It is the opinion of some of the most experienced officers that the blockading system of warfare which annihilated the naval power of France could never have been carried on unless sea scurvy had been subdued.” Such was the statement of Robert Finlayson, a surgeon in the Royal Navy during the Napoleonic wars, and there is much in the historical evidence to substantiate his observation that the downfall of Napoleon was in great measure dependent on the eradication of scurvy in the British Fleet.
The influence of disease upon history is a subject which has been strangely neglected by the historian, yet is one of the most interesting, as it is one of the most important in the story of the changes and vicissitudes which constitute human history. Take as an example the effect of one disease alone, smallpox, and its influence upon the history of North America. Along the Atlantic seaboard whole tribes of Indians were decimated by this disease introduced by the white colonists. Within less than 15 years after the voyages of Columbus, smallpox swept over Mexico and Central America and, it is estimated, killed over 3,000,000 people. The conquest of Mexico by Cortez with but a handful of men was due to this as much as to the courage and military superiority of his little army. The fall of the Aztec empire was due rather to smallpox than to arms. The successive smallpox epidemics which occurred during the colonial period of the United States were more than anything else the cause of the weak resistance made by the Indian to the advance of white settlement. The white man has been charged with the willful destruction of the Indian tribes, but in reality their virtual extermination was due rather to the white man’s diseases, the captain of which was smallpox, though measles and tuberculosis were able lieutenants. It must be remembered that these diseases were new to the North American Continent and that no racial immunity existed to them. As a consequence the death rates for measles which in Europeans was 5 per cent rose to 90 and even 100 per cent among the Indians. Whole communities were wiped out and whole areas depopulated. A story from our American frontier legends illustrates well the relative effects from gunpowder and disease in the warfare against the Indian. A young settler returned to his cabin to find it burned and the scalped bodies of his wife and children about it. For many years he took revenge by killing an Indian whenever opportunity offered and had marked 10 notches on his gun as a tally of his success. Then he died from smallpox. An Indian warrior dug up the body to obtain the scalp, carried the disease to his village and in the resulting epidemic more than 200 died.
Another disease that has dominated man’s history is malaria. It is the greatest known killer of the human race. Wars, wild animals, and automobiles as killers of men are insignificant compared to it. A belt 5,000 miles wide around the world at the equator is its home, the richest and most fertile parts of the globe and also the homeland of the human race. Yet this belt is owned and dominated by races from non-malarial regions whose vitality has not been sapped by the disease. Malaria kills in India alone more than a million a year and makes invalids of millions more. Modern research indicates that Greece and Rome both may have owed their decline to this pestilence and that the mosquito and a minute blood parasite contributed to the wreck of these two ancient empires.
The most famous disease and the only one to claim the attention of the historian is bubonic plague. A disease mainly of rodents transmitted to man by the rat flea, it was the so-called Black Death of the Middle Ages. Niebuhr, the great German historian of the Roman Empire, said “the ancient world never recovered from the blow inflicted upon it by the plague in the reign of Marcus Aurelius.” During the fourteenth century in a single year 25,000,000 people, estimated to have been half the population of Europe at that time, died there. The extermination of the white race seemed imminent. We can but dimly imagine the far-reaching effects upon society, the paralysis of trade and industry, the destruction of family ties, the fearful mental and physical suffering experienced by all classes of people as the result of this epidemic. Petrarch, the great Italian poet who lived through this time, said, “Is it possible that posterity can believe these things? For we who have seen them can hardly believe them.”
The influence of disease upon wars and military campaigns is another neglected subject but one which the modern military man cannot afford to overlook. It would require pages to list the campaigns that have been decided by disease rather than by arms. A few examples will suffice to show how often this has happened. The Persian invasion of Greece under Xerxes was turned back by epidemics of plague and dysentery rather than Greek resistance. The failure of three of the Crusades was due to epidemics of dysentery, plague, and smallpox. “All that we got from the Crusades,” said cynical old Voltaire, “was the leprosy. It alone remains as a permanent heritage.” Napoleon sent 58,000 men to Santo Domingo in 1802. Yellow fever and malaria quickly killed all but 8,000 and wrecked this campaign. In the French expeditionary force sent to Madagascar in 1895, of 18,000 men, 6,000 died of disease though only 25 soldiers lost their lives in combat. Although the general historian has failed to emphasize it and even has almost entirely overlooked it, the facts show that Napoleon’s Russian campaign of 1812 failed as much on account of typhus, typhoid, and pneumonia, as on account of climate and enemy action. Of 500,000 men nearly all died of disease except 80,000 who died of wounds or escaped. Scarcely 20,000 returned to France of this great army. The Austrians did not invade Serbia in 1915 due to their fear of the epidemic of typhus raging there which killed 150,000 people in 6 months. It is estimated that 3,000,000 died of typhus in Russia in the World War period and that it contributed much to the collapse of Russian military resistance.
It is no wonder that one of the modern students of epidemiology in relation to war has concluded that “Typhus with its brothers and sisters—plague, cholera, typhoid and dysentery—has decided more campaigns than Caesar, Hannibal, Napoleon, and all the generals in history.”
The table given here shows some of the facts in regard to the influence of disease upon wars and the effects of preventive medicine on military plans. The disease that was the principal killer of seamen and so markedly influenced naval history, maritime trade, exploration, and colonial expansion was none of these but one that was peculiarly a disease of the sea rather than one of the land, though by no means entirely unknown ashore. This disease was scurvy, “The Scourge of the Sea and the Spoyle of Mariners,” as one old writer calls it.
Deaths from Disease Compared with Those from Combat in Certain Military Campaigns
Campaign and Year | Army | Troops Engaged | Killed or Died of Battle Wounds | Died of Disease | Per Cent of Total Died of Disease |
Santo Domingo, 1802 | French | 58,000 | — | 50,000 | 86.2 |
Russian, 1812 | French | 500,000 | 60,000 | 420,000 | 84 |
Turkish, 1828-29 | Russian | 115,000 | — | 100,000 | 86.9 |
Crimean War, 1854-56 | Br. & Fr. | 200,000 | 25,000 | 67,000 | 33.5 |
Madagascar, 1895 | French | 18,000 | 25 | 6,000 | 33.3 |
South Africa, 1899-1902 | British | 448,435 | 5,773 | 16,171 | 3.6 |
Black Hawk War, 1832 | American | 5,000 | 5 | 300 | 6 |
Mexican War, 1846-47 | American | 108,475 | 1,549 | 10,986 | 10.1 |
Civil War, 1861-65 | Union | 2,213,365 | 111,874 | 202,252 | 9.1 |
Spanish-Amer., 1898-99 | American | 280,564 | 379 | 4,795 | 1.7 |
World War, 1917-18 | American | 4,016,936 | 50,385 | 58,119 | 1.4 |
Scurvy is what is known as a deficiency disease. These are diseases which result from the body being deprived of certain essential food elements. In the case of scurvy the deprivation is due to the absence of a substance found principally in fresh fruits and vegetables. This substance has been named Vitamin C. It is essentially ascorbic or cevitamic acid, the isolation of which in crystalline form is one of the triumphs of modern biochemistry. The citrus fruits and certain vegetables in the raw state, notably onions and potatoes, are extremely rich in this vitamin. The body is incapable of storing it in any quantity so that the absence or marked reduction of it in the diet is soon followed by symptoms of scurvy. Within two weeks on a ration lacking in fresh meats, milk, fruits, and vegetables, as was the ship’s ration of the old sailing ship days, signs of the disease would sometimes begin. Its onset was hastened by exposure to cold and wet, as well as fatigue and loss of sleep, all of which were frequently present.
The symptoms of scurvy were weakness and lassitude, swelling of the legs and arms, softening of the gums, and haemorrhages from the mucous membranes and under the skin. The teeth loosened and fell out. The breath became intensely foul.
Sudden death from heart failure was not uncommon; otherwise death resulted from exhaustion, apoplexy, or the appearance of some acute infection such as pneumonia which in the man’s weakened state was quickly fatal. Camoens, the great Portuguese poet, describes scurvy attacking Vasco da Gama’s crews on the first voyage to India:
“Never mine eyes such dreary sight beheld,
Ghastly the mouths and gums enormous swelled
And instant, putrid like a dead man’s wound,
Poisoned with foetid streams the air around,
No sage physician’s ever watchful zeal,
No skillful surgeon’s gentle hand to heal
Were found: each dreary mournful hour we gave
Some brave companion to a foreign grave.”
This description by the poet is remarkable for its true picture of some of the most characteristic features of the disease, and dwells upon the high mortality where its progress was unchecked due to the absence of fresh fruits and vegetables containing the protective Vitamin C.
Causes which made scurvy rampant among seafaring men were ignorance of its cause and prevention, the long voyages made by the sailing ships of the day, and the absence of methods of carrying fresh foods. We scarcely appreciate now how bad were the living conditions on board the ships of the sixteenth, seventeenth, and eighteenth centuries. Before 1500 most of the voyages had been coastal, but with-the opening of the sea route to India and the discovery of the New World, vessels were often at sea for months and absent from home for years. Small vessels with men crowded aboard them, and poor food lacking the essential elements required for health, often resulted in the ships becoming floating pesthouses with the crews rapidly diminished by disease. One English pamphleteer of the many of this time who were the forerunners of our present-day columnists, declared that where we had one man dyed by shot in the Navy we had ten dyed by bad provisions.” Another one in a pamphlet with the picturesque title “The Navy Ript and Ransacked,” says that “The men will, and do run away, rather than eat the food, and those that do or are forced to stay, contract disease, sickness, and often death.” When the effects of scurvy are considered these statements are great underestimates. Only an approximate estimate of the losses from the disease can be made, but from the statistics available of the British Navy during the eighteenth century, it is probably not too much to say that in the 300 years between 1500 and 1800 scurvy killed as many seamen as all other nautical hazards combined. This includes not only deaths from battle and shipwreck but from all other diseases as well.
Hawkins says that in his 20 years at sea scurvy killed 10,000 men. One of the most famous outbreaks of scurvy in the Royal Navy was on Anson’s celebrated voyage around the world. Nearly two-thirds of the crew of his little squadron died from scurvy. Two hundred were lost from this disease on the flagship, and it is recorded that there were but 6 able-bodied hands in a watch. By the time Cape Horn was rounded and the Pacific islands reached, only 335 men were alive of 961 who had left England. The first circumnavigator of the globe, Magellan, fared no better. The scurvy left but few to reach Europe as the vanguard of all subsequent girdlers of this old earth. An Italian volunteer named Pigafetta has left a firsthand account of this historic voyage and tells of their hardships and sufferings. “We ate biscuit, but in truth it was biscuit no longer but a powder full of worms and in addition it was stinking with the urine of rats. So great was the want of food that rats became a great delicacy and we paid half a ducat apiece for them.” He concludes by saying, however, that “During all this time and among so many sick I never had the slightest indisposition.” He appears to have had a tough constitution, or as the present-day slang expresses it, “He could take it.”
It is a remarkable fact that although the disease was early associated with lack of fresh vegetables and fruits in the diet and their preventative powers were recognized empirically, no official notice of this was taken by the administrators of the Royal Navy or by such great commercial organizations as the East India Company, though thousands of lives and millions of pounds sterling would have been saved by the practical use of the knowledge. The magically curative powers of both lemon juice and certain green herbs and fresh vegetables were well known yet the knowledge was seldom utilized and then only sporadically. One of the reasons, of course, was the difficulty of keeping fresh provisions in the days before refrigeration.
There is a story of a Portuguese sailor on one of their India bound vessels who came to request mast and asked that an onion be added to the bread, oil, cheese, and wine that formed their main ration. The captain roared out at him to demand if he wanted “luxuries.” Yet here was a scurvy preventing article the addition of which as a standard part of the ration of their men would have saved thousands of lives on the Portuguese trade routes to India alone.
Both the English and the Dutch had extensive whale and seal fisheries in the Arctic during the seventeenth and eighteenth centuries. The Dutch fisheries centered about Spitzbergen, the English in Greenland waters. The whaling ships were sometimes frozen in or wrecked and the crews had to winter in the Arctic. The voyages were long and outbreaks of scurvy frequent and serious. It was said that the Dutch suffered less because of their habit of carrying sauerkraut as a part of their regular provisions for these voyages. Its anti-scorbutic powers were considerable and there may have been some merit in the belief. Sauerkraut was used by Captain Cook on his voyages. His crews were remarkably free from scurvy, this, however, being in great measure due to his general hygienic precautions as to the cleanliness of the ship, and his care to obtain fresh provisions including vegetables and fruits at every opportunity. He understood, too, the importance of preventing undue exposure of his men to fatigue, cold, and wet, and his great interest in their health and comfort was reflected in the low sick rate.
Though the preventive measures for scurvy were known to many it was not until 1747 that a medical man definitely proved the value of lemon juice in the prevention and treatment of the disease. This medical man was James Lind, a surgeon in the Royal Navy and, like so many of them, a Scotchman. Lind is one of the great names in the history of naval medicine. First of all he was an advocate of the isolation of new recruits on receiving ships or in barracks for a period before distribution to the fleet. This prevented much contagious disease. He also urged the issue of a uniform for the men of the Navy. At that time the enlisted men had no regular uniform. Lind by recommending a period of quarantine, individual cleanliness, and the replacement of the frequently louse- infested civilian clothing by a regular uniform did much to limit typhus fever in the Royal Navy. Typhus, then usually called ship or jail fever, was one of the principal death dealers within the “wooden walls of England” and this contribution alone would entitle him to a great place in the history of nautical medicine. Furthermore Lind was one of the foremost pioneers in the practice of distillation as a practical method of obtaining fresh water at sea. But he made a greater contribution than these when he conducted his famous experiment on the treatment of scurvy, settled in a scientific manner the method of treatment, and pointed the way for the prevention of that disease. This experiment he made on H.M.S. Salisbury, which had at the time many cases of scurvy on board. Lind took 12 cases as nearly alike in symptoms and physical condition as possible. He divided them into 6 groups of 2 men each. He then used 6 different forms of treatment all in common use at the time, each with many medical partisans. In one group each man received a quart of cider a day; in another group each man received 25 drops of elixir of dilute sulphuric acid three times a day and a mouth wash of this preparation; in the next group each man received two teaspoonful’s of vinegar three times a day and diluted vinegar was also used as a mouth wash; in the next group each patient had a quart of sea water daily; in another group each man had a pill containing garlic, mustard seed, radish, balsam of Peru, and gum myrrh; and in the last group each man had a lemon and two oranges daily. In only six days these last two were so recovered that one man was sent to duty and the other was retained as a nurse for the remaining ten.
Today Lind would be entitled to the Nobel Prize in medicine for such an achievement and he deserves the warm admiration and gratitude of every sailor for with it he paved the way for the complete conquest of “The Scourge of the Sea and Spoyle of Mariners.”
Yet unaccountably enough it was nearly 50 years before the knowledge was applied on a wide enough scale to do real good. Many individual navigators utilized the knowledge but it took two other naval surgeons, also men of the highest ability, to arouse the indifference of the Admiralty and to generally apply the lessons learned. These two men were Dr. John Harness and Sir Gilbert Blane. In 1793 the Mediterranean Fleet under Admiral Lord Hood was greatly afflicted with the scurvy. Harness was the “Physician to the Fleet,” a position somewhat analogous to that of Fleet Surgeon. Through his strong recommendations Admiral Hood ordered lemon juice supplied to all ships and the disease was promptly and completely eradicated.
Blane had probably a more important part in the elimination of scurvy from the Royal Navy than Harness. A man of shining talents both as a medical man and as an administrator, Blane took Lind’s work, which he constantly extolled, and pressed strong recommendations to ship and fleet commanders to utilize it for the efficiency of the service and the nation. On Admiral Rodney’s flagship the Formidable, when Blane was Fleet Surgeon, out of 900 men not one was lost from scurvy in 6 months. Yet this was at a time when out of 12,000 men in the naval force in the West Indies, 1 man in 7 died from scurvy m a single year (1781). Two years before, the Channel Fleet came in with 2,400 cases after being at sea for 10 weeks, and every naval enterprise was jeopardized by the disease. Rodney was so impressed by the successful use of lemon juice on his flagship that he strongly supported Blane’s efforts. Ry 1795 when Blane was one of the Commissioners of the Sick and Hurt he succeeded in having Lord Spencer, then First Lord of the Admiralty, make it a requirement for all vessels of the Royal Navy. Among the Admiralty Orders and Instructions for 1795 a great many are found for the issue of lemon juice to ships. Here is one relative to its supply to the North Sea Fleet under Admiral Duncan.
15 June, 1795.
Admiral Duncan, commander in chief of a squadron of H.M.’s ships and vessels employed in the North Sea, having requested that the ships under his command may be supplied with lemon juice and sugar for the preservation of their respective companies; you are hereby required and directed to cause the squadron under the said Admiral’s command to be supplied with the articles above mentioned, in the same manner as they are supplied to the fleet under the command of Admiral Earl Howe.
Spencer.
C. S. Pybus.
J. Gambier.
The results of this policy were remarkable in its effects on the saving of life, the prevention of sickness, and the promotion of fighting efficiency. They paved the way, too, for the introduction of smallpox vaccination in the Navy shortly after Jenner’s discovery of this measure in 1798. Blane ardently recommended this also, and his success with the prevention of scurvy led the Admiralty to quickly follow his advice. It is not too much to say that the adoption of these two measures did as much to win Trafalgar and to maintain the blockade that broke the power of Napoleon as the courage and seamanship of the men whose lives were preserved by them.
With the introduction of lemon juice throughout the Royal Navy scurvy disappeared as if by magic. Where ships were scarcely able to man their guns after a month at sea because of the prevalence of the disease, a case was now seldom found. In the words of Dr. Harness, “Scurvy may be said to exist only in the painful recollections of those who were once witnesses of its fatal devastation.” In the same letter addressed to Lord Melville in 1816, Dr. Harness gives the statistics showing the marked decline in sick rates from 1779 to 1810. In the period 1779 to 1783 one in four men was sent to hospitals in the course of each year, from 1794 to 1798 it was one in six, while in the period 1806 to 1810 it had fallen to one in sixteen and a half. The actual figures for 1779 were 70,000 seamen and marines voted by Parliament and 24,226 sent to hospitals in that year. This is more than one in three for that particular year. In 1810 the number of enlisted men authorized for the Navy was 145,000 and but 9,965 were sent to hospitals. Most of this marked decline was due to the abolition of scurvy. In 1797, only two years after the general introduction of lemon juice, Lord Spencer in his inspection of the Royal Naval Hospital at Haslar found not one case of scurvy there, though usually before 1795 the wards of every naval hospital were filled with it. Some years after this Blane was able to make the remarkable statement that “because of the issue of lemon juice there are now many surgeons in the Navy who have never seen a case of the disease.”
It is of interest that the quantity of orange or lemon juice recommended by Blane, namely one ounce daily, contains almost the exact amount of ascorbic acid which modern scientific studies have shown to be needed to maintain the Vitamin C balance of the body. The Admiralty instructions provided that the issue of lemon juice should begin after the ship had been at sea for a fortnight. Also of interest is the fact that Blane recognized that heating lemon juice much impaired its scurvy preventing powers. He also was aware that preserved with a little sugar or spirits these powers were retained for a long time.
Gradually during the nineteenth century lime juice was often substituted for lemon juice. Unfortunately no investigation was made of its keeping qualities, the fact being that, though an effective antiscorbutic when fresh, its protective powers soon deteriorate. As a consequence its use in a number of arctic and antarctic exploring expeditions led to serious disasters and loss of life.
The conquest of scurvy is one of the great mileposts in human progress. It is a real landmark in the history of nautical medicine. This scourge affected exploration, the colonization of new lands, commercial enterprises, mercantile shipping, and all naval operations. If the ten greatest events in maritime history were to be selected, the conquest of scurvy would have to be one of them. The disease was like a blight over maritime affairs and held back the progress of exploration, colonization, and trade. The discovery of its cause and prevention is one of the great chapters in human history. The work of Lind, Harness, Blane, and many another more humble worker in this field justifies Pope’s translation of Homer’s famous lines:
“The wise physician skilled our wounds to heal, Is more than armies to the public weal.”