James Lind
Encyclopedia
James Lind FRSE FRCPE (4 October 1716 in Edinburgh
Edinburgh
Edinburgh is the capital city of Scotland, the second largest city in Scotland, and the eighth most populous in the United Kingdom. The City of Edinburgh Council governs one of Scotland's 32 local government council areas. The council area includes urban Edinburgh and a rural area...

 – 13 July 1794 in Gosport
Gosport
Gosport is a town, district and borough situated on the south coast of England, within the county of Hampshire. It has approximately 80,000 permanent residents with a further 5,000-10,000 during the summer months...

) was a Scottish physician. He was a pioneer of naval hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...

 in the Royal Navy
Royal Navy
The Royal Navy is the naval warfare service branch of the British Armed Forces. Founded in the 16th century, it is the oldest service branch and is known as the Senior Service...

. By conducting the first ever clinical trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...

,
he developed the theory that citrus fruits cured scurvy
Scurvy
Scurvy is a disease resulting from a deficiency of vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic...

. 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
Arsenic
Arsenic is a chemical element with the symbol As, atomic number 33 and relative atomic mass 74.92. Arsenic occurs in many minerals, usually in conjunction with sulfur and metals, and also as a pure elemental crystal. It was first documented by Albertus Magnus in 1250.Arsenic is a metalloid...

. He also proposed that fresh water
Fresh Water
Fresh Water is the debut album by Australian rock and blues singer Alison McCallum, released in 1972. Rare for an Australian artist at the time, it came in a gatefold sleeve...

 could be obtained by distilling
Distillation
Distillation is a method of separating mixtures based on differences in volatilities of components in a boiling liquid mixture. Distillation is a unit operation, or a physical separation process, and not a chemical reaction....

 sea water. His work advanced the practice of preventive medicine
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...

 and improved nutrition
Nutrition
Nutrition is the provision, to cells and organisms, of the materials necessary to support life. Many common health problems can be prevented or alleviated with a healthy diet....

.

Early life

Lind was born in Edinburgh in 1716. In 1731 he began his medical studies as an apprentice of George Langlands, a fellow of the Incorporation of Surgeons which preceded the Royal College of Surgeons of Edinburgh
Royal College of Surgeons of Edinburgh
The Royal College of Surgeons of Edinburgh is an organisation dedicated to the pursuit of excellence and advancement in surgical practice, through its interest in education, training and examinations, its liaison with external medical bodies and representation of the modern surgical workforce...

. 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. By 1747 he had become surgeon of in the Channel Fleet
Channel Fleet
The Channel Fleet was the Royal Navy formation of warships that defended the waters of the English Channel from 1690 to 1909.-History:The Channel Fleet dates back at least to 1690 when its role was to defend England against the French threat under the leadership of Edward Russell, 1st Earl of...

, and conducted his experiment on scurvy while that ship was patrolling the Bay of Biscay. Just after that patrol he left the Navy, wrote his MD
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...

 thesis on venereal diseases, and was granted a license to practice in Edinburgh
Edinburgh
Edinburgh is the capital city of Scotland, the second largest city in Scotland, and the eighth most populous in the United Kingdom. The City of Edinburgh Council governs one of Scotland's 32 local government council areas. The council area includes urban Edinburgh and a rural area...

, Scotland.

Prevention and cure of scurvy

Scurvy is a disease now known to be caused by a deficiency of Vitamin C
Vitamin C
Vitamin C or L-ascorbic acid or L-ascorbate is an essential nutrient for humans and certain other animal species. In living organisms ascorbate acts as an antioxidant by protecting the body against oxidative stress...

, but in Lind's day, the concept of vitamin
Vitamin
A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. In other words, an organic chemical compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on...

s was unknown. Vitamin C is necessary for the maintenance of healthy connective tissue. In 1740 the catastrophic result of Anson
George Anson, 1st Baron Anson
Admiral of the Fleet George Anson, 1st Baron Anson PC, FRS, RN was a British admiral and a wealthy aristocrat, noted for his circumnavigation of the globe and his role overseeing the Royal Navy during the Seven Years' War...

's circumnavigation
George Anson's voyage around the world
While Great Britain was at war with Spain in 1740, Commodore George Anson led a squadron of eight ships on a mission to disrupt or capture Spain's Pacific possessions...

 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.

Since antiquity in various parts of the world, and since the 17th century in England, it had been known that citrus fruit had an antiscorbutic effect, when John Woodall
John Woodall
John Woodall was an English military surgeon, Paracelsian chemist, businessman, linguist and diplomat. He made a fortune through the stocking of medical chests for the East India Company and later the armed forces of England...

 (1570–1643), an English military surgeon of the British East India Company
British East India Company
The East India Company was an early English joint-stock company that was formed initially for pursuing trade with the East Indies, but that ended up trading mainly with the Indian subcontinent and China...

 recommended them but their use did not become 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. It ranks as one of the first clinical experiments in the history of medicine.

Lind thought that scurvy was due to putrefaction
Putrefaction
Putrefaction is one of seven stages in the decomposition of the body of a dead animal. It can be viewed, in broad terms, as the decomposition of proteins, in a process that results in the eventual breakdown of cohesion between tissues and the liquefaction of most organs.-Description:In terms of...

 of the body which could be helped by acid
Acid
An acid is a substance which reacts with a base. Commonly, acids can be identified as tasting sour, reacting with metals such as calcium, and bases like sodium carbonate. Aqueous acids have a pH of less than 7, where an acid of lower pH is typically stronger, and turn blue litmus paper red...

s, and thus included a dietary supplement of an acidic quality in the experiment. This began after two months at sea when the ship was afflicted with scurvy. He divided twelve scorbutic sailors into six groups. They all received the same diet but, in addition, group one was given a quart of cider
Cider
Cider or cyder is a fermented alcoholic beverage made from apple juice. Cider varies in alcohol content from 2% abv to 8.5% abv or more in traditional English ciders. In some regions, such as Germany and America, cider may be termed "apple wine"...

 daily, group two twenty-five drops of elixir of vitriol (sulfuric acid), group three six spoonfuls of vinegar
Vinegar
Vinegar is a liquid substance consisting mainly of acetic acid and water, the acetic acid being produced through the fermentation of ethanol by acetic acid bacteria. Commercial vinegar is produced either by fast or slow fermentation processes. Slow methods generally are used with traditional...

, group four half a pint of seawater, group five received two oranges
Orange (fruit)
An orange—specifically, the sweet orange—is the citrus Citrus × sinensis and its fruit. It is the most commonly grown tree fruit in the world....

 and one lemon
Lemon
The lemon is both a small evergreen tree native to Asia, and the tree's ellipsoidal yellow fruit. The fruit is used for culinary and non-culinary purposes throughout the world – primarily for its juice, though the pulp and rind are also used, mainly in cooking and baking...

, and the last group a spicy paste plus a drink of barley water
Barley water
Barley water, usually flavoured with lemon or other fruit, is a traditional British soft drink. It is made by boiling washed pearl barley, straining, then pouring the hot water over the rind and/or pulp of the fruit, and adding fruit juice and sugar to taste. The rind may also be boiled with the...

. 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 while 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
Royal Hospital Haslar
The Royal Hospital Haslar in Gosport, Hampshire, England was one of several hospitals serving the Portsmouth Urban Area. The Royal Hospital Haslar officially closed as the last military hospital in the UK in 2007...

 at Gosport
Gosport
Gosport is a town, district and borough situated on the south coast of England, within the county of Hampshire. It has approximately 80,000 permanent residents with a further 5,000-10,000 during the summer months...

. When James Cook
James Cook
Captain James Cook, FRS, RN was a British explorer, navigator and cartographer who ultimately rose to the rank of captain in the Royal Navy...

 went on his first voyage he carried wort
Wort
Wort may refer to:* Wort, the liquid created by the mashing of malted barley to use in brewing beer* Worting, Hampshire, a large district and suburb of the town of Basingstoke, in Hampshire, England....

 (0.1 mg vitamin C per 100 g), sauerkraut
Sauerkraut
Sauerkraut , directly translated from German: "sour cabbage", is finely shredded cabbage that has been fermented by various lactic acid bacteria, including Leuconostoc, Lactobacillus, and Pediococcus. It has a long shelf-life and a distinctive sour flavor, both of which result from the lactic acid...

 (10–15 mg per 100 g) and a syrup, or "rob", 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
Watercress
Watercresses are fast-growing, aquatic or semi-aquatic, perennial plants native from Europe to central Asia, and one of the oldest known leaf vegetables consumed by human beings...

 (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. However Lind, like most of the medical profession, believed that scurvy was essentially a result of ill-digested and putrefying food within the body, bad water, excessive work and living in a damp atmosphere which prevented healthful perspiration. Thus, while he recognised the benefits of citrus fruit (although he weaken his case by switching to a boiled concentrated or "rob", the production of which unfortunately destroyed the vitamin C), he never advocated citrus juice as a single solution. He believed that scurvy had multiple causes which therefore required multiple remedies.

The medical establishment ashore continued to be wedded to the idea that scurvy was a disease of putrefaction, curable by the administration of elixir of vitriol, infusions of wort and other remedies designed to 'ginger up' the system. It could not account for the benefits of citrus fruits and dismissed the evidence in their favour as unproven and anecdotal. In the navy however, experience had convinced many officers and surgeons that citrus juices provided the answer to scurvy even if the reason was unknown. On the insistence of senior officers, led by Rear Admiral Alan Gardner
Alan Gardner, 1st Baron Gardner
Admiral Alan Gardner, 1st Baron Gardner was a British Royal Navy officer and peer of the realm. He became one of the Georgian era's most dashing frigate captains and, ultimately, a respected senior admiral.-Naval career:...

, in 1794 lemon juice was issued on board the Suffolk
HMS Suffolk (1765)
HMS Suffolk was a 74-gun third-rate ship of the line of the Royal Navy, launched on 22 February 1765 at Rotherhithe. She was designed by William Bateley, based on the principles of his earlier , and was the only ship built to her draught....

on a twenty-three week, non-stop voyage to India. The daily ration of two-thirds of an ounce mixed in grog
Grog
The word grog refers to a variety of alcoholic beverages. The word originally referred to a drink made with water or "small beer" and rum, which British Vice Admiral Edward Vernon introduced into the Royal Navy on 21 August 1740. Vernon wore a coat of grogram cloth and was nicknamed Old Grogram or...

 contained just about the minimum daily intake of 10 mg vitamin C. There was no serious outbreak of scurvy. This astonishing event resulted in a widespread demand within the Navy for lemon juice, backed by the Sick and Hurt Board whose numbers had recently been augmented by two practical naval surgeons who were well aware of Lind's experiment with citrus. The following year the Admiralty accepted its recommendation that lemon juice should be issued routinely to the whole fleet. Another Scot, Archibald Menzies
Archibald Menzies
Archibald Menzies was a Scottish surgeon, botanist and naturalist.- Life and career :Menzies was born at Easter Stix in the parish of Weem, in Perthshire. While working with his elder brother William at the Royal Botanic Gardens, he drew the attention of Dr John Hope, professor of botany at...

, picked up citrus plants and dropped them off at Kealakekua Bay
Kealakekua Bay
Kealakekua Bay is located on the Kona coast of the island of Hawaii about south of Kailua-Kona.Settled over a thousand years ago, the surrounding area contains many archeological and historical sites such as religious temples, and was listed in the National Register of Historic Places listings on...

 in Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...

 on the Vancouver Expedition
Vancouver Expedition
The Vancouver Expedition was a four-and-a-half-year voyage of exploration and diplomacy, commanded by Captain George Vancouver. The expedition circumnavigated the globe, touched five continents and changed the course of history for the indigenous nations and several European empires and their...

, to help the Navy re-supply in the Pacific.
This was not the immediate end of scurvy in the Navy, as lemon juice was at first in such short supply that it could only be used in home waters as a cure under the direction of the surgeons rather than issued routinely as a preventative. Only after 1800 did the supply increase sufficiently so that, on the insistence of Admiral Lord St Vincent, it began to be issued generally.

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.

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
Gallon
The gallon is a measure of volume. Historically it has had many different definitions, but there are three definitions in current use: the imperial gallon which is used in the United Kingdom and semi-officially within Canada, the United States liquid gallon and the lesser used United States dry...

 of weak beer
Beer
Beer is the world's most widely consumed andprobably oldest alcoholic beverage; it is the third most popular drink overall, after water and tea. It is produced by the brewing and fermentation of sugars, mainly derived from malted cereal grains, most commonly malted barley and malted wheat...

 daily (5/6 of the usual British gallon, equivalent to the modern American gallon or slightly more than three and a half litre
Litre
pic|200px|right|thumb|One litre is equivalent to this cubeEach side is 10 cm1 litre water = 1 kilogram water The litre is a metric system unit of volume equal to 1 cubic decimetre , to 1,000 cubic centimetres , and to 1/1,000 cubic metre...

s). As the beer had been boiled in the brewing
Brewing
Brewing is the production of beer through steeping a starch source in water and then fermenting with yeast. Brewing has taken place since around the 6th millennium BCE, and archeological evidence suggests that this technique was used in ancient Egypt...

 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
Wine
Wine is an alcoholic beverage, made of fermented fruit juice, usually from grapes. The natural chemical balance of grapes lets them ferment without the addition of sugars, acids, enzymes, or other nutrients. Grape wine is produced by fermenting crushed grapes using various types of yeast. Yeast...

 was also issued, often fortified with brandy
Brandy
Brandy is a spirit produced by distilling wine. Brandy generally contains 35%–60% alcohol by volume and is typically taken as an after-dinner drink...

.

A frigate
Frigate
A frigate is any of several types of warship, the term having been used for ships of various sizes and roles over the last few centuries.In the 17th century, the term was used for any warship built for speed and maneuverability, the description often used being "frigate-built"...

 with 240 men, equipped with stores for four months, carried more than one 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
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

.

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.

Family

Lind had two sons – John and James. The elder son, John (1751–1794), studied medicine and succeeded James Lind as Chief Physician at Haslar Hospital in 1783. The younger son, James
James Lind (Royal Navy officer)
Sir James Lind KCB was an officer of the Royal Navy who served during the American War of Independence and the French Revolutionary and Napoleonic Wars. The son of James Lind, a distinguished naval physician, Lind also embarked on a career at sea, but served in a more front line role...

 (1752–1823), also embarked on a career with the navy. He served at sea for a number of years, rising to the rank of post-captain
Post-Captain
Post-captain is an obsolete alternative form of the rank of captain in the Royal Navy.The term served to distinguish those who were captains by rank from:...

, and being notable for his role in the Battle of Vizagapatam
Battle of Vizagapatam
The Battle of Vizagapatam was a minor naval engagement fought in the approaches to Vizagapatam harbour in the Coastal Andhra region of British India on the Bay of Bengal on 15 September 1804 during the Napoleonic Wars...

 in 1804, for which he was knighted. He died a Knight Commander of the Order of the Bath
Order of the Bath
The Most Honourable Order of the Bath is a British order of chivalry founded by George I on 18 May 1725. The name derives from the elaborate mediæval ceremony for creating a knight, which involved bathing as one of its elements. The knights so created were known as Knights of the Bath...

 in 1823.

External links

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