Monday, April 20, 2015

James Lind and the Treatment of Scurvy

by Regina Jeffers

A portrait of Scottish doctor James Lind (1716–1794)
http://en.wikipedia.org/wiki/James_Lind#/media/File:James_Lind_by_Chalmers.jpg

James Lind was a Scottish doctor who studied scurvy first hand. Born in Edinburgh in 1716, Lind became an apprentice at Edinburgh’s College of Surgeons at the age of 15. At 23, he accepted the post of surgeon’s mate and sailed throughout the Mediterranean, Guinea and the West Indies. At 31, Lind became the surgeon assigned to the HMS Salisbury. During his service to the HMS Salisbury, Lind conducted experiments on the cause and symptoms of scurvy. (BBC: History)   The Salisbury was a fourth class ship and during a 10 week stint where the Salisbury did not return to port, 80 of the 350 sailors on board lost their lives to scurvy. (The James Lind Library)
Lind selected 12 men from the ship, all suffering from scurvy, and divided them into six pairs, giving each group different additions to their basic diet. Some were given cider, others seawater, others a mixture of garlic, mustard and horseradish. Another group of two were given spoonfuls of vinegar, and the last two oranges and lemons. Those fed citrus fruits experienced a remarkable recovery. While there was nothing new about his discovery - the benefits of lime juice had been known for centuries - Lind had definitively established the superiority of citrus fruits above all other ‘remedies’. (BBC: History)

Lind’s publications include his 1753 “A Treatise of the Scurvy”; 1757 “An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy,” and 1768 “An Essay on Diseases Incidental to Europeans in Hot Climates.” His work brought attention to the deplorable living conditions and diets of the King’s navy, as well as listing the diseases found in the colonies the English claimed and ways to avoid becoming ill. In 1762, Lind proposed a simple method of supplying fresh water to those aboard ship. (The James Lind Library)

The Journal of Royal Society of Medicine cites the voyages of George Anson, 1st Baron Anson, Admiral of the Fleet, for bringing Lind’s attention to the dangers of scurvy. Anson circumnavigated the glove and oversaw the Royal Navy during the Seven Years’ War. Anson’s  A Voyage Round the World, in the Years MDCCXL, I, II, III, IV: Compiled from Papers and Other Materials of the Right Honourable George Lord Anson, and Published Under His Direction, by Richard Walter, Chaplain to His Majesty's Ship the "Centurion" piqued Lind’s interest in scurvy, a disease Lind had seen firsthand. Anson reported that he lost 380 men out of a crew of 510 to scurvy.

Lind sought more information on the disease but came away with the knowledge that those who written of scurvy’s symptoms, etc., were men who never once been to sea. Lind considered this lack of information on the causes of scurvy led to confusion among medical professionals on diagnosis, prevention, and cure.

Lind judged his relatively small number of observations on twelve patients, reported in some detail, as convincing, particularly because the differences shown were so dramatic. In fact he “confirmed” them by selected observations on other patients, but these were not as reliable as his experimental results, nor were they quantitative. In these, as well as in other experiments designed in advance, it was the quality of basic observations rather than their quantity that was important for Lind. Careful observation of a single case could even be decisive; for instance, Lind said that that he had never had a great opinion of the elixir of vitriol because he had witnessed a patient contracting scurvy to whom he had prescribed it as a "reconstituent", that is, “while under a course of medicine recommended for its prevention” (Lind 1753, p 196). Similarly, postulated treatments for scurvy had not only been debunked by Lind’s experiment, but were “contradicted by the daily experience of seamen, [and] by the journals of our sea-hospitals…” When claiming this, he seems to have such evidence in mind, although he did not quote it explicitly. (The James Lind Library)

Lind’s therapeutic findings made little impact on medical opinion in Britain: indeed, the year after their publication (1753) the Navy’s ‘Sick and Hurt Board’ rejected a proposal to provide sailors with supplies of fruit juice. In fact, aware of the storage problems for adequate amounts of fresh fruit or fruit-juice during long cruises, Lind recommended that a condensate (called “rob”) should be prepared by evaporating a dilution of fresh fruit juice in nearly boiling water over several hours. Unfortunately, as we now know, heat destroys much of the ascorbic acid in fresh juice, and it is unsurprising that subsequent observers were unable to detect any beneficial effect of the condensate. (The James Lind Library)

In hindsight the story of how Lind’s work was received, entailing a lag of 42 years between his clearly described and experimentally “proven” treatment and its actual introduction by the relevant authorities, seemed to some “one of the most foolish episodes in the whole history of medical science and practice”. However, the Navy Sick and Hurt Board did not, during the first thirty years, act unreasonably when one considers that Lind’s was only one of a great number of treatises on the subject (see Lind’s own Bibliotheca Scorbutica, an appendix to the first edition of his work); the Board was inundated with suggestions concerning scurvy; lemon juice was by no means a new cure (a fact of which Lind was perfectly aware); and not least because, together with his "rob", he also recommended a list of vegetables for preventing scurvy which, on the basis of modern analyses, were unlikely to have been effective. Lind’s recommendations thus sometimes ignored his declared rejection of unwarranted speculation and his professed reliance on carefully observed facts.
(The James Lind Library)

For more on Lind and The Rise of Preventive Medicine in the 18th Century, join me today on my blog "Every Woman Dreams."

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Meet Regina Jeffers:

Regina Jeffers is an award-winning author of Jane-Austen inspired novels/mysteries, as well as Regency romances. A master teacher, for thirty-nine years, Regina passionately taught thousands of students English in the public schools of West Virginia, Ohio, and North Carolina. Yet, “teacher” does not define her as a person. Ask any of her students or her family, and they will tell you Regina is passionate about so many things: her son, children in need, truth, responsibility, the value of a good education, words, music, dance, the theatre, pro football, classic movies, the BBC, track and field, books, books, and more books. Holding multiple degrees, Jeffers often serves as a Language Arts or Media Literacy consultant to surrounding school districts and has served on several state and national educational commissions.

As the author of nineteen books, Jeffers is always busy writing, She has five new titles arriving in 2015, including The Prosecution of Mr. Darcy’s Cousin: A Pride and Prejudice Mystery; Elizabeth Bennet’s Deception: A Pride and Prejudice Vagary; Mr. Darcy’s Fault: A Pride and Prejudice Vagary; A Touch of Emerald: the Conclusion of the Realm Series, and Angel Comes to the Devil’s Keep.

Website: http://www.rjeffers.com
Every Woman Dreams: https://reginajeffers.wordpress.com
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1 comment:

  1. Thanks for yet another fascinating article, Regina Jeffers!

    ReplyDelete