The Discovery of Vitamins & the History of Scurvy

Hi everyone! 

Welcome back to another episode of Unsavory. I’m Becca, and…
I’m Sarah, and we’re two dietitians talking about true crime and food. 

I love today’s episode because when I chose this topic I was like “I bet this will be an easy one to write” because I thought I knew a lot about scurvy, and it turns out it’s more interesting than I ever expected and I went down 10 million wormholes and it blew my mind! So if you’re thinking “this is going to be boring, everyone knows about scurvy”, respectfully, it will not be boring. 

Becca is going to start out by giving us a little history lesson on the discovery of vitamins, which is more recent than you might expect, and then I’m going to share the tale of how millions of people died from a disease that could have been prevented by just eating some fruit and vegetables. It’s a fascinating story, and of course historical - our fave - but also pretty dang scandalous! 

Intro 

The most tragic part about scurvy is that it’s just so dang preventable. You just eat some food containing a decent amount of vitamin C! Of course, this is so clear in retrospect and researching this made me want to go back in time and grab some sailors by the shoulders and scream “LEMONS, just eat some LEMONS, please for the sake of your children” because when you consider that over 2 million sailors lost their lives to a disease that could have been prevented with a lemon or an orange, that’s pretty devastating and it feels so obvious, but it wasn’t at the time! There were all sorts of challenges that people faced as they tried to figure out what was causing this devastating illness, and unfortunately, chewable gummy vitamins weren’t invented yet. 

So, I think that people know that Scurvy is a disease caused by a long-term lack of vitamin C in the diet, but there is a lot more to it. Becca, when you think of scurvy, what is the first thing that comes to your mind? 

Scurvy is basically the slow and painful disintegration of the entire body. Vitamin C is a nutrient that the human body must obtain from food and is required to form blood vessels, cartilage, muscle, collagen, and bones. And when you think of all those different tissues, that’s basically the entire body. One of the earliest symptoms is actually an intense, debilitating fatigue, so strong that people once thought that laziness and sleeping too much could actually cause scurvy, but instead these people were already suffering from it. The collagen in the skin starts to break down and structures like blood vessels become weak and porous, little blood blisters start to form under the skin that then develop into painful ulcers.The gums begin to break down, sagging and swelling, leaking putrid blood, and eventually become black, and breath becomes absolutely foul as bacteria thrive on gingivitis. The hairs on your arms and legs become wiry and might bleed at the hair follicles, a phenomenon known as corkscrew hairs. Previously smooth, solid bones become porous like a sponge, leaving them more susceptible to breaking. Joints swell and become painful and the body retains water as it works to hang on to every last bit of vitamin C it can. On the inside, the arteries and capillaries begin to decay, as collagen is no longer available to support their structure, causing major cardiovascular damage. At any moment, someone with scurvy could suffer a seizure or aneurism. As the disease progresses, those suffering from scurvy become irritable, depressed, and begin to hallucinate. Dreams become vivid - much like in the Minnesota Starvation Experiment, individuals dream of food - only to wake up and find that there is none available, and that even if there was, they’re rotting mouths would have a hard time chewing it. An expert on scurvy in the 17th century named Thomas Willis, called Scurvy  “a falling down of the whole soul” because formerly strong, young humans (mostly men) would crumble and succumb to this slow and painful disease. Wounds can reopen and may never heal as the immune system becomes less effective. Eyesight becomes blurry and individuals become sensitive to light. And as the disease continues into its final stages, victims experience jaundice, full body pain, tooth loss, internal bleeding, delirium, organ failure, coma, and eventually and almost mercifully, death, at which point they are tossed into the sea. And all of this could have been avoided by sending sailors off to sea with some lemons or limes.

Fun fact: If something is related to or affected by scurvy, it’s referred to as scorbutic. So the symptoms of scurvy are scorbutic symptoms and something that prevents scurvy, aka vitamin C, could be called an anti-scorbutic. Vitamin C is also known as ascorbic acid, and fun fact, ascorbic translates to anti-scorbutic. So, that’s why vitamin c is also called ascorbic acid. 

But before we knew that vitamin C caused scurvy, most people had no idea why sailors were being stricken with this terrible disease. During the “Age of Scurvy”, which was from about 1500-1800, the problem was so common that shipowners and governments actually anticipated a 50% death rate from scurvy for their sailors on any major voyage. But scurvy didn’t just magically appear in the 1500s. For as long as their have been humans, scurvy has been a possibility. However, the “age of scurvy” conveniently coincides with the “age of discovery” or “the age of exploration”. 

Between the 1500-1800’s, extensive overseas exploration emerged as a powerful factor in European culture. Long seaward voyages, sometimes spanning many years, were made possible through technological advancements like improved ship design and the magnetic compass. So ships were able to head out to sea for significantly longer periods of time, and of course, fresh fruit and vegetables would quickly spoil so they weren’t on board ships for long. 

During these years, sailors diets consisted mostly of dry and preserved foods, typically, a combination of meats, fats, carbohydrates, and alcohol that varied based on their home country - but most fleets included beer, wine, or rum (often instead of water, because water would go stale, or mixed with water), salted anchovies and salted cod, pickled or salted beef and pork, oatmeal, rice, peas (½ cup contains 13% of the Recommended Daily Intake), cheese, and live animals would be brought along for their milk. The peas and the unpasteurized milk would provide a small amount of vitamin C, but not enough to meet sailors needs long term, and often these items would run out. Additionally, almost every ship had something called ship’s bread or hardtack biscuits, also known as survival bread. This is basically a simple type of biscuit or cracker made from flour, water, and sometimes salt. Ship’s bread is inexpensive and long-lasting, and was also lovingly nicknamed “worm castles” because insects would lay their larvae in these dry biscuits and they would be filled with little worms. Not ideal, but food couldn’t really be wasted on the ships! So sailors would break up the ship’s bread or the hardtack biscuits and drop it into their morning coffee. This would not only soften the hard bread, but it would also allow the little larva to float to the top, and the soldiers could scoop out the insects and eat the bread. 

As you can see from the diets that sailors were eating aboard most European ships, the absence of vitamin C was a major failure. Often, ship captains would do their best to stock up on fresh fruits and vegetables whenever they docked, but for millions of sailors, that wasn’t enough to fend off scurvy. 

This is a real shame because a minimum of 2 million sailors died from Scurvy and the numbers are likely much higher because deaths at sea often went unaccounted for, and it wasn’t just navy ships that were affected. Pirate ships were also impacted but pirates don’t keep great records. And I find it so heartbreaking and frustrating to think of a minimum of 2 million deaths knowing with the advantage of time and science, that the simplest cure was right there - if only the rations had included a massive vat of sauerkraut or even potatoes - millions of lives could have been saved from a drawn out, painful death. 

A bit of an aside, but when I was researching the naval diets of the 1500-1800s, I was surprised that potatoes weren’t included - especially when you consider that a small potato has about 33mg of vitamin C, so 3 small or 2 medium potatoes per day would have been enough prevent scurvy, and potatoes can store in a cool, dry room for a fairly long period of time. So I looked into why potatoes rarely appeared in sea rations, and learned that it wasn’t until the 19th century that potatoes were considered an acceptable food to eat by the English. This was partially because when potatoes sprout and form those little arms and start to turn green - and then are exposed to light - they actually become poisonous, and there are some instances in which people have died from eating sprouted potatoes. Also, many English people at this time thought of potatoes as “good food for the poor people”. So maybe if they weren’t so snooty about potatoes, they could have saved some lives… 

To add another layer of frustration to the sheer volume of scurvy deaths, there are plenty of cultures around the world that had found ways to overcome and prevent scurvy using their own traditional foods, and these “cures” or preventative measures were well known and sometimes even documented prior to the Age of Scurvy and the Age of Exploration. 

One of the earliest documented mentions of scurvy is from an Indian scientist named Susruta, who described Scurvy as early as 600BC. The Norwegians documented scurvy, which they called Skyrbjugr, as early as 1000AD. The Norse Vikings actually believed that scurvy was caused by eating too much Skyr, which is the Norse word for sour milk and you might recognize from the brand of Skyr Icelandic-style yogurt that is thick and creamy and so delicious. Skyr was often used as a source of nutrition on long viking voyages, and so they thought that too much Skyr caused Skyrbjugr, and the “bjugr” part actually means edema which is fluid retention and swelling, so it was on long sea expeditions that the Viking sailors got skyrbjugr or “sour milk swelling” and it was Scurvy. To overcome this phenomenon, the vikings figured out that cloudberries - which look kind of like an orangey-pink raspberry, they’re very pretty, and are native to arctic tundra and boreal forest regions - could prevent Skyrbjugr. 

Land scurvy was also common in places that experienced long winters, like Northern Norway, and they had figured out that wild plants and cabbage could prevent scurvy, and of course, wild berries like cloudberries. 

So what they would do is cook the berries in an earthen or metal pot to a soft consistency to make a jam, and then preserve this jam by covering it with a layer of butter so that it wouldn’t be spoiled by airborne microbes. This jam was an effective remedy against scurvy that could last the winter and was often served with reindeer milk. 

Another legend claims that on one of Columbus’ voyages, many of his sailors became ill with scurvy and so they asked to be dropped off on a random island to die instead of having to die on the ship. So Columbus dropped them off and sailed away, and then months later when they were passing by on their way back to Europe, the same men that they had dropped off were healthy and jumping up and down, waving at them from the shore. They had been eating island fruits and made a full recovery from scurvy, and this island was called Curacao meaning “cure”. 

Now, the indigenous peoples of North America had also been successfully preventing scurvy for ages before European explorers and settlers arrived on North American soil, and had been passing botanical remedies down through oral history for generations. One of the first documented uses of indigenous medicine in North America was from the 1536 voyage led by Jacques Cartier, in which his crew was struck by scurvy, but he noted that captured indigenous slaves were not dying from scurvy. 

This was because they were drinking a traditional remedy - a tea made from boiling leaves and bark from an evergreen tree known as “Annedda” - likely a white pine or white spruce - also known as the “tree of life”. The precise species of tree is actually a matter of debate because this happened before Linnean taxonomy was developed (1735). According to an article in Medium written by Karina Vega-Villa, Jacques Cartier asked a Huron native named Dom Agaya what the indigenous people were drinking and learned this it was this Anneda tree, and this knowledge spread quickly among the sailors and it was reported as a European “discovery”. 

So we have, throughout history, all these documented instances of successful scurvy prevention and different traditional cures, but yet well into the 1700s, millions of people died from this easily preventable disease. How is that possible? Well, let’s consider some of the reasons that scurvy and vitamin C were so tricky and confusing to figure out. First of all, the absolute coolest thing about vitamin C in my opinion, is that most mammals can internally synthesize their own vitamin C! My cats eat nothing but meat, they literally run away if I even show them something green like they’re scared of it, but they will never become vitamin C deficient because they make their own. In fact, the only mammals that do not make their own vitamin C are humans, guinea pigs, fruit bats, and some primates, a phenomenon that some have called an “inborn vitamin deficiency” and is also thought to be a quirk of evolution. So of course, the cats, dogs, mice, and rats aboard the ships remained perfectly healthy without fruits and vegetables, while the sailors around them fell one by one. 

Another factor, is that vitamins weren’t a thing during the Age of Scurvy. People, of course, knew that we needed food to be healthy and function, but the idea that the lack of a specific component of food could cause disease was not even on the table because vitamins weren’t even discovered until 1912, and vitamin C specifically was not discovered until the 1930s. So this is almost 150 years after the Age of Scurvy, and if you remember from our Typhoid Mary episode, the Age of Scurvy is even pre-germ theory, so most diseases at this time were thought to be caused by things like sinful lifestyles, spiritual blockages, poor hygiene, and bad air. SO the idea that scurvy was being caused by a lack of something was foreign, and many people actually believed that it was due to poor living conditions on the ships, being far from land, and eating excess preserved meats. This idea led some to believe that scurvy was caused by the physical misery of the seaward voyages, and in response, some captains went to great lengths to keep ships clean, dry, and warm. Others endorsed drinking seawater as the trick to curing scurvy, which only made things worse because now you’ve got scurvy and you’re dehydrated. Others even thought that scurvy was the result of extreme homesickness, and up until the 1700s, some thought that the smell of soil and being on land could maybe help scurvy, leading to the practice of “earth bathing”, which was when they would bring in a box of soil, strip the person with scurvy down, and cover them in the dirt, which of course… did nothing. 

Another factor that made it difficult to pinpoint causation or even correlation, is that once someone stops getting adequate vitamin C, it can take up to 3 months to show symptoms of scurvy. To complicate things further, it’s likely that there were also other nutrient deficiencies at play, like Pellagra (niacin deficiency) or Beriberi (thiamin deficiency), and as the ships spent months and months at sea, it became more likely that other diseases would hit the crew, even things like food poisoning, which only further obscured the vitamin C-scurvy relationship. 

Yet another complicating factor was that even after it was pretty widely known that fruits and vegetables could prevent scurvy, the preservation techniques available at the time often destroyed much of the vitamin C. I’m going to come back to this point later, when I tell you all about how the cure for scurvy was “discovered” in what is known as the first clinical trial, and how the royal navy earned the nickname “limeys”. 

But first, I want to tell you the story of the Royal Navy’s Worst Scurvy Outbreak - George Anson’s Voyage Round the World which lasted from 1740 to 1744, in which 1955 men set off,  and only 145 returned. That’s a 92.5% death rate. And just FYI, there are hundreds of voyages during the Age of Scurvy that I could have chose from, I just chose this one because of the devastating death toll and it’s fairly well-document, but if you’re interested in learning more about other voyages, there are plenty of stories to choose from! 

I got most of my information for this story from an article called The Age of Scurvy by Catherine Price in Science History Institute and an article by Dr. Eleanora Gordon called Scurvy and Anson's Voyage Round the World: 1740-1744 An Analysis of the Royal Navy's Worst Outbreak. 

I want to remind you quickly of how horrific this disease is with a quote from an unknown surgeon who was stricken with scurvy on a 16th century English voyage and survived - this quote is from a book by Stephen Bown called Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail.
 
“It rotted all my gums, which gave out a black and putrid blood. My thighs and lower legs were black and gangrenous, and I was forced to use my knife each day to cut into the flesh in order to release this black and foul blood. I also used my knife on my gums, which were livid and growing over my teeth. . . . When I had cut away this dead flesh and caused much black blood to flow, I rinsed my mouth and teeth with my urine, rubbing them very hard. . . . And the unfortunate thing was that I could not eat, desiring more to swallow than to chew. . . . Many of our people died of it every day, and we saw bodies thrown into the sea constantly, three or four at a time.” 

This was a foul disease that really stripped people of the very fabric of their bodies and they quite literally slowly decomposed alive. 

So the ill-fated voyage of captain George Anson, is considered one of the worst medical disasters at sea. In the mid 1700’s, there was a serious shortage of men who were eager to go to sea. In fact, the situation was so desperate that there were gangs called Press Gangs, whose sole purpose was to kidnap men for sea voyages. So as Captain George Anson looked for men to staff his 6-ship voyage, he relied on kidnapped men coerced to join the navy by Press Gangs, but even the Press Gangs couldn’t recruit enough men. The voyage would require about 2000 men and they were short a couple hundred, so the Royal Navy came up with a rather horrifying solution, and emptied out the nearby Chelsea Hospital, which was home to war veterans that were elderly, wounded, and often suffering from mental health issues, and could no longer serve in marching regiments of the military. Even after the veterans were added to the group, they still needed about 200 more men, and so the navy supplied about 210 young marines that were so inexperienced they had allegedly never been permitted to fire their weapons. So, that was Anson’s top tier crew, and now he could focus on his mission, which was to 'annoy and distress' the Spanish colonies on the South American coasts by 'taking, sinking, burning or otherwise destroying all their ships,' to seize any Spanish settlements which might be vulnerable, and to capture Spanish treasure. Specifically, he was to track down and capture a Spanish ship so valuable, that it was known as the “Prize of All the Oceans” and it transported silver from Acapulco, Mexico to Manila, Phillipines. 

Before the crew set sail from England, they had to repair some of the ships, which meant that during the 6-months of preparation the crew was already eating from the ships rations. Needless to say, when they finally departed in September 1740, it had already been months without access to fresh fruits and vegetables. The Navy was well aware of what was called “the scurvy” by this point, and so they supplied the ship with some of the most popular “treatments” for scurvy at the time: something called an “elixir of vitriol”, which sounds nice, and is a mixture of sulfuric acid and alcohol, and a medicine called Ward’s drop and pill, which was essentially a laxative. Both, spoiler alert, were useless against scurvy. 

The disease officially began to hit the voyage as they rounded Cape Horn, which is well known for being a dangerous and turbulent stretch at the tip of South America. This ship's chaplain, Richard Walter, was tasked with writing the voyage’s official account, and he wrote that March 7 was “the last cheerful day that the greatest part of us would ever live to enjoy”. The next day, stormy weather struck fast and furiously, with waves towering over the ships, and they were forced off course. Once the storms started, they raged for 3 months, battering the men with rain, hail, and even snow, leaving some of the men with frostbite. By the time the storms ended, two ships had turned back, the remaining 4 had been separated, and the majority of the veterans and young marines were dead. However, the voyage continued, and by the end of April almost everyone on board had scurvy and it was starting to become pretty advanced. 43 men died April, and nearly 90 men died in May. Victims developed the trademark blood blisters all over their bodies, legs swelled, gums bled, and everyone was debilitatingly exhausted. As more men died, the scene on board the ships got worse - rat infestations and damp living conditions were the least of the crews worries, because dead bodies began to pile up as the crew was too weak to physically lift them overboard. 

Walter, the documentarian and Chaplain, wrote that a dying sailor that had been wounded 50 years earlier, watched in horror as his wounds “broke out afresh, and appeared as if they had never been healed”. Others reported that previously broken bones that had been healed, essentially disintegrated and rebroke. 

Despite these horrific conditions and symptoms, three of the ships - the Centurion, the Gloucester, and the Tryal, arrived at Juan Fernandez Island off the Chilean coast. The ships had previously agreed that if they were separated during their travels, this is where they would meet. These three ships had originally held 1200 men between them, but only 335 arrived at the island. Walter wrote “To our great mortification, it was near twenty days after their landing before the mortality was tolerably ceased; and for the first 10 or 12 days, we buried rarely less than six each day, and many of those who survived recovered by very slow and insensible degrees”. Luckily for the crew, the island was filled with wild plants that were great sources of vitamin C, plus they found lots of fresh fish, so they ate really well and rebuilt their strength. The men stayed on the island for 3 months, recovering their health. 

There was a general consesus that fresh fruit and vegetables could prevent scurvy, but no one knew why, and of course, as the crew set out to finish their mission, the disease resurfaced during the long voyage across the Pacific during the summer of 1742. In mid-August, they had to abandon one of their ships because they physically didn’t have enough men left to operate it. It’s reported that the voyage lost up to 5 men each day to scurvy as they crossed the Pacific, but somehow, this ragtag crew that just won’t quit finally docked in Canton, which is now known as Guangzhou (gwaang·jow), China, with 227 people. 

Despite all this, and I would have given up months ago - I probably would have stayed on Jaun Fernandez Island, honestly - Captain George Anson did not lose sight of his original mission, and he found and ambushed and conquered a Spanish treasure ship on June 20,1743, in a battle that killed only 3 of his men. Not bad, considering they were probably very weak and malnourished. And because of this capture, the British Navy actually considered this deadly voyage a SUCCESS. Anson returned to England a rich and celebrated man and was appointed First Lord of the Admiralty in 1751. But Anson allegedly never forgot that of the nearly 2000 men he had set off with, only approximately 145 made it home. 

& that’s the kind of devastating story that makes you want to go back in time and just scream It’s vitamin C! Pack some lemons, make a bunch of cloud berry jam and pine needle tea and ferment some sauerkraut, ahhh. 

This is a quote from Catherine Price’s article that I like and I think summarizes the history of scurvy well: “One of the strangest things about the history of scurvy (and many other vitamin-deficiency diseases) is that people kept figuring out cures and then forgetting them. In 1535 the French explorer Jacques Cartier reported that after his ships had become locked in ice in the St. Lawrence River, his men were saved from scurvy by a special tea prepared by local Native Americans from the bark and leaves of a particular tree. In the 1500s and 1600s several ship captains suggested there might be a connection between fruits and vegetables and scurvy. In 1734 a Dutch physician named Johannes Bachstrom came up with the term antiscorbutic (“without scurvy”) and used it to describe fresh vegetables, thus becoming the first person known to suggest that scurvy might be a deficiency disease. Even Anson made a point of loading up on oranges whenever possible, and his chaplain, Walter, praised Juan Fernández Island for having “almost all the vegetables which are usually esteemed to be particularly adapted to the cure of those scorbutic disorders which are contracted by salt diet and long voyages.” Even though no one knew the cause of scurvy or what about these various foods made them antiscorbutic, many mariners recognized a connection between their diets and their health.”

And yet, people continue to die from scurvy. There are plenty of reasons that the connection between vitamin C and scurvy kept getting discovered and then forgotten, but one that I haven’t discussed yet is that at the time, it wasn’t exactly obvious where Vitamin C came from - even though it feels obvious to us that oranges, kiwis, cabbage, broccoli, and red peppers have a lot, but for example, Milk and eggs have none, liver and kidneys though - pretty good source - but not muscles meats. Potatoes are a decent source, but pears actually aren’t. But if you a boil your potato or your broccoli, you’re going to loose about half the vitamin C, and if you chop the potato and let it sit for a bit exposed to the air, and then you boil it in a copper pot, well now you’re really depleting the vitamin C! So even though vitamin C feels so obvious now, it really wasn’t at the time. 

To add another layer of interest to the Scurvy story, in 1747, Dr. James Lind, a scottish physician, conducted what is considered to be the first controlled trial and actually confirmed that lemons and limes were the superior treatment for scurvy. Remember, this is over 50 years before the Royal Navy would administer limes as a scurvy prevention. However, Dr. Lind’s discovery would be buried for decades because even though he technically proved that citrus fruits were effective, he didn’t even really believe it himself. Let me explain. 

Dr. James Lind recruited 12 soldiers who were at similar stages in their scurvy and divided them into 6 groups. Each group ate the exact same foods and lived in the exact same quarters, and the only difference was the treatment they recieved. Each pair was assigned a different popular scurvy “treatment” at the time - a quart of hard cider, 25 drops of vitriol, 2 spoonfuls of vinegar, a half a pint of seawater, two oranges and one lemon, or a mixture of garlic, mustard seed, balsam, radish, and gum myrrh ground into a paste. With the exception of the citrus fruit, which ran out in less than a week, Lind administered the treatments for 14 days. Despite having a much shorter course of treatment, the men being administered the citrus fruits recovered much more quickly than the others, so much so, that they actually began helping take care of the others. So, James Lind clearly discovered the official cure for Scurvy right? Not quite. 

So after this experiment, Lind wrote a book with the short & sweet title of A Treatise of the Scurvy: Containing an Inquiry into the Nature, Causes, and Cure of That Disease Together with a Critical and Chronological View of What Has Been Published on the Subject. In the entire 400 page book, Lind dedicated about 5 paragraphs to his clinical trial and squeezed the most important result into just one sentence that basically got lost in the rest of the book “As I shall have occasion elsewhere to take notice of the effects of other medicines in this disease, I shall here only observe that the results of all my experiments was, that oranges and lemons were the most effectual remedies for this distemper at sea.” Even Lind didn’t see how important his results were, and instead went on to describe his other theory - which was that scurvy was a digestive disease cause by blocked sweat glands. No idea where he got that from, but he thought that lemon juice, mixed with wine and sugar, might be effective against scurvy because it cleared out the sweat glands.  

In 1795, a physician named Gilbert Blane convinced the British Royal Navy to issue some form of lemon juice to its sailors. At this time, lemon and limes were both referred to as lemons, and so the sailors were actually issued lime juice, which is why they have the nickname “Limeys”. & the rest is history. 

Just kidding, the disease continued to emerge during the gold rush, wars, and other voyages despite the fact that the cure was pretty much known and confirmed since the late 1700s. Into the 20th century, scurvy continued to pop up in prisons (check out our prison episode), refugee camps, and in prisoners of war, and it even popped up in wealthy families in the early 1900s that were feeding their babies pasteurized cow’s milk formulas (heat treatment destroys the small amount of natural vitamin C in milk). 

So you might be wondering, despite everything we know about scurvy and vitamin C, do people still get it? Yes, they do. 

Dr. Kayla Dagdar was a medical student at McMaster University when she began looking through medical records from Hamilton, Ontario covering a 9-year period. Her results showed 52 patients with low Vitamin C levels, 13 of which had actually been diagnosed with scurvy. These patients had poor diets due to a number of factors, such as eating disorders, alcohol abuse, mental illness, social isolation, intentional dietary restrictions and dependence on others for food. I want to focus on that last point - dependence on others for food - because there are some pediatric cases where scurvy has developed in extremely picky children, like a 3-year-old boy in Russia who was eating exclusively rice and grains with a nearly complete avoidance of meat, fruit, and vegetables, and in an 11-month baby in Spain who’s parents were feeding him an almond-milk formula that contained no vitamin C. 

So, what do you need to do to make sure you never get scurvy? Try your best to meet the Recommended Daily Intake for Vitamin C, which is 75-90 mg/day, and can easily be obtained from consuming a single orange, a large kiwi, a red pepper, a cup of broccoli, a cup of brussel sprouts, or a large lemon, or if you are really pick, taking a multivitamin.

Hi everyone! 

Welcome back to another episode of Unsavory. I’m Becca, and…

I’m Sarah, and we’re two dietitians talking about true crime and food. 

I love today’s episode because when I chose this topic I was like “I bet this will be an easy one to write” because I thought I knew a lot about scurvy, and it turns out it’s more interesting than I ever expected and I went down 10 million wormholes and it blew my mind! So if you’re thinking “this is going to be boring, everyone knows about scurvy”, respectfully, it will not be boring. 

Becca is going to start out by giving us a little history lesson on the discovery of vitamins, which is more recent than you might expect, and then I’m going to share the tale of how millions of people died from a disease that could have been prevented by just eating some fruit and vegetables. It’s a fascinating story, and of course historical - our fave - but also pretty dang scandalous! 

Intro 

The most tragic part about scurvy is that it’s just so dang preventable. You just eat some food containing a decent amount of vitamin C! Of course, this is so clear in retrospect and researching this made me want to go back in time and grab some sailors by the shoulders and scream “LEMONS, just eat some LEMONS, please for the sake of your children” because when you consider that over 2 million sailors lost their lives to a disease that could have been prevented with a lemon or an orange, that’s pretty devastating and it feels so obvious, but it wasn’t at the time! There were all sorts of challenges that people faced as they tried to figure out what was causing this devastating illness, and unfortunately, chewable gummy vitamins weren’t invented yet. 

So, I think that people know that Scurvy is a disease caused by a long-term lack of vitamin C in the diet, but there is a lot more to it. Becca, when you think of scurvy, what is the first thing that comes to your mind? 

Scurvy is basically the slow and painful disintegration of the entire body. Vitamin C is a nutrient that the human body must obtain from food and is required to form blood vessels, cartilage, muscle, collagen, and bones. And when you think of all those different tissues, that’s basically the entire body. One of the earliest symptoms is actually an intense, debilitating fatigue, so strong that people once thought that laziness and sleeping too much could actually cause scurvy, but instead these people were already suffering from it. The collagen in the skin starts to break down and structures like blood vessels become weak and porous, little blood blisters start to form under the skin that then develop into painful ulcers.The gums begin to break down, sagging and swelling, leaking putrid blood, and eventually become black, and breath becomes absolutely foul as bacteria thrive on gingivitis. The hairs on your arms and legs become wiry and might bleed at the hair follicles, a phenomenon known as corkscrew hairs. Previously smooth, solid bones become porous like a sponge, leaving them more susceptible to breaking. Joints swell and become painful and the body retains water as it works to hang on to every last bit of vitamin C it can. On the inside, the arteries and capillaries begin to decay, as collagen is no longer available to support their structure, causing major cardiovascular damage. At any moment, someone with scurvy could suffer a seizure or aneurism. As the disease progresses, those suffering from scurvy become irritable, depressed, and begin to hallucinate. Dreams become vivid - much like in the Minnesota Starvation Experiment, individuals dream of food - only to wake up and find that there is none available, and that even if there was, they’re rotting mouths would have a hard time chewing it. An expert on scurvy in the 17th century named Thomas Willis, called Scurvy  “a falling down of the whole soul” because formerly strong, young humans (mostly men) would crumble and succumb to this slow and painful disease. Wounds can reopen and may never heal as the immune system becomes less effective. Eyesight becomes blurry and individuals become sensitive to light. And as the disease continues into its final stages, victims experience jaundice, full body pain, tooth loss, internal bleeding, delirium, organ failure, coma, and eventually and almost mercifully, death, at which point they are tossed into the sea. And all of this could have been avoided by sending sailors off to sea with some lemons or limes.

Fun fact: If something is related to or affected by scurvy, it’s referred to as scorbutic. So the symptoms of scurvy are scorbutic symptoms and something that prevents scurvy, aka vitamin C, could be called an anti-scorbutic. Vitamin C is also known as ascorbic acid, and fun fact, ascorbic translates to anti-scorbutic. So, that’s why vitamin c is also called ascorbic acid. 

But before we knew that vitamin C caused scurvy, most people had no idea why sailors were being stricken with this terrible disease. During the “Age of Scurvy”, which was from about 1500-1800, the problem was so common that shipowners and governments actually anticipated a 50% death rate from scurvy for their sailors on any major voyage. But scurvy didn’t just magically appear in the 1500s. For as long as their have been humans, scurvy has been a possibility. However, the “age of scurvy” conveniently coincides with the “age of discovery” or “the age of exploration”. 

Between the 1500-1800’s, extensive overseas exploration emerged as a powerful factor in European culture. Long seaward voyages, sometimes spanning many years, were made possible through technological advancements like improved ship design and the magnetic compass. So ships were able to head out to sea for significantly longer periods of time, and of course, fresh fruit and vegetables would quickly spoil so they weren’t on board ships for long. 

During these years, sailors diets consisted mostly of dry and preserved foods, typically, a combination of meats, fats, carbohydrates, and alcohol that varied based on their home country - but most fleets included beer, wine, or rum (often instead of water, because water would go stale, or mixed with water), salted anchovies and salted cod, pickled or salted beef and pork, oatmeal, rice, peas (½ cup contains 13% of the Recommended Daily Intake), cheese, and live animals would be brought along for their milk. The peas and the unpasteurized milk would provide a small amount of vitamin C, but not enough to meet sailors needs long term, and often these items would run out. Additionally, almost every ship had something called ship’s bread or hardtack biscuits, also known as survival bread. This is basically a simple type of biscuit or cracker made from flour, water, and sometimes salt. Ship’s bread is inexpensive and long-lasting, and was also lovingly nicknamed “worm castles” because insects would lay their larvae in these dry biscuits and they would be filled with little worms. Not ideal, but food couldn’t really be wasted on the ships! So sailors would break up the ship’s bread or the hardtack biscuits and drop it into their morning coffee. This would not only soften the hard bread, but it would also allow the little larva to float to the top, and the soldiers could scoop out the insects and eat the bread. 

As you can see from the diets that sailors were eating aboard most European ships, the absence of vitamin C was a major failure. Often, ship captains would do their best to stock up on fresh fruits and vegetables whenever they docked, but for millions of sailors, that wasn’t enough to fend off scurvy. 

This is a real shame because a minimum of 2 million sailors died from Scurvy and the numbers are likely much higher because deaths at sea often went unaccounted for, and it wasn’t just navy ships that were affected. Pirate ships were also impacted but pirates don’t keep great records. And I find it so heartbreaking and frustrating to think of a minimum of 2 million deaths knowing with the advantage of time and science, that the simplest cure was right there - if only the rations had included a massive vat of sauerkraut or even potatoes - millions of lives could have been saved from a drawn out, painful death. 

A bit of an aside, but when I was researching the naval diets of the 1500-1800s, I was surprised that potatoes weren’t included - especially when you consider that a small potato has about 33mg of vitamin C, so 3 small or 2 medium potatoes per day would have been enough prevent scurvy, and potatoes can store in a cool, dry room for a fairly long period of time. So I looked into why potatoes rarely appeared in sea rations, and learned that it wasn’t until the 19th century that potatoes were considered an acceptable food to eat by the English. This was partially because when potatoes sprout and form those little arms and start to turn green - and then are exposed to light - they actually become poisonous, and there are some instances in which people have died from eating sprouted potatoes. Also, many English people at this time thought of potatoes as “good food for the poor people”. So maybe if they weren’t so snooty about potatoes, they could have saved some lives… 

To add another layer of frustration to the sheer volume of scurvy deaths, there are plenty of cultures around the world that had found ways to overcome and prevent scurvy using their own traditional foods, and these “cures” or preventative measures were well known and sometimes even documented prior to the Age of Scurvy and the Age of Exploration. 

One of the earliest documented mentions of scurvy is from an Indian scientist named Susruta, who described Scurvy as early as 600BC. The Norwegians documented scurvy, which they called Skyrbjugr, as early as 1000AD. The Norse Vikings actually believed that scurvy was caused by eating too much Skyr, which is the Norse word for sour milk and you might recognize from the brand of Skyr Icelandic-style yogurt that is thick and creamy and so delicious. Skyr was often used as a source of nutrition on long viking voyages, and so they thought that too much Skyr caused Skyrbjugr, and the “bjugr” part actually means edema which is fluid retention and swelling, so it was on long sea expeditions that the Viking sailors got skyrbjugr or “sour milk swelling” and it was Scurvy. To overcome this phenomenon, the vikings figured out that cloudberries - which look kind of like an orangey-pink raspberry, they’re very pretty, and are native to arctic tundra and boreal forest regions - could prevent Skyrbjugr. 

Land scurvy was also common in places that experienced long winters, like Northern Norway, and they had figured out that wild plants and cabbage could prevent scurvy, and of course, wild berries like cloudberries. 

So what they would do is cook the berries in an earthen or metal pot to a soft consistency to make a jam, and then preserve this jam by covering it with a layer of butter so that it wouldn’t be spoiled by airborne microbes. This jam was an effective remedy against scurvy that could last the winter and was often served with reindeer milk. 

Another legend claims that on one of Columbus’ voyages, many of his sailors became ill with scurvy and so they asked to be dropped off on a random island to die instead of having to die on the ship. So Columbus dropped them off and sailed away, and then months later when they were passing by on their way back to Europe, the same men that they had dropped off were healthy and jumping up and down, waving at them from the shore. They had been eating island fruits and made a full recovery from scurvy, and this island was called Curacao meaning “cure”. 

Now, the indigenous peoples of North America had also been successfully preventing scurvy for ages before European explorers and settlers arrived on North American soil, and had been passing botanical remedies down through oral history for generations. One of the first documented uses of indigenous medicine in North America was from the 1536 voyage led by Jacques Cartier, in which his crew was struck by scurvy, but he noted that captured indigenous slaves were not dying from scurvy. 

This was because they were drinking a traditional remedy - a tea made from boiling leaves and bark from an evergreen tree known as “Annedda” - likely a white pine or white spruce - also known as the “tree of life”. The precise species of tree is actually a matter of debate because this happened before Linnean taxonomy was developed (1735). According to an article in Medium written by Karina Vega-Villa, Jacques Cartier asked a Huron native named Dom Agaya what the indigenous people were drinking and learned this it was this Anneda tree, and this knowledge spread quickly among the sailors and it was reported as a European “discovery”. 

So we have, throughout history, all these documented instances of successful scurvy prevention and different traditional cures, but yet well into the 1700s, millions of people died from this easily preventable disease. How is that possible? Well, let’s consider some of the reasons that scurvy and vitamin C were so tricky and confusing to figure out. First of all, the absolute coolest thing about vitamin C in my opinion, is that most mammals can internally synthesize their own vitamin C! My cats eat nothing but meat, they literally run away if I even show them something green like they’re scared of it, but they will never become vitamin C deficient because they make their own. In fact, the only mammals that do not make their own vitamin C are humans, guinea pigs, fruit bats, and some primates, a phenomenon that some have called an “inborn vitamin deficiency” and is also thought to be a quirk of evolution. So of course, the cats, dogs, mice, and rats aboard the ships remained perfectly healthy without fruits and vegetables, while the sailors around them fell one by one. 

Another factor, is that vitamins weren’t a thing during the Age of Scurvy. People, of course, knew that we needed food to be healthy and function, but the idea that the lack of a specific component of food could cause disease was not even on the table because vitamins weren’t even discovered until 1912, and vitamin C specifically was not discovered until the 1930s. So this is almost 150 years after the Age of Scurvy, and if you remember from our Typhoid Mary episode, the Age of Scurvy is even pre-germ theory, so most diseases at this time were thought to be caused by things like sinful lifestyles, spiritual blockages, poor hygiene, and bad air. SO the idea that scurvy was being caused by a lack of something was foreign, and many people actually believed that it was due to poor living conditions on the ships, being far from land, and eating excess preserved meats. This idea led some to believe that scurvy was caused by the physical misery of the seaward voyages, and in response, some captains went to great lengths to keep ships clean, dry, and warm. Others endorsed drinking seawater as the trick to curing scurvy, which only made things worse because now you’ve got scurvy and you’re dehydrated. Others even thought that scurvy was the result of extreme homesickness, and up until the 1700s, some thought that the smell of soil and being on land could maybe help scurvy, leading to the practice of “earth bathing”, which was when they would bring in a box of soil, strip the person with scurvy down, and cover them in the dirt, which of course… did nothing. 

Another factor that made it difficult to pinpoint causation or even correlation, is that once someone stops getting adequate vitamin C, it can take up to 3 months to show symptoms of scurvy. To complicate things further, it’s likely that there were also other nutrient deficiencies at play, like Pellagra (niacin deficiency) or Beriberi (thiamin deficiency), and as the ships spent months and months at sea, it became more likely that other diseases would hit the crew, even things like food poisoning, which only further obscured the vitamin C-scurvy relationship. 

Yet another complicating factor was that even after it was pretty widely known that fruits and vegetables could prevent scurvy, the preservation techniques available at the time often destroyed much of the vitamin C. I’m going to come back to this point later, when I tell you all about how the cure for scurvy was “discovered” in what is known as the first clinical trial, and how the royal navy earned the nickname “limeys”. 

But first, I want to tell you the story of the Royal Navy’s Worst Scurvy Outbreak - George Anson’s Voyage Round the World which lasted from 1740 to 1744, in which 1955 men set off,  and only 145 returned. That’s a 92.5% death rate. And just FYI, there are hundreds of voyages during the Age of Scurvy that I could have chose from, I just chose this one because of the devastating death toll and it’s fairly well-document, but if you’re interested in learning more about other voyages, there are plenty of stories to choose from! 

I got most of my information for this story from an article called The Age of Scurvy by Catherine Price in Science History Institute and an article by Dr. Eleanora Gordon called Scurvy and Anson's Voyage Round the World: 1740-1744 An Analysis of the Royal Navy's Worst Outbreak. 

I want to remind you quickly of how horrific this disease is with a quote from an unknown surgeon who was stricken with scurvy on a 16th century English voyage and survived - this quote is from a book by Stephen Bown called Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail.

“It rotted all my gums, which gave out a black and putrid blood. My thighs and lower legs were black and gangrenous, and I was forced to use my knife each day to cut into the flesh in order to release this black and foul blood. I also used my knife on my gums, which were livid and growing over my teeth. . . . When I had cut away this dead flesh and caused much black blood to flow, I rinsed my mouth and teeth with my urine, rubbing them very hard. . . . And the unfortunate thing was that I could not eat, desiring more to swallow than to chew. . . . Many of our people died of it every day, and we saw bodies thrown into the sea constantly, three or four at a time.” 

This was a foul disease that really stripped people of the very fabric of their bodies and they quite literally slowly decomposed alive. 

So the ill-fated voyage of captain George Anson, is considered one of the worst medical disasters at sea. In the mid 1700’s, there was a serious shortage of men who were eager to go to sea. In fact, the situation was so desperate that there were gangs called Press Gangs, whose sole purpose was to kidnap men for sea voyages. So as Captain George Anson looked for men to staff his 6-ship voyage, he relied on kidnapped men coerced to join the navy by Press Gangs, but even the Press Gangs couldn’t recruit enough men. The voyage would require about 2000 men and they were short a couple hundred, so the Royal Navy came up with a rather horrifying solution, and emptied out the nearby Chelsea Hospital, which was home to war veterans that were elderly, wounded, and often suffering from mental health issues, and could no longer serve in marching regiments of the military. Even after the veterans were added to the group, they still needed about 200 more men, and so the navy supplied about 210 young marines that were so inexperienced they had allegedly never been permitted to fire their weapons. So, that was Anson’s top tier crew, and now he could focus on his mission, which was to 'annoy and distress' the Spanish colonies on the South American coasts by 'taking, sinking, burning or otherwise destroying all their ships,' to seize any Spanish settlements which might be vulnerable, and to capture Spanish treasure. Specifically, he was to track down and capture a Spanish ship so valuable, that it was known as the “Prize of All the Oceans” and it transported silver from Acapulco, Mexico to Manila, Phillipines. 

Before the crew set sail from England, they had to repair some of the ships, which meant that during the 6-months of preparation the crew was already eating from the ships rations. Needless to say, when they finally departed in September 1740, it had already been months without access to fresh fruits and vegetables. The Navy was well aware of what was called “the scurvy” by this point, and so they supplied the ship with some of the most popular “treatments” for scurvy at the time: something called an “elixir of vitriol”, which sounds nice, and is a mixture of sulfuric acid and alcohol, and a medicine called Ward’s drop and pill, which was essentially a laxative. Both, spoiler alert, were useless against scurvy. 

The disease officially began to hit the voyage as they rounded Cape Horn, which is well known for being a dangerous and turbulent stretch at the tip of South America. This ship's chaplain, Richard Walter, was tasked with writing the voyage’s official account, and he wrote that March 7 was “the last cheerful day that the greatest part of us would ever live to enjoy”. The next day, stormy weather struck fast and furiously, with waves towering over the ships, and they were forced off course. Once the storms started, they raged for 3 months, battering the men with rain, hail, and even snow, leaving some of the men with frostbite. By the time the storms ended, two ships had turned back, the remaining 4 had been separated, and the majority of the veterans and young marines were dead. However, the voyage continued, and by the end of April almost everyone on board had scurvy and it was starting to become pretty advanced. 43 men died April, and nearly 90 men died in May. Victims developed the trademark blood blisters all over their bodies, legs swelled, gums bled, and everyone was debilitatingly exhausted. As more men died, the scene on board the ships got worse - rat infestations and damp living conditions were the least of the crews worries, because dead bodies began to pile up as the crew was too weak to physically lift them overboard. 

Walter, the documentarian and Chaplain, wrote that a dying sailor that had been wounded 50 years earlier, watched in horror as his wounds “broke out afresh, and appeared as if they had never been healed”. Others reported that previously broken bones that had been healed, essentially disintegrated and rebroke. 

Despite these horrific conditions and symptoms, three of the ships - the Centurion, the Gloucester, and the Tryal, arrived at Juan Fernandez Island off the Chilean coast. The ships had previously agreed that if they were separated during their travels, this is where they would meet. These three ships had originally held 1200 men between them, but only 335 arrived at the island. Walter wrote “To our great mortification, it was near twenty days after their landing before the mortality was tolerably ceased; and for the first 10 or 12 days, we buried rarely less than six each day, and many of those who survived recovered by very slow and insensible degrees”. Luckily for the crew, the island was filled with wild plants that were great sources of vitamin C, plus they found lots of fresh fish, so they ate really well and rebuilt their strength. The men stayed on the island for 3 months, recovering their health. 

There was a general consesus that fresh fruit and vegetables could prevent scurvy, but no one knew why, and of course, as the crew set out to finish their mission, the disease resurfaced during the long voyage across the Pacific during the summer of 1742. In mid-August, they had to abandon one of their ships because they physically didn’t have enough men left to operate it. It’s reported that the voyage lost up to 5 men each day to scurvy as they crossed the Pacific, but somehow, this ragtag crew that just won’t quit finally docked in Canton, which is now known as Guangzhou (gwaang·jow), China, with 227 people. 

Despite all this, and I would have given up months ago - I probably would have stayed on Jaun Fernandez Island, honestly - Captain George Anson did not lose sight of his original mission, and he found and ambushed and conquered a Spanish treasure ship on June 20,1743, in a battle that killed only 3 of his men. Not bad, considering they were probably very weak and malnourished. And because of this capture, the British Navy actually considered this deadly voyage a SUCCESS. Anson returned to England a rich and celebrated man and was appointed First Lord of the Admiralty in 1751. But Anson allegedly never forgot that of the nearly 2000 men he had set off with, only approximately 145 made it home. 

& that’s the kind of devastating story that makes you want to go back in time and just scream It’s vitamin C! Pack some lemons, make a bunch of cloud berry jam and pine needle tea and ferment some sauerkraut, ahhh. 

This is a quote from Catherine Price’s article that I like and I think summarizes the history of scurvy well: “One of the strangest things about the history of scurvy (and many other vitamin-deficiency diseases) is that people kept figuring out cures and then forgetting them. In 1535 the French explorer Jacques Cartier reported that after his ships had become locked in ice in the St. Lawrence River, his men were saved from scurvy by a special tea prepared by local Native Americans from the bark and leaves of a particular tree. In the 1500s and 1600s several ship captains suggested there might be a connection between fruits and vegetables and scurvy. In 1734 a Dutch physician named Johannes Bachstrom came up with the term antiscorbutic (“without scurvy”) and used it to describe fresh vegetables, thus becoming the first person known to suggest that scurvy might be a deficiency disease. Even Anson made a point of loading up on oranges whenever possible, and his chaplain, Walter, praised Juan Fernández Island for having “almost all the vegetables which are usually esteemed to be particularly adapted to the cure of those scorbutic disorders which are contracted by salt diet and long voyages.” Even though no one knew the cause of scurvy or what about these various foods made them antiscorbutic, many mariners recognized a connection between their diets and their health.”

And yet, people continue to die from scurvy. There are plenty of reasons that the connection between vitamin C and scurvy kept getting discovered and then forgotten, but one that I haven’t discussed yet is that at the time, it wasn’t exactly obvious where Vitamin C came from - even though it feels obvious to us that oranges, kiwis, cabbage, broccoli, and red peppers have a lot, but for example, Milk and eggs have none, liver and kidneys though - pretty good source - but not muscles meats. Potatoes are a decent source, but pears actually aren’t. But if you a boil your potato or your broccoli, you’re going to loose about half the vitamin C, and if you chop the potato and let it sit for a bit exposed to the air, and then you boil it in a copper pot, well now you’re really depleting the vitamin C! So even though vitamin C feels so obvious now, it really wasn’t at the time. 

To add another layer of interest to the Scurvy story, in 1747, Dr. James Lind, a scottish physician, conducted what is considered to be the first controlled trial and actually confirmed that lemons and limes were the superior treatment for scurvy. Remember, this is over 50 years before the Royal Navy would administer limes as a scurvy prevention. However, Dr. Lind’s discovery would be buried for decades because even though he technically proved that citrus fruits were effective, he didn’t even really believe it himself. Let me explain. 

Dr. James Lind recruited 12 soldiers who were at similar stages in their scurvy and divided them into 6 groups. Each group ate the exact same foods and lived in the exact same quarters, and the only difference was the treatment they recieved. Each pair was assigned a different popular scurvy “treatment” at the time - a quart of hard cider, 25 drops of vitriol, 2 spoonfuls of vinegar, a half a pint of seawater, two oranges and one lemon, or a mixture of garlic, mustard seed, balsam, radish, and gum myrrh ground into a paste. With the exception of the citrus fruit, which ran out in less than a week, Lind administered the treatments for 14 days. Despite having a much shorter course of treatment, the men being administered the citrus fruits recovered much more quickly than the others, so much so, that they actually began helping take care of the others. So, James Lind clearly discovered the official cure for Scurvy right? Not quite. 

So after this experiment, Lind wrote a book with the short & sweet title of A Treatise of the Scurvy: Containing an Inquiry into the Nature, Causes, and Cure of That Disease Together with a Critical and Chronological View of What Has Been Published on the Subject. In the entire 400 page book, Lind dedicated about 5 paragraphs to his clinical trial and squeezed the most important result into just one sentence that basically got lost in the rest of the book “As I shall have occasion elsewhere to take notice of the effects of other medicines in this disease, I shall here only observe that the results of all my experiments was, that oranges and lemons were the most effectual remedies for this distemper at sea.” Even Lind didn’t see how important his results were, and instead went on to describe his other theory - which was that scurvy was a digestive disease cause by blocked sweat glands. No idea where he got that from, but he thought that lemon juice, mixed with wine and sugar, might be effective against scurvy because it cleared out the sweat glands.  

In 1795, a physician named Gilbert Blane convinced the British Royal Navy to issue some form of lemon juice to its sailors. At this time, lemon and limes were both referred to as lemons, and so the sailors were actually issued lime juice, which is why they have the nickname “Limeys”. & the rest is history. 

Just kidding, the disease continued to emerge during the gold rush, wars, and other voyages despite the fact that the cure was pretty much known and confirmed since the late 1700s. Into the 20th century, scurvy continued to pop up in prisons (check out our prison episode), refugee camps, and in prisoners of war, and it even popped up in wealthy families in the early 1900s that were feeding their babies pasteurized cow’s milk formulas (heat treatment destroys the small amount of natural vitamin C in milk). 

So you might be wondering, despite everything we know about scurvy and vitamin C, do people still get it? Yes, they do. 

Dr. Kayla Dagdar was a medical student at McMaster University when she began looking through medical records from Hamilton, Ontario covering a 9-year period. Her results showed 52 patients with low Vitamin C levels, 13 of which had actually been diagnosed with scurvy. These patients had poor diets due to a number of factors, such as eating disorders, alcohol abuse, mental illness, social isolation, intentional dietary restrictions and dependence on others for food. I want to focus on that last point - dependence on others for food - because there are some pediatric cases where scurvy has developed in extremely picky children, like a 3-year-old boy in Russia who was eating exclusively rice and grains with a nearly complete avoidance of meat, fruit, and vegetables, and in an 11-month baby in Spain who’s parents were feeding him an almond-milk formula that contained no vitamin C. 

So, what do you need to do to make sure you never get scurvy? Try your best to meet the Recommended Daily Intake for Vitamin C, which is 75-90 mg/day, and can easily be obtained from consuming a single orange, a large kiwi, a red pepper, a cup of broccoli, a cup of brussel sprouts, or a large lemon, or if you are really pick, taking a multivitamin.