Scurvy in adults and youngsters: the Dutch experience. A review of the history and pathology of a disregarded disease

Abstract

AbstractPrior to the Dutch maritime expansion of the 17th and 18th centuries, scurvy was known in the Low Countries as an endemic disease. From the end of the 16th century the disease started to draw much more attention due to increasing long sea journeys of sailors. Already in the Dutch medical literature of the 16th century, a strong relation was expressed between the prolonged taking of foodstuffs of poor quality and the risk of contracting scurvy. Although from that time, many Dutch physicians recommended oranges, scurvy grass and brook‐lime, it took 200 years before inadequate therapy on the fleet was replaced by systematic prevention. Why did the old time effective recommendations for the therapy of scurvy stay inadequate for mariners? To understand, maritime and medical history were unfolded and evaluated with respect to palaeopathological findings reported for 39 cases of active scurvy and one case of healed scurvy.The palaeopathology of scurvy in adults and still growing youngsters was investigated from the remains of 50 Dutch whalers who had been buried during the 17th and 18th centuries on an island of the Spitsbergen Archipelago. Conforming the clinical literature, the original haematomas from scurvy were found as a black staining at the tips of dental roots. In the weight‐bearing bones of the lower extremities large black stains were positioned bilaterally around endofractures of the metaphyses, bilaterally on joint surfaces and bilaterally at epiphyseal discs of youngsters. In the non‐weight‐bearing bones they were often found unilaterally, such as at insertions of muscles. Immunoenzymatic staining of microscopic sections proved that the black stains were from remnants of denatured haemoglobin. No microscopic bone repair activities had happened. In a case of healed scurvy it could even be demonstrated how many times the recovery process had taken place from the layers of appositional bone which had replaced the original subperiosteal haematomas. Copyright © 2004 John Wiley & Sons, Ltd.