Scurvy is still with us

Lemons are a good source of vitamin C. Wikipedia, Karwath

Beriberi. Pellagra. Scurvy. These nutritional deficiency diseases have such short, pithy names, it should be difficult to forget them. But forget them we have, since in the developed world they are relatively uncommon nowadays. On the other hand, they are still common in the developing world.

Scurvy, which is caused by lack of vitamin C, used to be much more common in the west. Sailors at sea seemed to be particularly prone to getting scurvy, some even dying from it, for reasons not well understood centuries ago. Scurvy is characterized by bleeding gums, spots on the skin, fever, weakness, and depression. These symptoms result from the body’s inability to produce collagen, which requires vitamin C(ascorbic acid) to be synthesized. Collagen is an important protein that is the main building block of the body’s connective tissues.

It was sometimes mistakenly thought that scurvy was a contagious disease, until it became clear that there was something missing from the sailor’s standard diet of dried meat, dried fish, and grain. Simply adding fresh fruits and vegetables to their diet, in particular citrus fruits, seemed to cure scurvy, though they didn’t know why.

The Royal Navy’s solution in the early 19th century was to add lemon or lime juice to their sailor’s daily ration of watered down rum(grog). This is how the word “limey“, the derogatory word for people from Britain originated. Many other countries soon followed the British example(though some used sauerkraut instead of citrus juice), thereby reducing scurvy cases among seamen.

It wasn’t until the 1930s that scientists isolated and identified the mysterious “anti-scorbotic” factor(the factor that prevents scurvy), vitamin C. Studying the history of nutrition and nutritional deficiency diseases in particular is a great way to see how science works.

Nowadays scurvy is pretty rare in the U.S, but it is more common among certain subgroups like the elderly and homeless drug addicts. According to the Mayo Clinic, Scottsdale, Arizona, in Scurvy: a disease almost forgotten(2006):

RESULTS:

In addition to our patient, seven of 11 patients whose records in the institutional database mentioned vitamin C deficiency were women. The age ranged from a neonate to 77 years (mean, 48 years). The most common associated causes were concomitant gastrointestinal disease, poor dentition, food faddism, and alcoholism. Vitamin or mineral deficiencies other than vitamin C deficiency were also found in our patients who had scurvy. The most common symptoms were bruising, arthralgias, or joint swelling. The most common signs were pedal edema, bruising, or mucosal changes. Four patients had vague symptoms of myalgias and fatigue without classic findings, and five had concomitant nutritional deficiencies. Follow-up available for six of 12 patients treated by vitamin C supplementation showed complete resolution of symptoms in five.

CONCLUSIONS:

Patients with scurvy may present with classic symptoms and signs or with nonspecific clinical symptoms and an absence of diagnostically suggestive physical findings. Concomitant deficiency states occur not uncommonly. Taking a thorough dietary history and measuring serum ascorbic acid levels should be considered for patients with classic signs and symptoms, nonspecific musculoskeletal complaints, or other vitamin or mineral deficiencies.

In other words, scurvy hasn’t been completely eradicated, and we should be on the lookout for symptoms of it in the elderly who are eating poorly. This doesn’t mean that the elderly or you should be taking vitamin C supplements, though taking the occasional multivitamin for insurance probably won’t hurt.

Drinking orange juice or eating enough fruits and vegetables will give you well beyond the 60 mg of vitamin C we need to prevent scurvy. However, there’s no good reason to mega-dose with vitamin C, or any other nutrient for that matter.

Eclampsia strikes Downton Abbey

Eclampsia isn’t a word that easily rolls off most people’s lips. Unless of course you saw the most recent episode of the British period drama, Downtown Abbey, in which a major, beloved character died from eclampsia shortly after giving birth. Downton Abbey’s portrayal of eclampsia was, to my knowledge, very accurate. It was also vivid and very heart-breaking, especially when this death could have(supposedly) been prevented if Sybil was taken to hospital. Although I did not cry, some friends of mine who are big fans of the program cried for several minutes straight and are still teary-eyed.

Lady Sybil Crawley

Since I am not a huge fan, I’ve missed a few episodes here and there. That said, Sybil was my favorite of the 3 aristocratic Crawley sisters. She was the most free-spirited and a strong supporter of women’s rights in a society that was still very sexist and patriarchal. She also wasn’t a snob, in a very classist society, in spite of her upper class English upbringing, exemplified by her marrying the family’s Irish Catholic revolutionary chauffeur(talk about a mixed marriage!). All this made her easy to identify with, except to misogynistic snobs, so her death was a huge loss for the show.

I don’t want to get too bogged down in the details, but basically, her father, Robert Crawley(Earl of Grantham) comes off looking sort of like a villain now, even though he didn’t kill anyone on purpose(some Anglophile friends of mine who are fans of the show want to run over to England to kill him). Although they already had a highly-qualified family doctor, Dr Richard Clarkson(who has made a few mistakes here and there, none resulting in any deaths to my knowledge, though some may dispute this) to deliver the baby, her father, the Earl of Grantham, decided to bring in a more aristocratic yes-man kind of doctor to take care of his daughter. This new doctor effectively overruled Dr Clarkson who believed Sybil needed to be taken to hospital due to her pre-eclampsia.

The new doctor that everyone now loathes didn’t think the symptoms were a big deal, and, sadly, convinced Sybil’s father that they weren’t a big deal. As said before, Sybil eventually died from eclampsia, a rare though often fatal complication of pregnancy. It causes terrible seizures and the complete disruption of breathing, resulting in coma and death. We still don’t know for sure what causes this terrible condition.

The merits of this turn of events on the story that is Downtown Abbey isn’t the point of this post, but the disease of eclampsia is. It seems a lot of people blame her father, Lord Grantham, for Sybil’s death, for ignoring Dr Clarkson’s concerns and not taking his daughter to hospital. Yet, that just as easily could have killed Sybil, due to the primitive state of medicine in 1920. Modern scientific medicine was in its infancy, antibiotics were not available and surgical instruments weren’t properly sterilized, at least according to today’s standards. Even today, many people die due to medical errors in hospitals, though medical care has drastically improved since the 1920s.

Could Lady Sybil have been saved? I honestly do not know, as I am not a doctor, or medical historian, but I am very much fascinated by the subject. Based on my readings, a C-section done early enough could have possibly saved her, so long as the hospital conditions and surgical instruments didn’t give her a terrible illness. As said before, this was a risky procedure back then. Another possibility is intravenous magnesium sulfate, which had just been recently introduced as a treatment for pre-eclampsia.

I am not sure if it was widely available as a treatment in England at the time, but it should have been, since magnesium sulfate is better known to the world as Epsom Salt. The town of Epsom, near Surrey, has a spring that is rich in magnesium sulfate(hence the name) and wasn’t too far from Downton Abbey(which was in northern England). Another town where magnesium sulfate occurs plentifully is Magnesia, in Greece. This common laxative sure has an interesting history. According to: A Historical Overview of Preeclampsia-Eclampsia –

In addition to the diverse approaches to manage preeclampsia-eclampsia in the 20th century, the use of magnesium sulfate was introduced. Although a mainstay of current treatment, it was not until 1906 that Horn first used magnesium sulfate to manage preeclampsia-eclampsia (Chesley, 1984). During the 1920’s, the parenteral use of magnesium sulfate in the treatment of preeclampsia-eclampsia was popularized by Lazard and Dorsett (Chesley, 1984), for Dr. Lazard’s work (as cited in Gabbe, 1996) demonstrated that treatment with intravenous magnesium sulfate was both efficacious and safe.

Pre-exclampsia is also called toxemia, due to toxic levels of certain proteins found in the urine of sufferers. Although the exact cause of this is still not known, genetics likely play a role, along with “toxins”. In fact, vegetarians and vegans appear to have significantly lower rates of eclampsia, possibly due to not getting overloaded with the toxins that accumulate in animal fat: Preeclampsia and reproductive performance in a community of vegans –

Studies at “the Farm,” a community of spiritually gathered young people in Summertown, Tenn, have shown that it is possible to sustain a normal pregnancy on a vegan diet. The source of dietary protein (ie, animal or vegetable) does not seem to affect birth weight, as long as vegans are health conscious, receive continuous prenatal care, supplement their diets with prenatal vitamins, calcium, and iron, and apply protein-complementing nutritional principles. Preeclampsia may be caused by a relative prostacyclin deficiency in the face of excessive production of thromboxane A2. A vegan diet (one low in arachidonic acid) might provide protection against this condition, especially if the conversion of linoleic acid to arachidonic acid is inhibited by decreased activity of the enzyme delta-6-desaturase. We examined the maternity care records of 775 vegan mothers for symptoms of preeclampsia, and only one case met the clinical criteria. Since preeclampsia in our culture is frequently associated with unrestrained consumption of “fast foods” (foods having high levels of saturated fat) and rapid weight gain, it is possible that a vegan diet could alleviate most, if not all, of the signs and symptoms of preeclampsia.

People who eat a plant-based diet or try to eat healthy use the word “toxins” as an umbrella term to refer to what they are trying to avoid: pesticides and industrial chemicals that find their way into the food supply, which have a tendency to accumulate in animal fat. Sometimes this use of the word “toxins” has merit, sometimes it doesn’t. Though we have ways of removing or detoxifying many of these potentially harmful chemicals from our bodies, there is some evidence that they play a role in cancer, Parkinsons disease and other conditions. Through the process of biomagnification, these toxins can accumulate to high levels in animal fat, which may be one of the reasons vegetarians tend to have lower rates of heart disease and some other diseases. The higher up an animal is on the food chain, the more concentrated the toxins become – this is why big fish tend to be much more toxic than small fish.

Yorkshire, England. Source: Wikipedia

As ridiculous as it sounds, if Sybil had been a vegetarian, it could have prevented the eclampsia, and it would have easily fit with her free-spirited personality and progressive politics. Some British progressives of the era were vegetarians, like George Bernard Shaw, and Henry Stephens Salt. Interestingly enough, the founder of the modern veganism movement, Donald Watson(1910 – 2005), was born in Yorkshire, the county in northern England where the fictional Downton Abbey is located(though the Highclere Castle itself is actually located in southern England).

Eclampsia, unfortunately, is still with us, and kills many pregnant women, especially in poor countries. Now I fully realize this is fiction, but let’s imagine Lady Sybil had been a real, breathing person: my non-medical opinion is that Lady Sybil would have been better off being taken to hospital since even though whatever treatment they may have used would have been very risky, not treating her very serious medical condition was even riskier.