James Lind, surgeon, physician and pioneer of naval hygiene, died on the 13th of July, 1794.
James Lind was a Scottish doctor and the pioneer of naval hygiene in the Royal Navy – almost an oxymoron in the 18th Century. He is best known for his work in developing the theory that citrus fruits cured scurvy and for conducting the first ever, systematic or controlled clinical trial. Scurvy, a deadly disease caused by a vitamin C deficiency, was common amongst those with poor access to fresh fruit and vegetables at a time when it killed more British sailors than did battles. Whilst the earliest documented case of scurvy was described by Hippocrates around the year 400 BC and the practice of giving citrus fruits to sailors on long voyages had been known for nearly two centuries, Lind was the first to attempt to define a scientific basis for its cause. He published his work in 1753, in his ‘Treatise on the Scurvy’.
Although the importance of Lind's findings on scurvy were recognised at the time, it was not until more than forty years later, in 1795, that an official Admiralty order was issued on the supply of lemon juice to ships. With that, scurvy disappeared almost completely from the Royal Navy. Lind further argued for the health benefits of better ventilation aboard naval ships, the improved cleanliness of sailors' bodies, clothing and bedding, and below-deck delousing and fumigation with sulphur and arsenic. In addition to the use of hospital ships, he also proposed that fresh water be obtained by distilling sea water. His work advanced preventive medicine and improved nutrition, and his writings on tropical diseases helped prevent much unnecessary loss of life during British sea campaigns.
James Lind was born in Edinburgh on the 4th of October, 1716. He attended grammar school before being apprenticed, at the age of fifteen, to George Langlands, a physician at the College of Surgeons in Edinburgh. He entered the Royal Navy as a surgeon's mate, when he was twenty-three, and saw service in the Mediterranean, Guinea and the West Indies, as well as the English Channel. In 1747, he was promoted to surgeon and served for a total of nine years by the time he retired, in 1748, to go to Edinburgh University. He gained a medical degree within the year, due to his previous training and practical experience, and went into practice.
In 1753, he published 'A Treatise of the Scurvy' and in 1757 'An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy'. Lind dedicated his ‘Treatise’ to Lord Anson, because a 1748 account of Anson's circumnavigation had prompted his interest in scurvy; at least 380 out of a crew of 510 on one of Anson's ships had died of the disease. In 1758, Lind was appointed Chief Physician at the Naval Hospital in Haslar, Gosport, where he investigated the distillation of fresh water from saltwater. Later, in 1763, Lind published a work on typhus fever and in 1768, 'An Essay on Diseases Incidental to Europeans in Hot Climates'. In that latter essay, which was the leading source of information on tropical medicine for fifty years, he summarised the prevalent diseases in each colony and gave advice on avoiding infections.
Back in 1747, whilst serving on board HMS Salisbury, Lind carried out experiments to discover the cause of scurvy, the symptoms of which included loose teeth, bleeding gums and haemorrhages. Many people knew that far more sailors on British warships died from scurvy than from battle as on long voyages, entire crews could be decimated by scurvy. In the history of science, Lind’s work is considered to be the first occurrence of a systematic trial comparing results on two control groups. Notwithstanding Lind’s clinical first, a couple of centuries before, in 1537, the Spanish physician, Michael Servetus, said that citrus fruits were good for digestion and the British Admiral, Sir Richard Hawkins, noticed, in 1593, that daily feeding his men citrus fruits seemed to eliminate scurvy.
In his ‘Treatise’, Lind stressed that his work was founded "upon attested facts and observations, without suffering the illusions of theory to influence and pervert the judgement". His ingenious, but modest experiment, began when he selected twelve men from the crew, all of whom were suffering from scurvy. He separated them into six control groups, although he wouldn’t have used such modern terminology, and gave each group different complements to its normal rations. Basically, he tested the efficacy of dietary supplements on the disease as various groups were given cider, seawater, spoonfuls of vinegar or elixir of vitriol to drink. Other groups were administered a mixture of garlic, mustard and horseradish or citrus fruits – oranges and lemons.
Those who received the citrus fruits, full of vitamin C, experienced rapid and visible improvements, indeed a remarkable recovery, whilst the others didn’t. Although the sample sizes were grossly inadequate and other aspects of modern, clinical trials were not adopted, Lind’s results conclusively established the superiority of citrus fruits above all other 'remedies', that they were effective in preventing the disease. His discovery and proof demonstrated an effective way to treat and to prevent scurvy, but it was to be years later before it was adopted by the Navy’s ‘Sick and Hurt Board’.
It is often stated that the Pacific explorer, James Cook, benefitted from Lind’s remedy as his sailors survived several notably long voyages without succumbing to scurvy. However, Cook, along with Lind’s counterpart in the Army, Sir John Pringle, was skeptical and favoured unfermented malt or wort. Their stance was reasonable, because of Lind’s unfortunate mistake of believing that a condensate, called ‘rob’, made by evaporating citrus juice would have the same effect. Whereas ‘rob’ was cheaper and easier to store than fresh fruits, the process of evaporation actually destroys much of the ascorbic acid. Cook’s success had little to do with wort, which does contain vitamin B complex, and everything to do with being able to get fresh vegetables for his men. Ultimately, the Navy’s 'Sick and Hurt Board' adopted Lind’s method and instigated the daily regimen of sucking the juice of a lime. The Americans’ derogatory use of the term ‘limey’ as applied to Brits, originated from that practice.
Lind retired from the Royal Naval Hospital in 1783 and died on the 13th of July, 1794, in Gosport.