentally-induced scurvy have been conducted on conscientious objectors during WW II in Britain, and on Iowa state prisoner "volunteers" in the late 1960s. These studies both found that all obvious symptoms of scurvy previously induced by an experimental scorbutic diet with extremely low vitamin C content, could be completely reversed by additional vitamin C supplementation of only 10 mg a day. In these experiments, there was no clinical difference noted between men given 70 mg vitamin C per day (which produced blood levels of vitamin C of about 0.55 mg/dl, about 1/3 of tissue saturation levels), and those given 10 mg per day (which produced lower blood levels). Men in the prison study developed the first signs of scurvy about 4 weeks after starting the vitamin C free diet, whereas in the British study, six to eight months were required, possibly due to the pre-loading of this group with a 70 mg/day supplement for six weeks before the scorbutic diet was fed. Men in both studies on a diet devoid or nearly devoid of vitamin C had blood levels of vitamin C too low to be accurately measured when they developed signs of scurvy, and in the Iowa study, at this time were estimated (by labeled vitamin C dilution) to have a body pool of less than 300 mg, with daily turnover of only 2.5 mg/day.In other animals
Most plant and animal species synthesize vitamin C. Notable mammalian group exceptions include most or all of the order chiroptera (bats), and one of the two major primatePrimate
A primate is a mammal of the order Primates , which contains prosimians and simians. Primates arose from ancestors that lived in the trees of tropical forests; many primate characteristics represent adaptations to life in this challenging three-dimensional environment...
suborders, the "Anthropoidea" (Haplorrhini
Haplorrhini
The haplorhines, the "dry-nosed" primates , are members of the Haplorhini clade: the prosimian tarsiers and the anthropoids...
) (tarsiers, monkeys and apes, including human beings). The Strepsirrhini
Strepsirrhini
The clade Strepsirrhini is one of the two suborders of primates. Madagascar's only non-human primates are strepsirrhines, and others can be found in southeast Asia and Africa...
(non-tarsier prosimians) can make their own vitamin C (these include lemur
Lemur
Lemurs are a clade of strepsirrhine primates endemic to the island of Madagascar. They are named after the lemures of Roman mythology due to the ghostly vocalizations, reflective eyes, and the nocturnal habits of some species...
s, the Aye-aye
Aye-aye
The aye-aye is a lemur, a strepsirrhine primate native to Madagascar that combines rodent-like teeth and a special thin middle finger to fill the same ecological niche as a woodpecker...
, lorises, potto
Potto
The potto is a strepsirrhine primate from the Lorisidae family. It is the only species in genus Perodicticus...
s, and galago
Galago
Galagos , also known as bushbabies, bush babies or nagapies , are small, nocturnal primates native to continental Africa, and make up the family Galagidae...
s). Ascorbic acid is also not synthesized by at least two species of Caviidae
Caviidae
The cavy family is a family of rodents native to South America, and including the domestic guinea pig, wild cavies, and the capybara, among other animals...
, the capybara
Capybara
The capybara , also known as capivara in Portuguese, and capibara, chigüire in Venezuela, Colombia, and Ecuador ronsoco in Peru, chigüiro, and carpincho in Spanish, is the largest living rodent in the world. Its closest relatives are agouti, chinchillas, coyphillas, and guinea pigs...
and the guinea pig
Guinea pig
The guinea pig , also called the cavy, is a species of rodent belonging to the family Caviidae and the genus Cavia. Despite their common name, these animals are not in the pig family, nor are they from Guinea...
. There are known species of birds and fish that do not synthesize their own Vitamin C. All species that do not synthesize ascorbate require it in the diet. Deficiency causes scurvy in humans, and somewhat similar symptoms in other animals.
Further reading
- SCURVY: How a Surgeon, a Mariner, and a Gentleman Discovered the Greatest Medical Mystery of the Age of Sail by Stephen R. Bown. Published by Thomas Dunne Books 2004.
- The history of scurvy & vitamin C. by Kenneth J. Carpenter. Published by Cambridge University PressCambridge University PressCambridge University Press is the publishing business of the University of Cambridge. Granted letters patent by Henry VIII in 1534, it is the world's oldest publishing house, and the second largest university press in the world...
1986.