Near a Thousand Tables (10 page)

The new oceanic routes opened up from Atlantic-side Europe to cross the world in the sixteenth century regularly imposed much longer open-sea voyages on the seafarers. Travelers to the Indian Ocean normally spent at least ninety days without calling at an intermediate port and usually much more: 150 to 180 days constituted a normal run. No two major places on transpacific routes were normally less than ninety days apart. It was not unusual to spend six months at sea. Even transatlantic routes, which were shorter and faster, could involve journeys which exceeded the threshold period for scurvy, especially if they led straight across the Caribbean or were executed in convoy. A hundred or 130 days was within the normal range for a voyage from Seville to Veracruz. Voyages of such long duration were unprecedented and unanticipated. No one knew what the problems would be, let alone how to respond to them. In the early stages of this history, expeditions regularly ran out of food. Nor was it normal, or even possible, to carry antiscorbutics aboard ship. Of foods which can be classed as reasonably accessible in the modern West, blackcurrants are easily the best source: four times as rich in the vitamin as oranges or lemons, eight times richer than limes. None of these fruits, nor most other richly ascorbic fruits, had ever been classed as ship's stores, nor, even had seamen known of their properties, could they be successfully stored for long on board. The problem of obtaining vitamin C on long voyages is compounded by the fact that it is destroyed by heat—and therefore by most preserving processes—and dwindles rapidly in fruit that has been kept stored for a few days. Any oxidation—exposure to the air, slicing with an iron knife—increases the rate of loss.

In 1497-99, Vasco da Gama's first voyage to India and back, which involved two spells of fully ninety days on the open sea, was the occasion of the first great visitation of scurvy, which probably claimed the lives of most of the hundred men lost to sickness in the course of the expedition. Meanwhile, the explorers tried to
relieve their swollen gums, on the commanders' orders, by washing their mouths with their own urine. By the time Magellan's men reached Guam, on the first recorded crossing of the Pacific in 1520, they were reduced to eating weevily biscuit, sodden with rat's urine, and gnawing helplessly at leather casings off the yardarms with gums spongy from scurvy. Few of the men remained unaffected; twenty-one died. Scurvy was an unremitting enemy to long-haul navigators for the next 250 years.

Although other cases were known—among siege victims and soldiers on long campaigns—the fact that the incidence of scurvy was so commonly associated with long sea voyages turned physicians' speculations toward humidity and salinity in their search for the causes of the disease. Association with crowded shipboard conditions encouraged belief that it was an infectious or contagious affliction. The notion that fresh victuals might help was first suggested in the late sixteenth century, probably by readings in Galen, who had a strong prejudice against fruit but whose system of health emphasized the importance of a balance of humors in patients of cold and phlegmatic disposition; in particular, in a modification of his usual categories, Galen admitted lemons as a “warm” fruit for “cold” diseases. Scurvy was classified as a “cold” disease; even so, it was thought inadvisable to administer fruit to patients unless their temperaments were
suited to it
.

Meanwhile, the best progress in finding suitable treatments was made by physicians in Spanish America, who saw relatively large numbers of cases and had the pharmacopoeia of ethnobotany—the native knowledge of the properties of plants—at their disposal. The best account of both symptoms and remedies was published by an outstanding Franciscan writer, Fray Juan de Torquemada, in the 1560s. He described vividly the horror of treating men in agony, who could not bear to be touched or clothed, and who wasted with the want of solid food. The wonder cure he recommended was a kind of wild pineapple which he called by the native name, xocohuitzle,

and God gave this fruit such virtue that it reverses the swelling of the gums, and makes them grip the teeth, and cleans them, and expels all the putrescence and pus from the gums, and after a couple of ingestions of this fruit the patient recovers sufficiently to be able to eat properly again and try any sort of food without trouble or pain.

As early as 1569, the Pacific explorer Sebastián Vizcaíno was taking care to reprovision with fresh produce at every opportunity to cure scurvy or keep it
at bay. As soon as he got back on shore in Mexico after a grueling transpacific voyage,

the general ordered fresh food to be brought to the men on board ship, such as chickens, hens, kids, bread, papaya, bananas, oranges, lemons, squash and berries … so that in the nine or ten days they spent in port they all recovered their health and strength and rose from their beds so that by the time the ship sailed again, they could man the rigging and the helm and take their watches and do guard duty … for there was no medicine nor apothecary's drug, nor remedy nor doctor's prescription nor any other human cure against this disease; or if there was such a cure it was fresh food alone and
plenty of it
.

In 1592, a friar apothecary, Agustín Farfán, recommended the juice of half a lemon and half a sour orange with a little burnt alum. By that date, the effectiveness of such remedies had become widely known. English and Dutch navigators tried to get lemons, oranges or other fruit for their men where they could, but the problems of supply, storage and—from the point of view of naval administrators—expense all remained insuperable.

A crisis in the history of the disease occurred in 1740-44, when George Anson lost almost 1,400 out of a complement of over 1,900 men during his round-the-world voyage. Scurvy was only the worst of a plague of deficiency diseases, including beriberi, blindness, “idiotism,
lunacy, convulsions
,” but the Anson voyage provoked at last a systematic inquiry into how to treat it. James Lind, a naval surgeon who had seen service in the West Indies, tried out a large selection of the remedies previously proposed on a sample of twelve patients at sea, including such unpromising suggestions as seawater, “gutts of elixir of vitriol”—drops of a solution of sulfuric acid—and an ominous mixture of garlic, mustard, radish, quinine and myrrh.

Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of the knees. They lay together in one place … and had one diet common to all, viz., water-gruel sweetened with sugar in the morning; fresh mutton-broth oftentimes for dinner; at other times puddings, boiled biscuit with sugar, etc., and for supper, barley and raisins, rice and currants, sago and wine, or the like. Two of these were ordered each a quart of cider a day. Two others took twenty-five gutts of elixir of vitriol three times a day, upon an empty stomach, using a gargle strongly acidulated with it for their mouths. Two others took two spoonfuls of vinegar three times a day, upon an
empty stomach, having their gruels and other foods well acidulated with it, as also the gargle for their mouth. Two of the worst patients … were put under a course of sea-water. Of this they drank half a pint every day, and sometimes more or less as it operated by way of gentle physic. Two other had each two oranges and one lemon given to them every day. These they ate with greediness, at different times, upon an empty stomach. They continued but six days under this course, having consumed the quantity that could be spared. The two remaining patients took the bigness of a nutmeg three times a day of an electuary recommended by an hospital surgeon, made of garlic, mustard seed,
radix raphana,
balsam of Peru and gum myrrh; using for common drink, barley water well acidulated with tamarinds; by a decoction of which, with the addition of cream of tartar, they were gently purged three or four times during the course. The consequence was that the most sudden and visible good effects were perceived from the use of the oranges and lemons; one of those who had taken them, being at the end of six
days fit for duty
.

The cider drinkers showed a slight improvement. Everybody else got worse.

Lind had discovered a cure, but not a preventive; for there was still no way of preserving oranges and lemons at sea for long enough to secure the health of the crews. Nor was it clear from his work that citrus fruits would work for all patients: the theory of humors retained a residual hold on physicians' minds and universal cures were distrusted as quackery. During the 1750s and early 1760s, at least forty publications appeared in Britain alone with proposals for dealing with the disease. Richard Mead, who studied Anson's records and recollections, despaired of a solution: he concluded that sea air was irremediably unhealthful. Lind's own proposal was to issue rations of concentrated lemon juice; but the process destroyed the ascorbic acid and cost more than the Admiralty was willing to pay. John Huxham advocated the addition of cider to ships' rations, but the modest beneficial effects of this beverage vanished when it was stored aboard ship. Gilbert Blane realized that the therapeutic properties of fruit juice needed to be fortified to endure at sea and suggested adding alcohol: this kept the decoction drinkable but did not restore its effectiveness. David MacBride advocated unfermented malt, which, recommended by its cheapness, was adopted by the Royal Navy but was utterly inefficacious. It had the enthusiastic endorsement of Johann Reinhold Forster, the shipboard physician of Cook's voyage of 1772-75, though for the printed edition of his journal the
recommendation was deleted
. A surgeon with experience of Russian Arctic exploration advised “warm reindeer blood, raw frozen fish, exercise” with any edible greenstuff that might
come to hand
. During his Pacific odyssey
from 1785 to 1788 Jean-François de La Pérouse put his faith in breathing “land air” and mixing molasses, “wort, spruce beer and an infusion of quinine in the crew's
drinking water
” “Spruce beer” was an invention of Cook's, made of an extract from the Newfoundland spruce, mixed with molasses and pine sap and laced with spirits. It contained virtually no vitamin C.

The only vegetable food which retains reasonable quantities of ascorbic acid in a pickled state is sauerkraut, a food peculiar to Dutch ships among the navies of the early eighteenth century, but one which seemed to do good. In the 1760s and early 1770s Captain Cook's experiments convinced him of the virtues of this nostrum, which, thanks to Cook's matchless reputation, became standard-issue rations for long voyages. Cook virtually eliminated deaths from scurvy, after zealous trials of all the recommended remedies. His success was assisted by his regime of cleanliness, enforced by iron discipline. But until a way was discovered to preserve the juice of citrus fruits cheaply and without destroying the ascorbic acid, every substitute was of limited value. The only effective remedy was to replenish with fresh supplies at every opportunity and to eat as much greenstuff as could be encountered wherever a ship could land, ravaging desert islands for the barely edible weeds sailors called “scurvy grass.” By the time of the voyage of Alessandro Malaspina, the most ambitious scientific expedition of the eighteenth century, from 1789 to 1794, scurvy was virtually banished from the fleet, thanks to the conviction of the medical officer, Pedro González, that fresh fruits—especially oranges and lemons—were the essential remedies. Only one outbreak occurred in the entire course of the journey, during a voyage of fifty-six days between Acapulco and the Marianas islands. Five men, who were weakened by dysentery contracted in Mexico, went down with the disease and only one exhibited serious symptoms. After three days ashore on Guam on a diet rich in vegetables, oranges and lemons, he was
up and about
. Yet other navies, which lacked the Spaniards' advantage of a large colonial empire with frequent ports of call, remained desperate for alternative diagnoses and easier cures. As late as 1795, when Spanish crews were getting the benefit of assiduous treatment with citrus fruits, George Vancouver attributed an outbreak of scurvy aboard his ship to the men's “pernicious” practice of eating fat with their beans, though he took the opportunity of feeding grapes, apples and onions to the crews when they
reached Valparaiso
. The issue of lemon juice rations to English sailors began the following year.

Success in the treatment of scurvy reinforced the notion that food could be elevated, above its commonplace role as a nourisher, to the ranks of a healer. Food
health became a quest in which rising science met abiding religion. It was both a pseudo-science and a mystic vocation: pseudo-scientific because of the new prestige of science in the nineteenth-century West; mystical because it was developed beyond evidence by visionaries who, in many cases, were religiously inspired: if food was the key to physical health, why not
moral health, too?
The ancient sages, who formulated character-forming taboos of abstinence and restraint, had nineteenth- and twentieth-century successors.

Traditionally, to command prestige, medicinal foods had to be rare and costly. Readily available remedies tend to work poorly, because patients are disinclined to believe in them; part of every affliction is mental and cures have to be psychologically convincing to register mental effects. The great Jesuit traveler of the seventeenth century, Jeronimo Lobo, admitted that he had no medical knowledge outside the handbook he carried with him; but he found that he was much valued for consultations wherever he went: this was the common experience of deracinated “holy men.” On one occasion, during a spell when Catholics were persecuted, he was in hiding in Ethiopia, “surrounding ourselves with brambles in order to avoid attacks by thieves and wild animals, since the land had an abundance of both.” It was Lent and he wanted little food, but to get wheat for mass and lamb for Easter he treated a farmer's asthma in exchange. With difficulty, he persuaded his patient that an emetic would do no good. “Although there was a dearth of many of the things that could be of use to him, there was one item in abundance and very much available, namely, syrup of goat's urine taken in the morning on an empty stomach … which could not fail to bring him the desired result.” Lobo never found out whether the remedy worked: “I only know the payments
did not continue
.” Modern Western practice in healthy eating is in Lobo's tradition, because, instead of privileging rarities, it ranks commonplace foods and entire diets and “styles” of eating in order of healthiness.