Cure Scurvy with this one weird trick…! Doctors hate him

Anton Howes, an historian of innovation, wrote a piece on the history of scurvy here. It’s a great read (and Anton’s blog is well worth a follow) but for one glaring omission - James Lind! Given that we’re named after him, and our logo stylises the oranges and lemons he used in his own trial for scurvy, we felt we had to put that right! So, here’s one for the history/medical/naval(?) nerds: a history of scurvy and how a Scottish doctor invented clinical trials.

The problem with scurvy

Scurvy really isn’t great. In the early stages it causes lethargy, gum disease, poor wound healing and diarrhea, before eventually leading to teeth falling out, mental disorders and death. Not ideal. 

Fortunately in the modern world scurvy is very uncommon and you’d need to go without Vitamin C for at least a month to be at risk. Amongst all animals and plants, only humans, some primates, and guinea pigs are thought to need Vitamin C in their diet. Much of the evidence for this comes from tests the UK did with “experimentally induced scurvy” on conscientious objectors during WW2. I wonder if they had Research Ethics Committee approval?

Throughout history, scurvy has been a recurring problem during everything from sea voyages, Crusades, sieges, and even long winters. By looking at his gnarly jawbone historians have concluded that Louis IX died from scurvy during the 8th Crusade. And it’s estimated that scurvy killed 2 million sailors in the time between Columbus’ famous voyage and the start of the industrial revolution (no idea how they came up with this estimate). 

Off milk, bark and cloudberries

Despite scurvy being a problem for so long, no-one knew what caused it. Anton has the great fact that our word for scurvy comes from the Norse “skyrbjugr” - because they thought scurvy was caused by their soured milk (“skyr”) going off.

Fortunately some people had a better understanding of causation than the milk-drinking Norse, and many civilisations had their own DIY cures. Native Americans ate bark from the Tree of Life. Norwegians (I imagine not the ones drinking soured milk) ate cloudberries. And there were rumours for hundreds of years amongst superstitious sailors of the benefits of citrus fruit.

Enter James Lind!

With millions dead and all these home cures going around you’d think it would occur to someone to figure out what was going on (hello ingrained scientific method). But the first systematic trial didn’t take place until 1747, the brainchild of our namesake, James Lind.

At the time Lind was a surgeon in the Royal Navy working aboard HMS Salisbury, a 50 gun ship of the line patrolling the Bay of Biscay. It wasn’t long before scurvy struck and he had the brilliant idea of splitting 12 scorbutic (great word) sailors into 6 groups and testing different treatments on each. There’s some debate as to what prompted this, but it probably emerged from the contemporary popularity of empiricism.

All 12 sailors received the same diet but the 6 groups then received one of:

• a quart of cider daily
• 25 drops of elixir of vitriol (sulphuric acid)
• 6 spoonfuls of vinegar
• half a pint of seawater
• two oranges and one lemon
• a spicy paste plus a drink of barley water

I suspect everyone was very jealous of the sailors in the cider group, at least until their teeth started to fall out. Of course the oranges and lemons group recovered. But almost more importantly than curing scurvy, Lind had invented the clinical trial.

What next for Lind’s miracle cure?

Sadly this didn’t have the impact that it could or should have had and it took another 50 years for the Navy to translate this into a proper regime to avoid scurvy. As for Lind, he concluded that citrus fruits had a “peculiar advantage”, but continued to state that scurvy was the product of “improper diet, air and confinement”. So close...

James went on to write his medical thesis on venereal disease. Other than that this was also prompted by his time in the Navy, I can’t find much on this thesis, but that’s probably one for another blog post anyway!

There are some nefarious scholars who’ve suggested Lind fabricated his entire trial. But whether the trial took place or not, Lind was directly credited by Gilbert Blane, who convinced the Navy to include citrus in the diet of sailors, bringing about the nickname “limeys”.

We believe that in 100 years current health outcomes will seem just as ridiculous and intolerable as 50% of sailors dying of scurvy seems now, and that’s why we’re named Lindus Health.