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A review by charles__
Scurvy: How a Surgeon, a Mariner, and a Gentlemen Solved the Greatest Medical Mystery of the Age of Sail by Stephen R. Bown
2.0
The social, political and economic effects of curing the Vitamin C deficiency disease Scurvy during the Age of Sail.
Idealized picture of man-of-war, “cockpit” (sick bay) and scurvy palliative care
My dead tree version was a modest 254-pages. It had a 2003 US copyright.
Steven R. Brown is a Canadian author of non-fiction. He’s written more than ten books. This is the first book I’ve read by the author.
Note that some familiarity with maritime history, particularly the Royal Navy during of the Age of Sail, and with sailing ships of the period would be helpful, but was not completely necessary.
TL:DR Synopsis
This book was a somewhat patchy description of the mainly British efforts to cure the disease Scurvy during The Age of Sail (1571 - 1862) with the available medical knowledge and technology. The military, diplomatic and economic effects of the disease were described. The effect of British societal values on arriving at a cure were also covered. The book ends in 1795 when preventative nutritional changes were made to Royal Navy sailor's diets. These changes eventually spread to the merchant marine and then other countries.
The Review
The book includes: maps, pictures, two appendices, a bibliography and an index. The maps and pictures were well chosen. The bibliography contained solid English-language maritime history references. The book's prose was generally clear and concise. Although, I found it to be somewhat repetitive and containing a lot of extraneous material.
The author hangs the narrative on three (3), British notables of the period: James Lind (1716 – 1794) Naval surgeon and physician, Captain James Cook (1728 – 1779) Explorer, and Sir Gilbert Blane (1749 – 1834) Physician. I found the selection of these characters to be peculiar, particularly Lind and Cook. Only particular sections of their careers related to the disease were needed. Unfortunately, the reader was ‘treated’ to mini-biographies. In addition, I found the book to be: weak on the modern, scientific, nature of the disease; strong on the early theories of medicine and their failings; good on the organizational behavior of the British Royal Navy for the period; good on the operation of British society on the period; and overly involved in the maritime events of the period. For example, I didn’t find a blow-by-blow of Nelson’s battle of Trafalgar was needed to seal one of the author’s points.
For centuries during the Age of Sail, the typical common sailor's meal was: boiled beef (or pork), biscuit and water. These staple foods were stored in wooden barrels in the ship's hold until needed. The barrel's contents: quality, age, and storage conditions could vary widely. Spoilage was a given. The stored meat rations were preserved in brine. It was rinsed and boiled in less salty seawater until eatable for serving. The 'biscuit' was the bread ration. It was a large, hard baked, cracker very similar to a modern dog biscuit. It was made more for long-term storage than taste. Water was from natural sources, unfiltered or boiled before stored. During a long voyage of months or years these stored food and drink could reach a state of scarcely being eatable or drinkable. Meal portions of this monotonous diet were calorically sufficient for hard, physical labor, but nutritionally deficient by any modern standard.
Scurvy is a deficiency disease. Human beings and a very few animals don’t produce ascorbic acid (Vitamin C) naturally. They get it from food. It’s present in varying concentrations in both and certain plants and animal organs. However, ascorbic acid from natural sources is fragile. It does not store well, it quickly degrades, and it can be destroyed by cooking. The human body also stores ascorbic acid. Depending on the circumstances it has several weeks of reserves. All human societies have overtime developed a ‘normal’ diet to contain a ‘maintenance level’ of ascorbic acid. If the reserves can’t be refreshed, humans will sicken and even die. The later stages of the disease are gruesome. Scurvy has always been present in human societies. It typically appears in the extended aftermath of disaster, and extreme situations such as war. Any situation where a ‘normal diet’ is difficult or can’t be maintained for several weeks. It was only in the early 1900’s that ascorbic acid's role in the body was understood. In addition, the synthesis of synthetic ascorbic acid was developed shortly after that. This created a: cheap, easy to use, shelf-stable, vitamin supplement, food additive to prevent the disease.
Scurvy in the book was restricted to a certain vocation and class of people. It was “The Mariner’s Disease”. During The Age of Sail ocean going vessels finally became capable enough for months long voyages and spending extended period’s at-sea for military duties like blockades. During the early and mid-years of the period there were only, primitive food preservation techniques, and no understanding of ‘deficiency diseases’. The elusive and perishable nature of ascorbic acid made scurvy endemic in merchant and naval sailor populations. In general, those centuries: food technology, old ways of thought, and traditions resulted on in hundreds of thousands of maritime deaths from scurvy. To a greater or lesser extent history was affected by these deaths. However, I doubt to the extent to which the author describes.
My largest take-aways from the story were that the medical profession with the available science and technology could not deal with a ‘deficiency disease’. The other was, that the neglect built-into the British class-system of the Royal Navy caused hundreds of thousands of needless deaths in the effected 'lower' class.
During the Age of Sail, the medical profession was still paying heed to texts from the Greek and Roman eras. The ‘Scientific Method’ had only a weak influence on medical practitioners. Aegrescit medendo, (The remedy (cure) is worse than the disease) was also the case. In addition, modern concepts like ‘preventative medicine’ and ‘deficiency diseases’ did not exist. They were not part of the model with which physicians were trained to diagnose and cure diseases. Further confusing the matter was, scurvy was frequently mis-diagnosed for the myriad other diseases arising from harsh shipboard life. Available information on any treatment was little better than hearsay. In many cases physician ‘cults of personality’ set treatments, not all of them correct-- many of them harmful. Effective preventative (antiscorbutics) and palliative care for scurvy was ‘chanced upon’ several times, and discarded several times before it was institutionalized in the British navy and large merchant fleets. That was only possible when a predecessor generation of influential British physicians left practice and public life in the 1780’s.
The largest population effected by scurvy during the early and mid-period of the Age of Sail were the ordinary sailors of the sea faring nation states. The largest of these were: Spain, France, England and Portugal. The book's narrative mainly uses English sources, although examples from other navies were given. Navies, particularly during wartime were great consumers of seaman. Men-of-war were complicated, high maintenance weapons. Trained naval and merchant marine sailors were a scarce resource. Oddly, for almost the entire Age of Sail, particularly during wartime, naval sailors were held as human chattel. In the Royal Navy, “Our people are our most important asset”, only applied to the ‘well-born’ and particularly the wealthy, officer class. It should be noted that officers at sea, suffered from scurvy less than sailors due to: a more varied diet, less physical labor and stress, and more hygienic accommodations. Antiscorbutics that were cheap, easy to prepare, and could be stored indefinitely, like cannon balls, delayed their introduction for centuries by the Admiralty, the Royal Navy's leadership.
It was only during the Napoleonic Wars, that things changed. The Royal Navy’s war fighting capability was critically hampered due to its traditional, heavy losses to disease. The changes in naval warfare during the global, Napoleonic Wars consumed enormous amounts of sailors. Ships were at sea for longer than ever before. More sailors traditionally perished to disease than enemy action. Perversely, navies over-manned their ships to account for the attrition by disease. The naval leadership was solving the manning problem, not its cause. The unhygienic and crowded conditions of shipboard, abetted the spread of contagious diseases (unlike scurvy) causing further attrition. During the the Napoleonic Wars, sailors had finally become more expensive than the cost of: lemons, oranges and limes, the most potent antiscorbutics. The Admiralty found the political will to change centuries-old traditions and the education of surgeons (shipboard doctors) to adopt a large-scale cure to scurvy. Use of which eventually became universal on merchant and naval vessels.
As an aside, during the Napoleonic war, the arrived upon preventative measure for scurvy was to mix the antiscorbutic lemon juice sourced from the Mediterranean into the sailor’s, daily, alchohol ration (grog). This ensured they would drink it. After the war, less expensive and less effective lime juice sourced from the British West Indies was substituted. (Limes contain less Vitamin C than lemons.) Hence. British sailors being called, "Limeys".
In the Epilogue, Brown describes that it took almost another hundred years after the adoption of antiscorbutics for medical science to understand the mechanism by which they worked. Today, with better methods of food preservation, and availability of a cheap, synthetic antiscorbutic used as a prepared food additive, scurvy is now very rare.
This book was well written, but was not well organized. It went longer than it ought. The technique of hanging the narrative was on historical figures, and the lengthy descriptions of voyages of exploration and naval battles strayed very far from the subject of The Conquest of Disease. This modest volume could have been half its length with strict editing. I was disappointed that the great majority of sources for the book was mainly the Royal Navy. I'm sure there was a lot of non-English material on the subject that could have contributed to a better narrative. The story would also have been better concentrating on: the period’s physicians medical dogma leaving them unprepared to treat a disease arising from a crucial change in worldwide transportation and trade, and the British Admiralty’s, class and false economies-based lack of regard for a minority crucial to their warfighting mission squandered thousands of lives and at times threatened The Empire. Still, the book wasn’t that long, and it did appeal to my interest in: military history, maritime history, and epidemiological history.
If you’re interested in a similarly themed book, I recommend, Guns, Germs, and Steel: The Fates of Human Societies
(1997).
Idealized picture of man-of-war, “cockpit” (sick bay) and scurvy palliative care
My dead tree version was a modest 254-pages. It had a 2003 US copyright.
Steven R. Brown is a Canadian author of non-fiction. He’s written more than ten books. This is the first book I’ve read by the author.
Note that some familiarity with maritime history, particularly the Royal Navy during of the Age of Sail, and with sailing ships of the period would be helpful, but was not completely necessary.
TL:DR Synopsis
This book was a somewhat patchy description of the mainly British efforts to cure the disease Scurvy during The Age of Sail (1571 - 1862) with the available medical knowledge and technology. The military, diplomatic and economic effects of the disease were described. The effect of British societal values on arriving at a cure were also covered. The book ends in 1795 when preventative nutritional changes were made to Royal Navy sailor's diets. These changes eventually spread to the merchant marine and then other countries.
The Review
The book includes: maps, pictures, two appendices, a bibliography and an index. The maps and pictures were well chosen. The bibliography contained solid English-language maritime history references. The book's prose was generally clear and concise. Although, I found it to be somewhat repetitive and containing a lot of extraneous material.
The author hangs the narrative on three (3), British notables of the period: James Lind (1716 – 1794) Naval surgeon and physician, Captain James Cook (1728 – 1779) Explorer, and Sir Gilbert Blane (1749 – 1834) Physician. I found the selection of these characters to be peculiar, particularly Lind and Cook. Only particular sections of their careers related to the disease were needed. Unfortunately, the reader was ‘treated’ to mini-biographies. In addition, I found the book to be: weak on the modern, scientific, nature of the disease; strong on the early theories of medicine and their failings; good on the organizational behavior of the British Royal Navy for the period; good on the operation of British society on the period; and overly involved in the maritime events of the period. For example, I didn’t find a blow-by-blow of Nelson’s battle of Trafalgar was needed to seal one of the author’s points.
For centuries during the Age of Sail, the typical common sailor's meal was: boiled beef (or pork), biscuit and water. These staple foods were stored in wooden barrels in the ship's hold until needed. The barrel's contents: quality, age, and storage conditions could vary widely. Spoilage was a given. The stored meat rations were preserved in brine. It was rinsed and boiled in less salty seawater until eatable for serving. The 'biscuit' was the bread ration. It was a large, hard baked, cracker very similar to a modern dog biscuit. It was made more for long-term storage than taste. Water was from natural sources, unfiltered or boiled before stored. During a long voyage of months or years these stored food and drink could reach a state of scarcely being eatable or drinkable. Meal portions of this monotonous diet were calorically sufficient for hard, physical labor, but nutritionally deficient by any modern standard.
Scurvy is a deficiency disease. Human beings and a very few animals don’t produce ascorbic acid (Vitamin C) naturally. They get it from food. It’s present in varying concentrations in both and certain plants and animal organs. However, ascorbic acid from natural sources is fragile. It does not store well, it quickly degrades, and it can be destroyed by cooking. The human body also stores ascorbic acid. Depending on the circumstances it has several weeks of reserves. All human societies have overtime developed a ‘normal’ diet to contain a ‘maintenance level’ of ascorbic acid. If the reserves can’t be refreshed, humans will sicken and even die. The later stages of the disease are gruesome. Scurvy has always been present in human societies. It typically appears in the extended aftermath of disaster, and extreme situations such as war. Any situation where a ‘normal diet’ is difficult or can’t be maintained for several weeks. It was only in the early 1900’s that ascorbic acid's role in the body was understood. In addition, the synthesis of synthetic ascorbic acid was developed shortly after that. This created a: cheap, easy to use, shelf-stable, vitamin supplement, food additive to prevent the disease.
Scurvy in the book was restricted to a certain vocation and class of people. It was “The Mariner’s Disease”. During The Age of Sail ocean going vessels finally became capable enough for months long voyages and spending extended period’s at-sea for military duties like blockades. During the early and mid-years of the period there were only, primitive food preservation techniques, and no understanding of ‘deficiency diseases’. The elusive and perishable nature of ascorbic acid made scurvy endemic in merchant and naval sailor populations. In general, those centuries: food technology, old ways of thought, and traditions resulted on in hundreds of thousands of maritime deaths from scurvy. To a greater or lesser extent history was affected by these deaths. However, I doubt to the extent to which the author describes.
My largest take-aways from the story were that the medical profession with the available science and technology could not deal with a ‘deficiency disease’. The other was, that the neglect built-into the British class-system of the Royal Navy caused hundreds of thousands of needless deaths in the effected 'lower' class.
During the Age of Sail, the medical profession was still paying heed to texts from the Greek and Roman eras. The ‘Scientific Method’ had only a weak influence on medical practitioners. Aegrescit medendo, (The remedy (cure) is worse than the disease) was also the case. In addition, modern concepts like ‘preventative medicine’ and ‘deficiency diseases’ did not exist. They were not part of the model with which physicians were trained to diagnose and cure diseases. Further confusing the matter was, scurvy was frequently mis-diagnosed for the myriad other diseases arising from harsh shipboard life. Available information on any treatment was little better than hearsay. In many cases physician ‘cults of personality’ set treatments, not all of them correct-- many of them harmful. Effective preventative (antiscorbutics) and palliative care for scurvy was ‘chanced upon’ several times, and discarded several times before it was institutionalized in the British navy and large merchant fleets. That was only possible when a predecessor generation of influential British physicians left practice and public life in the 1780’s.
The largest population effected by scurvy during the early and mid-period of the Age of Sail were the ordinary sailors of the sea faring nation states. The largest of these were: Spain, France, England and Portugal. The book's narrative mainly uses English sources, although examples from other navies were given. Navies, particularly during wartime were great consumers of seaman. Men-of-war were complicated, high maintenance weapons. Trained naval and merchant marine sailors were a scarce resource. Oddly, for almost the entire Age of Sail, particularly during wartime, naval sailors were held as human chattel. In the Royal Navy, “Our people are our most important asset”, only applied to the ‘well-born’ and particularly the wealthy, officer class. It should be noted that officers at sea, suffered from scurvy less than sailors due to: a more varied diet, less physical labor and stress, and more hygienic accommodations. Antiscorbutics that were cheap, easy to prepare, and could be stored indefinitely, like cannon balls, delayed their introduction for centuries by the Admiralty, the Royal Navy's leadership.
It was only during the Napoleonic Wars, that things changed. The Royal Navy’s war fighting capability was critically hampered due to its traditional, heavy losses to disease. The changes in naval warfare during the global, Napoleonic Wars consumed enormous amounts of sailors. Ships were at sea for longer than ever before. More sailors traditionally perished to disease than enemy action. Perversely, navies over-manned their ships to account for the attrition by disease. The naval leadership was solving the manning problem, not its cause. The unhygienic and crowded conditions of shipboard, abetted the spread of contagious diseases (unlike scurvy) causing further attrition. During the the Napoleonic Wars, sailors had finally become more expensive than the cost of: lemons, oranges and limes, the most potent antiscorbutics. The Admiralty found the political will to change centuries-old traditions and the education of surgeons (shipboard doctors) to adopt a large-scale cure to scurvy. Use of which eventually became universal on merchant and naval vessels.
As an aside, during the Napoleonic war, the arrived upon preventative measure for scurvy was to mix the antiscorbutic lemon juice sourced from the Mediterranean into the sailor’s, daily, alchohol ration (grog). This ensured they would drink it. After the war, less expensive and less effective lime juice sourced from the British West Indies was substituted. (Limes contain less Vitamin C than lemons.) Hence. British sailors being called, "Limeys".
In the Epilogue, Brown describes that it took almost another hundred years after the adoption of antiscorbutics for medical science to understand the mechanism by which they worked. Today, with better methods of food preservation, and availability of a cheap, synthetic antiscorbutic used as a prepared food additive, scurvy is now very rare.
This book was well written, but was not well organized. It went longer than it ought. The technique of hanging the narrative was on historical figures, and the lengthy descriptions of voyages of exploration and naval battles strayed very far from the subject of The Conquest of Disease. This modest volume could have been half its length with strict editing. I was disappointed that the great majority of sources for the book was mainly the Royal Navy. I'm sure there was a lot of non-English material on the subject that could have contributed to a better narrative. The story would also have been better concentrating on: the period’s physicians medical dogma leaving them unprepared to treat a disease arising from a crucial change in worldwide transportation and trade, and the British Admiralty’s, class and false economies-based lack of regard for a minority crucial to their warfighting mission squandered thousands of lives and at times threatened The Empire. Still, the book wasn’t that long, and it did appeal to my interest in: military history, maritime history, and epidemiological history.
If you’re interested in a similarly themed book, I recommend, Guns, Germs, and Steel: The Fates of Human Societies
(1997).