Scurvy in the 21st century

Wednesday, 25 January 2017

Scurvy in 21st century Australia? Surely not!

Surely scurvy, a condition brought on by malnutrition, could not exist in an advanced OECD country like Australia in the 21st century?

Think again. Recent reports are of the presence of scurvy in metropolitan Australia.

For most of us what we eat is a personal choice, but for many, especially those in rural and remote areas, the choices are limited.

If this condition is present in disadvantaged metropolitan populations in Australia, how much more likely is it to exist in Australia’s rural and especially remote communities, where incomes are (on average) 20% lower, the price of food higher and the price of healthy food is substantially higher. For example, prices for oranges and lettuce for people shopping in an unnamed town in remote NSW are respectively $4 per kilogram and $3 per head compared with $2.30 per kilogram and $1.50 per head at a suburban supermarket (we telephoned the remote town supermarket and checked online for the city prices).

Not only should the prevalence of scurvy in metropolitan (and therefore rural and remote) Australia ring alarm bells, but the history of scurvy and its treatment reminds us of the important role of government in sensibly translating scientific knowledge into effective government policy.

Prior to the widespread use of ascorbic acid as a treatment for scurvy, it is estimated that scurvy claimed more lives of seafarers than enemy action. It was unusual for ships to return with their crews intact. Indeed, while George Anson’s circumnavigation of 1740–1744 commenced with six warships, two supply ships and 1854 men, it returned with one ship and 188 men (997 of the 1415 deaths were from scurvy, and if you do the maths, some neither died nor returned).

It was in 1753 that James Lind published the results of his clinical trial (possibly the first clinical trial in history) on the treatment of scurvy.

“On the 20th of May 1747, I selected twelve patients in the scurvy, on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of the knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet common to all, viz. water gruel sweetened with sugar in the morning; fresh mutton-broth often times for dinner; at other times light puddings, boiled biscuit with sugar, etc., and for supper, barley and raisins, rice and currants, sago and wine or the like. Two were ordered each a quart of cyder a day. Two others took twenty-five drops of elixir vitriol three times a day … Two others took two spoonfuls of vinegar three times a day … Two of the worst patients were put on a course of sea-water … Two others had each two oranges and one lemon given them every day … The two remaining patients, took … an electary recommended by a hospital surgeon … The consequence was, that the most sudden and visible good effects were perceived from the use of oranges and lemons; one of those who had taken them, being at the end of six days fit for duty … The other was the best recovered of any in his condition; and … was appointed to attend the rest of the sick. Next to the oranges, I thought the cyder had the best effects …”

Unfortunately, the then president of the Royal Society held the contract for supplying the Royal Navy with ‘extract of wort’ – the then favoured antiscorbutic. The benefits of Lind’s findings were downplayed and 42 years passed before the Royal Navy was to take ascorbic acid seriously, during which time many thousands of mariners died early deaths from what is an entirely preventable and treatable disease.

Of course, while lemons were the most effective of the available citrus, limes became the main source for the Royal Navy because of their dominion of the West Indies, and while French physicians appreciated Lind’s findings, French naval administrators did not, to the cost of their crews.

Do we live in a modern enlightened age where scientific understanding (such as the health effects of tobacco smoking and the serious societal long-term effects of climate change, for example) is efficiently and effectively converted into sound government policy, to the benefit of the people?

It is to our shame that people in Australia, both in cities and in rural and remote areas, have such poor access to healthy food as to develop diseases such as scurvy, higher rates of overweight and obesity, and subsequent long-term chronic diseases such as heart disease, diabetes and end stage kidney disease.

Listen to CEO, David Butt speaking to ABC NewsRadio's Glen Bartholomew about the resurgence of scurvy in Australia.