Of the Prevention of the Scurvy by Dr. James Lind

This is an excerpt from Dr. James Lind’s paradigm-shifting A Treatise of the Scurvy. Dr. Lind was the first to discover that citrus fruits could both cure and prevent a disease that had troubled sailors since voyages of long duration had become possible. The causes of the disease were still unknown, and Lind had no true understanding of how or why citrus was an effective treatment, but he knew that it was and that was good enough.

Incidentally, at the beginning of the 19th century (our era) it was determined that limes were a good substitute for oranges and lemons, because limes were quite readily available within the British Empire. It was also decided that lime juice was just as good as actual limes. Unbeknownst to doctors at the time, limes have far less Vitamin C than oranges and lemons and so are less effective against scurvy. This ineffectiveness was further increased by juicing the limes, which decreased the amount of Vitamin C in the limes in the first place. But by this time advances in technology had considerably shortened sea voyages, such that symptoms of scurvy never appeared and it was thought that limes worked as well as other citrus fruits. It wasn’t until long voyages were undertaken to reach the North Pole and find a Northwest Passage that scurvy once more appeared, confusing everyone.

The link between scurvy and Vitamin C deficiency wasn’t discovered until 1932.

A Treatise of the Scurvy

By Dr. James Lind

[…]

Of the Prevention of the Scurvy

I shall conclude the precepts relating to the preservation of seamen with showing the best means of obviating many inconveniences which attend long voyages and of removing the several causes productive of this mischief.

The following are the experiments.

On the 20th May, 1747, I took twelve patients in the scurvy on board the Salisbury at sea. Their cases were as similar as I could have them. They all in general had putrid gums, the spots and lassitude, with weakness of their knees. They lay together in one place, being a proper apartment for the sick in the fore-hold; and had one diet in common to all, viz., water gruel sweetened with sugar in the morning; fresh mutton broth often times for dinner; at other times puddings, boiled biscuit with sugar etc.; and for supper barley, raisins, rice and currants, sago and wine, or the like. Two of these were ordered each a quart of cyder a day. Two others took twenty five gutts of elixir vitriol three times a day upon an empty stomach, using a gargle strongly acidulated with it for their mouths. Two others took two spoonfuls of vinegar three times a day upon an empty stomach, having their gruels and their other food well acidulated with it, as also the gargle for the mouth. Two of the worst patients, with the tendons in the ham rigid (a symptom none the rest had) were put under a course of sea water. Of this they drank half a pint every day and sometimes more or less as it operated by way of gentle physic. Two others had each two oranges and one lemon given them every day. These they eat with greediness at different times upon an empty stomach. They continued but six days under this course, having consumed the quantity that could be spared. The two remaining patients took the bigness of a nutmeg three times a day of an electuray recommended by an hospital surgeon made of garlic, mustard seed, rad. raphan., balsam of Peru and gum myrrh, using for common drink narley water well acidulated with tamarinds, by a decoction of wich, with the addition of cremor tartar, they were gently purged three or four times during the course.

The consequence was that the most sudden and visible good effects were perceived from the use of the oranges and lemons; one of those who had taken them being at the end of six days fit for duty. The spots were not indeed at that time quite off his body, nor his gums sound; but without any other medicine than a gargarism or elixir of vitriol he became quite healthy before we came into Plymouth, which was on the 16th June. The other was the best recovered of any in his condition, and being now deemed pretty well was appointed nurse to the rest of the sick …

As I shall have occasion elsewhere to take notice of the effects of other medicines in this disease, I shall here only observe that the result of all my experiments was that oranges and lemons were the most effectual remedies for this distemper at sea. I am apt to think oranges preferable to lemons, though it was principally oranges which so speedily and surprisingly recovered Lord Anson’s people at the Island of Tinian, of which that noble, brave and experienced commander was so sensible that before he left the island one man was ordered on shore from each mess to lay in a stock of them for their future security. … Perhaps one history more may suffice to put this out of doubt.

James Lind: A Treatise of the Scurvy in Three Parts. Containing an inquiry into the Nature, Causes and Cure of that Disease, together with a Critical and Chronological View of what has been published on the subject. A. Millar, London, 1753.

Transcribed by and courtesy of Lars Bruzelius.
Image: James Lind Treating Scurvy by Robert A. Thom. From A History of Medicine in Pictures.

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