[BITList] Scurge of scurvy

[John Feltham]

To read this Life of the Day complete with a picture of the subject,
visit http://www.oxforddnb.com/view/lotw/2016-10-04



Lind,  James  (1716-1794), naval surgeon and physician, was born in Edinburgh on 4 October 1716, the son of James Lind, a merchant, and his wife, Margaret Smelholme (Smellum), a member of an Edinburgh medical family. (He is not to be confused with his cousin James Lind (1736-1812), also an Edinburgh-born naval surgeon, and later physician to the household of George III.) After attending grammar school in Edinburgh, in 1731 Lind was apprenticed to George Langlands, an Edinburgh surgeon. Lind is also recorded as having attended, in 1734, a course of anatomy lectures in the medical faculty of Edinburgh University given by Alexander Monro primus. With no formal qualification beyond his apprenticeship, Lind became a royal naval surgeon in 1738, serving until 1748. Most of his service was spent aboard ships in the English Channel during the War of the Austrian Succession (1740-48). These nine years at sea opened up for Lind the two areas of enquiry and concern that were to be his life's work, namely, the general welfare of seamen, and the nature and treatment of scurvy.

On leaving the navy Lind returned to Edinburgh, where, in 1748, he graduated MD from the university, with a thesis on venereal disease. His precise activities for the next ten years are unknown, but it is likely that he engaged in private medical practice in Edinburgh while participating in the professional medical life of the city. He was elected a fellow of the Royal College of Physicians of Edinburgh in 1750 and became its treasurer in 1756. He was also a member of the Philosophical and Medical Society of Edinburgh, and was elected a fellow of the Royal Society of Edinburgh in 1783. Lind's most notable work, A Treatise of the Scurvy, was published in Edinburgh in 1753. This was followed in 1757 by An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy. In 1758 he moved south to Gosport to take up the post of physician in charge at Haslar Royal Naval Hospital. Lind had dedicated A Treatise of the Scurvy to Lord Anson, first lord of the Admiralty, and it is believed that Anson helped obtain the position at Haslar for Lind. Lind held the post until 1783, when he was succeeded by his son John. While at Haslar, Lind published revised editions of both his Treatise and his Essay. He published a new work, An Essay on Diseases Incidental to Europeans in Hot Climates, in 1768, and papers on fevers.

Scurvy, the disorder tackled in Lind's first book, was a pressing matter for a nation whose maritime horizons were steadily expanding. The disorder regularly disabled ships' crews. The symptoms of scurvy had, for centuries, been widely recognized and carefully recorded. In the early stages of the disorder sufferers complain of stiff joints, loose teeth, and lassitude. In later stages, old wounds re-open and subcutaneous bleeding starts. Eventually, if conditions on board do not change, and the ship remains at sea, the sufferer dies. However, no clear consensus on a sure cure for the disorder had emerged, although several authorities, and many seamen, believed that fresh fruit and vegetables were potent remedies. A vivid demonstration of the ravages of what Lind was to call 'this foul and fatal mischief'  (Treatise of the Scurvy, 85) was provided by the four-year voyage of a small squadron under Anson, between 1740 and 1744. From a complement of 1400 men, very nearly 1000 died from scurvy. It was against the backgrounds both of Anson's disastrous voyage, and of his own first-hand observations of the disorder, made during his years at sea as a naval surgeon, that Lind wrote his Treatise of the Scurvy.

The book opens with Lind's critical review of earlier writers on scurvy. This review establishes two features of the long-standing consensus concerning the nature of the disorder. First, diet seems to be a key feature both in the onset of, and recovery from, scurvy, and second, outbreaks seem often to be associated with cold and wet weather. Lind then goes on to set out his own theory of the disease. Scurvy is, he says, essentially a disease of faulty digestion and excretion. The digestive system, according to Lind, operates optimally when people live in generally warm and dry conditions, and eat a reasonably varied diet. Under such conditions, he asserts, the digestive system breaks down food into the small particles necessary for the renovation of the body, and, eventually, for excretion. The mode of excretion is important. Lind was impressed by the work of the Paduan physician Sanctorius, who had calculated that over half of the body's waste products are evacuated by what Lind calls 'insensible perspiration' through the pores of the skin. On this theory, if food is imperfectly digested, and cannot, as a consequence, be insensibly perspired, it is likely to acquire 'the most poisonous and noxious qualities, and a very high degree of putrefaction'  (Treatise of the Scurvy, 203). Lind goes on to apply this theory to outbreaks of scurvy at sea. On long voyages, and especially when the weather is wet and close, the digestive system of an otherwise perfectly healthy seaman is hard-pressed to cope with the sea diet of unleavened bread and heavily salted meat. The stomach cannot break the sea diet down into small, digestible particles. At the same time, the pores of the skin are tending to close up in response to the poor weather, thus further jeopardizing healthy excretion by perspiration. The symptoms of scurvy then appear: the imperfectly digested, unexcretable food is starting to putrefy the body.

Lind then moves to his proposed cure. Broadly, he recommends the reversal of the conditions that produced the symptoms: a warm and dry atmosphere, coupled with a more readily digestible diet, must be provided. But plainly, such restorative conditions cannot be managed in a ship at sea, especially if it is on a naval blockade and is obliged to maintain its station for months at a time, in fair weather or foul. Medicines, rather than the re-establishment of a generally healthful environment, must then be prescribed by the ship's surgeon. It is in this context that Lind presents the results of what he called his 'experiments' with twelve scurvied seamen on HMS Salisbury conducted in May 1747, when he was in service as the ship's surgeon. Lind divided the twelve seamen into pairs, and prescribed for each pair a different potential remedy (1, cider; 2, elixir of vitriol; 3, vinegar; 4, sea water; 5, oranges and lemons; 6, a purge prepared from garlic, mustard seed, and other substances). The pair who were prescribed the oranges and lemons quickly recovered. The others did not. To the modern reader, these experiments seem conclusive. They are perfectly in line with modern knowledge both of the cause of the disease (vitamin C deficiency), and of the vitamin C richness of fresh oranges and lemons. But Lind had no conception of what would today be called vitamin deficiency, or of a single constituent, present in most fruit and green stuff, which is uniquely efficacious in the treatment of scurvy. His experiments, therefore, did not have the significance for him that they are likely to have for the modern reader. Lind gave the Salisbury experiments no decisive place in the Treatise: they take their modest place in a chapter which is devoted to a wide-ranging set of recommendations for the amelioration of shipboard life. The Treatise notably does not end with a ringing declaration to the Admiralty that seamen must regularly be issued with orange or lemon juice, even though the book, in common with most other books on seamen's health written during the eighteenth century, contained plenty of examples, along with the Salisbury experiments, of the efficacy of oranges and lemons in curing scurvy. But the Treatise as a whole did not deliver a single, clear, weighty recommendation.

In medical and naval circles, the potential force of Lind's work was further weakened by the extraordinary success of Captain James Cook, who, while ascribing no indispensable properties to oranges and lemons, and being unconcerned to provision his ships with them, managed to keep his crews free of scurvy during three celebrated circumnavigations of the globe between 1768 and 1780. Prevention of scurvy was easier for Cook than for captains of ships on station, for he had only small crews and could put into land whenever he needed to. Cook knew the curative potential of green stuff: he regularly foraged ashore for it whenever his ships were at anchor.

Lind's own practice, as physician at Haslar Hospital, indicates further that he did not regard his own Salisbury experiments as having been conclusive, for, while the range of treatments he prescribed to the thousands of patients who came under his care certainly did include oranges and lemons, these fruits were not seen by him as a routine, sovereign cure. In the third edition of the Treatise (1772), which recorded his experience at Haslar, he ruefully conceded that 'though a few partial facts and observations may, for a little, flatter our hopes of greater success, yet more enlarged experience must ever evince the fallacy of all positive assertions in the healing art'  (Treatise on the Scurvy, v-vi). It was not until 1795 that the Admiralty was persuaded, by Gilbert Blane (who freely acknowledged Lind's pioneering work), to issue seamen with a regular ration of orange, lemon, or lime juice.

In his Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy (1757, 3rd edn 1779), Lind argued for better hygiene on ships and for more humane, but efficient, treatment of seamen. Lind's tone is paternalistic. Ships should be regularly fumigated and ventilated. Seamen should be obliged to take baths. They should be issued with uniforms rather than having to clothe themselves. 'Such idle fellows as are picked from the streets or prisons' should not be included in ships' crews, for they bring contagious diseases and low morale on board with them  (Essay, 28). Diet should be improved. Pickled vegetables and 'rob'-extract of-oranges and lemons should be carried. Shallots and garlic should be included in 'the surgeon's necessaries'  (ibid., 34). Ships on station should be regularly supplied by small boats bearing fresh vegetables. The drinking of spirits, rather than beer, should be discouraged. Wholesome drinking water can be manufactured by distillation. Lind's book is highly practical and plainly written.

Lind's final book, his Essay on Diseases Incidental to Europeans in Hot Climates (1768), was conceived as a sequel to his book on the health of seamen. Having made recommendations for the improvement of the seaman's lot, he wanted to go further and 'draw the attention of all the commercial nations of Europe towards the important object of preserving the health of their countrymen, whose business carries them beyond seas'  (Essay on Diseases, 8). In his habitual sober and painstaking way, Lind reviewed everything that had been written on the subject, and surveyed the tropics, port by port, discussing the diseases peculiar to each locality. He identified 'fevers' as the commonest and most dangerous hazards and attempted to classify them. He had no clear general theory as to the causes of fevers, but associated them, time and again, with hot, swampy conditions which give rise to pestilential vapours. Violent changes in temperature, hot dry winds (which, he thought, tend to close up the pores), and certain types of sandy soil are presented as further signs of an unhealthy country. Lind's recommendations are unsurprising: he suggests that settlements should be built as far away as possible from low-lying, swampy regions. Ideally, they should be on breezy headlands, cleared of undergrowth. The work of clearing woods, draining swamps, and carrying water to higher, healthier ground can, he suggests, be undertaken by slaves. The book can be seen chiefly as a set of environmental, public health recommendations, rather than as a series of specific cures for precisely identified tropical diseases. The book was translated into German, Dutch, and French, and an American edition appeared in 1811. There were also French, Italian, and German editions of A Treatise of the Scurvy and a Dutch translation of the earlier Essay.

Lind seems to have had no taste for lobbying and politicking at the Admiralty or at metropolitan scientific and medical societies. This reticence, coupled with the unrhetorical, sometimes rather tentative nature of his writing, meant that he made no immediate and decisive impact on naval and medical practice. But his books were widely translated and quoted, and the regimes he established at Haslar, one of the largest hospitals in Europe, were respected. His influence on the health and welfare of seamen, though diffuse, is indisputable.

Lind died at Gosport on 18 July 1794 and was buried at St Mary's Church, Portchester, Hampshire, where a tablet was erected to his memory. The tablet also commemorates his wife, Isabel Dickie (d. 1797).

Michael Bartholomew 

Sources  Lind's treatise on scurvy, ed. C. P. Stewart and D. Guthrie (1953) + R. Stockman, 'James Lind and scurvy', Edinburgh Medical Journal, 3rd ser., 33 (1926), 329-50 + K. J. Carpenter, The history of scurvy and vitamin C (1986) + J. J. Keevil, J. L. S. Coulter, and C. Lloyd, Medicine and the navy, 1200-1900, 3: 1714-1815 (1961) + The health of seamen: selections from the works of Dr. James Lind, Sir Gilbert Blane and Dr. Thomas Trotter, ed. C. Lloyd, Navy RS, 107 (1965) + GM, 1st ser., 64 (1794), 767 + W. S. Craig, History of the Royal College of Physicians of Edinburgh (1976) + V. L. Bullough, 'Lind, James', DSB + tablet, St Mary's Church, Portchester, Hampshire
Likenesses  J. Wright, stipple (after G. Chalmers, 1783), Wellcome L. [see illus.]



========================================================================
©    Oxford     University    Press,    2004.    See     legal    notice:
http://www.oup.com/oxforddnb/legal/

We hope you have enjoyed this Life of The Day, but if you do wish to stop
receiving   these   messages,   please   EITHER   send   a   message   to
LISTSERV at WEBBER.UK.HUB.OUP.COM with

signoff ODNBLIFEOFTHEDAY-L

in the body (not the subject line) of the message

OR

send an  email to  epm-oxforddnb at oup.com, asking us  to stop  sending you
these messages.