The story of Scurvy, and the role of Cider

When cider was being developed in the UK into a fine product akin to wine on the Continent  in the 17C  and it came to the attention of the scientists and aristocracy of the day it was in a very different time than today in term of science and medicine. The Renaissance was underway but science still contained alchemy, astronomy was being developed from astrology and medicine was yet to emerge from Greek notions of medicine especially espoused by Galen. This revolved around the 4 humours blood yellow bile black bile and phlegm. 4 qualities hot cold moist and dry and 4 elements earth fire air and water. The physician Andrew Boorde writing in 1542  wrote of cyder  ” but the beestis not praysed in physicke, for cyder is colde of operacyon, and is full of ventosyte, wherefore it dothy ingendre evyll humours, and doth savage too moche the natural heat of man, and doth let dgestyon, and doth hurt the stomacke; but they the which be used to it, if it be drunken in harvyst, it doth lytell harm.” Against a back drop of this the current science based medicine progressed slowly, eg. the nature of circulation was established by William  Harvey in his key work  Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (Anatomical Exercise on the Motion of the Heart and Blood in Animals), published in 1628, with an English version later in 1653. And here is also a hurdle for its development. Medicine was conducted in Latin. Which distanced it from work in English the language of the emerging aristocracy and middle classes.

Scurvy which was first described in 16C was a disease that did not fit into the classical Greek model. Its local name was Schorbuk in Low German. This was Latinised to scorbutus and the finally changed to scurvy in English. In retrospect it was known in in antiquity Egyptians described scurvy in the Ebers papyrus as early as 1500 B.C but was mainly a disease of northern Europe. Scurvy manifests first as spots covering the skin over the  body , patients  complain of pains in their arms and legs, and their gums were red and swollen.  Patients then become lethargic, bleed both internally and externally and rapidly die

However given the vast expansion of European sailing out of Europe this disease literally exploded to the attention to all European medics. English attention was drawn to it in 1605 by a squadron of ships under the command of James Lancaster to the East Indies. Of 223 men on 4 ships 114 were lost to scurvy but not one from Lancaster’s own ship the Dragon.

Lancaster had happened upon provisioning his ship with lemon juice. This could have been the breakthrough but alas not. And some peculiarities of the diseases was noted. Firstly it was  the seamen that contracted it not the officers and secondly it was only on long voyages. This drew attention to diet that of the lowly seaman being rudimentary at best , and lemons were only one of many variables. Cider was another variable and often provisioned on ships particularly from Portsmouth because of the local cider industry of South Hamms. Not for its antiscorbotic value but because it was more healthy than potable water of the time. 

Francis Bacon 1561 – 1626 the father of empiricism” argued for the possibility of scientific knowledge to be based only upon inductive reasoning and careful observation of events in nature, noted circa 1600 that ” Cider and Perry are notable beverages in sea voyages” and that scurvy could be cured miraculously on return to England by cyder and oranges.” This was probably noted by Francis in corresponsence with John Taverner horticulturist who wrote a scientific tract "Certaine Experiments Concerning Fish and Frvite' in Jan 1600 

It was noted that whilst the cyder remained fresh scurvy did not develop ( long after the fresh fruit had been consumed or perished) but cyder in a barrel does become acetic and its anti scorbutic value then decreases resulting in a prolonged scurvy free period but still not enough for the longer and longer voyages undertaken.  Again the link was not acted upon because the apothecaries and surgeons communicated in English and ignored by the physicians who communicated in Latin and felt superior to the barber surgeons because their profession was based on academia not a trade. The Royal College of Surgeons was finally formed in 1800 (and a token of their former trade is retained by reverting to Mr  from Dr on becoming a Fellow). The other group knowing about the value of cyder of course were the cyderists but again communication with the other groups was only sporadic. Knowledge of the value of cider against scurvy was kept alive in the cyderists literature eg mentioned by Worlidge in Vinetum Britannicum in 1676. Huxham a cyderist and doctor in Observations… 1747  

James Lind surgeon in the British Navy  on the ship Salisbury 1747 read the earlier references and conducted a trial with oranges cider and other treatments popular in the day.

On May 20, 1747 when men on board were suffering from scurvy in large numbers,  he divided the ill men into six groups of two. All 12 had the same common diet. For breakfast, they ate water-gruel sweetened with sugar. For lunch, they had fresh mutton-broth, puddings or boiled biscuit with sugar. For dinner, they ate barley and raisins, or rice and currants, and wine. In addition, each group received a different supplement. The first group drank a quart of apple cider each day. Three times a day the second group ingested 25 drops of elixir vitriol, a strong solution of sulphuric acid combined with aromatics. The third group took two spoonfuls of vinegar three times a day on an empty stomach. The fourth group had a concoction including various herbs and spices, including nutmeg and garlic. The fifth group, who had rigid legs and were in the worst condition, drank a half-pint of sea water daily. The sixth group consumed two oranges and one lemon every day, the only supplement that contained a significant amount of vitamin C. The patients receiving citrus fruit fared the best and were cured those on cider held, those on other treatments worsened. However Lind’s results were not published till 1753 and then ignored partly because Lind had doubts. He had tried to concentrate citrus juice but heating it had destroyed the Vitamin C ( of which there was no knowledge at the time. It was not until 1912!)

Joseph Banks the naturalist on Captain Cook’s first voyage cured his own scurvy with citrus fruit.

However it was not until 1795, on the advice of Sir Gilbert Blane physician who had read the works of Lind and Banks the British Royal Navy provided a daily ration of lime or lemon juice to all its men.

Even as late as Scott’s first Antarctic expedition (1901-1904) it was thought that chemicals in decaying tinned meat were responsible for scurvy

It is a sobering fact that during the Age of Sail 1490-1850 far more lives were lost to scurvy than all other diseases, shipwrecks and wars combined. However this article is written from an English perspective.

I recently discovered this story recently translated from Spanish

"One group of interesting sailors never suffered from the disease at all. These were the Basque sailors, who were very successful in dominating the whale oil trade for some time. They were extremely skilled at hunting whales, and as a result, always had whale oil to trade. One of the ways they achieved this was incentivising the sailors, they were one of the first sailors to have contracts that ensured payment. And the payment had to be made in some part in oil, this gave them further motivation to produce as much whale oil as possible. The real interesting part of their contracts though, which was how they never caught scurvy, even though they probably did not know at the time: the contract stipulated Basque sailors had to receive at least 2 to 3 liters of sagardoa each day. Now sagardoa is a type of strong Basque cider, which as a result contained vitamin C, and prevented scurvy."