Almost 300 years after naval surgeon James Lind discovered that citrus juice was an effective remedy for scurvy, the vitamin deficiency is experiencing a resurgence.
Writing in the BMJ Case Reports journal, doctors from the Sir Charles Gairdner Hospital in Perth, Australia said scurvy is a “re-emerging diagnosis”. The report came after the doctors at the hospital treated a middle-aged man with an unknown condition who had had “weight loss gastric bypass surgery eight years earlier”, said ABC News. The patient “hardly ate any fruit and vegetables” and “survived mainly on processed foods”, said The Times, leading to a scurvy diagnosis. Despite exhibiting a rash and pains characteristic of scurvy, the diagnosis was not “immediately obvious” as hospitals don’t routinely test for the condition.
What is scurvy?
Scurvy is a condition caused by a lack of vitamin C, a “very key nutrient for the human body” which helps protect cells and support proper growth, healing, and other important functions, said Popular Science. A period of several months with insufficient vitamin C can produce symptoms including “general weakness, anaemia, gum disease, poor wound healing, and skin haemorrhages”. Left untreated, it can become fatal.
Scurvy is commonly associated with the Age of Sail, killing millions of sailors between the 16th and 18th centuries due to a lack of access to fresh fruit and vegetables during long sea voyages. After the beneficial effect of citrus fruit was confirmed in the late 18th century, navies regularly issued lemon or lime juice to prevent and treat scurvy. Modern-day patients will be given vitamin C supplements as well as “folic acid and multivitamins”, said ABC News. Following a more vitamin-rich diet thereafter will stop a recurrence.
Why are cases on the rise?
With “abundant vitamin C in our modern food supply” scurvy had been considered an archaic disease, and often slipped under the radar of doctors, wrote Professor Lauren Ball on The Conversation.
Numerous factors are potentially fuelling a scurvy resurgence, notably nutrient-deficient diets. Many people struggling with the cost of living “rely heavily on processed, nutrient-poor foods” because they are often cheaper and more convenient. Isolation or disability can also be a factor. A recent case in Canada involved a 65-year-old woman “limited by mobility issues” and with “little in the way of outside support” who contracted scurvy because of her restricted diet, said Popular Science.
There are signs that economic and social pressures are leading to a slight increase in scurvy cases in developed countries, but in the developed world the condition is still “generally rare”, said the magazine.
What about in the UK?
Almost 11,000 people were hospitalised in England in 2022 for conditions linked to malnutrition, according to The Times in 2023. Of those, 171 were treated for scurvy, while 482 people were treated for rickets (caused by a vitamin D deficiency), the majority of them children.
These conditions disproportionately affect poorer people and in the cases of scurvy were “indicative of the inadequate ‘tea and toast’ diet” of older people who are “unable to afford fresh fruits and vegetables” and may be hampered from frequent shopping by limited mobility.
What can be done?
While there is no programme to combat scurvy directly, the UK is facing a wider “epidemic of poor diets, food insecurity and poverty”, particularly in children, said The Guardian.
However, the key to warding off conditions such as scurvy in the long term includes “education, national dietary guidelines, and making fresh fruit and vegetables more affordable”, the doctors in the BMJ Case Reports journal concluded.