When Spring Fever Was a Real Disease

In centuries past an affliction struck the populace in spring, rendering them weak with joint swelling, loose teeth and poorly healing wounds.  The name given this disease of listlessness and weakness was “Spring Disease”, or “Spring Fever”, and that name has continued into our time as the listless loss of ambition that accompanies the first few days of warm weather in the spring.  A few centuries ago this disease of spring was more serious and was often fatal.  It was scurvy.  Scurvy is the lack of vitamin C, of course, and in the 18th century it was a major threat to life. 
On the land it was known as the “Spring Disease” because it occurred in that season.  During the winter, when no fresh vegetables were available, people depleted the vitamin C stored in their bodies during the preceding year.  More accurately it was an “End of Winter Disease”, striking people before fresh food became available once more.  Before the advent of urbanized society with its general decline in available fresh produce for the diet, the disease was less common, but when food had to be transported to cities; vitamin C deficiency became a serious problem.
There are several vestiges of this disease still present in our language although the disease that gave rise to them has since disappeared, at least in areas with access to fresh food year round.  One of the most common is the adage that “an apple a day keeps the doctor away”.  Apples are a source of vitamin C, and a daily dose of apple would avoid this “Spring Disease”.  Apples can be stored through the winter as well.  Johnny Appleseed, who is purported to have planted apple orchards across the United States, may have been one of the major public health figures of his time and his work may have enabled the “settlement” of the trans Appalachian region in the 19th century.
I can also remember getting an orange in my Christmas stocking each year, a tradition continued by my parents from their youth, even though we usually had oranges in our house at the time.  An orange would help keep the “Spring Disease” away, and in my parents’ day oranges were far less common.  An orange was a fitting “treat” and medicinal as well, at the beginning of winter.
When I worked in Appalachia in the 1970’s I remember the various “spring tonics” that were used there to “clean out the body” after the winter.  I don’t recall all the ingredients in these, they were many and varied, but onions and sauerkraut were common and both provide vitamin C.  Fresh vegetables were plentiful when I was in Appalachia as were oranges when I was getting my Christmas stocking.  Fresh vegetables obviated the need for either of these, but since the original givers of the tonics and the Christmas gifts were unaware of why they were giving them and why they worked, it is little wonder that the tradition persisted after the need had passed.  It is even possible that when your mother (or grandmother) told you to “eat your vegetables”, she was preventing a disease which she did not understand; even if she did know how to prevent it.
On the sea, scurvy struck ships of the 17th and 18th centuries but was at first believed to be a different disease than land scurvy.  As urbanization brought changes that made “Spring Disease” more prominent on land, changes on the sea made scurvy more prevalent.  Longer sea voyages were taking place, and sailors were being kept on board their ships when in port, to avoid the desertions inspired by the hard life at sea, particularly on warships. Even here it was noted that ships sailing in the spring were more prone to scurvy.  It was not suspected that the reason might be that the winter’s shipboard diet was deficient and therefore the sailors had less vitamin C than when sailing during the summer or fall.  Instead what was noted was that the officers were unlikely to be affected by scurvy while the sailors were.  The social elitism of the time led to the conclusion that scurvy was a deficiency of character, not diet; and ironically may have been used to justify the better diet afforded the officers aboard these ships.  Some even suggested that it was “sloth” that led to the disease since listlessness was one of the earliest symptoms.  Nonetheless, it was sea scurvy that led to the first insight into the disease.
Land scurvy and sea scurvy were established as the same disease by Johannes Bachstrom of Leyden in 1734.  Shortly thereafter James Lind decided to investigate various treatments for sea scurvy, and there were many that were advocated at the time.  The ones that Dr. Lind felt were worthy of inclusion in his study included: sea water, vinegar, cider, oil of vitriol, a pet concoction of garlic, radish, Peru balsam and myrrh, and of course the one that worked – oranges and lemons.  Dr. Lind conducted what may have been the first controlled clinical trial to investigate these possible treatments.  [A controlled trial is an experiment that compares two or more groups of subjects that differ from one another in only one characteristic, usually the “treatment” that is being investigated.  Dr. Lind was a veteran of the Navy and had ample opportunity to observe scurvy.  The investigation was carried out on board the frigate HMS Salisbury and had six groups of two patients each.  The results were impressive by any standards.  In six days, the patients treated with oranges and lemons were cured and helping care for their still sick shipmates who showed no improvement in their disease.  Lemons clearly cured scurvy.  Dr. Lind had no idea what the disease was, much less what it was in his treatment that made any difference in the disease, but still he had cured it and demonstrated the effectiveness of his treatment beyond any doubt – except that, as is still true today, bureaucratic doubt was stronger than proof.
Dr. Lind died before the British Navy adopted his treatment for a disease that killed thousands of its sailors.  Scurvy afflicted as many as 90% of Florence Nightingale’s patients in the Crimean War (1854-1856) and killed many Union soldiers in the American Civil War (1861-1865) as they camped only a few miles from Washington, DC.  Then as now, institutional wisdom often had little to do with proofs or truths.  Also interesting is that Dr. Lind’s experiment was terminated for reasons common in research today – he ran out of funding or in this case ran out of oranges and lemons.  No governmental bureaucrat “funded” his experiment, of course, he just did it himself.  Then again no bureaucrat interfered with him either.
Eventually limes, which were less expensive than lemons, became the standard treatment on all British ships, at first just the Navy, but in 1854 on the merchant ships as well.  This happened in spite of the fact the whole treatment with citrus fruit was questioned when the same amount of lime juice failed to prevent the disease as well as lemon juice did.  This occurred because there is less vitamin C in lime juice than in lemon juice, but of course no one knew that at the time.  It was complicated by the fact that when Dr. Lind did his historic experiment, lemons and limes were both referred to as “limes”, green and yellow, so the shift in language made the distinction of the two more obscure.  But limes became a standard on British ships and thus the British, or at least their sailors, became known as “Limeys”, and long ocean voyages became possible, even safe, and new worlds were colonized, for better or worse, by Europeans who brought with them new diseases and exposed themselves to native diseases in those new lands, all because of Dr. Lind and the lemons and limes.  Land scurvy disappeared largely due to the apples and other fresh foods that the improvement in transportation introduced into the urban diets.
As an aside, however, I wonder about the very common use of lemons and limes in alcoholic beverages.  The lime juice given to sailors to drink, was usually given to them in their daily rum ration, to dilute the taste perhaps or just to encourage them to drink it.  Is it possible that these citruses owe their popular place in bars and taverns to their use on board ships?  I wonder.  I also wonder if this simple discover by Dr. Lind made it possible for the British to sail far and wide across the seas and found an empire on which the sun never set.  Is it the adoption of limes by the navy the real reason Britannia ruled the waves.
The story of vitamin C is not complete yet, however.  At the beginning of the 20th century it was noted that guinea pigs could be given scurvy by severely restricting their diet, while other animals seemed not to be so affected when their diet was similarly restricted.  Thus the guinea pig became identified as the classic “experimental laboratory animal”.  Even though it is seldom used today for such purposes, we still speak of “being a guinea pig” when we feel as if we are the subject of someone’s experiment. 
The actual vitamin was discovered in 1932 in both Hungary and the United States simultaneously, but identified as ascorbic acid in the United States.  The disease was finally understood when it was realized that it was the same substance that was discovered in both countries.  Also understood was the reason why limes were less useful than lemons since they had less of the vitamin and why people got the disease in the first place.  Only humans and a few other mammals, guinea pigs included, cannot synthesize vitamin C themselves.  The impact of the discovery of vitamins cannot be appreciated in our age of balanced diets where only a true food faddist who refuses to eat all fresh fruits and vegetables can become vitamin C deficient.  In its time, scurvy was a lethal illness just as cancer is today.  To cure this disease was truly miraculous and led, in part, to the high esteem in which medicine was to be held at the beginning of the 20th century.  When I was in Appalachia there were still many “old time docs” who would give a vitamin B12 shot for almost every illness.
Is it any wonder that vitamins are regarded as miraculous substances even today?  Linus Pauling, a Nobel Prize winner, who came very close to discovering DNA before Watson and Crick, is probably better known for being an advocate of vitamin C for “colds” and heart disease than for his Nobel Prize winning research.  It is too early to say what the impact of Vitamin D will be on the our health, but the easy acceptance of the idea that this vitamin might cure us all is in part due to the miracle begun by Dr. Lind.  Vitamins may be fading now, at least in the main stream of medicine, to be replaced by the genome that Linus Pauling almost discovered.  DNA is believed to hold the secrets of life and disease in the 21st century just as vitamins were in the last century.  That vitamins have proved useful things, but not the panacea once thought, will not dim the glow of the new miracle: DNA – not until it is, in turn, replaced by the next great discovery.