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{{Short description|Disease resulting from a lack of vitamin C}}
{{Infobox medical condition
| name
| image
| caption = Scorbutic gums, a symptom of scurvy. The [[interdental papilla|triangle-shaped areas]] between the teeth show redness of the gums.
| synonyms = Moeller's disease, Cheadle's disease, scorbutus,<ref name=GARD2016/> Barlow's disease, hypoascorbemia,<ref name=GARD2016/> vitamin C deficiency, hypovitaminosis C
| field = [[Endocrinology]]
| symptoms =
Weakness, feeling tired, changes to hair, sore arms and legs, gum disease, easy bleeding<ref name=GARD2016/><ref name=Ag2015/>
| complications =
| onset =
| duration =
| causes = Lack of [[vitamin C]]<ref name=GARD2016/>
| risks = [[Mental disorder]]s, unusual eating habits, [[alcohol use disorder]], [[substance use disorder]], [[intestinal malabsorption]], [[Kidney dialysis|dialysis]],<ref name=Ag2015/> [[Age of sail|voyages at sea]] (historic), [[castaway|being stuck adrift]]
| diagnosis = Based on symptoms<ref name=Ag2015/>
| differential =
| prevention =
| treatment = Vitamin C supplements,<ref name=GARD2016/> diet that contains [[fruit]] and [[vegetables]] (notably [[citrus]])
| medication =
| prognosis =
| frequency = Rare (contemporary)<ref name=Ag2015/>
| deaths =
}}
<!-- Definition and symptoms -->
'''Scurvy''' is a [[deficiency disease]] (state of malnutrition) resulting from a lack of [[vitamin C]] (ascorbic acid).<ref name=GARD2016>{{cite web|title=Scurvy|url=https://rarediseases.info.nih.gov/diseases/10406/scurvy|website=GARD|access-date=26 September 2016|date=1 September 2016|url-status=dead|archive-url=https://web.archive.org/web/20170126020402/https://rarediseases.info.nih.gov/diseases/10406/scurvy|archive-date=26 January 2017}}</ref> Early symptoms of deficiency include weakness, fatigue, and sore arms and legs.<ref name=GARD2016/><ref name=Ag2015/> Without treatment, [[anemia|decreased red blood cells]], gum disease, changes to hair, and bleeding from the skin may occur.<ref name=GARD2016/><ref>{{cite web|title=Vitamin C|url=https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/|website=Office of Dietary Supplements|access-date=18 July 2017|language=en|date=11 February 2016|url-status=live|archive-url=https://web.archive.org/web/20170730052126/https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/|archive-date=30 July 2017}}</ref> As scurvy worsens, there can be poor [[wound]] healing, personality changes, and finally death from infection or bleeding.<ref name=Ag2015/>
<!-- Cause, mechanism, and diagnosis-->
It takes at least a month of little to no vitamin C in the diet before symptoms occur.<ref name=GARD2016/><ref name=Ag2015/> In modern times, scurvy occurs most commonly in [[Child neglect|neglected children]], people with [[mental disorder]]s, unusual eating habits, [[alcoholism]], and older people who live alone.<ref name=Ag2015/> Other risk factors include [[intestinal malabsorption]] and [[Kidney dialysis|dialysis]].<ref name=Ag2015/>
While many animals produce their vitamin C, humans and a few others do not.<ref name="Ag2015" /> Vitamin C, an [[antioxidant]], is required to make the building blocks for [[collagen]], [[carnitine]], and [[catecholamine]]s, and assists the intestines in the absorption of iron from foods.<ref name="Ag2015" /><ref>{{Cite book |last=Coffee |first=Carole J. |title=Quick Look: Metabolism |publisher=Hayes Barton |year=1999 |isbn=1-59377-192-4 |pages=26}}</ref><ref name=":0">{{Cite web |date=2014-04-22 |title=Vitamin C |url=https://lpi.oregonstate.edu/mic/vitamins/vitamin-C |access-date=2023-06-04 |website=Linus Pauling Institute |language=en |archive-date=2018-09-16 |archive-url=https://web.archive.org/web/20180916084650/https://lpi.oregonstate.edu/mic/vitamins/vitamin-C |url-status=live }}</ref> Diagnosis is typically based on outward appearance, [[X-rays]], and improvement after treatment.<ref name="Ag2015" />
<!-- Treatment -->
Treatment is with vitamin C supplements taken by mouth.<ref name=GARD2016/> Improvement often begins in a few days with complete recovery in a few weeks.<ref name=Ag2015/> Sources of [[Vitamin C#Sources|vitamin C in the diet]] include raw [[citrus fruit]] and several raw vegetables, including red peppers, broccoli, and tomatoes.<ref name=Ag2015/> Cooking often decreases the residual amount of vitamin C in foods.<ref name=Ag2015>{{cite journal|last1=Agarwal|first1=A|last2=Shaharyar|first2=A|last3=Kumar|first3=A|last4=Bhat|first4=MS|last5=Mishra|first5=M|title=Scurvy in pediatric age group - A disease often forgotten?|journal=Journal of Clinical Orthopaedics and Trauma|date=June 2015|volume=6|issue=2|pages=101–7|pmid=25983516|doi=10.1016/j.jcot.2014.12.003|pmc=4411344}}</ref>
<!-- Epidemiology -->
Scurvy is rare compared to other nutritional deficiencies.<ref name=Ag2015/> It occurs more often in the [[developing world]] in association with [[malnutrition]].<ref name=Ag2015/> Rates among [[refugees]] are reported at 5 to 45 percent.<ref>{{cite book|last1=Renzaho|first1=Andre M. N.|title=Globalisation, Migration and Health: Challenges and Opportunities|date=2016|publisher=World Scientific|isbn=978-1-78326-889-4|page=94|url=https://books.google.com/books?id=GrHACwAAQBAJ&pg=PA94|language=en|url-status=live|archive-url=https://web.archive.org/web/20170908182320/https://books.google.com/books?id=GrHACwAAQBAJ&pg=PA94|archive-date=8 September 2017}}</ref> Scurvy was described as early as the time of [[ancient Egypt]], and historically it was a limiting factor in long-distance sea travel, often killing large numbers of people.<ref name=Ag2015/><ref>{{cite book|last1=Toler|first1=Pamela D.|title=Mankind: The Story of All of Us|date=2012|publisher=Running Press|isbn=978-0762447176|page=296|url=https://books.google.com/books?id=aQfhYL_MT54C&pg=PA296|language=en|url-status=live|archive-url=https://web.archive.org/web/20170908182325/https://books.google.com/books?id=aQfhYL_MT54C&pg=PA296|archive-date=8 September 2017}}</ref> During the [[Age of Sail]], it was assumed that 50 percent of the sailors would die of scurvy on a major trip.<ref name="Distillations">{{cite magazine |last1=Price |first1=Catherine |title=The Age of Scurvy |magazine=Distillations |date=2017 |volume=3 |issue=2 |pages=12–23 |url=https://www.sciencehistory.org/distillations/magazine/the-age-of-scurvy |access-date=April 17, 2018 |archive-date=January 24, 2021 |archive-url=https://web.archive.org/web/20210124064127/https://www.sciencehistory.org/distillations/magazine/the-age-of-scurvy |url-status=live }}</ref> In long sea voyages, crews were isolated from land for extended periods and these voyages relied on large staples of a limited variety of foods and the lack of fruit, vegetables, and other foods containing vitamin C in diets of sailors resulted in scurvy.<ref name="Myers">{{Cite book |last=Myers |first=Richard L. |url=https://books.google.com/books?id=0AnJU-hralEC |title=The 100 Most Important Chemical Compounds: A Reference Guide |date=2007 |publisher=ABC-CLIO |isbn=978-0-313-33758-1 |pages=30–32 |access-date=21 November 2015 |archive-date=17 June 2016 |archive-url=https://web.archive.org/web/20160617093705/https://books.google.com/books?id=0AnJU-hralEC |url-status=live }}</ref>
== Signs and symptoms ==
Early symptoms are [[malaise]] and [[lethargy]]. After one to three months, patients develop shortness of breath and [[bone pain]]. [[Myalgia]]s may occur because of reduced [[carnitine]] production. Other symptoms include skin changes with roughness, easy bruising, and [[petechia]]e, [[gum disease]], loosening of teeth, poor wound healing, and emotional changes (which may appear before any physical changes). Dry mouth and dry eyes similar to [[Sjögren's syndrome]] may occur. In the late stages, [[jaundice]], generalised [[edema]], [[oliguria]], [[neuropathy]], fever, convulsions, and eventual death are frequently seen.<ref>{{cite journal |author=Lynne Goebel, MD |title=Scurvy Clinical Presentation |journal=Medscape Reference |url=http://emedicine.medscape.com/article/125350-clinical |url-status=live |archive-url=https://web.archive.org/web/20110623070318/http://emedicine.medscape.com/article/125350-clinical |archive-date=23 June 2011 }}</ref>
<gallery mode="packed" heights="200px">
File:Scorbutic tongue (cropped).jpg|A [[Child neglect|neglected child]] presenting a "scorbutic tongue" due to [[vitamin C]] deficiency
File:ASM-30-325-g001.jpg|A child patient with scurvy in flexion posture
File:ASM-30-325-g002.jpg|Photo of the chest cage with scorbutic rosaries
</gallery>
== Cause ==
Scurvy, including subclinical scurvy, is caused by a deficiency of dietary vitamin C since the human liver is unable to synthesize vitamin C. Provided the diet contains sufficient vitamin C, the lack of working [[L-gulonolactone oxidase]] (GULO) enzyme has no significance. In modern Western societies, scurvy is seldom present in average adults, although underfed people (drug users, the homeless, [[Child neglect|neglected children]] and geriatrics) are affected.<ref>{{cite journal |vauthors=Hampl JS, Taylor CA, Johnston CS |title=Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994 |journal=American Journal of Public Health |volume=94 |issue=5 |pages=870–5 |year=2004 |pmid=15117714 |pmc=1448351 |doi= 10.2105/AJPH.94.5.870}}</ref> Virtually all commercially available baby formulas contain added vitamin C, preventing infantile scurvy. Human [[breast milk]] contains sufficient vitamin C if the mother has an adequate intake. Commercial milk is [[pasteurization|pasteurized]], a heating process that destroys the natural vitamin C content of the milk.<ref name="Distillations"/>
Scurvy is one of the accompanying diseases of [[malnutrition]] (other such micronutrient deficiencies are [[beriberi]] and [[pellagra]]) and thus is still widespread in areas of the world dependent on external food aid.<ref>{{cite report | id=MIP/01/APR.SDE.3 | series= Meeting of Interested Parties: Geneva, 18 to 29 June 2001 |title=Area of work: nutrition. Progress report 2000 |url=https://www.who.int//mipfiles/2299/MIP_01_APR_SDE_3.en.pdf |date=4 June 2001 |publisher=[[World Health Organization]] |url-status=dead |archive-url=https://web.archive.org/web/20061216095355/http://www.who.int//mipfiles/2299/MIP_01_APR_SDE_3.en.pdf |archive-date=16 December 2006 }}</ref> Although rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.<ref>{{multiref2|{{cite journal |vauthors=Davies IJ, Temperley JM | title= A case of scurvy in a student | journal = Postgraduate Medical Journal | year= 1967 |volume = 43 | issue = 502 | pages = 549–50|pmid= 6074157 | pmc=2466190 | doi=10.1136/pgmj.43.502.539 }}|{{cite journal |vauthors=Sthoeger ZM, Sthoeger D |title=[Scurvy from self-imposed diet] |language=he |journal=Harefuah |volume=120 |issue=6 |pages=332–3 |year=1991 |pmid=1879769 }}|{{cite journal |vauthors=Ellis CN, Vanderveen EE, Rasmussen JE |title=Scurvy. A case caused by peculiar dietary habits |journal=Archives of Dermatology |volume=120 |issue=9 |pages=1212–4 |year=1984 |pmid=6476860 |doi= 10.1001/archderm.120.9.1212}}|{{cite journal |vauthors=McKenna KE, Dawson JF |title=Scurvy occurring in a teenager |journal=Clinical and Experimental Dermatology |volume=18 |issue=1 |pages=75–7 |year=1993 |pmid=8440062 |doi= 10.1111/j.1365-2230.1993.tb00976.x|s2cid=42245389 }}}}</ref><ref name="HPM 2016-08-15">{{cite news |last=Feibel |first=Carrie |url=https://www.houstonpublicmedia.org/articles/news/2016/08/15/162200/the-return-of-scurvy-houston-neurologist-diagnoses-hundreds-of-patients-with-vitamin-deficiencies/ |title=The Return of Scurvy? Houston Neurologist Diagnoses Hundreds of Patients with Vitamin Deficiencies |work=Houston Public Media |publisher=University of Houston |date=15 August 2016 |access-date=2016-08-17 |url-status=live |archive-url=https://web.archive.org/web/20160816121128/http://www.houstonpublicmedia.org/articles/news/2016/08/15/162200/the-return-of-scurvy-houston-neurologist-diagnoses-hundreds-of-patients-with-vitamin-deficiencies/ |archive-date=16 August 2016 }}</ref>
== Pathogenesis ==
[[File:ASM-30-325-g003.jpg|thumb|X-ray of the knee joint (arrow indicates scurvy line)]]
Vitamins are essential to the production and use of enzymes in ongoing processes throughout the human body.<ref name="Distillations"/> [[Ascorbic acid]] is needed for a variety of biosynthetic pathways, by accelerating [[hydroxylation]] and [[amidation]] reactions.
The early symptoms of [[malaise]] and [[lethargy]] may be due to either impaired [[fatty acid metabolism]] from a lack of carnitine and/or from a lack of catecholamines, which are needed for the [[cAMP-dependent pathway]] in both glycogen metabolism and fatty acid metabolism.<ref name=":0" /> Impairment of either fatty acid metabolism or glycogen metabolism leads to decreased [[Adenosine triphosphate|ATP]] (energy) production. ATP is needed for cellular functions, including [[Muscle contraction#Cross-bridge cycle|muscle contraction]]. ''(For low ATP within the muscle cell, see also [[Purine nucleotide cycle]].)''
In the synthesis of [[collagen]], ascorbic acid is required as a cofactor for [[prolyl hydroxylase]] and [[lysyl hydroxylase]]. These two enzymes are responsible for the hydroxylation of the [[proline]] and [[lysine]] amino acids in collagen. [[Hydroxyproline]] and [[hydroxylysine]] are important for stabilizing collagen by cross-linking the propeptides in collagen.
Collagen is a primary structural protein in the human body, necessary for healthy blood vessels, muscle, skin, bone, cartilage, and other connective tissues. Defective connective tissue leads to fragile capillaries, resulting in abnormal bleeding, bruising, and internal hemorrhaging. Collagen is an important part of bone, so bone formation is also affected. Teeth loosen, bones break more easily, and once-healed breaks may recur.<ref name="Distillations"/> Defective collagen fibrillogenesis impairs wound healing. Untreated scurvy is invariably fatal.<ref name=Naked>{{cite web|url=http://www.thenakedscientists.com/HTML/articles/article/forgotten-knowledge/|title=Forgotten Knowledge: The Science of Scurvy|date=28 November 2010|access-date=29 April 2016|url-status=live|archive-url=https://web.archive.org/web/20160510164237/http://www.thenakedscientists.com/HTML/articles/article/forgotten-knowledge/|archive-date=10 May 2016}}</ref>
==Diagnosis==
Diagnosis is typically based on physical signs, [[X-rays]], and improvement after treatment.<ref name=Ag2015/>
===Differential diagnosis===
Various childhood-onset disorders can mimic the clinical and X-ray picture of scurvy such as:
* [[Rickets]]
* [[Osteochondrodysplasias]] especially [[osteogenesis imperfecta]]
* [[Blount's disease]]
* [[Osteomyelitis]]
== Prevention ==
{| class="wikitable floatright"
|+ Foods and their Vitamin C content per 100 [[gram]]s
! scope="col" | Item
! scope="col" style="max-width:6em;" | Vitamin C contents ([[Milligrams|mg]])
|-
| [[Myrciaria dubia|Camu Camu]] || 2000.00
|-
| [[Phyllanthus emblica|Amla]] || 610.00
|-
| [[Urtica]] || 333.00
|-
| [[Guava]] || 228.30
|-
| [[Blackcurrant]] || 181.00
|-
| [[Kiwifruit]] || 161.30
|-
| [[Chili pepper]] || 144.00
|-
| [[Parsley]] || 133.00
|-
| [[kiwifruit|Green kiwifruit]] || 92.70
|-
| [[Broccoli]] || 89.20
|-
| [[Brussels sprout]] || 85.00
|-
| [[Bell pepper]] || 80.40
|-
| [[Papaya]] || 62.00
|-
| [[Strawberry]] || 58.80
|-
| [[Orange (fruit)|Orange]] || 53.20
|-
| [[Lemon]] || 53.00
|-
| [[Cabbage]] || 36.60
|-
| [[Spinach]] || 28.00
|-
| [[Turnip]] || 27.40
|-
| [[Potato]] || 19.70
|}
Scurvy can be prevented by a diet that includes uncooked [[Vitamin C#Sources|vitamin C-rich foods]] such as [[Phyllanthus emblica|amla]], [[bell pepper]]s (sweet peppers), [[blackcurrant]]s, [[broccoli]], [[chili peppers]], [[citrus]] fruits (lemon, lime, orange, etc), [[kiwifruit]], and [[parsley]]. Other sources rich in vitamin C are [[dandelion]], raw liver (23.6 mg/100 grams), [[sauerkraut]], and many fruits such as [[guava]], [[papaya]], [[Strawberry|strawberries]], and [[tomato]]. It is also found in vegetables, such as [[brussels sprout]]s, [[cabbage]], [[potato]]es, and [[spinach]]. Some fruits and vegetables not high in vitamin C may be [[Pickling|pickled]] in [[lemon juice]], which is high in vitamin C. Nutritional supplements that provide ascorbic acid well above what is required to prevent scurvy may cause adverse health effects.<ref>{{cite journal |author=Rivers, JM |title=Safety of high-level vitamin C ingestion |journal=Annals of the New York Academy of Sciences |volume=498 |issue= 1 Third Confere|pages=445–54 |year=1987 |pmid=3304071 |doi=10.1111/j.1749-6632.1987.tb23780.x |bibcode=1987NYASA.498..445R |s2cid=1410094 }}</ref>
Uncooked fresh meat from animals, notably internal organs, contains enough vitamin C to prevent scurvy, and even partly treat it.<ref>{{cite journal |author=Speth, JD |year=2019 |title=Neanderthals, vitamin C, and scurvy |journal=Quaternary International |volume=500 |pages=172–184 |doi=10.1016/j.quaint.2018.11.042|bibcode=2019QuInt.500..172S |s2cid=134893835 }}</ref>
Scott's [[Discovery Expedition|1902 Antarctic expedition]] used fresh seal meat and increased allowance of bottled fruits, whereby complete recovery from incipient scurvy was reported to have taken less than two weeks.<ref>{{cite book|author=Scott, R.F.|date=1905|title=The Voyage of the Discovery|url=https://archive.org/details/voyageofdiscover001scot|___location=London|pages=[https://archive.org/details/voyageofdiscover001scot/page/541 541]–545}} ''[26 September 1902] [The expedition members] Heald, Mr. Ferrar, and Cross have very badly swollen legs, whilst Heald's are discoloured as well. The remainder of the party seem fairly well, but not above suspicion; Walker's ankles are slightly swollen. [15 October 1902] [After a fresh seal meat diet at base camp] within a fortnight of the outbreak there is scarcely a sign of it remaining [...] Heald's is the only case that hung at all [...] and now he is able to get about once more. Cross's recovery was so rapid that he was able to join the seal-killing party last week.''</ref>
==Treatment==
Scurvy will improve with doses of vitamin C as low as 10 mg per day though doses of around 100 mg per day are typically recommended.<ref>{{cite book |title=Manual of Nutritional Therapeutics |date=2008 |publisher=Lippincott Williams & Wilkins |isbn=9780781768412 |page=161 |url=https://books.google.com/books?id=b0iiYNob_WwC&pg=PA161 |language=en}}</ref> Most people make a full recovery within 2 weeks.<ref name="nhs">{{cite web|url=https://www.nhs.uk/conditions/scurvy/|title=Scurvy|website=nhs.uk|date=25 October 2017|access-date=25 June 2019|archive-date=6 July 2019|archive-url=https://web.archive.org/web/20190706110232/https://www.nhs.uk/conditions/scurvy/|url-status=live}}</ref>
== History ==
Symptoms of scurvy have been recorded in [[Ancient Egypt]] as early as 1550 [[Before Christ|BC]].<ref name="Bradley S Buckler MD, Anjali Parish MD">{{cite journal |vauthors= Bradley S, Buckler MD, Anjali Parish MD |title=Scurvy |journal=EMedicine |url= http://emedicine.medscape.com/article/985573-overview |url-status=live |archive-url= https://web.archive.org/web/20100212005800/http://emedicine.medscape.com/article/985573-overview |archive-date= 12 February 2010 |date= 2018-08-27 }}</ref> It was first reported amongst soldiers and sailors having inadequate access to fruits and vegetables which resulted in vitamin C deficiency.<ref>{{cite web |title=Scurvy: Rediscovering a Forgotten Disease |publisher=National Library of Medicine |pmc=10296835 }}</ref> In [[Ancient Greece]], the physician [[Hippocrates]] (460–370 BC) described symptoms of scurvy, specifically a "swelling and obstruction of the [[spleen]]."<ref>Hippocrates described symptoms of scurvy in book 2 of his ''Prorrheticorum'' and in his ''Liber de internis affectionibus''. (Cited by James Lind, ''A Treatise on the Scurvy'', 3rd ed. (London, England: G. Pearch and W. Woodfall, 1772), [https://archive.org/details/treatiseonscurvy1772lind/page/285 page 285] {{webarchive|url=https://web.archive.org/web/20160101135046/https://books.google.com/books?id=T1OT3tYmh5wC&pg=PA285&lpg=PA285 |date=1 January 2016}}) Symptoms of scurvy were also described by: (i) Pliny, in ''Naturalis historiae'', book 3, chapter 49; and (ii) Strabo, in ''Geographicorum'', book 16. (Cited by John Ashhurst, ed., ''The International Encyclopedia of Surgery'', vol. 1 (New York, New York: William Wood and Co., 1881), [https://books.google.com/books?id=mDV11NpZyNgC&pg=PA278 page 278] {{webarchive|url=https://web.archive.org/web/20160505051643/https://books.google.com/books?id=mDV11NpZyNgC&pg=PA278&lpg=PA278 |date=5 May 2016 }})</ref><ref>{{cite journal |last1= Stone | first1 = Irwin |title= On the genetic etiology of scurvy |journal= Acta Geneticae Medicae et Gemellologiae (Roma) |volume=15 |issue=4 |pages=345–50 |year=1966 |doi= 10.1017/s1120962300014931 |pmid=5971711 |s2cid=32103456 |url= http://www.seanet.com/~alexs/ascorbate/196x/stone-i-acta_genet_med_et_gemell-1966-v15-p345.htm |url-status=live |archive-url= https://web.archive.org/web/20080210231005/http://www.seanet.com/~alexs/ascorbate/196x/stone-i-acta_genet_med_et_gemell-1966-v15-p345.htm |archive-date= 10 February 2008 |doi-access= free}}</ref> In 406 CE, the Chinese monk [[Faxian]] wrote that [[ginger]] was carried on Chinese ships to prevent scurvy.<ref name="pickersgill">{{cite book |editor1-last= Prance |editor1-first= Ghillean |editor2-last= Nesbitt |editor2-first= Mark |last1= Pickersgill |first1= Barbara |author-link= Barbara Pickersgill |date= 2005 |title= The Cultural History of Plants |publisher= Routledge |pages= 163–164 |isbn= 0415927463}}</ref>{{failed verification|date= February 2023}}<ref>
Compare:
{{cite book
|last1 = Torck
|first1 = Mathieu
|year = 2009
|chapter = Of junks and compasses: Food Supplies of pre-modern Chinese Seamen
|title = Avoiding the Dire Straits: An Inquiry Into Food Provisions and Scurvy in the Maritime and Military History of China and Wider East Asia
|url = https://books.google.com/books?id=2Dzl-cIIjxYC
|series = Volume 5 of East Asian economic and socio-cultural studies: East Asian maritime history, ISSN 1860-1812
|publication-place = Wiesbaden
|publisher = Otto Harrassowitz Verlag
|page = 127
|isbn = 9783447058728
|access-date = 31 March 2024
|quote = Unfortunately, [Faxian's biography] does not mention the nature of the provisions consumed aboard these ships in the Indian Ocean, or how they were stored and preserved.
}}
</ref>
The knowledge that consuming certain foods is a cure for scurvy has been repeatedly forgotten and rediscovered into the early 20th century.{{sfn| Cegłowski|2010}}<ref name="ceg">Maciej Cegłowski, 2010-03-06, [http://www.idlewords.com/2010/03/scott_and_scurvy.htm "Scott and Scurvy"] {{Webarchive|url=https://web.archive.org/web/20151019214816/http://idlewords.com/2010/03/scott_and_scurvy.htm |date=2015-10-19 }}. Retrieved 2016-05-31.</ref> Scurvy occurred during the [[Great Famine (Ireland)|Great famine of Ireland]] in 1845 and also the American Civil War. In 2002, scurvy outbreaks were recorded in Afghanistan following the most intense phase of the war.<ref>{{cite web |title=Everything you need to know about scurvy|last=Crosta |first= Peter |url=https://www.medicalnewstoday.com/articles/155758 |publisher=[[Medical News Today]] |date=November 15, 2023|access-date= 25 March 2025}}</ref>
=== Early modern era ===
In the 13th century [[Crusades|Crusaders]] developed scurvy.<ref>
{{cite book
|last1 = Hess
|first1 = Alfred
|author-link1 = Alfred Fabian Hess
|date = 31 December 2016
|orig-date = 1920
|title = Scurvy Past and Present
|url = https://books.google.com/books?id=zT85MQAACAAJ
|publisher = CreateSpace Independent Publishing Platform
|isbn = 9781540659040
|access-date = 15 March 2024
|quote = An interesting early description of scurvy, and one which is quite convincing, is that of de Joinville, who accompanied the Crusaders in their invasion of Egypt under St. Lewis, about the middle of the thirteenth century. [...] It is probable that scurvy existed in the northern parts of Europe and Asia ever since they were settled by man.
}}
</ref> In the 1497 expedition of [[Vasco da Gama]], the curative effects of citrus fruit were already observed<ref name="ceg" /><ref>As they sailed farther up the east coast of Africa, they met local traders, who traded them fresh oranges. Within 6 days of eating the oranges, da Gama's crew recovered fully and he noted, "It pleased God in his mercy that ... all our sick recovered their health for the air of the place is very good." [http://pediatrics.aappublications.org/content/108/4/e76.full Infantile Scurvy: A Historical Perspective] {{webarchive|url= https://web.archive.org/web/20150904021206/http://pediatrics.aappublications.org/content/108/4/e76.full |date= 4 September 2015 }}, Kumaravel Rajakumar, MD</ref> and were confirmed by [[Pedro Álvares Cabral]] and his crew in 1507.<ref>"Relação do Piloto Anônimo", narrativa publicada em 1507 sobre a viagem de Pedro Álvares Cabral às Índias, indicava que os "refrescos" oferecidos aos portugueses pelo rei de Melinde eram o remédio eficaz contra a doença (Nava, 2004). [http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext&pid=S1809-76342010000200007&lng=pt&nrm=iso. A medicina nas caravelas - Século XV] {{webarchive|url= https://web.archive.org/web/20150904021206/http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext&pid=S1809-76342010000200007&lng=pt&nrm=iso. |date= 4 September 2015 }}, Cristina B. F. M. Gurgel I; Rachel Lewinsohn II, ''Marujos, Alimentação e Higiene a Bordo''</ref>
The Portuguese planted fruit trees and vegetables on [[Saint Helena]], a stopping point for homebound voyages from Asia, and left their sick who had scurvy and other ailments to be taken home by the next ship if they recovered.<ref>On returning, Lopes' ship had left him on St Helena, where with admirable sagacity and industry he planted vegetables and nurseries with which passing ships were marvellously sustained. [...] There were 'wild groves' of oranges, lemons, and other fruits that ripened all the year round, large pomegranates and figs. [http://ler.letras.up.pt/uploads/ficheiros/4999.pdf Santa Helena, A Forgotten Portuguese Discovery] {{webarchive|url= https://web.archive.org/web/20110529065201/http://ler.letras.up.pt/uploads/ficheiros/4999.pdf |date= 29 May 2011 }}, Harold Livermore – Estudos em Homenagem a Luis Antonio de Oliveira Ramos, Faculdade de Letras da Universidade do Porto, 2004, p. 630-631</ref> In 1500, one of the pilots of [[Pedro Álvares Cabral|Cabral]]'s fleet bound for India noted that in [[Malindi]], its king offered the expedition fresh supplies such as lamb, chicken, and duck, along with lemons and oranges, due to which "some of our ill were cured of scurvy".<ref>''Logo que chegámos mandou-nos El Rey visitar e ao mesmo tempo um refresco de carneiros, galinhas, patos, limões e laranjas, as melhores que há no mundo, e com ellas sararam de escorbuto alguns doentes que tinhamos connosco'' in Portuguese, in ''Pedro Álvares Cabral'', Metzer Leone Editorial Aster, Lisbon, p.244</ref><ref>Germano de Sousa (2013) ''História da Medicina Portuguesa Durante a Expansão'', Círculo de Leitores, Lisbon, p.129</ref>
These travel accounts did not prevent further maritime tragedies caused by scurvy, partly because of the lack of communication between travelers and those responsible for their health, and because fruits and vegetables could not be kept for long on ships.<ref>Contudo, tais narrativas não impediram que novas tragédias causadas pelo escorbuto assolassem os navegantes, seja pela falta de comunicação entre os viajantes e responsáveis pela sua saúde, ou pela impossibilidade de se disponibilizar de frutas frescas durante as travessias marítimas. [http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext&pid=S1809-76342010000200007&lng=pt&nrm=iso. A medicina nas caravelas - Século XV] {{webarchive|url= https://web.archive.org/web/20150904021206/http://periodicos.ses.sp.bvs.br/scielo.php?script=sci_arttext&pid=S1809-76342010000200007&lng=pt&nrm=iso. |date=4 September 2015 }}, Cristina B. F. M. Gurgel I; Rachel Lewinsohn II, ''Marujos, Alimentação e Higiene a Bordo''</ref>
In 1536, the French explorer [[Jacques Cartier]], while exploring the [[Saint Lawrence River|St. Lawrence River]], used the local [[St. Lawrence Iroquoians]]' knowledge to save his men dying of scurvy. He boiled the needles of the [[aneda]] tree (generally believed to have been [[eastern white cedar]]) to make a tea that was later shown to contain 50 mg of vitamin C per 100 grams.<ref>[http://www3.sympatico.ca/goweezer/canada/z00cartier3.htm Jacques Cartier's Second Voyage] {{webarchive|url= https://web.archive.org/web/20070212063742/http://www3.sympatico.ca/goweezer/canada/z00cartier3.htm |date= 12 February 2007 }}, 1535 Winter & Scurvy.</ref><ref>{{cite journal |author= Martini E |title= Jacques Cartier witnesses a treatment for scurvy |journal= Vesalius |volume = 8 |issue = 1 |pages = 2–6 |year = 2002 |pmid = 12422875 }}</ref> Such treatments were not available aboard ship, where the disease was most common. Later, possibly inspired by this incident, several European countries experimented with preparations of various conifers, such as [[spruce beer]], as cures for scurvy.<ref Name="Guertin et al 2018">{{cite journal|last1= Durzan |first1 = Don J. |date= 2009 |title = Arginine, scurvy and Cartier's "tree of life" |journal = Journal of Ethnobiology and Ethnomedicine |volume = 5 |article-number = 5 |doi= 10.1186/1746-4269-5-5 |pmid=19187550 |pmc=2647905 |doi-access=free }}</ref>
In 1579, the Spanish friar and physician [[Agustín Farfán|Agustin Farfán]] published a book ''Tractado breve de anathomía y chirugía, y de algunas enfermedades que más comúnmente suelen haver en esta Nueva España'' in which he recommended oranges and lemons for scurvy, a remedy that was already known in the Spanish navy.<ref>{{cite web| url= http://abcblogs.abc.es/espejo-de-navegantes/2018/02/27/el-descubrimiento-espanol-de-la-cura-del-escorbuto//| title= El descubrimiento español de la cura del escorbuto| date= 2018-02-27| access-date=2018-02-27| archive-date=2018-02-28| archive-url= https://web.archive.org/web/20180228041646/http://abcblogs.abc.es/espejo-de-navegantes/2018/02/27/el-descubrimiento-espanol-de-la-cura-del-escorbuto//| url-status= live}}</ref>
In February 1601, Captain [[James Lancaster]], while commanding the first English [[East India Company]] fleet ''en route'' to [[Sumatra]], landed on the northern coast of Madagascar specifically to obtain lemons and oranges for his crew to stop scurvy.<ref>{{cite book|last1= Brown|first1= Mervyn|title= A history of Madagascar|page= 34}}</ref> Captain Lancaster conducted an experiment using four ships under his command. One ship's crew received routine doses of lemon juice while the other three did not receive such treatment. As a result, members of the non-treated ships started to contract scurvy, with many dying as a result.<ref>{{cite book|last1= Rogers|first1= Everett|title= Diffusion of Innovations|page=7}}</ref>
Researchers have estimated that during the [[Age of Exploration]] (between 1500 and 1800), scurvy killed at least two million [[sailor]]s.<ref>{{Cite book |last= Drymon | first = M. M. | title = Disguised As the Devil: How Lyme Disease Created Witches and Changed History | url = https://books.google.com/books?id=w-x8LwQ2ZeYC&pg=PA114 | publisher = Wythe Avenue Press | year = 2008 | page = 114 | isbn = 978-0-615-20061-3 | url-status = live | archive-url = https://web.archive.org/web/20160515224840/https://books.google.com/books?id=w-x8LwQ2ZeYC&pg=PA114&dq | archive-date = 15 May 2016 }}
</ref><ref name="Distillations" /> Jonathan Lamb wrote: "In 1499, Vasco da Gama lost 116 of his crew of 170; In 1520, Magellan lost 208 out of 230; ... all mainly to scurvy."<ref>{{Cite book | last = Lamb | first = Jonathan | title = Preserving the self in the south seas, 1680–1840 | url = https://books.google.com/books?id=hSoj1DR4ZSMC&pg=PA117 | publisher = University of Chicago Press | year = 2001 | page = 117 | isbn = 978-0-226-46849-5 | url-status = live | archive-url = https://web.archive.org/web/20160624044737/https://books.google.com/books?id=hSoj1DR4ZSMC&pg=PA117&dq | archive-date = 24 June 2016 }}
</ref>
In 1593, Admiral Sir [[Richard Hawkins]] advocated drinking orange and lemon juice to prevent scurvy.<ref>{{cite book|author= Kerr, Gordon |date= 2009|title= Timeline of Britain|publisher=Canary Press}}</ref>
A 1609 book by [[Bartolomé Leonardo de Argensola]] recorded several different remedies for scurvy known at this time in the Moluccas, including a kind of wine mixed with cloves and ginger, and "certain herbs". The Dutch sailors in the area were said to cure the same disease by drinking lime juice.<ref>{{cite book|author= Argensola, Bartolomé Leonardo de|date= 1609|title=Conquista de las Islas Molucas|___location= Madrid|publisher= Alonso Martín |url= http://cervantes.bne.es/es/su-biblioteca/conquista-islas-malucas2|access-date= 2022-12-12|archive-date=2022-07-01|archive-url= https://web.archive.org/web/20220701191003/http://cervantes.bne.es/es/su-biblioteca/conquista-islas-malucas2|url-status=live}}</ref>
In 1614, [[John Woodall]], Surgeon General of the [[British East India Company|East India Company]], published ''The Surgion's Mate'' as a handbook for apprentice surgeons aboard the company's ships. He repeated the experience of mariners that the cure for scurvy was fresh food or, if not available, oranges, lemons, limes, and [[tamarinds]].<ref name="bown">{{cite book |last= Bown |first= Stephen R |title= Scurvy: How a Surgeon, a Mariner and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail |___location= New York |publisher= Viking |year=2003 |isbn=978-0-312-31391-3 |url= https://archive.org/details/scurvyhowsurgeon00bown_0 }}</ref> He was, however, unable to explain the reason why, and his assertion had no impact on the prevailing opinion of the influential physicians of the age, that scurvy was a digestive complaint.
Besides afflicting ocean travelers, until the late Middle Ages scurvy was common in Europe in late winter, when few green vegetables, fruits, and root vegetables were available. This gradually improved with the introduction of potatoes from the Americas; by 1800, scurvy was virtually unheard of in Scotland, where it had previously been endemic.<ref>{{cite web|url= https://www.unhcr.org/4cbef0599.pdf|title=SCURVY and its prevention and control in major emergencies|website= Unhcr.org|access-date= 5 March 2022|archive-date= 12 July 2018|archive-url= https://web.archive.org/web/20180712091632/http://www.unhcr.org/4cbef0599.pdf|url-status= live}}</ref>{{rp|11}}
=== 18th century ===
In 2009, a handwritten household book authored by a Cornishwoman in 1707 was discovered in a house in Hasfield, [[Gloucestershire]], containing a "{{abbr|Recp.t|Recipe}} for the Scurvy" amongst other largely medicinal and herbal recipes. The recipe consisted of extracts from various plants mixed with a plentiful supply of orange juice, white wine, or beer.<ref>{{cite news|work=The Daily Telegraph |date=5 March 2009|url=https://www.telegraph.co.uk/news/newstopics/howaboutthat/4943570/Cure-for-scurvy-discovered-by-a-woman.html|title=Cure for Scurvy discovered by a woman|url-status=live|archive-url=https://web.archive.org/web/20090310021320/http://www.telegraph.co.uk/news/newstopics/howaboutthat/4943570/Cure-for-scurvy-discovered-by-a-woman.html|archive-date=10 March 2009}}</ref>
In 1734, [[Leiden]]-based physician [[Johann Bachstrom]] published a book on scurvy in which he stated, "scurvy is solely owing to a total abstinence from fresh vegetable food, and greens; which is alone the primary cause of the disease", and urged the use of fresh fruit and vegetables as a cure.<ref>{{Cite journal|title = James Lind and scurvy: A revaluation |last = Bartholomew |first = Michael |date = 2002 |journal = Journal for Maritime Research |doi = 10.1080/21533369.2002.9668317 |pmid = 20355298|volume= 4|issue= 1 |pages = 1–14 |s2cid = 42109340}}</ref><ref>Johann Friedrich Bachstrom, ''Observationes circa scorbutum'' [Observations on scurvy] (Leiden ("Lugdunum Batavorum"), Netherlands: Conrad Wishof, 1734) p. 16. [https://books.google.com/books?id=bj8_AAAAcAAJ&pg=PA16 From page 16:] {{webarchive|url=https://web.archive.org/web/20160101135046/https://books.google.com/books?id=bj8_AAAAcAAJ&pg=PA16 |date=1 January 2016 }} ''"... sed ex nostra causa optime explicatur, quae est absentia, carentia & abstinentia a vegetabilibus recentibus, ..."'' (... but [this misfortune] is explained very well by our [supposed] cause, which is the absence of, lack of, and abstinence from fresh vegetables, ...)</ref><ref>''"The Blood of Nelson"'' by Glenn Barnett — Military History — Oct 2006.</ref>
[[File:Portrait of James Lind, 1716-1794, Physician at Haslar Wellcome M0003113a.jpg|thumb|upright|[[James Lind]] was a pioneer in the field of scurvy prevention]]
It was not until 1747 that [[James Lind (physician)|James Lind]] formally demonstrated that scurvy could be treated by supplementing the diet with citrus fruit, in one of the first controlled clinical experiments reported in the history of medicine.<ref name=Lind1753/><ref>{{cite journal |last1= Baron |first1= Jeremy Hugh |title= Sailors' scurvy before and after James Lind - a reassessment |journal= Nutrition Reviews |volume= 67 |issue= 6 |year= 2009 |pages= 315–332 |doi= 10.1111/j.1753-4887.2009.00205.x|pmid= 19519673 }}</ref> As a naval surgeon on HMS ''Salisbury'', Lind had compared several suggested scurvy cures: [[hard cider]], [[vitriol]], [[vinegar]], [[seawater]], [[Orange (fruit)|oranges]], [[lemons]], and a mixture of [[balsam of Peru]], [[garlic]], [[myrrh]], [[mustard seed]] and [[radish]] root. In ''A Treatise on the Scurvy'' (1753)<ref name=Ag2015/>{{sfn|Lind|1753}}<ref name=Lind1753>{{cite book|author=James Lind|title=A Treatise on the Scurvy: In Three Parts, Containing an Inquiry Into the Nature, Causes, an Cure, of that Disease, Together with a Critical and Chronological View of what Has Been Published on the Subject|url=https://archive.org/details/b30511902|year=1772|publisher=S. Crowder (and six others)|page=[https://archive.org/details/b30511902/page/149 149]}}{{open access}} (Also archived [https://archive.org/details/treatiseonscurvy00lind second edition (1757)])</ref>
Lind explained the details of his clinical trial and concluded "the results of all my experiments was, that oranges and lemons were the most effectual remedies for this distemper at sea."<ref name="Distillations"/><ref name="Lind1753"/> However, the experiment and its results occupied only a few paragraphs in a work that was long and complex and had little impact. Lind himself never actively promoted lemon juice as a single 'cure'. He shared medical opinion at the time that scurvy had multiple causes – notably hard work, bad water, and the consumption of salt meat in a damp atmosphere which inhibited healthful perspiration and normal excretion – and therefore required multiple solutions.<ref name="Distillations"/><ref>{{Cite journal|title = James Lind and Scurvy: a Revaluation |last = Bartholomew |first = M. |date = January 2002 |journal = Journal for Maritime Research |volume = 4 |pages = 1–14 |doi = 10.1080/21533369.2002.9668317 |pmid = 20355298 |s2cid = 42109340}}</ref> Lind was also sidetracked by the possibilities of producing a concentrated 'rob' of lemon juice by boiling it. This process destroyed the vitamin C and was therefore unsuccessful.<ref name="Distillations"/>
During the 18th century, scurvy killed more British sailors than wartime enemy action. It was mainly by scurvy that during [[George Anson's voyage around the world]] he lost nearly two-thirds of his crew (1,300 out of 2,000) within the first 10 months of the voyage.<ref name="Distillations"/><ref>"[https://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_01.shtml Captain Cook and the Scourge of Scurvy] {{webarchive|url=https://web.archive.org/web/20110221073823/http://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_01.shtml |date=21 February 2011 }}" BBC – History</ref> The Royal Navy enlisted 184,899 sailors during the [[Seven Years' War]]; 133,708 of these were "missing" or died from disease, and scurvy was the leading cause.<ref>A. S. Turberville (2006). "''Johnson's England: An Account of the Life & Manners of His Age''". ISBN READ BOOKS. p.53. {{ISBN|1-4067-2726-1}}</ref>
Although sailors and naval surgeons were increasingly convinced that citrus fruits could cure scurvy throughout this period, the classically trained physicians who determined medical policy dismissed this evidence as merely anecdotal, as it did not conform to their theories of disease. Literature championing the cause of citrus juice had no practical impact. The medical theory was based on the assumption that scurvy was a disease of internal [[putrefaction]] brought on by faulty digestion caused by the hardships of life at sea and the naval diet. Although successive theorists gave this basic idea different emphases, the remedies they advocated (and which the navy accepted) amounted to little more than the consumption of 'fizzy drinks' to activate the digestive system, the most extreme of which was the regular consumption of 'elixir of vitriol' – sulphuric acid taken with spirits and barley water, and laced with spices.
In 1764, a new and similarly inaccurate theory on scurvy appeared. Advocated by Dr [[David MacBride]] and [[John Pringle (physician)|Sir John Pringle]], Surgeon General of the Army and later President of the Royal Society, this idea was that scurvy was the result of a lack of 'fixed air' in the tissues which could be prevented by drinking infusions of malt and [[wort]] whose fermentation within the body would stimulate digestion and restore the missing gases.<ref>{{Cite book|title = Physician to the Fleet; the Life and Times of Thomas Trotter 1760-1832|last = Vale and Edwards|publisher = The Boydell Press|year = 2011|isbn = 978-1-84383-604-9|___location = Woodbridge|pages = 29–33}}</ref> These ideas received wide and influential backing, when [[James Cook]] set off to circumnavigate the world (1768–1771) in {{ship|HM Bark|Endeavour}}, malt and wort were top of the list of the remedies he was ordered to investigate. The others were beer, [[Sauerkraut]] (a good source of vitamin C), and Lind's 'rob'. The list did not include lemons.<ref>{{Cite journal |title = Captain Cook's Beer; the anti-scorbutic effects of malt and beer in late 18th century sea voyages | last = Stubbs | first = B. J. | date = 2003 | journal = Asia and Pacific Journal of Clinical Nutrition |volume= 12 |issue= 2 |pages= 129–37 | pmid = 12810402 }}</ref>
Cook did not lose a single man to scurvy, and his report came down in favor of malt and wort. The reason for the health of his crews on this and other voyages was Cook's regime of shipboard cleanliness, enforced by strict discipline, and frequent replenishment of fresh food and greenstuffs.<ref>{{cite book |last= Fernandez-Armesto |first= Felipe |title= Pathfinders: A Global History of Exploration |year= 2006 |publisher= W.W. Norton & Company |page= [https://archive.org/details/pathfindersgloba00fern/page/297 297] |isbn= 978-0-393-06259-5 |url= https://archive.org/details/pathfindersgloba00fern/page/297 }}</ref> Another beneficial rule implemented by Cook was his prohibition of the consumption of salt fat skimmed from the ship's copper boiling pans, then a common practice elsewhere in the Navy. In contact with air, the copper formed compounds that prevented the absorption of vitamins by the intestines.<ref>{{Cite web|url=https://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_01.shtml|archiveurl=https://web.archive.org/web/20090303075047/http://www.bbc.co.uk/history/british/empire_seapower/captaincook_scurvy_04.shtml|url-status=dead|title=BBC - History - British History in depth: Captain Cook and the Scourge of Scurvy|archive-date=3 March 2009|website=Bbc.co.uk|access-date=5 March 2022}}</ref>
The first major long-distance expedition that experienced virtually no scurvy was that of the Spanish naval officer [[Alessandro Malaspina]], 1789–1794. Malaspina's medical officer, Pedro González, was convinced that fresh oranges and lemons were essential for preventing scurvy. Only one outbreak occurred, during a 56-day trip across the open sea. Five sailors came down with symptoms, one seriously. After three days at [[Guam]], all five were healthy again. [[Spanish Empire|Spain's large empire]] and many ports of call made it easier to acquire fresh fruit.<ref>{{cite book |last= Fernandez-Armesto |first= Felipe |title= Pathfinders: A Global History of Exploration |year= 2006 |publisher= W.W. Norton & Company |pages= [https://archive.org/details/pathfindersgloba00fern/page/297 297–298] |isbn= 978-0-393-06259-5 |url= https://archive.org/details/pathfindersgloba00fern/page/297 }}</ref>
Although towards the end of the century, MacBride's theories were being challenged, the medical authorities in Britain remained committed to the notion that scurvy was a disease of internal 'putrefaction' and the Sick and Hurt Board, run by administrators, felt obliged to follow its advice. Within the Royal Navy, however, opinion – strengthened by first-hand experience with lemon juice at the siege of Gibraltar and during Admiral Rodney's expedition to the Caribbean – had become increasingly convinced of its efficacy. This was reinforced by the writings of experts like [[Gilbert Blane]]<ref>Blane, Gilbert (1785). Observations on the diseases incident to seamen. London: Joseph Cooper; Edinburgh: William Creech</ref> and [[Thomas Trotter (physician)|Thomas Trotter]]<ref name="TrotterMilman1786">{{cite book|author1=Thomas Trotter|author2=Francis Milman|title=Observations on the Scurvy: With a Review of the Theories Lately Advanced on that Disease; and the Opinions of Dr. Milman Refuted from Practice|url=https://archive.org/details/b21522819|year=1786|publisher=Charles Elliott and G.G.J. and J. Robinson, London}}</ref> and by the reports of up-and-coming naval commanders.
With the coming of war in 1793, the need to eliminate scurvy became more urgent. The first initiative came not from the medical establishment but from the admirals. Ordered to lead an expedition against Mauritius, [[Alan Gardner, 1st Baron Gardner|Rear Admiral Gardner]] was uninterested in the wort, malt, and elixir of vitriol that were still being issued to ships of the Royal Navy, and demanded that he be supplied with lemons, to counteract scurvy on the voyage. Members of the Sick and Hurt Board, recently augmented by two practical naval surgeons, supported the request, and the Admiralty ordered that it be done. There was, however, a last-minute change of plan, and the expedition against Mauritius was canceled. On 2 May 1794, only {{HMS|Suffolk|1765|6}} and two [[Sloop-of-war|sloops]] under Commodore Peter Rainier sailed for the east with an outward bound convoy, but the warships were fully supplied with lemon juice and the sugar with which it had to be mixed.
In March 1795, it was reported that the ''Suffolk'' had arrived in India after a four-month voyage without a trace of scurvy and with a crew that was healthier than when it set out. The effect was immediate. Fleet commanders clamored also to be supplied with lemon juice, and by June the Admiralty acknowledged the groundswell of demand in the navy and agreed to a proposal from the Sick and Hurt Board that lemon juice and sugar should in future be issued as a daily ration to the crews of all warships.<ref>{{Cite journal |title = The Conquest of Scurvy in the Royal Navy 1793–1800: a Challenge to Current Orthodoxy |last = Vale |first = Brian |date = 2008 |journal = The Mariner's Mirror |volume= 94 | issue = 2|pages= 160–175|doi = 10.1080/00253359.2008.10657052 |s2cid = 162207993}}</ref>
It took a few years before the method of distribution to all ships in the fleet had been perfected and the supply of the huge quantities of lemon juice required to be secured, but by 1800, the system was in place and functioning. This led to a remarkable health improvement among the sailors and consequently played a critical role in gaining an advantage in naval battles against enemies who had yet to introduce the measures.
Scurvy was not only a disease of seafarers. The early colonists of Australia suffered greatly because of the lack of fresh fruit and vegetables in the winter. There, the disease was called '''Spring fever''' or '''Spring disease''' and was described as an often-fatal condition associated with skin lesions, bleeding gums, and lethargy. It was eventually identified as scurvy and the remedies already in use at sea were implemented.<ref>{{cite web|url=https://knoxpediatrics.com/watch-out-for-spring-fever/|title=Watch out for spring fever!|date=11 April 2018 |access-date=20 March 2022|publisher=Knoxville Pediatric Associates|archive-date=21 May 2022|archive-url=https://web.archive.org/web/20220521061019/https://knoxpediatrics.com/watch-out-for-spring-fever/|url-status=live}}</ref>
=== 19th century ===
[[File:A case of Scurvy journal of Henry Walsh Mahon.jpg|left|thumb|Page from the journal of [[Henry Walsh Mahon]] showing the effects of scurvy, from his time aboard HM Convict Ship ''Barrosa'' (1841/2)]]
The surgeon-in-chief of [[Napoleon]]'s army at the [[Siege of Alexandria (1801)]], Baron [[Dominique-Jean Larrey]], wrote in his memoirs that the consumption of [[horse meat]] helped the French to curb an epidemic of scurvy. The meat was cooked but was freshly obtained from young horses bought from Arabs, and was nevertheless effective. This helped to start the 19th-century tradition of horse meat consumption in France.<ref>Larrey is quoted in French by Dr. [[Béraud]], ''[http://leslivresoublies.free.fr/leslivresoublies/Sciences_et_techniques_muse/cheval.html Études Hygiéniques de la chair de cheval comme aliment] {{webarchive|url=https://web.archive.org/web/20160304002411/http://leslivresoublies.free.fr/leslivresoublies/Sciences_et_techniques_muse/cheval.html |date=4 March 2016 }}'', [[Musée des Familles]] (1841-42).</ref>
Lauchlin Rose patented a method used to preserve citrus juice without alcohol in 1867, creating a [[squash (drink)|concentrated drink]] known as [[Rose's lime juice]]. The [[Merchant Shipping Act 1867]] required all ships of the [[Royal Navy]] and [[Merchant Navy]] to provide a daily "[[Lime (fruit)|lime]] or lemon juice" ration of one pound to sailors to prevent scurvy.<ref>{{cite wikisource |title= Merchant Shipping Act 1867 |last= |first= |authorlink= |date= Aug 20, 1867 |at=section 4.5 |___location = UK}}</ref> The product became nearly ubiquitous, hence the term "[[limey]]", first for British sailors, then for English immigrants within the former British colonies (particularly America, New Zealand, and South Africa), and finally, in old American slang, all British people.<ref>{{cite book |last1=Simpson |first1=J. |last2=Weiner |first2=E. |title=The Oxford English Dictionary |publisher=Oxford University Press |year=1989 }}</ref>
The plant ''[[Cochlearia officinalis]]'', also known as "common scurvygrass", acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. Its bitter taste was usually disguised with herbs and spices; however, this did not prevent scurvygrass drinks and sandwiches from becoming a popular fad in the UK until the middle of the nineteenth century, when citrus fruits became more readily available.<ref>{{cite book |last=Mabey |first=Richard|title=Food for free |publisher=Collins |year=1972 |pages=93, 94 |isbn=978-0-00-724768-4}}</ref>
[[Key lime|West Indian limes]] began to take over from lemons, when Spain's alliance with France against Britain in the Napoleonic Wars made the supply of Mediterranean lemons problematic, and because they were more easily obtained from Britain's Caribbean colonies<ref name="ceg" /> and were believed to be more effective because they were more acidic. It was the acid, not the (then-unknown) Vitamin C that was believed to cure scurvy. The West Indian limes were significantly lower in Vitamin C than the previous lemons and further were not served fresh but rather as lime juice, which had been exposed to light and air, and piped through copper tubing, all of which significantly reduced the Vitamin C. A 1918 animal experiment using representative samples of the Navy and Merchant Marine's lime juice showed that it had virtually no antiscorbutic power at all.<ref name="ceg" />
The belief that scurvy was fundamentally a nutritional deficiency, best treated by consumption of fresh food, particularly fresh citrus or fresh meat, was not universal in the 19th and early 20th centuries, and thus sailors and explorers continued to have scurvy into the 20th century. For example, the [[Belgian Antarctic Expedition]] of 1897–1899 became seriously affected by scurvy when its leader, [[Adrien de Gerlache]], initially discouraged his men from eating penguin and seal meat.
In the Royal Navy's [[Arctic]] expeditions in the mid-19th century, it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining crew morale, rather than by a diet of fresh food. Navy expeditions continued to be plagued by scurvy even while fresh (not jerked or tinned) meat was well known as a practical antiscorbutic among civilian whalers and explorers in the Arctic. In the latter half of the 19th century, there was greater recognition of the value of eating fresh meat as a means of avoiding or treating scurvy, but the lack of available game to hunt at high latitudes in winter meant it was not always a viable remedy. Criticism also focused on the fact that some of the men most affected by scurvy on Naval polar expeditions had been heavy drinkers, with suggestions that this predisposed them to the condition.<ref>{{Cite journal |last= Armston-Sheret |first= Edward |date= 2019-09-01 |title= "A Good Advertisement for Teetotalers": Polar Explorers and Debates over the Health Effects of Alcohol, 1875–1904 |journal= The Social History of Alcohol and Drugs |volume= 33 |issue= 2 |pages= 257–285 |doi= 10.1086/705337 |issn=1930-8418|doi-access=free}}</ref> Even cooking fresh meat did not destroy its antiscorbutic properties, especially as many cooking methods failed to bring all the meat to high temperature.
The confusion is attributed to several factors:<ref name="ceg"/>
* while ''fresh'' citrus (particularly lemons) cured scurvy, lime ''juice'' that had been exposed to light, air, and copper tubing did not – thus undermining the theory that citrus cured scurvy;
* fresh meat (especially organ meat and raw meat, consumed in arctic exploration) also cured scurvy, undermining the theory that fresh vegetable matter was essential to preventing and curing scurvy;
* increased marine speed via steam shipping, improved nutrition on land, reduced the incidence of scurvy – and thus the ineffectiveness of copper-piped lime juice compared to fresh lemons was not immediately revealed.
In the resulting confusion, a new hypothesis was proposed, following the new germ theory of disease – that scurvy was caused by [[Ptomaine poisoning|ptomaine]], a waste product of bacteria, particularly in tainted tinned meat.<ref>{{Cite journal |last= Armston-Sheret |first= Edward |date= 2019-07-01 |title= Tainted bodies: scurvy, bad food and the reputation of the British National Antarctic Expedition, 1901–1904 |url= https://www.sciencedirect.com/science/article/pii/S0305748818301610 |journal=Journal of Historical Geography |language= en |volume= 65 |pages= 19–28 |doi= 10.1016/j.jhg.2019.05.006 |s2cid=202357562 |issn=0305-7488|url-access= subscription }}</ref>
Infantile scurvy emerged in the late 19th century because children were fed pasteurized cow's milk, particularly in the urban upper class. While pasteurization killed bacteria, it also destroyed vitamin C. This was eventually resolved by supplementing with [[onion]] juice or cooked potatoes. Native Americans helped save some newcomers from scurvy by directing them to eat [[Allium acuminatum|wild onions]].<ref>{{cite book |last=Whitney |first=Stephen |title=Western Forests (The Audubon Society Nature Guides) |date=1985 |publisher=Knopf |___location=New York |isbn=0-394-73127-1 |page=[https://archive.org/details/westernforests00whit/page/589 589] |url=https://archive.org/details/westernforests00whit/page/589 }}</ref>
=== 20th century ===
By the early 20th century, when [[Robert Falcon Scott]] made his first expedition to the [[Antarctic]] (1901–1904), the prevailing theory was that scurvy was caused by "[[ptomaine poisoning]]", particularly in tinned meat.<ref>{{cite book |quote=I understand that scurvy is now believed to be ptomaine poisoning |last=Scott |first=Robert F. |title=The Voyage of the Discovery |url=https://archive.org/details/voyageofdiscover001scot |publisher=Smith, Elder & Co |___location=London |year=1905 |page=[https://archive.org/details/voyageofdiscover001scot/page/550 550] }}</ref> However, Scott discovered that a diet of fresh meat from Antarctic seals cured scurvy before any fatalities occurred.<ref>{{cite book |quote=[no] party wintering in the Antarctic Regions will have great difficulty in providing themselves with fresh food; and, as we have proved, where such conditions exist there need be no fear of the dreaded word 'scurvy'. |last=Scott |first=Robert F. |title=The Voyage of the Discovery |url=https://archive.org/details/voyageofdiscover001scot |publisher=Smith, Elder & Co |___location=London |year=1905 |page=[https://archive.org/details/voyageofdiscover001scot/page/556 556] }}</ref> But while he saw fresh meat as a cure for scurvy, he remained confused about its underlying causes.<ref>{{Cite journal |last= Armston-Sheret |first= Edward |date= 2019-07-01 |title= Tainted bodies: scurvy, bad food and the reputation of the British National Antarctic Expedition, 1901–1904 |url= https://www.sciencedirect.com/science/article/pii/S0305748818301610 |journal= Journal of Historical Geography |language= en |volume= 65 |pages= 19–28 |doi= 10.1016/j.jhg.2019.05.006 |s2cid=202357562 |issn=0305-7488|url-access= subscription }}</ref>
In 1907, an animal model that would eventually help to isolate and identify the "antiscorbutic factor" was discovered. [[Axel Holst]] and [[Theodor Frølich]], two [[Norway|Norwegian]] physicians studying shipboard [[beriberi]] contracted by ship's crews in the Norwegian Fishing Fleet, wanted a small test mammal to substitute for the [[pigeon]]s then used in beriberi research. They fed [[guinea pig]]s their test diet of grains and flour, which had earlier produced beriberi in their pigeons, and were surprised when classic scurvy resulted instead. This was a serendipitous choice of animal. Until that time, scurvy had not been observed in any organism apart from humans and had been considered an exclusively human disease. Certain birds, mammals, and fish are susceptible to scurvy, but pigeons are unaffected since they can synthesize ascorbic acid internally. Holst and Frølich found they could cure scurvy in guinea pigs with the addition of various fresh foods and extracts. This discovery of an animal experimental model for scurvy, which was made even before the essential idea of "vitamins" in foods had been put forward, has been called the single most important piece of vitamin C research.<ref>{{cite journal | pmid = 12555613 | volume=122 | issue= 17 | title= Axel Holst and Theodor Frølich--pioneers in the combat of scurvy |date= June 2002 |vauthors= Norum KR, Grav HJ | journal= Journal of the Norwegian Medical Association | pages= 1686–7}}</ref>
In 1915, New Zealand troops in the [[Gallipoli Campaign]] had a lack of vitamin C in their diet which caused many of the soldiers to contract scurvy.<ref>{{cite journal| last1= Wilson | first1=Nick | last2=Ngheim | first2=Nhung | last3=Summers | first3=Jennifer | last4=Carter | first4=Mary-Ann | last5=Harper | first5=Glyn | last6=Wilson | first6=Nicholas|date= 2013|title= A nutritional analysis of New Zealand Military food rations at Gallipoli in 1915: likely contribution to scurvy and other nutrient deficiency disorders|journal=New Zealand Medical Journal|volume=126|issue=1373|pages=12–29|pmid=23797073}}</ref>
[[Vilhjalmur Stefansson]], an Arctic explorer who had lived among the [[Inuit]], proved that the all-meat diet they consumed did not lead to vitamin deficiencies. He participated in a study in New York's [[Bellevue Hospital]] in February 1928, where he and a companion ate only meat for a year while under close medical observation, yet remained in good health.<ref>{{cite journal | author = McClellan Walter S., Du Bois Eugene F. | year = 1930 | title = Prolonged meat diet experiment | url = http://www.jbc.org/content/87/3/651.full.pdf | journal = J Biol Chem | volume = 87 | pages = 651–668 | doi = 10.1016/S0021-9258(18)76842-7 | url-status = live | archive-url = https://web.archive.org/web/20160101135046/http://www.jbc.org/content/87/3/651.full.pdf | archive-date = 1 January 2016 | doi-access = free }}</ref>
In 1927, Hungarian [[biochemist]] [[Albert Szent-Györgyi]] isolated a compound he called "[[hexuronic acid]]".<ref>{{cite web |url=http://nobelprize.org/nobel_prizes/medicine/articles/carpenter/index.html |title=The Nobel Prize and the Discovery of Vitamins |access-date=2008-01-25 |author=Carpenter, Kenneth J. |date=22 June 2004 |website=nobelprize.org |publisher=[[Nobel Foundation]] |url-status=live |archive-url=https://web.archive.org/web/20080224141953/http://nobelprize.org/nobel_prizes/medicine/articles/carpenter/index.html |archive-date=24 February 2008 }}</ref> Szent-Györgyi suspected hexuronic acid, which he had isolated from adrenal glands, to be the antiscorbutic agent, but he could not prove it without an animal-deficiency model. In 1932, the connection between hexuronic acid and scurvy was finally proven by American researcher [[Charles Glen King]] of the [[University of Pittsburgh]].<ref>{{cite web |url=https://profiles.nlm.nih.gov/WG/Views/Exhibit/narrative/szeged.html |title=The Albert Szent-Gyorgyi Papers Szeged, 1931-1947: Vitamin C, Muscles, and WWII |access-date=2008-01-25 |website=nlm.nih.gov|publisher=U.S. National Library of Medicine |url-status=dead |archive-url=https://web.archive.org/web/20071024133109/http://profiles.nlm.nih.gov/WG/Views/Exhibit/narrative/szeged.html |archive-date=24 October 2007 }}</ref> King's laboratory was given some hexuronic acid by Szent-Györgyi and soon established that it was the sought-after anti-scorbutic agent. Because of this, hexuronic acid was subsequently renamed ''ascorbic acid.''
=== 21st century ===
Rates of scurvy in the developed world are low due to the greater access to vitamin C-rich foods.<ref>{{cite journal |last1=Pope |first1=Michael |last2=Elder |first2=Joshua |title=Scurvy: An elusive diagnosis |journal=Clinical Case Reports |date=2023 |volume=11 |issue=6 |doi=10.1002/ccr3.7418 |url=https://doi.org/10.1002/ccr3.7418|pmc=10225610 }}</ref> Those most commonly affected are [[malnourished]] people in the [[developing world]] and [[homeless]] people.<ref>{{cite journal|last1=Khonsari|first1=H|last2=Grandière-Perez|first2=L|last3=Caumes|first3=E|title=[Scurvy, a re-emerging disease].|journal=La Revue de Médecine Interne|date=November 2005|volume=26|issue=11|pages=885–90|doi=10.1016/j.revmed.2005.03.007|pmid=15949874}}</ref> There have been outbreaks of the condition in [[refugee camps]].<ref>{{cite journal|last1=Mason|first1=JB|title=Lessons on nutrition of displaced people.|journal=The Journal of Nutrition|date=July 2002|volume=132|issue=7|pages=2096S–2103S|pmid=12097702|doi=10.1093/jn/132.7.2096s|doi-access=free}}</ref> Case reports in the developing world of those with poorly healing wounds have occurred.<ref name="Westmead 2016">{{cite web |url=https://www.westmeadinstitute.org.au/news-and-events/2016/surprise-scurvy-cases-suggest-nutrient-deficiencie |title=Surprise scurvy cases suggest nutrient deficiencies, even amongst the obese |publisher=[[Westmead Institute for Medical Research]] |date=28 November 2016 |access-date=2017-08-23 |url-status=live |archive-url=https://web.archive.org/web/20170823122600/https://www.westmeadinstitute.org.au/news-and-events/2016/surprise-scurvy-cases-suggest-nutrient-deficiencie |archive-date=23 August 2017 }}</ref>
In 2020, the overall incidence of scurvy in the US was about one in 4,000 people, up significantly from even a few years before. About two-thirds of all scurvy is found in [[autism|autistic]] people.<ref>{{Cite journal |last1=Reikersdorfer |first1=Kristen N. |last2=Singh |first2=Aaron |last3=Young |first3=Jason D. |last4=Batty |first4=Miles B. |last5=Steele |first5=Amy E. |last6=Yuen |first6=Leslie C. |last7=Momtaz |first7=David A. |last8=Weissert |first8=Joleen N. |last9=Liu |first9=David S. |last10=Hogue |first10=Grant D. |date=2024-07-01 |title=The Troubling Rise of Scurvy: A Review and National Analysis of Incidence, Associated Risk Factors, and Clinical Manifestations |journal=Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews |volume=8 |issue=7 |pages=e24.00162 |doi=10.5435/JAAOSGlobal-D-24-00162 |issn=2474-7661 |pmc=11251681 |pmid=39018570}}</ref> Children and young people with autism are at risk of developing scurvy because some of them only eat a small number of foods (e.g., only rice and pasta).<ref>{{Cite journal |last1=Kinlin |first1=Laura M. |last2=Weinstein |first2=Michael |date=November 2023 |title=Scurvy: old disease, new lessons |journal=Paediatrics and International Child Health |volume=43 |issue=4 |pages=83–94 |doi=10.1080/20469047.2023.2262787 |issn=2046-9055 |pmid=37795755}}</ref><ref>{{Cite journal |last1=Kothari |first1=Priya |last2=Tate |first2=Anupama |last3=Adewumi |first3=Abimbola |last4=Kinlin |first4=Laura M. |last5=Ritwik |first5=Priyanshi |date=May 2020 |title=The risk for scurvy in children with neurodevelopmental disorders |journal=Special Care in Dentistry|volume=40 |issue=3 |pages=251–259 |doi=10.1111/scd.12459 |issn=1754-4505 |pmid=32330999}}</ref> For some of them, the restricted diet takes the form of [[avoidant/restrictive food intake disorder]] (ARFID).<ref>{{Cite journal |last1=Sharp |first1=William G. |last2=Berry |first2=Rashelle C. |last3=Burrell |first3=Lindsey |last4=Scahill |first4=Lawrence |last5=McElhanon |first5=Barbara O. |date=2020 |title=Scurvy as a Sequela of Avoidant-Restrictive Food Intake Disorder in Autism: A Systematic Review |journal=Journal of Developmental and Behavioral Pediatrics |volume=41 |issue=5 |pages=397–405 |doi=10.1097/DBP.0000000000000782 |issn=1536-7312 |pmid=32044868}}</ref>
=== Human trials ===
Notable human dietary studies of experimentally induced scurvy were conducted on [[conscientious objector]]s during World War II in Britain and the United States on Iowa state prisoner volunteers in the late 1960s.<ref name="Brit" /><ref name="Iowa" /> These studies both found that all obvious symptoms of scurvy previously induced by an experimental scorbutic diet with extremely low vitamin C content could be completely reversed by additional vitamin C supplementation of only 10 mg per day. In these experiments, no clinical difference was noted between men given 70 mg vitamin C per day (which produced blood levels of vitamin C of about 0.55 mg/dl, about {{frac|1|3}} of tissue saturation levels), and those given 10 mg per day (which produced lower blood levels). Men in the prison study developed the first signs of scurvy about four weeks after starting the vitamin C-free diet, whereas in the British study, six to eight months were required, possibly because the subjects were pre-loaded with a 70 mg/day supplement for six weeks before the scorbutic diet was fed.<ref name="Brit">{{cite journal |first=J. |last=Pemberton |title=Medical experiments carried out in Sheffield on conscientious objectors to military service during the 1939–45 war |journal=International Journal of Epidemiology |year=2006 |volume=35 |issue=3 |pages=556–558 |doi=10.1093/ije/dyl020 |pmid=16510534|doi-access=free }}</ref>
Men in both studies, on a diet devoid or nearly devoid of vitamin C, had blood levels of vitamin C too low to be accurately measured when they developed signs of scurvy, and in the Iowa study, at this time were estimated (by labeled vitamin C dilution) to have a body pool of less than 300 mg, with daily turnover of only 2.5 mg/day.<ref name="Iowa">{{cite journal |journal = American Journal of Clinical Nutrition |volume = 22 |pages = 535–548 |year = 1969 |first1 = R. E. |last1 = Hodges |first2 = E. M. |last2 = Baker |first3 = J. |last3 = Hood |first4 = H. E. |last4 = Sauberlich |first5 = S. C. |last5 = March |title = Experimental Scurvy in Man |issue = 5 |pmid = 4977512 |doi = 10.1093/ajcn/22.5.535 }}</ref>
== In other animals ==
{{See also|Vitamin C#Biosynthesis}}
Most animals and plants can [[Vitamin C#Synthesis|synthesize vitamin C]] through a sequence of [[enzyme]]-driven steps, which convert [[monosaccharides]] to vitamin C. However, some mammals have lost the ability to synthesize vitamin C, notably [[simian]]s and [[tarsier]]s. These make up one of two major [[primate]] suborders, [[haplorrhini]], and this group includes [[human]]s.<ref>{{cite book | first1 = R. Eric | last1 = Miller | first2 = Murray E. | last2 = Fowler | name-list-style = vanc | title = Fowler's Zoo and Wild Animal Medicine, Volume 8 | page = 389 | url = https://books.google.com/books?id=llBcBAAAQBAJ&q=Caviidae+%22vitamin+C%22&pg=PA389 |access-date=June 2, 2016 |url-status=live |archive-url=https://web.archive.org/web/20161207032904/https://books.google.com/books?id=llBcBAAAQBAJ&pg=PA389&lpg=PA389&dq=Caviidae+%22vitamin+C%22&source=bl&ots=ofF-Bu-mx-&sig=nPEZZ68O7v26lmGS9eAGfmaUZ1o&hl=en&sa=X&ved=0ahUKEwiIk471gInNAhUT0WMKHWlpAqAQ6AEISDAH#v=onepage&q=Caviidae%20%22vitamin%20C%22&f=false |archive-date=December 7, 2016 |df=mdy-all| isbn = 9781455773992 | date = 2014-07-31 | publisher = Elsevier Health Sciences }}</ref> The [[strepsirrhini]] (non-tarsier prosimians) can make their vitamin C, and these include [[lemur]]s, [[loris]]es, [[potto]]s, and [[galago]]s. Ascorbic acid is also not synthesized by at least two species of [[caviidae]], the [[capybara]]<ref>{{cite journal |vauthors=Cueto GR, Allekotte R, Kravetz FO |title=[Scurvy in capybaras bred in captivity in Argentine.] |journal=Journal of Wildlife Diseases |volume=36 |issue=1 |pages=97–101 |year=2000 |pmid=10682750 |doi=10.7589/0090-3558-36.1.97 |s2cid=6491859 |doi-access=free }}</ref> and the [[guinea pig]]. Certain birds and fish do not synthesize their vitamin C. All species that do not synthesize ascorbate require it in the diet. Deficiency causes scurvy in humans, and somewhat similar symptoms in other animals.<ref name=UKFSA>{{cite web |url=http://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/vitaminc/ |title=Vitamin C |access-date=2007-02-19 |publisher=Food Standards Agency (UK) |url-status=dead |archive-url=https://web.archive.org/web/20060701044718/http://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/vitaminc/ |archive-date=1 July 2006 }}</ref><ref name=UMM>{{cite web |url=http://www.umm.edu/ency/article//002404.htm |title=Vitamin C |access-date=2008-03-31 |date=January 2007 |publisher=University of Maryland Medical Center |url-status=live |archive-url=https://web.archive.org/web/20080412092448/http://www.umm.edu/ency/article/002404.htm |archive-date=12 April 2008 }}</ref><ref name=OSU>{{cite web |url=http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/ |title=Vitamin C |access-date=2007-03-07 |date=31 January 2006 |first=Jane |last=Higdon |publisher=Oregon State University, Micronutrient Information Center |url-status=live |archive-url=https://web.archive.org/web/20070306014837/http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/ |archive-date=6 March 2007 }}</ref>
Animals that can contract scurvy all lack the [[L-gulonolactone oxidase|<small>L</small>-gulonolactone oxidase]] (GULO) enzyme, which is required in the last step of vitamin C synthesis. The genomes of these species contain GULO as [[pseudogene]]s, which serve as insight into the evolutionary past of the species.<ref name="pmid1962571">{{cite journal | vauthors = Nishikimi M, Yagi K | title = Molecular basis for the deficiency in humans of gulonolactone oxidase, a key enzyme for ascorbic acid biosynthesis | journal = The American Journal of Clinical Nutrition | volume = 54 | issue = 6 Suppl | pages = 1203S–1208S | date = December 1991 | pmid = 1962571 | doi = 10.1093/ajcn/54.6.1203s| doi-access = }}</ref><ref name="pmid1400507">{{cite journal | vauthors = Nishikimi M, Kawai T, Yagi K | title = Guinea pigs possess a highly mutated gene for L-gulono-gamma-lactone oxidase, the key enzyme for L-ascorbic acid biosynthesis missing in this species | journal = The Journal of Biological Chemistry | volume = 267 | issue = 30 | pages = 21967–72 | date = October 1992 | doi = 10.1016/S0021-9258(19)36707-9 | pmid = 1400507 | doi-access = free }}</ref><ref name="pmid10572964">{{cite journal | vauthors = Ohta Y, Nishikimi M | title = Random nucleotide substitutions in primate nonfunctional gene for L-gulono-gamma-lactone oxidase, the missing enzyme in L-ascorbic acid biosynthesis | journal = Biochimica et Biophysica Acta (BBA) - General Subjects | volume = 1472 | issue = 1–2 | pages = 408–11 | date = October 1999 | pmid = 10572964 | doi = 10.1016/S0304-4165(99)00123-3 }}</ref>
==Name==
In babies, scurvy is sometimes referred to as ''Barlow's disease'', named after [[Sir Thomas Barlow, 1st Baronet|Thomas Barlow]],<ref>{{cite journal |author=Evans PR |title=Infantile scurvy: the centenary of Barlow's disease |journal=British Medical Journal (Clinical Research Ed.) |volume=287 |issue=6408 |pages=1862–3 |date=December 1983 |pmid=6423046 |pmc=1550031 |doi= 10.1136/bmj.287.6408.1862}}</ref> a British [[physician]] who described it in 1883.<ref>{{cite book | title=The History of Scurvy and Vitamin C | first=Kenneth J. | last=Carpenter | publisher=[[Cambridge University Press]] | year=1988 | isbn=978-0-521-34773-0 | page=172 }}</ref> However, ''Barlow's disease'' may also refer to [[mitral valve prolapse]] (Barlow's syndrome), first described by [[John Brereton Barlow]] in 1966.<ref name="pmid4159172">{{cite journal |vauthors=Barlow JB, Bosman CK |title=Aneurysmal protrusion of the posterior leaflet of the mitral valve. An auscultatory-electrocardiographic syndrome |journal=American Heart Journal |volume=71 |issue=2 |pages=166–78 |date=February 1966 |pmid=4159172 |doi= 10.1016/0002-8703(66)90179-7}}</ref>
== See also ==
[[Agustín Farfán]]
== References ==
{{reflist}}
== Further reading ==
{{refbegin}}
* {{cite book|author-link=James Lind|first=James|last=Lind|title=A Treatise on the Scurvy: In Three Parts, Containing an Inquiry Into the Nature, Causes, and Cure, of that Disease, Together with a Critical and Chronological View of what Has Been Published on the Subject|url=https://archive.org/details/b30511902|year=1772|publisher=S. Crowder (and six others)|page=[https://archive.org/details/b30511902/page/149 149]| edition=3rd | orig-date=1753 | ref={{sfnref|Lind|1753}} }}{{open access}}
* {{cite book|author=Carpenter, K.J.|title=The History of Scurvy and Vitamin C|publisher=Cambridge |date=1986}}
* {{cite web | author-link = Maciej Ceglowski | first = Maciej | last = Cegłowski | url = http://idlewords.com/2010/03/scott_and_scurvy.htm | title = Scott and Scurvy | date = 7 March 2010 | website = IdleWords.com | access-date = 10 March 2010 | archive-date = 10 March 2010 | archive-url = https://web.archive.org/web/20100310051741/http://idlewords.com/2010/03/scott_and_scurvy.htm | url-status = live }}
* {{cite EB1911|wstitle= Scurvy | volume= 24 | page = 533 }}
* {{cite book|author1=Vale, B. |author2=Edwards, G. |title=Physician to the Fleet: The Life and Times of Thomas Trotter 1760-1832|publisher=Boydell|date= 2011}}
{{refend}}
== External links ==
{{commons category|Scurvy}}
{{wiktionary}}
{{Medical condition classification and resources
| DiseasesDB = 13930
| ICD11 = {{ICD11|5B56.0}}
| ICD10 = {{ICD10|E|54||e|50}}
| ICD9 = {{ICD9|267}}
| ICDO =
| OMIM = 240400
| MedlinePlus = 000355
| eMedicineSubj = med
| eMedicineTopic = 2086
| eMedicine_mult = {{eMedicine2|derm|521}} {{eMedicine2|ped|2073}} {{eMedicine2|radio|628}}
| MeshID = D012614
}}
{{Nutritional pathology}}
{{Authority control}}
[[Category:Animal diseases]]
[[Category:Vitamin deficiencies]]
[[
[[Category:Nutritional anemias]]
[[Category:Collagen disease]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia neurology articles ready to translate]]
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