Lind Discovers a Cure for Scurvy

Date 1753

Building upon previous medical accounts and motivated by the medical disasters of long sea voyages, James Lind proved that citrus fruits can prevent and cure scurvy. His results, published in 1753, helped to convince the British court to order the rationing of citrus juice to all sailors, thus dramatically reducing scurvy in the Royal Navy.

Locale Scotland; England

Key Figures

• James Lind (1716-1794), a Scottish naval surgeon and physician
• Aleixo de Abreu (1568-1630), a Portuguese physician specializing in tropical medicine
• Lord Anson (1697-1762), an English admiral
• Sir Gilbert Blane (First Baronet Blane; 1749-1834), a Scottish physician
• James Cook (1728-1779), an English naval officer and explorer
• Sir John Pringle (First Baronet Pringle; 1707-1782), a Scottish military physician
• Boudewijn Ronsse (1525-1597), a Flemish physician
• Thomas Trotter (1760-1832), a Scottish naval surgeon and physician
• John Woodall (1570-1643), an English surgeon, physician, and chemist

Summary of Event

Scurvy is a deficiency disease caused by lack of ascorbic acid (vitamin C) in the diet. The word “ascorbic,” coined in 1933, derives from the Greek prefix a, meaning “not,” and the Latin scorbutus, meaning “scurvy.” Ascorbic acid is necessary for the body to produce collagen, an essential structural protein. Without sufficient collagen, capillaries break down, causing the typical symptoms of scurvy, such as spongy gums, anemia, general weakness, spontaneous bleeding, muscle pain, and sometimes ulcers, tooth loss, and dementia. Sudden death from hemorrhaging may occur at any time. In children the disease interferes with growth. Symptoms appear between one and three months after the last intake of ascorbic acid. Replenishing ascorbic acid to physiologically acceptable levels by consuming citrus products will usually cure scurvy, as the acid restores collagen.

Scurvy, especially common among sailors until the end of the eighteenth century, was a major problem for merchant, naval, and whaling fleets. Naval surgeon James Lind’s A Treatise of the Scurvy (1753) demonstrated empirically that the preserved juices of citrus fruits could prevent and cure this disease, which was dreaded among sailors on long voyages. However, Lind was not solely responsible for the conquest of scurvy. The disease came to be understood over a period of about four hundred years, from the sixteenth to the twentieth century. Citrus “therapy” was known before Lind but was not widely recognized or implemented even after his book appeared. Almost half a century passed before his recommendations were put into common maritime practice.

In 1564, Flemish physician Boudewijn Ronsse explained how sailors from northern Europe would cure themselves of scurvy by eating citrus fruits as soon as they reached Spain. English physician John Woodall, in his classic 1617 work on naval hygiene and surgery, The Surgions Mate, specifically mentioned limes, lemons, and oranges as cures for scurvy. In 1623, Portuguese physician Aleixo de Abreu described the use of a wide variety of natural food remedies, some of which contained ascorbic acid. John Pringle laid the foundations of modern military and naval medicine and hygiene with his Observations on the Diseases of the Army (1752) and A Discourse upon Some Late Improvements of the Means for Preserving the Health of Mariners (1776).

England and Spain were enemies between 1739 and 1748, the years occupied by the War of Jenkins’s Ear and the War of the Austrian Succession. In this context, Lord Anson commanded a British fleet of six ships—the Centurion, Gloucester, Severn, Pearl, Wager, and Tryal—that circumnavigated the globe and plundered more than £400,000 of Spanish treasure between 1740 and 1744. Anson returned home a hero. Both he and the treasure were paraded through the streets. However, the strategic and political success of his mission was overshadowed by the fact that only the Centurion and about two hundred sailors returned with him. More than 80 percent of the fleet’s crew had died of scurvy, so the voyage was widely regarded as a tragedy.

Reacting to Anson’s misfortune and inspired by Woodall, Lind resolved to find an answer to the scurvy problem. In 1747, he performed one of the first controlled clinical trials in the history of medicine. Aboard the Salisbury, where scurvy had appeared after about a month at sea, Lind chose twelve sailors suffering from early and similar stages of the disease, divided them into six pairs, and rationed each pair a different traditional remedy for scurvy. After six days of this treatment, only the pair that received two oranges and one lemon a day showed noteworthy improvement. The pair who drank apple cider improved slightly. None of the other four pairs improved at all.

Lind published the results of his clinical trial in his 1753 treatise, which he dedicated to Anson, and followed this work with An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy (1757) and An Essay on Diseases Incidental to Europeans in Hot Climates with the Method of Preventing Their Fatal Consequences (1768). He recommended preserving citrus juice in alcohol for use on long voyages. Despite the conclusiveness of Lind’s reasoning and the success of the Salisbury experiment, few sea captains took notice. Momentum for policy change slowly gathered, however.

Using Lind’s recommendations, Captain James Cook lost only one sailor to scurvy during his second exploratory voyage from 1768 to 1771. Pringle included Cook’s report in his 1776 work. Gilbert Blane commented favorably on Lind’s method and his own replication of citrus therapy in Observations on the Diseases Incident to Seamen (1785). Nevertheless, even after these events and testimonies, the highest officers of the Admiralty (Royal Navy board) remained unconvinced. On the skeptical side was naval surgeon and physician Thomas Trotter, whose Observations on the Scurvy (1786) proclaimed frankly that Lind’s work, even the Salisbury experiment, had not settled the questions of what causes scurvy or what to do about it.

Blane persisted in trying to achieve official recognition of citrus therapy for scurvy in the Royal Navy. From his prestigious posts as physician to the prince of Wales, attending physician at St. Thomas’s Hospital, fellow of the Royal Society, and member of the Admiralty Board for Sick and Wounded Seamen, he lobbied vigorously for reform, recalling his own experience as ship’s doctor in the American Revolutionary War when a captured cargo of limes had saved the crew from scurvy. The Admiralty was finally impressed by a nineteen-week voyage from England to Madras in 1793. The crew received regular rations of lemon juice preserved in alcohol and were entirely free of scurvy. In 1795, the Admiralty issued the order that all British naval ships must issue citrus juice to every crew member every day. By 1797, scurvy had practically disappeared from the Royal Navy.

Significance

Both James Lind and Gilbert Blane were largely responsible for the dominance of British naval power until the end of the age of sail. The combination of the best ships in the world plus healthier crews proved unbeatable. In the nineteenth century, British sailors and, soon, all Britons, especially Englishmen, became known as limeys because of Blane’s strict regulations on diet.

The final steps in conquering scurvy occurred in the twentieth century. Hungarian-born biochemist Albert von Nagyrapolt Szent-Györgyi discovered ascorbic acid in 1927-1928, isolating it from the adrenal glands. He subsequently found the same compound in paprika after noticing that paprika is a remedy for scurvy. In 1933, Leonard Parsons reported successful treatment of infantile scurvy with ascorbic acid. Since that time scurvy has existed only in mild cases in isolated populations with poor mixes of fruits and vegetables in their diet.

Bibliography

Bown, Stephen R. Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medical Mystery of the Age of Sail. New York: Thomas Dunne Books, St. Martin’s Press, 2004. Recounts the saga of Anson, Lind, Cook, and Blane, concluding that their work contributed to Admiral Horatio Nelson’s victory at Trafalgar.

Carpenter, Kenneth John. The History of Scurvy and Vitamin C. New York: Cambridge University Press, 1986. Supersedes Alfred Hess’s book as the standard history.

Cuppage, Francis E. James Cook and the Conquest of Scurvy. Westport, Conn.: Greenwood Press, 1994. A readable description by a pathologist of the medical aspects of Cook’s voyages.

Druett, Joan. Rough Medicine: Surgeons at Sea in the Age of Sail. New York: Routledge, 2002. An account of naval health care from Woodall to the early nineteenth century.

Harvie, David I. Limeys: The True Story of One Man’s War Against Ignorance, the Establishment, and the Deadly Scurvy. Stroud, England: Sutton, 2002. An investigation of why the British naval bureaucracy took forty-two years to endorse Lind’s findings.

Hess, Alfred Fabian. Scurvy Past and Present. Philadelphia: J. B. Lippincott, 1920. The standard history in its time.

Reiss, Oscar. Medicine and the American Revolution: How Diseases and Their Treatments Affected the Colonial Army. Jefferson, N.C.: McFarland, 1998. Shows how nine times as many American soldiers died from disease as from battle in the revolution and how typically marine diseases such as scurvy manifested themselves on land through long periods of poor diet.

Solomon, Joan. Discovering the Cure for Scurvy. Hatfield, England: Association for Science Education, 1989. A brief and clear account with maps.