Summary Of Scurvy: How A Surgeon, By Stephen R Brown

Critically acclaimed author Stephen R. Brown in his work titled “Scurvy: How a Surgeon, a Mariner and a Gentleman solved the greatest medical mystery of the age of sail.” Brown offers his readers a factual and historically accurate account of life at sea during the age of sail; however, one could easily mistake parts of this book for a work of fiction. Brown achieves this rare balance by employing techniques normally reserved for a work of fiction. By paying particular attention to the underlying motivations, actions, and choices made by individuals coupled with robust storytelling, Brown creates not only a narrative for the book but also a biographical account as well. Brown achieves this while maintaining both a factual and historically accurate account of life as an 18th century seaman. For the 18th century seaman prolonged time at sea oftentimes meant a substantial risk of suffering from scurvy. Brown notes that “scurvy is a hideous
and frightful affliction by which the body’s connective tissue degenerates, resulting in bleeding gums, wobbly teeth, rot-reeking breath, anemic lethargy, physical weakness, the opening of old wounds, and the separating of once healed bones. Untreated, it leads to a slow, agonizing, and inevitable death.” Brown examines the terrible toll scurvy took during the age of sail noting that more sailors died from scurvy than from storms, shipwrecks, all other diseases, and the combined total of every sea battle ever fought during the age of the sail. Brown asserts that the willful ignorance of the royal medical elite cost the lives of tens of thousand of seamen during the age of the sail and altered the course of numerous expeditions and battles at sea. He contends that these medical elites instead, endorsed ludicrous medical theories based on speculative research while ignoring the life-saving properties of citrus fruit.
In the prologue, Brown draws his readers into the age of the sail with a griping account of one Arthur James who was one of the more than two million sailors to succumb to the dreaded scurvy during the age of the sail. Brown succinctly explains the two major obstacles to preventing and curing scurvy. First obstacle was the medical community itself. The foundation on which world’s medical elites operated was the rigid Hippocratic theory which stated “ that all illness stemmed from and imbalance in the four bodily humours– the black bile, the yellow bile, the blood, and the phlegm.” Strict adherence to this theory resulted in a medical community that often seemed disconnected from reality. Second was the nutrition while on board ship for extended periods. The limitations of food preservation caused scurvy to reach “epidemic proportions during the age of the sail.”
Chapter one titled “The eighteenth–century seafaring world: The age of scurvy.” Brown begins this chapter utilizing the storytelling technique that gives this book a feel of fiction. He relates the story of an English sailor that has just returned from a successful voyage with coin in pocket he hits the local pubs. The English sailor tips back another pint this time a shilling rest at the bottom of his mug. He places it in his pocket and makes his way out of the pub. Upon existing the pub and entering the street he meet armed men who corral him and with the kings shilling in his pocket the lowly sailor attempted to resist the group of men to only be knocked unconscious. He awakes on board a Royal Navy vessel and is now one of the crew. Press gangs like the one that subdued the English sailor roamed seaside towns to replenish the scurvy ravished ranks of the Royal Navy.
Scurvy was devastating and the Navy so wanting for sailors that Brown noted that up to a third of a ship’s crew might consist of men pressed into Naval service. Once on board these impressed men were subject to the rules and regulations of the Navy. This meant any attempt to leave was desertion and was punishable by death. With no option to leave, the enslaved men now faced the harsh reality that “life was cheap” and many Captains were “authoritarian, and often violent.” Enslaved mariners in the eighteenth century suffered from a wide array of ailments, diseases, and dietary deficiencies ranging from “Syphilis, malaria, rickets, smallpox, tuberculosis, yellow fever, venereal diseases, dysentery, and food poisoning…typhus, or typhoid fever.” The living condition shipboard served as a ideal environment for these varied ailments to thrive. These ships were “infested with refuse, trash, rotting flesh, urine, and vomit…sanitary conditions aboard ship …were as bad as or worse than the filthiest slums in London, Amsterdam, Paris, or Seville.”
The aforementioned living conditions spread a myriad of diseases, but the standard naval diet, which consisted heavily salted beef and pork, died peas and grains, the ship’s biscuit or what ever else, could be preserved or stored for long periods. All of these food items contained little to no ascorbic acid (Vitamin C). A diet devoid of ascorbic acid brought about the dreaded scurvy. Brown spends a good bit of print on the sailors diet and one does not get the feeling that to much text was dedicated to this key issue. Brown constructs a narrative concerning the overall diet and health of the 18th century sailor while supporting his report with primary source document consisting of various accounts from ship captains, surgeons, and physicians. In addition, Brown provides a detail account of the average weekly menu for a sailor. Brown’s use of the primary sources to support his narrative affords his readers a vivid and detailed picture of just how deficient the average sailors diet was. The modern reader understands that scurvy is a deficiency disease; however, as the reader has already learned the medical elites of the 18th century would not accept this vital truth.
Chapters two provides the reader more grizzly details concerning scurvy and the terrible cost it wrought on the fleet.
While informing, the reader of the horrors of scurvy Brown also weaves the account of a 16th century French mariners who through the assistance of native peoples were about to drink a draft produced from boiling the branch’s of a “annedda tree” restored their ravaged crew. This anecdotal evidence juxtaposed against the medical reasoning of the most learned 18th century elites to provide the reader the sense that their was a willful neglect concerning the accounts that life-saving properties were found in various plants and fruits. Chapter three devotes a great deal of text to the telling of the story of Commodore George Anson who led a squadron of ships on a four-year voyage to attack the Spanish holdings. However, the reader learns that most of Anson’s crew succumbed to scurvy. Anson lost so many of his sailors that he was only able to crew just one of the five warships that departed England in
1741.
The key point in this account is that Anson’s h entire contingent of men were facing certain death from scurvy and would have perished if it had not been for their landing on Juan Fernandez Island. Their Anson’s crew ate fresh fruits and vegetables that were high in ascorbic acid and thus regained their strength. Chapter four offers the reader another example of how the cure for scurvy was found but not widely implemented by those holding the power to do so. Brown provides the reader with reasons why the elites neglected to adopt the proven cure of fresh fruits and vegetables that miraculously raised scurvy ridden crews to full strength. He notes the political and financial cost associated with providing in particular lemons to the crew of the Royal Navy. Upon reaching the end of chapter, four one might feel as since of outrage at the callous nature of those in power. Chapter five and six leave the reader flummoxed at how pervasive the willful ignorance and rigid medical theories of the 18th century completely crippled any concerted effort to view scurvy as a deficiency disease and treat it as such.
In these two chapters, the reader becomes acquainted with a lowly naval surgeon James Lind who conducted the first controlled trial in medical history. This trial offers yet another example of the benefits of citrus fruit in the curing and prevention of scurvy.