Medicine is hard

[nancylebov]

From Less Wrong, an article about losing track of the cure for scurvy for fifty years because of inadequate theory.

This article points in so many interesting directions that I had been putting off posting about it until I could do it justice. Then I saw it show up twice on my flist, so I don't have credit for posting it first. On the other hand, sometimes I don't get around to following links till I see them more than once, and it's not as though everyone on my flist sees all same the posts I do.

Anyway, when lemons were discovered as a cure for scurvy, no one knew what was important about them, nor that there was enough vitamin C in fresh meat to keep people healthy, nor that vitamin C is very fragile. They didn't know that there's a lot less vitamin C in limes than lemons, either.

People died on ships and Antarctic expeditions as result of this ignorance, and so did some upper class babies who'd been put on what was assumed to be the best possible diet of cooked food.

I've heard elsewhere that the Chinese prevented scurvy on ships by growing sprouts-- this is echoed in the story when the Scott expeditions grew watercress under glass on Antarctic, which I think of as charming as well as effective.

Also from elsewhere, the Amundsen expedition was less dramatic (more successful and didn't kill as many people)-- I wonder if they had a better guess about nutrition, and if so, what it was. More googling: Amundsen may just have been luckier, combined with a little less ambition.

Being right is not enough:

Lind tends to get the credit for discovering the citrus cure since he performed something approaching a controlled experiment. But it took an additional forty years of experiments, analysis, and political lobbying for his result to become institutionalized in the Royal Navy.

Being right really isn't enough:

Scurvy had been the leading killer of sailors on long ocean voyages; some ships experienced losses as high as 90% of their men. With the introduction of lemon juice, the British suddenly held a massive strategic advantage over their rivals, one they put to good use in the Napoleonic wars. British ships could now stay out on blockade duty for two years at a time, strangling French ports even as the merchantmen who ferried citrus to the blockading ships continued to die of scurvy, prohibited from touching the curative themselves.

The success of lemon juice was so total that much of Sicily was soon transformed into a lemon orchard for the British fleet. Scurvy continued to be a vexing problem in other navies, who were slow to adopt citrus as a cure, as well as in the Merchant Marine, but for the Royal Navy it had become a disease of the past.

Any further anecdotes about militaries failing to pick up on obvious useful things that their rivals were doing will be gratefully received.

It was a matter of luck that vitamin C as a cure for scurvy was rediscovered as soon as it was-- guinea pigs are the only non-primates which are knows to need vitamin C and get scurvy as a deficiency disease. This in itself might be a reason to be kind of nervous about animal study results.

Finally, that one of the simplest of diseases managed to utterly confound us for so long, at the cost of millions of lives, even after we had stumbled across an unequivocal cure. It makes you wonder how many incurable ailments of the modern world - depression, autism, hypertension, obesity - will turn out to have equally simple solutions, once we are able to see them in the correct light. What will we be slapping our foreheads about sixty years from now, wondering how we missed something so obvious?

We may not just be missing things that were obvious, we may well have forgotten things we already knew.

Sf about a cold trek: The Left Hand of Darkness by Ursula Le Guin

Sf about scurvy: Bedlam Planet by John Brunner

More cold: Norse Code by Greg Van Eekhout (packaged as urban fantasy/paranormal romance, but is actually about an effort to deal with Ragnarok-- pretty good and more like standard fantasy)

The Making of the Representative for Planet 8 by Doris Lessing (a planet freezes slowly, be warned that this is make up as you go science fiction from a non-science fiction author, I found it fascinating anyway)

The Winter of the World by Michael Scott Rohan, in which the big magical threat is malevolent glaciation (from memory, so I might be a little off).

More Lessing: The Good Terrorist. Just a nicely put together book that I enjoyed--it was interesting to track how much havoc the viewpoint character caused as a result of very moderate impulsiveness, how her fucked-upness had clear roots in her childhood, and possibly a hint as to why you shouldn't stock a terrorist cell with British people. As Ellison said (probably about Laffery's Past Master), humor so dark it's ultraviolet.

More free association: Past Master is really excellent. It's about Thomas More getting pulled out of the past to solve the problem of people on a planet based on his Utopia voluntarily forming slums. Lafferty is the only science fiction author I know of whose style is strongly influenced by tall tales.

There's a rain forest that goes down and down, there's killing a cyclops and eating its brains, there are programmed mechanical killers, there are the ansels that go on two legs or four or none and play fan tan, and there are snakes in the brain.

It's set in a temperate climate, in case you want a relief from all that cold.

A little wiseass about scurvy and incentive programs from wikkit42 at another link to the scurvy article

I probably still haven't done the scurvy article justice-- you'll need to read the article to find out how all the mistakes seemed entirely reasonable at the time. People have not gotten smarter.

Comments

[annafdd.livejournal.com]

If you want a wonderful book about Amundsen and Scott, which makes no bones about who was the better man, try The Last Place on Earth, by Roland Huntford. An incredibly engrossing read.

According to him, Amundsen spent some time with people who lived in sub-artic regions, and learned from them to eat seals. Just as he learned lots of other things about how to dress and how to behave in very cold weather. Seal blubber had enough vitamin C to prevent scurvy.

[nancylebov.livejournal.com]

Good sense can save you from lack of theory-- worth remembering.

I reread To Build a Fire by Jack London not so long ago. When I was a kid, it just made me nervous about getting my feet wet, even if it was moderately above freezing and I was solidly in civilization, and I was caught by the importance of thinking about things like whether you start a fire under a snow-laden tree.

As an adult, I noticed that it's an attack on the ideal of pig-headed masculinity. The protagonist is so caught up in his own coolness that he doesn't pay attention to experienced people or his dogs. And dies for it.

[annafdd.livejournal.com]

BTW, Scott and his men died of scurvy, not hunger or hypothermia. Or better, scurvy made them so weak that hunger and cold killed them.

[richardthinks.livejournal.com]

I only knew the 17th/18th century part of the scurvy story. Wow. That might also explain how Angostura Bitters came to be received in the Navy as a suitable cure-all (for mixing with gin) in the 1820s: it had been long enough since they'd felt the pain, and they started to lose the memory of it.

[richardthinks.livejournal.com]

I've heard and absorbed the popular wisdom that Amundsen was much better equipped and that he did more research among people who lived near the north pole in order to explore the south. Luck no doubt played a role, but he seemed to be well placed to take advantage of it.

Shackleton on his second outing, BTW, avoided scurvy through a healthy diet of fresh penguins. Sadly we can't follow the long-term health effects of this diet on his crew because, within a couple of years of their miraculous escape and rescue, most of them had died in the trenches. So: good boots, clean habits, regular fresh fruit/penguin and an avoidance of meat-grinder wars all seem to be important habits of long-lived explorers.

[houseboatonstyx.livejournal.com]

And how many real cures are currently relegated to health food stores and derided as 'snake oil' or 'placebo' because they are so cheap no one can make money selling them.

Example stevia leaf -- not that it cures anything, but it's a safe no-carb substitute for sugar. So the manufactuers of Splenda etc try to keep it from being approved. It's a plant, non-patentable, so no one can make much money from it.

Xylitol DOES prevent tooth decay; similarly not widely used.

[carbonel]

I've tried stevia, both before it was approved and now that (I assume, since I see it sold commercially) it has. My problem with it is that it has more of a taste than Splenda. I could probably get used to it, but right now I find it nasty.

Of course, my primary solution is to import cyclamates from Canada every time I visit, since that's the best sugar substitute I've found yet.

[carbonel]

Oh, and xylitol doesn't cause tooth decay, but a) it isn't low-calorie, and b) in large quantities it causes intestinal gas. That's true of all the low-carb sugar alcohols.

[anton-p-nym.livejournal.com]

And how many real cures are currently relegated to health food stores and derided as 'snake oil' or 'placebo' because they are so cheap no one can make money selling them.

My bet; vastly fewer than there are actual 'snake oil' and 'placebo' products being sold at health food stores because they are so cheap that they can make money selling them at enormous mark-ups. That's not to say that there's nothing on those shelves that could be useful, but rather that the issue's a tad overblown in supplement circles.

-- Steve has seen some that are actively harmful, such as diuretic "cleansers" that can lead to vitamin deficiencies if overused, or that can have drastic side-effects when combined.

[carbonel]

Destiny's Road by Larry Niven is set on a colony planet with a deficiency of available potassium.

I think the book is deeply flawed, but the medical bits were interesting.

Cultural change is hard

[siderea]

Absolutely fascinating! Thanks for the link.

[inquisitiveravn.livejournal.com]

For cold related SF, Alan Dean Foster wrote an entire trilogy about an ice planet called Tran-Ky-Ky. It's set in the Humanx Commonwealth universe. I have the entire trilogy on my shelves if you want to read it. For readers of your LJ who do not live in the same house with me, the novels are: Icerigger, Mission to Molokai, and The Deluge Drivers. I imagine that they're out of print, that doesn't mean that used copies can't be found.