The Glacially-Slow Conquest of Scurvy And Its Relevance to Modern Life

Scurvy is a disease of civilization because you need civilization to make long ocean voyages. It is the first disease of civilization to be understood and eliminated. In a paper called “Innovation and Evaluation” (gated), Frederick Mosteller, a professor of statistics at Harvard, noted how long it took. In 1601, James Lancaster, a sea captain, did an experiment involving four ships on a long voyage. Men on one ship got lemon juice, men on the other three ships did not. The men given lemon juice were far less likely to get scurvy.  In 1747, James Lind, a doctor, compared six purported cures for scurvy. Lemons and oranges (one cure) were much better than the other five (as Lind expected). In 1795 the British Navy started using citrus juice regularly and wiped out scurvy on their ships. In 1865, the British Board of Trade recommended citrus juice for commercial ships. It took more than 200 years for a simple and effective remedy — discovered before Lancaster — to spread widely.

The sailors at risk of scurvy did not control what they ate. The people who controlled what they ate never got scurvy. Sure, the people who controlled what sailors ate did not want them to get scurvy (high rates of scurvy were a big problem) but they also had other concerns. The lesson I draw from this story is do not let anyone else (doctor, expert, etc.) solve your health problems for you. Sure, other people, as part of their job, will sell you something, provide advice, write a prescription, provide therapy, do surgery, whatever. It might work. They want to help you — the more they help you, the better they look, the more business they attract. But it is entirely possible, this bit of history teaches, that they are slow on the uptake or have conflicts of interest and a much better solution is available.

Thanks to Steve Hansen.

10 Replies to “The Glacially-Slow Conquest of Scurvy And Its Relevance to Modern Life”

  1. Sorry, Seth, I’m having trouble understanding what you mean about the sailors: “The sailors at risk of scurvy did not control what they ate. The people who controlled what they ate never got scurvy.” Do you mean that the cooks on the ship always made sure that they ate lemon juice, but they didn’t build it into the menu for the rest of their shipmates? How do you know this?

    Seth: What the sailors ate was determined by the food they took on board at the beginning of their trip. This was not determined by the cooks, as far as I can tell from the books I have read about this. It was determined by higher authorities.

  2. gwern – that is the best article on health i have read.

    the lessons to be drawn, the parallels, and the sheer magnitude of the story are awesome.

  3. An alternative link for the Frederick Mosteller paper

    The paper Darrin and Gwern cite suggests that it isn’t so simple as saying “lemons cure scurvy.” What happened between Lancaster and Lind? It is not hard to imagine that people did experiments, and rejected citrus. It does seem, though, that they should have done enough to get the right answer.

    Seth: I think the paper they cite says that people forgot that lemons cure scurvy. Or were confused. Not that any experiment rejected citrus.

  4. There was no controlled experiment, but it wasn’t a matter of people forgetting. You can say they were confused, but Lancaster and Lind were just as confused.

    Several arctic expeditions got scurvy, despite lime juice. This wasn’t an experiment, but it was very good evidence. Actually, there was even better evidence: there was no difference between people on the ship, with more juice, and those off.

    The simple claim “citrus cures scurvy” is just not true. The biochemical situation is simple, but the food consequences are complicated. What if the British Navy had listened to Lind? They would have put lemon juice in his copper vats and found no effect on scurvy. Would we today know they had tried? We remember Lancaster and Lind because their experiments matched the slogan “citrus cures scurvy,” not because they were the only experiments, let alone the only claims of data.

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