When Life Gives You Limes, Solve Scurvy

Limey is an offensive term used to refer to British people, but how did such a term come about, and should it be a term of pride instead?

The earliest recorded use of “Limey” is from an 1888 Australian poetry compilation, and was used to describe non-professional British sailors and other British people who had just arrived in the land down under.^[1,2] This term seems to have derived from an earlier term, “lime-juicers,” which meant roughly the same thing.^[1] Lime-based nicknames weren’t chosen randomly, but instead accurately described the habits of British sailors and passengers, who were issued lemon or lime juice on long voyages, such as those to Australia and New Zealand.^[3] Along with livening the flavor of British food and pairing very well with shrimp, lime juice had another property: protection against scurvy.

Scurvy is a nutritional disorder caused by a lack of ascorbic acid, also known as vitamin C.^[4] Most animals make vitamin C from the food they eat, but rodents, bats, monkeys, and apes (including humans) do not.^[4] Instead, we get all our vitamin C from the foods we eat, such as leafy greens, broccoli, and citrus fruits like lemons and limes. Under normal circumstances, we store one to three months' worth of vitamin C in the body.^[4] During extended periods without fresh fruits and vegetables, people use up their vitamin C reserves and may develop scurvy.^[3,4] Scurvy can manifest with various systemic effects, including weakness, pain, and fatigue. Additionally, it may cause or worsen skin issues, mouth and gum deterioration, bone problems, impaired wound healing, blood and heart complications, and can cause death.^[4]

People in northern Europe, including Scotland, could experience symptoms of scurvy in the winter months, but the problem was most pronounced during the age of sail.^[3] Ships traveling for months at sea didn’t have access to fresh fruits and vegetables, and the results were catastrophic. Some sources claim that people expected 50% of those on long voyages to die of scurvy!^[3]

In medicine, there are things we know, things we don’t know, and how we find out what we don’t know. Back in the 1600s and 1700s, physicians were aware of the symptoms and complications of scurvy, but they did not know how to prevent it. There were efforts to fight scurvy, but people of the time lacked both a solution and a method to find the solution. There were many ideas for preventing scurvy, and some hit the nail, but clinical trials didn’t exist, and no one was comparing potential cures in a structured way or  - importantly - sharing their results.

Physician James Lind changed this in 1747 with the first randomized clinical trial.^[5,6] He compared six possible treatments among 12 randomly assigned patients with scurvy, and found that “the most sudden and visible good effects were perceived from the use of the oranges and lemons.”^{[6, pp. 191-192]} Critically, James Lind wasn’t trying to heal only the 12 people in his care, but was trying to solve scurvy for the whole of the British Navy. His results were published in 1753 and slowly made their way through the British admiralty until fresh fruits and vegetables, especially citrus, were the norm.^[6] James Lind had designed the method for how we learn what we don’t know and spread it to the world.

The impact of the first clinical trial can be seen clearly in the death toll of two British voyages around the world. In 1740, just a few years before James Lind’s trial, George Anson took off from England and sailed west with around 2,000 people.^[3] When we got home four years later, 90% had died, most from scurvy.^[3] Compare this with James Cook’s second circumnavigation. Captain Cook sailed in 1772, a couple of decades after James Lind’s results were published. Captain Cook mandated fresh fruits and vegetables for his crew, and as a result, no sailors died from scurvy over the three-year adventure.^[3] Large, real-world demonstrations like this are comparable to a large phase 3 clinical trial, and convinced Britain to issue lemons and limes to all sailors for long voyages.

Today, the term “limey” may be seen as offensive, but it should really be a celebration of James Lind and the first clinical trial.

Creative Director Benton Lowey-Ball, BS, BFA

References:

[1] Oxford University Press. (n.d.). Limey. In Oxford English dictionary. Retrieved April 14, 2025, from https://www.oed.com/dictionary/limey_n

[2] Chandler, A.T. (1888) Coaching the Coach. In  Sladen, B.A. (Ed.), Australian ballads and rhymes: Poems inspired by life and scenery in Australia and New Zealand. (pp. 31-34). Walter Scott. Retrieved April 14, 2025, from  https://archive.org/details/australianballad00slad/page/30/

[3] Price, C. (14 August, 2017). The age of scurvy. Distillations magazine. Science History Institute Museum & Library. [Website] Accessed 14 April, 2025, at https://www.sciencehistory.org/stories/magazine/the-age-of-scurvy/

[4] Amisha, F. N. U., Ghanta, S. N., Kumar, A., Fugere, T., Malik, P., Kakadia, S., ... & Kakadia, S. (2022). Scurvy in the modern world: Extinct or not?. Cureus, 14(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC8958866/

[5] Cook, J., & Price, A. G. (1971). The explorations of Captain James Cook in the Pacific, as told by selections of his own journals, 1768-1779. (pp. 7, 129, 192) Courier Corporation.

[6] Lind, J. (1753). A treatise of the scurvy: in three parts, containing an inquiry into the nature, causes, and cure, of that disease, together with a critical and chronological view of what has been published on the subject. Bulletin of the World Health Organization: the International Journal of Public Health 2004; 82 (10): 793-796. From https://www.jameslindlibrary.org/lind-j-1753