What is Scurvy?
The 18th Century dockmaster and seaman William Hutchinson filled part of his book A Treatise on Practical Seamanship with the description of his slow descent into scurvy. He first notices old wounds aching, then weakness. His legs turn black, his gums swell and his teeth come loose. Finally, he lies in his hammock, unable to feel his hands and feet, propping his head up on the side of the hammock so that the blood from his gums can pour over the side of his hammock.
Scurvy is the result of malnutrition: specifically, a lack of Vitamin C in your diet. Most animals produce their own vitamin C, but some vertebrates can’t. This is probably by chance loss of L-gulono-γ-lactone oxidase, the gene required to produce it. Humans are one of those lucky vertebrates! This means we need to eat vitamin C to live. In modern times, this is so easy that most people in the first-world countries get enough vitamin C in their diet without trying. One orange or lemon a day is enough to get by, as is medium-rare meat or watercress in your salad. Often cereals and juices are also supplemented with vitamin C.
Europeans started noticing scurvy when they began taking long trips to sea. The only food that would last long enough to feed adventurers and pirates for the whole journey was low in vitamins and nutrients, so after months of eating crackers and dried meat, they found themselves severely malnourished. It took them a painfully long time to work out how to eat to prevent scurvy, so for hundreds of years having half the crew die of scurvy on a one-way trip was nothing to raise an eyebrow at.
The devastating symptoms of vitamin C deficiency are seen due to its involvement in key body maintenance processes. These processes include cartilage production and cell membrane development, as well as growth and signaling between cells. Vitamin C is involved in the production of hormones, neurotransmitters and proteins essential for these processes.
Whilst it is easy to prevent scurvy now that we know its cause, people still suffer from it. The aging population is more socially isolated and less likely to provide themselves with adequate nutrition. Similarly, homeless populations are at risk, as are people on extreme diets due to allergy or misleading health advice. Scurvy is seen on a larger scale in refugee populations.
Modern scurvy prevention and treatment
William Hutchinson survived because he got to land, where he ate a more varied diet (presumably slowly, with wobbly teeth). Scurvy can be reversed just by eating 10 milligrams of vitamin C per day, recovery seen in miraculous style within about two weeks.
Nutritional assistance to populations at high risk for scurvy is simple in the sense that only a small amount of vitamin C is required to prevent or cure it, with no other medical intervention. The logistics of nutritional assistance are frustratingly complicated.
The World Health Organisation has reviewed multiple approaches to nutritional supplementation to prevent scurvy in refugee populations. In smaller populations, the distribution of fresh fruits and vegetables is practical and can also be achieved by increasing rations, where refugees often use the excess rations to barter for fresh food at local markets.
Larger populations cannot be assisted by such efforts: these populations are not often near markets and efforts to transport and distribute fruit and vegetables to these refugee groups have failed in the past due to logistic difficulty. Vitamin C degrades when cooked, so most research is currently going towards supplementation of less-cooked rations like sugar, oil and water with vitamin C.
Vitamin C supplementations in flour and whole grains are degraded to a great extent due to storage and extensive cooking, but these foods are so regularly consumed by refugees that research still goes into better methods of supplementation with vitamin C. At present, the supplementations that work best are purees of root vegetables and cereal powder and vitamin C tablets. However, refugee populations do not regularly eat these foods when provided in ration packs.
The best solution in the long term is to grow community gardens, but this requires time and a consistent water source. As Jacques Cartier, a 16th century explorer, noted, “If all the physicians from Louvain and Montpellier had been involved with all the medicines from Alexandria, they would have done no better [at treating scurvy] in a year than this tree in eight days”.
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