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A portrait of Scottish doctor James Lind (1716-1794)

James Lind (1716 in Edinburgh – 1794 in Gosport) was a pioneer of naval hygiene in the Scottish and Royal navies. By conducting the first ever clinical trial, ^[1] he developed the theory that citrus fruits cured scurvy. He argued for the health benefits of better ventilation aboard naval ships, the improved cleanliness of sailors' bodies, clothing and bedding, and below-deck fumigation with sulphur and arsenic. He also proposed that fresh water could be obtained by distilling sea water. His work advanced the practice of preventive medicine and improved nutrition.

[edit] Early life

Lind was born in Edinburgh in 1716. In 1731 he began his medical studies as an apprentice of George Bush Langlands,^[2] a fellow of the Incorporation of Surgeons which preceded the Royal College of Surgeons of Edinburgh. In 1739, he entered the Navy as a surgeon's mate, serving in the Mediterranean, off the coast of West Africa and in the West Indies.^[3] By 1747 he had become surgeon of HMS Salisbury in the Channel Fleet. A year later he retired from the Navy, wrote his MD thesis on venereal diseases, and was granted a license to practice in Edinburgh, Scotland.^[2]

[edit] Legacy

[edit] Prevention and cure of scurvy

Scurvy is a disease now known to be caused by a deficiency of vitamin C, but in Lind's day, the concept of vitamins was unknown. Vitamin C is necessary for the maintenance of healthy connective tissue. In 1740 the catastrophic result of Anson's circumnavigation attracted much attention in Europe; out of 1900 men, 1400 had died, most of them allegedly from having contracted scurvy. According to Lind, scurvy caused more deaths in the British fleets than French and Spanish arms.^[4]

Since the 1600s, it had been known that citrus fruit had an antiscorbutic effect, when John Woodall (1570 – 1643), an English military surgeon of the British East India Company recommended them^[5] but their use wasn't widespread. Although Lind was not the first to suggest citrus fruit as a cure for scurvy, he was the first to study their effect by a systematic experiment in 1747.^[6] It ranks as one of the first clinical experiments in the history of medicine.

Lind thought that scurvy was due to putrefaction of the body which could be prevented by acids; that is why he chose to experiment with dietary supplements of acidic quality. In his experiment he divided twelve scorbutic sailors into six groups. They all received the same diet, and in addition group one was given a quart of cider daily, group two twenty-five drops of elixir of vitriol (sulfuric acid), group three six spoonfuls of vinegar, group four half a pint of seawater, group five received two oranges and one lemon and the last group a spicy paste plus a drink of barley water. The treatment of group five stopped after six days when they ran out of fruit, but by that time one sailor was fit for duty and the other had almost recovered. Apart from that, only group one also showed some effect of its treatment.

Shortly after this experiment Lind retired from the Navy and at first practised privately as a physician. In 1753 he published A treatise of the scurvy, which was virtually ignored. In 1758 he was appointed chief physician of the Royal Naval Hospital Haslar at Portsmouth. When James Cook went on his first voyage he carried wort (0.1 mg vitamin C per 100 g), sauerkraut (10–15 mg per 100 g) and a syrup of oranges and lemons (the juice contains 40–60 mg of vitamin C per 100 g) as antiscorbutics, but only the results of the trials on wort were published. In 1762 Lind’s Essay on the most effectual means of preserving the health of seamen appeared. In it he recommended growing salad, i.e. watercress (662 mg vitamin C per 100 g) on wet blankets. This was actually put in practice, and in the winter of 1775 the British Army in North America was supplied with mustard and cress seeds. Lind also continued to advocate citrus fruit. But because he – and most other physicians – still believed that their curative effect was due to the acid, it was reasonable to replace them with cheaper acids.

It was Gilbert Blane who implemented a longer trial of citrus fruit. In an experiment in 1794 lemon juice was issued on board the Suffolk on a twenty-three week, non-stop voyage to India. The daily ration of two-thirds of an ounce mixed in grog contained just about the minimum daily intake of 10 mg vitamin C. There was no serious outbreak of scurvy. The following year the Admiralty took up the general issue of lemon juice to the whole fleet. Another Scot, Archibald Menzies, picked up citrus plants and dropped them off at Kealakekua Bay in Hawaii on the Vancouver Expedition, to help the Navy re-supply in the Pacific.^[7] This was not the end of scurvy in the Navy, as lemon juice was considered as a cure, not preventative, for scurvy and consequentially was dispensed by the ship's surgeon. Only after 1800 were the preventive qualities increasingly recognised.^[8]

[edit] Prevention of Typhus

Finding that typhus disappeared from the top floor of his hospital, where patients were bathed and given clean clothes and bedding, while it raged through the floors below where such hygiene measures were not in place, Lind recommended that sailors be stripped, shaved, scrubbed, and issued with clean clothes and bedding regularly. As a result, British seamen did not suffer from typhus, giving the British navy a significant competitive advantage over the French.^[9]

[edit] Fresh water from the sea

In the 18th century sailors took along water, cordial and milk in casks. According to the Regulations and Instructions relating to His Majesty's Service at Sea, which had been published for the first time in 1733 by the Admiralty, sailors were entitled to a gallon of weak beer daily (5/6 of the usual British gallon, equivalent to the modern American gallon or slightly more than three and a half litres). As the beer had been boiled in the brewing process it was reasonably free from bacteria and lasted for months unlike water kept in a cask for the same time. In the Mediterranean, wine was also issued, often fortified with brandy.

A frigate with 240 men, equipped with stores for four months, carried more than a hundred tons of drinkable liquid. Water quality depended on the original source of the water, the condition of the casks and for how long it had been kept. During normal times sailors weren't allowed to take any water away. When water got scarce, it was rationed and rain water was collected with spread sails. Fresh water was also collected when an opportunity presented itself en voyage, but watering places were often marshy, and in the tropics infested with malaria.

In 1759, Lind discovered that the steam of heated salt water was fresh. He also proposed to use solar energy for the distillation of water. But only when a new type of cooking stove was introduced in 1810 did the possibility arise of producing fresh water by distillation on a useful scale.

[edit] Family

Lind's son, James, also embarked on a career with the navy.^[10] He served at sea for a number of years, rising to the rank of post-captain, and being notable for his role in the Battle of Vizagapatam in 1804, for which he was knighted.^[11] He died a Knight Commander of the Order of the Bath in 1823.^[11]

[edit] Notes

[edit] References

• Tracy, Nicholas (2006). Who's who in Nelson's Navy: 200 Naval Heroes. London: Chatham Publishing. ISBN 1-86176-244-5. 

[edit] External links

• James Lind Library (including biography and extracts from Lind's most important works)
• The Lind pages with reference to the Lind family in general including a family tree and other family documents
• The James Lind Alliance, part of the James Lind Initiative to involve patients and clinicians in prioritising treatment uncertainties for clinical research