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history 175 AR Butler, AR Butler, 10.4997/JRCPE.2013.217 [email protected] –81 43:175 Edinb 2013; Coll Physicians J R +44 (0)1334 474720 (0)1334 +44 http://dx.doi.org/ Correspondence to Correspondence Building, Purdie Andrews, University of St 9ST, KY16 Andrews St UK , tel. e-mail © 2013 Royal College of Physicians of Edinburgh of Physicians of College Royal © 2013

Members of the expedition at the expedition at Nova Terra the of Members

figure 1 figure : F Scott, , Henry R Oates, Lawrence Robert F Scott, Pole: South (photographer: Evans Edgar and Wilson, A. Edward Bowers, the Library From Congress. of Herbert J Ponting). all died in their sleeping bags; their bodies and personal their bodies and personal all died in their sleeping bags; a search some months later by discovered were effects starvation simply it and Was die? they did Why party. never can Although we exhaustion or was it ? is a certain there amount of medical sure, for know that sheds light on these questions. evidence In 2 Amundsen’s dash to the Pole, although not not although Pole, the to dash Amundsen’s Scurvy, caused by lack of vitamin C, was a major problem for polar for problem was a major lack of vitamin C, caused by Scurvy, 1 ODUCTION Paper Honorary Professor of Medical Science, Medical School, University of St Andrews, UK Scotland, of St University School, Medical Science, Honorary Professor of Medical AR Butler The role of scurvy in Scott’s return from the the from return scurvy of role The in Scott’s Pole South contrast, the return of Scott and the four other other of Scott and the four the return contrast, Henry Bowers, Oates, members of his party (Lawrence was Pole the from Evans) Edgar and Wilson Edward and tragedy almost as soon as they mishap beset by Evans weeks few a only After 1). started(Figure out and he died which he did not recover had a fall from though it is not clear whether the fall was soon after, stage no member of the at this early Even the cause. were they later weeks Some partyhealth. good in was and tent the left Oates blizzard; a by tent a in confined been an act which has subsequently was not seen again, a others the allow to sacrifice deliberate a as regarded this stage the remaining Although by chance of survival. from miles 11 only partythe of members were three they food, was fuel and there Depot where Ton One that believe historians Some further. no go could Scott but continued have could Bowers and Wilson They him. leave want to not did they or back them held INTR the centenary 2012 marked of Robert year Falcon The the South Pole, from tragic on his return Scott’s Roald the Norwegian been beaten to it by having Amundsen. ABSTRACT explorers. It may have contributed to the general ill-health of the members of to the general ill-health of contributed have It may explorers. by caused been have to likely more partypolar are deaths their but 1912 in Scott’s that argued Some have hypothermia. and malnutrition frostbite, of combination a C, a lack of vitamin caused by dehiscence in particular war wound suffered Oates’s in Britain doctors many At the time, to support is little evidence this. but there FrølichTheodor and Holst Axel by the experiments of results the overlooked theaccept to continued and deficiencies nutritional of effects the showed which that polar scurvy was due to ptomaine Wright, Almroth Sir championed by view, duringScott to given advice any of this, Because . tainted from poisoning scurvyof effect the minimise him helped have not probably would preparations his on the members of his party. Oates Lawrence , scurvy, exploration, rds Polar Keywo No conflicts of interest declared. declared. interest conflicts of ions of Interests No Declarat devoid of hardship and setback, was relatively crisis- relatively was and setback, of hardship devoid partyhis of members other the and he and (Olav free Hassel and Oscar Sverre , Bjaaland, health and to base camp in good Wisting) returned during the journey. put on weight in fact, had, AR Butler

SCURVY AND POLAR TRAVEL The clinical features of scurvy The features of scurvy change with the severity of vitamin The causes of scurvy C deprivation. Initially the features may include lassitude, general depression and cutaneous abnormalities but with Scurvy posed a significant problem for polar explorers the passage of time more strident physical signs appear, in the nineteenth century as it had done for sailors in including bleeding gums, loose teeth, lower limb oedema the previous century. Its cause is now known to be and blurred vision. There may be dyspnoea, possibly due lack of vitamin C but in those times the concept of to anaemia. Minor cuts do not heal largely because vitamins, trace substances that had a profound effect vitamin C is a powerful antioxidant, removing radicals that on human health, was unknown. While Frederick would otherwise hinder the wound healing process.7 Gowland Hopkins’s seminal paper3 on what he called Acute scurvy can cause death and is clearly a considerable ‘accessory food factors’ did not appear until 1912, the hazard on a long polar journey. The cause, at the time, was concept was a familiar one before then. In a model thought to be ptomaine (or food) poisoning due to clinical trial in 1747, James Lind, a Scottish naval tainted or infected pemmican. However, the nature of surgeon, found a reliable treatment for scurvy: fresh ptomaine poisoning was ill-defined and there was little lemons.4 Humans, other higher apes, some monkeys clinical evidence to support this view. and guinea pigs are the only animals that cannot Prevention of scurvy during the 1901 expedition synthesise their own vitamin C and need to obtain it from an exogenous source; we can only store vitamin In contrast to the confusion surrounding the cause of C in sufficient quantity to last two or three months. polar scurvy, the means of avoiding it was well-known to After the publication of Lind’s results, the most polar explorers: consumption of fresh food by solved the problem of scurvy on long voyages by ‘living off the land’. Scott was well-aware of the dangers distributing fresh lemon juice (always called lime juice) of scurvy as it had been prevalent in base camp during to sailors. This worked well until lemons from Malta his 1901 expedition and, with greater severity, and Spain were replaced by the bottled juice of limes during summer training excursions. grown in the British and scurvy reappeared.5 became so ill with scurvy that he had to return to New Limes contain much less vitamin C than lemons, and Zealand.8 One member of Scott’s 1901 party (Dr during the extraction process, the juice was pumped Reginald Koettlitz) spent three years in the as a through copper pipes which catalysed the oxidation of member of the Jackson-Harmsworth expedition and had vitamin C.6 With the passage of time it therefore noted that scurvy was not a serious problem for them. appeared that the navy did not have a prophylactic for This he credited to regularly eating fresh meat (seal and scurvy after all. At the same time, the quality of food penguin). He tried to persuade Scott that everyone on board ship improved, sea travel was faster and the should eat fresh penguin meat frequently. Scott disagreed problem receded, particularly if the sailors were because he thought the slaughter of so many penguins healthy enough to have a store of vitamin C before the was cruel and would not be well-received by the British voyage started. In spite of the success of Lind’s study, public. He allowed a few meals of penguin but not by the beginning of the twentieth century the early enough to make a significant difference to health. In any confidence that a successful treatment for scurvy had event, the cook made no attempt to make the penguin been found had gone. meat palatable and it was unpopular. One member of the party () described it as tasting of ‘shoe For polar travellers the situation was somewhat leather steeped in turpentine’.9 Soon mild scurvy was different from that of sailors, for whom revictualling rife. When Scott was away on a trip, , a was possible. Polar journeys normally lasted many P & O line officer with Arctic experience, was left in months or even years, much longer than the store of charge and insisted on meals of penguin meat and, vitamin C in the human body, and for much of the time possibly more significantly, the cook found better ways no fresh food was available. The normal source of of preparing it. The situation improved to such an extent nourishment for polar travellers was pemmican, a food that even Scott was impressed when he returned, and he that North American trappers learned of from the allowed the new regimen to continue. Cree Indians. It consists of blocks of ground dried meat Scurvy and the second expedition (generally beef) and fat, although sometimes small amounts of other materials are added. It is very high in Although the expedition of 1901 had alerted Scott to calories, has an unpleasant taste and is not very the dangers of scurvy for polar travellers, it is not clear palatable. The high calorie to weight ratio (6 kcal per g) that he applied these experiences to the diet of the is its only virtue. It is, however, very low in vitamin C, so shore party during the first winter of his it is not surprising that scurvy was commonplace among second expedition. They certainly had meals including history polar travellers. fresh meat but also regularly ate pemmican. In contrast, Amundsen was absolute in his resolve to prevent scurvy.

176 J R Coll Physicians Edinb 2013; 43:175–81 © 2013 RCPE history 177 Although Scott and Shackleton Shackleton and Although Scott 17 Captain RobertCaptain writing in his diary F Scott

The role of scurvy in Scott’s return from the South Pole South the from return of scurvy role The in Scott’s figure 2 figure during the British Antarctic Expedition, 1910 or 1911 1911 1910 or Expedition, Antarctic the British during the Library From of Herbert J Ponting). (photographer: Congress. did not get on well, Scott could still have benefitted benefitted have still could Scott well, on get not did his experience. from complex but Wright and other members of the medical medical the of members other and Wright but complex of been aware have establishment in Britain would that Scott would It is not to be expected their findings. of the them but the ignorance or read be aware Eric his credit To medical establishment is surprising. 1908 expedition, the doctor in Shackleton’s Marshall, and insisted that the party the papers had as had read thus meat, seal including possible, as food fresh much scurvy. avoiding largely also advice for turned Scott whom to person Another In of personal bias. as a result possibly served him badly, it on test to to sledge motor a 1910 Scott took Fridtjof Nansen, met he While there Mjøsen. Lake frozen a was Nansen travel. polar of the pioneers of one an as later best known in his time, figure towering but with the , international statesman disciple of polar explorer, he was also a neuroscientist, of St Rector and Jaeger Dr Gustav the clothing reformer as a student at In 1888, (1925–8). University Andrews he defended ), (now Christiania of University the Professor was the examiners of one thesis; his doctoral thoroughly so findings his challenged who Holst Axel Holst When rejected. be might thesis his thought he that scurvy, on their papers published Frølich later and ridiculing newspaper a a vitriolic letter to wrote Nansen far this How it. and advised Scott to ignore the work how and scientific judgment a genuine was response treated been had he way the for revenge was much but it examination is difficult during his doctoral to say, was alarmed at however Nansen ill-advised. remained the for preparations ill-conceived hasty and Scott’s pulling the for dogs expedition and advised him to take but this on man-hauling, rather than relying sledges

13 In the case 11 These papers were were These papers 15,16 stating that scurvythat stating was 12 WRIGHT TH 10 O 2013; 43:175–81 2013; 14 Sir has hit the truth, he (Atkinson) he (Atkinson) Wright has hit the truth, Almroth Sir acidity of blood – acid in finding increased thinks, possible in recent methods only – by intoxication he holds the first cause to be In brief, years… but secondarytainted food or contributory causes the disease. potent in developing more be even may in fact, bad light, bad air, over-exertion, cold, Damp, condition exceptional to normal healthy any to change these conditions are Remedies existence. the better. for It was my plan to devote the entire winter to entire the devote to plan my was It perfection and to get as near on our outfit, working have should to which we Another thing possible. as some time was the killing of a sufficient to give ourselves for meat fresh provide to seals of number the worst Scurvy, the whole time. for and our dogs off at all be kept must expeditions, of Polar enemy intention to use this it is my to achieve And costs. day. every meat fresh J R Coll Physicians Edinb Coll Physicians J R © 2013 RCPE Scott’s acceptance of Wright’s view was reinforced reinforced was view Wright’s of acceptance Scott’s Edward of 1911, winter Antarctic during the when, to the polar party lectured on Atkinson (a doctor) diary It is illuminating to see the entry in Scott’s scurvy. 2): (Figure occasion that for In his account of his expedition he states: of In his account Sir Almroth’s obduracy is particularly obduracy damaging to his Almroth’s Sir Holst and Axel scientists, Norwegian as two reputation lengthy published two in 1907, Theodor Frølich had, experiments on from conclusively proving papers guinea pigs that scurvy what they was caused by ‘a one-sided diet’ and that it could be described as in eating habits. changes by cured Y AND ALMR SCURV in Britain he medical opinion back Scott consulted Had supportgeneral the ptomaine found for have would one of view the this was Importantly, theory. poisoning the in British medicine at figures powerful most the of medical respected Although a Wright. Almroth Sir time: his to discoveries significant of number with a scientist issues; of number a on wrong stubbornly he was credit, ‘Sir nicknamed disrespectfully and familiarly was he Almost Wright’ or Wrong’. ‘Sir even Always He claims also that he chose the for his Whales for of Bay the that he chose He claims also of of reports of the abundance base camp because there. animal life of scurvy the latter sobriquet seems justified. In 1900 he scurvyof justified. seems latter sobriquet the in The Lancet paper published a due to acidosis following ptomaine poisoning, a view he view a poisoning, ptomaine following acidosis to due junior his of one when until 1937 change to refused experimental conclusive produced LC Holt, colleagues, dietarya by caused was it that deficiency. evidence AR Butler

advice was rejected. Scott’s experience of dogs during his previous Antarctic expedition, admittedly in the hands of inexperienced drivers, was not positive. On the other hand, he did take Nansen’s advice on the use of skis, although he had little skill or experience.18

ROALD AMUNDSEN

Amundsen seems to have been unaware of the Holst and Frølich paper and Nansen, who gave him every possible support, appears not to have mentioned it. Instead, Amundsen relied on Nordic traditions and folklore. The northern peoples of Scandinavia travelled extensively in cold conditions through barren country but rarely displayed symptoms of scurvy. They ate fresh figure 3 The dogs on the deck of the Terra Nova, 1910 seal meat and the native cloudberries (Rubus (photographer: Herbert J Ponting). From the Library of chanaemorus), both of which have been shown to be Congress. sources of vitamin C, particularly the latter which is even better than lemons.19 At Amundsen’s base camp the perhaps ill-advisedly, to feed his dogs chocolate; some of cook regularly served pancakes covered with preserved the dogs returned with him to Norway.20,21 cloudberries for breakfast, a meal much enjoyed by the party. Their diet also included fresh seal meat and so, by As well as making vastly increased physical demands on the time the party set off for the South Pole, the men his men by insisting on man-hauling of the sledges, had built up stores of vitamin C. Amundsen learned Scott’s men had a daily ration of 4,593 kcal, not very much from his previous polar expeditions and applied it different from that of Amundsen’s party, but this was to his dash to the South Pole. His careful and informed reduced on the return journey due to dwindling supplies, preparations brought him the success he so single- in spite of the available depots laid on the inward mindedly sought. journey.20 Until recently the daily calorific intake required for men man-hauling sledges was not known but, in HEALTH AND POLAR TRAVEL 1993, Dr Mike Stroud and the explorer Sir set out, unsupported, to man-haul sledges across Before considering scurvy as a cause of death in Scott’s the Antarctic continent via the South Pole. It was a polar party on the return from the Pole, other possible challenging experience and, according to Stroud’s causes of ill-health must be considered. Frostbite was an account, an unpleasant one.22 During the journey, glucose obvious one. The extremities of the body are particularly levels, weight and energy expenditure were monitored susceptible to cold and, for the performance of certain using recently developed techniques. The two men did bodily functions, the removal of gloves was necessary. At not complete the journey due to exhaustion and were temperatures of –40°C that carried obvious risks and airlifted out but they did get well beyond the South Pole, speed was of the essence. Scott mentions in his diary so the expedition can be compared to that of Scott’s that members of the party had severe frostbite. It was journey to the South Pole and back. Man-hauling at painful and debilitating but probably not lethal. However, –30°C for 10–12 hours a day across the polar surface it almost certainly contributed to the appalling state of was much more demanding than they had expected. health of Scott’s party at the end. Their daily rations gave them 5,500 kcal and they also estimated the consumption of some body fat. In an A much more serious problem was malnutrition. In attempt to increase this they binged on fatty food during Amundsen’s polar party the sledges carrying food and their stay in South America before the last lap of their fuel were pulled by dogs and the human members of the journey to .23 They reported feeling party used skis for travel. As the sledges were emptied continuously exhausted. The consumption of their own some dogs were shot, as planned, and used as food for body fat started immediately and they both lost over 20 the remaining dogs, a procedure that Scott did not like, kg of body weight by the end of the journey. An although in extremis he did the same with ponies. The ingenious procedure using doubly-isotopically labelled 2 18 calorific value of Amundsen’s food ration has been water ( H1 and O8) enabled Stroud to determine, by estimated at 4,560 kcal per man per day, substantially examination of daily urine and blood samples, the levels above that required by a regular manual worker (3,600 of daily energy expenditure throughout the journey. At kcal).20,21 Such was the success of Amundsen’s planning all times it was greater than intake from food and, during history and speed that he was able to increase the daily food the ascent from the ice-shelf to the polar plateau (which ration to 5,000 kcal on the return from the Pole and, lies at 10,000 feet), they each used around 11,000 kcal

178 J R Coll Physicians Edinb 2013; 43:175–81 © 2013 RCPE history 179 Wilson was a 32 At day 162 perifollicular perifollicular 162 day At

and a definitive answer is unlikely. unlikely. is answer a definitive and 33 a young surgeon at Boston City Hospital City at Boston surgeon a young 30,31 The role of scurvy in Scott’s return from the South Pole South the from return of scurvy role The in Scott’s doctor and close to Oates and some would argue that argue would some to Oates and close and doctor learned of it. not have he would that it is unlikely his of condition the kept have could Oates However, the understand not did he himself because to wound Such a alarm. significance or did not wish to cause impeded his progress, seriously have disability would to him it was impossible for that leading him to realise been a have This may up with his companions. keep decision to sacrifice himself. contributing to his factor Surrender’ ‘No as known he was career During his army therefore must Oates and his decision to end his life did It provocation. extreme of result the been have cold lingering death from a more him from save however malnutrition. and subjected himself to a diet devoid of vitamin C in order of vitamin C in order himself subjected diet devoid to a the vitamin was After 41 days its effect. assess to after even his blood plasma but, absent from completely fatigue However, normal. still was healing wound days, 90 problem. major a became rapidly at day and legs his lower on developed haemorrhages to began wound old appendicectomy 180 a 15 year the same age as the This is approximately disintegrate. that possible it is so and wound war Oates’s from scar of the scar the age that it appears as occurred opening while However, disintegration. against safeguard is no that evidence direct is no there occurred this could have in mentioned is not the wound of The opening it did. Oates’ diary his companions. or those of CONCLUSION part his and Scott of death in the any scurvyDid play scurvyagainst and for is evidence as There colleagues? the cause of death However, there are certain aspects of which we can be certain of which we are aspects there However, (and food the shortageof Because fresh of certain. fairly and camp base both at diet the C) in vitamin hence that all members of it is likely during the polar journey, of some degree from the initial polar party suffered there and condition progressive a It is however scurvy. with the that, diaries the of all from evidence good is scurvy, acute had one no Evans, Teddy Lt of exception such as Some features that heralds death. the condition difficult loose teeth and aching limbs are bleeding gums, gave he before stage this to get not did Crandon hide. to have did Evans Teddy However, up his experiment. to the Pole, instead of proceeding bleeding gums and, when the final selection of the polar to base returned some us clinicalgive studies Crandon’s party was made. scurvyacute of onset the for timescale the of idea but party vitamin C while Scott’s diet of zero on a he was the on even and, camp base at meat fresh some had had pony cooked meals of lightly had several polar trip itself, So the sacrifice of one of the pack ponies. flesh following party survive to Scott’s of expect members would one longer than the time scurvywithout advanced even for Crandon, If 25 but gives gives that

29 20,27 The nature The nature 24 describing the dreadful describing the dreadful 26 and Mead (1762) and Mead 4 2013; 43:175–81 2013; Lack of vitamin C can also cause the dehiscence the cause also can vitamin C of Lack 28 J R Coll Physicians Edinb Coll Physicians J R © 2013 RCPE journey some of them made to the penguin rookery some of them made to the penguin rookery journey back bring to in order winter Antarctic the during believed He firmly penguins. pickled embryosemperor of party were Pole South in Scott’s those of the deaths that food. of the lack to due some anecdotal evidence from Lord Anson’s round-the- Anson’s Lord from evidence anecdotal some in references are there and in 1740–41 expedition world of Lind (1753) the writings of the ridged snow during the descent stage of Scott’s Scott’s of stage the descent during snow the ridged of expended have that his party meant journey would return energy. of amount similar a the estimate can we guide a as figures With these rations, on reduced party, of Scott’s condition physical caused Malnutrition the Pole. from their return during they weather and the appalling man-hauling by with the men to kill even enough experienced were layer The companions. his and Scott of grit and stamina is an essential part of fat in the human body of the body’s penguin, The emperor cold. of the effect against defence the during hatched and incubated are eggs whose days survivesimmobilised for standing winter, Antarctic fat. of body on end partlyof a 3 cm layer because of partially healed wounds. However, the opening of old of opening the However, partiallyof wounds. healed due to this deficiency is another matter and wounds Bourne to find. difficult are cases well-documented members of Scott’s partyof this lost substantial amounts members of Scott’s would weather the appalling of cold and the effect fat, on their parties march Polar been debilitating. have attributed to a remark to paraphrase stomachs, a member of Scott’s Cherry-Garrard, Apsley Napoleon. book a camp partybase wrote UNDS AND WO IN C DEFICIENCY VITAM as famous as almost the party, is one member of There an proved have whom scurvy for may Scott himself, Captain Pole: the from return the during hardship extra joined Scott’s He was a soldier and Oates. Lawrence asked have well Scott may the ponies. party for to care be would him to join the expedition so that the army War African During the Second South represented. bullet and, a by damaged badly was bone thigh Oates’s It is large scar. a was there well, healed it had although expedition Scott’s of accounts some in stated per day, twice what the ration provided for. ration provided twice what the per day, scurvyleading to the opening of old wounds can cause cause immediate the been have may this and pain intense with the the tent during a blizzard, from exit of Oates’s be I may outside, just going ‘I am words memorable vitamin C is that established It is well time’. some and wounds healing of fresh the proper essential for because greatly polar party suffered members of Scott’s this. of critical assessment of these historical examples is critical assessment of these historical examples is clinical observationsof set is a there However difficult. In 1939 John case. to Oates’s that is particularly relevant AR Butler

suggested by Crandon’s work. Significantly, Teddy Evans Epilogue had spent more time away from base camp sledging than When news of Scott’s achievement and tragic death on the others and would have been without fresh food for the return journey reached Great Britain, his reputation a longer amount of time. At the same time, Crandon’s rose to unprecedented heights for an explorer. He was work indicates how quickly scurvy gives rise to fatigue, the sort of hero that appealed to the British public. and this would have seriously lengthened the journey Amundsen, on the other hand was perceived as a time back from the Pole. Combine this with a serious somewhat dubious character, who at the beginning of his underestimate of the energy expended in sledge-hauling voyage had indicated that he was going north and his and the exceptionally bad weather that Scott and his change of plan was a shock to Scott. Yet he applied a companions experienced (a topic discussed in detail by professionalism to the task, in contrast to the gifted Solomon35), and it is clear why Scott’s carefully calculated amateurism, grit and courage of Scott and his companions. rations were inadequate and severe malnutrition Admiration for Scott was almost universal until 1979 resulted. Vigorous physical activity is a powerful antidote when published his influential book1 on to the effect of cold so the fatigue caused by scurvy Scott and Amundsen, emphasising Scott’s shortcomings exacerbated the hypothermia that the intense cold as a leader, his lack of polar skills and the incompetence caused. The death of shortly after leaving of his organisation of the expedition. In recent years, the Pole has been plausibly credited to scurvy because particularly in view of the centenary of Scott’s death, of certain clinical symptoms, but also to a number of Huntford’s harsh judgment has been revised. Diana other medical conditions; the situation is complicated by Preston’s biography of 199727 is far more sympathetic to the fact that he had a serious fall. So many diagnoses Scott; Ranulph Fiennes’ book32 is a robust, and largely have been made that Guly33 concludes ‘lack of more convincing, defence of Scott as both a leader and as a evidence makes further discussion somewhat fruitless’. man. Fiennes has the advantage of having experienced some of the situations in which Scott found himself. The cause of death of Scott and his remaining companions is most plausibly credited to the combination of Scott’s hut has been restored in situ and remains a frostbite, malnutrition and hypothermia, with the last monument to his achievements. As significant has been two exacerbated by sub-acute scurvy. Had it been the recognition of the scientific value of his expedition. possible to prevent the onset of scurvy the party’s Even during his return from the Pole the party took time hardship might have been reduced, but a successful to collect geological specimens and meticulous return would still have been far from certain because of meteorological records were kept by both the polar the other detrimental factors. In his book of photographs party and those back at base. The discipline of climate of polar travel, David Hempleman-Adams36 suggests that science has benefitted from the records of Scott’s party had Scott’s party succeeded in getting to the Pole first and some of the fossils collected gave the first indication they would have had the willpower to get back to base that Antarctica was once warm enough to support the camp. This must be doubted; there is a limit to the power growth of trees. Scott’s scientific achievements have of the will over a sick body. Scurvy was just one of the been fully explored in a recent book by the American unfortunate harmful influences affecting the party as it polar historian Edward Larson.37 For Amundsen the dash struggled on the return from the South Pole. to the Pole was everything and all his skill and experience was dedicated to that end. Scott’s aim was broader and, in spite of his shortcomings, he remains the more significant explorer. history

180 J R Coll Physicians Edinb 2013; 43:175–81 © 2013 RCPE history 181 The heartThe great of the . Oxford: Oxford University University Oxford Oxford: . . : Jonathan Cape; 1993. Cape; Jonathan London: . . London: Hodder & Stoughton; & Stoughton; Hodder London: . ), exercise performance, skeletal skeletal performance, exercise ), 8 O 18 1 H 2 Worst journey in the world: Antarctic 1910–1913. Antarctic journey in the world: Worst 1941; 116: 663–8. http://dx.doi.org/10.1001/ 663–8. 116: JAMA1941; 2012; 20:160–3. http://dx.doi.org/10.1258/ 20:160–3. 2012; J Med Biogr Robert Falcon Scott Journals Scott RobertFalcon 1993; 76:243–52. http:// 76:243–52. 1993; Occup Physiol Appl Physiol Eur J The role of scurvy in Scott’s return from the South Pole South the from return of scurvy role The in Scott’s muscle enzyme activities and plasma biochemical parameters biochemical parameters plasma activities and enzyme muscle energy inadequate with exercise of 95 days during intake. dx.doi.org/10.1007/s004210050243 penguins. huddling in Energy saving et al. Y Handrich H, Visser A, Ancel http://dx.doi.org/10.1038/385304a0 385:304–5. 1997; Nature A. Cherry-Garrard 1922. Company; and Constable London: 1997. Constable; London: tragedy. rate A first D. Preston and hydroxylation for requirement Ascorbate B. Peterkofsky collagen inhibition of to relationship procollagen: of secretion 54:1135S–40S. Am J Clin Nutr 1991; in scurvy. synthesis Proc wounds. healing of the vitamin C on of The effect GH. Bourne http://dx.doi.org/10.1079/PNS19460041 4:204–16. Nutr Soc 1946; otherwise Vitamin C deficiency in an Lund CC. JH, Crandon http://dx.doi. 222:748–52. N Eng J Med 1940; adult. healthy org/10.1056/NEJM194005022221802 Human experimental scurvy and the Crandon JH. Lund CC, and pneumonia postoperative of vitamin C deficiency to relation healing. wound to jama.1941.02820080003002 2003. Stoughton; and Hodder London: Scott. Captain Fiennes R. Robertof The death (1869–1912) and Falcon Scott H. Guly colleagues. jmb.2011.011039 M. Jones 422. p. 2005. Press; New antarctic expedition. fatal Scott’s The coldest march: S. Solomon 2001. Press: University Yale London; and Haven Stuart E. S, Gordon D, Hempleman-Adams Royal London: Antarctic photography. Shackleton and Scott, alone: 2009. Collection; of age Shackletonheroic and the Scott, of ice: An empire EJ. Larson 2011. Press; University Yale Haven: New . travel antarctic Huntford R. Scott and Amundsen R. Huntford 1979. p. 581. p. 1979. on the wasteland Shadows M. Stroud 1998. Cape; Jonathan London: Survival. the fittest of M. Stroud 5. Chapter Energy using expenditure et al. WA Coward Ritz P, MA, Stroud ( isotope-labelled water

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