Scotland's links to scurvy and its cure

AN AWFUL disease – not seen for some three generations – re-appeared in Scotland in the autumn of 1846. Physicians were puzzled by the symptoms since few had any experience of the illness.

Many people died from the ailment but the cure turned out to be quite simple and, surprisingly, was known some 100 years earlier. What happened over the course of time to explain the loss of valuable research and a resultant cure from an Edinburgh physician?

One of the first to succumb to this "new" ailment was a 36-year-old Edinburgh shoemaker who fell ill in September, becoming extremely weak with swelling and purple discolouration of his arms and legs; his gums began to bleed and his teeth became loose. By October people with similar symptoms were reported from other parts of the country. Among the earliest to show signs of the condition were several Irish labourers employed on the new railway from the south to the capital, but they were soon joined by working men and women from all over the country.

Some time was to pass before the disease was recognised as scurvy. Its causes were still a mystery to many.

One who had no doubt as to the diagnosis was a Dr Agnew Bogie of Annan in Dumfriesshire, who in 1846-47 described over 90 cases "among the pauper class." He knew that what he was seeing was scurvy, having previously encountered the disease on board ship where it had always been more common than on land.

The frequency with which scurvy afflicted sailors in the 1700s was the reason why Dr James Lind studied methods of treatment and prevention. Lind was a naval surgeon, born in Edinburgh in 1716, the son of a prosperous merchant and city burgess. After eight years studying the profession, he entered the naval medical service in 1739. On leaving the navy in 1748, Lind took up his medical degree and obtained his licence in Edinburgh, where for ten years he practised. Afterwards, he was appointed physician to the naval hospital at Haslar, near Oxford, where he worked for the next 25 years.

It was during this latter period of his life that Lind carried out his dramatic trial of treatment for the sea–going scourge that was scurvy. As a naval surgeon he would have been well aware of the calamity which befell the naval expedition to the Pacific in 1740; the commander, George Anson, sailed from Portsmouth with over 2,000 men but only 200 returned. Most had died from scurvy. Lind's findings were reported in his great work,A Treatise of the Scurvy, published in 1753 in Edinburgh and dedicated to then Lord Anson.

In his book, Lind described how he took 12 sailors with scurvy and fed them the same diet but prescribed different drinks. Among the elixirs issued were a quart of cider to two sick sailors, vinegar to two others, and sea water for another pair. Two fortunate souls were given two oranges and one lemon daily.

Lind said, "the most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them, being at the end of six days fit for duty."

Why had scurvy reappeared in Scotland? The reason was the loss of more or less the entire potato crop, destroyed by a fungal disease - not only in Scotland but also throughout the British Isles and Europe, with Ireland experiencing massive mortality from famine. The potato had become the staple diet of the poor, many existing on little else; labourers ate as much as 14 pounds of potatoes daily, an enormous amount but essential as the mainstay of the diet for a man carrying out hard physical work. The potato provided the essential vitamin C whose lack is the cause of scurvy, a fact that was not known to Lind or to 19th century scientists. What was of critical importance was Lind's work which had demonstrated conclusively that a regular intake of lime or lemon juice cured scurvy and prevented its development.

By the middle of the 1800s Lind’s discoveries had largely been forgotten, perhaps because Lind himself had not emphasised the significance of his findings. It was only the British navy that recognised the importance of his work by ordering the provision of lime juice to sailors at sea and in this way successfully preventing scurvy.

Lind's research was ignored with the result that in the middle of the 19th century scurvy re-appeared in Scotland, Lind’s native land, an outbreak that could have been treated successfully with his simple remedy of lime or lemon juice. The illness ended when the potato became plentiful again. This happened in Scotland around 1848, however in some areas the crop remained infected well into the 1850s.

The medical world was slow to pay tribute to Lind, in part because the disease disappeared largely as the result of his preventative work and the scientific community had no idea as to how the cure/prevention worked until the 20th century with the identification of vitamins.

The simple nectar of fruit not only helped save untold numbers of lives but it prompted the nickname that carries on to this day - "limey".

Dr Neil MacGillivray, a retired surgeon, is a Postdoctoral Fellow in the School of History & Classics - Scottish History at the University of Edinburgh, where he completed a PhD in 2004. He is a Fellow of the Royal College of Surgeons of Edinburgh and a Fellow of the Society of Antiquaries of Scotland.