How does one describe the indescribable? Before I read Jonathan Lamb’s book, I flattered myself that I had a clear, if somewhat sketchy, picture of the history of scurvy. It went something like this: during the age of discovery, sailors on long voyages often fell victim to this nutritional disease, which caused a variety of nasty symptoms, and frequently ended in death. The cause was a lack of vitamin C, or ascorbic acid, in their diets. The search for a solution accelerated in the mid-eighteenth century, after scurvy annihilated most of the British sailors who accompanied Admiral Anson on his voyage around the world. Within a few decades British naval surgeons, beginning with James Lind, had solved the problem: provide crews with citrus fruit. Captain Cook’s epic voyages demonstrated their antiscorbutic value. Oranges, lemons, and limes saved the day. British sailors became known as Limeys. End of story. If you prefer your history in such tidy packages, this may not be the book for you. Lamb’s history of scurvy is far more complicated, at times infuriatingly so. Enigmatic. Mysterious. Incomprehensible. Mind-bending. To Lamb, scurvy is not merely an unpleasant disease that killed a lot of people. It is a metaphor, almost a “thing” with a life of its own, a “scorbutic genius” mocking Lilliputian humans who pretend to understand it, upending their conceptions of science and order, driving them mad with alternating terror and delights, inspiring Bacon, Swift, Coleridge, and a host of other writers and artists. Protean in its manifestations, it masquerades as other diseases, both nutritional and infectious. It selects its victims seemingly at random. Among people consuming the same food, some would succumb, others would not. Irish males were particularly vulnerable. Eighteenth-century British naval doctors did not solve the problem of scurvy. They were on the right track, but they knew nothing of vitamins, and didn’t fully understand what their experiments demonstrated. Yes, citrus fruit does prevent scurvy, as will any foods with sufficient amounts of ascorbic acid, if you can get them into the bodies of the potential victims. Therein lies the rub. Providing fresh fruit and vegetables on long voyages away from landfalls was expensive and logistically difficult or impossible. Preserving foods, even citrus juice, reduced or eliminated their vitamin content. The West Indian limes the Admiralty favored on grounds of economy were low in ascorbic acid. The poor results undermined confidence in citrus generally. Misleading analyses of experiments confused things. One of the conclusions of Cook’s voyages was that malt wort was an effective anti-scorbutic. It isn’t. Rival theories, claiming that scurvy was due to a toxin of some sort competed with the deficiency theory into the twentieth century. The establishment of germ theory led many doctors to conclude that scurvy was an infectious disease, like cholera or tuberculosis. In the words of J. J. Keevil, the cure for scurvy “was repeatedly found, only to be lost again” (9). The final establishment of the deficiency theory awaited the discovery of ascorbic acid in the 1930s. Nowadays, scurvy is so rare that few people have ever seen a case, and most of us cannot comprehend the situation its victims found themselves in. To further complicate things, the victims were themselves bewildered by their situation. They could not find words to express it, and fell back on that old saw, “you cannot understand what it was like unless you experienced it.” It was not only that the physical symptoms were often loathsome, producing feelings of self-disgust. Scurvy, as medical science has discovered in recent decades, can produce profoundly disorienting effects on perception and thinking. Hallucinations are common. Sight, smell, hearing, and taste can be perverted. A blue sea turns green, ordinary smells and tastes become unbearably exquisite or disgusting, normal sounds become deafening. Sufferers often noted that they could no longer trust their own observations, a particularly distressing situation for men with a firm belief in empirical science. Their minds alternated between visions of hell and paradise. Many succumbed to what Thomas Trotter labeled “scorbutic nostalgia,” dreaming of home and the pleasures of eating and drinking, then plunging into despair and grief when they awoke to the realities of their condition. Scurvy was and is often thought of as a purely maritime disease. In a harrowing chapter on the early convict settlements in Australia, Lamb disposes of that notion. Not surprisingly, prisoners and crews were often scorbutic on arrival, after long months at sea. Reaching land normally brought an end to outbreaks of scurvy. Australia was not normal. Nothing was familiar: neither flora nor fauna. Australia not only imported scurvy, it produced it. A lack of anti-scorbutic foods in the local environment accounted for that, in part. Prison officials exacerbated the deficiency by feeding prisoners a scorbutic diet as punishment, and whipping their ultra-sensitive, ulcerated, weakened bodies when they refused to work. Reading this chapter is to enter the heart of darkness. To call Lamb’s book a history of scurvy is to do it a disservice. It is a cultural history of many aspects of western civilization during the age of discovery and imperialism. Lamb mines philosophy, literature, and art, as well as physical and medical science to paint a dazzling picture that is sometimes inspiring, often humbling, and like scurvy itself, occasionally repulsive. Twentieth-century medical science may have eliminated the mystery of scurvy, even as it has virtually eliminated the disease itself. We know what causes it, and what can prevent and cure it. Genetics can explain why some populations are more susceptible to it than others. Lamb’s book recaptures the mystery as it appeared to earlier generations, explaining why they missed or rejected explanations that seem obvious to us now. Scurvy: The Disease of Discovery is not an easy read. It requires the assimilation of information from diverse and often technical sources. But it amply repays the effort. I should note one minor error. The South Carolina doctor who investigated pellagra in the early twentieth century was not Thomas Babcock, but James Woods Babcock. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com
Journal of the History of Medicine and Allied Sciences – Oxford University Press
Published: Jan 1, 2018
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