Lind, James
Lind, James
(b. Edinburgh, Scotland, 4 October 1716; d. Gosport, Hampshire, England, 13 July 1794)
medicine.
The discoverer of citrus fruit as a cure for scurvy, Lind was the son of Margaret Smelum (alternately spelled Smellum or Smellome) and James Lind, a substantial Edinburgh merchant. (Many early biographical sketches confuse him with his cousin, also named James Lind, a physician to the household of George III) After attending grammar school in Edinburgh, in December 1731 he was apprenticed to George Langlands, an Edinburgh physician; and in 1739 he entered the British navy as a surgeon’s mate. He was promoted to surgeon in 1747. Most of his naval service was aboard ships patrolling the English Channel during the War of Austrian Succession (1740–1748), and his longest cruise was on the fourth-rated ship H.M.S. Salisbury (August-October 1746) in the English Channel. It was on a somewhat shorter cruise on this ship in 1747 that he carried out his classic experiments on scurvy.
Lind left the navy in 1748 and obtained his M.D. from the University of Edinburgh in the same year. His doctoral thesis on venereal lesions, De morbis renereis tocafihus, gives evidence of having been written in haste and is a trivial work but was sufficient to win him a license to practice in Edinburgh. In 1750 Lind became a fellow of the Royal College of Physicians of Edinburgh and served as treasurer from December 1756 to 1758, when he was appointed first chief physician to the new Royal Naval Hospital at Haslar. Lind was also a member of the Philosophical and Medical Society of Edinburgh and an original fellow of the Royal Society of Edinburgh. In 1753 he published A Treatise of the Scurvy, which created little stir in Edinburgh but apparently attracted the attention of Lord Anson, then first Lord of the Admiralty, to whom it was dedicated. It is believed that Anson was later influential in securing Lind’s appointment to the Royal Naval Hospital.
This post gave Lind additional opportunity for study. In the first two years of his administration the hospital received 5,734 admissions, of which 1,146 were cases of scurvy. The last edition of his Treatise includes additions derived, said the author, from four large notebooks of case histories and observations made at Haslar. Lind served as chief physician until 1783, when he was succeeded by his son John, who had been his assistant. On his retirement his portrait, now lost, was painted by Sir George Chalmers; a print of an engraving made from the picture is extant Lind was buried in St Mary’s Church, Gosport. The church register mentions his wife, Isobel (Isabel) Dickie, whom Lind must have married while practicing in Edinburgh.
Lind’s An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy (1757) throws much light on the living conditions and the diet of seamen. In Two Papers on Fevers and Infections (1763), which contains most of what is known of the medical history of the Seven Years War, Lind emphasized that the “number of seamen in time of war who died by shipwreck, capture, famine, fire or sword” was only a small proportion compared to those who died by “ship diseases and the usual maladies of intemperate climates.” (During the Seven Years War 133,708 men were lost to the navy by disease or desertion; 1,512 were killed in action.) Lind’s last major work, An Essay on Diseases Incidental to Europeans in Hot Climates (1768), was written primarily for the use of travelers and emigrants to tropical colonies and remained the standard work on tropical medicine in English for half a century.
Although Lind is now recognized as the greatest of naval doctors and as the “father of nautical medicine,” in his own day he was not elected a fellow of the Royal Society. He has also come to be regarded as one of the first modern clinical investigators and clearly was one of the first to have complete faith in the validity of his own observations and the logic of his conclusions. Lind’s scurvy cure was not officially introduced into the diet of the Royal Navy until after his death, and this delayed recognition has aroused considerable historical interest. Herbert Spencer, in his Study of Sociology, cited the navy’s neglect of Lind’s findings as the most flagrant example of administrative apathy on record. More recent investigators such as Sir Humphrey Rolleston and A. P. Meiklejohn regarded it as yet another example of the prejudice which greets many innovators.
Lind’s basic experiments were carried out in May 1747 while he was serving as surgeon aboard the Salisbury. Lind selected twelve scurvy patients with the most similar cases. He divided them into six groups of two, and although all received the same basic diet, he added different supplements to each one. Two he gave a quart of cider a day; two others, twenty-five drops of elixir vitrio three times a day; two were given spoonfuls of vinegar; two were treated with Seawater; two, with an electuary of garlic, mustard seed, horseradish, and other ingredients; and two were given two oranges and a lemon every day. Lind observed the most sudden and visible improvement in those fed citrus fruit: one was pronounced fit for duty after six days, and the other was reported to have made the best recovery of all. Lind held that cider had the next best effect (although only small improvements were noticeable) and that the other treatments were useless. The question is why Lind’s remedy was not quickly adopted. Meiklejohn held that it was because Lind was confronted with tenaciously held current medical practices and concepts about scurvy; Christopher Lloyd has given a somewhat more complex explanation.
Lloyd pointed out that while the voyages of Captain James Cook between 1768 and 1780 are assumed to have demonstrated the effectiveness of citrus fruits in preventing scurvy, this is not exactly the case. Cook himself emphasized that the absence of scurvy on his voyages was due to a diet of sauerkraut, soup, and malt. On his second voyage Cook also insisted on obtaining fresh water and vegetables at every opportunity, and while they undoubtedly served to prevent scurvy, no genuine experiments were made to determine their therapeutic effectiveness. Cook’s surgeons in their report attributed the absence of scurvy to the inclusion of malt, and this idea dominated naval thinking for a time.
The outbreak of the American revolution forced the British navy to reexamine this supposition, since in 1780, despite the inclusion of malt, one-seventh of the fleet, some 2,400 cases, were landed for treatment of scurvy, The high cost of.Mediterranean lemons was also a major factor in the delay of their use by the navy. By the last decade of the eighteenth century the navy had finally adopted citrus fruits as a remedy. By 1796 it was generally accepted that scurvy could be prevented by fresh vegetables and cured effectively by lemons or their juice, preserved effectively by boiling; and since that time scurvy has played little part in medical history. (One of the seamen’s demands during the mutiny of 1797 was a ration of lemon juice.) Limes replaced lemons in the British navy in the mid-nineteenth century because the West Indian lime was cheaper and easier to obtain than the Mediter-ranean lemon. However, there were still serious outbreaks of scurvy on several Arctic expeditions, and it was not until 1917 that preserved lime juice was discovered to have only one-third the antiscorbutic value of lemon. Unfortunately the same dosages had usually been followed.
Second only to his treatise on scurvy In importance to naval medicine was his general effort to improve the health of seamen. In his book on the subject, Lind included recommendations for the practice of shipboard hygiene, comments upon diseases in northern latitudes (especially scurvy), advice on the prevention of tropical fevers, and a means for procuring a wholesome water supply at sea. Others had suggested ways for distilling Seawater, but Lind’s method did not require the addition of chemicals as did those of his predecessors or even of his contemporaries. Lind’s importance in medical history lies in his willingness to experiment and to break with past medical tradition when it conflicted with his own observations. Although his ideas were very much of his own time, he modified them where necessary. Lind’s younger contemporaries and ardent supporters, Thomas Trotter and Sir Gilbert Blane, helped carry on his tradition; and the triumvirate is now regarded as responsible for the founding of the modern naval health service.
BIBLIOGRAPHY
I. Original Works. A Treatise of the Scurvy (Edinburgh, 1753) went through three eds.; the second ed. (London, 1757) is little more than a reprint, but the third edition, retitled A Treatise on the Scurvy (London, 1772)—the title most often cited—contains some additions based on Lind’s observations at Haslar and an updated bibliography. The French trans., Traité du scorbut, 2 vols. (Paris, 1756; repr. 1783), was published with a treatise on the same subject by Boerhaave, An Italian ed. was published at Venice in 1766, and a German ed. at Leipzig in 1775. The first ed. was reprinted as Lind’s Treatise on Scurvy (Edinburgh, 1953) with additional notes and comments by C. P. Stewart, D. Guthrie, and others as part of observances commemorating the bicentenary of its original publication.
An Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy (London, 1757) was reprinted in 1762; the third ed. (1779) includes Two Papers on Fevers and Infections, originally read before the Philosophical and Medical Society of Edinburgh and first published separately in 1763 in London. The Essay was translated into Dutch (Middleburgh, 1760) and was probably also published in French and German. Two Papers on Fevers and Infections was translated into French (Lausanne, 1798). Most of the Essay as well as the papers on fevers and infections were reprinted by the Navy Records Society as The Health of Seamen, C. Lloyd, ed. (London, 1965). An Essay on Diseases Incidental to Europeans in Hot Climates, With the Method of Preventing Their Fatal Consequences (London, 1768; 6th ed., 1808; Philadelphia, 1811), Lind’s most popular work during his lifetime, was translated into German (Leipzig, 1773), Dutch (Amsterdam, 1781), and French (Paris, 1785).
Two letters addressed to Sir Alexander Dick in Lind’s handwriting are extant, one resigning his office of treasurer of the Royal College, and a second describing his new place of work, Haslar Hospital; for text of both and photograph of one, see Lind’s Treatise on Scurvy (1953) pp. 390–391.
II. Secondary Literature. L. H. Roddis, James Lind (New York, 1950), is a rather naïve biography, valuable primarily for the author’s attempt to locate all eds. of Lind’s works. Much biographical information was gathered in Sir H. D. Rolleston, “James Lind, Pioneer of Naval Hygiene,” in Journal of the Royal Naval Medical Service, 1 (1915), 181–190. For explanations of the delay in adopting Lind’s cure see A. P. Meiklejobn, “The Curious Obscurity of Dr. James Lind,” in Journal of the History of Medicine and Allied Sciences, 9 (1954), 304–310; and esp. C. Lloyd, “The Introduction of Lemon Juice as a Cure for Scurvy,” in Bulletin of the History of Medicine, 35 (1961), 123–132. See also E. A. Hudson and A, Herbert, “James Lind: His Contribution to Shipboard Sanitation,” in Journal of the History of Medicine, II (1956), 1–12; C Lloyd and J. L. S. Coulter, Medicine and the Navy, 111 (Edinburgh, 1957); and the various articles on Lind, naval medicine, and scurvy in Lind’s Treatise on Scurvy cited above.
Vern L. Bullough
Lind, James
LIND, JAMES
James Lind (1716–1794) was an Edinburgh Scot, apprenticed to a surgeon at the age of fifteen, who entered the Royal Navy as a ship's surgeon at age twenty-three, serving for nine years. After leaving the navy, he returned to Edinburgh, where he gained a medical degree and went into practice. In 1758 he became consultant physician at a naval hospital and held this position for the next twenty-five years. His experiences at sea had aroused his interest in naval hygiene, and he is recognized as a pioneer in this field.
Lind is remembered mainly for his work on scurvy, the vitamin C deficiency disease. Having observed sailors with scurvy, which was then a prevalent disease among sailors on long sea voyages, he speculated about its likely cause, suspecting that the shortage of fresh food such as fruits and vegetables might be responsible. On his own long voyages he experimented with diets, and he is renowned now among exponents of clinical trials because he reported the first such clinical trial that was systematically designed and conducted. It was a modest trial in which twelve sailors were allocated in groups of two each to receive cider, elixir of vitriol, vinegar, sea water, purgatives, and citrus fruits (oranges, lemons). Those who received the citrus fruits recovered rapidly from their scurvy, while the others did not. Although the sample sizes were grossly inadequate and other aspects of clinical trials were not adopted, this successful demonstration of an effective way to treat and to prevent scurvy immensely enhanced the health prospects of seafarers on long voyages, such as those of the explorer James Cook in the Pacific Ocean a few years later. Cook's sailors had a daily regimen of sucking the juice of a lime, and none of these sailors got scurvy. The slang word "limey" applied to British sailors originated from this practice. Lind wrote several works on naval hygiene, including an Essay on the Most Effectual Means of Preserving the Health of Seamen in the Royal Navy (1757); his best known work is A Treatise of the Scurvy (1753).
John M. Last
Bibliography
Lind, J. (1953). A Treatise of the Scurvy. Edinburgh: University Press. (Reprint)