oranges and lemons were the most effectual remedies for this distemper at sea." however, the experiment and its results occupied only a few paragraphs in a work that was long and complex and had little impact. lind himself never actively promoted lemon juice as a single 'cure'. he shared medical opinion at the time that scurvy had multiple causes – notably hard work, bad water, and the consumption of salt meat in a damp atmosphere which inhibited healthful perspiration and normal excretion – and therefore required multiple solutions. lind was also sidetracked by the possibilities of producing a concentrated 'rob' of lemon juice by boiling it. this process destroyed the vitamin c and was therefore unsuccessful. during the 18th century, scurvy killed more british sailors than wartime enemy action. it was mainly by scurvy that george anson, in his celebrated voyage of 1740–1744, lost nearly two-thirds of his crew (1,300 out of 2,000) within the first 10 months of the voyage. the royal navy enlisted 184,899 sailors during the seven years' war; 133,708 of these were "missing" or died from disease, and scurvy was the leading cause. although throughout this period sailors and naval surgeons were increasingly convinced that citrus fruits could cure scurvy, the classically trained physicians who determined medical policy dismissed this evidence as merely anecdotal, as it did not conform to their theories of disease. literature championing the cause of citrus juice, therefore, had no practical impact. the medical theory was based on the assumption that scurvy was a disease of internal putrefaction brought on by faulty digestion caused by the hardships of life at sea and the naval diet. although this basic idea was given different emphases by successive theorists, the remedies they advocated (and which the navy accepted) amounted to little more than the consumption of 'fizzy drinks' to activate the digestive system, the most extreme of which was the regular consumption of 'elixir of vitriol' – sulphuric acid taken with spirits and barley water, and laced with spices. in 1764, a new and similarly inaccurate theory on scurvy appeared. advocated by dr david macbride and sir john pringle, surgeon general of the army and later president of the royal society, this idea was that scurvy was the result of a lack of 'fixed air' in the tissues which could be prevented by drinking infusions of malt and wort whose fermentation within the body would stimulate digestion and restore the missing gases. these ideas received wide and influential backing, when james cook set off to circumnavigate the world (1768–1771) in hm bark endeavour, malt and wort were top of the list of the remedies he was ordered to investigate. the others were beer, sauerkraut (a good source of vitamin c) and lind's 'rob'. the list did not include lemons. cook did not lose a single man to scurvy, and his report came down in favour of malt and wort, although it is now clear that the reason for the health of his crews on this and other voyages was cook's regime of shipboard cleanliness, enforced by strict discipline, as well as frequent replenishment of fresh food and greenstuffs. another beneficial rule implemented by cook was his prohibition of the consumption of salt fat skimmed from the ship's copper boiling pans, then a common practice elsewhere in the navy. in contact with air, the copper formed compounds that prevented the absorption of vitamins by the intestines. the first major long distance expedition that experienced virtually no scurvy was that of the spanish naval officer alessandro malaspina, 1789–1794. malaspina's medical officer, pedro gonzález, was convinced that fresh oranges and lemons were essential for preventing scurvy. only one outbreak occurred, during a 56-day trip across the open sea. five sailors came down with symptoms, one seriously. after three days at guam all five were healthy again. spain's large empire and many ports of call made it easier to acquire fresh fruit. although towards the end of the century macbride's theories were being challenged, the medical authorities in britain remained committed to the notion that scurvy was a disease of internal 'putrefaction' and the sick and hurt board, run by administrators, felt obliged to follow its advice. within the royal navy, however, opinion – strengthened by first-hand experience of the use of lemon juice at the siege of gibraltar and during admiral rodney's expedition to the caribbean – had become increasingly convinced of its efficacy. this was reinforced by the writings of experts like gilbert blane and thomas trotter and by the reports of up-and-coming naval commanders. with the coming of war in 1793, the need to eliminate scurvy acquired a new urgency. but the first initiative came not from the medical establishment but from the admirals. ordered to lead an expedition against mauritius, rear admiral gardner was uninterested in the wort, malt and elixir of vitriol which were still being issued to ships of the royal navy, and demanded that he be supplied with lemons, to counteract scurvy on the voyage. members of the sick and hurt board, recently augmented by two practical naval surgeons, supported the request, and the admiralty ordered that it be done. there was, however, a last minute change of plan, and the expedition against mauritius was cancelled. on 2 may 1794, only hms suffolk and two sloops under commodore peter rainier sailed for the east with an outward bound convoy, but the warships were fully supplied with lemon juice and the sugar with which it had to be mixed. in march 1795, it was reported that the suffolk had arrived in india after a four-month voyage without a trace of scurvy and with a crew that was healthier than when it set out. the effect was immediate. fleet commanders clamoured also to be supplied with lemon juice, and by june the admiralty acknowledged the groundswell of demand in the navy and agreed to a proposal from the sick and hurt board that lemon juice and sugar should in future be issued as a daily ration to the crews of all warships. it took a few years before the method of distribution to all ships in the fleet had been perfected and the supply of the huge quantities of lemon juice required to be secured, but by 1800, the system was in place and functioning. this led to a remarkable health improvement among the sailors and consequently played a critical role in gaining the advantage in naval battles against enemies who had yet to introduce the measures. scurvy was not only a disease of seafarers. the early colonists of australia suffered greatly because of the lack of fresh fruit and vegetables in the winter. there the disease was called spring fever or spring disease and described an often fatal condition associated with skin lesions, bleeding gums and lethargy. it was eventually identified as scurvy and the remedies already in use at sea implemented. 19th century page from the journal of henry walsh mahon showing the effects of scurvy, from his time aboard hm convict ship barrosa (1841/2) the surgeon-in-chief of napoleon's army at the siege of alexandria (1801), baron dominique-jean larrey, wrote in his memoirs that the consumption of horse meat helped the french to curb an epidemic of scurvy. the meat was cooked but was freshly obtained from young horses bought from arabs, and was nevertheless effective. this helped to start the 19th-century tradition of horse meat consumption in france. lauchlin rose patented a method used to preserve citrus juice without alcohol in 1867, creating a concentrated drink known as rose's lime juice. the merchant shipping act of 1867 required all ships of the royal navy and merchant navy to provide a daily lime ration of one pound to sailors to prevent scurvy. the product became nearly ubiquitous, hence the term "limey", first for british sailors, then for english immigrants within the former british colonies (particularly america, new zealand and south africa), and finally, in old american slang, all british people. the plant cochlearia officinalis, also known as "common scurvygrass", acquired its common name from the observation that it cured scurvy, and it was taken on board ships in dried bundles or distilled extracts. its very bitter taste was usually disguised with herbs and spices; however, this did not prevent scurvygrass drinks and sandwiches from becoming a popular fad in the uk until the middle of the nineteenth century, when citrus fruits became more readily available. west indian limes began to supplement lemons, when spain's alliance with france against britain in the napoleonic wars made the supply of mediterranean lemons problematic, and because they were more easily obtained from britain's caribbean colonies and were believed to be more effective because they were more acidic. it was the acid, not the (then-unknown) vitamin c that was believed to cure scurvy. in fact, the west indian limes were significantly lower in vitamin c than the previous lemons and further were not served fresh but rather as lime juice, which had been exposed to light and air, and piped through copper tubing, all of which significantly reduced the vitamin c. indeed, a 1918 animal experiment using representative samples of the navy and merchant marine's lime juice showed that it had virtually no antiscorbutic power at all. the belief that scurvy was fundamentally a nutritional deficiency, best treated by consumption of fresh food, particularly fresh citrus or fresh meat, was not universal in the 19th and early 20th centuries, and thus sailors and explorers continued to have scurvy into the 20th century. for example, the belgian antarctic expedition of 1897–1899 became seriously affected by scurvy when its leader, adrien de gerlache, initially discouraged his men from eating penguin and seal meat. in the royal navy's arctic expeditions in the 19th century it was widely believed that scurvy was prevented by good hygiene on board ship, regular exercise, and maintaining the morale of the crew, rather than by a diet of fresh food. navy expeditions continued to be plagued by scurvy even while fresh (not jerked or tinned) meat was well known as a practical antiscorbutic among civilian whalers and explorers in the arctic. criticism also focused on the fact that some of the men most affected by scurvy on naval polar expeditions had apparently been heavy drinkers, with suggestions that this predisposed them to the condition. even cooking fresh meat did not entirely destroy its antiscorbutic properties, especially as many cooking methods failed to bring all the meat to high temperature. the confusion is attributed to a number of factors: while fresh citrus (particularly lemons) cured scurvy, lime juice that had been exposed to light, air and copper tubing did not – thus undermining the theory that citrus cured scurvy; fresh meat (especially organ meat and raw meat, consumed in arctic exploration) also cured scurvy, undermining the theory that fresh vegetable matter was essential to preventing and curing scurvy; increased marine speed via steam shipping, and improved nutrition on land, reduced the incidence of scurvy – and thus the ineffectiveness of copper-piped lime juice compared to fresh lemons was not immediately revealed. in the resulting confusion, a new hypothesis was proposed, following the new germ theory of disease – that scurvy was caused by ptomaine, a waste product of bacteria, particularly in tainted tinned meat. infantile scurvy emerged in the late 19th century because children were being fed pasteurized cow's milk, particularly in the urban upper class. while pasteurization killed bacteria, it also destroyed vitamin c. this was eventually resolved by supplementing with onion juice or cooked potatoes. native americans helped save some newcomers from scurvy by directing them to eat wild onions. 20th century by the early 20th century, when robert falcon scott made his first expedition to the antarctic (1901–1904), the prevailing theory was that scurvy was caused by "ptomaine poisoning", particularly in tinned meat. however, scott discovered that a diet of fresh meat from antarctic seals cured scurvy before any fatalities occurred. but while he saw fresh meat as a cure for scurvy, he remained confused about its underlying causes. in 1907, an animal model which would eventually help to isolate and identify the "antiscorbutic factor" was discovered. axel holst and theodor frølich, two norwegian physicians studying shipboard beriberi contracted by ship's crews in the norwegian fishing fleet, wanted a small test