James Lind (4 October 1716 – 13 July 1794) was a Scottish physician. He was a pioneer of naval hygiene in the Royal Navy. By conducting one of the first ever clinical trials, he developed the theory that citrus fruits cured scurvy. Lind served in the Royal Navy and then went onto private practice. In 1758 he was appointed chief physician of the Royal Naval Hospital Haslar, then one of the largest hospitals in the world. While chief physician, Lind 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. He also proposed that fresh water could be obtained by distilling sea water. He retired in 1783 and was awarded a large pension by the naval commissioners.
Twelve sailors and six competing treatments
In 1747, after about two months at sea, Lind compared treatments for scurvy among twelve affected sailors. He divided them into six pairs and gave them the same basic diet. Each pair then received a different supplement: cider, an acidic preparation called elixir of vitriol, vinegar, seawater, oranges and a lemon, or a medicinal paste accompanied by barley water. The comparison was small, and did not resemble every safeguard of a modern trial, but it deliberately placed competing remedies within a shared shipboard setting.
The fruit supply lasted only six days. By the time it ran out, one of the sailors receiving citrus was fit to return to duty and the other had almost recovered. The pair receiving cider showed some improvement, while the other treatments did not produce comparable results. Lind had expected acids to counteract what he understood as putrefaction within the body; he did not know about vitamin C. The outcome nevertheless made the citrus treatment stand out among the six alternatives he had tested.
Disease aboard naval ships
After some 8 years as an apprentice, Lind decided to go to London to find a job in medicine and, in 1739, he joined the Royal Navy, his younger brother being a junior naval officer. He was examined at the Navy Office and Surgeon's Hall and then appointed to the position of surgeon's mate. Lind spent long periods with ships on blockade and patrol in the English Channel and Atlantic Ocean during the War of the Austrian Succession. Lind served in the squadron of Nicholas Haddock who blockaded the coast of Spain in the early 1740s. This included managing the effects of a major sea epidemic of typhus that affected the fleet. Lind also served in the Mediterranean, off the coast of West Africa and in the West Indies.
While at sea, alongside his normal duties, Lind made extensive records and medical observations on everything related to disease and hygiene on ships. He reported back to England on the poor hospital facilities for sick sailors in Mahón.
Why citrus mattered
Scurvy is a disease caused by a vitamin C deficiency, but in Lind's day, the concept of vitamins was unknown. Vitamin C is necessary for healthy connective tissue. In 1740, the catastrophic result of then-Commodore George Anson's circumnavigation attracted much attention in Europe; out of 1900 men, 1400 died, most of them allegedly from scurvy. According to Lind, scurvy caused more deaths in the British fleets than French and Spanish arms.
Since antiquity in some parts of the world, and since the 17th century in England, it had been known that citrus fruit had an antiscorbutic effect. John Woodall (1570–1643), an English military surgeon of the British East India Company recommended them but their use did not become widespread. John Fryer (1650–1733) too noted in 1698 the value of citrus fruits in curing sailors of scurvy. Although Lind was not the first to suggest citrus as a cure for scurvy, he was the first to study its effect by a systematic experiment in 1747. It was one of the first reported, controlled, clinical experiments in history, particularly because of its use of control groups.