Description of Scurvy Symptoms by John Woodall (1617)

Description of Scurvy Symptoms by John Woodall (1617) Harri Hemiläa, Elizabeth Chalkerb a Department of Public Health, University of Helsinki, Helsinki, FINLAND [email protected] https://www.mv.helsinki.fi/home/hemila https://orcid.org/0000-0002-4710-307X b National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, AUSTRALIA [email protected] https://orcid.org/0000-0003-1593-3770 Location of this file: https://doi.org/ 10.5281/zenodo.10651215 Background Vitamin C deficiency, scurvy, has occurred in various contexts throughout history. For example, in Nordic countries, fruit and vegetables were not available in Winter and such conditions can give rise to cases of scurvy. In addition, it is probable that during many sieges the people being surrounded did not have fresh food available and therefore started to suffer from scurvy. As an example, Olaus Magnus (1555) described symptoms consistent with scurvy in Nordic countries under sieges: “There is also another disease, the camp sickness, which distresses those who are enclosed under siege. Its symptoms are that the limbs thicken, the flesh appears to grow numb, and pus forms under the skin, so that it yields to the pressure of the fingers, like melting wax. It deadens the sensitivity of the teeth, which feel as if they will fall out, turns the colour of the skin a bluish white, and induces sluggishness together with a nausea which revolts against taking medicines” [1]. In Western countries, the harms of scurvy became particularly evident when technology enabled long voyages over oceans in sailing ships. Ships were slow, taking several weeks to reach their destination. There were no means to keep fresh foods edible for such long periods of time, and consequently most of the food available was nutritionally poor. Recent books have described scurvy from the point of view of long sea travels [2-5]. In the late 1700s, James Lind wrote a book about scurvy which is the most important book in the field of all time [6]. However, one and a half centuries earlier John Woodall (1617) wrote a book instructing ships’ surgeons for long sea voyages [7]; see biographies of Woodall [8]. Woodall’s book includes a separate chapter on scurvy, discussing symptoms, and possible causes and treatments. He describes oranges as a well-established method of treating scurvy. It has been puzzling historians that Lind did not refer to Woodall, even though Lind very extensively searched and summarized the earlier literature. In the 3rd edition of his book, Lind does mention Woodall’s book, but he does not discuss the content. Lind has often been credited for discovering oranges as a treatment for scurvy, but the benefits were known for some two centuries before Lind’s treatise. John Woodall’s text is old English and difficult to read. In addition, it is not easily available. Though the book is currently available through the web, the text on scurvy is difficult to find in the long book. In this document we have extracted and modernized the sections that describe the symptoms of scurvy and proposals for using oranges for the treatment of scurvy. A few words remain confusing even though we used several dictionaries, and they are marked with a question mark. The original version of Woodall’s section on scurvy is available at the end of this document. 1 References 1. Olaus Magnus. Historia de gentibus septentrionalibus. 1555. [Scurvy (schorbuk), Book 16, Chapter LI] https://en.wikipedia.org/wiki/A_Description_of_the_Northern_Peoples https://runeberg.org/olmagnus/0656.html [in Latin, Scurvy on p. 570-571] The extract is from the 1998 version edited by Peter Foote https://doi.org/10.4324/9781315090399 2. Kenneth J Carpenter. The History of Scurvy and Vitamin C. 1986. https://www.cambridge.org/fi/academic/subjects/history/history-medicine/history-scurvy-and-vitamin-c https://archive.org/details/historyofscurvyv0000carp 3. David I Harvie. Limeys: The True Story of One Man's War against Ignorance, the Establishment and the Deadly Scurvy. 2002. https://www.thehistorypress.co.uk/publication/limeys/9780750939935 4. Stephen R. Bown. Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail. 2003. https://www.stephenrbown.net/scurvy-description.php https://archive.org/details/scurvyhowsurgeon00bown_0/mode/2up 5. Jonathan Lamb. Scurvy: The Disease of Discovery. 2016. https://press.princeton.edu/books/hardcover/9780691147826/scurvy https://doi.org/10.23943/princeton/9780691182933.001.0001 6. James Lind. A Treatise of the Scurvy in Three Parts. 1753/1757/1772. https://doi.org/10.1017/CBO9781107256644 https://archive.org/details/b30507054 (1st ed 1753) https://wellcomecollection.org/works/xc2t7736 (2nd ed 1757) https://archive.org/details/treatiseonscurvy00lind (2nd ed 1757) https://archive.org/details/treatiseonscurvy1772lind (3rd ed 1772) https://archive.org/details/b30511902 (3rd ed 1772) https://babel.hathitrust.org/cgi/pt?id=ucm.5320216006 (3rd ed 1772) https://openlibrary.org/books/OL24970496M (3rd ed 1772) https://openlibrary.org/books/OL26752931M (3rd ed 1772) https://archive.org/details/bim_eighteenth-century_a-treatise-on-the-scurvy_lind-james_1772 7. John Woodall. The Surgion’s Mate. 1617. [Scurvy: pp.177-202] https://archive.org/details/surgionsmateortr00wood/page/176/mode/2up https://archive.org/details/b30331195/page/176/mode/2up https://archive.org/details/McGillLibrary-osl_surgeons_mate_BO4273_folioW88121639_1556-20151/page/n177/mode/2up https://doi.org/10.1007/978-3-319-25574-3 https://content.e-bookshelf.de/media/reading/L-5006873-cc9a1514fe.pdf 8. Papers related to John Woodall https://www.jstor.org/stable/24625578 https://doi.org/10.1038/133067c0 https://doi.org/10.1002/bjs.1800041502 https://doi.org/10.1179/amb.1962.10.3.108 https://doi.org/10.1017/s0025727300034578 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc1139038 https://doi.org/10.1177/096777209500300103 https://doi.org/10.1177/096777209500300202 https://doi.org/10.1016/0035-9203(54)90111-X https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5370681 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5167912 https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5194432 https://bshm.org.uk/wp-content/uploads/2021/04/thom-v1-6-24.pdf https://hekint.org/2023/08/03/john-woodall-author-of-the-surgeons-mate https://www.rmg.co.uk/stories/blog/library-archive/surgeons-mate-john-woodall https://en.wikipedia.org/wiki/John_Woodall 2 John Woodall (1617) The Surgion’s Mate. Selection of sections on scurvy (p.177-202) that describe symptoms of the disease and the described benefits from oranges and lemons. The original version of the section is copied at the end of this document. p.177 Of the Scurvy called in Latin Scorbutum. This lamentable disease, which has so long and so fiercely assailed sailors and seamen of all sorts more than land-men… p.178 What the disease called the Scurvy is. The Scurvy is a disease of the spleen, whereby is it sometimes wholly stopped, sometimes only distempered, sometimes also appearing with hard scyrros [hard tumour], swellings, beginning and showing themselves in diverse parts of the body, but more particularly on the thighs and legs, causing them to seem of a leady colour, the sharpness of which infectious humor often offends the mouths and gums of the diseased, and causes the flesh thereof to rot and stink. p.179 The causes of the Scurvy. The names of the disease. The Scurvy called of some Cachexia universalis, of other Sceletyrbe, & of some Stomacacen, it is a chronic disease, not simple but compound of many other diseases. p.180 But it is plain that this grief is a lasie [?] foule [stinking] disease with obstructions of the liver, or spleen, or of both; as also it appears that the head is much diseased, and that there is great obstructions in the brain, for that the eyes not only look evil coloured, but also the gums putrefy, and the teeth grow loose, and all the sinewy [tendon] parts of the body bear their part in the disease, for the shrinking and withering of the sinews with the great pains the party has declared no less. p.181 Of the Scurvy or Scorbutum the signs. The signs of the Scurvy are many, as namely, a generalized laziness and evil disposition of all the faculties and parts of the body, fauing [favouring] the stomach and the appetite which oftentimes is greater than ordinary with them along time. A discoloring of the skin as if it were fouler than ordinary, with spots darker colored than the rest, and sometimes also darkish blue spots. A fever at sea commonly ends in the Scurvy, wherefore by the way beware of too large purging, or phlebotomy, which increase often the grief, and make it incurable: I speak this because I have noted there is a fault in young surgeons of forwardness in taking too much blood at sea. Also itching or aching of the limbs are signs of the grief. 3 Sometimes the legs falling away, and drying the calves of the legs growing hard and dry, as also immoderate swellings of the legs: also the legs and thighs discolored into frekells [freckles], or spots of a dirty brown sad color much like the color of a gangrened or mortified member. Stinking of the breath. Great obstructions of the liver, or spleen, or both, and in the exercising of their bodies their limbs, and their spirit failing them. Shortness and difficulty of breathing, especially when they move themselves, but lying still finds little grief or pain. p.182 Their eyes of a leady colour, or like dark violets. Great swellings in the face, legs, and over all the body; paleness, or a foul pale color in the face. Swellings of the gums, rottenness of the same, with the ishewing [excreting?] of much filthy blood and other stinking corruption thence, looseness of the teeth: Also some are troubled with an extreme costiveness [constipation] that for 14 days together they go not to stool once, wherefore the surgeon is constrained with an instrument to rake out the excrements to avoid death, after which extreme costiveness often follows a great flux of blood, and a painful: also many have stoppings of the urine, or at the least making less water in two days than the party drinks in one day. A coldness and stiffness of the sinewy parts, chiefly of the legs. Some also have their muscles, yes and sinews of their thighs, arms, and legs so wasted away that there seems to be left only the skin covering the bones. [Dissections] Also, it is manifest that diverse of those which have been opened after death, have had their livers utterly rotted. Others have had their livers swollen to an exceeding greatness, some the spleen extremely swollen, others have been full of water, others their lungs putrefied and stunk whilst they have lived, these and diverse other signs too many all to be mentioned here, do afflict poor seamen, which often are past mans help, in such place and time as they happen, the cure whereof rests only in the hands of the Almighty. And yet to any man of judgment it may seem a wonder how a poor miserable man, coming on land from a long voyage even at the point of death, namely, swollen sometimes to an unreasonable greatness not able to lift a leg over a straw, nor scarce to breath by resort of strong obstruction, yet in a few days shall receive the fullness of former health, yes with little or no medicine at all. p.184-185 Further the surgeon and his mate must not fail to persuade the governor or purser in all places where they touch in the Indies and may have it, to provide themselves of juice of Oringes, Limes, or Lemons, and at Banthame of Tamarinds… And further experience teaches which I have often found true, that where a disease most rains [where a disease is most prevalent], even there God has appointed the best remedies for the same grief if it be his will they should be discovered and used: and note for substance, the Lemmons, 4 Limes, Tamarinds, Oringes, and other choice of good helps in the Indies which you shall find there do far exceed any that can be carried there from England… The use of the juice of lemons is a precious medicine and well tried, being sound & good, let it have the chief place for it will deserve it… p.191 … if the gums therefore are swollen, [so] that they hang over the teeth, stink or be putrefied… p.192 Further if it be a swollen member … But if the diseases proceeds with stiffness and hardness of the sinews… p.195 … the haemorrhage or bleeding at the nose… p.197 The ulcers which happen to them which have this disease are many ways different from the general forms and differences of ordinary ulcers in bodies not touched with this disease, all which I have here no time to amplify. But because this disease has two general and principal differences of appearance, namely some men deceased with the Scurvy are swollen exceedingly, as in the dropsy : Others their outward limbs withered, consumed, and dried up, their sinews shrunk and grown hard, though the ulcers in the one and the other should be like in show, yet doubtless the healing of these ulcers will be found very much different, wherefore for one general note remember that the ulcers in the full and hydropsical [with edema] bodies will require more desiccative medicines… p.198 … scurvy produces such extreme costiveness… p. 199 Moreover, if the patient his disease be in the form of a consumption, the body being dried up as it were, or with shrinking of sinews… but if he complains much of pains in his joints… 5 6 7 8 9 16 17 18 19 20 21 22 23 24 25 32 33