Scurvy was the scourge of sailors for thousands of years. An estimated 2 million sailors died of the disease between the 16th and 18th centuries alone, often decimating entire ship crews.

Scurvy is a dietary deficiency caused by a lack of vitamin C. The body does not naturally make vitamin C, so it has to come from foods rich in the vitamin such as citrus or from dietary supplements. Before modern refrigeration, sailors on long voyages relied mostly on salted or nonperishable food and had no regular access to fresh green vegetables or fruits that contain the vitamin.

The symptoms of scurvy are dramatic and terrible. In his 1820 textbook on nautical medicine, Navy surgeon Usher Parsons unflinchingly described the signs:

• "The gums become soft, livid and swollen, are apt to bleed from the slightest cause, and separate from the teeth, leaving them loose.
• About the same time the legs swell, are glossy, and soon exhibit foul ulcers.
• The same appearances follow, on other depending parts of the body.
• At first the ulcers resemble black blisters which spread and discharge a dark colored matter. These ulcers increase.
• Emaciation ensues.
• Bleeding occurs at the nose and mouth.
• All the evacuations from the body become intolerably fetid.
• Death closes the scene."

British 'Limeys' and the Cure for Scurvy

The U.S. Navy continued to struggle with scurvy into the 19th century even though the Royal Navy cracked the mystery of the disease in the 18th century thanks to surgeon James Lind. The British began storing citrus fruits on board all of its ships. The British Navy gave its sailors limes or lemon juice rations to ward off scurvy – earning them the nickname of "Limeys" among the American sailors who didn't know about or believe in the preventative treatment.

In his article on the history of scurvy in the U.S. Navy, naval medical historian André Sobocinski, wrote: "In 1809, Dr. William Paul Crillon Barton, a young Philadelphia-born Navy surgeon, took on the fight against scurvy while aboard USS United States, then under the command of Commodore Stephen Decatur. Turning to the medical literature out of Great Britain, Barton administered a citrus concoction to the most severely affected crewmembers and curing them of their symptoms."

Over the ensuing years Barton was the leading figure in the fight against scurvy. He lobbied the Secretary of the Navy and ship captains with what he described as a "clarified lemon-lime ration."

Despite Barton's success, "the decision to adopt vitamin C-rich rations would remain in the hands of individual fleet commanders, ship captains, and their consulting surgeons for well into the nineteenth century. And even if a ship did take necessary preventive measures against scurvy, long deployments could exhaust shipboard provisions leading to a host of nutritional diseases like scurvy," Sobocinski wrote.

The Navy Today

Scurvy, of course, is not a problem for today's Navy.

Jennifer Person, program manager and dietitian for the Navy Food Service, said there are many items on Navy menus to prevent the disease. For example, she said:

• Food service personnel are encouraged to provide 2.5 cups of vegetables and two cups of fruit daily to service members.
• Foods containing vitamin C are abundant.
• Navy menus include a combination of fresh, frozen, and canned fruits and vegetables.
• Vegetables and fruits offered include oranges, red peppers, kiwi, strawberries, broccoli, cantaloupe, tomatoes, potatoes, cauliflower, Brussel sprouts, kale, lemons, and grapefruit juice.
• Many more vitamin C options are available in a wide range of flavors that make it easy for sailors with different preferences to get their daily requirement.

"Leaders across the DOD recognize the importance of fueling our service members for performance with quality foods," Person said. "Galley menus are written according to DOD Menu Standards for Human Performance Optimization that ensure an array of foods are provided daily."

Scurvy Hasn't Gone Away Altogether

Today, scurvy still occurs in developed countries despite the widespread availability of multiple enriched and fortified foods.

According to the National Institutes of Health, those most at risk for scurvy are:

• living alone
• institutionalized with diets devoid of fresh fruits and vegetables
• missing teeth or toothless
• showing poor self-care
• lacking social support
• displaying destructive behaviors such alcoholism, drug abuse, or smoking
• mentally or chronically ill