H23 A sailor went to C

Abstract As modern fad diets and chronic illnesses have led to a re-emergence in the presentation of scurvy to dermatology services, we aimed to review the original cohort of patients that gave this condition notoriety – sailors. Scurvy is a disease process secondary to vitamin C deficiency. It has a number of dermatological manifestations, including petechiae, perifollicular haemorrhage, bruising and gingivitis. These presentations occur as vitamin C (ascorbic acid) plays a fundamental role in collagen synthesis. When this process is defective, impaired wound healing is seen. This condition became synonymous with the British and European sailing community during the age of exploration, and it is estimated that 2 million sailors died as a result between the 16th and 18th centuries alone. As ascorbic acid is not naturally produced by humans, we are reliant on external sources of vitamin C to replenish stores. Key sources of vitamin C include fresh fruit and vegetables, such as citrus fruits, spinach, potatoes, berries and tomatoes. Given that there were generally only nonperishable foods available on board these sailing ships, thousands of sailors fell victim to scurvy. James Lind played a notable role in the discovery of vitamin C as a therapeutic agent in the treatment of scurvy and is credited with being the father of the modern-day clinical trial as we know it. The first authenticated example of a therapeutic experiment with controls appears to have been James Lind’s trial in 1747 of the value of citrus fruits in treating scurvy in sailors. (Thomas DP. Sailors, scurvy and science. J R Soc Med 1997; 90: 50–4). Captain James Cook, the eminent sailor, was also one of the first to establish that the provision of fresh vegetables on board could prevent scurvy from developing while on long voyages of exploration. Even in the most severe and end-stage cases of scurvy, it was discovered that the disease process could be reversed with sufficient vitamin C supplementation. While this condition is often considered to be a historical disease, having once been referred to as the ‘plague of the seas’, it is one that dermatologists should continue to be cognizant of when treating patients in modern society.