NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.

16. The study’s sample is small, not representative of a general population, based on answering a questionnaire and not observation

Clinical studies of this nature face obvious limitations. If the authors are prepared to disbelieve the testimony of people who lived in a confined space with many victims of scurvy until the final fatal outcome, it is no wonder they complain about the study. Doubting is their prerogative, however, the way to discredit the study is to either find an error in the data or its interpretation, or conduct their own study and come up with different results.

17. The quoted personality changes peak on day 107. Certainly not an early symptom

Do the authors consider a symptom only when it peaks? Is pain not pain until it becomes unbearable?

18. Elevation of this triad is also found in prolonged semi starvation, and deficiencies of B-complex vitamins

Pavlos Plessas
Click on the image for author information

19. These changes are characteristic of individuals who are physically ill, as the subjects were

Yes, but in the beginning they did not know that they were ill (no clinical signs). Besides, there is another study which indicates that “behavioural change in human scurvy patients has a physiological rather than a solely psychological basis” (6). And there is a suggested biological explanation. “Vitamin C is a cofactor in the biosynthesis of catecholamines, most notably in the conversion of dopamine to norepinephrine, which may explain the behavior and mood disorders associated with vitamin C deficiency” (7). “Acutely hospitalized patients experience emotional distress for many reasons; therefore, it may seem unexpected that simple correction of their vitamin C deficiency could account for such rapid and dramatic improvements in psychological well-being. There are several reasons why this possibility merits serious consideration. First, the result is biologically plausible. Psychological dysfunction is known to occur in vitamin C deficiency, presumably because of the involvement of ascorbate in neuronal transmission and in brain neurotransmitter and fuel metabolism.” (8)

20. Vesalius’ reaction was normal in the view of many passengers getting sick, dying and being thrown overboard

Did all the passengers start begging the crew not to throw their dead bodies overboard? Did Boucherus do it? Why did he then only report Vesalius doing it? Was it normal behaviour for a distressed 16th century aristocrat to beg lowly-born sailors?

21. The only known symptoms of Vesalius are consistent with many other diseases

I think the best way for someone to debunk the scurvy theory is to make a list of diseases that could have killed Vesalius. It appears that the authors do not consider it too great a challenge. But these diseases have to be compatible with the circumstances and the authors will have to do considerably better than the suggestion of food poisoning.

22. Vesalius died from exhaustion combined by illness

All sources agree that Vesalius died from an illness. He had gone through an ordeal, he was probably malnourished and dehydrated to some extent but there is no evidence of exhaustion. He was sick, not tired. He was a passenger on a ship, not a galley slave. The crew, who worked around the clock, were fine. The only exhaustion was that of his reserves of Vitamin C.

23. In order to have a definite diagnosis, it will be important to locate the grave of Andreas Vesalius

Amen. I have one more reason to wish it than most of the many people who wish Theo and Pascale good luck in the search for the grave. I expect to be vindicated. And I hope that maybe my work will contribute in the beyond doubt identification of Vesalius’ remains..

PERSONAL NOTE: My thanks to all the authors who are part of this ongoing discussion and who are also friends and contributors to this blog. Everybody is correct in the fact that the only way to find the truth of the cause of death of Andreas Vesalius is to find his grave. The quest is ongoing and hopefully we are closer every day to this objective. Dr. Miranda

Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.

NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.

8. Echtius’ treatise was only published after his death in 1556

This is incorrect. Echtius was alive almost a decade after that and heard Boucherus describe Vesalius’ death with his own ears. The treatise was first published in 1564, the year of Vesalius’ death, albeit was wrongly attributed to Wierus.

9. Echtius believed scurvy was caused by a blocked spleen, leading to an excess of black bile

Echtius believed that an excess of black bile (melancholic humour) caused scurvy. He wrote that in addition to eating preserved foods and mouldy biscuit, and drinking foul water, the following conditions led to an excess of black bile: warm air, lack of sleep, hard manual work, anxiety and fevers. Each one individually could cause scurvy even if the diet was good . The reasons for Vesalius’ illness as indicated by the sources are: eating rotten biscuit, drinking corrupt water, hot weather and extreme worrying. Please compare with the list of causes given by Echtius in his treatise.

10. It is claimed that extreme fear and irrational behaviour … are well known early symptoms [Plessas]. This is not the case

Pavlos Plessas
Click on the image for author information

11. This (absence of extreme fear and irrational behaviour) is also the observation of one of the authors (RC) having observed scurvy patients in Ethiopian prisons

Did any of Dr. Coninx’s patients see other inmates die from scurvy? Did he ever observe one of his patients witness an accident? Were his patients evaluated by a psychiatrist? I would hazard the guess that the answer to all the questions is no. I choose to believe Rev. Richard Walter.

12. The Italian Pietro Bizzari based his account on what he had been told by an anonymous Venetian goldsmith

Bizzari’s account is not credible. It clashes with the accounts of three different people, who saw Vesalius’ grave in Santa Maria delle Grazie.

13. Metellus describes the symptoms of Vesalius’ illness

No, he does no such thing.

14. The possibility of rotten food as a cause of death on the ship is plausible

I hope this is not a suggestion that a great physician like Vesalius could not recognise the symptoms of food poisoning in others. If he did, it would have been possible to identify the particular source and he would not have fallen ill himself. Even if that was not possible they could have resorted to sharing the supplies of the crew, who had suffered no cases of illness. Surely it is best to be malnourished than risk death from food poisoning. In addition, had the cause of death been food poisoning, the sources would not have blamed Vesalius’ worrying for his illness. Finally, since the authors seem to agree that Metellus’ version of events is the most reliable, how is it possible for a man on the verge of death from food poisoning to be walking on the seashore of Zakynthos? Food poisoning as a cause of death is not plausible even though the sources claim the disease was somehow related to food and water shortage.

15. A 1971 study by Kinsman and Hood which allegedly claims that personality changes are amongst the first symptoms of scurvy

Why allegedly? I quote from the study: The personality changes occurred at an earlier stage of depletion than the psychomotor changes, which did not appear until obvious clinical scurvy was present (5). So the study does claim that personality changes are amongst the first symptoms of scurvy, the very first as a matter of fact. According to figure 3 of the study the MMPI T-scores started increasing when the level of Vitamin C in the body was at the equivalent of 761 mg. Clinical signs of scurvy became apparent only when the level went down to 300 mg. 

Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.

NOTE:  In 2014  Pavlos Plessas presented the compelling theory that Andreas Vesalius died in 1564 from scurvy on the island of Zakynthos. With his permission his original article entitled "Powerful indications that Vesalius died from scurvy" was published in this blog in 2016.

His theory was later challenged by Theo Dirix and Dr. Rudi Coninx in this same blog with the article "Did Andreas Vesalius really died from scurvy?". Pavlos Plessas' rebuttal to the latter article is published here from a letter to Theo Dirix.

Three years after my 2014 speech at the Vesalius Continuum meeting, where I suggested that scurvy appeared as the only possible explanation to Vesalius’ death, Dr. Rudi Coninx and Theo Dirix published a refutation. Theo is a dear friend and Dr. Coninx has dealt with scorbutic patients in Ethiopia. In addition, Theo is – along with another good friend, Pascale Pollier – the driving force behind the search for Vesalius’ remains. Arguments are always welcome, since they bring us closer to the truth, and are particularly important amongst people with common goals. Here is my reaction.

Quotes have been altered or truncated for brevity.

1. Vesalius must have eaten well in the Holy Land because he was a nobleman

The point I made was that at that time of year there was extreme scarcity of foods containing Vitamin C in that area, not that Vesalius was devoid of means or that he was not well looked after by the monks who hosted him.

2. Vesalius ate the food that protected monks from scurvy

Pavlos Plessas
Click on the image for author information

3. Scurvy was not uncommon in the area but people were not dying in large numbers

If they had been suddenly forced to migrate en masse, through desert and sea for three months in Vesalius’ footsteps, there would have been a very large number of deaths.

4. Liver and kidneys are also sources of Vitamin C

True, but they are not prime cuts. How many times a month would a nobleman be offered offal? I would say probably none.

5. Forty days at sea is not long enough to develop scurvy. Symptoms appear after 3 months at least

This is true for a previously healthy-eating subject of a study. An 18th century British warship could easily have a dozen dead and another 50 sick in less than 2 months (2) . There are many factors such as activity, infections, temperature, stress, smoking and possibly others, like age, gender, weight and genetic make-up. The most important though is the amount of Vitamin C in the body when the period of deprivation starts. Some historians seem to believe that West European aristocrats would not have fared very well in this field because of their diet. There is an intriguing study by Susan Maclean Kybett that suggests Henry VIII of England, a contemporary of Vesalius, died from scurvy. And he was neither in the Middle East nor at sea. Vesalius had been travelling for seven months prior to his death. Of those, more than two he spent at sea and more than three in arid conditions during the summer. This is how and where he spent the last five months of his life. He could have been affected by scurvy and died even earlier than he did.

6. “Clinical description is typical for scurvy”. This is simply not true

What is not true is that I ever made the above statement. I am not a doctor and I did not make a diagnosis. I presented a theory based on historical research. What I said is that every single thing we know about this case, not only the few symptoms known to us, either points to scurvy or is compatible with scurvy. At the same time no other illness fits the picture. I also made two more observations. First that the sources, which do not name the disease – scurvy had no universally accepted name yet – and do not consciously describe its symptoms, do give a number of causes for it, all of which feature in a list of causes of scurvy in the treatise of Johannes Echtius. Second that the fact Echtius took the trouble to meet Georgius Boucherus – the man who travelled with Vesalius and paid for his burial – and hear for himself the details of what happened is probably not coincidental.

7. Vesalius would have recognized the symptoms of scurvy and described them

We have no description of the disease or its symptoms by Vesalius. There is no reason to believe that Vesalius would have described symptoms of scurvy but not of the plague or of cholera for example. All sources are unfortunately silent on the symptoms. His mental state and his sudden death were only mentioned because they were unusual and impressive events, and in the case of the former also as a factor that contributed to his illness. I am the one who considers them as symptoms of an illness.

Sources:

1. "Voyages and Travels in the Levant in the Years 1749, 50, 51, 52" London 1766, p. 147
2. "Medicina Nautica: an Essay on the Diseases of Seamen" Volume III, London 1803, p. 387
3. "De magnis Hippocratis" Lienibus Libellus, Antwerp 1564, pp. 26a – 31b
4. A voyage round the world in the years MDCCXL, I, II, III, IV, 5th edition, London 1749, p. 101.
5. Robert A. Kinsman and James Hood, Some behavioral effects of ascorbic acid deficiency, The American Journal of Clinical Nutrition, April 1971.
6. Fiona E. Harrison, Behavioural and neurochemical effects of scurvy in gulo knockout mice, Journal for Maritime Research, Volume 15, Issue 1, 2013.
7. Olivier Fain, Musculoskeletal manifestations of scurvy, Joint Bone Spine 72, 2005.
8. Wang et al, Effects of vitamin C and vitamin D administration on mood and distress in acutely hospitalized patients, the American Journal of Clinical Nutrition, 2013.

The "Canal of Nuck" is the patent embryological remnant of the processus vaginalis in the female. The processus vaginalis is an extension of the peritoneum that forms to the side of the gubernaculum, a small fibrous cord that is attached to the lower pole of the gonad in the embryo. On the other end, the gubernaculum attaches to the inner aspect of the labioscrotal fold, an embryonic structure that will become the scrotum in the male and the labia majora in the female.

In the male, the processus vaginalis accompanies the gubernaculum and the testicle, on its descent towards the scrotum. In the female, the gonad (ovary) stays in the pelvis and the embryological remnants of the gubernaculum become the proper ovarian ligament (uteroovarian ligament) and the round ligament of the uterus which enters the inguinal canal, splits into multiple small fibers that disappear in the tissues of the labium majus.

In the male (and female) the walls of the processus vaginalis normally fuse, closing the communication between the scrotum (and the labia majora) and the main peritoneal cavity. If they remain open, the name is different, although the pathological consequences are similar (hernia, cysts or hydrocele). In the male, it is called a “patent processus vaginalis”, and in the female it is called the “Canal of Nuck”, which is found patent in 10-20% of the cases, although its presence does not per se imply the presence of pathology.

It was first described by Anton Nuck, a Dutch surgeon and anatomist (1650-1692) in his book "Adenographia & uteri anatome nova" published in 1722. In this book he questions why do some females present with inguinal hernias: "Haecce , praeter alias herniarium species , in utroque sexu obvias auditoribus meis anno fuperiori demonftrandi , difficile vifum fuit explicare , qui Hernia foeminarum inguinales orirentur?" Why when it is easy to see (the canal) in other species it is so difficult to explain to those listening why only some women have inguinal hernias?

In figure XL of the same book he proceeds to show the open processus vaginalis which was from then on known as the eponymic "Canal of Nuck"

The images in this article are from “Case Report: Infected Hydrocele of the Canal of Nuck” by Mandahan, P and Batthi, K. (see sources) Figure 1 shows the superficial hydrocele herniation; figure 2 shows the infected hydrocele; and figure 3 shows the excised opened hydrocele. Read the full article here. 

http://dx.doi.org/10.1155/2013/275257

My personal thanks to Dr. Sanford Osher who suggested this article. Dr. Miranda

Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. 
Click on the image for a larger depiction
 Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. 
Click on the image for a larger depiction
 Infected Canal of Nuck Hydrocele, Mandhan, P; Bhatti, K. 
Click on the image for a larger depiction

Did Andreas Vesalius really die from scurvy on the island of Zakynthos in 1564?
Evidence does not support this theory.

NOTE:  The following article authored by Theo Dirix, and Dr. Rudi Coninx, is a rebuttal of Pavlos Plessas' theory that Andreas Vesalius indeed died from scurvy. The original article entitled "Powerful indications that Vesalius died from scurvy" by Pavlos Plessas was presented in a meeting at the island of Zakynthos in 2014.

...continued...

4. The sudden death

Vesalius did indeed die upon arrival in Zakynthos. And sudden death is indeed associated with scurvy.

We know this from two accounts. Both are second hand accounts:
The Italian Pietro Bizzari based his account on what he had been told by an anonymous Venetian goldsmith. The goldsmith claimed that he had happened upon the sick Vesalius by chance on a deserted beach and, in spite of the opposition he had faced from the Zakynthians, had tried to assist him in his final hours and had buried him with his own hands in a plot he had purchased for that purpose. This account suggests the Vesalius’ death was not sudden, but was prolonged process, lasting at least hours, if not days. None of the typical scurvy signs like the bleeding and joint pain, the foul mouth, are mentioned in the account.

The second written account has come to us via Johannes Metellus, the Latinised name of a Frenchman named Jean Matal. Metellus claims to have received this information from a German traveller from Nuremberg named Georg Boucher. Boucher travelled on the same ship with Vesalius to Zakynthos.

Dr. Rudi Coninx, and Theo Dirix, authors of this article

Metellus describes the symptoms of Vesalius’ illness and they do not match the description of a scorbutic patient. The disease described by Metellus includes symptoms of extreme fear and irrational behaviour, immediately prior to his illness. These are not well known scurvy symptoms, as sometimes is claimed.

Metellus attributes the illness that broke out on Vesalius’ ship, at least partly, to food and water shortages. He is clear though in that the deaths were caused by illness and not directly by starvation or dehydration. Not everyone of the ship was affected. Boucher, for example, does not appear to have fallen ill at any point, despite having had to share the same food as other passengers. The possibility of rotten food as a cause of death on the ship is plausible.

The behaviour changes described by Metellus are sometimes given as proof of scurvy, and reference is made to a 1971 study by Kinsman and Hood [16] which allegedly claims that personality changes are amongst the first symptoms of scurvy.
However, this study was done on only five volunteer prisoners. Not a big sample and certainly not a sample representative of a general population, especially when making conclusions about personality disorders which, moreover are based on answering a questionnaire, not based on observation. In addition, the quoted personality changes appear related to the body pool of ascorbic acid, but the peak appears on day 107. Certainly not an early symptom. And finally, the authors admit that these signs are not specific for vitamin C deficiency: “elevation of this triad is also found in prolonged semi starvation, and deficiencies of B-complex vitamins. These changes are characteristic of individuals who are physically ill, as the subjects were”. 

5. Burial on Zakynthos.

We know that Vesalius died in Zakynthos and was buried there as his tombstone has been described by several contemperous travellers. The German traveller Christoph Fürer Von Haimendorff visited the island in 1565, just a year after Vesalius’ death, and described Vesalius’ grave in the Franciscan monastery of Santa Maria delle Grazie. Von Haimendorff provided us with the details of the burial inscription. In 1586 the tombstone had disappeared, looted in the Turkish attack of 1571, according to Giovanni Zuallardo (Johannes Schwallart), a compatriot of Vesalius, who visited Zakynthos in 1586.

We conclude that the death from scurvy theory, while not entirely implausible, is not backed up by facts. The symptoms attributed to Andreas Vesalius prior to his death simply do not correspond to scurvy. While his altered mental state and his sudden death are compatible with scurvy, the absence of typical tell-tale signs of scurvy (gingival bleeding, joint pain, ecchymoses,) which were known at the time, would certainly have attracted the attention of Vesalius, one of the most prominent doctors of his era. The two remaining signs -altered mental state and his sudden death- are non-specific and are consistent with many other diseases. We therefore agree with the conclusion recently advanced by three eminent Vesalius experts (M. Biesbrouck, Th. Goddeeris and O. Steeno) that Vesalius died from exhaustion combined by illness [17].

In order to have a definite diagnosis, it will be important to locate the grave of Andreas Vesalius, find the remaining bones and test them for signs of scurvy. X-ray changes to the long bones are typical for scurvy [18] and even in adults one should be able to find signs of osteopenia, pathological fractures or others.

This would provide a definitive diagnosis of scurvy, even 500 years after the death of the great anatomist.

Note: My personal thanks to Theo Dirix and Dr. Rudi Coninx for contributing this article to this blog. The search for the grave of Andreas Vesalius continues on and you can find more information on "The Quest for the Lost Grave" GoFundMe page. Dr. Miranda

Note: Pavlos Plessas has published a counterargument to this article in a separate document entitled "An answer regarding the death of Andreas Vesalius", also found in this blog.

1. https://circulatingnow.nlm.nih.gov/2014/10/15/the-death-of-andreas-vesalius/ accessed 27.12.2016
2. Matheson Cullen, G. Vesalius and the inquisition myth. Lancet, January 14, 1928, p 105-6.
3. Dirix Th. In search of Andreas Vesalius. The quest for the lost grave. Lannoo, 2014.
4. https://en.wikipedia.org/wiki/Andreas_Vesalius accessed on January 21, 2016
5. Biesbrouck M, Goddeeris Th, Steeno O. The last months of Andreas Vesalius. A coda. In Vesalius, Acta Internationalia Historiae Medicinae. 2012, 18 (No 2), 70-75.
6. Plessas P. http://www.parathemata.com/2014/09/pavlos-plessas-powerful-indications.html 2014. Accessed January 21, 2016.
7. http://www.clinicalanatomy.com/andreas-vesalius
Aa https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
8. Fain, O. La Revue de Médecine Interne, 2004; vol 25, Issue 12, 872-880.
9. Hodges RE, Hood J, Canham HE, Sauberlich HE, Baker EM. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr 1971;24:432-43.
x. Hirschman JV, Raugi GJ. Adult scurvy. Journal of American Academy of Dermatology, 1999, 41; No 6, 895-909.
xx. Bartley W, Krebs HA, O’Brien JRP. Vitamin C requirement of human adults. Medical Research Council Special Report Series No 280. London: Her Majesty’s Stationary Office; 1953. P 1-179. Quoted in Hirschmann et al.
xxx Hodges RE, Baker EM, Hood J, Saueberlich HE, March SC. Experimental scurvy in man. American Journal of Clinical Nutrition. 1969;22:535-48.
10. Harrisons Principles of Internal Medicine, 1998; p 484-85
11. Leung FW, Guze PA: Adult scurvy. Annals of Emergency medicine; 1981; 10:652-655
12. Bennet M, Coninx R. The mystery of the wooden leg: vitamin C deficiency in East African prisons. Tropical Doctor, 2005; 35: 81-84.
13. Carpenter K. The history if scurvy and vitamin C.Cambridge University Press 1986, p29.
11. Bown S R. 4he Age of Scurvy. How a surgeon, a mariner and a gentleman helped Britain win the battle of Trafalgar. Summersdale, 2003, p 96-99.
15. Lind J. A treatise of the scurvy. 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. Edinburgh: Sands, Murray and Cochran: 1753.
16. Kinsman RA, Hood J: Some behavioural effects of ascorbic acid deficiency. The American Journal of Clinical Nutrition, 1971, 455-464.
17. Biesbrouck M, Goddeeris Th, Steeno O: ‘Post Mortem’ Andreae Vesalii (1514 – 1564). Deel II. Het graf van Andreas Vesalius op Zakynthos. A. Vesalius, nr.4 December 2015. [in Dutch].
18. Bruce M Rothschild. Scurvy imaging. http://emedicine.medscape.com/article/413463-overview

Did Andreas Vesalius really die from scurvy on the island of Zakynthos in 1564?
Evidence does not support this theory.

NOTE:  The following article authored by Theo Dirix, and Dr. Rudi Coninx, is a rebuttal of Pavlos Plessas' theory that Andreas Vesalius indeed died from scurvy. The original article entitled "Powerful indications that Vesalius died from scurvy" by Pavlos Plessas was presented in a meeting at the island of Zakynthos in 2014.

...continued...

We believe the arguments in favour of scurvy unfortunately are not sufficient to draw a conclusion. And for each of the argument in favour of the scurvy theory, there are strong counterarguments too.

We will examine the main arguments here

1. Travelers to the Holy Land did have not enough food to eat that contained vitamin C.

There is no evidence that Vesalius, a man of means with introduction letters from the King of Spain, was deprived of food during his travels in the Holy Land. He could certainly buy food, and probably stayed at monasteries, sharing the same food that protected the residing monks from developing scurvy. And while scurvy was not uncommon, residents did not die in large numbers because of lack of vitamin C. Dying from scurvy was, even then, was limited to a small segment of the population.

Minimal daily intake of vitamin C for an adult is 90 mg per day [aa]. Most of that intake comes from fruits and vegetables (oranges, grapefruits …) but liver and kidney are also sources of vitamin C. These are all foods that Vesalius would have consumed in Jerusalem.

Dr. Rudi Coninx, and Theo Dirix, authors of this article

The sea voyage is too short (40 days) to develop scurvy. It takes about three months (120 days) for scurvy to develop [8]. In one study it took healthy volunteers four months to develop signs of scurvy when fed a vitamin C deprived diet [9] although some showed signs at day 29. The first sign to appear was petechial haemorrhage. In 1939, Johan Crandon, a surgical resident at Boston City Hospital, experimented on himself by eating a diet totally devoid of vitamin C [x]. Fatigue developed after 3 to 4 months, and the pathognomonic hyperkeratotic papules appeared on day 134 and the perifollicular haemorrhages on the legs on day 162. Symptoms appear after 3 to 4 months only, and there is no evidence of this in any description of Vesalius symptoms.

It has also been argued that the trip through the Sinai desert must have contributed to the presumed low intake of vitamin C. 
Vesalius’s entire stay in the Holy Land, including the Sinai desert trip –presumably lasting a month and a half- did not last for more than 4 months: he arrived in Jerusalem in May 1564 and boarded ship in Alexandria in September 1564. We believe this is not long enough to deplete all vitamin C and cause symptoms, even adding a 40 day sea voyage. And it is unlikely that his stay in Jerusalem was entirely free of vitamin C, as he was a respected guest of high authorities. We know that there was “no hint of shortages before their departure from Egypt” [Plessas]

Most studies indicate the earliest detectable change occurs after 120 to 180 days [xx] although there are studies where early signs appear earlier [xxx]. But in this study, which was stopped after 3 months, no serious effects occurred.

3. “Clinical description is typical for scurvy”.

This is simply not true. The clinical description we have, from second hand accounts, are vague and non-specific. The clinical signs and symptoms of scurvy are well known and clearly described today [10]. The typical clinical signs for scurvy are absent from all accounts: gingival bleeding, an early and typical sign, or the “rotten mound” is never mentioned. Subcutaneous bleeding [11] – ecchymoses - or joint pains, leading to difficulties walking, are never mentioned. Gum bleeding are typical signs, and so are swollen and painful legs, also leading to difficulties in walking [12]. They are all absent from the accounts. Non-specific signs such as laziness are also typical, with muscle pain in the legs as an initial sign, but they always evolve into bleeding, gum problems, putrid smell and other signs that Vesalius would have described. As a doctor, Vesalius would have been well placed to recognize these signs and to describe them. None of them appear in any account.

Authors claiming typical signs were present make a lot of the so-called melancholy and refer to the writings of the 16th century expert Johannus Echthius who wrote a treatise about scurvy in Latin, as was customary in these days, in 1541, although it was only published after his death in 1556 [13] Despite being considered an expert on scurvy, Echtihius –and all “experts” of his day could recognize the disease – they knew little about the causes of scurvy, its link with vitamin C and the treatment. In fact Echthius and his 16th century colleagues were dead wrong about the causes of scurvy. Echthius obtained his knowledge entirely from studying Greek and Roman classics, Celsus, Galen and others, and came to the conclusion that scurvy was caused by a blocked spleen, leading to an excess of black bile. The treatment therefore consisted in hot and wet medicines like oil and vitriol. The only useful cure, citrus juice, was considered a “cold” medicine, therefore of no use [14]. Doctors at the time recommended avoiding fruits and vegetables in case of scurvy! Knowledge about the causes of scurvy would have to wait till the work of James Lind, an officer of the British Royal Navy who published his now famous treatise on scurvy in 1753 [15]

But Echthius did know how to recognize the symptoms of scurvy: stomachache, a complaint of the mouth, and sceletyrbe, a complaint of the legs. Vesalius showed none of these symptoms. 

In another argument in favour of the scurvy theory, it is claimed that extreme fear and irrational behaviour … are well known early symptoms [Plessas ]. This is not the case. Lind was correct when he observed that “a listlessness to action … a lazy inactive disposition” that degenerates in “a universal lassitude” [Hisrchman] are typical signs. This is also the observation of one of the authors (RC) having observed scurvy patients in Ethiopian prisons [xx]

1. https://circulatingnow.nlm.nih.gov/2014/10/15/the-death-of-andreas-vesalius/ accessed 27.12.2016
2. Matheson Cullen, G. Vesalius and the inquisition myth. Lancet, January 14, 1928, p 105-6.
3. Dirix Th. In search of Andreas Vesalius. The quest for the lost grave. Lannoo, 2014.
4. https://en.wikipedia.org/wiki/Andreas_Vesalius accessed on January 21, 2016
5. Biesbrouck M, Goddeeris Th, Steeno O. The last months of Andreas Vesalius. A coda. In Vesalius, Acta Internationalia Historiae Medicinae. 2012, 18 (No 2), 70-75.
6. Plessas P. http://www.parathemata.com/2014/09/pavlos-plessas-powerful-indications.html 2014. Accessed January 21, 2016.
7. http://www.clinicalanatomy.com/andreas-vesalius
Aa https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
8. Fain, O. La Revue de Médecine Interne, 2004; vol 25, Issue 12, 872-880.
9. Hodges RE, Hood J, Canham HE, Sauberlich HE, Baker EM. Clinical manifestations of ascorbic acid deficiency in man. Am J Clin Nutr 1971;24:432-43.
x. Hirschman JV, Raugi GJ. Adult scurvy. Journal of American Academy of Dermatology, 1999, 41; No 6, 895-909.
xx. Bartley W, Krebs HA, O’Brien JRP. Vitamin C requirement of human adults. Medical Research Council Special Report Series No 280. London: Her Majesty’s Stationary Office; 1953. P 1-179. Quoted in Hirschmann et al.
xxx Hodges RE, Baker EM, Hood J, Saueberlich HE, March SC. Experimental scurvy in man. American Journal of Clinical Nutrition. 1969;22:535-48.
10. Harrisons Principles of Internal Medicine, 1998; p 484-85
11. Leung FW, Guze PA: Adult scurvy. Annals of Emergency medicine; 1981; 10:652-655
12. Bennet M, Coninx R. The mystery of the wooden leg: vitamin C deficiency in East African prisons. Tropical Doctor, 2005; 35: 81-84.
13. Carpenter K. The history if scurvy and vitamin C.Cambridge University Press 1986, p29.
11. Bown S R. 4he Age of Scurvy. How a surgeon, a mariner and a gentleman helped Britain win the battle of Trafalgar. Summersdale, 2003, p 96-99.
15. Lind J. A treatise of the scurvy. 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. Edinburgh: Sands, Murray and Cochran: 1753.
16. Kinsman RA, Hood J: Some behavioural effects of ascorbic acid deficiency. The American Journal of Clinical Nutrition, 1971, 455-464.
17. Biesbrouck M, Goddeeris Th, Steeno O: ‘Post Mortem’ Andreae Vesalii (1514 – 1564). Deel II. Het graf van Andreas Vesalius op Zakynthos. A. Vesalius, nr.4 December 2015. [in Dutch].
18. Bruce M Rothschild. Scurvy imaging. http://emedicine.medscape.com/article/413463-overview