Scurvy and the Absence of Fresh Fruits and Vegetables

SCURVY AND THE ABSENCE OF FRESH FRUITS AND VEGETABLES

ALMOST every generation of mankind has suffered from
the terrible disease of scurvy. Its cause can be definitely
traced to the absence of fresh food, particularly of juicy
fruits and vegetables. As long ago as 1734, Bachstrom
wrote :

" From want of proper attention to the history of scurvy
its causes have been generally, though wrongfully, supposed
to be cold in northern climates, sea air, the use of salt meats,
etc., whereas this evil is solely owing to a total abstinence
from fresh vegetable food and greens, which is alone the
true primary cause of the disease. And where persons, either
through neglect or necessity, do refrain for a considerable
period from eating the fresh fruits of the earth and greens,
no age, no climate, or soil are exempt from the attack. Recent
(i. e. fresh) vegetables are found alone effectual to preserve
the body from this malady; and most speedily to cure it
even in a few days, when the case is not rendered desperate
by being dropsical or consumptive." *

Symptoms. .

There is a remarkable uniformity in the symptoms of
scurvy. The onset is foreshadowed by a feeling of great
fatigue, not dissipated by sleep; there is headache and a
general disinclination for exertion of any sort ; the complexion
changes to a pallid dusky hue. At an early stage transient
pains in the joints and limbs are felt, and in the absence
of any other symptoms, are often wrongly regarded as
rheumatism; but in scurvy the pain and swelling are the
effect of haemorrhages into the tissues which may occur in
any part of the body. Small haemorrhagic spots (petechiae)
appear round the hair follicles of the legs, and patches like
bruises of varying size appear on the skin, particularly where
1 Lind's translation.
28

SCURVY 29

there is any kind of pressure. Larger haemorrhages occur in
the most frequently used muscles. Intense pain is caused by
haemorrhages between the limb bones and their covering
membranes, so that the limbs cannot be moved on account
of the pain. There is often bleeding from the nose. In
well-defined cases the gums are almost invariably affected;
soft spongy swellings sprout up between the teeth and are
followed by ulcer ation and haemorrhages of the gums. The
teeth become loose and may fall out ; the breath is very
fcetid. Unless the progress of the disease is arrested by a
timely change of diet it ends fatally.

The disease usually makes its appearance after four to
six months on a scorbutic diet. The most fearful effects
of scurvy have been evident at times of famine, during
sieges and among sailors on long voyages. It has been
an accompaniment of every war from the time of the
Crusades up to the last great war; yet history books
are strangely reticent as to the ravages of scurvy, which
had such a determining effect upon the result of campaigns
that scurvy was a political factor of no mean importance.
In our school-days we did not realise that Vasco da Gama
only achieved his pioneer voyage round the Cape of Good
Hope to the East Indies at the cost of 100 deaths from
scurvy out of a crew of 160 men. Neither did we realise
that France at the beginning of the seventeenth century
had seriously to consider relinquishing her colonies in
North America, so numerous were the victims of scurvy
there. Writing in 1755, Dr. James Lind said, " Armies
have been supposed to lose more of their men by sickness
than by the sword, but this observation has been more
than verified in our fleets and squadrons, where the scurvy
alone during the last war proved a more destructive
enemy and cut off more valuable lives than the united
efforts of the French and Spanish arms." These are but
a few instances of the destruction caused by scurvy.

The disease is still endemic among the civilian popula-
tion of Northern Russia, and in the dry parts of the
Australian bush a disease called " Barcoo rot " is probably
a mild form of scurvy. Epidemics have always been

30 VITAMINS AND THE CHOICE OF FOOD

most frequent after long winters; scurvy has never
existed in southern latitudes where fruit and vegetables
were used abundantly all the year round. In England
during the Middle Ages the food of the people in
the winter was nearly as devoid of fresh meat and
vegetables as the food of sailors on long voyages. Swede
turnips and other roots for feeding live-stock during the
winter were not grown, and the animals, except those
required for breeding purposes, were slaughtered in the
autumn and their flesh preserved with salt and spices.
Salt meat had to be used for about nine months in the
year, and the customs of game-preserving and pigeon-
breeding by the large landowners originated, not to
provide sport, but to furnish the lords of the manor
with fresh flesh during the winter as a relief from the
perpetual salt food. Green vegetables seem to have
been little relished, and when Henry the Eighth's wife,
Catherine of Aragon, desired a salad, a gardener had to
be imported from Holland to grow it for her. Potatoes,
introduced during the Elizabethan era, were at first only
used as food for pigs or by the very poorest classes.
In the early seventeenth century Harvey referred to
scurvy as "the disease of London"; it would thus
appear to have been more prevalent there than in the
country. As gardening and agriculture improved, scurvy
became less and less frequent, until finally it was almost
entirely confined to ships, armies on active service,
prisons, asylums and after famines.

The Treatise on the Scurvy published by Dr. James
Lind in 1755 contained all the historical and medical
information which he could collect on the subject, together
with his own extensive experiences and experiments on
long voyages as ship's surgeon. The book was a valuable
contribution to scientific literature. Lind freed himself
from the inherited dogmas which then fettered the
progress of medical knowledge ; he examined all evidence
with an open mind, rejecting theories which could not
be substantiated by facts. His final conclusions as to

SCURVY 31

the cause and cure of scurvy are essentially sound and
in accordance with the earlier observations of Bachstrom.
The medical men of that period were not encouraged to
observe facts and reason scientifically, but were either
weighed down by the accumulated tradition of many
years, or given over to fanciful imaginings which led
them to classify scurvy into hot and cold scurvies, acid
and alkaline scurvies, and land and sea scurvies, and to
suggest many weird and wonderful methods of treatment.
Certain passages in Lind's book suggest that traditional
beliefs were as difficult to combat then as they are now :
" Some persons cannot be brought to believe that a
disease so fatal and dreadful can be prevented or cured
by such easy means. They would have more faith in
some elaborate composition, dignified with the pompous
title of an antiscorbutic golden elixir or the like. Facts
are sufficient to convince the unprejudiced. It is no
easy matter to root out old prejudices or to overturn
opinions which have acquired an establishment by time,
custom and great authorities."

Lind does not seem to have received any public honour
for his valuable work, but a few years later Captain
Cook was awarded the Copley Medal of the Royal Society
because he had maintained good health and freedom from
scurvy amongst his seamen on long voyages. It is prob-
able that Captain Cook would not have accomplished his
voyages so successfully without Lind's work. The latter
was a pioneer in experimental investigation; his experi-
ments were carried out on men and not on the lower
animals. In 1747, on the ship Salisbury, he took out to
sea twelve patients suffering from the scurvy with
symptoms as similar as he could have them.

" They were all kept together in one place and fed upon
the same diet of water gruel sweetened with sugar, mutton
broth, light puddings, boiled biscuit and sugar, barley, raisins,
rice, currants, sago, wine, or the like. In addition two had a
quart of cyder daily ; two had 25 drops of elixir vitriol three
times daily upon an empty stomach ; two had 2 teaspoonfuls

32 VITAMINS AND THE CHOICE OF FOOD

of vinegar three times daily upon an empty stomach; two
had a course of sea water, half a pint every day; two had
each 2, oranges and I lemon which they ate with greediness;
they continued for six days on this course, having consumed
the quantity which could be spared; two took the bigness
of a nutmeg three times a day of an electuary recommended
by an hospital surgeon, made of garlic, mustard seed, red
raphan, balsam of Peru and gum myrrh; using for common
drink barley-water well-acidulated with tamarinds, by a
decoction of which, with the addition of cremor tartar, they
were gently purged.

" The consequence was that 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. The other was the best recovered
of any in his position and was appointed nurse to the rest of
the sick.

" Next to oranges the cyder had the best effect ; the other
remedies produced no improvement."

As a practical method of preventing scurvy on board
ship Lind recommended the growing of cresses on layers
of wet cotton.

Many subsequent epidemics of scurvy might have
been avoided if the teachings of Lind had been put
into practice. He laid much stress on the uselessness
of dried vegetables as an antiscorbutic, yet after his
time dried vegetables were repeatedly tried in the British
Navy and found a failure; their use did not prevent
scurvy in the American Civil War. The British public
were exhorted during the last war to dry and preserve
vegetables to send to our fleets and to our prisoners-of-
war in Germany, that they might have so-called fresh
vegetables ; the intention was excellent but the ignorance
lamentable.

Budd, in his series of lectures on Disorders resulting
from Defective Nutriment, delivered in 1842, pointed
out the failure to profit by past experiences as exemplified
in the history of scurvy at sea :

" On April 2nd, 1600, four ships left this country on an
expedition for the establishment of the East India Company.

SCURVY 33

Scurvy prevailed to such a degree that in three of the ships
one-quarter of the men died before reaching the Cape, and
the rest were so weakened that the merchants on board were
obliged to do the work of common sailors. A remarkable
circumstance was noticed, which if laid hold of and turned
to profit would have prevented many subsequent disasters.
While three of the ships were so weakened by scurvy, the
Commodore's own ship was in perfect health. This was
attributed to his having given three tablespoonfuls of lemon-
juice every morning to each of his men.

" The discovery of the virtue of lemon- juice as a preventive
of scurvy was soon forgotten, or at least only remembered
when chance again offered some striking proof of the efficacy
of oranges and lemons. No practical advantage followed,
the disease continued to devastate our Fleets until in 1795
an Admiralty order was given that every ship in His Majesty's
Navy should have a supply of lemon-juice. The effect of
this order was remarkable, the mortality fell suddenly and
to a degree that can scarcely be credited by one who has not
read the heartrending accounts of the sufferings occasioned
by scurvy in the voyages of Lord Anson and our earlier
navigators. Between the years 1771 and 1803 the sickness
in the British Navy was reduced to almost one-quarter of its
former proportion. Experience has established the efficacy
of lemon- juice in curing and preventing scurvy. It is so
cheap that it may well excite surprise that up to the present
time (1842) no regulation has been made for compelling our
merchant ships to take a supply of it. Every year a number
of miserable beings are brought into our ports as if to show
us the fidelity of the descriptions which the older navigators
have left of their sufferings."

It indeed seems likely that the disease would have
continued uninterruptedly to take its toll from the men
of the merchant service, had not sailing vessels been
gradually superseded by steamers, and the mortality
from scurvy reduced by quicker voyages. The prevalence
of scurvy in our prisons was attributed by Budd to
the mistaken notions of its cause still entertained in
spite of the earlier writings of Lind, Bachstrom and
others.

The history of scurvy in the Polar regions affords other
instances of the need for fresh food, but in these cases
prevention could be secured by the consumption of large
D

34 VITAMINS AND THE CHOICE OF FOOD

amounts of fresh meat, often eaten raw. The following
tale is told in the words of Dr. F. Millman (1772) :

" In 1663 the Dutch Greenland Company left seven stout
sailors to pass the winter in that country in order to get
observations on the climate. They were plentifully furnished
with provisions of every sort from the ships, but this provident
care proved a very baneful store to them. Such an indigest-
ible diet concurrently with the cold of so northern a latitude
rendered them scorbutic, and they became miserable victims
of the curiosity of their countrymen. Not deterred, however,
by the fate of these unhappy men, the Dutch Company the
year following repeated the experiment with the same event.
It seemed extraordinary that' they should have profited so
little by the example of eight Englishmen, who were accident-
ally left there in 1630. Though wholly unprovided with any
means of subsistence from June till the May following, but
such as they could procure by their own address and industry,
they not only kept free from scurvy but every one of them
survived the disaster. They had neither bread nor biscuit.
They had no sort of vegetable matter nor spirituous liquor.
Their drink was water, their food chiefly the flesh of reindeer,
of bears and other such wild animals as they could kill."

Stefansson's observations during the Canadian Arctic
expedition in the winter 1916-17 has corroborated the
accuracy of the experiences related above. The men
were expected to live entirely on musk-ox, reindeer, seal
and bear meat. Unfortunately a store, left from a 1910
expedition, of several tons of food consisting of flour,
salt pork, butter, honey, sugar, pilot bread, glasses of
preserved fruit, rice, beans and peas, was discovered.
Those men who lived largely on reindeer and other meat,
often eaten raw, did not get scurvy, but those who ate
mainly of the provisions from the store got scurvy.

Nansen's expedition escaped scurvy by eating large
quantities of fresh bear's meat, but Scott's Antarctic
expedition, well-equipped with provisions from home,
suffered severely from the disease. In the Jackson
Harmsworth expedition to Franz Josef Land (1894-7)
all the crew left on the ship, with tinned and salted
meat as food and with lime-juice, got scurvy; the land

SCURVY 35

party lived for three years on fresh bear's meat without
any scurvy.

INFANTILE SCURVY.

In the seventeenth century Glisson differentiated
between rickets and scurvy in infants, but for more than
two hundred years afterwards no further mention of
infantile scurvy was made. Dr. (now Sir Thomas) Barlow
in 1883 described peculiar symptoms in infants, distinct
from rickets and allied to adult scurvy; previously these
cases had been known as acute or haemorrhagic rickets,
but are now called Barlow's disease or infantile scurvy.
Improperly fed children may suffer from both rickets
and scurvy at the same time; such cases are still some-
times referred to as scurvy-rickets and wrongly believed
to be a form of rickets. According to data collected by
the American Pediatric Society, 45 per cent, of the cases
of infantile scurvy are complicated by rickets; the dual
symptoms are caused by a diet lacking in more than one
respect. Scurvy is most common in infants fed on over-
heated or over-diluted cow's milk, alkaline food mixtures
and certain proprietary foods. The disease is seldom
seen in infants under four months of age; most cases
occur during the ninth and tenth months; there is then
a gradual decrease in the number of cases, and scurvy
is rare in children after eighteen months.

Symptoms.

Many of the symptoms in infants resemble those of scurvy
in adults. The child is frequently well covered with sub-
cutaneous fat and does not appear ill-nourished. The first
signs of ill-health may be digestive troubles, and almost
invariably there is a marked pallor, intensified by blue rings
round the eyes. Suddenly the child becomes fretful in a
special kind of way; it is quiet as long as it is left alone,
but cries continuously when bathed or moved. The pain is
located in the lower limbs, and any attempt to move the leg
or thigh causes a scream. Swellings of the lower limbs, first
in one leg then in the other, may be detected. According
to Holt four-fifths of the cases of infantile scurvy have at

36 VITAMINS AND THE CHOICE OF FOOD

first been mistaken for rheumatism on account of the swollen
and tender limbs. The legs are not flexed as in the healthy
infant, but limp and straight (see Fig. 7), and owing to their
tenderness are kept so still that they seem to be paralysed.
The bones are brittle from imperfect bone formation and do
not bend as in rickets; the heads of the long bones may
completely separate from the shafts. Characteristic changes
take place in the microscopic structure of the tissue at the
junctions between the rib-bones and cartilages. Hess has
described cases of infantile scurvy not complicated with
rickets, showing a beading of the rib junctions indistinguish-
able to the touch from the beading regarded as a specific
sign of rickets (see p. 73). The nature of the beading, in
the absence of other definite signs, can only be determined
by the response to treatment : if the beading is due to rickets
it disappears on treatment with cod-liver oil, if due to scurvy
it is not cured by cod-liver oil but by orange- juice.

The gums of scorbutic infants with no teeth are pale and
swollen or marked with purple patches; if there are several
teeth the gums may be bleeding and spongy ; if the gums are
much affected the breath is very foetid, as in adult scurvy.
Nose-bleeding is a common sign; large bruises or small
purple spots appear on the skin wherever there is any kind of
pressure.

The swollen and tender limbs are due to haemorrhages,
either under the skin, in the muscles or between the bone and
its sheath. Haemorrhages may occur into the tissues of any
part of the body ; sometimes haemorrhage behind the eyeball
causes one or both eyes to protrude with almost startling
suddenness. Blood may be passed with the faeces or urine;
the latter is usually scanty in amount. Extensive haemor-
rhages may produce a rise in temperature to 101 or 102 F.,
or even higher.

Barlow and others have recorded identical symptoms
amongst children of two to ten years who had a curious
hysterical dislike of vegetables and meat. Barlow treated
scorbutic infants with undiluted fresh cow's milk, some-
times thickened with sieved potato, and a tablespoonful
daily of orange- or grape-juice. 1 Chick and Dalyell,
working among the famine-stricken children in Vienna,

1 Recent work (see table, p. 61) has proved grape-juice to have only
very slight antiscorbutic power ; larger quantities than are practicable
in infant feeding would have to be given. Orange-juice is cheaper and
much more effectual.

SCURVY 37

have used swede-turnip-juice and tomato- juice with good
results. Swede- juice is not popular amongst those in
charge of the infants, as it sometimes produces looseness
of the bowels.

Before 1892 few cases of infantile scurvy had been
recognised in the United States, but now the disease is
not considered rare, the increase being partly due to more
accurate diagnosis, and partly to an actual increase
following upon the extended use of proprietary foods and
the more general commercial pasteurisation of milk.
On both sides of the Atlantic, infantile scurvy is more
common amongst the richer classes; the giving-'im-a-bit-
of-what-we-'as-ourselves policy of the poorer people tends
to prevent scurvy, though it may have other drawbacks.
Dr. Northrup, at a time when infantile scurvy was still
rare in the States, wrote a vivid description of the
circumstances under which the disease commonly
appears :

" The patient was the offspring of wedded representatives
of rich and powerful families in the fashionable and political
worlds. There was no lack of love and devotion. The lack
was in wisdom and judgment; the abundance the nurse's
self-esteem and ignorance ; these allowed the present case and
history to continue on to full accomplishment.

" The child was sixteen months, a girl. Thriving very
well in early months ; breast-fed four months. After this the
child was fed on a proprietary food diluted with water and
milk ; by mistake too little milk was used. The child appar-
ently thrived well, though backward in walking and talking.
The teeth were normal ; there was no sign of rickets. Three
weeks previously (to consulting Dr. Northrup) the nurse had
noticed some slight change in the child's gums. The family
doctor ordered more milk to rectify the mistake, beef broth
and iron peptonate. One week later there was trouble in the
lower right limb, evinced by worrying sensitiveness on handling
and a tendency to keep the limb straight. Rheumatism was
diagnosed, but antirheumatic treatment had no effect. The
parents went away for a fortnight and the doctor was not called
in. The nurse drew no conclusions from the rapidly changing
gums. The parents returned and found the child ill. (Dr.
Northrup was now called in.) The child cried on seeing a
strange face and became alarmed for the safety of its lame leg.

38 VITAMINS AND THE CHOICE OF FOOD

In the wry face of crying the little patient fairly unbuttoned
from between its lips two rows of irregularly nodulated purple
gums, from the summits of which the points of the teeth pro-
truded. The gums were dark and bled freely in the act of crying
from the compression of the lips alone. There was no nose-
bleeding, nor purple spots on the skin, no blood in the urine nor
from the bowel. Spongy gums and swollen thigh were the only
symptoms. Confirmation of the diagnosis of scurvy was given
by the success in treatment. The child was sent to the country
and received fresh cow's milk, instead of the proprietary food,
beef -juice and baked potatoes. The one thing which the child
seemed to crave, for which it reached out, and which it seized
with ravenous avidity, was the orange. The child could
scarcely be restrained till it held the fruit in its grasp, and
then proceeded to souse its lips and nose in the juice. Improve-
ment began at once. The gums were normal in ten days, in a
month the child could stand. Soon she appeared as a child
small for her age, but as if nothing had ever been the matter
with her."

In comparatively few cases do all the symptoms of
infantile scurvy develop. One or more definite signs may
be present and the correctness of the diagnosis confirmed
by the response to treatment. If orange-juice is given,
slight cases improve immediately and severe cases by the
end of four days.

The acute form of infantile scurvy once seen is never
forgotten, but it is not the common form of the disease.
The usual form, described as subacute, latent, or incipient
scurvy, shows a general falling off in health with no very
definite symptoms. The infant, hitherto thriving, begins
to ail, weight may be lost, the appetite is poor and the
digestion disordered. The child becomes pale, fretful,
sleepless and miserable, and sometimes feverish. The
rapid improvement following two or three days' anti-
scorbutic treatment shows that these symptoms are an
indication of early scurvy. Slight tenderness of the thighs
and a rim of crimson on the upper gums, perhaps behind
an upper incisor, are often noticeable ; the respiration and
pulse are slightly quickened. This condition of latent
scurvy is quite common in large cities, especially if the
milk supply is pasteurised commercially and reheated

SCURVY 39

in the homes. In these cases the food contains sufficient
antiscorbutic to prevent acute scurvy, but insufficient to
ensure perfect health.

EXPERIMENTAL SCURVY.

Hoist and Frohlich were the first of the modern scientific
investigators on scurvy; they wished to determine the
cause of scurvy and beri-beri upon Norwegian ships.
The work of Eijkman on beri-beri was well known to
them, and their first work was practically a repetition of
his experiments upon birds, but later they tried feeding
experiments with other animals. They found that
guinea-pigs fed on a diet of groats, grain, or bread died in
about twenty-one days after having lost from 30 to 60
per cent, of their weight, with symptoms quite distinct
from those of beri-beri or starvation, but resembling those
of human scurvy, more especially infantile scurvy. No
fresh vegetables or fruit had been given to the guinea-pigs,
and it was found that the suffering animals could be cured
by adding to their food any well-proved antiscorbutic,
such as fresh cabbage, dandelion leaves, lettuce, endive, or
cloudberries. As human beings do not eat raw cabbage,
the effect of cooked cabbage was next tested on guinea-
pigs. They all developed scurvy, but the symptoms were
less severe than on the grain diet alone. Guinea-pigs
thus appear to be more susceptible to scurvy than man,
as it is by cooked vegetables that man is normally main-
tained free from scurvy for long periods of the year.
The uselessness of dried vegetables as an antiscorbutic
was confirmed by tests on guinea-pigs. Cloudberries,
or raspberry- juice preserved by heating for a short time
with sugar, were found to retain their anti-scorbutic
property. Other experiments showed that dried peas,
lentils and other pulses, so efficacious in preventing and
curing beri-beri, were of no use in preventing scurvy.
Some substance in growing vegetables thus appeared to
be the active agent against scurvy. Hoist and Frohlich
proved this by feeding guinea-pigs upon soaked and

40 VITAMINS AND THE CHOICE OF FOOD

germinated peas, lentils, barley and other grains; they
were protected 'from scurvy.

There seemed only one explanation to all these results,
an explanation put forward by Budd in 1840, that " the
cause of the disease is due to some essential element which
he hoped the chemist would soon isolate." Hoist and
Frohlich practically proved Budd's theory to be correct.
Further work is described on pp. 5861 and pp. 66-69.

SCURVY DURING THE WAR.

At the beginning of the War there was sufficient evidence
available of the cause and cure of scurvy, and also of
beri-beri, to have prevented these diseases from incapaci-
tating many men. In spite of this there were outbreaks
of scurvy amongst our troops in camp at home, in France
and in the East which might have been avoided. On the
whole there was little scurvy amongst the British troops
in Europe. The Mesopotamia Commission Report records
that 7500 men were lost to the force in nineteen weeks
in 1916 from scurvy; it was almost entirely confined to
the Indian troops, which had altogether 14,000 cases
from 1916 to 1918. Vegetables, meat and milk, the
ordinary antiscorbutics in the Indian diet, were generally
not obtainable on field service and in their absence signs
of scurvy appeared in four months at latest. The disease
was speedily curable at an early stage, but increasingly
difficult after delay. In Amara, where unlimited quanti-
ties of milk curds were available, incipient scurvy dis-
appeared. The scorbutic condition prevented the healing
of wounds and favoured the formation of pus, a fact which
had been recognised by our Navy surgeons in the old days.
In 1803 Sir Gilbert Blane wrote : " It is found from
direful and multiplied experience that not only those who
are affected with actual symptoms of scurvy, but those
who are exposed to the causes of it, are peculiarly suscepti-
ble to ulcers of the most malignant kind from the smallest
injury which breaks the skin. The peculiar susceptibility

SCURVY 41

of sailors to this complaint is no doubt owing chiefly to
their diet."

During the siege of Kut the British troops suffered from
beri-beri, while the Indians Were protected by their
coarse wholemeal flour (p. 22), but there were 1050 cases
of scurvy amongst the Indians and only one amongst
the British. The protection of the British troops from
scurvy was attributed to their ration of horse-flesh, which
was refused by most of the Indians. As soon as wild
herbs, shrubs and grass sprang up at the end of February
in sufficient quantities to be cooked and eaten, the
incidence of scurvy declined in spite of semi-starvation.

Scurvy in Mesopotamia became rare towards the end
of the campaign, as the Arabs were encouraged to make
gardens and sell vegetables; Government gardens were
also established in which radish, leeks and spinach were
grown. The Indians were advised to germinate their
dahl (that is, lentils and other pulses), which formed a
large part of their food.

In some parts of Russia and Central Europe, both
during and after the War, scurvy was widespread among
troops and civilians owing to the impossibility of getting
a proper food supply. Russia was the country most
afflicted, but after that came Roumania, where scurvy
was very prevalent among the German, Austrian and
Turkish troops. Epidemics of scurvy were also reported
from Bulgaria, Serbia and Turkestan. An epidemic
with many deaths among the civilians in Petrograd in
1916 was attributed to the extensive use of frozen meat
and spoiled potatoes.

In the extreme north of Russia scurvy is always endemic
during the winter; many cases were observed by the
medical officers with the British Expedition on the
Murmansk coast amongst the Russian peasants. The
Laplanders in the same district escaped scurvy, as they
used much more fresh meat and less cereals and preserved
food than the Russians. Amongst the British Force
in the Murmansk region there was little scurvy; many

42 VITAMINS AND THE CHOICE OF FOOD

cases of debility and depression were believed to be mild
scurvy, but a severe epidemic was warded off by the use
of germinated peas and beans as recommended by Chick
and Hume (p. 59).

Capt. A. J. Stevenson, R.A.M.C., carried out an experi-
ment on the scorbutic inmates of a Russian civilian prison
to test the curative value of different food-stuffs. The
prisoners were divided into six groups of six patients,
each group receiving the same scurvy-producing diet,
but a different curative food-stuff. The following were
given daily to

Group (i) 4 oz. fresh lemon-juice.

(2) 8 oz. germinated peas, cooked half an hour.

(3) 8 oz. germinated beans, ,, ,,

(4) 10 oz. fresh underdone meat.

(5) 8 oz. tinned fruits.

(6) 2 pints of lactic acid milk prepared by inocu-

lating with lactic acid bacteria and leaving
for thirty-six hours till nearly solid.

All groups showed marked improvement, but it was
most rapid with the lemon-juice, sour milk and germinated
peas. The peas were palatable, but the beans were disliked
and caused indigestion.

There was much scurvy amongst the Serbian troops;
Wiltshire reported 3000 cases. The available peas
and lentils were not suitable for germination as they had
been decorticated. A supply of beans was at length
received; they were soaked in water for twenty-four
hours, placed on trays and kept damp, but exposed to
air till they began to sprout. The germinated beans were
boiled for ten minutes. Their antiscorbutic value was
compared with that of lemon- juice : 30 scurvy patients were
given 4 oz. each of fresh lemon-juice daily; 27 others in
slightly worse condition were each given 4 oz. (dry weight)
of germinated beans daily. The beans looked and smelt
unappetising, and considerable prejudice had to be

SCURVY 43

overcome, as the Serbs regarded beans as " pigs' food."
The condition of the gums was taken as the index of
recovery. In those on beans the gums returned to normal
in an average of 3-1 weeks as against 3-4 in the lemon-
juice patients. Scurvy was reported at times amongst
the French and German troops on the West Front. In
1917, Harvier, a French medical officer, discovered that
95 per cent, of the 800 men in his charge were suffering from
scurvy. The cases of scurvy amongst German prisoners
captured on the West Front at the beginning of 1917 were
at first wrongly diagnosed as " purpuric rheumatism."
On the East Front, especially among the Russian troops,
scurvy rendered many men unfit for service and generally
lowered the resistance to infection and delayed the healing
of wounds.

Some of the records of outbreaks of scurvy in Europe
describe oedema and neuritic pains in the legs ; these are
symptoms of beri-beri and not of scurvy. It is therefore
probable that a certain amount of unrecognised beri-
beri was present associated with the generally disorganised
food supply. Fuller reports may definitely show that
both these diseases occurred amongst troops and civilians
to an extent quite unappreciated at the time. The
various defects in the quality and quantity of the food
would account for a commingling of symptoms which
would obscure the clear-cut picture of either beri-beri
or scurvy alone. At various times much has been written
about " the affinities " of beri-beri and scurvy, but they
are distinct diseases due to different deficiencies in the
diet, and if they occur at the same time in the same
patient, they can always be traced to a diet lacking in
both the antiberi-beri and antiscorbutic vitamins.

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