Scurvy Mystery Reveals Arrogance of Medicine

Physicians have been respected for thousands of years. That’s because people who are suffering look to healers for comfort. Hippocrates, the father of modern medicine, suggested an “oath” for medical students. Around 430 BCE he wrote: “I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.” Sadly, not all doctors have followed his precepts. As a result, an arrogance of medicine has persisted for hundreds of years. One example is how doctors bungled the diagnosis and treatment of scurvy.

Scurvy and the Arrogance of Medicine:

According to his book, “What’s Gotten Into You,” Dan Levitt notes that scurvy was a scourge. It killed approximately two million sailors in the three centuries between 1500 and 1800.

Long voyages often took a tremendous toll. Sailors became weak and irritable. They developed joint pain, bleeding gums and bruises. Their swollen gums could not hold on to teeth, which often fell out.

Old scars would open up and start to bleed, while new wounds failed to heal. By the 18th century, a captain on a long voyage might lose half his crew to scurvy.

Ignoring the Evidence:

It didn’t have to happen. That’s because the cure had been discovered more than a century earlier. In 1617 a textbook for ships’ doctors recommended daily doses of lemon juice.

Dan Levitt summarized this knowledge in his article in Popular Science (Jan. 26, 2023):

“The writer Stephen Bown observes that in the seventeenth century, captains made mad dashes from port to port in an attempt to outrun the disease. It was also known that lemon juice could prevent or cure it. In his 1617 textbook, The Surgeon’s Mate, John Woodall recommended lemon juice daily. The Dutch East India Company even established plantations in the Cape of Good Hope and Mauritius to provide lemons for their crews.

“Over time, unfortunately, the knowledge of lemon juice’s beneficial properties somehow vanished. The reasons were many, including simple complacency. When the incidence of scurvy grew worse again, there was resistance to citrus. Lemon juice was expensive and some shipowners suspected that merchants touted the imaginary medicinal powers of lemons just to drive up the price. At the same time, physicians were peddling a confusing variety of many other supposed cures. As author David Harvie observes, there were even “anti-fruiters,” who claimed that lemons hurt rather than helped sailors on some expeditions.”

The Arrogance of Medicine Delayed Effective Treatment:

It wasn’t until 1747 that ship surgeon James Lind performed a small and complicated experiment. He got permission to treat 12 sailors who were sick with scurvy. Modern medicine would laugh at such a small, short and seemingly silly “study.”

According to Levitt, Lind tried seawater, cider, vinegar, sulfuric acid, citrus fruit and a mystery mixture of garlic and radish root with some other herbal products. Only two people tested each remedy, and the trial lasted only a week.

The Lemons Won!

At that point, the ship ran out of lemons and oranges. But during that week, the duo getting citrus fruit recovered, while the others just got sicker.

It took Lind a long time to write up his findings, which he published in 1753. The British Navy was even slower, though. More than 100,000 men died of scurvy between 1756 and 1763, during the Seven Years’ War.

Scurvy continued to cripple crews during a cross-Atlantic altercation in the late 1770s that we call the American Revolution. Would the British Navy have prevailed if it had paid attention to Lind?

In 1795, the Navy finally began providing sailors with lemon juice. Read more about scurvy and other fascinating medical discoveries in Dan Levitt’s book, What’s Gotten Into You.

Clinical Experience vs. “Evidence-Based Medicine”

There was a time, not that long ago, when physicians trusted their clinical experience. They made mistakes, to be sure. Sticking an icepick into the eye socket to sever neuronal connections in the brain was barbaric. “Frontal lobotomies” were supposed to “cure” forms of mental illness such as schizophrenia. Instead, it left many patients in a vegetative state.

The arrogance of medicine allowed this barbaric “surgery” to persist for far too long. Tens of thousands of patients were lobotomized during the 1940s and 1950s.

Discovering Diseases and Treatments Through Observation:

Despite the disasters, many physicians discovered new diseases and treatments through careful observation. These days, though, doctors are not supposed to rely upon experience. Instead, we live in the age of “evidence-based medicine” and guidelines.

That means randomized clinical trials and recommendations from thought leaders based on data. We are enthusiastic about evidence, but we also appreciate careful observation and experience.

Another physician, Ignaz Semmelweis, made an important observation during the mid-19th century. He noted that the maternity ward staffed by midwives had a much lower maternal mortality rate than the one staffed by doctors. Medical students often had their hands in cadavers in the anatomy labs, which were close to the maternity ward.

The Hand Washing Experiment:

After considering other possibilities, Dr. Semmelweis ordered the medical staff to wash their hands and instruments with a strong chlorine disinfectant. As a result, maternal mortality plummeted.

You might think that the results of this “experiment” would have been celebrated by the medical community. Even more important, you would assume that the colleagues of Dr. Semmelweis would have embraced his idea of hand washing before delivering babies.

Once again, the arrogance of medicine reared its ugly head. This thoughtful physician was ridiculed. His research was rejected, and he ended up in an insane asylum. You can read more about this sad chapter in the history of medicine at this link.

Modern Day Arrogance in Medicine:

More than a decade ago the British health service (NHS) discouraged long-sleeve white coats, jewelry and ties.

CBS news reported on September 17, 2007:

“‘Ties are rarely laundered but worn daily,’ the Department of Health said in a statement. ‘They perform no beneficial function in patient care and have been shown to be colonized by pathogens.’

“The new regulations would mean an end to doctors’ traditional white coats, Health Secretary Alan Johnson said. Fake nails, jewelry and watches, which the department warned could harbor germs, are also out.

“Johnson said the ‘bare below the elbows’ dress code would help prevent the spread of Methicillin-resistant Staphylococcus aureus, or MRSA, the deadly bacteria resistant to nearly every available antibiotic.”

The Arrogance of Medicine in America Rejected That Idea:

To this day, most hospitals in the US have not implemented a “bare below the elbows” dress code.

The Harvard T.H. Chan School of Public Health shared this perspective in its 2019 News:

“While the doctor’s white coat may symbolize the profession of medicine, it may also be harboring bacteria and pathogens, studies have found.

“In an April 29, 2019 New York Times article, Austin Frakt, adjunct associate professor in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health, described research that found harmful bacteria on doctors’ white coats, on their ties, and on stethoscopes, phones, and tablets that they use.

“For instance, a systematic review found that as many as 16% of white coats tested positive for methicillin-resistant Staphylococcus aureus (MRSA), and up to 42% for the bacterial class Gram-negative rods. Both types of bacteria can cause serious health problems, such as skin and bloodstream infections, sepsis, and pneumonia. Another study, of orthopedic surgeons, found a 45% match between the types of bacteria found on their ties and in the wounds of patients they’d treated.”

You can read more about this controversy in our article at this link:

“Doctors Resist Removing White Coats and Ties”

Have We Learned Anything in 300 Years?

Drs. Lind and Semmelweis both conducted their experiments a long time ago because they had observed things that their colleagues ignored. Perhaps it is time for modern-day researchers to recognize the value of experience as well as experiments.

We would also like to see all hospitals and clinics supplying their staffs with clean or disposable outer wear. We think health professionals should change out of their street clothes and into clean clothes before they start seeing and touching patients.

What do you think? Is there still arrogance of medicine? Have you had a disappointing experience with a health professional who did not listen to you? Please share your story in the comment section below. And if you would like to protect yourself or someone you love from this kind of behavior, check out our book, Top Screwups at this link.