Scurvy and Medicine in the Age of Exploration

During the Age of Exploration, and on the first transoceanic voyages, a new disease began to emerge: scurvy.

Also known as the plague of the sea, it laid waste to many sailors on long sea voyages who were deprived of fresh food for months on end.

Medical knowledge at the time was limited, and based on the Greek idea of the body being made up of four so-called humors: blood, phlegm, yellow bile, and black bile.

However, humorism, as it was known, could not deal with this new disease, which had begun to appear during the first Age of Discovery.

Doctors

Doctors occupied the highest rung of the medical profession, and their training lasted four years. The career of a qualified doctor at the time was essentially a quick route to wealth and prestige, and their status meant that they rarely traveled on board ships.

They only accompanied the larger expeditions, or journeys on which members of the nobility were traveling.

The main task of doctors was to diagnose illnesses and provide a prognosis. They did so by taking the patient's pulse, and observing waste matter: feces, sweat, vomit, sputum, and, in particular, urine.

They only accompanied the larger expeditions, or journeys on which members of the nobility were traveling.

Surgeons

Healthcare on board a ship was mainly the responsibility of surgeons and barbers.

The surgeon and his assistant worked in the infirmary—a covered space with bunks; a brazier, and tools for lighting it; burlap; eggs; turpentine; and linen cloths to be used as bandages—ready to attend to the injured.

A surgeon usually accompanied every expedition. He traveled on the flagship and attended to injuries and amputations, lanced boils, cauterized wounds, and treated superficial complaints such as abscesses, carbuncles, ulcers, and cysts.

Barbers

Barber surgeons and barbers were ranked below surgeons, and one traveled on each vessel.

As in the army, barbers were the first to attend to any sort of illness, wound, or fracture.

In addition to their healthcare duties, they were tasked with shaving and hair cutting. They practiced bloodletting with lancets, leeches, and cups, and cleaned and extracted sailors' teeth.

When did it first appear?

Scurvy already existed in countries with long winters, due to a lack of fresh food. However, not much was known about it in Greco-Latin and Islamic medicine, which were the main sources of medical knowledge at the time. It reached epidemic proportions during the age of the great explorations, between the 15th and the 18th centuries.

It resulted in casualties in every naval fleet over a period of 300 years, especially in explorations and voyages across the Pacific Ocean. These trips lasted longer than the human body is able to conserve its reserves of vitamin C, which will only last for one or two months if no more is consumed.

The Manila Galleon, also called the China Ship, was the name given to the Spanish ships that crossed the Pacific Ocean between Mexico and the Philippines twice a year. These crossings were long and hard, and many of those on board died of scurvy or hunger.

The disease was first mentioned on Vasco da Gama's voyage from Portugal to India (1497-99), on both the outward and the return journeys. This is how it was recorded in the logbook:

"…and many men fell ill here, their feet and hands became swollen and their gums grew away from their teeth so much that they could not eat. And the captain sent a man to land with those who came, so that he would bring oranges the next day, which the ill men so desired."

The second voyage to record incidences of scurvy was the Magellan-Elcano circumnavigation of the globe (1519-22), in which it appeared on three separate occasions. In fact, this was the cause of death of Juan Sebastián Elcano.

A few years later, in 1535, the same disease was recorded on Jacques Cartier's journey to Canada.

What is scurvy?

Scurvy is a nutritional disease, caused by a lack of ascorbic acid (otherwise known as vitamin C).

This vitamin is mainly found in fresh fruit and vegetables such as oranges, lemons, limes, strawberries, peppers, onions, garlic, potatoes, and parsley. Berries such as blueberries and hawthorns contain the highest concentrations of vitamin C.

Symptoms

The disease is characterized by intense weakness and fatigue, joint pain, bleeding into the skin in the form of bruising and hemorrhaging on the limbs, as well as the characteristic effect on the gums, which bleed and become inflamed and swollen.

If left untreated, it can be fatal, causing significant hemorrhaging. This is what happened to most of the sailors who became ill with the disease. However, with the right treatment, sufferers can make a full, fast recovery.

Remedies

Despite the evidence for the benefits of eating fresh fruit and vegetables—especially oranges and lemons—and of the recommendations of several naval doctors, it took some time for this knowledge to become widespread. Meanwhile, people continued to use ineffective treatments, including brushing their teeth with urine or seawater, vitriol, pickled cabbage, and cider, which contains only tiny traces of vitamin C.

Cochlearia officinalis, or common scurvygrass, was heavily harvested while sailors were on land, in the belief that it prevented scurvy. However, its vitamin C content is similar to other vegetables.

In the late 18th century, several expeditions explored the Pacific Ocean in what was known as the Second Age of Discovery.

Having found a way to calculate longitude using Harrison's marine chronometer, the prevention and cure of scurvy became a more pressing issue for Bougainville, Cook, and Malaspina.

A Cure at Last

The crew on the 1764 expedition led by the Englishman John Byron suffered from scurvy while crossing the Pacific, recovering after eating coconuts.

Carpenter, in his A History of Scurvy, refers to this event:

"It is astonishing the effect these nuts alone had on those afflicted … many who were in the most violent pain imaginable … and thought to be in the last stage of that disorder, were in a few days by eating those nuts so far relieved as to do their duty."

In 1795 Gilbert Blane, a Royal Navy physician, put into practice what he had learned from his experiences.

His recommendations included the obligatory daily consumption of a small yet effective measure of seven fluid ounces of lime juice, mixed with grog (watered down rum).

Eventually, supplies of lemon juice on board ships of the British Royal Navy became obligatory. The results of this were astounding, and casualties from scurvy were hugely reduced, leading in part to the success of the British in dominating the seas.

The recommendations by the British were followed by most other countries, and although this did not happen in Spain for another few years, they did eventually manage to control scurvy, which had been the cause of so many deaths over the years.