HISTORICAL PERSPECTIVES Nutrition Vol. 13, No. 9, 1997

GUEST EDITORS:

DONALD McLAREN, MD, PHD West Sussex, United Kingdom

GEORGE WOLF, DPHIL University of California

Berkeley, California, USA

Eduard Schwarz, A Neglected Pioneer in the History of Nutrition

GEORGE WOLF, D PHIL

From the Department of Nutritional Sciences, University of California, Berkeley, California, USA

ABSTRACT

An account of the journey around the world by the Austrian ship’s doctor Eduard Schwarz on a sailing ship from 1857 to 1859, his successful cure of nightblindness among the sailors, and how he was maligned by some of the Viennese medical press for his view that nightblindness is a nutritional disorder. Nutrition 1997;13:844-846 OElsevier Science Inc. 1997

Key words: Eduard Schwarz, sailing ship, ship’s doctor, Austrian navy, nightblindness, ox liver, nutritional disorder

In the year 1856, when the Austrian-Hungarian Empire was at its zenith, the Archduke Ferdinand Maximilian, brother of the emperor Franz Joseph I, and chief commander of the Austrian navy, ordered the frigate Novara to be prepared for a voyage around the world. The voyage’s purposes were to train naval officer cadets in seamanship, to show the Austrian flag in ports of countries not yet aware of Austrian shipping and overseas trade, and to make scientific studies in a variety of disciplines, particu- larly maritime (ocean currents, trade winds, and depths), geo- graphic and geologic. The journey was described in great detail by the participating geographer, K. von Scherzer, in eight lavishly illustrated volumes. l

The three-master, 2000-ton sailing ship left the then Austrian port of Trieste in April 1857 with 352 men on board, including 17 officers, 14 cadets (among whom, curiously, there were one prince, four barons, and one count) and, characteristic for an Austrian ship, a navy music band of seven men who played merry tunes every morning to keep up the morale of the crew. The scientific complement consisted of a geographer-anthropologist, a geologist-physicist, two botanists, two zoologists, and four ship’s doctors. Eduard Schwarz, a young physician of 26, said to be open minded, imaginative and a good linguist, was selected from among 310 applicants as one of the four ship’s doctors. Eduard Schwarz had been born in Miskolz, Hungary, in 1831 of poor Jewish parents. During his medical studies in Vienna, he sup- ported himself as a house tutor.* He had a personal interest in physical anthropology and collected measurements of surface and volume relationships of crania from different human races that he encountered on the voyage.3

The Novara sailed via Gibraltar and Madeira to Brazil, then southwards to South Africa, Ceylon (now Sri Lanka), Madras in India, the Nicobaric Islands, Singapore, Java, Manila, Hong Kong, and Shanghai. While crossing the China Sea, the Novara survived a terrifying cyclone and arrived safely in Sydney, Australia. The next stop was New Zealand, then Tahiti, Chile, and back home round Cape Horn, past Gibraltar to Trieste, arriving in August 1859 in triumph, welcomed by the Archduke Ferdinand Maximil- ian with fireworks and music.

Throughout the voyage, observations were recorded of eco- nomic conditions in the countries visited, possibilities for trade, and anthropologic observations of local customs. Geologic and botanical specimens were collected on journeys inland in many places, and maritime data (currents, depths, and trade winds) were collected.

As a ship’s doctor, Schwarz was concerned mainly with the hygienic conditions on board4: decks were scrubbed daily, the crew took showers daily with a special soap designed for use with seawater, and the crew’s clothes were washed twice weekly. Although the microbial cause of disease was not known at that time, nonetheless, cleanliness as a condition for a healthy life was considered important. Schwarz comments on the hot, stagnant, moist air below deck (“bad air” or “mal’aria”), filled with “accumulated chemical toxins.” He thought it developed sponta- neously in decaying vegetable matter. It was called “miasma,” thought to be the cause of what we would now call infectious disease. He presents an elaborate table giving the incidence, duration, and cures of “sailor’s diseases” (e.g., bone fractures and constipation); “diseases of civilization” (e.g., syphilis and gon-

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EDUARD SCHWARZ AND THE TREATMENT OF NIGHTBLINDNESS 845

orrhea); “diseases due to climate” (e.g., pneumonia, otitis, and abscesses); “miasmic diseases” (e.g., malaria, typhus, cholera, and dysentery) and devotes a whole chapter to seasickness with- out, however, mentioning the equilibrium organ.

Schwarz was very much concerned with diseases caused by improper diet. Often food was spoiled by insects; meat, even in canned form (a recent innovation) underwent the “usual spoilage processes.” The sailors’ diet consisted of zwieback (plain or mixed with oil as a kind of soup, twice daily), cheese (twice weekly), rice (four times weekly), salt pork or boiled canned beef (disliked by the crew) (three times weekly), compressed, dehy- drated vegetable mixture (twice weekly), sauerkraut (once week- ly), cacao, wine, and a small amount of mm. Potable water was made from seawater by a distillation apparatus, an innovation that, however, broke down toward the end of the trip.

Cases of scurvy, caused by vitamin C deficiency, were most numerous during the long haul (82 days) between Chile and Gibraltar (115 cases among the remaining crew of 343 men), and definitely were ascribed by Schwatz to a dietary deficiency, cur- able with fresh fruit and vegetables obtained during stopovers in various ports. At sea, limited success in curing scurvy was achieved with Calamus aromaticus (a tonic), very dilute sulfuric acid and lime juice. Fresh limes, of course, are curative, but the lime juice provided for sea voyages had been processed commer- cially and thereby had apparently lost its vitamin C activity. In hindsight, one can conclude that the processing had destroyed most of the vitamin C (and carotenoids) in the dehydrated vege- tables. The rest of the diet would contain very little of those vitamins.

Schwarz noted that nightblindness was the “faithful compan- ion” of scurvy (71 cases between Chile and Gibraltar) and there- fore suspected it to be also of nutritional origin. Nightblindness, a disease caused by a dietary deficiency of vitamin A, was known in ancient Egypt 3500 y ago and was treated by administration of liver (rich in this vitamin), although some modem scholars have doubted this. Certainly, Hippocrates (460-327 BC) cured night- blindness by giving raw liver (dipped in honey to make it more palatable) to his patients5

Throughout antiquity, the middle ages, and the 18th century, liver was used here and there as a folk remedy to combat vitamin A deficiency, manifested as nightblindness. This disease became an acute problem among sailors on long sea voyages, such as the explorations of the 18th and 19th centuries. A scientific interest in this problem did not begin until the second half of the 19th century. The prevailing medical view at that time was that night- blindness was caused by overexposure to light. For instance, as late as 1872, A. Netter6 in Paris advocated a treatment for night- blindness in which the patient was kept in a dark chamber (cabinet tenebreux) for several days and given laxatives and emetics, to remove an “opaque pigment” thought to accumulate in the pupil due to excessive light.

Schwarz states that nightblindness should be regarded as a nutritional defect (“Em%hrungsstGrung”). He explicitly and pur- posely states that this view is contrary to that of the majority of scientists. He regrets that the then favored physical explanations of nightblindness-excess sun or moonlight or light in general- would have to be abandoned, even though propounded by the greatest contemporary authorities.

In a series of experiments carried out on the voyage, Schwarz exposed nightblind patients to different levels of light and concluded that the defect must be either an obstacle in the lightpath to the retina or a defect in the retina itself [we now know that it is caused by a defective response of the light- sensitive rods of the retina due to a decline in the visual pigment rhodopsin, consisting of vitamin A aldehyde (retinal- dehyde) joined to the protein opsin]. Schwarz described in

detail the behavior of nightblind sailors: at dusk, objects ap- peared darkened, as though seen from a distance, with indis- tinct contours, but never distorted. Light-absorbing objects were invisible in candlelight. Below deck, patients were prac- tically blind. The disease developed from mild to severe during 3-5 d. If the patient was kept in complete darkness for 3-6 d, he was momentarily cured, but became nightblind again within 2-4 days in daylight (we can conclude, from modem knowl- edge, that during dark adaptation, the small amount of vitamin A reserves remaining in the body reached the retina to reform the depleted visual pigment). Curiously, most of the members of the musical band were afflicted-perhaps they received less nourishment than the regular sailors.

Before his departure from Vienna, Schwarz had been asked by several physicians to test ox liver, the old Hippocratic prescription for nightblindness. He treated the eyes of his patients with the steam from ox liver in boiling water, followed by consumption of the liver by the patient. The patient’s normal vision was restored within days. Schwarz termed the cure a “true miracle” and comments that he regarded the eating and not the steam treatment as the true cure. Pork liver was equally effective and recovery was permanent. A year later, on board another warship, he was able to examine several of the sailors he had treated successfully on the Novara: he found no trace of the illness.

One wonders why, on long sea voyages fish was not caught to be included in the crews’ diets. It would surely have been a welcome change from the canned boiled meat that the sailors abhorred. In particular, it is strange that Schwarz did not also test fish liver, now known to be the richest source of vitamin A. Interestingly, in 1863, M. Desponts’ reported the successful treatment with cod-liver oil of nightblind soldiers in a Paris garrison. He remarks “the nauseating taste and repugnance which it inspires could perhaps explain the extraordinarily rapid cure-there could have been quite a few ‘simulators’ among the young soldiers.” Of course, cod-liver oil was ad- ministered as a medicine, not as a nutritional supplement. Schwarz’s merit lies in his realization that the cause of the disease was a nutritional deficiency.

Upon his return, Schwarz published his medical observations in one volume of the eight-volume account of the voyage. The medical volume received high praise in reviews in three different German (Prussian) medical journals. Two Austrian medical jour- nal+’ gave it cool, but reasonable reviews. However, the Weekly Edition of the Journal of the Imperial-Royal Society of Physicians in Vienna’0 came out (anonymously) with an extraordinarily scur- rilous and vicious attack on Schwarz. Especially in regard to his views on nightblindness and its dietary origin, the reviewer states that “the author must be seriously reprimanded for expecting the reader to accept as facts the exorbitant results of his observations. One who damns with strong words the beliefs of the authorities [regarding nightblindness] is confident enough in this, his first attempt, to expect us to believe his words.” The reviewer is indignant about the “frivolity” of presenting observations “with- out a shadow of proof” and declares it a case of “self-aggran- dizement.” The reviewer then waxes sarcastic: “but no, we take back all the above; we would prefer to believe that the author is completely ignorant of the literature on nightblindness.”

The real reason for this totally unjustified attack suddenly becomes clear in a sentence in connection with a remark by Schwarz in which he discussed the probability that humans could endure the world’s climates without impairment of their health, provided they accepted the appropriate customs and habits. The reviewer asks, “Von wannen kommt Euch diese Wahrscheinlichkeit?” (“How do you arrive at this probabili- ty?“). This sentence is not German, but mock-Yiddish. The anti-Semitic intention of this remark is unmistakable. The

846 EDUARD SCHWARZ AND THE TREATMENT OF NIGHTBLINDNESS

Viennese Medical Weekly ‘1 comes to the defense of Schwarz century Vienna. His funeral, at the Jewish cemetery of Vienna, and comments regarding that sentence: “confronted with man- though unattended by any family-he was unmarried and his ners of this sort, the pen drops out of one’s hand and one parents had died-nonetheless was witnessed by many who instinctively reaches for-the rod.” mourned his passing.

Poor Eduard Schwarz died of tuberculosis at age 31, only 3 y after his return from the arduous voyage around the world. His obituary* in the sympathetic Viennese Medical Weekly reports that the last year of his life was poisoned by the unjust contempt in which he was held by influential personages, reflecting the anti- Semitic undertow pervading even the medical profession in 19th

ACKNOWLEDGMENT

The author thanks Dr. Esther Alder, Department of French, for expert assistance with the Yiddish language, and Dr. Ken- neth J. Carpenter, Department of Nutritional Sciences, Univer- sity of California, Berkeley, for help with historical sources.

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REFERENCES

Schemer K. von. Reise der oesterreichischen Fregatte Novara urn die 7. Desponts E. De l’hemeralopie. Traitement de cette maladie par Erde. Vienna: KK Hof und Staatsdruckerei, 1861 l’huile de foie de morue a l’interieur. Bull Acad Med Paris 1861; Anonymous. Dr. Eduard Schwarz, der Novara-Reisende. Wiener 27:1016 medizin Wocherschrift 1862; 12:65 1 8. Anonymous. Reise der oesterreichischen Fregatte Novara urn Schwarz, E. Novara expedition, anthropology. A system of anthropo- die Erde, Medizinischer Theil. Zeitschr Prakt Heilkunde 1862; metrical investigations as a means for the differential diagnosis of 8:60 human races; some general results of the measurements and the 9. Anonymous. Reise der oesterreichischen Fregatte Novara urn die instruments required. Vienna: KK Hof und Staatsdruckerei, 1826 Erde. Medizinischer Theil. Wiener Medizin Wochenschr 1862: Schwarz, E. Ini Scherzer, K, ed. Reise der oesterreichischen Fregatte 12:s; Novara urn die Erde. Volume 8, Medizinischer Theil. Vienna: KK Hof 10. Anonymous. Reise der oesterreichischen Fregatte Novara urn die und Staatsdruckerei, 1861 Erde, Medizinischer Theil. Wochenblatt Zeitschr KK Gesellschaft der Wolf G. A history of vitamin A and retinoids. FASEB J 1996; 10: 1102 Aerzte 1862;18:82 Netter A. Traitement general de l’htmeralopie par les cabinets ttnt- 11. Anonymous. Dr. Eduard Schwarz bei der Londoner Weltansstellang. breux. Gazette HBpitaux Paris 1872;45:322 Wiener Medizin Wochenschr 1862;12:316