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close this bookScurvy and its Prevention and Control in Major Emergencies (WHO; 1999; 70 pages)
View the documentAcknowledgements
View the documentScurvy: definition
open this folder and view contentsIntroduction
close this folderScurvy
open this folder and view contentsSigns and symptoms
View the documentDiagnosis of scurvy
close this folderHistory of scurvy
View the documentOutbreaks
open this folder and view contentsTreatment and prevention
open this folder and view contentsVitamin C
open this folder and view contentsRecommended Daily Allowance (RDA)
open this folder and view contentsSources of vitamin C
open this folder and view contentsStrategies to prevent scurvy in large refugee populations
View the documentCosts
open this folder and view contentsConclusions and recommendations
View the documentReferences
View the documentAnnex 1
View the documentAnnex 2
View the documentAnnex 3
View the documentBack Cover
 

Outbreaks

A large number of men in our army were attacked also by a certain pestilence, against which the doctors could not find any remedy in their art. A sudden pain seized the feet and legs; immediately afterwards the gums and teeth were attacked by a sort of gangrene, and the patients could not eat any more. Then the bones of the legs became horribly black, and so, after the greatest patience, a large number of Christians went to rest on the bosom of the Lord.

Jacques de Vitry,
13th century.

Scurvy is one of the oldest diseases known to humankind. There is evidence of its existence in the Old Testament, the Ebero Papyrus, and the writings of Pliny (Marks, 1975). The first concise account of scurvy, written in the 13th century, appeared in Jacques de Vitry's history of the Crusades, which included travelling to the dry countries of Eastern Europe and Southern Asia where few green vegetables were available for the foreign travellers. Many fell ill with scurvy. In the Middle Ages scurvy was endemic in Northern Europe during the late winter months due to the unavailability of green and root vegetables. Europe was introduced to the potato in the late 16th century by explorers bringing tubers back from Central and South America; it began to be generally cultivated and eaten throughout Europe during the 18th century. By 1800, scurvy had disappeared from many parts of Scotland where it had previously been endemic. During the same period potatoes became a regular part of the diet. Scurvy reappeared in Europe during the Great Potato Famine (1845-1848) when potato crops were lost due to bad weather (Carpenter, 1986).

At the end of the Middle Ages, sailors began travelling farther away from Western Europe. The first outbreak of sea scurvy was recorded during the Portuguese expedition to India in 1497 led by Vasco da Gama. The expedition lasted 4 months and out of 148 crewmen 93 died, chiefly from scurvy (Watt, 1982). Thereafter, there were numerous reports of scurvy on voyages lasting longer than 90 days, with Dutch, English, French, Portuguese and Spanish expeditions all being affected. Many lost a large proportion of their crew due to lack of vitamin C in naval rations. McCord (1959) has argued that scurvy, which killed two million sailors between 1500 and 1800, should be classed as history's foremost occupational disease.

Another major outbreak of scurvy occurred in California between 1848 and 1850 (Lorenz, 1957). Gold was discovered in a remote part of northern California in 1848. Over the next two years, some 100 000 people set off from the East Coast, either by sea or overland, to the gold fields. The distance overland was some 2500 miles and the journey lasted more than 6 months. Typical provisions were similar to those taken for a long sea voyage, e.g. flour and biscuits, sugar and salt powder or beef. At certain places and times of the year berries could be picked. Generally speaking, however, vegetation was very sparse in the Rocky Mountains. It was reported that at least 10,000 men died of scurvy, outnumbering those dying from cholera (Lorenz, 1957).

The next large-scale outbreak of scurvy occurred during the Crimean War (1854-1856); the many thousands of cases were a major cause of the heavy losses sustained by both the Turkish and French armies (Carpenter, 1986). Other outbreaks were reported during the American Civil War (1861-1865) and the siege of Paris during the Franco-Prussian War (1870-1871). In all cases the cause was identical: an absence of vitamin C in the diet.

Expeditions to the Arctic (1850-1915) experienced scurvy, including the famous Scott and Amundsen expeditions to the South Pole that ended tragically, most probably due to scurvy. Food rations included pemmican, biscuits, butter, cocoa, sugar and tea, all of which lacked vitamin C.

Other major outbreaks of scurvy occurred among infants as a new "disease of affluence", especially during the period 1877-1917. The increased use of manufactured infant foods, which at the time were poor sources of vitamin C, was presumably the main reason why infantile scurvy became such a problem in relatively well-to-do families (Evans, 1983). In fact, infants in poor families showed no signs of scurvy since they were usually breast-fed and, later, given potatoes as a complementary food instead of more expensive farinaceous foods.

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