Vitamin C symptoms are malaise and lethargy, progressing to shortness of breath, bone pain, bleeding gums, susceptibility to bruising, poor wound healing, and finally fever, convulsions and eventual death. Until quite late in the disease the damage is reversible, as healthy collagen replaces the defective collagen with vitamin C repletion. Treatment can be orally or by intramuscular or intravenous injection. Scurvy was known to Hippocrates in the classical era. The disease was shown to be prevented by citrus fruit in an early controlled trial by a Royal Navy surgeon, James Lind, in 1747, and from 1796 lemon juice was issued to all
Scurvy boiling pans, then a common practice 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