The word “limey” did not, at first, denote an Englishman, nor was it American in origin. It is derived from the slang word for an emigrant ship carrying lime juice as an antidote to scurvy, according to the regulations laid down by the merchant shipping acts passed in the middle of the 19 th century. These ships were called “limejuicers” by the Australians, and the newcomers to that continent were known as “limeys.” Sometime about 1880 the word spread to the United States, where it began to be applied specifically to Englishmen.
The first of the shipping acts, which provided for an issue of lime juice or vinegar to ship’s crew and passengers after a vessel had been on salt provisions for ten days, was passed almost exactly 100 years after the true preventive of scurvy had been demonstrated by the first controlled dietetic experiment on record. This is probably the longest and most reprehensible delay in the adoption of a known cure for a disease in the whole of the history of medicine. Furthermore, when a remedy was suggested by act of Parliament, it turned out to be wrong; the answer to scurvy proved to be a lemon and not a lime.
For the past 50 years it has been known that this disease is due to a deficiency of vitamin C, and it is now known that a better remedy than any of the citrus fruits or fresh vegetables which used to be recommended is to be found in black currant or rose hip juice. If the ascorbic acid in 100 grams of lime juice is assessed at 25 parts, that found in a similar quantity of lemons or oranges is 50, whereas black currants or rose hips contain 200 or more. Thus, the medical term for the West Indian lime, from which most lime juice was prepared, is very misleading. It is called citrus medica acida, but it possesses only half the medicinal properties of the Mediterranean lemon, citrus limonum, which was the specific proposed in the 18th century.
Scurvy is the most ancient, loathsome, and fatal curse of the sea. A modern seaman may consider himself fortunate that he is living in an age when the pathology of the disease and its treatment have become clear. It began to be associated with long voyages at sea at a date when the only known means of preserving food was by salting it. Scurvy first appeared as a serious occupational disease when the European maritime explorers began to make long voyages to distant parts of the world. The first recognizable description of it is by Jacques Cartier in 1535, when he sailed up the St. Lawrence, only to be struck down by an “unknown sickness,” from which he recovered by taking an Indian herbal remedy vaguely described as “the juice of the leaves of a certain tree,” probably spruce beer, which continued in favor as an antiscorbutic for many centuries.
The last serious outbreak of the disease is described by a prisoner on board the German raider Wolf in 1917. Having been more than a year in the South Atlantic subsisting on whatever supplies she could take out of captured ships, the Wolf began to run short of food; her prisoners were the first to suffer.
Many had been in the first stages of scurvy for some time—had been listless, sallow and sick. Now their teeth began to fall out. Some swelled into dropsical wrecks with puffy, yellow flesh that marked when touched; others were covered with skin eruptions: purple, red and even green spots appearing all over their bodies. This diseased flesh was maddeningly irritating; and when the sufferers scratched their sores the irritated areas broke into huge ulcers. Some went blind. . . . None of us had seen scurvy before, and the old sea tales of this disease had seemed ridiculously exaggerated. But the foul symptoms of a serious outbreak of scurvy could never be overdrawn.
The story of the disease, from Cartier to the Wolfs prisoners, is one of the most remarkable in the history of medicine. It is the story of a remedy found only to be lost again and again. It is the record of a disease so baffling and so various in its manifestations that its diagnosis changed decade by decade. Cures of the most astonishing variety were constantly suggested: doses of vinegar or salt water; burying the patient up to his neck in sand because recovery from the disease was associated with arrival on dry land; limes, lemons, oranges, apples, cider, beer, onions, malt and a dozen other articles—each had its enthusiastic supporters. Nelson favored onions; Cook preferred malt; the Dutch grew mustard and cress on their quarterdecks. But all the time scurvy took its deadly toll in the form of emaciated and enfeebled crews, unable to fight or to work their ships.
The easiest available antidote in the form of lemon juice was discovered as early as 1600, when Sir James Lancaster sailed to the East in the Red Dragon in which there happened to be on board “certain bottles of the juice of lemons.” This singularly healthy voyage should have established the use of lemons as a preventive, especially when Sir Richard Hawkins shortly afterwards extolled the remedy in the plainest possible terms: “This is a wonderful secret of the power and wisdom of God, that hath hidden so great and unknown a virtue in this fruit, to be a certain remedy for this infirmity.” Furthermore, in the first handbook on naval medicine, The Surgeon’s Male by John Woodall, published in 1617, we are told that “the use of the juice of lemons is a precious medicine and well tried.” But it was 300 years before the “virtue” of the fruit was identified as vitamin C, and unfortunately, Woodall goes on to suggest that if lemons are unobtainable, limes and even egg flip might be used.
Thus was the remedy found, only to be lost again. By the end of the 17th century, no one was any the wiser, and the route to India and the East was littered with shipwrecks or losses at sea due to crews enfeebled by an unbalanced diet which consisted principally of salt meat, dried peas, and hard tack, or weevilly ship’s biscuit.
The classical case of the incidence of scurvy was on Commodore George Anson’s voyage around the world in 1740-1744. On that voyage, 1,051 men of the 1,955 who sailed in seven ships from England died—most of them from scurvy. The chaplain of the Centurion, which was the only one of the ships that returned home, writes:
The disease extended itself so prodigiously that after the loss of over 200 men we could not muster more than six foremast men in a watch capable of duty. This disease, so frequently attending long voyages, and so particularly destructive to us, is surely the most singular and unaccountable that affects the human body: its symptoms are inconstant and innumerable, and its progress and effects extremely irregular. . .
The casualties suffered on Anson’s voyage were so appalling that an obscure Scottish surgeon, Dr. James Lind, then serving on board HMS Salisbury in the Channel fleet, determined to carry out the first controlled dietetic experiment on record. He took 12 men afflicted with scurvy and gave them all the same basic diet of gruel, mutton broth, and boiled biscuit, to which he added various recommended antiscorbutics for each pair of men. Two were given vinegar, two salt water, others garlic, elixir of vitriol, or oranges and lemons. Those who received the latter were fit for duty again in a week. As he announced in his Treatise of the Scurvy in 1753, “the result of all my experiments was that oranges and lemons were the most effectual remedies for this distemper at sea.” Unfortunately Lind made one mistake: in order to preserve the juice in bottles he boiled it, so that much of the vitamin content was lost. But as long as fresh lemons or oranges were used regularly, a trustworthy prophylactic had been proved by clinical experiment.
Dr. Lind had thus hit on a sovereign remedy for the principal occupational disease of seamen. Yet, it was not until 1795 that lemon juice was officially adopted in the British Navy, and not until 1844 that it was laid down by act of Parliament (and then in ambiguous terms) for the merchant service. Captain David Porter is credited with the introduction of lemon juice into the American Navy in 1811; but as late as 1827, after scurvy had become a rare disease in other navies, we are told that the U. S. frigate Macedonian reported 101 deaths from scurvy, out of 376 men, over a period of six months.
How is this extraordinary delay to be explained? Thirty years after a sure preventive had been found, thousands of British seamen were invalided out of the navy during the War of American Independence because of scurvy. After a mere ten weeks cruise in the English Channel in 1780, no less than 2,400 cases of scurvy were landed at Portsmouth, where Lind, the father of nautical medicine, was still in charge of Haslar hospital. During the previous year, a Franco-Spanish Armada, on the brink of making a descent on Plymouth, was totally disabled by a combination of scurvy and the other killing disease of the period—ship fever, or typhus.
The voyages of Captain Cook during the years immediately preceding that war are supposed by many to mark the conquest of scurvy, and much of the credit which is due to Lind has often been given to Cook. The truth is that Lind was by no means the only physician to publish a cure for scurvy, though his happened to be the correct one. Other medical writers extolled their own nostrums; that recommended by Dr. David MacBride in 1764 proved to be particularly harmful, because Cook’s surgeons left their approval of it on record and the Admiralty jumped to the conclusion—on insufficient evidence—that it was the best, because it was the cheapest. This remedy was an infusion of malt in which modern chemical analysis finds no trace of ascorbic acid whatever. On all of Cook’s voyages he was liberally supplied with this stuff, although he also carried a small quantity of lemon juice for the sick. It astonished the world that he could sail on three extensive voyages without losing a single man from scurvy, though they failed to note that his surgeons reported a number of cases, none of them fatal. The reason for the extraordinarily high standards of health enjoyed by Cook’s men was that their captain compelled them, even to the extent of flogging them, to eat every food on board, and to take the first opportunity to gather fresh vegetables and meat as soon as they landed on any of the many islands which he discovered in the Pacific. Sailors, he complained are notoriously conservative in their taste, but by such blunderbuss tactics he persuaded them to eat what was good for them. He was much too busy charting unknown seas, however, to conduct scientific experiments in the comparative value of the foodstuffs with which his ships were victualled, and it must also be recalled that his crews were picked men, not the pressed men who normally manned the ships of the navy. After his second and longest voyage he wrote hastily (since he was about to embark once more) “that the dearness of the rob [juice] of lemon and oranges will hinder them from being furnished in large quantities. But I do not think this so necessary; for though they may assist other things, I have no great opinion of them alone.” He was much more cautious in his official report on the voyage, but the Admiralty and the medical profession accepted this statement at its face value. The consequence, as we have seen, was the loss or disablement of thousands of seamen during the ensuing war.
It was Lind’s disciples in the next generation—Sir Gilbert Blane, and Dr. Thomas Trotter—who revived his teaching on the subject of scurvy. Dr. Blane a much more influential man than Lind, was able to persuade the authorities, who were as usual worried by the wastage caused by disease, that “every fifty lemons might be considered as a hand in the fleet,” and, when he was head of the Sick and Hurt Board in 1795, he was mainly instrumental in making three- quarters of an ounce of lemon juice mixed with two ounces of sugar a daily issue in the men’s grog. Had not this precaution been taken we should never have heard of the success of the blockading fleets of Lord St. Vincent or possibly even the victories of Lord Nelson. In the year of Trafalgar, for example, Nelson purchased for his fleet 50,000 gallons of Sicilian lemon juice, and by the end of the war not a single case of scurvy was considered to be serious enough to be admitted to the principal naval hospitals at home.
Thus, at the beginning of the 19 th century, it was confidently expected that scurvy, like the plague, was a thing of the past. Because of the adoption of the grand specific of lemon juice, ships of war were no longer paralyzed by the incidence of this ancient curse of the sea. With the dawning of the age of steam, an age of shorter voyages and better preserved foodstuffs, the problem of victualling ships became less intractable. Canned meat was introduced into the British Navy in 1813 after Napoleon had awarded a prize to Nicolas Appert for this mode of preserving food a few years earlier. Because of their French origin, the cans were originally marked bouilli, hence the English word for such meat, “bully beef.” Nonetheless, at the beginning of the 20th century, the situation with regard to scurvy was just as confused as it had been before the days of Lind.
The experience of the various Arctic explorers on the quest for the Northwest Passage gives an almost clinical picture of the efficacy of the foodstuffs issued to the Navy during the 19th century. The earlier explorers, such as Parry and Ross, did not suffer in any marked degree from scurvy because of the introduction of canned meat and vegetables, and because they were liberally supplied with lemon juice. The one exception was the tragedy of the Franklin expedition of 1845-49, every member of which perished from a combination of scurvy, exposure and exhaustion, after their ships had been beset by ice for three years off Canada’s Boothia Peninsula. At the time it was thought that this was due to something like ptomaine poisoning, but many of the cans of food which the expedition left behind have since been opened for analysis and the contents have been found to be as sound as when they were first issued. What is probably the oldest steak in the world is now preserved at the National Maritime Museum in England, and it looks as fresh and tasty as anyone could desire. It is more likely that exposure over a long period to intense cold robbed the lemon juice of its efficacy.
Among the many British and American expeditions which set out in search of Sir John Franklin, the only one to suffer severely from scurvy was the party financed by Henry Grinnell and led by Lieutenant E. J. De Haven, U. S. Navy, because this expedition put its trust in beer rather than lemon juice.
Captain Sir Robert McClure’s men in HMS Investigator, which spent no less than three years in arctic ice, suffered little, because their lemon juice had been specially prepared from Sicilian fruit. In a book written about the medical history of that voyage, however, the ship’s surgeon, Alexander Armstrong, makes a significant and ominous mistake. Time and again he uses the words lime and lemon indiscriminately, as if they were the same fruit and of equal efficacy as antiscorbutics. What caused Armstrong to be so misled was that about the middle of the century the Admiralty began to contract for West Indian lime juice instead of Mediterranean lemon juice. This was because it was easier and cheaper to obtain citrus fruit from the British West Indies, and in the West Indies the lemon has never enjoyed the same popularity as the native lime.
The consequence was first apparent in Sir George Nares’ polar expedition of 1875, on which, with lime juice being consumed, there were 60 cases of scurvy out of a total of 122 men, of whom three died. The fact that the almost contemporary American expeditions in search of Franklin, the Polaris expedition of 1872 and that led by Lieutenant Frederick Schwatka, U. S. Army, did not so suffer was due to their adoption of an Eskimo diet of fresh seal meat and game, so that they did not have to rely exclusively on their lime juice.
The conflicting medical reports of these polar expeditions confused the understanding of the disease. Why did some suffer from scurvy while others escaped? One thing became increasingly certain, and that was that no reliance could be placed on lime juice alone. Yet it continued to be issued as an antiscorbutic as recently as 40 years ago.
In a paper on the subject read before the Royal Society in 1900, it is stated flatly that “neither lime juice nor fresh vegetables either prevent scurvy or cure it, because scurvy is a disease produced through the eating of tainted food.” Another hygienic expert came to the astonishing conclusion that scurvy was caused by parasites carried by cockroaches on board. Sterilization of preserved food and gallons of carbolic disinfectant throughout the ship was now the cry, while the old advice on lemon juice as the grand specific was quite forgotten.
If such was the attitude of the medical profession, it is not surprising that the Antarctic expeditions of Sir Ernest Shackleton and Captain Robert F. Scott suffered severely from scurvy, and that the latter’s party died from the combined effects of scurvy and exhaustion on its return from the South Pole. The prevailing confusion and ignorance about the disease was even more dramatically illustrated when General Sir Charles Towns- hend’s army surrendered to the Turks in Mesopotamia in 1916 after the prolonged siege of Kut-el-Amara. Over 1,100 cases of acute scurvy, out of the besieged garrison numbering 9,000 men, were reported.
By a curious coincidence it was in the year of Scott’s death, that Sir Gowland Hopkins published his first paper of vitamins, by which the road was opened for a true explanation of dietary deficiency diseases. Experiments carried out at the end of World War I confirmed what had long been suspected, namely that lime juice was almost useless as an antiscorbutic, and that lemon or orange juice, together with a plentiful supply of fresh vegetables, was a sure specific. The varied diet now made possible by new methods in the preservation of food have prevented any subsequent outbreaks of this ancient curse of the sea, at least on a large scale; but such diseases remain in ambush for all those who neglect Nelson’s maxim that “the great thing in all military service is health.” END