Excerpt

Prologue

A MEDICAL MYSTERY

scur·vy ['skurvi] n., adj. (-vi·er, -vi·est).
-n. Pathology.
a disease caused by lack of vitamin C, characterized by
swollen and bleeding gums, livid spots on the skin, and
prostration. Scurvy used to be common among sailors
when they had little to eat except bread and salt meat.
-adj.
low; mean; contemptible: a scurvy fellow, a scurvy trick.
scur·vi·ly, adv., scur·vi·ness, n.

Authur James was too weak to scamper up the masts and rigging, useless even for hauling on a rope or mending a damaged sail. Reluctantly ordered below deck, he crawled into the bowels of the ship, where the men's hammocks were strung up, and joined the others who had succumbed to the insidious illness. The worst of them were hideously drawn, feverish, dreamy, and insensible; their skin was like paper covered in blotches of ink as they lay shrunken and gap-toothed in their hammocks, swaying with the motion of the ship. They were listless and morose in their misery and despair, moaning under the dim light from a few oil lamps, patiently awaiting death from this most feared of all maritime diseases. Some cried because they were cold, others because they were hungry and thirsty. They could not eat because their mouths were in ruins-swollen gums, brown and spongy, grown over their wobbly teeth. Their breath rattled in their chests and their eyes were dull and unfocused.

Soon James's shipmates began to die, in such numbers that there were scarcely any strong enough to sew them into their hammocks and give them a proper farewell before pitching them overboard. Corpses lay in the fetid compartments belowdecks, stiff, blue, and shrunken, gnawed on by rats and abandoned by their comrades. Others sprawled about the deck until someone pushed them overboard. The ship left a trail of bobbing corpses in its wake as it limped into a safe port on Juan Fernandez Island, off the coast of Chile, where the crew desperately hoped to find fresh fruit and vegetables.

Arthur James was one of the hundreds of men who wasted away and died of the dreaded scurvy while Commodore George Anson's flagship, Centurion, rounded Cape Horn in on a mission to harass Spanish shipping in the Pacific Ocean. Of the nearly two thousand men who set off from Portsmouth the previous year in five warships and a sloop, only about two hundred ever saw home again, the vast bulk of them perishing horribly from scurvy. What happened on Anson's voyage is considered one of the worst seaborne medical disasters of all time. It sickened and appalled the English public and aroused the consternation of naval authorities concerned with the loss of the astronomically expensive warships. It sparked a golden age of scurvy research in England that would see the distemper practically cured, if not fully understood, before the century was out.

Scurvy was responsible for more deaths at sea than storms, shipwreck, combat, and all other diseases combined. Historians have conservatively estimated that more than two million sailors perished from scurvy during the Age of Sail-a time period that began with Columbus's voyages across the Atlantic and ended with the development of steam power and its adaptation for engines on ships in the mid-nineteenth century. Like a constant but irritating and occasionally violent companion, it had sailed with virtually every major voyage of discovery, from Jacques Cartier to Vasco da Gama to Francis Drake. Explorers feared it, the merchants of the Dutch and English East India companies feared it, and by the eighteenth century Europe's national navies feared it. It was not uncommon for a proud and lumbering warship to slide to sea from Portsmouth or sally forth from Brest with more than seven hundred mariners and return months later with only three hundred sickly wretches- the unlucky others perishing horribly from the "grey killer" during the months at sea, the life slowly sucked from them on a diet of salt pork, biscuit, and grog.

Scurvy is a hideous and frightful affliction by which the body's connective tissue degenerates, resulting in bleeding gums, wobbly teeth, rot-reeking breath, anemic lethargy, physical weakness, the opening of old wounds, and the separating of once healed broken bones. Untreated, it leads to a slow, agonizing, and inevitable death. Although it is associated with the sea and sailors, scurvy appeared regularly in northern countries during winter months, during sieges, in prisons, or when harvests failed-anytime and anywhere people have subsisted on foods insufficient in ascorbic acid, vitamin C. But on long sea voyages it became virtually an occupational disease for sailors, because they had no means to carry fresh foods rich in the vital vitamin. Although the bulk of scurvy-ridden sailors usually recovered and returned to active duty, they would often succumb to the disease many times during the course of their naval lives, at great expense in medical treatment and with disastrous implications when ships sailed short-handed.

Scurvy had puzzled physicians and philosophers since the time of the ancient Greeks. The Hippocratic theoretical foundation that all illness stemmed from an imbalance in the four bodily humours- the black bile, the yellow bile, the blood, and the phlegm-resulted in medical reasoning and treatments that today seem disconnected from reality. The greatest medical minds of the era put forth new theories and proposals. Dozens of tracts were written on scurvy, claiming such varied causes for the distemper as foul vapours, dampness and cold, an excess of black bile, laziness, copper poisoning, the Dutch method of refining salt, inherited predisposition, blocked perspiration, and divine disfavour.

Common folk cures were as varied, bizarre, and optimistic as the motivations for the multitudes of voyages. Typical cures included purging with salt water, bleeding, eating sulphuric acid or vinegar, smearing mercury paste onto the open sores, or increasing sailors' workload in the belief that the disease was caused by indolence and sloth. Not surprisingly, the cure often proved as deadly as the disease. What was surprising, however, were the truly effective suggestions that cropped up now and then, such as James Lancaster's sixteenthcentury recommendation to scorbutic sailors to eat lemons, a fruit modern researchers have shown to be high in vitamin C. Somehow these practical and useful propositions were overshadowed by other, less effective ideas, or were dismissed because of impracticality or cost. Scurvy could not be cured because it could not be understood.

Because of the difficulties and limitations of food preservation, scurvy reached epidemic proportions during the Age of Sail. It was a primarily European problem that cropped up when ships had grown large enough to ply the world's oceans on voyages lasting months or years, often with infrequent landings because of an inability to accurately navigate or a fear of hostile peoples. When crews did land, they had no knowledge to determine which local plants were poisonous and which were edible. Britain, France, Spain, and the Netherlands were the nations with the ships and knowledge to undertake lengthy deep-sea voyages or to mount naval blockades of enemy ports, and hence the nations that suffered the most from scurvy.

Millions of men perished horribly during these centuries of early seafaring, destroyed directly by scurvy or indirectly when the weakened state of crews meant ships were swamped in monstrous storms or ran aground on jagged reefs or were unable to defend themselves from pirates or enemy ships. Despite scurvy's horrendous impact on maritime exploration and global trade, it never achieved the death toll of other dreaded diseases, such as the bubonic plague, smallpox, or malaria. For most of its history, scurvy merely lurked in the background like a shadow, influencing events in a subtle and unpredictable manner, culling sailors and stunting maritime enterprise. But during one brief period of time in the late eighteenth century, the hinges of history turned on the discovery of a cure for scurvy-and the timely discovery of that cure changed the course of world events. At that time, a convergence of naval technology, greater geographical knowledge of the world, and intense international conflict conspired to elevate the cure from the solution to a deadly yet predictable irritant to a vital factor determining the destiny of nations.

Throughout most of the eighteenth century, England and France, with a series of shifting alliances, were grappling for pre-eminence in Europe. Apart from several brief intervals of official peace, the era was dominated by war: the War of the Spanish Succession, the War of Jenkins's Ear and the Austrian Succession, the Seven Years' War, the War of American Independence, the French Revolution, and the Napoleonic Wars. Control of the seas would prove to be crucial in determining the outcome of these conflicts. After centuries of halfhearted questing for a solution to the greatest disease of the Age of Sail, the terrible danger and cost of not finding a cure was becoming all too apparent-to ignore scurvy any longer was to make a wild gamble with national security. The time and effort required to put into port and transport scorbutic sailors to and from hospitals were a significant liability in times of war, when men and ships were direly important and in short supply. The plague of the sea sapped a navy's strength, both financially and in terms of manpower, and had a direct impact on a nation's ability to defend itself. Moreover, whoever defeated scurvy, the Achilles heel of all the European navies, would acquire a significant strategic advantage-the ability to remain at sea for longer periods of time.

It was a trio of individuals in Britain who converged to lift the veil of obscurity from scurvy-a bookish surgeon named James Lind, the famed mariner and sea captain James Cook, and an influential physician and gentleman named Sir Gilbert Blane. It was a long road to a simple solution, but in the eighteenth century, that solution was far from obvious. At that time, despite several centuries of suffering, scurvy was still the greatest medical mystery of the age, a puzzle that continued to baffle mariners and medical theorists. From the bewildering fog of conflicting ideas, Lind, Cook, and Blane, working independently over several decades, overcame not only the sheer magnitude of the problem but the preposterous theoretical foundations of medicine, a confusing array of other ailments with similar symptoms, bureaucratic intransigence, and the unknown and fickle properties of one of the most promising cures. They proved that scurvy was a disease of chemistry and food-not vapours and viruses. Although seemingly obvious from a modern perspective, scurvy's cure remained elusive for so long with good reason-its seeds were in the very nature of our biology, and the germination of those seeds was in the nature of early maritime enterprise and life at sea. Scurvy lurked on ships long before they ever left port, waiting to appear under the right set of conditions- conditions that a sea life hastened.

The defeat of scurvy was one of the great medical and sociomilitary advances of the era, a discovery on par with the accurate calculation of longitude at sea, the creation of the smallpox vaccination, or the development of steam power. The convoluted and bizarre story of the quest for scurvy's cure turns around an unusual quirk of human biology, the confusion of early medical theory, international politics, the yawning gulf between individuals caused by European class structure, and finally military necessity. How the cure for scurvy was found and lost and finally found again at an important juncture in the history of the world is one of the great mysteries of the age.