Yo Ho Ho and a Crate of Oranges

Author: Yumnah Jafri

Imagine being aboard a ship in the 16th century, not as part of Luffy’s Straw Hat crew chasing the legendary One Piece treasure, but on a grueling, years-long voyage with nothing to see but choppy waves for miles around. For the first few months, everything seems to be going smoothly, but suddenly, you start getting hit with periods of lethargy so soul-draining that getting up off the cabin floor feels impossible. Then, your arms and legs begin to swell to twice their size, while purplish bruises spread across your skin. Old injuries reopen and ooze foul blood, and as if things couldn’t get any worse, you spit out several loose teeth everyday as your gums start to grow…spongy?

This narrative isn’t just a far-off story of some imaginary plague, but rather, a very real concern and plight for sailors between the 16th and 18th centuries. ¹ Hypovitaminosis C, more commonly known as scurvy, killed an estimated two million sailors, and was responsible for more deaths during this era than storms, shipwrecks, or ship-to-ship combat combined. ² Scurvy was so prevalent in long trips in fact, that the shipowners assumed a 50% death rate of scurvy for crew members aboard their ships! ³

Scurvy can occur because of deficiency in collagen protein production in the body. ⁴ Your body can run all its daily functions by creating and using this protein for a variety of functions, from digesting your meals to building up your muscles after a hard day of swabbing the deck. Collagen protein, specifically, makes up a large percentage of the total protein in the human body (30%) and essentially holds our cells together. In fact, the word itself is derived from the Greek word for glue! ⁵ Without this essential protein, the body can’t repair itself effectively when you get a papercut or maintain the group of cells that make up your gums so that your teeth fit into them snuggly.

Collagen is created in the body with the help of vitamin C. Vitamin C helps other proteins in your body convert the primary or “unfinished” version of collagen, called procollagen, into the final form that our body can actually put to use. ⁶ Our bodies don’t naturally make vitamin C, meaning that we rely on external food sources to maintain sufficient levels of it in our bodies. Most fresh fruits and vegetables typically contain some level of vitamin C, but the food we tend to associate with the highest levels of it are tangy citrus fruits. Vitamin C is also water-soluble, meaning that it isn’t stored in our bodies. This means that any unused vitamin C that our body doesn’t use is flushed out with urine by the end of the day . So, we should be eating a variety of fresh fruits and vegetables on a daily basis.

Sailors typically had limited access to fresh produce since modern refrigeration was unavailable, therefore, salted and nonperishable foods made up the main dietary intake of sailors on long voyages. Although sailors knew that scurvy was less prevalent when ships were restocked with fresh produce, no one seemed to fully understand why. This was until James Lind, an 18th century surgeon, used the scientific method to test out several scurvy remedies. This included using common treatments of that era, such as vinegar and lemon juice on sailors suffering with the illness to find what actually helped curb symptoms. With the results from this experiment, society came to the realization that citrus was the most effective preventative measure for scurvy.⁷ This prompted navies to stock citrus fruits aboard all its ships, leading many at that time to believe that scurvy would soon be eradicated.

That’s what you would think would’ve happened, right? In reality though, even in the 21st century, doctors still diagnose cases of scurvy all over the world. These diagnoses are common in cases with underlying reasons for not having a proper nutritious diet, such as with notoriously picky eaters (like kindergarten children), the elderly, at-risk populations such as those suffering from depression or eating disorders, and individuals from low socioeconomic backgrounds.^8,9 So, how can you make sure that you’re getting enough vitamin C in your diet? The answer lies in eating a balanced diet. This includes consistently adding fresh fruits and vegetables in your daily intake, like citrus fruits and their juices (grapefruits, oranges, limes, etc.), potatoes, tomatoes, and bell peppers.¹⁰ Health supplements may also be a viable solution for some people, but before you go down that path, it is important to talk to a health care practitioner to determine what is right for you. The death toll to sailors and seafarers caused by scurvy serves as a powerful reminder of the importance of nutrition, specifically on the value of fresh fruits and vegetables in preventing disease. It could be argued that the real treasure obtained by pirates and sailors braving the high seas was the knowledge that having the right type and amount of provisions aboard their ships, such as the number of citrus fruits, could mean a difference between life or being sent to Davy Jones Locker. Shiver me timbers!

1. Parsons, Usher. “Sailor’s Physician, Exhibiting the Symptoms, Causes and Treatment of Diseases Incident to Seamen and Passengers in Merchant Vessels: With Directions for Preserving Their Health in Sickly Climates ; Intended to Afford Medical Advice to Such Persons While at Sea, Where a Physician Cannot Be Consulted.” Medicine in the Americas, 1610-1920, 1820. https://doi.org/http://resource.nlm.nih.gov/2566035R.

2. Price, Catherine. “The Age of Scurvy.” Science History Institute, May 31, 2023. https://www.sciencehistory.org/stories/magazine/the-age-of-scurvy/.

3. Price, “Age of Scurvy”.

4. Maxfield, L, S F Daley, and J S Crane. “Vitamin C Deficiency.” PubMed; StatPearls Publishing, November 12, 2023. https://doi.org/https://www.ncbi.nlm.nih.gov/books/NBK493187/.

5. Price, “Age of Scurvy”.

6. Price, “Age of Scurvy”.

7. “The British ‘Limeys’ Were Right: A Short History of Scurvy.” Military Health System, January 10, 2022. https://health.mil/News/Articles/2022/01/10/The-British-Limeys-Were-Right-A-Short-History-of-Scurvy.

8. Lu, Rui-Ling, Jie-Wen Guo, Bao-dong Sun, Yu-Lan Chen, and Dong-Zhou Liu. “Scurvy in a Young Man: A Rare Case Report.” Frontiers in Nutrition 10 (October 17, 2023). https://doi.org/10.3389/fnut.2023.1265334.

9. Colacci, Michael, Wayne L. Gold, and Rupal Shah. “Modern-Day Scurvy.” Canadian Medical Association Journal 192, no. 4 (January 26, 2020). https://doi.org/10.1503/cmaj.190934.

10. National Institutes of Health. “Office of Dietary Supplements - Vitamin C.” NIH Office of Dietary Supplements, March 22, 2021. https://ods.od.nih.gov/factsheets/VitaminC-Consumer/.