Introduction

The role of nutrition in wound healing has been heavily explored since the early part of the 20th century.¹ Addressing the proper balance of both macronutrients and micronutrients is a crucial part of the systemic treatment plan for patients with chronic wounds. Nutrition professionals are often highly valued members of any multidisciplinary healing team. There can often be adverse consequences of malnutrition, such as compromised immune systems and increases in hospital readmission rates.² As modern-day clinicians with access to advanced therapies, we may think that adding nutrient supplementation to a care regimen is a contemporary concept, but in reality it is steeped in history.

Scurvy’s Impact on Wound Care

During the 16th through the 18th centuries, it is estimated that 2 million sailors died of scurvy, often referred to as the “scourge of the sea.”³ Long sea voyages compounded by minimal food preservation methods led to horrible cases of malnutrition. The typical diet of a sailor of that era would be salted meat and biscuits, also known as hardtack. In particular, the lack of fresh fruits and vegetables available to sailors for long periods manifested as a hideous illness known as scurvy.

How to Identify Scurvy

Scurvy is a deficiency of vitamin C. It leads to poor collagen formation that results in hemorrhages of friable blood vessels. Common clinical manifestations of scurvy include bleeding gums with tooth loss, nonhealing cutaneous ulcerations of the legs, and diffuse joint pain that eventually leads to heart failure.⁴ A typical 18th-century treatment for scurvy was to administer an “elixir of vitriol” (solution of sulfuric acid) along with a round or two of bloodletting.⁴ Health and medicine at this time period in general still revolved around Claudius Galen’s Four Humors theory that originated during the Roman period.

Dr. James Lind: The Cure

Dr James Lind, a British naval physician, began an experiment in 1747 to see whether he could cure scurvy through use of citrus fruits.⁵ He took 12 sailors who had scurvy and treated half of them with the standard of care (elixir of vitriol) as the control group; the other half received 2 oranges and 1 lemon per day.⁵ After 1 week of treatment, those sailors consuming citrus fruits showed significant signs of recovery. This was indeed a medical breakthrough!

Dr Lind published his Treatise of the Scurvy in 1753. Unfortunately, it took the British Navy over 42 years to put it into clinical practice by distributing lemon juice routinely to sailors.⁶ For combating this scourge of the sea, he is widely regarded as the father of naval medicine.⁶

Conclusion

The mention of scurvy may conjure up images of seafaring folks from long ago, but in truth, it is still with us today. This vitamin deficiency is still present in certain populations, including those who are institutionalized, lack social support, live alone, have addictions, and/or have other mental health issues. The connection between nutrition and well-being is as important now as it was then, especially in terms of wound healing. Humanity owes much gratitude to Dr James Lind for curing scurvy, and there is much to be learned from the past as we move into the future.

References

1. Molnar JA, Underdown MJ, Clark WA. Nutrition and chronic wounds. Adv Wound Care (New Rochelle). 2014;3:663-678.
2. Yinusa G, Scammell J, Murphy J, Ford G, Baron S. Multidisciplinary provision of food and nutritional care to hospitalized adult in-patients: a scoping review. J Multidiscip Healthc. 2021;14:459-491. doi: 10.2147/JMDH.S255256
3. Aker JA. The British 'limeys' were right: a short history of scurvy. Health.mil. Military Health System; 2022. Accessed July 20, 2022. https://health.mil/News/Articles/2022/01/10/The-British-Limeys-Were-Rig… Miller C. A Guide to 18th Century Military Medicine in Colonial America. CreateSpace Independent Publishing Platform; 2016.
4. White M. James Lind: the man who helped to cure scurvy with lemons. BBC News; 2016. Accessed July 28, 2022; https://www.bbc.com/news/uk-england-37320399
5. Harvie DI. Limeys: The True Story of One Man's War Against Ignorance, the Establishment and the Deadly Scurvy. Sutton; 2002.

About the Author

Christine Miller DPM, PhD is a certified wound specialist by the American Board of Wound Management and a Fellow of the American College of Clinical Wound Specialists. She currently serves as the Co-Director of the Limb Salvage Program at the University of Florida, College of Medicine-Jacksonville.