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Humans are fascinated by gore and violence, but even more so, the mysterious and unsolved. Interest in these disturbing and unpleasant subjects is called Morbid Curiosity, and it has gripped millions of people throughout the ages. I am one of those people. My name is Hallie, and this is the Morbid Curiosity Podcast.
Skirvy is one of the oldest diseases in human history. It's also one of the few dietary diseases that has excessively tormented humankind, and estimated two million sailors died of Skirvy between the 16th and 18th century CE. Skirvy was responsible for more deaths at sea than storms, shipwrecks, combat, and all other diseases combined. Skirvy is not caused by bacteria, virus, or prion.
It's caused by a simple lack of a single essential nutrient, vitamin C. The human body doesn't naturally make vitamin C, also called ascorbic acid, but it needs it for many essential bodily processes. Vitamin C plays a major role in the synthesis of collagen, the main structural protein of connective tissues and blood vessels in the human body. It's part of tendons, joints, muscles, arteries, organs, hair, as well as layers of skin and the cornea of the eyes.
Vitamin C also promotes iron absorption and mobilization, which is essential for red blood cell creation and clotting. It's also involved in the breakdown of fatty acids, the synthesis of several neurotransmitters involved in the stress response and the immune response. We get vitamin C from eating foods that contain it, such as raw fresh fruit and vegetables. Citrus fruit, in particular, is rich in vitamin C.
Vitamin C can also be found to a lesser degree in meat, fish, and dairy. Before modern refrigeration, sailors on long voyages relied mostly on salted or non-perishable foods. They didn't have regular access to fresh vegetables or fruit, which is why Skirvy is usually associated with pirates, sailors, and explorers. It takes at least a month of little to no vitamin C intake before the symptoms of Skirvy begin to occur.
Because it's part of so many essential processes, the symptoms are many and varied. Early symptoms include weakness, fatigue, and sore arms and legs. The fatigue is so intense that it's debilitating, as is the joint pain. Along with weakness, the arms and legs may swell and bruise at the slightest touch.
As the disease progresses, there's a decrease in red blood cells. The gums become diseased, causing terrible breath and loose teeth. Hair begins to fall out, and bleeding under the skin may occur and cause splotches on the skin. In the latest stages, new wounds won't heal, and old wounds reopen.
The mucous membranes of the nose, mouth, and eyes rupture and bleed. Personality changes occur. Left untreated, death will likely occur due to a sudden hemorrhage near the heart or brain, or from infection of wounds. To put things into perspective, I have a quote I'd like to share.
In his 1820 textbook on nautical medicine, sailor's physician, Navy surgeon Usher Parsons unflinchingly described the signs of Skirvy. Quote, the gums become soft, livid, and swollen, are apt to bleed from the slightest cause and separate from the teeth, leaving them loose. About the same time, the legs swell, are glossy, and soon exhibit foul ulcers. The same appearances follow on other depending parts of the body.
At first, the ulcers resemble black blisters, which spread and discharge a dark-colored matter. These ulcers increase, emaciation ensues, bleeding occurs at the nose and mouth. All the evacuations from the body become intolerably fitted. Death closes the scene.
End quote. There are other symptoms of Skirvy that we weren't aware of until more recently, thanks to the developments of skeletal analysis and x-ray technology. The weakness of blood vessel walls causes hemorrhaging, bruising, bleeding, and inflammation. This can be so bad that it leads to inflammatory changes in the skeleton, reducing bone density and making it spongy and weak.
This usually occurs on the external surface of the skull, the roof of the orbit or eye, and around the jaw. The orbital lesions could be due to eye movements causing blood vessels to rupture. The jaw lesions are probably due to ruptures that occurred during chewing. In children, skeletal changes are more pronounced due to more rapid bone growth.
Skirvy can cause delayed bone growth, severely low bone mineral density, separation of the growth plates, and thinning of the outer surface of the bones. The first documented reports of the collection of symptoms we now know as Skirvy are found in the Eber's papyrus, which is a fraction of ancient Egyptian medical knowledge from about 1550 BCE. It recommended onions as a treatment, which may have helped as onions do contain vitamin C. Ancient Greek physician Hippocrates described symptoms in the 5th century BCE, naming it Elios Imantis.
He wrote of the stench of the rotting gums, bleeding from the nose, and bruises and wounds on the legs. He believed it was due to a, quote, swelling and obstruction of the spleen, end quote. Sporadic reports of outbreaks of Skirvy appear amongst the large armies of state-level European societies since the time of the Roman Empire. Before the era of European exploration, Skirvy was thought to be a winter disease affecting poor urban populations.
It was nicknamed the disease of London, the Dutch distemper, and black legs. The urban poor didn't have access to fresh fruits or vegetables in winter at the time, so it's not surprising that they suffered from Skirvy. It was also a problem in prisons and asylums, but there wasn't much interest in discovering the cause until the age of the sale, also called the era of European exploration. In the late 15th century, Skirvy became a major problem for the naval forces of many countries as they traveled far out to sea in search of new lands to colonize.
They spent months at sea with only heart attack and salted meat, the only real non-perishable foods at the time. Most times, the whole ship would begin to suffer at the same time as the whole crew lacked vitamin C. Portuguese navigator Vasco de Gama, who's famous for being the first European to circumnavigate Africa, wrote that many of his men fell sick at the same time, with swelling in the legs, arms and gums. This disease was described as amalati de la boca, the curse of the mouth.
In 1499, de Gama noticed that the symptoms seemed to subside after the ship replenished fresh food stocks. This was not the first time a connection was made between Skirvy and a lack of fresh food, and not the last time this information would be forgotten. In 1541, Danish doctor Johannes Echthius wrote one of the earliest descriptions of the symptoms of Skirvy as one disease. He referred to it as Skorbitus in 1556, which is based on a German word which roughly translates to lacerated or swollen belly.
The earliest mention of citrus fruits as a treatment is from 1579 in a treatise by Frei Augustin Varfam, a Spanish medical missionary. It's unknown why this treatment didn't catch on. Between the 16th and 18th centuries, there were numerous reports of Skirvy in contemporary medical literature. Both the cause and the treatment were discussed by physicians all over the world.
It was thought to be similar to a venereal disease, or perhaps rheumatism, and was treated with similar methods, including with mercury, which was disastrous, as mercury also causes tooth loss and severe skin ulcers. Skirvy was also thought to be caused by the sea air affecting the spleen, which harkens back to ancient Greek theories. It was also believed to be a putrid disease caused by decay of the humors, yes the four humors, which we've talked about in several previous episodes, or rotting food in the stomach. In 1639, John Woodall published his book The Cherurgians Made.
He recommended a broth made with fruits, spices, and sugar, or barley water with lemons and sugar. He stated lemon juice was a precious medicine and should be taken twice a day with a spoonful of sugar. His recommendation was lost soon after it was published. Thomas Sidnham, a famed English physician which we discussed in our episode on the Dancing Mania, recommended Skirvy Grass and oranges steeped in beer or white wine in 1685.
Skirvy Grass refers to Cochlear Rhea Ophishinales, also known as Spoonwort. This plant does contain a small amount of vitamin C. Unfortunately, his recommendation was also ignored. In 1694, Martin Lister noted that lemons, oranges, and citrons had an almost magical curative effect on Skirvy.
Not long after, English, surgeon, and personal physician to Queen Elizabeth I, William Klaus, recorded a recipe for a drink he called Mum to treat Skirvy. It also included Skirvy Grass. Again, these treatments were swept aside in favor of the widespread humeral system of medicine, which included treatments such as vinegar or substances that caused vomiting and diarrhea. Dr.
James Lind was a Scottish physician who served as a naval surgeon on the British ship the HMS Salisbury in 1747. When Skirvy plagued the ship, Lind devised an experiment, one of the world's first controlled experiments. Twelve sailors with Skirvy were divided into six pairs of two. All the men ate the same food and lived in the same quarters on the ship.
The only difference was their medical treatment. Lind gave each pair daily doses of one of six supposed cures for Skirvy. These cures included a quart of hard cider, 25 drops of vitriol, two spoonfuls of vinegar, a half pint of seawater, two oranges and a lemon, and electuary, which is a sort of paste, made of garlic, mustard seed, balsam of Peru, dried radish root, and gum, mer. With the exception of the citrus fruit, which ran out in less than a week, Lind administered the treatments for 14 days.
Lind's experiment showed that the men who were given citrus fruits, even though only for a short time, recovered so thoroughly and rapidly that they helped Lind care for the other sailors in the experiment. Lind is often given historical credit for recognizing citrus as a definitive cure for Skirvy, despite not recognizing the significance of his results. Lind's discovery was largely ignored during his lifetime because of the popularity of other prevailing theories of the time. James Cook, English navigator and explorer, is usually considered the first to put the citrus treatment into practice.
He insisted on cleanliness and ventilation in crew quarters, and a nutritional diet that included crass, sauerkraut, which is very high in vitamin C, and a sort of orange extract. Not one life was lost to the condition during his circumnavigation of the world from 1768 to 1771. Despite his success, politics of the time buried the use of citrus fruits to treat Skirvy. Sir John Pringle, president of the Royal Society of London, insisted that a concoction of wort and malt was the only treatment for Skirvy.
Throughout this period, sailors and naval surgeons were increasingly convinced that citrus fruits could cure Skirvy, but the physicians, who determined medical policy, dismissed this evidence as merely anecdotal. William Stark, an English physician, investigated Skirvy by experimenting on himself in June of 1769. He put together 24 restrictive dietary experiments and started with a basic diet of bread and water with a little sugar and ate only this for 31 days. He slowly added various foods to the diet one at a time, olive oil, milk, roast goose, boiled beef, fat, figs and veal.
After two months, his gums were red and swollen, a telltale sign of Skirvy. He died after eight months of experimenting during a diet of exclusively honey puddings and Cheshire cheese. Despite this, autopsy findings suggest that he died from a rare type of tumor. From the 1780s, Skirvy research was colored by the new nervous theories of disease.
Distinguished Edinburgh professor William Cullen believed that Skirvy was caused by a nervous system disorder, brought about by external agents such as weather or indigestible diet, or by personal dispositions and habits such as a lack of exercise or sleep, cold, sorrow and melancholia. Thomas Trotter, physician to the channel fleet in 1794, proposed that Skirvy was caused by a lack of fresh vegetables, with the juices of lemons and limes being particularly effective in treating it. While he was right about the fruit and vegetables, the mechanism he proposed was wrong. He argued that citrus fruits and fresh vegetables were rich in vital air, which protected ships' crews from Skirvy.
This sort of ties back into the miasma theory of disease. However, in 1786 when he published his findings, preserving fresh food on long voyages was still an issue, which prevented the British Royal Navy from instituting any changes to its sailor's diets. Naval physician Gilbert Blaine believed juices worked to treat Skirvy because they stimulated the body. He believed they provided what he called refreshment rather than nourishment.
Again, while this mechanism is wrong, Blaine was enthusiastic about citrus fruit and played a crucial role in securing the standard issue of citrus juices to naval vessels in 1795. Skirvy was effectively treated at sea without the knowledge of what had caused it. Blaine's insistence is likely what allowed Great Britain to successfully defend against an invasion led by Napoleon. The British created a blockade of the English Channel, which required many ships to stay on the water without coming to port for months at a time.
That blockade stayed in place for 20 years. This would have been impossible if Skirvy had continued to be a problem. Skirvy did continue to plague humans throughout the Crimean War, the American Civil War, and the Gold Rush. It began to affect infants in the 1870s due to the rise of bottle-feeding babies, either with heat-sterilized milk or condensed milk, both of which contain no vitamin C.
I'm going to dive into the discovery of vitamin C, as well as some horrific stories of Skirvy suffered by explorers. But first, an ad must play. If you find these ads annoying, you can get ad-free episodes by becoming a patron at the lowest tier, $2 a month, by going to Bitly slash Morbid Patron, that's B-I-T dot-L-Y slash Morbid Patron. There were many studies surrounding the cause of Skirvy in the 19th and 20th centuries.
The most important of these was that of Norwegian researchers Axel Holst and Theodore Frolic in 1907. During dietary experiments on guinea pigs, who also don't produce their own vitamin C, it was discovered that a lack of fresh vegetables and fruit led to symptoms similar to Skirvy and eventually death. It was clear that there was a specific component that had affected their health. In 1930, Hungarian scientist Albert Zent Giorgi conducted an experiment similar to the Norwegian scientists.
He and J. L. Sirebelli fed half of their guinea pigs a diet of boiled food, which destroys vitamin C, and the other half received food enriched with what was then known as hexeronic acid, but now known as as ascorbic acid, or vitamin C. The experiment confirmed their hypothesis that the acid was the missing component which caused Skirvy.
In 1932, Zent Giorgi isolated the active compound, which was later named ascorbic acid. In 1933, Swiss and English teams led by Taddeus Reichstein and Sir Walter Norman Howarth deciphered the molecular structure of ascorbic acid. Both were awarded Nobel prizes in 1937, and Reichstein devised a method for synthesizing ascorbic acid commercially. Human controlled dietary studies were conducted on conscientious objectors during World War II in Britain, and in the United States on Iowa State prisoner volunteers in the late 1960s.
These studies determined that all obvious symptoms of Skirvy could be completely reversed by additional vitamin C supplementation of only 10 milligrams per day. It was also determined that the first signs of Skirvy begin to occur about four weeks after starting a vitamin C free diet. Today, Skirvy continues to occur in at-risk groups such as children and youths with limited food repertoire and high-frequency single food intake, usually those with autism spectrum disorder or feeding problems. It's also associated with alcohol use disorder, gastrointestinal or malabsorption disorders, and neuropsychiatric disorders.
Treatment of Skirvy involves vitamin C supplements, and improvement of symptoms often begins after a few days with complete recovery in a few weeks. So many more lives would have been saved if the knowledge of citrus fruits hadn't been forgotten over and over again throughout history. Here are a few more stories of both disasters and recoveries involving Skirvy throughout history. As I mentioned, Vasco Di Gama was one of the first to document the curative effects of citrus fruit on his Skirvy-ridden crew.
During his search for a sea route to India, which began in 1497, of 170 men in his crew, only 55 returned. He made it to India, but on his way back, the journey was slowed by monsoon winds, taking 90 days instead of 23. When they arrived in Melindy, Kenya in 1499, over half the crew had died, and the rest were stricken with Skirvy. The people of Melindy gave them oranges and lemons, which seemed to miraculously cure all their symptoms.
About 20 years later, in 1519, Ferdinand Magellan and his crew of 270 spread over five ships, set sail to circumnavigate the globe with two years of supplies. Based on the incomplete understanding of world geography at the time, Magellan expected a short journey to Asia, perhaps taking as little as three to four days. The much longer journey exhausted their supply of food and water, and despite making many stops along the way, Skirvy plagued the voyage. Of a 270 men who left with the expedition, only 18 or 19 survivors returned, many of the deaths had been due to Skirvy.
In 1535, the French explorer Jacques Cartier and his crew became locked in the ice of the St. Charles River off the coast of Newfoundland in Canada. Skirvy soon broke out amongst the crew. When an Iroquois chief visited Cartier's fort, he told Cartier how to make a tea from the leaves and bark of a tree known as aneda, which is likely the white cedar or perhaps a balsam fir tree.
As the leaves are rich in vitamin C, the tea quickly relieved the crew of their Skirvy, allowing 85 of them to survive the Canadian winter. During the 18th century, Skirvy killed more British sailors than wartime enemy action. George Anson lost nearly two-thirds of his crew, about 1,300 out of 2,000 men, to Skirvy within the first ten months of his celebrated voyage around the world in 1740. The Royal Navy enlisted 184,899 sailors during the Seven Years' War.
A majority of the 133,708 reported missing or dead due to disease were due to Skirvy. Polar explorers also had a tough time with Skirvy. The British Arctic Expedition of 1875 and 1876, led by Sir George Nairs, was an attempt to reach the North Pole via the Smith Sound on the west coast of Greenland. Two ships, the HMS Alert and HMS Discovery, set sail from Portsmouth on 29 May 1875.
The Expedition was a near-disaster due to a lack of warm clothing and Skirvy. Nairs eventually retreated southward in the summer of 1876, upon returning to Britain, both Nairs and the Admiralty faced criticism, both for retreating and for the outbreak of Skirvy. The Belgian Antarctic Expedition of 1897-1899 was the first expedition to winter in the Antarctic region. Led by Adrian de Herlach de Gomry aboard the RV Belgica, the crew included Frederick Cook and rolled Amundsen, explorers who would later attempt the respective conquests of the North and South Poles.
Hairlach's expedition became trapped in the ice of the Bellingshausen Sea, near Peter I Island. It's likely that Hairlach intentionally sailed deep into the pack ice in order to freeze his vessel into the ice for the winter. The expedition was poorly equipped, they didn't have enough winter clothing, and there was a shortage of food, and what there was lacked in variety. Penguins and seals were hunted, and their meat soared before the onset of winter, which was wise as the winter left the region devoid of wildlife.
However, Hairlach disliked the penguin and seal meat, and initially tried to ban its consumption. Signs of Skirvy began to show in some of the men, and near the middle of winter several men reportedly lost their sanity, including one Belgian sailor who left the ship, quote, announcing that he was going back to Belgium, end quote. At this point, Cook and Amundsen took command as Hairlach was debilitated by Skirvy. Cook believed that raw meat was a possible cure for Skirvy due to his previous Arctic experiences.
He insisted that everyone eat the frozen penguin and seal meat. Slowly, the men recovered their health. It is now known that raw meat and organs contain a small amount of Vitamin C. The expedition eventually made it back to Antwerp on the 5th of November 1899.
This pattern of fresh meat preventing Skirvy became a common experience in polar exploration. It seemed to contradict the understanding of Skirvy as a deficiency in fresh vegetables and fruit. This is a good example of how the fact that Vitamin C can be found in a variety of foods made it hard to identify as the necessary nutrient that prevented Skirvy. Skirvy is not the only Vitamin deficiency disease recognized by physicians of the past and today.
Berryberry is a chronic deficiency of thymine, or Vitamin B1. This disease can take two forms, wet and dry. Wetberryberry affects the cardiovascular system, causing fast heart rate, shortness of breath, and swollen legs. Dryberryberry affects the nervous system, causing confusion, pain, and numbness in the hands and feet.
Both forms cause emotional disturbances, weakness, emaciation, and impaired sensory perception. In the U.S., thymine is often added to foods such as cereal to prevent deficiency. Caratomylicia is an eye disorder caused by a Vitamin A deficiency. Vitamin A is essential to maintaining the special skin cells of the cornea and the conjunctiva of the eyes.
Without Vitamin A, these tissues begin to atrophy, resulting in an opaque cornea. This is one of the most common causes of blindness in the world. A deficiency in Vitamin D can cause rickets in children and osteomylicia in adults. Signs and symptoms include body pains, muscle weakness, and fragile, pliable bones, particularly in children.
In skeletal remains, if the leg bones bow outward, it's likely the person suffered rickets in early life. This occurs because the weight of the body pushed down on the pliable bones and caused them to bend. This can happen in the legs and the spine. The bones do not regain their original shape after being deformed by rickets, even with additional Vitamin D.
Pelagra is caused by a lack of niacin, which is also called Vitamin B3. Symptoms include inflamed skin, peeling scaly skin on the hands and neck, hair loss, weakness, sores in the mouth, confusion, aggression, diarrhea, and eventually dementia. Niacin is often added to foods in the US to prevent deficiency. There are also several mineral deficiency diseases.
A goiter is a large swelling in the neck due to many issues, including an iodine deficiency, which causes an enlarged thyroid gland. The enlargement of the thyroid causes hypothyroidism, an endocrine disorder, where the thyroid doesn't produce enough thyroid hormones. This causes extreme fatigue, sensitivity to cold, muscle aches, depression, and weight gain. The swelling can be reversed with iodine supplements, but if left untreated for five years or so, the swelling becomes permanent.
In the US, we use iodized salt, which is salt processed with iodine, to avoid goiter. Iron deficiency anemia is the most well-known mineral deficiency disorder. It's caused by blood loss, as well as a low-iron diet. The slow onset of symptoms are vague, such as feeling tired, weak, short of breath, and having decreased physical abilities.
Chronic symptoms include tongue infections, spoon-shaped nails, darkening of the skin around the eyes, poor appetite, and chest pains. As vitamin C is a large part of iron absorption, scurvy can also lead to anemia. Scurvy has tormented humankind for centuries, responsible for the loss of millions of lives over the course of history, both on land and at sea. While simple to cure, the treatment remained as elusive as the cause.
The human body is a complicated web of interactions between internal and external compounds. Disruption of one compound can have systematic consequences, so make sure you eat a variety of foods and keep tending to your spark of curiosity. The Morbid Curiosity Podcast is produced by H. Lloyd.
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