This Podcast Will Kill You - Ep 19 Scurvy: Thanks a lot, evolution.

Episode Date: February 5, 2019

Arr, mateys, climb aboard for a swash-buckling tale of when the high seas were full of disease! Today we’re covering a non-infectious but no less terrifying scourge that has wrecked millions of lives and sent even the bravest of sailors quivering in their boots: Scurvy. From the open ocean to the California gold rush to modern times, scurvy has been causing collagen breakdown throughout human history, and we can blame it all on...evolution? See omnystudio.com/listener for privacy information.

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obliged to feed upon the very articles that had caused the disease, and growing daily weaker, without any reasonable prospect of relief. I was almost in despair, with only a blanket between myself and the damp, cold earth, and a thin canvas to protect me from the burning sun by day and the heavy dues by night. I lay day after day enduring the most intense suffering from pain in my limbs, which were now becoming more swollen, and were turning completely black. Above me rose those formidable hills which I must ascend ere I could obtain relief. I believe I should have died, had not by accident discovered a remedy. In the second week of my illness, one of our party found, strewn along a foot track,

a quantity of beans which sprouted from the ground and were in leaf. Someone had probably dropped them. He gathered a quantity and I had them boiled and lived entirely on them for several days, at the same time using a decoction of the bark of a spruce tree. These seemed to operate magically, and in a week I found myself able to walk, and with two companions walked into Coloma, they're living principally upon a vegetable diet, which I procured by paying $3 per pound for potatoes.

In a very short time, I recovered. covered. Wow. Hi. Hi. I'm Erin Welsh. And I'm Aaron Elman Updike. And you're listening to This podcast Will Kill You.

So that was some scurvy. Some scurves. That was really fun. And also $3 a pound for potatoes. I don't even think I pay that much today. No, you don't. In 1848. That's like got to be like, what, $100 today?

I mean, easily. thousand with inflation plus all the gold but also magical potatoes that yeah truly truly and we'll find out why soon so shortly so today's episode we're going to be talking about scurvy yeah i'm excited i'm really excited this is our first real departure on our own from infectious disease we've done crossovers where we talked about things other than infectious disease but this is our first solo journey down a non-infectious route. Yeah, I'm pretty excited about it. I think it's going to be great. I think so too. Actually, I know it's going to be great. Oh, good. Yeah. So we're going to cover the biology, the history, and the current status, question mark, question mark, question mark of scurvy.

But before we do any of that, it's quarantine time. Oh, yeah. What are we drinking? Today we're drinking the vitamin C legs. I forgot it and then I remembered it and was overjoyed by the name. Yeah. Yeah. Basically, it's a bunch of different citrus juices of your choosing. Yep. Vodka because it's made from potatoes or candy.

And soda water. Yeah. It's great. As always, we'll post the recipe on our Facebook, Twitter, and Instagram, which you can find us there. So we've got our quarantini, but don't worry because we're also going to be providing a recipe for our placebo-ridas. I still like that name.

It's a fine name. Anyways, that's our non-alcoholic version of our quarantinies. And those will also be on our social media. Okay. So my drinks in my hand. Mine too. I am preventing myself from getting scurvy with this delicious cocktail. Yeah.

But I want to know what the heck, how is this actually preventing me from getting scurvy, and what exactly is the beast of the disease? I can't wait to tell you. When was the last time you ate a nourishing breakfast that you felt good about? If you're looking to completely transform your breakfast, check out Daily Harvest. So one of my favorites is the chickpeas Zatar cup. It's tasty and full of fun flavors. That sounds good.

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like biology section over. Don't worry. We're going to get into more detail than that. Okay, good. So the first thing that I want to say, and this is because I don't want for people to feel silly if they don't know this, because I wasn't sure that I knew the actual answer to this. And that is what the definition of a vitamin is.

Like, I think I kind of knew, but I think having a good definition is a good place to start. So a vitamin is essentially an organic compound that we cannot make ourselves. and therefore we have to get it from our diet. So unlike most animals, actually, humans cannot synthesize their own vitamin C. Did you know that most other animals in the world make their own vitamin C? I did know that. They don't have to eat oranges.

They don't have to worry about it. They just make their own from sugar, glucose. The only animals that don't make their own vitamin C are, primates, except for the lemurs who are special and still make their own, guinea pigs and cabbaras, and some bats and some birds. And that's it. Everything else, your dog, you don't have to share your oranges with them. Yeah. They make it themselves. That is so cool. Yeah. And we just lost that ability. And so thanks a lot, evolution. Now we're dependent on oranges. Thanks evolution. Way to go. So the fancy scientific name.

for vitamin C is acorbic acid. Okay, we call it vitamin C because, again, it's a necessary part of our diet, so that makes it a vitamin. So the question is, what does vitamin C do and why is it something that's so important? How can it end up causing a disease as gnarly as scurvy? That's why I'm sitting here. Okay, it turns out that vitamin C actually does quite a lot of things, and because I'm not a biochemist, and this isn't a biochemistry podcast, I'm not going to get too, I'm not going to get too in depth on exactly the mechanisms of what it does. But the most important thing that it does and the way that you get most of the symptoms of scurvy are its effects on collagen. So collagen is this protein that makes up almost everything in your body. So collagen makes up your skin,

your tendons. It's the bottom layer in between all of your epithelial cells. So like in your bladder, there's collagen like lining the entire thing. It forms your bones. It's in your eyes. It's in your hair. Like everything in your body is in some way made up of collagen. Okay. So it's a really, really important protein. Must be. And it's a protein that's made of three different strands. So it's three single proteins that have to twist together into this triple helix. Like a pull and peel twizzler. Yes, like a pull and peel twizzler in order to be strong, right?

So you need like strong skin, strong bones. Strong twizzlers. So what happens when you have a vitamin C. So what vitamin C does is it allows for that folding, for that toezzlers. twisting to happen and for the bonds between those three strands of protein to be really strong. So without vitamin C, you can still make the strands of protein that make up collagen, but they can't bind together in the right way. So they're weak. I think everyone needs to go out and buy a pack of pull and peel twizzlers and try to pull

apart a single strand versus an entire rolled twizzlers. Oh my God. That's a great idea. Yeah. So excellent idea. And that shows collagen. Collagen. Boom. Boom. Oh my gosh, Erin. Way to go right now. Biochemistry outreach. So yeah. So that's essentially the biggest, most important role of vitamin C in your body that we know about. Like we know all of the details of this. And so when you have a lack of vitamin C and you can't make strong collagen, things in your body literally start to fall apart. part. So let's walk through kind of the progression of how this happens. So another thing that's important about vitamin C is that it's water soluble, which means that when you ingest it, you can absorb a lot of it, most of it, some of it, but you can't hold on to it in your body for very long. It doesn't

store in your fat tissues the way that some other vitamins do. So you pee out any excess vitamin C that you have, which means that you have to continually eat it. Like, you have to eat vitamin C every day. You're not going to be able to, like, store up a whole bunch. Like, something like vitamin B12, you can have, like, huge stores of that in your body. So it could take a really, really, really long time of being deficient in something like B12 before you actually see any symptoms. But with vitamin C, even just about a month of having little to no vitamin C, basically less than 10 milligrams a day in your diet, will lead to symptoms of symptoms. scurvy because it'll deplete your stores and then you'll just be running on nothing.

So here's what starts to happen. In about a month of no vitamin C, you'll start to feel really tired. You'll get lethargic and if you're, for example, a sailor out on the rough seas, you won't be able to do things like haul in that jib or swab the deck. Thank you. That's what I was trying to do, and I couldn't remember the words for it. I saw the motion. Thank you. Yeah. Your captain will be like, Schwab the deck, and you'll be like, but I'm so tired of my muscles hurt, and you just won't want to, and they'll probably throw you overboard, and you'll die that way. But if you don't, then you'll just keep getting worse. You'll probably start to notice a rash, especially on your legs.

Hence the name of our quarantini. Yeah, vitamin C legs. So you'll notice this rash and it'll probably look like little red or purple spots or splotches. And then those splotches might get bigger and bigger until your whole leg looks like you just went on a terrible snowboarding accident. And it's like, no, have you never been snowboarding? Sick reference, bro. I'm just saying you fall a lot. And then you end up with these bruises that are like the size of your entire. your butt cheek, but like you know where that came from, right? Because you fell a lot. But with scurvy,

you just wake up with these giant bruises and you're like, I didn't even fall. I haven't moved out of bed. I snowboarded in my dreams. Oh, did you get bruises? Anyways, you'll have these giant bruises, etc. Your joints will start to hurt. Do you want to know why? Of course. Your muscles are breaking down and bleeding into the spaces of your joints. And all those purple spots that you're seeing, that's tiny blood vessels just breaking and leaking blood into underneath your skin. Is it because they can't handle the pressure of like the blood flow and the collagen is so weak?

Yeah, exactly. Because you can't make any new collagen. And so collagen literally lines all of your blood vessels. Like the bottom of your, the cells of your blood vessels are made of collagen. and so yeah there's just collagen lining layers and layers of your blood vessel so when that collagen becomes weak then it just starts to burst and break leaky pipe leaky pipes and then your joints are hurting your muscles are tired you're bleeding under your skin and then you might go to take a bite of i don't know that stale bread or something that you've been eating for some reason and your tooth might

fall out because your teeth are held into your gums and your gums are full of collagen and your gums collagen is broken down so they're bleeding your gums are bleeding absolutely everywhere it's horrifying yeah bleeding gums is one of the sort of hallmark signs of scurvy so it's not really a great way to go are any of the diseases we've talked about a great way to go would you say no not really Okay. Just checking. Yeah. I mean, that's pretty much what Servi is. That's pretty much how it happens. You can't make collagen. All of the collagen in your body starts to break down and you bleed out. You can, really fun times, if you start to bleed into the sheaths that surround your nerves. So your nerves

are, they travel in your body sort of bundled together. A nerve is a bundle of a whole bunch of like individual nerve cells. And they're usually surrounded by these sheets. And if your blood vessels start to leak all over the place and leak into those sheets, you can compress the nerves and end up with paralysis and also a lot of pain because you're compressing these nerve fibers. So that's fun. So you die by bleeding out, basically.

That's one of the ways. Yeah, that's one of the common ways that you can die is just by bleeding out. You also, it's very common to die from secondary infection because vitamin C is also important in your immune system. And also collagen is just important in helping all of your cells work properly. And so you can die by secondary infection because your body just can't fight anything off because it's just trying to keep you alive and doing a poor job of it. So, yeah. I mean, that's scurvy. Do you have a question? I do have a question. You mentioned briefly that vitamin C is important in your immune system. All of these, and I know for a while there were so

many studies and products that are related to vitamin C and your immune system, the emergency packets or whatever, and if you take vitamin C, your cold will be shorter. Yeah. What is the actual verdict? What do clinical trials show? Great question. Excellent question. Here's the thing about vitamin C. We know a lot about what happens when you do not have enough vitamin C. So if you have less than 10 milligrams a day, then you will end up with symptoms of scurvy

and you will probably die if you don't get access to vitamin C. For a prolonged period of time, not just a day. Yes. Yes. Exactly. Yeah. For a daily basis, for, like a month, a couple months, many months. So we know that you need at least 10. That's like the bare minimum. Beyond that, there is no evidence that increasing amounts of vitamin C are beneficial in any way.

Okay. So we know that there's a minimum that you need to have in order to function normally. There is no evidence that taking things like emergency have any effect whatsoever on your immune system. In fact, there's been many studies and meta-analyses that show there is no additional immune boosting effect whatsoever. Okay. So it's not going to help you kick that cold faster, etc. There is evidence that having like relatively low levels of vitamin C, so maybe you're above that scurvy level, but you're still kind of low level, it can put you at higher risk for diseases like coronary artery disease. So it could be beneficial to have like a little more than absolutely

nothing, right? But beyond that, there's no evidence that having more than, say, like, 150 or 200, which is like the equivalent of eating a bell pepper a day, it's not any better. You don't, there's no impact on your overall mortality. Okay. Yeah. There's not even a standard number for like the recommended daily value. It totally depends on the country. So every country has their own version of the recommended daily amount of vitamin C. and it varies. Okay. Okay.

But yeah, so that's the best news about scurvy is that it's totally preventable. And even if you end up with pretty severe symptoms, like gums are bleeding, maybe your bones are starting to go, you're bleeding into all your joints. All of that is reversible if you give the person vitamin C. So even pretty severe symptoms are totally reversible. So it's a very preventable and very treatable disease. Yeah. That's cool.

Yeah. So talk to me about. how we figured out that scurvy was a thing and how we got to be where we are today. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's Working Hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented,

and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keef's. Just visit O'Keef's company.com slash this podcast and code this podcast at checkout. Why have I asked my age-fat guy I found on Angie.com to change my grandpa's trachea tube?

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Okay, two things, Deb. She's a nurse, too. I know. But also broccoli is full of vitamin C, one of the highest vegetable. And two, a lot of gummy candies have a scorbic acid in them. What's up, mom? Okay, I should warn you right now, though, because I mentioned the word pirates doesn't mean that I talk a lot about pirates. Because I talk about sailors.

And in that, I include pirates. So they're just kind of lumped in with all those other ones. That's fine. Also, pirates didn't really keep the best records as far as I know. I'm shocked. So they just have maps, right, with dots and X's. That's all they did. Yeah, exactly.

X marks the spot where you'll get scurvy. Okay. But when I started my research, right off the bat, I read a line that gave me an idea of just how rich and important scurvy's role in history was. You ready? Yeah. Quote, If we exclude straightforward famine,

Scurvy is probably the nutritional deficiency disease that has caused the most suffering in recorded history. Whoa. Yeah. That was a little surprising to me. I mean, I knew Scurvy must have been important, but I didn't have any idea of the scope and the scale of the history of this disease. So let me tell you.

Tell me. Let's start at the beginning. Scurvy is mentioned in several early texts, starting as early as 1500 BCE in ancient Egypt. Yes. We're finally back in Egypt. I love it. in the Ebers Ebers Ebers papyrus. I don't know how you pronounce it. It's a medical papyrus. It has also been found in writings from ancient India, Greece, Rome, China, etc., dating back thousands of years.

For the most part, these ancient texts focus on the clinical description of scurvy and recommendations for treatment, rather than identifying risk factors or any sort of pattern in disease incidents. Interesting. But it's pretty much a certainty that the disease existed during this time due to seasonal scare. diversity, crop failure, or during times of crisis like prolonged sieges during warfare. So it's interesting that there doesn't seem to be a consistent history of the burden of scurvy throughout these early years. There could be several reasons for this. For instance, if you were in the middle of a prolonged siege with little food, you probably had multiple nutritional deficiencies. And so scurvy could have had different appearances depending on the exact

conditions of your setting. But what I find really interesting about scurvy in these texts is not the apparent gap in its history, but that effective treatment for the disease was discovered, lost, rediscovered, debunked, rediscovered, rediscovered, et cetera. Oh my God. For thousands of years. The actually thousands of years. That ancient Egyptian papyrus that I mentioned earlier.

Yeah. It recommends a diet of fresh fruit and vegetables to cure the condition. Whoa. In 1500 BCE, 3,500 years ago. Wow. And yet, despite this knowledge, millions of lives would be lost due to scurvy in those 3,500 years. Wow. Isn't that crazy?

That is really crazy. I'll tell you why. Don't worry. I was going to say it's just because, like, nobody paid attention. Like, so much of ancient Egypt was lost for so long. It was. but it's more complicated than that. Oh, good.

Yeah. From around the 4th century AD or so, Scurvy rarely shows its face and writings for about a thousand years. In the 1400s, Scurvy suddenly picks up steam and is everywhere. Can you guess why that might be? Travel. Yeah. I thought I was going to get it wrong.

Because people started sailing really long distances, which meant potentially long periods of time without any fresh fruit or vegetables. As a result, descriptions of scurvy during this time and the next few hundred years focus on it as being a disease of sailors, including pirates, which would, of course, complicate things when trying to identify the cause of the disease. Yeah. But I'll get to that. The more that a culture or country was involved in oversee trade, exploration, or colonization

of distant lands, like Portugal, looking at you, the more we see scurvy descriptions. And obviously there were many names for the disease. In Portugal, it was known as the curse of the mouth, for instance. Bleeding those gums. We know that scurvy started appearing more and more in the 1400s, 14 and 1500s because people were sailing longer and longer distances. But why did people start doing this? Why did they start sailing longer and longer distances then?

The simple answer is that shipbuilding technology had been greatly advanced by Portuguese sailors, during that time, and better ships combined with better navigation, like improved compasses, meant that you could point in a specific direction and actually go there rather than just crossing your fingers and hoping for the best. Right. But why this surge in navigational technology? There's a point to this rabbit hole. Let's take a quick look at what happened between the years 1350 and 1,500.

If you remember from the plague episode, the Black Death took place. from around 1347 to 1352, during which time it wiped out a third to a half of the entire population of Europe. As I mentioned during that episode, the consequences of such enormous population loss were incredibly far-reaching. Before the plague, most books were in Latin, making them largely inaccessible to the majority of the population. But after the plague, many were translated into the vernacular, making education much more widely acceptable. Also, the economy boomed because so many people suddenly had more disposable income than they knew what to do with, the result of multiple inheritances from so many of their relatives dying.

Oh my God. The Overland Silk Road connecting to Africa, Asia, or connecting Africa, Asia, and Europe was dangerous, not fast enough to keep up with demand, and there were too many middlemen to pay for your goods to be delivered. This created a demand for an alternate route between Asia and Europe, which led people to the sea to venture on these long voyages with no end in sight. During these long months at sea, sailors primarily survived on preserved rations, stopping occasionally to restock their stores, but the lack of fresh vegetables and fruit led the way to a huge increase in scurvy.

Portugal led the world in these long voyages, and so it's in the journals and ship logs of those sailors that we see scurvy debilitate and destroy a ship's crew, as it would for the next 400 years. Whoa. From the Black Death, to economic boom and technological development, to exploration, to scurvy. Everything is connected.

Oh, my God. Isn't that thrilling? That is awesome. I mean, it's a really oversimplification of things. Yeah, but many factors. Still. But that's why I love the historical context. Everything is stinking connected.

I love this so much, and I feel like I really wish that when I had taken history for most my entire life, up to this point that any teacher I had ever did things like this. It's just so, I mean, it's so silly to study things in isolation. Yeah, I agree. Even Scurvy, even the Black Death, all of these things, everything is connected, shipbuilding technology, who knew that had a link to the Black Death or Scurvy or Inheritance tax. And like, of course it does because everything is connected. But like to see those connections is awesome.

Yeah. Oh, that is so cool. Back to Scurvy. Scurvy is beginning to be mentioned more and more as a problem on these oceanic voyages, but exactly how big of a problem was it? Let's see this by the numbers. Vasco da Gama was a famous Portuguese navigator who, side note, died of malaria. Oh.

And was also a really big a hole. Just check out his Wikipedia page if you're bored sometime. During his circumnavigation of A-Holk, Africa, Da Gama lost 30 men out of a crew of 140 to scurvy. Estimates vary. It would be a little higher, actually. Okay. And only a handful could operate the ships during times when everyone, like seven or eight

could operate the ships out of his whole crew because everyone else was sick with scurvy. So even those who didn't die, pretty much everyone had it at some point. Okay. The numbers would have been a lot higher if they hadn't stopped for some oranges in Mombasa. Mm. Another name that you may have heard of is, Ferdinand Magellan. Yes. Are you Jellin?

I'm Jellin. Like Magellan. Look at him yelling. He's so not jelling. I'm jelling. I'm jelling. Anyways. Anyway.

So Micellon, also a famous Portuguese explorer, is probably most famous for his attempt of circumnavigate the globe. His ships made it. He didn't. He was killed in the conflict in the Philippines. But along the way, 76 men out of the 237 that started the journey, died of scurvy.

In an English expedition in 1740 to capture a Spanish treasure ship, Pirates. I'm sorry, I'll stop. Maybe they were pirates, I don't know. 855 men out of 1,000 sailors. Died of scurvy? Died of scurvy. 855 out of 1,000. That's 85.5%.

Very high. Holy cow! Yeah. An English sea captain named Sir Peter Hawkins in 1590 said that during the 20 years he worked at sea, he could count at least 10,000 sailors that had died from scurvy. During the age of exploration, so between 1,500 and 1,800 roughly, an estimated 2 million sailors died of the disease. Oh, my God.

It's big. I had no idea. Yeah. Side note, hashtag not all sailors. Not everyone who went on these voyages died of scurvy. Captain Cook, for instance, constantly restocked his ships with fresh fruit and vegetables wherever they stopped. And I think he had just like one case of scurvy in his crew. Wow.

Yeah. And just because you were on land during this time didn't mean you were safe from scurvy. In fact, around the same time. that people started sailing these long distances, they started to settle in unfamiliar far-off lands where they didn't really know how to survive. For instance, in the first year of the English settlement of Jamestown in Virginia, many people died of scurvy, along with many other illnesses and just straight up starvation. Of the 500 that arrived in August of 1609, only 60 were left alive in May 1610, so less than a year later.

Holy cow. Yeah, Jamestown was almost like almost failed completely. Wow. Yeah. Several French expeditions to the great white north of Canada were also debilitated by scurvy when they stayed too long and had to overwinter in Quebec and around there. Is that where our firsthand account came from? No, our firsthand account came from the California Gold Rush. Ah.

If you're interested in this, you can read all about these expeditions and so, so, so many more. that we just don't have time for in Kenneth Carpenter's The History of Scurvy and Vitamin C. Clearly, Scurvy had become a pretty big problem in a short amount of time, and its impact was only continuing to grow, especially as commercial shipping increased throughout the 16 and 1700s. With so many lives, aka wealth, at stake, finding a cure or preventative for scurvy was a pretty pressing matter. Yeah. And you would think, based on the fact that valid remedies had been.

written about thousands of years before. Yeah. And that many people on these voyages reported getting instantly better after landing somewhere and eating fruits and vegetables for the first time in 10 weeks. Oh, no. That the issue of prevention or treatment would be more about the logistics of keeping these fresh fruits on board rather than actually identifying what it was that would stop a scurvy outbreak.

Yeah. But I'm guessing it's not from your tone. But no. Oh, dear. There was still no consensus amongst physicians and shipcapt. on what was the best anti-scorbutic. But before we dismiss them as being stupid or... Inattirvana, whatever.

Let's consider how these scurvy patterns would have appeared. Okay. First, cause. If you're a ship captain, you notice that after weeks and weeks at sea, your crew has bleeding and swollen gums, and their legs are full of sores. Yeah. You think, well, it's probably because they're lazy,

they're not moving around. And plus, there's that stagnant, damp, dank air in the ship's belly. Okay. It's probably not helping things. Okay. Probably true. Plus, if your diet is extremely limited for a long period of time, you're probably suffering from a number of different nutritional deficiencies in addition to scurvy,

which makes these disease symptoms inconsistent. Okay. From case to case and from ship to ship and journey to journey. I'll buy that. Okay. Now, treatment. You get to land and begin to chow down on the first. food that's newly available because you're really tired of the same salted meat and porridge or

whatever. Suddenly, everyone starts to rapidly improve. Scurvy's gone. Might be the air on land is different. You think back to what your captain pal has said about the restorative powers of citrus and you're like, oh, okay, that could be it. Better take some back with us before we set off again. And you do. You tell your crew to eat one lemon a day until you run out. But you do run out. And scurvy doesn't immediately reappear. In fact, it takes weeks before it starts to creep back. Okay, so maybe it's not the citrus necessarily that prevents scurvy, but you're not completely willing to give it up. So the next time you set off on an expedition, you try to find a way to bring citrus fruit with you. Storing crates of fresh fruit on board isn't a realistic solution, since they would all spoil

before you got to your destination. Yeah. So maybe you make a drink out of it to store it. But you have to preserve it in some way, like maybe you boil it. So the next time you go, you bring barrels of boiled lemon drink, which little do you know is actually useless against scurvy because the boiling actually inactivates the vitamin C. Yeah, it does, guys, it does. When your crew gets sick from scurvy, even while drinking the lemon juice, you're like, well, okay, I guess it's not citrus. And the links between what caused scurvy, what prevented it, and what treated it, they just weren't very straightforward. All right. Throw into that the fact that scurvy was also successfully treated by certain plants and the consumption of fresh meat.

And you can see why it remains such a mystery and problem for so long, even with all this knowledge. It's interesting, though, that in Egypt, their remedy was just a blanket, fresh fruits and vegetables, which is more broad. broad, right? We're not trying to get so specific, like you need to have a citrus fruit. It's interesting. But I buy it, I guess. They're just like, it's hard. It's interesting. And it's, I mean, I do think, I do think that we have a tendency to look back negatively on the observational powers of people. And I think that's not fair necessarily considering the context in which they lived. Right. Yeah. And I really, I think the way that you put it in context is really, it makes it a lot more clear. So thank you. Of course. But people had to do something. Money and goods. I mean,

lives are being lost. In walks, James Lynde, an officer in the British Royal Navy, who in the 1700s decides to run a clinical trial for scurvy curatives. Oh my gosh. Wow. Very exciting. Yeah. I'm not sure that it would pass a medical ethics review board today. That's not really the issue. They usually wouldn't. No. One group of men with scurvy would be given oranges and lemons, another apple cider, and a third, nothing. Okay.

And there were other treatments in there as well. As you might predict, the ones who ate the oranges and lemons recovered the fastest, followed by the apple cider group, and the third group just didn't get better. Did they eventually give them oranges? Or did they let them die? I don't know. I don't know. This was a pretty resounding answer, though, to how to prevent scurvy.

Yeah. Eat citrus. Yeah. Lind wrote up his results and thoughts, which were widely read, but it would take about 40 years for his advice to be heated. In the late 1700s, the practice of providing lime or lemon juice to British sailors began, hence the nickname Limey. Also, the words for lemon and lime were interchangeable, both in English and many other languages as we have. Limon, if we've learned. I have a question.

Yeah. You keep saying that they would eat lemons. Uh-huh. Would they just like chow down on a lemon? Were lemons different back then? Because I cannot imagine just chowing down on a lemon. Mostly it would be like lemon juice is what they would do. So they would maybe add sugar or, okay.

Yeah. I was just picturing them like, here, sancho on this lemon. And I was like, wow, people were bold back then. No, no. No. So even though sailors were being given lemon and lime juice, this didn't really mean that scurvy disappeared at all. Throughout the 1800s, it still popped up on some of the ships that were giving their crew lemon juice, mostly because during the preparation, the vitamin C was inactivated in some way. But it also started appearing more and more on land.

In prisons, for instance, where certain prisoners were denied potatoes and onions. I don't know why. In California Gold Rush country, like our first-hand account. So if you wanted to try your hand at gold prospecting, you had to either travel by land in a wagon across the entire U.S. You could travel by sea from a port like Boston all the way around the tip of South America and back up. Or you could take a boat down to Panama and walk across the narrowest part of the country. There was no canal yet.

and then you would take a boat on the other side of Panama up to Northern California. Wow. But basically the journey was very long and scurvy was almost inevitable. And if you didn't come down with scurvy on your way to California, you were sure to get it once you were there. Oh, God. That part of California was fairly remote at that time with few farms. So gold miners mostly ate flapjacks and molasses. Yeah, 49er flapjacks. That's the thing.

Mm-hmm. If you wanted to eat. onions or potatoes, get ready to fork over all of the gold that you found. That's so, man, capitalism. Right. Starts way back when. Scurvy was also really common in many Arctic and Antarctic expeditions, unless they found enough seals or penguins to eat, as long as they ate the meat mostly raw.

Unlike humans, not all animals, as we mentioned, have to acquire their vitamin C through diet. And so if you ate the flesh of these animals that produce their vitamin C, like many people who actually who are native to those parts of the world, they would just eat raw or barely cooked meat and replenish vitamin C. Sear on that penguin breast. Yeah. It's all you need. It's very cool. I like that a lot. Also, during the Great Famine in Ireland in the 1840s, scurriline.

Scurvy appeared alongside starvation since the potato crop, which had failed, was the usual source of vitamin C for those populations. In the late 1800s and early 1900s, Scurvy starts appearing unexpectedly in a strange population. Babies born to wealthy families. Oh, I know exactly where this is going from. Yep. Basically, these mothers weren't choosing to breastfeed, and instead, they gave their children formula which they could afford to buy, mixed in with milk, which had been pasteurized, and its vitamin C inactivated.

Yeah. In the past, these mothers would have given their infant to a wet nurse, so the kid would have gotten vitamin C that way. Yeah, because your breast milk is full of vitamin C, as long as the mother has adequate vitamin C intake. Amidst all these outbreaks of land scurvy was a renewed interest in finding out of finding out of out what the cause of the disease really was. And people had some nifty new ideas. In most of the episodes of this podcast, this is when germ theory pops up as a shining beacon to light the way for vaccines and antibiotics, but not so for scurvy. No, not so? No, because scurvy isn't an infectious disease. Yeah. But that's not what a

handful of people thought in the mid-1800s. Ooh, fun. So when germ theory began to catch on, pause for laughter. Sorry. It was trendy to call every disease contagious. I love this. Isn't it amazing? Yeah.

But it also, I do feel like, to their credit, scurvy has a lot of symptoms that I would totally believe seem infectious, right? Absolutely. You're bleeding from your gums. You've got these bruises and sores everywhere. Like that totally looks infect. And you can often get secondary infections on top of it. Well, and also it doesn't usually happen to just one person.

Yes, that's true. Yeah, it's like groups of people. Yeah. For instance, the guy who showed that tuberculosis was contagious, his name is Jean Antoine Viamen. I don't know how you say his name, said, quote, Scurvy is a contagious miasm comparable to typhus, which occurs in epidemic form when people are closely congregated in large groups. It is ridiculous to suppose that a lack of fresh vegetables is the cause of the disease.

And we're laughing at you, sorry, from 150 years later. No, I mean, yes, we're laughing at you, but also it's in an acute way. Yeah, sure. Another person suggested that lime juice was effective because it acted as an antibacterial mouthwash. Oh, I love that. These opinions were in the minority, but it just speaks to the fact that there was still active debate on the cause and thus the treatment of scurvy. Viewing a disease as a deficiency rather than as a positive state was a really difficult thing for people to conceptualize. Yeah.

Especially when everyone was looking for the thing, path. pathogen, toxin, whatever, that actively caused a disease. It was way past time for some real experiments to begin. Fortunately, in the 1900s, experimental studies of scurvy became popular, and more importantly, possible, thanks to a very lucky choice of animal model. Oh, my God, I was just going to say, how could they have done... Did they just happen to choose guinea pigs? Yeah.

Are you serious? Okay. Okay, so there's a reason behind this. I am amazed right now. Yeah. Because of all the animals, a freaking guinea pig you choose? Yep. Oh my gosh.

I don't remember if we've talked about what animal models are before in this podcast. I don't know. We've kind of mentioned them, but we haven't explained them necessarily. Yeah. Yeah. I mean, basically, in medical research, if you're trying to learn more about a human disease or a treatment for a disease, you can't really do a lot of experience. experimental research on humans directly, so it's really important to have an animal in which the

disease acts similar to the way it does in humans. Yeah. Anyway, the issue of an appropriate animal model for scurvy had come up before, because as I mentioned, some animals can synthesize their own vitamin C. Yep. So rats had been a popular lab animal at this time. Lab rats and pigeons, actually. Hmm.

But lab rats were viewed. as like infection carrying and gross, like the tide had turned against rats around this time, and they were really gross. But guinea pigs have started to be imported as pets for children and as little just cute things. And so possibly lab animals. Oh, my God. So some guy named Axel Holst somewhat randomly chose a guinea pig as a model for scurvy. And it just happened to work.

The amount of coincidence in science and scientific discoveries is phenomenal. Yeah. So now the experiments could begin. And they would show that scurvy was directly related to diet and that fresh fruits, vegetables, raw milk, some kinds of meat, prevented scurvy. There are so many important names that contributed to this research. But I want to quickly shout out. Dr. Harriet Chick, whose lab in London consisted almost exclusively of women because all the men were at Army

Labs during World War I. I love it. And her research showed that the amount of raw milk fed to a guinea pig determined whether or not the animal would get scurvy. Wow. Harriet. Harriet. So they knew what scurvy, so they knew that scurvy was related to diet.

But what was the unifying thing in all of these anti-scurvy? Fibutic foods, vitamin C, which at that point was still unknown. Yeah. It was just called vitamin C because vitamin A and B had already been found as nutritional factors which that were necessary for the growth of rats. Wait. So they just found these compounds and they just were like, okay, we'll call this one vitamin A and we'll call this one vitamin B.

And so with this, when they were trying to figure out scurvy, they were just like, well, we know it's something different. So we're going to call it vitamin C. but we have no idea what it is. Yeah, it was just a numbering system, a naming system. For things they don't know. Yeah. That's amazing.

I think A and B might have been known. I'm not sure about that. Okay. Yeah. But C was not. That is so hilarious. Yeah. In 1930, a Hungarian chemist named Albert Cent Gallorgi isolated a compound,

which was later named ascorbic acid, also anti-scorbic. Corbutic, escorbic. Oh, you just blew my brain. What's up? And so that was discovered to be the vitamin C that so many people had been looking for, which would get him a Nobel Prize, actually, for that effort. So now that the compound was isolated and described, a pharmaceutical company immediately took out patents to commercially produce the vitamin.

Of course. And make a fortune. Number one. But eventually, actually, actually, actually. success to vitamin C became very cheap and easy. And it's also in a lot of fresh fruits and vegetables. Yeah. Did people figure that out pretty quickly? They were like, oh, this is in tons of everything that we. Right. Oh, yeah. Okay. Yeah. No, it was, mostly it was testing these, foods and such for that. They were all found relatively quickly. Okay. So throughout, once,

once vitamin C was discovered, though, cases of scurvy really dropped off. And there were a few cases here and with a fad diet where you just drink green tea for that's it and honey or something. Green tea and fen, baby. Oh, my God. But I'm guessing that Scurvy didn't completely disappear. So, Aaron, tell me where do we stand with Scurvy today? I love to.

There basically are no solid numbers on how many cases. of scurvy exist in the world in 2018 or 2017 or 2016 or the 2000s for that matter. Okay. So it's eradicated. It's definitely not eradicated. I've really, I feel like I've said this on a few episodes already this season. I really tried hard to find numbers on this. And I couldn't. Everyone, if you're playing a drinking game, that's related to the podcast. That's one of the rules. Yeah, okay, anyways. CDC, WHO, FDA, they all failed me.

Nobody has numbers. Fighting words. Yeah, I'm ready to fight with someone about this. And I have a feeling that it's in large part because this is a disease that is so easily treatable and preventable, it's not reportable in any real way, right? it's not something that people are necessarily keeping tabs on at national or international levels. Okay. That doesn't mean that it's gone. When you search for epidemiological information on the status of scrovy, what you find are tons, like dozens and dozens of case reports. Case reports are when physicians, after they see a case of something that they don't see very often, they write it up.

But I found lots of these. Lots of them. All over the U.S., all over Australia, Europe. This is happening not just in places that we in the U.S. might think sound far away. This even happens in the United States even as recently as the last few years this year. I'm sure there's been cases of scurvy. But the real question that remains about scurvy isn't even necessarily how many cases there are,

but why these cases are happening. Because we know exactly what the cause is. We know exactly how to prevent and treat it, and it's very easy. You don't even need any drugs. You just need a bell pepper or a potato or an orange or a piece of broccoli. Right. Right? That's all it takes.

What is standing in the way of people having access to that kind of food or a supplement in another way? Exactly. And so that's really what it comes down to is for the most part, the people who end up getting scurvy have a lack of access. So scurvy tends to still happen today in modern times in populations like refugee populations that might not have access to any fresh fruits or vegetables and have a very limited diet in terms of what they can access and what they're able to eat because they might be getting food in like bags from organizations that send them to them, right, or things like that. Or they might just have severe malnutrition to begin with. And so scurvy is a very, very common, like you kind of mentioned, it's a very, very common

syndrome that comes along with generalized malnutrition. Right. And part of that is because since vitamin C, you can't store it in your body for very long, it's not one of the first things necessarily that you'll end up like dying from, but it is something that relatively early on, like within a month or two of having not enough food you can end up with scurvy or symptoms of scurvy. The other populations that it can happen to are lower income populations that can't afford fresh fruits and vegetables. Because the thing about vitamin C is that it breaks down relatively easily. So even if you're eating foods that in theory

have vegetables in them, if they are all canned foods or they're all microwaved to, oblivion, then you're not actually getting any of the vitamin C that might be in those foods. So even though you're eating a can of chicken tortilla soup that has bell peppers in it, you're not getting any of that vitamin C from those bell peppers. And that's an actual real case that I found in Houston of a woman who was eating only chicken tortilla soup to try and lose weight. And she ended up with scurvy diagnosed in Houston a couple years ago. Trying to wait.

Yeah. Okay. Yeah. Yeah. And so there's kind of, we've already hit on two populations. Just one kind of soup? One soup. Did she say anything about why she chose that particular soup?

What brand was it? And I quote, chicken tortilla soup. I'm sorry. That's all I got for you. Anyways. Yeah. Eat your vegetables. Yeah.

I mean, that's sort of the, that's the. long and short of it. Yeah, so it can happen in low-income populations. It can happen in displaced populations. It can happen also in populations maybe with mental illnesses who aren't eating, maybe who aren't eating at all, or who aren't eating fresh foods and vegetables. Maybe they're only eating toast or they're only drinking something or whatever. Right. Yeah, so there are definitely still populations both in this country, in every country. It definitely, it is still an issue. It still happens. The only numbers that I saw, some articles claimed that the overall rates of scurvy or of vitamin C deficiency, rather, not of scurvy necessarily, could be anywhere from 2% or 7% in

countries like the U.S. to up to 45% in other countries. And the other population that it can happen to is children, whether because they're very picky eaters or because they also don't have access to foods that are fresh. I also read something, speaking of populations, Bachelor Scurvy was a term that was used frequently. And this was to refer to older men who lived alone or widower scurvy. Yes. Who lived alone and this was largely in like the early 1900s.

And just did not eat any fresh food. they just ate. Yeah. Yeah. It definitely is, older populations are especially at risk for sure because they might not be eating much at all. Right. As you age, it might be like your metabolism slows down.

You're just not hungry. You're tired. Or you also, if you aren't working, you might not have a lot of money, et cetera. So you're eating things that, yeah. So it's definitely, I haven't heard the term bachelor scurvy. Yeah. But yeah, it definitely, that's a population that would definitely be at risk for scurvy. and one thing that I found interesting is that clearly scurvy still happens.

Right. Scurvy still happens everywhere. All it takes is just not eating fruits and vegetables. So it's not hard to get scurvy if you think about someone only eating like toast and rice or something like that. Chicken tortilla soup. Chicken tortilla soup, whatever. But yeah, so that's scurvy in the world today. Wow. Okay. Very interesting. Yeah. I had fun doing this. I love this. I thought it was a really fun departure. I loved seeing germ theory from the other side. Yeah, we've never seen that. How fun. And I'm sorry there weren't more pirates.

You know, I made them enough. I just kept shoving the pirates in there. I mean, the thing is, is that pirates were just a part of all of the sailors. If you want to read about sailors and pirates, Let's talk about sources. Let's. Okay. Great transition, by the way. So I read a book by Kenneth Carpenter, which I mentioned earlier, called The History of Scurvy and Vitamin C. It is extensively well researched. It is great.

It's a really thorough book. Also, A History of Scurvy and Vitamin C by Howard Sauer, Salberlick, in the book, Vitamin C in health and disease, the Cambridge World History of Human Disease, and then a couple of articles, which we'll post. Yes, we will post all of the articles that we used on our website. This podcast will kill you.com. You can find those under our episodes tab. Each episode, we have all of our book lists and our article lists.

If you are, for some reason, especially interested in any of the case reports, shoot us an email at this podcast, We'll Kill You at gmail.com. and I'd be happy to send you those. You also can find us on Twitter at TPWKY, and this podcast will kill you on Instagram, where we post lots of pictures and cool stuff that we find about each episode. Thank you to BloodMobile for providing the music for this episode and all of our episodes. We love it.

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